2

I hate cigarettes and the tobacco industry as much as the next non-smoker - however, I am concerned about recent talks to urge the FDA to ban mentholated cigarettes exclusively. (The link is a year old, but for some reason, a number of articles have come out from American Journal of Public Health this month and last about menthols)

African Americans are most likely to consume mentholated cigarettes and a ban would affect 90% of black smokers. If I could wave a magic wand, I would like to get rid of cigarettes, but sadly, reality is not so convenient. I still wish to look more into this topic, but I made some other preliminary comments elsewhere (link also presents related articles to the ban of menthols - seriously, haven't seen lazier public health/policy papers in quite a while).

...the fact that the majority of menthol smokers, if facing a ban, will turn to regular cigarettes presents another problem. It promotes the erroneous message that non-mentholated cigarettes, consumed by non-Blacks, are inherently safer than menthols – which is not true when you look at long-term outcomes – like lung cancer and even short-term outcomes like various biomarker loads...

But more importantly, a conversation about banning menthol cigarettes without a discussion on the inadvertent consequences of such a ban on minority communities, who are disproportionately harshly penalized by America's war against illicit drugs is a reckless one. See Warehousing of African Americans in prisons due to crack cocaine (and not the more affluent powder cocaine).

0

I shared this on my Reader, but thought I should also highlight the opportunity on this blog as well.

GHDOnline is calling for applications to their UpToDate International Grant Subscription program, due May 3rd. The grant provides free access to the peer-reviewed, evidence-based clinical information database to clinicians and medical organizations outside of the US. The application and FAQ can be found on the GHDOnline site. Apparently there is an American version of the program, too. Sorry for the short notice, but the application doesn't look terribly involved. A demonstration of UpToDate can be found here.

0

This was definitely worth another post this week.

Maybe by now, some of you have figured out beyond my penchant Nollywood, the mindless sputterings (made-up word, I think) of old Igbo men - such as this one and oh man, this one - I also have some interest in chronic disease management outside of the West (it's a budding interest, but an interest, no less). Even diseases traditionally thought of as acute (meaning you either get over it or die really quickly) are increasingly requiring a paradigm shift towards long-term care (namely, AIDS). Unfortunately, poor health infrastructure means that it is next to impossible to address such chronic disease care issues in the developing world (I know, I hate generalizations too, but bear with me)...I mean, seriously, check out the case of this guy...who happens to be the (former?) President of the the largest African nation, but has recently been relegated to receiving health care services at a glorified car park.

Developing nations find themselves in double jeopardy - battling acute infectious diseases while remaining horribly unprepared to face the rising threats of "first-world" health issues such as cardiovascular disease, cancer, motor vehicle accidents, mental illness, etc. Large-scale disease-centric interventions, at times serves to weaken overall health infrastructure, placing focus (and funding) on one or two diseases to the neglect of others - most oftentimes non-communicable or chronic diseases (NCDs). Consider NCDs as the latest addition to the category of Neglected Tropical Diseases (NTDs).

A recent study published in the the journal PLoS medicine (H/T Kaiser Daily Global Health Policy Report) found that high NCD burden served as a major barrier to achieving the UN's Millennium Development Goals (MDGs), which excludes NCDs among its list of health priorities, but includes HIV, tuberculosis, infant and maternal mortality. In regards to progress towards MDGs, reduction in NCD burden by 10% was nearly the equivalent to a 40% rise in GDP (or at least five years of economic growth in developing countries). The study highlighted the fact that NCDs plays an important role in the complicated relationship between poverty and health and as a result, greater emphasis should not only be placed on addressing NCDs, but health systems as a whole.

Our findings suggest that achievement of feasible reductions in the impact of these chronic diseases on poor households could greatly enhance progress towards existing health MDGs. If not adequately addressed, high rates of NCDs in low-income countries may further impede progress towards the health MDGs.

To bring it closer to home, the World Health Organization estimates that Nigeria loses about 400 million dollars a year in national income from premature deaths from heart disease, diabetes, and stroke. I wonder, if that figure includes revenue lost from exporting the healthcare of our presidents to other countries...

3

Faith-based organizations recently received some good press over the weekend with the publication of Nicholas Kristof's New York Times op-ed piece - Learning from the Sin of Sodom. In it, Kristof chastises liberal do-gooders for their "snootiness" towards Evangelicals and sings the praises Christian NGOs and churches for engaging in the thankless task of battling the "common enemies of humanity" such as poverty and exploitation. Considering the complicated past of foreign missionary work during colonial times and the recent Haitian adoption scandal by American missionaries, I am sure that religious communities everywhere are grateful for the article. Indeed, the church has been responsible for bringing about some good to the communities they serve in the developing world. When working in a long-term capacity, churches and other faith-based organizations have established schools, hospitals, and other needed infrastructure that rivals that of some secular organizations and local governments.

