How SUNDAY PUNCH rescued girl, 6, from kidney crisis

Miss Williams (not real name) looked like your typical six-year-old girl as she teased her four-year-old younger brother. The dark-skinned, petite Williams was a bundle of energy as she skipped gleefully.

But Williams has not always been this lively. About six weeks ago, she was bedridden and was being prepared for a surgery to save her from a life threatening ailment. Little Williams had a faulty kidney. However, before August 2014, the Williams were not aware that one of their daughter’s kidney wasn’t functioning. Several visits to public and private hospitals shed little light on William’s ailment.

According to her parents, the little girl had been contending with ill health which had defied medical explanation since a few days to her fourth birthday.

Her father, said: “Very early one morning, some few days to my daughter’sfourth birthday, my wife woke me up to talk about a dream. In it she saw that something happened to our daughter’s face. We were still in bed, when our girl walked in. Surprisingly, she started talking funny. My wife and I felt she was up to some pranks. But when she asked to be given water and she was drinking, the water was falling off from the left side of her face. The same with food. By this time, we had noticed that one side of her face was lopsided. The left side looked funny and distorted. That kicked off our travails which spanned more than two years.”

The mother, a graduate of English Language and a teacher in a government secondary school, said, “We quickly took her to a hospital where they conducted some tests. At the end of the day, we were given a damning result. Our daughter had facial palsy which means facial paralysis, the cause of which they could neither trace nor say.”

All the doctors could do then was recommend therapy. The parents took her to a private hospital, at Iyana Ipaja, another suburb of Lagos. The facility was owned and run by a consultant at a general hospital. Each therapy cost N2,000 and they had three in a week.

When her condition did not improve as the parents wished, she was moved to a military hospital also in Lagos courtesy of her grandfather who is a retired military man.

There the treatment continued and she improved. The family had some respite. But alas, it was to be for only a while.

“Few days to her fifth birthday, she suffered another facial paralysis. But now it was on the right,” said her father.

“With this development, family members started insinuating it could be a spiritual attack. Then began a spiritual battle which we combined with medical treatment. We again took her to the military hospital. In fact, we had to change our church to another which is renowned for its deliverance ministry. Again, therapy started. She was taken for therapy thrice a week. After months of therapy, her face returned to normal. But after some time, she had a relapse. Again, we took her to the hospital. It was this time that the head of department of the therapy unit refused to go ahead with another round of therapy. Her take was that something must have triggered the second facial paralysis and that it would not be kind on the girl if only the symptoms were being treated without establishing the cause. She said something must have caused the relapse and that it should be investigated. She directed us to a teaching hospital in Lagos.”

If the parents had thought they would find succour at the teaching hospital, they soon discovered their error of judgement.

The mother disclosed to our correspondent that at their first call at the hospital, her daughter, without being examined, was asked to come back in three months’ time. Reason: Hers was not an emergency.

Mrs. Williams said, “When we got to Lagos State University Teaching Hospital, they did not treat her. What they did was to give us an appointment for three months. She had the second facial paralysis on August 17, 2013 and her birthday was supposed to be September 19, 2013. After all the formalities, the hospital refused to attend to us insisting that her case was not an emergency and as such, she had to come back. But they referred us to a urologist. I begged, cried and begged but they did not yield. Hence, I had to take her home. But I returned the second day and took her to another doctor who referred her to the Ear Nose and Throat department. Then, my daughter was always complaining of noise in her ears. Thus I took her to the ENT who then referred her to a physiotherapist. Again the physiotherapist refused to treat her insisting that she must be seen first by a urologist who would determine whether it was an infection or not. I had to return to the military hospital where I wept and begged the HOD to please give her therapy. I couldn’t bear seeing her face distorted. It was so contorted. Her mouth had slid to a side and she talked very awkwardly. When she ate or drank, the food or drink would be dropping from the affected side of the mouth. She could not close her mouth. She could not also close the eye on the affected side. She looked so pathetic. Out of compassion, the doctor agreed to treat her. And within three months, her face returned to normal and it was as if nothing happened to her.”

