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Please join in the discussion on how to improve health care in Nigeria, Africa, and the developing world!

Countdown to ANPA 3.0......

The long-awaited refresh of the ANPA Home Page will be live at noon EST on Friday April 15, 2011.

Integrated with the new site is an exclusive section for members ("Members Zone") that provides access to the new discussion board ("ANPA Forum"). Members can also update their passwords and view the profiles of other registered ANPA members.

The new site also provides access for membership renewal and online registration for the upcoming annual meeting and scientific conference.

Here is a preview:

ANPA Signs Agreement with Nigerian Government

The ANPA President, Dr. Fiemu Nwariaku has issued the following memo to members:
April 8, 2011
From the Office of the President

Dear Colleagues,

I would like to use this opportunity to provide you with information that is relevant to our organization as it begins to engage the leadership in Nigeria. That Nigeria has some of the worst health indices among developing countries is not news. The reasons for this are myriad and do not require reiteration in this forum. Suffice it to say that in response to the health sector challenges in Nigeria, ANPA signed a Memorandum of Understanding (MOU) with the Federal Ministry of Health in Nigeria (FMOH), 6 years ago. Unfortunately, the MOU expired with no discernible action. Therefore a decision was made in June 2010 to renew the MOU and create an executive committee to begin the process of prioritizing tasks and delivering the necessary results.

ANPA President, Dr. Fiemu Nwariaku

I am pleased to report that the renewed memorandum of understanding (MOU) between ANPA, MANSAG (Medical Association of Nigerian Specialists and General Practitioners in the UK), and the Federal Ministry of Health in Nigeria was signed on February 14^th 2011. ANPA was represented by Past President Julius Kpaduwa and me. During that event, the MOU was activated by convening a joint technical committee (JTC) which will function as the executive body for initiative arising out of the MOU. Immediately after signing the MOU, the Honorable Federal Minister of Health commemorated a fourteen-member JTC. Represented on the JTC are members of ANPA, MANSAG, FMOH, Medical and Dental Council of Nigeria (MDCN), Nigerian Medical Association (NMA), National Institute of Medical Research (NIMR) and the Committee of Chief Medical Directors of Tertiary Hospitals. During his speech, the Honorable Minister for Health, Professor Onyebuchi Chukwu, reiterated the strategic plan by the FMOH to actively partner with Nigerian physicians in the Diaspora to help accomplish many of its objectives. In support of this, he pledged continuing support to the Diaspora Desk within the FMOH. Headed by Dr Bola Olowu, this unit has the responsibility for coordinating Diaspora activities in the health sector. 

The MOU focuses on five specific areas including, Education and Training, Health-related Research, Service delivery and skills transfer, Quality Assurance in Healthcare delivery, and  Private Sector Investments in the Health Sector (including Public Private Partnerships PPP and Private Investments).  During the first meeting of the JTC on February 15^th, members began the work of identifying priorities that match the resources of ANPA and MANSAG. The next meeting is scheduled for the summer of 2011. ANPA proposes to focus on Maternal/Child Health and Emergency Medical Services (EMS) as the initial priorities.  Our organization can then leverage our technical expertise and resources to address these priorities.

We strongly believe that this important initiative represents the beginning of a wonderful and highly desirable partnership. It supports our long held opinion that the immense professional resources within Nigerian physicians in the Diaspora can be used as a catalyst for positive change in the health sector in Nigeria.  The recognition of ANPA and MANSAG as partners with the FMOH will go a long way to facilitate our in-country activities. This relationship is also of benefit as we approach international development partners to support our programs in Nigeria. I hereby seek the assistance of all healthcare personnel who share our strong interest of improving the health sector in Nigeria, to please join this effort in any way possible. While we continue to seek financial support for these activities, I would like to emphasize that intellectual contributions, time commitment and expertise will be every bit as important to make this project successful. Anyone can indicate their interest by going to our website, www.anpa.org

I strongly believe that our organization can be a positive force for good in Nigeria. However we will need all hands on deck to accomplish this goal. The coming months are likely to be an exciting time for our organization. I will continue to keep you informed as these activities evolve.

Warm Regards

Fiemu E. Nwariaku, MD, FACS, FWACS

President, Association of Nigerian Physicians in the Americas Inc.

