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By Kingsley Obom-Egbulem

I won’t forget that weekend in a hurry. I had just rounded off a 3-day meeting in Abuja and was rushing to catch my flight back to Lagos when we met this unusual traffic jam on the Abuja International Airport Road. Not sure what was going on, the driver of the taxicab I was in decided to ask the street hawkers; who apparently were making the best out of the situation.

“Oga na Yar’Adua wife dey do fund raising o”, one of them told us in pidgin English. Meaning “Sir, Yar ‘ Adua’s wife is having a fund raising event”.

In less than four hours, about N7billion was said to have been raised out of the N10billion naira needed by  Turai make the dream of the center a reality.

Most  state governors especially the PDP governors at the fund raiser were falling over themselves to impress Hajia Turai Yar’Adua. They were committing huge state funds to this project; funds one analyst said would have been enough to resurrect some of the run down public hospitals in their states and even send health workers on critical training courses. But they didn’t do that. Instead, they came to Abuja and “invested” it towards the building of Turai’s N10b state of the art of Cancer Centre.

It is over one year now and we are asking; what is happening to the International Cancer Centre project believed to have been influenced by a visit in 2008 to the MD Anderson Cancer Centre in Texas by Turai?

Turai:did her dream for an International Cancer Centre fizzle out with her "office"?

Turai, like we all know, is no more the first lady of Nigeria and any Nigerian can guess how much influence  and credibility she has that can be leveraged to either drive more funds for this project or even the vim needed for its completion. It is also not known whether or not this project was part of a larger government plan for the health sector or it was just Turai’s dream which was never accommodated either in the health budget or even the National  Strategic  Health Development Plan Framework(2009-2015). Now, if the latter was the case, then where are we in this Cancer Project? Where are the experts(assuming there were any) who formed part of the think tank for the design and implementation of this project?

These questions are coming against recent launch of a Women for Change Initiative by Mrs. Patience Jonathan. If Nigeria  is still what is, and the first lady is not called to account, these are state funds about to be squandered. And it pays to ask what have happened to the ones used for similar projects in the past.

Before the International Cancer Centre project, Turai had mobilized female AIDS activists and advocates, women groups and wives of governors in the country  to launch the Women Coalition Against HIV/AIDS. This campaign concept was allegedly designed  by former  Health Minister who was then Chairman of the National Agency for the Control of AIDS(NACA), Professor Babatunde Osotimenhin. That project gulped a lot of money still. What is happening to that coalition today?

Shortly before Turia left the “office of the first lady”, she did  set up a skills acquisition centre at the Maitama General Hospital, Abuja, “for the training of special patients in income generating trades by the National Directorate of Employment (NDE)”. These “Special Patients” are supposed to be women and other patients affected by the HIV/AIDS. Ideas! ideas!  ideas! Sometimes, you want to wonder where these ideas are coming from considering how much they weigh on  the sanctity and sanity scale.

Patience:The new Dame on the block.A redemptive mission or another spending spree?

In a country where accountability is an alien  it may not be hasty to state that these projects have achieved their main objectives; top of which was to swell our list of venal millionaires (or perhaps billionaires)with our without necessarily putting a health system or  providing a template on which we can sustainably solve our myriad of health problems. Some of these projects certainly were not planned for the long haul else we would have been feeling the impact by now whether or not Turai is in “power”.

Expressing concerns over the Cancer Center shortly after the fund raiser, a UK based Nigerian epidemiologist, Chikwe Ihekweazu  gave an idea of how Nigeria can gauge whether or  not this project was another drain pipe or an institution designed to last.

“We hope she’s been advised on how to build cancer education programme across the country to inform people how to detect early tumours. We hope that her advisers are planning a screening programme, a referral mechanisms from primary health care centres to Abuja. We hope that she is being advised that it is necessary for the knowledge, skills and equipment necessary for Pap smears, Mammographies, Chest xrays and other means to detect tumors etc…We hope that they are advising her on the skills and capacity to manage this centre and that there is a clear strategy on how this center will interface with the rest of the country’s health system.”

Too many questions, concerns and doubts.

