When I broke the news of Kaka’s demise on his wall on Facebook within
seconds my inbox was filled with mails from friends and family, both
known and unknown – all asking the same question albeit differently:
‘’Is Ibrahim kaka really dead?’’
‘’Soni what is going on?’’
‘’What happened to kakson?’’
‘’When did this happen?’’
‘’Soni hope this is not one of your jokes.’’ Etc
How do I write a tribute for kakson in one page? I will rather explain everything that happened to Kaka since last year sometimes in October when he called me and complained about a persistent cough which has defiled all known medications he has taken. Now make no mistake, Kaka does not smoke or take alcohol – he is not just an Officer of the Nigerian Army, he is a Gentleman, as gentle as a dove despite his massive frame and intimidating biceps and triceps. One will be forgiven if you mistake him for a Pugilist. So his coughing has nothing to do with whether he smokes as most people have asked whenever I mention the debilitating cough.
Yes Kaka had complained about a persistent cough, and I ask what medication he was taking? He started coughing and requested that we should chat on Blackberry messenger so that he can copy the names of the drugs and dose, and send them to me. I was actually driving back to Abuja from Zaria where I had gone for an exams and it was getting late, but then this is Kaka , and it is matters of health. Even though I know it was risky, pinging and driving – I had no choice but to grant him all the attention he deserves. Luckily, the Express Road from Zaria to Kaduna was heavily barricaded, so whenever I get to the check points, I make maximum use of the snail pace of traffic to reply him until I exit the barricade. By the time I get to the next hold-up and caught up in traffic, I’ll address his next batteries of questions. He was concerned about his deteriorating health and was determine to do all he can to get well.
We continued that way until I got to the tollgate along Kaduna – Abuja express way at about 8pm and I told him I was actually on my way to Abuja and I have been driving all the while. He scolded me and was apologetic that he was not aware I was driving all the while. He excused me and promised to check up on me when I arrive Abuja safely.
Back to the cough, I noticed he was taking a generic brand of an antibiotic, Amoxicillin/Clavulanic acid 625mg twice daily. I asked who gave him the drug, and he said it was from a private clinic in Port Harcourt. He has been on the drug for three weeks with no improvement. I ask him to immediately discontinue taking the drug because apart from the fact that it is an under-dose for him, I don’t trust the quality of the drug. I ask him to buy the innovator brand and he should take 1gram twice daily which is the correct dose for upper respiratory tract infection which he was being treated for. I told him the medicine will cost about seven to eight thousand naira, give or take a few hundred and his response was – ‘’Health First,’’ and that he will think of money later. He wants to get well by all means and he has spent over a hundred thousand so far, but he is not bothered – all he is after is to get well.
He got the drug the next day and five days later he called to say he felt better but he is still coughing and he wanted me to recommend a good cough syrup for him. At this stage I became worried and I went through the history of the cough with him. He said he suspects the noxious gas he inhaled one night when he was the officer on duty at an oil platform belonging to a Multinational Oil company in Rivers state to be the cause of the cough. That he noticed he started coughing shortly after coming in contact with the toxic gas. I told him to go to the hospital the next day, let them run a battery of test, let them take his chest x-ray, let them do sputum test, let them check for Tuberculosis, Streptococci species, let them do a Microscopy, Culture and Sensitivity (MCS) test, let them do a Full Blood Count and Differential (FBC), let them just check him and get to the root of the cough. He said he will but that would be when he gets back to Port Harcourt because the location where he was on official duty is a village and it is only one small chemist that provides health services for the people. He said that was where he got the initial drugs I asked him to discontinue and that he had to go to Port Harcourt to get the one I asked him to buy. He was coughing again and he needed me to recommend a very good cough syrup for him. I was really sorry and felt his pain and I didn’t want to contribute to his trouble, so I reassured him and told him the truth about cough syrups. I told him cough syrup don’t cure cough. They are not really as effective as people think. A Cough, whether productive or non-productive is self limiting, most times they run their spectrum and go away unannounced as they came. I told him not to worry that he will be fine, he should go to the hospital the next day.
We all went back to our daily schedules and normal activities as the Christmas was approaching. I didn’t hear any complaint from him again concerning the cough and I assumed he is fine and has gone back to work. The last time we spoke, he promised to visit his family in Makurdi during Christmas and I was also going to be in Makurdi, so I was looking forward to seeing him during the yuletide.
I had planned to visit him at his house on Christmas day but I couldn’t make it due to my tight schedule. At about 9Pm in the night when I visited my Auntie, I saw his car parked outside and I was happy that at least we’ll see and chat briefly. I met him at the door as he was on his way out and seemed to be in a hurry. I walked him to his car and from his look he was alright, so I didn’t bring up the cough issue and all that. I guess he was okay so no need resurrecting the sad episode. I promised I will visit him the next day, which is Boxing Day so that we can all go out for ice cream with the family. He said that would have been lovely and apologised that he won’t be able to make it because he is going back to Port Harcourt first thing the next morning, he just got a call from his ‘’Oga at the top’’ to report at work and take charge since he is the number two man there and his Boss wants him to be on ground to oversee the boys so that nothing goes wrong.
