Square One

Richard Smith reviews Nigel Crisp‘s  Turning the World Upside Down: The Search for Global Health in the 21st Century in this week’s BMJ. The striking comment in the review was an explanation for health workforce brain drain in Africa:

His case for “turning the world upside down” might begin with the stark facts that Africa has 25% of the world’s burden of disease but only 3% of its healthcare resources and 1% of health workers. North America, in contrast, has 3% of the disease burden but 25% of healthcare resources and 30% of health workers.

Rich countries are plundering health workers from poor countries, and one reason that’s happening is that rich countries have exported their outdated health systems and ways of thinking—meaning that health workers in poor countries are trained inappropriately and feel more comfortable in rich settings.

It has just occurred to me that developing countries might indeed be in the best position to redefine the health worker for the 21st century in the light of America’s super-expensive over-doctored system, and the sheer effect of grappling with chronic illnesses on health systems globally.

The full review is here.

Muza Gondwe from Malawi is presently on a six-month fellowship at the Centre of African Studies on the Public Understanding of Science in Africa in Cambridge. She writes on BMJ Blogs about her project which seeks to develop ways of engaging science through communication in Malawi and to identify and celebrate distinguished black African pioneers of science. She was motivated to do this after reading these:

“It will be seen that when we classify mankind by colour, the only one of the primary races, given by this classification, which has not made a creative contribution to any one of our twenty-one civilizations is the Black Race.” – Dr. Arnold Toynbee, The Study of History, Vol. I, page 233. (Vol I: Introduction; The Geneses of Civilizations (Oxford University Press 1934).

“[I am] inherently gloomy about the prospect of Africa” because “all our social policies are based on the fact that their intelligence is the same as ours – whereas all the testing says not really.” James Watson, in 2007 in an interview with the Sunday Times.

And what does she find?

In my investigation I have learnt some startling facts: no black African has won any of the Nobel prizes in science; the UK has six times as many researchers as Sub-Saharan Africa; and, according to the Mathematicians of the African Diaspora (MAD), 0.1% of the total number of mathematicians in the world are of black African heritage.

The full post is here.

Muza Gondwe’s personal blog, “Communicating science, the African way” is here.

This is an article from Nature about how the recession has dampened donor enthusiasm for scientific research in Africa and here is an excerpt about Nigeria:

Countries that don’t depend on aid are also struggling. In Nigeria, the drop in demand for oil and gas, exacerbated by a stricken banking sector, means that private donations — a major source of funding for Nigerian universities — are slowing. “In the past, a conference like this would have a lot of Nigerians coming, supported by industry grants. We don’t find many today,” says Oye Ibidapo-Obe, president of the Nigerian Academy of Science in Lagos. Nigeria’s government won’t pick up the slack left by the drop in private investments, Ibidapo-Obe adds. “Research is not seen as the major driver of the economy.”

I am not sure where Nature got these assertions from, or why Oye Ibidapo-Obe said what he is quoted to have said, but this certainly reeks of falsehood. Someone is either making up stories to mislead Nature, or Nature itself is doing the  embellishment. Nigerian banking sector, and industry grants being a major source of funding for Nigerian universities? This is just so false.

There are many reasons for me to blog about David Morley (1923-2009), who perhaps more than any other western scientist has done more towards the development of paediatrics and child health in Nigeria, Africa and possibly the whole developing world. His work started at the hospital where I was born many years after he worked there, where I later studied, and afterwards stayed back to work: Wesley Guild Hospital, (WGH) Ilesha.

His former colleague and fellow professor of International Child Health at UCL, Andrew Tomkins reflects on his life in the Guardian UK:

When David qualified in medicine in 1947, one in four children in developing countries died before their fifth birthday. As a young doctor in a mission hospital in Nigeria, he established that effective treatment for such children should not revolve around hospitals but community-based healthcare and technologies, some of which he developed himself. His findings had a great impact on governments and agencies worldwide, and many have subsequently adopted that approach. He also set up training courses for medical staff and a charity, Teaching Aids at Low Cost (TALC).

