Oct-Dec 2021

Issue7 |  $0.00

Nigeria's First Digital Health Magazine for Doctors

RED-FLAGS

.
IN THE

i e s . .
RED-EYE

e r g e n c
Em DOKITA ORI
ATLS:
A strategic tool in
trauma
management

AFEFE:
A community health talk show
with impact
 Editor's Message
CONTENT

The Sage's Corner

Dokita Ori Afefe: A

community health show
with impact
Health Tips

•Red Flags in the Red Eye

•Management of Diarrhoea
in Children
• Foreign Body in the Airway

Trending
The Abysmal Energy Situation

Health Science

ATLS: A strategic tool in

trauma management

-2-
EDITOR'S
MESSAGE Olumide Elebute
(MBChB,FWACS,FACS,MBA)
Emergencies are part of everyday life. An emergency is
a situation or problem that requires urgent attention
or timely intervention. Medical emergencies come in
various shades and are present in virtually every field
of Medicine, from obstetrics to adult medicine.

The colossal impart of emergencies in terms of human and

material loss is literally speaking unquantifiable and the
appreciation of the sheer gravity of this problem by various
stakeholders has led to the creation of a distinct, fully-
fledged field of Medicine tagged emergency medicine.
Issue 7 takes a glimpse at various emergencies and ways to
manage them at the home front, and equally reveals the
ideal management protocol that should be initiated in a
hospital setting.
The strategic importance of the eye to human's existence
and survival is uncontestable. The 'red eye', stands out to
be one of the most common ophthalmic emergency
presentation, resulting in visual impairment in some. Dr. Ilo
gives an expert review of causes of red eyes and red flags
that could be a harbinger of something more sinister.   

Two different kinds of emergencies are particularly common among the Paediatric age
group and these are worthy of attention. The first is diarrhoea, which    reportedly is one of
the leading causes of death among under five's in Subsaharan Africa. The next, foreign
body inhalation has led to preventable and irreversible disabilities and even death in
otherwise healthy children. Dr. Akinkunmi and Dr. Ogunbiyi's contribution on diarrhoea
and foreign body inhalation respectively, serve to highlight the importance of both the
prevention and the need for prompt action in tackling these potentially lethal
conditions.   

The doctor is entrusted with the solemn responsibility of enlightening the public on vital
health issues. The need for dissemination of proper and accurate health information
cannot be more pertinent than now, in view of the upsurge in misinformation and
disinformation, a sad development that has now become the order of the day. It is indeed
gladingly to have Dr.Akinbodewa on board to share his vision in the pursuit of the noble
task of engaging the public through his periodic radio talk show,'DOKITA ORI AFEFE'.   

To cap up the assortment of contributions from doctors from diverse disciplines to the
7th issue of the Naija Docs Magazine,    Dr.Elebute gives an insightful perspective of the
worrisome power situation in the    country and its impart on the citadels of learning.   

Finally, on the behalf of the editorial team, I would love to express our heartfelt appreciate
to our numerous readers for your unflinching support and patronage and I truly believe
that this last issue of the year will make a great read.   
-3-
Red Flags in
the Red Eye

Olubanke Ilo is a
Consultant Ophthalmologist at
the Lagos University Teaching
Hospital and a Senior Lecturer
at the College of Medicine,
University of Lagos, Nigeria

Broad
spectrum of
disease entities

The term ‘red flag’ in which can result from a *Self -limiting conditions e.g.,
ocular allergy, microbial
medicine was first variety of conditions both conjunctivitis, and inflamed
described in association within the eye/its adnexa pterygium
with back pain in 1980. or any part of the body.  
Since then, it has been *Potentially sight threatening
associated with many other Redness of the eye may conditions such as dry eyes,
orbital cellulitis, uveal tumour,
ailments including red eye. involve one eye
and endophthalmitis
Red flags are a literal (unilateral) or both
warning of some danger (bilateral). Its causes *Potentially life-threatening
and show the need for spontaneous or traumatic systemic conditions such as
investigations and/or (induced).   poorly controlled DM,
Hypertension, bleeding
referral.  
disorders like leukaemia's,
Up to 35% of primary care clotting abnormalities.
Red eye is a non-specific consultations are eye
term to describe an eye that related.  
appears red due to illness,
injury, or some other
condition. It is a clinical
problem encountered daily
in most Emergency Units
and it is one of the cardinal
signs of ocular inflammation

-4-
 Red eyes can be a sign of a minor or serious medical
condition. Red flags are signs and symptoms within
the red eye that can help to differentiate these
conditions and indicate the need for urgent referral to
an Eye Specialist for professional management and
care.

Numerous conditions could lead to red eyes, including

conjunctivitis (bacterial, viral, fungal, allergic),
blepharitis, corneal injury, keratitis, episcleritis,
scleritis, iritis, dry eye syndrome, acute angle-closure
glaucoma, subconjunctival haemorrhage, and trauma.
Many of these causes of red eye can be managed by
primary care providers in as much as these red flags
can be quickly found and referral of patient done
promptly.   