We kept tab via social media, facebook, blackberry and it was all good. I remembered having a good laugh at him when he commented on one of my facebook status on the reclassification of different categories of bank accounts/account holders and the minimum deposits and maximum withdrawal they can make in a day by CBN Governor, Sanusi Lamido. He read the attacked link and was confused as everybody on the thread and he asked; ‘’So which category I (kaka) dey?’’ That’s Kakson for you. A jolly good fellow, always smiling and putting smile on people’s faces.
I remember how he encouraged me to join the Nigerian Navy Medical Corp through Direct Short Service (DSS). I developed cold feet on the day of the aptitude test and he did all he could to convince me to show up. I told him am not cut out for drills and all the regimented life in the military. The little I had in Command was enough for me. I don’t like the ‘’obey the last order and zombie-like’’ nature of the military. I confessed to him that I actually bought the form because someone provoked me and I felt that by joining the military, with my ‘khaki’ I will be in a better position to deal with such erring and bloody civilians in the future. He had a good laugh at me and he let me be – after dismissing me as an unserious and bloody civilian.
Kaka was fun to be with and there was never a dull moment with him. So it was with a jolt that I reacted when I got a call from my Cousin, Tom, that Kaka is on admission at the National Hospital in Abuja, for over a week. I ask what the problem was and he said he started coughing again and the condition has deteriorated badly, so the doctor admitted him.
I found my way to the hospital and met him sitting on a chair, with his head on the bed and he was putting on an oxygen mask to aid his breathing. He raised his head and looked at me, I made a sign that he should not talk, I can feel his pains. All he said was, ‘’Soni look at me.’’
I wanted to know what was wrong with him, and the only way I could do that was look at the battery of medication in his locker since I cannot open his file for confidentiality and medical ethics.
I saw a packet of a drug containing Artemether/Lumenfantrine which is for Malaria. Kakson had malaria.
I saw medications for pains, opoid and non-opiate analgesic, the strongest pain killers you could think of. Kakson was in pains.
I saw vials of Rocephine injection, a second generation cephalosporin antibacterial agent and I did a mental check of the spectrum of activity of ceftriaxone. Kakson has an infection. What is the specific pathogen? While I was trying to figure out what the role of the Rocephine injection in the therapy was and to check if it is the best option, my eyes caught a pack of ventolin Nebules by the corner. On impulse, I asked his Mum whether he is asthmatic? She said No. I then asked myself why did they nebulise him? What is the active ingredient in ventolin again? Ok Salbutamol.
From my residual knowledge of pharmacology it occurred to me that Salbutamol works by opening up the air passages in the lungs so that air can flow into the lungs more easily. At this juncture, I narrowed the sickness down to his lungs. Kakson has a lung disease, an infection in the lungs that is causing him to cough, I inferred, but what exactly is it?
He was grasping for breath and coughing intermittently and as the cough persisted he became angry and shouted at a point – ‘’This cough is want I don’t like!’’ I held him and tapped him on the back, he appears to be in a state of reverie and staring blankly into space.
He eventually calmed down and told me that there is a drug the doctor prescribed for him. That they have been unable to get the drug in Abuja. They had to scan the prescription to someone in America to get the drug and send it down. I ask for the prescription. My auntie handed it to me. It was a prescription containing a single drug Pirfenidone. While I was trying to check what the indication for the magic drug which is not available in Nigeria was, she said there is another prescription that they sent to India. I was alarmed at this stage. How can a patient be in Nigeria and you are sending his prescription to US, Canada and even India to fill his drugs? Why not take the patient there so that he can be adequately catered for where the drugs for his ailment are available? And by the way, the health workers at the National Hospital have been on strike for the past one week, what if the drugs arrive and the doctor changed the prescription by the time he gets the result of the biopsy and other lab tests he requested for?
How will you feel if you spend N1.7 million to order for a drug and by the time the drug arrives the doctor says you don’t need it? Of course, health is wealth but money is an issue as well. The bills were piling up and there is no meaningful progress in his recovery. I need to know what is wrong with kakson so I made a quick check on the indications for pirfenidone , and ‘’Pulmonary Lung fibrosis’’ popped up.
