Mr President and his vice, Chairman, executives, social and organizing committee, members, well-wishers, invited guests, distinguished ladies and gentlemen. I welcome you to this auspicious occasion organized by the Atani welfare union of the USA. It gives me great pleasure to give this key note address of which the title is:
‘’Healthcare in Atani, Arochukwu, past, present and future’’.
I am both humbled and proud to be here today. Humbled because there are a host of well qualified individuals who could so easily do justice to this topic and proud that I was chosen to do so.
Public speaking has so many nuances, a good speaker wants to hold the audience captive because it is so easy to have people lose interest and have their minds wander with a dry topic and a boring monologue. A great speaker wants to carry the audience along and knows the right, pitch, tempo and time allowed. I hope to be the latter.
With that preamble, let’s get right into it.
Disease has played an important role in human history. It has determined the fate of armies, weakened and precipitated the fall of political communities, and caused tremendous human suffering. In Africa in particular, biological interactions among pathogens, vectors, and hosts (humans and other vertebrates) have produced an uneven disease environment characterized by a disease balance in some areas and disease endemicity in others.
It is no secret that in Africa, infectious diseases such as malaria and HIV/AIDS cause 69% of deaths. Africa bears one-quarter of the global disease burden, yet has only 2% of the world’s doctors.
In addressing the place of global health on this forum, I will be speaking about success, shocks, surprises, and moral vindication.
To address this health disparity, we must focus on building better healthcare infrastructure in Africa and increasing the scope of health education. For example
THE PAST:
I invite you on a journey with me to a town in Eastern Nigeria named Arochukwu and I will be discussing healthcare in a village called Atani. This town will represent a microcosm of healthcare in Africa in general and in Nigeria in particular and the challenges we face.
Little villages with their mud huts and thatched roofs, no running water and certainly no water system.
We are told that hunting and gathering societies had few epidemic diseases because of their small sizes and their mobility and that agricultural societies experienced endemic, contagious diseases because of mingling with domestic as well as wild animals. In due course, because of this, Africans developed healing traditions that were holistic, dynamic, and open to cross-cultural exchanges and continual change. Use of certain roots and herbs, plants like the ‘dogon yaro leaf’ or ‘ogwu akum’, lemon grass, bitter kola for cough and laryngitis. The kolanut for its ability to keep any one who chews it awake and focused.
The period of the slave trade witnessed an increase in the frequency of contagious diseases, such as yaw and smallpox, as well as the introduction of new diseases, chief among them yellow fever and syphilis. The increasing disease threats gave impetus to regional and trans-regional healing cults. Although colonial conquest, rule, and exploitation contributed to the burden of disease, early Missionaries with western medicine and public health measures helped reduce mortality and achieve population growth. The Missionaries were instrumental in stopping the killing of twins and the initiation of early obstetric care.
Lepers colony at Uzuakoli were set up to treat lepers and the local indigenes were trained in the treatment methods.
Aro settlements were scattered all over Eastern Nigeria and as the Aros migrated they mixed up with indigenous people and learnt different ways of healing, including several plants from the Efik and Ibibio.
Health in Africa is determined by various environmental, social, economic, political, cultural, religious, and ideological as well as external factors.
THE PRESENT:
The 21st century began well for public health. When the governments of 189 countries signed the Millennium Declaration in 2000, and committed themselves to reaching its goals, they launched the most ambitious attack on human misery in history.
There was a need to address the root causes of ill health.
The recent Ebola outbreak put into focus the prevalence of infectious diseases in Africa. Though we can deliver short-term aid and try to develop innovative vaccines or treatments for these diseases, the real issue is the danger of a weak healthcare system and the need to find long term solutions to this problem.
A lot of global health initiatives sprung up, with many designed to deliver life-saving interventions on a massive scale.
New financial systems, grants, NGO’S and clever ways were found to secure new money for purchasing medicines and vaccines.
Official development aid for health more than tripled.
