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Friday Sermon: Heart Transplant: A Testimony

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By Babatunde Jose

Organ transplantation is certainly one of the “miracles” of modern medicine and one of the most challenging scientific steps of the modern era. The ability to replace, functionally or anatomically, the failing heart has been a revolutionary medical feat and in December 2020 the world marked the 53rd anniversary of the world’s first human heart transplant: And on Sunday 28 March, 2021 our brother Ahmad Olayinka Jose had a successful heart transplant; becoming one of the less than 3500 would be recipients in the year.

Throughout most of history, the heart has been regarded as the seat of human emotion and, consequently, considered to be sacred. Now, human anatomy is much better understood and even though we know that the heart is not the center of emotions, it is however affected by them, alongside stress and many other factors. Nevertheless, the heart is an organ like any other and when some organs, including the heart, fail beyond medical treatment, there is an option to surgically replace them with healthy organs from donors. Hence, transplantation.

Many brilliant and ingenious doctors and surgeons have added their names to the annals of heart transplant history. Doctors such as Dwight Harken (an innovator in heart surgery who introduced the concept of the intensive care unit), Norman Shumway (a pioneer of heart surgery at Stanford University and the first to perform an adult human to human heart transplantation in the United States, 1968), and Christiaan Barnard (a South African cardiac surgeon who performed the world’s first human-to-human heart transplant operation) all dedicated their lives to understanding this incredible organ. Their contribution to the knowledge and practice of heart surgery has changed the outcome for many people with end-stage heart failure. American medical researcher Simon Flexner was one of the first people to mention the possibility of heart transplantation. In 1907, he wrote the paper “Tendencies in Pathology,” in which he said that it would be possible one day by surgery to replace diseased human organs.

The history of heart surgery spans more than a hundred years and has seen many challenges and triumphs, including the treatment of various congenital heart defects, the development of the heart-lung machine, animal, and artificial heart transplantation, and finally, human heart transplantation.

On December 3, 1967, 53-year-old Louis Washkansky received the first human heart transplant at Groote Schuur Hospital in Cape Town, South Africa. The Surgeon, Christiaan Barnard, who trained at the University of Cape Town and in the United States, performed the revolutionary medical operation based on the technique initially developed by a group of American researchers in the 1950s.

The development of immunosuppressant drugs, which help prevent the body’s rejection of transplanted organs, added impetus to the ultimate success of these surgical procedures. Today, the only factor that limits the number of people whose lives are saved by cardiac transplants is the availability of healthy heart donors.

After the first South African transplants in 1967 other transplants were performed around the world however, by June 1970, only 10 survivors could be counted among 160 transplant recipients. But that has changed considerably, though supply of organs remains the most persistent problem in the field of organ transplantation.

Heart transplants are done in people of all ages, even children. A routine heart transplant surgery can be performed in less than four hours, while some complex ones may take seven, eight, nine hours—or more, especially if there is need to remove a heart pump or clean up scar tissue from previous surgeries. Regardless, the basic procedure remains the same. The patient is given general anesthesia and connected to a bypass machine that takes over the heart’s function. Surgeons make an incision in the chest, divide the breastbone, and remove the diseased heart. They sew the donor heart into place and connect it to the remnants of the old heart and the major blood vessels.

But given today’s shortage of available organs, the sickest patients are prioritized for transplants, so, many patients waiting for a heart to become available are already in the hospital on various types of medicine or heart pumps.

United Network for Organ Sharing (UNOS), a private, non-profit organization under contract with the government to manage the organ transplant system in the U.S., allocates newly available hearts based on such priorities as medical urgency. Patients who are hospitalized or dependent on mechanical assist devices to help their heart function are at the top of the list.

About 3,500 people in the U.S. are waiting for a heart, and many will wait more than six months. But some will die before a heart becomes available to them.

Heart transplants would not be possible if it were not for the drugs that prevent people’s bodies from rejecting the transplanted organ. These drugs have vastly improved in the last 15 to 20 years. The drugs can however have adverse effects, including high blood pressure, as well as blood sugar and kidney problems: So, there is a trade-off. One notable advance is that doctors can now tailor an immunosuppression strategy for each patient.

One reason patient can now live longer after transplantation is close monitoring and follow-up, especially in the months after their surgery. This is most intense in the first six months after a transplant, when doctors see patients frequently.