The mother took her for the appointment at LASUTH when the time came. Again, she was given another three months. After the lapse of this, the mother took her again to the hospital. Again, she was asked to bring her in another three months. This appeared to be the last straw; the mother would not take it, she gave vent to a loud protest which attracted some senior doctors.

She was promised that her daughter would be attended to but with a caveat: only if her name was on the list of those given appointment to see the consultant that day.

Mrs. Williams added, “As we were scanning the list together I saw her name and called the doctor’s attention to it. Thus, very reluctantly, they agreed to see her.”

The little hope she felt was dimmed when she discovered that the daughter would be attended to by a trainee doctor.

Mrs. Williams said, “A student doctor was first asked to attend to my daughter. He asked her and me all the routine questions about our family, her feelings, sensations and all that. He then took her pulse. After this he took us to the consultant urologist.

“The consultant asked the mercuric metre to be brought to check her pulse himself. Later, he called on a female doctor to do it. She did and looked shocked. They again called on another doctor. All of them looked shocked. The reading was 140/90. They looked alarmed. They said they had to place her on admission because her blood pressure was very high and if they should release her, she might have a stroke or bleed into her brain. She was placed on admission and we were asked to do several tests which we did. Still they could not find anything. After that, they asked us to do Magnetic Resonance Imaging.”

This the family refused on the grounds of the danger such a sensitive test might have on their daughter.

All this while, the little girl was placed on anti-hypertensive drugs and multi vitamins.

Her mother told SUNDAY PUNCH, “It was a tablet which they asked me to split into four and we were giving her once daily. But anytime, she took the drug, she would sit down looking dull, complaining of severe headache. We were in the hospital for three days.”

Mr. Williams called for the discharge of his girl. “I couldn’t allow my daughter to remain there. She was in the midst of very sick people. The person beside her had HIV and another one another disease. I was asked to sign that I was taking her away against medical advice. So we took her home,” he said.

After asking the little girl to be discharged against medical advice, the parents took her home and intensified their praying and fasting.

On July 2014, as Mrs. Williams sat in her sitting-room thinking about the worsening state of her daughter’s health, she came across a health column in SUNDAY PUNCH.

Mrs. Williams said: “One Sunday afternoon, I saw our landlord reading a copy of the Sunday Punch. I asked him to allow me read which he obliged. Going through it, I saw an article, “Hypertension in children”. I quickly took the section out and returned the paper to him. I took my time to read the article. When my husband returned from work , I showed him and we decided to get in touch with the doctor who wrote the column, Sunday Doctor in the paper.

“On the day I took my daughter to the hospital, I was holding the newspaper article. After explaining to Dr. Sylvester Ikhiesemojie who writes Sunday Doctor in SUNDAY PUNCH again, he took my daughter away to examine her. Her reading that day was 130/80.

“Immediately, he asked us to go for a scan which we went for at a nearby laboratory. It was during the scan that I first learnt that she had a problematic kidney, that was the first time I knew my daughter’s kidney was faulty. All the previous doctors were treating hypertension.”

Eventually, after series of tests and examinations, Miss Williams was operated on by Dr. Ikhisemojie and Dr. Oluwatoyin Grillo leading the team at the JK Randle Memorial Hospital, Lagos. The surgery was conducted on September 9, during the last nationwide industrial action by medical doctors.

The diseased kidney was removed and seven days after, little Williams was discharged. Now, according to her mother, the six-year-old is no longer on anti-hypertension drugs, a situation which has totally removed the excruciating headaches which had been her lot while taking the drugs. Her BP has returned to normal while her face is no longer distorted.

Also, her face is no longer distorted and there are no tell-tale signs that it had once been. Furthermore, anyone who did not know little Williams would never know she used to have a protruding stomach., a result of her earlier ailment. Her stomach is now flat save for a long scar on a side .