Please read this article by 234next.com for more updates

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Please find below a list of information on latest job openings  within the health sector in Nigeria.

Job Title – Medical Officer, needed in an expanding hospital in Warri
Closing Date – November 5,2010
Organisation –Not Stated
Offer     – Attractive Salaries and Fringe benefits
Qualifications: Minimum of 5years Post NYSC Working experience
Apply to: warrihospital@yahoo.co.uk or call 07043358538

Job Title – Medical Director needed for a hospital chain in Port Harcourt
Closing Date – November 5  2010
Organisation –Not stated
Offer  – Attractive Salaries and Fringe benefits
Qualifications: Minimum of 5years Post NYSC Working experience
Apply to: emo_mem@yahoo.com

Other Positions:
•    Medical Doctors, with 5years post MBBS experience
•    Radiographers(Degree qualified and registered with professional bodies regulating radiography practice in Nigeria
•    Laboratory Scientists(Degree qualified)

Closing Date – November 5  2010
Organisation –Not stated
Offer – Attractive Salaries and Fringe benefits
Qualifications: Minimum of 5years Post NYSC Working experience
Apply to: emo_mem@yahoo.com

Job Title – Medical Representatives
Closing Date – November 5,2010
Organisation –Cipla Evans Nigeria Ltd-as subsidiary of Evans Medical Plc.
Qualifications: Minimum of B.Pharm Post NYSC Working experience.
Candidates with less than 6 months to complete their NYSC will be considered for interview. Candidates above 30 years need not apply.

Apply to: career@evansmedicalplc.com  with a copy of your CV.

Job Title – National Programme Analyst, Reproductive Health Commodity Security,needed in an expanding hospital in Warri
Closing Date – November 5,2010
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Offer     – Not Stated
To apply: visit http://www.nigeria.unfpa.org/vacancy.htm

1)Job Title – Medical Representatives, needed in a fast growing Pharmaceutical company
Closing Date – November 5,2010
Organisation –Not Stated
Location: Abuja, Kano, Benin and Middle Belt
Qualifications: B. Pharm. Interested candidates must not be more than 27years

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Closing Date – November 5,2010
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Apply to: paratieko@gmail.com with resume for positions 1 and 2

1)Job Title – Medical Representatives, needed in a young dynamic multinational  Pharmaceuticals
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Please Note:It is always advisable to apply for jobs immediately the openings are announced!

By Kingsley Obom-Egbulem

Imagine this scenario: You are the governor of a state and there is an outbreak of cholera epidemic which has killed over 100 people in your state. The epidemic has not only exposed how clueless you are in dealing with minor health problems but have also exposed your lack of leadership in mobilising resources to address an emergency as a governor.

Sensing the precarious situation in which the people you claim to govern have found themselves in the face of this epidemic, several organisations have come to your rescue.

Unfortunately,(or so it seems)one of those who seem to be trying to help is one of your political opponents; in fact the man who has declared interest in your seat. The man decides to take advantage of the ugly health situation the cholera outbreak has created in the state you are governing to” assist” by donating drugs worth millions of naira to treat patients affected by cholera.
What do you?

Disgusting irony:Cholera patients in one of the world's largest old producing nation?

Rather than accept the donations,celebrate the donor and probably make him look like a good man that he is not(and then go back and work on your leadership capacity),you turn down the “gesture”  at the detriment of hundreds of lives hanging in the balance.

The governor of Yobe state definitely needs some schooling on where to draw the line when it comes to playing the game of politics. With over 188 lives lost and more not sure whether they will live or leave, this is not the time to score cheap political points.

I read the story and for me it is a frightening reflection of how a man’s short sightedness is costing his people their lives.

Any governor worth his mandate should be concerned that cholera (a disease that has been banished in poorer climes) could be linked with his state in the first place and with casualty figures as high as 100. It is simply a symptom of visionless leadership and not to accept help from a political opponent is even more infantile and petty.

