AIDS Campaign ribbon for World AIDS Day 2011

Thirty years ago, HIV – a murderous, delinquent, devious and mysterious virus seemingly appeared out of nowhere. The first five cases of what is now known as the Acquired Immune Deficiency Syndrome (AIDS) among homosexual men were reported in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. The amount of knowledge gained since that sombre day of June 5, 1981 when the disease was first reported has been remarkable, but much remains to be done with regard to delivering treatment to the people who need them most.
In the 30 years since its first recognition, AIDS has killed nearly 30 million people worldwide, turning another 16 million children into orphans. Today, an additional 34 million people are living with the virus that causes the disease, Human Immunodeficiency Virus (HIV). In Nigeria, it is estimated that approximately 280,000 AIDS-related deaths occur in the country every year and 2.23 million children have already been orphaned by the disease.
In many families and communities in Nigeria, HIV is a stark reality. Visit any community or health facility in any of the 36 states including Abuja, you will hear a familiar tale of the losses to AIDS and its manifold clinical presentations due to its weakening of the body’s immune systems. In many of these locations, HIV/AIDS has a face and it is not pretty. Pictures of poverty, hopelessness, sickness, depression and death have come to characterize this debilitating illness. From the first time I shook hands with an HIV-infected person in one of the communities supported by an NGO in Kenya in 2004, information and infection of HIV is now widespread. The person sitting next to you might be HIV positive.
The World AIDS Day is a platform to commemorate people who lost their lives to HIV, applaud progress made in responding to the epidemic and recommit to ending the tragedy. The theme of this year’s campaign, “Getting to Zero” echoes the vision of the Joint United Nation’s Programme on HIV/AIDS for the next five years. UNAIDS is focusing on achieving “Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths by 2015.” Other groups are also talking about Zero discrimination.
As we enter the fourth decade of HIV/AIDS, our task in Nigeria is to build on available advances and deliver scientifically validated interventions to everyone who needs them, both in the rural and urban communities. Domestically, access to treatment and care also is not optimal. Despite a lot of efforts by international organizations and Nigerian partners, large numbers of HIV-infected individuals are not aware of their infection. This is largely due to the long gestation period of the virus before clinical symptoms begin to appear. This is a challenge for HIV testing efforts. Greater numbers of HIV-infected individuals need to be identified early in the course of their disease through expanded voluntary HIV testing programs and linkage to appropriate care and antiretroviral treatment.
Earlier in the history of the disease, there was a lot of focus on trying to prevent the epidemic spreading than treating the affected. Recent research and innovations have addressed this shortcoming. Treatment can now be said to be one of the best forms of prevention. If you can stop the virus reproducing in someone’s body, you not only save his life, you also reduce the number of viruses for him to pass on. If we can get enough infected people on drugs, it would be like vaccinating them, thus breaking the chain of transmission. Antiretroviral treatment regimens can prevent HIV infection. When given to pregnant HIV-infected women and their newborns, these drugs have been enormously successful in preventing mother-to-child transmission of HIV.
There is a huge task ahead which would involve bringing in those with already weak immune systems who should already be on the drugs, with others who are not yet showing symptoms but are also infected with the virus. This requires more effective screening and also willingness by those without the symptoms to be treated.
The USG through PEPFAR is a key partner in Nigeria’s HIV response and recently signed a Partnership Framework with the Government of Nigeria to guide collaboration through 2015. Other lead donors and development partners include the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United Kingdom, and the UN agencies. A large number of NGOs in Nigeria are also leading the fight against HIV/AIDS but they require a lot more support in order for their efforts to yield the desired results. The Mailman School of Public Health at Columbia University was one of the USA-based institutions that rose to the challenge of working with local and global partners to address HIV/AIDS challenge in sub-Saharan Africa and established the International Center for AIDS Care and Treatment Programs (ICAP) as the platform for action in this respect. Since 2005, the organization has given hope to millions of Nigerians particularly in the states of Kaduna, Gombe, Akwa Ibom, Cross River, Benue and Kogi states; providing access to free diagnosis, medical care, pharmaceuticals and other supportive services to persons living with HIV. The baton for this support has since passed on to the Centre for Integrated Health Programs (CIHP) which is a successor indigenous organization taking the lead in Nigeria’s HIV response with a focus on sustainability in partnership with the US Centers for Disease Control and Prevention.
Organizations such as these and many others who are working daily to reduce the transmission of HIV in Nigeria require critical support from the government and the private sector in order to achieve total elimination of HIV transmission. In addition, prevention programs using proven tools need to be dramatically scaled up, refined, improved, and made more cost-effective. This requires a lot of funding and efficient management.
Despite these challenges and the huge burden of this disease, we now look at the fight against HIV/AIDS and our chances of prevailing with considerably more optimism than we previously have felt. With the medical and public health tools now or soon-to-be available, controlling and ending the global HIV/AIDS pandemic are feasible goals.
For persons living with HIV and their families, children who have been orphaned by the disease, and those who have lost loved ones, the decision to choose “Getting to Zero” as the theme of the 2011 World AIDS day is a very welcome development. The understanding is that the theme was developed after extensive consultations among people living with HIV, health activists and civil society organizations.
Observed worldwide on 1 December since 1998, World AIDS Day is the moment of the year where millions of people come together across the globe to commemorate people who lost their lives to HIV, applaud progress made in responding to the epidemic and recommit to ending the epidemic.
Unfortunately, we are in a difficult situation of considerable global constraints on resources to support this goal. Every effort must be made to efficiently apply existing resources so that proven interventions are delivered in the most cost-effective manner. In addition, public-sector, commercial, and philanthropic commitments to HIV/AIDS research and implementation of proven findings must be sustained and strengthened with the investment of additional resources to ensure that HIV treatment and prevention services are universally available to the people who need them, wherever they live. With additional commitment and support from the organized private sector in Nigeria, we can control and ultimately end the HIV/AIDS pandemic.
On this commemoration of the 2011 World AIDS Day, let us recommit ourselves to that goal.

Related posts:

1. HIV/AIDS: African Mothers and Babies Face Extinction
2. Anti-AIDS gel changes face of Africa fight
3. HIV/AIDS in Africa: The Comedy Continues: by Paul Adepoju

Stethoscope

In 2001, the National Assembly passed the Medical Laboratory Science Council of Nigeria Act of 2001. Two years later, 2003 to be precise, the act was signed into law by President Olusegun Obasanjo and the published Federal Government’s official gazette to that effect is now issued to every newly inducted medical laboratory scientist to guide his or her practice, and to provide them with the legal machineries and backings that delineate their practice from those of other professionals. Part of the new professional package is the introduction of a specific scheme of service. The law also describes who should head the laboratories in addition to a couple of other medico-legal issues.

But just like almost everything that is Nigerian, the interest of the OBJ’s health administration under Prof. Eyitayo Lambo wasn’t sustained by subsequent administrations notably those of the late President Umaru Yar’Adua and the incumbent President Goodluck Jonathan. In a twinkle of an eye, ten years had gone bye; and just a miniature fragment of the 2003 Act has been backed with meaningful federal actions. It is therefore quite understandable by everyone when the Association of Medical Laboratory Scientists of Nigeria (AMLSN) under the amiable leadership of its national executive led by Okara G. C. (PhD) after an emergency meeting directed its members to embark on a five-day work-to-rule civil action to gain government’s attention backed with meaningful action.

But just few hours into the exercise, it became evident that the government cannot rest on its oars and allow normal activities in the laboratories to become paranormal and disrupted for five days before consulting the professionals. In a highly revered government-owned medical laboratory in Ibadan for instance, an overzealous resident doctor reportedly signed out a positive malaria parasite test result (+++) only for a scientist around to redo the test and gave a negative result. Such misdiagnosis is currently ubiquitous across the country, and thousands of patients are being given very wrong results that are not only putting their lives at risk, but predisposing the nation to a potential public health crisis.

The life sciences form a category of professions that shouldn’t be taken for granted because of the thousands of lives at stake, and the attending associated security risks. Take the tuberculosis laboratory for instance. Since the commencement of the work-to-rule exercise, positive M. Tuberculosis cultures are left unattended to. And if improperly handled, unsuspecting individuals can inhale the deadly strains that are kept in some of the nation’s laboratories. This has the potential of causing a mortality rate that cannot be achieved by MEND and Boko Haram put together.

