This was our fourth year, as with previous years we knew the turnout would be huge but this time around we made a few changes to ensure smooth implementation of the project, increase our efficiency and improve service delivery.

To start off this new and improved program we tried to deal with our biggest challenge CROWD CONTROL. The major problem was usually on the female day as they come as early as 3:00am to get numbers and start lining up. Women face multiple barriers in terms of access to healthcare, due to this the outreach tends to have an overflow of female patients on their day.  To deal with this we had two staff members rotating on alternate days to come as early as 5:00am to give out numbers before the program commences at 9:00am.  Once we’ve exhausted the daily 150 numbers excluding children and the elderly we ensure every one with a number is attended to on that day. Therefore, not only were we able to reduce the amount of loitering and rowdiness early throughout the day, more patients were able to see the doctors in a timely and organized manner.

Another major change was the availability of a morning doctor and 2 nurses five days a week, wait time was reduced significantly for the patients. The program was divided into morning and afternoon shifts for the medical personnel. More patients were screened in an orderly and timely manner while stress was reduced for all staff members.

Lastly, we had a fast track team that focused on patients with low vision. The team was trained to identify cataract and emergency cases so they go directly to the doctor. Operational efficiency increased drastically because of this measure. Even though our services are free of charge patient satisfaction is a priority, we try to assess the needs of our patients and find systemic solutions for problems that drives our need for continuous improvement.

A few weeks after the close of the screening program we were ready for surgery at Jinya Hospital. Due to the high number of patients screened surgery commenced on Thursday instead of Friday as we normally do. From the very old to the young teenagers 220 eyes were operated on. We returned again for the one-week post op review and the outcome of the surgeries was good.

Our emphasis this year has been to get the parents more involved. Children will be able to reach their full potential when their families take interest and support them. Getting involved in your child’s education has a significant effect and continues to do so into adolescence and adulthood. It gives them confidence, increased motivation and stability which in turn helps them achieve their full potential. Unfortunately, most of the parents do not know how to help their children with their education as they themselves have not been to school and are not literate. With guidance and support from the school they have become increasingly involved. Their support has helped school authorities by ensuring children do their homework on time.

HAMI currently has 60 students and by September we should have 80! As we grow it’s important we have an effective way of ensuring all new students and parents integrate successfully and happily to our school rules and regulations. We outline our expectations from the parents and regularly communicate about what the children are learning. This year we started having interactive sessions with parents at the beginning of the term. We use this forum to go through the scheme of work for the term and briefly discuss the topics, this enables the parents to have a better understanding of what their child will be learning. Also, the school encourages parents to talk staff members and ask about pupils progress through well planned parent teacher conferences and open day.

When parents are actively involved in school activities their children perform better in school. Vice versa when schools encourage families in ways that improve learning and support parent involvement at home and school, students make greater gains. Here at HAMI School we try to build partnerships with families so as to have healthy, happy students. Students that will achieve their dreams and grow up to build a strong communities.

Investing in the education is paramount to the development of our country. At HAMI we aim to be a school where young people enjoy learning, achieve highly and enter into the adult world with confidence.

Modern science is still in darkness as to the exact physiological mechanism(s) responsible for ageing. So many theories prominent among which include programmed cell death, free radical theory, have been propounded. Most body organ systems have a functional reserve that reduces with age. The reduction in this reserve capacity may precipitate crises in cases of mild stress induced by illness or unaccustomed exercise. It also should be recognized that the effects of ageing are usually insufficient to interfere with the function of an organ under baseline conditions.