By Kingsley Obom-Egbulem

I read an amazing story published on Tuesday, October 12, 2010 on 234next.com. It was the story of Oluwadamilola Olusola,a 25 year old law graduate currently serving in the National Youth Service Corps programme in Ogun State. Damilola facilitated renovation of the children’s ward at the General Hospital in Abeokuta.

One can arguably say that the corps member had no business embarking on such daunting task especially when she is not serving in the hospital; neither is she a graduate of medicine pharmacy of any of the science course. But the leader in her could not just stand and do nothing. She is just another Nigerian with the spirit of excellence who believe we must do things right.

“I am naturally very passionate about children,” Ms Olusola told 234next. “I came to the children ward with a couple of friends that have kids, and I saw that the condition was bad, then I decided that as a youth corps member I will use the platform to carry out personal community development project to do something about the condition.”

Please note the words “DO SOMETHING.”

She added, “I just wanted to do something to influence the community, so I embarked on this project to renovate the children’s ward at least to make the ward conducive for the sick children. I was very sad when I first saw the state of the ward, but I thank God that makes it possible for me to do something about it and make it better and conducive.”

Now, what exactly did Damilola do? It is worth analyzing because Nigerian politicians have a penchant for making little problems look so herculean that you think solving it would require rocket science.

According to the 234next story, she gave the ward a facelift by “re-painting the walls, providing new mattresses, window blinds, pillow cases, ceiling fans, new bed sheets, fixing of electrical and light fixtures, installation of wall notice board, installation of mosquito nets, decorations, and other aesthetic arrangements.”

The renovated ward.Poof that it really doesnt take a lot of silver to look as good as gold.Pic:234next.com

Although the total cost of the renovation was not disclosed, one can simply guess by estimating how much you spent the last time you painted your house, bought a ceiling fan, bed sheets and window blinds for your office. But you can tell that would not be the real amount Ogun State ministry of health would have spent if they were to renovate that ward.

So,why was the ward (a children’s ward for that matter) left in such a deplorable state? The answer is not far fetched. Why did it take the foresight of a corps member to wake up the sloppy and slumbering top government officials and, civil servants in the state to do something about the hospital? How many wards in that hospital is desperately begging for attention with everybody looking away and not willing to do anything? And you would want to also ask “don’t they have a chief medical director in that hospital? If they do, would he allow his or child to be on admission in such a ward?

Too many questions!

I’m particularly amused at the people Damilola went to while raising funds for the renovation. I even try to imagine what was going on in their minds as they made their donations. These are men and women whose responsibilities it is to put in place policies that would guarantee access to quality health care for the people of Ogun state .But they are all went asleep, leaving a 25 year old youth corps member to wake them up from slumber.

Just in case you are wondering, find below a list of those who donated to Damilola’s fund raising effort and you’ll understand what I mean:

“I generated the funds from corporate bodies and individuals like the state Commissioner for Local Government and Chieftaincy Affairs, Permanent Secretary, Ministry of Justice, Permanent Secretary of Local Government and Chieftaincy Affairs, Permanent Secretary Ministry of Environment, Permanent Secretary Bureau of Cabinet and the Redeemed Christian Church of God, Soul Winners Chapel, Lagos state and the Attorney General of Ogun state also donated generously.”

I don’t know what other definition we have for leadership if not what Damilola has demonstrated. And if we are concerned about increasing the life expectancy of Nigerians from the current 46years to 70years and above like in most oil producing nations, the leadership demonstrated by Damilola must be a way of life here especially among public office holders.

It is frightening to note that Nigeria like most countries in sub-Saharan African has a health systems crisis; a crisis made worse by lack of capacity to handle the disease burden and a wicked political class that is not just insensitive but clueless when it comes to solving very simple health problems. We have not forgotten the recent Cholera epidemic.

Damilola has just shown that our problem is not an absence of leadership or lack of capacity but the fact that our politicians have lost their sense of shame; nothing can embarrass them no mater how grave.

As we conclude our discussion on the role infertility is playing in swelling cases of violence against women and the attendant health implication especially the spread of sexually transmitted infection, perhaps it won’t be out of place to ponder on the words of Dr. Oliver Ezechi.

