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| Prof. Awotedu |
HOW would you compare the practice of medicine in Nigeria with South Africa where you currently work?
The practice of medicine when I graduated was very good and I can give credit to my teachers, though the facilities were not as elaborate as we have now, with what we had then the training was excellent. Unfortunately, due to economic considerations, one could say that the practice went down a little bit. But I’m happy to note that there has been an improvement in both material and human resources over the past five years, so it is not all gloom and doom, things are getting better. Comparing the practice of medicine in Nigeria with South Africa is like comparing an apple with an orange, because the resources and personnel are different. Don’t let us forget that South Africa is a country of two worlds; first-world technology and third-world technology as we have in Nigeria. South Africa pioneered heart transplantation ahead of Britain and America, that says something about the skills they have, especially among the white population. Medical services and training in South Africa in some centers: Cape Town, Johannesburg, Pretoria and Durban are at par with services offered in most leading centers in Europe and North America. However, if you go down to some of the towns in South Africa too, you will find out that some of the services are just like what we have in some of the hospitals in Nigeria. It is a contrast that you have first-world technology on one hand and just 100 kilometers down the road you have third-world technology, but with the end of apartheid people are able to access health care wherever they are without too much cost.
In what areas of health care delivery do you think Nigeria can learn from South Africa so as to improve on what it has presently?
The areas we can learn include that of sub specialty and specialty training. Some Nigerians are already making use of that facility by coming for the training, we call them supernumerary, they are trained for three months or a year in whatever they specialize on and then go back home. South Africa does not want to drain human resources from other parts of Africa, this is because many people when they come for such programme want to stay on, but South African government always discourages it.
You think government should be more involved?
Government should be more involved. Health care has moved from mainly government to private public partnership (PPP). It should be a partnership; government should provide the infrastructure, private sector too should come in. I grew up in the era of free education, free health services, but things have changed in terms of sophistication of health care, no government can provide absolutely free health services without going bankrupt. There are so many competing diseases now that were not present in 1950s and 60s, that time it was only malaria and a little bit of infections, but right now there are multi drug-resistant TB and HIV/AIDS which is very expensive to treat and there are other non-communicable diseases too. If the government says it is going to devote its attention to health care, then it would not be able to run other services. Government should be honest and come up with what it can do, while individual citizens should also partner with the government to jointly intervene in the sector.
Asthma has been described as a global challenge and a disease causing inflammation of the airways in humans, can you expatiate on this?
Asthma like you rightly said is a global disease. Many people in the past did not recognize whether what they had was asthma or not. Anybody who coughed for a period of time was considered to have tuberculosis and given treatment for tuberculosis. Few people were dying because they were not given early diagnosis and proper treatment; there was this fear that if anybody coughed or wheezed, he/she would die. It is not an uncommon disease, in any community between eight and 10 per cent of the population has asthma. There is no doubt that the prevalence has been increasing gradually over the years in most communities. A good example is the study that was done in Gambia. 45 years ago, there was no case of asthma after diligent search in the community under study. 20 years ago another study was done, and it was discovered that about five per cent of the population has asthma. Asthma is an inherited disease, once you have a gene that promotes it, you just need to come in contact with the trigger factor and you experience the symptoms of asthma.
A research study carried out recently in the US among African-American communities established the susceptibility of African-Americans to asthma. It also associated African ancestry with asthma through ancestry informative markers (AIMs). How true is this claim?
That cannot be correct because all communities, be it Caucasians living in Europe or North America and blacks living in Africa and US as well as aborigines in Australia have asthma. It is not in any way higher among blacks, in fact the highest incident of asthma is in Australia, and they are white there. So, it is not an African disease. What we can say, however, is that poverty and lack of access to health care services, even in the US, makes many blacks to suffer the brunt of asthma than the white population. If you are living in inner parts of New York with cockroaches and rodents, you are likely to have the disease. There is what we call urban/rural difference in asthma; it means that asthma is more common in the urban areas, especially poor urban areas. In the urban areas, pollution and exhaust from vehicles predispose one to asthma. Also in poor urban areas, rodents and cockroaches and all other things come into play to cause the disease, that is why African-Americans are said to have higher prevalence of asthma than the white population. South Africa gives the best example because you have blacks, whites who have been there for the past 300 years, coloured and everybody living in the same environment and community, the genetic pool is not the same either. Why it seems to be higher among the blacks has to do with the issue of poor access to medical care and poverty.