While I commend the efforts of Christians to live out the tenets of our faith through service, I find problematic some of the more recent trends I have personally witnessed amongst churches and individuals - primarily the interest in short-term international missions projects. One to three weeks long, such short-term projects are typically glorified (or should I say, church-ified) versions of slum tours. Merely donating to an established local entity is not enough. Rather, some feel the need to "experience first-hand" the raw poverty and pestilence that plagues the non-western world. No real training or skills are needed other than a heart for down-trodden people (or an eye for poverty p*rn). The emphasis is thus taken away from selfless Christ-like service, and is rather placed on fulfilling the short-term missionaries' desire to be needed.

In providing the lay person with this short-term experience, oftentimes, no thought is given to long-term implications of the excursion. In the case of short-term medical missions projects, which are sometimes conducted independently of local hospitals and resources, thousands of patients are attended to but little consideration is given to follow-up care. The goal is to reach the greatest number of people in an allotted time frame. More than 70% of patients with chronic, non-communicable diseases live in the developing world; and therefore long-term management of such patients is required. To say that short-term medical missions is like putting a bandage on a festering wound would be an understatement. I guess it's more like saying to a brother or sister without clothes or food, "Go, I wish you well..." without doing anything for their physical needs.

I also find that with short-term missions projects, there exists little discussion on evaluation or assessment of their interventions. In order to meet fundraising goals, emphasis is placed on the wow factor a project can evoke - "we saw x amount of patients," "we donated x number of y," etc. And because record-keeping remains virtually non-existent, no one can definitely measure the long-term impact of such excursions on target populations. Such projects are only answerable to their congregations, who may not be terribly familiar with the nuances of outcomes measurement.

Admittedly, the aforementioned also applies to secular non-profits and organizations. However, I feel as if some of these issues are particularly aggravated in the Christian community, where motive trumps means or outcome. The attempt to shuttle scores of Haitian "orphans" to the Domincan Republic by a church group, highlights such pervasive attitudes. It seems as if faith has provided us with the license to embark upon hastily organized projects and missions, because regardless the means or outcome, our intentions are sanctioned by God. While Christian organizations such as World Vision, highlighted in the Kristof's oped piece, should be commended, I do think that for a vast number of faith-based organizations and initiatives, our strategies need to be re-evaluated.

3

Earlier this year, Minister of Health, Babatunde Osotimehinin, in response to the decades-old "brain drain" of the continent's healthworkers, urged developed nations to invest in African medical schools and facilities. His request, is largely based on the belief that the continent's pervasive health woes are linked to the emigration of its health professionals. The draining of Africa's intellectual capital has also been witnessed in other fields as well, including business and academia. Current opinion holds that the flight professionals and academics to western shores is a destabilising force in developing nations. While developing nations invest resources into the training of its professionals, developed nations are poised to reap the benefits of such harvests.

Lately, several have begun to challenge such notions. Emeka Okafor, of Africa Unchained, asks if the brain drain might have some beneficial outcomes in the form of flow of capital through remittances, collaborations between foreign-based Africans and institution in their home countries, etc. Interestingly enough, some who aim to fight the continent's brain drain have been, at some point, primary beneficiaries of this phenomenon.

Within the arena of healthcare, the premise that brain drain of health workers equals poor health outcomes, is a a notion that also requires re-examination. Within the Nigerian context (anecdotal evidence alert!!!), I have met recent medical school grads who seek employment in more lucrative alternative fields. While noble, the pursuit of a career in medicine oftentimes fails to support its heroes. Beyond this, the success of a nation's health system depends on far much more than its healthcare workers.

Over the weekend, Foreign Policy, debunked a number of myths associated with the emigration of healthcare workers (an by extension, other professionals) to western countries. An argument I found of particular interest was that against the idea that developing nations waste resources on healthcare professionals who emigrate to western countries.

"The belief that skilled emigrants must cause public losses in the amount of their training cost is based on a series of stereotypes. First, large numbers of skilled emigrants are funded by themselves or by foreign scholarships. A survey of African-born members of the American Medical Association conducted by one of the authors found that about half of them acquired their medical training outside their country of birth. Second, many skilled emigrants serve the countries they come from for long periods before departure. The same survey found that African physicians in the United States and Canada who were trained in their country of birth spent, on average, over five years working in that country prior to emigration. This constitutes a substantial return on all investment in their training."

