Monday, 23 February 2009

Sextuplets delivered in Nigeria

On Monday, the 23rd of February 2009 the news wires picked up a story

Feb. 22 Chairman of Board of Directors of the Teaching Hospital, Professor Femi Ajayi said the babies, three boys and three girls, who are under intensive care unit at the hospital, weighed between 650, 600, 850, while the three others weigh 900 grams respectively. He disclosed that the woman had two kids before the latest delivery.

The woman, who comes from Ijebu Igbo in Ogun State, is said to be in stable condition. Professor Ajayi attributed the feat and the success of the birth to "pure professionalism"....but then the lady died and he described it to the Nigerian Tribune as “unfortunate”

This was the first time the nation would be recording this highest birth as four were delivered at one hospital in Minna, Niger State, last year. The father, a battery charger, was said to have fled when he received the news. The Ogun State Commissioner for Health Dr Abiodun Oduwole was on ground to see the mother and the children. The management of the Hospital has decided to take care of the medical bill in a bid to lessen the burden of the parents of the sextuplets.

Then the mother died…The sad situation with maternal mortality in Nigeria is often referred to these days ….but as an academic and technical term.

This lady’s story brings this situation to life.

Obvious questions: How many times did the lady to antenatal care during the pregnancy? If she did, who knew how many babies she had inside her? What was her haemoglobin? Were any ultra sound scans done? Where and to who was she referred.

If, as it is likely to have been the case, the woman appeared at the hospital in labour, how were the healthcare workers to have known anything about her condition? If she did not go for antenatal care…the question is why? It was not her first baby, so she would definitively be aware of the need for this. What was her pre-delivery condition and who knew aboout it?

The nation has been taken to the heights and depths of the emotional roller-coaster by this story. When this lady appeared in hospital there would have been a lot of activity.. Doctors and nurses would have operated through the night, for the babies to be delivered at 4.00am. Governors and concerned Nigerians would make commitments of money, equipment and expertise to ensure survival of these tiny babies. We gather that incubators were promised and delivered to the hospital by the state executive governor….they ended up in the store of the hospital!

But this is the problem! Do we always have to wait for a catastrophy to occur and then begin to throw huge sums of money at it when simple preventive measures costing next to nothing in comparison could have prevented it? As we needed a series of plane crashes in Nigeria to take safety importantly in our airspace, so might it be with maternal mortality, sadly.

We hope that these kids survive….but lets face it…if they do it will be a miracle and truly by the HIS Grace, nothing else. The reason…simple….

If you fail to prepare, you must be prepared to fail...

Mrs Amuda Bello [now of blessed memory] is married to a battery-charger. That simple statement gives a fair idea of the family income. They already have 2 children and this was her third pregnancy.

Now imagine this scenario in Ogun State;

  • Mrs Amuda Bello suspected she was pregnant and went to a comprehensive health centre near her house and registered for ante-natal care.

  • At the time she is given her ‘health passport’. This is a green book similar to versions used in Japan and Malaysia, where vital health information is recorded.

  • Her height, weight, blood pressure, haemoglobin, blood type and urine analysis are done and recorded. The healthcare worker also records her civil state, number of previous children and various other details that are known to impact positively or negatively on pregnancy outcomes; including who to call in an emergency.

  • The mother-support scheme which the local state chapter of the National Union of Road Transport Workers [NURTW] supports Mrs Amuda Bello to get safe and timely transport to healthcare centres when they are in labour.

  • Throughout the pregnancy, Mrs Amuda Bello gets to visit the health centre at least 4 times. She gets her two doses of tetanus toxoid as necessary.

  • An ultrasound scan is done shortly after her first visit; the operator was a little unsure of what he saw and refers her to the radiographer in Ogun State University Teaching Hospital.

  • The several small limbs were seen and there is excitement in the hospital in anticipation of delivery of these special children in a few months time.

  • Her blood levels, blood pressure and weight gain and all other crucial indicators are all monitored carefully and any concerns are recorded. Any anaemia is detected and managed.

  • After the sixth month visit, she and her husband are referred to OSUTH because of the number of babies.

  • Naturally Mr Bello is worried – more mouths to feed – but he knows that the state government is responsible and sympathetic.

  • Mrs Bello goes to OSUTH with her ‘health passport’. Immediately the nursing sister looks through the book, she calls the consultant obstetrician who swings into action. Mrs Bello is admitted in anticipation. Theatre is booked and prepped, blood is ordered to be on stand-by, the anaesthetist and paediatrician are called into conference, the nursing sister in SCBU [Special Care Baby Unit] is ready with the incubators… only 2, but never mind, the babies will be tiny, they can share. The hospital grapevine buzzes with the excitement, Nigeria’s first set of sextuplets in a long time, perhaps ever, are about to be delivered!

  • In the best of circumstances the children would need intensive care for several months. In the best of circumstances it would be a challenge….

  • Is this really too much to ask...really?

But the greatest challenge would be for the children….not the mother.

Not the mother…yet she died. Our country…

If only we could say with confidence that we did the best that we could to prepare for emergency paediatric health care (before, not after the event).

If only our country allowed us to celebrate Mrs Adamu! We would have mobilised as usual…send gifts and love for the mother, the babies, the family…instant fame. What would it have taken?

The ‘health passport’ is not a figment of imagination. It exists in type in many various forms in many places. At its most basic, it expands the scope of information that is presently available in the ‘Road to Health’ chart used nationally to record all infants’ immunisations. The ‘health passport’ could easily be adopted by state governments as part of their free health programmes to ensure that the free health goes where it is directed, achieves what is expected and gives reliable data of who it has impacted.