IN ADDITION,
bilateral redness is more likely to be severe
and often shows a systemic association   

When a red-eye is painful, there is a risk of the patient

instilling harmful traditional eye medications such as urine,
sugar or saltwater, animal dung or ground cowry shells in
the eye. There is also a risk of patients patronising patent
medical stores to buy over the counter steroids.
These substances can lead to corneal infection, corneal
Red eyes can be opacity, cataracts, and even life-threatening complications
a sign of a like encephalitis and cavernous sinus thrombosis, among

minor or serious others. Primary healthcare workers need also be wary of

prescribing steroids and non-steroidal anti-inflammatory
medical eye drops because of the potential risks associated with
condition. them.

• These red flags include

classic trio of
•    • moderate to severe pain Misdiagnosis can lead to litigation as causes of the red eye
(5/10 and above) may cause major vision-threatening sequelae. Remember
• reduced vision   to Look out for the Red Flags in the red eye to minimize
•  photophobia   missing serious diseases in primary care. With a high
Other red flags include: deeply index of suspicion, a prompt referral is key. Save an eye or
red coloured patch in the eye save a life.
(like tomato paste/blood clot)
• unreactive pupils
• foreign body in the eye
• blood or pus in the anterior
chamber (hyphaemia and
hypopyon respectively).   

-5-
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HEALTH
Tips
 Management of
Diarrhoea in
Children
Diarrhoea is a major cause of presentation in the Paediatric

emergency department, it is the second leading cause of Francis Akinkunmi is a Consultant

death in children under five years old. Though the Paediatrician, with a special interest in
Paediatric Cardiology and Critical care.
morbidity and mortality burden of diarrhoea is extremely He also doubles as a lecturer and Acting
high the disease is both preventable and treatable.    HOD of the Department of Paediatrics
and Child Health, University of Medical
Sciences, Ondo, Nigeria

Diarrhoea Stats
Mortality- 525,000 kid/year

Death lead- 2nd leading

cause of death in children
under 5 years old
Rates- 3 years and younger
experience an average of 3
periods/year
Result- deprivation of
Diarrhoea is the passage of three or more loose or liquid stools nutrition necessary for
growth
“Diarrheal disease - World Health
per day (or more frequent passage than normal for the
Organization”

individual). Frequent passing of formed stools is not diarrhoea nor

is the passing of loose “pasty” stools by breastfeeding babies.

Diarrhoea is the second leading cause of death in children under

five years old and accounts for    525 000 death annually.

-8-
In low-income countries, children
under three years old experience on
average three episodes of diarrhoea
every year. “Each episode deprives
the child of the nutrition necessary
for growth” (Diarrheal disease-World
Health Organization), as a result,
diarrhoea is a major cause of
malnutrition, and malnourished
children are most likely to fall ill from
diarrhoea.

Childhood diarrhoea is majorly

caused by viral infections, bacteria
and parasitic organisms spread by
faecal contaminated water and food.
Rotavirus and Escherichia coli are the
two most common aetiological
agents in low-income countries.

The risk factors associated with

diarrhoea in children are:-

Poor food and water hygiene

Lack of exclusive breastfeeding

  
Poor handling of complimentary
food

Poor sanitary condition

The major threat caused by

The major
diarrhoea is dehydration. The loss of
body water and electrolyte in excess
of replacement poses a significant

threat caused
risk of development of electrolyte
imbalance, acute kidney failure,
metabolic acidosis, and death if
quick and right intervention is not
instituted.    by diarrhoea is
Thus, the assessment of the level of
dehydration is important to the
successful management of
dehydration.
childhood diarrhoea disease.

-9-
Severe dehydration:  the
presence of any two of the
following's signs:-  
• Lethargy/ unconsciousness  
Mild dehydration:  
• Markedly Sunken eyes
• Depressed anterior
fontanelle Dry mouth
• Too weak to drink
• Very dry/ parched mouth Dry eye
• Slow shrinking of skin
pinch > 2 seconds

Moderate
Dehydration:  

• Restless/ Irritable

• Drinks eagerly/ thirsty

• Sunken eyes  

• Not tearing when crying  

No dehydration  

When there is no sign of dehydration

- 10 -
 Apple iPhone 11
Pro Max, 64GB,
ere can also be fever and vomiting in a child with
diarrhoea disease.  
Based on the duration of the illness and the presence
of other constitutional symptoms, childhood
diarrhoea can be classi ed as:-  
Midnight Green -
1. Acute diarrhoeal disease: Passage of loose stool
which resolves less than 14 days (about 2 weeks)   Unlocked
2. Persistent diarrhoea disease: the passage of loose (Renewed
Premium)
stool for 14 days or more

3. Bloody diarrhoea/dysentery: Presence of blood in

the diarrhoea stool.  
e management of diarrhoea in children will
depend on the level of dehydration.  
e aim of management is rst to prevent
dehydration if it has not yet occurred and to
rehydrate if the child is already dehydrated and,
secondly to continue to supply ade uate nutrition
during the episode, and lastly to replace loses of uid
and electrolyte

