Dr. Raphael Ogbolu is a consultant psychiatrist at the Lagos University Teaching Hospital (LUTH), Idi Araba, Lagos and coordinator, Suicide Research & Prevention Initiative (SURPIN) domiciled in LUTH. In this interview, he discusses factors driving depression, the need to enact Mental Health Law, tackling stigma around depression and suicide, among others. APPOLONIA ADEYEMI reports
You highlighted the global increase in depression. What is the trend in Nigeria?
The WHO’s Global Health Observatory, states that in Nigeria, the estimated rate of depression is 3.9 per cent of the population as at 2015. If we are using the last estimated population size of before 2015 which was about 180 million, we should be talking about seven million Nigerians have depression. However, we do know that it is more than that because most of them go undiagnosed. There have been local studies that said it is 3.1 per cent.
What are the causes of this depression?
We all have neuro-transmitters in our brains; they are like chemicals. They regulate our moods. For some people the level of those neuro-transmitters would drop. Once the level drops to a certain point that is when the symptoms of depression manifest. Most of the medicines try to raise the level back to where they should be.
Other things that could make the levels low could be traumatic life experiences including childhood abuse, traumatic experience early in life, chronic medical conditions, poorly treated diabetes, poorly treated hypertension, chronic medical conditions are stigmatising like epilepsy, HIV, people suffering cancer who feel that life is no longer worth it can go into depression.
Also, depression could be hereditary. However, we want to sound a note of caution that even if you inherit the genes, it does not mean that you must come down with depression; you may never become depressed in life.
However, if you inherit the genes and live’s problems now impact you, it will bring out that genetic vulnerability and the fellow can now become depressed. Also, we do know that some treatment can make some people who are predisposed to come down with depression.
Some of the drugs we use to treat hypertension could reduce the level of transmitters in the brain.
Also, people who are on long duration of treatment of steroids could put them at risk of depression. A study in Europe found that oral contraceptives for some women can put them at risk of depression because they are steroids, too.
Also, drug abuse, especially people who are struggling with drug abuse can come down with depression. Each time they fail in their attempt to stop, they feel that they are failures; they feel that the drug has ruined them and that their lives are not going on well. Hence, some of them would now become depressed.
Cases of depression has been on the increase. Why is this so?
The World Health Organisation (WHO) decided in 2017, to make depression the theme for the World Health Day and the reason is that the world body had observed that there has been a global increase in the rate of depression, which had increased more than 18 per cent over a 10 year period between 2005 and 2015. It was also the greatest cause of disability worldwide and that has steadily been increasing as a result of the global disease burden.
What it meant was that people with depression were disabled to the point that they could not be productive and that this would impact on global economies, beginning with the income of the household. That is why the WHO felt that it was time to begin to break the silence and for people to begin to talk about depression because it is something that is not too difficult to diagnose.
Hence if we talk about it at community level even people in the community would be able to identify the signs of depression among people around them and among themselves.
Depression is treatable and it is the single largest contributor to suicide, it means that if we can address depression we can also help to reduce suicide.
What are the signs people should look out for?
If the person experiences low mood, that is sadness that occurs every day or some of the days for at least two weeks.
The personal experiences loss of interest in the things he/ she used to enjoy doing,, but suddenly finds that when he does those things now, he does not derive pleasure from doing them anymore.
Such persons will begin to experience loss of energy; they are always tired, fatigued and it is always as if their energy is sapped. When you have at least two of these signs in someone for at least two weeks, it is the first warning sign of depression.
Similarly, when you have the core symptoms of depression together with other symptoms of depression, which include a change in sleep pattern, usually insomnia; the person no longer gets enough sleep. He cannot fall asleep or when he falls asleep, he wakes up earlier than he used to, most times it is excessive sleep, but sometimes, it is less sleep.
There is also change in appetite, usually less appetite but most times, most people begin to eat more. With the loss of appetite there is also a loss of body weight.
The fellow will also feel that he can no longer concentrate; the fellow will be reading the same page over and over because it does not sink.
The person will also begin to feel worthless, helpless and feeling unduly guilty about things he had done in the past and all of a sudden he will begin to feel that it had just happened.
Also, the person begins to feel pessimistic about tomorrow and when that hopelessness comes, the next thing is suicidal thoughts, that is, feeling that life is no longer worth it.
Once anyone has any of the first three I mentioned and any two of the other two, definitely the person has depression. These are signs we can easily see in people around us. Such people should seek help for depression.
Does the poor economic situation has any role in the depression of some Nigerians?
Yes, when I talked about stressors, it includes financial stressors. There are also relationship stressors, medical stressors arising from medical conditions. The irony is that in the majority of those we have seen that have attempted suicide, financial problems are not the most prominent cause. The most prominent cause that we have seen in those that commit suicide are relationship issues: marital or other relationship issues – have featured prominently even more than financial problems.
What are the challenges we face in addressing depression?
We need to have a Mental Health Act. We don’t have Mental Health law. What has been operating since is the Lunacy Act, which has been in place before the 1920s. Obviously, that kind of law cannot cater for today’s problems.