Budgetary Allocation to Health: Shame of a Nation

The lack of commitment on the part of the federal government of Nigeria to increasing the budgetary allocation needed to improve the health of Nigerians remains a disturbing one. Recently, it was reported that Nigeria earmarks 3.5 per cent of its national budget to the health sector. With the well documented intrigues surrounding the release of budgetary allocations, no one is even sure if all the earmarked funds are ever gets released, and if released what percent is spent on services or lining pockets. With this level of allocation, Nigeria ranks just above Burundi in Africa in budgetary allocation to health. It is shameful that a nation that ten years ago hosted African Heads of State and Government at a conference in Abuja and led in the pledge for governments to allocate at least 15 per cent of their national budgets to health does not even allocate a paltry 5 percent of its budget to care for the health of its citizens. According to Ademola Olajire, a Nigerian and the Director at the Social Affairs Department at the African Union Commission, only six countries have achieved the target set in Abuja. It sure must break Mr. Olajire’s heart to provide such information that gives Nigeria a black eye. The six countries, namely Rwanda, Botswana, Republic of Niger, Malawi, Zambia and Burkina Faso that have passed the 15 per cent mark are all less endowed than Nigeria. Leader of Africa, who are you leading.

Did someone say “Cry my beloved country”, oh no I am the one who said it. As a healthcare professional, the healthcare infrastructure in Nigeria breaks my heart every time I think of it. As one of my colleagues said “because we all have parents and relatives in Nigeria who depend on this healthcare system and cannot afford to fly them out to countries with better facilities every time they fall ill, we cannot fold our hands and watch without doing anything.” The question is what can we do as non-politicians to force the hand of the government to allocate more resources to delivery of healthcare services to Nigerians? At a National Association of Resident Doctors’ roundtable in 1987, Nigerian physicians were called out for forgetting the “Hippocratic Oath” and not insisting on receiving needed resources when they become commissioners or ministers of health. It will be recalled that the late Professor Olikoye Ransome-Kuti extracted a committment from Babangida before he accepted the position of Minister of Health that the resources needed by the ministry will be provided to ensure that programs are implemented. He remains the only minister in recent memory to have done this. He got most of what he wanted albeit during a military regime.

In an interview with The Guardian after delivering a speech at the on-going Conference of African Ministers responsible for Finance, Economy, Planning and Economic Development in Addis Ababa, Ethiopia, Nigeria’s Minister of Health Professor Onyebuchi Chukwu said “funds allocated to security and the electoral system, among other competing needs in Nigeria, might have robbed the health sector of much-needed higher allocation in the budget.” The minister’s statement does not provide any succor to many Nigerians who still rely on government provided healthcare. In addition, the minister’s assertion that government's per capita expenditure on health was rising steadily and it's about $20 contradicts independent sources including the Africa Public Health Info which puts the figure at $10.

This is not surprising as anyone following the political debates and campaigns in Nigeria would have noticed that none of the candidates at the local, state, or national levels including the presidential candidates have mentioned or articulated any strategies to improve the health of Nigerians or arrest the decay that is the Nigerian health infrastructure. As the elections are conducted, winners announced, and executive councils formed, it is time for the Nigeria Medical Association that have done a good job of insisting on physicians running the ministry of health to go a step further to insist on improved allocation to the health sector and preventing its members from accepting health commissioner and minister positions as a form of protest if government allocation is not increased. Professor Olikoye did it and it still can be done if the focus is on the overall interest of Nigerians and not on holding a political position. When it is all said and done, physicians are going to be reminded that they presided over the decay of the Nigerian healthcare system.

The African Woman: A Priority in Medicine?

Researchers link preparation of smoked fish to lung diseases! For my fellow fanatics, this recent article in The Guardian will undoubtedly be a disheartening revelation of the hidden cost behind the savory goodness that is smoked fish. My initial thoughts after reading the title were admittedly, selfish. My mind skipped through the numerous pulmonopathies that I have encountered during my first year in medical school. I ranked the diseases in order of severity, hoping that the punishment for my affair with smoked fish would be selected from the bottom of the list. As I read further, I soon realized that I was not the subject of article. In this case, the unfortunate victims of lung disease are the manufacturers of smoked fish – predominantly women (“manufacturers” because the things that these women do to smoked fish are nothing short of magical). The Togo-based study suggests that these women who are “constantly exposed to smoke, heat and burns, during the process are at high risk of developing chronic chest and respiratory infections or disease."