The need for the speedy federal government’s intervention in the ongoing work-to-rule action is further highlighted by the battle for supremacy that the pathologists’ association is trying to turn the whole civil action into. The Association of Pathologists of Nigeria (ASSOPON) has an online Yahoo ‘cult’ group (Association_of_Pathologists_of_Nigeria@yahoogroups.com) which is exclusively for pathologists. However, someone successfully hacked into the group and was able to make vital secret documents and plans of members available. In the ‘Wikileaked’ transcript of the group’s discussions, some of the highly respected pathologists, including notable professors like Prof. Ima-Obong Ekanem of University of Calabar Teaching Hospital are all planning to use residents to work on benches despite the fact that he acknowledged their limited hands-on experience, apart from the potentially disastrous sheer disregard for the MLSCN Act. Also in less than twenty four hours, another medical professor in Ibadan allegedly said that concerning the civil action, “blood will flow.”

To those without any medical affiliation, the closest way they can describe the so-called professionals’ attitude is that of the proscribed Ibadan chapter of the National Union of Road Transport Workers (NURTW). At every given opportunity, Nigerian health practitioners are at each others’ jugular and it is quite disheartening that previous and current Nigerian leaders had been ill-advised hence are unable to convincingly and conclusively resolve the inter-professional dilemma. While interviewing some of AMLSN’s members, their sheer frustration with the status quo was palpable and to say the least, they have every right to be frustrated.

Why is the federal government dragging its feet when it comes to agreeing to the scheme of service for the scientists when it has already done so for other professionals? The various confusions in statuses, professional titles, intra- and inter-professional frictions have been in existence for decades yet year-in and year-out, the federal ministry of health has been diabolical, indecisive, confusing and self conflicting on the matter. According to the professionals, they can’t take it any longer. It is quite unfortunate that medical unrests like this, is now as common as ASUU strikes in Nigeria. Worse still, the medical professionals are forever enemies and instead of solving these and other issues, the ministry of health has become politicized to the extent that political office holders are not well informed or wrongly advised.

In Obafemi Awolowo University Teaching Hospital (OAUTH), University College Hospital Ibadan (UCH), Jos University Teaching Hospital (JUTH), University of Calabar Teaching Hospital (UCTH), Federal Medical Center (FMC) FMC Aba, and other state and local government medical laboratories across Nigeria, patients who need laboratory diagnoses are being sent back home and told to return next week. For some, it is no big deal while for others, it may be too late.

Packed cell volume (PCV) estimation, clinical chemistry, hormonal assays, tissue processing, microscopy, culture and sensitivity… are highly essential procedures that the hospital cannot do without. Therefore, throughout this week, many hospitals will be forced to suspend their operations while others will attempt to manufacture funny results like the malaria test example described in previous paragraphs, thus offering dangerous services that are disservices to their patients who might be totally ignorant of what is actually going on.

Like the rich class, Mr. President may not be using the nation’s hospital services hence he might be less perturbed compared to lots of Nigerians. He however is saddled with the inundating task of making the nation’s hospitals perform maximally which is a prerequisite to a number of visions and global initiatives that Nigeria is part of (Vision 2020 and Millennium Development Goals are examples). And despite the childish schemes of ASSOPON online community to sabotage the civil exercise, the government ought to, and must listen to the medical laboratory scientists considering the fact this is the very first time they will be embarking on such a national civil exercise to ask for their rights, unlike their colleagues that are perennial complainants.

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Minister of Health, Prof. Onyebuchi Chukwu

With an estimated 608 deaths per 100,000 deliveries, Nigeria ranks second only to India in the list of nations with the worst child mortality.

According to Women Health and Action Research Centre, an organisation committed to the promotion of sexual and reproductive health and social well-being of women and adolescents, out of 100,000 women that enter labour rooms, 50 of them do not come out alive.

With the figure (death of 50 women), the group said Nigeria also ranked second in the global number of maternal deaths.

The Chief Executive Officer of the centre, Prof. Friday Okonofua, said at a dissemination workshop on ‘Assessment of Infection Control Practices in Delivery Care Units in Edo State,’ that three major factors were responsible for the high maternal mortality in Nigeria.

They are bleeding after birth, pregnancy hypertension and post-delivery infections.

He said, “Studies, including data from Edo State have shown that up to four out of 10 Nigerian women experiencing puerperal infections die from the complication.

“Besides, maternal mortality in Edo State reflects the national average. Maternal health is presently not prioritised by the state government.”

According to Okonofua the “results demonstrate the lack of appropriate policies and practices relating to infection control in maternal units in Edo State, given that puerperal sepsis is the third leading cause of maternal mortality in the country.”

Worried by the lack of data on maternity care and puerperal sepsis in health facilities, the centre recommended that record keeping be prioritised as an important strategy to monitor the outcomes of infection control measures.

The workshop, which had in attendance officials from the state ministry of health, women affairs, health workers from public and private health institutions, accused governments of insensitivity to the problems of women.

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In the ongoing fight against the spread of the Human Immuno-deficiency Virus (HIV) and the Acquired Immune Deficiency syndrome (AIDS), African mothers and babies constitute an endangered breed. A statement released at the end of a meeting of world leaders at the United Nations (UN) headquarters in New York last week identified yet again sub-Saharan Africa as the most ravaged region, owing to poverty that has become a major hindrance to effective and sustained medical treatment.

Despite the unanimous agreement by national leaders and representatives of some 160 countries at the UN forum to halt the spread of HIV-AIDS “epidemic with renewed political will and strong, accountable leadership”, popular support for the fight against the disease remains pitched at the level of political declarations. What is missing is pragmatic action by African leaders in particular and the developed world to fight the virus with unparalleled determination and urgency that it deserves.

Ever since the discovery of HIV in 1981, Africa has remained the focus of international discussion, especially deliberation by the medical and scientific community, for two reasons, among others: the rapid spread of the disease among the human population in the continent; and the contested perception of Africa as the original birthplace of the virus.

At the UN meeting, secretary-general Ban Ki-Moon explained the agony that HIV-AIDS have caused to families and nations. “If it pains us to see a baby contract HIV in the developed world, that pain is felt just as much when a baby contracts HIV in the developing world. African mothers, Asian mothers, Latin American mothers all feel the same love for their children as mothers everywhere. They deserve exactly the same options for treatment.”

Within Africa and elsewhere, HIV is widely regarded as a major illness that accounts for the deaths of a large number of mothers. Children are not left out too. The British Broadcasting Corporation (BBC) cites a UN report which indicated that a child is “born with HIV nearly every minute, almost all of them in sub-Saharan Africa”. In fact, in 2009 alone, approximately 370,000 babies were tainted at birth with HIV and most of them were from Africa.

In light of these dreadful scenarios, two key concerns require urgent attention. First, there must be significant reduction in mother-to-child transmission of the virus. Second, there must be considerable reductions in AIDS-related maternal deaths. It is important to focus on the healthcare needs of mothers and babies because research shows they are the people most at risk of being infected with the HIV or in danger of dying from AIDS. As we enter the second decade of the 21st century, humanity must not allow this health monster to consume the lives of mothers and babies.

In his address at the UN meeting, Ban Ki-Moon sounded more optimistic than current statistics suggest. He said: “We are here today to ensure that all children are born healthy and free of disease. We are here to ensure that their mothers live to see them grow. This is every mother’s wish – and we can make it a reality.” If the UN can pull off this lofty goal, it would be one of the most remarkable achievements of our lifetime. However, in Africa as in other developing regions, there is no basis to rejoice yet. The HIV is still spreading fast. Mother-to-child transmission rate is still unacceptably high and AIDS-related maternal deaths are still rising. Additionally, many governments in Africa are not channelling much required funds to the purchase of antiretroviral drugs to improve the healthcare needs of HIV-AIDS patients.

Strangely, one of the Millennium Development Goals (MDGs) aims to put an end to the spread of the HIV-AIDS by 2015. Is this objective attainable by the deadline? Only compulsive optimists will be driven to hold such a strong faith. Research-based evidence does not support the notion that the spread of HIV-AIDS will be halted across the world in the next four years.

