jokingmary:

please where is Abiriba

In Abia State

^^^

No, there is no ‘strategic plan or map’, because a lot of the fatuous bills passed in our national assembly have been, at best, knee jerk reactions. Most have been the end products of avaricious leveraging by our ignorant politicians.

Do we need more states? For the sake of everything sane, HELL, NO! It’s not in our overall economic interests as a nation.

Can one understand the agitation for it? Most certainly, Yes! The agitation has nothing to do with economics, but more to do with perceived ‘marginalisation’. I honestly don’t like that word, ‘marginalisation, but seeing that it has somehow integrated itself into our everyday discourse in Nigeria, I will use it to make my point.

Marginalisation.  It can be political, economic and yes, even psychological. Some ethnic groups (or subgroups) feel that the present political structures have marginalised them within their states to the point where they don’t feel that they are achieving their fullest potentials as a people given the status quo. They hope that a re-juggling of the structures would give them greater access to the machineries of power and therefore better control of their destiny.

What am i saying? Well let’s take the Igbo nation as an example.

In the days of the East Central State the ‘southern Igbo’s’ felt marginalised by their ‘Northern brothers’, the guys from the Anambra-Enugu axis,  and felt jubilant when the state was broken down into Imo and Anambra in 1976. Even within that arrangement there remained a sense of perceived marginalisation, leading to the agitation for more states.  The Ngwas, for instance, who were mostly Civil servants, were agitating for their own state, hoping that when the military government starting talking about state creation, they would not be lumbered together in the same state with their more ruthless and business savvy brothers from the Igbere-Abiriba axis, whom they thought they would not be able to compete with economically and therefore politically.

So after Abia State was carved out of Imo in 1991, most Ngwa people did not feel jubilant with the new political arrangements.

The rest is history. The Ngwa are yet to have a governor from amongst them, in spite of being the biggest ethnic subgroup in the state and also the most educated. I may be biased with regards to the latter, given that my evidence is strictly anecdotal.

But the problem doesn’t stop there! Even within Ala Ngwa, Isiala Ngwa people are maligned. In Isiala Ngwa people complain about Ngwa Ukwu. In Ngwa Ukwu the problem is Ahiaba Okpuala. In Ahiaba Okpuala it’s the people from the kith and kin of the Eze that are deemed to be the problem etc etc.

So would state creation solve the problem? Not unless you give me a state where i wouldn’t have to struggle politically with the Eze’s children who have benefitted immensely from their association with the governor and his predecessor and as a result have amassed stupendous wealth and power, leaving me and my kindred, feeling marginalised!

Johnnny:

Is there any strategic plan or map that we are supposed to be following in this country at all?

No

The 'marginalisation' of the Ngwa is political.  There is no part of Abia state that can claim to have benefitted economically from the current thief in government and his predecessor.

I was in Aba and Umuahia barely 2 weeks ago, and i can state 'authoritatively', in my Ngwa accent, that the whole of Abia state, quite honestly is nothing but a putrid Poo h.o.l.e!

reindeer:

Beautiful idea!
Sure to tackle all forms of quackery.
I only hope people will take full advantage of it,

It will take a while for people to acquire the culture of actually demanding of service-providers, the services they have actually paid for. It is going to be even more difficult to demand such services from the already disenchanted Doctors and the so many derelict private and public hospitals that litter the Nigerian landscape. But once a person has paid (or is willing to pay) to be treated, and the doctor accepts (or is willing to accept that treatment) then the Doctor (or the hospital s/he works for) becomes legally bound to offer the right care and treatment.

It's not- and should never be-the patient's fault that the hospitals are poorly funded or that the doctors are inadequately trained.  And as the Doctors have a right to strike when they are not getting what they want from government, patients also have a right not to be victims of clinical negligence.

Our Patient Advocay Services (PAS) empowers the already impoverished patient with accessible means, with which to pursue their rights to respect and better services from Doctors, no matter what the difficulties are that doctors face within the Nigerian Health system.

For the records, I am a Doctor.