As I sympathized with the women from the article, my thoughts led me to the broader topics of feminism and the empowerment of women. March 8, 2010 was the 100^th anniversary of International Women’s day, a global celebration of the political, economic and social achievements of women. Using the Togolese fish smokers as a take-off point, I thought about women in Africa and what I believed was an on-going struggle to empower them. My mental exercise soon turned into a “Google” exercise as I realized the inadequacies of my knowledge base about African women. In the course of my search, I stumbled upon an inspiring article: Empower Women to Realize the African Dream written by Obiageli Ezekwesili, the World Bank Vice President for the Africa region. From the piece, it’s clear that the African woman has come a long way over the last few decades. Progress is evident in the worlds of business, politics, education and medicine. However, as Mrs. Ezekwesili reminds us, “the feminization of poverty still remains acute.” Women bear the brunt of the African situation, standing at the front line in wars against malnutrition, overpopulation and discrimination. Equality and gender issues have seen some improvement, but we still have a long way to go.

Women in Nigeria proudly show a hand-painted banner for peace

Of Mrs. Ezekwesili’s points, I was struck most considerably by those that highlight the things medicine is NOT doing for our women. “One in 20 girls born today in Angola, Mozambique, Liberia and Sierra Leone will die in childbirth. An African woman is 25 times more likely to die during labor than a European woman […]; three young women are infected with HIV/AIDS for every young man in Africa; [and] girls still face genital mutilation in 28 African countries.” Like most others, the medical sector is doing a miserable job as regards protecting and providing for our women. I’m in no position to criticize the field, or to recommend things that we can do to advance women’s rights in Africa, but I do know that we can do much better. So even as we remember International Women’s Day and take our hats off to the women who make life worth it, I ask that we make it a priority to empower the women of Africa through medicine. Our mothers, wives, daughters, sisters – our women – are our “hope, strength and opportunity.” Let’s play our part to make sure they are always treated as such.

Reasssessing the Notion of a "Brain Drain"

The idea of a drain hardly ever evokes a positive reaction especially in the context of the siphoning of intellectual capital from developing countries. The impact of the “brain drain” phenomenon has been hotly debated in development circles, particularly in relationship to the flight of health care workers who emigrate from countries facing incredible public health challenges. This has been discussed previously on the ANPA blog here and here. Outside of the usual culprits – corruption, bad governance, and the like – some are wont to place the blame of Nigeria’s health care struggles on the backs of doctors and nurses who participate in destabilizing the healthcare infrastructure by abandoning the country. Nearly one in ten Nigerian physicians practices in the United States or Canada. To add insult to injury, reports surface indicating that foreign-trained health professionals in developed countries, at times, outperform their home-grown counterparts – begging the question, why have we (Nigerians) not benefited from the fruits of our labour (that is, educating such professionals)? One may come to conclusion that while developing nations invest resources into the training of its professionals, developed nations are unfairly poised to reap the benefits of such harvests. However, this line of reasoning requires a serious rethink. In full disclosure, I must admit that I am a somewhat biased, since I am a product of Nigerian intellectual refugees, and would not wish it any other way. But, I cannot help but highlight a number of incorrect assumptions made by the above argument that may debunk the notion of the brain drain as the critical destabilizing force in Nigerian healthcare.

I’ve struggled with how best to say this without being offensive, but, the idea of that the Nigerian government has and continues to lose out on its investment into the training its healthcare force, is, quite simply, laughable. Investment, ke? When overall health infrastructure spending falls at a paltry 4% of a nation’s total budget, one can only imagine that how much less is “invested” into training the healthcare force – in terms of financial assistance for education and future career support. For the overwhelming majority of Nigerian physicians practicing both in Nigeria and abroad, the heavy lifting of such support primarily rested on self, family, benevolent communities and non-governmental organizations. Furthermore, the American Medical Association reports that more than half of African born physicians practicing in the United States spent a significant portion of their educational careers at American universities and hospitals.

