Wednesday, 27 May 2009

Who takes care of our doctors?

by ndubuisi edeoga

We are happy about all the positive posturing by the new minister of Health. We are happy about his utterances so far. We await the outcomes....

While we wait for him to walk the walk, we would continue to add to his "to do" list, with our growing list of health related problems and concerns.

Let’s leave the sphere of physician kidnappings, the much talked about issues of physician assisted death or deaths due to negligence, the ever present polio cases, the perennial malaria, the lack of roadside assistance for accident victims and for once talk about these species on the extinction list in Nigeria.

The doctor-patient ratio stands at 28/100,000, which breaks down to one doctor to 3,572 Nigerians.

I got off the phone with a physician friend of mine practicing in Nigeria. He was watching the champion’s league semi-finals and suddenly started bleeding from the nose. He finally had to go to the Emergency Room when he could not stop the bleed. Final diagnosis was high blood pressure, really high systolic of about 230/ and diastolic of about 110 and yes mmHg! (230/110mmHg). If you are a physician and you are reading this article please take a moment and go get your blood pressure checked and come back and finish.

Apparently he had not checked his blood pressure for the past 10-15years, even though he has a family history of high blood pressure in both parents.

When a doctor does not have time to care for himself, how can he have the time to care for his patients adequately. Some people might say that the doctors as so engrossed in caring for their patients that they do not have time to care for themselves, well same thing.

It gets even worse for the Nigerian doctor, If he is not worried about his next salary because of strike, he is worried about being kidnapped, if he has his own personal protection, then he might be worried that there would be no light to effectively use the equipments supplied by VAMED to care for his patients.

What is the state of post exposure prophylaxis, what existing laws and protocols exist for our doctors. Especially for areas with high prevalence of HIV infection.

What rules and provisions are made for continuing medical education (CME) for our doctors?

What is the role of the Nigeria Medical and Dental council (NMDC), apart from collecting annual practicing dues, in making sure our doctors are regularly updating their knowledge base? Do you require CME credits or some extra knowledge or education before you can renew your license or is practicing medicine enough to keep practicing medicine? (Pardon my tautology).

With the high cell phone usage and increasing tele-density in Nigeria, my grandmother in the village even have a cell phone (actually 2 cell phones MTN and Glo). Is it time to start looking at the e-medicine/tele-medicine model that has worked in some other countries? When one doctor has to take care of 3,572 patients, I guess he needs all the help he can get....but ...but ...how do we thinkk of e medicine without electricity???


Where do we start?...where?

Monday, 25 May 2009

Malaria Matters

If you follow this blog, you should also follow .... this most important blog "Malaria Matters". It is maintained by Bill Brieger, a Professor in the Health Systems Program of the Department of International Health at Johns Hopkins University...and a long term friend of Nigeria. From 1976 to 2002 he was Professor in Health Education at the African Regional Health Education Centre, University of Ibadan, Nigeria. Many of his posts relate directly to Nigeria.

If you are interested in health in Nigeria....follow this blog!







I wished we could give you the stats....but you probably do not need them.

Malaria matters! It matters to Nigeria!

For many years....we have accepted malaria as an inevitable part of our reality in Nigeria. Little progress was made in scaling up any of the available public health interventions to have an impact on the populations level....

April 2009 - The World Bank is "investing" US$300 million in International Development Association (IDA) funding to expand Nigeria's efforts to control malaria. Combined with Nigeria's initial 'Malaria Plus' package of US$180 million (approved in 2006), the bank's support to Nigeria is expected to approach US$500 million, which would make it the largest single-country malaria control investment in the bank's history.


May 2009 - Nigeria's National Malaria Control Program (NMCP) and the Kano State Government launches the first wave of a national bed net distribution campaign designed to reduce by half the number of malaria deaths in the country over the next few years. Nigeria’s Minister of Health, Babatunde Osotimehin, tells a recent malaria summit in Washington, DC. “By the end of 2010, over 60 million treated bed nets will blanket the country,”.

