Thursday, 28 June 2012

A quiet miracle.....Is this the end of CSM?

Very rarely have vaccines given us the opportunity to create a small miracle. Unlike the miracle of surgery and antibiotics that brings the ill back to health, vaccinations prevent you from getting ill; so the miracle of vaccinations is often not obvious and not celebrated. We do not experience the emotional roller coaster of coming back to life - so we tend to underestimate the impact vaccines have. Every family in Northern Nigeria is aware of "CSM"......cereberospinal meningitis. Particularly affecting children and young adults, they would have fever, signs of collapse, neck stiffness and may even slip into a coma as the bacteria invades their blood and the space around the brain.

Picture courtesy of MSF
The most common cause of this is a bacteria -  meningococcal A. This presents in waves of epidemics every 2 - 3 years in an area across West Africa called the "Meningitis Belt". With it comes pain and death to many families.Until recently,the options for a medical response was a very painful injection of chloramphenicol or a polysaccharide vaccine of limited use because its effect only lasts for short periods,and it had to be given after the outbreak was already underway - often too late (you can imagine what it would take to mobilise outbreak responses with mass vaccination in our Nigeria). So the term "CSM" is widely associated in the North with pain, suffering and death. 

But in the past few years - we have a new vaccine - the meningococcal A conjugate vaccine developed through the Meningitis Vaccine Project. This vaccine will not need to be given every year and has a long lasting impact and therefore the ability to reduce and potentially eliminate transmission. In a project that is really unique in its conceptualisation and execution, the vaccine was produced with almost no commercial value in the West, entirely for use in the developing world, produced entirely in India. The partnership between the Bill and Melinda Gates Foundation, PATH, the World Health Organization (WHO), the Serum Institute of India, the Centers for Disease Control (CDC), SyncoBio, and academia has made this happen. But as with everything of this nature - it required the relentless energy and passion of one man to push the agenda over a 10 year period - Dr. F. Marc LaForce for which he has just been awarded the Sabin Prize.

In 2011, the meningococcal A conjugate vaccine reached 3 new countries and more than 35 million people including Nigeria. Pending adequate funding, the Meningitis Vaccine Project and its partners hope to vaccinate an additional 265 million people throughout the African “meningitis belt” by 2016, thereby ridding the region of a disease that has caused havoc for more than a century. With all the pain in our country ...maybe this is one thing we should celebrate.

But in Nigeria, this programme, like many other public health programmes is at risk. The insecurity in many areas of the North will eventually compromise vaccination programmes. So we need a miracle of peace for the miracle of vaccination to be possible.

Thursday, 7 June 2012

A lose, lose, lose situation...

Doctors employed by the Lagos State Government have been on strike. Subsequently 788 of them were sacked by the Lagos State Government, then recalled, now they have refused to go back to work until the recall is put in writing. In all the articles written about the strike, sack, recall one thing has been extremely disturbing. The almost complete lack of empathy about the fate of the patients. This refers to those in support of the doctors, and those in support of the government - there appears to be a cold bloodied disregard for the fate of the hopeless poor that have no other place to go to than public sector hospitals in Lagos State. The fate of the patients has hardly come up in all the could it have come to this?

Why have we hardened our hearts so? Is it because we cannot imagine ourselves in the place of the patients served by the the public sector in Lagos? Maybe because they are poor? Is it because they do not have access to influence ? They do not tweet...they do not write. They do not call into radio talk shows. Even when they have the opportunity to vote, it is taken away from them. We take it away from them....

Both the governor and the doctors took oaths. Oaths to serve the people, to put their interests first - the doctors swore - above all things to do no harm. To do now harm! 

After the oath ....they asked "so help me God!"

And the people's voice? We have been blunted by the struggles of daily life, hoping not to to fall ill. When we do - we hope that our local 'chemist' store will be able to provide a remedy. If the health issue appears serious, we reach out to our brethren to support the charges of the private hospitals, where the quality of care, we have no clue about. We pray hard - that at least we can do, we are very good at prayers. We have some of the greatest prayer warriors on earth. So we pray very hard - and pay out tithes religiously....hoping for a miracle. 

