A medical Exhibition in Africa with very few African Exhibitors

There is a lot of talk everywhere about Africa "rising". This is definitely the case in many sectors of the economy in several African countries. There is definitely a rise in the extractive sectors, which has fuelled the consumerism produced by a growing middle class. This is not only manifest in the expansion of Walmart into South Africa and but also in the expansion of Shoprite from South Africa to the rest of the continent. The same phenomenon is also happening in other service sectors. But, as we see this trend grow - one cannot help but wonder how we can rise out of poverty by being consumers only. Where is the associated industrial base of "Africa rising"?

I recently attended the Africa Health Exhibition and Conferences which held for the 3rd time in 2013, in Johannesburg, South Africa.

Millions of girls in developing countries to be protected against cervical cancer, but ...

...countries will need to develop the infrastructure to deliver the HPV vaccine to those that need it! This is precisely where we struggle the most in our Nigeria.

Most people working in the public health community were excited at the recent announcement by GAVI that it had negotiated a new price of $4 for the vaccine against Human Papilloma Virus (HPV), which causes cervical cancer. The same vaccines can cost more than $100 in developed countries and the previous lowest public sector price was $13 per dose (see more at here). The following eight African countries will initially benefit from GAVI's support to introduce the vaccine; Kenya, Ghana, Madagascar, Malawi, Niger, Sierra Leone, Tanzania and Rwanda. No sooner had GAVI made the announcement, when the Rwandan Minister of Health (who you must follow on Twitter! @agnesbinagwaho) clarified the situation with this tweet.

Amazingly - Rwanda was the first country in Africa to introduce the HPV vaccine into its immunization schedule in 2011, when it negotiated a price with Merck, and subsequently attaining 93% coverage for the first three-dose course of vaccination in the target population. Now - show me a better example of public health leadership. By showing the light, they have not only saved thousands of Rwandan lives, but they have influenced a global reduction in the cost of the vaccine on the continent, potentially saving millions more!

Cervical cancer is the third most common cancer in women, and the first for which we have the opportunity to prevent by vaccination at a population level. The HPV vaccine is one of the major public health breakthroughs of our time. It had here thereto also held the unflattering title of being the most expensive childhood immunisation in the world, initially costing US$360 for the required three doses. As THE LANCET noted in its editorial, "as GAVI scales up the use of the vaccine, the price is expected to come down further". It also notes that; ..."The challenge now is to make sure that countries have strong enough health systems for national roll-out".

This, ladies and gentlemen is the challenge facing our dear country, with its much quoted 7% growth! We have not developed the institutions - across all sectors, to make economic growth benefit the Nigerian people. The above is just a "small" example from the health sector, there are many more. Tell me dear friends, of what use is economic growth if it is nothing more than a number quoted at the World Economic Forum?

So - are you surprised that despite having the largest burden (by factor of our population) of cervical cancer in Africa, GAVI has chosen to ignore Nigeria in its immediate plans? I am not, sadly.

Nigeria - well represented at the 66th World Health Assembly

This year, as in most years, we are well represented at the 66th World Health Assembly currently going on in Geneva, with a small delegation of 47 official delegates (listed below). On the opening day, our Minister of Health has assured the world that we will eradicate polio - no shaking. We wish them a lot of fruitful deliberation on our behalf! Aluta continua....

NIGERIA - NIGERIA

Chief delegate - Chef de délégation

Professor C.O. Chukwu

Minister of Health

Deputy chief delegate - Chef adjoint de la délégation

Dr M. A. Pate

Minister of State for Health

Delegate(s) - Délégué(s)

Mrs F.B.A. Bamidele

Permanent Secretary, Federal Ministry of Health

Alternate(s) - Suppléant(s)

Dr U.H. Orjiako

Ambassador, Permanent Representative, Geneva

Dr P. Gbeneol

SSA (MDG)

