Not letting the celebratory mood die off so quickly with the Vatican’s recalcitrance, Nigeria is in the headline of The Lancet, with a development worth celebrating. The National Health Bill was finally passed following a lot of pressure from civil societies and women threatening to go naked in front of the parliament house. The bill pledges to develop a national health policy that includes US$380 million devoted to primary health care each year, commitments to the provision of essential drugs, and comprehensive vaccination programmes for pregnant women and children under 5 years. The bill also provides a framework for the provision of national health services, defines the rights of patients and clients and outlines strategies to reduce health workforce brain drain. There has never been this much momentum for real commitment to improving health in Nigeria; Nigerians will at the very last be able to hold the government to account for their right to health.

Now the mood flies out of the window when we remember that the G8 confirmed our worst fears that they had left out global health from the agenda of the Deauville meeting. The only redeeming feature were David Cameron of the UK (hisimpassioned defence of aid spending and his pledge to raise a “substantial” part of $3.7billion in global aid to increase immunisation programmes) and Stephen Harper of Canada (his hope, albeit unrealised or unrealistic, of squeezing promised but undelivered maternal-health aid funds out of the G8 leaders). Issues like HIV/AIDS and maternal and child health were off the table apart from Mrs. Carla Bruni-Sarkozy’s luncheon for G8 spouses which received scant media attention. The global health community needs to find ways of getting these issues on the agenda of the G20 meeting in November which is also hosted by France.

Finally, before the party (or weekend) begins, PLoS Medicine Editors remind us that we much too often leave “Big Booze” (or Big Alcohol) out of the discussion of corporate conflicts of interest, inappropriate marketing to children, impotent self-regulation, and general flouting of the rules while we continue to deservedly harp on Big Tobacco and Big Pharma. For them we must also” target more attention to and research on the alcohol industry that can support and fuel legislative, regulatory, and community action to protect the public health.”

To have a medical school is an expensive, audacious undertaking anywhere in the world. From very humble beginning at the Yaba Medical School which produced 62 doctors in 18years (1930-1948) Nigeria has made unparalleled achievement in training medical manpower of all cadres. Nigeria has about half of all the medical schools in Sub-Saharan Africa, all nestled within universities, all with accompanying teaching hospitals. My last count was at least 25 medical schools in Nigeria. Each medical school produces about 100 doctors each year. Medical education has flourished in Nigeria in spite of several obstacles mostly due to the doggedness of their founding fathers and those who subsequently took over, their pragmatic willingness to settle for less, adapt to difficult realities, and jettison juvenile dreams while they continued to keep their eyes on the beatific vision of the heaven of sophisticated high tech medicine in teaching hospitals.

Two years ago I did my national service at the medical school of Ebonyi State University, Abakaliki. I was highly impressed that Ebonyi was confident enough to have a medical school. I am from Ondo and Ekiti, arguably two of the most educationally advanced states in Nigeria, with no medical school between them – not even one run by the federal government – because it too expensive. Physician and writer Lewis Thomas who was dean at different times of the medical schools at Yale and New York University once observed that “the annual budget of some medical schools matches or exceeds the operating budget of all the university.” Beyond being impressed, I was also puzzled. How does Ebonyi manage to run a medical school, while Ondo, though an “oil producing” state could not afford one? I was keen to know how much the medical students paid, how the medical students were recruited, if there is a preference for indigenes of the state and if non-indigenes paid more. We are big thinkers in Nigeria and medical education seems to be one area where our audacity has paid off at least to illustrate what we can achieve as a country.

The beatific vision of sophisticated tertiary care in Nigeria is largely inspired and sustained by looking to the West to provide models. Thomas wrote in 1983 about pre WWII US medical schools which were “small affairs by today’s standards” with a “small and relatively inexpensive clinical faculty” and teaching hospitals were “supported by the local community.” Like US universities at that time, Nigeria’s first two medical schools (Ibadan and Lagos) also shared a fixed proportion of their general endowment with the medical school. The University College Hospital, (UCH) Ibadan and Lagos University Teaching Hospital (LUTH) grew rapidly early post-independence as expected for institutions charged with the education of a new nation’s first indigenously trained professionals. Like the pre WW II medical schools in US, things were pretty small scale and operated at an internationally competitive level so much that long after UCH was completed in 1957 it was still regarded as one of the best within the British Commonwealth and continued to be a prime research centre in the world for much longer, reaching its global heyday in the late 70s and early 80s.

