Wednesday, 24 October 2007

Nigerian Doctors in the UK meet

The Medical Association of Nigerian Specialists and General Practitioners (MANSAG) is holding its annual conference and general meeting this weekend. For details click here

In other news, the health minister proposes a Tertiary Hospitals Commission suggesting that she acknowledges the need to improve tertiary health care while focusing on primary health care as a priority

For the latest developments in the case brought against Pfizer by the Nigerian government, see here and here

Sunday, 21 October 2007

Why children continue to die from a disease that can be prevented with 50 cents!

...Our inability to raise coverage of routine immunisation in Nigeria remains one of the biggest scandals of our age. Huge outbreaks are still happening in 2007! 3 years ago I had one of the most disturbing experiences of my public health career, working to manage an outbreak of measles in Adamawa state, with a case-fatality raion of 10%. I.e. 10% of all children with measles died. Measles can by prevented by a vaccine that costs less than 50 US cents. 50 cents = N60!!!!

Find below one of the reasons why!
THISDAY ONLINE on 10.17.2007 by Kayode Komolafe,

IT WILL SHOCK YOU...or not..)

For those interested in an authentic version of how health policies and campaigns have been distorted by mismanagement and sometimes fraud a new book entitled Academics, Epidemics and Politics: An Eventful Career in Public Health is recommended. The author is Idris Mohammed, a professor of Medicine and former Chief Medical Director of the University of Maiduguri Teaching Hospital (UMTH). It is a story of how not to implement policies in the name of the poor. Incidentally, the author dedicates the book to the "Talakawa of Nigeria of Nigeria whose suffering has grown exponentially over time, and to all the poor of sub-Saharan Africa who continue to live in dehumanising conditions in the midst of plenty- in an unjust world that cares little for regional or global ethical responsibility".
Professor Mohammed insists that his work, published by Bookcraft, is not autobiographical. This column too is far from being a review of the magnificent book, which tells the story of Mohammed career in academics, politics (interestingly at an early age) and other areas of public service. Mohammed offers his perspective on the global politics of public health.
He gives his impressions about the primary healthcare delivery championed by the late Professor Olikoye Ransome-Kuti as well as the clinical trial of Trovan in Kano. However, it is what he writes in the book about the National Programme on Immunisation (NPI) that is isolated for this discussion. For any humane person the passion should be how diseases such as polio, which has long become history in most parts of the world, would be eradicated in Nigeria. But what Mohammed demonstrates lucidly and courageously in the book is that the passion of some other persons was for something else - how to make millions from a programme that was supposed to put an end to human misery. Little surprise that the author refers to a point in the writing of the book when "a threat to stop the publication of the book by external forces loomed large".
Mohammed was on sabbatical and served as a consultant to NPI. He was later appointed as the Chairman of the Board of Management of the programme. Although the appointment was supposed to be part-time, Mohammed elected to serve full time without pay to cap his 30 years in public survive. He needed the time to cover the huge field that is Nigeria and to meet the poor people in the rural areas. He wanted to be fully involved. This was how he expressed his passion for immunisation. While Mohammed nursed his own passion, some others also expressed their own the passion for the funds meant to execute the programme.
According to him: "The NPI had been well known in Nigeria as a conduit pipe for diverting immunisation funds to private accounts of a few people on an unbelievably massive scale. How they managed to acquire notoriety in misappropriating funds on such large scale and in circumstances that made the average Nigerian to know almost exactly what was going on is a matter for deep regret. Many of my friends and professional colleagues admonished me to be careful".
Mohammed reports how even former President Olusegun Obasanjo even acknowledged (in a conversation) the mess and the fraud being perpetrated with the NPI and how someone was invoking the name of the President to secure contracts from the programme.
Mohammed says that his position on the NPI was later vindicated by external observers of the programme. For instance he writes:" Towards the end of 2005, the World Bank country director for Nigeria, Mr. Hafez Ghanem, had to write to the ministers of finance and health in strong terms, complaining about the failure of the NPI to achieve its immunisation objectives and targets. The immunisation rate had remained low at 13 per cent, which was lower than in Nigeria's neighbours ( e.g. Benin and Niger) and even lower immunisation than in many countries in conflict (e.g. DRC). The cost of immunisation was scandalously high and according to the bank chief, ' conservative estimates show costs in 2005 at $56 per fully immunised child. This is more than double the norm for developing countries'. Since 2003 the World Bank has provided about $80 million for polio eradication alone with little result. 'I am concerned that unless the problems facing the management of immunisation services are addressed it will be difficult for the Bank to justify its continued support for immunisation' warned Mr. Ghanem"
The author richly supports his arguments with documents in the appendix to the book. He has written an unambiguously provocative book that should attract readers seeking to know why programmes designed to help the poor become avenues for the rich to feed their avarice.
It is a story of the political economy of epidemics. It is about how smart guys first politicise an otherwise technical programme and feed fat on the mess so created. Significantly, Mohammed says he does feel triumphant to have been vindicated by the World Bank's observation. He says that he is "saddened by the palpable failure of disease control and prevention, (a) sequel to poor performance in immunisation, classified by the United nations as a fundamental right of all people, most particularly women and children'. He adds that this is "indefensible and scandalous, because I know that for sure that the government has funded the immunisation programme on a massive scale".
The reference to Mohammed's new book is to show why development activists should be alert to ensure that programmes designed to curb poverty do not become moneymaking ventures for corrupt public officials. If this trend continues, poverty would be exacerbated rather being eradicated. The massive corruption that plagues programmes meant for poverty alleviation should be a major focus of campaigns by development activists.
It is not enough to fight for pro-people policies to be announced. The implementation should be closely monitored to ensure it does not end up serving the greed of corrupt officials. The cynical approach to poverty eradication should be combated mercilessly as poverty itself is being confronted. It will be illusory to imagine that poverty can be made history without tackling this monumental perversion of the development process.
Incidentally, poverty eradication is implicit in President Umaru Musa Yar'Adua's seven-point agenda. The corruption inherent in anti-poverty programmes should, therefore, attract the attention of the President if he wants to develop a workable social charter as part of his development strategy.

