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Friday Sermon: Al Jannatul Firdous: An Excursion in the Afterlife 2

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By Babatunde Jose

Many sources agree that paradise has “various degrees and levels”. The Holy Prophet (SAW) was once credited to have assured the mother of a martyr: “O Umm Haritha, there are gardens in Paradise … and your son has attained the highest, Firdaus”, indicating a hierarchy of levels. But he did not say how many levels there are.

Scriptural suggestions allude to the fact that there are many levels of Jannah and not all the locations of paradise and hell are easily discernible or indeed mutually reconcilable.

For example, Q.23:17 states: “We created above you seven paths (Ṭarā’iq)”, from which is drawn a heaven of seven tiers, “a structure familiar to Middle Eastern cosmogony since the early Babylonian days”.

Some descriptions of Jannah/the Garden indicate that the most spacious and highest part of the Garden is Firdaus which is directly under the Throne, and the place from which the four rivers of Paradise flow.

Another possibility is that there are four separate realms of the Garden, of which either Firdaus or Eden is the uppermost. This is based on Surah 55, which talks about two Gardens: But for such as fear the time when they will stand before (the Judgment Seat of) their Lord, there will be two Gardens. (Quran 55:46)

Here two Gardens are mentioned, and indeed they are four, counting the other two mentioned in Sura 55:62-76. Opinions are divided about this, but the best opinion is that the two mentioned in verses 46-61 are for the degree of those nearest to Allah. And those in verses 62-76 for the Companions of the Right Hand.

According to one source only God knows the exact number of the levels of Paradise.

Two verses of the Quran (Q.7:40, 39:73) mention “gates” or “doors” (using the plural form) as the entrance of paradise, but say nothing about their number, names, or any other characteristics.

“To those who reject Our signs and treat them with arrogance, no opening will there be of the gates of heaven …” (Q.7:40)

“And those who kept their duty to their Lord (Al-Muttaqoon – the pious) will be led to Paradise in groups till when they reach it, and its gates will be opened” (Q.39:73)

In traditions, the highest level is known as Firdaus (sometimes called Eden) or Illiyin. Entrants will be greeted by angels with salutations of peace, As-Salamu Alaykum.

Notably and contrary to many ideas on heaven, God (Allah) does not reside in paradise.

Life after death takes two forms: a life in Paradise for those in whom their good deeds preponderate over the evil and a life in hell for the evil doers.

As to those who believe and work righteous deeds, they have, for their entertainment, the Gardens of Paradise, (Quran 18:107)

The description of Paradise as a garden with flowing rivers is a parable or a likeness and not an actuality as we know it here.

Inside there will be neither too much heat nor bitter cold; there will be fountains (Q.88:10), abundant shade from spreading tree branches green with foliage (Q.53:14-16, also Q.36:56–57). They will be passed a cup (Q 88:10–16) full of wine “wherefrom they will get [no] aching of the head” (hangovers) [Q.56:19], and “which leads to no idle talk or sinfulness” (Q.52:23), and every meat (Q.52:22) and trees from which an unceasing supply of fruits grow (Q.36:56–57), “that looks similar ˹but tastes different˺”;(Q.2:25) adornment with golden and pearl bracelets (Q.35:33) and green garments of fine silk and brocade (Q.18:31); attended upon by [ghulman] (Q.52:24), servant-boys (eternal youths (56:17, 74:19)) like spotless pearls (Q.52:24).

 The Quran explains: The parable of the Garden which the righteous are promised! –Beneath it flows rivers: Perpetual is the enjoyment thereof and the shade therein: Such is the End of the Righteous; and the End of Unbelievers is the Fire. (Quran 13:35)

Now no person knows what delights of the eye are kept hidden (in reserve) for them–as a reward for their (good) Deeds. (Quran 32:17)

The prophet (SAW) said: “Allah says I have prepared for my righteous servants what no eye has seen, and no ear has heard, and what the mind has not conceived.” Bukhari

The fruits of Paradise, whatever the names mentioned, are not the fruits of this life. Similarly, is the case with the rivers of water, milk and honey all of which are plainly spoken of as a parable; the thrones, cushions, and carpets; the ornaments, bracelets and silk robes, are not things of this world and only serve to perfect the picture of the happiness of man as his sense are incapable of perceiving these things. They are only a likeness as is explained in the Quran.

