•UK Based Naija Doctor, AMONIA GASPER Tells City People
She is pretty and intelligent, and she is absolutely focused on helping mankind live a better and healthier life. Dr. Amonia Gasper is Kalabari lady from Rivers State. She is a London based Medical Doctor who is a member of the Royal College of General Practitioners. Her advanced training in the United Kingdom saw her obtaining Specialist Knowledge in Family Medicine after she earned her Bachelor of Medicine and Bachelor in Surgery (MBBS) degree at the University of Port Harcourt Rivers State Nigeria.
She has devoted her career to taking care of Covid 19 patients, especially with the care for the elderly, since the Covid 19 pandemic broke out in 2020. On the 3rd of November, City People Magazine Port Harcourt Bureau Chief, Emeka Amaefula (+234(0)8111813069) interviewed her during which she spoke about the latest development in the Covid 19 mutation and revealed that there is a new variant called COVID ENCEPHALOPATHY which affects mostly the Elderly. She opened up on the dreaded disease and how Nigerians can cope with it and so on. Excerpts.
Can you tell us how as a Medical specialist in the United Kingdom, you have been able to manage the Covid 19 cases brought before you?
This is one question that many people have talked about in every function that one attends now, this is the topic of discussion. Once upon a time it used to be ‘How is the weather’ but now it is ‘how have you coped with the Covid 19 pandemic?’ and ‘what has the pandemic meant to you?’ And it depends on who you are actually talking to. For some people, believe it or not, it has been opportunity galore for them as some businesses have done extremely well and for others, it has been unimaginable pains losing loved ones in the most difficult circumstances as well as other businesses holding up completely with no hope of reparation once this pandemic is over. I think for the entire global community it really depends on who you are talking to. What is uniform to everyone is we have now learnt to live for the moment whereas previously we used to plan ahead for days and for months ahead and for years ahead. Other than living in the past with regret but now it is all a situation of we are not guaranteed tomorrow as everybody is living for the moment as much as they possibly can.
How has it been with the ongoing COVID 19 pandemic protocol that hit the global community?
To add to what I said earlier, this generation that is living through this pandemic will only have bits of information to give, I think the full impact is more or less akin to a war that we are in and the full impact of the pandemic both positive and negative will only truly be described when the pandemic is over in generations to come. They are going to be the true people who will feel the impact of the pandemic. What we are doing now is really just doing everything that we can to stay alive and live as best as possible.
So, as a Clinician in the United Kingdom, at this moment it is mostly positive. But as we all know we lost a lot of colleagues in this pandemic. I think initially we didn’t realize the impact that it would have as my primary training is to care for people, to heal sickness and to look after people in the hospital with diseases. So, we threw ourselves into it with maybe a somewhat reckless attitude towards our own personal safety. The positive side is that in terms of pandemic preparedness, we have had what you would regard as drills of what would happen. This would have happened at the Governmental level and of services that would be kick-started once the pandemic happened. Of which you would have heard people mentioning about the government may have been advised about XYZ pre-pandemic. So, there were discussions in place and there were practice measures that had already been elaborated such that once pandemic hits we wouldn’t be finding our feet at that time.
In terms of my own personal experience, I think we’re quite privileged working in Northwest London as we did have adequate Personal Protection Equipment-PPE to help us with our work and I am a Family Physician, so a lot of my work was face-to-face. But when we eventually got into the COVID harms we had to go to a more hybrid style of working where we would have telephone and virtual consultations as well as face-to-face for patients that we were quite concerned about. But we were privileged that we did this with full PPE and with full support even with that, unfortunately, may their souls rest in Peace we did lose too many professional colleagues than we should have had but I guess that’s the risk and the nature of the job.
In addition to the immediate equipment, we also have wrap-around support from secondary care. We were guided by the government and the Infectious Disease Team as they were On Call 24/7. So, we had telephone access for cases that were really quite complex. As you know admission to a hospital would only happen when patients deem it safe for them to stay home in the community either due to very low oxygen levels or other complications; these were mostly patients who had other co-morbidities. And we also know that the black and minority ethnic populations were affected more also.
What have you found out that has made COVID 19 pandemic not to have reached the alarming prevalent rate in Nigeria when compared with the high morbidity rate in the Western world?