Together with Malaria Matters, we will keep you informed as mush as possible on progress. But for now...we invite you to read these posts all related to Malaria in Nigeria.

Universal Coverage of LLINs Kicks off in Kano


Malaria Training Trounced by Transfers

Friday, 22 May 2009

Down Syndrome Association of Nigeria

Thanks to GoodNaijaGirl.....we bring you this important post...

about the ...Down syndrome Association of Nigeria is a non-governmental, not-for-profit association of children with Down syndrome as well as their parents, caregivers, and other interested stakeholders.

The association of Nigeria was formed on 4th of December, 2001 by a parent of a child with Down syndrome. Societal attitude toward parents of people with Down syndrome is totally negative in the Nigerian society. Society defines them by what they do not have rather than what they have; what they cannot do rather than what they can do; they are relegated, denigrated and stigmatised on the basis of some retrogressive myth and tradition They are abused physically and sexually with impunity and in extreme cases; even their right to life itself is denied them. It is against this rather harrowing and ugly backdrop that Down Syndrome Association of Nigeria evolved with a vowed commitment to bridge the gap between children/adults with Down syndrome and the rest of the society through a support system that seeks ultimately to integrate them. This commitment is rooted in the firm belief that if given the necessary encouragement and enabling environment to grow like others, people with Down syndrome can and do actualise their potentials and live a fulfilled life. In a vast country like Nigeria, as well as in the entire West African coast, with a combined population of well over 230 million, we are the known non-governmental organization working to provide leadership in all areas of concern as it relates to persons with Down syndrome. It should be noted that charity/volunteer work in our part of the world could be most challenging and frustrating, especially as there is very insignificant, if any, support (both morally/financially) from the Government and corporate concern

Mission Statement

Vision - Our vision is a world where all young people with Down syndrome are offered the opportunities that they need to achieve their individual potential.

Now they need your help!

LIFE SAVING HEART SURGERY FOR 3 DS BABIES

...on behalf of the underlisted babies who have been diagnosed with a serious heart defect:

Ajoke Taofeek (F) – 9 months
Felicia Oyinloye (F) – 12 month
Etim Gabriel (M) – 18 months.

In view of the urgent need for an immediate corrective surgery so as to save the lives of the remaining three babies, the association is making urgent arrangements towards this, but are not financially in a position to bear the total cost hence the appeal for partnership/support in this life-saving venture. It is estimated that the total amount required for the corrective surgery on the three babies in India is approx =N=10.5m. These donations will be used for the sole purpose and benefit of the children
Any donations, no matter how little, will be highly appreciated. Please note that all cheques should be made payable to: DOWN SYNDROME ASSOCIATION OF NIGERIA or paypal payment to info@dsanigeria.org
.

For those of you in Nigeria who would like to donate money in person, or volunteer your time, please call or visit the DSAN headquarters. They are located in Lagos, and can be reached by phone at +234 (1) 2704710, +234 (1) 8119718 or +234 (0)8032285545.

Wednesday, 20 May 2009

Food for thought: Cholera/Zimababwe vs Meningitis/Nigeria

Who remembers

Cholera epidemic in Zimbabwe - The international outcry, consternation at what was happening, at a point....even some suggestion that this might lead to the fall of the Government of Zimbabwe....

Now...who heard about Cerebrospinal Meningitis in Nigeria? Barely a whimper in the press, barely a reaction internationally....not even a public acknowledgement by our president.

Now compare the figures:

Zimbabwe - As of March 2009, 91 164 cases with 4 037 deaths.

Nigeria - As of March 2009, 24 868 cases with 1 513 deaths.

The LANCET reports that it is 47 902 cases 2148 deaths—reporting that the Nigerian Health Ministry has admitted that the outbreak is more serious than was initially suspected. (!?!)

