•At Unilag inaugural lecture, Prof Okubadejo explores neurological care in Africa
Cosmas Omegoh; Gabriel Dike
Did you know that at least one Nigerian dies of stroke every five minutes, every day? Did you know that that poor handwriting, that irregular signature, might be a sign that Parkinson’s disease is inches away from the door?
These are among the many startling revelations made last Wednesday at the University of Lagos Inaugural Lecture Series 2018, delivered by Prof. Njideka Ulunma Okubadejo. The lady don teaches neurology at the College of Medicine, University of Lagos.
Commenting on the inaugural lecture, Prof Felicia Oyekanmi, a retiree of UNILAG, said: “It was a wonderful opportunity for Prof. Okubadejo last Wednesday, and she made the best of it. Her lecture was titled ‘Strokes of movement and trips; strategic opportunism as an approach to improve neurological care in Africa.’ In it, she took her audience through what she had done to improve the lot of humanity, warning Nigerians to be mindful of the enormous dangers posed by stroke.”
It was an occasion long awaited. The magnificent J.F. Ade Ajayi Lecture Hall was filled top capacity. The guest population stood in the region of 3,000 people. Seated in the front were some high networth personalities, among them former governor of Abia State, Dr. Orji Uzor Kalu. Some of Prof. Okubadejo’s siblings and relatives flew in from the United States and other places to listen to her.
For Prof. Okubadejo, the occasion was more than a lecture. First, it was her first chance as the first female professor of neurology in the country. In February 1978, as a little girl, she had listened to her own father, the late Prof. Sunday Nnanta Nwosu, deliver his own inaugural lecture “Educating for values,” at the same institution.
When the hour came, Prof. Okubadejo, a product of FGGC Owerri, and OAU, Ile-Ife, led the top echelon of the university management to the rostrum in an academic procession. They all wore dark academic gowns and hoods. But her own gown was different, a blood-red gown and a black hood.
At the podium, she stood solid like an Amazon, full of life, radiant with beauty.
After the preamble, she began: “My research and career have focused largely on two main sub-speciality areas of neurology: movement disorders and stroke. In arriving at the title of this lecture, I have selected to play on words to give a hint as to the direction of the talk, while highlighting the nature of the journeys that have led me to where I am today and prospects for the future.
“I will describe my research contributions in the fields of strokes and movement disorders, achievement in translating research into practice, the role that collaboration, friendships and networks have played, and future prospects.”
She then gave a description of neurology. “It is the field of medicine that deals with the diagnosis and treatment of disorders of the nervous systems (which includes the brain, the spinal cord, peripheral nerves and all structures associated with them such as their covering and blood vessels).
“A neurologist is a physician who specialises in evaluating and treating all types of diseases affecting the nervous system, including conditions such as stroke, infections (meningitis, brain abscess) headache (such as migraine, tension, headache secondary) epilepsy, Alzheimer’s disease and other forms of dementia, and movement disorders, including Parkinson disease.”
Prof. Okubadejo also expressed worry that stroke was on the rise in the country: “A stroke is a medical condition in which the flow of blood to a portion of the brain stops suddenly. Brain cells are dependent on oxygen within the blood and without this, they start to die after a few minutes.
“Stroke symptoms reflect the area of the brain that has been injured, and although recovery is possible, particularly with early intervention, stroke can result in lasting brain damage, long-time disability or even death. There are several reasons why stroke occurs, but the leading risk factor for stroke is hypertension (also known as high blood pressure.) Other risk factors include diabetes, heart disease and social factors (cigarette smoking, drug abuse and heavy alcohol consumption.)
“The estimated stroke mortality rate in Nigeria is between 120 and 240 per 100,000 population. Extrapolated to our current estimated population of approximately 184 million, this translates to about 281,520 deaths annually, more than a quarter of a million deaths every year. In other words, this means that in every two minutes, one Nigerian dies from stroke.”
From her words, she had been around the world teaching and researching with the best hands in the field of neurology. Working with other colleagues, she had conducted various researches in the country, particularly in Lagos, and has come out with startling revelations.
She made it clear that the human body is no less than the earth’s crust where a lot of tremors take place, asserting that not all of them were devastating, however. But she noted that poor handwriting and irregular signatures, especially among elderly people, are indicators of tremors.
“When one has a shaky hand, that means there is a tremor going on within him, and when one picks a pen to write, that may cause the handwriting or the signature to be irregular. We all have tremors anyway; when we are hungry, the hand shakes. But we don’t worry about that, that is a physiological tremor. But when a tremor is pathologic, when it goes beyond that, it might be essential tremor, Parkinson tremor. So one needs to see a neurologist for evaluation,” she said.
She regretted that efforts to combat movement disorders in Africa, Nigeria in particular, were being hampered by paucity of funds and data and access to medicine. She said she had worked very hard through collaborative efforts and networks to improve the treatment and quality of care, especially at LUTH.
As an established authority in her field, she has written tens of papers in academic journals; her membership of venerable platforms focusing on neurology continues to widen by the day. And she is the chair of some of those bodies in Africa and beyond.
In the concluding part of her lecture, she tasked government and all stakeholders to join hands in the development and implementation of a national policy on neurological disorder, the enactment of legislation specifically for neurological disorder and improved financing for neurological services. She also made a case for development of social welfare support for neurological disorders, and prioritisation of neurological drugs in the medication supply chain management process. She also made a case for the strengthening of undergraduate neurology exposure through development of a uniform case-based neurology curriculum for all medical school and a neurology workforce scale up. Above everything, she enjoined her colleagues to make an impact through research. In her words, “the land is green.”
While emphasising on the need for concerted efforts to improve on the quality of neurological care and practice, she told journalists: “We need to understand what is going on in our community and we have to ensure that our research and our teaching make the right impact in order to improve the welfare of the society.”
Okubadejo, who became a professor in 2001, reiterated that, every five minutes, a Nigerian dies of stroke.
“The important thing to emphasise here is that some strokes will not give the patient the chance to get to the hospital. That is why we need to address particularly the strongest risk factor, which is hypertension. This will reduce the number of people who are dying of stroke every day. So, people need to have regular health screening, find out whether they have the strongest risk factor. Make sure that your hypertension is treated and ensure that your blood pressure is controlled.”
As the first female professor of neurology, she said she had started work on increasing the number of women going into the field.
“I have started that,” she said. “I deeply believe in mentorship. When I became a neurologist, there was no female neurologist. But right now, there are about 10 practising female neurologists across the country. Some of them have even gone into academic medicine, training young doctors and contributing their quota to the development of medicine and showing that the females are capable of excelling in the field.”
She criticised the idea of doctors relocating abroad after their training, saying that it was like someone abandoning their family members because things were wrong. She said doctors needed to go overseas, improve themselves and come back home and fix the country. However, she enjoined government at all levels to look inward and prioritise health and education. She also charged rich individuals and organisations that have access to funds to begin to partner with health institutions, so that the masses would benefit from the healthcare delivery system.
The professor called for the improvement of the National Health Insurance Scheme so that a sizable percentage of Nigerians would be able to get improved health.