Ebonyi State Government: Immunize to Save the Nigerian Child!

Some of the common childhood killer diseases are pneumonia, measles, malnutrition, neonatal tetanus and tuberculosis. They are all avoidable and can be prevented through immunization and provision of nutritional supplements like Vitamin A. Other vaccine-preventable diseases include polio, whooping cough, hepatitis, diphtheria and neonatal tetanus.  Polio may have low mortality rate but can be very debilitating and prevents children and by extension societies from achieving their full potentials. 

Nigeria is one of the 3 countries in the world that is yet to eradicate polio virus; the other two are Afghanistan and Pakistan. Nigeria also one of the highest infant and under-five mortality rates globally. The federal government has made commitment to intensify efforts to eradicate polio in the country possibly by 2015. During National Immunization Plus Days (NIPDs), states provide counterpart funds to ensure the distribution and administration of vaccines to children in their homes or schools. This activity helps to provide herd immunity and protect the child from the vaccine-preventable diseases. It has been demonstrated to save lives of many children in Nigeria.

Our attention has been drawn to the non-participation of Ebonyi State in the on-going National Immunization Plus Days. The state is allegedly not interested in providing counterpart funding to facilitate the NIPD process. We are very concerned by this development as it would make Ebonyi children vulnerable to childhood killer diseases. It may also reverse the gains made so far in the effort of the Government of Nigeria to eradicate polio in the country. Although cases of polio are predominant in the northern part of the country, relocation of people from the crisis-ridden northeast to other parts of the country makes every state vulnerable.

More so, Ebonyi State has the highest cases of childhood malnutrition and performs low in many other health indices in the Southeast. Most of the residents of the state live in rural areas many of which lack access to orthodox health service delivery. Failure to participate in the NIPD will prevent many Nigerian children resident in Ebonyi State from getting immunized. This, in our opinion, is most unfair to the innocent children and dis-service to the country. 

We strongly encourage the Government of Ebonyi State to reconsider its position and act swiftly to save the children. We also call on the Minister of Health, Professor Onyebuchi Chukwu; who incidentally hails from the state; the State House of Assembly, National Assembly and all well-meaning Nigerians to prevail on the governor to do the needful as soon as possible in the interest of the country.  The human right of the Nigerian Child resident in Ebonyi State is being trampled upon by the state government. Time to ACT is NOW! May God bless the Federal Republic of Nigeria.

Health Equity Nigeria (HEN) is a coalition of youth-led organizations in Nigeria. We believe that every Nigerian should have access to best possible quality of preventive and curative health care services no matter where the person lives or socioeconomic status. We use various media platforms to advocate for improved health access to ensure health equity in Nigeria.

Signed:

Dr Laz Ude Eze, MPH, CPH

Executive Team Lead,

Health Equity Nigeria

Tweet us @healthequityng

Industrial Disputes in the Nigerian Health Sector: A Need to check the Rising Trend

This piece was first published in June 2009 edition of The Health Advocate, the magazine of the Nigerian Medical Association (NMA). 

Labour unions exist in every sector of the economy and are recognized worldwide as a platform through which workers seek to improve their general well being as well as that of the society. The health sector is not left out as we have the Nigerian Medical Association for medical doctors, Nigerian Dental Association for dentists, National Association of Nigerian Nurses and Midwives, Medical and Health Workers Union of Nigeria, Pharmaceutical Society of Nigeria, Nigerian Association of Physiotherapists among others. The primary goal of these labour unions in the health sector is to ensure the welfare of her members which would eventually result into better services at the various health institutions.

In fact, industrial disputes are inevitable as it is normal to have employers and their employees take different positions on policies or matters bothering on the welfare of the later. What is important is for such disputes to be resolved timely and amicably through dialogue and mutual respect. Unfortunately, this has not been the case in recent times in the Nigerian health sector. Even when agreements are reached, government at times does not implement them and in some instances suspend or abrogate policies emanating there from. 

As I write, the entire health workforce in Ebonyi State University Teaching Hospital are on the eleventh week of an indefinite strike action over the failure of the hospital management and state government to implement an agreement to improve staff welfare and provide adequate facilities in the hospital. The resident doctors in same hospital had embarked on strike for three weeks over same issue last September and were also forced to down tools for four days in February this year over the state of insecurity in the same hospital. In a related development, doctors under the employment of Lagos State government went on strike twice within the last the last six months; their counterparts in Anambra State had just suspended an almost eight month old strike a few months ago. Edo State doctors also had dispute with the state government over an alleged outrageous taxation imposed on private hospitals in the state.

Furthermore, resident doctors in Federal Medical Centre, Abeokuta reportedly downed tools because of an arrest of one of their colleagues by an anti-graft agency while on duty post. Doctors in Ladoke Akintola University Teaching Hospital, Oshogbo have also embarked on strike on at least two occasions within the last couple of years. In Abia State University Teaching Hospital, Aba, resident doctors were also on strike over the failure of the state government to implement the consolidated tertiary institutions salary scale (CONTISS). It could be recalled that a few years ago, doctors in the same hospital downed tools over an alleged physical assault on their colleague by a spouse of one of the political top shots in the state. Also in Oyo and Imo State, some health workers in the state were recently reported to be on strike. I could go on and on.

