In the second part of the two-part series, TOLUWANI ENIOLA and UMAR MUHAMMED report that apart from shunning condoms, the common practice of patronising native doctors, who perform uvulectomy with unsterilised instruments, is another major reason fuelling the rise of HIV/AIDS in Nasarawa State
When Mrs. Juliana Adoki (not real name) developed throat inflammation and distorted speech late in 2010, she visited a native doctor in the Adogi area of Assakio, Lafia-East Development Area of Nasarawa State for treatment.
After a cursory examination, the native doctor said she was suffering from “Belu belu.” Adoki said the native doctor told her that the throat pain was caused by the enlargement and inflammation of the uvula, a bell-shaped tissue which hangs down from the soft palate of the mouth.
Pharyngotonsillitis, popularly called Belu Belu in local parlance, is an inflammation of the tonsils and the pharynx caused by viral or bacterial infections.
“The native doctor said the solution to my problem was the removal of my uvula. I consented and he removed it with some instruments. I was very okay after the surgery,” said the primary school teacher.
Shortly after, Adoki said she got pregnant and went to the hospital to conduct some medical tests.
She said, “The results showed I was HIV positive.”
“Before we got married, my husband and I underwent medical tests and both of us were confirmed HIV negative. A few years after the wedding, I developed pains in my throat. I visited a traditional doctor and he treated me. The pain left.
“It was when I went for antenatal check that I received the shocking news of my HIV status. After the sad news, I began to ponder on how I contracted the virus. My husband is HIV negative. I remembered that the local uvula specialist carried out surgeries with the same surgical knife on three persons before me; he used the same knife on all of us. He also did not sterilise the instruments. I believe that was where I contracted the virus,” she added.
While relieving the psychological trauma of living with the virus, Juliana said she tried to expose the native doctor in order to stop him from further infecting others.
She stated, “I went to his clinic but I was told he (native doctor) was dead.”
Adoki is one of the many residents of Nasarawa State who may have contracted the Human Immunodeficiency Virus innocently from the recklessness of quack doctors, operating under the aegis of Association of Native Doctors in the state. Medical experts in separate interviews with SUNDAY PUNCH said the quack doctors had infected many ignorant residents of the state with HIV.
Statistics from the Nasarawa State AIDS Control Agency show that in 2013, 23,719 pregnant women enrolled for the Prevention of Mother to Child Transmission of HIV in the state but by October 2015, the number of pregnant women seeking same treatment was 175,755. Experts say that rampant aversion to the use of condoms, and quack doctors are the two major reasons for the rapid spread of the virus in the state.
Although the native doctor who treated Adoki is dead, many of his ilk can be found in different towns of the state.
These native doctors, who have no history of medical education, are patronised by residents of the state whenever they develop an enlargement of their uvulas which causes pain, difficulty in swallowing food and distorted speech. Our correspondents observed that the quack doctors operated freely owing to the laxity of regulatory agencies in the state.
One of the native doctors, Abubakar Ibrahim, boasted to SUNDAY PUNCH that his late father taught him ‘medicine and surgery. ’ He stated that for 38 years, he had been ‘curing’ residents of the state of Belu Belu by cutting their uvula, whenever they developed inflammation.
The traditional doctor, who is the General Secretary of the Association of Native Doctors in the state, said he had desisted from using the same surgical knife for his patients after he realised it was fuelling the transmission of the virus among his patrons. He was silent on the fate of the people he operated on before he started sterilising his instruments.
He said, “I now sterilise all my equipment. Recently, our association fined some native doctors who persisted in the practice of using same instruments for uvula surgery without sterilising them. They paid N1, 500 for breaking our rules. As an association, we are organised but we are worried because some are still curing patients of belu belu without sterilising their instruments.”
Our correspondents traced another native doctor in the state, Muhammed Awal, to his shed. Awal, who removes belu belu for N3,000, also boasted of his ‘medical prowess.’
Asked where he got his medical training from, Awal said, “It was my grandfather that trained me when I became 18 years old. We are recognised by the state government. For patients who prefer home service, I charge between N5, 000 and N10, 000. It depends on how they negotiate.”
Awal’s ‘theatre’ was an empty room with a mat on the floor. The clinic contrasted sharply with what obtains in orthodox hospitals. His patient that day was a middle-aged man, who identified himself as Adamu.
Adamu squatted on the floor; his legs soon began to shake visibly due to the prolonged squatting.
After sorting some metallic instruments from his bag, Awal asked Adamu to open his mouth and bend his head backwards to enable him to conduct the ‘operation.’ Fright overwhelmed Adamu as Awal thrust the knife into his throat.
After cutting the uvula and applying some substances to stop the bleeding, Awal asked Adamu to bend downward so as not to swallow his blood. It lasted for 30 minutes.
Adamu left the ‘theatre’ almost immediately after the surgery, walking sluggishly out of the room.
Native doctors spreading HIV
The Executive Director, Nasarawa State AIDS Control Agency, Dr. Zakari Umar, confirmed that the native doctors, who use unsterilised tools to conduct surgeries on their patients, are responsible for the increase in the transmission of HIV in the state.
Umar, in an interview with SUNDAY PUNCH, stressed that such native doctors needed to be educated on the dangers of their practices, adding that this would reduce the figures of new infections recorded monthly in the state.
