Wednesday, 28 July 2010

Final reflections on AIDS2010

It has been my pleasure to share with you some of my reflections from AIDS2010, from a Nigerian perspective. I have not covered in detail a lot of the interesting scientific issues emerging from the conference. The hope of new vaccines, microbicides, and the relative success of programmes from around the world, and emerging epidemics in eastern Europe. You can watch webcasts of most oral sessions here.

It is important that you the reader pay particular attention to the areas I have not spoken about. The sad data coming out of Nigeria, and the absence of leadership from our Ministry of Health at this conference, as well as the little scientific research from Nigeria - all lost opportunities. The name of our country's capital was often mentioned at this conference, but not for anything happening in our country, but in the context of the "Abuja Declaration" where African countries committed to spending 15% of their budgets on health. This has not happened in any African state and definitely not in Nigeria. Our representatives in the Nigerian senate have just approved 17 Billion Naira to "celebrate" 50 years of our comatose existence.

I recall one particular session I attended on advancing country ownership of HIV and AIDS programmes, and reflect on an interesting tool called National AIDS Spending Assessments (NASA). These are designed to describe the financial flows for the response to AIDS in different countries. The NASA for Nigeria is compulsory reading for anyone interested in this area in Nigeria. You can find the report here. Below are the two most important facts in the report to ponder on;
Nigeria spent a total of US$ 300M (N35Billion) in 2007 and US$ 400M (N45Billion) in 2008 on HIV and AIDS
External financing sources accounted for 85.4% of all HIV expenditure in 2007 and increased to 92.3% in 2008. 
Lets think about this - in 2008,  92% of all funds spent on Nigerians, the 7th largest oil producer in the world was from donor funds! 

Through my interaction with colleagues involved with the response in Nigeria, I can report that the coverage for the Prevention of Mother to Child Transmission of HIV(PMTCT) is about 10% and that only about 30% of people living with HIV, for whom treatment is recommended according to the old guidelines ( CD4 < 250/mm2) get treatment.

Lets think about this - 10 years after Durban only 1 in 10 children born to mothers with HIV will receive life saving antiretrovirals.

Challenging thoughts for Nigerians to ponder on....

Let me end on a personal note. At these conferences, one always meets interesting and inspiring people. I met several people that commit so much time and energy to the response to HIV/AIDS. But the one person that made an impression on me, was Rolake Odetoyinbo. Rolake was the most prominent face from Nigeria at this conference. At home, she is director of the Positive Action for Treatment Access (PATA), a non government organisation. From speaking at sessions, to chairing sessions she was all over the place - eloquently, passionately and articulately making the case for an improved response to HIV and AIDS, especially in Nigeria.

Rolake has been living with HIV for over 10 years and has seen her life change, from one where she lived in fear, silence and stigma to a positive, active and fulfilled one. I sought her out, and we had lunch. I left the conference relieved that there were still some real leaders among us and that one day, we will overcome the pain of the present state of affairs in Nigeria. She left me convinced that every country deserves the leadership it has, and that as long as Nigerians choose to sit around and moan, and do nothing more, we will have what we have...and we will have to live with it. Find below a clip from her talk at the TAC Satellite session and apologies for the audio quality!

That's it from the conference....! We will appreciate your feedback

Saturday, 24 July 2010

Front-line work from Nigeria at AIDS2010

Further to the response about one of our previous posts on posters out of Nigeria, we spent Wednesday afternoon at the International AIDS conference going round the posters from Nigeria. We do realise the hurdles of presenting work from Nigeria at a conference like this. From finding the time and space in a country with almost no electricity, writing up a scientific article, finding funds, getting a visa...the hurdles appear endless. It was no surprise therefore that most of the colleagues at the conference were funded predominantly by our "development partners", mostly USAID grantees. But all the same, one cannot help but wonder how much the work done by colleagues, presented here at the conference influences the response in Nigeria. One wonders how much our colleagues at the Federal Ministry of Health, and the National Agency for Control of AIDS are doing in collecting the evidence from research projects in the country, and how much it is being used to inform the evidence base for policy formulation. Each day I looked around for these colleagues, hoping to see some of them at least going round to encourage our colleagues that have made the effort to present, flying the flag and presenting their work at this conference. Well....maybe they did go round...and I did not see them! Did you?