As if the above were not enough, the federal government inaction over the restoration of MSS/MSSS she unilaterally suspended about eleven years ago compelled the National Executive Council (NEC) of NMA to issue a 28 working the ultimatum to do so or face a nationwide withdrawal of services by doctors. But for the success of the negotiations between NMA and FG, Nigeria with her terrible health indices would have been left without the services of doctors for some time. However, only the timely implementation of the agreement would completely avert an industrial action.

The upsurge of industrial disputes and withdrawal of services by health workers is so alarming and not expected in any society with a people-oriented, responsible and responsive government. The contributions of Nigerian doctors and other health workers to national development cannot be over emphasized despite poor remunerations and unconducive working environment. Without sounding immodest, no other sector or group of workers make as much sacrifice like health workers. When people go to a health institution for care, they would of course want to be attended to by well trained and up-to-date health professionals with appropriate diagnostic and therapeutic equipment and also in good time, anything short of this is not acceptable. Ironically, same people criticize health workers when they withdraw services to compel the government to make the hospitals better equipped and more conducive for patients care. 

Nigerian doctors are very diligent, dedicated and go extra mile to care for their patients. We contribute money and sometimes donate blood to save our patients, even when the patient’s relatives may have abandoned them. This situation is commonly encountered in paediatrics department where children usually present as emergency with life threatening ailments and severe financial constraints on the part of the parents. I am sure that doctors detest withdrawal of services. NMA rarely go on strike. This is recently demonstrated in Ebonyi State where the state chapter of NMA despite the unacceptable treatment of her colleagues in the teaching hospital and sustained provocations by political jobbers in the state refused to be compelled to embark on statewide withdrawal of services. Similarly, the National Executive Council of NMA recently suspended her planned withdrawal of services to allow the federal government act on their agreement over restoration of MSS/MSSS.

It should be noted that the health sector alone cannot thrive when other sectors are also torn apart by regular industrial disputes, therefore, government must equally meet the demands of the Nigerian Labour Congress, Academic Staff Union of Universities, Nigerian Union of Teachers, NUPENG/PENGASSAN, etc to move the nation forward.

Nevertheless, the ugly consequences such as loss of lives resulting from industrial disputes in the health sector are unquantifiable. Also, the adverse effects of the strikes in the education and other sectors on manpower and socioeconomic development of the nation are better imagined. The persistence of these regular industrial actions would not only undermine the efforts to improve the nation’s health indices but would also make the achievement of the Seven-point agenda, Vision 20-20 or the UN millennium development goals a wild goose chase. 

In conclusion, prevention is better than cure; therefore, industrial action of any form should be avoided especially in the health sector. This can only be possible if government at various levels demonstrate strong political will by improving the situation of health in Nigeria through motivation of health workers, provision of modern diagnostic and therapeutic facilities in the hospitals as well as providing a qualitative and affordable education at all levels; to say the least.

A Need for Improved Healthcare Delivery in Ohaozara

This piece was written and shared in Forum for Ohozara Progressives in March 2013

Ndi ibe anyi ekene m unu (my people I greet you),

I plead with you to make out time and go through this piece.

I’m very concerned about the situation of healthcare delivery in Ohaozara. I grew up in my hometown Okposi and have always spent some days with my parents at home every year. My friends and relatives use the health centers and hospitals within Ohaozara and share their experiences. The situation at this time is that most of the healthcare facilities in our area do not have the capacity to manage medical emergencies. They also lack the capacity to treat some common curable health conditions in our area. The implication is that every one of us is at risk of dying from a treatable medical emergency or having complications/disabilities from curable diseases.   Why did I say everyone when all of us don’t live at home? An emergency can happen when one visits home.  It may happen to our loved ones. This is 21^st Century; we need health facilities that should be able to comfortable treat most of the common diseases experienced in our area. Don’t you think so? 

On Saturday, April 30, 2011; exactly 5days after my friends and I founded Okposi Education Initiative, my childhood friend, Ukpa Nwankwo had a road traffic accident and died the following day. I always shed tears on his birthdays and death days; it was one of my most traumatic experiences.  More so, my parents travel to Abakaliki treat conditions that any of the General Hospitals in our area would have been able to handle if they are functioning optimally. We have been losing many of our loved ones to highly preventable and curable health conditions. We can’t continue that way. 

Many individuals and groups have carried out free medical outreaches from time to time. It’s very good, we need more of that and I pray that God continue to bless them. However, the gains of such programs cannot be sustained if the healthcare system remains very weak. Apart from lack of modern facilities in our health centers and hospitals, the number of health workers is grossly inadequate. Lack of supportive supervision and capacity building trainings for the available workers also contributes greatly to the poor quality of health services in Ohaozara. If I’m asked to name one factor that is responsible for this, I will say it is LACK OF POLITICAL WILL. Therefore, our LGA s and more importantly the state government need to demonstrate strong political will in this regard.