Mr I.A. Okowa

Chairman, Senate Committee on Health

Ms M.C. Okadigbo 

Deputy Chairman, Senate Committee on Health

Mr G. M. Guma

Chairman, House Committee on Health

Mr G.N. Elumelu

Chairman, House Committee on Health

Dr K. Ohiri

Dr O. Idris

Commissioner for Health, Kogi State

Dr B. Okoeguale

Head, Department of Public Health, Federal Ministry of Health

Dr B. Wapada

Head, Department of Family Health, Federal Ministry of Health

Mrs M. Okpeseyi

Head, Food and Drug Services

Mrs A. B. Ogu

Director, Health Planning, Research and Services

Dr P. Orhii

Director-General, NAFDAC

Professor K.S. Gamaniel

Director-General, NIPRID

Dr A. Mohammed

Executive Director, NPHCDA

Dr A. Sambo

Executive Secretary, NHIS

Dr A. Usoro

Head, NCD

Dr N. Ezeigwe

National Coordinator, National Malarial Control Programme

Dr E.A. Abanida

Director, NPHCDA

-31-Dr M.J. Abdullahi 

Director, NPHCDA

Dr H.U. Yusuf

Director, NAFDAC

Dr K.K. Nzinongo

NHIS

Dr. N.R.C. Azodoh

Head, IC/RM/MDG

Dr A. Oyemakinde

Chief Consultant Epidemiologist, NCDC

Mrs R. Kuje

DD/MultilateraL/ D.O

Dr I. Okoh

SSA( HMH)

Dr I. Kana

TA, PS

Dr C. Elenwune

Senior Medical Officer

Mr A. Yakubu

Principal Health Officer 

Mr U.B. Aduagba

Senior Health Research Officer

Mr G.O. Asaolu

Minister, Permanent Mission, Geneva

Mrs I. Chibogu

Director, Legal

Dr I. Anabogu

Mr A. Abdulsalam

Mr G. Pwajok

Mrs M. Okodugha

Director, Nursing Services

Dr B.S.F. Akpan

Adviser(s) - Conseiller(s)

Mr I. Yusuf

Deputy Director, Press

Mr N.D. Osondu

Mr S. Mohammed

Mrs A. R. Abdullahi 

Mr C. Muanya

Mrs A. Angbazo

NANS

Mrs M. Aneke

Coping with grief and loss without faces in Baga and Bama

Do you know the lady in the picture below? My guess is that you do not, and honestly, neither do I. I found her in one of the very few articles that has dealt with impact of the violence on innocent Nigerian families, who just happen to live in Northeast Nigeria, now also in Nasarawa. One cannot help but wonder what is happening to these families, these women, children, their dreams, our dreams for Nigeria. 

Picture courtesy of REUTERS/Afolabi Sotunde shows a woman sits amongst the ruins of the burnt Bama Market, which was destroyed by gunmen, in Maiduguri, northeast Nigeria, April 29, 2013. (Original article here) 

Now, reflect for a minute about the difficult pictures out of the Boston bombings a few weeks ago in the USA, covered for 24/7 for almost for a full week. Anyone with access to the cable channels watched the coverage. Every newspaper and magazine covered the story from the bomb blasts, from the search, to the identification of the bombers, to the success and the recovery. We listened to President Obama speak and we felt the pain of Boston. We saw a city come together, we felt a country hold together. We shared the joy of the rapid success in the investigation, and took solace in the resolve of the people to pick up the pieces.

Now to our Nigeria, how can we grief if we never see the faces, if we never read the stories, or hear the voices. Our president never speaks, neither do the governors. The only TV who journalist that we know actually visited Baga was Yvonne Ndenge of Aljazeera. Where is NTA news?  Where is the cover of Newswatch or Newsweek with the faces of the mothers and children affected. It is impossible for our Nigerian society to respond if we do not have an emotional connection with the events in other parts of the country. We cannot have an emotional connection if all the press tells us are numbers of dead (on which they cannot agree!).

