Wednesday, 22 September 2010

What Jonathan said about Health in his speech

Picture courtesy of 234Next
On Saturday, 11 September,  Nigerian President Goodluck Ebele Jonathan (GEJ), who came into the office of the presidency accidentally declared his intention to run for President our Federal Republic in 2011. At 3:24pm, he made the declaration. "I, Goodluck Ebele Azikiwe Jonathan have decided to humbly offer myself as a candidate in the Presidential Primaries of our great party, the PDP". The speech went up, literarily minutes later on his Facebook page and within a few hours there were more than 2,000 comments. GEJ is quickly catching onto the emerging fact that technology, and the Internet have finally given people a voice they have not had for a long time. But in reaching out to Nigerians on the web - he must be prepared not only to speak but to listen as well.

In a speech that his team must have been working on for weeks...this is what he said his "dreams" for the health sector...
"Let the word go out that our health sector will receive maximum priority in a new Jonathan administration, a priority that will ensure maximum health care and stop our brain drain."
"We will fight for HEALTH CARE REFORMS"
 He then ended his speech by saying....
My dear country men and women, give me your support, give me your votes and together we will fight to build a great nation of our dreams!
So ..the question is - can we be hopeful that the health sector will receive some real attention if GEJ wins the next election?. While it is impossible to make this judgement based on one speech, we will take some positive pointers from the mentioning of heath, but advocate for much more attention to the sector in the coming dispensation.

But his speech reminded me of another speech made by another presidential candidate in Nigeria. I was 14 years old in 1985, listening to my father's radio, sharing his excitement at the emergence of a gentle Nigerian General - a certain Ibrahim Badamosi Babangida as he delivered one of the most passionate speeches of any Nigerian leader. He made the now famous reference to ...
"...hospitals still remain mere consulting clinics"
This ex-General went on to destroy the very fabric of Nigerian life. I watched the relative comfort of my family's life degenerate beyond belief. As our middle class existence slipped away from us, we took solace in the promises presented by the longest transition programme in modern Africa. We lived in hope and on hope. As June 12 1993 arrived, we celebrated. We had proved the world wrong...or so we thought! We had carried out a free and fair election, we were proud...proud young Nigerians. This moment was taken away from us, by the same General - Ibrahim Badamosi Babangida.

Now he wants to lead us again! 

As we struggle to put health squarely on the political agenda in Nigeria, we know that it cannot be done in isolation. It has to be done in the context of good governance,  accountability, integrity and on kept promises.

In January...I will use my vote wisely, I hope you do too!

Wednesday, 15 September 2010

The kidnapping of doctors and why it matters

That kidnapping is said to have become one of the biggest industries in Imo and Abia States is no longer news. An analysis of the tragedy of leadership and governance in these two south eastern Nigerian states is beyond the scope of this blog. Suffice to say until we fully realise the tragedy that has befallen us and the long term effects on our society, we cannot rise to the challenge of mounting a response. Aba, the "kidnapping capital" of Nigeria holds beautiful memories of a vibrant, entrepreneural city, alive with drive and energy. Even in the mid-nineties when I happened to be doing my housemanship at the same time our current Minister of Health had taken up his first consultant appointment at the new Abia State University Teaching Hospital, Aba, there was something special about Aba. Today, neither myself nor the minister would dare go to Aba (without the escorts of course)....

Prior to recent reports from Imo and Abia, most of the kidnapping of doctors seem to happen in Benin City. What is about these locations that has made them so risky for doctors? I am not sure whether the increasing number of reports about kidnapped doctors is reflective of a real targeting of doctors, or just that these are being reported more. And why does it matter any more or less when doctors are kidnapped - what makes them special ?. Nothing...I hear you say. I could not agree more. There is nothing more or less painful for the kidnapped person's family, depending on whether they are a medical doctor or not.

But it matters to society, it matters a great deal.

But before we go into why it matters - read a small selection of stories that have caught my eye. These rarely take people by surprise these days as we seem to have "normalised" them.

234 NextFormer Imo commissioner kidnapped
Just two weeks after Vincent Udokwu was sacked by the "the new face of Imo" as Commissioner for Health in the state, he was  kidnapped.from his hospital, Udokwu Memorial Hospital, Amaifeke in Orlu Local Government Area of Imo State. Coincidence? Who knows....Now doctors in Imo State are going on strike.

