Health Minister Gives Progress Report on the First Six Months

Nigeria's Health Minister, Professor C.O. Chukwu came into office just over six months ago, at a time of great political turmoil, and following a rapid turnover at the helm of the health ministry. Prior to his appointment, he was Chief Medical Director at the Ebonyi State University Teaching Hospital, and then Professor of Orthopaedic Surgery and Deputy Provost of the College of Health Sciences, Ebonyi State University at Abakaliki. He had just taken a sabbatical as Visiting Professor of Surgery at the College of Medicine, University of Nigeria but before he could settle in Enugu, he received the fateful call from President Goodluck Jonathan that would thrust the health of Nigeria's 150 million people into his hands.

President Goodluck Jonathan 

So what progress, if any, has been made in Nigeria's health care under President Jonathan and Minister Chukwu? In an exclusive interview given to The ANPA Blog, the Minister made his case directly and rendered a progress report on the activities of the ministry during his first six months in office. We asked: "You have been in office for less than 6 months, so it may be too early to discuss your achievements. However, are there some things you are particularly proud to have accomplished?".

Professor Chukwu opened by touting the "new sense of urgency and responsiveness at the Federal Ministry of Health" and his drive to establish "trust and confidence-building" as his guiding principles. Also, he revealed that President Jonathan has been singularly focused on health policy and has invested enormous political capital to pass the Health Bill that will facilitate the development of a functional health system for the country.

But, what specifically has he achieved, we asked. First he recalled that during his Senate confirmation hearings, the entire healthcare sector was in crisis over the wage dispute between the ministry and several groups of health workers. He had swiftly quelled the crisis, he said, by implementing "payment of the new wage structure for health workers and the arrears thereof". To produce transformational changes in the health system, however, the Minister said that he is focused on passing the National Health Bill and the implementation of the National Strategic Health Development Plan. The Health Bill has passed both chambers of the National assembly and is awaiting harmonization. President Jonathan recently expressed confidence that he will sign the bill before the New Year.

A top priority of his ministry, said Professor Chukwu, is to ensure that Nigeria meets the health-related Millennium Development Goals (MDGs) by 2015. However, he recognized from the outset that little will be achieved without fostering a sense of collegiality among all health workers. Notably, during his Senate confirmation, Professor Chukwu was embroiled in a controversy over whether only doctors should be appointed to the top job. Then, he had forcefully emphasized the important role of all ranks of health workers, saying: "The bottom line is that without team work nobody can do it alone." To this end, he said, he went on to create the "Committee on Harmonious Working Relationship among Health Workers/Professionals" charged with  instilling a sense of common purpose among physician and non-physician health workers. Professor Chukwu said he is working at full speed to fully implement his “Action Push Agenda for Health” plan before a new government is sworn in in May 2011. He reiterated what he had told The Guardian about his plan:

‘The Action Push Agenda’ is a compass for the period from April 2010 to May 2011. During this period, our top priorities will be on governance and stewardship, team work and industrial harmony, keeping on track the realisation of the MDGs especially the Health MDGs, disease prevention, surveillance and control, provision of affordable but world-class healthcare services at our public and private tertiary health institutions, and the establishment of a reliable referral system.”

Regarding dissatisfaction among resident doctors, the Minister said he was determined to address them comprehensively and has therefore established a "Committee to Review the Residency Training Programme". He noted that he has invited a broad coalition of medical experts to serve on this committee, including ANPA, which is represented by the Chair of the Education Committee, Dr Dotun Ogunyemi. The Minister said that ensuring quality training and meeting the MDG goals were part of his push to "inspire international confidence in the Health Sector". He pointed out the vital role that diaspora organizations such as ANPA can play in this regard, noting his full personal engagement during the "Retreat for Health Professionals in the Diaspora" held by the health ministry in July 2010.

Other achievements listed by the Minister include: audit/mapping of skills and facilities in the federal tertiary health institutions; providing support for first ever ATLS course in Nigeria; deployment of 2488 midwives across 652 primary health facilities; update of health data and statistics update; convening an inter-country inter-ministerial meeting with Nigeria’s neighbours to discuss and sign an agreement on cross-border health issues; and hosting of the 2nd International Cancer Week.

Health Minister: Increased Government Funding and Inter-Sectoral Cooperation Vital To Improving Health of Nigerians

Nigeria's Health Minister, Professor Onyebuchi Chukwu

For watchers of healthcare delivery in Nigeria, it did not come as a surprise when the country was ranked among the worst countries with weak national health systems; ranking 197 out of 200 in a recent World Bank survey. This poor ranking was attributed to inequitable distribution of healthcare resources between urban and rural areas; and lack of functional referral system due to poor funding. To refresh our minds, only 39 percent of births are assisted by skilled health professionals, just as only 23 percent of children between12 and 23 months receive full course of immunization against childhood killer diseases.

Against this backdrop, the ANPA Blog sought the audience of the Nigeria’s Minister of Health Prof. C.O.Onyebuchi Chukwu on these and other issues related to healthcare delivery in Nigeria during his visit to the United Nations in New York. It is a fact that most diseases responsible for mortality and morbidity in Nigeria are preventable and tied to areas outside of the ministry of health's purview (water supply, sanitation, environmental pollution). The ANPA Blog posed this to the minister and wanted to know what the ministry of health was doing to educate the leadership of the ministries involved and mobilize them for a common purpose of improving the nation’s health.

The minister agreed with facts as posed by the Blog and said that inter-sectoral cooperation was vital to improving the health and health outcomes for Nigerians. He said: “We have engaged those ministries (particularly Education, Water Resources, Environment, Interior and Finance) in bilateral discussions but intend to establish the inter-ministerial/inter-sectoral committee meeting on health.” He maintained that the better educated the leaders of these sectors are, the better will be the health of Nigerians.

The minister touted the great strides made in polio prevention in Nigeria saying “From January 2010 to October 2010 only 10 cases (2 awaiting confirmation) of Wild Polio Virus transmission has occurred in Nigeria.” and that WHO acknowledges that Nigeria has reduced transmission by 98%. The ANPA Blog congratulated the minister on this achievement but reminded him that successes are directly the result of immunization campaigns that are largely driven by external agencies and that there are still pockets of morbidity to vaccine preventable diseases, for example the 100 cases of polio paralysis reported from Jan to Sept 2009 in Kano alone. The ANPA Blog was concerned about the over-reliance on outside funding agencies and minimal national resources devoted to vaccine preventable diseases. The minister acknowledged that foreign donors are helping in the polio eradication program in Nigeria, but that more domestic funds have been committed to the operational cost (about 80%) of polio eradication effort in Nigeria than from external sources. He said: "External donor funds have been used to bridge funding gaps. This is not peculiar to Nigeria.” With regard to polio vaccine procurement, the minister said that domestic funding accounts for 50% while external funding accounts for the balance of 50%.

