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Challenges Of Paediatric Surgery In Nigeria

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According to the United Nations Children’s Fund (UNICEF), Nigeria is a ‘country of the young’ with 92 million of its over 200 million population under the age of 15 years. Also, according to Professor of Paediatric Surgery at the University of Lagos, and former Chief Medical Director (CMD) of University of Lagos Teaching Hospital (LUTH), Prof Christopher Bode, the number of children under 5 years old in Nigeria are over 30 million, with about 7 million new babies being born yearly. Prof Bode was the keynote speaker at the second edition of memorial lecture, held last week at the University of Port Harcourt, in honour of one of the pioneers of paediatric surgery practice in Nigeria, late Dr. Melford Graham-Douglas.
According to him, paediatric medicine is the medical care of children, a broad name for treatments for those from zero to 15 years of age, of whom Prof Bode observed are tender and voiceless, because they mostly can’t speak for themselves, depending on their parents for important lifecare decisions. Paediatric surgery which deals with surgical cares, mostly of birth defects in babies, demands the utmost skilled personnel, equipment and specialist handling, considering the tenderness of babies. Since the introduction of paediatric surgery in Nigeria, child-care professionals have continued to champion the awareness that children need specialised healthcare and infrastructure more customised to their needs as distinct from general medical practice.
Despite the achievements made so far in Nigeria in reducing infant mortality rates from previously untreatable birth defects, thanks to the foresightedness of pioneer paediatric surgeons like the late Dr Melford Graham-Douglas, enormous challenges still face the discipline from achieving its full objectives.As part of the general challenges of the Nigeria healthcare system, health screenings for disorders are mostly relegated out of ignorance, to the effect that paediatric cases requiring earlier surgeries are presented late, while most children are unable to communicate their health challenges. Where emergencies occur, paediatric surgeons have had to wait endlessly, for the general surgeons to free-up adult theatres before they could exercise efforts to rescew babies in critical conditions.
Considering that children are different in size and physiology, their cases become more delicate. Their body surface to mass ratios are much higher than in adults, that they dissipate body heat faster in normal ambient temperatures, and easily catch cold in the cold conditions of adult surgical theatres. Warmer surgical theatres designed and dedicated for children are always needed or they easily succumb to life-treathening hypothermia. Basic amenities are also needed to transport children in warm ambulances, especially babies, from hospitals of first call, to the centre of definite care.Paediatric surgeons also need to monitor children’s blood levels with specialist care because children have very low blood volumes that a minor loss could tip the balance between life and death. Due to anatomic differences from adults, children need special anaesthesia to undergo successful surgeries, and careful drug calculations to cope with their tender metabolic systems, their airways being so narrow, many routine anaestetic steps in adults are unsuitable for newborns and infants.
Drugs and the amount of fluid infusion to be administered to a child must be carefully calculated to conform with body weight, and in isothermic conditions. These are reasons paediatric surgery is such a speciality area that requires the skills set and infrastructure it deserves. It has been a huge challenge to practitioners who have had to work in poorly equipped environments. Paediatric surgery units in Nigeria should therefore be provided with neonatal intensive care units (NICUs) and paediatric intensive care units (PICUs) to ensure adequate post-surgery cares for babies and children, in addition to providing exracorporeal membrane oxygenation (ECMO) machines.Prof Bode however regrets that low man power remains a challenge in the field. According to him, in a survey conducted in Nigeria, about 2.9 million Nigerian children live with surgically correctable conditions, meanwhile there are just 38 treatment centres and only 115 paediatric surgeons in the country, some of whom have left for greener pastures, leaving a workload of about 25,000 patients per surgeon. There are only 22 professors of paediatric surgery to train needed personnel. There is therefore a need to create significant incentives that reverse the exodus of skills.
The labours of specialist surgeons like the late Dr Melford Graham-Douglas, who worked tirelessly to save lives remain commendable and they need being immortalised as an encouragement to others. There is need to celebrate those who served humanity selflessly and bequeathed a legacy of patriotism and hardwork.Late Dr Melford Graham-Douglas was the first African surgeon under the British Technical Assistance Scheme. He was a fellow of the British Association of Paediatric Surgeons, a fellow of the Royal College of Surgeons of Edinburg and England and a fellow of the American College of Surgeons. He was the first registrar of the Nigerian Medical Council, was among the founding fathers of the University of Lagos, as well as being a council member of the universities of Ibadan and Port Harcourt, respectively. Back home, he served the Rivers State Ministry of Health as permanent secretary who laid the foundation of health infrastructure in the state. He was honoured with the Order of the Federal Republic (OFR).
An icon of the Orubibi Group of Houses in Abonnema, the University of Port Harcourt honours late Dr Melford Graham-Douglas with a Professorial Chair in Paediatric Surgery at the university’s College of Health Sciences, in recognition of his contributions to humanity. The chair, currently occupied by Prof Amabra Dodiyi-Manuel, is dedicated to research and development in paediatric surgery.Government should build upon the foundations established by men like late Dt Graham-Douglas to equip the College of Health Sciences of the great University of Port Harcourt, with state of the art facilities in paediatric surgery, as a centre of reference within the South-South region. As it stands today, there is no significant paediatric surgery centre in the region. The management of UNIPORT should engage both federal, state and regional stakeholders to ensure this becomes a reality.