While doctors and nurses play an irreplaceably essential role in a nation’s overall healthcare, one must remember that the success of any national healthcare system depends on far much more than its healthcare workers. The World Health Organization identifies a number of key components of an effective healthcare system, of which, interestingly, health care staff play a merely supporting role. Of chief importance are, again, good governance and financing, but also functioning information systems, diligent public health surveillance and access (to be distinguished from availability) to essential drugs and technologies. While the desire to return home and practice medicine in Nigeria remains a strong desire for many a Nigerian physician in the US, packing up and re-inserting oneself into a virtually non-existent health system may prove frustrating to both healthcare provider and patient. It goes without saying that organizations such as ANPA have and continue to contribute to the welfare of Nigerian patients and some Nigerian physicians in America, have in small groups, given back to their homelands, whether in financial assistance, educational support, or short-term projects. Though not yet quantifiable, doctors in the West may be contributing far more than they could have while in Nigeria and a mass exodus back to Nigeria, may prove counterproductive, particularly in the absence of policies and structures. It is critical, therefore, to reassess what is actually being drained and what the consequences are of haphazardly reversing that process.

ANPA Leadership Secures Waiver of Back Payment of Licensing Fees for Nigerian Physicians Practicing Outside Nigeria

In a landmark decision, the Medical and Dental Council of Nigeria (MDCN) has agreed to waive the requirement for back payment of registration and licensing fees for Nigerian physicians who have been in practice outside Nigeria. The news of this agreement was conveyed to the ANPA members by its President, Dr. Fiemu Nwariaku today. The President said the MDCN decision was conveyed to ANPA representatives by the Registrar of the Medical and Dental Council of Nigeria during the recently concluded signing of the MOU between ANPA and Federal Government of Nigeria in Abuja.

Prof. Roger Makanjuola, Chairman MDCN

Before now, foreign-based Nigerian physicians were required to pay back registration and licensing fees whenever they requested for certificate of good standing, often needed to register or obtain licenses in their countries of practice. The fees in some instances may be for over twenty years as was the case for one of my colleagues who recently moved to Chicago and had to obtain an Illinois license. Many have condemned the payment of fees for a period during which one is not practicing in the country as exploitatory and punishing. The granting of this waiver is therefore a welcome relief. The waiver according to the Dr. Nwariaku is contingent on the Nigerian physician being able to demonstrate that they have been and continue to be in good standing (dues paying) in their current location. Practitioners who wish to renew their licenses will however be required to pay renewal fees for the current year of practice.

Former ANPA President, Dr. Julius Kpaduwa

ANPA Blog has learned that the Chairman of MDCN, Professor Roger Makanjuola, was swayed by representation made on multiple fronts by ANPA, pleading the case for thousands of diaspora Nigerian doctors who are eager to contribute to their homeland. Former ANPA President, Dr. Julius Kpaduwa, raised the matter at the the July, 2009 retreat with the Ministry of Health attended by the the health minister, Professor  Buchi Chukwu. Furthermore, ANPA Blog pestered Professor Chukwu with the issue during our interview with him in the fall of 2010, and extracted his promise to present our case to the MDCN.

 In his message, Dr. Nwariaku said: “ANPA has worked hard to secure a waiver of the requirement for back payment of medical license renewal fees for physicians and dentists who have been out of Nigeria for some time. We strongly argued that this was a major barrier to the desire of Nigerian trained physicians and dentists living outside Nigeria, to resume practice (fully or intermittently) in Nigeria, and that this regulation worsened the critical shortage of a skilled healthcare workforce within Nigeria.”

This decision by the MDCN couldn’t have come at a better time as the Nigerian government struggles to attract diaspora doctors to contribute their skills to the development of the country. In addition, the long drawn issue of whether Nigerian physicians practicing outside Nigeria need to obtain temporary licenses when they go on medical mission trips can be put to rest. With this agreement, obtaining a temporary license will be much easier for foreign-based Nigerian doctors who want to spend time back home providing care for our citizens without the back payment of fees hanging over their heads like a sword of Damocles.

I salute the hard work of the ANPA leadership in securing this waiver and join the President in applauding the current leadership of the MDCN for making right the wrong that has been perpetuated over many years.

Update from ANPA President

ANPA President, Fiemu Nwariaku

March 3, 2011
From the Office of the President

Dear Colleagues,

As promised, I would like to use this opportunity to provide you with updates on the activities of our organization. Much has happened since our strategic retreat in Houston in November. I am pleased to announce that the much awaited memorandum of understanding (MOU) with the Federal Ministry of Health in Nigeria was signed on February 14th 2011. Some of you may recall that the initial MOU signed 6 years ago did not result in any significant activity. As a result the current leadership of the FMOH assembled a meeting of stakeholders in Abuja, last July. During that meeting, the decision was made to renew the MOU, but make it active by convening a joint technical committee (JTC) which will become the effector arm for the MOU.

