Mr Ola (not real name) recently underwent a brain operation in Abuja. He had presented with a brain tumour causing severe headaches. The symptoms started many years ago and he was treated at various hospitals in Nigeria. He also went to lots of prayer sessions and saw an herbalist for completeness.
Things changed when he started having convulsions and the headaches radiated in a searing pain into the face. Eating, drinking and even smiling, elicited a hot fiery sensation into the face. This was unbearable and demanded that something be done.
An MRI scan of the brain (long overdue) revealed a massive brain tumour causing significant pressure inside the brain and lots of brain swelling. The tumour (a meningioma) had been growing inside his head till the brain shouted, ‘l have had enough!’ The brain had been pushed to the limit.
So, an operation was required as a matter of urgency and we did this in Abuja. He made it. The tumour was removed and he had a safe recovery, leaving hospital to recuperate at home after 10 days.
He is the lucky one!
The unlucky one
Mrs Ade came over some time ago complaining of headaches, nausea and vomiting. She had previously had surgery and treatment for a breast cancer. The Indian doctors said she was cured. So, little attention was paid to her recurrent headaches till she started vomiting uncontrollably. Alas, the brain scan showed up a large tumour (breast cancer metastasis in her brain). There was massive brain swelling and on-going pressure in her head. An emergency operation was required.
At the operation, there was so much tumour and massive bleeding that made life miserable for the team. We persevered and she got through the operation. But, what happens next?
Why patients do badly or die?
Many patients present with massive brain tumours, and tumours in awkward, difficult to access places in the brain, presenting humongous challenges for the neurosurgeon. Of course, the symptoms have often started months and years previously.
Many simply ignore the signs or fail to present to the appropriate person. Our Nigerian clients have often visited pastors, faith healers and traditional medicine men for assistance. Many have also visited real doctors, optometrists and other specialists!
If the symptoms and signs are missed then patients end up being treated severally for malaria and typhoid, glaucoma, poor vision and many other ailments. The penny often drops when additional signs and impending doom surfaces. This is when we (neurosurgeons) often get called. By this time, the patient is spent and all the money is gone.
They say, ‘We have spent all our money going from pillar to post’. ‘Doctor, please help us’.
The care for patients with brain tumours, after surgery, is poor in Nigeria because highly trained nurses and other key staff are in short supply. Often, intensive care is required and often, unaffordable. So, we take a chance, especially in an emergency situation, hoping and praying all will be well.
In a few cases, it is!
The brain is unforgiving and calls for the utmost respect. We usually plan to sneak into the head like a thief in the night, without disturbing vital structures. Huge materials, equipment, computer aided surgery and robotic surgeries are now common place in the realm of brain surgery, yet sorely lacking in Nigeria. We often have to strategize, improvise, use limited resources and rely on prayers. Still, surgeries on the brain require planning, tact, skill and equipment, many of which are also in short supply.
Bleeding, brain injury, poor recovery and unskilled support kill patients after brain surgeries. Bleeding can sometimes be unpredictable and vicious. Some patients have died on the operating table or subsequently afterwards. Brain injury leads to weakness of an arm or a leg, paralysis and other deficits that hamper recovery. Such poor recovery causes other complications such as chest infection, deep vein thrombosis and bed sores leading to disability or death.
Brain tumour surgery is expensive in any language. Brain tumour surgeries costs an average of N10M (ten million Naira) to be done well in many parts of the world. In those places, many strategies, staff and equipment can be deployed to encourage a good outcome. This is why it can be very expensive.
When patients require blood transfusions, intensive care and the like, cost can be a major issue. It costs up to N1M per day in some cases. Credible intensive care units and skilled intensivists (specialised doctors looking after patients in the intensive care unit) are also in very short supply. If you need one and you cannot find one, you rely on prayers.
May God help us!