By: Joseph Nwankwo

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Addressing Nigeria’s Social Ills Through Cultural Education

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One of the critical problems confronting Nigeria today is the lack of recognition and appreciation of our tangible heritage, values, and norms – elements that are crucial for fostering social cohesion and responsibility. These values, which are inherently adaptive, can only be transmitted effectively through cultural education.Nigerian food Cultural education involves socialising individuals into the norms, values, and heritage of a given society through mediums such as folktales. Its primary intent is to nurture socially responsible and morally upright individuals who contribute positively to their community. In essence, cultural education is a learned behavioral pattern shared and transmitted from one generation to another. It encompasses customs, traditions, beliefs, arts, and philosophies of life. As Babs Fafunwa (1994) observed, every society, regardless of its size, has its unique ways of transmitting its cultural heritage.
Cultural education plays a vital role in shaping a child’s character and physical skills. Cultural education also has unique ways of instilling respect for elders and authority in the child. In addition, cultural education helps in developing intellectual abilities, fostering a sense of belonging, and promoting active participation in family and community affairs. This concept also cultivates a healthy attitude towards honest labour while it also helps to preserve the community’s cultural heritage. However, since Nigeria’s independence in 1960, the infiltration of foreign cultures, technological advancements, religious beliefs, and political systems have significantly helped in the erosion of the country’s social fabric. Today, Nigeria grapples with the loss of cultural values in more ways than one. The country also grapples with moral laxity among youths, violence, delinquent behaviours as well as the disruption of traditional political systems.
Beyond these, lack of cultural education has also triggered a decline in political will among the country’s citizenry. Thus, social issues such as sex abuse, prostitution, drug trafficking, kidnapping for ransom, internet fraud (which are more commonly known as 419); cybercrime, militancy, armed robbery, and examination malpractice have become rampant. However, these challenges can be mitigated through the promotion and sustenance of cultural education in Nigeria. Bringing cultural education forward in the country’s socio-political and economic systems would go a long way in redirecting the citizenry from the identified social ills. For instance, cultural socialization teaches children the proper ways to greet elders and interact respectfully. Observing parents during ceremonies are also a way to achieving this. Ceremonies such as weddings, child-naming, or funerals help children learn appropriate behaviour at such and sundry ceremonies, and decorum. Unfortunately, many youths today lack respect for elders and are antagonistic to cultural values. Instead, they are influenced by foreign films, contents and literature which often glorify disrespect to our culture; violence and weapon use. As a result, some have become political thugs, religious extremists or armed robbers. They now pose a severe threat to Nigeria’s national survival.
Furthermore, exposure to undesirable foreign cultures has led to extensive moral degradation which manifest in ways such as drug abuse, prostitution, theft, and internet fraud. Dressing among Nigerian youths is another concern. Many young people disregard their cultural heritage and show utmost disdain for their geographical environment. For example, some young women wear clothing that leaves vital parts of their bodies exposed, while young men adopt unkempt appearances, including sagging their trousers and leaving their shirts unbuttoned. There are also instances of unfastened shoelaces. These issues can be addressed through family-based cultural socialisation, where parents play a critical role in imparting cultural education. It is therefore recommended that, to address these social ills, the following measures are suggested. The first is that there should be ways to incorporate cultural education into the curriculum of our schools. Nigeria’s education system should be reviewed to emphasise cultural education, including the use of indigenous languages for instruction. Cultural elements such as morality, taboos, mores, and folktales should be promoted to shape human behaviour positively.
Another suggestion is that we should indigenise the Nigerian political systems. The political system should incorporate cultural principles and practices specific to Nigeria’s diverse cultural environments. This will encourage greater participation and accountability among political leaders. Thirdly, we must promote local content in media. A ban should be placed on the excessive use of foreign entertainment packages in media houses and on social media. Instead, Nigerian cultural content should be prioritised and promoted to reinforce cultural identity. Also, we must strengthen parental socialisation. Through this, families must embrace parental socialisation as a key method for imparting cultural education. Parents should model cultural values and behaviours to guide their children effectively. Cultural education is very essential for curbing social ills in Nigeria. By integrating it into our education system, political practices and media content, we can foster a society rooted in strong moral values and cultural heritage, thereby ensuring a strong and brighter future for generations to come.