Whaooo! PLF? Pulmonary Lung Fibrosis? I asked kaka, ‘’kakson what did the doctor say is wrong with you? And he murmured in between breaths – ‘’Interstitial lung Disease.’’ How did we get here? What do I know about this rare disease? I went in search of all could gather on Pulmonary lung Fibrosis. I found out that PLF is a group of diseases which produce interstitial lung damage and ultimately fibrosis and loss of elasticity of the lungs. It is a chronic condition characterised by shortness of breath, diffuse infiltrates on CXR (chest xray) and inflammation and/or fibrosis on biopsy. Hmmmmm I sighed. I noticed kaka was looking at me and he was interested in knowing what is wrong with him. I was amazed at the way he pronounced the name of the disease – ‘’interstitial lung disease (damage)’’ accurately as if he was a medical personnel. I looked at him again, I knew the prognosis was bad. All the subjective signs of Pulmonary Lung Fibrosis were visible on physical examination. He has a history of over five months productive cough, he has difficulty in breathing, he was in great pains, he can hardly lie on his back, he sits on a chair with his head resting on the bed, he was dying by the second and nothing, I mean absolutely nothing that will reverse his condition was being done. The only treatment he was receiving was supportive therapy. He was given pain killers for his pains. He has difficulty in breathing and they place him on oxygen after nebulising him with a beta-adrenergic agonist to help keep the airways in the lungs open, so that air can enter the tissues. Nothing was being done about the interstitial lung damage, because nothing can be done in Nigeria.
How did we get here? How did Kakson developed ‘’Pulmonary Lung Fibrosis’’ a rare disease that has an incidence of between 6.8 -16.3 per 100,000 person –years in a UK study between 1999 and 2003?
I tell you what I think. The cough no doubt was as a result of the noxious gas he inhaled at the oil facility of a multinational company in Port Harcourt while on duty. This must have damaged his lungs over time and he was treating the symptoms (cough, pain, fever) while the main and underlying condition which has to do with damage of his lungs parenchyma was not even on the radar.
From the medical history he presented at the National Hospital, Abuja he was taking medication for pulmonary tuberculosis which a doctor in Port Harcourt placed him on. Now here is the intrigue – the doctor in Port Harcourt concluded that he has tuberculosis and commenced treatment for tuberculosis. Unfortunately he does not have tuberculosis.
How did we get here? Take a look at the one of the risks factors for developing Pulmonary lung fibrosis;
‘’Some forms of pulmonary fibrosis are caused by drugs and environmental causes, including occupational.’’
This is becoming interesting, is it? Here we have a worker who was exposed via occupational hazards to noxious gases in his environment. You may want to ask, ‘why didn’t the oil company provide a gas mask for an officer providing security at their facility? Why?’’
Ok he came in contact with a toxic gas at an oil facility which was damaging his lungs gradually over time. The symptoms of a major disease appeared in the form of a cough and he started treating the cough without any relieve, until a doctor further worsen his condition by placing him on a cocktail of anti-tuberculosis drug. Now you all must know that, that cocktail of drugs is a killer. You can imagine taking a cocktail of about 24-30 tablets daily for months for the wrong illness. The addition of the anti-TB drugs clearly worsen his condition. At this juncture, I also need to point out that one of the known cause of Pulmonary Lung Fibrosis is Tuberculosis, pneumonia and infarction, which cause what is known as ‘’replacement fibrosis secondary to lung damage.’’
Hmmmm how unlucky can one be? He was under a two pronged attack – occupational (environment) and drug induced lung damage.
How did we get here? In the developed countries, doctors face malpractice charges regularly. Many have stopped practising due to lawsuits. In Nigeria it is catching on. Of course, doctors who make gross inexcusable mistakes are liable, as those who are unqualified. When a patient dies in the hospital, there must be something the doctor should have done he did not do. And in the case of kaka, they were legion. I am not God and I don’t intend to play God, but last Saturday when I saw Kaka for the first time in the hospital, I knew he it was a bad case and he was not going to make it out of the hospital on his feet. I prepared my mind for the worst but was relieved to see that as a soldier he was hanging on and he was determined to fight to the last – for his wife, for his son and for his daughter! Before they left for Makurdi last Saturday, (his wife, Ella had been on maternity leave in the last four months and she needed to go and report at work on Monday before taking permission to come back to Abuja to nurse her hubby back to recovery), his immediate family, Wife-Ella, two year old Son- Ethan and five month old daughter – Elkasy all gathered by his bedside in a solemn moment. I am not playing God, but I had an inkling, this was their last moment with him. I prayed and hope I am wrong, but he continue to cough and with each cough the infarction of the lungs worsened and the pain increases. My fear was confirmed yesterday, shortly after he gave up and his mum was at peace, not even a single tears. She said she already knew he was not going to make it, the doctor told her so two weeks ago.