What is the prevalence of asthma in Nigeria?
It has been put between four and eight per cent, though there are variations in towns, villages, North and South; we need to do a comprehensive study to map out the prevalence of asthma in the country.
The president, Asthma and Chest Care Foundation, Professor Greg Erhabor, was said to have put asthma sufferers in Nigeria at 50 million. Could this be true?
Not in Nigeria, the figure is for Africa. What is the population of Nigeria? Nigeria is 150 million, if 50 million are asthmatic, which is 30 per cent, that will be the highest in the world. He must have been misquoted. Be that as it may, we need to conscientise our people.
50 million figure of asthma sufferers in Africa? That is alarming, what could be wrong or responsible for this?
There is nothing wrong genetically, though there are environmental factors that trigger it. In Africa, we don’t have a body of clinicians devoted to the care of asthma. We just have general practitioners that are treating people, and they can only treat people based on what they know.
You launched a book recently, what is its thrust?
It is to establish a pattern for Africa as an African. What I did was to ask different contributors to tell us their experiences in each of the geo-political areas, in West, East, Central and North Africa. We have a basis stating that as at 2012, this is the case of asthma in Africa, with the hope that it will ginger up governments in those sub-regions, to say we now know what is happening in our sub-regions, what can we do about it? It is to create awareness about the disease and about what is on ground, what is available and what we should be aiming at, because in many parts of Africa, the management of asthma still calls for concern.
2012 World Asthma Day’s theme was “You can control your asthma”, how do you think asthma sufferers can achieve maximum control of this health challenge?
It is just like what I said earlier. Let them recognise what triggers their asthma, this differs from person to person, they should make sure they have their medication with them. Management of asthma is a partnership between doctors and patients. It does not preclude you to do whatever you want to do, provided you take your medication.
The practice of medicine when I graduated was very good and I can give credit to my teachers, though the facilities were not as elaborate as we have now, with what we had then the training was excellent. Unfortunately, due to economic considerations, one could say that the practice went down a little bit. But I’m happy to note that there has been an improvement in both material and human resources over the past five years, so it is not all gloom and doom, things are getting better. Comparing the practice of medicine in Nigeria with South Africa is like comparing an apple with an orange, because the resources and personnel are different. Don’t let us forget that South Africa is a country of two worlds; first-world technology and third-world technology as we have in Nigeria. South Africa pioneered heart transplantation ahead of Britain and America, that says something about the skills they have, especially among the white population. Medical services and training in South Africa in some centers: Cape Town, Johannesburg, Pretoria and Durban are at par with services offered in most leading centers in Europe and North America. However, if you go down to some of the towns in South Africa too, you will find out that some of the services are just like what we have in some of the hospitals in Nigeria. It is a contrast that you have first-world technology on one hand and just 100 kilometers down the road you have third-world technology, but with the end of apartheid people are able to access health care wherever they are without too much cost.
In what areas of health care delivery do you think Nigeria can learn from South Africa so as to improve on what it has presently?
The areas we can learn include that of sub specialty and specialty training. Some Nigerians are already making use of that facility by coming for the training, we call them supernumerary, they are trained for three months or a year in whatever they specialize on and then go back home. South Africa does not want to drain human resources from other parts of Africa, this is because many people when they come for such programme want to stay on, but South African government always discourages it.
You think government should be more involved?
Government should be more involved. Health care has moved from mainly government to private public partnership (PPP). It should be a partnership; government should provide the infrastructure, private sector too should come in. I grew up in the era of free education, free health services, but things have changed in terms of sophistication of health care, no government can provide absolutely free health services without going bankrupt. There are so many competing diseases now that were not present in 1950s and 60s, that time it was only malaria and a little bit of infections, but right now there are multi drug-resistant TB and HIV/AIDS which is very expensive to treat and there are other non-communicable diseases too. If the government says it is going to devote its attention to health care, then it would not be able to run other services. Government should be honest and come up with what it can do, while individual citizens should also partner with the government to jointly intervene in the sector.
