Honey and Placentas

Honey and Placentas

I was reading a recent article about how a type of honey called Manuka honey from New Zealand has been found to have antibacterial properties. It is not necessarily effective as an antibiotic when eaten, but more so when applied locally over wounds. As a dressing it was found to be more effective at healing wounds than some of the more expensive dressing materials.


This took me back to my medical school days in the town of Zaria in Northern Nigeria. It was thirty years ago, and I was doing a General Surgery rotation. Our Senior Registrar was Dr. Vincent Odigie. A handsome young man, he was bold and assertive and always supremely confident. He was also very smart and often did things in an unconventional way.


One day we were seeing an elderly man with an infected diabetic foot ulcer. Conventional treatment with antibiotics and traditional dressings had not helped for several months. Dr. Odigie said we need honey. We students were incredulous. Honey? Yes, honey he said. He told us that traditional honey had natural antibacterial properties and bacteria could not utilize honey for food. I still remember him telling us that only bees, humans and bears could use honey for nutrition.


He asked the patient’s son to go and get some traditional honey from the local market. The store bought honey is not as effective he told us as it has additives. The patient’s son soon came back with a jar of local honey. It did not look too clean and we students were not very optimistic. Dr. Odigie laughed and assured us this will be sterile.


He unwrapped the wound and covered it with honey and wrapped it up. He then told the students that the wound will not be inspected for seven days. We were incredulous. However seven days later when we inspected the wound. All the infection was gone and it was just healthy granulation tissue ready for a skin graft. All of us students were thoroughly impressed.


On another day, we had a young lady who had sustained significant burns. The burns were not deep but she was in considerable pain. Dr. Odigie looked at her and said we need some placental lining. Even though we students were used to his unconventional approach, we were very confused. The lining of a human placenta he explained is very effective in treating these kinds of relatively superficial burns. He taught us that a dressing made of the placental lining of a human embryo helps ease pain and promotes healing of the skin.


Where are we going to get this placental lining one student asked? The labor and delivery ward he said. It was late in the evening, but Dr. Odigie was a very dedicated physician. He marched the students to the labor and delivery ward and asked the rather surprised charge nurse there if she had a discarded placenta we could have. The nurse was used to Dr. Odigie and did not bat an eyelid. She said the Gynecologists were just doing a C-section and she would get us that placenta instead of discarding it. Dr. Odigie beamed a smile.


She soon brought out a placenta for us. Dr. Odigie then proceeded to cut out the placental linings. He then rigorously washed the tissue and then put it in a disinfectant and proceeded to the burn patient. The sun had set and we students were tired, but we had to see this.


The young lady was in considerable pain. Dr. Odigie carefully undressed her wounds and then proceeded to place the placental lining tissue over the wounds. He then wrapped the wounds with a regular dressing. Once he was done, our patient did look more comfortable.


Our patient did quite well and within a week her wounds had healed enough for her to be discharged. I saw a recent study done that showed placental dressings reduce pain and allow for faster healing.


We students learnt a lot from Dr. Odigie. He may not remember me or these lessons he taught us, but I will never forget them. Today he is Professor Vincent Odigie of Surgery at my old teaching hospital.

Sometimes unconventional approaches can be very effective and just imagine my delight to see all this talk of using honey for wounds today in the more developed countries. I can say confidently that this approach is effective as I have seen this myself thirty years ago!

Manuka Honey

The American Indians

The American Indians

Today I read about the untimely death of Indian actor Tom Alter at age 67. He had died of skin cancer. He likely developed this skin cancer in part due to the abundant sun exposure in India. You see, he was a fair skinned Caucasian.

Mr. Alter was the grandson of a missionary who had come to British India in 1916 from Ohio in the United States. Mr. Alter's grandfather had a son who was born in the city of Sialkot which is in present day Pakistan. When the Indian sub- continent was partitioned in 1947, the elder Alter remained in what is now Pakistan, but his son (Tom's father) had become a missionary in the city of Mussorie in India.