In a recent interview with NIGERIAN HEALTH JOURNAL, Ezechi who is consultant Obstetrician & Gynaecologist and Chief Research Fellow and in the Sexual and Reproductive Health Research Unit of the Nigerian Institute of Medical Research, Lagos said:

“The pressure from society forces men infertile relationships to engage in extramarital affairs to prove their manhood. Now, because of the intense pressure, some women will also go out searching for pregnancy especially if they suspect the fault is from the man. This is so that the woman can be at peace, save her head and shut the mouth of everyone because sometimes the torments from family members can push people to unimaginable length.”

This is puzzling, to say the least. To think that there is a married woman somewhere, currently having affairs with other men(with the approval of her husband; by the way) so she can get pregnant and protect him from society’s ridicule is  one of the weirdest thing to imagine let alone do.

It doesn’t make sense to any observer who is not too conversant with the African society and how it is dealing with

African women:when will your jubilee come?

issues of infertility. But these stories are real and like some public health physicians and epidemiologists may have realized, have added to the list of harmful cultural practices believed to be driving the HIV/AIDS epidemic in most African societies.

Part of what this reality suggests is that  perhaps, marriage is becoming particular risky and dangerous for an average African woman as it appears that she is even more exposed to HIV in marriage than as a single woman.

Doesn’t this provide the basis for interrogating some of the cases of HIV sero-discordance we’ve had to deal with in Africa?

Dr. Ebun Adejuyigbe, consultant pediatrician and associate professor, Obafemi Awolowo University, (OAU) Ile Ife, Osun State would rather say an emphatic yes to that poser and she has a strong case to support her stand.

Just  in case you are wondering “HIV discordance refers to a pair of Sexual partners in which one is HIV positive and the other is HIV negative.”

After studying several cases of pediatric HIV infection she and her colleagues have had to deal with over a period of time  and the fact that only the mothers of the children were the ones with HIV, Adejuyigbe soon discovered that sterility or sexual impotency and infertility were all at the root of the whole problem.

“We discovered that these women  with HIV positive babies apparently were encouraged by their husbands to go out and be impregnated by another man. The choice of man the woman decides to opt for would be determined by the possession of certain physical features that could clear any possible doubts about the child’s paternity. No one would ever imagine that a man irrespective of his medical condition would allow his wife to go out and get pregnant by another man and pose as the father when the child is born”, said Adejuyigbe.

That is the norm in some parts of Nigeria and the women in a bid to shield their husbands from social stigma that comes with sterility or impotence would actually go and have sex with another man and come back pregnant for her husband. But these days, the women are not only coming back pregnant. They are also coming back infected with HIV. And their husbands may  never get infected especially for those whose husbands are sexually impotent.

“I never knew this was happening until we started noticing an unusual trend at the pediatric ward in OAU. We were seeing several sick children, infected with HIV and expectedly ,you will have to talk to the parents of such kids and after encouraging the mothers to go for HIV counseling and testing; the result is usually positive”.

That is often the beginning of several revelations according to Adejuyigbe, especially if the clinician insists that the father of the child should also be tested for HIV.

“The women involved would wonder at our display of naivety if we conclude that the man probably would also be infected with HIV. But they will tell us emphatically that their husbands cannot be HIV positive. Of course, you want to ask is he not infected and the women would tell you their husbands can never get infected because “he doesn’t, and can’t have sex with them. If you probe further they will tell you because he is impotent”.

This development was confirmed following further survey and interview of several women visiting the pediatric ward with children infected with HIV. The women are counseled to go for HIV test and if the result turns out positive, they are usually not in doubt as to the source of the infection.

It all started as a problem of infertility and the need to shield themselves from the social stigma that  infertility attracts. One partner decides to cover the shame of infertility they both will have to live with and it turns out that she is actually laying down her life.

Again, the question many would want to ask is ‘how can men protect their wives from society’s ridicule if indeed she is medically confirmed to be the one with the problem that has caused the couples infertility?’

Marrying a second wife or even divorcing the woman has been the norm for most men. If a woman could decide to get pregnant by another man just to protect her husband from the shame of sterility(and eventually get infected with HIV)then men should start thinking of a better sacrifice to make when the table is against their partners.

