Management of acute childhood diarrhoea (9)

4 March, 2019

Dear All

I am grateful that Timeyin Ogungbe shared this interesting story with all of us on this forum [CHIFA:]. I say thanks for sharing, because the same is happening as we write this across all cities, towns, villages and every corner of Nigeria today: delay in diagnosis and treatment leading to avoidable death and morbidity. It is not the only cause of Nigeria's chronic poor health indices - appalling indices of preventable and avoidable death of children of all ages, but it is one that can be changed if we all 'first do no harm'.

Let me share a similar personal experience before I ask the question I would like to pose at the end: My wife and I attended a medical education workshop in Stockholm a few years ago. She had a cold so we stopped over at the Boots Pharmacy in Gatwick airport on arriving London. As we strolled from shelf to shelf looking for a cold remedy, an assistant walked up to my wife and asked: 'Madam it appears you are looking for something. And my wife answered yes, a cold remedy. The staff/ assistant asked, 'have you seen your doctor?'. And my wife answered, 'No, but my husband is a medical doctor'. The staff said, 'oh, well then, help yourself'. And left us to continue our search.

Contrast the two experiences, and I wonder if the pharmacy assistant in Nigeria who attended to the '3 month old child with 'high temperature'/fever and gave her a 'teething medicine', recommended by the neighbour of the baby's mother for teething, should have acted the same way that the assistant in Boots pharmacy in Gatwick airport London: advised the mother of the sick baby with high fever to see a doctor for diagnosis and prescription? Would the story have ended differently? Could the 2-3 days delay have been avoided with a good end effect?

We end as we had in our previous postings on this forum and elsewhere: in Nigeria and LMICs we need to educate and empower not only parents and carers but health workers / health assistants as well.

Joseph Ana


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

National Implementing Organisation: PACK Nigeria Programme for PHC

Publisher: Medical and Health Journals; Books and Periodicals.

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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group:

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