I commend the efforts of dedicated health workers in our area who do their best under the challenging circumstance to do their job. The efforts of individuals and groups that carry out free medical outreach in our communities are also pleasing and commendable. (I’ve been involved in a couple). From my interaction with lots of folks, I observed that many people are as frustrated as I am. But it’s not enough to lament about the problem and do nothing. The question now is what are we doing about it? What do we intend to do about it?

 I must mention that through the efforts of one of our illustrious sons, Dr Nkata Chuku, Ohaozara and Onicha LGAs were selected to be part of the 5 LGAs where Global Fund Health System Strengthening projects are being implemented. I was part of the implementing team of the project in Ohaozara and Ezza South when it started in 2011 and Ohaozara LGA did very well in doing what was required of it to support the project. However, the idea is to use the 10 health centers in the local government to serve as a model of what government should replicate in the rest. I hope our LGAs and Ebonyi state government will do the needful. 

Over the last couple of years, I’ve been undergoing postgraduate training in health policy, global health and health systems management. But I wouldn’t be fulfilled if I don’t use whatever knowledge and skill I’ve acquired for the benefit of my community. I’ve decided to start an advocacy and treatment support program for indigent people (especially widows) in Okposi living with hypertension (with possible expansion to other communities). I will be making a presentation about this in 2 weeks time during the Clinton Global Initiative (CGIU) meeting at Washington University, St Louis in United States. Using the platform of my NGO – HAPPYNigeria, I hope to implement this beginning from the end of this year. We would also use the opportunity to draw attention of government and development partners to the health needs of our people. I seek everyone’s support in this. 

I would also want everyone to brainstorm what we as a people should do to improve the standard of hospitals and quality of healthcare in Ohaozara nation. I will want us to continue to have conversation on this. Please feel free to share your thoughts.  God bless you.

Lead Poisoning: Bagega and the Failure of Leadership

Last week the media was agog with a news report titled “Saraki commends Jonathan’s intervention in Zamfara village”. When I read this title on twitter, I quickly clicked on the link with excitement to read the details. I thought the reason for the commendation could be that the problem of lead poisoning which has reportedly claimed the lives of more than 400 children in Zamfara State has probably become a thing of the past. I was completely wrong. The Chairman of the Senate Committee on Environment, Dr Abubakar Bukola Saraki was commending Mr. President for his “approval to release promised funds for the remediation of Bagega Community in Zamfara State”. My excitement immediately turned to strong feeling of disappointment. I feel you may want to know why, please read on.

In March 2010, an unprecedented epidemic of lead poisoning was discovered in Zamfara State. This was a consequence of the activities of local gold miners in the affected communities.  Although there has been gold mining in Zamfara for decades, the substantial appreciation in the price of gold since 2009 led to an upsurge in artisanal mining activity. Local miners dig up rocks by hand, breaks them into pebbles with hammers, grinds the pebbles to sand with flour mills, and extracts gold from the sand using sluicing, panning, and mercury amalgamation (and in some cases, cyanidation). Usually the health problems associated with artisanal mining are related to mercury and/or cyanide use. However, in Zamfara, gold bearing deposits contain unusually problematic concentrations of lead. Consequently, the environment has become terribly polluted, so much so that the CDC described the epidemic as the worst in modern history. This has resulted to the devastating effects of lead poisoning especially among children and pregnant women in the community. The worst hit community at this time is Bagega.

 

An international organization, Medecins Sans Frontieres (MSF) also known as Doctors without Borders has been on ground since the discovery of this tragic epidemic helping to treat people affected particularly children. According to its recent report, MSF has enrolled more than 2500 children in her treatment programme; 2000 were still on treatment, 500 on follow up while 300 had been discharged at the time of the report.  Lead poisoning affects both children and adults but children have more risk of exposure (closer to the ground, crawl and play often) and the effects on them are more catastrophic. Lead poisoning may cause a lower intelligence quotient (IQ), behavioral problems, stunted growth, chronic anemia, deafness or chronic kidney disease/failure. Lead poisoning rarely shows any sign or symptom until the exposed person becomes very sick.   Some scientific studies have documented a correlation between lead exposure among women and higher rate of miscarriage, premature deliveries, stillbirth and congenital malformations. But is treatment of identified cases as MSF is doing enough? Absolutely not! Chelation therapy without remediation is like using basket to fetch water.

 

More so, mining of natural resources is in the Exclusive List of the 1999 Constitution (as amended). Therefore, the federal government bears the responsibility of controlling the activities of the miners and protecting the environment from pollution that may arise from those activities. So it won’t be out of place to say that the lead poisoning epidemic is a sign of governance failure. One would have expected any responsible government to react swiftly and stop illegal mining in Zamfara, train the local practitioners on better and safer techniques to maintain a healthy environment without denying the local miners their source of economic sustainability. A responsible government would also embark on immediate remediation of the affected communities and treatment of identified cases. 

