Odia Iyoha
Lagos, Nigeria

It was 1838 in the ancient town of Ake, the era of the Abikus. The harmattan wind blew with reckless abandon, tinting everything living and non-living along its course. The leaves turned reddish brown from green, the roofs were caked with layers of dust and the buildings encrusted with patches of dirt.

People sneezed openly and nostrils dripped faster than a running tap.

E ku Oye—Happy Harmattan Season, a greeting coined specially for this period, became the accepted greeting.

Under the thickness of the dusty sky, coming from the compound of Pa Segun Olomola and Ma Funke Olomola, were the sounds of gangan and chants. There was a procession of men in white led by the chief priest. They were there to perform the rites of Irapada—rebirth—for Kasimawo. Kasimawo was so named because eleven children had been born before him and died before reaching the age of five. When he was born, his parents named him “Kasimawo,” meaning “Let us still observe this one.” It was common to find children with this name. If they survived beyond their fifth birthday, they held their first naming ceremony and christened them “Kokumo,” meaning “This one has stopped dying.”

Kasimawo made it to seven. When he turned six, his parents feared he would die like the others before him. So they waited one more year. When his seventh birthday approached, Pa Olomola sent word out to the chief priests to inform them that their child had crossed the line of “no going back” to the spirit world. The community was informed of the rites, which would take place in a fortnight.

There was wild jubilation—everyone was genuinely happy for Pa and Ma Olomola who had lost eleven children before the death of Kasimawo. Men and women came with rams, goats, native chalks, fowls, wrappas, mats, palm oil, tubers of yam, cassava, cowries, coconuts, sticks of sugarcane, pineapples, Ileke, raffia-made baskets, and more. By the time the Olomolas were done receiving the first gifts, they had provided all that the chief priests had requested for the naming ceremony.

The day was festive and memorable. The harmattan was not felt because of the intense heat that was emitted from the lighted palm fronds in different parts of the compound. Kasimawo was made to walk in bare feet, clad in white Sokoto and Danshiki, with ground native chalk smeared all over his body. He was made to jump over seven heaps of burning palm fronds as he made three trips around the compound.

The leader of the procession held a broom, which he dipped in water and sprinkled on Kasimawo, making sure he hit him with the broom. Every time he sprinkled the water, he chanted incantations to send away the spirit of death hovering above Kasimawo. But by the time they finished, Kasimawo’s feet hurt so badly that he almost passed out. When he complained about the blisters, he was chided for trying to aid the evil spirits to bring doom on the land.

Three days later, Kokumo’s pain had worsened. He screamed to the skies, and his parents ran helter-skelter looking for a solution. The chief priests blamed the agony on the evil spirits, who had become angry that the Irapada ceremony was held when it was time for the child to return to the spirit world.

Three days later, Kokumo died.

Pa and Ma Olomola never recovered from the shock. They too died just a few days later.

Generations later, in the year 2015, history was threatening to repeat itself. When Mr. Kunle Olomola and Mrs. Derin Olomola, descendants of Pa Segun and Ma Funke Olomola, birthed their first child and lost him before his first birthday, they blamed the unfortunate occurrence on perceived family enemies. In a tradition that has been passed down for generations, all descendants of the Olomola lineage must birth their babies under the supervision of Yeye Ifafunwa, a position reserved for every first female child born into the Olomola family. When Yeye Ifafunwa dies, the next first female child in line takes up the position. As a result of this ancestral tradition, the Olomolas do not visit hospitals.

Ms. Derin Oluyomi knew of this family tradition when she agreed to marry Mr. Kunle Olomola and live by the family traditions. For this reason, Mr. and Mrs. Olomola did not go for any pre-marital counseling nor had any blood tests or screenings performed. “The gods will always guide our path,” they would say.

Mr. and Mrs. Olomola lost four children before they reached the age of five. It was not until the fourth child was lost that Mrs. Olomola’s siblings said that enough was enough. They did the unthinkable, an action considered to be a serious offense—they kidnapped their sister and her husband and forcefully took them to a health facility for testing. They were ready to bear the consequences of this action. Mrs. Derin Olomola’s extended family was a fine mix of lawyers and doctors.

Alas! The result of the test confirmed their fears. Mr. Olomola had sickle cell trait, the same as their daughter, Mrs. Derin Olomola. The four children that had died very likely had the SS genotype, given the similar symptoms they had all exhibited when they fell ill and died.

When their fifth child was born the Olomolas defied tradition and had her in a hospital. The child also had sickle cell disease but lived well into adulthood. Because they were aware of her genotype, she received all the necessary care and managed her condition well under the guidance of their family physician.

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The above piece is a work of fiction, but will be familiar to anyone who knows the myths that surrounded sickle cell disease (SCD) in West Africa centuries ago. Children who are now known to have the HbSS genotype were labeled Ogbanje among the Igbo-speaking tribe of Nigeria, and Abiku among the Yorubas.¹

These children were believed to have been sent from the spirit world to cause their earthly parents pain. Sacrifices were offered after consulting with the chief priests, who served as the intermediary between humans and spirits. The children often died before their fifth birthdays because of the harsh conditions they were subjected to, all in the name of finding a solution to their problems.

Traditions, culture, beliefs, religion, and society have shaped humans for centuries. In the days before health information was available, people still sought answers for the illnesses and diseases that befell them. When they could not find answers, they blamed spiritual causes, which ultimately caused a lot of damage.

Children who were labeled Abiku in those days were children who had SCD. Ages before European colonization of West Africa, the people had identified a chronic condition variously called Abiku, Ogbanje, or Sankara–jimi in Nigeria.¹ Shortly after SCD was defined in the United States, studies at the University of Ibadan confirmed the condition in Nigeria.¹

People with sickle cell disease have atypical hemoglobin molecules called hemoglobin S, which can distort red blood cells into a sickle or crescent shape and disrupt the transportation of oxygen.² For the first six months of life, infants are protected largely by elevated levels of HbF.³ Sickle cell disease usually manifests early in childhood with its characteristics signs and symptoms that may include: acute and chronic pain, bone pain, anemia, growth retardation, delayed sexual maturation, being underweight, pulmonary hypertension, hand-foot syndrome, and others.³ SCD is endemic in West Africa.¹

Though it has no cure, SCD can be managed using pharmacologic and non-pharmacologic approaches. A physician will guide a patient through the best treatment options available. The goals of treatment in SCD are symptom control and management of disease complications.³

References

1. Sunday JA, Florence DT, Benjamin UE. ‘Traditional Herbal Management of Sickle Cell Anemia: Lessons from Nigeria. National Center for Biotech.’ Info. 2012; 2012: 607436. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3502758/. Accessed January 14, 2020.
2. The U.S. Department of Health and Human Services. Sickle cell disease. Genetics Home Reference https://ghr.nlm.nih.gov/condition/sickle-cell-disease. Published January 7, 2020. Accessed January 14, 2020.
3. WebMD LLC.  Sickle Cell Anemia. Medscape. https://emedicine.medscape.com/article/205926-overview. Updated November 26, 2019. Accessed January 14, 2020.