Appendectomy (operation to remove a person’s appendix) may not be seen as one of the deadliest surgeries but then, so many people still cringe and even exercise some kind of fears if they are told the operation would be carried out on them.
By the way, Appendicitis is not even a contagious disease, so what could be the reason for a situation
where almost nine, out of 10 persons, in a particular community have undergone surgery as a result of the illness? This was the question that gripped our correspondent during a recent visit to Agu-Amede, a rural community in the Isiuzo Local Government Area of Enugu State.
As unbelievable as it sounded when our correspondent got hint of the story, all doubts disappeared within minutes of our correspondent’s arrival in the sleepy community, which, in addition to the unusual health challenges faced by its residents, is also characterised by lack of basic amenities.
Bad roads, lack of potable water, poor power supply, and clustered habitations signal the level of deprivation in a community with little or no government presence.
Coming back to the issue of appendicitis – instant confirmation of tales of the high rate of the ailment in Agu-Amede welcomed our correspondent into the community.
At the very first stop in the village – a bus stop which apparently also serves as a community centre, judging by the presence of small kiosks and food vendors, and other small businesses – our correspondent approached a number of youths who were gathered by the motorcyclists’ park. The youths, numbering about 11, were initially suspicious of our correspondent’s presence in their midst but relaxed a bit when our correspondent introduced himself as a journalist.
And just as soon as our correspondent brought the issue of appendicitis up, nine out of them exclaimed they had had the operation!
In fact, many among the youths, whose average age was about 35 years, also said they had undergone surgery for hernia. Some of them said they had had surgery for hernia on multiple occasions.
The youths informed our correspondent that appendicitis and hernia were common among members of the community. They disclosed that several persons have died as a result of the matter.
However, while (from the accounts of the youths, and from the testimony of other villagers, including elders and community leaders who would later speak to our correspondent), it was beyond doubt that appendicitis was prevalent in the community, the cause of the high rate of the ailment among the population was not certain in any case.
Those who spoke to our correspondent could not agree on a particular reason for the situation, but from the various responses, it could be deduced that the villagers mostly blamed their travails on bad drinking water, hardship, hard work and farming. Interestingly, some of them also seemed suspicious of the medical practitioners.
Like most other rural communities, the people of Agu-Amede are mostly farmers. And, being a particularly poor community, the villagers work extra hard in order to feed themselves and their families, and also meet other contingent needs. Daily life in Agu-Amede involves a lot of physical exertion.
The situation was further compounded by the absence of potable water in the community. The Ankpe stream, the nearest source of water, which our correspondent visited, was definitely not good for drinking but because the Ebenyi River (which has comparatively cleaner water) was quite far from the village, the villagers are, most times, forced to drink from Ankpe stream.
Fetching water from the Ebenyi River, which stretches to parts of Ebonyi State, is a Herculean task, considering the distance and the nature of the road, but given the fact that it provides the cleaner drinking water in the community, it is not difficult to appreciate the level of physical exertion that is involved in the lives of the villagers.
A native of the community, Augustine Ede, viewed the matter from a political perspective. Ede, a vulcaniser, said, “I had surgery for appendicitis in 1993, when I was still very young. The doctors don’t usually tell us the cause of any ailment they are treating, including appendicitis, because it is believed that Agu-Amede is a village that will never be emancipated. So they just do their thing. But all I know is that I was operated upon, my stomach was opened and something was removed. Many people in my family have gone through surgery several times. Many died in the process. It was only by the grace of God that I survived.
“The problem is that we don’t have good government hospitals in this place, what we have are private hospitals. Some doctors move down to this village from the city to open private hospitals and because they are privately owned, we can’t tell whether they are genuine or not. We can’t question them.
“The only government hospital is the maternity clinic, which is just for the women. Although we were told it was built by the government, it is not well equipped. You can’t find anything there. The appendicitis operations are done in private hospitals.”
Emmanuel Ebe, another youth, informed our correspondent that he had surgery for hernia in 2014. Ebe believes that strenuous physical activities in the course of their daily lives is responsible for the plight of the villagers. He, like the others, added that lack of potable water could be another cause of the illness.
“We do a lot of hard work in Agu-Amede. To the best of my knowledge, the prevalence of appendicitis and hernia in this area is as a result of too much of hard work in the farms and the bad water we drink. We only drink clean water when there is rainfall, otherwise we fetch from Ankpe stream, running water which is not very clean,” Ebe said.
A septuagenarian, Clement Ogbodo, took a break from a game of draft with his friends to tell our correspondent that he had undergone surgery on two different occasions – one for appendicitis, the other for hernia.