This ‘health passport’ would also produce a sense of responsibility to both patient and health worker. Mothers-to-be have all their vital information with them wherever they may end up. Healthcare workers no longer have to work ‘blind’ when faced with a pregnant patient. No matter what cadre of healthcare worker a patient meets, relevant information is recorded that can determine future life-saving care.

That important first step into a care pathway.

It is time we stopped applying the fire engine approach and started planning for avoidable disasters? Just as a driver has a moral obligation to object to driving a car with bad tyres on the highway, are healthcare professionals not obliged to insist of getting the tools they need to work…and not MRIs, CT scans…but the very basic tools to start off with.


Special thanks to the colleague "on ground" who has kindly provided most of the ideas for this post...and for insisting that all it really takes is a critical mass of people to stand up and be counted. She chooses to stay annonymous!

Lassa....the question no one was asking

When the UK media was the alight on the 23rd of January on the case of Lassa Fever in a patient who had returned from Nigeria, we highlighted in our blog then...if there is an importation into the UK...there must be a significant outbreak in Nigeria! seemed obvious.

...and it was!

We have also asked severally....if there was an outbreak, as there is now...who will respond to the public health threat in the absence of a national centre for infectious disease control?

...and we also have an answer for you! The Chief Medical Director of the National Hospital, Abuja (NHA), Dr Olusegun Ajuwon, is reported by the Leadership Newspaper to have confirmed the outbreak of Lassa fever in Abuja and the adjoining Nasarawa State! The report also states that Dr Ogugua Osi-Ogbu, Consultant Physician and co-ordinator of the Lassa Fever Infection Control at the National Hospital, told NAN that: "The outbreak usually occurs between January and April because of bush burning". ..."The rodents run out of the bush and move to houses within the area" Literature says that it is transmitted only through body fluids, but we are beginning to see from our staff who are contaminated (sic) that it could be air-borne as well," Osi-Ogbu said.

If this is the case, then apart from controlling the colleague is in fact on the verge of a major breakthrough, he is potentially on the verge of the Nobel Prize and we must all be afraid!
....very afraid!

Can you really imagine the possible consequences of airborne transmission of any of the viral haemorrhagic fevers?

If there is no hard evidence to support this then it is an extremely irresponsible statement to be making! Extremely....

We conclude today as we concluded then...

...while we invest considerable resources in the apparent modernisation of our teaching hospitals we need to remember the not so glamorous infectious diseases.

Surveillance, outbreak investigation and control are public health functions representing the first link in a chain of activities aimed at countering the threat of infectious viral and bacterial agents.

Nigeria needs a Centre for Infectious Disease Control, adequately staffed, equipped and resourced or we will pay a price. This is not a problem that the odd clinician at our National Hospital nor a Ministerial task force can solve...

We need one desperately! As it is now...we do not know how big the outbreak of Lassa is, we do not know who is infected, how many have died, how quickly it is spreading, to whom,

....and most of all, a clinican, even at the National Hospital in Abuja...cannot answer these questions. It is like asking a dentist remove your prostrate!

Thursday, 19 February 2009

The Minister's Agenda

Below is the text of the speech made by the Minister of Health, Professor Babatunde Osotimehin at his 1st meeting with donor/partners working in the Nigerian health sector who have organised themselves into a committee called the Health Partners Coordination Committee (HPCC) that held recently.

It provides interesting insights into his plans...

Pity that the Ministry does not have a website...else this seminal speech might have been on it....but I am sure they are working on it.



Honourable Minister of State for Health,

Honourable Minister of National Planning,

Honourable Minister of Foreign Affairs,

Permanent Secretary,

Directors and Members of the Top Management of FMOH,

Chief Executives of Parastatals,

Your Excellencies, Head of International Agencies/Partners,

Members of the Press,

Distinguished Ladies and Gentlemen

1. It is my pleasure to address you all at this meeting of Health Partners Coordination Committee (HPCC). I welcome you all and I sincerely thank you for honouring our invitation at a very short notice. This is my very first meeting with Development Partners as the Hon. Minister of Health. I am therefore taking this opportunity to introduce myself and the Hon. Minister of State for Health, to you and to kick start our sincere desire to interact more closely with you.
2. As you are all aware, the HPCC is a statutory forum that provides the Federal Ministry of Health and her International partners/donor agencies the opportunity to interact on issues of importance and concern to all stakeholders in the Nigerian Health Sector.
3. This meeting offers me a great opportunity to present the agenda and direction of the Federal Ministry of Health in under the new dispensation.
4. It is a well known and indeed an over-flogged statement that the Nigerian health system and the health status of its citizens are poor with overall health system performance struggling in the bottom among member states of the World Health Organization. The reasons for this dismal performance are also well known, and these include:

1. Inadequate stewardship function of government
2. Fragmentation of health service delivery
3. Inadequate, inefficient and inequitable health financing
4. Mal-distribution of health workforce
5. Poor infrastructure in health care delivery system
6. Poorly motivated workforce
7. Inadequate utilization of the private sector and a
8. Health Ministry that is not structured to provide needed leadership and stewardship roles

5. While there have been some efforts in the recent past to address these challenges and to reverse the trend (the most recent being the Health Sector Reform Programme 2004-2007) only very modest achievements have been recorded.


