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Dr Okenwa Nwosu is a consultant surgeon of international repute as well as a cultural exponent. A man with great charisma, his arrival to the recent annual conference organized by the Pan-Igbo Foundation (PNF) that was held in Sheraton Hotel, Dallas, Texas, was greeted with a resounding ovation. In this interview with ADEZE OJUKWU the Howard-trained medical doctor spoke about Nigeria’s health sector and other critical development issues with unusual fervor and urgency. Here are excerpts:

Kindly give an overview of your educational background

I graduated in the class of 1965 at DMGS, Onitsha. My final year of Higher School at same school was interrupted by outbreak of the Civil War in 1967. I joined the Biafran resistance in 1968 and remained active till the war ended in January 1970. I left Nigeria for USA in November 1970 to resume my educational pursuit at Howard University College of Liberal Arts in 1971-spring semester. I was admitted into an accelerated program at Howard University College of Medicine, which made it possible for me to obtain my MD in May 1975. I did internship and surgical residency at Howard University Hospital (HUH) between 1975-80. I served as a clinical instructor in HUH Department of Surgery for one year before I became board-certified as a general surgeon in December 1981.

"Quacks and charlatans compete with qualified specialist doctors for patients who are often mesmerized by exaggerated claims of fantastic cures by potions from native doctors, even with concoctions that have no intrinsic medicinal value. The depressed state of the nation’s economy makes it extremely difficult for medical doctors to earn adequate income to enjoy a lifestyle, which is close to that of their counterparts residing overseas. Nigerian doctors play major roles in health systems of European and American countries as well as Arab nations of the Middle East. Nigeria, whose indigenes have acquired modern medical skills in very large numbers, still operates a health-care delivery system that ranks amongst the worst in the world." ....... - Dr. Nwosu
Why did you embrace a medical career? Was it by accident or by choice?

This is an interesting question. I actually came to the US with the design to continue my high-school ambition of being a chemical engineer. My post-secondary study at DMGS was a combination of Pure Math, Applied Math, Chemistry and Physics, which prepared me for career in chemical engineering. My cousin, who was already a medical doctor in the US at the time of my arrival here, persuaded me to change course from chemical engineering to medicine. I heeded his counsel and the rest is now history. My preference for surgical specialty was the closest I could come to the practice of engineering in the field of medicine.

Can you throw more light into your professional experience?

I left the US for Nigeria in early 1982, less than two months after my board certification in general surgery, to resume medical practice with my cousin, Professor Uchenna Nwosu, who had founded Apex Medical Center, Igboukwu, several months earlier. I later served as Medical Director and Consultant Surgeon of Union Hospital, Igboukwu, before starting LaSalle Hospital, Nnewi and Igbo Surgical clinics, which were sited at Igboukwu, Nnewi and Amichi. My clinical practice in Nigeria covered all aspects of surgery, obstetrics & gynecology as well as internal medicine specialties. I even found myself performing limited dental procedures when no help was immediately available.

How was your re-entry into the American health practice?

My family and I returned to the US in end of 1995. After dusting up my certifications and licenses, I resumed office-based practice in Washington DC metropolis in early 1996. The economics of health care delivery that I encountered upon my reentry into the US compelled me to adjust the nature of my practice to resemble what I was engaged in during my stay in Nigeria. I am slowly phasing out my surgical practice while devoting more of my time and resources in developing general practice in a walk-in setting. I have taken interest in primary health care and my practice presently offers pediatric immunization, adult screening for cancers and an active weight-loss programme as important preventative and lifestyle changes that augur well for extended healthy life.

In your candid opinion, what is the major obstacle to Nigeria’s health development?

