Professor Kofi Duncan, a foremost oncologist, is the first radiotherapist and cancer manager in West Africa. He became a Fellow of the Royal College of Radiologists of England in 1961 and ever since he has been affecting lives in this area. As a professor of Oncology, Duncan looks after people who have cancer and was instrumental in bringing the first radiotherapy machine to Nigeria, which was set up at the Lagos University Teaching Hospital (LUTH), Idi Araba. In this interview with Yetunde Oladeinde, he talks about how he got the opportunity to study radiotherapy, working as a Lt. Colonel during the Nigerian. Civil War, why childhood cancer is on the increase and the state of healthcare in the country, amongst other issues.
How would you describe the state of healthcare in the nation today?
I would say that it is not as good as it should be. A lot more needs to be done. I think that advocacy and health awareness is best to teach the ordinary man the lifestyle that would lead to good health and longevity. We are trying but we are inundated in Nigeria in particular with various disciplines from the Chinese, Indians and others from the Western world. Unfortunately, they have infiltrated the country to a point where our healthcare is in a bad shape. Primary healthcare is very important and the tertiary part is also difficult.
I am in the discipline of Oncology and I believe that a lot can be done for our people. The equipment required are very few and far between. Sadly, we are nowhere near the World Health Organisation’s requirement for the type of population that we have. In Nigeria, we have only six centres and this cannot take care of the kind of population that we are talking about. Therefore, many patients are unable to get near the facilities requirement not to talk of the general awareness and possibilities of early detection.
What are some of the challenges working on cancer patients?
In Nigeria we have the common tumours like breast cancer, cancer of the cervix, prostate cancer, kidney problems and the other childhood tumours. Surgery is it but because of late presentation, things are more complicated than it should have been. In addition, the cost of chemotherapy is quite expensive like the other methods that are also available. I work here at the EKO Hospital and it is the only private hospital that has radiation machinery that is actually functional. The other facilities are in government hospitals and university hospitals. Unfortunately, the problem with the facilities in some of these hospitals is that the machines work today and may not work tomorrow. So, I believe that the state of our healthcare really needs to improve at all levels. From every area of primary health to the various hospitals and local government centres, there should be lot of awareness here as well as the market place and other areas. If that happens, then it might be possible to channel things early.
The late Prof Olikoye Ransome -Kuti showed interest in primary healthcare when he was the Minister of Health. How would you assess what we had then to the situation on ground now?
It has improved but the improvement is visible only in some states. Some of the states have advance primary healthcare but there is lack of information for those who are supposed to access these facilities. Some of the steps and stages that the patient needs to go through are very expensive and people don’t have means for each of the investigation that needs to be carried out.
In other parts of the world, the Health Insurance Scheme is used to fill in such gaps. How would you assess the National Health Insurance Scheme (NHIS) in the country?
It is not okay and it is obviously being bugged down by other challenges. But I honestly, believe that what has been given by government is far from being enough. The only problem we have is how to monitor what government has given to make sure that it is getting to the right channel.
These days there are so many cases of childhood cancers. What is responsible for this trend?
Some of the tumours that we see are actually in the position to come up because of HIV infection. Childhood cancer would be on the increase in so far as infections are on the increase. The good thing is that they are treatable and efforts are being made to improve the situation.
Is it also possible to get wealthy citizens to support healthcare?
Well, it is an ideal thing for rich people to support healthcare. Some have actually built structures and other things to make things better for the less privileged ones in the past. But this is just a drop in the ocean. We need enough time to channel these things properly.
There is also the herbal and alternative medicine input and some think that some of the problems come from the abuse of some of these drugs. What do you think?
I cannot say it is wrong to use herbal drugs. Interestingly, you would find that it boosts the morale of our people. There is a lot of good in herbs but the good is often mixed with the concoction. There is need for more clinical research in terms of dosage. I know a couple of people who have benefitted from herbal drugs and they are doing well. Our people believe strongly in it and if that is helping it should be encouraged.
For so long electricity to power medical facilities and other services has been a problem? Do you think that the recent moves to privatise the sector would change all these?
The major drawback in the progress of this country is energy. I cannot tell you in words how unfortunate this has been and the pains it has caused so many families and individuals. It is sad that a country that produces oil and gas has not been able to get access to this. Lack of constant electricity makes some of the machines get spoilt. I think that our government should look into this and stop dissipating funds in other areas. For three weeks we haven’t got electricity and when you get it, it is just for five minutes or so.
Some allege that people who import generators have been sabotaging the process?
There is always an ulterior motive, not just in Nigeria but all over the world. Our attitude must begin with the innermost self. In Ghana some people won’t tolerate what is going on here. We have not developed the fact that being a Nigerian comes first and not tribe or religion. If we think this way things would certainly get better and it would make us stronger as a people. We need to be united and attack the common enemy.