One begin to wonder, why admit a patient for three weeks, providing supportive treatment only when you know there is nothing you can do for him, other than watch him die painfully and slowly? Why don’t you refer him elsewhere? Truth be told, in this case the Doctor was handicapped. He got his diagnosis spot on, all the supportive treatment was provided but the specific antidote for pulmonary lung fibrosis/interstitial lung damage was not available in Nigeria. The doctor wrote a prescription and we combed Abuja, every big pharmacy outlet you could think of, returned negative! In fact they were hearing about the drug for the first time. Last resort was to scan the prescription and sent to the US and Canada, and the waiting game began. So many bureaucracies involved. The US is not like Nigeria where a customer can just walk into any Pharmacy and pick up a controlled drug. Kaka hanged on like a soldier, even though his strength was failing, he hanged on. Any time the door opened, he look up expecting to receive the good news – that the magic drug have arrived. Whenever discussion shift to the drug, he is always sad and at a point he scolded his sister not to mention that drug to his hearing again, that it depresses him. For two weeks he has been waiting for a magic drug to arrive from the US. How long does it takes an astronaut to travel from the earth to the moon? Is the US farther than the moon? But it does not work that way.
So we continue to wait while kakson hanged on! On Thursday night his condition became worst. The consultant finally referred him to India. Now he cannot breathe without an oxygen mask and he was took weak and in a very bad shape to travel in a commercial jetliner. The only alternative was an air ambulance. Now an air ambulance is charging N25 million for the trip. Where will an ordinary captain of the Nigerian Army get that huge amount of money to pay for his flight across the Mediterranean sea in the quest for a solution to his health challenge? Oh kaka! Nigeria is not a place to be critically ill. You are not a politician with access to the treasury, so you have to wait until Monday for your ‘’Oga at the top’’ in the Army Headquarters to find out if they will foot your bill as an Officer who slinged a shot in the line of duty.
I presume John F. Kennedy, it was that said, ‘’Ask not what your country can do for you, ask what you can do for your country.’’ My fellow Nigerians’’ What have our country done for us? Without much ado, I can tell you, they have reduced our life expectancy to 35 years! Yes Kakson was just 35 years old. What can we do for our country? We must put on our whole armour, and with our revolutionary might march on our oppressors. Daily our senses of responsibilities are being assaulted by our so called leaders. We hear of billions and trillions being budgeted and allocated for projects in the health care sector and the number one hospital in our nation, the National Hospital, Abuja is nothing but a mere consulting clinic!
Despite all the odds in front of kaka he fought the good fight like a gallant Airborne soldier that he was. At about 1pm in the afternoon yesterday, he knew his time has come and he can no longer wait. He was in so much pains and he became agitated. He started screaming, ‘’help me’’ ‘’call the doctor to come and help me’’ ‘’I want to sleep’’ ‘’help me’’ ‘’pray for me’’ ‘’call the doctor to come and give me injections’’ were some of the words he stringed together. He calmed down. They brought some pain killers which he took. He was offered food and he ate. Immediately he finished eating, he uttered the words, ‘’Am in pains, I want to lie down.’’ His younger sister, Hannatu supported him from the chair with his Mum, and they transferred him to the bed. He has never lied down on his back since he was admitted. He died in Hannatu’s arm immediately his back touch the bed.
He fought dead the grim riper to a standstill. He held on like a Soldiers’ soldier.
Kaka is a jovial and a jolly good fellow. I cannot do a short tribute for Kakson and I have left out a great chunk of the things I planned to talk about. I have focused mainly on his travails, what he went through, the pains, the disappointment and all the anxiety one could think of when you are faced with a life and death situation and you are holding the shorter end of the stick. The forces against Kaka were not insurmountable – but of course NOT in Nigeria, for ours is a nation where one cannot afford to be critically ill.
Truth be told, the Doctors at the National Hospital were handicapped. Theirs’ is a case of a master sending a labourer to the field without working implements. Other than refer him abroad, there was nothing the Doctor could have done for him. The typical scenario in Nigeria is that the patient has taken all sorts of self medication including traditional concoction, and when organs have damaged they are rushed into the hospital for the doctor to perform a miracle.
I shudder at what it would mean for patients if doctors walked away from medicine because of frustrations. Many laboratory investigations cannot be carried out because there are no reagents. There are many diagnostic tools that Nigerian doctors only read about in textbooks. Many patients are poor and cannot do investigations when it is available and cannot buy their medications. So a doctors medical knowledge in Nigeria hangs in the air.
For Kaka, the curtain has fallen. It was road block at every corner and intersections. So many things went wrong and since the organ that was affected is a very delicate and sensitive one, it was just a matter of time. So while waiting for his ‘’Oga at the top’’ in the Defence Headquarters to approve to foot the bills for his trip abroad for medical treatment, Nigerian Army, Captain Ibrahim Kaka breathe his last and gave up the fight. Rest In peace, my brother.
Nigeria Army, captain Ellis Imeh Ekpe-John, takes it from here!
‘’Dear Ibrahim, I’ll remember you for your kindness and guidance back in the Military School. I’ll remember you for your strict advice. I’ll remember your face and your laugh. You are truly a Soldiers’ Soldier. God bless those you left behind. Believe me when I say, I’ll remember you for as long as I can. God bless those you left behind. Rest on Sir!