'By the time they did anything for her there were worms dropping out of Mrs Adekoya's foot. The whole instep was rotten with just a piece of skin holding it in place. She was alive but her foot smelt like a dead person'



The above scenario could have happened. The patient Mrs Adekoya, sought treatment for in-growing toe nail, but ended up getting a whole leg amputated out of sheer clinical negligence. This should not happen.

“Primum non nocere”  ‘first do no harm’; is the central tenet of contemporary medicine. Whenever we receive medical treatment, we expect and are entitled to receive a certain level of care. Unfortunately not everyone’s experience of healthcare is problem free.

Unfortunately a lot of patients like Mrs Adekoya, may have no where to turn to for help or advise when they have suffered clinical negligence. That is, until now.

PAS is a new service in Nigeria, that aims to prevent clinical negligence, by indirectly encouraging care providers to become more careful in the course of providing care to their service users. When there is a suggestion of Clinical negligence, we will assist the patient to pursue a disclosure, whether in the form of explanations, apologies or as in the case of Mrs Adekoya, a redress.

For more information, follow this link: http://www.bpshealthcare.com/index.php?edata=MzA2MiNtZW51

Hi there folks!

After being stranded in Paris and finding my way home by Ferry and train through the Ports of Calais and Dover I am back!
As promised, here is the link to our new service in Nigeria http://www.bpshealthcare.com/index.php?edata=MzA2MiNtZW51

The link should take you straight to the Patient Advocacy Service page of our website. We are now ready to go!

Hi folks! I'm excited about my trip to Naija in the next few days. Got my ticket and i'm ready to go.

Unfortuntately I can only stay 6 days as my day job is getting increasingly hectic these days (I have 3 mental health review tribunals that cannot be postponed).
Anyways, My team in Naija are ready to go and hopefully the PALS and other service (which will be featured on the website from next week) should be up and running sooner than later (by the end of next week, hopefully)!

Sagamite:


A vast majority of girls that sleep with married men or even the pastor do not frequent churches in Nigeria

Even postitutes do not visit churches in Nigeria

Nigeria's corrupt looters do not visit churches frequently

^^^

A innocuous portrayal of reality

There, corrected.

This shouldn't disintegrate into an e-fight. I didn't find the church scene in the least embarrasing. At the time though, I did wonder out loud what they were trying to say about Nigerians, given that it's not a secrete that all over the world we have a rather impressive reputation for church going!

Shoot2Kill:

A panel of judges preferably from the abroad will now select the best candidate and that candidate will be nominated the new minister for his/her particular ministry. This process will be similar to process used in the TV “Apprentice” to select the best professional. This way you will be able to select your freshest most talented candidate for the job. If this idea is taken seriously, a competition that will last 3 week can be created and experts hired from abroad to judge the candidates and select the best one.
To further strengthen the government and the ministries, once the new ministers are appointed, a new independent ministerial watch dog agency should be established that will monitor all the ministers. This agency should comprise of foreign professionals who are not prone to bribery and corruption. This agency will have the power to suspend a minister without the president’s intervention should he not be performing well. This will ensure transparency.

Your thoughts are very interesting, but there’s need for clarification on the bolded parts:

When you talk about ‘judges preferably from abroad’, did you mean foreign nationals, ‘diasporan Nigerians’, or in your minds eye where you thinking of Caucasians? Would say, an Indian national qualify to be a judge ‘from abroad’? Which ‘foreign professionals’ exactly are not ‘prone to bribery and corruption’? There aren’t any, really, whether they be ‘diasporan Nigerians, blue eyed blond haired PhD holders or whatever.

It’s the system that you have in place that creates or expunges the ‘proness’ to corruption. It is not a function of race, ethnicity or geography.

@ Sefago

You make a lot of hypothetical sense. But looking at the form in question, one wonders whether the sense you make is particularly relevant. Going by your argument Samoans, for instance would also not qualify to have a box of their own to tick.