Logistic problems and poor quality control mechanism are major areas that stunt development of Nigeria’s health care industry. Lack of physical facilities, like well-established hospitals and clinics, compounded by decrepit societal infrastructure constitute a nightmarish scenario for whoever wishes to join medical practice in Nigeria. To get my hospital functioning, from day to day during my stint in Nigeria, I needed to procure and maintain heavy-duty power generators and construct private water cisterns for storing daily deliveries from water tankers. During the fuel scarcity that still afflicts the country on regular intervals, I did dissipate a lot of time and resources to acquire enough diesel and petrol to power generating plants, ambulances and vehicles for both my personal and hospital needs. Because of uncertain power supply, I had to operate in surgical theaters without air conditioners, sometimes, for hours at a time. Poor quality control affects every aspect of health care delivery. All categories of medical equipments and medications are still mostly purchased at the Bridge Head (Head Bridge) Market from vendors and merchants who have little understanding of standard protocol that should be complied to by whoever deals with those vital commodities. Counterfeit drugs and medical equipments are commonplace throughout Nigeria. There is little or no oversight by the government or professional bodies regarding the qualification of health-care practitioners and adherence to minimum standard of care provided to the average patient. Quacks and charlatans compete with qualified specialist doctors for patients who are often mesmerized by exaggerated claims of fantastic cures by potions from native doctors, even concoctions that have no intrinsic medicinal value. The depressed state of the nation’s economy makes it extremely difficult for medical doctors to earn adequate income to enjoy a lifestyle, which is close to that of their counterparts residing overseas. Nigerian doctors play major roles in health systems of European and American countries as well as Arab nations of the Middle East. Nigeria, whose indigenes have acquired modern medical skills in very large numbers, still operates a health-care delivery system that ranks amongst the worst in the world.

Is this an excuse for the fever-pitch flight of Nigerian professionals from the country otherwise called brain drain given its adverse effects on Nigeria’s socio-economic development?

I can use myself as an example. I left Nigeria soon after the Civil War for further studies in America. After accomplishing specialist certification in general surgery, I returned to my hometown, Igboukwu in Anambra State in 1982, to practice my profession, which was obviously in demand in that rural town and surrounding communities. I subsequently extended my practice to Nnewi and environs. After building my practice for more than 13 years, I was compelled to move my family back to the US because of the deterioration in the educational system and marked devaluation of the naira. My daughter, Adora, just finished her high school and there was no future for her in the Nigerian university system, which was shut down repeatedly due to one strike or the other. The tough decision to abandon the work I had done for past 13 years, my employees, long-term patients, relatives and friends was made in order not to deny my very children the chance to, at least, get the level of education of their parents. Since my departure, dust and gloom have descended upon everything that meant much to our lives for more than a decade of living in Nigeria. On a broader scale, the Nigerian economy is ailing badly while millions of its well-educated and qualified citizens are residing and providing top-class services to their host countries overseas. Human capital is the basis for realizing Nigeria’s socioeconomic advancement. The task of moving the economy forward becomes even more daunting when there is paucity of skilled qualified manpower to translate policies into palpable accomplishments. The brain drain continues to intensify with each passing day that no visible change is seen in the status quo. Nigerians are entrapped in material poverty, disease and deteriorating infrastructure while their kith and kin, who possess the skills and training to provide relief, are not available to help. Need I say more?

Can you draw some parallels between the US and Nigeria in terms of health care delivery systems?

Beyond overcoming all the impediments to delivery of health care in Nigeria as explained above, the medical doctor must first find it within his heart to perform his professional duties with one aim in mind: putting the welfare of the patient above everything else.

In the United States, doctors are well rewarded for fulfilling the demands for their profession in the society. In the hyper dynamic socioeconomic system of Nigeria, the economics of survival makes many doctors to adopt practice models that further retard development of modern health care delivery in the country. Nigeria has little industrial manufacturing base. In the US, all logistical needs for normal medical practice as well as instruments of quality control are not only handled within the country but also they could be local. The greatest difference between the two systems is the ways in which these contrasting systems are regulated. Both professional self-regulation and government oversight are the standard practice in the US. In Nigeria, on the other hand, both regulatory instruments are deficient or barely perceptible. Health care delivery is an important social service but it takes money, discipline and willpower to execute well-planned health care system that can enhance citizens’ quality of life. Nigerian economy, particularly the private sector, should be empowered and encouraged to take needed bold ventures to improve the quality of life of the average citizens.

