Tuesday, 30 September 2008

MANSAG Conference holds in Birmingham - October 17 to 19

The Medical Association of Nigerian Specialists and General Practitioners in the British Isles MANSAG, holds its 19th Authum Conference.

Despite the organisational challenges of holding an annual conference at a different venue every year...MANSAG has succeded in bringing Nigerian doctors in the UK together every year. These meetings have been have always had a full relevant scientific agenda as well as a full social programme for the family.

In recent years with the energetic leadership of Dr Stanley Okolo, MANSAG has engaged with other Diaspora medical organisations in fighting for the rights of doctors from ethnic minorities working in the UK and built links with the Federal Ministry of Health, the Nigerian National Volunteer Service and the Association of Nigerian Physicians in the Americas (ANPA).
The one criticism that many have had is its apparent exclusivity to specialists....apparent from its name, unlike other organisations representing the interest of doctors from ethnic minority populations in the UK. This however seems more perception as fact but one that should be addressed soon. For this conference there is a 30% subsidy for doctors in training.

Like its sister body in the USA; ANPA, MANSAG is the single body that has taken on the responsibility of protecting the interests of Nigerian medics in a geographic location with a large concentration of Nigerian doctors and proactively seeking its progress as a community. This is an onerous task.

There are a million other roles we would all want MANSAG to play. We want "them" to fight for our rights in the UK, advocate for health policy changes in Nigeria, foster academic relationships between north and south, etc etc etc

To deliver on these MANSAG needs the engagement of Nigerian medics in the UK to enrole, engage and drive the agenda. In the process you'll get to make useful acquaintances, true friendships and find new mentors.

See you in Birmingham...

Thursday, 25 September 2008

Health stories in the Nigerian Press

Vanguard: Principal Recipient for the Global Fund Round Five TB Grant, the Christian Health Association of Nigeria (CHAN), commissions of the National TB Reference TB Laboratory at the Nigerian Institute of Medical Research (NIMR), Yaba, Lagos. Details here

Guardian: It is a welcome relief that Lagos State University Teaching Hospital (LASUTH) Ikeja is becoming the preferred option. Kudos to the state government which pumped money into the place as it overhauled the former Ikeja General Hospital. Details here

UN information networks: Local government officials say cholera outbreaks across Katsina, Zamfara, Bauchi and Kano states in northern Nigeria have killed 97 people in the past two weeks, making it the worst outbreak in the north for several years. Details here

Leadership: Man Divorces Wife for Immunising Children. Details here
Funmi Iyanda's blog: The past two days has been spent breathing in the decay of our lives and systems. From the hospital to the police stations, I watch the desperately ill and hurt, the dying and the sometimes valiant, some times indifferent hospital personnel. Details here

Thisday: Nigeria "leads" in Polio cases. Details here

Thisday: We should all be worried. We should all be angry. I am ready to concede that some things have changed, but obviously not enough has changed to make us shout Uhuru. In fact, most of the stories you hear from our hospitals are heart-breaking. I like to illustrate the rot in this society with personal experience. I will do so again today. Details here

Thisday: Medical and Dental Council of Nigeria (MDCAN) has warned that it will soon impose severe sanctions on Medical Colleges in Nigerian universities, over gross violations of admission quota rules and non-adherence to objectives of quality medical education. Details here

Vanguard: Nigerians should expect universal health insurance coverage by 2015, says NHIS boss Details here

Thisday: DNA Testing - the Embarassment of a Nation: Details here

Thisday: Workers of the National Hospital Abuja, yesterday began a three-day protest against alleged insensitivity of the hospital's management to their welfare. Details here

Wednesday, 24 September 2008

The rising storm: Polio in Nigeria

When will we take ownership of this problem?

When will our Ministry of Health, our State Governors, our Religious Leaders, our Commmunity leaders take ownership of this problem? Until we do that...the world is at our mercy!

Nigeria could well go down as the country that sabotaged the one of the largest public health initiatives of our time.

The 3 other polio endemic countries, India, Pakistan and Afghanistan, have made significant progress....yes...even Afganistan!

September 2008: Nigeria has 675 cases of wild poliovirus in 2008, compared to 207 for the same period in 2007.

September 2008: Nigeria accounts for 85% of the global wild poliovirus type 1 cases (the type-1 polio - the most dangerous strain of the virus) and 10% of wild poliovirus type 3 cases

September 2008: Nigeria accounts for 91% of the cases in Africa.

