Saturday, 31 December 2011

What a year: 2011

This guest post by Chima Onoka....brings the year to an end for NHW

What a year it was.....2011 seemed to be one of those years when it started, but it turned out a significant year in many respects to history bookmakers. The events are numerous – End of an era in many countries – people who have been national leaders since I was in primary school – from Libya (Ghaddafi) to Egypt (Mubarak), Tunisia, North Korea (Kim Jong il), Ivory Coast etc (though Mugabe seems to be the oldest last man standing, and perhaps the Cameroonian and Ugandan presidents). There were uprisings that changed the face of the Arab world in a direction yet to unfold, exchange of 1 Israeli life for over 1,000 Palestinian prisoners, declaration of interest for statehood by Palestine at the UN, death of Bin Laden, a Nuclear disaster in Japan to remind us of what we live with, a new global economic crisis, suspension of a funding round for HIV/AIDS by Global fund, slash of funding for UNICEF and other organizations, death of Steve Jobs of Apple, break-up of Sudan into two nations, 2 royal British weddings mixed with riots, and protests in the USA.

There were also Cancer hits – from Venezuelan and Argentine presidents (which Chavez says US is giving them), unbelievable protests in Russia, threatened Euro zone, some hope for a malaria vaccine, breast implant recall, downing of a Drone in Iran for inspection, memorable election in Nigeria and Liberia, Barcelona winning all football competitions it participated in, 3 joint female Nobel peace prize winners, and the world hitting a population of 7 billion despite all the deaths inflicted on others by evil hearted people, conflicts and numerous natural disasters.

In Nigeria, where do we start? Recurrent massacres of innocent, ordinary Nigerians by an ill-defined sect called Boko Haram has left the country and its people bewildered. ...Christmas day saw 43 killed in the Madalla Church and still counting. But there were other deaths too.... some of those who influenced the path of Nigeria – gold medallist Sunday Bada, industrialist and publisher Alex Ibru, the Dim, Odumegwu Ojukwu, Admiral Aikhomu on the day his boss IBB clocked 70, banker Aderinokun of GTBank, singer Christy Essien-Igbokwe, many in the bombed UN house Abuja who are from nations around the world that helped shape health related policies, and so many uncountable people whose names are little known.

For many who face our health system, the challenges they go through navigating the system are just too painful to be ignored. The absence of accessible and quality health care especially in rural and peri-urban areas, the absence of emergency and referral services, absence of health insurance cover for over 150 million of Nigeria’s 160 million population, poor commitment to implementation of health policies by politicians, health facility managers, and professional associations, and unending strikes in hospitals. The situation is further compounded by problems with institutional and infrastructural promoters of health – poor roads and transportation, loss of accreditation by medical schools, insecurity and impoverishment, a health bill that is still waiting for the president’s signature, and the deficiency of labour and civil society organizations with sincere interests and political power to influence change.

As we enter the New Year, we could all determine to make a difference in our society. Let us determine in the New Year to show love to those who are products of conflicts...orphans, widows, homeless, and to those with difficult marriages, children and parents, and the poor. These all have underlying social determinants, precipitators and propagators of ill health. Let us also chose to Care for the poor, visit those who are unfortunate to be in hospital beds or who live in fear with health conditions that threaten their very existence. May we all spend more time thinking about solutions and praying for and about our leaders than we do criticizing them. Let us determine to help develop systems that will hold our political leaders and health managers to account. Let us also provide support in any way we can to the people who meet us daily in health facilities... while we hope that health will be taken more seriously in the political agenda in 2012.

Finally, let us pause a while and reflect on our blessings, God’s mercies, forgiveness, and love even when you did things that were inappropriate...or took risks... on the road, in the air, and in places that people go to and never return because of insecurity. We may have talked about what we ‘were passing through’... but really...we passed through them with God’s help... since we are still around. The gift of life we have as we enter the New Year is enough for us to determine to make the contribution necessary for people to be thankful that we existed. 

Happy New Year!