The US medical schools were often partly privately owned and they actively sought funds on their own, did not require the university to pay academic physicians who earned their living in private practice. The economic boom in the US following WWII altered the quietude and the National Institutes of Health (NIH) drove a massive revolution in research funding. In the UK, there was renewed confidence of the power of research to solve health problems which spread through the British Colonial Office to Africa with strong influence on the direction of “tropical medicine.” The period was also when several UK colonies in Asia, especially India gained independence, freeing colonial researchers and funds for other parts of the Empire. Hence the medical school in Ibadan, founded in 1948, flew on the wings of UK and US expatriates, ideas, funds, inventions, initiative and influence. For its first eight years, medical students in UCH only had their preclinical education in Ibadan; the clinical training was in London. These were to become the group of professionals that would shape medical education and practice in Nigeria as they did well to establish other medical schools post-independence inspired and supported by governments, regional, state and federal. It is kudos to successive Nigerian governments that the UK model was imported, if indiscriminately for medical education, practice and research in Nigeria. While there were and still are no rich grant awarding institutions in Nigeria, the government took it upon itself to fund every aspect of the academic enterprise in Nigerian universities, and by extension, medical schools after the inevitable withdrawal of British researchers and funds.

To my relief, there was open preference for the indigenes of Ebonyi in admission and indigenes paid less. That I often had to make arguments in support of this policy shows how we have been so spoilt in Nigeria that we are blind to the economic implications of health care and medical education. If the state government devotes scarce resources to the running of a medical school, then her indigenes are to be primary beneficiaries. The staffs of Ebonyi State University Teaching Hospital were on strike for four successive months during my service year, agitating to be paid the same amount as their colleagues in other, mostly richer states. The question then is where we should expect the money to come from? Is it from a government that might be doing too much already? From the students who seem to be the immediate beneficiaries of the medical school? The community that benefits from the teaching hospital that owes its existence to the medical school?

Fifty years on, for academic medicine to survive, improve quality and ensure growth, the federal and state governments need to rethink their funding policy. Like the old inexpensive US medical schools, medical schools need to actively seek out grants from philanthropists locally and internationally, and involve all stakeholders: the students, their parents, the host community, alumni, and the sponsoring government. More importantly, it is time to cast our eyes to a new god, a new vision; that often ignored god, the one within. The best newspaper article on Nigerian medicine I’ve read this year was a feature by NEXT journalist Allwell Okpi titled Your Friendly Neighbourhood Pharmacy. The author stated that “some of the pharmacies have served their neighbourhood long enough that they are now trusted sometimes more than hospitals” and “their proximity makes them the doctors next door.” What we have in Nigeria is a tertiary care based system where doctors stay in the hospitals, often remote and expensive, for patients to come in and consult, a relic of the colonial history of Nigerian medicine where the development of services started mainly from the high places, the holy of holies of tertiary care – UCH and the ones that followed. We have abdicated our responsibility for primary care to the Friendly Neighbourhood Pharmacy. In planning for the Nigerian health system we ignore these most important if informal and untrained health providers at our peril.

The generation of medical schools that were started post-independence saw the flaws in the existing system and tried to found medical schools on a philosophy that put primary care and the community first with fresh and innovative ideas. Ibadan, as an afterthought in 1963 started a community project in Ibarapa. However, it was the medical school in Ife (1972) which pioneered the movement to organically integrate primary care and the community into medical education, which was soon taken up by Ilorin (1976), Ogun (1982), Bayero (1985), and Maiduguri (1990). The Ife programme was to inherit and build on the work and legacy of David Morley within the community zones that were marked for the Ife medical school, and went on in its early years to conduct ground breaking research especially in child health that would directly influence WHO and UNICEF policies. The Ilorin programme was adopted by the WHO as a model for community based medical education. However, most medical schools did not catch on, and the early fervour was not sustained, not least because soon after Ife started graduating doctors who were called “community doctors” the medical school slowly and quietly abandoned its earlier idealism and community, preventive and primary care focus for a big teaching hospital after the model it had struggled with distinction to avoid.

