Friday, 29 August 2008

My school, my heritage, my shame...

When we started this blog...we promised ourselves that we would stick to health issues. Irrespective of our several hopes, dreams and frustrations of being Nigerian, we would stick to the one issue we feel have earned the right to share our views

Today, Ill break that rule...somewhat. I justify it thus...Education is one of the key determinants of health. Therefore today, Ill share a personal story of my education.

I have always felt that my most formative years were the 6 years I spent as a boarder in Peace House, Federal Government College, Enugu, Nigeria. I still remember the very first day my mother dropped me in school...God did I cry. But in the end...the school, its teachers, my classmates, my dorm mates made me and us what we are. It shaped our politics, kindled our interests, aroused our intellect, and developed our emotions. We played football, argued football, tried to impress the ladies, claimed conquests, jumped fence, hated school food, envied day students…and waited for visiting days.

From the Principal Mr Joe Adigwe, to all the teachers, the nurse in the sick bay, the warden we hated, the gatemen that would not let us out….the cooks! Those guys made us. They really did...We owe them…big time!

We knew neither race nor colour. Taofik was my class prefect…when Musa Sale sat next to me. My man Gbenga…or corner mate Mbang. My nemesis Dykes...
Our lingua was English at day....and "Pigeeon"....from "school over"...

God…did we have a great time or what?
This was the Nigeria of my dreams. We lived the dream. We were the dream...

Then it all fell apart. Silently through the Abacha years….in our sleep…Our heritage disappeared. Two years ago, erstwhile Minister of Education woke us up to the reality of what our Federal Schools had turned into. She suggested solutions. Public private partnerships, the banks should adopt schools...etc.

There was fire and brimstone! The papers went awry...

Crucify her…crucify her…the people shouted.
We would not have it…we will not loose our Federal Schools…sadly sadly…the schools were long lost.

In came Mr Aja Nwachukwu, and in the true fashion of our present Government responded to the public outcry and chose not to rock the boat. He reversed Ezekwesili’s initiatives and returned to status quo ante. The Federal Schools will remain under the management of the Federal Ministry of Education…

In July 2008 I visited my school. School had just closed for the summer holidays the week before. My set…the set of ‘89 has a vibrant egroup. Next year we plan to celebrate 20 years of entering “Federal” …20 years! How much the world has moved in 20 years. We have been discussing what to do? Party? Visit the school? Fund a project in the School? We are full of ideas....

I have kept quiet.

This is the reason…

This is my school …20 years after….

Share my tears…

The it it is....

empty words...

my class windows..
...and from the rear
my source of drinking water, old on the floor, new standing proud
S.U.Beee....for 10.45
hold your breath...
No need for NEPA

new IT center from the outside
from the insideFor the days students....
the corridors....
Air conditioning :)
light....:) :)
Our black board
in "storage"
Our dorm
JSS block...
in all its beauty...
assembly hall...
...and from the outside
the new CHURCH! YEAH...something new!

...are you thinking what I am thinking?

Wednesday, 27 August 2008

Are you sick?

chikwe ihekweazu
I would not want to join the debate on the validity of alternative forms of medical practice. Anyways I have always thought that the framing of the debate has been flawed. Until we decide on how to assess effectiveness for specific remedies and who does this assessment, any such debate is always too emotionally laden to make sence. This debate is not limited to Nigeria as the NHS in the UK has had to make similar tough choices on whether or not to fund such pratices.

Let us for the purposes of this piece, work on the premise that some forms of alternative medicine have some benefit to patients. My questions then will be:

1. Who regulates this practice, on what principles?

2. Why should they not be bound by the same principles of conventional medical practice in terms of advertising thier "skills"?

3. And most importantly, who protects the interest of the patient?
This are the questions I asked when I saw this "special report" in one of our favourite weekly magazines in Nigeria.
Welcome to the world of "Dr" Godspower Ikechulwu Amadi, The "Medical" Director and Chief Executive of Boundary Clinic and Radionic Computer Test Centre, Ajegunle, Lagos.