The book is not on Amazon....if you find a copy..please let me know!

Tuesday, 16 October 2007

Nigerian Health Minister in London and other updates

Recently we blogged about the appointment of Professor Adenike Grange as Minister of Health and the enthusiastic response in the Nigerian health sector. She comes to London to deliver the UCL Lancet Lecture for 2007 on Friday 9 November at 6 p.m. UCL Cruciform Lecture Theatre, Cruciform Building, Gower Street. Her talk is titled:

'Implementing health sector reform for better performance'

To book a place please contact Eda Pierce, or telephone her on +44 (0)20 7679 7675. Please state your title, name, organisation/ affiliation and email address when booking a place.

We also recently blogged on the insistence of Nigeria's premier private University, Convenant University to insist on HIV negative tests before graduating students. We can now bing the "good news"..that this has now been rescinded after a lot of clamor by advocates. Kudos to the D-G of NACA in using dialogue to resolve also kudos to those that brought this to light. Now let Convenant concentrate on what it does best...teach students....

Health stories from the papers in September

Find a few health stories from the papers in September...nothing ground breaking but the first one could be very on!

ThisDay: Yar’Adua says that the assignment of responsibility for primary health-care to local governments is a major defect. He said it was, in his view, clearly a mistake to have assigned responsibility for primary health-care services on which about 80 per cent of the population depend, to the tier of government with the least capacity for providing efficient health-care services. Details here…

Guardian: PRESIDENT Umaru Musa Yar'Adua has put paid to the continuation of the controversial local council primary healthcare centres initiated by his predecessor, Chief Olusegun Obasanjo. Details here…

Guardian: THE Yobe State government has awarded contracts for the establishment and building of a new General Hospital in Damaturu, the State Capital at the total cost of N1.6 billion. Details here…

Nigeriaworld: Gbagada Rotary to provide artificial limbs to 50 amputees. Details here…

Tribue: The Federal Government has moved to end the frequent flight of Nigerians of all social classes to seek medical check-up and treatment abroad as it has partnered with American Hospital Limited, a US-based hospital agency, to build a world class hospital at a cost of $500 million in the country. Details here…

Monday, 8 October 2007

Oh No...just how do we communicate this?

Like many on this forum will know, Nigeria has come to be closely associated with the near collapse of the Global Polio Eradication programme. Several states in Northern Nigeria suspended polio immunization efforts for nearly a year in 2003-04 in response to vaccine safety rumours (vaccines allegedly causing impotence)
that led parents to refuse to have their children immunized. This led to the re-infection of several countries that had not had a polio virus identified for years. Nigeria was the eye of a major storm and on the lips of every public health professional. Slowly, with a lot of hard work, the situation is being turned around. With only 201 cases reported this year, there finally seems to be light at the end of the tunnel. After all the hard work in bringing the programme back on track in Nigeria, last week the news broke that the biggest outbreak of vaccine-derived polio virus (known in the shorthand of polio as VDPVs) in the literature has been going on in Nigeria with 69 cases of children paralyzed by polio related to the virus in the vaccine.

Such vaccine-linked outbreaks have occurred before but each comprised fewer than a handful of cases. The Nigerian outbreak is the largest on record involving vaccine-derived viruses. This can again be a potential threat to the polio eradication effort because of its location and the context.

The major issue at stake is why the outbreak has taken so long to come to light.
There have been rumours for months, through contacts and back channels. Why would an outbreak be going on for more than a year and a half and we have nothing at all about it until now? Dr. D.A. Henderson, the infectious diseases expert who led the successful smallpox eradication program, broke the news to the public health community in the UK, in the annual Pump-Handle lecture at the LSHTM on Tuesday 11th September the before the WHO published this on the 28th of September in its Weekly Epidemic Report.