The statistics on HIV-AIDS is uninviting. Across the world, 30 million people are reported to have lost their lives through AIDS and 16 million children have been turned into orphans. Still, about 33 million people are known to be living with HIV and for every new day, about 7,000 people are infected. That’s not all the bad news. A report issued by the European Commission in 2009 stated that one in three people who were infected with HIV were unaware that they were carrying the virus. This is seen to account for a rapid rise in the rate of infection.

But it’s not all grim news all the way. The UN meeting last week identified some major successes in the global fight against HIV-AIDS. For example, it was reported that there has been approximately a 25 per cent drop in the spread of HIV infections in over 30 countries, including more than 20 per cent drop in AIDS-related fatalities over the past five years. The reduction in AIDS-related deaths has been attributed to increased ability of more countries to buy antiretroviral drugs for distribution to patients. This suggests that in the absence of any vaccine or cure for the virus, antiretroviral medications are helping to prolong the lives of sufferers.

Nevertheless, in the struggle against the deadly virus, the development of a vaccine or cure remains a priority. Also, the cost of accessing antiretroviral drugs must be further reduced in order for more patients, particularly those in poorer countries, to access the medication. Healthcare deserves priority attention. And the battle against HIV-AIDS deserves even a higher consideration for the reason that a nation with a sick population is a deceased country.  Unfortunately, rather than provide funds to uplift the poor standards of healthcare, African countries are quick to allocate huge sums of money to arms build-up to be used to defend autocratic leaders’ grip on power and to suppress pro-democracy movements.

Another source of worry in the campaign against this global disease is the sharp decline in the flow of money required for the treatment of patients. Funds have remained disappointingly low, well below the minimum required benchmark to advance global research on HIV-AIDS, to prevent or reduce the spread of the disease, and to provide access to medication by all infected people particularly in resource-poor developing countries.

Already, African countries, perpetually in search of foreign aid to provide basic services to the population, have failed to honour the Abuja Declaration and Framework for Action for the Fight against HIV-AIDS in which, believe it or not, they pledged to commit a minimum of 15 per cent of their yearly budgets on enhancement of their public health systems. This is like playing a game of hide-and-seek. Why did African countries pledge to devote a large chunk of their budgets to the fight against HIV-AIDS if they knew the goal was unattainable or that they could not afford the money? What manner of leaders do we raise in Africa? Yet, as someone argued this week in an online discussion forum, “The correlation between health and economic development is clear and unequivocal. Health leads to development, which leads to better health, which leads to development…”

In his address to the UN, President Goodluck Jonathan sounded upbeat about the development of new ideas on how to generate funds in Africa to tackle the global health epidemic. He said: “We cannot rely only on donor funds to fight the malaise, especially considering that the MDGs is to wind down in the next four years. I believe there is no African country that can say we can get out of it in the next four years.” This is almost like an admission of failure to meet the key objective of just one of the Millennium Development Goals (MDGs).

Jonathan did not quite elaborate on his innovative alternative pathways to raise funds for the cause of HIV-AIDS other than the statement: “I have a number of ideas of my own, especially at the ECOWAS where Nigeria controls about 55 per cent of the economy.” However, he was quick to admit that “the time is now for Africa to find a lasting solution”.

It is 30 years since the discovery of HIV-AIDS and the world is still grappling with ideas on the best way to develop a vaccine or enduring medication for the virus. While the world races for a solution, African mothers and babies remain most at risk of dying from this disease. The obligation is on African leaders to commit more funds and resources to the fight against HIV-AIDS in order to save the most vulnerable members of our society from extinction.

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2. Women Seek Extension Of Maternity Leave To Six Months
3. “Getting to Zero” on HIV and AIDS in Nigeria

Since the first republic, Nigerian legislature has been passing bills ranging from serious national issues like national security to selfish laughable and unarguably comic ones like the one that apportioned a sizable portion of the national cake to political office holders’ wives. In all, despite the fact that the National Assembly is a strong third arm of Nigeria’s democracy – and the nation at large, it’s been the least respected considering the numerous corruption allegations, boxing bouts, fat paychecks, and less insightful arguments on the floors of the two chambers. And to the average Nigerian, the National Assembly is nothing but expensive chambers filled with all sorts of people.

Since 1999 when the country returned to democracy, the National Assembly has processed a total of 206 bills into Acts. According to LEADERSHIP, a total of 556 bills (220 Senate and 336 House of Representatives) were passed by the National Assembly between 1999 and 2009. Between 1999 and 2011, 206 were forwarded for presidential assent of which 176 have been signed into laws, while 32 are still awaiting presidential assent.

Out of the 556 bills, only one has so far attracted appreciable attention and generated sufficient ripples that got everyone talking. It is the National Minimum Wage (Amendment) Bill, 2011, which was sent for presidential assent on March 13, 2011. The reason is simple, Nigerian civil servants want some share of the oil windfall, excess crude oil account, and other sources of national funds that the executive and legislature dip into monthly.

Apart from this, Nigerians worry less about legislative duties. Or who among the traders in Bodija, Amakohia, Lokoja, Okenne and dust-laden Mararaba markets would worry him or herself about Supplementary Appropriation Bill 1999, Second 1999 Supplementary Appropriation Act, 1999, Appropriation Act, 2000, Appropriation (Amendment) Act, 2000, Appropriation Bill, 2001, Corrupt Practices and Other Related Offences ATC, 2000 (Explanatory Memorandum) and National Assembly Service Comm. Act, 2000, National Order of Precedence of Public Officers and Other Persons Bill, 2000, Niger Delta Development Commission Act, 2000 or Police Service Commission Act, 2000? None I guess.

But on Wednesday, May 18, 2011, ‘angry’ Market Women Association members and several pressure groups protested at the National Assembly against the delay in passing a Bill that several erudite Nigerians – including National Assembly seat warmers and salary earners – are unaware of. They threatened to go into the Chambers naked if security personnel prevented them from going in.

According to Daily Independent’s report, some of the placards displayed read: “Market Women Association (FCT), Pass the National Health Bill; 241,000 new born die yearly!!! Stop the death!!”, “Nigeria needs the Health Bill; Life Expectancy: Nigeria – 42 years, Ghana – 60 years,” and “We have voted, give us health care, pass the Bill; fix the health system, pass the National Health Bill.”

The protesters were pacified by Obasanjo-Bello and Senator Gyan Dantong, both of who assured them that work on the Bill was in progress. Obasanjo-Bello told them that the Senate had worked on the Bill night and day so that health care in Nigeria can be well funded, that the Conference Committee had met over it and that by Thursday the legislative work would have been completed, leaving the rest for bureaucracy and the executive.

And on Thursday, the bill was passed. Senate President David Mark said it was an important Bill which took a while to go through the legislative mill. He explained that anything that deals with health needs to be scrutinized rigorously, so “We did not pass the Bill because people were protesting; we are only doing our work. The Bill was slated in the Order Paper when they were protesting.”

The dust seemed settled until less than twenty four hours later when real war of words broke out. Threats were issued, ultimatums were given and the various factions are now challenging themselves to public debates.  The end is not in sight until President Goodluck Jonathan decides whether or not to sign the controversial bill into a federal law.

On May 24, 2011, Vanguard duo of Victoria Ojeme and Caleb Ayansina reported that the Assembly of Healthcare Professional Associations and Unions has called on President Goodluck Jonathan not to give assent to the National Health Bill recently passed by the Senate. According to the report, the association said “there will be no peace in the health sector if the bill becomes law.” The National Vice President of the Association of Medical Laboratory Scientists of Nigeria, Dr. Godswill Okara, who spoke alongside other executives, maintained that the bill single-handedly proposed by the Federal Ministry of Health infringed on their rights and vowed to take legal means to fight it.

