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  • ‘ Cancer is now an epidemic in Nigeria’

    ‘ Cancer is now an epidemic in Nigeria’

    Prof. Remi Ajekigbe is a consultant at the Department of Radiotherapy, Radiodiagnosis and Radiography at the College of Medicine, University of Lagos (CMUL) and Lagos University Teaching Hospital (LUTH), Idi-Araba. In this interview, he tells OYEYEMI GBENGA-MUSTAPHA some of the steps that can be taken to stem the cancer tide ravaging the country. 

    hat have you discovered over the decades in the treatment of cancer?

    I have learnt in close to 40 years that the management of cancer and its care treatment have not changed. We still see cancer patients coming late to the hospital. I remember we have written papers, talked at seminars and made recommendations on what the positive difference of early presentation can make in the overall treatment of cancer patients. And till date, we still have patients coming in at very late stages.This is traceable to our cultural belief that these diseases are caused by human beings in form of ‘enemies’, ‘the other woman’, as a form of attack through diabolical means.The hospital, unfortunately, is not the first place of call by these sufferers, except for few highly educated ones, who come in early. Even those ones, how early in the real sense do they come? So, we are tasked with educating people on cancer.

    Why did you say that?

    It appears that the government is not too serious about cancer treatment in Nigeria. As of today, I can say categorically that cancer has become an epidemic in Nigeria. I do not know when the government will be convinced that cancer is now an epidemic. We haven’t got enough facilities to treat cancer to international acceptable standard. And the manpower is not enough. Virtually all the cancer machines across the country are down. When we were being trained abroad, we were told that we are doctors of the future in Africa and the future is now here. Africa, especially Nigeria, is not prepared for cancer treatment. When we talk of Africa here, I mean the Sub-Sahara black Africa. North and South Africa are ok. Why Sub-Sahara Africa is not prepared for cancer treatment is still a puzzle. I do not know. Nigeria is the future of the black man. I hope Nigeria will take up the challenge.

    Cancer rate is that it is an epidemic. There is no Nigerian family that would say it does not know or have somebody affected by cancer. The reality is that everybody is a potential cancer victim.This disease does not have respect for age, creed, gender, wealth, and position. Everybody should avoid it. For instance, prostate cancer is becoming at par with cancer of the breast. Virtually all men, who come to the hospital have cancer of the prostate. Some argued that it is due to awareness. That is, men report themselves to the clinics. The rate is on the increase, not only caused by ageing factor, for we now see 42-year-old patients.

    What do you think are the causes?

    For cancer, the genetic factor is there, social factor is there. Total environmental factors are there as well. Frightening enough, we are becoming less and less Africans except in our complexion. We are becoming more westernised. Cancer with other non communicable diseases are the supreme prize.

    What is the way out?

    Cancer education should be done in all nooks and crannies of the country. Every state should have a cancer centre. This is possible because more manpower should be trained in cancer care and treatment.The ones trained some years ago are already ageing and close to retirement, and will ease out of the system. The younger ones are not showing much interest because it is not a lucrative part of medicine. Many medics are moving across the country now with titles like ‘I’m an oncologist’, because cancer is now ravaging. If the government wants to ensure that cancer, as an epidemic, is arrested in the country, it must as a matter of urgency allocate an oil bloc to cancer. That will create more cancer centres across the country. It will train more manpower that can be deployed in all parts of the country as cancer specialists. That will stop people from travelling from one part of the nation to another in search of treatment.

    Imagine somebody living in Maiduguri coming to Lagos, or from Calabar to Abuja. Every state will have cancer centres with the necessary machines. At least, two machines so that when one breaks down, the other gets people treated while the former is being repaired. The situation is so bad that patients are requesting to be transferred to Ghana. That is an insult to the country. Even referrals to India is insulting. We have qualified hands here, but lack  facilities.

    Are there other ways out of this epidemic?

    We should just encourage more doctors into the field of oncology. And those trainees should forget about the lucrative part of medicine and come to cancer management. Naturally, such trainees will have milk of kindness. People with cancer are really suffering. Many do not even know that cancer is a bone-seeking disease. It can affect any part or bone of the body except hair, teeth and nail, leading to severe pains. If you see a male cancer patient crying, you will be dejected knowing that ordinarily men don’t usually cry. I see all these and I do not feel comfortable with them and that is why I am appealing to those, who matter in government, to please listen to what we are saying on cancer management.