But we will not let that distress us. We will bring to you a cross selection of the posters from Nigeria presented at the conference. These Nigerians deserve to be heard. As they stood by their posters waiting, a few of us walked round and listened with interest to the work they did and to their results and recommendations. Summaries are presented below. If you want to get in touch with any of them directly on an issue related to their work - get in touch with us and we will link you up.

Their voices deserve to be heard, you deserve to hear these voices...

Nwokedi Ndulue was presenting on the outcomes of a national pharmacovigilance, reporting on projects taking place in rural HIV clinics in Northern Nigeria. The project attempted to track the side effects of antiretrovirals in our context, and using the data to influence policy on the choice of first line combination therapies...(an MSH project)

Jude Amaechi Ilozumba presented a retrospective review of medical records of 102 infants delivered to HIV positive mothers, and found a negative correlation between the duration of exposure to ARVs and birth weight. Jude who leads the Prevention of Mother to Child Transmission of HIV programme of AIDS Relief shared with me the difficulties they face in getting mothers identified as HIV positive in PMTCT programmes into comprehensive AIDS care.  (project of the Institute of Human Virology, University of Maryland)

B. Faloye presented the results of a project implementing workforce programmes to prevent and care for HIV positive individuals in multinationals in South West Nigeria. Of course I asked him what the plans were to take this beyond multinationals...:). (project of the Society for Family Health and PSI.)

Abiodun Adetoro then spoke to me about an innovative project partnering labour unions to provide HIV counselling and testing services. He told me about the interesting positive experience he has had working with the unions both large and small...(project of the AED)

Mohammed Jantato's poster was on a most important piece of work exploring how to reach female out-of-school girls in Northern Nigeria. No easy work and kudos to them...(project support by USAID, UKAid and  PSI)

Mrs Chidi presented her work on promoting HIV and STI services among female sex workers and shared with me the demand for the services she provides, and how this is affecting the health of a community where many workers live far from their spouses and the inherent challenges this causes (a project of the oil companies based in Bonny Island)

Seye Babatunde of the Department of Preventive and Social Medicine at the University of Port Harcourt presented the results of his work comparing the willingness to test for HIV in school vs community based youths in Port Harcourt. Seye's work was one of the few I found not obviously supported by one of our development partners....

Cornel Ekeh told me about the work he has been doing for the past 4 years across Imo and Abia States with support groups of People living with HIV. He described the challenges he faced on a daily basis, but also the satisfaction he got from doing this work....(a PSI project)

I ended my day with Adejoke Sonoiki of Journalists against AIDS (JAAIDS) she took me through the work JAAIDS is doing on budget advocacy, and human rights...trying to hold governments and stake holders accountable for their own promises. 

I dedicate this post to my dear friend Omololu Falobi, founder of JAAIDS, with whom I spent a lot of time at my first International AIDS Conference in 2000 in Durban. Omololu was an inspiration to many of us, an ordinary Nigerian hero. At the conference in Durban in 2000, Omololu who had just set up the JAAIDS eforum on HIV/AIDS, still Nigeria's largest forum on HIV and AIDS organised the first meeting of Nigerians at such conferences which then became a tradition. Serious countries would celebrate a man like this....but if our government does not, we will. Omololu was brutally murdered in yet uncertain circumstances in Lagos, Nigeria. But he lives in our hearts...and this post, and indeed a lot of the work on this blog is inspired by him.

Rest in Peace Omo! We will never forget!!

Thursday, 22 July 2010

Activism at the International Conference of AIDS

The International AIDS conferences and activism are inextricably linked. Many aspects of the pandemic and our response have been shaped by activists. The historical approach to infectious diseases prior to HIV was one of containment, quarantine and we attempted to restrict transmission. But HIV, with its long incubation period, its prevalence initially in marginalised populations led to a movement that eventually resulted in a human rights approach to the response involving voluntary counselling, informed consent, involvement of civil society  etc. There are several heroes that defined the response and continue to do so. The work of activists makes the International AIDS conference different from any other medical conference you could possibly attend and makes us think beyond odds, ratios and confidence intervals.....a good thing!

Right from the opening ceremony of this conference, activists made their voices heard asking the G8 countries about their broken promises....