In continuation of our series on Women, infertility and the price for saying ‘I do’, Kingsley Obom-Egbulem spoke with Dr. Oliver Ezechi who is consultant Obstetrician & Gynaecologist as well as a Chief Research Fellow and in the Sexual and Reproductive Health Research Unit of the Nigerian Institute of Medical Research, Lagos, Nigeria. Ezechi in this revealing interview shares his perspective of infertility as one of the causes of domestic violence  and sheds some light on what society can do to reduce the pressure felt by women whenever a couple is faced with infertility.  Excepts.

Is it true that infertility is not defined within the context of individuals…and that there cannot be an infertile man or woman. Can you clarify this?

Yes. Infertility is a couples thing as it takes two to make a baby. Infertility is defined as the inability of a couple to achieve pregnancy after regular and unprotected intercourse for a full one year. One partner may not be a able to achieve conception in one union but can succeed in another union. So it takes two for pregnancy to occur  and it takes two also in the case of infertility.

Given this definition why is it that men, especially in Africa don’t identify with sterility or infertility. Where is the origin of this norm?

It is purely a cultural thing. In patriarchal societies like most African setting, men never do wrong. In this setting, they have traditional ways of handling infertility when it is confirmed that the man has a medical issue. A brother or relation may be arranged to impregnate the wife and the child bears the name of the husband. But if the problem is with the woman, it is very obvious as she will not be able to get pregnant. The man just remarries. But if it’s the man, nobody

Dr.Oliver Ezechi

will ever know. Some women even protect their husbands and suffer the ridicule.

What is the implication of our perception of masculinity and infertility?

Because in our setting, we believe that infertility is always the fault of the women, a lot of women are violated even when it is not there their fault. We need to re-educate the populace that either party could be the cause of infertility in a relationship. Men and women contribute equally to infertility. Male – 30%, Female – 30%, Combined – 30% and unknown -10%. We have been wrongly socialized to accept  that men are superior to women and as such cannot be the cause of infertility in any union. Hence the man would not even want to see a doctor because he has been absolved of any problem by society in the first place. So, it is the woman that should ‘go and find out what is wrong with her.’

A lot of women have suffered various forms of violence perpetrated by their husbands due to infertility. Can you identify with this?

Yes. Because of the perception , even when the man is the cause he will except his wife to go out there and get pregnant. And when she refuses both him and his family will continue to inflict both psychological and physical violence on the woman.

What would push a man to this point?

To prove that he is a man after all. The male ego is at play here and the need to meet society’s expectation even if it means hurting your wife.

How can such domestic violence hinder a woman’s chances of conception?

With the psychological trauma the woman is very unlikely to ovulate as this affects the higher centres that regulate the reproductive hormones and signals. Also abusive men are more likely to engage in extramarital affairs with associated sexual infections. When he infects his wife, it leads to damage of the reproductive tract and infertility. Even in non abusive men , the pressure of the society forces them to engage in extramarital affairs to prove their manhood. Now, because of the intense pressure, some women will also go out searching for pregnancy especially if they suspect the fault is from the man. So, she can be at peace, save her head and shut the mouth of everyone because sometimes the torments from family members can push people to unimaginable length.

How can one address cases of domestic violence apparently resulting from infertility?

We need cultural reorientation and education of the populace on the causes and contribution of partners to infertility.

A black eye;a broken arm:the price to pay sometimes for saying I do?

We also need to address issues of assisted reproductive treatment and making adoption culturally acceptable as an alternative to having a biological child. In the case of assisted reproductive treatment, it should be made affordable for families given the implication of divorce and multiple relationships in a bid for couples to prove they are fertile.

Some men see it as a sign of weaknesses to go for fertility checks especially before marriage…can this be encouraged so as to prevent the pressure on their would be wives?

This should be encourage but we need  a reorientation before this happens.