The body of psychiatrists in Nigeria has been pushing for the National Assembly to pass the Bill on Mental Health Law. If we don’t have that theres nothing to guide the issues of addressing mental illness including depression in the country.
Also, we need to create awareness about depression and maintain our mental health practitioners to practice in the country. Unfortunately, our doctors and nurses are leaving the country in droves, but among doctors leaving, psychiatrists are very attractive outside the country.
Meanwhile we never had enough; we have less than 300 practicing psychiatrists for our population in Nigeria and many of them are leaving every year.
We also have to insist that things like suicide attempts should be de-criminalised. Suicide should not be a crime because people who attempt suicide and don’t succeed will not come for treatment because of fear of being arrested.
One of the biggest risks that somebody will die by suicide is if the fellow had previously attempted it. So, anybody who had previously attempted suicide needs to be treated, but they can’t come forward because it is a crime in Nigeria, which attracts one year imprisonment.
WHO has been pushing for countries around the world to de-criminalise suicide; there are not many of us left. Criminilisation of suicide is negatively affecting suicide prevention.
What’s the way forward?
The way forward is to try and reduce the stigma associated with mental illness. Once we are able to do that, more people will come forward to seek help. That is why I am happy that more people are calling the HELPLINES of LUTH’s Suicide Research & Prevention Initiative (SURPIN): 0908-021-7555; 0903-440-0009; 0811-190-9909; and 0701-381-1143, seeking clarifications on issues of depression.
That is one way forward. The hotline is providing them an avenue to anonymously call and come to seek help, but because of the stigma, most people will not come forward.
The more we create awareness it will go a long way to help. The more we discuss it, the more people will understand that it is not a crime to suffer depression.
500 for Kwara surgical interventions
No fewer than 500 patients will benefit from a week-long free multimillion naira medical and surgical interventions funded by the Kwara State Government that would kick off on Monday at the Ilorin General Hospital in the state capital.
First in the history of the state, the interventions, which involve procedures such as cataract, glaucoma, hernia, and neurosurgery, among others, are in partnership with the trio of Kwara State Association of Nigeria USA, Sakinah Medical Outreach, and the Kwara State chapter of the Nigeria Medical Association (NMA).
Slated to hold between September 23 and 27, the surgical interventions are a follow up to the statewide medical mission during which doctors attended to over 2500 patients suffering from various ailments and offered medical advice and the ongoing medical screenings across most of the general hospitals in the state.
“These interventions are a part of Governor AbdulRahman AbdulRazaq’s agenda to ensure good healthcare for the people. The governor had graciously released the sum of N26.9 million for the interventions, covering the medical missions conducted across the state a few weeks ago and the cost of purchasing the equipment to prepare the hospital for these procedures in line with global best practices,” Prof. Wale Sulaiman, Special Adviser to the Governor on Health Matters, said in a statement on Sunday.
“The exercise is in partnership with the KSANG, Sekinah and the Kwara State chapter of the NMA which brought US and Nigeria-based medical experts for the mission,” he said.
Patient’s safety as key to adequate care provision
September 17 has been adopted as the World Patient Safety Day by the World Health Organisation (WHO) and ministers of health in the United Nations member states. REGINA OTOKPA explores its significance
The year 2030 is almost here, meeting up with the Universal Health Coverage (UHC) target where everyone can access the care they need without financial hardship, has been on the top burner of the issues being addressed by governments, the World Health Organisation (WHO), other development partners, as well as civil society organisations operating in Nigeria.
However, poor access to health care services, especially at the primary health care (PHC) level where most facilities are moribund, the high rate of out-of-pocket spending and poor health infrastructure are some of the issues limiting a good number of persons from accessing quality care without much stress.
In Nigeria, there have been many cases of preventable deaths arising from misdiagnosis, self medications, quackery, hospital infections, insufficient medical equipment and inability to meet up with required medical bills but this shouldn’t be as every patient has a right to a safe healthcare.
In its efforts to change the narrative, the federal government through the former minister of Health, Professor Isaac Adewole, announced earlier in the year that plans were underway to develop a patient safety guide, as part of measures to ensure patients were protected from unnecessary harm by ensuring the use of safe and suitable medical infrastructure.
According to Wikipedia, “Patient safety is a discipline and responsibility that emphasises safety in health care through the prevention, reduction, reporting, and analysis of medical error that often leads to adverse effects.”
Given the importance of patient safety, at the 58th session of the WHO regional meeting, member states took time to deliberate on the issues and solutions to patient safety in African health services.
In a message to mark the first World Patient Safety Day with the theme ‘Patient Safety: a Global Health Priority,’ WHO Regional Director for Africa, Dr. Matshidiso Moeti, pointed out that one of the ways to achieving the UHC is by paying paramount attention to placing the patient at the centre of health services, by creating access and driving demand through a conducive environment free from further infectious agents to promote better survival, better outcomes not only for the patient, but health providers as well.
To make this happen, she harped on the need for African governments to build strong health systems to ensure patients’ access to adequate, quality and efficient treatment when seeking health care through the provision of a range of actions such as the needed infrastructure, qualified and duly trained health personnel, supply of right medicine and equipment, right diagnosis and dissemination of the right information.