“I was operated upon twice; I had to travel to Anambra State to do the surgery. I was told that my problem was due to hard work. We do a lot of hard work in Agu-Amede,” he said.
For Chiagozie Maduabuchi, a youth who said he is yet to experience appendicitis, the unusual rate of the ailment in the community is due to hardship.
Maduabuchi said, “Bad road is one of our biggest problems and we also lack potable water. We drink water from the Ebenyi River, which is very far. We usually use bicycle to get the water to the village. Because the road is bad and the river is far, fetching water is very difficult, it is hard work. Whenever I go there, I experience pains and body ache.”
Admitting the high rate of appendicitis in the community, Maduabuchi said, “Agu-Amede people usually suffer from appendicitis, but honestly I don’t know why it is so. I think it is because of the bad water. I am yet to have it (appendicitis) but so many people I know have had surgery for appendicitis.”
The councillor representing Eha-Amufu Ward 1, Isu/Agu-Amede/Odenigbo ward, in the Isiuzo local council, Hon. Prince Emmanuel Eze, admitted that appendicitis and hernia are unusually common in the community.
“Most of our people who go to hospital are there because of appendicitis or hernia but I don’t know why it is so. But if I am to comment, I think too much hard work can cause hernia,” the councillor told our correspondent.
But as many of the villagers blamed the lack of potable water and perhaps, strenuous work they undergo, as the reason for the rapid rate of appendicitis among them, they also seem to have reservations for the private hospitals in the area.
From encounters with some of the villagers, it was apparent that they are not happy at the absence of a standard government hospital in the area, and as a result, tend to view the private hospitals, where the surgeries are usually carried out, with a degree of resentment.
In several, separate encounters with different villagers, it was not uncommon to hear comments like ‘I was told I had appendicitis’, or ‘my stomach was opened and something was removed’.
Meanwhile, a medical doctor, Doctor Chidi Nebo, Chief Medical Officer, District Hospital, Ikem, Isiuzo Local Government Area, which Agu-Amede is also a part of, gave an insight into the problem.
Nebo, who spoke to our correspondent on the phone, described the people of Agu-Amede as “surgically aware” and “unusually brave” when it comes to the illness.
According to him, the villagers have got so used to the cases of appendicitis and as such, do not cringe at any form of surgery, and would sooner undergo appendectomy, and thus get rid of appendicitis and its accompanying discomforts, so as to go back to their farming activities.
However, he said that although it appeared as if there was a higher rate of appendicitis in Agu-Amede than other places, it was not necessarily so.
Nebo said, “Why it looks as if it (appendicitis) is common here is because of the fact that it is a community that is localised. It appears as if it is common here because the awareness rate, or the health conscious rate, among the natives here is high. So once there is a medical condition, the person concerned wants to go for surgery.
“In the olden days, they used traditional healing remedies to treat appendicitis, but the high mortality and morbidity rate among the population as a result of that form of treatment led to an urge to turn to expert care to remove appendix.”
The medical doctor noted that diet was a factor in appendicitis. He listed the consumption of guava fruits, parboiled rice as major risks.
However, Nebo added that a specie of beans, known as ‘uzuakoro beans’, which is commonly consumed by the people of Agu-Amede, could be a major cause of appendicitis.
“They eat it (uzuakoro beans) a lot. Some people tend to break it in their mouth and subsequently swallow without chewing it,” he explained.
He doubted the villagers’ belief that bad drinking water could be responsible for the appendicitis cases.
He said, “The water here is contaminated but it wouldn’t lead directly to appendicitis, it could lead to water borne diseases like cholera, typhoid and diarrhoea. The water they take is not the best because faecal droppings are washed by the rain into the river.”
Noting that a person cannot have appendicitis twice, as claimed by some of the villagers, Nebo pointed out that there was even a much higher rate of hernia in the community.
He also noted that hard work, or physical exertion, could be responsible for the high rate of hernia.
The doctor said, “Most of the people of Agu-Amede ride bicycle to fetch water. They ride about five kilometers, going uphill and then downhill. This could result in abdominal pressure, which could lead to hernia.”
He pointed out most of the villagers are engaged in some form of manual labour, especially through farming, which is the vocation of about 97 per cent of the population.
“It looks as if every household has had up to two or more people that have had it (hernia). These two things (appendicitis, hernia) combined together, make it appear as if Agu-Amede have more cases than any other place,” he added.
Describing the people of Agu-Amede, Nebo said, “They are very surgically aware, unlike people of other areas, they are very brave when it comes to surgery. They always want to get the surgery over and done with very quickly so as to go back and attend to their farms.”