Commentary: We reap what we sow. KA Harrison We reap what we sow. Kelsey A. Harrison MD, DSc. (London) FRCOG, FMCOG Nigerian National Order of Merit Winner 1989 Nigeria Centenary Awards 2014 Emeritus Professor of Obstetrics and Gynecology and former Vice-Chancellor University of Port Harcourt. Email: [email protected] Presented in part at the University of Medical Sciences, Ondo on 15th June 2016. Copyright permission granted by Prof Friday Okonofua, Vice-Chancellor, University of Medical Sciences, Ondo Niger Delta Medical Journal 2017; 2(1): 2-13 SUMMARY This is an account of the work of Kelsey Harrison given by the man himself (1933 - ), a pioneer undergraduate at University College Ibadan (1951-55), an obstetrician and gynaecologist, a researcher, a teacher, a relief worker during the Nigerian civil war of 1967-1970, a sort of social activist, and a cricket fan. At University of Ibadan in the 1960s, his researches were focused largely on the elucidation of how severe anaemia affects the mother and her baby. The results of this work led to the world-wide adoption of the treatment of this life threatening condition by the use of rapidly acting diuretics combined with direct blood transfusion instead of by the more elaborate and costly exchange blood transfusion. At Ahmadu Bello University (ABU) Zaria, his work analyzing 22,774 consecutive deliveries from 1976-1979 at ABU Teaching Hospital and published as a supplement to the British Journal of Obstetrics and Gynaecology (BJOG) in 1985 turned out to be a major factor in the launching of the global safe motherhood movement. At University of Port Harcourt (1981 – 1998) where he became that university’s vice chancellor, his powerful advocacy for better health for women was important and the ideas therefrom are still hugely relevant. INTRODUCTION information generated through our research in Nigeria, would lead to improvement in Coming under the influence of many good the health of our women. This then is an people, as I did, I went into medicine, account of some research seeds, how we specialized in obstetrics and gynecology, acquired the seeds, how they were planted, and then took to practicing, teaching and how they grew into fruition and who researching. Fellow Nigerian colleagues and benefitted. We reckon that we led an I were all pioneers, whose working life interesting life. The events are told in two of coincided with some great events in our my books. One is an autobiography (1), and country and in international maternal health. the other is a compilation of some of my It is some of these events and my own research publications from 1966 to 2010 (2). contributions that I wish to share with you believing as I do that this sharing of MY MENTORS experiences especially in a budding university community is important for I count myself fortunate in having many various reasons, not least, the acquisition of mentors in my career. Eight were knowledge for improvement of our society. outstanding. We reasoned that the correct application of Nig Del Med J 2017; 2(1): 2-13 page 1 Commentary: We reap what we sow. KA Harrison Ethel Taylor of Abonnema was my mother. account of the associated obstetrical and She told me in my early teens why she gynaecological complications. It has preferred hospital based maternity care brought misery and unhappiness to many available at Aba, in Abia State to local husbands and wives. When critically traditional birth attendants (TBA) at analyzed, the practice has nothing to Abonnema in Rivers state. She died aged 91 support the claims by its protagonists to years in 2001. perpetuate it. It is a primitive and barbaric Chief Anthony Karibi Bob Manuel of custom. I condemn it in its entirety.” The Abonnema was my surrogate father, a top world bodies he then appealed to act to man in the administrative arm of the banish the harmful custom did nothing until colonial civil service in the 1920s and now over 50 years later. Incidentally, the 1930s. His archives drew my attention to the first caesarean operation I saw performed success of the Church Missionary Society in was by him at Obubra General Hospital in reducing maternal mortality in its area of rural Eastern Nigeria in 1953. It was for the influence in parts of Eastern Nigeria in the relief of obstructed labour and was 1940s (3). He died in 1972 aged 92 years, successful. He died in 1995 aged 82 years. heart broken by our bitterly fought civil war John Bateman Lawson was the foundation of 1967 - 1970. professor of obstetrics and gynecology at William Simpson, an Englishman, was in University of Ibadan from 1953 to 1969. charge of Umuahia Government College, Later as Vice President of the Royal College where I received my secondary education of Obstetricians and Gynaecologists