I doubt that this has anything to do with 'seditious tactics' or trouble making, as you suggested. I would have been more inclined to echo the thoughts raised by ndu_chucks if 'Nigerians' actually had a common language (other than English) or agreed on who is/or is not their hero(s). But as we don't one may suggest that other African ethnic groups with sizeable presence in the USA, should also write down the names of their own ethnicities.

To be honest with you, the label 'black' doesn't define me, or any of us, in anyway. Perhaps questioning 'the black box' as a means to qualify our people would be the next step in the gradual breaking of the chains they have used to bind us. I am in agreement with the OP.

So let it rest.

^^^

We reckon a lot of the health providers will want to settle out of court! But even if they don't and want to go the whole way, then our legal team will be up to the task. We are in it for the long haul and plan to bring about change in our own little way. That's the passion. The idea is that If change won't come from top-to-bottom, then we will effect it from bottom-to-top. It's a win-win situtaion in the long run. Though we acknowledge that there will be initial hiccoughs, the service-providers will gradually learn to offer the patients the evidence-based treatments that they are in a contractual agreement to offer. There is no excuse. If it's not evidence-based, we will sniff them out! We will also sniff out all the quacks. That's the vision.

What is ADR?

BlueDiva:

@ beneli,
Interesting write up there.

Compensation? . . .hehehe
Welcome to Naija, a land where everything is in reverse order.

@BlueDiva
I no understand dis ya laughter LOL. Make you explain am small to me! 

@Ajanlekoko, thanks. But honestly, these things have a way of always looking (or sounding) better on paper!

But to be honest, I am increasingly excited about the prospects of the PALS and some of the other products we'll be introducing into the Nigerian system. Of course, I know that reality doesn't always turn out quite as smooth as the vision that births it, but I expect it's still going to be a very interesting journey. We have identified an office in a very strategic (i.e. accessible, not too posh but certainly not derelict) place on the Island (TBS), which comes with a lot of other functioning services (the use of a secretary, the mandatory generator etc) and we'll soon be piloting the service to test run how we'll manage the deluge of service-users (turned clients) that will most certainly come.  Once I have met with the team in the next few weeks, I'll give a link to our online presence. Did I say that i am excited? I certainly am!

So make people begin to dey prepare warn their doctors to treat them kindly. Or else alarm go blow!

Fisay:

Those in community practice are not smiling to their banks, with Patient Medicine Dealers, faith healers, laying claims to higher percentage of their would be clients.

As Fisay rightly noted; we're all in the same boat, when it comes to that overhanging sense of having been abandoned by the government etc etc, and especially when it comes to the difficulties experienced as a result of the activities of the patent medical dealers and the faith healers! Both engage in some very worrying practices and one wonders why they are allowed to continue in these dodgy 'practices', without adequate regulation. The truth is that Doctors and Pharmacists short change themselves by not ensuring that there is better regulation in the health services industry. The way things are everybody (doctors, pharmacists and the service-users) suffers! 

@ Fisay, I don't agree with you though, that Pharmacists went through more stress in their training! The experience of 'stress'-as you highlighted-is, at the end of the day, a very subjective thing!

Welcome to MY office

I am Elias Beneli. Well that’s my pseudonym anyway. I call myself different things, depending on my mood! My pseudonym came about when I used to fancy myself a writer. I still wear that cap sometimes, but the cap that I have worn for the longest time, is that of a Medical Doctor.  I am called a Psychiatrist now, a specialist in illnesses to do with the human mind, sometimes leading to 'aberrant' behaviour. But I prefer to call myself a Social Entrepreneur. I call myself the latter, not only because it sounds kinda posh, but also because I am an affilliate fellow of the Global association of social entrepreneurs and a friend of Ashoka Innovators for the Public.

My Psychiatrist cap involves providing clinical services to private and NHS hospitals through my own limited liability company. In other words I could also be called an 'Independent Psychiatrist'. My client group are patients that are closely involved with the criminal justice system, so I do quite a lot of medico-legal reports and I am called on to defend my opinions before solicitors and judges who have to decide whether the clients are safe enough (or well enough) to leave hospital. Most times my argument is that they’re not!