 

How did the federal government respond? An Inter-Ministerial Committee on Lead Poisoning was inaugurated by the Presidency in 2010. What did the committee achieve? Nothing! In May 2012, the federal government convened an International Conference on Lead Poisoning in Abuja during which President Jonathan reportedly pledged a release of N850 million to clean up the affected communities. Sadly, none of the 7 action points unanimously agreed at the conference has been fully achieved 8 months after.  According to MSF report, the technical sub-committee of the Inter-Ministerial Committee visited Zamfara in mid-October 2012 (more than 2years after the discovery of the crisis) for an assessment and also met with stakeholders. Expectedly, the visit was widely publicized; the Federal Ministry of Information wrote a story on its website titled, “Lead poisoning: Proper management system stepped up in Zamfara State”.  What happened thereafter? Absolutely Nothing! There has been ongoing advocacy by MSF, Human Rights Watch and local civil society groups. Not even the action of Nigerians who besieged Mr. President’s facebook page last year to express their frustration with his inaction was enough to spur government to expedient action. 

 

I’m not unaware of the efforts of Senator Saraki’s committee to draw attention to the situation; I’ve personally read his tweets on that. But I find it difficult to understand why he should be commending the President for “approving” money to solve a problem that has claimed the lives of more than 400 children and left many others with permanent disabilities almost 3years after the discovery of the crisis. As usual, the federal government will have their explanation but none will be acceptable for this horrendous display of leadership ineptitude and crass insensitivity, to say the least. The government of Zamfara State that kept waiting ‘forever’ for the federal government’s intervention when it could have mobilized funds, saved her children and the environment and apply for refund from the federal government isn’t better either. For how long would Nigerians continue to suffer from anemic and marasmic leadership especially when it concerns health matters? Action is long overdue; Save Bagega!!!

Tweet me @donlaz4u

How Fever Kills our Children in Nigeria

Yes please, you read it correctly, fever. But does fever kill? Can it really cause death? Of course it can, particularly among children less than 5years. Nigeria has retained her unenviable record as one of the countries with the highest cases of childhood death globally. I used to think the figures were being inflated. However, from my experience as a physician and public health practitioner, I feel the magnitude is likely underestimated; no thanks to our poor data management system.   

Is fever a disease, of course not, it is actually a common symptom of many childhood killer diseases in Nigeria. Fever is defined as body temperature of more than 37.4 degrees Celsius. The common childhood killer diseases that present with fever in Nigeria include malaria, pneumonia, measles, HIV/AIDS, otitis media, meningitis, tuberculosis and urinary tract infections. All the conditions listed are preventable and curable or treatable. So when a child has fever in Nigeria, it is usually due to at least one of the listed diseases. If appropriate medical care is not provided in good time, the health situation may deteriorate and cause serious complications or even lead to death. Besides the danger posed by the progression of the disease pathology, the progression of the fever can also lead to convulsions; this is known as Febrile Seizure/Convulsion.

Febrile seizures occur in children aged between 3months and 5years of age. It is triggered by high body temperature in a sick child. It can lead to permanent disabilities or death. Sometimes the body temperature can be very high and may not be detected by palpation; the most objective way is by measuring it with a clinical thermometer. Every family with children less than 5years should have the thermometer at home. The right action to take when one suspects that a child has fever should be to expose the body; if the temperature is above 38 degrees Celsius, immerse a clean piece of cloth in cold clean warm-to-cold water and use it to tepid-sponge the child and take him or her to a health facility for appropriate care as urgently as possible. Delay can be very dangerous. Self medication is very risky especially in children and strongly discouraged. The use of herbal concoctions is also very dangerous and can lead to kidney or liver failure as those organs are too young to metabolize the contents of the concoctions.

Furthermore, we as a people must have to make deliberate efforts to save our children and ourselves from the nightmare caused by the above highly preventable and treatable health conditions. The burden of disease and mortality has remained too high for a long time despite the efforts being made to solve the problem. It is either we are not doing enough or we are not getting it right. It is inexcusable and totally unacceptable for Nigeria to be losing up to a million children annually to childhood killer diseases. According to World Malaria Reports 2011, out of every 4 children with malaria in the world, one is a Nigerian. About 300,000 Nigerian kids die from malaria every year and the financial cost to the country is estimated to be N132 billion annually. On the other hand, pneumonia is also causing havoc and ranks second to malaria as the killer-in-chief of Nigerian children. Studies show that at least 17 children die every hour in Nigeria from pneumonia. Diarrhea may or may not present with fever but is also a major childhood killer disease.

The good news is that many countries have defeated these ailments. Countries like United States had similar experience in the 19^th and 20^th centuries but took measures to make it history. Nigeria can do same and everyone’s effort is needed to make it happen. The main focus should be on primary prevention. It is the duty of government to enact and enforce policies that will create an environment that will make the incidence of the killer diseases negligible. It is also the duty of the Nigerian people to abide by the regulations. Good personal hygiene is key. Childhood immunization and utilization of antenatal services by pregnant women is strongly recommended. On her own part, government at all levels must demonstrate strong political will and strengthen the health system particularly the primary health care. Nigeria is almost always among the top five countries in every poor health index, a comeuppance of chronic systemic corruption and poor governance. All hands must be on deck to reverse the situation and without further delay. Let our children live. Have a splendid and disease-free new year.