Since the performance of the first human heart transplant in 1967, heart transplantation has changed from an experimental operation to an established treatment for advanced heart disease. Worldwide, about 3,500 heart transplants are performed annually. The vast majority of these are performed in the United States (2,000–2,300 annually).

Now the testimony: We give all thanks to Almighty God for putting a smile on our face today as we make a declaration of the successful heart transplant on our brother Ahmad Olayinka Jose. He was wheeled to the theatre on Sunday 28th March shortly after a matching heart was found. The operation started immediately after he had been fully prepared and placed under anesthesia and intubated. The operation which lasted four hours ended in the early hours of Monday 29th and he was transferred to the ICU. He was gradually extubated from Wednesday 31stand on Thursday April 1st he was fully extubated and started breathing on his own; Allah be praised! On Good Friday, April 2nd, he regained full speech and was able to make phone calls to his loved ones. He also started walking unaided. And behold last Tuesday, April 6, 2021, accompanied by a retinue of medical staff, Yinka went home; a new man albeit with a lot of dos and don’ts and immunosuppressant drugs which he would use for the rest of his life. May Allah make that life a long one. Yinka has lived with a problematic heart for 25 years and ten years ago, after he was given a pacemaker, the doctor warned that he might eventually need a transplant. This is Yinka’s story, a story for another day.

We thank the surgical team and support staff of Atrium Health Carolinas Medical Center, Charlotte, North Carolina, USA for a wonderful job. Most importantly, we thank Almighty God for His mercy. TO GOD BE THE GLORY!

“Our Lord! Give us good in this world and good in the Hereafter and defend us from the torment of the Fire!”(Quran 2:201)

As we start Ramadan 2021 next week, may Allah make it easy for us and accept our fast as acts of worship.

Barka Juma’at and happy weekend

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Senate Approves Tinubu’s ₦1.77trn Loan Request

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The Senate has granted approval to the ₦1.77 trillion ($2.2b) loan request of President Bola Tinubu after a voice vote in favor of the request.

The Senate presided by Deputy Senate President, Barau Jibrin, approved the loan after the Senate Committee on Local and Foreign Debts chaired by Senator Wammako Magatarkada (APC, Sokoto North) presented the report of the committee.

The request which was submitted by the President on Tuesday is part of a fresh external borrowing plan to partially finance the N9.7 trillion budget deficit for the 2024 fiscal year.

Tinubu had on Tuesday written to the National Assembly, seeking approval of a fresh N1.767 trillion, the equivalent of $2.209 billion as a new external borrowing plan in the 2024 Appropriation Act.

The fresh loan is expected to stretch the amount spent on debt servicing by the Federal Government. The Central Bank of Nigeria recently said that it cost the Federal Government $3.58 billion to service foreign debt in the first nine months of 2024.

The CBN report on international payment statistics showed that the amount represents a 39.77 per cent increase from the $2.56bn spent during the same period in 2023.

According to the report, while the highest monthly debt servicing payment in 2024 occurred in May, amounting to $854.37m, the highest monthly expenditure in 2023 was $641.70m, recorded in July.

The trend in foreign debt servicing by the CBN highlights the rising cost of debt obligations by Nigeria.

Further breakdown of international debt figures showed that in January 2024, debt servicing costs surged by 398.89 per cent, rising to $560.52m from $112.35m in January 2023. February, however, saw a slight decline of 1.84 per cent, with payments reducing from $288.54m in 2023 to $283.22m in 2024.

March recorded a 31.04 per cent drop in payments, falling to $276.17m from $400.47m in the same period last year. April saw a significant rise of 131.77 per cent, with $215.20m paid in 2024 compared to $92.85m in 2023.

The highest debt servicing payment occurred in May 2024, when $854.37m was spent, reflecting a 286.52 per cent increase compared to $221.05m in May 2023. June, on the other hand, saw a 6.51 per cent decline, with $50.82m paid in 2024, down from $54.36m in 2023.

July 2024 recorded a 15.48 per cent reduction, with payments dropping to $542.50m from $641.70m in July 2023. In August, there was another decline of 9.69 per cent, as $279.95m was paid compared to $309.96m in 2023. However, September 2024 saw a 17.49 per cent increase, with payments rising to $515.81m from $439.06m in the same month last year.

Given rising exchange rates, the data raises concerns about the growing pressure of Nigeria’s foreign debt obligations.