But the cap that I like to wear is my Social entrepreneur’s cap. I think that’s what I will want to keep updating here on this 'blog' of a sort. My company is setting up office in Nigeria and has come up with the rather grandiose objective of indirectly affecting the overall healthcare delivery system in the country! How we plan to do this is through a series of products , which we will be introducing gradually into the Nigerian system. The first one will be our Patient Advocacy and Litigation service. Essentially what this is, is that we will be empowering the patients with information and the litigation muscles to seek redress in cases of perceived clinical negligence! We also have a product that will allow people to access health care without the constraints of that 'almighty' deposit without which you can't access health even in life threatening emergencies. But the latter will come a bit later.

Our office will soon (within the next one month) be opening in Lagos Island. Members of the public who have been poorly treated or subjected to clinical negligence or psychological trauma from contact with our derelict health systems in Nigeria will be able to access advocacy and legal aid on a ‘no win no fees basis’. Yep, you guessed it-I plan to turn against my own kind! I plan to introduce the compensation culture into the Nigerian health system! Well, that’s the idea anyway,

I will be visiting Nigeria in a few weeks time to sort out the office and meet with my team.

Watch this space.

^^^

The average cost of dialysis is £30,000 per patient per year.
http://www.kidney.org.uk/campaigns/Transplantation/ukt-press-dec03.html

Each session will cost about £230
http://www.privatehealth.co.uk/hospitaltreatment/find-a-treatment/dialysis-treatment/bmi-healthcare/

The cost of a kidney transplant would be in the region of £20,000 per patient per transplant.

If you are thinking of accessing these interventions privately, then below are the contact details of people you may wish to contact:

The London Independent Hospital
Renal Dialysis Unit
1 Beaumont Sq
Stepney Green, London, E1 4NL

Tel: 0800 656 9606
Fax: 020 7780 2416
Email: dialysis_lih@bmihealthcare.co.uk
Web site: www.bmihealthcare.co.uk


Good luck!

zerocool:

1- All medical students at accredited Nigerian universities offering medicine as a course are expected to write the NMA exam in their final year before they can graduate as a doctor,so that automatically makes them a member of the NMA and qualifies examinees for a medical license to practise in Nigeria. 2- A medicolegal issue in Nigeria is the same as other parts of the world especially same as in the UK, e.g negligence, abortion etc. Here in Nigeria, you hardly ever hear of doctors go to jail or license revoked for such because of the reasons i mentioned in my last post. 3- The doctor concerned pays the compensation required.

Thanks Zerocool.

I can't remember having registered with the NMA while practicing in Nigeria. On returning to Nigeria after my basic medical qualification, I had to sit the exam for Foriegn trained Doctors, following which I was registered with the Nigerian Medical and Dental Council and then recieved my license to practice. So, I thought the Nigerian Medical and Dental Council were the ones that facilitate the medical licensing exams, and not the NMA. In the UK, the equivalence of the NMA is the British Medical Association (BMA), membership of which is not mandatory. There are different organisations appart from the BMA which provide support in the event of litigation, but they don't make it mandatory that you join. Each have their different Membership fees and other packages, which entitles you to advise, legal representation etc in the event that you find yourself liable to litigation from aggrieved patients.

I had actually asked about SERIOUS medico-legal issues but i understand what you mean.

The culture of litigation has indirect advantages for Health service delivery as it encourages the health providers and Doctors to strive towards evidence-based good clinical practice. In a society where it doesn't happen, then anything goes, unfortunately. For the patient, it's empowering perhaps to the irritation of the health providers, but you can't hold back the clock! I see this culture of litigation and patient empowerment soon creeping into Nigeria-sooner than most people realise-as the middle class grows. With that culture will come organisations that provide training in evidence-based practice, clinical governance, medico-legal work etc.

Do guys see this as a welcome development or not?

zerocool:

I think the reasons why doctors are not sued in Nigeria is because most nigerians are ignorant of their rights and the legal system. And fortunately also,the Nigerian Medical Association effectively support and protect doctors in the case of a serious medicolegal issue.