Expert opinion is divided over the danger posed by VDPVs. The WHO insists the transmission chains formed by these viruses are easier to break than those created by wild polio viruses. Others believe these viruses, if left unchecked, will become every bit as dangerous as wild polio viruses.

The consensus in the public health community is that the outbreak is as a result of under-vaccination - not vaccination itself - that caused the problem.

BUT...just how does one communicate this?

The bottom line is....whatever skepticism we might have about how the initial outbreak was handled, whatever our disappointment might be in the present communications strategy, our views (of which there are always plenty :))....WE CANNOT AFFORD TO DROP THE BALL, NOT NOW, AND NOT IN NIGERIA.

Extra notes
On rare occasions oral polio vaccine paralyzes children. About one out of every one million doses leads to paralysis. And the vaccinated children shed viruses in their stools for weeks. Those viruses mutate. If they circulate long enough, the built-up mutations can restore the virulence stripped out in the vaccine production process, giving these viruses back the power to paralyze months and even years after their progenitors came out of a vaccine vial.

Thursday, 4 October 2007

Doctors in power: We are proud!

Since restoration of democracy in Nigeria in 1999, we in the medical profession have been extremely lucky to have some of our own in positions of power in Nigeria, called to serve the people in a capacity that can have far more impact than a stethoscope. Considering the text of the Hippocartic oath that we all make (Bible in Hand)...part of which reads "I will remember that I remain a member of society, with special obligations to all my fellow human beings... ." the people of Rivers and Enugu states could feel nothing but pride, joy and expectation when Dr. Peter Odili and Dr Chimaroke Nnamani were called to serve as governors of Rivers and Enugu States.

Dr. Odili graduated from the Medical School of the University of Nigeria, Nsukka, and has a Diploma in Tropical Medicine from the University of Liverpool. He is the proprietor of PAMO Clinics; a private medical facility in Port Harcourt and it is remarkable that in those years of practice, he won several awards including the highest Award of Distinguished Medical Practitioner of Nigeria.
On May 29, 1999, he was sworn-in as the first Executive Governor of the new Rivers State...we celebrated...

Today, Dr. Odili is trying to prevent Nigeria's anti corruption agency, EFCC from trying him on corruption charges! Read the story here. Why is our colleague afraid? He did so much for his people! His most visible achievement in Rivers State is definitely the building of “a befitting” Government House (Brick House). He bought a "befitting" jet for the use of the Governor in the difficult task of governing Nigeria's richest state.

The annual income of Rivers State government has increased by leaps and bounds in recent years, fueled by dramatic increases in the price of oil. During the first eight months of 2006 the state government’s average monthly federal allocations topped $95.5 million per month, according to a report by Human Rights Watch. In further analysis of this report, in one of Nigeria's most popular internet site "Nigerian Village Square", the 2006 budget allocated $10 million to “Entertainment, Hospitality, Gifts & Souvenirs for visitors to Government House" while the budget for the health sector was $21 million for the same period! Maybe we are just not hearing about the immunisation activities he orchestered, the treatment programmes for HIV/AIDS, the new hospitals, access to primary health care. Maybe the press and EFCC is being unfair to our colleague. Maybe we should take out newspaper adverts and defend him, he is one of ours, and we have to be proud!

Then there is Dr Chimaroke Nnamani. Ex Governor of Enugu State and Distiguished Senator. Our good governor built a befitting teaching hospital for Enugu Obviously the University of Nigeria Teaching Hospital, established in 1960 was thought to have lost its usefulness. Dr Nnamani...did not just build, he wrote...and advocated! Read here his open letter to the federal Minister of Health, writting eloquently on how he was weighed down by his "African Dream" for health care in Nigeria...having fulfilled his American dream "with a Porsche (993 Carrera 2 Cab) in the garage, success in medical practice and the academia". On his own website he lists his achievements in the health sector thus.

So , what is this we now hear? EFCC has moved in too. What is happening here? Properties belonging to our dear ex Governor, including Rain-bownet Telecommunications Limited, Cosmos FM Station, Capital Autos and Renai-ssance Hospital all located in Enugu have been siezed!. But he says they do not belong to him!. When EFCC came knocking, our colleague sort refuge in the National Hospital, Abuja, where thankfully colleagues prevented his arrest, albeit for a few days. Why are Enugu residents marching against our dear colleague? Why he is not smiling any more...

Should we not be ashamed of our colleagues and the fame they have brought us? What type of fame? As doctors, we were taught that probity and honesty are central to the role we play. That this applies to apply to all things doctors do, not just in patient care. We are taught that we are role models in society. That we are priviledged to get a medical education in a country where most would not dare dream. Considering this, surely, non of our colleagues could possibly have done these things…EFCC must be mistaken, the people must be mis-guided....OR COULD THEY?

In whose interest is it to buy jets for state governments...while people suffer? While the Niger Delta burns? Our Enugu..our dear Enugu...Time was when one could go out at 2 am in the morning. Yet the peace has been killed in Enugu. Whatever EFCC finds...when asked under whose watch did these things will be our colleagues. Ashamed...I am.