Features
SICKLE CELL DISEASE AND COVID-19
“What do I need to do (or know) as a person with Sickle cell disease?” The enquirer is health care student. In response I came across nice piece written by Nitin et al published in the Pan African Medical Journal (Vol 36, May -Aug 2020). The World Health Organization (WHO) has identified sickle cell disease (SCD) as a major concern of public health significance. It has been estimated that around 5% of the global population carry Sickle Cell Trait genes. About two-thirds of the sickle cell disease patients of the global burden reside in sub-Saharan Africa. COVID-19 Pandemic caused by Corona virus 2 (SARS COV2) is having a devastating effect on socioeconomic and health indicators in counties worldwide. The additional financial burden of supporting health care management system in tackling COVID-19 impact at the same time preventing mortality rate of COVID-19 deaths is a matter of great concern to all.
The pathogenesis of the sickle cell disease is attributed to the polymerization of the deoxygenated haemoglobin S(HbS). The polymerization leads to alteration in the normal biconcave shape of the red blood cells making them rigid and more prone for intravascular haemolysis. As a consequence of repeated hypoxia driven polymerization of HbS there is development of cyclic cascade leading to blood cell adhesion, vaso-occlusive crisis and ischaemic reperfusion injury. SCD patients may develop complications such as Acute Chest Syndrome, pulmonary embolism and stroke
About two thirds of new borns born with SCD worldwide are found in sub-Saharan Africa. The sickle cell gene HbSS is commonly identified in Africa in SCD while HbSC and HbS/ beta+thalassemia has been observed in West Africa. SCD had led to the death of about 50-90% of the affected as the disease remained undiagnosed during the childhood. The various studies done in Africa were found that SCD patients have higher mortality rates. In Ghana-the programme to enhance health care for sickle cell disease is a big relief.
The development of knowledge of understanding the pathology and management protocol of SCD has been helpful in management of the disease. The presence of malaria, undernutrition and other infectious diseases also contribute towards mortality rate in Africa. Of late it has been seen that because of the devoted and dedicated health care services provided by the health personnel the mortality rates are declining and this life-threatening disease of children is now progressing to chronic disease of the adult.
It has been observed that pulmonary functions are decreased in SCD. Lung functions are compromised in patients of sickle cell disease and Sickle Cell Trait (SCT). Repeated chest infections in SCD and SCT lead to alteration in geometry of lung parenchyma and physical properties of elastic and collagen fibres thus decreasing pulmonary function parameters such as Forced Vital Capacity, Forced Expiratory Volume and Forced Expiratory Volume 1%. Moreover the pulmonary vasculature is highly sensitive to hypoxia (absence of enough oxygen) driven micro-occlusion of pulmonary vasculature which along with cell adhesive changes may cause pulmonary hypertension and further compromise lung functions]. Persons with SCD have an increased susceptibility to infection. The impaired leucocyte function and humoral and cell-mediated immunity loss have been reported to account for the immunocompromised state in patients with sickle cell disease. The SCD patients being immune compromised are more prone for recurrent chest infections. The major cause of mortality in patients of SCD is acute chest syndrome, pneumonia and acute respiratory distress syndrome.
COVID-19 is the acronym for corona virus disease 19 and has been termed as SARS-COV-2 by International Committee of Taxonomy on Virus (ICTV). The common clinical manifestations observed in patients of sickle cell disease include cough, fever, shortness of breath, loss of smell perception and loss of taste sensation. Most of the patients of COVID-19 may have a mild course of disease while few may develop severe clinical manifestations. The clinical manifestation of severity in COVID-19 patient includes Acute Respiratory Distress Syndrome (ARDS), Pneumonia, Multiple Organ Failure, Septic Shock and Sepsis. The severity of pneumonia manifests with dyspnoea (difficulty or laboured breathing) and tachypnoea (abnormally rapid breathing)
COVID-19 infection can worsen the pulmonary manifestation in SCD patients especially in those having pulmonary complications such as Acute Chest Syndrome, Pulmonary Hypertension and ARDS. COVID-19 infections in SCD can also increase morbidity and mortality risk in these patients.