The resurrection means quite a new life and new order of things, a new heaven, and a new earth. Paradise extends over the whole of heaven and the universe:  Be quick in the race for forgiveness from your Lord, and for a Garden whose width is that (of the whole) of the heavens and of the earth, prepared for the righteous, (Quran 3:132)

The prophet (SAW) was asked, if Paradise encompasses all the universe, where then is Hell; he replied: Where is the night when the day comes?  This shows that Paradise and Hell are more like two conditions.

Watchful preparation in Life, and the light of faith, which reflects the divine light are matters of personal life and cannot be borrowed from another. So, in Christ’s ‘Parable of the Ten Virgins (Matt. 15:1-13), when the foolish ones had let their lamps go out for want of oil, they asked to borrow oil from the wise ones, but the wise ones answered and said, “Not so; but go ye rather to them that sell and buy for yourselves”.

The wall will divide Good from Evil. But the Gateway in it will show that communication will not be cut off. Evil must realize that Good-i.e., Mercy and Felicity-had been within its reach, and that the wrath which envelops it is due to its own rejection of Mercy.

It is in this vein that those who have conspired to make our lives miserable in this country will find themselves on the other side of the Resurrection divide. These include, the 10 percenters: Embezzlers, outright raiders of the Exchequer, subsidy racketeers, kidnappers and the wreckers of our economy, including the Dasukites.

As noted earlier, the things mentioned about Paradise are not the things of this world. It is therefore, with the same end in view that mention is made of the company of men and women in that state to which sensually minded people have attached a sensual significance.

This is the root of the misconception of ‘women in Paradise’. Nowhere in the Quran is it suggested that there would be a sexual orgy between men and women in Paradise. This idea is a figment of the lustful imagination of depraved minds who think of part of the pleasures of paradise as having sexual intercourse with young virgins. Perish the thought. Like they say, ‘dead body no de smoke’. The Quran makes no such promise. The wives of the righteous are mentioned as accompanying their husbands in paradise as co-beneficiaries of Allah’s Grace:

They and their associates will be in cool groves of (cool) shade, reclining on Thrones (of dignity); (Quran 36:56) See also (Quran 40:8)

According to the Quran concerning women in Paradise, we read: We have created (their Companions) of special creation.  And made them virgin pure (and undefiled), Beloved (by nature), equal in age, For the Companions of the Right Hand. (Quran 56:35-38)

What is true of women is also true of children in Paradise. Round about them will (serve) youths of perpetual (freshness), (Quran 56:17)

And those who believe and whose families follow them in Faith, –to them shall We join their families: Nor shall We deprive them (of the fruit) of aught of their works: (yet) is each individual in pledge for his deeds. (Quran 52:21)

Literally, progeny, offspring, family; applied by extension to mean all near and dear ones. Love is unselfish, and works not merely, or chiefly, for self, but for others; provided the others have faith and respond according to their capacities or degrees, they will be joined together. Even though on individual merits their rank might be less.

As already noted, though the love poured out by Prophets, ancestors, descendants, friends, or good men and women, will secure for their loved ones the enjoyment of their society, it is an indispensable condition that the loved ones should also, have shown their faith and their goodness in deeds.

Each individual is responsible for his conduct. You cannot ride on the good deeds of loved ones, parents and so on to enter the kingdom. Your own good works must speak for you.

Allah hath promised to Believers, men and women, Gardens under which rivers

flow, to dwell therein, and beautiful mansions in Gardens of everlasting bliss.

But the greatest bliss is the Good Pleasure of Allah: That is the supreme felicity. (Quran 9:72)

The ultimate goal of Paradise is our meeting with God. And that life is above all corporeal conceptions.

“…Our Lord! Perfect our Light for us and grant us Forgiveness: For Thou hast power over all things.” (Quran 66:8) 

 The true joys of Paradise are thus really the true joys of advancement in righteousness.

The truth is that only the righteous shall experience paradise, and we pray to be counted among them; including our departed ones: Amin.

Barka Juma’at and a happy weekend.