According to her, the patient is not only a beneficiary but equally a decision maker on the services he or she has access to, unfortunately, majority of patients do not know they have a right to ask questions and have access to every information about their health, as well as appreciating or condemning the services received.
Reading the Regional Directors message in Abuja, the WHO’s Officer in Charge Clement Peters, maintained that the discussions around patient safety is meaningless if the health system is bad and hospitals remain a death trap powered by the absence of national guidelines, poor implementation, inadequate funding and human resources, weak health care delivery system and partnerships.
While expressing the WHO’s resolve to assist countries in determining the status of patient safety, development and implementation of national policies, guidelines and protocols for enhancing safety, as well as facilitating patient safety networks and partnerships, she gladly noted that about 80 per cent of the global disease burden from patients harm originating at primary and ambulatory levels were preventable if found in the settings of an improved diagnosis, prescription and the use of medicines, among others.
“The WHO Regional Office for Africa recognises and places high importance on patient safety to ensure that it has the rightful prominence within health care in the region.
“There are many challenges in strengthening health systems to ensure patient safety in the region: there is a lack of national policies, strategies, standards, guidelines and tools on safe health-care practices, and ineffective implementation where they exist; inadequate funding; inadequate human resources for health, weak health-care delivery systems with suboptimal infrastructure, poor management capacity and under-equipped health facilities; and ineffective mechanisms for forging strong partnerships to adequately involve patients and civil society in the improvement of patient safety.
“Half of the global disease burden from patient harm originates at primary and ambulatory care levels. The good news is that up to 80 per cent of harm in these settings is preventable. For example, improving diagnosis, prescription and the use of medicines, responsible for most detrimental errors, would significantly reduce the risk of harm.
“Available evidence suggests that 134 million adverse events occur annually in hospitals similar to our setting here in the African Region. In low and middle income countries, one out of every ten patients in health facilities acquires health care-associated infection. More importantly, in developing countries, more than half of all infants housed in units for newborns suffer health-care associated infections with a fatality rate of between four per cent and 56 per cent. In turn, while caring for the sick, health-care workers are also exposed to risks such as tuberculosis (TB), hepatitis, HIV and other infections.
“Efforts to improve the health facility environment, enhance practice of infection prevention and control, and adherence to standard operating procedures would go a long way in addressing this problem.”
To make patients safety feasible in Nigeria and Africa at large, WHO has stressed on the importance of engaging all key stakeholders to allow providers, seekers and managers of health care services express solidarity and commitment to making health care safer and commit to promoting an open communication to enhance understanding and give patients a voice.
This means carrying the government, the community, religious leaders, health workers, the media and even the patients along, according to the WHO, is the bigger picture of human development.
“We cannot win UHC without putting the patient at the centre and we cannot get UHC if the services are not there, if people are not getting the services. We cannot achieve UHC if financial protection is not there for the patient, the various health services including the outcome of services of patient in hospitals is very important.
“The fundamental principle is to do no harm. There is an urgent need to raise awareness and understanding of patient safety. We must galvanise action towards safer systems, services, procedures, and practices in health care to eliminate harm to patients and to mitigate any risk of harm to patients.
“Patient safety is an essential component of health care that should be given immediate attention. The campaign also calls for promotion of open communication for learning from errors and to emphasise the importance of patient safety, as well as increasing the voice of the patient, hence the slogan speak up for patient safety!
“WHO is committed to support countries in determining the status of patient safety, development and implementation of national policies, guidelines and protocols for enhancing patient safety, as well as facilitating patient safety networks and partnerships.
“I call upon all stakeholders to make strong commitments, prioritise and take early action, and support the implementation of strategies for ensuring patient safety, managing risks and fostering supportive, learning cultures.
I encourage all to widely share information regarding observance of this first World Patient Safety Day. Your involvement, support, and enthusiasm will help to ensure the impact of this campaign.”
Ensuring patient safety in Nigeria is a welcome development however, the poor doctor to patient ratio currently standing at one doctor to 5,000 patients as against one doctor to 600 patients as recommended by the WHO, and the grave issue of losing 12 doctors to other countries on a weekly basis could pose a serious challenge to achieving this.
The onus is therefore on the Federal Government to address this daunting public health challenge that has continued to weaken the health system and limit patients’ access to adequate heath care if indeed Nigeria must meet the 2030 UHC target.
‘Poor capacity utilisation limiting adequate production of essential medicines’
Prince Christopher Nebe is the managing director, Pharmatex Industries Limited. In this interview, he discusses factors militating against local production of essential medicines, the impact of irregular power supply, how importation and taxation policies erode profit margins and render investments outcome negative, among others. APPOLONIA ADEYEMI reports
What are the factors that contribute to drug resistance?
That is actually a question of pharmacology. One of the major problems that we have in Nigeria is the unbridle use of drugs whereby people go to those who are not pharmacists, collect drugs and use according to how other people have been using them. Of course, by the time they use the drugs in dosages that could create resistance, use them wrongly or under-dose themselves, the organisms will become very used to the product and that is the major cause of drug resistance.