We witnessed significant shift toward primary care during the golden Olikoye Ransome-Kuti years when Nigeria recorded some of the highest immunization rates in the world. The progress made in those years could not be sustained partly because they were achieved through means that were not owned by the communities. Nigeria is dotted with failed primary heath care centres. If people have structures and systems to which they have grown to be loyal and accustomed, we must opt to build health systems around them, à la the Friendly Neighbourhood Pharmacy. The future of Nigerian academic medicine is in the community, and we must sustain our innovations this time around. The first 50 years have taught us lessons about what works and what we are able to achieve. We have looked outwards to the West with a steady gaze for far too long. It is time to innovate from realities at home. The running of our medical schools and health systems will continue to be increasingly expensive and hinder access, if we choose to remain in the past. The challenge is upon us to see with new eyes. The god we look to the West for, that beatific vision can well be created in Nigeria, but differently.

It is not at all usual that I find myself grinning at the result of medical research; I’ve been rather successful at maintaining equipoise on quite a range of research issues, but not on male circumcision. My first serious non-medical engagement with male circumcision occurred during an argument for the rights of a child. My contention was that piercing the ear of a girl child, indoctrinating children into the religion that their parents practice were instances of child abuse.

The retort was simple, a bit below the belt. Will you circumcise your male child? Growing up in southwestern Nigeria, and spending six years in boarding schools with common bathrooms, I never saw an uncircumcised penis. I had taken it for granted that it was normal to remove the prepuce. I did not even know what the prepuce looked like until I got to medical school!

Thankfully, there was at the time of the argument, very fresh evidence of the protective effect of male circumcision against heterosexual HIV transmission in sub-Saharan Africa. I replied in the affirmative. However, it got me thinking: what if this evidence had not existed? Much of the routine male circumcision I had been part would have been illegal, or would at least lack scientific merit.

In a BMJ feature article, Circumcision: Divided we fall, to be published in next week’s edition, Sophie Arie considers how recent research on the drawbacks of routine circumcision in boys is provoking medical bodies in different countries to review their position. I took some malicious pleasure in reading her report of a finding that may debunk the previous HIV protection claims for male circumcision:

“… the African trials are flawed in several ways and, if anything, they show that circumcision can delay infection for heterosexual men, not prevent it. ”

This was backed by evidence that have been largely ignored in the wake of the media frenzy about the new wonder solution to the HIV problem in sub-Saharan Africa: male circumcision. South Africa’s president, Jacob Zuma, recently made a point of getting circumcised to encourage others.

Here are further excerpts from the article:

“For a medically futile operation, not one complication can be justified. In the US and Israel, rates of complication in neonatal circumcisions have consistently been reported at between 0.2% and 0.4%. …research published in BMC Urology in February [2010]concluded that side effects such as bleeding and swelling occurred in roughly 1.5% of all procedures carried out by a medical professional on infants in 12 countries.

The Netherlands: “The Royal Dutch Medical Association became the first to decide that the procedure is not only medically unnecessary but also an abuse of the rights of the child in a similar way to female genital mutilation. Under the Dutch constitution, altering a child’s body without medical reasons is illegal, and the Dutch medical body therefore argues there are grounds for banning routine circumcision of babies and children. It has not, however, called for a legal ban on the procedure for fear that it would drive circumcision underground.”

The UK: “The British Medical Association’s guidance… states that the evidence on health benefits was “insufficient for this alone to be a justification,” but… “as a general rule, however, the BMA believes that parents should be entitled to make choices about how best to promote their children’s interests.””

Australia and New Zealand: “The Australasian Association of Paediatric Surgeons (AAPS) states that “it is considered to be inappropriate and unnecessary as a routine, “…but allows for elective circumcision in children over 6 months old when parents hold a very strong opinion.”

Sweden: “Sweden attempted to ban circumcision after the death of a child from complications in 2001. The initial ban was watered down, and the operation is illegal in Sweden in the first two months after birth.”

Nigeria: ???

If you were given the task of formulating the policy regarding male circumcision in Nigeria, what would you propose? My take on this is that indeed, divided we fall. There’s no reason why female circumcision should be any more frowned at or campaigned against. I like to think the foreskin may be almost as important as the clitoris.

Every nation has laws by which it abides. The constitution is the basis for the legal systems that exist in each country. Each country’s constitution is equally binding on all its citizens and there is nobody that is above the dictates of this document. The sovereignty of any nation state is guarded by its constitution and indeed, no external influence should bear enough influence to revert that document. Nationhood is the child of a state’s constitution. It is a binding structure that supports the nature and limits of a state’s functions. It seeks to unify all members of a state under a common umbrella, purpose and destiny.