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Friday Sermon: Israel’s Unforced Error in the Destruction of Gaza

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By Babatunde Jose

One man of you shall chase a thousand: for the LORD your God, he it is that fighteth for you, as he hath promised you. (Joshua 23:10) “And they utterly destroyed all that was in the city, both man and woman, young and old, and ox, and sheep, and ass, with the edge of the sword.” (Joshua 6:21).

This is the scenario being played out in Gaza but being denied by the Israeli high command. It is purely genocide by no other name.

In the days of old in Apesin village, a thief was tied to the stake early in the morning and people going to the market all saw him and abused him with hisses and condemnatory remarks. On their return in the evening, they were astounded to still meet the thief tied to the stake. To them it has become overkill. They started raising questions: What did he steal? Is it not ‘common’ goat? Must he be killed because he stole…….? This narrative exemplifies the current public opinion on the Gaza issue. In short, the punishment is seen as very disproportionate to the crime.

The central slogan of the war in Gaza is ‘Together we will win!’, to which the governing Israeli right automatically adds ‘with God’s help’, giving the conflict with Hamas a religious dimension.

At a press conference in Tel Aviv on 28 October 2023, and in a letter of 3 November to IDF soldiers that praised their ‘fight against the murderers of Hamas’, Binyamin Netanyahu quoted from the book of Deuteronomy (25:17): Remember what Amalek did unto thee by the way, when ye were come forth out of Egypt; how he met thee by the way, and smote the hindmost of thee, even all that were feeble behind thee, when thou wast faint and weary; and he feared not God. Therefore, it shall be, when the LORD thy God hath given thee rest from all thine enemies round about, in the land which the LORD thy God giveth thee for an inheritance to possess it, that thou shalt blot out the remembrance of Amalek from under heaven; thou shalt not forget it.

Although such language aims to give the conflict a religious gloss, it predates the reaction to the Hamas atrocities of 7th October. The Israeli authorities have used this sort of rhetoric for several years, albeit less overtly.

Testimony from an officer of the Golani infantry brigade published by Breaking the Silence, an organization of veteran soldiers opposed to the occupation of Palestinian territories, exemplifies this: during Operation Cast Lead in 2008-09, the IDF’s chief rabbi Avichai Rontzki urged the soldiers of ‘God’s army’ to show no mercy towards the enemy, invoking the wars of conquest in Canaan, the Promised Land.

And in 2014, during Operation Protective Edge in Gaza, General Ofer Winter, commander of the Givati infantry brigade, wrote in an official dispatch, ‘History has chosen us to spearhead the fighting against the terrorist Gazan enemy which abuses, blasphemes, and curses the God of Israel’s [defense] forces.

In 2003, Matti Steinberg an expert on Palestinian issues was summarily dismissed because he had gone against government policy by criticizing Prime Minister Ariel Sharon’s outright rejection of the peace initiative that Saudi Arabia put forward at the March 2002 Arab League summit in Beirut. This plan, which remains the Arab League’s official position, offered normalization of relations between Israel and its Arab neighbors in exchange for Israel’s complete withdrawal from the Palestinian territories it occupied in June 1967.

In addition, Steinberg had questioned the targeted killings of Palestinian leaders; but above all he felt the government was putting the country’s future at risk by looking at the Palestinian question merely in terms of security. In his view, only the creation of an independent Palestine would allow Israel to remain both a Jewish and democratic state. Now a respected academic, Steinberg has continued to voice his opinions over the last two decades.

The current aim of Israel is to freeze the diplomatic process, freeze the political process, and prevent the establishment of a Palestinian state and also prevent a discussion on the subject of refugees, return of the same to their former abode and talks on borders. However, with the current acts of genocide and wanton wholesale destruction of Gaza, the whole strategy has become an unforced error.

US Secretary of State Antony Blinken warned Israel not to reoccupy Gaza, to refrain from a major Rafah operation, and to finalize a day-after plan for the enclave; he spoke to reporters during his visit to Kyiv. “When it comes to the future of Gaza, we do not support and will not support an Israeli reoccupation,” Blinken said, but this is exactly the game plan of Netanyahu.

It would be clear that Israel does not have a day-after plan, a step that had only prolonged the military conflict in the enclave. The open secret is that Israel wants to seize the Palestinian land and annex it.