So, what I will always recommend as a pharmacist is that whenever you are diagnosed with any disease and you go to the right sources to get prescriptions, follow up by going to a pharmacist. He will make sure that you receive the right regimen of drugs. Once people do that, I’m sure we will be able to tackle drug resistance.
Considering the Nigerian business environment is harsh. What do you have in place to sustain your investment in Pharmatex Industries Limited?
Well, we just hope in God and try to survive. It’s not really easy. This is our 7th year in business.
We also do some importation. It’s not only the manufacturing of pharmaceutical products that we do, but you can see the huge investment there.
We need a working capital and other things to run the business. We still owe banks a lot of money and this is to sustain our business because you can’t just invest all these money and still have money. We also do some little businesses here and there.
As a matter of fact, we have been on pharmaceutical business for a very long time, at least for 30 years. So, we have been trying to manage and we also represent some companies that are abroad in Nigeria. For instance, we are the representative of Hovid in Nigeria. Hovid is a Malaysian health care provider and pharmaceutical company.
The state-of-art industry you established here is laudable, but currently your packaging is still done manually. Whats being done to end the manual method of packaging?
As for manual packing, tell me a company in Nigeria that is doing auto-packaging? But we are doing more here. We have an auto-packaging machine, but there are a lot of technical issue in that part that the manufacturers of the equipment need to come and install. We are still waiting for them from china. That is where we bought the machine from.
What is being done to achieve the World Health Organisation (WHO) prequalification?
Pharmatex is pursuing product pre-qualification with the WHO for one of its products- Levofloxacin 500mg. “The product is undergoing USP/PQM international certification for the drug and that of malaria drug, Artemether /lumefantrine 80/4080mg tablets.
Sir you said that local manufacturers need help and that manufacturing in Nigeria is not given encouragement. What exactly is the change you are calling for?
Where is the regular power supply we are using to manufacture? There is poor electricity power supply. You can see bad roads leading to our company. How can we manufacture in this atmosphere/environment and you can see also that there are no incentives, although, we are not asking for free-term loan. We are asking for very minimal interest on loans if the government wants to encourage manufacturing.
There are a lot of things that government needs to do. You have to give local manufacturers some facility that will have some interest free rent rates. Make clients available, make roads available, make everything to be available.
I will like to know how much this business has cost you?
I don’t like to say how much the business has cost me. It’s not the figure that’s the issue. The issue is how do you remedy/sustain this kind of plant?
How do you do business outside Nigeria, which country do you partner with the most in terms of raw materials purchase?
We can get raw materials from Europe. We get from china and India, depending on which one is good and which one we can get cheaper. Of course, you know we have the testing materials here. We have to test our raw materials to confirm if it is okay.
Sir, you said you manufactiure below 30 per cent. Tell us the things you think the government should do to ensure that you function effectively.
Excuse me the issue is that when I told you that the current manufacturing capacity is 30 per cent, but if we have the market we have the capacity to manufacture the drugs here. Let me also tell you one thing, producing quality medicine is about money.
What I am trying to say here is that the capacity to measure is about the market. Now if you have steady power supply, the production cost will go down; there are so many things that can be done to decrease the production cost.
Sir you told us about the contentions in Nigeria. Tell us about the local content:
If you know what is called raw materials, its not like go and bring garri and beans (laughs). We don’t have the mechanism to provide the raw materials locally; we don’t have one per cent or even 0 per cent raw materials here.
Why are drugs always bitter? Are there ways to make drugs a bit sweet?
Okay, its seems like my brother does not like bitter drugs, but please don’t let us lose sight that most drugs for children are sweet and if they were not palatable children won’t take them. We should also realise that most drugs either one way or the other are either synthetically or naturally come from herbs. That is the basis of most of them. You will also realize, a lot of the local herbs are bitter and that is the reasons why drugs in general are bitter.
In order to answer your other questions, when we went upstairs earlier I showed you tablet coatin. Tablet coatin can be for several reasons. There are tables known as sugar-coated tablets; are also film-coated tablets. There are tablets that are not supposed to work in the stomach, but work in the intestines. There are all kinds of drugs and there are all kinds of ways they can be prepared.
There are also tablets for children such as chewable tables like vitamin C. There are also many things that can be added to them to make them better, So it really depends on the drugs you have taken. But it is possible to mask them.
Why do Nigerians prefer foreign goods. Nigerians prefer foreign goods?
The issue is they believe that it is the culture or habit of our people. However, quality is key; quality is money. We are manufacturing a lot which is expensive.
When manufacturing cost is so high. Anything about quality is money. There are some machine you need to have and to maintain.
On Pharmatex interaction with Obi Adigwe, the Director-General of the National Institute of Pharmaceutical Research and Development (NIPRD).
The Director-General of the National Institute of Pharmaceutical Research and Development (NIPRD), Obi Adigwe, was here just the way you too visited our company. He came here he talked and we were also open to him. If there is anything he can do, we are waiting for him. They are the ones to formulate policies.
We told him a lot of things when we came here. We told him our problems.