"DR" Amadi is quoted as claiming that his patients do not need to tell him their ailments, nor get examined...all they need to do is provide a urine sample for his "Radionic Computer Analysis System".

In all my years of medical practice, I had missed the definition of the term "Radionics". Anyways I did find out that it is said to be "the use of blood, hair, a signature, or other substances unique to the person as a focus in order to supposedly heal a patient from afar". The concept actually orginated from Albert Abrams (1863–1924),an American doctor. However, Abrams was never able to demonstrate that his devices were effective; no radionic device has been found effective in the diagnosis or treatment of any disease, and the United States Food and Drug Administration does not recognize any legitimate medical uses for such devices.

"Dr" Amadi says he became a Doctor of Homeopathic Medicine and Surgery after completing his training in 1989 at the an African Homeopathic Medical College Osse-Motor Imo State Nigeria.

On the very next page of the same magazine is an advert titled "ARE YOU SICK?"

On the very next page of the same magazine is an advert titled "ARE YOU SICK?"


...all you have to do is give us a urine or blood sample and we will analyse it from head to toe...

...Asthma, High Blood Pressure, Diabetes, Bareness, Headaches, Constant Malaria, Typhoid, Heart problems, Liver, Kidney....all solved!

No surprise that his clinic is in AJ city...with its poor and vulnerable population.

Those that are paid to protect your interests, who campaigned for your votes, who promised...promised to provide decent health care...ALSO READ THIS MAGAZINE...and then looked away...

Friday, 22 August 2008

Time is Brain!!!

by ndubuisi edeoga
The new teaching by the National Stroke Association and so many other agencies involved in health care world over demands that we get people with Cerebrovascular accidents popularly called STROKES to the nearest emergency room as soon as possible, withing 3 hours of stroke onset!( that is assuming the existence of functional emergency rooms). With the introduction of medicines called clot busters (thrombolytics) we can reduce morbidity and mortality from strokes. Getting the stroke patient to the emergency room is so important that Dr Olajide Williams one of the foremost Neurologists in United States, spends most of his time educating children about strokes with his revolutionary "Hip Hop stroke" programe in concert with the National Stroke Association. In summary they agree that the faster a stoke victim gets to the hospital the less brain cells die from ischemia, hypoxia and their likes, hence the TIME IS BRAIN dictum.

The American Association of clinical endocrinologists and other endocrinologists worldwide agree that Diabetic patients presenting with Diabetic keto acidosis (DKA), which is a severe form of hyperglycemic (too much sugar in blood) crisis. Require urgent admission into an intensive care unit ICU ( that is assuming the existence of a functional ICU), and institution of intravenous Normal saline would reduce mortality and morbidity, again TIME IS LIVE.

Then comes the American Heart Association talking about the need to act fast when someone is having a heart attack, bringing the person to a functioning emergency room within 90minutes, that is the proverbial “door-to-balloon time” this has been shown to reduce mortality and morbidity.

The Infectious disease (Infectious Disease Society of America) people not to be outdone, have also instituted their own timing to the treatment of sepsis. Starting Intravenous antibiotics within first hour (1-hour) of diagnosis of sepsis has been shown to improve mortality and morbidity.

So....does the article above, published in The Punch of April 2 2008 bother you?

A few quates from the article include:

..."Investigations by our correspondent revealed that it took members of staff and average 30 minutes before attending to patients brought in through the accident and emergency center"...

..."when his brother was treated it took nurses 7 hours to transfer him to the ward..."

..."CMD of LUTH denied that there were delays in attending to patients in the hopspital!..."

Why do we have to be different?

About 12weeks ago our health minister was removed, since then I guess someone would be "acting". But if you check the meaning of "acting" ( dictionary) it's just act!!!. Our under performing health institutions cannot survive without the necessary leadership, provided by the health ministry , with the health minister as the captain...we all know what happens to a ship without a captain.....?