    What about drugs availability?

    The drugs that really work in cancer cases are very expensive, especially the ones called Monoclonal antibodies (mAbs). These drugs are effective. Monoclonal antibodies (mAbs) with a chemotherapy drug or a radioactive particle are called conjugated monoclonal antibodies.The mAb is used as a homing device to take one of these substances directly to the cancer cells.The mAb circulates throughout the body until it can find and hook onto the target antigen.  A Federal Government civil servant with cancer of the breast was a patient here. The breast cancer dictated the drugs it needed and they are Monoclonal antibodies (mAbs). We cost it and arrived at N18.6million. There was no way she could raise the money being a junior civil servant. If all she has, along with friends and co-workers are put up as bazaar, all cannot amount to that amount. I had to write to the Executive Secretary of the National Health Insurance Scheme (NHIS) that the patient was too young to die, appealing that he should use his offices to assist a Federal Government civil servant.

    After many attempts, he listened and approved the drugs. He gave a condition: that the drugs would be procured but first doses given at a Federal hospital in Abuja and others in Lagos, to be absolutely sure. The lady and I complied and she was sent to Abuja for the first cause of chemotherapy and the Monoclonal antibodies (mAbs). She is cancer free now. That is an isolated case. How many have gone because they could not afford the drugs – males, females, even children, and cannot be helped; the list is endless. Another was the wife of a soldier. She too could not afford the drugs and I cited the isolated case because I know her as a civil servant working in LUTH. That if the couple can follow same by requesting the Chief Commandant to write such a letter, who knows? They did and the woman is also ok.

    What lessons did you draw from those experiences?

    I will strongly recommend that the NHIS include the coverage of cancer treatment to, at least, an extent. For instance, take a look at children with cancer, otherwise called childhood cancers. When these children are in pains, no matter how strong you are,you will break down; something will give way in you. Each time I see them in that ward  – I ask, what is the government doing for its citizens? This is not a game-blaming situation. The poor have many children and when those children fall sick with cancer, you cannot but see their raw sufferings. There are no charity organisations that give out drugs, no government, so the children suffer. Government really needs to help cancer patients.

    The Federal Ministry of Health recently took some steps on cancer care nationwide, do you see them working?

    I think the Federal Ministry of Health is the only ministry that does not bring in money to the coffer of the government. It is ever spending. So, in budget allocation in spite of the World Health Organisation’s recommendation, the country is way far back. Health is wealth. If Nigerians are healthy, they will work and increase the gross domestic product. More investment should be done in the health sector.

    What are to be done to avoid developing cancer?

    Nigerians should re-embrace organic foods. Enough of this western diet – fast food, fizzy drinks, noodles, pasta, white bread, over processed food, can food, smoked/burnt food etc. Nigeria is yet to see what the future is like because these noodles-eating generations by the time they grow up, without being a pessimist, we will be recording more colorectal, and gastro-urinary cancers. This is the time to go back to our natural foods. Most Nigerian staple foods have fibres that help  to ease digestion and passage of faeces.Women should avoid expired or inferior cosmetics. Some of those ingredients – lead, mercury etc are carcinogenic. They can lead to cancers of the skin, breast, even leukemia (cancer of the blood), among others. Also, the moderate use of roll-on is good. Most Nigerians are right handed, so when they apply roll-ons, they apply much on the left side, hence higher cases of left cancer of the breast. The nation is paying a lot of price for civilisation.

  • CMUL inducts first MLS students

    The College of Medicine (CMUL), University of Lagos has inducted its first set of Medical Laboratory Science (MLS) graduates as professional members of the Medical Laboratory Council of Nigeria (MLSCN).

    The 36 students specialised in one of five units of the programme- Medical microbiology, Chemical pathology, Haematology and Blood Group Serology (BGS), Histopathology and Immunology and Immunochemistry and Molecular Diagnosis.

    Addressing the professionals at the Old Great Hall, Provost of the college, Prof Folasade Ogunsola, urged them to be change agents and continue to seek knowledge.

    “This college has produced many notable health professionals who are changing Nigeria and the world and you must be proud to be counted as one of them. I therefore implore you to keep in mind all the basic ethical principles of your profession and be a good ambassador of this great institution,” she said.

    Head of the department Prof Oluyemi Akinloye, praised the institution for starting the programme.