6. To address the challenges confronting the Nigerian Health system and to lay a foundation for a sustained reform of the system, in line with current and emerging challenges, the new leadership of the Federal Ministry of Health is adopting the following strategic agenda in order the deliver on the Human capital development programme of the president’s 7 point agenda. The overall theme and slogan for this strategy and the fulcrum of the change is “Working Together to Improve Our Health”. The elements of our strategic focus are:
1. Enhancing the Stewardship role of the Ministry:

The Ministry will work hard to change the current perception role of that of service delivery to that which provides the much needed enabling environment and leadership for all stakeholders to contribute to the goals and objectives of the health sector optimally.

2. Revitalize the Health System with Emphasis on Delivery of quality health services through Primary Health Care and strengthen referrals with Secondary and Tertiary Institutions to reduce the disease burden and improve the health status of Nigerians.

The Ministry will work with the new management of NPHCDA to reposition and assist the agency to provide leadership in this regard. On its part, the Ministry will engage in proactive advocacy with all relevant stakeholders, particularly with States ad LGAs, civil societies, communities and agencies on key reform issues of the PHC system in Nigeria.

Given the urgent need to interrupt the wild polio virus in Nigeria and to control measles and other vaccine preventable diseases, the Ministry will lead the concerted efforts of all stakeholders through the NPHCDA, high risk states, LGAs and our development partners to ensure the eradication of the virus in the shortest possible time.

3. Enhancing Financial Resource Mobilization through the expansion of the NHIS and other Public Private Partnership (PPP) arrangements:

It is obvious that the public sector alone cannot adequately finance and deliver health care services. We will explore more vigorously how the public and private sector can share the financing, risks and benefits of projects, initiatives and plans. And because PPP has grown worldwide as a tool for management and financing, we would be calling on your assistance to help build requisite skills of practitioners within the Ministry, to inform them of new capacity building activities such as the exposure to the Global PPP Core Learning Program that the World Bank Institute and other multilateral partners are planning to deliver sometime in 2009. We are ready and willing to explore other available health care financing opportunities. The Ministry has set up a PPP Unit to oversee, promote and monitor all PPP initiatives.

4. Enhancing the Coordinating Role of the Ministry and its interface with states and Local Governments.

There are some significant peculiarities of the health sector that must be addressed for the Ministry to deliver on its mandate. Some past efforts at identifying the problems revealed the Ministry as an institutional arrangement that is inadequate for “management effectiveness, human resource distribution, transparency and efficiency”. The new leadership at the Ministry intends to work sincerely and transparently with all major stakeholders to examine all the past efforts at repositioning the Ministry to deliver on its mandate with a view to making recommendations for effecting the needed changes.

5. Human Resource for Health:

For the Nigerian Health System to provide the much needed improvement in its overall performance, the requisite human resource must be available in the right quantity, mix and distribution. There is a challenge regarding the skewed distribution of the workforce in the urban areas compared to the rural areas, the private sector as against the public and the south more than the north. In this regard, the FMOH has developed a national Human Resource for Health Policy and a national strategic plan to guide its implementation

6. Strategic Information Management and Research:

One of the key weaknesses in the Nigeria’s health system is the lack of data to guide planning, resource mobilization and effective implementation of policies and programmes. A strengthened Health Management Information system is necessary to provide this needed data and the Federal Ministry of Health will take urgent steps to strengthen HMIS.

7. Communication and Public Relation Management:

For the successful implementation of the strategic agenda of the new leadership, it is important to mobilize and galvanize public support for increased personal responsibility for health through utilization of preventive and health promotive services. The media will be crucial in this role. The Ministry will utilize several media to ensure that timely and comprehensive evidence based information about its activities are made available to build broad based understanding of and foster acceptance and support for the new strategic agenda of the Ministry and government programme as a whole.

7. For the avoidance doubts, the above elements of our stewardship over the next 24 months or so are also being worked into the much broader and long-term national strategic health development plan.

National Strategic Health Development (Framework) Plan (NSHDP):

8. You will recall that last year we started the process of developing a costed National Health Investment Plan. At the same time, we were embarking on a parallel initiative, a follow-on program to the Health Sector Reform Program (2003-2007), as the health sector contribution to NEEDS2, this was just before NEEDS2 was re-christened by Government as the National Development Plan (NDP). The 2 initiatives: Health Investment Plan; and the Health Sector/NEEDS2 initiatives have now been harmonized into the preparation a National Strategic Health Development Framework and Plan (NHSDP) process that us being lead by the Federal Ministry of Health working with all the States, development partners, non-state actors, etc… This process is currently being managed via the Health Systems Forum in which most of you have been participating.
9. The NSHDP is aimed at ONE single country health plan; ONE single results framework; ONE single policy matrix; ONE costed plan that will be the basis for funding; ONE single mutual monitoring and reporting process; ONE single country-based appraisal and validation process for country health plan; ONE single fiduciary framework; Benchmarks for Government performance, Benchmarks for development partner performance; agreement on aid modalities; and process for resolution of non-performance and disputes. These are the cross-cutting principles of the IHP+ built on the Paris Declaration on Aids Effectiveness.
10. A series of processes to develop the NSHDP will culminate in a framework that will guide the states and LGAs in developing their own plans, with assistance from partners working at the State level. We will make a presentation at this meeting on the process steps towards producing the NSHD framework and related plans at Federal and State levels.
11. The NSHDP is indeed for us, a call to action, and in working together to meet the goals of our national health systems. We recognize that mobilizing additional resources in these times is a major challenge…but that is precisely the reason why the development of the NSHDP becomes even more urgent. We are therefore calling on you to identify with this process and make commitments accordingly to take the process to its logical conclusion. When finalised, the document will serve as the country level compact that commits development partners and government to support one results-based National Health Plan, in a harmonized and aligned way, and improve resource mobilization and outcome through ensuring a predictable long-term financing. At the end we will have a product that we have jointly developed and jointly owned.