What viable solutions can you proffer?

We must expand Nigeria’s industrial base by opening up new opportunities by developing an economic corridor east of the Niger River, which is currently lagging behind in industrial growth. A buoyant economy that is self-sustaining is the engine that shall power the nation’s healthcare industry and hence the physical and mental well being of the average citizen. Improvement in Nigeria’s health care system must be propelled by a strong private sector-driven economy. This system shall minimize corrupt official practices that are ubiquitous due to excessive dominance of government bureaucracy in the national economy.

What other issues should be tackled especially at the individual level?

Buoyancy of the nation’s economy determines the health care system that Nigeria can afford to provide for its people. The economic woes that confront Nigeria are not expected to vanish overnight and thus the dilemma in the nation’s health care industry shall also linger for a while longer. We must utilize whatever meager resources we have at present to implement basic policies in the realm of primary care and provision of adequate food, clean water and hygienic environment for the population. Immunization and avoidance of HIV infection must be emphasized, especially amongst children and youths. Regular physical exercise and avoidance of obesity as well as proper treatment of persistent high blood pressure and increased blood sugar level must emphasized in the adult population so as to enhance longevity in this group. The philosophy, in current scheme of things, is to do the basic things we can while anticipating emergence of a more robust health care delivery system that will be buoyed up by a revitalized national economy.

Having traversed several fields in your professional career, what are some of the major challenges militating against the nation’s development?

The challenge facing my generation today is to lead the implementation process of many good ideas about which we have pontificated over the years. Having lived and worked within the context of rural Nigeria and US, I had the unique chance to see the problems facing our people from the grassroots perspective. The most daunting challenge facing the South East today is the erosion menace, which is defacing, desecrating and ravaging our ancestral land.

Transportation infrastructure is the first casualty of uncontrolled flood erosion. Without optimal land and water transportation network, socioeconomic development of our society is being retarded. Erosion gullies that scar our ancestral land today constitutes an eyesore, which cannot be allowed to exist for even a day longer. Starting the process of containing this great threat is a challenge that stares my generation in the face.

There is a cacophony of voices all pointing to solutions. In your views what are the most realistic options for the Igbo and other communities?

There is material poverty in Nigeria anywhere you look. Rather than focus on obtaining our fair share of the national shrinking pie, I believe that Ndigbo should play a leading role in bringing a turnaround of Nigerian economy through the pursuit of new wealth creation and entrenchment of a robust private sector. I am Chairman of Igbo Agenda Committee that is tasked to derive plans of action for issues about which Ndigbo have pre-existing consensus. New wealth creation and erosion control have now been identified as key areas of consensus on which everyone can start work immediately. Information collation and its dissemination to the grassroots level is the challenge that we face at the moment. With interest of the mass media outlets like yours enlisted, the campaign in these crucial fronts shall soon pick up required momentum.

What role can the Igbo in Diaspora play in this development drive?

The Igbo Diaspora can play a leading role in revitalizing the home economy because they are well placed to leverage the financial and technological resources of their host nations for a speedy transformation of Nigeria. Ultimately, it would take synergistic interplay between home-based and Diaspora Igbo to achieve the best outcome for our people in the shortest possible time. Growth, whether in sheer numbers or wealth, is always a welcome phenomenon. Ndigbo have come a long way, as a people, since the Civil War ended 34 years ago. Alaigbo has virtually eliminated all visible scars of Africa’s most brutal war, which was waged on its turf for 30 long months. There is an untapped economic genius within the mindset of the average Igbo and this latent resource base holds great promise for orchestrating a quantum leap in economic potential of Nigeria, in particular and the West African sub-region, in general.

How best should the menace of erosion be tackled since it has become a major environmental problem, threatening the economic and social progress of many communities in the Southeast?