The partition of the Indian sub-continent by the British split many families including those of my parents. I however never imagined that it also would affect an American family living in India.

Mr. Tom Alter was born to his missionary father in Mussorie in India in 1950. His grandfather remained a missionary in Pakistan, and the young Tom Alter grew up in the Indian state of Uttar Pardesh. He was fluent in Hindi and Urdu. When it was time to go to college, he was sent to Yale university in the United States.

He however did not like Yale, and left after a year and came back to India. After trying a few different things, he fell in love with an Indian movie starring the Indian super hero of those days, Rajesh Khanna and decided to become a movie actor.

I can imagine that it must have been difficult for a Caucasian man to make it into Indian movies in the 1970’s, but Tom Alter did. Some of his roles portrayed him as a British man speaking poor and broken Hindi. Interestingly he himself was very fluent in both Hindi and Urdu, and even well versed in Urdu poetry.

He did succeed and eventually worked in over 300 movies including a movie with his idol Rajesh Khanna. Also, incongruously for a man of American origins, he became a great fan of the game of cricket and even became a correspondent for a cricketing news organization. He was eventually given the fourth highest civilian national award of India, the Padma Shri and was much loved in India. He once said in an interview that he hates being called an ‘angrez’ (white man). He said he was Hindustani (Indian) and proud of it.

In this day and age, it is more common to see immigrants to the United States rather than the other way around. I myself am an immigrant. While growing up in Nigeria, two of my closest friends were American brothers. Their father had moved to West Africa in the 1960's, but it is generally rare to see an American who has made another country home. However, recently I met another.

I work as a doctor in a small town in North Carolina. On one recent day in the clinic, a man in his late sixties came in as a new patient. He had just moved to our small town to live close to one of his daughters who lives here.

As part of my history, I asked what he did for a living? He had been a teacher, he told me and he had just retired. Where did you teach I ask? ‘India’, he replies. I was taken aback. You mean the country of India? Yes indeed, he replied.

This made me very interested and I asked him for more details. He told me that as a young couple both him and his wife had been interested in missionary work. They left America in the 1980’s and first lived in North Africa for a few years. Their first child was born there. They then moved to India. They moved between different cities in India. Their second child was born in the Indian city of Patna.

I found this very interesting as my parents were originally from the Patna area of North Eastern India. He lived with his family in India for 28 years. His daughters grew up there. He came back to America to take care of his elderly father. The family was initially split as his wife tried to stay on in India with his children.

After four years, his wife also moved back. One daughter had gotten married and moved to my small town. My patient moved here after his father died. He found a job here and became my patient. Both him and his wife are some of the most humble and nicest people I have ever met.

When I decided to write this essay, I titled it ‘The American Indians’, even though this has nothing to do with Native Americans who are also called by that name. I think it is the people above who more accurately fit this title

Tom Alter

Sabo

Sabo

This is a memorial for my dear friend Sabo Saleh who died a few years ago. Sabo Saleh was my classmate in medical school and we also started out residency together. We had many memorable times with each other. Here is one incident that I remember distinctly.

Sabo was the son of a farmer from a small village in Bauchi State in Northern Nigeria. His family was of modest means and most people in his village became farmers. Sabo was different. He excelled in his elementary school and got a scholarship to secondary school. Over there, he excelled again and was eventually admitted to medical school at the Ahmadu Bello University in Zaria, Northern Nigeria. I was his classmate.

Sabo was muscular, stocky and a picture of strength. He was characteristically bold and feared no one. He never hesitated to speak his mind and could be quite blunt. This attitude would sometimes get him into trouble, but he was much liked by his classmates. We all respected his fearless attitude and we knew that he had a great heart underneath that gruff exterior.  

After graduation and an internship year, Sabo eventually started a residency in General Surgery. By that time, I had started a residency in Orthopedics. We would meet often in the hospital.

