Professor Olu Akinyanju received his medical training at the University of London’s St. Mary’s Hospital Medical School, now the Imperial College School of Science, Technology and Medicine. He returned to Nigeria and took up a joint appointment in the departments of medicine and pathology. He tells GREGORY AUSTIN NWAKUNOR how his encounter with patients with sickle cell disorder led to his life as a medical activist.
We are going to start with something extremely important, what informed your decision to major in haematology in Canada, when you only encountered sickle cell in the university, as a faculty staff in the department of medicine and pathology?
It was fortuitous. I had specialised in internal medicine in the UK, before I applied to join the department of Medicine at the Lagos University Teaching Hospital (LUTH). My job interview panel included all the departmental Heads at LUTH. The department of Medicine had no immediate vacancy but the department of Pathology had one. In the end, the options offered were a temporary (locum tenens) appointment in the department of Medicine or a substantive joint appointment in the departments of Medicine and Pathology. I accepted the latter and then chose to sub-specialise in Haematology, which happens to be a sub-specialty of both internal medicine and pathology.
How did you start sickle cell disorder campaign and what informed the decision to start the campaign?
The Nigerian Society for Haematology and Blood Transfusion of which I was a member, had, around 1972, formed the Sickle Cell Club of Nigeria (SCCN). The Club was a non-governmental, non-profit making Patient & Parent Support and Advocacy organisation, with branches in university centres such as Benin, Ibadan, Lagos and Kaduna/Zaria and officers from amongst its members. All the branches were hampered by the lack of any funding whatsoever, but the branch in Kaduna was the most active owing to the passion and drive of its leader, Professor Alan Fleming. Most other branches, including the one based in LUTH, were dormant.
In 1984, a Mary Jo Agba visited me in my Sickle Cell Clinic in LUTH. She said she had sickle cell anaemia and had just returned to Nigeria from the USA and was working for the Nigeria Television Authority in Lagos. She asked me to join her in setting up a Sickle Cell Association. I introduced her to the President of the Lagos branch of the SCCN and we persuaded her to join and help revive the existing Club rather than form another organisation. The President also asked me to immediately succeed him because he felt I would be able to make the Club functional.
I accepted and then we renamed the branch Sickle Cell Club Lagos Nigeria because I figured that the two paramount causes of its dormancy were its unitary rather than local semi-autonomous structure and its exclusion of lay members of the public from local executive positions. Hence, as soon as I became President, I was able to persuade Chief Opral Benson to accept nomination as Vice-President. Mary Jo Agba was elected Publicity Secretary.
When you first encountered people with sickle cell disorder, were there any kind of feeling in you?
Yes, a realisation that because of their numbers and the peculiarity of their condition, they should be seen in a dedicated Sickle Cell Clinic and not in a General Haematology Clinic. So, with due permission, I was able to create a Sickle Cell Clinic where they could learn more about their condition and we also learn more about them and deliver to them appropriate specialised care.
What necessitated the formation of the Sickle Cell Foundation of Nigeria?
The Sickle Cell Clubs are community-based non-governmental, non-profit-making patient/parent Support and Advocacy organisations that are basically unsuited to addressing some other important aspects in sickle cell disorder (SCD) control, such as awareness creation, public and government education, research, clinical care programmes, capacity building and policy development and monitoring in a sustained manner. In order to address these important aspects, the Sickle Cell Foundation Nigeria was established as a non-governmental and non-profit-making organisation in 1994.
How come sickle cell is not getting as much awareness as HIV/AIDS pandemics, Hepathatis, Cancer and Malaria?
Of the conditions you have mentioned, that is, HIV, Malaria, Hepatitis and Cancer, I disagree that Nigerians are less aware of SCD than all of them, except for HIV and Malaria. Malaria is an endemic infection we have all suffered from and like HIV its control is largely, if not wholly funded from abroad by Bill Gates and other such international philanthropists. Creating awareness requires planning and resources, which are not yet available for SCD but which we hope will soon come with the United Nations declaration of June 19 starting from 2009, as World Sickle Cell Day.