It is our hope that the minister will follow up on his promise to forge true inter-sectoral cooperation to improve the health of Nigerians particularly the poor and disadvantaged.

LUTH to boost medical tourism: Lessons from Colleagues Who have Gone Home

Since I left Nigeria after completing medical school, I have been back several times and have been in contact with my school mates both inside and outside Nigeria. I have been involved in both soft and heated discussions on the path forward for health care in Nigeria. In some cases, people have blamed physicians like me who received medical education in Nigeria then left Nigeria. In other cases, people see physicians like me as a potential to help pull Nigeria forward by collaborating with our colleagues in Nigeria.

I have had several opportunities to speak with Nigerian physicians in Diaspora that have gone home “successfully”, others who had to rush out after going home and many others who want to yield to calls from both the Nigerian government and people of Nigeria to return home to help.

Although I believe all physicians do not have to go back to Nigeria to help, I think a critical mass may need to go home to develop a collaborative atmosphere that currently is lacking in many medical schools in Nigeria, and which inhibits the potentials of working across the Atlantic.

Prof. Akin Osibogun, CMD of LUTH 

In a recent report that appeared in The Guardian, the Chief Medical Director (CMD) of the Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun, announced an initiative to "boost medical tourism" through a "public -private initiative arrangement". After reading this story, I wondered if it would be helpful for physicians who have gone home successfully and those who had to return to share their experiences with ANPA members as there might be a lesson or two they can give those thinking of returning home on the “dos” and “don’ts”.

The Indian government successfully attracted its citizens in diaspora back to their country by working with them to answer the question: what do you need for the government to have in place (policy) for you to come back?

Will Nigeria do the same?

Meet Our Bloggers: Nneoma Nwachuku, MPH

We are pleased to announce a new addition to our blogging team. Ms. Nneoma Nwachuku is a member of our partner organization, the Distinguished Nigerian Physicians of Tomorrow (DNPT).

Ms. Nwachuku is a medical student at the University of Connecticut School of Medicine (class of 2013). She received her undergraduate degree from Yale University where she also subsequently completed a Master in Public Health degree.

A proud Ohuhu native, Ms. Nwachuku calls Umuahia in Abia State home. She co-edits a group blog, NigeriansTalk.org, writes a personal blog and is an avid tweeter. Ms. Nwachuku brings to this blog a valuable perspective from the next generation of Nigerian physicians, on how to address the challenges facing health care in Nigeria.

Meet Our Bloggers: Asishana (Shana) Osho

We are pleased to announce the addition of new bloggers from our sister organization, the Distinguished Nigerian Physicians of Tomorrow (DNPT). The DNPT, which is sponsored by ANPA, is a coalition of Nigerian Medical students all over the world with the mission to help find solutions to Nigeria’s health care problems.

The first of our DNPT bloggers is Mr. Asishana (Shana) Avo Osho, a medical student at the Duke University School of Medicine (class of 2014). Mr. Osho is a native of Edo State and grew up in Lagos. He attended secondary school at Loyola Jesuit College, Abuja and subsequently graduated from Oberlin College, Oberlin, OH where he studied biochemistry and French literature.

Mr. Osho is dedicated to the empowerment of marginalized and deprived groups. He is also interested in the delivery of care and in the implementation of health policy in Nigeria and will reflect these interests in his writings.

ANPA Member, Dr. Charmaine Emelife, Explains Why Hypertension is a Killer Disease

As Chairperson of the ANPA Georgia chapter, Dr. Charmaine Emelife, worries constantly about how to improve health care in her home country, Nigeria. An ANPA Board member  and Chairperson, ANPA National Bylaws Committee, she has volunteered for several ANPA medical missions to help address the problem. However, like most  ANPA members, she expends most of her professional time and expertise taking care of her own patients in  Atlanta, GA, where she is partner at Atlanta South Nephrology.

Dr. Emelife, who is a proud alumnus of the University of Nigeria, and Chairperson, University of Nigeria College of Medicine Alumni Association (UNCOMMA), North America chapter, completed an internal medicine residency at the Cook County Hospital, Chicago and then a fellowship in Nephrology/Hypertension at Loyola Medical Center, Maywood, IL. In this video, Dr. Emelife explains why hypertension, or high blood pressure, can cause serious heart and kidney disease and why you should not take it for granted.

Reversing the Brain Drain Phenomenon

The subject of brain drain or professional intellectual loss from underdeveloped to developed countries remains a hot topic.This phenomenon is not unique to medicine and, in fact, encompasses many professional fields including other areas of science, humanities and professional sports.

To elaborate on the brain drain attributable to the medical profession, let me start by saying that many people choose to go into the medical field for various reasons. Most physicians have the gift of knowledge, forming the core of intellectual elites that elect to delay their gratifications from many years of educational torture that might eventually result in a comfortable life style.While many choose the profession to help others, some believe they do so because of the respect or prestige bestowed by the society at large. Others do so for money and yet others pursue the art of medicine because of their special gifts.

Whatever the reasons for choosing this noble profession, the fundamental act of practicing medicine must be supported by the right environment, offering adequate nurturing , security and diagnostic equipments to treat the sick and the injured. Any imbalance in this unique medical equilibrium will create an uncomfortable force that shifts the effort of the professional giver to look elsewhere and transport their expertise to a more favorable environment. Large scale migration of trained medical professionals whether from Nigeria, India or any other place seems to have the common denominators of poverty, lack of adequate medical infrastructures, poor security and inadequate allocation of health care funding. Thus the same brain that is been drained from one area can easily be filled elsewhere with the right environment. The transformation of acquired skill from a country with poor health structures is therefore not because of incompetent professionals or pure monetary seeking behavior, but rather because the new environment offers the right climate of innovation, improved experience, competency and well equipped facilities to entertain favorable and humane health care practices.