Our grief has not began, only when it does shall we be able to find the compassion to chart a way forward. There is a piece of Baga and Bama in each of us. A piece of us that has been lost and, we must share the grief and sorrow. Baga and Bama is as much our home as Shagamu, Abakiliki and Eket are. Until we are allowed to share that pain - we will not have peace in our hearts.

How do we start asking about the provision of counselling services, of mental health services, of orthopedic surgery, of burns units? How can we explore the rights of medical personnel in the University of Maiduguri Teaching Hospital who have gone on strike because the Nigerian Police took out their anger on them?

How can we, when we do not feel connected to the mothers, fathers and children who continue to die needlessly in our country. How can we feel grief and compassion without their faces?

We pray for Nigeria....and for the woman in the picture.

A polio-free Nigeria as a critical step to a polio-free world

Guest post by Iruka N Okeke

...and we endorse and actively support its content! 

Nigerian scientists, doctors and technical experts  joined their colleagues from around the world to launch the Scientific Declaration on Polio Eradication on 11 April 2013. Today, the world is closer than ever to eradicating polio, with just 223 cases in five countries last year. To capitalize on this time-limited opportunity to finally end the disease, a wide range of experts have signed the declaration to emphasize the achievability of polio eradication and endorse the Eradication and Endgame Strategic Plan, a new strategy by the Global Polio Eradication Initiative (GPEI) to reach the end of polio by 2018. The scientists and experts signing the declaration come from more than 75 countries and include Nobel laureates, vaccine and infectious disease experts, public health school deans, paediatricians and other health authorities. For additional information about the Scientific Declaration or to view a full list of signatories, please visit the Emory Vaccine Center Website.

Image courtesy of GPEI/ Scientific Declaration on Polio Eradication

  

Image courtesy of GPEI/ Scientific Declaration on Polio Eradication

 Polio.  Frightening, crippling and, half a century ago, a leading cause of death and disability worldwide.  The battle against this deleterious and transmissible threat to human health has spurred major advances in health care science and delivery.  Many of the vaccine development strategies used to control a range of diseases today were pioneered by poliovirus specialists like Sabin, Salk and Koprowski.  Polio was also the initial focus of the March of Dimes, a US health charity that pioneered methods to fundraise for research and health care.  And on an international scale, polio is one of few diseases around for which we have both the tools and international consensus to eradicate.

Image courtesy of GPEI/ Scientific Declaration on Polio Eradication

Close to home, we can credit polio, and the international eradication effort against it, for a cold chain for essential vaccines for Nigerian children. Oral polio vaccine itself is one of the easiest to administer.  The polio eradication program has also been the driver for a network of virology laboratories in Nigeria and other African countries, which have boosted diagnostic capacity for a range of infections and will continue to serve public health after polio is gone.    Nigerian virologists have played leading roles in the Global Polio Eradication Initiative and thousands of paid and volunteer health workers and advocates have worked tirelessly to drastically reduce the incidence of this disease in recent years, successfully eliminating polio from most states in Nigeria.

Image courtesy of GPEI/ Scientific Declaration on Polio Eradication

In spite of these advantages and advances, and in visible contrast to over 125 other countries that have halted poliovirus transmission in the last three decades, Nigeria is yet to see its happy ending to the saga on polio.  It was originally hypothesized that India would be the greatest challenge for polio eradication but India has recorded no cases in the last two years.  In 2013 Nigeria remains one of only three countries worldwide, and the only one in Africa, where children still contract the disease in nature.  And each time that it looks as though we might be getting our handle on polio, something unexpected happens.  Far too often, the happenings that set us back have nothing to do with the virus or the disease.  Rumour-fuelled vaccine boycotts have more than once derailed Nigeria’s eradication program, allowed children that should have been protected become paralysed, and facilitated reintroduction of the polio to other countries that have successfully eliminated the disease.  And an unconscionable number of Nigerian deaths in the last year can be connected to polio, sadly, not all of them to the virus.