If a child is severely dehydrated it is assumed that he

has lost about 10% of his body weight as water loss
e child will thus re uire rehydration with 100x
body weight (volume of uid). Because they are
usually too weak to drink or lethargic it is better to
rehydrate severely dehydrated children intravenously
over 4-6 hours. If the child presents in shock (cold
clammy extremities, weak/thread peripheral pulse
and hypotension, they are given an antishock bolus
of isotonic uid (normal saline or Ringer's lactate
20ml/kg). is can be repeated up to 3 times until
there is evidence of restored hemodynamic status.
e ongoing loss if diarrhoea persists is calculated as
10ml/kg /loose stool. e daily maintenance uid
should also be given spread over a 24-hour period.
If a er rehydration further assessment put
the hydrations status as moderate
dehydration, rehydration will be based on
Other measures in the treatment of childhood
a loss of 7.5% of body weight. Which is 75 x
diarrhea includes Zinc supplementation which has
bodyweight. ORS can be used to hydrae
been shown to reduce the duration of diarrhoea
here; ongoing loss and daily maintenance
episode.  
( uid/food) are also considered.
e use of Probiotics is also advocated
e use of antibiotics is only in cases of dysentery and
If the dehydration status is put at mild,
persistent diarrhoea.
rehydration will be based on 5% of body
e use of antidiarrheal drugs (Loperamide, alazole
weight loss as uid. e rehydration uid
etc.)  is not helpful in children.
will be 50 X bodyweight (volume of uid
to be given) over 4-6 hours.  
e key measures to prevent diarrhoea include:-

In children with severe and moderate

Access to safe drinking water
dehydration, it is necessary to ascertain
their electrolyte status so that ade uate
Use of improved sanitation
correction of possible electrolyte
imbalances can be instituted.  
Handwashing with soap  

e usual electrolyte imbalance includes

Exclusive breastfeeding for rst 6 months of life  
hypokalemia, hyponatremia,
hypernatremia.
Good personal and food hygiene  

e new low osmolar ORS is preferred.

Rotavirus vaccination
ORS generally replaces uid and
electrolyte loss but in a severe case of
In conclusion diarrhoea disease in children is both
diselectrolyremia supplemental electrolyte
preventable and treatable. Ade uate hygiene, EBF  
is given. e presence of metabolic
and other preventive measures will reduce the
acidosis usually resolves with ade uate
unwarranted burden of diarrhoea, prompt and proper
rehydration.
intervention will also prevent and greatly reduce
Diarrhea mortality.
"...diarrhea disease
in children is both
preventable and Reference  
treatable." Who.int/newsroom/fact sheet

- 12 -
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- 13 -
FOREIGN BODY IN THE AIRWAY
Agboola Ogunbiyi is the Chief Registrar,
Otorhinolaryngology Department, Lagos
University Teaching Hospital, Nigeria

- 14 -
"Foreign body in the
airway (foreign body
aspiration) is a
potentially life-
threatening event in
children."

EPIDEMIOLOGY:

Children aged 1-3 years are the most

susceptible. Overall, it occurs in
patients less than 15 years of age. The
male to female ratio is about 3 to 2.
This is commonly found in this age TYPES OF FOREIGN BODIES COMMONLY
group because of their curiosity, ASPIRATED
adventurous nature, lack of molars for
proper mastication, playing and           ORGANIC
running with objects in their mouth
leading to accidental swallowing           Food (Peanuts, Popcorn, Seeds of
fruits, Hot dogs, Vegetable matter)

ANATOMY:           Non- food e.g., Bones

The airway serves as the conduit of air
from the external environment to the
lungs and this comprises of the nasal
cavity, larynx, trachea, bronchi, and
the bronchioles. The commonest sites
being the nasal cavities and the right
main bronchus. Generally, the site of
foreign body impaction depends on
the size of the foreign body. Large
foreign bodies settle in the larynx and
trachea while smaller ones settle in
the trachea or bronchus.
          INORGANIC
          Toy parts, Crayons, Pen tops, Pins,
Tacks, Nails, Screws
Foreign bodies get to the airway
accidentally during sudden deep inspiration
while swallowing due to fright, shock or
laughter. These may also get to the airway
through the nasal cavity.  