International Health Partnership +Related Initiatives:

12. As you are all aware, the IHP+ is a Country-led and Country-driven initiative that calls for all signatories to accelerate action in order to scale-up coverage and use of health services and to deliver improved outcomes against the Health-MDGs as well as honour commitments to improve universal access to health. The process calls for pooling of expertise and resources to drive the initiative, especially for aids effectiveness.
13. As you are also aware, countries that signed up to IHP+ are committed to developing “Country Compacts” with International development partners. These compacts are expected to result in: increased focus of national resources for health and AIDS strategies and plans on health-related MDGs; improved harmonization and alignment of aid; and in long term predictable financing.
14. Nigeria signed unto membership of the IHP+ in May 2008 during the 61st Session of the World Health Assembly in Geneva. In the process, Nigeria committed to addressing Health Systems bottlenecks in the country. Under the leadership of the Federal Ministry of Health, we have worked with our partners to re-conceptualize the National Strategic Health Development Plan, which will serve as the reference context for IHP+ compacts.
15. However, and more importantly is the challenge that we now face in the midst of financial crisis – how do we rise up to the challenges of making and delivery on financial commitments. It is a common knowledge that our national budget is facing unprecedented challenges as we struggle through a combined global financial crisis and more particularly the instability in oil revenues.
16. We recognize that domestic funding should make a significant contribution in meeting the challenges for Health-MDGs. Thus, the Government has steadily improved on its funding support for Health-MDGs in recent years: =N=15 Billion in 2007; =N=17 Billion in 2008; and =N=22.5 Billion proposed for 2009. We are internally challenged by issues of efficiency and in spending wisely…and we are thus looking for technical assistance in this regards, especially in building capacity for proper costing for Health-MDGs, and in innovative mechanisms that offer tremendous potential to save lives through new and creative solutions. Domestic funding alone is unlikely to meet all the challenges of funding Health-MDGs. We also remain concerned on whether or not we are making real progress in terms of the indicators.
17. Arguably, the greatest burden of disease in Nigeria is attributable to the index diseases of HIV/AIDS, Malaria, and Tuberculosis (ATM), and the diseases are at the heart the Health-MDGs Global compact. As mentioned above, the level of resources, both from within and external, to fight these diseases has increased steadily. However, the national response remains complex and confusing with multiple overlaps and poor coordination. Progress has been very slow. We certainly can do far more, and we intend to do so. For this reason, a Task Force on ATM has been established, under my direct supervision, as part of a renewed spirited effort to ensure visible progress on Health-MDGs.
18. Membership of the Task Force are drawn from the Federal Ministry Health, other Federal Ministries (National Planning, Ministry of Finance/Budget Office), and representative of States MOHs, members from Cooperating Partners active in ATM, representatives from Civil Society, and representatives from private sector bodies. The Committee has focal point persons from the Federal Ministry of Health to assist in both technical and administrative work of the Committee. The Hon. Minister of Health shall be the Chairman, with the Hon. Minister of State for Health serving as Alternate Chairman and Member of the Committee.
1. The Terms of Reference (TORs) includes: to take responsibility for the development and overall performance in the implementation of a coordinated ATM plan of action in meeting established Key Performance Indicators (KPIs) for ATM;
2. Develop and use a common validation/appraisal framework for planning and implementing ATM activities, with a strong M&E component.
3. Discuss and approve allocation of resources and related expenditures
4. Identify the bottlenecks that prevent the fulfilment of commitments of the and identify national level action that is required to address these bottlenecks
5. Make recommendations for focus of activities in ATM
6. Review existing programmes and activities to determine which ones should be continued, modified and, where necessary, suggest new programmes and activities
7. Ensure that development assistance for ATM implementation is in full compliance with the principles of Paris Declaration on Aids Effectiveness and the Accra Agenda for Action and the IHP+ principles...
8. Identify institutional, legal and administrative frameworks for effective and efficient implementation of ATM programmes and activities.
9. Where necessary, establish specialised technical sub-committees to work on specific areas of concern.
10. Establish a secretariat to be responsible for the preparation of working papers for endorsement by the Task Force, at least 7 days before the date of the Task Force meeting. The secretariat shall include ATM Program Managers a representative of cooperating partners.
11. The Task Force shall meet at least once a month, in the first instance, and thereafter quarterly. Ad hoc and/or Emergency Meetings may be called by the Chairman as deemed necessary. However, technical working groups which may be established will meet on a more frequent basis. Further, the Task Force shall participate in an annual Health Sector National Conference.
19. The Task Force will have its first inaugural meeting next week, and further details will be shared in due course.

20. With regards to mitigating the likely impacts of the twin forces of global financial crisis and dwindling oil revenues on the health sector, we are looking for ways and means of handling this, and we are counting on you for innovative approaches. In this particular regards I want to solicit your understanding in permitting fiscal space for flexible response within your respective framework of engagements, to take cognizance of these unexpected worsening global financial crisis. I believe we may need to re-prioritize areas of technical and financial assistance to the health sector within existing support programs.
21. We have a secretariat within the Ministry to anchor the IHP+ activities. In addition as will be shown in the NSHDP presentation, I will soon re-inaugurate a single Technical Working Group that would serve as the Country Health Sector (strategy development) Team. The Ministry, through my predecessor had earlier committed to review some of the existing structures such as the HPCC and the HSF and Health Recipients Forum and align these with the IHP+ implementation processes. We shall soon prepare and share a draft concept paper on a Coordinating Mechanism for the health sector.