The world should ensure that Israel will not establish civilian control over the Gaza strip, nor establish military governance in Gaza. And if they are not disposed to Hamas rule in Gaza, a governing alternative to Hamas in Gaza should be raised immediately. Afterall Hamas is an Israeli creation used to supplant Fatah.

In an interview with CNBC, Netanyahu stressed that once the war is over, Gaza should be governed by a “non-Hamas civilian administration,” but the IDF would retain military responsibility. What exactly is the meaning of that?

It is not possible to put in place a local alternative to Gaza, as long as Hamas remains there, he said. Therefore, millions of Gazans should be displaced, and thousands killed, particularly children and women, in order to flush out the 4 battalion Hamas troops in the Gaza Strip. How many months will it take to achieve this? Unfortunately for the Israelis, every Gazan is Hamas, even the children who are currently the victims of the genocide. The situation in the last eight months has swayed opinion against Israel.

In his interview with CNBC, Netanyahu stressed in particular his position on Palestinian statehood, which, coming in the aftermath of the Hamas invasion of Israel on October 7, he said would be a reward to terror.

The US has said it wants Israel to promise to leave Gaza once the war is over and support Palestinian statehood. The “two-state solution that people are talking about, basically would be the greatest reward for the terrorist that you can imagine,” Netanyahu said.

“It would be a state that would be immediately taken over by Hamas and Iran. And it wouldn’t advance the purposes of peace. It would just be a launching ground for a future war against Israel,” he said.

As the matter stands therefore, Israel is against Palestinian statehood and the United States knows that. All the shuttle diplomacy and long talks about the war in Gaza are mere transparent sham and the ruse of Two-State solution an opaque sham. It is therefore left to the Arab neighbors to gird their loins and find a lasting solution to the 75-year-old Palestinian question.

A two-state solution on the formula of the partition of India in 1947 that led to the creation of West and East Pakistan, might be a feasible solution. Hence, we would have West Palestine in present Gaza and East Palestine comprising present West Bank.

The question also arises, who will rebuild the Gaza Strip? The United Nations must step into the matter to make the State of Israel pay reparations that would help pay for the rebuilding of the infrastructure it destroyed in Gaza, just as Germany was made to pay after the First World War. Israel must not escape paying reparations for the present orgy of destruction in Gaza.

Egypt says it will formally join the case filed by South Africa against Israel at the International Court of Justice (ICJ), which accuses Israel of violating its obligations under the Genocide Convention in its war on the Gaza Strip.

The Egyptian Ministry of Foreign Affairs said last Sunday that Cairo intended to join the case due to escalating Israeli aggression against Palestinian civilians.

Egypt will join Turkey and Colombia in formally requesting to join the case against Israel. This month, Turkey said it would seek to join the case after Colombia asked the ICJ last month to allow it to join to ensure “the safety and, indeed, the very existence of the Palestinian people”.

Egypt said it is calling on Israel “to comply with its obligations as the occupying power and to implement the provisional measures issued by the ICJ, which require ensuring access to humanitarian and relief aid in a manner that meets the needs of Palestinians in the Gaza Strip”.

It also demands that Israeli forces do not commit any violations against the Palestinian people. This is exactly the demand made by the American President when he threatened to stop further arms shipment to Israel.

Egypt is the cornerstone of Israel’s standing in the Middle East. The connections that Israel has in the Middle East and North Africa today, including with Jordan, the UAE and Morocco, are all “a result of what Egypt did 40 years ago”, referring to the 1979 peace treaty between the two countries.

“With Egypt joining South Africa now in The Hague, it’s a real diplomatic punch. Israel would have to take it very seriously.

Israeli Prime Minister Binyamin Netanyahu said the Rafah offensive was needed to defeat Hamas. However, it is now 8 months the genocide started, and it has not defeated Hamas. It is clear, Israel is not after Hamas but the Palestinian territory of Gaza. Will the world allow that to happen? Videbimus.

It is said that ‘Malu ti’o niru. . .. . a cow that has no tail. . ..’ . A word is enough.

All is not lost, it shall be well with Palestine, In Sha Allah.

Subhana Rabbika Rabbil ‘izzati ‘amma yasifun, Wa salamun ‘alal-Mursalin, Wal hamdu lillahi Rabbil ‘alamin: Thy Lord is Holy and clear of all that is alleged against Him (by the non-believers); and He is Exalted.

