Thursday, January 21, 2016

Another milestone reached!

Thank you to everyone who has continued to follow our blog, we have now reached 5,000 views! Make sure to keep checking in with us, as we will be increasing the number of stories we write this year from a number of different authors. Thank you for seeing change happen.
Alysha Bennett Web Developer

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Wednesday, January 20, 2016

Lassa Fever Outbreak, Nigeria - A First Hand View

It was a Tuesday morning and I was covering the morning shift as usual. It was around 12pm and in came Patient 0. He was a 23 year old male who presented with symptoms of fever, cough, eye infection and skin rashes. That was his third visit to the hospital. A review of his previous visits showed he was being managed as a case of allergy, with little improvement. 

A quick examination showed a febrile state of 37.8 degrees, conjunctivitis, macula-papular rashes mostly on the face and upper trunk and a blood pressure of 160/100 mmHg, which was very high for a young man who had no previous history of hypertension. There was history of pain during urination. I requested for some investigations which showed evidence of infection along the urinary tract. At last I have a diagnosis: There was chest, urinary and eye infections, a clear case of sepsis. However, there were the rashes which were characterised as exanthems. Exanthems are eruptive skin rashes which are most commonly related to infections, and of these, viral infections are the most common. 

I explained to the patient that there was clearly an infective process going on, most likely a viral infection with super-imposed bacterial infection. The only way of knowing the infective organisms is through bacterial culture which is readily available here, and viral culture, in which the blood sample has to be taken to Lagos. I placed him on some drugs. 

During the night, the patient’s condition deteriorated. He had developed new symptoms; vomiting and abdominal pain and a drop of blood in his urine. That was the beginning of pandemonium. There was an outbreak of a viral hemorrhagic fever (Lassa fever) in Nigeria, Kano State inclusive, and Patient 0 was presenting with non-specific symptoms and blood in the urine! He was immediately referred to the Teaching Hospital. The State Emergency Response Team was quickly deployed to the hospital. Before the arrival of the team, we launched a discussion on why some doctors think it was a suspected case of Lassa fever and why others think it was not. 

During the past 8 weeks, Nigeria has been afflicted with an epidemic of Lassa fever. The outbreak was first reported in Bauchi in 2015, which was then followed by Kano State and subsequently other states (Nassarawa, Niger, Taraba, Rivers, Edo, Oyo, Gombe, Plateau, Ondo and Abuja). In his speech last week, the Minister of Health, Prof. Isaac Adewole, stated that “as at today, records of our surveillance show that the number of suspected cases is 93, number of 2 laboratory confirmed cases is 25 and the number of reported deaths is 43, with a case fatality of 44.0%.” 

A doctor testing village children for the virus during the 1993 outbreak - Mike Blyth, 1993

Lassa fever is an acute viral hemorrhagic fever. It is a zoonotic infection, which means that humans become infected via contact with infected vectors. The animal host is a rodent called Mastomys natalensis or more commonly known as “multimammate rat” due to the female’s multiple and prominent mammary glands. Lassa virus may also be spread between humans though direct contact with blood, urine, faeces or other bodily secretions of an infected person. The disease was first discovered in 1969 when two missionary nurses died in Borno, Nigeria. The virus is named after the town in Nigeria where the first cases occurred. Most cases do not have symptoms. When symptomatic, the onset of illness is gradual and symptoms are not specific and difficult to distinguish from other viral hemorrhagic fevers and even common ailments such as malaria, typhoid and so on. Symptoms include fever, sore throat, chest pain, vomiting, diarrhoea, abdominal pain, headache, muscle pain, and others. As the disease progresses, the patient starts to bleed from the mouth, nose, vagina or rectum, skin or into the eyes. 

Back to patient 0. He presented with the above symptoms and a drop of blood in the urine! In my review of the his condition, I’ve confirmed an infection involving the urinary pathway, and it is not uncommon to find blood in the urine of such cases. All the same, there was an outbreak of a viral hemorrhagic fever and the wheels have been set in motion. The Emergency Response Team arrived to take data and do contact tracing for everyone that has come in contact with Patient 0. The hospital was in confusion and in a state of near-panic. There was no reason for panic. At least the panic is not going to reverse the infective process, if it is in fact Lassa fever. We can only pray. But the job has to be done. This is why we are health professionals. This is why we took an oath to preserve life, to serve humanity. This is the job. 

Meanwhile in the Teaching Hospital, Patient 0 was taken to the Accident and Emergency ward, where he was seen by the casualty officer who also made an assessment of a viral infection of unknown type. Upon further review, patient was diagnosed as a case of sepsis and adult measles. My first thought was “ Measles in an adult”? It’s not impossible but it is very rare. Patient 0 confirmed that he has been in close contact with 2 cases of measles in children. Measles is a highly contagious virus and is normally passed through direct contact and through air. It is one of the leading causes of death especially among children under the age of 5 years. 