Stand Still everyone, an Officer and Gentleman has left the front lines!!! Attenchuuun!!! Salute!!!
‘’What happened to kakson?’’
‘’When did this happen?’’
‘’Soni hope this is not one of your jokes.’’ Etc
How do I write a tribute for kakson in one page? I will rather explain everything that happened to Kaka since last year sometimes in October when he called me and complained about a persistent cough which has defiled all known medications he has taken. Now make no mistake, Kaka does not smoke or take alcohol – he is not just an Officer of the Nigerian Army, he is a Gentleman, as gentle as a dove despite his massive frame and intimidating biceps and triceps. One will be forgiven if you mistake him for a Pugilist. So his coughing has nothing to do with whether he smokes as most people have asked whenever I mention the debilitating cough.
Yes Kaka had complained about a persistent cough, and I ask what medication he was taking? He started coughing and requested that we should chat on Blackberry messenger so that he can copy the names of the drugs and dose, and send them to me. I was actually driving back to Abuja from Zaria where I had gone for an exams and it was getting late, but then this is Kaka , and it is matters of health. Even though I know it was risky, pinging and driving – I had no choice but to grant him all the attention he deserves. Luckily, the Express Road from Zaria to Kaduna was heavily barricaded, so whenever I get to the check points, I make maximum use of the snail pace of traffic to reply him until I exit the barricade. By the time I get to the next hold-up and caught up in traffic, I’ll address his next batteries of questions. He was concerned about his deteriorating health and was determine to do all he can to get well.
We continued that way until I got to the tollgate along Kaduna – Abuja express way at about 8pm and I told him I was actually on my way to Abuja and I have been driving all the while. He scolded me and was apologetic that he was not aware I was driving all the while. He excused me and promised to check up on me when I arrive Abuja safely.
Back to the cough, I noticed he was taking a generic brand of an antibiotic, Amoxicillin/Clavulanic acid 625mg twice daily. I asked who gave him the drug, and he said it was from a private clinic in Port Harcourt. He has been on the drug for three weeks with no improvement. I ask him to immediately discontinue taking the drug because apart from the fact that it is an under-dose for him, I don’t trust the quality of the drug. I ask him to buy the innovator brand and he should take 1gram twice daily which is the correct dose for upper respiratory tract infection which he was being treated for. I told him the medicine will cost about seven to eight thousand naira, give or take a few hundred and his response was – ‘’Health First,’’ and that he will think of money later. He wants to get well by all means and he has spent over a hundred thousand so far, but he is not bothered – all he is after is to get well.
He got the drug the next day and five days later he called to say he felt better but he is still coughing and he wanted me to recommend a good cough syrup for him. At this stage I became worried and I went through the history of the cough with him. He said he suspects the noxious gas he inhaled one night when he was the officer on duty at an oil platform belonging to a Multinational Oil company in Rivers state to be the cause of the cough. That he noticed he started coughing shortly after coming in contact with the toxic gas. I told him to go to the hospital the next day, let them run a battery of test, let them take his chest x-ray, let them do sputum test, let them check for Tuberculosis, Streptococci species, let them do a Microscopy, Culture and Sensitivity (MCS) test, let them do a Full Blood Count and Differential (FBC), let them just check him and get to the root of the cough. He said he will but that would be when he gets back to Port Harcourt because the location where he was on official duty is a village and it is only one small chemist that provides health services for the people. He said that was where he got the initial drugs I asked him to discontinue and that he had to go to Port Harcourt to get the one I asked him to buy. He was coughing again and he needed me to recommend a very good cough syrup for him. I was really sorry and felt his pain and I didn’t want to contribute to his trouble, so I reassured him and told him the truth about cough syrups. I told him cough syrup don’t cure cough. They are not really as effective as people think. A Cough, whether productive or non-productive is self limiting, most times they run their spectrum and go away unannounced as they came. I told him not to worry that he will be fine, he should go to the hospital the next day.
We all went back to our daily schedules and normal activities as the Christmas was approaching. I didn’t hear any complaint from him again concerning the cough and I assumed he is fine and has gone back to work. The last time we spoke, he promised to visit his family in Makurdi during Christmas and I was also going to be in Makurdi, so I was looking forward to seeing him during the yuletide.
I had planned to visit him at his house on Christmas day but I couldn’t make it due to my tight schedule. At about 9Pm in the night when I visited my Auntie, I saw his car parked outside and I was happy that at least we’ll see and chat briefly. I met him at the door as he was on his way out and seemed to be in a hurry. I walked him to his car and from his look he was alright, so I didn’t bring up the cough issue and all that. I guess he was okay so no need resurrecting the sad episode. I promised I will visit him the next day, which is Boxing Day so that we can all go out for ice cream with the family. He said that would have been lovely and apologised that he won’t be able to make it because he is going back to Port Harcourt first thing the next morning, he just got a call from his ‘’Oga at the top’’ to report at work and take charge since he is the number two man there and his Boss wants him to be on ground to oversee the boys so that nothing goes wrong.