As you read this, we are mourning our dead from the Dana plane crash in Lagos. The plane crash did not discriminate - men, women, husbands, fathers, wives, mothers, children, rich, not so rich. May their souls rest in peace. It is no comfort to them - but we will remember them. We recognised many of the names as the news broke on Sunday night....They are like us reading this blog. But you will not find many of those that rely on the public health care system in Lagos State on that Dana flight. Those that have died in Lagos State as a result of the strikes are unknown, unseen, unheard; plane loads of them. No tweets with their names, no pictures on facebook, no hysteria, no public crying, no 3 days of national mourning, no investigation, no hospital to hold accountable nothing......nothing..... just their poor families left to mourn them. 

So ...what if there were survivors from the Dana plane crash.....which hospital would we have taken them to? And the injured on the ground....they live in Iju Agege! Where do we think they get their healthcare from? Oh Nigeria ...what happened to us? What happened to us?

It is time for us to admit that our leaders and politicians are a reflection of us. As we change, so do they. Not the other way. - Francis Daniels


Monday, 4 June 2012


7 years ago, my emotion laden brother Ike Anya wrote this piece after the Sosoliso crash. Today I read it again and share it with you.... true today as it was on the day it was written on Friday December 16 2005.  

I am sitting at my computer, transfixed by the images on the internet of the grieving parents and relatives of the over one hundred people that died in Port Harcourt at the weekend in an aeroplane crash. I am still reeling from the news that one of my younger brother's closest friends, someone we had all grown up with also died in the crash. Each time I shut my eyes, I can still see his bashful smile as I opened our front door to him and he asked whether my younger brother was home. Occasionally he would ask how my medical studies were going; occasionally I would ask how he was doing. He was like a younger brother, his sister was my classmate, his parents we called Uncle and Auntie and they were there at all our celebrations just as we were at theirs. And yet, today he lies lifeless, murdered, like so many other thousands- by you and me- his fellow Nigerians.
I do not choose my words lightly. We murdered that young man, just as surely as we murdered all the young school children on board that flight, children going home on their Christmas holidays. The fate of these children holds particular poignancy for me, for I too, remember flying home at the end of school term for Christmas. I remember the harmattan haze that often meant that flights were cancelled, which on more than one occasion meant that we had to sleep at the airport. I remember particularly the apprehension in December 1983, just after a Nigerian Airways plane had crashed, killing many; but despite our fear we eagerly looked forward to going home, to circling the dirt brown, harmattan dried fields around Enugu and to touch down into the warm embrace of our families. These children and these families will not know that joy. And we are all responsible.

We are all responsible- starting from the owners of these aeroplanes who cut corners, wanting to make a quick buck, regardless of how many lives they put at risk, ignoring the myriad other opportunities to make money in Nigeria. And before you leap to exclude yourself, saying, "I don't own an airline", I will point out to you, that each time, you doctor, owner of a private hospital, provide drugs of doubtful quality and efficacy at an extortionate price, you are equally responsible. Each time you delay referring a patient when you are well aware that the illness is beyond your capability, you are responsible.

Each time we turned aside and paid a bribe, or jumped the queue because we knew some big man; from the market woman who slips in rotten tomatoes into the bottom of the heap cheating her less eagle-eyed customers, to the airline regulators who are supposed to inspect and maintain safety standards but either through incompetence or sheer corruption shun their duties, to the journalists who collects brown envelopes and turn the other way when evil is committed, to the civil servant who signs in at 8 and disappears thereafter, to the legislators and politicians who prefer ferrying Ghana must Go to providing true leadership, we are all every one of us guilty of murder. And I do not excuse any sector of society- the teachers and lecturers who abandon their classrooms, the pastors and imams who abandon their callings and have become sucked into the quagmire that our Nigeria has become all carry their share of blame. Because we all went to the thanksgiving services and celebrations of these people who had acquired their money trading in human lives, we drank their beer, or Five Alive, danced to their music and hailed them. And so they thought it was acceptable.