- 15 -
 INVESTIGATIONS
PATHOGENESIS 1. Xray soft tissue neck (AP and Lateral) and
Chest Xray (at Inspiratory and Expiratory AP,
1. No Obstruction: This is common can help lateralize the foreign body)
with vegetative foreign bodies and     - Can show opaque objects
usually a chronic condition, leading to - Translucent objects may show atelectasis,
initiation of inflammation on the walls obstructive emphysema, mediastinal shift,
of the airway. This after leads to consolidation of the lung or abnormal position
of the diaphragm.
granuloma formation, causing
    - The presence of normal findings on Xray
haemoptysis and pneumonia.
does not exclude the presence of foreign
body.
2. Partial Obstruction: Partial
obstruction in the airway, especially 2. Computerized Tomography scan of the
the bronchus, causes valvular neck and/or chest
obstruction in which air gets into the
lungs during inspiration but air is 3. Fluoroscopy
trapped in the lungs during expiration,
leading to emphysematous bulla TREATMENT
which can rupture to cause
pneumothorax 1. Heimlich manoeuvre- For children younger
than 1 year of age, back slaps, and chest
3. Complete obstruction in the larynx thrusts with the infant in a head down position
and/or trachea can cause death while is done while for those older than 1-year,
complete bronchial obstruction leads abdominal, abdominal thrusts is
to collapse of the lung. recommended. These techniques are aimed at
forcing the diaphragm upwards, generating
increased intrathoracic and intratracheal
CLINICAL FEATURES
pressures which help in expulsion of the
foreign body.   
- Patient may be asymptomatic
2. Emergency tracheostomy (to relieve the
- Sudden onset of cough +/- upper airway obstruction) and direct
haemoptysis laryngoscopy with foreign body removal
- Choking 3. Laryngoscope
- Noisy breathing    4. Bronchoscopy and foreign body removal
- Dyspnoea 5. Thoracotomy (if bronchoscopy fails)
- Restlessness
- Cyanosis
- Stridor
- Wheezing
- Decreased breathe sound on
auscultation
Culled from:-
https://www.mottchildren.org/health-
library/chkng#aa111986

- 16 -
COMPLICATIONS OF FOREIGN BODY ASPIRATION

1. Perichondritis and stenosis of the larynx

2. Persistent lung infections
3. Bronchiectasis
4. Pneumothorax
5. Croup
6. Atelectasis
7. Cardiac arrest

PREVENTION/LEGISLATION

            1. Education of the parents and caregivers on

withholding certain types of food e.g., peanuts, until the
child is old enough to chew.

       2. Small household objects like pins and tacks should

be taken out of the children's reach

            3. Conversion of currencies from coins to notes, to

prevent access of these children tp coins, which can be
aspirated or ingested.

      4. Laws by the Consumers Products Safety Commission

requires a federally mandated test to screen toy parts for
potential ingestion by children under 3 years of age. Toy
manufacturers are should clearly label their products when
they hold small parts that can be aspirated.  

- 17 -
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ATLS: A STRATEGIC TOOL IN
TRAUMA MANAGEMENT  
Introduction
Trauma is defined as injury to a living tissue
caused by an extrinsic agent and can be due
to RTA, falls, assault and violence.    Major Adewole Akinsulire is a
trauma represents an injury or combination Consultant Orthopaedic
of injuries that are life threatening and Surgeon. He is a Fellow of the
could be life changing because it may result West African College of
in long term disability. Up to 20% of all ED
Surgeons. He is currently based
visits are trauma related with 10% of these
in the United Kingdom
are severe enough to require admission.[1]
Worldwide , injury is    the fourth    highest
cause of mortality   accounting for up to 4.4
million deaths annually and the
fifth    highest cause of moderate to severe
impairment.[2,3]    Close to 90% of the
mortality occur in Low and middle income
countries .[2,4] Globally trauma accounts
for more deaths than from malaria, HIV and
TB combined.[2]

Figure 1 Trimodal distribution of death

following trauma

- 20 -
MORTALITY IN TRAUMA  
Deaths following trauma occur in 3 peaks
and are described by a trimodal curve (Fig
1) with the first peak occurring seconds to
minutes after the injury and representing a
catastrophic injury such as rupture of the
heart, severe brain injury or high spinal
cord injury. Only primary prevention of
accidents will reduce the incidence of such
catastrophic injuries. The 2nd peak occurs
within minutes to several hours after the
injury and represents conditions such as
pelvic fractures, splenic laceration and
hemopneumothorax which if expediently
and competently managed will prevent a
fatality. The 3rd peak of death usually
occurs days to weeks after the injury and is
usually due to Sepsis and MODY. Adequate
care in the initial period of injury can also
affect the long-term outcome and reduce
this peak.
With approximately 30% of all in-hospital
trauma deaths occurring within the first
hour of injury, the golden hour of care after
injury represents a critical window where
rapid assessment and resuscitation of the
patient is required to improve the outcome.
[5] While trauma can present in several
ways, a universally acceptable, systematic,
and structured approach in the initial
management of injuries is necessary.
Advanced Trauma Life Support (ATLS)
achieves this by formulating a safe and
reliable way of initial management of
trauma patients.[6]
- 21 -
HISTORY OF ATLS  
ATLS originated from events following a
tragic plane crash involving an orthopaedic
surgeon and his family in 1976 in Nebraska.
He was appalled at the quality of trauma
care he received at the incident and the
rural hospital. He then collaborated with
colleagues and set up the ATLS course to
teach doctors the skills to evaluate and
initially manage patients with trauma. The
1st course was in 1978 and further
collaboration with the American College of
Surgeons (ACS) expanded ATLS to an
international course, training over 1.1
million doctors and offered in over 85
countries. It is strictly for doctors and
other medical staff to be excluded from this
certification. The certification lasts for 4
years, and recertification is required every
4 years.
Originally designed for emergency
situations where only one doctor and one
nurse are present, ATLS is now widely
accepted as the standard of care for initial
assessment and treatment in trauma
centres.[6]  
KEYPOINTS OF ATLS
The core concepts of the ATLS program which differentiates it from the conventional non-
emergent patient review are:[7]