Trying to find out any information about the response in Nigeria is like searching for meet in in my soup bowl while in boarding school....but finally....we did find something....reported ...no not by the Ministry of Health, but by Doctors Without Borders/Médecins Sans Frontières

MSF reports that;

"At the end of the intervention, almost 4.8 million people will have been vaccinated by MSF/Ministry of Health in Nigeria during this epidemic"

....so whats the food for thought;

Where is the public consternation at so many preventable deaths?

Where is the Government's explanation for so many preventable deaths?

Where is the Ministry's explanation for such a slow and fragmented response to an outbreak every one knew was coming for the past 2 years?

How can all of us...our people, our leaders turn and look the other way?

So ...what would have happened without MSF?

Monday, 18 May 2009

Is real reform underway in the health sector?

Professor Babatunde Osotimehin has a tough job.


He was appointed Minister of Health half way through this administration's tenure. An administration that has been criticised as not keeping pace with the yearnings of the Nigerian people for true reform. Snubbed internationally, unable to carry out the simplest of elections and one that has unashamedly declared its inability to meet the millennium development goals as they relate to health.

He was appointed to a Ministry marred by corruption. The previous Minister, Professor Grange openly declared... "As a professional and technocrat, I must admit that the level of decay and corruption within the Ministry is in glaring need to be decisively tackled and purged"....

Now the Minister minister himself is reported by Thisday as saying

"the sector is still in a comatose state"


BUT THE GOOD NEWS is that he also said that...

"we restructuring the sector in such a way that there are not just enough resources but BETTER COORDINATION to ensure that those who work in secondary and tertiary health sectors do interact with those at the primary level for effective healthcare delivery"

Recently....we have been privy to the framework for a new plan for the health sector. A plan that will bring together the Federal, State and Local governments to work together within a single framework for the development of the health sector. Finally, our Government seems to be in the driving seat in defining the agenda and asking our development partners to come and join hands with us in our plan. While still in consultation...we see the beginnings of real reform. The challenge lies not just in getting agreement on the plan by all those engaged in the health sector....but to give Nigerians an opportunity to know and own the plan, engage with its operationalisation and hold accountable those entrusted to deliver on it.

Nigerians are hopeful...as hope is all we can have...

These are the plans of the past as elucidated by Professor Umaru Shehu at a recent conference in London:

  • The 2nd Post Independence Economic Development Plan that included the restoration of health services destroyed during the civil war, control of communicable diseases and training of healthcare workers.
  • The 3rd Post-Independence Economic Development Plan: 1975 – 1980
  • The first national health summit organised by the then Minister of Health; Dr Ihechukwu Madubuike.
  • The Vision 2010 under General Sani Abacha.
  • ...and finally Professor Elitayo Lambo's Health Sector Reform Programme 2004 - 2007

No Nigerian needs be told the outcomes of these plans....we feel then in our febrile children, our dead mothers and our "mere consulting clinics" as aptly described by one of our great leaders...

Now is the time to move from strategic planning to strategic action. As tough a job he has, Professor Babatunde Osotimehin has an opportunity to be a hero....a true hero to the ordinary Nigerians that bear the burden when basic health services fail....

As the saying goes....an acre of performance is worth a whole world of promise...

Wednesday, 13 May 2009

The Business of Health in Africa

While we have focused mostly on the challenges facing the public sector in health care delivery in Nigeria, the private sector is similarly challenged in providing private health care to anywhere near the standards available in India, Brazil, South Africa....and similar countries with whom we would like to rub shoulders ...on our path to being among the 20 largest economies by the year 2020 :) (if only it depended on how often the newscasters reported this on network news!)

Find below a link to thought provoking report on the role of the private sector in health in Africa from the World Bank.

The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives.

Specific sectors include:

  1. The Role and Likely Evolution of the Private Sector in Health Care in Sub-Saharan Africa

  2. Actions Needed to Mobilize Private Sector Participation in Health Care

  3. The Case for Investing in the Private Health Care Sector in Sub-Saharan Africa

Most importantly find a presentation on Nigeria from 2008


Thanking Timbuktu Chronicles for this link!

