Women's Healthcare: Is Nigeria's Healthcare System Really Doing Enough for Female Sicklers?

       As Sickle Cell Day is celebrated today, I think of all the Sickle Cell patients, including my younger sister, around the world. But one theme in particular hovers restlessly in my mind: Rethinking women's healthcare in relation to Sickle Cell Disorder (SCD) in Nigeria and by extension, Africa and the world at large.
        

    Even though I do not have any medical expertise, I won't be so negligent as to not tell you what SCD actually means or implies for those who suffer from the disorder. According to the official website of the U.S department of Health and Human Services, "Sickle cell disease is a group of red blood cell disorders that are passed down from your parents. People with sickle cell disease have some red blood cells that are shaped like a 'sickle' or crescent, instead of round. Normal, round red blood cells are flexible enough to move through blood vessels to carry oxygen to the body. Sickle-shaped red blood cells can stick to each other inside blood vessels, blocking blood flow and causing pain and problems in many different parts of the body. People with sickle cell disease also have fewer red blood cells, because sickle cells die sooner than normal red blood cells. Over time, blocked blood flow and lack of oxygen can cause serious health problems and organ damage." Although there are about three or four different types of this disorder, one of the most severe and common types is SS or Sickle Cell Anemia (the one that is usually described to us in Biology classes like a death sentence). Fortunately or unfortunately, the greatest burden of SCD is in sub-Saharan Africa, where access to medical care is not uniformly available.
      

     Now, you may be wondering why I am only talking about rethinking healthcare for female sicklers and not just all sicklers. Well, after intensive research and empirical observation from my sister's experience with Sickle Cell Anemia, I have come to understand that SCD affects women in some technically different ways than other sexes. Women with SCD may experience delayed puberty, more pain crises (pain caused by sickle cells blocking blood flow in blood vessels) before and during their period, increased complications during pregnancy, problems for them and their baby during pregnancy, heightened negative effects from some certain types of birth control, problems getting pregnant due to SCD treatments and increased pain during sex. It is crucial to note that not all female sicklers experience these symptoms and there is no need for any pity-partying or stigmatization. In addition, SCD does not only affect the physical health for some, but can also have implications for their mental health in the form of anxiety disorder or depression. A couple of things trigger crises for sicklers including high altitudes, low oxygen activities like scuba-diving, sudden temperature changes such  as jumping into a cold pool, dehydration, intense exercise, infections from injuries, and stress. Many pain symptoms are chronic and can often be managed by resting and taking certain prescriptions. However, in severe cases, more powerful drugs may need to be used or procedures like blood transfusions have to be undergone.
  

     "Nearly 90% of the world's SCD population lives in three countries: Nigeria, India and the Democratic Republic of Congo"(DeBaun et al). Nigeria alone has been estimated to have at least 150, 000 newborns with SCD annually, yet SCD is still shrouded in a lot of ignorance. We often hear the saying that, "Ignorance is bliss." Well, this is definitely one of those cases where ignorance isn't. It was ignorance that caused many of our ancestors to call children that probably suffered from SCD, "Abiku" (Yoruba) and "Ogbanje"(Igbo). The second time I read Chinua Achebe's 'Things Fall Apart,' set in pre-colonial times, my eyes opened to see that the repeated reincarnation of one of Okonkwo's children was actually just several children dying from either malaria or SCD. The descriptions of the children's condition before their deaths sounded quite like the crises I have seen my sister experience on very bad days. Even though we may have come a long way from performing mutilations on Ogbanjes and tagging multiple deaths of children as an ancestral or mystical curse, and maybe even stigmatization of Sickle Cell patients, there is still more to be done.

         Back in their courting days, my parents were practically hyper aware of the dangers of giving birth to an SS child. They got themselves tested and already told themselves that they would not get married if their blood types were not compatible. Alas, the results came out and the hospital told them they were good to go. They gave birth to me and everything was great. Then came along the second-born and everything also started out great till she stopped being able to walk at the age of two (because of a stroke). They got her tested and then the shocking news came: Their daughter had SCD. But how was this possible? After getting themselves tested? Had their village members come looking for them? Then more shocking news came: They had both been Sickle Cell carriers (AS) after all. But the hospital claimed to have made a mistake with the test results because the test had apparently been affected by the fact that my mom had had Typhoid at the time. What? Of course, my mother did not disappoint and took action to sue the-now-closed-down hospital. Well, the rest is history, and my sister is doing just fine now (In case you were wondering). I wish I could be cheesy and say that I always remind her to take her drugs or to drink a lot of water, but it's honestly not that easy to even remember in the first place. I also wish I could be like "Because of my sister's condition, I want to become a medical doctor and find lasting, affordable and secure treatments for SCD." Alas, that is not my calling but I certainly would live up to the fact that I am my mother's daughter and sue any pharmaceutical company or hospital that gives wrong and potentially life-threatening treatments or test results to people. 

        

    Even though more and more sicklers live into adulthood today, there are still other challenges in our healthcare system, especially during this Covid-19 pandemic where sicklers are predisposed to the virus because of their underlying health condition. Many sicklers may face more pronounced symptoms in the event of getting infected by the virus, especially those who are pregnant. It would definitely be a far cry to say that our healthcare system is fully equipped for these kind of scenarios.

    

    In places like Northern Nigeria, there are some social customs that prohibit men from carrying out some medical procedures on women. Hence, there needs to be an increase in opportunities for more women to be medical practitioners. There should be the liberty and the means to be able to go to properly funded schools with good infrastructure and qualified teachers. Indeed, there should be better pay and working conditions for health practitioners to even want to work in Nigeria in the first place. Also, we need more women in leadership positions in the health sector to be able respond to women's needs ranging from issues like SCD to others like, reproductive health, breast cancer, assistance for rape victims, infant and maternal mortality, mental health, transwomen health, sexual health etc.
      

      Still on the issue of SCD, a bone marrow transplant is a permanent but still largely risky treatment. More research should be done to find out how more people can donate their bone marrow, how to make bone marrow transplants safer for people with sickle cell disease, and how to stop side effects from bone marrow transplants, such as infertility. More research also needs to be done on the possible use of gene therapy (Changing the genes of someone with Sickle Cell disease could cure the disease). Researchers should explore whether gene therapy can help sickle blood cells make a healthy type of hemoglobin. To be able to run all these tests and clinical trials, funding obviously has to be in the equation. The first step for that is for some government officials to finally stop stealing public funds and then start allocating more funds and resources for healthcare uniformly across all states. Other bodies like NGOs can also buttress government efforts by playing their own part in finding lasting solutions and setting up Sickle Cell centers.
        
        Finally, it is important to note that women's access to quality healthcare intersects with different domains such as their ethnicity, socio-economic status, sexuality, race etc. For example, some women with SCD or women with SCD children are not the ones that get to determine when to seek medical help. Decision-making regarding maternal and child healthcare, is up to culture, gender roles (that define men as financial providers), and economic influence. Financially dependent women often have to rely on their partners for money to access pregnancy healthcare and other related costs and the financial status of these partners also affects the quality of healthcare they can access. Hence, supporting women's financial independence is also an important step in ensuring women's access to quality healthcare.

Visit The Sickle Cell Foundation, Nigeria to contribute your own part to a worthy cause today.

This post is dedicated to my babe, Dade.💗💗💗💗💗💗💗

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