HEALTH AS THE CENTRE OF ALL HUMAN, COMMUNITY AND NATIONAL

DEVELOPMENT: WHAT PLACE IN A [NIGERIAN] UNIVERSITY?

A. Health in the UI at its onset.

Dr. Michael C Asuzu(*Professor of Public Health & Community Medicine)

(*Director, Ibarapa Community & Primary Health Care Programme)

Dept. of Preventive Medicine & Primary Care[COMMUNITY MEDICINE]

Faculty of Clinical Sciences, College of Medicine,University of Ibadan, Ibadan.

(Being the 36th UI Lectures (for the 2012/2013 academic year) given on the 27 th of Feb., 6th and 13th of March, 2014)

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Gratitude & felicitations 1• Mr. Vice Chancellor Sir, …………….• With utmost gratitude to God for a life perhaps

not so very well spent, I have the privilege today and for the next two Thursdays also to address this most worthy audience of the entire University of Ibadan on this 36th UI Lectures for the 2012/2013 academic year.

• I am however comforted that the story of “life perhaps not so very well spent” is not my exclusive experience but that of virtually all of us in this place, and especially of our locally most honoured university, still the first and the best!

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Gratitude & felicitations 2• Indeed, this very lecture that I will be giving is all about

“this life PERHAPS not so very well spent” (because it could have been spent elsewhere if we chose to) – by ourselves singly & corporately; yet without any doubt, we remain here, which is still the first and best university in the country.

• However, we ought to be far better than this. We ought to be striving to be the best in the world, and surely we can very easily be that!

• Therefore, this lecture is going to be as titled – of human health, welfare and happiness (of ourselves & our NIGERIAN people) as the centre of all of our lives’ endeavours, even in this university – our long and should by now be well known personal vocation!

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Gratitude & felicitations 3• This lecture is therefore going to be on the design

for medical education and services by the university and her medical school, based on community health and on the Ibarapa Programme. We will see how the programme was so very well designed and established but began on a downward derailment soon after its founding was seemingly concluded; and the current recovery process. We will explore what we should do to fast track that recovery as well as to restore it to at least 15 years ahead of primary health care, as it was at its beginning. I again thank those who got us to being involved in this recovery exercise and of this lecture itself. As went the Ibarapa Programme, so also the university; and therefore this recovery exercise as well. God will surely help us in the exercise!.....? 4

Presentation outline• Lecture 1: Health in the UI at its onset (i.e.,

today’s exercise)

• Lecture 2: Health in the interregnum: a mixture of sorts

• Lecture 3: Reclaiming our foundation and heritage

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Outline for this 1st lecture• The abstract• Introduction (with nostalgia & very briefly!) - UCI & the UI when we came here; & the Medical School - the deterioration of the university - the recovery of the university• Clarifying the theme again!• The character of the university & other lectures• Health, its nature; the UI and health at founding• The Ibarapa Programme at its founding• Onset of deterioration (to date); yet first and best• Come next week still as you have not heard

ANYTHING YET! 6

The UI when we came here• The abstract• UCI in in 1948• UI and health in 1962/63• UI when we came here in Sept. 1971.• UI and health 1973/74 till 1978• UI and health 1978/79 to 2007• UI and health after 2007• Our expectations: a healthy clinical health care,

usual vertical but healthy public health, a healthy community medicine and health as the natural “cure-all”, if we will ever get it right!

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Clarifying the theme of this lecture• Obvious objections – education, agriculture and

nutrition, industrialization and employment, peace with God, are the obvious centres of all human, community and national development!?

• But what are the objectives of each and everyone of those? Is it not health, wellbeing, happiness, human fulfillment (Alafia)? – All different dimensions of the human health? So then, what is the ultimate centre of all of these?

• Would anybody here need more practical explorations thereof? – inaugural lectures, etc

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The university itself and its character• The universe of all that is best in teaching,

research and human services in a small city – John Cardinal Newman

• An international centre per excellence!• Centre of cultures, civilization, non-materialism, no tribalisms or hegemonies, NO CULTISMS, hard work till very late into the nights as need be, no religious fanaticisms, youthful students unionism but not “student union government”!, student clubs, excellent teacher-student relationships, etc; these are what we met in 1971 and operatedly in place here till about 1984! 9

Deterioration in the wider society• End of war, the oil boom & doom, militarization of

our psyches, corruption, cultisms, and else• 1973/74, admission explosion full spoilage by 1984

and the lessons thereof for the university; loss of university autonomy, age of universal strikes, etc.