Barka Juma’at and a happy weekend.

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Friday Sermon: Reflections on Death and Reminiscences: We Are Not Many Left

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By Babatunde Jose

“Sorrow is part of the earth’s great cycles, flowing into the night like cool air sinking down a river course.

To feel sorry is to float on the pulse of the heart, the surge from living to dying, from coming to being to ceasing to exist. Maybe this is why the earth has the power over time to wash sorrow into a deeper pool, cold and shadowed. And maybe this is why, even though sorrow never disappears, it can make a deeper connection to the currents of life and so connect somehow, to sources of wonder and solace.” – Kathleen Dean Moore

Reflecting on the inevitability of our death can help us snap out of the trance of taking the beauty and wonder of life and the universe for granted. It’s easy to put our heads down and focus on what’s in front of us, but memento mori can help us tune back into the astonishing beauty and majesty of life.

Death brings suffering to the body, the heart, and the mind. Therefore, the progressing loss of a loved one brings sadness, often despair and a deep pain which we wish to acknowledge for all who have loved another.

Death teaches us about the finiteness of life and time, and that the longer we continue to hold onto our past, the longer we continue to be burdened by things that will soon hold no value for us.

Death at root is a separation. In humans, it’s what happens when the physical body and the immaterial part of us (called the spirit or soul) separate. As James 2:26 puts it, “The body without the spirit is dead.” When people we love die, the rest of us feel separation too.

“When someone you love becomes a memory, the memory becomes a treasure.”

The Book of Maccabees says that it’s a healthy thing to pray for the dead and that, every so often, it’s healthy too to think about death, both by remembering those who have died and by contemplating the reality and certainty of our own deaths.

It was late Bob Marley who said ‘Good friends we have, oh, good friends we’ve lost, Along the way. In this great future, you can’t forget your past; So dry your tears, I say,  ..No, woman, no cry.

And indeed, there were good friends we had and good friends we lost, along the way in this journey called life. Reminiscing over these losses brings sweet and sad memories.

Among those good friends were Sikiru Akinpelu who died shortly after I returned from Port Harcourt, in the late seventies; Yemi Bakare a very good friend, (gone but not forgotten). And Isiaka Allison (Soku) with whom we rocked not only in Lagos but later in Manchester and then back to Lagos till he died shortly after his 70th birthday.

Professor Lateef Hussein and I were in UI and later in Manchester. He lived not far from my house in Charlton-Cum-Hardy, and we shared many evenings together. That friendship was continued when we both came back home, and he later became VC LASU. A gifted Quranic scholar and very jovial fellow, the Prof was an Abibu Oluwa fan till the end. We still miss him. May Allah grant them all, Jannatul Firdous.

In the university days, many friends were made in Great Ife courtesy of my frequent visits to my bosom friend DelFaj.  It was at Ife I met Onome Ibru whose death in an accident on the Lagos Ibadan Road brough untold grief and sadness to us.

Another friend at Ife was Doyin Akinyosotu (Tenko Lash, Aladan) who later became Chairman of the Ifesowapo local government at Ile Oluji, in Ondo State. He later died of cirrhosis of the liver.

Another Ife friend was the unbreakable Akin Fashakin, who passed away under mysterious circumstances in Lagos about 30 years ago. I used to enjoy his company during my many visits to Kano where he lived. But all that is now in the realm of reminiscences.

How can I forget Bob, (Ade Bombers), my friend, partner in crime and In-Law, Ade Owolade? From Ibadan to Swaziland and South Africa. The Hugh Masekela DVD (Time) he gave me is still much cherished. Ade died in a Pretoria hospital in 2005. May his soul continue to rest in peace. He was not only my in-law but ‘my cousin’, which was how we introduced ourselves to others.

Another good friend we had and lost was indomitable Dele Adeola, a very sociable and dependable friend. I remember the New Year parties in his place, our occasional lunch and travels to Ondo, Dubai, and many other places.

In that same group were Joe Alagbe, former Provost Marshal of the Air Force, Air Marshal Ibrahim Alfa and lately AVM Atto, who at a time succeeded Alagbe as Provost Marshal. All gentlemen officers. The Allen Avenue days will forever remain fresh. There was also our very own, Popo Akinyanju, a gentleman per excellence.