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DIAMED CENTRE: Kesington Adebutu is a Father in a million – Daughter, Abiola Olorede

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By Eric Elezuo

A United States and United Kingdom trained prolific doctor, Dr. Abiola Olorede, the first daughter of accomplished businessman and renowned philanthropist, Sir Kesington Adebukunola Adebutu, is not a run-off-the-mill medical practitioner. She knows her onions, her worth and the mandate she is programmed to fulfill.

She is the Chief Medical Director of the just opened DIAMED CENTRE, a fully equipped diagnostic and medical facility saved with the responsibility of catering to the medical needs of the Nigerian public.

The hospital, which was built and handed over to her by her philanthropic father, is located at Kuboye Street, in the heart of Lekki Island, Lagos.

In this brief chat, the achiever, who lived most of her educational life in Dublin, Poland, expressed her gratitude to a father like no other, and how she and her team intends to make the best of the facility and equipment to totally affect humanity for the better.

Excerpts:

CAN YOU TELL US THE IDEA BEHIND THIS GREAT PROJECT?

Thank you very much, my name is Abiola Olorede, I am a medical doctor by profession. I schooled in Dublin, worked in the United Kingdom and in United States of America. When I came back home to Nigeria after my education including postgraduate studies, I realized that one of the major challenges is that a lot of the diagnostic tools that we need to use for evident-base treatment of our patient were lacking. Since then, I have always had a dream that when i am able to afford it, I will like to have a place that Nigerians can go to as comparable as those round the world because, just as I have always spoken about it, every Nigerian should have any treatment obtainable anywhere in the world in their home country.

CAN I DEDUCE THEREFORE, THAT YOU INTEND TO STOP MEDICAL TOURISM BY ESTABLISHING THIS ALL INCLUSIVE MEDICAL CENTRE?

Hmmm…Intend to stop is a very big word. I am hoping by the service we would offer here, a lot of Nigerians will see it as comparable to anywhere in the world and would want to use it instead of going out of the country. So, a lot of people that go out of the country can benefit from world class treatment in Nigeria.

SO OUT OF ALL YOUR DAD’S PHILANTHROPIC GESTURES, HOW DOES THIS ONE MAKE YOU FEEL?

If you noticed, the Kensington Adebutu Foundation, KAF, as it is fondly referred to, has major pillars and that’s education and health. It does a lot of other projects no doubt. I know that in any society, if the people are not educated, it’s a big loss to the country, if you don’t have the healthy workers too, it’s a big loss. So this brings out much of my pride in the service of Nigeria.

AS A PROUD DAUGHTER, WHAT MORE COULD YOU SAY ABOUT YOUR FATHER?

First of all, I would like to thank him. I tell everybody that he is father in a million. He supported his children over the years, financially, and with wisdom. I’m going up to 60, and my father still supports me pursue my dreams; it’s very rare. I want to thank him from the bottom of my heart. He’s always there, so thank you dad, you are a wonderful dad.

CAN YOU JUST ANALYZE THE KIND OF EQUIPMENT WE HAVE HERE?

We have a lot of facilities that are available, we have 3D monogram, it gives better images, and it’s less painful when you do that. We also have 64 high CT scan, digital X-rays, a lab, Haematology, Dialysis department, Dental suite, Opthalmology and Physiotherapy. We have a fully functional Pharmacy; so it’s like a one stop shop.

We have a Cardiac Suite where you can do ECO and other tests. We engage patients morning to night, make them comfortable as they get their test done. We don’t want you to feel you are in a hospital premises; you come from home and get all your test done.

WHAT DO YOU PROMISE NIGERIANS USING THIS FACILITY?

I promise Nigerians is that only experts, who will give the right diagnosis will be engaged here so we can give world class treatment and service. We want to use evidence and innovations to manage patients. Those are our promises to Nigerians and others as an organization and God will help us deliver all these promises.

AND HOW AFFORDABLE IS IT TO PATRONISE THIS PLACE?

We would try to make it cost effective in as much as medical care is not cheap. I tell people that being healthy is cheaper that being sick and that’s true, and that’s what we hope to accomplish. It is difficult to maintain some of this machines, some of them are very expensive so we must be able to recoop cost to get and replace equipment when due.