Eradication is an absolute term.  Just as a woman is either pregnant or not, a disease is either globally eradicated or it is not.  Elimination and control are good things but they do not offer the supreme benefits the world gains from eradication.  As long as poliovirus in transmitted anywhere in the world, all children remain at risk from an infection that could disable or kill them.  Until eradication, expenses will continue to be incurred from vaccine programs that could otherwise be stopped and there is a small but real possibility that the virus will evolve away from current control tools into something that we are less able to contain.

Thankfully, we are close enough to eradication to avoid the dire consequences of failure.  Perhaps the greatest concern is that now that polio is almost gone, stakeholder support for the eradication program that got us this far could start to wane.  We need to reassure our supporters that their long-term investments will combat this disease for good.  While it is true that fewer children are stricken by polio – even in Nigeria – than by malaria, diarrhoeal disease or pneumonia, we MUST press on and finish the job we began three decades ago.  Eradication of smallpox in the 1970s – through a program that cost an estimated US$1 billion has saved the global community US$1.4 billion in control costs each year.  Thousands of lives have been saved and millions have been protected from scarring and blindness.  In a world where polio is eradicated, comparatively more could be saved when it no longer becomes necessary to vaccinate against this dreaded disease or to provide life-long rehabilitation to those that are disabled by it. And in spite of the fact that the polio eradication effort is past its due date, we are so close that ending transmission now will be easier than at any time previously in history. If the eradication program is neglected at this point, countries like Nigeria that are still endemic for polio will be hit hard by resurgence of the virus first.  At this crucial point in the endgame, we must motivate our overworked, threatened and justifiably disillusioned workforce, make the necessary investments and encourage Nigerians like people everywhere to work together and obliterate this disease.  We know eradication is possible because cases in Nigeria have fallen dramatically in recent years and most countries in the world have eliminated the disease.  We are close to the end of this challenge and must marshal all efforts to complete it.

Image courtesy of GPEI/ Scientific Declaration on Polio Eradication

Scientists often view the battle against disease as a straightforward between an infectious enemy and immune and pharmaceutical allies.  The current situation with polio has made us sit up and take a hard look at every piece of the complex paradigm that stands in the way of polio eradication.  In Nigeria, mitigating factors extend beyond the biological to socio-economic, health system and behavioural concerns.  Along with similarly motivated scientists and clinicians worldwide, Nigerian scientists and clinicians are supporting the all-encompassing polio endgame with a target date for completion of 2018 laid out in the Polio Scientific Declaration.   This enhanced plan builds on the strategies that have been used to eliminate polio from most of the world with a renewed push to address roadblocks that come from insecurity, resource-limitation and public outreach.  We invite other scientists and clinicians, public health practitioners and advocates, vaccine producers and distributors, our government and our civil society as well as international partners and sponsors to join us and the rest of the world in this essential and historic effort.  Lest you think that the declaration represents externally-imposed  agenda,  I emphasize that as many as 5% of the over 400 signatories are Nigerians based at home or abroad who are concerned that, unless we act decisively and now, the current situation within our country represents a perpetual threat to children in Nigeria and globally.  We’re in it for as long and for whatever it takes and will work with everyone to ensure that we do come out on top.   Let’s End Polio.

Image courtesy of GPEI/ Scientific Declaration on Polio Eradication

Iruka N Okeke,

 Department of Biology, Haverford College

We must face the future with courage...