Symptoms of measles include fever, conjunctivitis, rhinorrhoea, sorethroat and cough. At the initial phase, koplik spots may appear which are small, gray-white papules on the inside of the cheeks. This is mostly followed by the typical exanthem which erupts behind the ears and in the hairline, and then later spreads all over the skin. The exanthem resolves in the order of appearance. Most cases of measles occur with complications such as pneumonia, bronchitis, conjunctivitis, diarrhoea, encephalitis and so one. Complications are more common in children under the age of 5 years and in adults over 20 years. 

Patient 0 had presented with all of the symptoms of measles plus the history of exposure to 2 measles patients. He is 23 years old. Why would he have measles? People who are at risk of developing measles include unvaccinated children, unvaccinated pregnant women, severely malnourished, immune-compromised and any non-immune person who has not been vaccinated or was vaccinated but did not develop immunity. Patient 0 has fallen into the latter group. He was vaccinated but apparently he did not develop the immunity. 

This is in contrast to Lassa fever which does not have a vaccine. The people at the highest risk of Lassa fever are those living in areas of poor sanitation, family members that come in contact with body fluids of infected persons and health workers if caring for patients in the absence of proper barrier nursing and infection control practices. 

The working diagnosis for Patient 0 is Adult Measles. Confirmatory tests can only be done in Lagos which is about a thousand kilometres away. Thank God for clinical medicine as we can make a diagnosis of measles using symptoms, signs and some basic investigations. It does not require any special tests. In the case of Lassa fever, definitive diagnosis can only be done in specialised centres, currently available only in Lagos. 

A house being investigated for the virus in 1993 - Mike Blyth, 1993 -

It is however, good to know that Lassa fever can be prevented and controlled. But it will require a collaborated effort with the government, community and individuals. An important aspect of prevention and control is community hygiene. Since it is not entirely possible to eliminate all rodents, from the community, measures should be taken to discourage rodents from going into homes. Food should be stored in rodent-proof containers, garbage should be disposed of far away from residential areas, maintaining clean homes and keeping cats. Thus Lassa fever is one more reason to keep a pet. Family members caring for sick persons should be careful and avoid contact with body fluids of their sick relations. Health care workers should apply standard measure of infection prevention and control, and should apply universal precaution while caring for patients, irrespective of presumed diagnosis. Basic hand hygiene is very important and the use of personal protective equipments such as hand gloves, face masks, overalls and goggles. The government should try to get the diagnostic centres more evenly spread across the nation. Due to the previous Ebola scare, the government is better prepared now. Measures have been put in place to contain the epidemic. 

Patient 0’s condition is greatly improving. No more spikes of temperature, chest infection has improved remarkably and the exanthems have cleared. We wish him a very speedy recovery. We are most thankful to God that it was not in fact a case of Lassa fever. We are also praying for an end to this epidemic before it claims more lives.

*Dr Maryam Nasir Aliyu is currently volunteering with Ripples Foundation and using her medical experience to help us deliver Medical MOT events to communities in Kano State. She will be regularly posting on this blog to inform us of her experiences working as a doctor and living in Kano. Dr Maryam hopes that this post will inform people of the symptoms of the lassa virus and encourage those who are showing them to seek medical advice.

*If you would like to donate towards Ripples Medical MOT Programme which provides medical care to rural African villages, please visit
Dr Maryam Nasir Aliyu Web Developer

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Friday, January 15, 2016

Women At War

Back in December last year the US Army made the historical announcement that women would be free to join the military in ANY role, finally opening up the army to both genders equally. Whatever your opinions on the role of the military, this was a huge step forward for American women as it showed them that their government thought them capable of handling such jobs which are typically seen as very macho.

And why shouldn't they be? After all, gender equality means inclusiveness for everyone in all aspects of life.

US Defence Secretary Ash Carter has warned that we will not see an instant increase of women in the forces, but that it will be a trickle effect. He said that there are "physical differences on average" between men and women and that "thus far, we've only seen small numbers of women qualify to meet our high physical standards" for some units.

The physical differences between men and women is one of the main arguments against this decision. Obviously biology and studies have shown that men are built differently, and on average are physically stronger than women. However with the right training women can reach the same level of fitness as most men, just look at female athletes and bodybuilders! It simply depends on the commitment of the individual person. In addition, physical fitness is not the only part of being a soldier, although being a huge part of it. The scenes that soldiers have to witness during their service are often harsh and unimaginable, and it takes a particular type of person to be able to deal with that. The bravery of soldiers is celebrated worldwide, but you often hear of shocking cases of post-traumatic stress syndrome when they return home form combat. Marine Sgt. Maj. Justin Lehew, an Iraq war veteran, puts it best by saying that "When it comes down to it, I would much rather fight alongside a female warrior than a male coward any day of the week."