Thank you doctor Abiola, you have been very helpful and I wish you well in the management of this facility to the best interest of Nigerians. God bless you ma.

The pleasure is mine

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The Independence of the Judiciary in a Democratic Dispensation (Pt. 4)

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By Mike Ozekhome

Introduction

In the last part of this intervention, we examined the abuse of ex-parte orders as part of our survey of the independence of the judiciary. We then moved on to political pressures exerted on the judiciary. We continues with this theme today and extend economic/fiscal pressures which undermines judicial independence. We shall also x-ray the intellectual dimensions of the judicial remit as well as the relevant legal codes for their appointment. Come with me.

 

POLITICAL INDEPENDENCE (continues)

The duty of maintaining a Judiciary that is free from political influence, an independent and impartial Judiciary in line with section 17(2)(e) of the 1999 Constitution, rests on the honourable men and women on the bench, the political class, the other two arms of government and all and sundry. An independent Judiciary that inspires confidence is a sine qua non for sustainable democracy. Judges have a special role to reject any attempt to undermine the independence of the Judiciary in this dispensation. It is sacred! The admonition of Hon. Justice (Prof.) A.F.D. Kuti in this wise is instructive.

“Of course, judges make laws by interpretations, as judges, by nature and training do not succumb to partisan considerations they are political, they should be abstinat a fabia. They must not allow themselves to be torn apart by any form of differences in our societies… The judges have a duty to chart an independent course and let it be known that the independence of (the) judiciary is of vital importance to the democratic process to maintain Human Rights Provisions and to maintain the non-adoption of sate Region… The Judiciary itself must be like Cinderella living in a glass house, above board like Caesar’s wife, also above suspicion”.

Economic/Fiscal Independence

It is a trite warfare strategy that the easiest way to weaken an army and overrun it is to cut off its supplies and starve it. Vital in the question of independence of the Judiciary is the issue of fiscal autonomy, and proper funding. As soon as we institutionalize the practice of judicial officers going cap in hand to beg for funds from the Executive, the idea of independence of the Judiciary has been trampled upon and blown into smithereens! Independence must involve economic ‘self-reliance’ and fiscal autonomy. By these, we mean that the Judiciary under this dispensation should always be able to have the funds due to it constitutionally falling directly to it without having to approach the Executive for any form of lobbying before funds can be released to it. The Constitution has substantially taken care of this area. It only remains for the frontiers of fiscal autonomy to be widened so that the Judiciary, (especially State Judiciaries) would be able to carry out capital projects so as to maintain befitting physical infrastructure for the Judicial institution. Agbakoba has argued that:

“Judicial Independence is meaningless if it is not accompanied by economic independence. Dishonest judicial staff has no credible claim to judicial independence. It is necessary to take steps to ensure that judges and magistrates can enjoy a professional status capable of guaranteeing them the required amount of professional independence coupled with an adequate remuneration package that can effectively isolate them from pecuniary pressures.”

In Nigeria and under this democratic dispensation, some jurisdictions have had to contend with dilapidated office buildings, inadequate supplies and regular power outages. Starvation of funds is a weapon used by the Executive, the keeper of the Federation purse, to achieve a balance of judicial power by giving judicial officials a sense of economic/fiscal dependency.

To stave off starvation of funds, many countries have had to increase budgetary allocations significantly in favour of the judiciary both to provide adequate physical facilities and to allow for the continuing education of judges, magistrate and their staff. In some cases, as in Madagascar, this new approach has resulted in the establishment of a school solely dedicated to the training of judicial personnel.

The poor state of fiscal ability of the Judiciary in Nigeria today aptly depicts the observation of the Federalist, Alexander Hamilton that:

“The Judiciary is beyond comparison the weakest of the three departments of power. It has no influence over either the sword or the purse; no discretion either of the strength or the wealth of the society; and can take no active resolution whatever. It may be said to have neither FORCE NOR WILL, but merely judgment.”

Although the salaries and recurrent expenditures of the Judiciary are constitutionally charged upon the Consolidated Revenue Fund, it does not appear that the Constitution specifically ensures the provision for the capital expenditure of the Judiciary. This is another ploy to still keep the Judiciary low and check its ferocity in holding the balance over government excesses. There are other pockets of ploys and half-truths.