A nation exists because people choose to keep existing together. The will has to be there, if not it disintegrates or atrophies from within. However, the history of a people, like no other factor, has been responsible for melding similar or disparate entities into well blended or tensely intertwined communions. States are structures erected to give order to governance. The leadership shapes the state. The citizen is the individual to whom much belongs and from whom all is expected as he identifies with the state structure within a nation body.

Where is the sense of belonging in all this? Merely existing within the geographical boundaries, under the governance of the state structure, or in submission to the constitutional doctrines, still does not in any way draw out the sense of belonging from an individual. How do you come to belong to where you believe you belong? Who owns you or to whom will you be owned? For most, birth is a good answer to that question. Rudyard Kipling does justice to that concept in his poem, “Land of Our Birth” (1906). He sees within this land all that it would take to make an individual grow into a proud citizen. He also describes values that, if imbibed, would help one gain a consciousness of selfless service and comradeship in the context of nation building.

However this is not always the case. The making of a citizen is not simply accomplished by native birth, shared history, cherished folklore, citizenship documents, taxation or fear of harassment. The nation and the citizen should share a compact that breeds patriotism. A citizen has roles to play and responsibilities that need to be fulfilled as a member that belongs to, and functions as part of a state. This calls for maturity, a sense and conscientiousness that mandate a citizen to enter into ‘his own’ where he belongs. Not an alien but fully integrated. Not a slave but a freeborn. Not as a loss to the state but a joint investor in the common good, shared purpose, and progressive future of the state and its commonwealth.

The citizen is a beneficiary of the liberal standing of the governance of the state. He profits from their exercise of public goods and popular benefits, and he sees to it that he is always staying on the right side of the law. That is the call of the citizen, executed not from fear or compulsion but as a joy and a delight- the joy and freedom of the empowered.

Nigeria as a nation has suffered much from a demoralizing colonialism, a stillborn democracy, a disorienting war, decades of emasculating and corrupt military leadership, and a backward-looking democracy. Much evil was done by external forces, much worse has been done by her own. Nigeria needs healing. The national psyche has been battered then traded for worthless values that lay no hope for a progressive agenda of nation building.

There is a national orientation agency but much of the nation lacks an orientation to see beyond the daily bread or even the next meal. Poverty has laid the people bare and toughened the cause for daily survival. There is the strength to build but the will is lacking. There are few harnessing the means properly, much fewer calling and mustering to service, and the true leaders where are they? Quo Vadis Nigeria?

Citizens must arise in this nation. Each individual must make the choice to arise and build, be an example, shine a light, and work to profit the common good. We cannot work as base fellows. We must uphold pristine values. There is dignity in labour. Every man must be honoured for the service he renders for the common good, building the nation. The charge must be, “Not for us but for others” (Non sibi sed allis). It is indeed up to us, as we approach the 50 year mark to repent, truly repent, turn to God as a nation, and take what He has given us to build a strong, formidable and productive nation. It is our call!

Guest blogger Simon Adebola is a physician working with the WHO in Geneva. He blogs at iInitiative.

Simon Adebola: So tell me, what is new in the nebulous world of cells transmitters and neurobiology?

Seye Abimbola: Nebulous world?

Simon Adebola: Just teasing. But wait, let’s see how well you can guard your territory. Imagine I thought it was nebulous and even went a bit further to say that science could be tricky and the analysis dodgy.

Seye Abimbola: …and you’d be perfectly right. That is indeed the true nature of science and the bravado and hubris of science in its more modern history is a loss and the way science has fed public imagination with promises of its powers is also unfortunate… That said, it is still the only way we know by which we can grasp the mysteries of  the natural world, hence the need for constant doubt and skepticism, from the makers and the consumers of science alike.

Simon Adebola: Wait a minute, you remind me of this Oxford Prof Jerome Ravetz. He wrote on post normal science, citing much of what you just stated above. It could be that much of what we call hard facts, especially in modern science is not as factual as we tend to want to make our journal editors, peers and larger public believe.

Seye Abimbola: Journal editors and peers are often conniving partners in the business… and unfortunately, the scientifically illiterate public and newspaper editors just take it in, and spread it… and it backfires some times, with the recent example of Climate Science. Climate science had an agenda and I am suspicious of any science with an agenda and unfortunately that is what much of science is today.