By Kingsley Obom-Egbulem

The burden of infertility, especially in Africa is borne by women. This is not arguable. Aside being the one to carry the pregnancy(whenever it occurs) ,she is also the evidence of  infertility in the relationship. Even in churches,what you  hear most times is “sisters trusting God for the fruit of the womb”.But  it takes someone to plant the seed that bears the fruit there. How about “brothers also trusting God for a seed for the womb” for a change?.

So, whenever a woman’s tummy is not protruding, she is infertile irrespective of the fact that she needs someone(yes a man) to get her pregnant. And it doesn’t matter if that man in question has impediments that  appears to have limited his reproductive capacity.

Now, when the man is apparently the  source of infertility in a relationship, the African society tends to cover it up and protect him from the  ridicule that most women  suffer even when it has not been medically proven that she has problems conceiving.

The sad side of the story is when  the woman is subjected to all forms of physical and emotional abuses- a problem she is not  even responsible for.

In my interactions with organizations dealing with issues of domestic and gender-based-violence  not a few of them confirmed that infertility among couples have contributed to cases of battery and physical abuse in some homes. Leading eventual to divorce.

I was told the story of a woman whose husband was  diagnosed with aspermia (a medical condition in which no spermatozoa are present in the seminal fluid). For years, this woman suffered dehumanization from her in-laws because she couldn’t conceive. Of course she couldn’t have been able to conceive given the problem with her husband. She wasn’t too sure whether her husband knew he had this problem before they got married but what was clear was that the man was always brandishing his clean bill of health whenever she demands that they both see her doctor.

She was always doing one medical tests after the other just to be sure she wasn’t the problem. During some of her appointments her doctor will tell her “your eggs are ok and would be released between now and mid-day tomorrow; please make sure you have sex with your husband during this period”.

Unfortunately for her, this is the period the man chooses to “travel” for one business engagement or the other just to conceal his problem.

After several of such suspicious strips which often coincides with her ovulation period, the woman insisted on eithertravelling with him or stopping him from travelling. That was when the man restored to violence and physical abuses.

Sometimes he will beat her to pulp, lock her up in the house for days and “travel”.

But there was this trend that made her suspect that either there was something fundamentally wrong with her husband

Women:always at the receiving end of every infertility-related humiliations:But would our patraichal society turn the table in her favour?

or that she was in for a nightmarish relationship. She noticed that whenever her husband goes for these phony trips, his younger brother will visit the house.

He comes in close to midnight; feigning ignorance of his brothers purported trip. Since it is too late to go back home, he would opt to pass the night and throughout the night he would make passes at her, hoping that it will culminate in sex.

Her husband’s younger brother is apparently aware her husband is suffering from aspermia and his regularly visits especially when she’s ovulating (and the brother is “away”) is an orchestrated move to get her pregnant and save the husband the shame of being seen as sterile or not being man enough.

Being her ovulation period, the thinking is that her chances of accepting her brother in-laws overtures will be higher and her chances of getting pregnant will be  higher too. Ultimately ,the baby that would come out of this arrangement may have some resemblance with her husband since he looks so much like his younger brother.

The plan never worked. The woman didn’t fall for it. At a point the brother in-law almost raped her. That was when she reported to her husband what has been happening each time he “traveled”.

The husband’s remark was a frightening wake up call albeit a critical flash point .

“So what, if my brother decides to sleep with you? What is the problem with that? Don’t you know that what belongs to me belongs to my brother too and when Im not around it is his duty based on tradition to “take care” of you?”.

That was all she needed to decide whether or not to remain in the marriage. And the fact that the beaten from her husband had assumed a rather brutal and senseless dimension at this stage was  also a deciding factor. For him, not accepting to sleep with his brother frustrated his game plan and continues to expose him to ridicule. So the beating was an expression of his frustration and a way of making her pay for her stupidity.

Eventually, she escaped from the house-back to her family house and never went back till date.

Why should society continue to torment a woman for a problem she is not responsible for? Even if she responsible for the problem there are some that she couldn’t have done anything about especially if it is congenital. Why should couples live in hatred and violence or be torn apart  due to cases of infertility that can be medically resolved?

The answer to  any of these posers is definitely anybody’s guess.