Saturday, 17 December 2011

GMC withdrawal of recognition from some Nigerian medical schools: a lesson in poor information management

The General Medical Council in the United Kingdom recently posted on its website a list of medical schools whose primary medical qualifications were no longer accepted for registration or licencing. Graduates from these schools from certain dates were advised that they were not to apply for the PLAB examinations which are the main route for international medical graduates seeking registration to practise in the United Kingdom. Nine Nigerian medical schools were listed including the University of Nigeria, the Universities of Benin, Jos, Port Harcourt and Nnamdi Azikiwe University. The full list of universities is available here

As the editors of this blog are all graduates of the University of Nigeria, we were naturally concerned. But apart from some agitation by colleagues on Facebook and Twitter, we could not identify any activity in response to this. We therefore decided to contact the relevant parties to understand why this decision had been taken and what steps were being taken to resolve the situation. We received a prompt response from the GMC asking us to put our request in writing to the press office, which we did. Attempts to contact the Medical and Dental Council of Nigeria by telephone and email failed. Similarly, an attempt to contact the Chief Medical Director of the University of Nigeria Teaching Hospital did not produce any response.

In its formal reply to our enquiries, the General Medical Council said
“The decision to add a number of Nigerian qualifications to our list of qualifications that we do not accept for the purpose of registration was made in light of information we received from the Medical and Dental Council of Nigeria (MDCN). We were advised that the MDCN had suspended their accreditation of those schools…..The decision to add the Nigerian qualifications to our list of those that we do not accept took effect on 14 February 2011. The decision only applies to students who graduated from those medical schools after the MDCN suspended their accreditation. The GMC is currently considering information from the MDCN indicating that the medical schools’ accreditation has been reinstated. We hope to be in a position to make a further decision regarding the acceptability of these qualifications shortly and subject to receiving responses to any relevant enquiries that we may need to make.”
It speaks volumes that there is no information about the withdrawal of accreditation from these institutions on the MDCN website or the websites of the concerned universities or the Federal Ministry of Health (their website is down - on 17/12/12) There has been virtually no news article about this in Nigerian newspapers or websites. The MDCN has not proactively stated why it withdrew the accreditation from these universities, to the best of our knowledge. There might have been press releases in local Nigerian newspapers, but in 2011 this is hardly enough. The universities themselves have not tried to put their own sides of the story in the public domain.

We have previously on this blog commended the MDCN for its attempts at trying to take more seriously its role in regulating professional standards in Nigeria. However it is important that it communicates clearly to the public what it is doing and why it is doing it. As a publicly funded organization, and one whose role includes promoting public confidence in the medical profession, clear and timely communication is not only essential but critical in today’s world. If the MDCN found the time to communicate its decision to the GMC in the UK, surely it could have found the time to do the same for the Nigerian public. Perhaps in the past, these decisions could be made in secret rooms and private meetings; this is no longer the case.

As for the affected institutions, they appear not to have grasped the importance of communication in an age where the internet has made information easily accessible. Once the information was published on the General Medical Council website, it was accessible to virtually the whole world- potential employers, graduates, patients all over the world. The first step people would take after reading the article would be to seek a response from the affected institution or the Medical and Dental Council of Nigeria. In the absence of their side of the story, there is the opportunity for rumours to spread. A statement on their website would take an hour to put up!

In addition to this, it is important that in addition to not being proactive in communicating its own decisions or its impact, it was only the British General Medical Council that felt it was important enough to respond to our queries. The Nigerian media also has an important role to play in ensuring patient safety- that they all appeared to have missed this story is an indictment.Given that the response from the GMC suggests that they expect to be able to issue a revised statement soon, it appears that this issue may be resolved soon. However, the key lesson for the institutions, the Medical and Dental Council of Nigeria, the Nigerian media and other social institutions seems to be that although things go wrong even in the best organized societies how information and communication is handled can either improve or worsen the situation.

We hope that the public relations directors in these organisations are listening; but more importantly we hope that the leaders of these organisations referred to above realise that communication is not some "extra peripheral activity" but an integral and important part of the leadership function. They will either learn from this or learn the hard way in the future...