We kept tab via social media, facebook, blackberry and it was all good. I remembered having a good laugh at him when he commented on one of my facebook status on the reclassification of different categories of bank accounts/account holders and the minimum deposits and maximum withdrawal they can make in a day by CBN Governor, Sanusi Lamido. He read the attacked link and was confused as everybody on the thread and he asked; ‘’So which category I (kaka) dey?’’ That’s Kakson for you. A jolly good fellow, always smiling and putting smile on people’s faces.
I remember how he encouraged me to join the Nigerian Navy Medical Corp through Direct Short Service (DSS). I developed cold feet on the day of the aptitude test and he did all he could to convince me to show up. I told him am not cut out for drills and all the regimented life in the military. The little I had in Command was enough for me. I don’t like the ‘’obey the last order and zombie-like’’ nature of the military. I confessed to him that I actually bought the form because someone provoked me and I felt that by joining the military, with my ‘khaki’ I will be in a better position to deal with such erring and bloody civilians in the future. He had a good laugh at me and he let me be – after dismissing me as an unserious and bloody civilian.
Kaka was fun to be with and there was never a dull moment with him. So it was with a jolt that I reacted when I got a call from my Cousin, Tom, that Kaka is on admission at the National Hospital in Abuja, for over a week. I ask what the problem was and he said he started coughing again and the condition has deteriorated badly, so the doctor admitted him.
I found my way to the hospital and met him sitting on a chair, with his head on the bed and he was putting on an oxygen mask to aid his breathing. He raised his head and looked at me, I made a sign that he should not talk, I can feel his pains. All he said was, ‘’Soni look at me.’’
I wanted to know what was wrong with him, and the only way I could do that was look at the battery of medication in his locker since I cannot open his file for confidentiality and medical ethics.
I saw a packet of a drug containing Artemether/Lumenfantrine which is for Malaria. Kakson had malaria.
I saw medications for pains, opoid and non-opiate analgesic, the strongest pain killers you could think of. Kakson was in pains.
I saw vials of Rocephine injection, a second generation cephalosporin antibacterial agent and I did a mental check of the spectrum of activity of ceftriaxone. Kakson has an infection. What is the specific pathogen? While I was trying to figure out what the role of the Rocephine injection in the therapy was and to check if it is the best option, my eyes caught a pack of ventolin Nebules by the corner. On impulse, I asked his Mum whether he is asthmatic? She said No. I then asked myself why did they nebulise him? What is the active ingredient in ventolin again? Ok Salbutamol.
From my residual knowledge of pharmacology it occurred to me that Salbutamol works by opening up the air passages in the lungs so that air can flow into the lungs more easily. At this juncture, I narrowed the sickness down to his lungs. Kakson has a lung disease, an infection in the lungs that is causing him to cough, I inferred, but what exactly is it?
He was grasping for breath and coughing intermittently and as the cough persisted he became angry and shouted at a point – ‘’This cough is want I don’t like!’’ I held him and tapped him on the back, he appears to be in a state of reverie and staring blankly into space.
He eventually calmed down and told me that there is a drug the doctor prescribed for him. That they have been unable to get the drug in Abuja. They had to scan the prescription to someone in America to get the drug and send it down. I ask for the prescription. My auntie handed it to me. It was a prescription containing a single drug Pirfenidone. While I was trying to check what the indication for the magic drug which is not available in Nigeria was, she said there is another prescription that they sent to India. I was alarmed at this stage. How can a patient be in Nigeria and you are sending his prescription to US, Canada and even India to fill his drugs? Why not take the patient there so that he can be adequately catered for where the drugs for his ailment are available? And by the way, the health workers at the National Hospital have been on strike for the past one week, what if the drugs arrive and the doctor changed the prescription by the time he gets the result of the biopsy and other lab tests he requested for?
How will you feel if you spend N1.7 million to order for a drug and by the time the drug arrives the doctor says you don’t need it? Of course, health is wealth but money is an issue as well. The bills were piling up and there is no meaningful progress in his recovery. I need to know what is wrong with kakson so I made a quick check on the indications for pirfenidone , and ‘’Pulmonary Lung fibrosis’’ popped up.