We have been quiet on this blog for some time. We write about the health sector in Nigeria.  It is tough because there is rarely good news. The map below is a bit dated but shows where most of our challenges lie with all the health indices in Nigeria. It is also no news to you that this has become one of the most violent regions in the world at the moment. When the next bomb goes off in Yobe, Adamawa, Kano or Bornu….we hardly blink. Its …same old, same old. I recently spoke to a class mate and colleague working in Kano – an orthopedic surgeon. He is struggling with several patients from the most recent Kano bombing. Distraught ….he could not bring himself to say how bad things were. He has become numb. Managing a single patient with 3rd degree burns is traumatic in our setting, to manage tens of patients, most of whom will die, causes pain beyond words. Medical school did not prepare us for this he told me…

DPT3 Vaccination Coverage - 2007

I think about the few doctors still working in the North East, or the nurses. I wonder how many of those deployed under the much taunted Midwifery Service Scheme of the NPHCDA were still there, or how many NYSC doctors accept their postings to Maiduguri. I wonder where mothers give birth and how. Who does the caesarean section when indicated or manages the other complications of pregnancy. Who carries out the blood services, the emergency care? When at the end of last year a report described Nigeria as the worst place on earth to give birth; it barely made the news in Nigeria.

Yet our country is in the news every day. It is said that we will become the largest economy in Africa very soon. The richest African is Nigerian, the richest black woman, “owner” of a lucrative oil block – Nigerian, fastest growing market for private jets – Nigeria, booming real estate market…yes you guessed it; Nigeria. Rich Nigerians carry themselves with pomp! Giants of Africa…..

Yes, we have been writing about the health sector for many years – and as we read through our archives, we realize that nothing really has changed for the better. So, in addition to writing, we will do our bit. We do not think we can change the world, definitely not the world around Nigeria, but we will find our small niche and give it the best shot we can. You can too!

And…we will not give up on the blog. It may be slower than usual, but we will keep it going. And if you really want to keep your finger on our pulse, join us on Twitter @nighealthwatch.com

For Nigeria - the next few years will take courage....lots of it.

The re-awakening of the Nigerian Medical Association

Until recently the Nigerian Medical Association (needs a better website!) has been little more than a labour union, protecting the narrow interests of its members. It's voice was rarely heard in the public space on issues of critical national importance. Rarely was it seen as a champion for the interests of the patients who doctors swear at graduation to serve and protect for the rest of our lives. Thankfully this is changing...! The current leadership of the NMA has just concluded its first Health Summit. We asked Dr Joseph Ana, Former Commissioner of Health of Cross River State during Mr Donald Dukes's Government, to give us an account of how he saw it. 

However, we hasten to add that while this is a great start, it is only a start. There is still a long way to go for the profession to restore faith in the Nigerian population in its intent, commitment and ability to put the patient first. 

This is his account - enjoy! 


Dear All,

The first Health Summit hosted by the Nigerian Medical Association (NMA) ended with a terrific grand Banquet on Saturday 26th January, 2013 in Asaba, Events centre, Delta State, Nigeria. The Delta State Government of Governor Emmanuel Eweta Uduaghan, CON is justifiably proud to have hosted what has been appropriately called 'the reborn of the NMA'.

NMA is born again because before the event, it was the talk of beer parlours and hairdressers that its members had lost most of its priviledged status amongst the population because of the attitude and behaviour of many of its members. Most Nigerian doctors remain the epitome of professionalism,  ethics and good medical practice, but the minority 'renegades' in the profession was getting bigger and bigger at an alarming rate. Some doctors, members of the noble profession, had found themselves mired in the whole system failure environment of the country. From incessant strike actions to conflicts of interest in working full time in at least two places at the detriment of quality and safe health care they are able to provide.

From left:  Dr Chris Ngige; Governor Uduaghan, Dr Kitchner, & Dr Joseph Ana

In the short time of about 9-months, Dr Osahon Enabulele, President of NMA and his team organised a superb and historic transformation event. I don't think many observers gave it any chance of achieving anything, considering the prolonged slumber that the association pushed itself into. The great success of the event was therefore even sweeter and motivating. The theme 'Repositioning the Medical Profession and Nigeria's Health System for National Development' said it all.  At the final count there were over 1,000 participants over the seven days and resolutions galore. The lectures were delivered by a select knowledgeable faculty on an ever excited audience. Some of the resolutions include:

SAME SEX MARRIAGE PROHIBITION BILL – THE SILENCE OF NACA

Those that follow Nigerian politics may be astounded at the speed with which the SAME SEX MARRIAGE PROHIBITION BILL is passing through our houses of parliament (especially considering that the National Health Bill is still in the making after 8 years). This is one bill that appears to have united Muslim and Christian leaders, with the Senate President recently quoted as saying "Ban on same-sex marriage irrevocable". Can it really be that there is universal agreement on this in Nigeria and the lawmakers are protecting the interests of their constituents, weak and strong, as they were elected to do. To offer a perspective  we invited Dr Cheikh Eteka Traore, an international consultant on HIV and sexual diversity to provide some insights. 


