Agony of sickle cell carriers and their relatives

Although, effort to educate people on genotype compatibility has intensified recently, hardly do many people especially those in Africa know the financial, pcychological and medical consequences of sickle cell anaemia.

Apart from knowing the financial and psychological consequences of some medical issues, working in an hospital as an accountant has opened my eyes to the uneasy life of sickle cell carriers popularly known as "sickler" and the effects on their guardians; the reason you have to know your lovers' health status before saying "yes!" to the "will you marry me?" proposal.

I have mixed feelings working in an hospital especially being in the billing and financial department of the sector. While I enjoy working in an hospital for the knowledge I gain both in medication, purposes of certain tests, medical procedures and seeing how invaluable it is to be healthy; it aches my mind when I bill many patients for certain ailments like sickle cell, especially when the patients or their family are obviously financially incapacitated.

At least, I know two different sickle cell patients in the hospital: one, a couple whose wife constantly experiences crisis which cost them average of not less than N80k to N120k/daily. Apart from the cost, the lady lament the stigma she receives from being an SS, the reason why her first reply when her admirers first walk up to her is "I am SS! Can you bear my burden?"

The other patient is a small boy whose aged and helpless parents look pathetic to me. Sometimes, when I see the gruelling boy on bed crying for his life with his parents beside him lamenting their penurious condition, I feel like crying with imagination of having a super power to change his genotype, and those of other patients that were wheeled onto the sick beds.

However, I believe the only help I can offer, just like other sympatisers, is to educated people on sickle cell in order to save themselves and their offspring the cost and their likely stigma and discomfort.

Sickle cell anaemia is inherited by offsprings whose biological parents have incompatible trait.

Normally, unlike a healthy red blood cell that is round and flexible, a sickle cell is long and spiral, thus, unable to move freely and to convey oxygen around the body.

Sickle cell, an inherited red blood cell disorder in which there are not enough healthy red blood cells to carry oxygen around the body, is characterised by intense pain and discomfort in the patients when in crisis.

Sickle cell crisis is a period of grave discomfort and pain by the carriers. The crisis occurs when sickle-shaped red blood cells clump together and block small blood vessels that carry blood to certain organs, muscles, and bones.

Although, there is haemoglobin "C" trait, the four major and common genotypes are AA, AS, SA and SS.

Genotypes are results of pairing of each haemoglobin of one parent and that of the second parent. For instance, if a parent with AS marries someone with AS, their children are likely to be any of the following: AA, AS, SA, SS.

This means one of the four children will be SS - sickle cell - with only one being AA - homozygous.

Genotype compatibility table

Father's Genotype	Mum's Genotype	Outcome	Advice
SS	SS	SS, SS, SS, SS	Too bad and never advisable
SS	AS	SA, SS, SA, SS	Bad and not advisable
AS	AS	AA, AS, SA, SS	Not bad but not advisable
AA	SS	AS, AS, SA, SA	Good and advisable
AA	AS	AA, AS, AA, AS	Better and very advisable
AA	AA	SS, SS, SS, SS	Best and always advisable

As seen in the table, SS results from the pairing of "S" and "S", that doesn't mean that marrying someone who is SS is bad in as much you are AA.

The worst case scenario is when an SS marry an SS. Also, the slightest fair case is when AS marries SS but it has never been advisable. 

Someone can only understand the agony of sickle cell patients and their relatives if you have them as close relatives, friends or patients with the financial, psychological and stigma that comes with it. However, it prevention is better than it management.