Physiological changes associated with ageing affect all the body system from the digestive system to the special senses (eyes, nose, tongue, ears).
Elderly people suffer from digestive disorders because of many different factors. Although the gastrointestinal (GI) tract does not usually change very greatly due to the ageing process, there are influences other than ageing that take their toll. Malnutrition, a reduction in exercise, or abnormality in any other part of the body may lead to digestive symptoms ranging from abdominal pains, constipation to dysphagia (difficulty with swallowing). The elderly people are more prone to developing cancer in the digestive system compared to the general population. Chromosomal instability is often the cause, but other factors include a diet low in fiber and high in carcinogens (cancer inducing agents) or a chronic inflammation of the lining of the stomach. Diverticular disease is also common among the elderly. Again, a low fiber diet is one of the leading cause of this painful condition (diverticular disease) in which pouches or sacs form in some part of the digestive tract. A low fiber diet often causes constipation and this in turn increases pressures in the colon (large intestine) promoting the formation of these sacs. Ulcerations near the diverticula may then cause colonic hemorrhage, complicating matters.
The incidence of gastric ulcers rises with age. In many cases, these ulcers are found in people who must take aspirin and other kinds of medications, as the elderly often do. Diseases of the mouth and esophagus are also found more frequently among the elderly than amongst younger folks. Many of these age- related diseases can be prevented with regular tooth brushing, gum massage and flossing. Gallbladder pathology develop in the elderly because as individuals age, their bile contains fewer acids which break down the substances that cause gallstones.

Changes within the connective tissue results in the loss of elasticity of the skin with associated wrinkling. Connective tissue damage is accentuated by excessive exposure to sunlight, and is particularly striking in fair skinned individuals. The elderly also have relative difficulty controlling their body temperature in warm weather due to decline in sweat glands. This results in high incidence of cardiovascular disease during heat waves. There is diffuse loss of hair, and the hair also becomes finer.
The risk of developing high blood pressure increases as we grow old due to hardening of blood vessels. The decline in function of the kidneys results in delayed elimination of many drugs thus, the need for adjustment of dosages by Physicians.

A physical change in the ageing lens in the human eye leads to reduce deformability of the latter thereby impairing good near vision without near spectacles correction (presbyopia). Cataract (opacity of the lens) and glaucoma are major causes of blindness in the aged. Changes in the cochlea (hearing apparatus) result in a high tone hearing loss (presbycousis). A decline in taste and sense of smell affect appreciation of food.

In the central nervous system, there is decrease in the number of neurons in the cerebral cortex, but this has minor effect on mental function. The elderly may develop acute confusion, which requires full medical evaluation to rule out any background disease. Senile Dementia, a clinical syndrome characterized by a loss of previously acquired intellectual function in the absence of impairment of consciousness, is relatively common amongst the aged. Acute confusion, urinary incontinentce, immobility and falls are quadruple causes of incapacity in the elderly patients referred to as ‘giant of geriatric medicine’.

Other physiological changes include delayed wound healing and depressed immunity. It has been established that ageing, poor nutrition, and chronic ill health in many old people interact with each other to interfere with the immune function. This immunological impairment in turn, interacts with several other factors to modify and mask the symptoms and signs of diseases in many elderly patients. This implies that an elder person may present with symptoms slightly different from the usual pattern of presentation in young persons.

The physiological changes associated with ageing are too many, some of which are too academic and technical for this piece. Good knowledge of what the aged under go will help us to support them and prepare our minds towards these physiological changes as we slowly but surely transit to that age group. A wide variation exists on the onset and progress of the changes associated with old age. This brings us to the management of these normal but distressing physiological changes in the aged.
Alcohol consumption and smoking are two enemies that work synergistically to accelerate some of the adverse changes associated with ageing. The effect of chronic alcoholism in older people differs greatly from what is obtained in the young. Elderly persons who indulge in excessive alcohol consumption to overcome the stress induced by old age are termed “reactors”. It is more frequent in women than men and about one third of drinking excessive alcoholism among the elderly falls into this category. They do not obtain the “high” that young drinkers seek, but may have memory lapses, headaches and confusion as a reward for their alcohol intake. Their response to alcohol is also much stronger because of the physiological changes earlier highlighted. There is therefore the need to shun these social vices. Regular and tolerable exercise even in the form of walking could go a long way in promoting good health and delay in onset of symptoms. The environment of the aged should be free of all injurious appliances since they are prone to falling. There is also a need for dietary adjustment to meet their demands. Vegetables and high fibre diets reduce constipation to which they are susceptible to. Regular medical check ups is of paramount importance as it allows for full clinical evaluation and to rule out any concomitant disease. Vision can be improved by use of medicated glasses for near work and distance if need be. It is advisable that reading is done under good illumination. Hearing aid may be of benefit as deem necessary by an ENT (ear, nose and throat) Doctor.