This is totally against the view of Nigerian Tribune’s report of Friday, April 8, 2011 in which the Nigerian Medical Association (NMA) called on President Jonathan to exercise his executive power and ensure that the National Health Bill is passed and assented to before the end of this legislative and executive term. Addressing a press conference in Abuja, President of NMA, Dr Omede Idris, said: “For the health bill to go through this current legislative assembly without passing it into law smacks of the government’s insensitivity to the plight of all Nigerians — adults, men, women, youths, children and newborns alike, health wise. Over this period of six years, six million Nigerian children and 317,400 Nigerian mothers have died.”

“These children and mothers do not have voices; neither do they have deep pockets to have alternative choices of place of care. The government must know and realize that health is one of her key social and humanitarian responsibilities to it citizens.”

On the surface, one can conclude that democracy just got interesting but closer second, third, infinite views of past and current events in Nigerian health politics would reveal the poor prognosis that the system has on its perdition-bound journey along Destruction Avenue. Almost every Nigerian professional medical association has scores to settle with at least one professional body. The crisis range from simple administrative paper works to life deciding decisions thus putting the lives of unsuspecting members of the public – like members of Abuja Market Women Association – at great risk.

Anyone that is familiar with the crisis in Nigerian health sector would see the current series of attacks on the newly passed National Health Bill as yet another unnecessary uproar by perturbed professionals. I had the same view when I first heard the news. The position was sustained when I got a copy of the bill and read it for the first time. Even after a second peruse, I saw nothing wrong with the bill. However, my attention was drawn to some quite salient aspects of the bill that speak volumes.

Plagiarism

A sizable portion of the bill was “copied and pasted” from Republic of South Africa’s National Health Bill (as amended by the Portfolio Committee on Health (National Assembly)). A conservative plagiarism match test conducted on the bill gave a plagiarism score of 57 per cent.

Both bills encompass public and private providers of health services; promote a spirit of cooperation and shared responsibility among all providers of health services; provide for persons living in each country the best possible health services within the limits of available resources; and protect, promote and fulfill the rights of the people to have access to health care services.

They both dwell, almost verbatim, on issues like rights and duties of users and health care personnel; health establishments; control of use of blood, blood products, tissue and gametes in humans; national health research and information and several others. However, unlike the South African bill which presented the nation’s National Health Council as one that advises the minister on policies concerning any matter that will protect, promote, improve and maintain the health of the population; Nigerian National Health Council, according to the bill, will be the all-in-all as stated section 1 subsection 1.

Section 1 Subsection 1

There is hereby established for the Federation the National Health System, which shall define and provide a framework for standards and regulation of health services, and which shall –

(a) Encompass public and private providers of health services;

(b) promote a spirit of cooperation and shared responsibility among all providers of health services in the Federation and any part thereof;

(c) provide for persons living in Nigeria the best possible health services within the limits of available resources;

(d) set out the rights and duties of health care providers, health workers, health establishments and users; and

(e) protect, promote and fulfill the rights of the people of Nigeria to have access to health care services.

This portion of the bill is the major reason why so much dust is being raised by Assembly of Healthcare Professional Associations and Unions. This subsection makes the proposed NHS the alpha and omega when it comes to every health decision in the nation.

Currently, there are numerous regulating bodies – usually on professional basis. For instance, medical laboratory practice in Nigeria is regulated by the Medical Laboratory Science Council of Nigeria as established by the Medical Laboratory Science Council of Nigeria Act 2003. Section 4 (b) of the act empowers the council to: “regulate the practice of Medical Laboratory Science in Nigeria”. Other professions are also backed by similar laws. But with the National Health Bill, these regulatory bodies would be rendered insignificant – or at best, impotent. And the NHS would coordinate and regulate everything.

Section 1 Subsection 2

This subsection defines who will be included in the National Health System thus:

The National Health System shall include –

(a) the Federal Ministry of Health;

(b) the State Ministries of Health in every State and the Federal Capital Territory ;

(c) parastatals under the federal and state ministries of health;

(d) all local government health authorities;

(e) the ward health committees;

(f) the village health committees;

(g) the private health care providers; and

(h) traditional and alternative health care providers.

This subsection does not favor other medical professionals apart from the NMA whose members are the minister of health, state commissioners for health, heads of health parastatals and other members of the NHS. This is seen as a calculated move by the brains behind the bill to totally remove the inputs of other health professionals from the operations and day-to-day running of the nation’s health system which according to AMLSN’s Dr. Godswill Okara, is an orchestration of the ministry and NMA who are seeking to legitimize the culture of tyranny in the sector, “by choosing to ignore our views”. But the logical question to ask is that why did they wait until the bill is passed before screaming at high decibels?  . . . (to be contd)

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It is reasonable to expect that in this month of general elections, all attention should be fixed on the outcomes of the first of the exercises – the National Assembly elections which were conducted last Saturday. Nothing attracts public commentary as much as the results of elections in which politicians are deeply divided on how best to transform the nation. Given our fondness for protesting election results, it is uncertain whether the defeated candidates will accept the results released by the Independent National Electoral Commission (INEC).

General elections offer an important opportunity for the public to select political candidates with proven record of achievement or those with preeminent ideas about how to govern or make laws at national and state levels. However, a discussion about how to resuscitate our anaemic and crumbling healthcare system is equally important. Even in the face of politics, healthcare remains paramount because politics is for the living, not for the dead.

There are many reasons, we are told, why we should visit our doctors in public hospitals or in their private clinics regularly. By training, doctors are equipped to assess our medical conditions, diagnose symptoms of serious ill health that could prove terminal if undetected, and assist in treating the sick. Prompt diagnosis serves as an early warning signal and helps to detect future trouble spots. Without regular medical check-up, today’s tiny blot on the skin could develop into a massive cancer tumour tomorrow. Health is wealth, we are repeatedly reminded.

For the sick man or woman, there is no better place to seek medical treatment than in a highly equipped and professionally staffed hospital. However, in our current situation, it is a major challenge to find well equipped and moderately staffed public hospitals in regional centres and some urban areas. These hospitals, public or private, are not sufficient to serve the local population. Well-resourced private hospitals are not patronised by many people in Nigeria owing to lack of funds to cover the high cost of treatment.

In Western countries that boast efficient healthcare, the hospitals suffer a different kind of problem – overcrowded outpatient clinics, operating theatres, emergency units, and wards. This places enormous burden on the healthcare system. In our situation, the pressure brought on public hospitals by public demand implies that hospitals will struggle regularly to cope with long queues of patients on the waiting list. The government is therefore confronted with the difficult problems of how to fund and manage the healthcare system effectively.

In a country with a large aging population, public hospital resources are often stretched to their limits. Owing to their frail nature, old people easily become the target of all kinds of diseases. Arguably, it costs more to attend to the healthcare needs of elderly people than it costs to look after younger ones. Treating the elderly also requires expensive medical equipment some of which help to keep them on life support. This adds to the huge cost of maintaining an efficient public hospital system.

Every country has its peculiar problems associated with sustaining an effective healthcare system. In Australia, under the existing medicare scheme, citizens and permanent residents are treated mostly free in public hospitals. But, sometimes, it takes years, not months, to be admitted for major or minor surgery. In some cases, it can take up to six months or more to get an appointment to see a consultant. These are the side effects of free medical services provided in public hospitals.

Anyone expecting free medical treatment must be confronted with the reality that is the spiralling cost of servicing the hospital system. Free medical services don’t come cheap. There are consequences for the government, the hospital administrators, and the public. When patients are treated free in public hospitals, someone must pay the bill. In most cases, the government is the first in the line of institutions that fund public hospitals. There are also some foundations and organisations that make regular donations to public hospitals to enable them to continue their work, including ongoing research into problematic ailments.

Meeting the healthcare needs of our society is not a burden that should be left to government alone. Certainly, by its nature as the provider of services that are deemed to be in the interest of the public good, government must fund public hospitals in order for them to provide basic services to ordinary people. Unfortunately in Nigeria, the most basic of services are lacking in many public hospitals.

The hospitals are poorly managed. They lack essential medicines. They are dirty; the cleaning staff are perpetual faultfinders; the facilities are substandard and are not maintained. Some of the hospital equipment are consistently raided by the same staff who are expected to keep the equipment for public use. They hold the bizarre view that public property is nobody’s property.