The person in charge of running a National Immunization Programme thinks that it is acceptable to misappropriate funds that mean that young children die; administrators at schools and universities mismanage their resources, blighting the future of the young. Pilots and airline stewards fly planes that they know have not passed safety checks, because the alternative is hunger for them and their families. At motor parks, we freely tolerate the sale of strong alcoholic beverages and then climb aboard cars crammed full, driven by half-drunk drivers, saying our prayers as we board. Politicians are more interested in their internecine petty squabbles and how to make money than in building up the country and showing leadership. And we all celebrate mediocrity and materialism and flamboyance and in doing so, played our part in bringing this tragedy to pass.

And if perhaps you are thinking- I am abroad, I am not involved- I say to you "It is a lie, you too are culpable" For each time we condoned the kleptomania and corruption of our leaders and our society, for each time we turned our backs on Nigeria, justifying our decisions to ourselves- my children are still young, I need to finish my degree, my family needs the money I'm sending back- we too are responsible. For each time you saved up all year, maxing your credit cards to the limit to go back home and live lavishly for a little while, boosting the asinine materialistic culture that thrives there, ignoring the poverty around, you are culpable.

I am not suggesting that any of these decisions or life choices are easy, far from it. All I want us to do is to acknowledge that even as we make these decisions - to emigrate, to take ten per cent, to bend the rules, to glorify ill-gotten wealth- that there are negative consequences to balance all the positive reasons we have for making our decisions and culpability in murder is a part of it.

Thousands of Nigerian children die each year because they are not immunized. We demand debt forgiveness, improved aid, and when we get it- are the children immunized? No, some people are busy squabbling about which company will supply the vaccines. You can apply the same analogy to the water sector, energy sector, the banks, and virtually every sector of the economy. At election time, it is all about money, we do not care who is elected, and we continue to say "Wetin we go do? Na only God fit save Nigeria", abdicating our God given responsibilities.

Tragedy after tragedy happens as a result of our sins of omission and our sins of commission and we move on, forgetting. Who killed Bola Ige? Nobody has ever been held to account but we moved on. Who killed Dikibo? No one knows, but still we moved on. The list is endless- disaster after disaster occurs, often manmade, often preventable, but no one is held to account and we move on. Instead of tackling these issues, we are caught up in political scheming and one-upmanship, seeking power not because we want to make things better but because we want to improve our individual lot. The roads are bad, so we plunder and scheme and steal to buy 4 wheel drives, there is no electricity, so we buy generators, the Police is a farce, so we build high walls and hire security or travel with armed security escorts. Our schools are bad, so we open new expensive private universities or send our children abroad; the country teeters and so we go to have our children abroad to gain foreign citizenship as insurance. Our hospitals do not function and then we go abroad for check-ups. And so we continue to ignore the rot, trying to slap a plaster on what we know is a huge gaping sore. We are appointed to jobs where we are not given the equipment we need to function and we stay there, pretending that all is well. And in doing so, we acquiesce to murder.

What emergency plans are in existence for searching for and rescuing victims of a major disaster? What medical expertise exists and is ready, and how are they primed for mobilization? There is a National Emergency Management Agency and there are people employed there, where were they in the thirty minutes it was alleged it took for any form of rescue to begin? What contingency plans do they have in place to deal with incidents like these? How much money has been allocated to this agency since its inception? Is it adequate? How can we still be asking Julius Berger, a private company for any sort of basic assistance when we encounter disasters like these?

When are we going to say enough is enough? Today, tomorrow or never? Are we going to continue in complacency, wringing our hands and saying what can we do? When are we going to say "a decisive no" to evil and begin to build a real society?

While we ponder the answers to these questions, let us remember that it may be our kin or us next time. And let us not forget the millions of Nigerians who do not fly in aeroplanes but who everyday suffer from what we have done and what we have failed to do. How are we going to atone for the lives of these children, men and women, extinguished through our own omission?

It is time we stopped crying and pointing fingers at the aviation industry, or at individuals for in the end we are all guilty of murder. We can choose to continue as before, and simply move on, or we can decide that there is value in the life of every single Nigerian and that we will do all that we can to protect it. But regardless of our choices, let it be clear that by our actions and inaction, we are accomplices to murder.

To my brother's friend and the hundred that died with him, please rest in peace and forgive us for failing you. For in tolerating the evil that pervades our society, we all had a hand in your deaths.