How would you compare the new crop of doctors that we have now and medicine when you started in the good old days?
If I want to talk of the good old days, then I was a young man. I know what existed then and I think that they were getting the best. Unfortunately, I think there is no motivation. Everyone is looking over the shoulder to getting rich. The practice is good in some states and it could be better in others. However, I think that expression is on the bad level and English language is not taken seriously.
For some months students have been at home because of the ASUU strike and this has created some setbacks for students, parents and the society. How can this be resolved?
I would say that government is at fault. At all times, government is at fault. I know that when I was organising a hospital, whenever it was end of the month, workers salary should be ready. So it is government that allowed ASUU to be on strike, they caused it.
A number of the vices in the country today have been traced to the get-rich-quick syndrome. What do you have to say about this?
It is an unfortunate trend. For me, we had a great country but we came into oil at a time when we were not ready to utilise it in the right way. A lot of things that could have been done were therefore not done and oil blocks were given at random to all kinds of people. The result is what we see around today and you hear comments like, ‘I have so much money but I don’t know what to do with it.’ We got away with so much money and now our country is in so much trouble. My pension is N40, 000 from years of serving in the teaching hospital. I was a Lt. Col. in the Army during the Civil War. I volunteered and went to do Surgery and was removing bullets, repairing bones. I was eight years old when the Second World War broke out in 1939 and ended in 1945. As small as I was then, I was conscious of it because we knew some uncles went to the war and they just didn’t return.
How did you get into radiotherapy and how does it feel being the first Radiotherapist in West Africa?
I was trained to be a surgeon. As a young boy, I admired my uncle H.O. Thomas who was a surgeon and plastic surgeon and I wanted to be like him. The man was a strict disciplinarian and he advised me to look into another area. Determined, I went into Surgery and after a lot of difficulties and challenges, I ended up in the Lagos General Hospital. I worked in the department of Surgery and Papa Wiliki was there and I was the third assistant.
One day, he was dissecting the lower end of the oesophagus for about six hours. When he finished and closed up the patient and was taking off the gloves, he said: ‘if we are lucky, he would survive another three weeks.’ That was very discouraging and I imagined the time and energy that had been put into the surgery. He then went on to say that: “If we had radiotherapy and had been properly diagnosed probably he would have lived for another five years. Curiously, I asked him what Radiotherapy was and he told me. My uncle also called and encouraged me to think about a career along this line. Meanwhile, I was doctor to the prison and during this period I was able to talk to the late Chief Obafemi Awolowo in prison.
I was given an offer in Cambridge to study Radiotherapy. I left reluctantly saying that I would change if it turned out that I did not like the course. I was a government scholar and when I got there I liked what I saw. There were a number of facilities they had that we didn’t have and my desire was to come back home to make an impact. There is also a Bayo Banjo who is in Radioecology which deals with chest x-ray which is different from radiotherapy.
If we had to turn back the hands of the clock, would you still want to be a doctor?
Yes, I would.
As a professor do you consider yourself successful in your career choice?
Yes. It could have been better. A man who is a professor should think of how little he knows of what he is professing. This way you don’t get jealous or frustrated but determined to do more. This should be the hallmark of successful people. You must have the ability to cross the bridge when you get there. You should believe in doing the right thing at all times. I retired as a professor in 1975 at the College of Medicine, University of Lagos.
What was childhood like and your growing up years?
I am an ex-Kings College student and in those days you could not step out without dressing properly. These days things have changed and you find all kinds of funny dress codes in schools. Well, the only constant thing is change but I think we should be on the level that projects quality standards. I was born in Lagos on October 2, 1931 into the family of the late Joseph Willie Kofi and Cecilia Victoria Queenie McNeil, a Scottish. My father was a civil servant in the Labour Department and was a member of Boys Scout then. He was healthy, thin and well known in Lagos as J.W. Duncan.
I attended Holy Cross School and those early years were quite memorable. In the neighbourhood, there were people from different ethnic groups and religions and we all lived like brothers and sisters. We learnt from one another and we were not bothered with the differences unlike what we have now.
My father came to Nigeria from Cape Coast in 1922 at the age of 19 years and he went back in 1947. He went to Lagos Grammar School and met my mother who came from Sapele. We all have Ghanaian names like Kwame, Amaa, Kofi and others. I speak a little bit of Fanti and the population in Ghana is compact compared to what we have here. At a point, my father felt that I was getting spoilt and he whisked me off to Kaduna to an uncle in 1941 when I was barely ten years old. My brother joined me there the following year and we used to walk four miles to school and another four miles back on a daily basis. I came back to Lagos and went to the Lagos Government School and later to Kings College in 1946.