Unpleasant Tales from a Nigerian Hospital (1)

Nigerian doctors and nurses work under conditions that few of us in the Diaspora can fathom. Despite lack of equipment, broken facilities, and poor remuneration, the vast majority of these health workers do a fabulous job. We have noted on this blog the atmosphere of insecurity under which Nigerian doctors perform their work, having become targets of a thriving kidnapping industry, particularly in the South Eastern part of the country. The incessant strike actions, such as those recently called by Lagos State and Edo State doctors, reflect deep overall dissatisfaction by these doctors. So, it is not surprising that such poor working conditions might take a toll on their professionalism.

While we feel common cause with our colleagues at home, and support their fight for better working conditions, we are troubled by the myriad complaints that ANPA members receive from family members and friends alleging unprofessional and unethical treatment at some of Nigeria's flagship hospitals. The following from a Nigerian parent is, unfortunately, an all too common tale (the identity of the patient, doctors, and hospitals have been removed):

"My daughter's condition exposed me to the level of corruption in the public healthcare system in Nigeria. The doctors are a Lord unto themselves, operate private hospitals and divert patients to their hospitals with impunity. The only language that drives them is money. At the first private hospital we went to, we met a doctor who turned out to be a [Teaching Hospital] staff. He initially said the condition could be treated with antibiotics. Each time we went, we were arm-twisted to buy antibiotics at four times the normal price. Even when the X-ray showed that surgery was necessary, he continued to prescribe the same drugs for us which must be purchased in the clinic. On another visit, we met a second doctor who was so lackadaisical in his manners and utterances that we decided not to go back to the hospital.

Nigeria's Health Minister, Professor Onyebuchi Chukwu, Speaks to The ANPA Blog

Several weeks ago, Professor Onyebuchi Chukwu, Minister of Health of Nigeria, was at the United Nations headquarters in New York where he addressed a summit on the Millennium Development Goals (MDGs). With only five years left until the 2015 deadline, there is a renewed sense of urgency among under-performing countries such as Nigeria to accelerate progress towards achieving the MDGs.

Soon after Chukwu took office six months ago, he lamented that Nigeria faced unique problems that made attainment of the MDGs very difficult. Within a few months, however, he was more optimistic, touting the National Health Strategic Development Plan before the Commonwealth Health Ministers meeting in Geneva, a plan which Chukwu said specifically addresses core health-specific MDG targets for infant mortality, maternal mortality, HIV and AIDS, tuberculosis and malaria.

Taking the podium at the UN, Chukwu while acknowledging the difficulties ahead was also exuding confidence, reeling off statistics to show recent progress:

"Nigeria is reasonably on course to achieve the target of MDGs on reducing child mortality with a fall from 100 per 1,000 to 75 per 1,000 live births between 2003 and 2008. Similarly, in the same period, the under-5 mortality rate fell from 201 per 1,000 to 157 per 1,000 live births .... and a drop in the maternal mortality ratio of 545 maternal deaths per 100,000 live births........a fall in the prevalence of HIV/AIDS from 5.8% in 2001 to 4.24% in 2008; doubled treatment of patients from 16.7% in 2007 to 34.49% in 2008." 

During his UN visit, the Honorable Minister who revealed that he reads The ANPA Blog, agreed to take questions from Deji Adefuye and Ben Nwomeh, in the first of a periodic feature in which we will interview stakeholders in Nigeria's health system. In subsequent posts, The Blog will report the Minister's views on a wide-range of issues, particularly those of concern to ANPA members.

Is ANPA a Social Club ?

I have been debating this question for the past few weeks. I typically try to take stock when the year begins to come to a close and one of the thoughts that came across my mind was what exactly does ANPA mean to me or in what ways does it impact Nigeria as a whole in the Health care sector.

I reviewed the different posts by members on the group emails, blogs etc. and the comments reflected issues of concern to Nigeria i.e. safety, kidnapping, state of the economy, healthcare delivery, criticisms of the government , discussions about dues, membership issues etc. We celebrated the successes of our members and their families and commiserated with the families of those that passed away (may God Bless their souls). But really, how do these conversations differ from the conversations we have in other fora or gatherings? When we meet at parties and other occasions where 2 or 3 are gathered in the name of Nigeria, the same conversations take place.

So what is the value of ANPA?

The Abuja Medical School

It was really sad for me to hear that there are now 3 classes of medical students (class A, B, C) waiting to take their first professional MBBS exam at the University of Abuja.

While this university is still admitting and frustrating the young and bright in Nigeria who chooses to become doctors, both the Nigerian University Commission (NUC) and Medical and Dental Council of Nigeria (MDCN) have removed their accreditation.

My question is: Should schools be allowed to admit and collect school fees without accreditation? Should accreditation be given to a school without facility to run a medical school as was the stated reason for removing accreditation by NUC?

Nigeria: Partnership for Health Conference Opens in London, November 6, 2010

The second "Partnership for Health Conference" organized by the Public Health Foundation of Nigeria (PHFN), convenes at the Royal College of Obstetricians and Gynaecologists in London on November 6, 2010.

The PHFN is a network of individuals and organizations that advocate evidence-based public policy for health in Nigeria. It's mission also includes building professional, organizational and system capacity for public health and creating and sustaining peer support for Nigerian public health professionals. A spokesperson for the PHFN, Dr. Chikwe Ihekweazu, said that this year's conference "will focus on how sustainable collaboration between Nigerian health professionals working in the West, and Nigerian health institutions can lead to health gains for the Nigerian people."

Speakers at the conference to be drawn from NGOs, government and the private sector, will include Dr. Dilly Anumba, President of the Medical Association of Nigerians across Great Britain (MANSAG).

Registration for this event is still open.

Diaspora Groups Helping to Combat Nigeria's Cholera Outbreak

I have received a number of calls and e-mails from friends and medical professional comrades about the recent Cholera outbreak in Nigeria. Some are asking what is ANPA going to do about this?

Cholera can wreck havoc in a relatively short period of time if the outbreak is not quickly contained. While Haiti may have a legitimate reason to suffer the inevitable fecal oral infections brought about by unsanitary conditions in the refugee camps, Nigeria simply has no excuse at this day in age.

By mobilizing its resources to help during the last big band of the Haiti destructive earthquake, ANPA demonstrated its capacity to intervene in similar disasters in Nigeria, under the appropriate circumstances.