Will you say the awareness being created by the Foundation has brought a reduction in the number of people suffering from the disease?
It is impossible to know without conducting a meticulously planned long-running survey of the incidence of SCD through newborn screening. Newborn screening has been advocated by the Nigerian Expert Advisory Committee on Sickle Cell but it is not yet introduced by government.
How will you assess government efforts at addressing the disorder?
Government resources are not targeted to the control of SCD. This is probably because of the abysmally low budgetary allocation to health and to frequent changes of Ministers of Health and in their respective areas of focus. For example, the late Professor Olikoye Ransome-Kuti, as Hon Minister of Health, formed a National Expert Committee on Non Communicable Disorders including hypertension, diabetes and sickle cell. The committee worked very hard under the chairmanship of Professor Oladipo Akinkugbe and we produced four informative and educational books for health care workers, which are now out of print and forgotten. The committee seemed to leave with the Minister.
What best practical advice would you give to those who are suffering from the disorder?
People with sickle cell disorder should never be complacent and should contact the Sickle Cell Foundation Nigeria by email, to find the nearest sickle cell organisation and/or Clinic to their location and learn as much as possible about recognising danger signs and how to treat, prevent or mitigate them.
What efforts are being made to discourage two carriers from marrying one another?
We neither encourage nor discourage friendship, love or marriage between couples based on their inherited haemoglobin types. We offer genetic counselling on SCD, which leaves the people counselled in a position to make informed choices about their life-style options including reproduction. Coercion is not an acceptable strategy, as it never works and would increase stigmatisation.
What other challenges are you facing in the Foundation?
Challenges include those caused by the unreliable power supply, the inadequate health care provision, the lack of welfare services, and inadequate resources for service, training and research programmes.
In spite of the challenges, what has been the driving force for you?
My driving force is an inherent part of my personality — rather perfectionist, as I seek, as imbibed from my late father, to do as well as possible anything I believe is worth doing.
Can you hazard a guess as to how many works you have done on the disorder till date?
I would have about 70 publications on sickle cell disorder.
Considering your achievements in the areas of hematology, would you say that there are still dreams unconquered?
My unfulfilled visions are twofold. One is to see that all Nigerians with SCD have equitable access to appropriate standard modern health care. Second is that research will soon reveal treatment that will convert the disorder into one that is compatible with a normal quality and duration of life.
As a reputable professor, who would you say was influential in the shaping of your career?
Influences in the shaping of my career are difficult to identify and I believe that they have been largely providential, and being at the right place at the right time has helped. Having said that, I have admired the professionalism and attitude of some colleagues, junior and senior and I believe that this also helps imperceptibly to shape one’s journey through life.
As a growing child, was it your dream to be part of the fight to change the country’s medical system?
As a growing child, I wanted to be a doctor, who would conquer cardiac disease. This fascination for cardiology must have been instilled by my regular perusal of my father’s copies of the Reader’s Digest. The health pages were full of the ravages of heart attacks and nothing was ever written about SCD.
Trivia
How and where did you meet madam?
I met my wife in Lagos.
Before Madam joined you in this crusade, did you find time to be with her as much as she wanted?
We both take more than a passing interest in each other’s work and with her excellent organisational skills, she has been there whenever necessary to assist in organising events for our organisation. Many other unrelated people have contributed immensely to what we have achieved to date with SCD in Nigeria. My wife is a hard worker at her own job and I am certain she would rather I was busy doing what I can than being lazy or uncaring. Far from being threatened, I think our relationship is strengthened by our mutual dedication to work.
How do you relax?
We relax by reading, attending social events, watching favourite TV or Cinema programmes, and I also relax by watching cricket and football, now mainly on television.
Are you a fashion freak; what is your favourite dress?
I am not a fashion freak. My favourite dress wear is buba and sokoto.
What of perfumes; do you use them?
I use an aftershave cologne and I hope the women notice, but none of them has dragged me seductively towards her as a result of it (laughter).
Your best travel destination?
Again, travel is sadly dictated by professional international conferences I am invited to attend. Otherwise, England, Canada, Ghana and the Republic of Benin have been old favourites for different reasons.
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