• Spoilage of the medical education here and of health also but for slightly different reasons – withdrawal of foreign participation, the PSM phenomenon and the dumping game, new world developments not reflectively followed through, etc

• The present recovery and why; for the first and the best university and medical school in Nigeria still!

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University Lectures and others• The main university and other lectures – the

inaugural and University Lectures, valedictory lectures – possible at the different levels.

• The PG School Inter-disciplinary discusses

• The faculty and other permissible lectures

• Our experiences of & participation in ALL of these; gratefully, despite our underdog status (perhaps, arguably, the best way to be in our country!) – & so perhaps of our personal life NOT so badly spent, or “NOT so well spent” after all!

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The University Lectures 1• The University Lecture series was established to

provide a forum whereby the university can address the nation on some important matters of social interest - Akin Mabogunje, the 5th UI Lecturer

• Both Inaugural and University Lectures are now hallowed by tradition, the one usually a discourse in an area of specialty, often ending with a flourish simulating an academic thanksgiving, and the other treating of a broad area of social concerns with a flavour of (an) intellectual sursum corda - Ladipo Akinkugbe, the 16th University Lecturer

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The University Lectures 2• The University Lectures are designed to lift the

spirit; and in it, we cast aside the restraining armour of narrow specialization and adorn a new garment woven with yarn from different disciplines and stitched together with the golden thread of knowledge and sound judgement - Mark Nwagwu, the 20th UI University Lecturer

• OO Kale as the 28th, 2003 UI Lecturer and the 5th from College; after AO Lucas (3rd), A Adeloye (10th), OO Akinkugbe (16th) and O Akinleye (22nd); and so, this one as the 6th thereof.

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The University Lectures 3• Prof Kale explored the nature of these three

established university lectures in culinary language. He was of the opinion that each of these lectures were like being served from the academic cuisines of the lecturers; and of the two statutory ones, the one (inaugural) being a one course meal and the other (the University Lectures) a three course meal. He summarized the inaugural as a choice a la carte, the valedictory as a potpourri (a variety of the lecturer’s favourite, and maybe not so favourite dishes), a journey down memory lane of exciting culinary expeditions and the celebrities that were entertained; an account of favoured haunts, hideouts, ‘mama puts’, chop bars, ‘bukaterias’ and a variety of eating places, etc; a “what does it all add up to” exploration.

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The University Lectures 4

• Finally he described the University Lectures as “the rare and extra-special gourmet’s three-course meals, prepared and served, buffet-like, once a year, by Epicurean chefs from a variegated pool of different academic disciplines; an ambrosial delight, fit for the gods on Mount Olympus”.

• These are the various perceptions of what I am about to do; and I assure you all that I will try to meet all those perceptions, God alone being our helper thereof, of course!

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The unique approach of this year’s lecture• The past lectures had either treated on what the

individuals or all of us as UI had done and considered to be good news worth sharing

• Others had treated on what we as a country (or other Nigerians) had not done well; and a call to or perhaps list of how these should be corrected

• However, this year’s exercise is going to be slightly different: we are going to be doing an entirely personal & corporate self-examination of ourselves as UI staff & of the UI itself and finding out how we can change for the better; and only thereafter, to discuss how to carry this on to the wider Nigerian communities as Nigeria’s first and best university & as the staff thereof.

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My expectations of this UI Lecture• Of myself (an elder’s stimulated family dialogue)• Of the audience (full participation howsoever!)• Of our leaders in this university (selfless leading)• Of the entire university; all of us, leadership, all

others; and influence on the general society• Of those who are here from the other universities

or else (like the rest of us a mea culpa, sursum corda, habemus ad Dominum and an ite missa est!)

• The mea culpas, resolve and actions – the clean gown to town phenomenon; leaven, salt and light – the basis for a sursum corda “a-la-Pa-Akinkugbe”!

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Some questions to be thinking about 1• As an intended university of international stature

when we started (2ice), is the UI still an international centre or one of a local and growing parochial nature?

• Do our staffing, students, programmes, leadership, opportunities, expectations, etc, reflect or going to start reflecting these qualities?

• Is the recovery that we are or shall be exploring possible here? Can it be accomplished in the next 10 years?; With all due respects, will it ever be possible after that, if not achieved before then?