Unmet needs for new drugs and vaccines drove the creation of a new breed of strategic R&D partnerships that have already licensed impressive innovations.
This desire to cooperate internationally for better health had an impact. Doctors without boarders, health missions , more primary care providers than ever before were introduced into the hinterlands to address the needs of the populace.
The number of people in low- and middle-income countries receiving antiretroviral therapy for AIDS moved from under 200 000 in late 2002 to nearly 7 million today. The number of under-five deaths dropped to its lowest level in more than six decades.
Atani Village in Arochukwu has seen its fair share of the changing dynamics of a present day healthcare system with its struggles and its triumphs.
The number of people newly ill with tuberculosis peaked and then began a slow but steady decline. For the first time in decades, the steadily deteriorating malaria situation turned around. Countries following WHO-recommended strategies are seeing drops of 50% and higher in malaria deaths.
Yet, for much of the decade, the number of maternal deaths stayed stubbornly high. The explanation is not hard to find. Reaching the goal for reducing maternal mortality depends absolutely on strong and accessible health services.
The roads to and from Arochukwu are some of the worst in Eastern Nigeria. Many villages are almost cut off due to erosion and poor maintenance culture.
Even when the medications and healthcare personnel are available , how to get them to the people without a good network of roads is another challenge to consider.
As the drive to reach the goals taught us, commodities, like pills, vaccines and the cash to buy them will not have an impact in the absence of delivery systems that reach the poor. When the overarching objective is poverty reduction, if you miss the poor, you miss the point
The strengthening of health systems was not initially, a core purpose of most single-disease global health initiatives. One of the biggest bonuses of all this progress came in the form of a frank realization, that goals cannot be reached and progress cannot be sustained in the absence of well-functioning health systems.
WHO has welcomed news of dramatic price slashes for vaccines sold by the pharmaceutical industry to the developing world. This represents a sea change in pharmaceutical policies. Investment in health development is working and despite the many crises and obstacles thrown our way, the high place of health on the development agenda has held steady. The momentum to improve health outcomes has persevered. We just have to find a way to deal with the regulation of fake and counterfeit drugs and medical supply influx into the African market.
THE FUTURE:
Ladies and gentlemen, the year 2019 will likely go down in history as the tipping point that demonstrated the perils of living in a world of radically increased interdependence.
Last year experienced a fuel crisis, a food crisis, and above all, a severe financial crisis. This was felt most keenly in Africa in general and in Atani, Arochukwu in particular.
That year also demonstrated that these crises are entirely different from those experienced in previous centuries. They are not just temporary dips and blips in the up-and-down cycle of human history.
Their origins are so deeply embedded in the international systems that govern today’s interdependent world that we must begin to accept them as recurring, if not permanent features of life in the 21st century.
These days, the consequences of an adverse event in one part of the world have far reaching effects. We have mass exodus of refugees fleeing war torn countries in search of stability, and safe havens, some are bringing diseases endemic to their geographical location with them.
Under the conditions of this century, the health and economic costs of chronic diseases have created an impending disaster. The burden of these diseases has shifted from affluent societies to the developing world, where nearly 80% of mortality is now concentrated worse in rural towns and Villages.
Most health systems in the developing world are designed to manage brief episodes of illness from infectious diseases. They are entirely unprepared to cope with the demands and costs of chronic, sometimees life-long care.
Prevention is by far the better option. Unfortunately, the forces that drive the rise of chronic diseases, including demographic ageing, rapid urbanization, and the globalization of unhealthy lifestyles, are beyond the direct control of the health sector.
To combat the rise of these diseases, policies in other sectors, like food, agriculture, and trade, must change. Access to drugs was a huge challenge as many developing country procurement and supply chain management systems are not prepared to deal with the sheer volume of medicines that treatment scale up requires. New strategies and alliances were required, drug regimens and diagnostics had to be adapted to local conditions, new infrastructure had to be built, and whole new cadres of health workers have to be trained.