Thanks for your response Zerocool. I wonder if you'd be able to clarify some further issues:

1. Are there Doctors not covered by the NMA or is membership with them mandatory for all doctors practicing in Nigeria?
2. What constitutes a serious medicolegal issue or can the NMA offer support in all cases involving litigation?
3. If there is litigation, leading to a requirement to pay compensation, who pays-the NMA or the concerned Doctor?

^^^

Thank God it's at least rousable!

Anyways, I am curious about what guys think are the reasons why the compensation culture (as it applies to health) has not yet kicked off given the pervasive dissatisfaction with the services available.

My questions are:
1. Why are Doctors/Hospitals not being sued in Nigeria?
2. Are Doctors routinely insured in Nigeria? i.e. is there a requirement for Doctors to get insured against bad practice etc?

I'd like to hear what guys think about this. Question 1 is open to everybody, Doctors and non doctors alike.

Thanks.

Ok let’s talk about Autism, shall we-

Autism belongs to a group of disorders considered as Pervasive Developmental Disorders (PDD). They are called Pervasive (as against Specific) developmental disorders because they affect multiple functions.  This is in contrast to Specific Developmental disorders, where specific functions like reading (dyslexia), spelling/writing (dysgraphia) etc are affected.

In Autism, the ‘pervasiveness’, so to speak, includes the following 3 areas:

1.Speech/language delay-the individual is unable to engage in meaningful interactive communication. Strangers may struggle to understand what they are saying. Some may just dismiss them as 'olodo'.

2.Problems with social interaction-the individuals have a problem with understanding normal social cues. They lack awareness of people’s emotions and cannot see things from other people’s point of view. A brilliant book I would recommend is ‘The Curious Incident of the Dog in the Night Time, by Mark Haddon, supposedly written by somebody with Aspergers syndrome (a variant of PDD, closely related to Autism and which belongs in a group called the Autism Spectrum Disorders). This book is actually very interesting and will give an insight into how these folks think and interact with others.

3.Lack of flexibility of behavior and thought-they are set in their routines. Any slight change will cause them extreme frustration. This leads to the incidents of temper tantrums etc. You could say, if you want to sound 'clinical' that they have a 'narrow and restricted repertoire of behavior and thinking'.
 
Autism is NOT considered a Learning Disability per se. However the rule of thumb is that 50% of them have an IQ lower than 50; 70% have IQ’s lower than 70, while 100% have IQ’s lower than 100. To qualify as having Mild Learning Disability, you need to be functioning at an IQ less than 70. So one can say that up to 30% are not learning disabled,

The approach to management is Behavioral interventions. The objective is to positively re-enforce good behavior, setting boundaries and that sort of thing. You could do what we call a 'functional anaysis' of any unacceptable behaviour. This would include understanding the Antecedents of that behaviour (i.e what immediately lead up to the maladaptive behaviour like throwing a temper tantrum); and how it was dealt with, in order for you to understand if there is any clear pattern of behaviour that may be nipped in the bud by responding to it differently (i can elaborate on this if my explanation is not clear enough).

Language and Social skills training is also very important. In an ideal situation the severely disabled should be in special schools.  The few who are borderline learning disabled and in the lower spectrum of ‘normal’ intelligence should be able to be go to mainstream school and end up being vocationally trained.

Unfortunately, in societies where the condition is not understood they will be bullied by both their teachers, peers and even their family.

Medication is only symptomatic.

^^^

I shouldn't have time to respond to this, but what the heck!

rosejen:

h Doctorkk1,

Thanks for being here, i hv a cousin sister who is developing some sign of mental of recent after giving birth to her fourth child, she had complication during child birth and weeks later she started acting funny and she will always say that some people want to kill her and that she is seeing some spirt, sometimes she will sit down alone and be talking to herself, so many times we have confronted her to take her to a doctor but she would not, she will keep saying that she is ok and we re the ones that have problem not her, this problem of hers does not occur always. her husband and everyone is confused on the next line of action to take.