1. Treat the greatest threat to life first.

2. The lack of a definitive diagnosis should not delay the application of an indicated
treatment measure.
3. A detailed history is NOT essential to begin the evaluation of a patient with acute
injuries.

Competence in ATLS should be achieved by ATLS emphasizes the need for teamwork
any doctor who participates in trauma care and usually, the various ABCDE
in all levels of care from the primary health components can be assessed by various
centre to a tertiary centre. The following personnel simultaneously. For every
are the phases in managing injured patients identified problem, appropriate treatment
Preparation, Triage, Primary survey with is immediately instituted. Once the patient
immediate resuscitation, Assess need for is stabilized, a decision can be made to
transfer, Secondary survey, Definitive care. transfer the patient to a centre with
[7] appropriate skill, personnel and equipment
for further resuscitation or definitive
The ATLS concept in initial patient treatment. If a patient’s condition
evaluation and care is epitomized in an deteriorates after a primary survey has
easy to remember mnemonic ABCDE.    It is been completed, the patient primary
based on the realization that injury leads to survey is repeated to identify the cause.
mortality based on reproducible time
frames. The loss of a patent airway will
result in death faster than being unable to ATLS AND TRAUMA CARE
breathe. Furthermore, the inability to
breathe will kill a patient more rapidly than For ATLS to be effective, it must exist
the loss of circulating blood volume. under the framework of a managed and
Consequently, all injured patients are efficient Trauma network/System. A
reviewed, and interventions initiated trauma system is an organized, coordinated
during the primary survey using the effort in a defined geographic area that
ABCDE.[7]   delivers the full range of care to all injured
patients and is integrated with the local
A -Airway and Cervical spine public health system.[8]  
immobilization  
B -Breathing and ventilation  
C -Circulation and control of haemorrhage
D -Disability, drugs  
E -Environment/ Exposure.  

- 22 -
A trauma network
includes all the providers
of trauma care
particularly pre-hospital
service, all hospitals
receiving acute trauma
admissions and
rehabilitation services.
The ideal sequence of
events following an
accident is as shown in
figure 2.

"Threat the greatest

threat to life first."

- 23 -
The chart in fig 2 highlights the intricate interaction of various health
personnel to provide an integrated seamless service. They need to work in
tandem to provide prompt response, evacuation, and efficient transport of the
injured patient to the trauma centre (TC) ideally within an hour of injury. A TC
is a hospital equipped and staffed to provide care for patients suffering from
major traumatic injuries. In a trauma network, hospitals (trauma centres) are
designated into various levels i.e. I, II, III, IV & V based on the level of advanced
trauma care they can provide with Level I being the highest. Patients are
triaged at the scene of injury to the TC which is suited for their injuries.  

"For ATLS to be effective, it must exist under the framework of a managed and
efficient Trauma network/System."

Figure 2 WHO Emergency care system framework

- 24 -
 ATLS training
improves the
knowledge, clinical
skills as well as
organization and
priority approaches of
participants..".

EFFECTIVENESS OF ATLS

ATLS training improves the knowledge,

clinical skills as well as organization and
priority approaches of participants who
manage multiple trauma patients.[9]
However there is no evidence which
supports ATLS training improving
morbidity and mortality. The absence of
level 1 evidence does not imply lack of
effectiveness but the difficulty of
performing RCTs to study the impact of
ATLS training on trauma death. [10–
12].  

- 25 -
CHALLENGES OF ATLS AND
TRAUMA CARE IN NIGERIA

-Need for more training/revalidation courses- ATLS training was introduced to Nigeria in
2003. The Postgraduate Medical College decision that trainees should undergo ATLS
courses prior to their fellowship examination is quite commendable. Efforts should also be
made to make ATLS mandatory for doctors involved in trauma care at primary and
secondary health centres and conduct recertification courses

-Absent organized Trauma network – this will provide seamless transport and care of
patients.

- 26 -
-Inadequate Emergency Medical services – only a few states have created
ambulances services to transport injured patients. However, long transit times
and the need for a synchronized network remains a bane. Less than 3% of
trauma patients were transported via ambulance in Lagos compared to about
40% in the UK. [1,4]

-Training of other health personnel – ATLS is for doctors. There is a need for
trauma-specific training for other staff including nurses, paramedics involved in
trauma care. This will ensure the entire trauma teamwork in tandem.