As she moved around the modest living room of her parents that Sunday afternoon asking the reporter several questions, one could not but wonder how different things would have been if her mother hadn’t read a copy of the Sunday Punch the fateful day.

‘My daughter might have died’

How did you feel when you discovered that your daughter was not properly diagnosed in all the clinics you had taken her to?

I was unhappy. I felt as if what was wrong with her was not ordinary. If not, they should have seen it and given us a right diagnosis. I was not myself. I was sad.

Mrs. Williams

How has it been taking care of a sick child for almost three years?

It has been very stressful. Though most of the time she behaved normally, yet anytime I took her for reading of her BP, and it remained so high, I was always distraught. I always felt so distressed. Again, if I had to take her to the hospital, which was often, we had to leave the house early and moving in commercial vehicles was always hectic. It also entailed taking a lot of permission from my place of work. I never felt comfortable with this and the notoriety of absenteeism it might give me. Really, it has not been easy.

Why did you believe that the doctor’s column you read in SUNDAY PUNCH would help your daughter?

I believed because that was the first time I would come across an article on hypertension in children which my daughter had been diagnosed of. All other literature I had read, both hard copy and online, did not tell me this. Hence, immediately I saw it, I just felt relieved that at least her case was not non-existent.

How did you feel when Dr. Ikhsiemojie said a surgery would be carried out?

Actually, when Dr. Ikhsiemojie asked me to go for the scan, I was told at the lab that she would need a surgery. This left me shocked and sad. Immediately I got home, I sent the report to Dr Ikhsiemojie via text, he replied mildly. He is not an alarmist. He replied with the text, ‘Her case is treatable but the damage to the kidney is irreversible’. I asked him a lot of questions which he answered. I wanted to know what effects this would have on her in the future, whether or not it would affect her childbearing and other things. He explained a lot of things to me. But I was still sad. I commenced serious praying and fasting and also informed my pastor and parents to join me.

How did you feel on the day of the surgery?

Despite having read a lot about it and assurances from the doctor, I was very afraid. The operation took so long as if it won’t end. It was later that I realised that it was just over an hour. But it seemed like forever. A few days after, my daughter was really in pains. I really felt for her. But miraculously she recovered so fast even to the surprise of the doctor.

How much did you pay?

I paid N30,000 for surgery, bed space and feeding. I also bought everything that was used for the surgery.

What is the difference in your daughter after surgery?

Thank God for SUNDAY PUNCH, Dr. Sylvester Ikhsiemojie and his team. My daughter is okay now. If not for the article in the newspaper, who knows by now, my daughter may have died. Now her bulging tummy has become flat. She used to have a bulging tummy before the surgery. If she ate any little thing, it would just shoot out as if she had eaten all the food in the world. Also, her BP has gone down to normal and she does not complain of headache again. I am a happy mother now.

‘She was a rare case’

Dr. Sylvester Ikhisemojie, the consultant paediatric surgeon who writes a health column for SUNDAY PUNCH, Sunday Doctor, sheds light on the surgery

What was your reaction when you received Mrs. Williams message?

She sent a short message to the cell phone number provided on the column. It was a very passionate message and I was only half-way through it before realising it was different in terms of seriousness from many of the other hundreds of emails, sms, even phone calls I receive on that line every week. I was very concerned that such a young girl had suffered a stroke which was not being treated with the seriousness it deserved. I feared something much worse happening to her. As a result of all those considerations, I asked her to call me on my private line so we could discuss what we should do for her.

Ikhisemojie

Have you come across a child with such condition before?

Yes, I have. That was a-three-week old baby whose affected right kidney was so large that it was obstructing the flow of intestinal contents through the small intestine. He had an emergency operation to relieve the obstruction but we were quite surprised to find out what the real cause was. It was a hugely enlarged kidney full of cysts.

How many have you come across and how frequent?

These are the two cases I readily recall now. This is a rare condition and although we have no figures for this in this part of the world. It is estimated to affect about 12.5 million people around the world from the new-born to people about 60 years old.