And you cannot be at this conference and miss Paula Akugizibwe of ARASA. (AIDS and Rights Alliance for Southern Africa)...passionate, knowledgeable and articulate.... 
Below are images from ARASA's advocacy campaign on the proliferate spending of our "leaders" (we should do something similar for our senators in Nigeria)
Then there were the Catholics for Choice who insist that good Catholics use condoms...
And you could not miss Annie Lennox even if you tried...she brought all her stardom to bear drawing attention to AIDS, linking it all back to the effect Madiba had on her life...
The President and Secretary of the Treatment Action Campaign to whom we have a whole lot to be thankful for on the continent, for his sustained campaign enabling more people to have access to ARVs...
And if you want to learn about how counselling evolved with the pandemic in Africa and the engagement of the community and people living with HIV, then you have to study the The AIDS Support Organisation of Uganda. The founder, Noerine Kaleeba below...phenomenal woman.
.....and do you recognise these faces?
...or these ones?

...and finally no prizes for guessing the proudest country around these days :) Don't you envy them? Their Deputy Prime Minister spoke at the opening ceremony, and their Minister of Health was a plenary speaker. I know what you are thinking...but don't bother asking. And you would think that our new Minister of Health would be here...but what can we say? 

Wednesday, 21 July 2010

Where is the research out of Nigeria at the International Aids Conference ?

Yes, we have two stands at the exhibition zone of the conference, but our contribution to the science at this conference has been minimal at best. I am yet to find any oral presentation out of Nigeria ...and believe me I have been searching. Yes our National Agency for the Control HIV/AIDS has a stand at the conference, with some literature on the state of the epidemic in Nigeria, but over the first two days I have seen good research presented by colleagues from South Africa, Lesotho, Zimbabwe, and Rwanda. They have all been invited to present key aspects of their response on the big stage. I have looked around the sessions, hoping to find the odd presentation out of Nigeria, something to hold onto but nothing yet....Ill keep looking! I hoped that we would do more in presenting results from the operational research from the ARV treatment programmes in Nigeria. I thought we might join the scientific debate on the effects of raising the level of CD4 count at initiation of treatment to 350. I hoped to see some evidence or preventive research...Ill keep searching!

Some of the the best new research in any conference is often found in the posters. They provide a good feel of work being done at the front lines. For the first two days of the conference, there were 1,200 posters on different aspects of the HIV/AIDS epidemic presented daily. In the abstract book, the country in which it was done  is identified. I marked every abstract out of Nigeria and sorted them out to learn about work being done in Nigeria in order to share it with you. It was an eye opening experience....some good news and some sad news. The good news first. I found a series of Nigerians that are really doing excellent work. 

These are my heroes at the conference...the sources of hope....the small speckles of light from our Nigeria. 

Adebayo Solomon informed me how a "bottom-up" approach to planning had led to a more effective response to HIV/AIDS in 5 Nigerian states.
Chuka Onwuamah spoke to me passionately about the work they had done to set up a quality assurance programme and how this has led to improvements in several processes and outcome indicators at the HIV reference laboratory at the National Institute for Medical Research in Lagos.
Mrs Osuji discussed exciting results of her work in Enugu that has led to an increase in uptake of HIV testing among men (yes men), during antenatal visits through integrated couple counselling.
Bukola Adesina presented a poster on the burden of Malaria among HIV positive women.
Adedayo Adeyemi talked passionately about how he has accessed archived data in our Ministry of Health, and is now using this to answer important public health questions of our time.

That was the good news. Now Ill share with you a perspective that tore me apart. Of the 2,400 abstracts at the first two days of the conference there were 59 posters out of Nigeria. Of these 59, just 23 posters (40%) were actually displayed. The rest apparently did not make it to the conference. We will send a summary of this information to the Network or HIV/AIDS Research in Nigeria. We need to understand why Nigerian colleagues that have done the hard work, had a poster accepted and yet are unable to present this at the conference. We will send them a file with pictures of all the posters on the first two days. Including pictures of the 26 poster stands that were as below with their poster numbers. We will implore our colleagues to use some of their funding to write to these colleagues to understand the impediments they faced in coming to the International Aids Conference  in Vienna, despite having their abstracts accepted as posters.

Tuesday, 20 July 2010

2nd Day at AIDS 2010 belongs to Bill Clinton

It is difficult to describe the emotions that Bill Clinton stirs in people.  I cannot forget the images of his first appearance at the closing ceremony of the X1V International Aids Conference in Barcelona, eight years ago. This was one year after he left office, when he slowly walked onto the stage holding the hands of Nelson Mandela, like a son walking his father. The auditorium rose and chanted for almost 10 minutes “4 more years....4 more years!!!”. It was another Bill Clinton “master class” in gauging the mood of the people. This man’s ability to connect with people emotionally is simply amazing.