On February 14th 2011, the Hon. Federal Minister of Health signed the MOU and commemorated a fourteen-member JTC. Represented on the JTC, were ANPA, MANSAG, FMOH, Medical and Dental Council of Nigeria (MDCN), Nigerian Medical Association (NMA), National Institute of Medical Research (NIMR) and the Committee of Chief Medical Directors of Tertiary Hospitals. Our organization was represented by Past President Kpaduwa and myself. Also present from ANPA were Drs Igho Ofotokun, Vincent Idemyor and Abdulkareem Lateef.

Dr. Nwariaku and Hon. Min. of Health, Prof Chukwu, sign MOU 

The JTC held its first meeting that day, and began the work of identifying priorities that match the resources of ANPA and MANSAG. The next meeting is scheduled for late March 2011. ANPA proposes to focus on Maternal/Child Health and Emergency Medical Services (EMS) as the initial priorities. Our organization will then leverage our technical expertise and resources to address these priorities. We believe that this is a huge step by our government, and will rely on our members to deliver on our promises. I will continue to keep you abreast of the JTC activities as they pertain to our organization.

Secondly, ANPA has been fortunate to secure financial and logistical commitment from the Health Systems 20/20 project of the U.S. Agency for International Development (USAID). As part of this project, ANPA has offered to provide technical assistance to facilitate the revision of medical school curricula in Nigeria. With assistance from the Medical and Dental Council of Nigeria, the National Universities Commission (NUC), NIMR, the Diaspora Desk of the FMOH, and the University of Ibadan, the Hon. Minister for Health also inaugurated a committee to serve in an advisory role to the regulatory bodies in Nigeria, whose responsibility it is to revise the medical school curricula. This group also had a very successful meeting between February 15th and 18th 2011. Represented by Drs Igho Ofotokun, Vincent Idemyor and myself, our organization provided perspective on the American medical training. During that meeting, the decision was made to assemble the relevant materials to assist the NUC, MDCN and interested medical schools in Nigeria to begin the long process of curriculum reform. This process will likely take months to years; however we have been fortunate to secure the commitment from USAID and other partners for the duration of this project. We believe that this will be an important long-term investment to rebuild and strengthen the health care sector in Nigeria.

On the home front, preparations are underway for the next Annual Scientific Convention in Chicago. As usual, Professor Scott-Emuakpor and his program committee have put together a solid program. With a powerful theme of Maternal and Child Health, we will certainly attract significant attention from the public and private sectors. The projects described above will require significant financial commitment from our organization. As such, I hereby seek your assistance to begin making the calls to your friends, family, partners and acquaintances that are in the position to provide such assistance, both here and in Nigeria. Our organization will need a lot of financial support for many of these important activities that are underway. We all strongly believe in the activities of our organization to improve healthcare in Nigeria. We now need to communicate that need to our network of sponsors. I strongly believe that our organization can be a positive force for good in Nigeria. However we will need all hands on deck to accomplish this goal, and will need to convince other organizations about the importance of our work. The coming months are likely to be an exciting time for our organization. I will keep you informed as these activities evolve.

Warm Regards

Fiemu E. Nwariaku
ANPA President

Pediatric Public Health: How much are we doing for the children?

Whenever I start to think about pediatric health care in Nigeria, my thoughts quickly veer toward obstetrics, neonatal care and immunization. The host of baby formula and child immunization campaigns has seen some success, evident in the steady improvement in infant mortality rates. UNICEF statistics indicate that Under-5 mortality rates in Nigeria have declined by 35% since 1990 and by 27% since 2000. In addition, about 74% of routine vaccines were funded by the government in 2009. These numbers, although far from being perfect, suggest that we are moving in the right direction with infant health care.