Whaooo! PLF? Pulmonary Lung Fibrosis? I asked kaka, ‘’kakson what did the doctor say is wrong with you? And he murmured in between breaths – ‘’Interstitial lung Disease.’’ How did we get here? What do I know about this rare disease? I went in search of all could gather on Pulmonary lung Fibrosis. I found out that PLF is a group of diseases which produce interstitial lung damage and ultimately fibrosis and loss of elasticity of the lungs. It is a chronic condition characterised by shortness of breath, diffuse infiltrates on CXR (chest xray) and inflammation and/or fibrosis on biopsy. Hmmmmm I sighed. I noticed kaka was looking at me and he was interested in knowing what is wrong with him. I was amazed at the way he pronounced the name of the disease – ‘’interstitial lung disease (damage)’’ accurately as if he was a medical personnel. I looked at him again, I knew the prognosis was bad. All the subjective signs of Pulmonary Lung Fibrosis were visible on physical examination. He has a history of over five months productive cough, he has difficulty in breathing, he was in great pains, he can hardly lie on his back, he sits on a chair with his head resting on the bed, he was dying by the second and nothing, I mean absolutely nothing that will reverse his condition was being done. The only treatment he was receiving was supportive therapy. He was given pain killers for his pains. He has difficulty in breathing and they place him on oxygen after nebulising him with a beta-adrenergic agonist to help keep the airways in the lungs open, so that air can enter the tissues. Nothing was being done about the interstitial lung damage, because nothing can be done in Nigeria.
How did we get here? How did Kakson developed ‘’Pulmonary Lung Fibrosis’’ a rare disease that has an incidence of between 6.8 -16.3 per 100,000 person –years in a UK study between 1999 and 2003?
I tell you what I think. The cough no doubt was as a result of the noxious gas he inhaled at the oil facility of a multinational company in Port Harcourt while on duty. This must have damaged his lungs over time and he was treating the symptoms (cough, pain, fever) while the main and underlying condition which has to do with damage of his lungs parenchyma was not even on the radar.
From the medical history he presented at the National Hospital, Abuja he was taking medication for pulmonary tuberculosis which a doctor in Port Harcourt placed him on. Now here is the intrigue – the doctor in Port Harcourt concluded that he has tuberculosis and commenced treatment for tuberculosis. Unfortunately he does not have tuberculosis.
How did we get here? Take a look at the one of the risks factors for developing Pulmonary lung fibrosis;
‘’Some forms of pulmonary fibrosis are caused by drugs and environmental causes, including occupational.’’
This is becoming interesting, is it? Here we have a worker who was exposed via occupational hazards to noxious gases in his environment. You may want to ask, ‘why didn’t the oil company provide a gas mask for an officer providing security at their facility? Why?’’
Ok he came in contact with a toxic gas at an oil facility which was damaging his lungs gradually over time. The symptoms of a major disease appeared in the form of a cough and he started treating the cough without any relieve, until a doctor further worsen his condition by placing him on a cocktail of anti-tuberculosis drug. Now you all must know that, that cocktail of drugs is a killer. You can imagine taking a cocktail of about 24-30 tablets daily for months for the wrong illness. The addition of the anti-TB drugs clearly worsen his condition. At this juncture, I also need to point out that one of the known cause of Pulmonary Lung Fibrosis is Tuberculosis, pneumonia and infarction, which cause what is known as ‘’replacement fibrosis secondary to lung damage.’’
Hmmmm how unlucky can one be? He was under a two pronged attack – occupational (environment) and drug induced lung damage.
How did we get here? In the developed countries, doctors face malpractice charges regularly. Many have stopped practising due to lawsuits. In Nigeria it is catching on. Of course, doctors who make gross inexcusable mistakes are liable, as those who are unqualified. When a patient dies in the hospital, there must be something the doctor should have done he did not do. And in the case of kaka, they were legion. I am not God and I don’t intend to play God, but last Saturday when I saw Kaka for the first time in the hospital, I knew he it was a bad case and he was not going to make it out of the hospital on his feet. I prepared my mind for the worst but was relieved to see that as a soldier he was hanging on and he was determined to fight to the last – for his wife, for his son and for his daughter! Before they left for Makurdi last Saturday, (his wife, Ella had been on maternity leave in the last four months and she needed to go and report at work on Monday before taking permission to come back to Abuja to nurse her hubby back to recovery), his immediate family, Wife-Ella, two year old Son- Ethan and five month old daughter – Elkasy all gathered by his bedside in a solemn moment. I am not playing God, but I had an inkling, this was their last moment with him. I prayed and hope I am wrong, but he continue to cough and with each cough the infarction of the lungs worsened and the pain increases. My fear was confirmed yesterday, shortly after he gave up and his mum was at peace, not even a single tears. She said she already knew he was not going to make it, the doctor told her so two weeks ago.
One begin to wonder, why admit a patient for three weeks, providing supportive treatment only when you know there is nothing you can do for him, other than watch him die painfully and slowly? Why don’t you refer him elsewhere? Truth be told, in this case the Doctor was handicapped. He got his diagnosis spot on, all the supportive treatment was provided but the specific antidote for pulmonary lung fibrosis/interstitial lung damage was not available in Nigeria. The doctor wrote a prescription and we combed Abuja, every big pharmacy outlet you could think of, returned negative! In fact they were hearing about the drug for the first time. Last resort was to scan the prescription and sent to the US and Canada, and the waiting game began. So many bureaucracies involved. The US is not like Nigeria where a customer can just walk into any Pharmacy and pick up a controlled drug. Kaka hanged on like a soldier, even though his strength was failing, he hanged on. Any time the door opened, he look up expecting to receive the good news – that the magic drug have arrived. Whenever discussion shift to the drug, he is always sad and at a point he scolded his sister not to mention that drug to his hearing again, that it depresses him. For two weeks he has been waiting for a magic drug to arrive from the US. How long does it takes an astronaut to travel from the earth to the moon? Is the US farther than the moon? But it does not work that way.