The bolded parts are NOT symptoms of 'depression' even if it's postpartum. Once you have psychotic symptoms post partum, it's mostly likely puerperal Psychosis. As doctorkk1 rightly stated this is predominantly affective in texture, giving the impression of a manic episode with psychotic features. But it can still be predominantly a paranoid psychosis, as is the case described here. Of course psychotic symptoms are found in severe depression, so i can sympathise with snowdrops confusion, but once it is postpartum, 'Doctor', you are dealing with postpartum (puerperal) psychosis. And you should treat it as such because it is an emergency!

So if you are not out of your depths here and you happen to be a doctor, then i honestly advise that you brush up on your knowledge and communication skills. You'd be a lot safer that way, both to your patients and around your colleagues. I dare say, however, that your uncouth manner is most unprofessional. It's naughty to turn up out of the blues and try to spoil a thread started by someone who seems to KNOW what he is on about. Very naughty!

I apologise to doctorkk1 for this distraction. I promise i won't respond to this rude intrusion again. Like i said, you are spot on doctorkk1. Ignore snowdrops, he doesn't know what he is on about!

This should be in the 'Tribalism' section and should never have made front page.

The Nigerians that I know are not as hatefilled, ignorant and Bigoted, as has been demonstrated by most of the drivel, filling these 10+ pages. Continuing to leave this topic here (if it won't be locked) is both mischevious and disgraceful. Allowing it to flow has nothing to do with encouraging freedom of expressing ones 'political' views even if they are based on ethnocentric sentiments-it rather insinuates a deficiency of wisdom on the part of whoever has allowed it to continue!

Moderator, you should be Ashamed of yourself!

snowdrops:

HAHAHAHAHA
Very funny. Thank godness for the anonymity of the internet. Was only pulling your legs though.Well i admit the history is brief but you cannot conclude it is peuperal psychosis. [b]The lady may have had a history of schizophrenia, either diagnosed or not. In that case it may be a relapse of her previous illness.
It starts between 2 and 14 days post partum. What you described is postnatal depression.[/b]Otherwise sound advice.
On treatments, remember the lady may be in Naija where resources are usually limited or unaffordable.

You are wrong. Doctorkk1 is spot on.

^^^

I have responded to your question but for whatever reason it's not reflecting here! The moderator may have to intervene here, otherwise you may just have to click on my name and read the penultimate post. I have clicked on the notify button and hope the MOD will act on it.

Best regards.

^^^

Your Questions:

1. How likely is a hypochondriac to respond to treatment?

The response to treatment depends factors such as the ones below:

i) What are the co-morbidities?- A lot of people who suffer from Somatoform disorders generally are known to have a high level of co-morbid conditions such as Generalised Anxiety Disorder, Depression, Anxious Personality Disorders etc. The intensity hypochondriacal preoccupation may be delusional (in other words psychotic) etc.

ii) What treatment is offered?-Like you rightfully mentioned there is need to be clear about the diagnosis. Is this actually a Somatoform Disorder with Hypochondriasis? Is this a monodelusional psychotic disorder? Are there any neurological explanations for the presentation-in other words have we excluded the differential diagnoses?

Generally, the mantra for treatment of such disorders is to approach it ‘holistically’, in other words tick the biological, psychological and social interventions boxes.:

Biological-be clear about the medication. If there are no psychotic co-morbities then your anti-depressant (TCA, SSRI’s etc) should suffice. If there are elements of delusional interpretations of his experiences, a trial of low dose antipsychotic would not be out of place. But in this case the patient has insight, so it wouldn’t be necessary for him.

Psychological-the psychological intervention of choice would be CBT. In the absence of CBT, psycho-education would suffice. This will involve explaining to the patient in detail about his illness, why he feels the way he does (e.g. an increased cognitive and sensory awareness of his body functions that otherwise he would not have paid attention to if he were not ill), allaying fears about dying from it etc.

Social-this is to look at the exacerbating and maintaining social factors.  You mentioned that it started when he was in his second year in University. Perhaps understanding the particular social stressors he is under will allow you to offer appropriate advice.