The question then is what happens after infancy? What are these under-5 statistics hiding that statistics about different age groups (say under-10 or 5-15yrs) would expose? A recent interview with Dr. Efunbo Dosekun in The Guardian newspaper hints at inconsistencies in continuity of care for Nigerian pediatric patients. Dosekun, the Chief Medical Director at Outreach Children’s Hospital, Lagos believes that Nigeria has focused a little too much on immunization and neonatal care, what she describes as “public health initiative.” In her words,

“We seem to have forgotten that if you save a child from having diarrhea with an immunization, there are still other illnesses he/she has not been immunized against […] It makes more sense to prevent first and then put into place centers where the child can go when he/she falls sick.”

In the rest of the interview, Dosekun points out that even with our immunization programs, Nigeria’s overall child mortality statistics are dismal. One in six children does not make it to adulthood, putting us at par with many war torn countries. Of those who survive, the number that are significantly disabled as a result of childhood illnesses is staggering. The 48 year life expectancy of the average Nigerian is further testament to the fact that many children will not lead full, fruitful lives. Is this the best that Nigeria can do?

President Obama Taps ANPA Member, Dr. Funmi Olopade, for Key White House Post

Olufunmilayo Falusi Olopade, MD, FACP

Nigerian-born Chicagoan and ANPA member, Olufunmilayo Falusi Olopade, MD, FACP, has been appointed by President Barack Obama to the National Cancer Advisory Board. The Board advises the administration with respect to the activities of the National Cancer Institute, including reviewing and recommending for support grants and cooperative agreements, following technical and scientific peer review.

Dr. Olopade is an alumnus of the University of Ibadan College of Medicine, Ibadan, Nigeria, where she received the MBBS degree in 1980. News of her appointment has set off jubilation among ANPA members who hold her as one of the organization's shining stars. ANPA President, Dr. Fiemu Nwariaku congratulated Dr. Olopade for her great achievement and expressed gratitude to President Obama for an appointment that he said was clearly based on merit. According to Dr. Nwariaku, this is a fine example of the contribution that thousands of Nigerian-born physicians are making to improve the health of their fellow citizens.

Also, the Ibadan College of Medicine Alumni Association, (ICOMAA) through it's president, Dr. Benedictus Ajayi, released a statement praising Dr. Olopade for doing her home country proud and  for flying "an unstained Nigerian flag". Dr. Olopade, he added, "has never forgotten her roots .... and has continued to work relentlessly to ensure that our Alma Mater becomes one of the world's best".

In naming her to this top administration post, the White House released the following citation:

Olufunmilayo Falusi Olopade is the Walter L. Palmer Distinguished Service Professor of Medicine & Human Genetics, Associate Dean for Global Health, and Director of the Center for Clinical Cancer Genetics at the University of Chicago. She is also a practicing clinician and Director of the University's Cancer Risk Clinic. In her clinical work, Dr. Olopade is an authority on cancer risk assessment, prevention, and individualized treatment based on risk factors and quality of life. She also works with educators, doctors, government officials and pharmaceutical companies to improve access to quality education and medical care in low-income communities. Dr. Olopade has received numerous professional honors and awards, including the MacArthur Foundation Fellowship, the ASCO Young Investigator Award, the James S. McDonnell Foundation Scholar Award, and the Doris Duke Distinguished Clinical Scientist Award, among others. She holds an M.B.B.S. from the University of Ibadan in Nigeria, completed her residency in internal medicine at Cook County Hospital in Chicago, and completed a postdoctoral fellowship in hematology and oncology at the University of Chicago.

Meet our Bloggers, Chinyere Anyaogu, MD, MPH

We are pleased to announce that Dr. Chinyere Anyaogu has joined our blogging team. Dr. Anyaogu attended Federal Government College, Warri and subsequently received her medical training at the University of Nigeria.

She received dual sub-specialty training in Internal Medicine and OBGYN at the Montefiore Medical Center and Albert Einstein College of Medicine in New York. Also, Dr. Anyaogu Subsequently completed a Master in Public Health  at Columbia University and has a special interest in maternal mortality.

Dr. Anyaogu practices OBGYN and is currently the Medical Director of the Women's Care Center, Huntersville, NC. She is an active ANPA member, in the Carolinas chapter. Her blog posts will focus on women's health, maternal issues, and work life balance.

Rapid Recall for the Internal Medicine Boards by Dr. Chinedu Ivonye, ANPA Member

A new book, Rapid Recall for the Internal Medicine Boards, by ANPA member Chinedu Ivonye MD, FACP, billed as "a powerful tool to help you ace the boards", has just been released by CreateSpace Publishers. The book is intended for use by candidates preparing for the American Board of Internal Medicine (ABIM) certification examinations.