Sunday, 10 May 2009

The President speaks, but not about health...

Our president hardly ever grants interviews. When The Guardian got him to sit down with them for his most detailed interview to date, they called it Umaru Yar'Ardua: President... on a mission incredible. For 3 hours he spoke to the editorial team from the Guardian...in what they described a voice ... though gentle, had a bell-like jingle to it that seemed to emphasise his authority on the subject of discussion.

And yes...he did speak in detail, with more insight than I have ever heard a Nigerian president speak, about most of the big issues that confront us in Nigeria....all except health.

In all 16,500 words (yes 16,500) ...just 441 were vaguely related to health. Within these 500 words is the most painful admittance of our collective failure as a country "Nigeria cannot meet the MDG target by 2015, on the issue of child maternal mortality and morbidity"

These 441 words are reproduced below. I'll let you draw your own conclusions on the Government's commitment to health, and draw your own conclusions about how much we the people and the press has placed the health sector on the political agenda.


...Talking about the "enablers for development"... you must have the manpower - educated and skilled manpower - to operate within those sectors, especially education and health that determine quality of human capital.



...The same thing we are doing in the health system. We are concentrating on primary health-care. We said all contracts awards from building the clinics, purchase of drugs, we should get out. We should help with the policy, help build capacity, supervise and make sure that those policies are implemented by the state governments. And we concentrate on the tertiary sector. Right now, we have said that the special project fund should concentrate on three teaching hospitals: the University of Ibadan Teaching Hospital, Ahmadu Bello University Teaching Hospital, University of Nigeria, Enugu Campus Teaching Hospital. To bring these teaching hospitals up to the minimum acceptable international standard so that any research hospital, any university hospital you see abroad, you can compare these three teaching hospitals with those teaching hospitals. We believe by doing this, it may take us say, three or four years to accomplish, we may not use this year to complete this. It may take two years, it may take three years.

...on the issue of the Millennium Development Goals. Last week, I was at a quarterly meeting where we received the MDG quarterly report. If you cast your mind back, at the end of that meeting, we said Nigeria cannot meet the MDG target by 2015, on the issue of child maternal mortality and morbidity and on the issue of poverty and hunger. So what I have asked the Senior Special Assistant on the MDGs and other officials to do is to look at what we need to do between now and 2015 to ensure that we increase the pace of investment in these areas and to determine what additional time do we need to realistically be able to say that we will be able to achieve these human development goals. So this is what we are doing now: they are working it out now. We are aware of that and we are being frank to this nation that this is the position and that we have asked officials to look at these two issues. What we need to do is to raise the level of investment in these four areas between now and 2015 and at what time would we be able to say that we have made progress and achieve these goals. Is it by 2018, 2020, at what point? I told them that by the next meeting which will be in three months time, these are the issues we will be deliberating on.

Thursday, 7 May 2009

"Where is the local health centre?"

Find attached this excellent piece by my friend; Kalu Aja on his dialogue with a new friend visiting our country. A must read! - posted here unedited, undiluted,... ENJOY!


In the papers today “the lost tribe of Taraba” was the editorial. The story says that a Christian missionary group, the Mission Light House Wukari, “discovered” a community of mountain dwelling people of Jibu. It is said that their condition is worse than the Koma people, they were completely naked, and drank water from a well that their animal drank from. They were “primitive” no less. hmmmm

Last year I had this expat friend whose son, Tom decided to come to Nigeria for a week, he came to explore and had an open mind. So I was detailed, (since we were of the same age) to take him around town. I went to pick up Tom at the house in Lekki. Nice enough chap, he quickly asked me, “where is the local health centre”? I need to get anti malaria shot Tom, I replied “we have none in Lekki, there are private clinics though”, No local clinics? "Well how do the guys who can’t afford private health care survive"? Tom asked, Well I replied “they pray, visit their herbalist or drink Agbo. Wow no health care!