These included a robust scale for weighing infants in the community, parent-owned Road to Health Charts and a simple mid-upper arm circumference (MUAC) tape for detecting severe malnutrition. He set up the Tropical Child Health Unit (TCHU) at the Institute of Child Health (ICH), London, which formed the basis for the present Centre for International Health and Development

Three missionary doctors working in the Wesley Guild Hospital in Ilesha, Nigeria, obtained research funding from the West African Medical Research Council and the Methodist Missionary Society to help tackle the limitations of traditional (western) clinical services when applied in the developing world. Andrew Pearson, David Cannon and John Wright recruited David to do the work and, in 1953, he set up an extensive health and nutrition study of 413 children in Ilesha. It was the first of its kind and produced very influential publications.

Earlier this year, a month after his death on 2 July 2009, bloggers at the Nigeria Health Watch invited Bryan Pearson, publisher of Africa Health to write an obituary of David Morley. He wrote about how the missionary doctors at WGH Ilesha had brought the problem they strove to solve upon themselves by increasing patient population “having negotiated a deal with their new regional governor, Obafemi Awolowo, to provide free health services for under 18s.” The full obituary is here. This is an excerpt:

A full longitudinal study was initiated and over the next 18 months all children born into the community were registered and then followed with monthly checks for a full five years. Growth charts were introduced (now utilised universally) and a special ‘Under Fives Clinic’ was initiated back at WGH. High protein weaning food was introduced. Mothers kept the children’s records (less loss than for hospital based records); Grade II midwives were taught to deal with 90% of clinical need and to refer the other 10%.

By 1960 outpatient attendance had reached 200 000 at WGH, 80% of whom were under 18 year olds. The first measles vaccine was trialled at Ilesha and Imesi-Ile in 1960.

 And thus the community-based health revolution was born. Quickly the Imesi-Ile population started growing at more than 9% per annum, and the first family planning programme (as it was known then) had to be initiated.

It is no accident that Olikoye Ransome-Kuti was closely involved and inspired by David Morley. Just a shame, that despite all Olikoye’s efforts, so little of what was learned from this landmark work of community-based prevention was adopted throughout the Federation. Many other countries did take heed, and probably millions of children have benefitted.

There are other obituaries from the Telegraph and the Independent both in the UK. I doubt that any Nigerian daily has reported his death or published an obituary. We are often far too caught up in our politics of misrule to have time for that.

It is well worth mentioning though that the special ‘Under Fives Clinic’ still runs as Wesley Guild Hospital under Oyeku Oyelami, (professor of Paediatrics and Child Health at OAU Ile-Ife) without regard for Nigeria’s numerous public holidays or strike actions, continuing to benefit thousands of children and their families in Ilesha and its environs.

Build AfReCa! (Build African Research Capacity), an international network of young scientists supporting the advancement of biomedical research in Africa and its diaspora is conducting a survey to help identify the needs of biomedical research training (BSc, MSc, or PhD) in Africa from the perspective of young scientists and graduate students throughout Africa and around the world.

The survey results will be published for academic institutions, nonprofit organizations, policy makers, and other stakeholders to assess and strengthen capacity building for health service and biomedical research in Africa.

We hope you will find 20 to 30 minutes to participate in this important endeavour no later than October 30th, 2009. All your identifying information will be kept confidential.

We are eager to get as many people as possible to complete the questionnaire, so please send out the link to everyone within your network of friends,  your colleagues in the office or laboratory, your classmate or old schoolmate, anyone that would satisfy the description “young scientists and graduate students throughout Africa and its diaspora.”

The survey is here.

If you have any questions or need assistance in French please contact Denis Zofou at zofden@yahoo.com, and if in English, contact Seye Abimbola at seyeabimbola@hotmail.com or simply leave a message as comment on this blog post.

Thanks.

It’s easily been my best song ever, as far as best songs go; even the video, right from childhood. A tiny globe appears, the earth, rotates, as on an axis, momentarily becomes bigger, and the maps apparent in the regular blue and white haze. The earth becomes bigger, and then flattens out into a white square with USA for Africa (United Support of Artists for Africa) in bold print. It recedes to a corner of the square as the signatures emerge; the signatures and a single thumbprint. I could make out Ray Charles’ signature so I’ve since concluded that the thumbprint must be Stevie Wonder’s.