22. For us in the Federal Ministry of Health, will push to sign a compact with our partners, starting with the development of the NSHDP to which I urge you to support and fund the process agenda that will provide the mechanism and road map and context for follow-on compacts for delivering on results.

23. Like many other countries, we are opened to work with our partners to deepen our understanding and domestication of the IHP+ process to avoid setting up confusing institutions and structures. We believe that the IHP+ is not a project but ways of working together to deliver results together. We believe that there is a large scope for us to improve on aids effectiveness in Nigeria. In addition we need to begin to work now to anticipate how we shall respond to the country compact process once the NSHDP is finalized and ready for implementation. I will welcome concept papers on this issue. I will also want to urge you to begin to anticipate and think how to harmonize your assistance with the NSHDP, in terms of what needs to change and how, and also including your expectations from us on improving country systems.

24. Finally, because the NSHDP holds the key for implementing the change-management process for aids effectiveness that the IHP+ stands for, it may appear too early for us to assess IHP+ impact in the Nigeria health sector. But I want to say that our joint articulation of the NSHD process agenda so far is itself an achievement. And I am confident as the actual plans documents at Federal and State levels are completed, momentum will be poised for greater success.

25. We intend to attend the International Health Partners (IHP+) meeting coming up in Geneva from 4-5 February 2009. We shall use that opportunity to explore further how to rise to the challenges of country compact mechanisms in the face of the global financial crisis.
26. In conclusion, ladies and gentlemen, I wish to note that this forum is of great value and it should continue to hold quarterly, more so since we are going to be using it to monitor and review the implementation of the NSHDP and our joint monitoring exercises. Honourable Minister of state, permanent secretary, your Excellencies, distinguished Ladies and gentlemen, I thank you all for your attention.

Professor Babatunde Osotimehin, OON

Hon. Minister of Health

January 30, 2009

Monday, 9 February 2009

Letter to Thisday...

Since we published the story about the Nigerian that allegedly found a cure for diabetes, we have been inaudated by emails, comments and our blog has had more hits than ever before.

Among all that, we have chosen to publish just one letter. It gives us confidence that even in the present state of afairs in our country there are several good men; role models for us growing in our careers to look up to. Dr Shima Gyoh was Permanent Secretary of the Ministry of Health during the tenure of Prof. Olikoye Ransome-Kuti as Health Minister (considered by most as the only bright spot in our health sector since independece). Until February 2008 he was the Chairman of the Nigerian Medical and Dental Council (MDCN). Gyoh is a Professor of Surgery, currently at the Benue State University, Makurdi, Benue State, and has just been named as Chairman of the board of Governors for the University of Jos. To read his thinking about the health sector in Nigeria, read this piece published in Newwatch in October 2008 titled How to Fix Nigeria: Health

We publish his letter to the Editor of Thisday, unedited below.

The Editor,

This Day Newspaper

Interview: ‘I stumbled on the treatment for diabetes by chance’ -Dr. Louis Obyo Obyo Nelson –ThisDay

By Paul Ibe, Etim Imisim and Senator Iroegbu, 02.07.2009

I wish to comment on this interview. The claimant of the discovery is not a medically trained man, so his understanding of diabetes mellitus, which presumably is what he is talking about, is severely limited—there is no mention of the specifying word mellitus in the interview. I note the following important points.

  1. He seems to be unaware of the fact that no country in the world, not even Nigeria, would permit human trials until extensive animal trials have given a good idea of efficacy and what side effects to expect in human beings.
  2. He is also confused by the difference between permanent cure and management of the condition. He uses the term stress of the pancreas without really knowing what it means. By insisting on the change of lifestyle, he is inadvertently admitting that his wonder drug is, at best, no advance on other oral hypoglycaemic agents currently available.
  3. The greatest indication that he is on a fraudulent mission to become super-rich is the bit about its aphrodisiac side effect in men and women. Millions would go for whatever drug is reputed to produce this effect. Since human sexual behaviour is highly encephalised, since most impotence is psycho-somatic, taking any placebo and believing it to be aphrodisiac would produce positive results and an explosion in demand, like in the horn of the rhinoceros, the demand of which has been threatening to make the animal extinct. The owner of the patent would become a billionaire by the time his drug is scientifically proved to be worthless as secrecy and Nigeria’s tortuous legal processes would take years.

It is unfortunate that these journalists went to print to build the claimant into a hero and a legend without first obtaining the views of known experts on this complex and highly specialised topic.

Shima Gyoh.

Professor of Surgery

College of health sciences

Benue State University


Sunday, 8 February 2009

A few good signs....

Is this a sign of openess and transparency by the new Minister of Health Professor Babatunde Osotimehin? If it is a sign of good things to come. See story in The Punch below as well as others out of the Nigerian Press this Friday.

Punch - My Pikin: Ministry confirms deaths of 84 children, 111 cases

The Federal Government on Thursday reported the deaths of 84 children between the ages of two months and seven years from the contaminated “My Pikin” teething mixture. It, therefore, ordered the immediate surrendering of the deadly product by all drug pharmacies, government medical stores, patent medicine stores, clinics, and hospitals in the country to the nearest office of the National Agency for Food and Drug Administration and Control. In a press statement in Abuja, the Minister of Health, Prof Babatunde Osotimehin, said the government was deeply concerned about the number of deaths and would leave no stone unturned in getting to the root of the matter. Osotimehin asked parents to quickly get in touch with Dr Henry Akpan (0807626718), Dr Oladejo (08062278615), and NAFDAC (09-6702823), if they suspected that their children were sufferring from the use of the product. As expected this is also all over the international press today. CNN - Poison in teething drug kills 84 Nigerian children

On the other hand...there are worrying signals from a group on Nigerian elders, led by the man many consider as the one the most erudit thinkers in modern Nigeria - Professor Pat Utomi...., and former director of the Lagos Business School.