We need to focus on three areas: leveraging digital technologies, improving knowledge, skills and resources, and creating collaboration and consensus among key stakeholders.
- Digital technologies
We’ve seen that mobile phones have been particularly beneficial where infrastructure is limited in Africa. As mobile devices become increasingly common, they become an unexpected force in delivering better healthcare. Government health workers can be trained in mobile health systems. Pharmacists can register their patients for surveys in order to redistribute medicines to areas where they are most needed.
- Getting the right knowledge, skills and resources where they’re needed
Secondly, we must focus on making sure all those who need them have the right knowledge, skills and resources, for example by training the next generation of scientific leaders.
We’ve seen increased commitment to training local scientists and encouraging research through programmes such as Human Health and Heredity in Africa (H3Africa), which was recently established by the NIH and Wellcome Trust. This initiative funds African scientists and local institutions to conduct basic research on health issues prevalent on the continent. Additionally, Novartis is supporting scientific exchange through a partnership with H3-D. The goal of H3-D is to train local scientists to develop treatments that address widespread conditions in Africa, such as tuberculosis, malaria and cardiovascular disease.
Trained community health workers have been vital to improving outcomes in many different areas of public health and medicine. We believe that they can form the backbone of a community based approach to effective global pandemic response.
Investments in community health workers generate other development dividends as well. They offer formal employment for women and unemployed youth. They can also become pathways out of poverty and informality for low-income and low-skilled workers
- Public-private partnerships for health
Public-private partnerships can really make a difference.
Bringing together public sector community health workers and private physicians to bring high-quality, cost-effective care to people’s homes for example.
Health mission initiatives:
This grass-roots approach can make a big difference, as the cost of a patient spending one day in a hospital could fund two health workers for a month.
Finally, as healthcare stakeholders, it’s our responsibility to develop new medicines to treat disease, but these medicines are useless if they can’t get to the patients who need them most. We need to commit ourselves to working together with all other healthcare players to move away from simply donating aid, to building sustainable infrastructure that can ensure needed therapies are available in even the most remote areas. Everyone should have access to good health, no matter where they live.
Our world is dangerously out of balance. The gaps in health outcomes, within and between countries, are greater now than at any time in recent history.
The difference in life expectancy between the richest and poorest countries is more than 45 years. In the USA, Government expenditures yearly on health can range from as little as US$ 1 per person to nearly US$ 7 000.
Some one one said and I quote “A world that is greatly out of balance is neither stable nor secure.”
Some cite the crumbling of public health services, after years of utter neglect, so that the best care goes to the elite and the poor pay unregulated, exaggerated prices for even the most routine care.
This is nothing new for public health. We are all about ensuring that those who suffer most or benefit least get help from those who benefit most.
This is the essence of social justice and solidarity. Public health has been on the right moral and ethical track for ages.
It is time the world’s politicians and economists wake up and open their eyes to the moral imperatives that have always driven the best in public health and always will.
I spoke earlier about moral vindication:
I will end with a short story and an analogy:
A certain man was travelling from Jerusalem to Jericho was set upon and attacked by armed robbers and left for dead, a Priest and Levite both saw him and walked past not bothering to render any aid. A certain Samaritan stopped and helped the wounded man taking him to what would likely be a clinic in todays’ world. He paid for him to be taken care of and settled the bill without any question.……..
The Levite and priest are our failing Government and their policies both at the state and national levels, both unwilling to do anything to help what is so clearly a broken system.
The good Samaritans are the volunteers, the NGO, the Grants, the Billionaires and Millionaires who are investing in the developing world with no thought of any financial gain/ reward, who are willing to give what they have and travel to and fro in spite of the security risks and the financial expenses to make a difference no matter how small that difference is perceived as being.
Who do you identify as?
The Levite?, The priest or the Good Samaritan?. It is imperative that we understand that the life we save today may well be our own tomorrow.
Thank you.
NNENNAYA DUKE, MD, D.O
April 2019, NY USA
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