Hospital provides free surgery to save indigent 16 year- old Subdural Empyema patient

Mr and Mrs Godwin Ehi-Ebhodaghe would never forget May 21, 2018. It was a day the couple had lost all hope of seeing their 16 year-old son, Godisgreat, who was diagnosed with Subdural Empyema, fulfill his dream of becoming a medical doctor. Subdural empyema is a collection of stored pus in the subdural space, which is located between the surface of the brain and the covering over the brain, both on the right and left side called the dural.

It all began with one bad fall and life began to change for Godisgreat. He complained of constant headaches and fever, but was treated for typhoid due to ignorance from both his parents and the healthcare practitioners.His parents had taken him to a private hospital in Badagry, where he was being placed on admission and later discharged. The headaches and fever persisted as he kept complaining despite the medical treatments he received.

His parents took him back to the same hospital, where his father, Ehi-Ebhodaghe was asked to do an X-ray on him. They were later referred to Badagry General Hospital, where he was sent for a CT scan. As if the referral syndrome was not enough, they were again referred to the Navy Hospital, where there was no equipment to handle the medical situation.

Godisgreat situation grew worse, he could no longer attend school, his parents had spent all the money they had on them going from one hospital to another seeking for solution to his ailment. They were later referred to Lagoon Hospitals, Apapa, where his parents concluded was their only hope remaining.Unknowing to them, the serious medical condition that had befallen their son, they entered the hospital with the hope that it would be the usual typhoid; they never knew it was a very serious condition that has to do with the brain.

When Godisgreat was carried in to the reception, he was given a bed at the emergency unit due to the severity of his condition, which had left him emaciated, looking like a lifeless body.God is great was later diagnosed with subdural empyema, the CT scan showed a hypodense collection in the frontal region of the subdural space, which is the space between the skull bone and brain – with a collection of gas above it. Based on clinical features and radiological findings, by Consultant Neurosurgeon, Lagoon Hospitals, Dr Chiazor Onyia, the diagnosis was a bi-frontal Subdural Empyema, involvement of both sides of the anterior aspect of the subdural space.His parents were told he would be operated immediately in the brain as the case was almost getting to the worst stage, which the doctor said a further delay, Godisgreat would lose his life.

As Mr Ehi-Ebhodaghe and wife Veronica were directed to get the medical bills at the reception, the shock on hearing the amount left the couples devastated, they wonder why God could place their family in such situation that had no remedy but to prepare for death.”The doctor said they would perform a surgery to open up his skull and when the bill was checked on the computer, we were told that the deposit for the treatment was at least N3.5 million. We lost all hope thinking, our entire mind was that whatever happens if we get home we would just have to prepare for his death when it comes,” he sobbed.

Confirming the situation to The Guardian, the Medical Director, Lagoon Hospitals, Apapa, Lagos, Dr Mowa Falase, said the circumstances under which Godisgreat was brought to the medical facility proved the essence of his name.She said he was brought at a time when government hospitals went on strike, adding that the two teaching hospitals in Lagos, which Godisgreat could be referred to for treatment due to the equipment present, were on strike, as a referral would be at the detriment of his life, going by the financial capacity of his parents.

The Pediatrician said: “He came in that evening to us and that was during the time health workers were on strike, the federal and state hospitals, both Lagos University Teaching Hospital LUTH and Lagos State University Teaching Hospital (LASUTH) were on strike and there are no other places they could have handled such a case as this.”
Falase lamented over state of the healthcare system, revealing that Nigeria has a total of 81 neurosurgeons in the country to attend to 200 million people, noting that the specialists are rare and should be well remunerated and cared for in Nigeria to avoid brain drain as well as the safety of the citizens.She said Godisgreat was brought to the hospital with a CT scan showing the problem he had, which enabled the doctors detect his condition that required urgent surgery around his brain.

“It was decide that he needs this surgery around his brain. Understandably, this kind of surgery do cost a lot of money and at the same time he had been carrying this condition for so long that some times waiting in his case could have caused more damage than anything else,” she said.The Guardian learnt that such complex surgeries in the brain require a deposit of not less that N3.5 million, which means that the total amount would be more than N4 million. This shows that only the rich can afford the treatment, but in the case of Godisgreat, whose father is unemployed and mother a petty trader, a senior member of the health facility, who saw that he would not survive much longer with an operation, recommended that the surgery is done pro-bono (free of charge).

The entire staff of Lagoon put together their support and resources to ensure the surgery, which took place on May 22 was successful. Today Godisgreat is back to his feet like any normal child.“The family was supposed to deposit at least N3.5 million for the operation to take place, but they didn’t even have enough money to register him as a new patient. God Is Great’s case is just one in a million,” she said.She advice’s parents to protect the health of their children and look out for signs that could be taken for granted and then seek medical help immediately to avoid getting to a worse stage.

“If you have a cold beyond two weeks, there is a need for you to see your family physician, paediatrician, an ear, nose and throat specialist that can pick those symptoms, so they can be treated on time,” she advised.Explaining the nature of the health condition and the treatment process, the Consultant Neurosurgeon, who performed the surgery , Dr Chinazor Onyia, said Godisgreat’s case was critical and required emergency surgery where his skull is opened to have better access to the collection of pus and then ensure it is properly drained.“So we drilled a hole in the skull where the bone flap was opened because the pus had gone beyond the features. I had to open more because of his age so that I would be able to drain it properly,” the doctor clarified.

For Godisgreat, Dr Onyia said due to his age and the large amount of pus in his skull, as seen in the CT scan, a collection of foul smelling pus was on both sides of the anterior aspect of the subdural space, extending into the frontal sinus, which was evacuated, after which the patient was subsequently placed on antibiotics.
Dr Onyia affirmed that Godisgreat is currently doing well after he has been discharged.According to Dr Onyia, the prevalence of subdural empyema worldwide is approximately five to ten percent and also high in developing countries generally than in developed ones.

On the causes of subdural empyema, the neurosurgeon explained that “sometimes, patients’ immunity and capacity to fight infections could be from not having good diets, and some common factors can expose the patient to viral infections and when that is done, the risk of having bacteria occurs. We suspected that he had recurrent catarrh after the fall, which became unusual with yellow mucus, which was a sign of infection.”Speaking further on the symptoms, Dr Onyia said subdural empyema complication can rapidly spread to involve an entire cerebral hemisphere as patients develop meningeal signs.

” Most of the times, subdural empyema tends to occur in teenagers/ adolescents. It often causes recurrent sinusitis or sinus infection, which is inflammation of the air cavities within the passages of the nose. When young adolescents have sinusitis, they tend to have a recurrent headache, fever and because the catarrh is infected, the pores occurs which puts pressure on the brain, the patient might develop seizures that usually progress over several days or even recurrent convulsion, and if nothing is done at this stage, the patient would begin to have impaired abnormalities like speech loss or might even be in a coma,” he explained.He, however, added that in most cases the medical condition could lead to death, while he called for more enlightenment to enable parents present their child early at the health facilities.