Old age is a transition that we all hope to pass through. Thus the need to support those already there. As earlier mentioned our highly cherished communal way of living is supportive and should be jealously guarded. The government and other stakeholders have a duty to support this dependent age group by subsidizing their medicals and other social needs. Old men are as vulnerable as children in the society and therefore deserve equal attention. AGE GRACEFULLY.
Written by: Dr. Murtala Umar
Email: murtalau@gmail.com

Cataract is a condition in which the lens in the human eye becomes cloudy, usually as part of normal aging process, thereby compromising the quality of image we see depending on the location and size of the opacity. It is the commonest cause of blindness worldwide. Fortunately, the World Bank has rated cataract surgery as one the most cost effective medical interventions.

Here at AMA Foundation we have sponsored over 800 free cataract surgeries all over the country and hope to maintain the tempo. Despite all these individual and collective efforts, there are hundreds of thousands of Nigerians needlessly blind from cataract. Mal distribution of cataract surgical services, cost of surgery, socio-cultural issues are some of the barriers identified and need to be overcome to reduce the burden of blindness from cataract.

Glaucoma is a disease that silently and irreversibly, steals our sight unknowingly. It is the commonest cause of irreversible blindness globally. A National blindness survey conducted in Nigeria showed that up to 16% of persons 40 years of age and older are glaucomatous. Research is still ongoing to decipher the mystery behind these groups of diseases whose end result is death of the optic nerve that connects our eye to the brain. Persons with family history of glaucoma, high eye pressure, black race, 40 years and older, are at risk of developing the disease. Most persons with glaucoma are symptom free because it affects the peripheral vision at the early stage, the central vision being affected at advanced stage. Every adult that has attained the age of 40 should visit an eye Doctor for glaucoma screening, as waiting for symptoms of poor vision is synonymous to securing a place in the blind world. As medical teams go out to conduct cataract surgery outreaches, they should screen their clients for glaucoma too and refer as appropriate.

Trachoma is a disease associated with poor personal and environmental hygiene especially in dry, dusty areas. It is caused by bacterium that mainly infects children one to nine years with dirty faces, nasal and eye secretions. Blinding stage occur after 15 years of age as a result of in turning of eye lashes leading to opacity of the cornea (the outermost black part of the eye). Vision 2020 initiatives have reduced significantly the prevalence of trachoma though still endemic in some selected communities of Northern Nigeria. Provisions of adequate water, improvement of personal and environmental hygiene, are key to preventing the onset of trachoma.
Onchocerciasis is on the decline thanks to control programme like ‘African Programme for Onchocerciasis Control (APOC), lunched in 1995. Is an infestation that commonly affects people living in riverine areas. Of the 125 million people at risk worldwide, 96% being Africans, 10 to 20million are infected, about a million blind. The disease mainly affects the skin (swellings, rashes) and the eye, where blinding complication can result.

Childhood blindness is of concern to all because of the number of ‘blind years’ affected children will have to live relative to adult. Every minute 500 children become blind worldwide. One can imagine the negative physical, social and psychological impact of blindness on affected children, parents and the society in general. Most of the causes such as measles, eye injuries and vitamin A deficiency, are preventable. Health promotion by way of adequate nutrition/breast feeding and immunization are some of the control measures. Studies have shown that countries with high under 5 mortality rate are more likely to have high incidence of childhood blindness.

Diabetes mellitus as most of us are familiar is a chronic, multi systemic disease that is associated with complications due to sustained high blood sugar. Recall that the retina is that part of the eye on which the image of objects we view are formed and thereafter transmitted to the brain for interpretation. The most common complication of diabetes is retinopathy, referring to barrage of conditions affecting the retina as a result of uncontrolled diabetes. Diabetic retinopathy has taken the lead as the most common cause of blindness in the industrialize countries and exponentially rising in the developing nations. The emphasis should be on adequate blood sugar control. Diabetics should visit Eye specialist for clinical evaluation as soon as the diagnosis is established and thereafter as indicated.
All hands should be on deck to reduce the barest minimum, blindness from avoidable causes to break the vicious cycle of poverty, dependency and socio-economic handicap among several other ills. This column prays that come 8th October 2015 when we shall be marking the next WSD, If God spares our life, the present alarming indices of blindness would be in the decline.