Many other countries rely heavily on female soldiers, including Eritrea where women make up 30% of the military, and The Gambia where women can volunteer for any role including combat. 

The US Army is currently voluntary, no-one is forced to join up - they do so of their own free will. However the country still has in place a draft system which can be put in place if the USA is engaged in major warfare and requires more soldiers. Between their 18th and 26th birthdays, American men have to sign up with the Selective Service System (SSS) so that if that situation arises then civilians can be called up for service, which was what happened during the First and Second World Wars. This system has yet to be put in place for women, which raises the question: Is the US Army fully equal? If women are allowed to sign up for service, then surely they should be treated equally to men when it comes to being obliged to sign up for national service in warfare situations? This seems like gender inequality in a reverse form to what we are used to! If we want true equality, we need to take the bad aspects along with the good.

In the past women have taken more active roles during wartime, a famous example being the land girls of the United Kingdom during World War, who stepped up whilst their fathers, husbands, brothers and sons were away fighting. 

They took their jobs in factories, farming and every other walk of life in order to keep the country running. However this did not involve any active warfare. In the UK today women almost have equal rights as men in the army, with the only jobs still closed of to them being the Household Cavalry, Royal Armoured Corps and Infantry. They are able to lead soldiers into combat and receive the same promotional opportunities as their male counterparts. 

War is a heated subject and adding gender equality to the mix is going to cause disagreements within these institutions that have long been male dominated. However in our opinion, if women meet the requirements for jobs and can prove that they will not be a danger to their fellow soldiers, there should be no barriers to stop them advancing to the highest positions in the military.

We'd love to hear your opinions on this, so feel free to comment below with your thoughts. Should women be allowed in the army? Should drafting be applied to both genders? Are there any other jobs where gender based selection should apply?
Alysha Bennett Web Developer

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Friday, January 8, 2016

The Bride Price

The Bridal price is a quantity of gifts, property, an amount of money or other form of wealth that is paid by a groom or his family in many cultures to the parts of the woman he has married or is just about to marry. It can be used to help establish the new household and, in Africa, the bride price is taken very seriously. Bride price must be valid before the couple are granted permission to marry in the church or civil ceremonies. The bride has no say in the bridal list, and in most cases in Nigeria the wife commits social suicide by marrying a man of a lower income than her. In continuous the bride’s family may pity the grooms, or whomever is paying by cutting the list. In the Yoruba tribe, when a groom’s family pays a certain amount of money depending on how rich they are, the bride’s family returns the money later on, as they believe they are not selling their daughter and so don't accept the money.

An idea of a bride price in Nigeria differs between the different cultures. In the Yoruba culture, bride lists often consist of:

  • 42 Bitter kolas (Orogbo)

  • 42 pieces of dried Fish (Eja Osan1 Dish of peppered corn meal (Aadun)

  • 4 Crates malt soft drinks

  • 1 Bag of salt

  • 1 Bag of rice

  • 1 Umbrella

  • 1 Goat

  • 1 Big suitcase containing clothes, shoes and handbags including aso-oke fabric, 2 sets of lace with gele and 2 sets of ankara, 1 Wrist watch, Earrings and Chains.

  • Engagement rings for bride and groom

  • Bible(for Christians).

  • Quran, praying mat, praying kettle, rosary, white hijab, veil and tasbir (for Muslim weddings)

In the Igbo culture there are 4 categories in the Igbo bridal price:
  • Gifts for the UMA-ada: Gift for the grown daughters in bride extended family.i.e shoes and bags (assorted colours and designers), drinks and jewellery etc.
  • Gifts for the Umuna: Gifts for the male heads of the extended family of the bride to be i.e kola nuts, a goat, tobacco stuff and palm wine  (in gallons/Jerry cans)\
  • Nmepe Uzo (general gifts): “to open the door”. i.e 5 sets of   (George or Abada such as Vlisco Hollandaise, ABC,  Nigerian wax),  Igbo style lace blouses and kerosene etc
  • Cash gifts (during the Ime-Ego/Bride price ceremony): Symbolic cash gifts, the groom and his family may or may not negotiate each one down. i.e: Money for in-laws (ego-ogo cherem)- N50,000 (ogo cherem basically means ‘in-law, wait for me’ , Lump sum cash (ogwe-ego)-N5,000 etc.