...and forget all the reasons you hear!

Its not about religion...or try entering Saudi Arabia without a certificate showing your polio vaccination status.

Its not about resources...

Its not about awareness...

Its all about LEADERSHIP. Our own leadership. Starting from leadership at the family level, at the community level, at the church amd mosque level, at the local government level, and at the state level.

How often have you heard their voices? How often have you heard the voice of the Governor of Kano State, the geographical patch with the highest density of polio cases in the world?

Sadly...this problem cannot and will not be solved by WHO and the FMoH....despite thier best intentions and efforts.

It will only be solved if our leaders at the levels above see this as our problem.

We have the tools....we have the resources...lets get to work.

So much is at stake ...so much...

Monday, 22 September 2008

Nigeria and the Global Fund

We have previously blogged on the The Global Fund; one of Kofi Annan biggest legacies as Secretary General of the UN. It was created to finance the fight against AIDS, tuberculosis and malaria. Of the US$9.9 billion committed worldwide, US$400,000,000 has been approved for projects in Nigeria.

Many will remember in 2006 when the Global Fund threatend to suspend the funding of projects in Nigeria because the country failed to meet targets on drug access and "transparency".

"TRANSPARENCY" is a really difficult concept in Nigeria. Virtually all government information in Nigeria is classified as top secret and covered in a veil of secrecy. Since 1999 our legislature has used every opportunity to reject the Freedom of Information Bill.

It is within this context of secretiveness that Ill introduce you to the website of the Global Fund as it relates to Nigeria. You can find all the details of funding for individual projects here. For instance we can tell you that in the last GRANT round: The Christian Association of Nigeria was given N25M to scale of TB treatment.

The Program will increase access to Directly Observed Treatment Short Course (DOTS) facilities and improve the quality of care for TB patients, with targets of 70% case detection rate and 85% treatment success rate by 2010. The expected outcome is that DOTS services will be available to the entire population of Nigeria in an equitable manner. It is expected the Program will enable the detection of 70'000 new TB cases annually and curing approximately 60'000 of those cases. You will find such clear health outcomes in most Global Fund projects.

Who is driving this? You can find out the members of the Country Controlling Mechanism here.
Country Coordinating Mechanisms are unique to the Global Fund and includes representatives from both the public and private sectors, including governments, multilateral or bilateral agencies, non-governmental organizations, academic institutions, private businesses and people living with the diseases. You will not find detailed information as this on any other site realted to health in Nigeria. You could try the website of The National Agency for the Control of AIDS, or your can try the National Food and Drug Administration Agency. Sadly you cannot look at the site of the Ministry of Health ....because there is none...

Transparency in its funding is a great aspect of the GF, we wonder how much extra it would cost to set up a website locally to make public the operations and fund-disbursement at country level thereby giving GF funded projects some publicity. That would indeed complete the chain....

The Global Fund even has an NGO supporting its activities...

Friends Africa (Friends of the Global Fund Africa) is a Pan-African organization which works to mobilize strategic political and financial support for the fight against AIDS, TB and Malaria through education, multisectoral advocacy and documentation.

So....some good things are happening in health and health care in Nigeria. All we need now is visionary leadership to take it forward. Maybe the MoH can borrow some from the GF?...

Friday, 19 September 2008

Putting Health on the Agenda in Nigeria

Despite its importance, health is not highly invisible on the political agenda in Nigeria.

Politicians hardly mention it, people rarely make a fuss when they feel let down by our hospitals, the press pays occasional lip service; the health professions would rather squabble over whether the next minister should be a doctor, pharmacist, nurse or chemist, and government sends all its senior officials to Germany and Saudi Arabia for treatment.

Yet we suffer in our ignorance. We stay glued to CNN and watch as health and health care is one of the defining issues in the American elections. We ally ourselves to either the conservative party's republican stand or the slightly more socialistic ideals of the democrats. Yet, in our almost 50 years of independence we have not given much strategic thought to how we can best deliver health and health care to 140 million Nigerians. Our health policies and strategies have not changed significantly since colonial times.

When politicians are asked about health; they reel out statistics about the new hospitals they have built. No one has bothered to ask…since when did the responsibility of "building" move from the Ministry of Works to the Ministry of Health.

How many lives has the "hospital building" saved?

Until the National Programme of Immunisation (NPI); a body that still exists legally was suddenly scrapped and became an appendage of the National Primary Healthcare Development Agency (NPHCDA), what did NPHCDA do? It built health centres! Has anyone challenged the government on how many of the Primary Health care centres promised and built since 1999 when Nigeria returned to democratic governance is actually providing primary health care?