- 27 -
- Prohibitive cost of trauma care- healthcare is mostly out of pocket and unaffordable to
most people. A sustainable financing mechanism to healthcare is essential to create a
robust system that can cater for anyone who sustains major trauma.

CONCLUSION  
ATLS is recognized as the basic, minimum preparation for trauma and a strategic tool in
providing adequate training to physicians involved in trauma care. There is a need to
upscale and develop robust and efficient regional trauma networks to ensure an integrated
effective approach to managing injured patients from the scene of the accident to their
discharge.  

- 28 -
Bibliography

1.  Hospital Accident & Emergency Activity 2018-19 [Internet].

NHS Digit. [cited 2021 Sep 26];Available from:
https://digital.nhs.uk/data-and-
information/publications/statistical/hospital-accident--
emergency-activity/2018-19

2.  Global Health Estimates [Internet]. [cited 2021 Sep

26];Available from: https://www.who.int/data/global-health-
estimates

3.  Injuries and violence [Internet]. [cited 2021 Sep 26];Available

from: https://www.who.int/news-room/fact-
sheets/detail/injuries-and-violence

4.  Ibrahim NA, Ajani AWO, Mustafa IA, Balogun RA, Oludara MA,
Idowu OE, et al. Road Traffic Injury in Lagos, Nigeria: Assessing
Prehospital Care. Prehospital Disaster Med 2017;32(4):424–
30.  

5.  Søreide K, Krüger AJ, Vårdal AL, Ellingsen CL, Søreide E,

Lossius HM. Epidemiology and contemporary patterns of trauma
deaths: changing place, similar pace, older face. World J Surg
2007;31(11):2092–103.  

6.  Søreide K. Three decades (1978–2008) of Advanced Trauma

Life Support (ATLSTM) practice revised and evidence revisited.
Scand J Trauma Resusc Emerg Med 2008;16(1):19.  

7.  10th Edition of the Advanced Trauma Life Support® (ATLS®)

Student Course Manual. Chicago (IL): American College of
Surgeons; 2018.  

8.  Trauma System Agenda for the Future: What Is A Trauma

System [Internet]. [cited 2021 Sep 26];Available from:
https://one.nhtsa.gov/people/injury/ems/emstraumasystem03/traumasystem.htm

9.  Mohammad A, Branicki F, Abu-Zidan FM. Educational and

clinical impact of Advanced Trauma Life Support (ATLS) courses:
a systematic review. World J Surg 2014;38(2):322–9.  

10.  Jayaraman S, Sethi D, Chinnock P, Wong R. Advanced trauma

life support training for hospital staff. Cochrane Database Syst
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- 29 -
 TH
SAG
COR
HE
GE'S
RNER
 My name is Dr Akinbodewa A. Akinwumi,
the originator of Dokita ori Afefe, an
DOKITA ORI AFEFE:
indigenous, live, 30-minute-long phone-in
radio programme designed to educate the
public on matters that bother on their health
using the local Yoruba dialect, the
predominant language in Ondo City, Ondo
State, south-west Nigeria where the show is
domiciled. “Dokita Ori Afefe” is Yoruba for
“Doctor on Air” which colloquially connotes
the sort of doctor whom the people can
consult over the radio; that really is the idea.
Let the people have access to the doctor
without the usual bottlenecks of having to
A COMMUNITY HEALTH TALK

pay a consultation fee, travel to the hospital,

wait long hours in the lobby and the likes. At
the least, the doctor should be a half-a-dial
SHOW WITH IMPACT

tone away.  

We are all most likely to agree that even

nowadays when communication has been
made easy by nearly seamless access to
telephony and internet facilities, the doctor
remains mysteriously (and surprisingly) far
drawn from the public in our clime!

- 32 -
- 33 -
 This, of course, is not entirely the fault of the medic but the result of a
complex interplay of people’s misconception of the doctor as a demigod
(believe me, regardless of what anyone is saying, that is still the case in
the majority of places in Nigeria) to whom one must go a-bowing, a
sense of over-estimation of one’s self-worth among doctors, continual
"Sometime in the last attrition of in the number of medical personnel, national and local
quarter of 2016, I began insecurity, unpredictable volatile aggression of clients and their relatives
setting up my own towards doctors as well as job dissatisfaction occasioned by poor and
practice after having often irregular remuneration from the government to mention a few.

pioneered the Kidney

Now, that brings us to how Dokita Ori Afefe came to be. Sometime in
Care Centre as part of
the last quarter of 2016, I began setting up my own practice after having
the conglomerate of pioneered the Kidney Care Centre as part of the conglomerate of mono-
mono-specialist hospitals specialist hospitals within the Medical Village in Ondo City (which has
within the Medical now metamorphosed into the University of Medical Sciences Teaching
Village in Ondo City Hospital) in Ondo State. In the first quarter of 2017, I was inspired to start
(which has now a programme on air in a dual bid to educate the public and draw their

metamorphosed into the attention to my young private practice. I had a simple plan; talk to the
people in the language they would best understand. Talk to them as if
University of Medical
they were in my consulting room. Give each person enough room to
Sciences Teaching express him/herself. Allow them to call in and ask life-impacting
Hospital) in Ondo questions and when responding, avoid using technical medical jargon.
State." My aim was to speak. Just speak; speak freely as if I were in the market
square. I was focused on responding to the questions as if they were
with me in my consulting room. I wanted to have a conversation with
each caller; the aim was to strike a lasting chord with the public while
handling each question.