Dr. Ivonye is an Associate Professor of Medicine at Morehouse School of Medicine, Atlanta, Georgia. He also serves as the Associate Program Director for the Internal Medicine Residency Program, the Director of Primary Care, and the Chief of Ambulatory Services at Morehouse.

The book is the culmination of several years devoted to teaching and development of curricula for residents and medical students. Dr. Ivonye's passion for teaching has received wide recognition, including The J. Willis Hurst, M.D. Award presented by the Georgia chapter of the American College of Physicians.

Dr. Chinedu Ivonye

His motivation for writing the book, Dr. Ivonye told The ANPA Blog, was "to help the candidates preparing for the ABIM focus on the high yield materials". He added that "my experience over the years with residents has shown me that even the most intelligent candidates still need to focus on the high yield materials for the ABIM".

ABIM is one of 24 medical specialty boards that make up the American Board of Medical Specialties (ABMS). Through ABMS, the boards work together to establish common standards for physicians to achieve and maintain board certification. ABIM certification is regarded as evidence that that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care.

The book is available here on Amazon.

ANPA Member Named Chief of Neurosurgery

Dr. Wale Sulaiman, MD, PhD

ANPA member, Dr. Wale Sulaiman, has been named Chairman of Neurosurgery at the Ochsner Health System in New Orleans, Louisiana, part of the Ochsner Clinic Foundation, effective July 1, 2011.  

Dr. Sulaiman's medical career began at the Medical University, Varna, Bulgaria, where he completed a combined MD/MSc degree. His interests in Nerve and Spinal cord injury and regeneration research led him to the University of Alberta in Edmonton, Canada where he also completed a PhD in Neurosciences. He completed his Neurosurgery residency at University of Manitoba in Winnipeg, Manitoba, Canada and is board-certified in Neurosurgery by the Royal College of Physicians and Surgeons of Canada. He also completed clinical fellowships in complex nerve reconstruction at Louisiana State University and complex spine surgery at Medical College of Wisconsin.

In addition to his clinical expertise, Dr. Sulaiman has extensive research experience in both nerve and spinal cord injury and regeneration, and has authored several peer reviewed publications and book chapters in these areas and serves as a Reviewer for many neurosurgery and neuroscience journals.

In announcing the appointment, Dr. Richard Guthrie, Regional Medical Director (New Orleans) for the Ochsner Clinic Foundation  noted that Dr. Sulaiman has been "a strong presence in Neurosurgery" since he joined Ochsner in 2008. Also he complemented Dr. Sulaiman for helping to establish and serving as the the Medical Director of the Ochsner Spine Center.

Minister of State for Health Indicted?

Minister of State for Health Alhaji Sulaiman Bello

We were alarmed by this morning's scandalous headline from The Daily Trust, but were quickly reassured that the financial shenanigans being reported has nothing to do with the Federal Ministry of Health. Not again!

The newspaper reported that the Minister of State for Health, Alhaji Sulaiman Bello has been indicted by the Independent Corrupt Practices and Other Related Offences Commission (ICPC) over an alleged N11.2 million bribe.

However, the alleged offense was purportedly committed during Alhaji Bello's previous post as Resident Electoral Commissioner (REC) with the Independent National Electoral Commission (INEC). The minister was alleged to have unlawfully solicited the sum of N11.2m from the governor of Adamawa State and given a N0.5 million bribe to an official of INEC. Court hearing has been set for January 31st, 2011.

We should point out that this is merely an allegation and the Minister may be entirely innocent of these charges. After all, the ICPC does not have a stellar record of winning convictions against those public officials it has taken to trial.

Reflections on Brain Drain and Brain Gain in Nigeria

Over the holidays, a colleague of mine who has a thriving practice here in the United States shocked me and many of our friends when he said he was planning on returning home to Nigeria to set up a private clinical practice. In fact, he said he has shipped personal belongings and medical equipments to Nigeria. He said he believes he has learned all there is to learn in advances in medical science having undergone training in the United Kingdom and the United States. He said it is time to return to Nigeria and give Nigerians the benefit of the expertise he has acquired over the almost twenty five years since left the shores of Nigeria in search of greener pastures. One of our colleagues jokingly asked if the pastures were no longer and that he hoped he was making the right decision.