I was quite encouraged to read about the recent efforts by the Nigerian Global Diaspora Forum and the Nigerian Pharmacists Association of Tampa, Florida to assist the cholera victims.

Ted Turner - What Really Happened?

I was excited to read the story below about Ted Turner's support for the fight against polio in Nigeria. I thought it would be a good discussion since Nigeria remains one of few countries with wild cases of polio. I was disappointed when I can back to blog on this story and saw the disclaimer. My question is: What really happened? Does anyone know?

Ted Turner: Pledges $80 million to fight polio in Nigeria
Wednesday October 27, 2010

ABUJA, Nigeria -- Media mogul Ted Turner has announced that he will give $80 million to a United Nations foundation to fight childhood polio and measles in Nigeria, Africa's most populous nation.

Speaking in Nigeria's capital, Abuja, Turner said his gift would help further reduce polio rates in Nigeria, home of 150 million people. The nation had 381 new polio infections at this time last year during an outbreak that saw the disease threaten a belt of sub-Saharan nations.
Previously, some northern Muslim religious leaders spread rumors that the vaccine would sterilize children or infect them with AIDS. Now, local foundation and others have convinced clerics the vaccine will not harm children and will prevent them from being like many of the withered-limb beggars standing on street corners throughout Nigeria.
The efforts at vaccinating the young appear to be working so far in oil-rich Nigeria. Statistics show only eight cases reported so far this year.

Turner said continuing to vaccinate Nigeria's children would ensure their health and eradicate the disease from the country.
"Working together, I know we can finish the job on polio," Turner said.
The money will go toward the U.N. Foundation, an organization Turner helped create. About $60 million will go toward purchasing additional vaccines for the country, U.N. Foundation President Timothy Wirth said. The remaining $20 million will go toward efforts to combat measles.

A billionaire philanthropist, Turner is most known for founding CNN in 1980. He joins Microsoft co-founder Bill Gates in fighting polio in Nigeria.

STORY REMOVED: AF--People-Ted Turner
Monday, October 25, 2010; 6:32 PM
ABUJA, Nigeria -- The Associated Press has withdrawn its story about Ted Turner pledging $80 million to a United Nations foundation to fight childhood polio and measles in Nigeria. Amy DiElsi, a Washington-based spokeswoman for the United Nations Foundation, says Ted Turner has made no such pledge

Cholera Outbreak: Tale of a Country in the Doldrums

Today’s report from the United Nations Children's Fund (UNICEF) that a new outbreak of cholera has killed 1,555 people in Nigeria is another sorry tale of a country in the doldrums. The current outbreak which has been declared the worst cholera outbreak in Nigeria in recent years has recorded 40,000 cases, three times higher than last year and seven times higher than in 2008. According to the UNICEF report, women and children account for four of every five cases and new cases are still being reported in parts of the country, particularly the northeast.

Cholera is a disease of poverty, poor hygiene, and poor environmental conditions. During epidemics such as the current one, the source of the contamination is often the feces of an infected person, and infections can spread rapidly in areas where there is poor sewage treatment and a lack of clean drinking water. The rapid spread of this outbreak is not surprising given that two-thirds of rural Nigerians lack access to safe drinking water, and fewer than 40 percent of people in affected areas have access "to toilet facilities of any description," according to the Nigerian Ministry of Health. The situation no doubt would have been exacerbated given the level of poverty with its attendant malnutrition and compromised immunity associated with HIV/AIDS among the Nigerian population. The average Nigerian household also eat together often from the pot thereby increasing household exposure.

Nigeria Making Progress in the Fight Against Polio

The news from the Expert Review Committee (ERC) on polio that Nigeria had a 98 per cent drop in polio cases between 2009 and 2010 is heartwarming. According to the ERC, this reduction is the largest single drop in polio cases ever recorded in the world. The report noted that Nigeria has recorded only eight cases of polio to date in 2010 compared to hundreds of cases in the previous years that gave Nigeria the negative distinction of a carrier state from which the infection was spreading to other parts of Africa where it had earlier been eradicated.

Not too long ago, 2007 to be precise was Nigeria fighting an unusual outbreak of polio caused by mutating polio vaccine. Also, vaccinations were halted in 2003 for nearly a year because of rumors that the polio vaccine sterilized Muslim girls or contained the AIDS virus. It is worthy of commendation that Nigeria through the National Primary Health Care Development Agency (NPHCDA) of the Federal Ministry of Health recognized that the only remedy is to keep vaccinating children there. International agencies that have collaborated with Nigeria in this endeavor, notably United Nations Children’s Emergency Fund (UNICEF) and Rotary International deserve commendation for their efforts.

mHealth Africa Summit

With 379 million mobile subscriptions and over half of the population in African countries currently using mobile phones, is there a unique opportunity to leverage the mobile phone platform to revolutionize delivery of health care across the continent? This will be the focus of the Mobile Health Africa Summit, being convened on December 2, 2010 in Accra, Ghana.

Prior to this year's event, the World Bank Day @ mHealth Summit in Washington D.C. last year brought the consensus that mHealth had great potentials, especially in developing countries. Obiageli Katryn Ezekwesili, World Bank Vice-President for the Africa Region noted that Nigeria alone had 250 millon mobile phones, compared to only 250,000 fixed phone lines seven years earlier. She pleaded that "Africa can’t let this unique possibility in mHealth and ICTs offer pass by".

Dr. Nwariaku, ANPA President and featured speaker

Some experts have projected that harnessing the full potential of mobile technology will allow delivery of heath care to entire populations at less than 25% the cost of traditional delivery models. Areas of the health delivery system in which mobile devices can have a huge impact include the collection of clinical and community health data,monitoring patient vitals signs in real-time, augmenting the direct provision of care by linking health care workers to patients, delivering healthcare information to practitioners, researchers, and patients, and addressing supply chain management problems.

The mHealth Africa Summit will feature, among others, an interactive panel on deploying m-health applications across several countries, a cross-sector panel discussion on overcoming challenges in mobile health, and another on leveraging mobile technology to bring health care to the masses.

Speakers will include Dr. Fiemu Nwariaku, President of ANPA and Associate Dean for Global Health at the University of Texas-Southwestern; Dr. Egbe Osifo-Dawodu, who was an Adviser to the World Bank for many years and recently joined the Anadach Group as Founding Partner; and Dr. Mohamed Pate, CEO of the National Primary Healthcare Development Agency, Nigeria.