• Will any promising academics still have to leave the UI to lesser, or even not mentionable, institutions else because of parochialisms (as some of us will know very well of in this place)? 18

Some questions to be thinking about 2• Do our leaders in this university now (and the rest

of us followers, and therefore potential future leaders here) know or believe in the necessity for us to become less parochial, less hegemonic and more globally visionary and missioned, if the UI will be able to continue to be first and best in Nigeria?

• Do we all know or believe that without these world view and global culture requirements, or on the contrary, if we go on with a dominant PhD (Pull him Down) intellectual and academic culture, our institution will only grow less; and so all of us individually and together?

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Some questions to be thinking about 3• Does anyone of us in this university who thinks

that s/he is a senior academic realize that his or her primary duty must be to open the academic, research and international linkages to younger academics, protect them from harm and ensure that they put their talents disciplinarily to the utmost use and success?

• Do we know that the success of such younger people can never make our own any less, nor that of our university; but must truly make all of us the greater?

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Some questions to be thinking about 4• Would the UI try to make the present Ibarapa

territories, the Ibarapa Meje, the primary development communities of the future endeavours of the university as ought?

• Can the College of Medicine not again return to make use of the unique properties of the Ibarapas as her primary applied field laboratory, especially as the position of the UCH as such has now become an unnecessarily discomforting issue, mainly and understandably, because of the abusive or derogatory use of that phrase in the recent past, rather than as the MOST HEALTHY AND DIGNIFYING TRUTH OF IT THAT IS ACTUALLY THE CASE?

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Some questions to be thinking about 4• Will the UI and the College of Medicine recover

themselves and once again see the Ibarapa Programme as one of the main and most beautiful beads on her crown as it was; and strive to recover those beads, clean them up and make them even brighter than it ever was?

• Will the next round of the Educational Trust Funds biddings (the last one of which produced the present “Ajibode wonder”) remember the Ibarapa Programme when it comes to what to do with the money?

• Will the coming NIGERIA UNIVERSITIES economic boost from the recently “successful 6 months ASUU strike” remember the Ibarapa Programme when the money comes?

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Some questions to be thinking about 5• Will the UI/College be ready to put the remaining

36.4 hectares of the 43.6 hectares of land given to us by the Igboora people for the Ibarapa Programme to full use (only 7.2 hectares of which we have put into any use so far) AND according to the master plan that we have produced for this, with inputs from all over the UI in the last 3 years; knowing that we can be given more of such land if needed?

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Some questions to be thinking about 6• Can/shall we set up the needed committee at

the university or medical school level to fast track the full establishment of the Institute of Community Health & Development as approved by the past and present leaderships of the university, at the last episode some 2 years ago; and as the necessary authorities at the federal levels have assured us that they are waiting for, officially, from these institutions?

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Some questions to be thinking about 7• Will UI & her College of Medicine/Medical School

be able to understand and distinguish disciplinary, statutory and ethical public health & community medicine & health or primary health care from all the other good & not so good understandings and uses of the words “community” in the medical & health practices, especially practically within themselves?

• Shall we understand family medicine OR primary medical care similarly and give both of them thee pride of place that must be in modern medicine?

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Some questions to be thinking about 8

• Will it now be possible to make the IP enough priority in the UI and College that the campus and conditions of life and work there is good enough to attract and retain good and competent staff in the place for the work needed there?

• Can the IP be used by the UI, as hoped for, to showcase best practices in integrated agriculture, education, health, human, community and national development practices as many departments have enthusiastically been showing in the last 3 years?

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Health, globally, as at 1948, at 1963 till 1975• Health as understood from the 1930s by

Sigerist, etc, up to the WHO constitution, the UCI and the UI foundations & right up to the birth of community medicine & PHC in the 1970s – wholeness of “soul, spirit, mind, heart and body” and not mere absence of disease.

• The Ottawa Charter in describing health considered it as '…a concept for everyday life…emphasizing social - i.e., peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice & equity; and personal - physiologic - resources’.

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The major milestones in P&CH development• The origins and natural gravitation of the medical

(and health) professions by all of us!• Venetian birth of public health in 1374; the

natural missionary moves before that; the development of preventive medicine gravitations by all truly maturing doctors, of social medicine and of both (P&SM); birth of the “PH of the public health services” in Pennsylvania in 1751

• Birth of community medicine & health from public political enlightenment; of “primary care” and right up to community health & PHC

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1950 WHO health services statement• the pill of public health or preventive medical

services should be delivered within the sugar coating of curative medical care, even though the internal contents of the pill will in the long run prove to be the most important constituents of that pill – the very wisdom of community medicine & health specializations and paradigms; the healthy cure of vertical, power and money-mongering, public health as usually happens & of the runaway-disease-palace and disease-worshipping clinical medicine & health services – BY ALL OF US WITH VERY FEW EXCEPTIONS!