- 34 -
The choice of language of delivery was deliberate and calculated.
This also informed the choice of the radio station. At first, we chose
a fully Yoruba speaking radio station that naturally had a wide "The programme, which
listening audience among the Yoruba and Ondo speaking folks. holds weekly on
While there were obviously educated people in Ondo City, we Saturday evening by
recognized that there were many more who might not fully grasp
5:00 pm usually begins
the description of many symptoms when presented even in their
simplest terms in English. For example, how do you explain words
with a 1-minute jingle..."
like “paraesthesia”, “asthma” and the rest to someone who does
not understand English? More so, we reckoned that most educated
people in Ondo City understood Yoruba (except those from other
geopolitical regions of Nigeria). Nevertheless, I must mention that
even though the programme is delivered in Yoruba, questions
presented in English or pidgin (a form of broken English) were also
entertained.   

The programme, which holds weekly on Saturday evening by 5:00

pm usually begins with a 1-minute jingle followed by a 15-minute
talk on a topical health issue and then the last 14 minutes are used
to field questions from the public. The content changed per
episode (except where otherwise determined), taking into
consideration the prevalent ailments in the community by the
common vernacular which we learned while in medical school,
“common things occur commonly”. So, we discuss matters that
affect people directly in Ondo City and Nigeria at large. We also
handle global diseases of importance such as COVID-19, malaria,
chronic kidney diseases etc. To further encourage people to have
access to their doctor, I announce my phone number on air and
encourage them to call, send SMS or WhatsApp messages after the
programme for a detailed explanation.

- 35 -
That way, many whose calls did not go through were
addressed over the phone at no cost. I take care not
to prescribe medications over the phone. I could offer
them counsel on exercise, lifestyle adjustment,
adherence to clinic appointments etc. but never on
drug prescription or dose adjustment. Some with not-
so-straightforward cases are recommended visiting
me for physical assessment and diagnostics.
Overall, the programme has given thousands of
listeners a reprieve. What some thoughts was deadly
diseases have often been dispelled when I explained
the pathophysiological processes to them in a
language they understood. It was as if a weight was
lifted off their chest. Many of the listeners have been
saved from the expenditure of precious resources on
phantom illnesses, visit quacks, extortion by
unscrupulous “healthcare workers’ and psychological
trauma.
- 36 -
Most have been appreciative of the programme. I am
encouraged by their positive response with some
calling in specifically to pray for me. Some even tell
me that they record the show just so they could listen
to it over and again! When sometimes we missed an
episode, some fans would take time to call or chat,
asking about my welfare.  
The programme is fully paid for by my company. We
had to limit time on-air to 30 minutes (which is not
sufficient) due to the charges by the radio station plus
some callers who eventually visited us for
consultation even expected free consultation in the
clinic.  
Despite all these, it has been a fulfilling venture and I
have since realized that once people understood the
processes going on in their bodies, they became less
apprehensive. It’s like they were being delivered
without medications. From my personal experience
with my listeners and those who have visited me, I
can comfortably conclude that some of what people
think is sickness can be cured if doctors spend more
time talking with their clients in simple, easy to digest
language and style.  
Akinwunmi Akinbodewa is a Consultant
Nephrologist and an Associate Professor in
Internal Medicine at the University of Medical
Sciences, Ondo State, Nigeria. He is a Fellow
of the International Society of Nephrology and
the Medical Director of the Kathreena Medical
and Kidney Centre, Ondo City.
Phone contact:-+2348135641399
kmkc.nig@gmail.com
 W h o ?
o c t o r
D

e x t i s s u e ...
s w e r s i n n
See a n
T re n
d
ding
The Abysmal
Energy Situation
Olumide Elebute is a Consultant Paediatric
Surgeon at the Lagos University Teaching
Hospital and a Senior Lecturer in the
College of Medicine of the University of
Lagos, Nigeria
THE perennial power outage that has
continued to plague this nation appears
to have no end in sight. e Federal
government has however tried to take
the bulls by the horns and correct the ill.
It was hoped by its privatization agenda,
the much-desired transformation in the
energy sector will nally become
exposed. Sadly, this change does not
appear to be in the nearest future.
is is against the backdrop of huge nances that had
been committed into the power sector by successive
governments. If there is any section of the society that
appears to be worse hit by the current state of things, it is
the ivory tower of learning - the teaching hospitals and
the Universities.
Experts have corroborated the
obvious i.e. the grave
importance of adequate
illumination for meaningful
reading and assimilation of
the study material.
- 40 -
Experts have corroborated the obvious
i.e. the grave importance of ade uate
illumination for meaningful reading and
assimilation of the study material. With
the dismal state of the power sector,
many have resorted to burning the
midnight oil or candle or seeking
alternatives sources of illumination to
stay 'a oat'.
e writer has had cause to however to interact with one
or two people in our public tertiary institutions who have
relayed harrowing tales of how they have tried to survive
in the heat of the current electricity challenges. eir
stories are however not much di erent from that of the
average person on the street, but one cannot but raise
serious concerns about the situation because of the
strategic role higher institutions play in the development
of any, particularly society.