On what government can do, the issue of steady supply of electricity has to be a priority because if you manufacture with diesel, I tell you diesel will be consuming like N12 million per month. So, we need lot of regular electricity power supply, then they also need to put 0 per cent on the importation of raw materials for the production of medicines.
HEWAN tasks ministers on increased health budget, others
The Minister of Health, Dr. Osagie Ehanire and the Minister of State for Health, Dr. Adeleke Mamora have been urged to ensure improved and adequate funding of health as well as implement the primary health care (PHC) policy that would pave the way to attain universal health coverage (UHC) in the country.
In a congratulatory message to both ministers by the Health Writers Association of Nigeria (HEWAN), the association said increased budgetary allocation to the health sector was imperative to end doctors’ brain drain.
The congratulatory message was signed by the President and Secretary of HEWAN, Chioma Obinna and Lucy Osuizigbo respectively.
It would be recalled that a 2017 poll by the Nigerian Polling Organisation (NOI) found that over 90 per cent of medical doctors in the country intends to seek employment opportunities abroad because of low job satisfaction, poor remuneration and high deductibles from their salaries.
Also, based on available evidence, HEWAN believes that Nigeria cannot achieve Universal Health Coverage (UHC) if health insurance was optional.
Consequently, the association urged the ministers to make the national health insurance scheme (NHIS) functional while health insurance should be made mandatory. The president and secretary of HEWAN said, “Millions of Nigerians continue to face health challenges because they cannot afford quality care. Health insurance has largely been ineffective in the country.”
According to HEWAN, disease burden would drop drastically if the challenges affecting primary healthcare were addressed properly. “It is in the interest of the nation for the ministers to rejig our PHCs to make them viable. It is also pertinent for the ministers to continue with the 10,000 primary health centres project across the country.
Similarly, the association called for subsidised healthcare services for the elderly, saying there was an urgent need to put in place measures to address the healthcare needs of the elderly and retirees in the country, because old age comes with some unavoidable associated ailments of which they cannot afford to manage on their own.
Making reference to the huge burden of medical negligence and misdiagnosis, HEWAN said the country was in dire need of effective medical laboratory services. “Many of the national laboratory facilities have gone moribund.”
“There is a need to revitalise these facilities for better treatment outcomes as medical laboratory remains the bedrock of medical treatment.”
In addition, HEWAN said there was the need for improved efforts to reduce maternal and child mortality and morbidity, which has continued to be on the increase. “There is the need to investigate and prosecute cases of negligence in the hospitals to serve as deterrent and build confidence in the health system, they added.”
Furthermore, the president and secretary of HEWAN urged both ministers to address the inter-professional rivalry in the public health sector, adding that it should be among the first steps by the new health minister. They said, “There should be zero tolerance for discord in the sector.”
It would be recalled that the Joint Health Sector Union (JOHESU), a body of health workers that exclude medical doctors, has allegedly been on a war-path with the Nigerian Medical Association (NMA) over the years especially because doctors opposed most of their welfare demands.
As a matter of necessity and without prejudice, HEWAN stated that the age-long inter- and intra-professional rivalries, discord, acrimony, and crisis that have always thrown the Nigerian Health Sector into unending and perennial discord should be tackled.
NISA seeks identification, treatment of 1.9m Nigerians living with HIV
The Nigeria Implementation Science Alliance (NISA), has called for the identification and placement of the 1.9 million Nigerians estimated to be living with HIV on treatment, in order to put an end to the disease in the country.
New Telegraph recalled that results released in March this year after the Nigerian HIV/AIDS Indicator and Impact Survey (NAIS), indicated that about 1.9 million Nigerians were currently living with HIV, with a prevalence of 1.4 per cent among adults aged 15 to 49 years. Previous estimates had indicated a national prevalence of 2.8 per cent.
NISA board chair, Prof. Echezona Ezeanolue, who made the call on Tuesday during a 2-day NISA conference with the theme ‘Achieving Impact through Implementation Research,’ said the huge amount spent in conducting the NAIS would be said to have made meaningful impact if the persons said to be living with HIV are not identified and placed on prompt treatment.
In his words, “The NAIS study cost $100 million to look at how many people actually have HIV in Nigeria when you get that information what do you do with it that is called implementation science so one of the things we did now is that once we have gotten that information and we know exactly where people who live with HIV are living, we want to go there and identify them so that we can put them on treatment.
“Once you put some one who has HIV on treatment, you can actually stop that transmission from that person to another person and that is one of the ways we can use the Information we get from research into making an impact.
“It is not about research if you don’t use it to do something. Use the research to get the data, the information that helps us to actually make the impact.”
If we know this is the area that has the highest number of HIV, we need to identify the people, we need to place them on treatment so that we can stop transmission.”
Also speaking, Chef Executive Officer and Co-chair of the conference, Dr. Patrick Dakum, stressed on the need for government to implement a comprehensive health intervention that would address all cases of communicable and non-communicable disease in the country, rather than focus on selected few.
Dakum who stressed that every disease entity was crucial, noted that a key objective of the conference was to ensure an increase in low uptake of health service outcomes in the country, in collaboration with the public and private sector.