in from 1946 to 1951. He counselled me London (RCOG), he was responsible for successfully to study medicine, not civil overseas affairs at the College. Generations engineering, my preferred choice when I of health care workers in and outside UK was a teenager. He went to great lengths to benefitted enormously from his work inculcate modesty and character building as towards the betterment of women’s health in the two previous mentors did. He died in developing countries. Women with vesico 1959 at his home in UK aged 58. vaginal fistula (VVF) have cause to be Dr. Mason Thomas Dokubo Braide of grateful to him. He died aged 75 years in Bakana qualified as a medical doctor in 1997. Glasgow University. He spent his entire William Charles Wallace Nixon was career in various capacities in the Nigerian professor of obstetrics and gynecology in Civil Service. Touched by the awful state of University of London at University College women’s health, he singlehandedly collected Hospital. A thoughtful and humane man, data on over 2000 women in Eastern who, while I was a London undergraduate Nigeria. Some were circumcised, the rest medical student, helped to groom me were not. He compiled his observations into towards what I eventually became. More a thesis and was awarded the Doctor of importantly, he personally taught trained and Medicine degree by his alma mater in 1956. researched towards improving the welfare of He titled it “a study of female circumcision women from all back grounds. He initiated in Eastern Nigeria: its medical significance”. and directed the 1958 National Perinatal In it, he identified female circumcision in Mortality Survey of England and Wales. It these words: “It is a custom that causes a lot was the first of its kind and it led to many of suffering and ill health in African women. changes nationally and worldwide, in It is a custom that is bound to affect the span maternity care. He died aged 62 years in of life of African women adversely, on 1966. Nig Del Med J 2017; 2(1): 2-13 page 2 Commentary: We reap what we sow. KA Harrison Frank E. Hytten is an Australian, a qualified revealed that poor nutrition especially folic medical doctor, a pioneer and top researcher acid deficiency, malaria and sickle cell and writer in the field of Human disease were the principal causes. When Reproductive Physiology. He is judged to be anaemia became extreme, exchange blood the most influential editor of the BJOG. transfusion, not straight blood transfusion, Now aged 92, he and I still keep in close was needed to raise the low haemoglobin touch. level quickly without killing the patients Finally, there was Niilo Hallman, a Finn. He through overloading the failing anaemic was Professor of Paediatrics at University of heart. But exchange blood transfusion was Helsinki in Finland. While serving in that too complicated and costly to set up and use capacity, he became the moving spirit in the in rural settings where the patients first modernization of the Finnish health system. reported for treatment. While I was still a In later years, his support for the creation of house officer, I suggested that a group maternal and child health clinics in rural should be tasked with the responsibility of Africa became legendary, and in the case of undertaking rigorous research to look for a Zaria, the support came always when it was simple method of transfusion to replace the most needed. He died in 2011 aged 94 years. complicated exchange transfusion. The small group made up of me and Mr. A. I. THE IBADAN YEARS 1960 – 1972 Kadiri, the senior laboratory technologist of the department, measured the major changes My time in Ibadan began with me as one of in the circulation severe anaemia produced only three house officers in the 107 bedded (4) and in the end, devised the method of department of obstetrics and gynecology at combining direct blood transfusion with a University College Hospital (UCH), and rapidly acting diuretic, ethacrynic acid. It ended when I rose to the post of a professor worked as well as exchange transfusion (5) in the same department, and left. The which it has since replaced worldwide. department handled about 3000 deliveries Frusemide is now preferred to ethacrynic annually with a large proportion of acid. complicated deliveries. Consultant staff Two years later, we showed for the first time strength was never more than six. The that anaemia in the mother impaired the facilities provided were sufficient to allow growth of her baby in the womb, and that us to cope, although we were occasionally the correction of the anaemia during stressed. pregnancy led to catch-up growth of the The subject of maternal deaths dominated baby (6); an issue of enormous public health much of the department’s activity.