This reminiscences are by no means exhaustive. In the London scene were Ademola Elegbege, his wife Joko and then Dotun Animashaun (Ani Bongolo), Wasiu Elegbege (Ejo), Demola Bamgbala, Uncle Femi Ajasa in whose place late Yemisi, my life-long friend and companion, stayed on Blackstock Road N4, by the old Arsenal Stadium and his friend Mr. Ojobara (Mr. Baro). May their souls rest in peace. Lest we forget, Peju Odunsi of Chelmsford (Sister Donohue). Those were the good days.

Recently we lost Mustapha Abiodun Bashua, Wasiu Masha, Tunde Goodluck (Goodie), all of Ahmadiyya, Eleyele, Ibadan. Olu Dada and Damola Oluwole and before them Segun Adebo, Mexico, Tunde Alabi (Banana), Sola Odunubi, and of course, Toyin Ojibara.

Modele Williams, our very own ‘Emperor Modus’. Senator Muniru Muse, my friend, and prayers partner, every Juma’at for many years. And my inimitable Veronica Chaka, an Amazon, secretary, and convenor of our monthly Bosnia nights.

Demola and Tunde Fagbayi (Engine); unforgettable boat rides to Ilashe, Tarkwa, and the skiing, fishing, and overnight escapades at Tarkwa Bay. In this, we must not forget Segun Adesanya, my paddy man of blessed memory. And later his brother Femi.

In UI: Never to be forgotten Tunji Alamutu, my mentor; Tunji Awobadejo; my roommate, brother and friend, John Azukaego Jideonwo; Tunde Oloyede, Sir Tune. Soji Osoyintuyi, Rufai Ibrahim, all ‘Great Independents’ and our PRO, Yakubu Abdul-Azeez. Another classmate we lost was Professor Shina Sambo (Sambele).

My lecturer and friend who was instrumental in my going to Manchester, Dr Ajibola, ‘People’s Ajibs’. Unfortunately, he had died in an accident by the time I returned from Manchester. May his fiery soul rest in peace.

Lest we forget Tunde Adeyemi of Temples and Golders, late of Itamogiri, Ijebu-Mushin.

And of course, my cousin, Captain Tunde Ashafa. Definitely, not many of us are left.

We need to reflect and take good care of what is left, so that we may not be in loss. The Quran said, Wal‘aṣr, ’innal ’insāna lafī khusr(in) , ’il-la l-lzīna ’āmanū wa‘amilu ṣ-ṣāliḥāti watawāṣaw bilḥaq-qi watawāṣaw biṣ-ṣabr: 1. By (the Token of) Time (through the Ages), 2. Verily Man is in loss, 3. Except such as have Faith, And do righteous deeds, And (join together) In the mutual teaching Of Truth, and of Patience and Constancy. (Quran 103)

Our being is bound by time from birth to death. Reflect on death, remind yourself that you have a limited (even shorter than you think) time on this planet.

Philosophy itself is, in fact, a kind of “training for dying”, a purification of the philosopher’s soul from its bodily attachment. Thus, Socrates concludes, it would be unreasonable for a philosopher to fear death, since upon dying he is most likely to obtain the wisdom which he has been seeking his whole life.

According to an even more extreme view, life is made more meaningful by the recognition that it will end with death. According to this view, we gain a deeper appreciation for the common satisfactions of our everyday experience when we fully realize that someday we will die and will then have nothing at all.

In a sense, death is the ultimate purveyor of perspective. It helps us see trivial things for what they are—and face up to the fact that much of what we worry about and consume ourselves with isn’t so important after all. Reflecting on death can help us stop fretting about things that are outside our control.

Death is repeatedly compared with sleep, which is at times described as “the little death.” It is Allah that takes the souls (of men) at death; and those that die not (He takes) during their sleep: Those on whom He has passed the decree of death, He keeps back (from returning to life), but the rest He sends (to their bodies) for a term appointed. Verily in this are Signs for those who reflect. (Quran 39:42).

Death can come any minute; as a Muslim, live every moment in your life as if it’s the last, live with faith, hope, preparation, and bear in mind that there is no time for later.