“You go to a particular place they are doing very well in medicine and immunisation, if you go to a particular place they are doing very well in HIV so the prevention and the treatment is known but the uptake of the service is low the question is why?
“So implementing partners with public and private sector and communities are looking at how to increase the uptake of health services. The essence of this is how do we ensure that the uptake of services is optimal.
“Non-Communicable Diseases (NCDs) are a concern and in this implementation science we are looking at NCDs too and how to ensure that implementation is very apt. This disease entities are very crucial; there are several programmes that address them, but definitely a comprehensive health intervention is what we need in this country.”
Mushroom: The forgotten superfood
In April last year, I had a meeting with a group of local farmers in Ewu village in Edo state, about 200 of them. It was part of our community outreach programme at Paxherbals, getting the people to identify, discuss and analyse their challenges and then proffer solutions from within. The local people complained that cassava farming is no longer profitable. Many families cultivate cassava, which they harvest, eat and then sell the leftovers. This is subsistence farming. The people spend so much time and energy in the sun clearing the bush, planting and then waiting for the cassava to grow and mature. They are able to harvest a few bags of cassava, which is priced very cheaply in the local market.
The government, to give a higher yield of cassava, shares thousands of fertilisers they claim help to improve soil yield. But the people know the fertilisers don’t provide the solution, and only deplete the soil. They know organic farming is best.
At this meeting the group agreed to invite the most elderly women in the communities to the next meeting. These grandmothers and great-grandmothers are custodians of knowledge in the local communities. The oldest among them was an energetic old mama, 120 years old, while the others were between the ages of 75 to 110.
‘Once upon a time’, the eldest woman in the community, Mama Ageless, as she is fondly called, said, ‘mushrooms were growing all over the land, and we used to harvest them to cook. These mushrooms supplied us most of our nutrients. But these days, there are not more mushrooms. Rather, we have bread and fries. ‘Bring back mushrooms to the village’, said mama Ageless.
In the next meeting, the group of farmers decided to explore oyster mushroom farming. But all believed mushrooms only grow in the wild, and no one knew they could be cultivated. Within two months, I organised a training session on mushroom cultivation to a select group of the local farmers. The species cultivated was Pleurotus Ostreatus, popularly called the Oyster mushroom. Many of the selected people did not attend the training session because they did not believe mushrooms can be cultivated. Those who attended were enthralled, surprised and excited. It was a eureka moment for the participants, and they all exclaimed, ‘So it is possible!’
Since the initial training, hundreds of local farmers have applied to join in the next training.
The goal is to move from subsistence farming to secure livelihoods, from food sufficiency to food security, from agriculture to agribusiness. While a 100-foot plot of land can only give a few cassavas worth N36,000, the same plot of land could produce bags of mushrooms worth N200,000.
Unlike cassava cultivation, a mushroom is planted inside the house rather than in the open, and the waste from the mushroom soil is far more useful as fertilisers than the synthetic fertilisers provided by the government.
How is mushroom cultivated? What we did was to culture the tissue cells of the mushroom from the wild, and carefully extract the seeds in the laboratory, through different processes of sterilisation and pasteurisation. The result is that we can now distribute the seeds in large quantities to farmers.
Mushroom farming is often referred to as millionaires farming or executive farming because it is cultivated indoors rather than outdoors. In fact, you can grow mushroom in your bedroom!
What is a mushroom? Mushrooms are edible fungi with different names under the scientific name of ‘Agaricus’. The study of mushrooms is called mycology, and mushroom cultivation is technically called ‘fungiculture’. Mushrooms are saprophytes, the organism (plants that do not have chlorophyll), which feed on nutrients from dead and decaying plant and animal matter.
Many people mistakenly refer to mushrooms as plants. The fact is that MUSHROOMS ARE NOT PLANTS, VEGETABLES OR ANIMALS. They are scientifically classified as fungi.
Fungi have always been a puzzle for scientists. Mushrooms share a lot of attributes with plants and vegetables and animals, but they belong to a different kingdom of the organism which also contains yeast, mould and many other variations of fungus. Mushrooms, lie all fungi, occupy a place between plant and animals. They do not have a root system, and they do not make chlorophyll, the chemical in plants that makes them green. While plants thrive by transmuting sunlight into food, mushrooms ‘eat’ or absorb nutrients from by-products of rotting vegetation, which explains why they grow well in damp and dark conditions.
There are approximately 140,000 species of mushroom-forming fungi in the world, but science is only familiar with about 10 per cent, while only 100 species have so far been studied for their potential health benefits and medicinal applications.
Are you interested in becoming a mushroom farmer? Get in touch for directions on how to get mushroom seeds and grow your own superfood!
It will take volumes of books to describe the health benefits of mushrooms. I will discuss just a few of them here.
CHOLESTEROL: If you have been battling with high cholesterol, mushroom might be the best remedy for you. They are high in fibre and healthy enzymes, provide you with lean proteins, since they do not have cholesterol and fat, and have a low level of carbohydrates. The high level of lean protein in mushrooms helps to burn cholesterol when ingested and helps maintain a balance between bad cholesterol or LDL and good cholesterol or HDL. Mushrooms are highly recommended for the prevention of heart disease, stroke and atherosclerosis.