9

i have apparently been living under a rock (aka the United States) since it is only recently that I heard of the great Dr. Louis Obyo Obyo Nelson, who has been touted to have found a "cure" for diabetes.

last week, several Nigerian newspapers, including ThisDay, celebrated Nelson as a home-grown national hero, relishing the idea that something good has finally come out of Nigeria. Recently appointed Minister of State in the Federal Ministry of Health, Dr. Aliyu Idi Hong echoes such sentiments by describing Nelsons' "medicament" as historical....one would think Obama was being elected all over again considering the excitement that has been generated over the past few days.

why this news bothers me....let me count the ways....or rather let me start with the positives. In light of a piece I wrote some time back for mimimagazine about the growing, yet silent, dangers of chronic disease amongst Nigerians, I am quite elated that a discussion of diabetes has taken a prominent place in national headlines. The World Health Organization predicts that in Nigeria, mortality due to infectious disease, maternal/perinatal conditions AND nutritional deficiencies are expected to decline by 6% by 2015. However, in that same period, deaths due to diabetes and related conditions are expected to increase by 52% (please check my numbers, i just lifted this from and old assignment). I expect that this is largely due to the fact that we hardly talk about chronic disease on a national scale in Nigeria - or in developing nations in general....and when we do - its a whole lot of misinformation. But at least, diabetes is getting some shine time.

and speaking of misinformation, this brings me to my dear Dr. Nelson. from some work I did in the East sometime ago, I made the crude observation that many talk about chronic diseases, such as diabetes, as a condition to be cured. I guess the infectious disease model of you have an infection which requires a drug to rid the body of that foreign body is being applied to diabetes as well. I have encountered several Nigerian patients, family and friends who have either sought a cure for their diabetes or claimed to have been cured - medically, spiritually, or otherwise. Such thinking, my friends, is dangerous. This is because, in thinking that they are cured, diabetics abandon needed treatment/monitoring to keep their ever-fluctuating blood sugar levels under control. So when Nelson talks of a cure for diabetes, not only am I highly suspicious, but also, I am greatly concerned at the message he and his unofficial advertisers (Dr. Aliyu Idi Hong) are sending to folks. Now if Nelson's medicament (you can tell I am totally digging this my new word, medicament...) could manage diabetes....then all well and good.

several people have cited that the credibility of Nelson's claim lies in the fact that he's getting an almighty US patent and is working in conjunction with GDPAU - which I found out is a school of Ayurvedic medicine in New Jersey of all places (thanks google). Honestly people, I could scrape dandruff off my weave, bottle it, medicament-ize it and submit it for a US Patent - as long as someone has not done it before. I just hope that ordinary Nigerians are not the ones to suffer from some wuru wuru clinical trial remiscent of my other good friend, Pfizer.

oops....i lied....apparently Nigerians are indeed the guinea pigs of Nelson's drug.....forgot to read the rest of the ThisDay article....its really late....

now, you may have noticed that the title of this post mentioned erectile dysfunction....well, not only was it a carefully crafted ploy to get more hits on my blog....Nelson has also claimed that a side effect of this drug includes improved sexual function. Considering that erectile dysfunction and diabetes almost go hand-in-hand for men, I would be quite impressed with any drug that addresses both diabetes and prior vascular damage caused by diabetes that leads to erectile dysfunction....and that's about all I have to say about erectile dysfunction and related medicaments.

by the way, I am very pro-alternative and complementary medicine....its just that at the same token, i am anti-misinformation....

4

apparently, mosquitoes are not just for the poor anymore (or those unfortunate souls caught in Connecticut boonies during the summer....ehem....like me).

Bill Gates, speaking at the TED2009 conference, desired to make this plain to his audience by releasing 150 (who counted?) malaria free, though hungry, mosquitoes on his audience.

The stunt is cute, but what is even better is his commitment towards funding efforts to find a malaria vaccine to prevent related deaths in the future. For more on the "ideas worth spreading" being discussed at TED, check out their website for streaming coverage (and links to live bloggers at the conference).
thanks mommy for the link...