One particular day in early 1993, we were both working in Operation Theater two. I was with the Orthopedics team and Sabo was with the General Surgery team. The other resident in Surgery was our mutual friend Ahmed. Like Sabo, he was also from Bauchi state. On that day, for some reason, Sabo was mercilessly teasing and taunting him in his characteristic style. However, it was all in good fun and all of us were laughing.

I went in for a case, and then when I came out, Sabo was scrubbed in another Surgery case. In the physicians lounge I come across Ahmed. He was sneaking out Sabo’s clothes from the changing room. What are you doing I asked? He put a finger to his lips and said to me, “Quiet, I am getting back at Sabo, don’t say anything”. He explained that he was only going to hide the clothes for a little bit as a prank.

It appeared a harmless prank, and I thought nothing of it. I went back in for another case. When I got out, there was pandemonium in the physician’s lounge. Sabo had come out and noticed his missing clothes. He became upset as his home keys were in his pockets and he thought somebody might use them to break into his house. He got another resident to drive him home immediately while still in scrubs. The theater staff was busy trying to find the missing clothes and keys.

I ran back in and grabbed Ahmed who was just coming out of another case and told him. A look of fear came over Ahmed. He looks at me and says Sabo will kill us. Us, I say? Why us? I have nothing to do with this I protested! You knew about it he replied, that makes you an accomplice. Now take me to him so I can return his stuff to him. Ahmed later told me that he wanted me along as he thought Sabo will then go easier on us, since he was my good friend.

So, we changed and I drove Ahmed to Sabo’s apartment. Sabo was standing outside his locked door, not looking happy. We ran up to him, both pleading for forgiveness even though I was not sure what I was apologizing for. A surprising thing then happened. Sabo started laughing. I think he saw the fear on our faces and found it very funny. In the end, there were no hard feelings.

Some months later I was leaving for America and both Ahmed and Sabo were at my farewell reception. The very macho Sabo had tears in his eyes as he hugged me and bade me farewell. I never realized at that time that it would be the last time I ever saw him.

A few years ago, Sabo was diagnosed with cancer. This cancer took the life of my strong and tough friend leaving behind a wife and three small children. I will never forget the fun times with him and pray that his soul rests in perfect peace.

As students with Sabo in 1989

With Ahmed in 1993

In Operating theater two in 1992

The Croup

The Croup

In my career in Medicine, I have seen many challenging patients. I remember one particular little girl in my early years. The dedication and skills of the doctors treating her made a great impression on me. This is her story.

It was 1990, and I was doing my internship year after graduating from medical school. I was at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria. Our Internship was also known as the ‘Housejob’ and involved us rotating in the different departments of Surgery, Pediatrics, Internal Medicine and Obstetrics and Gynecology.

After 3 months in Surgery, I had come to Pediatrics. My good friend and former classmate Kabir Abubakar had already been in Pediatrics for a couple of months and quickly showed me the ropes. He took me around the EPU (Emergency Pediatric Unit) and introduced me to the patients. He taught me how to calculate doses of medications for these small children and how to obtain intravenous lines.

Kabir was my friend, and also a great teacher. I had a good first day, but towards the evening, we heard a small commotion in our intake area where the Pediatric emergencies were brought. It was a frantic Mom, with her 4-year-old daughter. Her daughter had developed a cold followed by breathing difficulties.

Both Kabir and I rushed to her side. She was having difficulty breathing. We diagnosed croup with epiglottitis. This is an infection of the trachea that can become serious in small children. We tried conservative measures initially, but she was not getting better. We called our anesthetist to intubate her. Intubation would be difficult as she was so small and likely had inflammation in the trachea.

While waiting for the anesthetist, Kabir told me that we should be ready to do an emergency tracheostomy (a small hole in her neck) if she gets into acute distress. Have you done one before, I asked him. No, he said, but this is an emergency, and he had his scalpel ready. He also told me to have a large bore needle we could stick in the trachea as an alternative. I was nervous, and I marveled at his calmness as he continued to provide the child with oxygen and other conservative measures.