How many of these centres would you take your child and have him treated for malaria?

To how many primary health care centres can you go for your antenatal visits?

What has been the strategy of our government at different levels to provide for our health?

Our last government spent most of the capital expenditure on health equipping 6 tertiary hospitals in the country with what they regarded as state-of-the-art diagnostic facilities. No one bothered to do the strategic thinking that would have shown that this would only be accessible to less than 1% of the population, that we neither had the electricity nor the technical expertise to use these…and even if we did. Even if the brand new multi-million dollar MRI machine did reveal that you had an anterior lesion at C2, posterior lesion at C2-C3 with swelling at C2-C3. What do you think can be done about it in any of our Teaching Hospitals?
Of what benefit is a diagnosis to your health? That is the questions Nigerians should learn to ask.

So what is the opportunity cost of that MRI machine? 1 million doses of the measles vaccine? Maybe 100,000 antenatal visits for pregnant women? maybe providing life-saving antiretroviral drugs for 10,000 Nigerians for life? Any Nigerian will tell you why these are not viable options to our politicians. There is no large infrastructure contact to be awarded!

It is not an issue being mentioned in the press. Health is not necessarily a topic that sells newspapers. Being complex, technical and dry, except when one is personally affected, it has a daunting problem in attracting media attention - Most journalists and their editors run and hide from health. Unlike politics and sports, which any journalist can easily write about, health is a bit more difficult. It requires some in-depth understanding of the issues, a luxury that most of our journalists probably cannot afford. But they need to. As Paul Collier said in his TED Talk, relating to his book "The Bottom Billion", unless we have a critically enlightened population, politicians will continue getting away with gestures. See below:

How do we address such a complex problem, one that is not even appreciated yet? When people die in accidents in Nigeria it inevitably hits the headlines, but no one lifts a finger about the death of a child from measles, a disease preventable with a vaccine that costs less than a bottle of coke. We accept the lackadaisical attitudes of physicians in public hospitals as inevitable. Something will have to give sometime.

Who will convene this national conversation?

Tuesday, 16 September 2008

Rising voices for health in the Nigerian press

We have often wondered why the Nigerian press has kept relatively quiet on the state of the health sector in Nigeria.

Why is no one upset?

For health, as for Education...there are no off-the-shelve solutions available. Unfortunately, we cannot get Julius Berger to sort out the health sector. If we could...we would.

But...there might be change in the air.

Simon Kolawole in his premium column in THISDAY asks; Just How Sick are Nigerian Hospitals?

Like the good journalist he is...he framed it around the personal story of his driver's experiences...

"...The person who was supposed to issue registration cards had taken a stroll"

"...Card issued, they waited for another one hour to see the doctor"

"...The lady, who said she was not a card issuer, was obviously the one who would grant them access to the doctor, but she was busy talking and gisting on “MTN Xtra Cool”"

"...here was no bed space, so he would refer them to Lagos State University Teaching Hospital (LASUTH), Ikeja,"

...no bed space again..so they went to LUTH

“...LUTH is the worst so far,” he said. “The lady who attended to us was so merciless."

"...He moved his father to a private clinic across the road where he was asked to deposit N150,000 before treatment would commence"

Last Wednesday, early in the morning, he received a call informing him that his father had died.

Why is no one listening to these stories...WHY?

Thursday, 11 September 2008

Lost and found planes, DNA testing and the intrigues of our beloved country...

After "disappearing" from the skies for 6 MONTHS, the remains of the Beechcraft 1900D aircraft belonging to Wings Airline aircraft was found by hunters in Busi in Obanlikwu Local Council Area of Cross Rivers State on the 2nd of September 2008.

...not to worry! In steps the Nigerian
Accident Investigation Bureau (yes! they have a website) created out of the Ministry of Aviation in 2006.

