I had just come out of the parking lot, heading to work that morning when I got that terrifying first call from my sister. She told me that my cousin was with her in Lagos, and she was “feeling down.” My cousin was at the time a 24-year-old woman, born and raised in New Jersey, who had travelled “home” for perhaps the second time in her life to attend a Christian conference in Ibadan, Nigeria.
While at Ibadan, she had three days of diarrhoea, nausea, vomiting after eating eba, and egusi at the conference. She took some antibiotics, which she bought from the local pharmacy without significant improvement. By the time she got to Lagos, she was not eating as much anymore; she looked and felt exhausted. She had been trying to keep up with fluid intake by drinking water and Lucozade but was now not urinating as much. She thought that maybe her “stool was mixing with pee,” making her urine look like tea.
It was a perfect storm, really. It had rained on the Island the day before, and the roads had become swimming pools thanks to the weak drainage system in a lot of parts of the Lagos.
So, my cousin was taken to the only open clinic they could access immediately in the Lekki area of Lagos. At that facility, she received a bag of IV fluid because they tried to get a urine test and she could not pee. They also drew a blood count (PCV) and were asked to go home as the doctor had left for the day. As the roads improved, they went to see a different doctor at another facility. The next call I got was astounding to me. The doctor had just examined my cousin and decided that based on her physical assessment and vital signs (blood pressure, heart rate, and temperature), we did not have as much cause for concern. She said she was going to give her multivitamins, and “she should be fine.”
I urged that they get a basic metabolic panel including kidney function. The doctor in this second facility also did not see a need for this before this request. My cousin had to go to a third facility, a bigger facility in Victoria Island, where the basic metabolic panel was finally done, and she was found to be in kidney failure. She was going to need dialysis – at 24 years old! We had to go to yet another facility to get her started on dialysis.
She had three physician encounters at different facilities before a diagnosis that could easily have been gotten from a simple blood test! Four facilities before she could receive appropriate treatment! After hearing multiple stories of encounters of different people at health facilities and being personally involved in some of these, I realize that my cousin’s experience is the norm, and not the exception.
So, what happened here?
The condition my cousin experienced is known as acute renal failure. In my cousin’s case, we eventually found out that the renal failure was due to a combination of severe infection which got into her bloodstream as well as significant dehydration.
The kidneys serve multiple functions; one of which is to filter blood and remove waste, which dissolves in the urine. The kidneys produce a substance that stimulates the production of red blood cells that carry oxygen and help maintain the right balance of fluids and chemicals that our organs need to function. If the kidneys are not working correctly, these waste materials can build up in the body causing fluid overload and eventually death. Some symptoms that the kidneys may not be working well include tiredness, aches/pain, swelling around your eyes, and sometimes in the legs, change in urination, just to mention a few. Please note that sometimes, people may not feel any symptoms from low functioning kidneys if complete failure has not occurred.
Some of the most common causes of sudden kidney failure include dehydration, infections, injury to kidneys due to certain medications, any process that blocks the flow of urine from the kidney such as cancer, enlarged prostate, etc.
In many cases, acute renal failure can be reversed if the cause is found and addressed. The most common causes of long-term (chronic) kidney diseases are high blood pressure and diabetes. A small percentage of people will need dialysis either permanently or temporarily while the kidney recovers and the underlying reasons for the damage are being addressed.
Not everyone that has the symptoms listed above has kidney failure. But there are some rules of thumb that you can have in mind, so you know when to request testing.
1. If you have diabetes or hypertension, please request routine testing of your blood and urine at least once or twice a year.
2. If you newly started a blood pressure medication, you may need your kidneys checked within a few weeks
3. If you develop new symptoms of extreme fatigue, aches, cramps after experiencing fluid loss, e.g., from constant heat exposure, vomiting, bleeding, infection.
4. If your urine amount has decreased significantly, please ask for a blood and urine test for your kidneys
5. Most importantly, please discuss any new symptoms with your doctor/nurse and ask if you need to get your kidneys checked.
Information is power; information is health; information is a life-saved! I shudder at what could have happened had we not known what to ask for. Friends, I feel humbled and privileged to have this platform to provide some health information. My hope is that the information I share on this forum is a source of empowerment.
As a physician, I encounter these stories regularly, and I have come to see that there is value in shared learning through our encounters with the Nigerian health care system. In this column, I will share stories I have encountered and some lessons learned. But in addition to sharing this information, I would like to hear from you.
Please share your stories and together we can find paths to getting our healthcare system to give us a better chance at living.
About Columnist Tomi Uwazota, MD
She is a Family Physician currently working as a Hospitalist (Inpatient care provider) at York Hospital. She also works in a Federally Qualified Primary Care Center and volunteers monthly in a free clinic in York Pennsylvania. She is completing a Masters in Public Health with a focus on global health and on Maternal Child Health at Johns Hopkins Bloomberg School of Public Health. She’s a Christian, a wife, and a mother of an adorable toddler.