BODY WASH
Unpleasant body odour results from a combination of many factors such as chemicals in sweat, wastes excreted through the skin, action of bacteria that lives on the skin and unwashed clothes e.g. dirty underwear. It is recommended that every person should wash his/her body at least once in a day and apply deodorant to reduce body odour. Scrubbing your body slough off dead, dry skin, by so doing acne and skin eruptions are removed, thereby ensuring healthy skin. Do not share your towels with anyone and wash them regularly.
We can easily transfer germs from unwashed hands to our mouth or food especially when we have common cold, diarrhea or close contact with an infected person. It is therefore imperative that we regularly wash our hands with soap and clean water. The World Health Organization (W.H.O) recommends the use of ash where soap is unavailable. One can then use clean towel or tissue paper to dry his or her hands. Hand sanitizers, if affordable, should be close by to supplement soap and water. Hand washing is highly recommended in the circumstances below:

• Before preparing or eating food
• After handling garbage
• After using the toilet
• After handling human corpse
• After handling domestic or wild animals (especially for hunters, butchers
• After coughing or sneezing
• Close contact with a person that suffers from excessive coughing and sneezing

HAIR
Keeping your hair clean and combed improves your appearance and prevents dandruff and lice from growing. Wash your hair regularly and apply shampoos and conditioners that helps kill germs, reduce greasiness and prevent itching sensation.

TEETH AND MOUTH
It is recommended that we brush our teeth with fluoride based, soft tooth brush at least twice a day to maintain good oral hygiene and appeal to people when we smile. Flossing, a procedure that removes food particles trap in between our teeth is complementary to brushing and healthier than tooth picking. Excessive intake of stuffs like tea, coffee and red wine can stain ones teeth. There are quite a number of commercially available mouthwashes that reduce oral bacterial load. Halitosis (bad breath) is not only due to oral infection but may result from dehydration and empty stomach. Ingestion of garlic and onions also gives you bad breath. By maintaining good eating habit and adequate water intake, halitosis can be reduced. Flavoured chewing gums after meals help improve oral hygiene and good breath. However, despite all these measures bad breath may persists, thus the need to visit your dentist regularly.

FEET AND GENITALS
These areas are prone to fungal diseases due to warmness and inadequate ventilation. Smelly feet do occur due to excessive sweat glands in this body part and constant use of socks that prevent evaporation and promote bacterial growth. Athlete foot is a well-known condition that may be associated with pain, sore and flaky skin. You can contact your Doctor on the right topical and oral medication to use.
Health experts recommend the following measures;

• Wash regularly and dry thoroughly with a soft towel and an anti-bacterial foot powder or baby talc.
• Allow feet to air when feasible and wear open shoes as much as possible.
• Change socks more than once a day if needed and make sure they are cotton or other breathable fabric.

The genital area is also prone to infection due to poor ventilation. Interval exposure and regular washing with mild soap and water will help maintain good hygiene. Note that that soap can irritate the genital areas calling for caution. We should avoid the use of tight synthetic underwear and as much as possible use materials made of cotton. Women should change tampons and sanitary pads at least four to five times during menstruation. On the other hand, uncircumcised men need to pull back the penile foreskin and clean with water. This is because the foreskin can serve as a point of collection of secretions, ‘sme gma’ which will promote infection.

WOUND CARE
Accidental or incidental wounds sustained should be kept clean and properly dressed to enhance healing and prevent spread of infection to unaffected body parts or close contacts.

FINGER NAILS
Fingernails should be cut short as they grow to prevent them from keeping germs and reduce disease transmission. Keeping long nails can be injurious to ourselves and persons close to us.

Finally, we must remember that maintaining good personal hygiene not only promoteS our own health and protectS other people we interact with, it affects how we are perceived in the community. A clean, tidy person will socially and psychologically interact freely with his or her peers, gain confidence and more likely to attain success in life. Most importantly, we will minimize the spread of Ebola Virus.

It was a great adventure as they were able to explore fully all they had learnt in the classroom. Part of our educational objective is to broaden their horizons, build their self-confidence and provide our students with a sense of a wider world.

School trips are not only beneficial to the students but to their teachers as well. It gives the teachers a unique insight to the way each child learns and views the world. Coming from underprivileged homes these trips are a rare opportunity for our kids and will introduce them to new opportunities and passions. With education and hard work the HAMI children can achieve their dreams.

