Walking Through The Shadow of Death - Nigeria And Her President -

“Yea, though I walk through the valley of the shadow of death, I will fear no evil: for thou art with me; thy rod and thy staff they comfort me.” – Psalm 23:4

President Yar’adua of Nigeria got into office under a cloud of confusion on the state of his health with various speculations and little truth emanating from him. The initial clue to the state of his health was when he collapsed during the campaign period and was hastily rushed to Germany for treatment. He returned to complete the campaign and was eventually declared the winner of the election and sworn in as President of the Federal Republic of Nigeria.

A look at what has transpired as per his health prior to his becoming the president and what has happened since, will point more to an ominous foreboding that ideally should have disqualified him from contesting the election in the first place. 

President Yaradua was said to have a kidney problem during the period he was governor of Katsina state from 1999-2007 and it was even said that he took about 6 months off to recuperate at a point during that tenure. Information in the public domain and some of which have been confirmed by his media team includes the fact that he suffers from an auto-immune disorder called Churg-Strauss syndrome. Churg-Strauss syndrome is noted to be a serious disease that can be fatal and if left untreated for a while can be extremely dangerous causing extensive damage to some organs that are affected but an early and effective treatment can lead to a total remission of the disease.

Unfortunately, we were also told by his media team in the early days of his presidency that he was actually suffering from Asthma(one of the presenting diseases of the Churg-Strauss syndrome) and for which he was treated for many years without actually treating the syndrome. We have also be informed that he has end-stage-renal-disease for which he has been on Dialysis for many years. It was also in the early days of his presidency that a medical team in Germany was able to connect the asthma and the renal disease to a single disease pattern emanating from Churg-Strauss syndrome. We can then emphatically say that the diagnosis of Churg-Strauss syndrome is only recent, which means the disease was diagnosed late when likely all the possible complications are already manifesting. The manifestation of the complications includes the end-stage-renal-disease and the recent acute pericarditis(which is an inflammation of the sac surrounding and protecting the heart). 

Generally speaking, End-Stage-Renal-Disease is a highly disabling disease with a high mortality rate that most people diagnosed with it die within four to six years mostly from cardiovascular disease and is the key reason why those diagnosed with this disease are often placed on a waiting list for a Kidney transplant immediately.  

As at today, President Yaradua has been treated for end-stage renal disease for longer than six years which equates to the fact that we may be seeing a late phase of the mortality process. Based on the nature of the end-stage-renal-disease due to an auto-immune disease, the option of a kidney transplant does not exist in this instance as a foreign organ is more likely to induce a further immune reaction leading to further devastating reaction and organ damages.  There is a high possibility that President Yaradua might have been told about not being a good candidate for a kidney transplant and the likely reason why he stopped going to Germany and instead going to another German Hospital in Jeddah, Saudi Arabia. The issue of going to Saudi-Arabia is more likely a key to the possibility of what has occurred from his transfer to the hospital as there has been information that he probably got a kidney transplant there against all medical advice and ethics involve in someone with an auto-immune disorder getting such a transplant. It is therefore a possibility that in addition to the known fact of the late stage of an end-stage-renal-disease, we may also be seeing a rapid immune reaction against the organ from the effect of a kidney transplant.

The current episode of acute pericarditis may actually be a pointer to the final stage of multiple organs damage and its associated mortality. The fact that President Yaradua has been acknowledged to be at this level is a pointer that he is at the end leading to mortality.

The definition of disability is a physical or mental handicap that prevents a person from living a full, normal life or from holding a gainful job.

Within this definition, the mere fact that President Yaradua has not been able to live a full normal life and unable to gainful hold his job as President makes him disabled.

In addition, his current medical conditions also make him disabled. End-stage-renal-disease is within its definition, a disabling disease by the US Medicare standard which allows any  one with end-stage-renal-disease irrespective of age to be classified as disable based on requiring dialysis or a kidney transplant. 

Within all these medical issues with President Yaradua along with the fact he has been out of the country for more than fifty days, it is imperative that whatever his current mental state, he is disabled and should allow the Nigerian constitution on permanent incapacity to become effective immediately. The permanency of the incapacity of President Yaradua can also be inferred from the fact that his Kidney disease irrespective of continued dialysis or a kidney transplant will ad infinitum make him to remain incapacitated. 

All these make the Nigerian Presidency as walking in the shadow of death. 

The 1999 Nigerian constitution under section 144 states what will be required to ensure that the President ceases to be in power if he has a permanent incapacity. The first requirement of this section is that two-thirds majority of the Executive Council members should make a resolution declaring that the President is incapable of discharging the functions of his office and the declaration is verified by a medical panel established under sub-section 4. The medical panel under this subsection 4 should include the personal physician of the President and four other medical practitioners who have in the opinion of the President of the Senate, attained a high degree of eminence in the field of medicine pertaining to the medical examination to be conducted in view of the section 144. Once the declaration is verified, a report to this effect is then sent to the President of the Senate and the Speaker of the House of Representatives.