Modupe is Chief Museum Education Officer, National Commission for Museums & Monuments, Osogbo, Osun State.

Veronica Adewole

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Opinion

Promoting Citizens’ Power In Democracy

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2027 is sealed for Mr. President. When I say 18 over 18, it means we are going to deliver our 18 local governments to Mr. President.”
Reading the above statement by the governor of Edo State, Mr. Monday Okpebholo, one wonders what the future holds for Nigeria’s democracy. In any true democracy, the power to elect leaders rests solely in the hands of the people. This principle is the foundation of democracy, ensuring that governance is based on the will of the majority rather than the rule of a single individual or a privileged few. Unfortunately, in Nigeria political elites and influential figures attempt to manipulate the electoral process, undermining the will of the citizens. We often hear governors and some other politicians talking tough, boasting of how they would sweep all votes in an election. This practice not only weakens democracy but also fosters corruption, inefficiency, and a disconnect between leadership and the people’s actual needs.
Such statements suggest a predetermined outcome of an election rather than a free and fair electoral process. And in a democratic society such as our, this has several implications. Firstly, there is a threat to free and fair elections. Democracy thrives on competitive, transparent, and credible elections where citizens freely choose their leaders. The claim that all votes will go to one candidate suggests electoral manipulation, coercion, or suppression of opposition. Secondly, it portrays a disregard for voter choice. It is said that in a democracy, the electorates are the kings because they are supposed to have the power to determine who sits on any political seat. But when a governor claims that the votes to be cast in his state in the next two years are already meant for a particular candidate, it suggests that the election result is already determined, it makes voters feel powerless and discouraged to participate in politics.
Statements and actions like Okpobholo’s erode political pluralism. Democracy requires multiple parties competing fairly. Declaring total victory before an election dismisses the role of opposition parties and reduces political competition to a mere formality. The statement also raises concerns about potential election rigging, vote-buying, or manipulation of electoral institutions to favor one candidate, which damages public trust in the democratic system. If there are no plans to commit these electoral offences, how possible is it that all the numerous opposition parties, including the Peoples Democratic Party (PDP) which just handed over power to the ruling party in Edo State will not win even a single local government area?
This idea of a government in power winning elections at all cost and making elections in Nigeria less competitive and predetermined outcomes is the reason institutions like the Independent National Electoral Commission (INEC), judiciary, and security agencies are seen as compromised.
This, no doubt, weakens our democracy. Another implication of Okpobholo’s rhetoric is that it can provoke political unrest, resistance from opposition parties, and loss of faith in democratic processes, leading to increased instability and potential conflicts. Nigeria is already soaked with too much political and economic tensions and cannot afford to have more due to the selfish interest of a few individuals. Another troubling trend is the growing influence of governors, party leaders, and other politicians in handpicking candidates for elections. Instead of allowing a free and fair process where citizens decide, these power brokers often impose their preferred candidates, who may not necessarily represent the interests of the people. Such interference leads to a leadership that is accountable not to the electorate but to the few individuals who orchestrated their rise to power.
Have we not seen enough of this in display where elected lawmakers both on the federal and state levels would choose to do the biddings of their masters in the executive arm of government over the interest of Nigerians who elected them? Former President, Olusegun Obasanjo while speaking on the failure of democracy in Africa recently aptly defined what we currently have in Nigeria thus, “Today we have democracy which is government of the people, of a small number of people, by a small number of people over a large number of people who are deprived of what they need to have in life.” Some people have come heavily on the former president and the former governor of Anambra State, Peter Obi who shared the same sentiment for daring to criticize the present-day practice of democracy in Nigeria when in their days in offices some of their actions accountable and effective leadership.
Additionally, the legal framework governing elections should be strengthened to ensure transparency. INEC and the states’ electoral umpire free from political interference, must oversee the entire process, guaranteeing that every vote counts and that the people’s choices are respected. Political parties should also be mandated to conduct primaries that genuinely reflect the will of their members, rather than serving as a mere formality for predetermined outcomes.Our elected leaders across board should be advised to face governance and deliver the dividends of democracy to Nigerians who put them in office instead of politicking all the time. It is about two years to the next general elections and the major preoccupation of the leaders seems to be plans and scheming of how to come back in office in 2027 instead of dealing with economic, insecurity, unemployment and other challenges facing the country. How can Nigeria move forward like that?