The main cause of concern in patients of SCD is that these patients are immunocompromised and may suffer from both acute and chronic complications which require hospitalization and close contact with the medical system. There is overlap in clinical manifestations of fever and lung disease in COVID-19 and SCD. The increased complications will amplify health care utilization-e diagnostic, management and logistic challenges. In view of the above facts it is necessary for health care workers to educate SCD patient registered in their areas regarding care and precautions to be taken during COVID-19 pandemic to prevent getting affected with COVID-19 infection. Although the education applies to everyone, there should be more emphasis for persons with SCD.
All persons with SCD need to be educated regarding COVID-19 signs, symptoms and mode of spread. They should be explained regarding the increased risk of contracting COVID-19 infections in them due to their immunocompromised state. All patients of SCD should be advised to strictly adhere to social distancing, isolation polices, use of face mask, and frequent hand washing with soap to prevent COVID-19 infections. They should keep adequate medication of SCD such as analgesic and antipyretic drugs, hydroxyurea. They can be advised regarding use of clinical thermometer at home as fever is common sign in SCD patient and thereby these persons can take appropriate precautions and medication after seeking telephonic consultation with their health care providers. They can use pharmacy home delivery services in case they require medication during emergency situations.
Until then regularly/daily consume polyphenol-rich cocoa. It is been useful for persons with SCD.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
Features
Tears of Ghanaman, home and abroad
The typical native of Sikaman is by nature a hospitable creature, a social animal with a big heart, a soul full of the milk of earthly goodness, and a spirit too loving for its own comfort.
Ghanaman hosts a foreign pal and he spends a fortune to make him very happy and comfortable-good food, clean booze, excellent accommodation and a woman for the night.
Sometimes the pal leaves without saying a “thank you but Ghanaman is not offended. He’d host another idiot even more splendidly. His nature is warm, his spirit benevolent. That is the typical Ghanaian and no wonder that many African-Americans say, “If you haven’t visited Ghana. Then you’ve not come to Africa.
You can even enter the country without a passport and a visa and you’ll be welcomed with a pot of palm wine.
If Ghanaman wants to go abroad, especially to an European country or the United States, it is often after an ordeal.
He has to doze in a queue at dawn at the embassy for days and if he is lucky to get through to being interviewed, he is confronted by someone who claims he or she has the power of discerning truth from lie.
In short Ghanaman must undergo a lie-detector test and has to answer questions that are either nonsensical or have no relevance to the trip at hand. When Joseph Kwame Korkorti wanted a visa to an European country, the attache studied Korkorti’s nose for a while and pronounced judgment.
“The way I see you, you won’t return to Ghana if I allow you to go. Korkorti nearly dislocated her jaw; Kwasiasem akwaakwa. In any case what had Korkorti’s nose got to do with the trip?
If Ghanaman, after several attempts, manages to get the visa and lands in the whiteman’s land, he is seen as another monkey uptown, a new arrival of a degenerate ape coming to invade civilized society. He is sneered at, mocked at and avoided like a plague. Some landlords abroad will not hire their rooms to blacks because they feel their presence in itself is bad business.
When a Sikaman publisher landed overseas and was riding in a public bus, an urchin who had the impudence and notoriety of a dead cockroach told his colleagues he was sure the black man had a tail which he was hiding in his pair of trousers. He didn’t end there. He said he was in fact going to pull out the tail for everyone to see.
True to his word he went and put his hand into the backside of the bewildered publisher, intent on grabbing his imaginary tail and pulling it out. It took a lot of patience on the part of the publisher to avert murder. He practically pinned the white miscreant on the floor by the neck and only let go when others intervene. Next time too…
The way we treat our foreign guests in comparison with the way they treat us is polar contrasting-two disparate extremes, one totally incomparable to the other. They hound us for immigration papers, deport us for overstaying and skinheads either target homes to perpetrate mayhem or attack black immigrants to gratify their racial madness
When these same people come here we accept them even more hospitably than our own kin. They enter without visas, overstay, impregnate our women and run away.
About half of foreigners in this country do not have valid resident permits and was not a bother until recently when fire was put under the buttocks of the Immigration Service
In fact, until recently I never knew Sikaman had an Immigration Service. The problem is that although their staff look resplendent in their green outfit, you never really see them anywhere. You’d think they are hidden from the public eye.
The first time I saw a group of them walking somewhere, I nearly mistook them for some sixth-form going to the library. Their ladies are pretty though.