Nigerian Doctors in the UK Meet in Newcastle, October 22-24, 2010

Nigerian doctors in the British Isles, under the umbrella of the Medical association of Nigerians Across Great Britain (MANSAG), are gathering in Newcastle-upon-Tyne for their 21st scientific conference and annual general meeting on October 22-24, 2010.

The theme of the 3 day conference, to be held at the Copthorne Hotel in Newcastle, is "Optimising Your Professional Potential". The Honorable Federal Minister of Health, Professor Onyebuchi Chukwu, is scheduled to deliver the keynote address at the opening session.

Over the years, MANSAG has developed a robust mentoring program for Nigerian trainees and medical students in the UK. At this year's conference, a special session will be devoted to updating these up-and-coming doctors on training and career opportunities in various medical and dental specialties in the UK.

MANSAG President, Dr. Dilly Anumba, has said that the Newcastle conference is already "promising to be a very exciting meeting, with guests expected from all across the globe". He invited ANPA members to join their UK counterparts as they have done in previous years, noting the strong partnership between both diaspora organizations of Nigerian physicians. Dr. Anumba hailed ANPA for "blazing the trail in the engagement of the Medical Diaspora with our home country".

The full program for the conference is available here.

Efficacy of Antimalarials in Nigeria

The Nigerian National Malaria Control Programme recently published the result of an efficacy trial of two different combination therapies for malaria (artemether and lumefantrine; artesunate and amodiaquine) in which it claimed that concerns that many antimalarial drugs in Nigeria are ineffective are largely unfounded. The trials which were conducted in seven sites across the country used antimalarials from the official government stocks.

The finding by the Malaria Control Programme failed to touch on an important issue, that of fake or counterfeit drugs. The concerns of lack of efficacy of antimalarials in Nigeria are based on the believe that most medicines in Nigeria including antimalarials are fake or contain a lower amount of the active ingredient than labeled. A better approach would have been to use samples of the antimalarials in the open market where most Nigerians get their medications. A World Health Organization study on quality of antimalarials in ten Sub-Saharan African countries which used the open market sampling approach found that in some countries almost 40 per cent of drugs, whose production and quality have not been checked by the WHO, underperformed.

The bigger issue here is the distrust of medications available to treat the most endemic disease in Nigeria for which the Nigerian government has not provided any real solutions. Most Nigerians don’t get their antimalarials from government stores, it is therefore ingenious to conclude that fears of Nigerians on the efficacy of antimalarials which obviously come from the open market are unfounded.

The Malaria Control Programme needs to work with the National Agency for Food and Drug Administration and Control (NAFDAC) and relevant agencies to assure that medications on the Nigerian market are efficacious and safe. As a matter of urgency, the government needs to put in place mechanisms for inspecting companies that manufacture medicines in Nigeria and enforce the regulations on inspection of medicines imported into the country. While many will say this is easier said than done, we have no other option.

Meet Our Bloggers: Johnson Adeyanju, MD, FACP

Dr. Johnson Adeyanju is an attending physician and specialist in internal medicine. He is an honors graduate of the University of New Orleans, and subsequently obtained his medical degree from the Louisiana State Medical School in New Orleans. Dr. Adeyanju received medical residency training at the University of California, Davis VA Medical Center in Martinez. A diplomate of the American Board of Internal Medicine, Dr. Adeyanju was inducted as Fellow of the American College of Physicians in 2005.  He serves as Chair, Continuing Education Committee at the  John Muir Health Network, Concord, CA Campus.

Dr. Adeyanju is an active member of ANPA and currently Chair of the Northern California chapter. His passion for writing was evident at a young age when he won the John F. Kennedy Memorial Essay. He is the author of "Deadly Revenge", a  thrilling and entertaining book about Lagos, Nigeria underworld (available on Amazon).

The True Size of Africa

Did you know that Africa is about 11.7 million square miles, large enough to fit the United States, China, India, Japan, and a large portion of Europe? Well, Kai Krause, the graphic artist renowned for his mastery of the Adobe Photoshop software, has just released this eye-opening map of Africa at Creative Commons.(h/t to Calabar Boy). He called it "a small contribution in the fight against rampant immapancy", a new word he has invented for "insufficient geographical knowledge". The image (full version here) is apparently going viral because Stephen Fry tweeted it.

"Open Access Africa" Holds November 10-11, 2011

We previously reported on the plan by BioMed Central and Computer Aid International to convene a 2-day conference that will bring together researchers, librarians, university administrators and donors to discuss the issues surrounding access to scientific and medical research, and the role that open access journals can play in Africa.

The conference, Open Access Africa, will now hold at Kenyatta University in Nairobi, Kenya, from 10-11 November 2010.

According to BioMed Central, "open access to the results of scientific and medical research has potential to play an important role in international development, and this conference will discuss the benefits of open access publishing in an African context, from the perspective of both readers seeking access to information, and researchers seeking to globally communicate the results of their work."

The preliminary program of the conference has just been released. Registration to the event is free.

When Charity Does Not Begin At Home

This piece in the Rwandan Sunday Times gave me much food for thought. The article quotes the previous Minister of Health, Babatunde Osotimehin, currently with the WHO’s Partnership for Maternal, Newborn and Child Health, complimenting the Rwandan government for achieving the Millenium Development Goals (MDGs).

During his tenure as Minister of Health, Nigeria was off-track in attaining its MDGs.

What an irony.

The reasons for Nigeria being off-track may be myriad including policy, infrastructural, religious as well as cultural but this is an area where I believe physicians as well as other healthcare practitioners in the diaspora can contribute in a meaningful and sustainable way.

The beauty about goals is that they can be measured and so progress can be ascertained, and strategies can be adjusted until the goals have been met. While there have been many well meaning efforts to address the health care deficits either through medical missions, donations of learning materials and equipment, a central forum may be the best way to ensure that these resources, both human and material, are directed to the areas of greatest need or of measurable impact.

One of the biggest issues that impacts policy decisions is that whenever there is a change in the government or cabinet, policies of the outgoing government or minister are altered or scrapped even if certain elements are exemplary. It may be better for us to work closer with the technocrats in the ministries i.e. Directors or Director Generals within these ministries - they tend to have longer tenures - and unless the Ministers come from within the ranks, these Directors or DG's have a greater understanding of the issues and also can provide information on the policies that have failed or succeeded in the past.