Calista Ezeaku

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Opinion

 Making Wise Decisions Amid Pressure

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Look before you leap”, is one of the wise sayings that over the years I have been emotionally attached to. It means so much to me because the debilitating consequences of unguided actions are better imagined than experienced. “Look before you Leap” teaches me to  be thoughtful,  articulate, discreet dispassionate and solicit for advice of the experienced and reasonable people where necessary. I have seen people  reveal their stark ignorance because they took decisions rashly and without  considering the implications of their actions or inactions, only to say, “had I known” which is an euphemism for failure. It has therefore, become  necessary to “look before you leap”. Rehoboam, son of Bible’s King Solomon lost 10 of a 12-tribe kingdom of lsrael to Jeroboam. The negative consequences of lack of conscientious and enlightened  guide before taking action has landed many to avoidable regrets.
Thoughtless actions happen every day and they are evidenced in the unpleasant outcomes of such decision. In 2024, a Federal High Court, Abuja sacked 20 Cross River State House of Assembly members which serves as an object lesson for thoughtless Lawmakers’ and elected representatives who want to defect from the party on whose platform they were elected to a preferred political party, whether the choice was based on sound judgement, ignorance or pecuniary gains. The Electoral Act is unambiguous and crystal clear so does not make judicial interpretation necessary, on the ground for an elected representative to leave his or her political party for a preferred one either by inducement, anticipated pecuniary benefits or blind loyalty.And the sublime reason must be premised on irreconcilable crisis in the  political party of  those elected who want to decamp or cross-carpet
Recall that on Monday  March 18, 2024 a Federal High Court in Abuja  sacked 20 members of the Cross River State House of Assembly. The Peoples Democratic Party (PDP) had instituted a suit against the lawmakers over their defection to the All Progressives Congress (APC). Ruling on the case marked “FHC/ABJ/CS/975/2021 , Taiwo Taiwo, the presiding judge, held that the lawmakers should vacate their seats, having abandoned the political party that sponsored them to power. The affected lawmakers are: Michael Etaba, Legor Idagbor, Eteng Jonah William, Joseph A. Bassey, Odey Peter Agbe, Okon E. Ephraim, Regina L. Anyogo, Matthew S. Olory, Ekpo Ekpo Bassey, Ogbor Ogbor Udop and Ekpe Charles Okon.Others are Hillary Ekpang Bisong, Francis B. Asuquo, Elvert Ayambem, Davis Etta, Sunday U. Achunekan, Cynthia Nkasi, Edward Ajang, Chris Nja-Mbu Ogar and Maria Akwaji.
The Independent National Electoral Commission (INEC), Speaker of the House of Representatives, National Assembly, Clerk of the National Assembly, Cross River State House of Assembly, Clerk of the Cross River State House of Assembly and the All Progressives Congress, were also joined as defendants in the suit. Though, in their defence, the lawmakers argued that there was rancour in the Peoples Democratic Party  (PDP),which led to their expulsion from the party,  the judge held that the defendants had intentions to mislead the court. He said he found gaps and loopholes in their defence as they tried to twist events to suit their own narratives.”They wined and dined under the umbrella of the plaintiff who also gave them shelter,” he said Taiwo noted that they not only defected loudly, “they took pictures of their defection and were received by the officials of the 26th defendant”.
“There is no doubt that the defendants can belong to or join any political association and assembly as they are free to do so,” he ruled. “I consider the attempts of the 6th – 25th defendants to justify their defection feeble in the circumstances of this case.” Taiwo said the public voted for the lawmakers through the plaintiff who sponsored them and they were not elected as independent candidates.”They had a vehicle which conveyed them and that vehicle belongs to the plaintiff. They cannot abandon the vehicle,” he held. Justice Taiwo’s judgment and several other judgments on thoughtless defections should have been a basis, landmark and precedent to determine whether the 27 Rivers State House of Assembly members elected on the platform of the Peoples Democratic Party (PDP), have the locus to publicly decamp to the All  Progressives Congress (APC) and still retain their seats in the House as elected and honourable  members of the House as declared by the Supreme Court in its Judgment on consolidated suits on the political crisis in Rivers State.
The judgment of the “learned” justices of the Supreme Court on the 27 defectors is a bitter pill to swallow. It is however, not a surprise because the aroma of the fart tells the substance of the poo. The wise man learns from the experiences of others and  history. History repeats itself because people have refused to come to understanding. They are close-ended in learning. The essence of history is to avoid a reinvent of the negative past, use the ugly past to reconstruct the future. Legislators are elected to represent constituency consisting of people of all walks of life. They should rather strive to serve the people, solicit the consent of popular opinions on critical issues rather than serving their selfish interests. Those elected should see themselves as stewards and as stewards they are accountable to the people and God, not their political godfather.
It is high time our political leaders knew that the legitimacy of their positions is derived from the magnanimity of the people. They should therefore not take decisions without taking into cognisance the interest of the people they are representing,  through intentional consultation.

By: Igbiki Benibo

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