The Guardian - Utomi; Nigeria: a failed state

"The team also discussed issues of healthcare and noted that a lot of Nigerians of prominence seem to be dying in foreign hospitals and a great deal of our resources being poured into air ambulances bailing Nigerians out at a cost above 30,000 euros per person every night with some days having as many as 10 persons being flown abroad," he said.

And after 5 years of oil selling at over a $100 per barrel....we go to the World Bank again. With a 10 year moratorium....this is the legacy we are leaving for our children....

Thisday - FG, World Bank sign 12.8Billion naira health care agreement

The Federal Government yesterday in Abuja signed an additional N12.870 billion International Development Association’s (IDA) credit agreement with the World Bank for the strengthening of primary health care systems in the country. ...the facility had a 40-year repayable period, 10 years moratorium and is interest free, but with a commitment charge of 0.5 per cent per annum and a s 0.75 per cent payable on amount withdrawn....the World Bank Country Director, Dr Onno Ruhl, said that between 2002 and 2009, the project renovated and equipped 1,329 primary health centres and trained more than 9,000 health workers. Beneficiaries of the loan Abia, Akwa Ibom, Anambra, Bauchi, Benue Borno, Ekiti, Gombe, Imo and Kebbi states and the FCT. Others are, Kogi, Kwara, Nasarawa, Ondo, Osun, Plateau, Sokoto, Taraba and the Federal Ministry of Health.

And our hospitals get boards...with a few good men definitely among them...

Thisday - Yar’Adua Approves Varsity Hospitals Board Appointments

University of Port Harcourt, Professor Nimi Briggs, is the Chairman of the Board of University of Benin Teaching Hospital, Chief Sunny Folorunsho Kuku Chairman of the Board of the University Teaching Hospital, Ibadan. University of Calabar Teaching Hospital - Dr A.Y.E. Dirisu (Chairman), The University of Nigeria Teaching Hospital, Enugu has as Chairman, Professor Mbonu, University of Lagos Teaching Hospital board is headed by Dr Omotayo Dairo. For Obafemi Awolowo University Teaching Hospital, Professor Wole Akande is Chairman, University Of Ilorin Teaching Hospital has Professor John Idoko as Chairman, while the Chairman of Otibor Okhae Teaching Hospital, Irua, is Dr J.I. Okey. Professor Shima Gyoh is the Chairman of the board for the University of Jos.

....I planned end on that positive note...but just found this. Caused me to cuddle my 3 month old...extra tight.

Thisday 18 Babies Escape Death in UBTH Inferno

Eighteen babies undergoing intensive care at the University of Benin Teaching Hospital (UBTH), miraculously escaped death, when the Special Care Baby Unit (SCBU) of the Hospital was gutted by fire Wednesday night. The unit was the only functional Special Care Baby Unit in the whole of Edo State.


Thursday, 5 February 2009

When will we stop kidding ourselves?

Nothing can be more painful than when the credibility, integrity, resourcefulness and intelligence of an entire people is brought into disrepute by the few that have access to pages of newspapers. The only thing worse is the editor that allows stories that can have such a profound effect on people be published. Especially in our country where the newspapers are considered at the same level of The Lancet. Its a sad state of affairs in our country; Nigeria proud in the knowledge of all the experts it has produced in all areas of human endeavour. Yet our patriotism will stop most of us from asking the hard questions once there is a story of success out of Nigeria. This is the reason the Dr Abalaka phenomenom could blossom among others...

Today we woke up to a headline in THISDAY. One of Nigeria's most respected dailies...

History, As Nigerian Finds Cure for Diabetes

It stated boldly....
"It’s official – a Nigerian scientist, Dr. Louis Obyo Obyo Nelson, has finally found a cure for the dreaded diabetes disease which afflicts over 123 million sufferers all over the world"

No less than the Minister of State for Health
Dr Aliyu Idi Hong is quoted as describing this as "epoch (sic) and historical"

The paper reports further that:
  • "THISDAY had exclusively reported on May 23, 2003 that Nelson had been granted a United States patent entitled “Medicament for the Treatment of Diabetes”
  • That an agreement had been signed between Nelson and GDPAU, New Brunswick, New Jersey, USA, for the commercialisation of an Antidiabetic Phaytopharmaceutical in Abuja (Note that GPPAU stands for "GD Pandey Ayurveda University" - Ayurveda is said to be ancient wisdom of India, though a system of medicine but aims at self realization or knowing one’s essential nature)
  • The drug, which was said to have been administered on many diabetic victims, has been found to be very safe and highly effective.
  • Nelson recorded a breakthrough in his research for a drug that could cure diabetes when the US government issued him with a patent (No. 6,531,461) for his medication, which can effectively treat Type I and Type II diabetes.
  • Unlike insulin which has been used for many decades to manage diabetes, Nelson's "wonder" drug can be administered orally, making it possible for patients to administer it as capsule, tablet or syrup. Insulin can only be injected into the body.
  • At the first clinical trial, the initial extract derived from Vernonia amygdalina was orally administered to 26 patients all of whom had been previously diagnosed as suffering from insulin deficiency. For control, a group of five were used, who maintained diet discipline throughout the trial.
When this story first appeared in Thisday in 2003, I wrote a rejoinder on Nigerianworld that is still on the site. If only the reporter googled the name...he would have at least found reason to ask a few more questions. ...2003!!!