I took him to Silverbird,( I wanted to show off with our mall). On the road were lots of potholes so Tom asked “why so many potholes? “Don’t the guys in this borough pay their taxes”?, suppressing a snigger I replied “Tom, first of; Nigerians don’t pay taxes, second if they even paid the tax, why should the LGA chairman fix a road? He needs to buy his L3 Landover first, then accumulate his re-election war chest, then after that maybe fill a few potholes” wow potholes!

Just as we were about to turn into Silverbird, an Okada rider slammed into our car, the “passenger” was thrown up into the air, “quick” Tom cried, “call 911, tall them to send an ambulance”. Where do I start? “Tom, first there is no 911 call centre, even if there was, I have no credit” , “ok” tom said, “where are the phone booths, there is usually a free emergency number”, sorry no public phone booths. Wow, no phone booths, no 911 emergency!

In the mall Tom said, “Kalu I need to get some D Banji tunes, where is the Apple media store”? Tom, we have no ITunes for Nigeria? Wow no ITunes! So we left Silverbird and I took him to go bowling (yes we have one) suddenly the lights went off, Tom dove under the desk, “Kalu quick, it’s an earthquake, the powers gone”. Dear me, “Tom see in Nigeria, power does tend to go out from time to time”, wow no constant power! Leaving the bowling alley we saw some mai ruwa (Hausa water sales men) pushing 25 liter jerry cans on a cart in Ikoyi. What’s that? Tom asked “well Tom, that water”, “for what?” he asked, Well the resident in Ikoyi buy it, but hang on Kalu Ikoyi is a high brow area yeah, you mean they don’t have running water in their homes? Yep. Wow no running water!

Tom peeped out and saw a sign saying “don’t urinate or defecate here, by Order” “Kalu he asked, is this like candid camera? would people actually “go” on a bridge? Where are the public toilets? Cant they just pull up at a gas station and go?” Well tom, actually there are public toilets for now”, wow no public toilets!

We then got stuck in traffic jam; “Kalu” Tom asked why are those buses on our lane? Tom I sad they are doing “one way” “so where are the traffic cops”? He asked, well they are over there collecting N20 form the okada guys”, “collecting bribes!” tom exclaimed? “Aren’t they scared the CCTV will catch them doing that”? Well there is no CCTV. Wow no Traffic Cops, no CCTV! The traffic jam was too bad, so Tom has a brainwave, “Kalu, park the car, then let’s get on the subway”, emm, “Tom there is no subway”, wow no subway!
I took Tom home, it was pretty late, so the OPC boys (security men) stopped us, Tom nearly has a hearth attack,” kalu they have machetes, hide”, “Tom theses are our security men”, “your security men?” Tom screamed “where are the police”? Well half are in Abuja with the politicians the other half are in Ekiti, I replied. Wow no police men doing beats.

I left tom feeling good about myself, we are developing now, I mean Lagos was wearing a new look, roads have been fixed, street and traffic light working, even BRT, we try jare, Eko o ni baje.Tom left the next day, last month I got a letter from him, reads as below

Dear Kalu,

I cannot thank you enough for being a tour guide to a helpless foreigner like myself. You know I told you I was a student, well I was studying anthropology, and I could not get material to write my thesis till I got to Nigeria.

My classmates went to Egypt to see the pyramids, other went to Rome to see the Coliseum, other to China to see the Great Wall, but providence brought me to Lagos, you see I “discovered” something new and it’s all because of you.
I discover a new type of humans, they have quite a lot of resources, but they can survive without, health care in their local governments, bad roads, no power, and no public transportation, no running water in their homes, no public toilets, no 911 emergency responder, no traffic police, no CCTV, they “go” on the streets without a care, hire private armies for security, worse of all, they have no ITunes. When I told my professor such a people existed he doubted at first but I showed him pictures. He was floored he, said it is impossible for people to live so “primitive”. My school has given me a junior fellowship, next month I am back in Nigeria to further study these unique people, I even hear there are better cities to study than Lagos, like Ekiti, Aba and Jigawa. I am so excited.

