Dr Chikwe Ihekweazu

Dr Chikwe Ihekweazu: Consultant Medical Epidemiologist, talks to Perspectives Editor Adaugo and takes us on a journey from medical student to being the co-founder of the Nigerian Public Health Network and how he still finds time to blog

Adaugo: How did you get involved in Epidemiology and Public Health? Is it something you always wanted to do?

Dr Chikwe Ihekweazu: No. During medical school, my big hero was a top successful surgeon in Nigeria, he walked around the hospital with broad shoulders, fully aware of the hoard of registrars running about after him. It was my dream to be like him. When I left Nigeria after medical school at the University of Nigeria, Enugu my plan was to go to the USA via Germany. Because of the time it takes between the USMLE exams, I didn’t want to spend the whole year waiting to take exams, so I registered for a Masters in Public health, so make maximum use of my time. I was fascinated by what I heard and for the first time since I became a medical student I wasn’t just cramming, I was given complex issues to think about and to find solutions for. It was a totally new life me, something I really enjoyed doing….thinking, not cramming!

Towards the end of my MPH, I applied for a fellowship to attend for the International Conference on HIV/AIDS conference in Durban, South Africa, at the time it was seen as the epicentre of the AIDS epidemic. At the time anti-retrovirals weren’t widely available on the continent and there was a big push advocating for treatment to be made available at more reasonable prices in places they were needed most. I knew then that this was what I wanted to do. But it was still a tough decision. Initially I thought of public health as a hobby and thought I would always go back to clinical medicine. But after this conference I knew that this was where my path lay.

A: So your medical career became more directed towards Public Health after Durban. How did you then become more interested specifically in Nigerian Public Health?

C: So I got my MPH (Masters in Public Health) and got a job in Germany, did that for a few years continued along those lines. In a similar kind of moment, another turning point occurred. A couple of colleagues and I were attending another AIDS conference in Barcelona as then AIDS had become a major part of my work. There were a lot of Nigerians at that conference who travelled from across the globe, and like always, we attract each other end up in a bar in the evening. While in this bar we started talking and realised, that all of us there were passionate about public health and Nigeria. It was time to do something more than sit together and moan. So together with a good friend Ike Anya, we started the Nigerian Public Health Network. We literally invited Nigerians working Public Health to join us, to firstly support each other in our careers but to also try and influence policy in Nigeria, the best we can. So that started as a kind of informal group but it kind of snowballed as we invited other people e.Network started 6 years ago and today we have over 200 members. It then metamorphosed into the Nigerian Partnership for Health Foundation (NPHF). We recently applied for charity status in UK in order to engage in a more strategic way with health in Nigeria while in the UK.

A: Can you give an example of what the NPHF can do?

C: The network was a way of looking for partners to collaborate with on projects in Nigeria. There’s are a lot of resources available for global health at the moment, especially in Nigeria. We feel that we are in a unique position to bid for some of these funds. To implement projects on the continent requires a lot of technical and socio cultural expertise. We have also found that to get that expertise locally in Nigeria is sometimes challenging so consultants are often outsourced from the West. Members of the NPHF are in a unique position, having both benefitted from the excellent training available in many countries in the West and therefore able to match the expertise offered by colleagues in the West and at the same time have the social/cultural competence to work in Nigeria. We consider this a unique advantage.

A: As you mention the idea is similar to redirecting highly skilled medical doctors from the UK to work in Nigeria and get involved in Nigerian healthcare. There is an increasing trend of doctors trained abroad travelling and returning to their native countries to work in both private and public health sectors. If we and other developing countries like Nigeria could do the same there’s a possibility they could benefit from this growing medical tourism.

C: I agree, firstly we have to realise that Nigerians abroad are a resource and not their adversary to Nigerians at home. There is a lot opportunity to be created by encouraging Nigeria’s from abroad back home. What happened in India is no coincidence, the country has had a proactive approach encouraging people to come back. This makes the environment suitable something we need to explore and pushing. But we’re not deterred and we have made a lot of progress from a small group. I also think that the current minister of Health Professor Babatunde Osotimehi is quite progressive on what he plans to do for Nigeria.

A: That brings me to another Minister of Health. Back in 2007 we both attended a talk with the then Minister of Health Dr Adenike Grange, sponsored by UCL and the Lancet. She discussed the increasing mortality rates of women and children in Nigeria due to poor access to basic primary healthcare. I particularly remember your very direct and amusing question that went something along the lines of “what do you plan to do to change these statistics and how can we hold you accountable to show for your work within the next few years of your period in office ?” She never did answer that question as directly as you put it.