Follow me on twitter - @donlaz4u

 

Between Stress, Anxiety and High Blood Pressure (Hypertension)

In my community, whenever someone suffers stroke or is said to have high blood pressure (commonly addressed as ‘high BP’), people would ask, “what is s/he thinking about?” I grew up with the notion that high blood pressure (hypertension) is caused by deep thoughts arising most probably from financial difficulty. But later, some affluent men I knew were also said to have high BP. Theirs were said to be caused by “stress” – that rich people were always ‘stressed up’ thinking about their money.

A few weeks ago, I was watching Cable News Network and I was amazed with the news of Frankie Muniz, a 26 year old American who was diagnosed recently of mini-stroke. I was wondering what could be responsible for stroke in an apparently healthy young man, but in medicine, you can never say ‘never’. The CNN Chief Health Correspondent, Dr Sanjay Gupta went ahead to interview the actor/musician and he said he started feeling funny, gradual loss of balance and dizziness on his way back from a workout station. The diagnosis was made after clinical evaluation and radiological investigations.

More so, veteran actor, Enebeli Enebuwa was reported to have died last week. He was being treated for stroke (a complication of hypertension) he suffered over a year ago. Was he thinking too much? Was he anxious or under severe stress? What is the relationship between stress, anxiety and high blood pressure? What really causes hypertension? Find out in the following paragraphs.

Blood pressure is expressed as a fraction – the numerator represents the systolic while the denominator represents the diastolic. For most normal people, the systolic ranges from 110 to 120mmHg while the diastolic from 70-80mmHg. It is usually a bit lower in people who exercise a lot which is good. Hypertension occurs when the blood pressure is sustained for a long term at or above 140/90mmHg and can only be diagnosed by a trained medical personnel. Stressful situations can cause your blood pressure to spike temporarily and return back to normal. Doing exercise up to 30-60minutes a day can reduce your blood pressure and stress level too. There is no proof that stress itself causes long term high blood pressure.

What about anxiety? It doesn’t also cause chronic hypertension. But episodes of anxiety may lead to a dramatic temporary blood pressure rise. If those episodes occur too frequently, such as everyday for a long period of time, it may damage some vital organs of the body. Anxiety may also lead one to engaging in abnormal behaviors such as smoking, excessive alcohol consumption, etc which are risk factors for hypertension.

Hypertension is mainly of two types: primary (essential) and secondary. The primary type is commoner and the cause is yet-to-be known. There are factors that increases a person’s chance of developing hypertension, they include – overweight, obesity, smoking, men above 50yrs, postmenopausal women, etc. Some of these factors are not modifiable, for instance, you don’t need to change your sex to avoid the risk of getting hypertensive. How do you know whether you have hypertension or not? You can only know by checking your blood pressure. If it is very high, you may be required to rest for about 4hours and it is repeated. Hypertension does not usually show any symptom or sign until it gets complicated. It damages the blood vessels, heart, kidney, etc gradually and the damages caused may not be reversible if the hypertension is not identified and controlled in good time. Some of the complications include but not limited to the following: stroke, heart attack, chronic kidney disease and dementia. Secondary hypertension is caused by some health conditions and disappears when the causal disease if treated/cured.
Treatment for primary hypertension is for life. Strict adherence to medication as prescribed by the doctor is strongly recommended. I’m not aware of any scientific proof that herbal medication is effective; rather, it may damage the kidney and cause a sharp rise in blood pressure and may result in stroke or sudden death. It can be very debilitating. 
In conclusion, stress and anxiety don’t cause long-term hypertension. Early diagnosis and treatment of hypertension will prevent complications which can lead to sudden death. Do regular exercise, avoid tobacco smoking, eat healthy foods and check your blood pressure at least once in a year if you are less than 50years. Have a good week.

 If you have questions, kindly mail them to leze@happynigeria.org. Follow me on twitter - @donlaz4u

Road Safety: Between Prayers and Behavioral Change

About this time 5years ago, I met with my cousin Chukwuma who had just started his business after 7 years of apprenticeship. He had his goods on a mobile truck which he pushed round the streets of Ibadan to make a living. Then I was in my final year in medical school. Chukwuma and I grew up together and I had wished he was in school like me. We shared ideas on how he can grow his business and get a shop. I was looking forward to when I would graduate and make some money to be able to assist him raise some capital. Later that month, he travelled home for the Christmas holiday. On his way back to Ibadan, he died in a road traffic accident alongside other 18 passengers on board a commercial bus. May his soul continue to rest in peace.

What could have led to the accident? Could it have been due to bad road network, bad weather, vehicular technical problem or over-speeding, drunk-driving, or other practices that violate of traffic regulations? Could it have been caused by evil spirits (the usual culprit in sad events with unfound causes or with causes we refuse to accept)?  I don’t really know; but must have been due to at least one of the above. Most of the roads across the country are in deplorable conditions, the level of indiscipline among road users is terribly high while the ineptitude or endemic corruption among the enforcers of traffic regulations remains unacceptably high.