One of the problems that have undermined public hospital system in Nigeria is the questionable work ethic of the medical and paramedic staff who provide essential services to public patients in hospitals. Some of them do not possess proper or recognised qualifications. For paramedic staff in particular, the job is seen as best performed on the basis of trial and error.

This is one way we undermine effective management of hospitals in the country. Rather than engage the services of staff who are qualified, hospital authorities appoint staff on absurd grounds such as old school ties or membership of the same religious faith or that they hail from the same ethnic group.

The rich and the poor all want to use public hospitals. This means a growing number of patients waiting to be treated. The Australian government has embarked on a campaign to take the pressure off the public hospitals by encouraging people to take out private healthcare (insurance) cover. We cannot implement this system in Nigeria because many people just can’t afford private health insurance cover.

The impression one gets is that healthcare in Nigeria is in a state of mess. Illegal private health clinics administered by half educated people are set up indiscriminately in the suburbs of our major cities and villages. Behind the counter at major chemists and pharmacies are apprentices drawn straight from primary or secondary schools, people whose knowledge of healthcare does not go beyond mere pronunciation of the names of medicines.

One of the things I enjoyed, some years ago, about travelling by road to the east from Lagos was sitting inside a ‘luxury’ bus (as it is known) and listening to itinerant medicine hawkers advertise their wares by recounting rib-cracking tales associated with the manifestations of various diseases. Take the common but serious ailment, malaria, as an example.

The peddlers tell us that whenever we suffer a bout of malaria, it is common for us to experience intermittent dreams. Dreams induced by malaria are significant by the experiences they impose on us: a sumptuous dinner with royalty, perhaps the Queen of England; a soccer session with Pele or Maradona; or securing a million dollar lottery prize. All these we experience in our dreams. Through dreams we attain the unattainable.

Some of the humorous stories relayed by itinerant medicine hawkers may sound disgusting but the more distasteful the easier it is for the peddlers to loosen up the mood of their victims. The marketing strategy is a simple one that has been tried for years. To sell your product, you need to earn the trust and confidence of your potential clients. We enjoy the humour of drug peddlers but it is through sheer wit that they market ill health to everyone.

A mixture of face powder and water, a combination that should ordinarily not be contemplated by any sane person, for example, could sell inside a luxury bus as a veritable one-cure medicament for all illnesses. No one queries the credentials of the hawkers. Worse still, expiry dates mean nothing to drug hawkers, so they don’t tell their victims about expiry dates usually inscribed on product packages.

There is reason to be concerned about the health and well-being of Nigerians in the current climate in which people with dubious credentials market and dispense drugs freely. In a society that cares for the welfare of its citizens, drugs should be classified in such a way that certain categories can only be dispensed through doctors’ prescriptions while the less harmful ones could be bought over the pharmacy counter. Another step is to stop unqualified story-tellers from selling and dispensing drugs in public places.

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2. Revisiting Public Service Delivery in Nigeria
3. Saving Endangered Languages Through Public Service Broadcasting

Maybe as her own demonstration of love during the Valentine season, the First Lady of Nigeria – Dame Patience Jonathan on Sunday 13th day of February 2011 turned a portion of Aso Rock into a repository for insecticide-treated nets (ITNs) that were subsequently distributed to some categories of Nigerian women. Her love gift is one out of the numerous efforts by various individuals, groups, communities, societies, agencies, governments, stakeholders and non stakeholders alike, in the fight against malaria that has decisively and ruthlessly dealt with the third world tropical countries of sub-Saharan Africa.

Public health officials had hoped to wipe out malaria during the 20th century. However, malaria parasites have developed several defense mechanisms against many anti-malarial drugs. This response, known as drug resistance, makes the drugs less effective. In addition, the Anopheles mosquitoes that transmit the disease have become resistant to many insecticides.  Hence malaria remains a global health problem although Nigeria and other sub-Saharan Africa countries are worst hit, and public health efforts today focus on controlling it.

Although a worldwide effort is under way to develop potent vaccines that protect against malaria, the prospect so far has not been bright and medical scientists are still several light years away from making reliable, stable and safe malaria vaccine available. In the meantime however, researches by the WHO and other bodies have found that sleeping under mosquito bed nets treated with insecticide can greatly reduce deaths from malaria, especially among children.

Nets treated with insecticides—known as insecticide treated nets (ITNs) — were developed in the 1980s for malaria prevention. Insecticide-treated nets (ITN) are estimated to be twice as effective as untreated nets, and offer greater than seventy per cent protection compared with no net. These nets are dip treated using a synthetic pyrethroid insecticide such as deltamethrin or permethrin which will double the protection over a non-treated net by killing and repelling mosquitoes. ITNs have been shown to be the most cost-effective prevention method so far against malaria and are part of WHO’s plan towards the realization and actualization of Millennium Development Goals (MDGs).

Unlike ordinary mosquito nets, ITNs protect people sleeping under the net and simultaneously kill mosquitoes that come in contact with the net. Some protection is also provided to others by this method, including people sleeping in the same room but not under the net. However, mathematical modelling has suggested that disease transmission may be exacerbated after bed nets have lost their insecticidal properties under certain circumstances including direct sunlight and repeated washing.

Online searches for negative side effects associated with the usage of insecticide treated nets often give no clear-cut results as Google search results usually redirect users to web pages that speak glowingly of the potency, efficacy and safety of ITNs. These often give the impression that ITNs are trouble-free; and more effective than the much elusive malaria vaccine. But in the real sense, this is not the case – ITNs have their own Pandora box that has been discouraging many Africans from embracing its usage. These issues are economically, socially, psychologically, chemically and medically relevant.

It’s only in TDR News (a WHO tropical disease research newsletter) and other similar publications that the usage of insecticide treated nets is improving in Africa and other parts of the world. The data, though true, are often confusing and they fail to present the true picture of the status of ITN usage in Africa. In Nigeria for instance, the Roll Back Malaria programme, Society for Family Health, Nothing But Nets, World Health Organization, and several others distribute nets freely yet more Nigerians prefer to buy and burn mosquito coils. . . even on credit, than to get ITNs free of charge. Some things must be wrong somewhere! The cost is one of such.

Some experts argue that international organizations should distribute ITNs to people for free in order to maximize coverage (since such a policy would reduces price barriers), others insist that cost-sharing between the international organization and recipients would lead to greater usage of the net (arguing that people will value a good more if they pay for it). Additionally, proponents of cost-sharing argue that such a policy ensures that nets are efficiently allocated to those people who most need them (or are most vulnerable to infection). Through a “selection effect”, they argue, those people who need the bed nets most will choose to purchase them, while those who need it less will surely opt out.

In real practice however, this is not the case. Although many Nigerians are at risk of malarial infection if left unprotected, only a minute fraction of the demography purchase the nets and if the notion of “needs” is put into consideration, most Nigerians at risk don’t need the net. Apart from the lack of interest, tales of those who had bad experiences with the nets are enough to discourage others from using ITNs.

Insecticide treated mosquito nets have very small pore sizes that reduce air flow to a large extent. Hence sleeping under ITNs is hotter than sleeping without one. This is uncomfortable in tropical countries like Nigeria with epileptic, erratic, unstable and unreliable power supply to power electric fans and air-conditioning units. For people who have difficulty with breathing and those who love free flow of air while asleep, the alternative for reducing mosquito bites is to use a fan to increase air flow as mosquito prefer still air. To them, mosquito nets are no options when the fan is not on. They utilize alternatives which include applying insect repellent cream to the skin, “flitting” the room with Raid or Mortein, or burning the cheap but hazard-prone coil.

The chemical component of the insecticide treated nets is another issue of concern. Although ordinary literature searches often yield no negative results, interaction with users give an expose on what they face. In the first few days of usage, ITN (Permanet®) users complain of serious overwhelming burning sensation. The long-term effect of this, especially the longer term impact it has, on the user calls for concern; it questions the justification for users to continue to sleep under the controversial nets.

The burning sensation could be traced to the chemical that the net has been impregnated with. Several patients also present with bloated swollen painful faces of varying proportions. Medical books are inconclusive on whether users should tremble and panic, or to consider the disproportionate bloated face which often corrects itself later on, as just “one of those things”. The insecticide content of ITNs that are distributed in Nigeria has menthol as its solvent. This is a very useful chemical, but constant exposure to it has been associated with several side effects.