So we continue to wait while kakson hanged on! On Thursday night his condition became worst. The consultant finally referred him to India. Now he cannot breathe without an oxygen mask and he was took weak and in a very bad shape to travel in a commercial jetliner. The only alternative was an air ambulance. Now an air ambulance is charging N25 million for the trip. Where will an ordinary captain of the Nigerian Army get that huge amount of money to pay for his flight across the Mediterranean sea in the quest for a solution to his health challenge? Oh kaka! Nigeria is not a place to be critically ill. You are not a politician with access to the treasury, so you have to wait until Monday for your ‘’Oga at the top’’ in the Army Headquarters to find out if they will foot your bill as an Officer who slinged a shot in the line of duty.
I presume John F. Kennedy, it was that said, ‘’Ask not what your country can do for you, ask what you can do for your country.’’ My fellow Nigerians’’ What have our country done for us? Without much ado, I can tell you, they have reduced our life expectancy to 35 years! Yes Kakson was just 35 years old. What can we do for our country? We must put on our whole armour, and with our revolutionary might march on our oppressors. Daily our senses of responsibilities are being assaulted by our so called leaders. We hear of billions and trillions being budgeted and allocated for projects in the health care sector and the number one hospital in our nation, the National Hospital, Abuja is nothing but a mere consulting clinic!
Despite all the odds in front of kaka he fought the good fight like a gallant Airborne soldier that he was. At about 1pm in the afternoon yesterday, he knew his time has come and he can no longer wait. He was in so much pains and he became agitated. He started screaming, ‘’help me’’ ‘’call the doctor to come and help me’’ ‘’I want to sleep’’ ‘’help me’’ ‘’pray for me’’ ‘’call the doctor to come and give me injections’’ were some of the words he stringed together. He calmed down. They brought some pain killers which he took. He was offered food and he ate. Immediately he finished eating, he uttered the words, ‘’Am in pains, I want to lie down.’’ His younger sister, Hannatu supported him from the chair with his Mum, and they transferred him to the bed. He has never lied down on his back since he was admitted. He died in Hannatu’s arm immediately his back touch the bed.
He fought dead the grim riper to a standstill. He held on like a Soldiers’ soldier.
Kaka is a jovial and a jolly good fellow. I cannot do a short tribute for Kakson and I have left out a great chunk of the things I planned to talk about. I have focused mainly on his travails, what he went through, the pains, the disappointment and all the anxiety one could think of when you are faced with a life and death situation and you are holding the shorter end of the stick. The forces against Kaka were not insurmountable – but of course NOT in Nigeria, for ours is a nation where one cannot afford to be critically ill.
Truth be told, the Doctors at the National Hospital were handicapped. Theirs’ is a case of a master sending a labourer to the field without working implements. Other than refer him abroad, there was nothing the Doctor could have done for him. The typical scenario in Nigeria is that the patient has taken all sorts of self medication including traditional concoction, and when organs have damaged they are rushed into the hospital for the doctor to perform a miracle.
I shudder at what it would mean for patients if doctors walked away from medicine because of frustrations. Many laboratory investigations cannot be carried out because there are no reagents. There are many diagnostic tools that Nigerian doctors only read about in textbooks. Many patients are poor and cannot do investigations when it is available and cannot buy their medications. So a doctors medical knowledge in Nigeria hangs in the air.
For Kaka, the curtain has fallen. It was road block at every corner and intersections. So many things went wrong and since the organ that was affected is a very delicate and sensitive one, it was just a matter of time. So while waiting for his ‘’Oga at the top’’ in the Defence Headquarters to approve to foot the bills for his trip abroad for medical treatment, Nigerian Army, Captain Ibrahim Kaka breathe his last and gave up the fight. Rest In peace, my brother.
Nigeria Army, captain Ellis Imeh Ekpe-John, takes it from here!
‘’Dear Ibrahim, I’ll remember you for your kindness and guidance back in the Military School. I’ll remember you for your strict advice. I’ll remember your face and your laugh. You are truly a Soldiers’ Soldier. God bless those you left behind. Believe me when I say, I’ll remember you for as long as I can. God bless those you left behind. Rest on Sir!
Stand Still everyone, an Officer and Gentleman has left the front lines!!! Attenchuuun!!! Salute!!!
BY SONI AKOJI
Adeiu Soldier! To all his loved ones, may God comfort u. Faith D.
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