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Community health in the UI at founding• As community-oriented enterprise as PSM was

known then but not really as disciplinary PH & CM as eventually evolved and never got caught up with despite frantic efforts by people like Prof. Oyediran

• Homely discussions with so many dramatis personae inform me that it was not quite without squabbles and controversies then (as Prof. Ajose had left for Ife) & ever after!

• On the whole, a most daring event, thanks to the visionary, capable and humble leadership of the Great Prof. Alexander Brown!

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Objectives of the IP at its founding• To teach medical students and doctors, through

practical work, the principles and practice of “community medicine”.

• To study the problems of health care delivery in the Ibarapa Community and to develop the health services of the district into a model of what an integrated local health service should be, in collaboration with the Government of Western Nigeria, in a manner which can be applied to other rural districts in Nigeria and other developing countries.

• To carry out research into various aspects of health and disease in the community, and thus to build up a body of knowledge on the various factors (social, economic, epidemiological, statistical) which are involved in health promotion and disease prevention in rural communities31

The rest of the story 1• Generous financial backing of the Rockefeller

Foundation• Generous technical, personnel and other

assistances of the London School of Hygiene & Tropical Medicine as well as the Liverpool School.

• Some of these foreign staff also got research and other development grants which made their stay and input here very robust and enjoyable

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The rest of the story 2• Inappropriate use of the political de-facto census

data for the project; but OK for a PSM one; etc!• Nigerian staff who joined in the programme

primarily (e.g., then Dr. PA Oluwande) also experienced these comforting supports for a good job of it.

• Great outputs of twin pregnancies by Prof. PPS Nylander, environmental health by Dr. PA Oluwande, social anthropology and political leadership byDr. Barber, etc – the genesis of the beads on the crown of the Ibarapa Programme

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The rest of the story 3• The then tri-partite (or at most quadri-partite)

project, fairly easy to run; compared with the present and more complex 12 interest group (or more) exercise.

• The simple and tropically sensitive architectural designs of the place

• The first telemedicine programme set up in the programme as part of our first and best legacies; and which we can always recover and advance, even as of todays state of the art!

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The rest of the story 4• The successful renewal of the previously not

expected 5-year Rockefeller grant• The 1972/73 academic year as the last year of any

actual institutional funding of the Programme and the onset of the drift and locust years!

• Disciplinary community medicine and health only just then nascently developed from within the profession in the UK for the first time, nobody would seem to have caught up with or thinking of it here then; but the dumping that had already begun, Topley to Kale, the Medical School Programme to a virtual Dept. of PSM one, etc!

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Table 1. Populations of the Ibarapa communities from the 1963 national (de-facto) census.

• 1. Igbo-ora Town...................................................29,435• Villages associated with Igbo-ora ......................14,481• • 2. Eruwa Town........................................................22,586• Villages associated with Eruwa...........................19,010• • 3. Lanlate Town.......................................................11,982• Maya and associated villages............................... 5,921• • 4. Aiyete Town........................................................ 11,171• • 5. Tapa Town............................................................ 7,684• Villages associated with Tapa/Aiyete...................4,101• • 8. Igangan Town.......................................................9,800• Villages associated with Igangan..........................5,756 • • 9. Idere Town...........................................................5,300• Villages associated with Idere.................................395• Total 137,542

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Fig. 1. The medical records building at the Comprehensive Health Centre of the Ibarapa Project, 1963.

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Fig. 2. Comprehensive Health Centre Igboora Out-patients’ Consulting Clinics since 1963.

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Fig 3. Western Region of Nigeria in 1963 at the founding of the Ibarapa Programme

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Fig 4. The Ibarapa District in 1963 at the founding of the Ibarapa Programme

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Fig 5. The component local communities of Igboora in 1963

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Fig 6. The VHF radio-telephone system linking the Igboora Health Centre with the UCH in 1963.

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The remaining 2 lectures• It surely would be very good if all of you who

have heard us so far will come and hear the more important parts of this story in the next two remaining lectures: of our years of the locusts, our errors and issues for repentance; and then, of course, the sweet story of our recovery that is yet “work in progress” but for which all hands must be on deck.

• See you then in the coming weeks and God bless you all, real good!

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THANK YOU FOR YOUR ESTEEMED AUDIENCE!

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