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.

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.

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)