Thursday, 28 June 2007

Proudly Nigerian at TEDGlobal

Having been recommended by a friend, I ended up with 99 other young Africans that received a fellowship to attend a conference called TEDGlobal in Arusha, Tanzania. Not being quite sure of what to expect, I spent quite a while on their website listening to powerful inspirational speeches from past TEDs, but these only became real to me when I listened to Ngozi Okonjo Iweala. At that point I knew then how lucky I was to be going to Arusha!

Much has been written about the conference, and you can look up the TEDBlog …but I will focus on 2 Nigerians that brought their innovations in healthcare to TED. In the sessions themed “Health and Heroism”, and Tales of Innovation.

Ernest Madu …I first met this guy during one of the coffee breaks, taking pictures and bursting with enthusiasm, we did the normal introductions.
But nothing prepared me for his story! Ernest, himself a cardiologist working in the USA has set up a massive, modern and apparently very efficiently run heart centre in The Caribbeans. The obvious question…why there? The obvious answer, Nigeria was not ready at the time. But things are changing and Ernest is working on setting up a similar centre in Port Harcourt Nigeria. Then maybe, just maybe we could stop some of those deaths from heart disease, and help all those "poor" Nigerians forced to go abroad for small ailments. Heart disease is never easy or cheap to manage. Dr Madu has shown that in an interconnected world, technology, expertise and the human (I’d say Nigerian spirit) spirit can support make the seemingly impossible, possible. Ernest reminded us all that while it is important to focus on AIDS, Malaria and TB, we should not forget all the other important causes of illness and death! His question: What would happen if any of us had a heart attack here in Arusha, Tanzania at 11pm at night….for the answer…Watch out for Ernest’s talk on TEDtalks, on the website over the next few weeks.

Then there was Seyi Oyesola....boy, did he give a good talk. But he should, he spent hours working on his presentation.:-)...and it was well worth the time. (Seyi...sorry had to say this). Where are the well-trained African doctors? Seyi asked...the answer: Overseas. Where they're better paid, better treated and enjoy modern hospital settings. In contrast, most hospitals on the continent lack vital equipment. On a mdeical mission back home, Seyi was distressed by the conditions in a Nigeria hospital where he came to perform a dozen open-heart surgeries; floors were dirty; X-rays taped to windows etc...and he decided to "do something". Precisely what he is doing....Oyesola resolved to find a portable solution for bringing modern medicine with him. He co-developed the a complete operating room in a small trolley that can run on electricity, solar and batteries..or a combination of these. These are now in production and Seyi is heading home with them.

OK...not about health....but just as important! Leaving the best for last....Ngozi Okonjo Iweala closed the conference with the most powerful and inspirational speech..I have heard. If you heard the first one, you will want to look out for this one. But if you cannot wait, read the summary here or here.

And to think that we had almost stopped believing...In Africa, we say it takes a village, but sometimes all it takes is an individual! These individuals motivate thousands of others to believe again. Thousands of inspired, committed, competent and motivated individuals…."the village"! It does take a village! The challenge is to transform these villages into institutions. It is up to us, young Africans to draw inspiration from the Okonjo-Iwealas, and prove our competence in taking our destiny in our own hands and going out there and doing it.

Thank you Ngozi for helping to restore to many of us young Africans the self-belief we need to fulfil our shared dreams for the continent.

Saturday, 23 June 2007

Pfizer and the 1996 meningitis outbreak in Nigeria: Who is lying?, and 9 other questions

It is now common knowledge that Pfizer used a drug trovafloxacin (commonly called Trovan) to treat Nigerians in a 1996 cerebrospinal meningitis (CSM) outbreak in Nigeria’s Kano district. This drug was not licensed for use for meningitis. The critical issue has been the company’s possible breach of global ethical guidelines on pharmaceutical trials.
Of the 200 children who participated in the trial, five of those given Trovan died and many others were left with disabilities.

Many believe that this single event, has led to the mistrust by the population of public health interventions that in turn was probably responsible for the rejection of polio vaccination, resulting in a massive outbreak in Northern Nigeria in 2003. This set back the entire polio eradication programme several years, costing the world billions of dollars. Today, many public people have become pessimistic on the achievability of this goal.

Pfizer has always rejected the allegations saying “Pfizer rejects the charges, saying in it is ‘proud of the way the study was conducted’ the study was ‘well conceived and well executed,’ and it ‘saved lives.
The company’s exonerating claim has been that it obtained prior consent from both the Nigerian government and patients' families.”

For several years the families of those affected have been pursuing lawsuits in Nigeria and the US unsuccessfully. The official report of the incident conducted by a panel led by Dr Abdulsalami Nasidi, a virologist and one of the top civil servants in Nigeria’s Ministry of Health was never released by the Government until now!
It concludes that “A panel of Nigerian medical experts has concluded that Pfizer Inc. violated international law during a 1996 epidemic by testing an unapproved drug on children with brain infections at a field hospital” and crucially stated that “concludes that Pfizer never obtained authorization from the Nigerian government to give the unproven drug to nearly 100 children and infants.”
Suddenly there are 2 lawsuits, by the Governments of Kano State and the Federal Government suing Pfizer.

Questions Nigerians are asking:

1. Who is lying?

Pfizer’s Managing Director, Nigeria Director, Miss Ngozi Edozien, insists that the 1996 clinical study was undertaken with the full knowledge of the Nigerian government in a responsible and ethical way consistent with the company’s abiding commitment to patient safety. The Nigerian government says "The plaintiff contends that the defendant never obtained approval of the relevant regulatory agencies ... nor did the defendant seek or receive approval to conduct any clinical trial at any time before their illegal conduct.