Menthol in the form that is being used in ITNs has also been associated with breathing problems, difficulty swallowing, chest tightness, irritation in the nose, redness and irritation at site of application, etc. Over the years, various health professionals, institutions and bodies had reiterated the fact that allergic reactions cannot be associated with the usage of ITNs, yet numerous instances had been experienced in practice when users present with blisters and several other dermal (skin) reactions.

Apart from reactions, the active pesticide in Africa’s major ITNs – deltamethrin – also has some associated risks to the user, and malaria control itself. It is used as one of a battery of pyrethroid insecticides in control of malarial vectors. The major challenge it is currently facing in recent times has been resistance, although advocates of ITN usage are playing it down, hence it’s not yet a huge press issue.

Resistance to deltamethrin is now extremely widespread and threatens the success of worldwide vector control programmes. In medical science terms, resistance has been characterised in several important vectors of malaria. Resistance include thickening of the cuticle of the vector to facilitate less permeation of the insecticide, metabolic resistance via over-expression of metabolising P450 mono-oxygenases and glutathione-S-transferases, and the sodium channel mutations which render the action of insecticides ineffectual, even when co-administered with piperonyl butoxide. Characterisation of the different forms of resistance has become a top priority in groups studying tropical medicine due to the high mortality of those who reside in endemic areas. Field caught Permethrin-Resistant Anopheles gambiae over-express CYP6P3, a P450 that metabolises pyrethroids.

The simple explanation for the complex medical science terms of previous paragraph is that malaria vectors (mosquitoes), and the malaria parasites are devising methods of evading the activities of the chemicals that has been saddled with the responsibility of killing mosquitoes in and around ITNs. Apart from making the nets, in the nearest future to be nothing but heat-producing potentially risky ineffective extremely tight fish nets, resistance also create new challenges that could make the search for vaccines more difficult, maybe impossible, if the malaria parasite is also undergoing mutation (changes) that could compromise its well understood pathogenesis (the stages through which an infective organism go through to cause infection and establish a disease state).

Chemical poisoning is another issue of paramount concern in the usage of ITNs. Deltamethrin (mentioned earlier) is a neurotoxin, it attacks the nervous system. Skin contact can lead to tingling or reddening of the skin local to the application. If taken in through the eyes or mouth, which might occur when children “play” with the net, a common symptom is facial paraesthesia, which can feel like many different abnormal sensations, including burning, partial numbness, “pins and needles”, skin crawling, etc. According to recent medical case reports, chronic exposure to pyrethroid insecticides like deltamethrin can cause motor neuron disease.

Apart from medical and chemical complications, there are psychological, social and safety issues to put into consideration. Many users feel incarcerated and restricted, like prison inmates, whenever they sleep under the net. This is of paramount concern for the claustrophobic members of the public that are depressed, and uncomfortable when confined to a “safe” secluded area – a bed draped with chemical laden nets. Is it right to protect them from malaria and expose them to their much dreaded phobia?

Also, the instructions on how to sleep under the net make the whole idea too bogus and excessive for “ordinary malaria”. In the same vein, lack of extensive freedom and fear of being caught within the net when there are house accidents like fire accidents create more bottlenecks for the WHO’s desire to see that every African child sleep under an ITN in the nearest future.

Recently, health experts across several tropical countries in Africa began to advocate the incorporation of sweetly scented mosquito insecticides into household anti-malaria plan in addition to the usage of insecticide treated nets. Apart from sleeping under the nets, they recommend that the room should be flitted with insecticides like Raid or Mortein three times in a week. This budding phenomenon connotes that going by the current pace, sooner than later, families would have to assign a sizeable portion of their annual household budget for the fight against malaria and its vectors. There is the risk of making malaria a very expensive disease to treat, just like cancer and Alzheimer’s disease. And if this happens, Africa would be the worst hit.

In South Africa, residues of deltamethrin were found in breast milk. Lactating babies ingesting such milk during lactation are bound to have several medical aberrations that might cause permanent deformation to the innocent children. It is quite disappointing that apart from insecticide treated nets, the only thing that has come out of the various multibillion dollar malaria research labs across the world since the 1980s has been more insecticide treated nets. Like other infections associated with increased morbidity and mortality, malaria deserves new thoughtful capricious changes that catch the parasite unawares instead of the current predictable measures that are both archaic and potentially harmful for the next generation.

Like most inept and supercilious African leaders that are unperturbed with the status quo, malaria researchers with their continual reliance on insecticide treated nets as viable protective measure against malaria infection are sitting on a malaria time bomb which can escalate beyond imaginable proportions. The nets ought to be temporary stop gap measures until a vaccine is discovered; but as it is gradually becoming evident, the WHO, other health organizations and government health ministries had embraced it as the last hope for those at risk of contracting malaria. If this is true, then they’ve not done enough.

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3. Nigerian Health Care System – A ticking time bomb (1): by Adepoju Paul Olusegun

As a struggling teenager, Eve blackcurrant flavoured drink was my affordable substitute for Coke®. The 5g net weighing sachet that cost five Naira (now twenty Naira) yields more than six bottles of bottled drink when dissolved in water. It even tastes better and becomes more refreshing when served chilled. But when my financial status improved, I forsook Eve.

Few days ago however, our paths met again at a local supermarket, where it stood on a shelf in its glorious unmistakeable famous wrapper. I couldn’t resist the urge to buy one. With my medical science knowledge, I thoroughly analysed the sweet content of the powder that once placed me on the same pedestal with the nouveau riches — the only social class that could afford energy drinks (better known as soft drinks) without thinking thrice. Three contents caught my attention: citric acid, aspartame and sodium cyclamate.

On its own, citric acid is harmless, but it becomes harmful when abused, misused or overused by its users. Citric acid is naturally found in a variety of fruits and vegetables. High concentrations of it are found in lemons and limes. It is often used as a natural preservative to add sour taste to foods and soft drinks. However, taking too much citric acid can create a variety of problems.

The most common symptoms of citric acid overdose include stomach cramps or pain, diarrhoea, nausea or vomiting, loss of appetite, increased sweating and swelling, and pain in the abdominal or stomach area. In rare cases, yellow colouration of the eyes or skin may occur. Less common symptoms of too much citric acid are more serious.

Symptoms include bloody or black, tarry stool, or bloody or cloudy urine. There may be a frequent urge to urinate or a decrease in the amount of urine. Other symptoms may include fever, headache and an increase in blood pressure. Individuals may also experience back, side or muscle pain. Other symptoms include nervousness or restlessness. Skin rashes, hives or itching may also occur. Sores, ulcers or other blemishes may appear on the lips or in the mouth. There may also be sore throat; swelling of the face, fingers, ankles, feet or lower legs are other potential side effects. Unusual bleeding or bruising, tiredness or weakness and weight gain, could indicate citric acid overdose.

More serious episodes from side effects may include severe stomach pain, on-going diarrhoea or vomiting. Other severe side effects include coughing up of blood, slow breathing and an uneven heart rate that may be too fast or too slow. In some cases, there may be confusion, anxiety, weakness, irritability and mood changes. Seizures and convulsions are also possible. These are too much hamper to purchase with just five Naira.

The next content – aspartame, otherwise known as NutraSweet, consists of two amino acids, aspartic acid and phenylalanine. The phenylalanine content is of concern to individuals with inherited recessively transmitted genetic disorder known as phenylketonuria (PKU). Approximately one out of every fifty people in the United States carries a single defective PKU gene; the prevalence is higher in Nigeria. It can cause mental retardation and other serious neurological problems that could impair brain functions. Currently, there is no cure; the only available management option is a strict diet that limits phenylalanine. My favourite Eve is surely not one of such.

The third component is sodium cyclamate which is a salt (an ester) of cyclamic acid that is used as a sweetener. It is artificially synthesised. The cyclamates were first used in the United States in the early 1950s, but were banned in 1969 after a study of them in rats implicated them as possible carcinogens.

Eve is just one out of the several hundreds of manufactured products, and thousands of ways that the lower class is struggling to compete with the upper class in the society with associated fatal health hazards when precautionary measures are not taken. Meat pies represent another similar category of such products.