The genesis and perpetuation of flood erosion in South east are not complex and thus not difficult to identify and correct. Erosion gullies are recent phenomena in the equatorial rain forest region of Nigeria to which the South east zone belongs. The South east receives about 80 inches of rainfall annually and this precipitation pattern has existed possibly for thousands of years. Our ancestors where more knowledgeable in land husbandry than our present generation because they hardly experienced any erosion-induced disasters as are commonplace today. Rainwater is meant to sink into the soil as close to where it falls as possible. Our ancestors developed farming techniques that ensured zero runoff from the farmlands they cultivated. Whenever runoff occurred, it was carefully channeled through well-delineated flood paths, which usually ended in wooded meadows where the floodwater gradually soaked into the soil. Contemporary attitude and development patterns as well as rapid population growth has put intense pressure on our land management skills. Metal roofing sheets, concrete and bitumen pavements as well as haphazard soil cultivation methods help to generate huge volumes of flood water runoff from our homesteads and farmlands nowadays even after only a light drizzle.

The end result of this enormous floodwater discharge is emergence of ugly gullies in low-lying areas downstream. The torrents generated as floodwater rivulets converge possess enormous power with which it can easily devastate the road network in the area, especially during the peak of rainy season. These torrents also carry our valuable topsoil and other debris to nearby springs, streams and lakes thereby polluting them beyond belief. Some springs and stream have simply disappeared after repeated bouts of heavy silting by floodwater debris and a marked reduction in underground water supply due to reduced volume of filtration upstream.

Solution to erosion menace lies in understanding of the mechanism of its development and perpetuation. I am heading a group that is determined to address this menace in a comprehensive manner, find solutions to it as well as provide leadership in their implementation. As we speak, there is a draft legislation titled "Erosion Control and Road Maintenance Bill" which has been submitted to some state legislators of the Southeast and the Governor of Anambra State for debate, amendment, adoption and enactment. This bill provides the legal framework for implementing and enforcing zero-runoff principle in all states of the Southeast. It is our expectation that this model shall be adapted and replicated in other parts of Nigeria where the menace of flood erosion exists.

Beyond the erosion problems in the South east, the nation’s overall environmental status is equally deplorable and this also bears negatively on the citizens and their health status. What are your views on this unfortunate trend?

Grassroots enlightenment is the key to improving both poor health and environmental status of Nigeria. With regards to health, emphasis on preventive and other primary health care methods, like immunization and avoidance of HIV infection, shall go a long way in initiating a turnabout in the overall well being of the populace. Likewise, environmental standards are better implemented and sustained when the grassroots are properly sensitized to the negative consequences of environmental decay and the role they can play in arresting and reversing the present trend. Floodwater erosion, for example, can be effectively checked by implementing zero-runoff principle from each homestead, village and community of areas that lie upstream from gully sites. If each homestead tidies up its immediate surroundings, the entire community would come out looking squeaky clean. Urban sanitation is in deplorable state now because people dispose of waste by littering even the streets in front of their places of residence. We need a legislation that mandates everyone to clean up his immediate surroundings or face prompt enforceable sanctions. We just need to invest our time and resources in re-orientation of the grassroots. This form of community-based education will yield tangible visible dividends within a very short period of time.

Why did you establish www.osondu.com web site?

The Internet has revolutionalized how information is communicated and managed. I consider myself to be a restless writer because I have come to the realization that the written word is a very powerful tool for eliminating ignorance and effecting change. Therefore www.osondu.com is the publishing outlet for Osondu Foundation, Inc., a Washington DC-based non-governmental organization (NGO), dedicated to the actualization of Igbo renaissance. The site is primarily a tool for sharing the vision of founders of this NGO with the public at large. It is also used for communicating the essence of being Igbo, Nigerian and African in today’s world. Because of the strong ideological conviction that underlie the creation sustenance of this publication outfit, its message has begun to influence the thinking of many who write often to show appreciation for what it tries to do. We expect this site to become a popular port of call for anyone who desires to learn what it would take to build a strong, united and tolerant Nigeria for the 21st Century. You are welcome to visit us soon at www.osondu.com and let’s know what you think.