    “It is commendable that the University of Lagos is joining the league of universities in turning out Medical Laboratory Scientists of high repute despite scarce resources in the country. This shows the resilience of this great institution in helping to build a virile Nigeria during this era of change”

    Meanwhile, Abidoun Olalekan emerged the best overall student and best student in Chemical Pathology; Akinlolu Oluwasegun won the prize for Medical Microbiology; and Aliyu Bisola for Haematology and BGS.

  • Physiologists decry poor research equipment

    Physiologists decry poor research equipment

    Pysiologists have decried lack of adequate equipment to carry out researches.

    They said this was a major problem facing their profession.

    A don at the College of Medicine at the University of Lagos (CMUL), Prof Olusoga Sofola, who spoke on physiologists’ constraints, noted that research equipment were necessary to build the capacity of young physiologists and students to ensure hands-on training.

    Sofola spoke at the International Union of Physiological Sciences (IUPS) regional teaching and research workshop and 34th Physiological Society of Nigeria’s (PSN’s) scientific conference with the theme: Paradigms in Physiology, Teaching and Research.

    He said getting funds to buy some of the equipment was a big problem, adding that there were inadequate tools for teaching and research.

    The professor of Physiology said Exchange-Traded Fund (ETF) had given some grants for research equipment.

    According to him, this would enable Nigeria to develop its capacity to international standard.

    The Chairman of IUPS Educational Committee, Brody School of Medicine, East Carolina, United States, Prof Robert Carroll said another challenge physiological education is training physiologists in modern educational techniques.

    He said: “Too often, we think about teaching and we find a room to lecture but a good educational research has shown that students do not retain the information as effective as it should be.”

    The battle, the expert said, is training the trainers so that physiologists can be exposed to various approaches of teaching and research to impart positively on the students.

    Besides, there is need to ensure that tools for teaching are appropriate for Nigeria and West Africa, he said.

    “We have to make ensure that the right education is applied so that research can be done appropriately,” Carroll added.

    A member of PSN Prof Ibiyemi Olatunji-Bello said the society discovered that the method of teaching among physiologists was “far behind internationally acceptable standards”.

    She said there was need to replicate what others were doing in the country.

    The expert said this was why PSN ensured that the IUPS workshop was brought to the country to build the capacity of lecturers.

    Prof Olatunji-Bello said the workshop would bring development to the country in the short run because there would be knowledge transfer to physiologists to contribute to learning.

    She added: “There will be novel methods that we are going to introduce to enhance teaching so that learning can be better. The learning section of the students will be greatly imparted. This will in turn have a positive impact on the society.”

     

  • How to tackle ageing

    How to tackle ageing

    To most people, wrinkles, crow’s feet around the eyes, age spots and skin thinning; gray hair, memory slips, tooth loss or decay, balding, hearing loss and difficulty in reading small prints are a few visible signs of ageing. However, there are more signs than our eyes can see.

    According to a Consultant in the Department of Community Health and Primary Care, College of Medicine, University of Lagos (CMUL), Prof Muriel Oyediran, growing old is a fact of life. Getting old means we lose some of our physiological functions that hasten death. This is something we cannot stop, but we can slow down. This loss occurs primarily within the cells in our brain, heart, kidney and bones.

    She spoke during this year’s Faculty Day Lecture of the Faculty of Public Health, National Postgraduate College of Nigeria, held in Hall 36, Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos.

    The theme was: Even Nigerians grow old! The problems and challenges of ageing in Nigeria.

    She said: “Who are the elderly? The elderly is the term used to describe people who are 60 years and over. They are subdivided into ‘young old’ from 60 to 74 years; ‘the aged’ from 75 years to 79 years and the ‘oldest old’ who are 80 and above. However, in the developed countries where life expectancy is higher, the oldest old refers to people aged 85 years and above. Eye diseases such as cataract and glaucoma; osteoarthritis (OA) and alzheimer’s disease are some of the signs that characterise ageing, especially in Nigeria. A receding hairline and certain other signs of ageing may be far more than cosmetic problems. They can be signs of poor heart health.”

    Also, she said what typified ageing include decrease in energy, strength, and speed; decrease in muscle mass; decrease in metabolism and decrease in kidney function. “If you will observe closely, as we grow old, we tend to move slower than when we were younger because we get tired easily. This is because of decreased energy level. The only way to combat this is to eat more protein and exercise frequently. You should eat foods rich in vitamin B, folic acid, and phenylalanine.”