Pray as if it’s your last time, read Qur’an as if it’s your last time reading it, worship your Lord as if it’s your last chance, cause one day, most certainly, it will be your last day!

Honest prayer can help us walk that tightrope and honest prayer is what we do when we can bring ourselves naked before God, unprotected by what we do, by what we own, by what we have achieved, and by anything else we have to fend off loneliness, fear, and death. In honest prayer we can be deep without being morbid.

We will conclude this sermon with late Abibu Oluwa’s admonition: Oku s’adua f’araiye, araiye s’adua r’ero orun. K’aye o yewa, k’orun o yewon; aw ana ‘nbo wa d’abi awon. Translate?

Barka Juma’at and a happy weekend.

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Friday Sermon: Sickle Cell Anaemia: A Revisit

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By Babatunde Jose

Nobody knows the trouble I’ve seen; Nobody knows my sorrow; Nobody knows the trouble I’ve seen; Glory, Hallelujah –  Song by Louis Armstrong

Sickle cell disease (SCD) is a group of inherited red blood cell disorders. Red blood cells contain hemoglobin, a protein that carries oxygen. Healthy red blood cells are round, and they move through small blood vessels to carry oxygen to all parts of the body. In someone who has SCD, the hemoglobin is abnormal, which causes the red blood cells to become hard and sticky and look like a C-shaped farm tool called a “sickle.” The sickle cells die early, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, they get stuck and clog the blood flow. This can cause pain and other serious complications (health problems) such as infection, acute chest syndrome and stroke.

People with sickle cell disease start to have signs of the disease during the first few months of life, usually around 5 months of age. …And that is when the nightmare starts for parents. Particularly those that have no idea of genotype or blood related disease.

It’s a most harrowing experience, even for knowledgeable parents as they are helpless.  Parents can only empathize but cannot feel the excruciating pain of the patient. In the infant stage of the affliction, parents keep sleepless nights depending on the frequency of the crisis. Crying, wailing, and weeping rent the air all night and they eventually end up in the emergency department of the hospital, where they ultimately become familiar faces.

Yet, that is the beginning of their life challenge as SCD is a disease that worsens over time. No two cases are the same in terms of severity; though, treatments are available that can prevent complications and lengthen the lives of those who have this condition; their life usually hangs on the will of God. Sometimes a simple crisis might not only be life threatening but life taking. My daughter and an unknown lady were both on admission, same evening at Redington hospital for the same Vaso-occlusive crisis. The lady dropped dead in the morning just as they were about to be discharged.

Sickle cell disease is a lifelong illness. A bone marrow transplant is currently the only cure for sickle cell disease. Gene therapy is also being explored as another potential cure.

As a result, treatment for sickle cell anemia is usually aimed at avoiding crises, relieving symptoms, and preventing complications. People with sickle cell disease face many challenges, including severe pain episodes, stroke, and organ damage, including adverse side effects of drugs, like hydroxyurea.

The drug Hydroxyurea, when taken daily reduces the frequency of painful crises and might reduce the need for blood transfusions and hospitalizations.

Hydroxyurea, however, exposes the patient to increased infection as it lowers the number of white blood cells in the blood. It can also lower the number of platelets which are necessary for proper blood clotting. And there is some concern that long-term use of this drug might cause problems later in life for people who take it for many years.

According to Mayo Clinic there are certain precautions you can take, especially when the blood count is low, to reduce the risk of infection or bleeding:

·        Avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back, or side pain, or painful or difficult urination.

·        Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.

·        Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.

·        Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.

·        Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.

·        Avoid contact-sports or other situations where bruising or injury could occur.

“Using this medicine for a long time may increase your risk of developing leukemia (cancer of the blood) or skin cancer.

“While you are being treated with hydroxyurea, do not have any immunizations (vaccinations) without your doctor’s approval. Live virus vaccinations (eg, nasal flu virus vaccine) should not be given while you are using hydroxyurea.

“This medicine may increase your risk of having lung or breathing problems (e.g., interstitial lung disease). Check with your doctor right away if you develop a fever, cough, or trouble breathing while using this medicine.

“The results of some tests (e.g., continuous glucose monitor) may be affected by this medicine.

“Talk with your doctor before using this medicine if you plan to have children. Some men who use this medicine have become infertile.

“Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

“Using a special ultrasound machine (transcranial), doctors can learn which children have a higher risk of stroke. This painless test can be used on children as young as 2 years. Regular blood transfusions can decrease stroke risk.

“Childhood vaccinations are important for preventing disease in all children. They’re even more important for children with sickle cell anemia because their infections can be severe.” These are some of the directives of Mayo Clinic on use of Hydroxyuear.

Blood transfusions carry some risk, including infection and excess iron build-up in the body. Because excess iron can damage the heart, liver and other organs, people who undergo regular transfusions might need treatment to reduce iron levels.

The two gene therapy treatments for sickle cell disease recently approved by the FDA in the US, called Casgevy and Lyfgenia, cost $2.2 million and $3.1 million per patient, respectively. Definitely beyond the reach of the average sufferer.

Sickle cell anemia can make life more difficult, particularly for a child, who will need to deal with delayed sexual maturity and stunted growth. You will need to avoid things that can cause a crisis, such as certain medication that restricts blood vessels, high altitudes, and strenuous exercise.

As people with sickle cell anemia grow older, they may develop different and more serious medical problems that happen when organ tissues don’t receive enough oxygen. People with sickle cell anemia are at increased risk for stroke and lung, kidney, spleen, and liver damage.

The leading causes of death in sickle cell diseases are infection, pain episodes, acute chest syndrome and stroke. Death can be sudden and unexpected in sickle cell anemia. Vaso-occlusive crisis is one of the commonest presentations and a leading cause of death.

The pain of a Sickler child is the agony of parents who are helplessly left to witness their child writhing in pain during a crisis, spending endless hours with them in the hospital during frequent bouts of admission and sometimes having the ill-luck of watching them die.

The pain of having a Sickler is well known and cannot be overemphasized. It is this threshold of unbearable bouts of pain that made my daughter to pen the following preamble to the NGO she is currently setting up: THE CRESCENT INITIATIVE for Sickle Cell, to empower those living with Sickle Cell Anemia:

“Two years ago, I sat down on the floor in my bathroom crying and thinking about the quickest method to end my life. I had had a painful episode that went on for several days and I was feeling hopeless.

“My pain score felt like 100/10 and my body felt like I had been hit by a bus. The pain got so bad that I could feel it in my fingers, and I could feel the floor under my feet. Due to the severity of my pain and my low blood level, I had to have a blood exchange.  Managing the pain was too much for me and it ate away my faith, my confidence, and my will to keep on surviving.  I was tired, my life seemed hopeless, and it was unfair that this kept happening to me.

“I cried for several hours recalling all I had gone through…several needle pricks just so that they could find a vein; my foggy memory, a side effect of the medications; and my long absence from work which had started to become “an inconvenience” to my manager and a sign that I might be losing my job.

“It was too much….it was unfair…. I did not want to be here anymore. I cried for several hours and decided to call my therapist whom I had just started seeing.

“Just hearing his voice made me break down again and in between sobs, I explained what I was feeling. He calmed me, listened to what I was going through and tested me for depression which the test confirmed.  Since then, I’ve been taking antidepressants and seeing a therapist regularly.

“During my sessions, I began to notice an improvement in how I felt and discovered that some of the issues I thought were unique to me were actually common for individuals with sickle cell. For example, I became aware that my emotions and stress levels could trigger my pain episodes, which, coupled with anxiety, attacks became more frequent.

“Learning coping strategies and positive affirmations helped me find balance. Through opening up to my therapist and later my hematologist, I realized that many individuals with sickle cell disease could and should benefit from mental health therapy, though it is often not included in their treatment plans.

 “Therapy was transformative for me, and I knew other warriors would also benefit. After thorough research and consultations with healthcare professionals, I decided to establish The Crescent Initiative for Sickle Cell.”

Fortunately, in everything, we always have cause to thank God. (Quran 16:53) and also (Quran 16:78)

We thank Almighty Allah for preserving the life of our daughter Asia Atinuke Jose (AJ) as she clocks 45 next week, May 8 and still counting, In Sha Allah.

Allah has found it pleasant to preserve her despite the Sickle Cell challenges. We also pray for other afflicted souls. May it please Allah to make it easy for them. For all those who have walked this path with us this far, I say a very big thank you.

Barka Juma’at and a happy weekend.

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