Since he left office, Bill Clinton’s single most important achievement might be the incredible negotiating power he brought to the debate on the cost of ARVs. The Clinton Foundation managed to negotiate a cost reduction in price of  ARVs from tens of thousands of dollars to $350. Today, first line drugs are now below $90 per year.  Over 5 million people are now on treatment worldwide. He has now brought this same negotiating power to 2nd line drugs – bringing this down to $400 per year. His foundation has raised over $50 billion in commitments for HIV/AIDS initiatives. Bill Clinton pointed to the fact that there has been more investment in HIV/AIDS related initiatives, than in any other public health problem in history. He particularly praised the progress in South Africa, doubling the number of people that will be on treatment in the next 2 years. He also praised the fact that the US Government of Barack Obama has now permitted US government funds to be used to fund needle exchange programmes. He highlighted the progress being made in Rwanda, particularly praising the example of leadership and investment in health being shown in that country. Bill Clinton urged that we stop creating false dichotomies in communication. There is no difference between treatment of AIDS and reducing child and maternal mortality; one is dependent on the other. He ended by warning that “more of the same is not good enough”…quoting Winston Churchill;
“This is not the end, it’s not even the beginning of the end but it is the end of the beginning”.  

There are quite a few Nigerians at this conference. Two organisations that have specific exhibition stands are the National Agency for the Control of HIV/AIDS and the Network for Research for HIV/AIDS in Nigeria. More on this in future posts.

My conference day ended with my attendance of a special satellite session organised by the Treatment Action Campaign.  This organisation has played a key role in the response to the HIV pandemic in South Africa. Ably led initially by Zachie Achmat, it fought drug companies and won a historic victory in court over the pharmaceutical industry that made it possible for the price of antiretrovirals to crash to levels that could be afforded by African countries. They also championed a treatment action plan for South Africa. As TAC pushed for rapid roll out, their own government dithered. Their own Minister of Health the infamous Manto Tshabalala-Msimang insisted that garlic was more efficient than ARVs, and with President Thabo Mbeki, this heralded a dark era in South Africa. But now, TAC has persevered and continues to fight, and today there are estimated to be 1 million South Africans receiving ARVs....and TAC has a new leadership.

Then the irrepressible Stephen Lewis, the former Special Envoy for HIV/AIDS in Africa spoke – always unafraid to say what he feels to be true. He describes TAC as the most effective, influential, powerful NGO on the African Continent. At his eloquent best, he challenged the absence of women, several important committees and groups ….even at this conference. A final quote from Stephen....
Over 40% of deaths in children under in Southern Africa – is from AIDS. Why does it then come as a surprise that the fall needed in maternal mortality to achieve the MDGs (Millenium Development Goals) is not happening in this same region.  Too much self congratulatory back slapping is going on at this conference! We have been astonishing delinquent over the past 20 years.
Then came Nigeria's own Rolake Odetoyinbo ....of Positive Action for Treatment Access. If you follow HIV/AIDS in Nigeria you will know Rolake as one of the most articulate advocates for the rights of people living with HIV. As we have come to expect, she spoke powerfully and eloquently about TAC and the impact it had on her own advocacy in Nigeria. She spent 3 months in South Africa learning from TAC. Her powerful story of advocating for access to treatment in Nigeria is a blog for another day. Stay tuned as her story is absolutely amazing! You don't want to miss it!

Monday, 19 July 2010

First day at the XVIII International Conference on AIDS in Vienna

When I attended my first International Conference on AIDS in Durban, South Africa, exactly 10 years ago, I was still swinging between returning to a clinical career or staying in public health. That conference sealed the deal. The energy at what is now referred to as the historic Durban conference, was beyond anything I had ever experienced. Watching Nelson Mandela "Madiba" at the closing ceremony was the icing on the cake. As I listened to him speak, I knew then that public health was indeed my calling and with HIV/AIDS being the biggest public health challenge of our time, these were inevitable linked.