ANAEMIA: Mushrooms are an excellent source of iron. In fact, over 90 per cent of the Iron in mushrooms are absolved by the body. If you eat mushrooms, you will notice how quickly you feel energised and refreshed. Low levels of Iron in the blood lead to fatigue, headaches, digestive problems and reduced kidney function. Mushrooms promote the formation of red blood cells and keep people healthy and active. Those suffering from sickle- cell Anaemia will find mushrooms particularly beneficial.
CANCER: My search for more effective medicine for cancer led me to carry out more research on cancer. The results so far are very encouraging. Mushrooms are effective in preventing breast and prostate cancer because of the presence of beta-glucans and conjugated linoleic acid. Beta-glucans stop the growth of cancerous cells in prostate cancer cases. Linoleic acid helps in suppressing the adverse effects of excessive estrogen production, which is one of the causes of breast cancer, especially after menopause. Much scientific research work has shown the antitumor properties of mushroom.
DIABETES: There are many reasons mushrooms are excellent for diabetic patients. They are high in fibre, water, natural insulin, and enzymes which help in breaking down sugar in food. The enzymes in mushrooms also support proper functioning of the liver, pancreas and other endocrine glands. This explains why they promote the formation of insulin and its effective regulation in the body. For people with diabetes, mushrooms are the ideal low-energy diet: they have no fats, no cholesterol, little carbohydrates, high proteins, vitamins and minerals.
African congress on sickle cell disease to foster solutions
In order to address the challenges of sickle cell disorder and foster possible solutions to its effect as a public health burden, the first African Congress on Sickle Cell Disease (ACSCD) is set to take place.
The event which will bring together stateholders will be organised by the Dr. SickleCell – Center For Sickle Cell Disease in association with Olusegun Obasanjo Foundation.
The programme, which is the first African Congress on Sickle Cell Disease (ACSCD) will be supported by of a host of sickle cell organisations across Africa and the World.
ACSCD co-Chair, Dr. David Ajaere who disclosed during a press conference in Abuja, said the event will take place at the Landmark Center, Victoria Island, Lagos from October 31 to November 2.
He added that Key stakeholders and Organisations expected at the Congress include the Federal Ministry of Health (FMOH), Lagos State Ministry of Health, Lagos State Blood Transfusion Services (LSBTS), World Health Organisation (WHO Africa), amongst other non-governmental & corporate organisations, multilateral donor agencies and institutions, health researchers, civil society organisations, and the academic community. The conference is first of its kind in the history of health intervention programmes for sickle cell disorder in Africa.
Dr. David Ajaere ACSCD co-Chair also said that the overall goal of the conference is to facilitate exchange of information among public health experts, medical professionals, researchers, policy-makers, key stakeholders to highlight challenges and opportunities and enhance strategies to control Sickle Cell Disease in Africa.
Eminent dignitaries who are expected to attend the event include the Minister of Health Osagie, Ehanire, Nigeria, Dr. Matshidiso Moeti, Director – WHO Africa, His Majesty, Ronald Muwenda Mutebill – The Kabaka of Buganda Kingdom, Uganda, Dr.ChitaluChilufya MP, Minister of Health Zambia, Kwaku Agyaman, Minister of Health Ghana, Dr. Jane Ruth Aceng, Minister of Health Uganda, Dr. Randal Mills, CEO – National Marrow Donor Programme/Be The Match, USA and (Mrs.) Toyin Saraki, Founder – Wellbeing Foundation Africa. The ACSCD Congress is being held under the High Patronage of Former President Olusegun Obasanjo.
Other key delegates expected to Grace the event include, Mike McCullough, Chief Information Officer – National Marrow Donor Programme/Be The Match, USA, Dr. Lakiea Bailey, Director- Sickle Cell Consortium, USA, Dr. Carol Ossai, Founder -Sickle Cell and Young Stroke Survivors, UK, Mrs. LanreTunji-Ajay, President- Sickle Cell Awareness Group of Ontario, Canada, Samuel Mbunya, Programme Administrator- AMPATH Kenya, Dr. Enam Bankas, Founder- Sickle Life Ghana, Adam Thompson, Executive Director- eHealth Africa, Cassandra Trimnell, CEO- Sickle Cell 101,USA, Ms. Toyin Adesola, Executive Director– Sickle Cell Advocacy & Management Initiative, SsebandekeAshiraf – East Africa Sickle Cell Alliance, Samira Sanusi, President- Samira Sanusi Sickle Cell Foundation and Anne Welsh, Author – Painless &The New face of Sickle Cell and chronic Disease Advocacy in Africa.
ACSCD International Affairs Coordinator, Amb. Eddie Resphanto said that because of the magnitude of the event, opportunities abound for those who want to be a sponsor, exhibitor, a Speaker or partner, which also includes non-governmental and corporate organisations.
This event is coming at a time when a medical expert, Dr.Emoruwa Oyefo of Eko Hospital disclosed that Nigeria has the largest population of Sickle Cell children in Africa.