Suddenly the Anesthesia team showed up. They rushed the child to the Operating room and intubated her. She was subsequently moved to the Intensive Care Unit. With her airway restored she became much more calmer and was breathing comfortably. Eventually, she was taken off the ventilator and remained comfortable with the breathing tube in place.

Our Pediatrics team continued to follow the patient. During this time Kabir rotated off Pediatrics, and was replaced by another close friend and classmate, Adoyi Ameh. At this time, an attempt was made to remove the breathing tube, but she immediately went into respiratory distress and had to have the tube reinserted.

Another course of antibiotics and steroids followed, but she again failed attempts to remove the tube two more times. Subsequently, our team decided to see if she could be evaluated by an Ear Nose and Throat Surgeon. Unfortunately, we did not have one on staff at that time and we decided to take her to see one in the nearby town of Kaduna.

We arranged an ambulance to take her there, and our senior registrar decided that one of the house officers will accompany her. I was chosen even though that would mean that poor Adoyi would be manning the Emergency Pediatric Unit alone at the height of the meningitis epidemic. However, Adoyi is an amazing guy and with great grace, simply said “Go, I will take care of everything here”.

So, I sat in an ambulance for the first time in my life for the one hour ride. We saw the ENT doctor who said he could do a tracheostomy, but said he did not have the ability to provide her the care afterwards. Defeated, I came back to our hospital. Adoyi had managed all the admissions alone for that day superbly.

Our Surgical team then decided to do the tracheostomy and take out the tube themselves. The child did very well and was able to be eventually discharged home. At a subsequent follow up, the tracheostomy tube was removed and the child made a full recovery.

About a year later, I was walking in the local Sabon Gari market, when I heard an excited voice shouting ‘Doctor’! I turned around and it was the mother of the child. I asked her how her daughter was? She turned around to show me the clothing store she ran in the market and inside was a happy little girl playing. A small scar on her neck was the only reminder of her illness. The Mom thanked me profusely. I reminded her that I was just a small part of the large team of doctors that took care of her daughter.

Kabir went on to become an Orthopedic Surgeon, Adoyi Ameh a Pediatric Surgeon. I came to America and became an Infectious Disease Physician. I will however never forget the selfless way in which all those doctors came together to help this child who is probably a grown woman today.

Zia with Kabir in the EPU 1990, inset is Adoyi Ameh.

Walo Black

Walo Black

On October 1^st 2004, my dear friend Auwal Abubakar was killed in a car accident along a highway linking the cities of Kaduna and Kano in Northern Nigeria. This was devastating news for me as he was very dear to me. Amongst my many memories of Auwal is one that involves the same highway on which he eventually lost his life. Here is that story.

We called him Walo in our class tradition of having nicknames that ended in “O”. I was thus “Sifo” (from Asif). However, we had another Walo in our class. In order to differentiate them from each other, one became “Walo black” as he was slightly darker complexioned and the other became “Walo white”! While both were my close friends, this story is about Walo black.

It was in 1990, and I was doing my house job at the Ahmadu Bello University Teaching Hospital in Zaria, Nigeria. The hospital assigned us apartments with two house officers to an apartment. Walo was my roommate. While we rotated in different departments, we were both posted to the Internal Medicine rotation at the same time. I moved to Obstetrics and Gynecology from Internal Medicine. Auwal (Walo black) had now moved to Pediatrics.

I had gone to the Internal Medicine office to pick up my evaluation. The secretary asked me if I would take Walo’s evaluation to him as well as he had not picked it up and he was my roommate. It was sealed in an envelope, but with a twinkle in her eye, she told me that his evaluation was much better than mine.

I loved Walo, but in order to punish him for doing better than me, I decided to play a trick on him. I went home to my portable typewriter (we did not have home computers in those days) and typed up a letter.

The letter was addressed to Auwal Abubakar from the Medical and Dental Council on a plain piece of paper (of course I did not have their letter head). It said to the effect that “We are sorry to inform you that because of your poor evaluation in Internal Medicine (attached), the Medical and Dental council regrets to inform you that your medical license is cancelled”! I signed it with my own signature and enclosed both his sealed evaluation and this letter in another envelope and put it in his mailbox in the Pediatrics department. It was such an obvious forgery, and along with his good evaluation, I thought we will both laugh about it later.