Today, on the 18th of July 2010, I find myself in Vienna, at the opening ceremony of another International Conference on AIDS. Its 10 years on, and in the context of the global financial crisis things are a bit subdued. Okay - obviously Vienna is no Durban and in place of the legendary lively dancing of the South Africans, we were entertained by the Schloss Schoenbrunn Orchester. Ten years on, there are over 4 million people now on life-saving antiretrovirals in the developing world, but the problem of HIV/AIDS has not gone away. In fact the numbers are so large that they make little sense unless  you are infected or affected....and the problem is that many still do not know if they are infected or not. The bottom line is that we cannot afford to let up in the fight against AIDS, or it will re-emerge with a vengeance. We were reminded of the work still to be done by these simple slides.

While both the number of new infections (and deaths) have peaked, the burden of disease continues to increase, challenging us to continue the work already started. This year in Canada, the G8 failed to follow through on the promises they made in Gleneagles. While they have no qualms in bailing out the defaulting banks and defaulting countries, letting more people die from AIDS appears to be an acceptable area to cut public spending. This is all at a time of new emerging evidence that treatment with ARVs is also an effective prevention tool, with new studies in partner organisations demonstrating a risk reduction for transmission by as much as 90% when one of the partners is taking antiretrovirals.
Treatment is becoming prevention ~ Treatment 2.0
 Michel Sidibe addressed an International AIDS conference for the first time as the Director of UNAIDS, taking over from Peter Piot after several years. He spoke with passion about his vision calling for a "Robin Hood" tax on financial transactions to sustain the response to HIV/AIDS. He spoke about his sadness at the persistence of mother to child transmission in the developing world after so many years, and said that its elimination by 2015 was 'sacrosanct'. In this area Nigeria made its d├ębut at the conference when it was shown as the country with the highest number of untested exposed infants in the world. Honestly - what could possible be sadder:

The opening ceremony ended with the Deputy Prime Minister of South Africa Kgalema Petrus Motlanthe. He proudly defined a new era of South African commitment to antiretrovirals as comparable to its commitment to delivering the just concluded football world cup. He said of his country's new drive:
"I am responsible, we are responsible, South Africa is taking responsibility."

I leave the venue after the opening ceremony, deep in thought about the past ten years. I have come to reinvigorate and recharge my batteries. To remind myself of the reasons I chose public health. I wonder if it is possible to be a good public health physician without being a bit of an activist....we still have a huge problem on our hands on the continent...not time to relax just yet! I thought of the campaigners that interrupted the opening ceremony complaining about the broken promises of the G8...and wonder if I should have joined them....

Friday, 16 July 2010

Preparing for Vienna: Another International AIDS conference

Every other year, the HIV/AIDS ‘community’, an odd mixture of scientists, youth, community workers, activists, politicians, and various other groups gather in one city in the world for one of the largest conferences related to an area of scientific endeavour. Its that time of the year again - time for AIDS2010 

It is inspiring to see in these conferences the community effort rallying and supporting science to overcome one of the biggest health issues of our time; HIV/AIDS. Nigeria Health Watch (NHW) has attended most of the conferences in the recent past; Durban where it started for us…with its powerful theme “Break the Silence”, Barcelona and the launch of  the ambitious “3 by 5” initiative, Bangkok and the euphoria of ABC (Abstinence, Be Faithful and Condom Use), Toronto when it was finally “Time to Deliver”.

You can read about our experiences at those conferences

Toronto AIDS conference 2006: A Nigerian Perspective

Four years ago we were at another AIDS conference in Toronto. It was not good news, 25 years on; with close to 40 million people infected, mostly resident on our continent, it was impossible not to feel guilty about how it had all come to this. Often as workers in the “scientific community”, with our self gratifying altruistic attitude, we are all too quick to imagine that we can come up with quick solutions. But this has defied us all.

Peter Piot’s remarks during the opening ceremony were poignant;
“in an exceptional crisis, we must learn to act in exceptional ways”. 
Many scientists now moan at the lack of scientific rigor at these AIDS conferences. I will argue that it is just as important that this conference is open to a wide variety of people from all backgrounds. I remember the conference in Durban, in 2002. My decision to pursue a career in “public health” was motivated less by the over-whelming science than by the inspiration of people like Zachie Achmat , a South African activist  and founder of the Treatment Action Campaign (TAC). At the time, it was considered almost insane to imagine that ARVs, then costing about $10,000 per person, per year would ever be available to treat people living in Africa. Yet, Zackie Achmat and his group believed and convinced us that it was possible. Today we have seen that it is possible. This was not achieved by science or scientists!
History will not judge us by our scientific advances, but what we do with them.
Where will we be in 25 years time? A quick death from pandemic influenza, or a slow and painful death from HIV/AIDS? I remember clearly the words of Peter Piot, former Director of UNAIDS….
“we know what works….What remains is the will”. 
Next week another International Conference on HIV/AIDS starts in Vienna, Austria.