It has, for example, been argued from the Bench that the concept of accountability has often been relied upon to justify restricting the administrative independence of the Judiciary. The Executive must, in this democratic dispensation, allow unfettered fiscal independence for the judiciary by freeing its funds from all restrictions so that judges do not have to continue to go to the Executive to seek for funds for capital projects and recurrent expenditure or extra budgetary expenses.

Judicial accountability, in fact, complements and reinforces judicial independence by creating the public confidence on which judicial independence ultimately depends. There is no gainsaying that the point is sometimes made that in relation to their judicial functions, judges are subject to a higher degree of accountability and transparency than any other public officers, or even with the present democratic dispensation, than indeed any holder of political office, be they ministers or special advisers or chairmen or members of parastatals.

It has also been argued from the Bench that financial independence of the Judiciary can only be guaranteed where the ‘order’ allows physical projection and administrative control of finances by officers accountable to the Judiciary.39 The notion of Independence of the Judiciary would remain mere rhetoric without complete fiscal autonomy for the Judiciary.

Intellectual Independence

This subhead is used here in a technical sense as an issue of judicial independence. But, it can best be described by the story in the Bible of Israel’s sojourn in the land of Egypt. A wicked king that hated the Hebrews and was afraid of their independence and prosperity had given an instruction to midwives in this manner,

“When ye do the office of a midwife to the Hebrew women….if it be a son, then ye shall kill him but it if be a daughter, then she shall live…Every son that is born ye shall case into the river, and every daughter ye shall save alive.”

Pharaoh preferred Hebrew females because he was afraid of male power in the event of war with the Hebrews. The same stratagem has been employed to destroy the intellectual vibrancy of the judiciary so as to weaken its independence. The calibre of judges that can stand their ground against assault on judicial independence are those imbued with high independent, incorruptible and analytical mind laced with profound intellectual fecundity. While the High Court Bench has a mixed multitude of judges, the Court of Appeal and the Supreme Court are filled with such high calibre of intellectually vibrant and independent-minded justices. This would explain why the Court of Appeal and the Supreme Court have not only set impressive records of independent-mindedness and incorruptibility. Those two courts can hardly be faulted in the area of independence and absence of external influence. The problem of intellectual freedom mainly lies at the High Court Bench, and the lower benches.

Appointment

By virtue of section 250(3), 256(3) and 271(3) Constitution of the Federal Republic of Nigeria 1999, a person shall not be qualified to hold office of Chief judge or a judge of the Federal High Court, Chief Judge or a judge of the High court of the Federal Capital Territory and a judge of a High Court of a state, respectively:

“Unless he is qualified to practise as legal practitioner in Nigeria and has been so qualified for a period of not less than ten years”.

We are not really concerned here about the procedure for appointment of High Court judges. What has threatened the system with collapse is the bare assumption in these constitutional provisions that tends to imply that once a person has spent ten years on earth since he/she was called to the Bar, the person automatically has all the intellectual capability to be appointed a judge.

More than anything else, judicial incompetence (encompassing law intellectually, law productively etc) has contributed to rob the Judiciary the necessary intellectual freedom it needs to assert and guard its independence. According to Schewart:

“The quality of justice….depends more upon the quality of the men who administer the law then on the content of the law they administer.”

In his keynote address at the recent Bar Conference at Enugu, Chief Afe Babalola, SAN, observed on the constitutional qualification for appointment as a judge as follows:

“This allows great latitude for the appointment of ‘any lawyer’ who has met the ten years requirement regardless of where he is prior to his appointment. This explains why a new wig from the Nigerian Law School who, immediately after his call (and probably Youth Service) went straight to work in a company, multinationals and the life without any experience whatsoever in practice could be and are being appointed as High Court Judge”.

At the swearing in of the new Senior Advocates of Nigeria on Monday, September 8, 2003, the Honourable Attorney-General of the Federation and Minister of Justice, Chief Akin Olujinmi, SAN hinted that more stringent criteria for appointment of judges would be introduced. According to the Chief Law Officer of the Federation:

“We will propose that only those who can furnish evidence of contentious cases they handled in the Supreme Court, Court of Appeal and the High Court within, say, three years preceding their application should be considered for appointment. By so doing, it will be possible to select only seasoned practitioners to occupy positions on the Bench.” (To be continued).

Thought for the Week

“I believe that an independent judiciary is the crown jewel of our constitutional republic. Brett Kavanaugh”. (Charles Evans Hughes).

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