Unfortunately, it did not go as planned. Later that afternoon, I ran into Walo in the hallway in the hospital. He looked very unhappy, and he instantly accosted me and said in an aggrieved tone “Do not Laugh”! Confused, I said, Laugh at what? You know what you did he said in a severe voice. What happened I asked?

Apparently Walo had got to his mailbox that morning and read the letter. He saw his perfectly good evaluation and felt very upset at the letter supposedly from the medical council. He went immediately to his Pediatrics team and told them about the letter and that he had to go to the office of the Medical and Dental council right away to sort this out.

Unfortunately, that office was in the neighboring town of Kaduna, which was an hour bus ride away along the Kaduna - Kano highway, (which passed through Zaria). He left for that office immediately by bus. After a long hour in a crowded bus, he got there and started arguing with the staff there as to how dare they send such a letter for a perfectly good evaluation.

The Medical Council told him that they had issued no such letter. It was then Walo took a proper look at the letter and realized it was fake. He saw my signature and knew that I was responsible for this deed.

To add insult to injury, when he got back, he had to tell his Pediatrics team what had really happened, and they burst out laughing. Instead of getting sympathy, everyone was laughing, and Walo was mighty upset at me.

I did not laugh at that time but apologized profusely. I told him I never imagined that that he would not realize it was fake. I had even signed it with my name! In the end he forgave me, and as penance, I took him out to dinner at our favorite restaurant “Shagalinku”.

We did laugh about this afterwards. I eventually left for America and lost touch with him. Walo became a specialist in Pediatrics and was a Consultant at the time of his tragic death. It was the same highway, but this time he was going the other way towards Kano.

I pray that his soul rests in perfect peace.

                                              Walo and Me at Graduation in 1990

Drying Up Of The Vine

Drying Up Of The Vine

I recently saw an elderly patient of mine. He was in his late eighties, but he stood tall and was sprightly. He was in excellent health for his age. The only evidence of his advancing years was a hearing aid in one ear.

We took care of his routine health needs. On one visit, he talked about how things change over time. I asked him how? He then told me his story.

In his younger years, he had moved to a very small town in Georgia. This town was established in 1820 and was one of the oldest towns in that area. In 1887, the railroad came through and the town boomed. People moved there and businesses were established.

In the 1920’s, this area became a favorite visiting place for the future President Franklin Delano Roosevelt. FDR loved the wide open areas and the multiple springs beneath the land. He kept visiting until his death in 1945.

This area continued to do well, with cotton mills and some manufacturing plants. Almost forty years ago, my patient opened a hardware store there. He ran it with his wife and worked every day except Sunday. Both husband and wife knew most of their customers by name and business was steady.

Unfortunately, a few years ago the main industrial plant in town shut down. This was a food processing plant, and with it came the loss of several hundred jobs. Many people moved out and businesses started shutting down.

His hardware store also started to decline. This was hastened by the opening of a large chain department store in a nearby town. My patient was getting older and the store, in his words, was bleeding money. He decided to try to sell it.

There were no offers on the store. He finally closed the store and auctioned the inventory. The town agreed to buy his building, and they used the building as a medical office. My patient was now officially retired.

He finally decided to move away from his small town and move closer to where his children and grandchildren were living. While he is much older, he remains in good health. He spoke with a little sadness of the decline of his store and his small town. His description of it struck me. He said it was like the “Drying up of the Vine”.

This was a beautiful way of expressing his thoughts. I later found out that this expression comes from the Bible; “The vine is dried up and the fig tree is withered; the pomegranate, the palm and the apple tree, all the trees of the field are dried up. Surely the people's joy is withered away”. (Joel 1:12).

After our visit, I looked up his old town. It had declined to a population of less than a thousand. However in recent times there had been a renaissance. Tourism had remained popular as many people would come to see President Roosevelt’s cabin. This fairly modest cabin was known as the ‘Southern White House’.  This term has been used for many presidential retreats, but this is probably the most modest.