Much as this is desired the possibility of

living in an environment devoid of
power outage continues to be mirage.
e social media is a washed with many
overly critical comments emanating
from people from virtually all levels of
society due to the perceived poor
handling of the Power problem in the
nation by the government; little has
however been heard from the higher
institutions of learning.

- 41 -
"The tertiary institutions serve the
triple role of dissemination of
information, engagement in
research and provision of
education."

The tertiary institutions serve the triple role of

dissemination of information, engagement in research and
provision of education. The deplorable energy situation in
the country is however threatening these functions. It is sad
to hear the unfortunate account of several on-campus
hostels or halls of residence thrown into darkness and many
students have been forced to resort to the use of kerosene
lanterns and candles to fulfil their obligation of reading.
The situation is even worse on off-campus residential areas,
as in many campuses, the authorities have to some
reasonable level tactically managed the situations by
setting up alternative power supplies, getting gigantic
generators to salvage the situation.

Research has been hampered or put on hold because of the

poor power state in the nation. Our institutions have had to
expend a considerable amount of hard-earned, internally
generated revenue on the purchase of diesel to power the
generators.

More notably, the situation in the country has become direr

following the spate of frequent fire outbreaks. The last
three years have witnessed a string of conflagration in
heavily density areas of Lagos State, the commercial nerve
centre of Lagos, which has resulted in the loss of lives and
properties. Many of these unfortunate cases were avoidable
and some have been suspected to have been caused by
using candles as a means of supplying illumination in the
dark while a couple has been attributed to the storage of
fuel in living quarters. The root cause bothers on nothing
other than the abysmal energy situation in the land.  

- 42 -

Interestingly, the Federal
government has been
awakened to the enormous
benefit that could be
accrued from renewable
energy, most importantly,
solar power, and in its
quest recently pioneered
some landmark projects to
explore and harness this
untapped natural resource.
Some recent projects
inaugurated by the
government have centred
on the provision of solar
power generation
plants/equipment in public
facilities within the country,
but its benefit is far from
universal, and many others
will take several years to be
complete.   appliances, cooking gas to the
The need to treat this issue at
hand with utmost urgency
cannot be overemphasized,
considering the incessant fire
outbreak that has assumed
untold proportion in many parts
of the country. In Lagos, the
main commercial hub of the
nation, no single part of the city
has been spared from
incalculable damage from fire
incidence. Fire has gutted
properties worth billions of
Naira and very sadly, several
human lives have been lost in
the wake of these disasters.
According to one of the most-
read national dailies, several
causes have been attributed for
these infernos, ranging from
failure to turn off electrical
storage of inflammable
products in unauthorized areas
to the use of candles for
illumination. The latter two
reasons are the fallout of the
dire situation in the power
supply in the land. Many homes
use generators and stock fuels
in unpleasant areas. And many
disasters have been tied to t1his
practice. Candles, which are a
major source of illumination in
many homes, have equally
contributed to their quota to
- 43 -
When the late President Yar’dua
promised in his election manifesto
to declare a state of emergency
in the energy sector, the news was
greeted with much enthusiasm
and hope but sadly, nothing much
has changed despite much widely
acclaimed rhetoric.  
The way out of this quagmire is
for the Federal government to
stray from the norm by backing
its words with action. Paying lip
service to something as crucial as
the provision of regular energy
does not promise well to many
people. One major step in the
right direction would be to
declare a state of emergency in
the power sector. The tremendous
economic benefits, in terms of
increased foreign investment and
increased industrialization, that
has since eluded this nation is
enough reason to put all
necessary machinery in place to
tackle this albatross. The entire
power sector should be
overhauled. Although this was
pledged some years ago, the
stack reality is that the changes
so promised are not overt enough
to be appreciated by the average
person. The Government owes it
as a responsibility to alleviate the
mass of the populace and save
many lives that would inevitably
be lost if this situation is allowed
calm.
 The Naija Docs Magazine is Nigeria's premier
digital magazine of doctors, for doctors, and by
doctors. The magazine is published quarterly. It is
to serve as a tribute to the ingenuity and sacrifice
of Nigerian doctors in discharging their duties and
in promoting the tenets of the medical and dental
profession in Nigeria and beyond.

The magazine also acts as a medium for the

dissemination of information on sundry health
issues and other related matters.

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