Dr. Louis Obyo Obyo Nelson has a patent...

But what is a patent...
I went to the website of the USA's Patent office and found their definition as "A U.S. patent for an invention is the grant of a property right to the inventor(s), issued by the U.S. Patent and Trademark Office. The right conferred by the patent grant is, in the language of the statute and of the grant itself, "the right to exclude others from making, using, offering for sale, or selling" the invention in the United States or "importing" the invention into the United States." Then I looked for the criteria for which a patent can be issued on the same site and came up with "Patents may be granted to anyone who invents or discovers any new and useful process, machine, article of manufacture, or compositions of matters, or any new useful improvement thereof"

Nowhere does it say that the invention (which may be a product, a method of production, or indeed a plant classification) has gone through any scrutiny apart from that of the inventor neither himself...nor any peer review.

In effect anybody can apply for a patent based on the above criteria!

The substance Dr. Louis Obyo Obyo (he describes himself on his website as a PhD in Chemistry) d
escribes as a cure may well turn out to be one...but there is a long way to go.... and until that point is reached can we celebrate. The Newspaper will do well to live up to its motto of "The Pursuit of Truth and Reason" and seek this truth even if it takes verification of the authenticity of such articles prior to publication by any of the abundant learned scientists scattered around Nigerian institutions of learning.

The study on which he based his conclusions was made on a "grand total" of 31 people (26 patients and 5 controls!). Results as quoted by the newspaper...It was revealed that the 26 patients receiving the initial extract no longer required maintaining diet discipline after the first month and examination showed remission of the disease after three months.

  • This is exactly the same statement mande in 2003, probably referring to the same "study"
  • No reference is made to a source of the publication in any peer review journals as is the standard in any health research.

This is what Thisday refers to as Nelson's "wonder" drug

Dr Nelson will do well to seek counsel on the necessary scrutiny any invention (especially medical) needs to go through before it is released unto human "guinea pigs" as has often been done by various claimants that pop up in Nigeria from time to time.

The assumption that most of us NIGERIANS are unintelligent and stupid and consequently vulnerable to believing as the truth whatever is written by some of our newspapers must be put to rest. We in the scientific community have a responsibility to respond. Those of us that have taken the Hippocratic oath, as doctors must remember the words "I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow." It is the lives of people that we are dealing with…and even if it seems so cheap in Nigeria today, we must not forget.

Most importantly our Minister of State has a responsibility when he speaks. He must take this extremely seriously. His prescence must have given THISDAY the impetus to start with the audacious statement...."ITS OFFICIAL..."

I am sure that I will be barraged by accusations of not being patriotic but fortunately (or unfortunately for others) good science knows no boundaries....


Monday, 2 February 2009


The first time I saw Bill and Melinda Gates close up was at the opening ceremony of the XVI International AIDS Conference, Toronto, I truly believed that in front of us was a man in the process of redefining his legacy. Having recently given up day-to-day running of Microsoft, a company that has revolutionized our way of life, I could not help but think; in 10 years time Bill Gates might be remembered less for his role in the growth of information technology but for the public health issues he has chosen to dedicate the rest of his life to. Perhaps I am being overly optimistic and many of my colleagues will say I am, but I hope not. Often as workers in public health, with our self gratifying altruistic attitude, we are all too quick to condemn and question the motivation of people like Bill Gates. I chose to remain optimistic, and believe in this man's intentions. Today he has brought his energy to our country.

Read an account by a colleague who was present at his visit. Maybe....just maybe we will learn something from the life story of this remarkable man ...and create the environment for the gifted Nigerian children to grow in his image. But first we have to solve a few problems most other countries have solved years ago.

...The problem of eradicating Polio....


By Felix Abrahams Obi
2nd Feb. 2009

It was one of those normal Monday mornings but I didn’t know it would be a different one. My colleague and I drove down to Transcorp Hilton Hotel, Abuja for the meeting between international donor agencies and the officials of the Federal Ministry of Health who are hosting Mr. Bill Gates-on a 2-day visit to Nigeria. The roll call included the cream la cream and all who call the shots at the strategic level of health policy making in Nigeria: Prof. Babatunde Osotimehin ( Minister of Health), Dr. Iyabo Obasanjo-Bello( Chair,Senate Committee on Health), Hajia Amina Ibrahaim ( Senior Special Assistant to the President on MDGs), Dr . Ali Pate (Executive Director, National Primary Health Care Development Agency), Dr. A. Nasidi (Chairman, Presidential Task Force on Polio Eradication), Prof. Adetokunbo Lucas (Foremost eminent Public Health Professor at Harvard who taught the current Minister of Health at Med school). The international community was represented by the Country Heads of USAID, DFID, JICA, CIDA, World Bank, European Union, WHO, UNDP, UNICEF, Rotary International among others.