Most restaurants and fast food joints in Nigeria sell meat pies at an average price of hundred and fifty Naira per pie which is almost the daily income of Nigerians occupying the lowest class. In desperation to make them compete with the upper class, they also eat meat pies, though with a whole lot of difference, and at a cheaper cost.

Instead of having chopped meat as filling, the poor man’s “meat pie” often contains potato which is quite nourishing if consumed on the day of preparation. But medical problems arise when the pie stays for more than twenty four hours under improper preservation conditions. At this stage, putrefaction (decomposition) sets in as a result of bacterial activities. Although the exterior part of the pie might look clean, sumptuous, even palatable, the inner core of the pie could be rotten. This is largely due to the poor preservation method used by the local bakers.

Big eateries have microwave ovens and other heating machines that could generate enough heat that would kill any bacteria – foreign pathogen or harmless normal flora – that might be lodged anywhere in the pie. These preservation devices are quite expensive and beyond the reach of the baker who bakes pies that would go for fifty-Naira-a-piece.

The poor preparation and preservation methods could create great public health problems such as diarrhoea, dysentery, typhoid, food poisoning and several other food borne diseases. Hence when the poor taunts the rich with arteriosclerosis, obesity and diabetes, it’s worthy to make them realize their own health troubles.

Starchy staple foods constitute another category of worry for the health of “struggling” Nigerians. Foods like akpu, eba, amala, tuwo, and the rest are the delight of the Nigerian lower class, members of which eat these treats on a daily basis.

In the morning, most Nigerian families would choose tuwo, egbo, noodles, bread, rice or yam, all of which are polysaccharide carbohydrates. In the afternoon, solid foods like akpu, amala, garri, eba or Semovita – all of which are carbohydrates – are nationally ingested; while at night, akamu/ogi/pap, yam, bread, potato, kunu and the rest are the food of choice, all of which are also starchy carbohydrates. While members of the lower social class might derive satisfaction in filling and feeling the stomach, the cumulative risk to health cannot be overemphasized.

What many Nigerians don’t know is that digestion doesn’t end by storage in the stomach; it entails a series of specific enzyme/hormone activities. Since we keep bombarding the body with carbohydrates, the pancreas – the organ that secretes insulin is the worst hit since it keeps firing and producing insulin for the metabolism (handling) of ingested foods. As age sets in, the insulin-secreting activity of the organ decreases and the body’s ability to handle sugar (carbohydrate) reduces considerably. This is what happens in type II diabetes.

While much emphasis, attention and public funds are committed to issues like HIV/AIDS, cancer, malaria, tuberculosis, cardiovascular disorders, diabetes and other popular health conditions, the success of such efforts had not commensurate with the massive investment in the various projects majorly because they are often treated out-of-context.

Nigeria is in dire need of better public health policies that address the peculiar health challenges of Nigeria and Nigerians. Despite the pitiable standard of living of the average Nigerian, a lot could still be achieved with the available resources at the disposal of every Nigerian, if only they know what to do, and how? There is a lot of work to do concerning the nutritional status of Nigerians and more attention should be given to healthy food combinations that are safe – both in the short and long terms.

Unlike the current nutritional advices that are focused on ensuring that individuals eat “balanced” diets that contain all the food classes, the twenty first century Nigerian nutritional challenge should be focused on recommended dietary allowances (RDA) that would decrease the risk of chronic diseases for most individuals in the population considering the fact that not every Nigerian knows or can afford to consult nutritionists.

We should also consider individuals with nutrition-sensitive health conditions that are not even aware of their health status in the first place, talk less of keeping away from products containing substances that their health conditions forbid.

It’s unfortunate that although the various governments’ efforts at ensuring that every Nigerian, no matter the social status eats well, are difficult to come bye, the recommended dietary allowances (RDA) at the hospitals are similar to what we’ve been using for several decades. Our RDAs should be updated to reflect new knowledge of nutritional needs. Our current out-dated RDA shows that our nutritionists are either not researching, or the government is not following their research works.

We also need to raise the consciousness of Nigerians to the importance of eating healthy foods by making nutritional facts available to them. If the federal government of Nigeria can afford to spend billions of Naira to celebrate the nation’s fiftieth independence anniversary, we shouldn’t become prudent when it comes to promoting health and nutrition awareness for every Nigerian. This becomes important when we consider the fact that a lot of diseases could be prevented when people eat right.

Studies of populations that eat many fruits and vegetables reveal a decreased incidence of diet-related cancers, and laboratory studies have shown that many fruits and vegetables contain phytochemicals, substances that appear to limit the growth of cancer cells.

We can only imagine the number of Nigerians that would be spared the agony of living with preventable cancer if only they are aware of the right fruit to choose, and the herbs to chew. NAFDAC should also be more alert to its saddled duty of protecting Nigerians.

Like I was ten years ago, not every Nigerian, regardless of social class, knows what citric acid, phenylalanine, sodium cyclamate, aspartame mean; that’s why we have the various regulatory agencies. They should ensure that whatever the label reads, every food substance on the shelf is safe.

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December 1 is Worlds AIDS day 2010

Cymbeline is one of the best tragicomedies of all time. Written by William Shakespeare, the play has three interrelated plots: one concerns Imogen’s love for her husband, Posthumus, and his jealousy; another involves the long-lost sons of King Cymbeline; and the third concerns Britain’s challenge to the power of Rome. The three plots marvellously come together in the play’s astonishing conclusion, as characters move from error to truth, from scepticism to faith, and from hatred to love. Confusion and loss are replaced by clarity and gain, as families and nations are reunited and are again at peace.

Although Cymbeline was released in 1623, its storyline is still similar to those of the twenty first century where an upright, diligent and [often] intelligent “actor” scales the hurdles, overcomes the temptations and neutralizes the threats that are hulled at him (or her) by “the boss”. It is also an extension of life’s lessons of hope, faith, astuteness and resilience which often yield proportionate rewards. To a considerable extent, this principle holds sway in several areas of human endeavour, but AIDS via its microscopic causative agent: a retrovirus, is rewriting every written human rule, and has compromised the intellectual capacities of genus Homos sapiens.

Ordinarily, HIV is the easiest riddle to figure out, and the most helpless of all causative agents of human infections. Virology (study of viruses) has revealed that the virus is a pathetic parasite that can not live for long on its own; it is entirely dependent on the host that literally provides food and shelter for the homeless virus. Also, the virus is the stupidest or how do we describe the initiation of a chain of events that negatively affect the organism’s lifeline, and ultimately results in the death of the patient and itself considering the fact that the virus is non communicable via means that do not entail contact with body fluids such as blood, semen, vaginal secretions and breast milk?

Also, the human immunodeficiency virus ought to be the cheapest to control if men (and women) obey the fundamentally basic rules of life and follow the divinely ordered course. Sex for instance, is the major route of contracting the virus in Africa; yet African cultures outlaw and discourage illicit sex. Also, Africans value blood; they respect the sacredness of the body tissue and other body fluids hence on paper, contracting HIV via body fluid exchange shouldn’t be an issue in Africa — It ought to be the least of Africa’s worries.

In the same vein, finding cure couldn’t be expected to take this long yet without any headlight pointing anywhere because as early as three months after the first case was reported in the United States, scientists at the Centres for Disease Control and Prevention (CDC) came up with probable cures for HIV infection. But after more than twenty years, scientists all over the world are still clueless over which direction to follow concerning the search for cure.

Also, medical economists agree that HIV has gulped more money than any other infection in human history. The whooping sums of money (running into several billions of dollars) that has been expended on the various aspects of HIV control, prevention, awareness and research are sufficient enough to finance the annual budgets of some African countries. This further supports the assertion that maybe the virus is nothing but a façade that is being used by the medical elites to get their sizeable share of global cash.

Furthermore, to the superstitious mind, current trend of HIV infection in Africa presents the continent as one under a strong spell. This becomes quite fathomable when a comparison is made of HIV prevalence and mortality data from across the world. Currently, southern Africa has the highest prevalence rate while the only African country that sustains the ancient African monarchy system: Swaziland has recorded a prevalence level of about 40 per cent in recent years.