1

wait...so i think this is the first time i realized that the Nigerian government is representing the families affected by the 1996 Pfizer meningitis trials in Kano. i blogged about this case briefly sometime back. as of Tuesday, the Nigerian government, representing these unfortunate families, has decided to settle out of court with Pfizer. hmmmm, how convenient for enlargement of federal government coffers.

why, again, is the Nigerian government representing these families (scratches head)? i am all for government helping the needs of the less fortunate, but it seems that in the interests of these familes and the Nigerian government can and probably do conflict. I am not terribly familiar with the details of this case, since such info is not being broadly distributed to the public....but it seems like a better course would have been to hold two trials (unless I am in the dark and this is what is in fact going on...). One trial would be Nigeria v. Pfizer and would give the federal government the opportunity to sue the company for operating such a drug trial without proper permission from the Nigerian government. The second would be that of the Kano families v. Pfizer in which the drug company would be charged for crimes they committed against these individuals. Let me know what you think on this one....or please share other resources on this particular issue....

justice may remain elusive for these families after being pimped by large pharma (Pfizer) and now quite possibly, their own government. well, i guess this is the end of the road for this particular case. quite unfortnately though, this is an increasing trend on the part of pharmaceuticals to test their product in developing nations. trying to get my hands on Sonia Shah's "the body hunters," which I plan to devour and share after i get thru a brutal exam next week.

22

amongst older African Americans, there is this saying that "the white man's ice is colder than that of the black man." It's usually said with some sarcasm because everyone knows that ice is ice, regardless of who sells it or not. What they are trying to say is that some people have been so brainwashed so as to think that things of the West are ultimately superior in every respect and that such a fact can never ever be questioned. I am sure we have all seen instances of this both in Nigeria and abroad. Like for example, we may know of someone who insists on buying their "Made in China" shoes when the AbaMade brand looks similar and may be superior in quality.

So what does all this have to do with our formerly esteemed, but now fallen, Minister of Health, Dr. Adenike Grange. Plenty...well at least, in my humble opinion....your own opinions are most welcomed.

Two weeks ago (yeah, I know, I'm late), Dr. Grange resigned from her post as the nation's Minister of Health, under allegations of corruption and mishandling of funds allocated to the Ministry of Health. As for the specifics, N300 million of unspent funds meant to return to the national treasury went missing or - according to the Ministry - were spent on Christmas bonuses. Grange claims that she did not personally benefit from these funds, but, in my opinion the gross mishandling of these funds hints that she handled her post irresponsibly, at the least.

I was still in Nigeria when Grange was appointed to the position of Minister of Health. When I did a proper search on her credentials (ehem...google), I was more than impressed. Actually, I was inspired, even hopeful. Beyond being a Nigerian woman, (because most Nigerian women are simply awesome...), she served as the president of the International Pediatric Association (IPA) and as a consultant for respected institutions such as the World Health Organization and UNICEF.

I believe it is safe to assume that while she was working for these institutions, which are heavily funded and monitored by the West, she must have been very careful in carrying out her responsibilities. I'm sure that is why she was recommended to and later given the post of Minister of Health (as for the junior Minister, who in his former life was an architect...i no know wetin he dash Yardy make da man call am...but i digress).

But what happened when she entered the Ministry, if this whole debacle is indeed, as she claims, a "lapse" in duty on her part?

That is where the white man's ice comes in. I feel that many (including myself at times) tend to perform differently amongst different people. I feel that amongst the company of her oyinbo peers, Grange probably was meticulous in her various appointments. But when it came to handling the affairs of Nigerians, it seemed as if her guard went down. After all, this is Nigeria - anything goes (including the sum of N300million). If, Grange felt that the white man's ice is colder, then when she goes into his store to buy such ice, it required of her a higher degree of decorum, as she displayed when working with the likes of WHO, IPA, and UNICEF. I guess entering the black man's store she let her guard down and the millions of women and children she claimed to protect.

Dr. Grange is not the first, and definitely not the last, to behave in such a manner. I know that I have done the same too (I won't get into specifics). But I guess this post and the Grange issue serves as a reminder to myself that we should be careful when we approach the work of humanitarian aid or service to our fatherland (or motherland, whichever). Grange in her resignation shifted blame to inherent political corruption in the Ministry. But I wonder if that is a good enough excuse to ignore her own personal call to promoting high moral standards in government. Personally I think she did not take her post as seriously as she did her other appointments in the West simply because she was amongst Nigerians.

But then again, this is just my take on things. She might have had this "lapse" because of personal problems at home or work that made her miss the millions of naira being reshuffled.

But I do agree with her, in a speech she made in 2005, when she quoted Rev. Martin Luther King that "'We shall have to repent in this generation, not so much for the evil deeds of the wicked people but for the appalling silence (and inactivity) of good people.'"

Might I add, that our generation shall have to repent, not so much for an unwillingness to do good, but for being crappy at doing good (sorry, I'm having a brain freeze - no pun intended - and "crappy" was the only word I could think of...)

8

I know it's been long since I last posted but for a number of reasons over the holidays I took a mental, physical and otherwise break from everything. I think I am sort of back into the swing of things, school, blogging (maybe) etc.