Their stated mission is

"To carry out a highly professional accident investigations(sic) with highly trained and dedicated aviation professionals using well equipped facilities"
The Accident Investigation Bureau (AIB) is reported to have "rushed" to the scene...and its spokesman Mr. Tunji Oketunbi....saying

"...the agency is awaiting the result of the DNA test on the remains of the crew members sent to the National Hospital in Abuja to be churned out by the hospital management..."
Even in more detail.... Thisday reported the same spokesman as saying:
"...the results could be released as early as Monday next week...".
...and then giving some more details...
"...Samples were taken from the parts deposited at the University of Calabar Teaching Hospital to the Abuja National Hospital because of non-availability of required facilities and manpower for Deoxyribonucleic Acid (DNA) testing at the Calabar hospital"...
...then 9th of September...to the surprise of Nigerians waiting keenly for DNA results from our "ultra modern" National Hospital.......Leadership reports:

"...The Chief Medical Director of the National Hospital, Abuja, Dr Segun Ajuwon, said yesterday that the hospital does not have the capacity and facilities to carry out DNA tests..."

"...We do not have the capacity yet to carry out any DNA test; no samples have been sent to us but even if they do, we are not in a position to do such tests..."

"...I am not aware of any government hospital in the country that does DNA test," Ajuwon told NAN...."


I remembered ....the advert below in the papers recently...


"DNA parentage and identity test is not just any test...it is about who you are!. ...On the question on how life began...IGNORANCE IS NEVER BLISS!"

Kai...our country!

Tuesday, 9 September 2008

WHO - New meningitis vaccine to prevent epidemics in Africa

Why does it matter to us in Nigeria? Well...click on the links below...and there are a lot more!

BBC 1998 - Meningitis outbreak in Nigeria
MOFA 2003 - Emergency Assistance to combat the Meningitis Epidemic in Nigeria
Bio Medicine 2006 - Meningitis Kills 5 In Nigeria
Leadership 2009 - Meningitis Outbreak in Zaria

We have grown accustomed to the meningitis epidemics that occur with remarkable seasonality in our country. Beginning with the dry season around November and disappearing with the first rains in May or June. No one really understands why...

One hypothesis is that the Harmattan dust increases transmission of the disease, which is spread person to person through respiratory droplets.

Another is that the Harmattan conditions irritate the mucus membranes, enabling the bacterium to more easily penetrate and enter the spinal fluid, where it causes disease.

Across the contries belonging to the "meningitis belt"...every year brought tragedy with it.

There has been a vaccine existing for Meningitis a since the 1960s
but this "polysaccharide" does not work very well. I.e. while it prevents those carrying the bacterium from getting ill, it does not provide long lasting immunity, can only prevent illness for a few years at best and it also has little effect in children younger than 2. Therefore for it to be of any use, it will have to be given annually! Because of these limitations, WHO has long recommended that it be used only to control epidemics, not to prevent them. This strategy that has its critics...notably Prof Idris Mohammed, and Dr Abdulsalami Nasidi as published in this paper for the WHO Bulletin.

But there is good news in the air....

A new conjugate meningococcal A vaccine ("MenAfriVac"), expected to sell initially for 40 US cents a dose, much more effective in protecting against meningitis than the currently available vaccine will soon become available. Studies have shown good results and there is great hope...

The 58th session of the World Health Organization (WHO) Regional Committee for Africa took from 1 to 5 September in Yaoundé, Cameroon. In attendance were all the Ministers of Health in Africa. (I guess we were reperesented by our Minister of Labour also overseeing the Minsitry of Health for the last 6 months)

The Minister of Public Health of Chad ended the meeting saying; "On behalf of all affected countries in Africa, today we are collectively committing ourselves to put an end to devastating outbreaks of this disease. We will ensure that this effective new vaccine is made available to populations throughout the Meningitis belt,"...

Truly...this new vaccine can change completely our approach to meningitis, potentially significantly reducing its burden to many African countries including Nigeria.

But a vaccine can save lives only if a child gets the vaccine!

That is where the Nigeria Primary Health Care Development Agency (NPHCDA)comes in. They are the parastatal responsible for delivering vaccines to our children. What they really do is still unclear.

Sadly ...I suspect that for Nigerians to access this vaccine they might well have to get it privately...that is the situation we find ourselves in.

If you are interested read stories, watch documentaries and get all the gist here.


Wednesday, 3 September 2008

The Bare foot doctors

by ndubuisi edeoga

A physician in Nigeria gets about twenty years of education and training , in the United States it’s about the same, and so in most other countries. In the end you are given a license to practice medicine.

Many years ago in china barefoot doctors were the rave. These barefoot doctors usually received about half a year, but sometimes as short as a few months, and as a long as one and a half years of training that was very focused on preventive medicine and curing simple ailments that were common in the specific area. They also got more training in the form of apprenticeships under qualified medical doctors, who live within the area they cover. These Barefoot doctors acted as a primary health-care provider at the grass-roots level. Infact the system of barefoot doctors was among the most important inspirations for the Alma Ata Declaration in 1978. Interestingly, about a fifth of the barefoot doctors later entered medical school.