Nigeria has never lacked for competent individuals; we hope we can influence the government to engage experts like they have done in the other areas such as Finance, Power etc so that finally charity can begin at home.

Giving HOPE: ANPA Supporting Rebuilding Medical Education and Training in Haiti

HOPE volunteers Kristin Parlman, Physical Therapist and Lisa Jane Evans Occupational Therapist from Massachusetts General Hospital, working at Diquini Hospital in Haiti. Courtesy of Project HOPE

On Tuesday, January 12, 2010 a 7.0 magnitude earthquake struck Haiti at a depth of 8.1 miles. The epicenter was located 15 miles WSW of Port-Au-Prince. The earthquake was followed by aftershocks that ranged from 4.2 to 5.9 magnitude in strength. This earthquake according to the US Geological Survey was the strongest earthquake to hit the area that is now known as Haiti since 1770. The earthquake left behind major devastation in every aspect of the lives of the people of Haiti prompting global appeal for aid. The appeal witnessed an unprecedented global response to address the needs of the over 2 million homeless and 3 million in need of emergency aid.

The Association of Nigerian Physicians in the Americas (ANPA) responded to the appeal for aid by setting up a Haiti Relief Fund to which many its members made contributions. The Haiti Relief Fund raised $36,150 which was donated to Project HOPE (Health Opportunities for People Everywhere), a Virginia based organization dedicated to providing lasting solutions to health problems with the mission of helping people to help themselves. Project HOPE has been providing health care in Haiti prior to the January earthquake and was a natural choice to receive ANPA’s donation not only because they knew Haiti and logistics of delivering healthcare in the country, but also because their mission and vision align with those of ANPA. It is on record that immediately following the devastating earthquake, Project HOPE sent more than 100 volunteer doctors, nurses and medical technicians and delivered more than $60 million of medicines and medical supplies to Haiti.

Professor Ajovi Scott-Emuakpor

Several ANPA members including Dr. Ajovi Scott-Emuakpor also made humanitarian visits to Haiti to provide medical care to the sick and wounded. Dr. Scott-Emuakpor, a Professor of Pediatric Oncology at Michigan State University, Lansing, MI, and Chair of ANPA Program Committee told The Jackson Citizen-Patriot: ``For a whole week we watched the television, and the more we watched, the more incredulous it became,'' he said. ``We reached down deep into our hearts and asked, `Can we do something?' ... And we started making calls.'' Within a few days, Dr. Scott-Emuakpor and three other doctors traveled to Haiti to treat patients in a makeshift clinic near the airport outside of Port-au-Prince. The team treated more than 300 patients each day for a whole week.

The work of Project HOPE continues in Haiti with the efforts now focused on rebuilding medical education and training as focus turns from disaster relief to intermediate care and long-term health education and care programs that will help ensure those injured during the January earthquake have hope for a full recovery. It was therefore heartwarming when ANPA received a letter of appreciation from Project HOPE signed by Dr. John Howe, President and Chief Executive Officer last month. In the letter, Dr. Howe stated that “… this grant will support our efforts to rebuild medical education and training, beginning with an assessment of health profession needs and resources in Haiti…”

As a member of ANPA I can not be more proud of our organization’s contribution to ensuring hope for a full recovery for those injured during the earthquake. Members of ANPA should also be more pleased to see that not only is their donation being put to good use, but also for one that is congruent with our mission. Kudos to ANPA, its executive committee, and all its members. This act has once again demonstrated that we are our brothers’ keeper and that we are committed to the service of humanity.

Thank you ANPA and keep up the good work !!!!!!

Solar Power Lights the Way for Maternal Health in Nigeria

Unreliable power supply is among the greatest impediments to health care in Nigeria. The tens of billions of dollars "invested" in power production by successive governments has had a reverse effect on power production. Surgical operations interrupted by power outage is a common occurrence. Hospitals are frequently unable to maintain stock of blood transfusion products and drugs that require refrigeration.

Enters Laura Stachel, a retired obstetrician-gynecologist and Associate Director of Emergency Obstetric Research for the Bixby Center of Population Health and Sustainability at UC Berkeley: she has been researching maternity care in Nigeria over the last two years, in collaboration with the Ahmadu Bello University Teaching Hospital (ABUTH), Zaria. Dr Stachel co-founded WE CARE Solar, which has designed portable solar electric kits that fit in a suitcase-sized package ("solar suitcases").

In this video, Dr. Stachel demonstrates the impact of a basic solar-powered lighting system and how energy-efficient LED lights revolutionized the quality of care in a Nigerian maternity ward.

Meet our Bloggers: Temisan Etikerentse, MD

Dr. Temisan  Etikerentse is an attending physician with Board certification in Internal Medicine.  He graduated from the College of Medicine of the University of Lagos in 1991 and completed his residency at  the Michigan State University, East Lansing, MI. Dr. Etikerentse and his wife, Ijeoma, live in Charleston, SC with their four children.

Dr. Etikerentse has been an active member of ANPA since 2001and will write in general about issues of relevance to health care in Nigeria with occasional commentaries on other aspects of Nigerian life.

Book review: My Nigeria - WSJ.com

I found this review in the Wall Street Journal of My Nigeria: Five Decades of Independence by Peter Cunliffe-Jones and thought it might be worth while to share as we celebrate our 50th Independence.

It's a concise review of Nigeria's post colonial struggle in a country with so many broken promises.

A country so wealthy and yet so penniless.

Nigeria at 50: To Celebrate or not to Celebrate?

Tomorrow Nigeria will celebrate fifty years of independence from Britain. At independence in 1960, Nigeria held out great promise based particularly on our human and material resources. This promise has to a very large extent not been fulfilled, and the gap between potential, promise and fulfillment seems to be getting wider. In view of our shortcomings and lack of direction as a nation, does the 50th anniversary of our independence from our colonial masters deserve to be celebrated or not?

Two weeks ago, I was involved in a discussion with some of my Nigerian colleagues in Chicago on what the Association of Nigerian Physicians in the Americas (ANPA) Chicago/Northwest Indiana Chapter should contribute to the Nigerian Independence Organization to make the celebration of Nigeria’s 50th birthday a success. The Nigerian Independence Organization in Chicago is a coalition of several Nigerian civic and professional organizations in the Chicagoland area that has been organizing parades, fanfare and other fun activities to celebrate Nigeria’s independence for many years.