Thursday, 1 December 2011

Musings on World AIDS Day 2011

Dear Friends,

Today is World AIDS Day.

HIV continues to be one of the most important communicable diseases in Nigeria. It is an infection associated with serious morbidity, stigmatization of the infected, high costs of treatment and care, significant mortality and a high number of potential years of life lost. Each year, many thousands of individuals are diagnosed with HIV for the first time, and tragically in 2011 - about 70,000 babies were born infected with HIV in Nigeria - a completely preventable situation.

But we talk about HIV/AIDS so much that no one seems to notice any more. So, I thought I'd spend today reminiscing about the moment I made the decision to leave clinical medicine, and pursue a career in public health; a decision initially driven largely by the emotions at one conference. I was halfway through my MPH programme (which at the time I considered a stop-gap measure) when I stumbled upon an opportunity to attend the XIII International Conference on HIV/AIDS that was taking place in Africa for the first time - the location was Durban, South Africa in the summer of 2000.

Nothing quite prepared me for this experience. It all started with the opening ceremony where a young man spoke. At the time, the political establishment in South Africa was in denial of the AIDS epidemic, and the world had accepted a situation that life-saving antiretrovirals would be out of reach to most people living in Africa. At the opening ceremony; Nkosi Johnson spoke 7 words that brought most of those gathered in Durban to tears - literally - when he said "I am a very lucky little boy." He had lost both his parents to the virus and was raised by foster parents. But he felt lucky because at the time of the conference he was South Africa's longest surviving AIDS baby. He stood on the stage at Durban that day and begged South Africa to stop stigmatising people with HIV/AIDS. On the day, he shared the stage with the then President of South Africa, Thabo Mbeki, who at the time refused to accept that HIV caused AIDS.

Then at the first plenary, the Jonathan Mann lecture was delivered by Constitutional Court Justice Edwin Cameron, who was the first South African in a senior official position to disclose his HIV/AIDS status as positive. On stage he held the audience spell bound with his speech ending with the profound words  ..."I am here because I can pay for life itself".  In 2005 Edwin published Witness to AIDS, described as a “part-memoir, part compelling analysis” of his struggle with HIV/AIDS in South Africa. These two heroes re-defined for me what leadership really meant.....

At the conference there was a meeting of Nigerians attending the conference, an initiative of Mr Omololu Falobi (RIP). Just a year into our then new democracy, with a HIV prevalence that had just crossed the 5% mark, a new “National Action Committee on AIDS” etc, we were enthusiastic about defining the way forward. A wide variety of issues were discussed…an innovative plan to place the first 10,000 patients on ARVs, a new strategic plan, our poor research capacity and then raging  “Abalaka issue”. In attendance at that meeting included Prof. Maurice Iwu, at the time, an active researcher on alternative medicines for diseases (before his foray into election management he later became the IEC Chair) as well as Professor Idoko (The current DG of NACA). We sat around that table, in a meeting chaired by Professor Akinsete, and we left…full of hope. 

Today, 11 years later...little has changed. The HIV prevalence has marginally decreased to about 4% of the sexually active population. While a lot more Nigerians are receiving life-saving antiretrovirals, 95% of these are funded by donor funds. But, the Nigerian Senate has been busy! In less than a year, they passed the Anti-gay marriage bill, while the Anti-HIV stigma and discrimination bill has been sitting in their offices for over 7 years now....In many ways ....I sit back and wonder about the theme of that epoch making conference when advocacy for antiretorivirals took the centre stage and wonder if we in Nigeria are any closer to "breaking the silence". Sadly not - we are still at a stage most countries were several years ago - clouded in stigma, looking for scapegoats.

Yet, the bottom line is that global leadership is nearly exhausted. Western countries are completely enmeshed in their own domestic politics and crisis management. Our government, professionals and our people must get beyond the soft money available “chop” from donor funds, as well as the short-sightedness of our stigmatising attitudes, prejudices and dogma, and face up to the challenges that lie ahead of us. It will not get better on its own, and we are simply not doing enough. Business as usual will not get us far....and that is all we have at the moment. 

Welcome to World Aids Day 2011.