Some of the old stores were renovated and antique shops were opened in them. More recently a Korean auto parts manufacturer has opened a plant in that area and the population is slowly increasing.

My patient is also doing well. He is a little bored in retirement but is content. His phrase ‘Drying up of the Vine” has stuck with me.

However it now appears that the vine is growing again!

                                    President Roosevelt's Southern White House in Georgia

The Denial

The Denial 

Health care coverage has changed these days. In the old days, if you had medical insurance, you went to the doctor, and perhaps had to pay a small co-payment. If you had a deductible, it was fairly small. Over the last few years, this has changed. Now most insurance companies have large deductibles. A deductible means that you have to pay the first several thousand dollars of your medical bills, before the insurance company will pay anything. There are also ever increasing lists of reasons for denial of payment for specific services.

This improves the insurance company’s bottom line, but the effects on the patient can be devastating. I have seen many people forego appointments and tests, simply because they found the deductible too expensive or coverage was denied. Here is one such story that I found particularly heart wrenching.

Several months ago, I was seeing a new patient in my office. He was in his fifties and came in with his wife. He had developed abdominal pain several months ago, and had difficulty keeping anything down. He had lost considerable weight of about sixty pounds and felt very unwell.

He had been to two other doctors. They had done lab work on him, but this did not show anything. A CAT scan had been recommended, but not done, as he had been concerned about both his deductible and the insurance company coverage.

When I examined him, the weight loss was very concerning to me. I told him that I too would like to get a CAT scan of his abdomen. He was concerned about the costs. I however reassured him and was fairly confident that insurance coverage would not be a problem.

My patient however was very despondent. He felt something was seriously wrong with him, but he was concerned about his high deductible and he knew that he would be unable to pay for the scan if insurance would not cover it. He was so resigned that he told me that he would prefer to die rather than go into debt that potentially his wife and four teenaged children may have to pay.

I obtained a prior approval from his insurance company and he went for his CAT scan. I still remember that day, because I got a call from the Radiology department. His insurance company had suddenly denied coverage of the scan for no clear reasons. My patient had been sent away. I was just being given a courtesy call.

I was incensed. I called the insurance company and told them right there that I was ordering the scan for possible cancer of the colon, and if the insurance did not cover this, they would be responsible for anything that happened to my patient. This was of course a possible cause of his symptoms.

The effect of this was instantaneous. The CAT scan was approved and my patient was immediately called back in to get it. Two hours later, the radiologist called me. He did have cancer. He had a large mass in his colon. Now, I was totally taken aback. This was the last thing I had wanted to find.

I immediately called my patient and gave him the news. He was more relieved at finding the diagnosis, rather than being upset. He wanted to know what would be the next step to take.
I called our surgeon that afternoon and he agreed to see him the next day. He was scheduled for surgery within a day or two and the mass was removed from his abdomen. Pathology of the mass confirmed cancer, but it was localized and had not yet spread.

My patient made rapid progress thereafter and regained his appetite and weight. He went back to work. He came to see me several months later. There was no sign of the cancer and he was doing extremely well.

I thought this was a happy ending, but it was not to be. My patient kept regular appointments with the Gastroenterologists and Oncologists and there was no signs of the cancer. About a year and a half after his initial diagnosis, he came to me with complaints of abdominal pain. I immediately repeated his CAT scan. The report showed multiple areas of cancer in his liver. He had just had a colonoscopy which was negative, so the cancer in his liver probably started at his first diagnosis but was too small to be detected at that time.

His cancer doctors could only offer him palliative care and he declined. He went into hospice care and died five months later. I will forever wonder if the delay in his initial treatment contributed to the seeding of the cancer in the liver.

There are many others that also do not end well. They have delayed diagnosis or treatment because of their high deductibles or insurance denials, and this is for people with insurance. I hope and pray that this state of affairs changes in the future.

CAT scanner