There comes a time when we heed a certain call (Lionel Richie)
When the world must come together as one (Lionel Richie & Stevie Wonder)
There are people dying (Stevie Wonder)
Oh, and it’s time to lend a hand to life (Paul Simon)
The greatest gift of all (Paul Simon/Kenny Rogers)

The world hasn’t come a long way since 1985 when this group of high-profile artistes sang We Are the World, (written by Michael Jackson and Lionel Richie, produced and conducted by Quincy Jones.) The song was intended to raise funds to help famine relief efforts in Ethiopia. We really don’t seem to have come a long way. People are still dying, all around the world, seemingly unnoticed, from wars, famines, economic repression et cetera, and there’s still as much insensitivity, and embarrassingly, the world still relies on pop stars to bring all of this to our notice.

We can’t go on pretending day by day (Kenny Rogers)
That someone somehow will soon make a change (James Ingram)
We’re all a part of God’s great big family (Tina Turner)
And the truth (Billy Joel)
You know love is all we need (Tina Turner/Billy Joel)

The USA for Africa effort came probably as an American response to the 1984 success of British super group, Band Aid‘s Do They Know It’s Christmas? organised by Bob Geldof. Twenty-two years after, Bob Geldof still finds himself playing the same role. What déjà vu!

(CHORUS)
We are the world, we are the children
We are the ones who make a brighter day so let’s start giving (Michael Jackson)
There’s a choice we’re making we’re saving our own lives (Diana Ross)
It’s true we’ll make a better day just you and me (Michael Jackson/Diana Ross)

To ensure as many artists as possible could participate, the recording was done on the night of the American Music Awards. If you watch the video of the song, especially the making, (I suggest you try it out on YouTube) you’ll find that they all complied with Quincy Jones’ famous advice to them in his written invitation that they “check your egos at the door.” In all, 45 musicians attended. It’s always beautiful to see pretty Michael Jackson sing side by side with young Diana Ross.

Well, send’em your heart, so they know that someone cares (Dionne Warwick)
And their lives will be stronger and free (Dionne Warwick/Willie Nelson)
As God has shown us by turning stone to bread (Willie Nelson)
And so we all must lend a helping hand (Al Jarreau)

Indeed, they sent the world their hearts, and I suppose we all caught it. We Are the World hit the stores on Tuesday, March 7 1985, and all 800,000 copies sold out before the end of the weekend. On April 5 (1985 Good Friday), more than 5,000 radio stations played the song at the same time. It became the United States’ number one single on April 13 and held the position for four weeks. On June 10, 1985, USA for Africa’s first airlift delivered food, medicine and shelter materials to famine victims in Ethiopia.

(REPEAT CHORUS)
We are the world; we are the children (Bruce Springsteen)
We are the ones who make a brighter day so let’s start giving (Kenny Logins)
There’s a choice we’re making, we’re saving our own lives (Steve Perry)
It’s true we’ll make a better day just you and me (Daryl Hall)

The song went on to win three 1985 Grammy Awards (Song of the year, Record of the Year and Best Pop Performance by a Duo or Group.) Ultimately, the single sold 7.5 million copies in the US. It was released on an album, We Are the World, which sold over three million copies. Including revenues from the single, the album, the video and related merchandise, We Are the World raised about $50 million for famine relief.

When you’re down and out there seems no hope at all (Michael Jackson)
But if you just believe there’s no way we can fall (Huey Lewis)
Well, well, well, let’s realize that a change can only come (Cyndi Lauper)
When we (Kim Carnes)
Stand together as one (Kim Carnes/Cyndi Lauper/Huey Lewis)

“…when the world must come together as one.” What audacity, what a great dream they had, what idealism. That the world could possibly someday stand together as one. This was the most moving part of the song for me, the image of all of us standing together as one, as they stood to sing the song, and the success that often comes when people choose to stand as one.

(REPEAT CHORUS AND FADE)
(with ad-lib by Bob Dylan, Ray Charles, Stevie Wonder, Bruce Springsteen, James Ingram)

It may be argued though, that efforts like USA for Africa’s have the tendency to challenge recipient’s sense of dignity, as it sometimes may make us appear like beggars with empty bowls and supplicatory faces, but these are arguments made on full, not empty stomachs. It is also possible to criticise efforts like this as being more about publicity than charity, and one defence I’ve always put up against this charge is that most human actions have a goal and a motive, which are not necessarily the same. Even if their motive was publicity, their goal, undeniably was charity, and indeed, it was well outstandingly achieved, and remains a symbol even now.