SAME SEX MARRIAGE PROHIBITION BILL – THE SILENCE OF NACA
by Dr Cheikh Eteka TRAORE

As 2012 was ending, many of us, working for most-at-risk communities in the AIDS community were reflecting on the year, and whether the last AIDS conference in Washington, DC had any impact. It was a very eventful year in so many respects. From human rights controversies to new breakthroughs in prevention science, and off course all the talk about “Turning the tide” and the “AIDS Free generation”. We witnessed last year many policy and political ‘wins’ for the groups we work for. Groups who despite their higher vulnerability to HIV, suffer neglect in country AIDS responses. Namely, injecting drug users, men who have sex with men and sex workers. Leaders and advocates representing these groups were very visible and were the subject of policy debates during the Washington conference.

At Christmas we are "Only As Strong As Our Weakest Point"

Dear Friends, 

Christmas two years ago, I asked my friend; Patrick Anigbo to reflect on a very personal story. This Christmas, I was reminded of the post as the issues are still as relevant now as they were then, maybe more so. The central message is that our society, indeed any society is only as strong as its weakest point....this is Paddy's story....enjoy, reflect, do. 

Merry Christmas! 

Only As Strong As Our Weakest Point

by Patrick Anigbo

This year my first child, a son we named Odinakanna (translated - it is in the hand of GOD), celebrated his 10th birthday. It has become custom, at least amongst my friends, to mark our children’s 10th birthday with some sort of fanfare – it is a milestone of some sort. And so it was that close family and friends organised for Odi a truly breath-taking day. Not even the spring downpour and the attendant travel chaos could put a dampener on proceedings.

Laboratory medicine matures in Africa: How should Nigeria translate talent to impact?

We could not attend an important conference on Laboratory Medicine in Africa this month because we were involved in another important event in London at the same time, so you can imagine our excitement when a dear colleague - Iruka Okeke sent us her take from the conference. Iruka has contributed a lot to the development of laboratory medicine on the continent. Her seminal book -  Divining without Seeds: The Case for Strengthening Laboratory Medicine in Africa is compulsory reading for all those really interested in improving health care in Africa. 

By Iruka N Okeke

It was my privilege to attend the first scientific meeting of the African Society for Laboratory Medicine (ASLM; Dec 1-7, 2012, Cape Town) .  Yes there were the usual plenaries, symposia, break-out sessions, exhibitions and networking opportunities, but this was so much more than just another scientific congress.  Barely two decades ago, certainly in most of Africa, medical laboratory science was the hole in which biologists or chemists with little training or ambition fell into and settled to the bottom with a dull thud.  A few stars led pivotal programs but the vast majority would report daily to a bare bench or, in frustration, seek genuine employment in other sectors.  This was the state of affairs in spite of the fact that most patients on the continent had an infectious disease that could easily and reliably be diagnosed with a simple laboratory test and that testing was essential to optimize treatment. 

So much has changed in the last decade and as one who as argued throughout this time for strengthening laboratory medicine in Africa, the meeting afforded a truly delightful opportunity to see how laboratory medicine has blossomed over the continent in the last decade.  In addition to the better-known developments in point-of-care testing for malaria and laboratory capacity building for HIV diagnosis and monitoring, it was heartening to see considerable progress in the diagnosis of other common diseases, in diagnostic test development, and a much-needed rise in morale among laboratory scientists.