Today as I reflect on this conversation with our friend, I am once again drawn into the ever contentious exchanges on “Brain drain” and Brain gain”. Many have argued that my Nigerian professionals including physicians would not have reached full potentials and achieved professional expertise and competence if they had remained in Nigeria. May be and may be not. Others argue that even if this was the case, Nigerian professionals should return home after their training to contribute to the development of the country; after all to whom much is given much is expected. This is so much so when one remembers that most individuals in my generation were literally paid to go school. We all received bursaries, scholarships, and all kinds of grant to attend universities in Nigeria, and did not pay tuition.

So my friend is turning brain drain into brain gain by returning to Nigeria to contribute his expertise to health care delivery. Returning home to Nigeria is one way of turning brain drain into brain gain. Unfortunately, many Nigerian professionals can not take such giant leaps for fear of failure, insecurity, and an unfriendly practice environment that does not engender professional satisfaction and fulfillment. For the majority for whom returning home is not feasible, there should be other ways to give back to Nigeria and contribute to her development. Nigerian professional organizations in the Diaspora need to develop constructive, long-term sustainable strategies to develop particularly the education and health sector in Nigeria. The Diaspora Commission set up over a year ago is still bugged down with bureaucracy and has no tangible achievements to date. During my days in academia, I had Indian colleagues who go to India every summer to teach in medical schools and provide development workshops to practicing physicians. Such arrangements are done through their professional associations, are not done sporadically for self-recognition, develop clout, or for personal or political gains, but regularly in the overall interest of Indians.

Wherever you stand, or whatever your believes, “Brain drain” or “Brain gain” one thing is clear; Nigerians in diaspora particularly professionals need to be more involved in the rebuilding of the Nigerian state.

Partners in (Nigerian) Health

A report from the Federal Ministry of Health (FMOH) highlights a new initiative – the Data Inventory and Documentation Initiative (DIDI) – that aims to better align Nigeria’s health survey database with international standards. The report argues that such data “are invaluable resources for statisticians, researchers and analysts”, a statement that could very easily be extended to include benefits for health care professionals. After all, proper cataloging of health information could mean the difference between treating 200 patients today (preventing the spread of a disease) and treating 20,000 patients tomorrow in a full blown epidemic. I admit that this is an extreme example, but then again, health care is all about extremes. We can’t expect any less when we’re dealing so intimately with human life.

In any case, the report identifies the International Household Survey Network (IHSN), the World Bank, *PARIS21, the International Health Facility Assessment Network and USAID, as organizations that will help the FMOH with this transition. **MEASURE Evaluation will provide much of the technical support. In addition, the ministry has requested that data from private surveys (conducted by individuals and organizations) be contributed to the program. In all, it seems like a multi-faceted effort that is well poised to do wonders for the health situation in Nigeria.

It’s an incredibly fortunate coincidence that the FMOH would launch such a program shortly after the appointment of ex-minister of health, Babatunde Osotimehin to the position of Executive Director at the United Nations Population Fund (UNFPA). From such a position, Osotimehin can contribute greatly to programs like DIDI and thankfully, he seems ready to do just that. In a visit to his successor at the ministry (Prof. Onyebuchi Chukwu), Osotimehin re-affirmed his dedication to the health sector, promising to “provide more for Nigeria than ever before.” Embracing the sentiment, Chukwu praised the efforts of the ex-minister, asserting that his appointment at the UNFPA was a clear indicator of his exemplary leadership during his tenure.

Photo courtesy of the UNFPA (https://www.unfpa.org/public/home/news/pid/7103)

This alliance is encouraging on multiple levels. Most clearly, it holds great promise for the development of epidemiology and heath care management in Nigeria. In addition, it legitimizes Nigeria’s position as a country that has the potential to be a forerunner in global health. Very importantly, it’s a great example of a smooth hand-over in a leadership position, something that Nigeria doesn’t see very often. Let’s hope that the Nigeria-UNFPA relationship will live up to expectation and ultimately, help programs like DIDI reach their full potential.

* PARIS 21 - Partnership in Statistics for Development in the 21st Century (Founded in November 1999 by the United Nations)

** MEASURE Evaluation - Monitoring and Evaluation to Assess and Use Results (Program sponsored by USAID)