The issue with the Nigerian constitution so far analyzed lies with the fact that the two-thirds of the Executive Council Members have to start the process of confirming the permanent incapacity of the President. This does not take into consideration the bias and political exigency that may exist among that many people required to make such a huge change in the government of a country outside outright military coup. It could also be a ground for abuse if a group of members of the executive council decides to push out a healthy but non-conforming president. 

One could argue that the need for medical experts including the President personal physician may counter any such bias but not necessarily if the President of the Senate is the one mandated to appoint four out of the five physicians. The fact that this is the second step on an issue of medical incapacity is a pointer to defective nature of the Nigerian constitution on this. One would have expected that the medical experts will be the first step in defining if a President has a medical incapacity that could affect his function and not members of the executive council, most of whom were appointed by him. There have also been arguments that the statement “members of the Executive Council of the Federation” does not necessarily mean “members of the Federal Executive Council”. But, this has been very well defined under section 144(5) as reference to the body of Ministers of the government of the Federation, howsoever called, established by the President and charged with such responsibilities for the functions of the government as the President desires. Also under the concept of Ejusdem generis in statutory interpretation, one can definitely say that the statement refers to the same.

Once the above stages have been met and the medical report confirms the President infirmity as permanently incapacitating, a notice signed by both the President of the Senate and the Speaker of the House of Representatives shall then be published in the Official Gazette of the Federal Republic of Nigeria. The President based on this report will then ceased to hold office from the date of this publication.

 In a system, where the ruling party holds the majority and control of every aspect of the implementation of this constitution along with the fact that we are barely 15 months to the next election, it is no rocket science that different delaying tactics will be used in holding forth till the next election in April 2011 by the forces that have currently hijacked the government and running it for their own personal gains with the hope that by December 2010, they will be able to install their own person as the Presidential candidate for the election. This will allow them to thwart any effort by the current Vice-President to take over as the President which may lead him to contest and continue thereafter through the next election.

It is obvious that the way the current Nigerian constitution is written, the country is walking in the shadow of death and it is not giving any direction on the way to go with a nation besieged by issues afflicting a sick and weak President.

What are the tenable options in the midst of so many uncertainties?

One thing is very clear and that is the fact that President Yaradua by all definitions is very sick and permanently incapacitated by virtue of his end-stage-renal-disease and further reiterated by the fact that he has been sickly and not functioning for more than 50 days while out of the country. It is also very clear that the current constitution will not resolve the impasse now existing that has also allowed few in the government who are unelected led by Mrs Turai Yaradua(the President’s wife) and Tanimo Yakubu Kurfi (The President’s economic adviser). Under the suspicion that the last budget was “thumb-printed” by the sick President while the Senate was on recess, it can be argued that some of the people running the country may be committing illegalities and will need to be held accountable at a point in time.

The best option right now is for President Yaradua to acknowledge his infirmity and the fact that he needs time to recuperate and spend good time with his family. This will then open the room for his cabinet members to push forward the section 144 of the constitution or President Yaradua can save us the legal rigmarole and tender his letter of resignation. The problem with this option lies on the premise that we expect him to be alive and fully conscious to take these actions. But based on the late stage of his medical conditions with possible associated organ failure, he could be in state of fugue in which his mental alertness is affected, not conscious of time, place and person, or even in a vegetative state. If he is in any of these states, he is more likely never to fully recover from that level of multiple organ damage.

The only other option is an immediate impeachment of an absentee President who at least by his own confession suffers from a debilitating illness of which full recovery he does not know, if we are to believe that the interview broadcasted by the BBC News was actually by him.  Under section 143 of the 1999 Nigerian constitution, an action of gross misconduct by the President could be tabled by one-third or more of the members of the Senate to start the process. The basis for the allegation of misconduct could be that of the President leaving his job ab initio without handling over to his Vice-President and in the process abandoning his job for more than 50 days. The process will still require majority of the membership of the ruling party but it will be an easier process that following the terms of section 144.

While the President walks in the shadow of death, it is imperative that the country also not be allowed to walk in the shadow of death because if the current state in which the President remains incommunicado and not functioning while the likes of Turai Yaradua and Tanimo Yakubu Kurfi who are unelected officials continue to run the country, the essential ingredients of a good country being well governed will continue to be lacking. In the interim, the treasury is being looted, cronies are being better empowered to cause more havoc in the next election, the constitution is being debased, essentials for the man on the street like water, electricity, gas(petrol), etc are abandoned and being left to speculators to make a kill making such essentials are virtually out of reach to the man on the street.

And for this I pray that though my country walks through the shadow of death, it shall fear no evil for the hope, aspirations and sagacity of its people have always seen it through.

Segun Toyin Dawodu is a physician and attorney based in the US and UK and editor/webmaster dawodu.com