Asthma has been described as a global challenge and a disease causing inflammation of the airways in humans, can you expatiate on this?
Asthma like you rightly said is a global disease. Many people in the past did not recognize whether what they had was asthma or not. Anybody who coughed for a period of time was considered to have tuberculosis and given treatment for tuberculosis. Few people were dying because they were not given early diagnosis and proper treatment; there was this fear that if anybody coughed or wheezed, he/she would die. It is not an uncommon disease, in any community between eight and 10 per cent of the population has asthma. There is no doubt that the prevalence has been increasing gradually over the years in most communities. A good example is the study that was done in Gambia. 45 years ago, there was no case of asthma after diligent search in the community under study. 20 years ago another study was done, and it was discovered that about five per cent of the population has asthma. Asthma is an inherited disease, once you have a gene that promotes it, you just need to come in contact with the trigger factor and you experience the symptoms of asthma.
A research study carried out recently in the US among African-American communities established the susceptibility of African-Americans to asthma. It also associated African ancestry with asthma through ancestry informative markers (AIMs). How true is this claim?
That cannot be correct because all communities, be it Caucasians living in Europe or North America and blacks living in Africa and US as well as aborigines in Australia have asthma. It is not in any way higher among blacks, in fact the highest incident of asthma is in Australia, and they are white there. So, it is not an African disease. What we can say, however, is that poverty and lack of access to health care services, even in the US, makes many blacks to suffer the brunt of asthma than the white population. If you are living in inner parts of New York with cockroaches and rodents, you are likely to have the disease. There is what we call urban/rural difference in asthma; it means that asthma is more common in the urban areas, especially poor urban areas. In the urban areas, pollution and exhaust from vehicles predispose one to asthma. Also in poor urban areas, rodents and cockroaches and all other things come into play to cause the disease, that is why African-Americans are said to have higher prevalence of asthma than the white population. South Africa gives the best example because you have blacks, whites who have been there for the past 300 years, coloured and everybody living in the same environment and community, the genetic pool is not the same either. Why it seems to be higher among the blacks has to do with the issue of poor access to medical care and poverty.
What is the prevalence of asthma in Nigeria?
It has been put between four and eight per cent, though there are variations in towns, villages, North and South; we need to do a comprehensive study to map out the prevalence of asthma in the country.
The president, Asthma and Chest Care Foundation, Professor Greg Erhabor, was said to have put asthma sufferers in Nigeria at 50 million. Could this be true?
Not in Nigeria, the figure is for Africa. What is the population of Nigeria? Nigeria is 150 million, if 50 million are asthmatic, which is 30 per cent, that will be the highest in the world. He must have been misquoted. Be that as it may, we need to conscientise our people.
50 million figure of asthma sufferers in Africa? That is alarming, what could be wrong or responsible for this?
There is nothing wrong genetically, though there are environmental factors that trigger it. In Africa, we don’t have a body of clinicians devoted to the care of asthma. We just have general practitioners that are treating people, and they can only treat people based on what they know.
You launched a book recently, what is its thrust?
It is to establish a pattern for Africa as an African. What I did was to ask different contributors to tell us their experiences in each of the geo-political areas, in West, East, Central and North Africa. We have a basis stating that as at 2012, this is the case of asthma in Africa, with the hope that it will ginger up governments in those sub-regions, to say we now know what is happening in our sub-regions, what can we do about it? It is to create awareness about the disease and about what is on ground, what is available and what we should be aiming at, because in many parts of Africa, the management of asthma still calls for concern.
2012 World Asthma Day’s theme was “You can control your asthma”, how do you think asthma sufferers can achieve maximum control of this health challenge?
It is just like what I said earlier. Let them recognise what triggers their asthma, this differs from person to person, they should make sure they have their medication with them. Management of asthma is a partnership between doctors and patients. It does not preclude you to do whatever you want to do, provided you take your medication.
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