Nigeria Health Watch  will bring you the insights as it relates to our country on the blog, twitter and Facebook!

All for you!

Tuesday, 13 July 2010

Job seeking in Nigerian Hospitals

Recruitment for specialist positions in a complex sector like health, will always be a challenge. This is especially the case if the management team of a facility are really looking for the best people to provide care for their patients. This has been a problem in Nigeria for years as the recruitment process is hardly ever transparent. Previously, the only option for recruiters and job seekers was  the Guardian newspaper on Tuesdays and lately also on Thursdays. But the world has moved on, things have begun to change. Website aggregators are picking up jobs advertised in Nigeria, and making them available to a much wider range of people. It can only be in our best interest. But now we have to solve the problem of electricity and bandwidth. Despite the challenges we face, it is great that these jobs are now available to a much wider and diverse audience. Let us just hope that the recruitment process is equally as transparent.

Find below some current openings in Nigerian Hospitals 

Consultant Physician and Medical Officers at Reddington (describes itself as a 5-star medical facility) ...details here

  • Consultant Accident and Emergency and Traumatologist and Therapy Radiographer at the University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu...details here

  • Medical Officer and Medical Laboratory Scientist at St. Nicholas, Lagos ...details here

    Friday, 9 July 2010

    "Africa Health" not just a journal!

    Growing up with a physician for a father in 70s Nigeria, had a few of advantages and challenges. In the small university town of Nsukka, there were not many medical journals that came through the post. One that did come through inevitably every month was "Africa Health". As I slowly developed an interest for my father's profession, I began looking forward to this journal. It came with a good mix of stories and articles, inspirational and informative - but most intriguing of all was the quiz....with the answers upside down at the end of the journal.

    For over 30 years, Africa Health has been a leading source of clinical and managerial information for health professionals from across Africa. Incorporating the old Medicine Digest title in 2002 for a few years, it appeared as a part of Mera (Medical Education Resource Africa) journal which also incorporated the excellent African Health Sciences journal as well as sister journals, the African Journal of Diabetes Medicine, and the African Journal of Respiratory Medicine. But it did not really matter under what name it existed - it was always produced to a high quality in terms of content and appearance. Now Africa Health has its own website @ with almost all the content available for free, online.

    A few years ago, I finally met the brain behind getting Africa Health out to the African continent despite, the odds.  I heard from him the amazing story of how it has evolved. The journal was launched in 1978 by IPC Middle East Publishing Co Ltd (now part of Reed Elsevier) from an office in Morden, South London. The first editor was Ken Edghill who employed Bryan to be the Feature Writer for the title at its launch. Bryan took over as Editor in 1983, and then in 1985, effected a management buyout to set up what is now FSG Communications Ltd as an independent entity. Bryan Pearson bought the title back at the end of 2001, relaunched FSG Communications Ltd, and took over again as editor in a slimmed down operation.

    One obvious question is; what is the business model? Well, apparently it is a mixture of grants, advertising and subscription - but it has never been easy getting AH to colleagues all over the continent...not easy at all. Bryan appears to be constantly in search of funding to sustain the journal. Another obvious question is how this journal is distributed across Africa, and to this he has developed a complex system of distribution involving a group in every country that clears copies from customs and then organises distribution in country. Bryan's stories on how he keeps the show on the road are absolutely amazing! I have encouraged him to start work on his autobiography....

    What drives him I ask....he describes the work of his father, an eminent colleague Dr Andrew Pearsen. Dr Pearsen worked at the Wesley Guild Hospital, a Methodist foundation at Ilesha in Western Nigeria for 23 years of his life. Ilesha became the centre of world attention for its innovative and effective approach to both preventive and curative medicine. Bryan himself has become inextricably linked to Ilesha!

    With eminent colleagues like Professor Shima Gyoh, former Chairman of the Medical and Dental Council of Nigeria maintaining a regular column, "Africa Health" continues to grow from strength to strength as a resource for continuous professional development on the continent.

    Long may it feature on the desks of physicians around the continent!

    Click here to subscribe to Africa Health...and never miss the quiz!