“He who opens a school door, closes a prison” – Victor Hugo

Medically, viruses are acellular organisms whose genomes consist of nucleic acid, and which obligately replicate inside host cells using host metabolic machinery to form a virion that in turn proffer protection to the genome and enable transfer to other cells. . As simplified by Wikipedia ‘A virus is a small infectious agent that replicates only inside the living cells of other organisms.” A virus has the ability to infect not only humans, but animals, plants and even other known infectious organisms such as bacteria.

The Ebola Virus derived its name from the Ebola River in the present Democratic Republic of Congo, This followed the first ever recorded simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo. Ebola Virus Disease (EVD) has traditionally remained contained in Central and West African countries notably Congo. Gabon,Cote d’Ivoire, etc. Ebolavirus comprises 5 distinct species:Bundibugyo ebolavirus (BDBV),Zaire ebolavirus (EBOV),Reston ebolavirus (RESTV),Sudan ebolavirus (SUDV) and Taï Forest ebolavirus (TAFV). All the species have been associated with EVD outbreak with the exception of RESTV and Tai Forest.

The World Health Organization (W.H.O) has so reported 358 cases of EVD across central, East and West African countries between the periods of 2003 to 2012 with a case fatality of 94%. The world is recording the worst outbreak that has claimed more than 1350 lives in some West African countries notably Liberia, Sierra leone and Guinea Conakry. The disease which was imported into Nigeria by the late Librarian Diplomat, Patrick Sowyer has so far claimed five Nigerian lives out of the fourteen officially confirmed cases. While we were celebrating the fact that the disease has been contained in Lagos with only one index case remaining, a Doctor has just lost his life in the City of Port Harcourt, south south Nigeria.

In Africa, fruit bats, particularly species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, are said to be the natural host of Ebola virus. Chimpanzee, monkeys gorillas and forest antelope are known reservoirs of the virus. Human contract the virus from their interaction with these animals body fluid or tissues and humam-human transmission results. Ebola spreads in the community through human-to-human transmission, with infection resulting from direct contact (through broken skin or mucous membranes) with the blood, secretions, organs or other bodily fluids of infected people, and indirect contact with environments contaminated with such fluids. People who come in direct contact with the dead body of an infected person can spread the disease. Seven weeks after recovery, the virus can still be transmitted sexually through the semen of infected men. Health-care workers who come in direct contact with suspected or confirmed EVD are vulnerable to contracting EVD.

The good news is that Ebola is not as contagious as more common viruses like colds, influenza, or measles.

The virus has an incubation period (symptom free period) of 2-21 days depending on the immune status of the victim. The symptoms the affected persons come up with are related to the ability of the virus to invade and damage the immune system and body organs. This eventually leads to drop in the concentration of platelets, which are blood-clotting cells. This leads to severe, uncontrollable bleeding. This informed the hither to name of the disease; Ebola haemorrhagic Fever.

The initial symptoms may be mistaken for common cold, malaria or typhoid fever leading to misdiagnosis. Established symptoms may include:

• High fever
• Headache
• Joint and muscle aches
• Sore throat
• Weakness
• Stomach pain
• Lack of appetite
• Impaired kidney and liver function

As the disease gets worse, it causes bleeding inside the body, as well as from the eyes, ears, and nose.  Some people will vomit or cough up blood, have bloody diarrhea, and get a rash.

EVD definitive diagnosis is made in specialized laboratories from blood samples of infected persons. Samples from patients are an extreme bio-hazard risk; testing should be conducted under maximum biological containment conditions. The scientific community is yet to discover the definitive cure or vaccine the treatment for EVD, even though several animal trials are still been undertaken. Patients require supportive treatment to take care of their nutritional, oxygen, fluid and electrolyte requirements in isolated treatment camps like is happening in Lagos.

To effectively manage EVD,control measures must be put in place eliminate the reservoir and interrupt the chain of transmission in humans and domestic animals.

Control measures recommended by W.H.O and infectious disease experts include:

1. Close physical contact with the infected should be avoided or reduced as much as possible. Where this is not possible, gloves and other protective clothing should be worn to limit direct skin-to-skin contact. These protective items should then be safely disposed of.

2. Communities affected by Ebola should inform the population about the nature of the disease and about outbreak containment measures, including burial of the dead. People who have died from Ebola should be promptly and safely buried.