Enyi MD Foundation Raises Funds for Emergency Healthcare in Nigeria

Late Dr. Enyi Okereke, former ANPA Treasurer

When the late Dr. Enyi Okereke traveled home in the fall of 2008, his mission was to provide emergency care to trauma victims and train surgeons at the National Orthopedic Hospital, Enugu. Then the unimaginable happened: Dr. Okereke, who was Chief, Division of Foot and Ankle Surgery at the University of Pennsylvania Health Systems and an Associate Professor in Orthopedic Surgery at the University Of Pennsylvania School Of Medicine, suffered a heart attack during his medical mission. Sadly, he became a victim of the very inadequate emergency medical services that he tried to improve.


Today, a foundation established in his memory, The Enyi MD Foundation, is committed to improving the dire state of emergency healthcare in Nigeria, so that more lives won't be cut short. The Foundation is already having a measurable impact. At the 2010 ANPA conference on July 3, Ms. Moriam Tokunbo Okereke, the Executive Director of The Enyi MD Foundation, presented a generous sum of $10,000 to ANPA for its emergency medical services (EMS) program. 

Meet our Bloggers: Flora Ukoli, MBBS, DPH, MPH

Dr. Flora Aroma Ukoli received her medical degree at the University of Ibadan, Nigeria (1975), a Master in Public Health degree from the University of Glasgow, Scotland (1980), a Master’s degree in epidemiology from the University of Pittsburgh, PA, in 1998, and is a Fellow of the West African College of Physicians. Dr Ukoli is a Professor of Community Medicine and joined the Department of Surgery at Meharry Medical College in July 2003.

Meet our Bloggers: Adedeji S. Adefuye, MD, MPH, FRIPH

Dr. Adedeji S. Adefuye is Associate Medical Director for Postmarketing Safety Evaluation at Abbott Laboratories. Before his appointment at Abbott Laboratories, he served as the Director of the HIV/AIDS Research and Policy Institute and professor of epidemiology in the Department of Health Studies at Chicago State University. Dr. Adefuye has over 15 years experience in clinical, behavioral and public health research and practice. He graduated with honors from the University of Lagos College of Medicine in 1984. He obtained his MPH from the University of Illinois at Chicago (UIC) in 1999 and was awarded a fellowship of the Royal Institute of Public Health in 2001.

In 2002, Dr. Adefuye was appointed Assistant Dean for Urban Health and Diversity Programs at the UIC School of Public Health where led a team charged with developing programs to address racial and ethnic disparities in health and health outcomes, and the disproportionate representation of minorities in the health professions. Before coming to the US, Dr. Adefuye had served as Associate Medical Director at and Director Clinical Services and Administration at Global Medical Center, in Lagos Nigeria. He has served at various times Director/Coordinator for UNICEF and USAID projects in Nigeria.

Dr. Adefuye has authored and co-authored several publications and received funding from government agencies and foundations. He is co-Investigator on 4-year $1.58 million NIH grant to implement and evaluate a condom promotion education for African American males in Chicago.

Dr. Adefuye serves in many leadership positions including member of the Board of the Black Caucus of Health Workers of the American Public Health Association, Chair of the ANPA Chicago chapter, member of the ANPA Board, member 7^th Congressional District Health Taskforce, and member Community Advisory Council of the Urban Health Program of the University of Illinois.

Tale of two Americas

Two friends growing up as neighbors in Nigeria both left for America, one went to school, did things the right way and struggled while his friend went into a life of crime and fraud. The one who was involved in fraud sent home cars and built a house for his father, while the other one was able to send home some money from time to time. When the good boy came home one day for Xmas, his father asked him whether he did not see all the things his mate had achieved and material possessions he had accrued and said to him, My pikin, no be the same America both of una go? abi you go South America?

This tale encapsulates some of the problems we are facing today in Nigeria from Politics for personal gain, kidnapping, sex trafficking, 419 etc. As long as it is more important to display wealth and no questions are asked about the source it is unlikely that any singular solution can solve these problems.I would like to share my thoughts on the scourge of kidnapping which is a relatively new phenomenon in Nigeria. Initially it started out as part of the so called struggle in the Niger Delta and then spread as a tool for political infighting, no deaths were recorded and the governors at that time always seemed to be able to locate the expatriates after ransoms were paid even though they never seemed to prosecute the perpetrators. Somewhere along the way, it became business and now it seems it cannot be stopped.What, however, strikes me is that this kidnapping as business seems to be concentrated in the Eastern States of Nigeria and Edo State. 

Meet our Bloggers: Echezona E. Ezeanolue, MD, MPH, FAAP

Our goal for this blog is to provide readers with an informed commentary on  health issues relevant to Nigeria from a diverse team of ANPA members drawn from different specialties. We are pleased to welcome Dr. Echezona Edozie Ezeanolue as a member of our blogging team. Dr. Ezeanolue  is an Associate Professor of Pediatrics and Public Health at the University of Nevada School of Medicine. Board certified in Pediatrics and Infectious diseases, his interest in health policy is focused on unintended consequences of health care policy in addition to his clinical and research activities.

Education in Nigeria: A State of Emergency

Worldwide, there is a general recognition of the role of education in shaping the future of a nation. In 2002, President Thabo Mbeki of South Africa said “…we have to exert maximum effort to train the necessary numbers of our people in all the fields required for the development, running and management of modern economies. This again must be a national effort in which we should consider the necessary expenditures not as a cost but as an investment in our future.”

It is against this backdrop that I ponder on four headlines in Nigerian newspapers in the past week. In the first of the headlines, the Director General, National Directorate of Employment (NDE), Abubakar Mohammed said that one of the reasons why Nigerian graduates were facing unemployment problem in the country is that they lacked marketable skills. On his part, the National Publicity Secretary of the Action Congress of Nigeria (ACN), Alhaji Lai Muhammed said poor level of education is the single militating factor against Nigeria. A career civil servant on the same page as politicians is a rarity in Nigeria’s polity. Does this however mean education will be better valued and given the resources it needs? I don’t think so. The NDE Director General went on to say the agency was being repositioned to impact global marketable skills in the youth for them to be relevant to the needs of the modern economy. Another sweet talk devoid of specifics that we heard too many times. Repositioning hmm or rebranding? Give me a break.