Before my cousin’s demise, I’ve seen many victims of the daily carnage along Lagos-Ibadan expressway being treated at the University College Hospital, Ibadan. Besides, I’ve also been involved in at least 4 road accidents in commercial vehicles (along Lagos-Ibadan, Abakaliki-Enugu, Asaba-Benin and Abuja-Lokoja roads); thankfully, I left unhurt unlike many other co-passengers. The major problem here, in my opinion, is not lack of knowledge about the causes of the road accidents but the lack of will by individuals to adopt favorable behavioral changes. Politicians have continued to award road contracts with poor or no execution. The system is not also doing enough to enforce the existing regulations. Many people hold on to this assumption that most road crashes are caused by evil spirits or “enemies” and consequently fail to take preventive measures seriously. That’s absolutely ridiculous.

I believe in the existence of spirits – good and bad, I also believe in the power of prayers; but I do not agree that prayers alone will provide the solution to accident-related morbidities and moralities. Even the bible said that “prayer without work is dead” Prayers are not lacking in Nigeria, what is lacking is the “work” component. The Federal Road Safety Commission has improved in recent times as has made good safety policies like use of helmet, seatbelt, compliance with traffic regulations, etc. However, according to Road Safety Report of 2010 by World Health Organization, helmet wearing rate in Nigeria is less than five percent and more than 50 percent in Chad. It might interest you to know that in more pedestrians, bicycle and tricycle vehicles users die from road accidents than users of other vehicles. I think road safety did a lot in publicizing the laws, the people need to change their behaviours, the enforcement agents need to step up and deal decisively with identified violators in line with the provisions of the law.

Road traffic accidents is one of the leading causes of death among people aged 15 to 49, the most productive age group in the country. Sadly, Nigeria has not prioritized investment in the improvement of road safety. The people themselves have jaundiced assumptions on the causes and required solutions to it.  If it’s all about evil spirits, the prayers said daily in motor parks, churches, mosques, shrines, etc would have stopped road accidents. As we continue to pray, let drivers stop getting intoxicated with local kparaga before hitting the roads, let all road users observe traffic regulations (many Nigerian road users don’t even know them), let the government at all levels make our roads smooth, wide and usable,  let FRSC sanitize itself and give drivers license only to those who have adequate knowledge of road traffic laws and good driving skills, let the police enforce the law especially in all traffic offences, let the government strengthen the medical emergency system to effectively attend to people who may inevitably be involved in accidents and let every individual resolve to be law-abiding.

 As people travel to different parts of the country to spend the Christmas holiday with their loved ones, it is my hope that compatriots will drive carefully so as to reach home alive and safe. Prayer only is not enough, act right!

George Egbuchulam: why we must act now!

I write with tears in my eyes. I’m heartbroken, I weep for the future of my country if people like George Chimezirim Egbuchulam should be dying from curable medical conditions. I’m terribly disturbed because I’ve continued to see this kind of deaths since my days in medical school. While some may see it as an act of God, it is perhaps more traumatic for those of us who due to our professional training, know it ought not to happen. The question then is, why can’t we stop it?

A lot of times, determinants of health and outcomes of health conditions are not within the control of the medical personnel. The behavior of the people and the actions and/or inactions of the leadership of any society largely determine the state of health and life expectancy. In the case of George, the later is to blame.

Late George Egbuchulam

Over the last months, George, his family, friends and well-wishers, medical personnel at the University College Hospital (UCH), Ibadan and even folks like me that haven’t met him fought through prayers, fundraising, professional input, blogging, etc to save his life. How I wish death had spared George for the sake of the loved ones and what he stands to contribute to societal development, but it didn’t. What do we do now? The usual stuff: shed tears, blame health workers or UCH, observe one minute silence, fill condolence registers, do candle light procession, post nice words about George on our facebook and twitter timelines; and move on? No, George deserves better that. Nigerian youths deserve better! We must not allow this to repeat itself, but how do we stop it? Let me give a brief background about the medical condition that killed our beloved friend, George.

Chronic Renal Failure (CRF) is an abnormal condition when the kidney is no longer able to perform its functions optimally and it is usually caused by chronic kidney diseases (CKD).  Common causes of CKD in Nigeria include chronic glomerulonephritis, hypertension, diabetes, sickle cell, urinary tract obstruction, etc.  The functions of a normal kidney includes blood formation, maintaining calcium balance to make bones strong, removal of harmful metabolic waste products (like urea and creatinine), control of blood pressure, maintenance of potassium balance which enhances the activities of the heart and also regulates the pH of the blood. When the kidney fails, there will be low blood count (anemia), weak bones, accumulation of toxic substances in the body, high blood pressure, heart failure and increased acidity of the blood. All these do not occur at the same time but anyone that occurs progressively gets worse as the illness progresses with time. The goal of haemodialysis is to remove excess fluid and toxic metabolic products from the body. It is not and can never be as effective as the kidney will do it naturally. It has its own side effects too. It’s only a temporary measure and transplant ought to be done as quickly as possible. 
   

A cross-section of the human kidney

 

In the case of George, a scanned UCH radiological investigation request paper I found in google images suggests he had chronic glomerulonephritis (CGN). The functional unit of the kidney is the nephron. The part of the nephron responsible for filtration of harmful waste substances is the glomerulus.  CGN is the inflammation (swelling) of the glomerulus and it has various types; needless to bore you with their names. It appears to me that he was in Stage 3 renal failure around July 2012. There are some types of CGN that 80 to 90% of patients may progress to Stage 4 (end-stage) renal failure within 10 days to few weeks. If transplant is not done early enough, the body progressively gets weaker even with ongoing dialysis. It may get to a level that it may not be strong enough to even withstand and survive the transplant. This is the problem most people with this condition face in Nigeria.