    Oyediran said: “Muscle mass also decreases by about seven pounds every 10 years, but this speeds up as we reach the age of 45. We can, however, slow this down by exercising and maintaining a healthy diet rich in fruits and vegetables. Our Base Metabolic Rate (BMR) also decelerate as we grow older; that is why older people find it hard to digest the foods they eat. The aged’s thyroid gland makes fewer hormones, so he or she should increase protein intake to make the body produce more hormones again. They should also avoid eating foods rich in fat and carbohydrates. As we all know, our kidney is a very important organ in our body that filters our blood and acts as thermostat. Refraining from eating red meat and drinking more water everyday will help us slow down ageing.”

    She said: “The factors governing mortality and fertility changes in populations, which affect life expectancy, and the effects of these changes, which resulted in lower fertility and mortality rates are known as ‘the Demographic Transition’. At the moment, a higher proportion of elderly persons are found in Europe compared to Africa. However, even though the decline in fertility rate started later in Africa, the older population in Africa is growing at a faster rate and is also taking place over a shorter period of time and is occuring in a larger population basis. This unprecedented increase in the percentage of the elderly in developing countries will have a tremendous impact on any nation because of its effect on developmental programmes.

    “Originally most countries experienced high mortality rates and high fertility rates and the balance between these two rates resulted in populations with fairly stable growth rates. In the more developed or developed countries, population ageing took a longer time to occur allowing those nations a longer time to make national adjustments to allow for ageing processes in society. The fact that in the developing countries, these changes are happening in a relatively shorter period, means that they have much less time than the developed countries to make the necessary adjustments designed to meet up with the challenges posed by these rapid changes in age structure.

    “This is shown by the fact that at present the average annual growth rate of the population of persons over 60 years is 2.5 per cent in the less developed countries compared to .9 per cent in the more developed regions. This is almost three times as high as that of the more developed countries. This trend is emphasised by the projection of the figures for 2004 to 2050 where the rate of growth of the over sixties in the least developed counties is estimated to grow at a rate of 3.7 per cent compared to the growth rate of the same age group in the more developed countries of 0.2 per cent.”

    She called on the government to be aware of the increasing financial, social and health needs of the elderly and to be more proactive in providing affordable health care for the elderly through health insurance schemes and care providers that provide different levels and types of care including palliative care.

    “The main challenges for successful ageing to be achieved are the provision of programmes, services and facilities that enable the elderly to retain their ability to live useful and productive lives in good physical; mental; emotional and spiritual health for as long as possible.

    “To ensure the full potential of the elderly is realised, the Nigerian governments at all levels have a commitment to provide conditions that promote quality of life for the elderly so that they can continue to participate in their communities, and to live and work independently for as long as possible,” she said.

  • Nigeria lacks capacity in nursing, says don

    There is a dearth of nurses and midwives in Nigeria, a don at the Department of Nursing Science, College of Medicine, University of Lagos (CMUL), Prof Boluwaji Fajemilehin, has said

    According to him, the Integrated Human Resource Information System (iHRIS) Qualify data, the country has fewer nurses and midwives available to care for the sick.

    He spoke at the Seventh Lagos State University Teaching Hospital (LASUTH) Nurses Yearly Conference. The theme was Nursing: task shifting and other strategies in a resource challenged environment.

    Fajamilehin, represented by a lecturer at College of Nursing, University of Lagos, Mr Adeboye Jojolade, said records from the Nursing and Midwifery Council of Nigeria (NMCN) showed there were about 240,000 qualified nurses and midwives, adding that the iHRS Qualify data quoted the registered number as 136,000.

    Describing the shortage, Fajemilehin said, there are two or three nurses for a 30-bed ward in the morning, one or two in the afternoon and only one for night duty despite the state of physical dependency of each patient.

    This, he said, made nurses set priorities and shift some roles to less professional ones, adding that they besar the burden of shifted loads at the state and local government levels for limited number of doctors, with only teaching hospitals located in the cities being fairly adequate.

    He berated the Nigerian constitution for its failure to clearly define who should fund and provide health care among the three tiers of government – federal, state and local government.

    “Lack of constitutional definition of roles, has caused complete absence of effective linkages and referrals, as such allows the governments to manage healthcare at their discretion,” he said.

    “It is the immediate backup for shortfalls of medical demands in any period of change at various levels of care under the pretence of expanded roles without legal string attached,” he added.