Speaking on the dangers of such surgeries, the Financial Secretary of the Nigeria Medical Association, Nasarawa State chapter, Dr. Ashiegbu Kelechi, says patronising quack doctors for uvula removal is dangerous.
Kelechi said only a qualified medical doctor or physician shpuld examine such patients to really understand the nature of the throat problem.
On the implications of such surgeries, Kelechi said such patients, who patronised such quack doctors, could lose their voices and contract HIV.
He added that since the quack doctors were not properly trained, they might not know what to do when there is excessive bleeding.
“Those quacks, who conduct these surgeries, are actually not fully aware, in the first instance, what HIV/AIDS is all about. They use unsterilised instruments continuously for many people, thereby ensuring the transmission of the virus.
“We have always advised patients to always see qualified doctors, who will subsequently refer such patients to an Ear Nose and Throat surgeon or dentists,” he told SUNDAY PUNCH.
Corroborating Kelechi’s statement, a former NMA Chairman in Nasarawa State, Dr. Friday Omolei, said the native doctors were operating illegally and unqualified to conduct uvulectomy.
He dismissed Awal’s claim that the native doctors were recognised by the state government.
He explained that the native doctors were not like the traditional birth attendants, who are being incorporated into the national health programmes geared towards reducing maternal mortality rate across the country.
He added, “They are not recognised by law to do what they do because they are not trained. What they are doing presently is against the law of the land. We are calling on the people of the state to stop patronising them because of the complications that may arise from such surgeries, taking into cognizance that they risk being infected with diseases such as HIV/AIDS and hepatitis.
“The patients risk excessive bleeding from the cutting of the uvulas and further complications. It could also affect the way they speak and cause pain while swallowing food. Since they don’t have the prerequisite skills and qualifications recognised by law to conduct such surgeries, whatever they are doing is simply quackery.”
Omolei noted that uvulectomy is usually recommended only for certain medical conditions such as Pharyngotonsillitis. The doctor said if pharyngotonsillitis is resistant to the routine antibiotics, it becomes embarrassing.
Omolei said, “There are certain conditions that require an uvulectomy. If a patient has repeated pharyngotonsillitis, it may be recommended to a surgeon to have a look. In such instance, such a patient may be advised to undergo an uvulectomy to stop the infection. If one has uvula that is painful, such may also require an uvulectomy.
“In a situation where there is difficulty in swallowing food as a result of discomfort from the uvula, uvulectomy may be recommended, but one will need to have seen a qualified medical personnel, who, after considering the patient’s medical history, examination and investigation, will then give a definitive diagnosis before recommending uvulectomy.”
He advised the state government to embark on advocacy across the state in order to sensitise the residents to the dangers of uvula surgery and to regulate the activities of the native doctors in the state.
The Chief Medical Director of the Dalhatu Araf Specialist Hospital, Lafia, Dr. Yakubu Ashuku, also expressed concern over the activities of the native doctors.
Ashuku said native doctors do not sterilised instruments because they lack understanding about the transmission of HIV/AIDS.
He advised residents of the state to stop patronising the quacks.
“Our people hold on to superstition. When they are diagnosed with certain diseases, instead of seeking ways to remedy their situation, they may start blaming unseen forces for their woes and visiting unqualified personnel.
“We need to intensify efforts on health education to increase the level of awareness of the people on the danger of contracting HIV,” he said.
Why residents patronise native doctors
Nezifi Abdullahi, 30, who had his uvula removed by one of the local doctors, stated that he chose to patronise native doctors because hospital fees were “too high.”
Abdullahi said if he had undergone the same surgery at an accredited hospital, he would have spent more.
He said, “I prefer to patronise the native doctors because in government hospitals, the fee is higher compared to that of the local doctors. I cannot afford to pay N10,000 or N15,000 for uvula operation in government hospitals in the state. Also, there is always a delay in government hospitals compared to native clinics.”
Another patient, who identified herself as Mrs. John, said she contacted a local doctor to remove her uvula because “doctors at government hospitals would place me on drugs for some weeks, unlike the native doctor, who only asked me to boil hot water and after some days, the pain disappeared.”
Speaking with SUNDAY PUNCH, the Nasarawa State House of Assembly said it will not spare native doctors operating in the state illegally.
The member representing Doma North in the House of Assembly, Mr. Muhammed Opkede, stated that the lawmakers would sanction native doctors operating without licence in the state.
Okpede, who is the Chairman, House Committee on Health, said the proliferation of quacks was alarming, noting that plans were underway to enact a law that would regulate their activities.
He said, “If they refuse to comply with the law that we are going to enact, anybody caught will be sanctioned and prosecuted appropriately so as to serve as a deterrent to others.
“We will address the root causes of the rise of HIV/AIDS in the state and move to clamp down on these quack doctors. We will create awareness so that the people of the state can be sensitised to the dangers of patronising them.
“We will make sure that we correct the abnormalities ravaging the health sector in the state in order to bring down the prevalence of HIV/AIDS in the state.”
When asked if the police had arrested any of the quack doctors, the Police Public Relations Officer, Nasarawa State Command, Mr. Kennedy Idirisu, told one of our correspondents that the police had not arrested any of the native doctors because no complaint had been made against them.