Now how long before we get over with the act and bring in a new health minister. How come health is not a priority for our rulers, and our political class.

My President, abeg give us the health minster we deserve...TIME IS NOT ON OUR SIDE!!!

Wednesday, 20 August 2008

DFID launches 50 million pound Nigeria Malaria project, PATHS website and reports

by ike anya

The UK Department for International Development (DFID) has recently announced its funding of a 50 million pound initiative to support the Nigerian National Malaria Programme. The programme will be led by the Malaria Consortium and you can read the details here and will run from 2008 to 2012. One of the aims is to ensure wider availability and access to effective preventive interventions and treatment, a very important point as I reflect on my journeys around Nigeria and the visible lack of insecticide impregnated bed nets in most of the places I went to, rural or urban. Kudos to the Malaria Consortium for publishing the proposed outputs for the project ensuring transparency and accountability. We will be watching for progress.

The PATHS I project to strengthen health systems in six Nigerian states has some very useful information and documents on its website. The monitoring report also makes for interesting reading. Its good that DFID is making these docments accessible

- would that all other donors would follow suit...

Sunday, 17 August 2008

How NPI "saves" the lives of Nigerian children: Book by Idris Mohammed

This is my final blog on Professor Idris Mohammed's recently published book: “Academics, Epidemics and Politics”….and eventful career in public health"

I still recommend that you buy the book. Buy the book, read the book.

Among the several important roles Dr Mohammed has held in Public Health in Nigeria is Chairman of the Board of the National Programme on Immunisation.

This was during the tenure of Dere Awosika as Chief Executive. It is public knowledge that there was no love lost between the two during their time at NPI, it is also public knowledge that on their watch, by self admission on page 219 of his book, routine vaccination coverage for EPI diseases in Nigeria went down to an all time low of 13% and Nigeria experienced an outbreak of polio that might yet have compromised the polio eradication programme for good. the book...

To open the chapter on his tenure at NPI, Professor Mohammed quotes from a document of the UK Department for International Development published in 1991...thus...
"...the chances of rehabilitating the routine immunisation programme in the short term are zero. The resurrection of a service is technically feasible but requires re-education, management training and repair of the system in which immunisation must function..."
Again...I make no conclusions from Professor Mohammed's assertions...but believe that Nigerians need to be aware of these incidents and allegations to understand why their children still die from a disease like measles for which a vaccine has been available for 40 years and which costs less than a bottle of coca cola.

On the management of NPI:
"...There was no management structure and the agency was run by one individual...there was practically no middle management staff (...) those employed included a handful of doctors and pharmacists who were afraid to proffer advice. No one had a schedule of duty and the programme was rub on a day-to-day basis...(...) The Chief executive dealth directly with minister of health and office of the first lady"
On the finances of NPI:
"...The President released the equivalent of nearly USD500 million at NPI over 7 years (...) in addition to the undisclosed millions donated directly to NPI by donour agencies every year..."
On one specific incident:

In 2003, the British Medical Journal as well as other press outlets reported that National Programme for Immunisation distributed expired anti typhoid vaccine, Vivotif Berna, in some parts of the country.

Professor Mohammed responded by saying "The attention of the National Programme on Immunization has been drawn to this serious allegation, and an urgent investigation is underway to determine how this happened. The Programme will respond more fully at the end of this investigation"...this is what he said he found:

"...I obtained solid evidence that NPI had purchased the soon-to-expire VIVOTIF typhoid vaccine (...) at a stagerring cost of USD 36,572,002.50. The routine use of the vaccine is not recommended by WHO in Africa and is not among those NPI is statutorily required to procure (...) the vaccine was procured without due process, the whole process from negotiation to procurement took one week... "
On this sober note...I leave you as you walk sadly to the bookshops to buy the book.

Read it and show it to your children when they grow up. They need to understand how their country got to the state it is in.