At what point did you decide to operate on her?

After reviewing the results of the intravenous urogram, the special X-rays she had, it was clear the affected kidney was not functioning at all and the decision to remove it was taken. It was unable to produce any urine and so could also not excrete any waste. Besides, such a kidney if it can be called such, was of immense danger to her. The hypertension it had caused could not be effectively controlled with medications.

Would there have been an alternative to surgery in her case?

The answer to that is no. This matter has been settled by exhaustive research.

What are the chances of success of surgeries like that?

The chances are quite good once competent staff is on the ground to perform their various tasks. It is not a one-man show.

How long did the surgery take?

A little over one hour.

What are the implications of a six-year-old living on one kidney?

Contrary to what many will believe, the chances are very good indeed. There are perhaps hundreds of thousands of people who live normal lives from a very early age with one kidney. Some people are born with one kidney and they live well with that. Others may have one large kidney that is actually a fusion of the two kidneys and it will end up functioning as one unit. That’s why we needed to confirm that the other kidney is present and that it is functioning well before taking the grave decision to remove one.

It was a delicate surgery — Anaesthetist

What is your name please?

I am Dr. Oluwatoyin Omopero Grillo.

Grillo

When and how did you know of Miss Williams case?

I got to know of the case through Dr. Ikhisemojie who is the consultant paediatric surgeon in the hospital I work. It was during the last industrial action embarked upon by medical doctors. He told me of a parent who got to know about her child’s condition through SUNDAY PUNCH and that after examining her he discovered that she had a tumour which had to be removed and that he needed an anaesthetist. I said no problem as long as I examined her, because she had to be fit for surgery first. It was an interesting case because she was a six-year-old who had already had a stroke in the layman’s term. Hearing that, being a mother and then the confines of the profession, I was moved. I was like wow! It is an uncommon case here: a six-year-old having a stroke and already on anti-hypertension drugs.

Which type of anaesthesia did you use on her?

It was a challenging one. It was a very specialised and technical type of anaesthesia that we used on her because of the peculiarity of her case. There are some conditions which do not favour some kinds of anaesthesia because some people suffer stroke on the table. That is why having the patient’s medical history before bringing them to the operation table is important. Hers was a very challenging case. She had to be examined thoroughly and all her results checked. We did not want a situation that she would be worse off after the surgery. We needed to select drugs that are cardio stable i.e. heart friendly, since she has a condition because whatever is giving her problems has affected her heart. She had hypertension. It was not an everyday or routine operation. She had to be well managed. We had to use cardio depressant agents too.

What were chances of survival when you wanted to do the surgery?

In our assessment or diagnosis, her case was an ASA4 which means she is a high risk kind of patient. This means her case was a 50/50 one. ASA is an acronym for American Society of Anesthetists which grading is used globally.

How many of such cases in patients of such age have you operated on?

None. But even with that we know how to handle them. She is quite young and she has suffered a stroke also the pathology, that is, the defective organ had not been removed. There was an urgent need for the surgery. It couldn’t have been delayed. I also need to commend the efforts of my team: the doctors and nurses that worked with me because I didn’t do it alone. They were all wonderful.

How many hours did she spend on the table?

The surgery was over an hour. Again, we have to commend the expertise of the paediatric surgeon because when a surgeon is skilful, he works faster. Elsewhere, the surgery might have lasted around four to five hours. The speed of the surgeon is also important because the longer a patient stays on the operation table, the more dangerous it is because complications may arise. But everything went well.

How much did it cost?

The least such a surgery would have is about N500,000. But because Randle is a government-owned hospital, treatment of children is heavily subsidised hence it cost about N30,000.

I don’t feel headache anymore — Miss Williams

How old are you?

I am six years old.

What happened to you?

I was very sick. I was feeling pains and I was always having headache. I used to have tummy pains. I was having chest pains too.

How do you feel now?

I am feeling better. I don’t have headache again. My chest is no longer paining me too.

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