From there I went to the University of Ibadan for pre medical for four years. Here we got our second MB and we were allocated to places like Oxford, St Mary’s or Kings Cross. In 1955, I went to St. Mary’s Hospital in London and qualified. My first job was at Amersham Hospital and married in 1959 to my lady friend.
Was it love at first sight?
Not really! If I say yes or no there would be comments. I just know that a man must be a man. These days you hear a lot of nonsense like gay, lesbian and homosexuals in public. That was not common in our days and they were few that existed and far in between. I must say that the trend that you have today has confused the average young man. So many things including our values have been thrown away. I can’t imagine taking money that doesn’t belong to me. I don’t believe in millions and billions. Our value for money has degenerated and we keep running after the wrong things. We do not have good libraries and good books. I belong to a group that is working to improve libraries in schools as well as reading culture.
What can be done to bring about a change?
Nothing! Money would come and it would disappear. Now the foreigners like the Chinese are here to filter what can be taken away. I feel so bad that my country has become a dumping ground for so many things. The foreigners are everywhere. Does it mean that we do not have labourers, artisans or engineers and other professionals amongst us to do what they are doing? At 80 plus, I don’t expect my country to be like this and can say that I am sad.
Let’s talk about some of the memorable moments in your life?
A number of things happened which I felt good about in life. One of such was passing my exams from the Royal College of Surgeons in Radiotherapy. Being a radiotherapist is an opportunity I felt God planned for me. It is the best thing that has happened to me. If I come back again, my dream is to treat a dying person and make them better. It has also made me a teacher and I often felt like relating what has happened to others. Making people better is a feeling that I have always had and a personal experience also influenced this to an extent. I had a sister with year’s differences in age who suffered from sickle cell. My mother and father were AS while I am AA. She was always in pains and I was miserable.
I am also happy when I look back and remember the lives that I have touched. I have trained many house officers, doctors and registrars who are doing well in there endeavours. The list includes doctors like Prof. Durosinmi-Etti who was my first houseman. I also trained Prof. Ketiku who still works with me, Prof. Campbell in Ibadan. I am now known as grandfather of oncologists.
Who or what is the greatest influence in your life?
I would say it is my mum without any doubt. Mama was a typical good woman. She went to St. Mary’s Convent and became a seamstress. She picked up girls from good home to Lagos for about two or three years at her CV Duncan Sewing Institute. It was here that Anthony Enahoro picked his wife, Helen, one of mama’s girls. So I grew up knowing many girls but at that point I had left home. My father was a great disciplinarian. She died at the age of 90 years while my father died at 65years. In addition, I always emulated those that I felt were better than me. In my class, there was a man who was good in Latin, Kamoru Shansi, and through him I got a credit by learning from him. The doyen of the Accounting profession, Akintola Williams, is an example of a man that I admire and love to emulate. He is 94 and still sharp. Even after retirement, it is good to be active; activity would reduce depression and keep you in shape. I play scrabble and Sudoku.
As the nation marks its 53rd anniversary do we have cause to celebrate?
Yes, we do but things would have been better if we did things the right way. I was a doctor to Bata Shoe Factory many years back. The manager was a nice English man who had focus. In factories over there, you find people tell you that their father and grandfather were shoemakers and they are also in the same line of business. They also want their sons and daughters to step into their shoes. You don’t find that here, many just stumble into things and do not have plans for the future. There are other areas that need to be looked into like traffic. The government does not have a good transport system in place and whatever a particular government puts in place crumbles after the administration. This is unlike what you find in London and other developed parts of the world.
How can parents help to make a difference now?
There is so much that is going on now and parents need to follow up on their children. I remember my daughter failing Biology and I was curious. I went to WAEC to find out why. When it was cross checked it was discovered that her results answered to a BSc standard but the examiner was jealous and he failed her. Today, she is a senior lecturer in Public Health. So, I strongly believe that parents must follow up on their children regularly. A number of my students have told me that I did not give them fish but I taught them how to fish.
Insecurity is another challenge for the nation. What can be done to check kidnapping, Boko Haram and other threats?
Sadly, this is the state of our country today. A lot of people who are educated also have faulty backgrounds. Sometimes, we find that those who claim to have gone to reputable schools like Cambridge and Oxford have not shown credibility. This is the way I feel; I’d love to see my country get better.
What advice do you have for young people all over the country?
They should be able to differentiate the good from the bad at all times. Whether they can realise that which is good is another matter. The truth is that it is easier to realise that which is bad but it comes with a number of consequences. You often hear the phrase, ‘God moves in a mysterious way.’ No, I disagree with that, He moves in His way and we are too blind to follow this line. It is government’s duty to check out the person who has stolen a lot and expose such people. They are supposed to be the light of the nation. From one candle light, you can light a million candles. It may not change in my time, my children or grandchildren’s. But I believe that there is bound to be a change, the revolution would come.