So after all, Sikaman has an Immigration Service which I hear is now alert 24 hours a day tracking down illegal aliens and making sure they bound the exit via Kotoka International. A pat on their shoulder.
I am glad the Interior Ministry has also realised that the country has been too slack about who goes out or comes into Sikaman.
Now the Ministry has warned foreigners not to take the country’s commitment to its obligations under the various conditions as a sign of weakness or a source for the abuse of her hospitality.
“Ghana will not tolerate any such abuse,” Nii Okaija Adamafio, the Interior Minister said, baring his teeth and twitching his little moustache. He was inaugurating the Ghana Refugee and Immigration Service Boards.
He said some foreigners come in as tourists, investors, consultants, skilled workers or refugees. Others come as ‘charlatans, adventurers or plain criminals. “
Yes, there are many criminals among them. Our courts have tried a good number of them for fraud and misconduct.
It is time we welcome only those who would come and invest or tour and go back peacefully and not those whose criminal intentions are well-hidden but get exposed in due course of time.
This article was first published on Saturday March 14, 1998
Join our WhatsApp Channel now!
https://whatsapp.com/channel/0029VbBElzjInlqHhl1aTU27
Features
Decisions have consequences
In this world, it is always important to recognise that every action or decision taken, has consequences.
It can result in something good or bad, depending on the quality of the decision, that is, the factors that were taken into account in the decision making.
The problem with a bad decision is that, in some instances, there is no opportunity to correct the result even though you have regretted the decision, which resulted in the unpleasant outcome.
This is what a friend of mine refers to as having regretted an unregretable regret. After church last Sunday, I was watching a programme on TV and a young lady was sharing with the host, how a bad decision she took, had affected her life immensely and adversely.
She narrated how she met a Caucasian and she got married to him. The white man arranged for her to join him after the marriage and processes were initiated for her to join her husband in UK. It took a while for the requisite documentation to be procured and during this period, she took a decision that has haunted her till date.
According to her narration, she met a man, a Ghanaian, who she started dating, even though she was a married woman.
After a while her documents were ready and so she left to join her husband abroad without breaking off the unholy relationship with the man from Ghana.
After she got to UK, this man from Ghana, kept pressuring her to leave the white man and return to him in Ghana. The white man at some point became a bit suspicious and asked about who she has been talking on the phone with for long spells, and she lied to him that it was her cousin.
Then comes the shocker. After the man from Ghana had sweet talked her continuously for a while, she decided to leave her husband and return to Ghana after only three weeks abroad.
She said, she asked the guy to swear to her that he would take care of both her and her mother and the guy swore to take good care of her and her mother as well as rent a 3-bedroom flat for her. She then took the decision to leave her husband and return to Ghana.
She told her mum that she was returning to Ghana to marry the guy in Ghana. According to her, her mother vigorously disagreed with her decision and wept.
She further added that her mum told her brother and they told her that they were going to tell her husband about her intentions.
According to her, she threatened that if they called her husband to inform him, then she would commit suicide, an idea given to her by the boyfriend in Ghana.
Her mum and brother afraid of what she might do, agreed not to tell her husband. She then told her husband that she was returning to Ghana to attend her Grandmother’s funeral.
The husband could not understand why she wanted to go back to Ghana after only three weeks stay so she had to lie that in their tradition, grandchildren are required to be present when the grandmother dies and is to be buried.
She returned to Ghana; the flat turns into a chamber and hall accommodation, the promise to take care of her mother does not materialise and generally she ends up furnishing the accommodation herself. All the promises given her by her boyfriend, turned out to be just mere words.
A phone the husband gave her, she left behind in UK out of guilty conscience knowing she was never coming back to UK.
Through that phone and social media, the husband found out about his boyfriend and that was the end of her marriage.
Meanwhile, things have gone awry here in Ghana and she had regretted and at a point in her narration, was trying desperately to hold back tears. Decisions indeed have consequences.
NB: ‘CHANGE KOTOKA INTERNATIONAL AIRPORT TO KOFI BAAKO INTERNATIONAL AIRPORT’
Join our WhatsApp Channel now!
https://whatsapp.com/channel/0029VbBElzjInlqHhl1aTU27