C: (Laughs) well yes but there is a bigger problem in Nigeria’s health care system – Management. The best clinicians are catapulted into management positions but have no management expertise. And they don’t know what strategic thinking is about or how to manage a budget. Many have never managed a team before beyond their. They suddenly bring a professor of paediatrics (Dr Adenike Grange) who in her entire career knows everything about paediatrics but she’s not a manager and suddenly she’s made minister of health. And this is pervasive across the entire system.

It is no surprise then that she delivers a talk where she talks about the problems and not how she plans to solve them. This is what is missing. I think the current minister of health has learnt a lot from the predicament of his predecessor. The management of our health services is a huge problem and while lot of emphasis goes into clinical expertise, and infrastructure but not enough is put into how to manage the resources.

For example with the NHS, the idea of amalgamating services to create Polyclinics is an example of making use of limited resources and is clear example of healthcare reform. That’s what we need to focus on in Nigeria; the strategic thinking required to manage the available resources.

Nigeria, in my opinion compared to other African nations has far better infrastructure and huge expertise but its potential is not being utilised. For example a referral system from primary to secondary to tertiary in Nigeria is non-existent. People don’t know how to refer, who to go to, etc these are system issues, that can’t be solved by building more hospitals.

A: So with the wealth of students here in the UK eager to go back to Nigeria to do something, but don’t know where to start. How would you advise us?

C: The truth is, it’s not easy. But having said that there a few pockets of hope emerging in Nigeria and my advice is to find a platform to engage. You are not going to find a perfect set up where you email someone, and everything else is arranged! Still young enthusiastic medical students have to show the way. The only way for Nigeria to change will be if people are ready to get their hands dirty. In an article we published in the Lancet 5 years ago, 50% of my classmates, had left Nigeria. I have to emphasise that it is not the average 50% but the top 50%. So we’re leaving an entire country with the remaining 50%, the less than average medical doctors, you don’t expect professionalism.

So that’s why I feel that I don’t have the right to complain, I don’t feel that I’ve done enough. I can only complain when I feel that I’ve done my best and I don’t think enough of us have. We have to earn the right to complain, by trying the best we can to make things better. We just might actually stop complaining when we have tried!

A: I have to agree and disagree, you are doing a lot, in addition to being a Public Health Physician, regional Epidemiologist for the South East, running the NFPH, you also write a blog dedicated to Nigerian Healthcare, titled the Nigerian Health Watch: http://www.nigeriahealthwatch.com/ When did you start the blog?

C: Three years ago. Ike and I went to the TED (www.ted.com) conference in Tanzania. It is held every year and people are invited to come and talk about their experience and what they have done in order to inspire others. When I was invited I was initially sceptical about leaving very important work to go to what I thought of as a holiday. It turned out to be a truly inspiring event. At the same time we heard from a lady in Kenya who went to the Kenya parliament every day and wrote a blog on proceedings. Making this information available to the public for the first time. The blog became extremely popular as it was one of the only ways the average Kenya would be able to hear about what was really happening with their Government. Realising the power of blogging, Ike and I decided to start one focusing on Nigerian Health care. We have had good feedback and encouragement from people saying that it is very good, although it is a struggle to keep up.

A: You’re too modest; your blog is fantastic, easy to read and is such a great source of information on healthcare in Nigeria, and I found it particularly exciting that the aids to Bill Clinton contacted you for some background information for Clinton’s support team ahead of his trip to Nigeria. Any way before we finish, we must talk about the conference you organised last November, Nigeria: Partnership for Health Conference held at UCL. Lande Ogunsanya and Lois Haruna (both 4th year medical students) and I helped out and attended the conference. We were very impressed by the speakers and the quality of the workshops.

C: (Laughs) You can’t believe the amount of pressure it take to organise but yes, we plan to another conference next year. From the energy in the room on the day, you could really feel that people were frustrated by the conditions in Nigeria. But we made a conscious decision not to do another one this year as we want the next conference to focus on what people are actually doing, what projects are available to join. We also hope to make the event a two-day event, with the first day on public health and the second on curative medicine. There is a lot going on in Nigeria but sadly these projects are in spite of government and not because of government, something we hope to change. We also want to try and give opportunity for students to engage.

A: Hopefully it would be something UCL Medsin will be able to get involved in.

C: Absolutely, we would also like to arrange workshops for student thinking about starting internships, research or gaining work experience abroad.

A: On behalf of UCL Medsin and Perspectives, I would like to thank you Dr Chikwe Ihekweazu

C: Thank you

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Adaugo Amajuoyi is a second year Medical Student at UCL and the 2009/10 Chief Editor or Perspectives.

Dr Chikwe Ihekweazu

Blog : http://www.nigeriahealthwatch.com/
Nigerian Public Health Foundation
Details for the Nigeria: Partnership for Health Conference: http://www.nigeriahealth2008.org/faq.html