Thisday - Psychiatric Hospital Boss abducted in Benin
Management and staff of the Federal Psychiatric Hospital, Uselu, Benin City were yesterday thrown into confusion following the kidnapping of the Chief Medical Director of the hospital, Mrs.Olabisi Ihenyen along with her husband by unknown gunmen. 
Although details of the abduction are sketchy as at the time this report was published, THISDAY however, gathered that the kidnappers who abducted the CMD and her spouse while on their way to a social function in Benin, are demanding for a N50 million ransom. 

THEWILL - A professor of Medicine at the University of Benin Teaching Hospital (UBTHabducted in Benin. 
Professor. A. N. Onunu was on Wednesday night, August 25, 2010, abducted by gunmen at his residence in the Evbomore area of Benin City, Edo State. THEWILL reports that the gunmen stormed the residence of the medical professor at about Following his kidnap, all medical doctors in UBTH have suspended their services until the professor is released unconditionally. Also, the Edo State chapter of the Nigerian Medical Association (NMA) has directed all doctors in the state to down tools and only render emergency services to patients from 8 a.m. tomorrow (Friday), until he is returned.

Huhuonline - Five doctors were kidnapped in the space of one week in Benin. 
Benin City, medical doctors took to the streets, and marched to the palace of the Oba of Benin, Erediauwa Palace, following the trend where doctors had become primary target of kidnappers. Five doctors were kidnapped in the space of one week in Benin. Prominent among the kidnapped doctors is Dr. Osaro Osifo who was abducted by gunmen in May 2010.

Vanguard - Doctor kidnapped in Port Harcourt
Following the kidnap of a medical doctor, Princewill Obele, yesterday, in Port Harcourt his colleagues have threatened to embark on an indefinite strike if Obele is not immediately released by his abductors.

So what does this really mean for society?

A few of my colleagues who initially stayed in Aba, Benin and Port Harcourt are now moving to anywhere else they can live. Some are digging in while they have sent their families to Lagos and Abuja in search of security, while saving up to join them. What happens to the patients left behind ? To our old frail parents ?. Who cares for them ?. What does it say for our society that we accept that this happens ?. The kidnapped individuals are usually taken, often in full one swoop, communities lose the little that they still have. I just don't want to believe that society will not rise up.....and I am worried about what will happen when we do. Not one Nigerian that I know, not one ....has any faith in the Nigerian police. Now the Assistant Inspector General, in Zone 9, the epicentre of kidnapping in Nigeria, head-quartered in Umuahia, the capital of Abia State has been appointed the Inspector General of the Nigerian Police Force.

What does it say of our society when law enforcement fails? People are left with option but to respond. The widely reported kidnapping of journalists led to widespread protests. The NPF threatened fire and brimstone....but as these things happen, its all gone quiet since.

Recently, Vanguard reported that Catholic faithful protest kidnapping in S-East - Economic activities and vehicular traffic ground to a halt in parts of Imo State for the greater part of last yesterday as Catholics stormed the streets in a peaceful prayer procession against the ills plaguing the South Eastern States.

I remember an incident in Owerri vividly. It was in 1996. A mob went around town identifying the houses of all those known to be involved in "419" aross the town, with their shining new buildings marked by their fancy roof work. A young boy by the name of Innocent Ekeanyanwu had been brutally murdered allegedly for ritualistic purposes. His death was actually the straw that broke the camels back as people took the law into their own hands and went house to house knowing full well the individuals involved. The carcases of some of those buildings still litter the streets of Owerri.

We hope that people are never driven to take the law into their own hands again. But we know the people kidnapping. They live in the same communities where the doctors being kidnapped live and work. When doctors are kidnapped, a point has reached in our communities where something will have to give.

When there is so much pain in our communities....something will have to give.....

Tuesday, 7 September 2010

Nigeria at 50 - a cholera outbreak and an unperturbed elite

While in medical school in Nigeria, I learnt a bit about cholera ...that it is an infection caused by the bacterium Vibrio cholerae, and that the main symptoms include profuse watery diarrhea and vomiting, with the management being primarily with oral rehydration therapy (ORT) etc etc. The truth however is that I barely saw a case of cholera while practicing (...while aware of our limited diagnostic capacity). Cholera's main relevance was in the historical context, and a good examination question. 