Aluta... I published by Bookcraft ( Contacts of the publishers are,

23 Adebajo Street, Kongi Layout. Ibadan, NIGERIA.+234 2 8103238; +234 2 7517153, +234 803 3447889; +234 8037220773

Wednesday, 13 August 2008

The “Trovan” story by Idris Mohammed

Dr Idris Mohamed was the Chairman of the Taskforce of the Federal Republic of Nigeria sent to manage the Outbreak of Cerebrospinal Meningitis when the unfortunate trail of trovofloxacin took place among Nigerian children in Kano.

He recently wrote a book: “Academics, Epidemics and Politics”….and eventful career in public health

You would have read my earlier blog on the book. I still recommend that you buy the book. Buy the book, read the book.

Now…to be clear, and in response to a comment on the last blog, I have drawn no conclusions about the validity of Dr Mohammed’s statements in his book. Autobiographies are by definition always an exercise in self adulation. However the issues Dr Mohammed has raised in this book are extremely extremely important. They need to be in the public space. This is not just anybody. This is the man that was the Chairman of the Taskforce of the Federal Republic of Nigeria sent to manage the Outbreak of Cerebrospinal Meningitis when Pfizer came in to do what is now generally accepted to be a criminal trial in the most unethical of circumstances. The case is still in court today…12 years after.

One thing that I have never come to understand about this episode is the role of our Government and its agents in their regulatory capacity. This book has only increased my confusion. I have always been plagued by a simple question.

Did our government or its agents give approval for the trial to take place?

Below is an excerpt from a letter from the Minister of Health at the time to Dr Mohammed as it appeared in his book;

“You were the chairman of the Task Force on epidemic control; you were reported to have expressed satisfaction with the protocol before the trial begun, and you participated in the trial in a supervisory role. More importantly, you were also the Minister’s representative. In this capacity, you were in the best position, if you were in doubt, to ensure that all the requirements were fulfilled before the commencement of the trial. (…). Nigerian doctors (including you) supervised the management and treatment of the patients. You started crying foul only when you relationship with Pfizer soured, when the company could not reportedly meet your personal demands”

To this Dr Mohammed responds strongly saying:

“I state categorically that I never authorised the trail of trovofloxacin by Pfizer during the epidemic of CSM in Kano, neither did I take part in any capacity whatsoever as claimed by the minister of health. Therefore, as the minsters representative I can state categorically that Pfizer did not receive governments approval for the trial, since by implication I held the power for such approval on behalf of the government of the Federal republic of Nigeria”

….c’mmon. Pfizer could never come in and conduct this trial without the active collaboration of some Nigerians…

So Nigerians, so while we continue asking Pfizer the tough questions, Isn’t it time we also turn to our Government and ask…

  1. The goal of any drug company is to bring as many products to the market as possible to maximise its profits. The role of our Government is to protect us by regulating the drug industry as they do so. The primary liability in this case I suggest lies with my Government. To date, there has not been a clear open and categorical statement from the Federal Republic of Nigeria to say NO, at no point, under any circumstances was any permit given to Pfizer by us or any of our agents to conduct the trials in Kano.

  1. From the communication revealed by Dr Mohammed in this book our Government has been privy to the “irregularities” (using the mildest possible term) of this trial from the very beginning. Why did it take the efforts of The Washington Post to bring the matter to the public in 2000, 4 years after it occurred? Why was the first case against Pfizer by the Government (not the patient groups) instituted in 2007, 11 years after the event.

  1. Our Government set up a panel of enquiry to look into this matter in 2001. At least there was a chance to redeem itself, but no. No report was released until again The Washington Post got a copy of report and made the entire report available online for all to read in 2006. Why this report was kept hidden for 6 years?

The only ratification we can feel today is that things have changed. The medicines regulatory environment has changed. Can you see this happening in the context of Prof. Akunyili’s NAFDAC? There are lessons in this event for Nigerians. Pfizer is an easy target…and rightly so. They should pay! But they are not the only ones that have a case to answer...