You seem to have a lot on your hands. For instance, how do you combine a very busy medical practice with the demands of running a web site, www.osondu.com?

My residency years prepared me for a profession that runs on 24-hour basis. I am totally immersed in my professional practice at any point in time. But I have learnt, over the years, to find time for other aspects of life and world that exist outside the practice of medicine. In recent years, I schedule physical exercise workout in the morning before heading out for the office. In between seeing my patients and handling other administrative issues, I work on completing a publication, catching up with Nigerian news or partake in Internet forum discussions within the Nigerian Diaspora. I admire the power of the computer. It enables me to multitask thereby accomplish more in any given timeframe. Any other free time available to me is deployed in building Tribex Corporation, an IT enterprise and its online Yellow Pages directory offered at www.conzumerguard.com. I have invested almost 30 years of my life in the practice of medicine. I still have the zeal in me to explore other possibilities of making even greater impact on improving the lives of our people. Greater percentage of my time and focus will eventually shift away from medical practice to allow me to engage in other equally compelling tasks that lie ahead.

Can you elaborate on some of the compelling tasks you referred to?

I was the founding president of Association of African Physicians in North America (APNA), which was inaugurated in May 1981. This was the first organizational platform for African doctors in the US, Canada and the Caribbean. We now have many successful professional groups that, among other things, regularly go on medical mission to Nigeria and other parts of Africa. In 1988, I led the group that founded the Run for Life Campaign of Nigeria. This youth-oriented non-governmental organization

conducts regular jogging exercises to emphasize the importance of good health habits, societal responsibility and charity in the upbringing of future builders of a prosperous Nigeria. In February 2002, I took part in a Run for Life Campaign outing in Nnewi, Anambra State. I was quite active politically during the aborted Third Republic transition program. I was Deputy Chairman of National Republican Convention (NRC) in Anambra State and was heavily involved in electioneering politics of that era. I am active in Osondu Foundation, Inc.; a US-based NGO that publishes the Osondu Newsletter and Osondu.com web site. I am co-founder of Tribex Corporation, which does business out of Northern Virginia suburbs of Washington, DC. I collaborate with individuals and groups in planning and executing projects of mutual interest. I belong to many professional and community-based organizations.

Mention some of your major achievements including awards and publications.

Beyond awards received during the period of formal education and professional training, I do not have many accolades that are worth mentioning here. I have spent almost my entire time in private practice setting both here and in Nigeria. I was really never interested in academic medicine as such. My obsession has been to translate the technological know-how in my profession for service where it really counts, at the grassroots consumer level and that approach has worked for me thus far. For the past 20 years or more, I have been writing profusely on issues that range from medicine to the discriminatory Osu caste system in Alaigbo. My writings have been published in almost all major newspapers in Nigeria over the past 2 decades and part of my work is referenced by authors, particularly those with special interest on Nigeria. Most feature articles and poems in Osondu.com have my input in authoring or editing them. I invest time and effort in a few Internet forums that deal with issues of concern to Ndigbo, Nigerians and Africans on a global basis. I look forward to making compilations of my writings into books when I retire from active practice in a decade or so. There are interesting thoughts that I would like to share in my autobiography when I get to put it together.

Are you continuing at this level or are you taking a new turn in terms of public service and political engagements?

My journey is not yet done. I am now at the stage of my life where implementation of life-long ideas is the watchword. I have tried my best in various aspects of human endeavor to serve the world around me. I am presently consumed with the task of creating reliable avenues for new wealth creation to further empower others and me in the implementation of the noble ideas that we have dreamt for our people since my childhood. As long as there is health, there are many more mountains to scale and many more horizons to explore.

Courtesy of Champion Newspapers Limited.
Published June 19, 2004 - Lagos, Nigeria

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