The Bornu Hall at Hilton played host to these men and women, and we all sat round the U-shaped table to listen to presentations on the efforts being made at halting the spread of polio among Nigerian children, the challenges and solutions being proffered to address them. Sure the figures are not encouraging as Nigeria is among the only 4 countries in the world that have a large deposit of the wild polio virus, and Nigeria has been ‘exporting’ this deadly virus to other countries within the sub-region.And it was for this reason that Mr. Bill Gates is visiting Nigeria. Yesterday, i.e. Sunday, the 1st of February, 2009, he visited the Sokoto Caliphate and was well received by the Sultan and his cabinet. About 30 trumpeters heralded him to the delight of his entourage. Bill Gates visited Mabera Primary Health Centre, in Sokoto State where he immunized a Nigerian child with the oral polio vaccine as part of the flag off for the first round of Immunization Plus Days (IPDs) for 2009. Interestingly, he observed that the Primary Health Centre had no stock of essential drugs, and was taken aback when he saw midwife go out to buy some drugs for a patient outside the clinic.

I watched Bill Gates with keen interest and wanted to glean a lot from merely observing him. His simplicity awed me. He was dressed in a simple suit, and his brown tie didn’t look much like the product of a top fashion designer. His shoes were simple and not glistening from the work of a shoe-shiner. His address was very apt and he didn’t display the kind of oratory that Americans have popularized in the world of today. He expressed his commitment to help the fight against polio and his speech showed that he had a good grasp of our health situation and how things are run at the national level.I also observed that he is a south paw, and took notes with his left hand as Dr Nasidi, Dr Ali Pate, and Hajia Amina made their presentations; all were in Microsoft Power Point! I watched keenly how a man is watching a presentation being made with a powerful product that his company had produced.

He had no long list of special assistants and sycophants running around to pander to his ego and needs. When he needed a drink, his aid dashed out briefly to get a plastic bottle of diet coke for him from which he took sips. He has this amiable and gentle smile on his face, and when he was offered a Rotary Club-branded yellow face cap, he gladly accepted and wore it to the delight of all in the small hall.I had no camera to take close-up and personal shots of one of the world’s richest man save for a few shots I took with my small mobile phone from where I sat. As this welcome ceremony ended and we broke out for a tea break, I meandered my way to where Bill Gates was exchanging pleasantries with the top dignitaries present. I squeezed myself into the group photos and made sure the camera flash hit and illumined my face when the shutters clicked repeatedly. At least it would be on record that I joined the Country President of Rotary in the picture he took with Bill Gates. But I felt that wasn’t enough to remember today.

When the photo section was over, I walked up to Bill Gates and shook his hands saying; “Welcome to Nigeria”. Yea there were no paparazzi around to take the shot, but it was a dignifying moment to see a great man and shaking his hands, without having to pass through the eye of a needle. His simplicity in any way didn’t mask his greatness and I wonder if the magnitude of his riches has in anyway entered into his head for once as he carried no airs around him. Soon after, he was led Enugu Hall for another session of meeting, and between 14:00- 15:45, he will hold a meeting with State Governors to galvanize support for immunization activities in Nigeria. And between 15:45 and 16: 30, he will round up his trip after holding a Press Conference and interaction with the Nigerian media.

One question I’ve asked myself since I left the meeting and went back to my office is: Will Nigeria as it is be able to produce someone in the ilk of Bill Gates? Will our system allow the development of the creative talents and potential in such an individual? Will our poorly managed and weakened health system be able to provide quality services that can prolong the life of that individual? What if the potential Bill Gates of Nigeria are one of those children who are crawling on all-fours because they had polio, or possibly died from measles infection, or maybe their mother/s died from complications of child birth? Stretching it a bit further, will our educational system be able to nurture and groom the intellectual curiosity of the likes of Bill Gates? Will the curriculum be structured in a way that allows a student to pursue the same dream that fuelled Bill Gates’ intellectualism? And sadly, will the society be able to forgive, and also support a Harvard University Drop-out like Bill Gates to live his dreams without being permanently tagged as a failure in life?

For those who are in doubt, I actually shook hands with Bill Gates because I wanted to know if his fingers were different from mine. The only difference is in the color of the skin. He is white and I am black…but that’s the only difference I saw. Yes he allowed me to shake his hands and it made me see that a great man is also as ordinary as the seemingly insignificant man who walks on the same streets with great men. I guess the difference is that the great man does something great those impacts on both the great and small. Honestly, I really would like to live, and eventually die as a great man, even in my small little way!
By Felix Abrahams Obi
Abuja Nigeria

Sunday, 1 February 2009

The Minister talking the talk....

Many stories in the Nigerian press start with this phrase

"The President/Governor/Minister/Senator/Chief/ etc has called for do XYZ"

No critical questioning about the issues. No historical perspective, no context, no questions. This is moreso when there is a new appointee doing his round of familiarisation visits.

Here are a few reports from the first few weeks of our new Minister of Health
Professor Babatunde Osotimehin.

Health Minister Professor Babatunde Osotimehin, yesterday unveiled his ‘Strategic Agenda for Health,’ which he said is aimed at addressing the challenges confronting the Nigerian health system, and to lay a foundation for a sustained reform of the system, in line with current and emerging challenges....details in the Champion

...calls for the State,Local Government and other Health stakeholders to work together with theFederal Ministry of Health to ensure that the health indices in the country is improved. details at NPR

....we will eradicate polio from Nigeria by the middle of this year. details in the Vanguard

... we will collaborate with state and local government in the country to provide quality healthcare services to Nigerians. details in the Leadership

...commends the work of the Clinton Foundation in Nigeria. details in Thisday

tasks health professionals on work ethics. details in Vanguard

...commends Lagos State Government for its giant strides in the health sector details in Thisday

...vows to deal with any health professionals in the federal health institutions, who fails to carry out their responsibilities to patients as expected. details in Thisday

Lots of promises my people...lots of promises...