In India, Ayurvedic medicine is one of the most ancient medical systems using the alternative medicine schema. Some time in the early forties, the Central Council of Indian Medicine (CCIM) recommended and implemented policies for the research and development of the Ayurvedic system. In India, practitioners in Ayurveda undergo five and a half years of training including a year of internship in select Ayurveda medical schools wherein they earn the professional doctorate degree of Bachelor of Ayurvedic Medicine and Surgery (BAMS). Some go on to get doctorates and postgraduate training such as MD (Ayurveda) which includes a three-year residency and a dissertation similar to the MD or MS degrees in modern systems of western medicine.

What is the common thread running through all these: Training…Training…More training…accreditation….standardization…..oversight…….control….and more control. This training can be formal or informal.
Since approximately 80% of the world population uses traditional medicine as their primary health care, and most of these live in Africa. This formalization and accreditation of training becomes even more important.

Growing up my grandmother believed in the power of “dogonyaro”,(Neem tree) as the ultimate cure for malaria, I know a lot of pharmaceuticals come from plants like dogonyaro, but after rigorous, studies, standardization of dose and quality controls.

Now is the time to really do something about allowing all comers contribute to providing heath care for the most people with the caveat….that you must be trained, accredited, standardized, effectively under some form of control and more.

In India today the ASHA ( accredited social health activists), which is a refined version of an earlier community health worker scheme is doing great things in providing health care to the people with the least access to health care. The weaknesses and failure encountered in earlier projects have been seriously considered in formulating the current scheme.

This in line with what the Millennium Village Project of the Columbia University earth Institute is doing in many African, Asian and Latin American countries.Now most of these workers have bikes, cell phones but the basic concept still remains the same.

I will end by saying that the Nigerian Government, Nigerian Medical and Dental council, Nigerian Medical Association and all other established health bodies or other bodies delegated to enabling and monitoring the health of our people have failed us.

Yes….I called names.

If you don’t point fingers (four points at me and you of course) the buck will always get passed.

Monday, 1 September 2008

"Good" health news out of Nigeria

When we started this blog we regularly posted news stories on health out of Nigeria.

It was and is a difficult experience as there is hardly positive news to report. We hope that there are positive things happening and not getting reported rather than the lack of any positive activity in the health sector.

Yes...we do not have a Minister...

Yes...our President might have some health challenges...

But...this cant be the reason we can find only the following stories in the Nigerian press on health in Nigeria. If you do find positive stories...please send them in. We need them desperately. These are the ones we found....

1. Fire guts NACA headquaters in Abuja
"With the fire gutting most of the paper documents and stored data on the damaged computer systems, the fight against the AIDS scourge in the country may have suffered a terrible blow...."

2. Health situation in Nigeria getting more precarious -NMA Secretary
"Our health indices are among the worst in the world despite our endowments. In the 2008 state of the world‘s children report by UNICEF, Nigeria is pitiably ranked among the 12 countries with the highest under-five mortality rate. Highlights of the report for Nigeria include under-five mortality rate of 191 per 1000 live births, infant mortality rate of 99 per 1,000 and life expectancy at birth of 47 years...."

3. Hostility to polio immunisation persists despite rising cases
"Our health indices are among the worst in the world despite our endowments. In the 2008 state of the world‘s children report by UNICEF, Nigeria is pitiably ranked among the 12 countries with the highest under-five mortality rate. Highlights of the report for Nigeria include under-five mortality rate of 191 per 1000 live births, infant mortality rate of 99 per 1,000 and life expectancy at birth of 47 years...."No fewer than 578 Nigerian children are reportedly infected with wild polio virus cases across 23 states of the federation, a figure representing 88 per cent of the world polio virus cases.

BUT.....we also did find some "GOOD" news

Nigeria: Sokoto Sponsors Medical Training Abroad

Sokoto State government is sponsoring 30 of its students to United Kingdom to study medicine and pharmacy. Special Adviser to the Governor on Scholarship and Students Matters, Dr. Muhammad Ali Inname made this known while briefing newsmen in Sokoto. He said the state government had approved about N300 million as tuition and allowances to the beneficiaries drawn from the 23 local government areas of the state. Twenty of the 30 beneficiaries would study medicine while the remaining 10 would study pharmacy.

Nigeria we hail thee....