… it is always easier to blame a crime on an outsider than on one of your own.

Buy the book and read it!

Next is the final part of this series: How our National Programme for Immunisation (NPI) took vaccination coverage to an enviable 13% (no typo!). Don’t wait for the blog… Buy the book and read it! I published by Bookcraft ( Contacts of the publishers are,

23 Adebajo Street, Kongi Layout. Ibadan, NIGERIA.+234 2 8103238; +234 2 7517153, +234 803 3447889; +234 8037220773

Sunday, 10 August 2008

Academics, Epidemics and Politics: a book by Idris Mohammed

There are several reasons why this blog has been a bit slow over the past 2 weeks. One of of them is that I have been deeply engrossed in the most significant book in contemporary times written on health and health care in Nigeria as titled above. If you are reading this blog…you must read this book. My attention was initially drawn to this book when it was mentioned in an editorial in the Thisday newspaper and I mentioned it in a previous blog. All my attempts at getting hold of the book via etc failed as it was not listed.

In Nigeria, despite the evolving renaissance of reading spurred by the run away successof new Nigerian writers as Chimamnda Adichie, Sefi Atta, Ike Oguine etc, bookshops are still rare, and Nigerian books in bookshops are even rarer. Well, I decided to start my search for this book in the most obvious of places for the new Nigerian elite…in The Palms; our new state-of-the-art mall in Lagos…our pride and joy :). I was not disappointed. There lay the book I had spent a year trying to get hold of.

I started in tears and ended in tears.

You MUST read this book, whether you are interested in health or not. When there is a plane crash, we are beside ourselves with emotion (rightly so!). Millions are released to the Fani Kayodes and the Borishades to fix our airports (and we can see what happens then). However when planeloads of children die every week from vaccine preventable diseases no one else is dieing from, no one bats an eye lid. Not even you!

The author, Professor Idris Mohammed had served his country as an academic; a Professor of Medicine and Immunology as well as the Chief Medical Officer of the College of Medicine of the University of Maiduguri. One of the first 2 Nigerians to obtain a doctorate degree in immunology and in whose laboratory, the first case of HIV/AIDS was identified in Nigeria in 1986.

He served his country in operational public health roles as the leader of the task force for the control of the outbreak of cerebrospinal meningitis when the infamous “Trovan” experiment by Pfizer took place, as the Chairman of the board of the National Programme on Immunisation when the national coverage for childhood immunisation fell to 13% (no..this is not a typo!) and the Chairman of the committee that investigated claims of cure for HIV/AIDS including that of our esteemed colleague Dr. Abalaka.

The good professor has been right in the mix…and he spills it all…in all its often gory detail.

The only question on my mind was why was this book not on everybody’s lips? His story begins in Tafawa Balewa Square at the handover of our country from our colonial masters and runs through the next for and half decades. Prof Mohammed has been intricately involved in most of significant public health events of our time and does not hold back in describing these. He uses appendixes of original documents to back up his presentation of events to back up his assertions.

One except here:

At the close of the meeting Mr President (Obasanjo) grabbed my hand and took me to a place I had only seen before on television…asking” Professor, what is going on at NPI?” I said noting despite the question being put to me repeatedly. “…” “if you are not going to tell me, I will tell you. I am told that you are not being allowed to apply your professional experience to move immunisation forward, so coverage has remained low; there is no due process in financial transactions at NPI; contracts are awarded without tenders. I understand that a particular individual has been using my name to get you to award contarcst to them, their friends and

Over the next week….I will pick out a few excepts for the 2 most important events from the book…the Trovan Case…and the NPI story. Nigerians need to hear from Professor Idris Mohammed how the health of its children has been managed.

If you are not emotionally strong, do not read this bookelse buy the book I published by Bookcraft ( Contacts of the publishers are,

23 Adebajo Street, Kongi Layout. Ibadan, NIGERIA.+234 2 8103238; +234 2 7517153, +234 803 3447889; +234 8037220773