2. Why has this report been kept locked up for 11 years? A report like this does not get suppressed without someone high up being involved.

3. What have Ministers of Health since 1996 been doing in this regard?

4. Who takes responsibility for trials conducted in Nigeria, who authorises foreign interests to conduct trials in Nigerian clinical settings and who leads on the trials?

5. Who protects the interests of patients when trails are conducted? What is the role of the National Health Research Ethics Committee would expect a stand from them?

6. Was informed consent got from the patients?

7. Why does Pfizer, the world’s largest drug maker, with a net profit of Net $268.4 million in 2006 not pay these few hundred patients they treated, or at least the families of those that lost their lives a reasonable compensation package as proposed by the now released report?

8. Who is responsible for the ongoing duty of care for the patients that the doctors on this Phizer clinical trail provided?

9. Will Polio ever be eradicated, and will this outbreak mark the begining of the failure?

10. Where is the public health leadership? Where are the voices advocating for the rights of the citizens.

Thursday, 21 June 2007

Measles outbreak update, civil society oversight and some cheering notes

The death toll from the measles outbreak in Borno continues to rise with 80 deaths reported by Thisday newspaper as at yesterday. There is still little evidence of an intensified immunization campaign which is critical if control of the outbreak is to be achieved. That the outbreak has occurred should not surprise anyone in the light of a recently published WHO evaluation of immunisation programmes in Africa which included Nigeria as one of the countries in 2004 where immunisation coverage remained at less than 50 per cent. You can read the report here

The refusal of the Permanent Secretary in Borno State to reveal the actual number of people affected is another disturbing note. Promoting greater transparency in public services in Nigeria is important and public officials need to realize that it is not acceptable to withold relevant information from the public. Doing this requires greater oversight from the media and civil society organizations and it is cheering to see an analysis (even if limited) by a journalist outlining challenges in healthcare for the new Yaradua administration and also a letter from a civil society group SERAP to the new Nigerian president calling for universal access to health care to be a priority for the incoming administration

On a more cheering note, UNICEF has recently commended Nigeria on having successfully completed its salt iodization programme, which means that 98 per cent of the population should now have access to iodized salt, a major pillar in the prevention of iodine deficiency.

Another cheering note is the move by anti-tobacco organizations to move the battle for better tobacco control in Nigeria to the courts. This is particularly important as the tobacco companies, having been driven out of the West have moved massively into developing countries like Nigeria. Raising awareness of this issue will be key but also challenging in view of the powerful role of companies like British American Tobacco in the Nigerian economy.

Tuesday, 19 June 2007

Another Measles Outbreak

The Nigerian Guardian reports that 60 children have died from a measles outbreak in Borno State, northeastern Nigeria. 400 other children are said to be infected. If we are to believe these figures we should be very angry! Angry that 40 years after the measles vaccine became available, at the cost today of less than 30 cents, children still get infected by the measles virus. Angry that when children do get infected, 15% of them die from it! 15%! Even in a worst-case scenario mortality from measles hardly exceeds 7%! Why are our future leaders dying from a disease that is preventable by less than 30 cents?

We are told that "the health department of the council has been directed by the Secretary to procure and distribute drugs to all the affected villages and communities infected by measles". What drugs I pray? This is measles, a viral illness! the children need good nutrition and supportive care! 2 years ago, working with MSF we reported on a large measles outbreak in Adamawa state, just south of Borno, with what we called an unacceptably high mortality. It was 10%! No mention of the response of the National Programme for Immunisation.

Some good news from the science side. A new conjugate vaccine for meningitis, could prevent the annual outbreaks experienced in Northern Nigeria and surrounding countries. Protection is expected to last for several years, and will be used to prevent epidemics, rather than dispensed reactively to control outbreaks as the older polysaccaride vaccines.

The challenge will be getting it to the people that need it once available. The managerial challenges of converting science into health benefits will define how we attain the Millennium Development Goals (MDG).

Did I hear someone shout "what of the HPV vaccine?"
That will be the day!
Cry not....


Blogging Nigeria's Health Scene

Why start a blog about health and health care in Nigera, who has time to read them...and really who cares?

Questions we asked ourselves.

Ike Anya and I have frequently commented on health issues relating to Nigeria in various conventional media as here, here and here. Just before the last elections, with our colleagues in the Nigerian Public Health Network, we tried to stir national debate on health issues. We collect and put up news articles relating to health on the website of the network. But the urge to be more proactive and bring these issues to the attention of most people in real time became most glaring when we attended an awesome conference in Arusha, Tanzania; TEDGlobal. If you have some time, listen to some of the talks on the web, time very well spent.

Our time is now! It is time to do a bit more, and demand a bit more. The Nigeria health sector is currently struggling out of the doldrums that it has found itself in. The problems are multifaceted and seem unsumountable. But we thought the same about other sectors and see what is happening now!

Why is it no longer acceptable to take a sleeping mat to the bank, but still okay to take a mattress to the hospital out-patient-department? With the growth in the profit driven sectors of the Nigerian economy as seen in the financial, communication sectors, one major challenge facing the country is how the health, education and other public sector domains will keep up and strive. Yet, non of the growth in the other sectors is sustainable without attention paid to education and health.
So, using this blog, we will draw attention to the things that matter, relating to health in Nigeria. Coming from a public health backround, will will attempt to give a population perspective, ask the difficult questions and seek pragmatic solutions.

We look forward to your support, comments and criticism!