Then I left Nigeria to study epidemiology. I learnt about the fascinating epidemiology of cholera. The disease spread by trade routes (land and sea) to Russia, then to Western Europe, and from Europe to North America. The beginning of modern epidemiology is credited to John Snow's investigation into the famous London cholera outbreak in 1854. John Snow later used a spot map to illustrate how cases of cholera were centered around a water pump. He also used statistics to illustrate the connection between the quality of the source of water and cholera cases. He showed that the 2 water companies: Southwark and Vauxhall Waterworks Company were taking water from sewage-polluted sections of the river Thames and delivering the water to homes with an increased incidence of cholera. Snow's study was a major event in the history of public health, and is widely regarded as the founding event of the science of epidemiology. The most amazing aspect of this bit of history is that the connection between water and illness was proven before the discovery of the bacterium "cholera" - indeed it was before the acceptance of what was then considered the "germ" theory of disease.

We can also look at Zimbabwe where between 2008 and 2009, the country faced one of the largest cholera outbreaks in recent history with over 4,000 deaths. Conventional wisdom was that Zimbabwe had such economic problems that one could rationalise this as a symptom of its broader challenges.

Why do I give this short historical perspective? Its just to say that cholera is one of the oldest diseases known to the medical profession, it can be prevented by the simplest of interventions - clean drinking water, it is treated by the simplest of interventions - water, sugar and salt. So when there is a huge cholera outbreak in Nigeria, with close to 400 deaths, in 2010 - one has to think how the nation's public funds are being used when the International Airport in Abuja is apparently being renovated to celebrate 50 years of nationhood! My understanding is that the outbreak is still not under control. Even if it were, the next one is surely round the corner. Now it is time to sit back and think.... 
Why should we be having an outbreak of cholera in Nigeria in 2010?

Most medical textbooks will tell you that cholera is caused by a bacterium. What very few will tell you is that it is really a disease of poverty, and a failed society. Yet, one wonders why there was hardly any protest in the newspapers as the outbreak escalated. Our elite in Abuja, Lagos, Kano and Port Harcourt hardly said a word as they were not affected. When a patient does get cholera, there is still no reason in 2010 why the patient should die! Every single death should be treated as manslaughter. A failure of our health care services to provide the most basic of care - water, sugar and salt - for the most vulnerable in our society. 

But even at best, the current response to cholera outbreaks tend to be reactive, in the form of an emergency response. While this approach prevents many deaths, it fails to prevent cases of cholera. Cholera is usually transmitted through faeces contaminated water or food. Outbreaks will continue to occur sporadically anywhere that the water supply, sanitation, food safety, and hygiene are inadequate. So why then is this not a priority for our governments in the affected states. In all their pronouncements on NTA network news at 9 pm every night ( best a most painful experience to watch)  - not once have any of the governors or commissioners taken responsibility. 

When about 400 Nigerians died in air crashes in our Nigeria 4-5 years ago, the country was up in arms, the press was alive, it filled the national discourse. Investigative committees were set up, airlines were banned, airports closed, protests filled the streets. So why are Nigerians silent about the 400 men, women and children who have died of cholera in 2010? The answer is simple - they are poor, they do not read or write in newspapers, and are largely seen and unheard. They do not belong to the elite. They are forgotten, neglected, disenfranchised. Their votes do not count. THEY DO NOT MATTER. A truly sad state of affairs.

We are all guilty - you and I!

But we can do something about it. As we move into the election season, lets us ask our politicians what plans they have for providing us with the basics, the very basics. As our president buys 3 jets for the presidential fleet - lets us remind him that people are dying in Nigeria, in 2010 - of cholera! Let us ask the senators representing these areas - where they have been. How often they have raised their voices in protest? If you are reading this blog - you will probably never have a challenge like cholera - but it is still our problem. 

Let us put health back on the political agenda! 


Thursday, 2 September 2010

Nigeria Health Watch on Twitter: aggregating health stories out of Nigeria

Those of you that read Nigeria Health Watch regularly, will know that we routinely collect interesting health news stories in the Nigerian press, and then blog about them. Well, technology is evolving rapidly. Information placed in the hands of the citizens will change our relationship with our "leaders" forever. So, as Nigerians prepare to monitor the polls, we will continue monitoring the health scene. But rather than waiting for us to collect these stories, and sending them out - we will send them to you as they are published on twitter. You can access them by following us on  Twitter here -

This way - you will never miss a story. Anywhere you are, on a cell phone, on your laptop, ipod, ipad or blackberry! The information you need, to influence the destiny of our health will always be - one click away.

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