If I do this right, I could be in for a job with the Discovery Channel, wish me luck. I remain in your debt.

Your friend Tom


It’s our problem, we can fix it
Kalu

Monday, 4 May 2009

Kidnapped!

On this blog....we made a decision at the beginning that no matter how strongly we feel about other social and political issues in Nigeria, we would keep our blog related to health issues.

We still try to...but pls...bear with us this time.

Today, I found out that yet another person I know had been kidnapped in Anambra state. Why is this important to this blog. The person is a colleague, a consultant obstetrician and gynaecologist who taught me and hundreds of other doctors as we passed through the University of Nigeria. He is one of the leading obstetricians in eastern Nigeria who has literally delivered thousands of babies, most of who will be teenagers today. That is how low our society has reached.

This happens because we have kept quiet as our governments has abdicated on its responsibilities.

We think it will not happen to one of "ours", we pray that our own families are spared, and that we are not called on to raise the ransom for our friends.

Doctors rightly or wrongly have been reverred and protected by societies. If this eminent colleague can be kidnapped in his own home...our society has disintegrated...truly. Thinking through the consequences of this on our society is scarry...truly.

If you think this does not affect you...think again.

For our leaders...."leaders!"...well

On the same day this happens, the Governor, the chief security officer of the state ....is quoted as "reading the Riot Act to kidnappers and their sponsors in the state"

What a joke....what a joke!

Friday, 1 May 2009

Swine Flu - Before we embarrass ourselves

Before we embarrass ourselves like the Egyptian Government that exposed the depth of their ignorance, and Africa to ridicule yet again by ordering the slaughtering all the pigs in their county...

We appeal to our Government to get its act together and give correct and coherent advice to the Nigerian people on the new H1N1 virus, that emerged from Mexico.

As we have said severally on this blog, as long as there is no central agency to organise infectious disease surveillance and outbreak control, we will have to continue fumbling through these incidents.

Our government needs to act responsibily and seek the best advice from the best possible sources and advise its citizens.

The 2 objectives have to be:


1. To mitigate the public health risk.

2. To manage public anxiety.

Both these are equally important and one will not work without the other.

Reports like these in the papers show an emerging ignorance on the key issues:

Vanguard: Nigeria swine flu-free — Minister of Health Prof. Osotimehin

How does he know this??? (assuming he was quoted directly). Nigeria does NOT have the laboratory capacity to diagnose this new virus. Thats a fact you can quote us on. Even if it did...the only reason there are no cases in Nigeria would be that there are no direct flights to Mexico, and travel between Nigeria and Mexico is minimal. Once there is significant community spread in countries with significant air travel to Nigeria, transmission in Nigeria becomes inevitable.

Thisday: FG Orders Aircraft, Ships Clean-Up On Arrival - Minister of Environment Mr. John Odey

This requires no further comment and just exposes the depth of ignorance on the problems we face.


Most of the public health workforce around the world is working flat out to mitigate the impacts of this virus, as the world faces several other problems. Governments are launching proactive programmes daily to advise their populations on what to do, how to do it and when to do it.

We might yet stop its spread. But at this point in time...we simply do not know that. Any responsible government will be at its highest possible level of preparedness.

Does anyone remember what happened after the explosion at the Ikeja Miltary Cantonement on the 27th of January 2002? 90% of the estimated 1100 Nigerians that lost their lives, died not from the explosion but from the ensuing anxiety that led to people drowning in a canal while trying to "escape". Have lessons been learnt? Only time will tell...


Please if you have access to those that make policy, do your country a favour and bring this to their attention, and push them to act.