Education is both labor and resource intensive and we can not educate Nigeria’s leaders of tomorrow with outdated books and technology. This much was said by Mr. Segun Onilude, scribe of the Universal Basic Education Board (UBEB) when he identified lack of basic textbooks as being among the reasons for mass failure in the last NECO examination while reacting to the mass failure in English Language and Mathematics in the results of the senior secondary schools examination released by NECO last week Monday. In a scathing headline titled “Exam failure: Endless Shame of a Nation,” NECO’s Registrar and Chief Executive, Promise Okpala, was quoted as saying that about 870,305 candidates from a total of 1, 113,177 who sat for the examination failed to get credit passes in English. Broadly speaking, 79 per cent failure was recorded in the subject, while about 24 per cent or 838,031candidates' inability to make impressive scores in Mathematics.This is more than a national shame; it is tragedy that demands a state of emergency.

Kidnapping of Nigerian Doctors is a Public Health Crisis, says ANPA Members

Nigerian doctors in the US are taking President Goodluck Jonathan to task for being slow to tackle the booming kidnapping industry in the South East part of the country. ANPA members are also expressing solidarity with their colleagues at home who have become the target of the out-of-control kidnapping racket.  According to the Nigerian Medical association (NMA), more than 20 doctors have been kidnapped in Abia State alone in the past one year. Nigeria Health Watch, a blog that focuses on health care in Nigeria, has rounded up several recent cases in which doctors were the victims.

The kidnappers, increasingly emboldened by a seemingly incompetent and flat-footed police, routinely terrorize citizens and have paralyzed economic activities in the once bustling Abia and neighboring states. Perhaps, the most brazen incident occurred last week when gunmen murdered Dr. Stanley Uche, a gynecologist and proprietor of Victory Christian Hospital, Aba, even after allegedly collecting N30 million ransom from the wife. Just a year ago, the then President of the NMA, Dr. Prosper Igboeli and his wife, narrowly escaped the onslaught of a gang of kidnappers who attacked his hospital, also in Abia State.

Besieged by the spate of kidnappings and the general insecurity of life, doctors have embarked on limited strikes, protest marches, and public appeals to the government. After Dr. Uche's murder, many public and private hospitals in Abia State were shut down for several days and some doctors have begun to flee the state. ANPA member, Dr. Obi Emerole is troubled by this development, stating that "violent crime has become the number one public health issue in the country especially in the eastern states". Dr. Emerole, who is a cardiologist, worries that the siege on doctors will only exacerbate the already severe shortage of doctors and demoralize the few who risk their lives in the service of their patients. The ultimate victims, Dr. Emerole fears, will be the masses of Nigerian citizens for whom the already poor health conditions will worsen as more hospitals close and doctors flee to safer parts of the country or migrate abroad.

Will Open Access Replace Medical Libraries in Sub-Saharan Africa?

Visiting the library of a Nigerian medical school last year, the empty shelves and outdated journals conveyed a sense of emptiness and decay. The familiar reference books on front-row display were all several editions behind. The librarian took me to a section with rows of desktop computers that were rarely used due to epileptic power supply and lack of internet access. A few working computers shared a slow bandwidth connection.

The library, once the indispensable hub of learning in medical schools has become increasingly irrelevant in some institutions. Lack of funding has caused some libraries to cancel journal subscriptions and eliminate the budget for new books. So, how could medical libraries in sub-Saharan Africa restore their roles as gateways of information, and reestablish their position as an intellectual partner in the sphere of medical education, training, and research?

Help Fund Training of Health Workers, CapacityPlus Urges Diaspora Groups

Faced with severe shortages of physicians, low income countries must build capacity among lower cadres of health care workers who can deliver health services to rural communities. This is the goal of an innovative program recently introduced by CapacityPlus, a USAID-funded global project uniquely focused on the health workforce needed to achieve the Millennium Development Goals. 

A pilot project has been launched in Malawi to train Clinical Officers who will work in their own  rural communities. Funds raised by Capacity Plus,  through the GlobalGiving network, will be used to pay the $7,500 tuition fees for a four-year program at the Malamulo College of Health Sciences.

Nigerians are Smart, Says Google in an Instant

Just today, Google unveiled a new search tool, Google Instant, that extends the power of semantic search. Now, we can all search "faster than the speed of type". As you begin to type, Google is no longer content with suggesting some terms for you, instead it now shows you what it thinks you are looking for......

 So we took it for a quick spin to find out what folks are thinking when they begin to say "Nigerians are...".

Well, it turns out that the new improved Google is just as smart as....you guessed it, Nigerians, correctly noting that Nigerians are the most educated people in America. Also, Google shows that though Nigerians are unfairly smeared with the false allegation of being 'crook' and 'scammers', they continue to confound everyone by being the happiest people on earth.

Worth the Fight

Nigeria, home to 150 million people, is the most populous country in Africa. Endowed with huge amounts of natural resources, it hardly sits well among the category of "low income countries". Even the relatively large population is a poor excuse for Nigeria's tragic underdevelopment. Its 2008 estimated GDP was $206 billion, the second largest in Africa, behind only South Africa ($276 billion). While the 2008 GDP per capita ($1,401) ranked 18th in the continent, it was still nearly twice that of Ghana, and more than ten times larger than Burundi.

The contrast with Ghana could not be more stark. Facing tough times three decades ago, 1 million Ghanaian citizens fled to Nigeria, whose newly found oil wealth powered the regional economy. However, as Nigeria's leaders began to loot the nation's wealth on an unprecedented massive scale, economic anxiety across the land produced a xenophobic rage that led to the expulsion of Ghanaian refugees in the infamous "Ghana must go" affair of 1983. Ghana licked its wounds and picked itself from up from its bootstraps, while Nigeria continued searching for scapegoats for its many missed opportunities and self-inflicted wounds. In the current UNICEF rankings, Nigeria lags behind Ghana in Infant Mortality Rate (96 vs. 51 per 1000 live births) and Maternal Mortality Ratio (1160 vs. 550 per 100,000 live births, adjusted).

High infant and maternal mortality is, of course, only a symptom of the myriad problems facing Nigeria's health system. Fortunately, the resources for an enduring solution can be found in Nigeria's abundant natural and human resources, including the 5,000 to 6,000 physicians and tens of thousands of allied health professionals in the diaspora.

ANPA is geared up for the fight to improve Nigeria's health system, working with Nigeria's government and citizens, international agencies, and the many friends of Nigeria across the globe. Please, join us. It is a goal worth fighting for.