This is quite a very difficult question for me to answer simply because I haven’t worked in Nigeria during the pandemic. From the information coming and with the records coming out from Nigeria a bit part of it has been on inadequate information and statistics for a population of two hundred plus Million. We haven’t done any justice to the number of people who had suffered with COVID 19. Covid 19 is a condition that thrives with proximity. And apart from the big cities which have recorded the highest numbers most of the population is dispersed in the rural areas where there is adequate distancing. And that obviously would have contributed to it. Predominantly, I think that the reason that Nigeria has not recorded as high numbers is the fact that for one, we are predominantly a young population. I think the average life expectancy is about 45 years and COVID 19 mortality we know is more in the older age groups. We also haven’t been testing as much as we would like. And if we don’t test, we aren’t going to get the Statistics.
So, if there’s no testing at all then we will have zero cases. We know that the young age group can have Covid but presented with a milder form of the Disease which mimics a lot of common illnesses such as Malaria, even the common cold. But if it is not tested for here in the UK it is testing, testing and testing. For every symptom that remotely looks like Covid 19 we always recommend that patient for testing. Obviously, finance will be a big factor in it, because it costs money and if the government is unable to provide the resources then the common man in the street is not going to prioritize testing for Covid 19 overfeeding himself and his family after.
So, I think that these are really the main factors of insufficient testing, the younger population generally across the board. But we have had Covid 19 especially coming out of the big cities. So, we can’t say that we haven’t had any Covid but what we don’t have is enough information as to the real picture, the real number that is happening.
What are the latest research findings in Covid 19 pandemic globally?
In terms of research into Covid 19 globally, this is an ongoing process, the process started well before the pandemic hit and it is not something that is going to stop tomorrow as research is ongoing. And new medications and new vaccines are being discussed as we speak. What is happening now is that we are pushing for booster doses. What we do know is that if we have had the infection then your body has produced antibodies and we will have some immunity. But what we are finding now is that that immunity starts to go down after about 6-months. So, getting a vaccine will help to boost that natural immunity for people who have had Covid 19. And the Vaccine immunity does wean as it is not forever as that also starts to wean after about 3-months and then you get a second dose. We know that the combination of first and second dose Vaccines are starting to weaken and so now we are offering booster doses especially now that we are coming into the Winter season in the United Kingdom or in the West generally. All those at risk and vulnerable people are being offered booster doses.
You can’t still get breakthrough infections but we have to understand that the purpose of the Vaccination the endpoints are all being met. And these are to prevent severe disease, hospitalization and death. The vaccine reduces transmission in the community as well. It doesn’t mean that you may never get Covid, you may still get Covid but you will be very mildly unwell that you need to see a Doctor for it. And if you are tested you will know that that mild illness that you had a headache, cough, cold sometimes diarrhoea, vomiting, tummy pain and just general aches and pains might have been from Covid. Only by testing will you know that. So, the endpoint for vaccination is to reduce severe illness, hospitalization and death.
And what we hope for and what the research is looking at is if we can manage it in such a way that it becomes endemic as opposed to a pandemic. So, every so often you would have pockets of flare-ups in the community as opposed to the situation as it is now. The only way we can get to this stage is via a mass vaccination campaign which the World Health Organization, W.H.O is pushing for as much as possible and we know that the developing countries are still challenged by lack of vaccines. Also, by uptake of vaccines in their population. So, there’s a huge amount of education that has to go into it. There is a huge amount of Public Health measures and interventions that need to be put in place for the community for people to understand the reason and accept to be vaccinated. We do have quite a long way to go in terms of containing the pandemic as nobody is safe until everybody is saved.
Even though in the Western world such as in the UK now, over 40 percent of vulnerable active groups have had their booster doses which are given 6-months after the second dose has been received. Well in some parts of the developing world some people haven’t received their first vaccine at all, you know that we are in a global village as people travel all the time. And the longer that we leave people unvaccinated the higher the chances of us getting more mutant strains and more variants of the virus which will evade the effects of our existing vaccines at the moment. Ns. Not dementia and not delirium.
A new diagnosis has just been discussed. More reason to prevent getting Covid. It is called COVID ENCEPHALOPATHY. It happens to senior citizens. Patients presenting with severe anxiety. Basically, we can now confirm that the virus affects the brain, no matter if it was a severe or less illness. We have a new pill that is taken within 72hours cuts the risks of hospitalization admission and death. The treatment consists of 30 pills given over 5-days. It is similar to the treatment for HIV and Hepatitis. Vaccines still remain the way out of the pandemic.