So over the course of this semester I will be writing on health disparities in cardiovascular disease outcomes, particularly amongst black immigrants to the US and the influence of acculturation on health (I know, that was a mouthful). Some of the things I have come across is that relatively few people care about the health of black immigrants (seeing that I can't find that much on it) and that studies of black immigrants and their health could have some potential for addressing the health of African Americans.
In the course of digging through the literature for information on acculturation and African immigrants (I had to dig very deeply), I came across the African American Acculturation Scale, (AAAS) which I wanted to ignore at first, but sat down and thought about it for a while, especially in light of my own experiences.

I think of myself as a lot of different things, being a first generation American to African immigrants. In the United States, I identify myself as African American, not only in a literal sense, but also partaking in the African American culture which over the past 400 years has come to mean so many different things. I think the African American culture is one of the most diverse, seeing that it comprises of people like me, biracial people, and those who's roots can be traced all the way back to the trans-Atlantic slave trade. It took me a long time to realize this, especially while attending a predominantly black high school where most were from similar backgrounds and found it necessary to to categorize who was "black enough" and who talked or acted like white people. Needless to say, my accent and my inability to rattle off rap lyrics from the top of my head placed me in the latter category. Fortunately, there was a growing silent majority of "blacks" and "whites" at my high school who felt that the definition of blackness is quite flexible.

Apparently in academia, the definition of blackness is not as expansive as I and some of my high school mates believed. According to the AAAS, blackness can be measured in your thoughts toward traditional African American foods, willingness to date outside of your race, and political affiliations. Yes, I sort of see the rationale behind looking at these social and cultural aspects of race in order to determine willingness to engage in certain health practices. But there is a part of me that shudders at the thought of determining who's a traditional African American and who is not. And honestly, I think its somewhat outdated. It almost reminds me of a comment a teacher of mine made when I was in high school in which she wanted to find out if my family was "tribal." (yeah, she actually seriously asked me that - I was too stunned to give her a smart answer like if her family still lived in caves or waved the Confederate flag in front of their house or something like that).

Anyway, those are my initial thoughts on the subject, they may change over time or maybe I might find myself challenging these notions in a more public forum (meaning, beyond my blog).
Thoughts?

4

well, not me, but an article I wrote for MIMI Magazine, an online publication for young African women. Here is a snippet:

" In the time it takes you to count from one to ten, another individual dies from complications relating to diabetes. According to the World Health Organization, 80% of chronic disease deaths occur in low and middle income countries and deaths attributed to diabetes and related diseases surpass that of HIV/AIDS. While we in Africa continue to hang-up our bed-nets and practice safer sex - as we should - we remain helplessly behind in the fight against chronic diseases. This leaves our continent vulnerable to having to fight two enemies - acute infectious diseases such as malaria, but also long-term chronic diseases such as diabetes."

Not terribly inspiring, but I thought that the message needs to get out...

now back to books...until December 21st.

4

Today is officially World AIDS Day which largely brings to light issues of awareness, prevention, stigma surrounding the HIV/AIDS epidemic globally. I think key amongst these issues is prevention, so as to keep this epidemic at bay. Like my friend Femi Kuti says - AIDS no dey show for face....

Recently I attended a talk by Dr. Esther Ofoegbu , an Endocrinologist, and head of Department of Medicine and Head of the Office of Medical Education at the College of Medicine, University of Nigeria Teaching Hospital in Enugu. Like the Maduekwe talk, it was uninspiring, at best (actually it was much worse, at least Maduekwe is skilled in the art of BSing, the Ofoegbu talk was embarrasing - I almost did not want to raise my hand when she asked if there were any Nigerians in the audience). A member of the audience, yours truly, brought up the recent trend towards an integration of traditional healers into the national healthcare discourse. Such was dismissed by our esteemed visitor as nonsense seeing that traditional healers are nothing short of rogues, and she could not possibly understand why Nigerians, even the ones who can afford to attend hospitals, would still frequent these people.

Well, I am not easily deterred in my opinions and it seems like in terms of prevention and basic healthcare needs, it would not be such a bad idea to work in concert with traditional healers in order to reach the larger Nigerian populus with prevention messages like those that relate to not only infectious diseases such as AIDS, but also chronic diseases like hypertension and diabetes. Integration of traditional healers would inevitably lead to increased monitoring of false information being spread about prevention and cure of disease and they could serve as effective screening tools in which they could actually encourage their patients to see health professionals in complex cases. The possibilities are endless when one thinks creatively and gets their minds out of the box. In fact, Ofoegbu, the integration of traditional healers into modern practice is not a bad idea, says the World Bank and the World Health Organization.