3. Regular hand washing and hand rubbing with soap and water.

• If your hands are not visibly soiled, hand rubbing be used. This is a 20-30 second procedure that involves using soap and rotational rubbing actions, without water, to get your hands clean.
•  If your hands are visibly soiled, more thorough hand washing should be used. This is a 40-60 second procedure that involves using soap and rotational rubbing actions, with water, to get your hands clean. Caution must be applied at every stage, even turning the faucet off after the washing is complete.

4.  If you do start showing the symptoms of Ebola, contact a medical centre immediately and follow their advice closely. Keep away from others so they don’t contract the disease and be careful with your vomit, diarrhoea and other bodily fluids.

5. Routine cleaning and disinfection of pig or monkey farms (with sodium hypochlorite or other detergents) should be effective in inactivating the virus.

If an outbreak is suspected, the premises should be quarantined immediately. Culling of infected animals, with close supervision of burial or incineration of carcasses, may be necessary to reduce the risk of animal-to-human transmission. Restricting or banning the movement of animals from infected farms to other areas can reduce the spread of the disease.

6. Reducing the risk of wildlife-to-human transmission from contact with infected fruit bats or monkeys/apes and the consumption of their raw meat. Animals should be handled with gloves and other appropriate protective clothing. Animal products (blood and meat) should be thoroughly cooked before consumption.

Key Points

1. Be vigilant. Stay aware of the people around you and be on the lookout for Ebola symptoms.
2. Be careful. Limit your contact with others as much as possible. Do not touch bodily fluids.
3. Be thorough. Engage in the regular, thorough hand hygiene procedures suggested by the WHO

HEALTH INTERACTIVE WITH DR MURTALA UMAR GUSAU

GSM NO: 08093343357 (Text message only)

Email: skynewshealth@gmail.com

Cataract is the leading cause of avoidable blindness and for most of our patients this might be the only chance they get due to the fact they cannot afford surgery otherwise. The economic and emotional burden on relatives and the patients themselves is reduced greatly by this 20 minutes procedure.  The similes the morning after remain one of the highest points of our program. Therefore, at the end of the program we are ecstatic to say 198 eyes were operated on and children with congenital cataract were referred to National Eye Centre for further treatment sponsored by the foundation.

Prior to the commencement of the program announcements were made early so as to enable us achieve our target of reaching out to as many patients as we can. Access to quality and adequate healthcare still remains a major challenge for the vast majority of Nigerians, due to this we were determined to see as many as possible.

We started on the first day of Ramadan, six times a week for four weeks. As the days passed the number of persons we saw grew astronomically, patients came from all over the State, some from places as far as Niger and Katsina State.

Meeting Osama Muhammad was an experience that put into perspective the dearth of the health sector and the immense poverty faced by most Nigerians. He was suffering from orbital cellulitis; an inflammation of the bony structure that houses the eye, it’s a common disease seen in children and can result to meningitis. His mother brought him from Mararaban Jos a farming community near Kaduna seeking for help and was directed to us. His situation was so bad he was admitted to the hospital for several weeks. When we first met him, he could barely speak and was in a lot of pain. At the end of the day, we were finally able to see and get to know the real Osama who happens to be a jovial kid with an answer for everything.

Though our primary focus was on eye care, Osama was not the only patient given extra care. We also met Abubakar Tsoho fondly referred to as Baba Tsoho, he walked into the centre hanging on to the cord of a catheter tucked in between his threadbare trousers and skeletal frame. He was suffering from a severe case of urethral constriction that took him to various hospitals until he found us. Today we can proudly say Baba Tsoho is walking around catheter free.

After a month of eating and breathing eye care, over 3500 patients, 763 reading glasses we all heaved a sigh of relief, from the management team to the medical team all the way to the cleaners and guards. It was time to say goodbye even though we were relieved there was a sense of nostalgia.

Each borehole will have a storage capacity of 20,000 liters of water. They will be situated at the central mosque, entrance to the LG School, the market area, Galadima area. The last will be located at the Dutsen Lella. For the year 2014 we have completed 2 solar powered boreholes in Kano State.
The water crisis claims more lives through disease than any war through guns (UNDP 2006). Therefore, it’s importance to our health cannot be overemphasised. Water is life.