Our health system unfortunately is in a condition where about 70% of expenditure is out-of-pocket in a society where about two-third live in poverty and half of the youths are unemployed. The disease does not understand that the money is not there, it continues to get worse if unattended to. Many countries including Rwanda have social health insurance covering this type of condition. If Nigeria had such, perhaps George might have had his transplant as early as July, and wouldn’t have had to be on dialysis until September when good-spirited Nigerians were able to raise adequate funds for the procedure. Perhaps we wouldn’t have lost him. Yes, he would have lived. I’m very upset, same way I was when I lost a 17year old patient who was the only child of her widowed mother; same way I was when a youth corps member with similar condition had to leave our care in hospital for prayers because of lack of funds only to return later in a worse condition and eventually died. Some got sponsorship from their state governments and went to India for transplant, but couldn't return alive; the funding came late. Too many cases!  I can still see their faces, they all shared their dreams and life ambitions with me but they are gone with those lofty dreams. I wept the days I lost them, it could have been me, and it could have been anyone else.

More so, one thing I’ve learnt from many change-makers is that they’re usually inspired by an unpleasant occurrence. I heard many of such accounts while watching the presentation of CNN Heroes recently. The Tunisian revolution was reportedly instigated by an unemployed youth who committed suicide.  My health advocacy activities since my undergraduate days at the University of Ibadan (UI) were also inspired by some ugly personal experiences and furthered strengthened by my professional experiences too.  We need a stronger health system in Nigeria to provide good quality, affordable and equitable health care. When I read Fisayo Soyombo’s piece on George in July, I decided to do an article on this blog to support the fundraising effort and draw attention to what people with such conditions go through. Like Fisayo, George would have been a very close friend if I had met him in person. They both share admirable and enviable qualities. Beyond that, my colleagues and I in HAPPYNigeria launched a #SaveAll campaign to demand that government begin a functional social health insurance scheme. We started an online petition and expected that thousands of Nigerian youth will rush to sign it, so far, less than 200 have signed it.

For the sake of George, we must insist that government takes the needful measures to make our health system stronger and also begin a universal health insurance for all Nigerians irrespective of socioeconomic status. We should do it with same vigour and enthusiasm demonstrated during the #SaveGeorge campaign. I have started it in HAPPYNigeria, feel free to join the #SaveAll campaign by signing the petition here. A youth ambassador like Nze Sylva Ifedigbo wrote about it here. You can do same – update your facebook wall, tweet, blog, and sing about it, use your respective organizations, organize peaceful rallies; send SMS, call or mail your legislators and governors; just do whatever you can.  

George had a very bright future. I and many others started just like him in UI with active participation in campus journalism and other extracurricular activities. Our development as a nation will reman stunted if we continue to lose people like George in similar circumstances. No one knows who would be next. For the love of George, for the love of us and for the love of Nigeria, let the youths take action to persuade the government to make Nigeria healthier. By so doing, George will be remembered for not only doing well in life but also that his death brought about lasting change that saved many lives. Let’s #SaveAll, Act Now!

May the soul of George Chimezirim Egbuchulam rest in the bosom of the lord, and may God strengthen his family to bear his painful demise, amen.

Follow me on twitter - @donlaz4u

 

Managing Health Projects in Nigeria: My PATHS2 Experience

This piece was published on PATHS2 page in August 2012. Enjoy.

 

I’m a graduate student of the University Of Kentucky College Of Public Health in United States. I’m studying for a Certificate in Global Health and Masters in Public Health with concentration in Health Services Management. I did my summer internship at Partnership for Transforming Health Systems phase 2 (PATHS2) country office in Abuja, Nigeria.

Prior to the commencement of my graduate studies, I had a one year experience working on implementation of the Health System Strengthening project of Global Fund with focus on HIV/AIDS, Sexual & Reproductive Health, Tuberculosis (HAST) and Malaria.

I wanted a different experience during my practicum and PATHS2 provided that. Being aware that PATHS2 project being implemented by a consortium of 5 different organizations led by Abt Associates; my interest was in learning how they all work together to manage the project successfully. The experience was awesome, I must confess.

My Supervisors - Dr Amina Aminu and Dr Sam Usman

I worked directly with the Service Delivery Team at a very important period of the project when PATHS2 was preparing for annual review as well as development and costing of the Year 4 Work Plan of the project. I participated and prepared the report on a technical meeting to review the service delivery component of the project.

The 2-day meeting improved my understanding of project management and report writing skills. Although the project has same output/outcome indicators and targets, I was excited to learn how the implementation strategies varied from state to state (factoring in the people’s culture, religious belief, and some other peculiar circumstances etc) to bring about lots of success stories already recorded. The supportive supervision from Bethesda headquarters office of Abt Associates and the cooperation/ team spirit demonstrated by all the partners including DFID were amazing.