The Hausa traditional marriage is mostly fixed on Islamic rites and not as time consuming or expensive like the Igbo tribe and Yoruba tribe traditional marriage ceremonies.

Most of these lists have been enhanced. A lot of unnecessary things have been added  to bridal lists, but do we really need all these things? Is this right? The message of the bride price is being lost in today’s world; we are erasing our forefathers culture, our culture. Who do we blame: the bride’s family for their prolonged list of things from all ends of the world? I personally witnessed a bridal list from my uncle’s wife, the list went on for days. 

I wondered if she wanted to open a shop with all the items i.e 65 packs of juice. I also heard a story of a man that paid N2.5 million, which is around £8,600. Afterwards he bought the wedding materials for all the relatives, from the mother and father, down to the uncle, aunts,sisters and cousins including the nephews. He also funded  two family members for their school and businesses. Even after the wedding the family’s list still continued, the father asked for the latest Mercedes Benz  while the mother asked for a full stock for her mini market. A lot of stories are based on that story, some stories even worse. 

The bride price which has been a ritual part of Nigerian weddings has evolved and now is so horrendous. We could say that the ‘Bride Price’ has been a way of showing respect to your wife's family. ‘The bride price’ has been a part of a lot of weddings all around the world. The woman would bear the man children in the near future who will pass down the family name and I suppose the bride price also has to do with some kind of gratuity by the man to the woman's  parents, something like "thanks for bearing me a beautiful woman who shall now become my wife.”

In some countries, like India the woman pays ‘the bride price”. They believe that the woman should pay the ‘bride price’ for she  would be having the privilege of enjoying her husband's wealth and properties. The bride will be living in her husband's  house. And she will benefit  all the facilities. Furthermore, the bride will be relying  upon her husband's  income for the next years so, as a repayment, the bride's family must pay. Amazing logic, right? Well, if you lived 100 years ago, then yes. In some parts of india the tradition still continues. Some women feel honoured about the bride price, they feel it shows that the husband is capable of showing them that they can provide for the them and also the children they would eventually have in the near future. In my own opinion I also agree, bridal price is very relevant in marriages, however there are some ridiculous lists that I think we women should reduce, for love has no price. 

Ripples Foundation helps to empower women through micro-financing their small businesses and helping them earn their own living. This boosts the women's confidence and hopefully makes them see themselves as more than just “objects” or means of exchange. Most of the items on the list cannot be provided by those who live in the rural areas where we deliver our projects. By helping women in these villages we are able to help their children: children who would surely grow up and get married, especially boys, who are expected to pay the bride price. Ensuring that rural families are financially secure means that this tradition can continue without adding any stress or worry to families who simply want to see their children happily married. Check out our programmes via our website to see how we are empowering women, youths and communities in West Africa.

Have you seen any shocking bride prices? What do you think about this tradition? Please comment below - we'd love to hear from you!
Stephanie Phillips Web Developer

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Friday, January 1, 2016

Welcoming in the New Year and looking forward to 2016

So that's it - it's 2016! What a year it has been for Ripples Foundation, with many successful projects and plenty to look forward to in the coming year. We just can't wait to share our work with you all.

Whilst many countries take the coming of the New Year to reflect, many places have their own unique New Year traditions. Here are a few of our favourites!

1. "Auld Lang Syne", a song well known at new Year, is one of the most popular songs that nobody knows the lyrics to. The title literally translates as "old long since" and means "times gone by". The song asks whether old friends and times will be forgotten and promises to remember people of the past with fondness, "for auld lang syne, we'll tak a cup o' kindness yet."

2. In Scotland, New Years Eve sees the Hogmanay celebrations take place. One widespread national custom is first-footing, which starts immediately after midnight. This involves being the first person to cross the threshold of a neighbour's house and giving a symbolic gift such as coal, shortbread, whisky and black bun (a rich fruit cake). This is supposed to set the luck for the upcoming year. Traditionally tall dark men are preferred as the first-foot.

3. In Japan, Buddhist temples strike their gongs 108 times as the clock hits midnight on December 31st in the belief that it will help man overcome 108 earthly temptations as he proceeds into the New Year and moves closer to 'nirvana' or salvation.

4. In Chile, taking a walk round the block with an empty suitcase before midnight is believed to make travel dreams in the New Year come true.

5. In Spain, it is traditional to eat 12 grapes at midnight on New Year's Eve, one for each of the clock's chimes. Each grape is meant to represent a different month, for instance: if the 3rd grape is a bit sour, March may be a bad month.

Have we missed any? Comment below if you know of any more interesting New Year traditions, we'd love to hear!

Happy New Year Everyone!

Alysha Bennett Web Developer

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