At the initial outbreak of the COVID 19 pandemic were you able to undertake emergency training in combating the pandemic?
Your question brings to the scenario that I experienced, the answer is yes, we did have preparedness to what to do at the ground level in terms of taking care of patients and my experience as I walked into one of the COVID homes this was before it actually took off seeing patients and everything. What happened was that I didn’t realize and pay attention to the markings as I was just chatting with my colleague and just walking in straight on and everybody waving and shouting ‘stop, stop and stop’ and I was like what’s really going on? And I then realized that I was walking into a red zone. It really brought home to me that through this pandemic that one needed to be extremely observant at all points in time. Which was quite alien in terms of how one reacts to one’s colleagues in normal situations or non-pandemic situations.
So, we went through a series of drills on how to darn and doff PPEs and that’s put on our PPEs and take it off with appropriate infection control measures. We went through scenarios of what will happen If a patient is brought to us. Being in the community, we were as much affected by what was happening in secondary care in terms of protocols, hospital protocols or admission into Intensive Care Protocols as we did our community training for seeing patients face-to-face that needed to be seen and infections control measures in our clinic environment.
Give us a rundown of your academic background?
My academics started in Nigeria as I trained at the University of Port Harcourt Teaching Hospital and I did my first degree that is my Bachelor of Medical Science in Physiology at the University of Port Harcourt and then went on to do my MBBS at the same university. Then I moved to the United Kingdom where I trained as General Practitioner or a Family Physician. I have done lots of other Courses to support that primary training. I am also a member of the Royal College of General Practitioners. In terms of other qualifications that I have or interests that I have, I worked with Migrants and Disadvantaged populations. And I do a lot of mental health work as well as female Health.
I am currently Lecturing 3rd Year Medical students at the Hull/York Medical School in the UK as well.
While you were in Nigeria did you encounter challenges that shaped your current workplace productive engagement?
I had a very rewarding medical practice when I worked in Nigeria and I hoped that I would be able to do some more of that again in the future. Every day was a scenario for a case that really touched me and has remained with me through my medical career one that always comes to mind that I will never forget. They are two actually as they are both in Pediatrics in University of Port Harcourt Teaching Hospital like I mentioned and the first lady lost her young toddler in the wards early hours of the morning and the mother’s attitude while her child was in the last few hours of life has remained with me. This lady was unable to afford what was needed for the child therefore presented late to the hospital and it was just a case of lack of knowledge, lack of resources in terms of the parents of the child. And in the end, it was a lack of hope.
You know she completely gave up and was literally waiting for the child to pass on. And she packed all the belongings and left the ward without a second glance back. And it was for me a young Medics very impressionable and trying to do my best and save all patients like all young medics are wont to do. That has really influenced me and remained with me. And has informed my work that I do with mostly Disadvantaged Populations with the Black and minority ethnic population, giving them education, talking to them about their health more about preventative Health than Curative or managing conditions once they arise.
The second again was in the Pediatrics and it was an outright case of the very verbally aggressive man who was being asked to donate blood for his child and he was totally against it and he was making comments like ” I don born the pikin now una say make I give am blood” which fall to complete lack of understanding and adequate education as to the purpose for the child being given blood transfusion as this child had acute severe Malaria and was severely anaemic at this time and could have survived if he had the resources to a sort of expected level of a national level where blood donation is something that the hospital just request from Blood services as opposed to asking families to donate. So, that also stuck with me and informed my choice of Specialty in Family Practice.
What is your opinion on wealthy Nigerians who embark on medical Tourism to Western nations?
I think we are coming into quite contentious ground here. I have no problems for people or families who are able to afford it to seek medical care outside of Nigeria. The problem that I have and the challenge that is in my mind is how do we repair our medical services such that that need is no longer there and it is a choice between an excellent medical practice and another excellent medical practice. At the moment if anybody is able to afford it the comparison isn’t like for like. So, I am not going to begrudge anyone who is able to afford it to go outside Nigeria whether it is other African countries or to the western world for Medical care. I think our purpose should be more on improving our own medical state such that it is like a choice.
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