Smile train partners WACS to launch surgical certification programme
Smile Train, the world’s leading cleft organisation has announced their partnership with the West African College of Surgeons (WACS) to launch the Smile Train-WACS Cleft Surgical Certification.
The Certification will grant six surgeons per year over the next five years the opportunity to specialise in cleft care across West Africa.
In a statement by Emily Manjeru, Smile Train PR & Communications Manager, Africa, the one- year Post-Graduate Programme will commence in February 2020. WACS will identify accredited centers to serve as training sites in Nigeria, Ghana and French West Africa.The
Certification is open to applicants in all West African and CEMAC zone countries with priority being given to trainees from countries without significant Smile Train presence.
Speaking during the signing of the Memorandum of Understanding (MoU) which took place at The College in Lagos, Smile Train Programme Director of West and Central Africa, Mrs. Nkeiruka Obi noted that the care for cleft patients required more capacity building for surgeons, hence will leverage the College resources to elevate the surgical expertise for local surgeons in the region.
“Smile Train’s sustainable model provides training, funding, and resources to empower local medical professionals to provide free cleft surgery and comprehensive cleft care in their own communities. Through this ground-breaking investment, we will enhance our interventions by establishing centers of excellence across West Africa,” noted Mrs. Obi.
Alongside Mrs. Obi, the President of WACS, Professor Serigne Magueye Gueye welcomed the partnership and expressed commitment to ensuring that the local surgeons from the Certification match the global quality standards of cleft care set forth by Smile Train.
“We are dedicated to ensuring that we not only equip the local surgeons handling cleft, but also aim at establishing connections in developing other programme areas of comprehensive cleft care such as speech therapy and orthodontics. Our highly skilled faculty will be sourced from local cleft surgeons and adjunct lecturers from relevant departments in the hospital in which the programme will be running,” said Professor Gueye.”
Globally, every three minutes a baby is born with cleft. A cleft occurs when certain body parts and structures do not fuse together during fetal development. Clefts can involve the lip and/or the roof of the mouth, which is made up of both hard and soft palate. To-date, Smile Train has supported more than 113,000 cleft surgeries across 38 countries in Africa. In addition to cleft surgery, they actively support training of nurses, anesthetists, surgeons, speech therapists and orthodontists in cleft care, nutrition programmes, speech therapy and orthodontics.
US baby born on 9/11 at 9:11 weighs 9lb 11oz
A US mother says her newborn daughter is a “little miracle” after she was born on the anniversary of the 9/11 attacks at 9:11pm weighing 9lb 11oz.
Little Christina Brown came into the world at Methodist LeBonheur Hospital in Germantown, Tennessee.
“She is a new life amongst the devastation and destruction,” said her mother Cametrione Moore-Brown.
Commemorations were held across the US to mark 18 years since the attack, on September 11, 2001.
Christina was born by Caesarean section and operating theatre staff were stunned when the baby’s time of birth and weight were recorded.
“We heard the doctor announce the time of birth 9/11 and then when they weighed Christina, we heard gasps of astonishment when everyone realized Christina weighed 9/11, was born at 9:11 and on 9/11,” said father Justin Brown.
“It was really exciting, especially to find some joy during a day of such tragedy.”
Rachel Laughlin, head of women’s services at the hospital said such a coincidence was extremely rare.
“I’ve worked in women’s services for over 35 years, and I’ve never seen a baby’s birthdate, time of birth, and weight all be matching numbers,” she said.
Christina’s parents say that when she is older they will share with her the significance of her birth, reports the BBC.
The 18th anniversary of the attack saw a moment’s silence take place at various locations, including the sites of the attack, “Ground Zero”, in New York, at the Pentagon, Virginia, and at Stonycreek Township in Pennsylvania.
Nearly 3,000 people were killed in the attack and thousands more were injured.
Kenya becomes third African nation to introduce world’s first malaria vaccine
Kenya on Friday added the world’s first malaria vaccine to the routine immunization schedule for children under two, becoming the third country in Africa to roll out the vaccine for the disease that kills one child globally every two minutes.
Malaria is a top killer of children under five in the East African nation, and the vaccine is critically important to its efforts to combat the disease because other measures such as mosquito nets have not proven adequate, the director general of Kenya’s health ministry, Wekesa Masasabi, told Reuters.
“We still have an incidence of 27% (malaria infection) for children under five,” Masasabi said before Friday’s launch of the vaccine in the western county of Homa Bay.
The Homa Bay program was the government’s first step toward creating awareness of the new vaccine, he said.
African nations Ghana and Malawi launched their pilot programs of the vaccine earlier this year. Kenya plans to roll out the vaccine to eight of its 47 counties over the next two years, Masasabi said.
Malaria can be eradicated within a generation, global health experts said in a major report last weekend that was commissioned by The Lancet medical journal. The Lancet report contradicted the conclusions last month of a malaria review by the World Health Organisation , and its experts urged the WHO not to shy away from this “goal of epic proportions”.
Malaria infected about 219 million people in 2017, killing around 435,000 of them, the vast majority babies and children in the poorest parts of Africa.
Due to ongoing transmission, half the world’s population is still at risk of contracting malaria.
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