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.

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).

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 !!!!!!

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.