Whenever I see young people in the clinic, I try to engage them in a conversation. The millennial in me wants to understand their perspective: how they think, what occupies their minds, and what the trending problems of teenagers and young adults. You would be surprised by the wealth of knowledge I have gathered in the past few years.
When I was young, my only problem was passing my exams. Period, but it’s not so for this generation.
A couple of weeks ago, a young girl of 21 came to the clinic with her mother. They were from a village on the outskirts of Kano. The first thing I noticed was how painfully thin and malnourished she looked. However, her face looked puffy and a quick glance at her midriff also revealed a distended abdomen. Sickle cell perhaps? I thought to myself. Or maybe kidney failure?
The young woman sat on the chair and proceeded to smile brightly at me. I greeted her and she answered me heartily. As I opened my mouth to start proper history taking, she began to tell me about her sisters, and how they planned to celebrate Sallah, her speech was rushed and not coordinated. I gave her mother a questioning look.
She looked helplessly at her daughter, sighed and then proceeded to narrate the story. Let’s call the patient ‘Halima’. Halima was apparently well until two weeks ago when she started talking irrationally. For someone who was previously known for her quiet nature, this outpour of speech worried her parents and it was not just that she was talking too much, but Halima seemed not to be in possession of her senses. She talked rubbish throughout the day and well into the night, sleeping for less than four hours a day, and did not seem to be know where she was. She had episodes of aggression where she would suddenly start hitting her young siblings, accusing them of verbal abuse. She talked loudly to herself and to people nobody else could see. The young woman, who was previously an aspiring tailor, suddenly did not know what to do with people’s clothes. One time, she was caught wandering aimlessly around the neighborhood. Her family was in shock.
After two weeks of relentless and aggressive Rukiya (exorcism), Rubutu drinking and Hayaki (incense burning) to chase the devils possessing her away, an uncle decided it was time to bring her to the hospital.
I took my time taking a detailed history from Halima and her mother. Auditory hallucinations? Delusions? Thought insertions? Negative symptoms like withdrawal, neglecting self-hygiene? In my mind, a picture of ‘Schizophrenia’ as diagnosis was already forming.
While examining her, I casually asked about her weight, to her mother, ‘Has Halima always been this underweight?’
‘Yes, in fact, her cousins always made a jest of her, and that is why she started taking one medicine a few months ago.
Alarm bells went off in my head. ‘What medicine?’
‘I don’t know fa, but in my village, we call it ‘sha ka fashe’’
I immediately pushed ‘schizophrenia’ to the bottom of my diagnosis pile. A new one had popped up.
Apparently, Halima, after being mocked all her life for her bone-thin stature, was persuaded by friends to try a popular drug known to cause weight gain. The medicine popularly called ‘Sha ka Fashe’ is a steroid called Dexamethasone.
Weight gain is a common side effect of dexamethasone, and it is often related to the drug’s effects on the body’s metabolism. Dexamethasone increases the body’s production of insulin, a hormone that helps to regulate blood sugar levels. This can lead to an increase in appetite and a decrease in metabolism, which can result in weight gain. In addition, dexamethasone can cause fluid retention in the body, leading to an increase in body weight. This is particularly true in individuals who are already prone to fluid retention, such as those with heart or kidney disease.
Research has shown that up to 80 per cent of people may experience weight gain as an adverse impact of dexamethasone therapy. According to one study, patients who took dexamethasone for longer than two weeks acquired weight on average of 3–4 kg, with some patients gaining as much as 15 kg. Patients who were overweight or obese before therapy, as well as female patients, were more likely to experience weight gain. Because of its weight-gaining side effect, young men and women worldwide have continuously abused this medication despite its deadly side effects.
I remember reading an article a year ago on livestock farming. Reports showed that some livestock farmers allegedly use fattening substances, a weight-gain drug popularly referred to as “Sha Ka Fashe”, to artificially fatten cattle and sheep.
Steroids have numerous side effects ranging from mild to deadly. I shall not bore you with the list as a simple Google search will satisfy your curiosity. For the purpose of Halima’s case, the one that immediately came to my head was ‘steroid induced psychosis’. In lay terms, consuming high concentrations of the drug could cause mental illness.
Despite my shock, I was morbidly fascinated. I had never actually seen a case of steroid induced psychosis. I quickly asked for permission to discuss with a psychiatrist so as to decide on how best to manage her.
Halima’s mother was aghast. In her wildest dreams, she could not fathom how a seemingly harmless drug that her daughter had been taking over the past four months could have led to this. Why, she even encouraged the girl! Halima’s face and stomach were said to have swollen when she was taking the drug. Halima’s mother thought it was a sign that her daughter was adding weight.
In the past few years, mental health advocates have increasingly raised concerns about body dysmorphic disorder. Body dysmorphia, also known as body dysmorphic disorder (BDD), is a disorder that is characterised by the preoccupation with a nonexistent or minimal flaw in appearance. In a bid to look better, people resort to excessive exercise, cosmetic surgeries, taking drugs such as steroids, skin bleaching, and even eating disorders.
Young people today, in addition to the myriad of Nigeria’s problems, have to deal with the additional burden of ‘looking perfect’. Everywhere you turn, women are looking curvy, voluptuous, with clear glass skin, long Brazilian hair and pearly white teeth. The pressure to conform to certain standards is shocking. Even for those in the villages.
The pharmaceutical companies are aware of these vulnerabilities and so continue to push drugs legally and illegally into the system, where our ignorant businessmen see an opportunity to make a quick cash grab with both hands.
Everywhere you turn, whether in Maitama or Apapa, you will sight one man selling prescription medicines illegally on a tray perched above his head, promising to make you better, slimmer, fatter and even fairer.
Where do we even start?