The objective of treatment should really be to increase the patient’s ability to cope with the symptoms, rather than to eliminate the symptoms completely

2. Do most live with symptoms for the rest of their life?

I can’t give you any evidence-based figures, regarding prognosis and outcome, but it is estimated that up to 2/3 continue to live with the symptoms. They however learn to cope with it. Like i mentioned above, the objective of your intervention should really be to make him to cope better. If he happens to be among the 1/3 whose symptoms disappear then that’s an added bonus.

I hope that's useful.

^^^^

Let’s break it down point by point.

1. 5 year hx of neck pain, feeling of heaviness in the head, associated with feeling of collection in the occipital scalp(?)
2. Mild alteration in sleeping pattern. Belief that if he doesn’t sleep before 12am he has been afflicted with serious illness; believes the problem can only be solved by divine intervention from an highly experienced doctor or a priest
3. Limitation in his functionality for the past 5 years
4. On antidepressants (TCA) which brings mild symptomatic relief, only to become refractive to treatment.
5. Current trend in the mgt.

Some questions we need to clarify-

1. How did it all start? Were there any clear precipitants or did it develop insidiously?
2. Has the neck pain and feeling of heaviness been progressively getting worse over the past 5 years?
3. Are there any neurological signs associated with these complaints (weakness in specific parts of the body;  visual disturbances; dyspraxia etc)
4. Are his beliefs about being afflicted with ‘serious illness’ delusional in intensity-in other words are they unshakeable in spite of all contrary evidence?-i’ll help out here. Most people back home would share the same belief! So if he continues to hold on to the beliefs in spite of all investigations to rule out a space occupying lesion for instance, such as a CT-scan, then you could add ‘Over valued ideas’ to his symptomatology, given that culturally we believe in divine intervention and that sort of thing. That, however, doesn’t change much. People can have overvalued ideas even if they have serious illnesses!
5. What functions exactly are limited?

The approach to management is to move from the most simple to the more complex:

i) Use physical examination (including neurological examinations and cranial nerve exams) to rule out lesions in the neck region; then carry out basic blood investigations (check for inflammatory markers etc); doing a radiology (X-ray of the neck region) should be a must; ideally a CT-scan/MRI of the head to exclude space-occupying lesions etc should be included. You wouldn’t be forgiven if you don’t recommend it here (UK), but one can understand financial considerations back home.
ii) Based on the findings, you would make your formulation-neurological vs non-neurological (psychological). If there are no findings then you could work on the hypothesis that the patient suffers a Somatoform (pain) disorder, with hypochondriasis.
iii) Somatoform disorders are usually difficult to treat with medication alone. The approach should be Cognitive-Behaviour based psychological intervention, which will challenge his reasons for believing that he has a ‘serious illness’. Selective serotonin re-uptake Inhibitors (SSRI) are the medications of choice, but I can understand the rationale for a TCA, like Nortryptiline, especially if the concern is that the patient has Neuropathic pain.

I hope the above is helpful

morpheus24:

I appreicate the experience sharing. This is what I am aimed at exposing. there are not alot of onlline outlets of African travels by Africans to give such insight into travels. The more you here of personal one on one stories the more you are equiped before embarking on such journeys and the smoother your holiday will be. Regardless of the hicups you had I can see you really cherished the experience.

I too am trying to hit cape verde as I heard it offers a ver mediternean feelind and after that will try to journey more in East Africa , the limpopo River in Zambia and so on. There is much to see within this continent and personally i am tired of the glit and glamour of European cities taht ofer you less of a welcolming atmosphere and expect you to spend spend spend in order to be appreciated and valued in the western world.

nice story,

An Indian colleague says that she did the East Africa circuit once. Her destination was Victoria falls by road from the South (i think she started off in Botswana). She can't seem to get over the experience of suddenly 'discovering' the falls in all of it's magnificence from the bush path they had stumbled on, which was rarely traveled by tourists. She and her little adventurous group had wanted to 'discover' it for themselves. And they did!