Here in Nigeria, HIV-related issues had created a fascinating conundrum which is a true eye-opener to the dismal status of the health system. In the first instance, there is no reliable HIV prevalence data; Nigeria only has circumstantial prevalence data that changes with fluctuations in HIV funding. This is typified in the variations in Nigeria’s HIV/AIDS data from 2006 to 2008.

In 2006, Nigerian HIV epidemiologists painted a scary prevalence data that attracted several foreign attentions. These were characterized with the influx of more money into HIV researches and control plans in Nigeria. The following year, possibly to show that they are doing something good, Nigeria’s HIV prevalence data significantly reduced. In response, the donor agencies decided to slash the funds being pumped into Nigeria’s HIV programmes. Realizing this, the Nigerian HIV prevalence data hit the roof the following year. If this is true, then it’s worthy to ask “who are they fooling?” Nigerians are not sure which report (and data) to believe.

African leaders, African scientists and individual Africans need to stop fooling themselves. It cannot be overemphasized the need to start contending with the fact that soonest, the ironic seriousness of some African countries would pose great danger to the success being recorded elsewhere. Although African countries like Kenya and South Africa are doing a lot and have gone as far as testing HIV vaccines for potency, efficacy and safety, the inactions and wrong actions of other nations make their brilliant lofty efforts nothing but a small drop of water in the Atlantic Ocean.

HIV/AIDS in its current status in Africa is a real life/fake imagination dichotomy where what is on paper negates what the truth really is. African citizens in their millions still crack jokes with the virus, many still take it as fake, and governments pretend as if they are on top of the pandemic while in the true sense, the virus is the one on top of us all on this side of the planet!

After more than twenty five years of confirmed diagnosis, the only entity that can smile, click wine glasses and celebrate is the virus itself. Repeatedly, smartly and covertly, it has penetrated every city of the world – from the Sin City to the Holy Vatican. Unlike human beings, the virus, despite not having brain, has been steps ahead of the best of brains in medical science.

The virus has a defence mechanism that evades every human effort, as if it has an informant in our midst. Also, despite several schools of thought, there is no conclusive statement on how and where the virus came from. And since it has closely guarded its primary source, human beings are still at lost over the virus’ next destination. Socially, the virus has successfully decimated human demography with stigmatization and stratification of the population, especially here in Africa.

On national TVs and from their air-conditioned penthouses, government agencies reiterate their zero tolerance for victimization and stigmatization although Africans know more about the ubiquitous stigmatization that preponderates, even in nuclear families. Voluntary Counselling and Testing (VCT) is openly supported and preached, yet numerous churches compel members to go for HIV testing before they can get married. Generally, our utterances do not match our actions, and the virus is very happy about it.

Like Cymbeline where William Shakespeare determines the fate of his characters, the course of HIV infection in Nigeria, Africa and the rest of the world is solely dependent on who is in charge. In the developed countries of the world, the government and relevant agencies had snatched the wheels from the virus. They accepted the challenges that living with the virus comes with, and have taken practical steps to reduce the effects to the barest minimum. Currently, living with HIV/AIDS in these countries is similar to being infected with malaria in tropical Africa – it’s no longer a big deal. We need to get to the same awareness and action levels in Africa.

Little can be achieved with the current falsehood and denial approach that most African countries are utilizing when it comes to HIV/AIDS and other issues. However, accepting failure is the first step towards being successful. Hence taking the bull by the horn embraces the usual advice of “going back to the drawing board”. Researchers also need to start from the scratch and pick up any missing clues that past researchers failed to notice. Who knows, they might be the master key that would unlock the highly secured yet vulnerable HIV mystery. Happy World AIDS Day Celebrations.

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3. “Getting to Zero” on HIV and AIDS in Nigeria

Tunde is farmer in a village in Ijebu-Ode, South-West Nigeria. One day, he woke up in disbelieve to notice that his two legs were swollen. Tunde’s wife was convinced that her husband was a victim of envy from his colleagues who had smeared jazz (juju) on his foot wears and this has resulted in the engorged feet. The solution was to refer him to a spiritualist who will dispel the evil spell. After months of ‘treatment’ the sores neither healed nor disappeared. A village nurse was called in and upon further examination, declared Tunde to be diabetic.

That was the beginning of the dilemma; Tunde’s family could not afford the cost of treatment from the nurse – whose expertise was rather limited. They could neither seek proper medical attention from the General Hospital which was about 200 kilometres from their village. Tunde’s limbs lay precariously close to amputation. Paradoxically, in that same village, reproductive health counselling is ubiquitous. Yet the villagers are so steeped in poverty that they cannot afford basic health care for diabetics.

Tunde is quite ‘lucky’ since his ailment was diagnosed others are not so fortunate. I had the good fortune of hosting a long time friend, a doctor, who just completed his National Service in Igboho, a town in near Ibadan. As such we – joined by another doctor – went for a drink. The conversation was numbing. Chinedu glee of his fame in Igboha looked superficially vain – with children always happy whenever he laid his hands on them, like the Pope. However, it made sense, since in that town, majority of the women are delivered of their babies at home. Those that make it to the hospital only do so due to post-natal complications. It is pretty obvious why Chinedu became a celebrity in Igboho.

Ambrose’s tale was gorier, as he works in a hospital in the heart of Ibadan. He lamented that most paediatric fatalities could have been averted with a N200 ($1.15) worth of anti-malaria medicine. Their parents – usually bus conductors and kola nut hawkers – cannot just afford the cost of the prophylaxis and have to watch their children die.

Although poverty stands out clearly as the major factor in the cases narrated above, yet lack of access to information, corruption and inability of the government to provide for the common good, all have a fair share.

It is difficult to demur with Olaniyan and Bankole (2005)[i] that “the poverty situation is Nigeria …presents a paradox considering the vast human and physical resources that the country is endowed with. It is even more disturbing that despite the huge human and material resources that have been devoted to poverty reduction by successive governments, no noticeable success has been achieved in this direction.” To situate this in context, it is a shame that Nigeria is one of the poorest among the poor countries of the world, ranking 54th with respect to the human poverty index (HPI) – making it the 20th poorest country in the world.

Yet poverty cannot carry the blame alone. The mentality of public and non-governmental officials sitting in air-conditioned offices in Abuja and conjuring interventions for the rural poor is really pitiable. “This shows a certain attitude of policy makers and the media who set public agenda by talking for the people rather than talking with the people.[ii]”

It is really a question of development. And this a great deal to do with communication, not so much about the usual jingles, but rather placing the needs of the people first. Or else, we have the situation outlined above lingering for a very long time. While we all seem satiated with information about HIV/AIDs, it seems that malaria and other diseases are creating more havoc. Communicating development issues need therefore to originate from those involved, not just going to them to implement ‘artificial’ policies.

Unfortunately this is the situation in many African countries, including Nigeria. Ojebode (2008) asserts that, this is one more manifestation of the deeply ingrained military culture in Nigeria. “The result is a government or an agency which decides what the citizens want and goes ahead to do just that, the way it understands it, using the means it is pleased with.[iii]” And by so doing, thinks that their wishes will become reality by divine or magical fiat.

While we all anticipate that government will one day wake up to its responsibilities, we all have the duty to save the Tunde’s of this world. Granting people access to health is a prime development agenda. Yet how will the needs of the rural poor be heard, if no one cares to listen to their voice?

[ii] Nwachukwu Egbunike (in press) “New Media and Health Communication: Communication Strategies in Malaria Control in Nigeria” in Wachanga Ndirangu D (Ed), Cultural Identity and New Communication Technologies: Political, Ethnic and Ideological Implications. Hershey PA: IGI Global, USA.

[iii] Ayo Ojebode (2008). Low Patronage of Development Radio Programmes in Rural Nigeria: How to Get Beyond the Rhetoric of Participation. Journal of Multicultural Discourses, July, Vol. 3 Issue 2, p 135-145, 11p.

Related posts:

1. Social Media: Political Flame or Damp Squib? by Nwachukwu Egbunike
2. The Challenge is Great; the Goal is Clear; Jonathan get Working. By Nwachukwu Egbunike
3. Let us zone poverty: by Sylva Ifedigbo