In my Health Economics class, I learnt about the management of scarce resources to get optimal value in service delivery and I learnt how PATHS2 uses the principles to get maximal value for money. I observed a technical meeting on the financing of the project, value for money for activities already executed was demonstrated and costing of the work plan for the subsequent year done. I may not be able to aptly express the impact of that meeting on me, but I have no doubt that the experience has enhanced my management skills.

PATHS2 focuses on strengthening health systems and improving the maternal, child and new born health services to reduce Nigeria’s unenviable high maternal and infant mortality rate. With the support of PATHS2, the free MNCH programme of Jigawa state government is being implemented in a cost-effective manner with satisfactory outcome.

The emergency transport scheme has brought about lots of success stories in Kano; ongoing partnership with private sector in Lagos is expanding the availability of good quality services and the support to DRF system in Enugu has solved problem of stock-outs in supported cluster facilities. Apart from advocating for the sustenance of the gains of the project, PATHS2 is also making deliberate and targeted efforts to persuade government to replicate her model in the non-cluster facilities. I consider that awesomely good.

PATHS2 has very dedicated and lovely staff; I enjoyed my time with the organization and cherish the experience and new skills I acquired. My supervisors - Dr Amina Aminu and Dr Sam Usman were awesome. My only regret is not having more time to work on the project as I have to return to Kentucky to complete my studies. I will miss the jokes of Dr Mike Egboh, the National Program Manager.

 

PATHS2 Country office Service Delivery Team

 

 

Will Nigeria’s ‘Saving-One-Million-Lives’ Initiative save a thousand?

As a growing child in my hometown, Okposi (Ebonyi State), news of a new born child in our neighborhood was always a pleasant one. My peers and I always looked forward to visiting those homes to rub a local liquid powder-mix called nzu and watch our mothers sing and dance. Our joy came from the fact that there was an additional person who would queue behind us to pick whenever gifts are shared by seniority; the new born was also a potential playmate. Okorie (not real name) was only 2years old and had many episodes of febrile convulsion. Usually while we play, we would see the mom rushing him to the clinic after applying some local herbs and palm oil, the siblings wailed while we watched with fear and apprehension. We had lost a couple of our playmates with similar condition in the past. We didn’t lose Okorie but he grew up with a very low intelligence quotient (IQ). No doubt, those convulsions caused significant brain damage.

In another development, one of our neighbors, a widow had only one daughter – Chi Chi. She got married to one spare parts dealer who used to buy biscuit for us. We loved her because she also used to shower us with gifts. We were patiently waiting for her arrival from a missionary hospital where she had gone to deliver her first baby. They came back with the baby, and everyone’s face was gloomy and eyes were red and tearful.  Chi-Chi reportedly died after child delivery. Her mother almost became psychotic.

Since then, I grew up with lots of questions on my mind. Why was Okorie’s fever always leading to seizures? What may have caused Chi-Chi who was hale and hearty to die after delivery? Could such occurrence be stopped? If yes, how? I found answers many years later during my medical training. Those childhood experiences and my desire to be part of the solution to the disaster of high maternal and child mortality in our clime influenced my decision to build a career in public health.

President Jonathan, health ministers and legislators during the launch

President Goodluck Jonathan launched an initiative to Save-one-million-lives by 2015 in Abuja a few days ago. It is a comprehensive program to scale up access to essential primary health services and commodities for Nigeria’s women and children. Nigeria accounts for about 10 per cent of the global maternal mortality and has one of the highest infant and Under-5 mortality rates in the world. This initiative builds on a growing international momentum behind maternal and child survival.

I consider this initiative laudable. Any program that can save one woman or child from dying should be applauded and supported. Perhaps if this was started much earlier, Nigeria would not have lost Mrs Ngozi Nwozor-Agbo (initiator of the Campus Life page of The Nation newspaper) to child birth 4 months ago. She was one of the most intelligent and inspiring women I’ve ever met. But am I excited about this initiative? The answer is no. But I have cautious optimism.

Nigerian health professionals are among the best one can find anywhere in the world. We have always come up with laudable health initiatives many of which have been used as a template for health programs in other countries. But the biggest problem has always been in implementation. It is depressing to know that the primary motivation for a majority of the people who would implement this initiative would be how much money they would make rather than the number of lives saved. Endemic systemic corruption in the system has led to stunted growth of our health system despite billions of naira spent annually. This is what makes me worried. My expectations have been dashed on several occasions.

I have browsed the website of the Federal Ministry of Health to find details of this initiative but it appears the last update of the site was more than a month ago. By launching this initiative, I believe government has demonstrated the political will to improve the maternal and child health situation. The Midwives Service scheme, I hope, will provide human resources for the severely under-served communities but would that be enough?  Will the government strengthen the logistics management information system to ensure those essential commodities reach the intended beneficiaries and not end up in the homes of some unscrupulous officials? Will the monitoring & evaluation system be strengthened to effectively monitor the impact being made? With this top-down approach, are the local government councils who directly oversee the primary health centers effectively engaged in this scheme? Will this initiative not end up becoming Saving-one-million-naira for the officials involved?

Will this Saving-one-million-lives initiative save up to a thousand lives by 2015? Only time will tell.

May God continue to bless Nigeria.