ADEZE OJUKWU

Lagos, Nigeria

Thursday, November 4, 2004

Dr. Odocha is a renowned transplant surgeon who recently joined the ranks of 19 reputable Black doctors in the United States of America (USA) to bag awards in pioneering work in liver transplantation. Nigerian-born Dr. Odocha who resides in the US spoke to Health Correspondent ADEZE OJUKWU on critical issues beleaguering Nigeria’s health sector. Excerpts:

Q: 44 years after Independence, the nation’s health sector continues to perform below expectations, could you give your candid view over this?

Government has to take a very strong posture over health. It follows that any investment in health will yield an enormous dividend in the long run not necessarily immediately. I mean if all Nigerians were sick, productivity is affected adversely. The engine that runs our economy is manpower. The quality of your manpower is directly related to the health of the workforce. And naturally, productivity will increase if the population is active and healthy. The emphasis on health should be accentuated because the amount per capita spent on health in this country is so low. Generally, there are two aspects of health - Health of the nation and the health of the individual. The health of the nation is dependent on the health of the individual. If you have a sick population, productivity will be very low. Prevention of chronic disease must be emphasized. We do not have an ageing population because our people are dying early.

Meanwhile liver cancer remains one of the leading causes of cancer in young adults in Nigeria and Mozambique. It is related to hepatitis B and aflatoxin. Aflatoxin is a fungus that affects groundnuts. When you eat them, it affects the liver.

Q: HIV/AIDS is another public health epidemic affecting many Nigerians. Is there any solution to this pandemic?

In Nigeria the most common way is by vertical transmission from mother to child. While in the US it is through intravenous drug and sexual transmission. HIV/AIDS spread in Nigeria and other African countries is sex-driven. We need to get to a point where every doctor should be able to diagnose, treat and institute preventive measures. But the problem we have is socio-cultural attitude. For instance, in the North, the Sharia legal system forbids advertisement of condoms because it is anti-Islamic. The best preventive measure is abstinence. And when that is not possible then the use of condom should be considered.

Voluntary and free screening of young and adult population especially the saliva. It can be transmitted by kissing. If there is damage to the mucosal lining of the oral cavity, transmission is possible. There are several reasons why Nigeria is at the brink of an explosion in terms of HIV spread. The major reason is ignorance. Many people are not just ignorant, but fatalistic in reasoning. With the general belief in predestination, preventive measures are often rendered futile. The Catholics also do not promote condom use.

Q: What other factors have directly or indirectly affected the growth of the sector?

Poverty is a major problem that has exacerbated health crisis. The resources are not available, the medical infrastructure such as ambulance, drugs and facilities. Sadly, Nigeria has a lot of natural resources that should support its population in terms of education, health and welfare but development is truncated because of poor leadership, misguided priorities, corruption and political instability. These things affected for instance Singapore. But in 25 years of effective leadership, this Island, bereft of natural resources and even water, is now a financial center in Asia. Their leader decided they must move forward. Despite their multi-cultural profile they emphasized training. The World Bank advised them but they rejected the World Bank and ended up being strong, through commitment and discipline. Corruption is almost inexistent in Singapore. They banned chewing gum for example when it became a source of environmental menace to the system.

In terms of Food Security, Nigeria’s performance is unimpressive. Despite the huge population in the US, food is cheap and surplus. From the East Coast to West Coast, you have a great variety and abundance. But in Nigeria we produce a lot but lack storage facilities. We need cooling, refrigeration, refrigerated trucks, power supply and fuel. For instance in the US the government pays the farmers to produce hence agriculture is heavily subsidized. Apart from this subsidy, government provides incentives for farmers as well as a ready market. We need to go back to the 1960s when we used to have groundnut, cocoa and palm nuts. We need to emphasize agriculture. We need to ensure that the revenue from oil is ploughed back into agriculture.

Q: What are the major constraints to the development of transplantation surgeries in the country?

As our population ages, we will start noticing the emergence of chronic diseases such as chronic liver disease, chronic kidney disease, obstructive lung disease. And some of these diseases may only be amenable to treatment through organ replacement therapy, which is transplantation. Unfortunately transplantation surgery remains a very expensive undertaking for most developing countries but it is my belief, that if Nigeria can develop its satellite industry, then the health sector can also be advanced technologically. Recently, Nigeria set up a nuclear reaction in ABU and also sent a satellite in the orbit in terms of scientific advancement. I believe it is time for the government to consider moving our medical care to the frontiers of medical technology. That will help to develop manpower, decrease brain drain reserves used in sending people abroad.

Q: Can you give a brief overview of your educational background?

I graduated from Ife in 1980. I did NYSC in Enugu and worked in Igbo-Ukwu in 1981. Got the nation honours award. Did surgery training in Howard six - two years of transplants in Pittsburgh. I was chief of liver transplant in Howard University Washington DC for six years then became an Associate professor. In 2004, I went into private practice. In February 2004, I was one of the 19 Black transplant surgeons that got the award for pioneering work in transplant.

Q In the US Liver transplantation has transformed in recent times with better prospects for patients. What are the significant changes?

In liver transplantation, the emphasis was on transplanting the whole organ but currently, there is a trend towards using the split liver either in cadaver or in living related, where you may either take the left lobe or right lobe, through sophisticated surgical techniques. Then you implant it into the recipient after having removed the diseased one.

A major draw back has been the problem of exposing a healthy individual to morbidity or mortality. Sometimes death donors do occur. Because of this, the tendency has been to be highly selective in choosing living related liver transplant options. I must point out that the recipient is compelled to be on immuno suppressive drugs.

Q: What are your final thoughts on Nigeria's health crisis?

The future of Nigeria is very bright regardless of the current chaos. The problems in the health system can be summed up as teething problems. I am a product of Nigerian educational system because I left Nigeria after training as a physician. And I have performed at world’s standards and there are many Nigerians who have excelled abroad in computer science, engineering, medicine and arts. As we apply our resources equitable, we will excel as a country.