Simon Adebola: Well, all writing, I was taught, has an agenda, and that virtually spoilt films and entertainment for me because I then acquired a magnifying lens and sometimes it descends much lowers to an agenda for money. Science like religion has proven not to sit comfortably with the kind of scrutiny it has gotten. They both would rather prefer to be seen as being infallible and yet no enterprise with humans at the helm should be seen as such.

Seye Abimbola: It is troubling how money and agenda drives a lot of research, including medical research and how unfortunately no one beyond the club is even able to really scrutinize. When I was at the BMJ (British Medical Journal) I had a different impression of how science worked. There was the image of science in its most perfect, ideal sense, and although it showed that there was a lot of crap science and studies going on, it didn’t quite ring home that it was a given in “the holy of holies of intellectual objectivity” (Wole Soyinka).

Simon Adebola: Being a strong believer in objectivity and experimentation (I find it truly fascinating) I wonder what the scientific community can do to regain its credibility.

Seye Abimbola: I don’t think it will happen unless we redefine our index of academic credit and the way science is funded – number of papers in peer reviewed journals is a bad idea and funding according to result – often number of papers or positive result – is killing science. It forces scientists to want to say something, when there isn’t anything to say, creates publication bias, unnecessary data analysis et cetera.

Simon Adebola: Sometimes it is like the case of a serially abused individual. Concurrently ignored and used by those they hoped would care about them – politicians and to a lesser extent industry. Over at Cuba (Forum 2009, Global Forum for Health Research) there was this palpable inferiority complex in the research community, a complex not devoid of pride, seemingly crying to be heard by policy makers. As they say in Yoruba, it is a thief who knows how to trace the footprints of another thief on a rock. Once the politicians/policy people see through the credibility flaws, they just would rather use, rather than trust the research community. What would you recommend to improve the assimilation of science into policy?

Seye Abimbola: There’s a lot that is wrong about how science is presently done and how it feeds into policy. I’ve been thinking a lot about policy these days…Ultimately what we need to do is improve scientific literacy. I wouldn’t mind suggesting a model that has scientists, not necessarily practicing, as policy makers in science/medicine…

Simon Adebola: …building a bridge sort of.

Seye Abimbola: Yes, because it’s so easy for scientists to stand on the other end of the divide and send in dumbed down, over-edited, information that lack the nuances, and the element of doubt that comes with science…I’m not happy about the example of Al Gore who has been the most public face for climate change for a long time…It would be a different scenario entirely if he is re-echoing what scientists in the field are saying to the public. However, scientists in the field are the ones trying to re-echo what he is saying by making their data agree.

Simon Adebola: No one is comfortable with the ‘everything is caused by climate change’ line. It gets rancid after a while, with science making the claim on both sides. Ten years ago, science predicted that due to climate change some parts of the world experience drops in snow, for example I heard they said British children would not know what snow was. Now science is proving to us that due to climate change, there would be fiercer snow storms. That breeds the reaction you get when you discover the movie you are watching does not have a plot you want to turn it off, but again you want to see if its plotlessness, is the ingenuity of the director in display, so you hang on watching, hoping it would eventually make sense, somehow.

Seye Abimbola: Again, this is because scientists are not committed to saying the truth the way it is…

Simon Adebola: …and that is the context in which post normal science explores its stance. “Post-Normal Science is a concept developed by Silvio Funtowicz and Jerome Ravetz, attempting to characterise a methodology of inquiry that is appropriate for cases where “facts are uncertain, values in dispute, stakes high and decisions urgent”. It is primarily seen in the context of the debate over global warming and other similar, long-term issues where we possess less information than we would like.” (Wikipedia)

Seye Abimbola: …and again it boils down to scientists feeling a need for that sort of misplaced recognition…

Simon Adebola: …true, opening them up to near destructive abuse. I guess each side just has to make peace with its roles. Oxford would never be Hollywood, or Washington DC, or the Super bowl. Hollywood with its fortune, sports with its fame, and Washington with its power wielding capabilities. The strength of science like you have said would continue to lie in its innovativeness and simplicity once other interests start driving it, that inferiority complex bites in, and self destruction could result. For now we observe the movie, hoping there is a plot. Those profiting off this, increase the hype, the noise, silence the naysayers and hope to bank as much as they can, such that win or lose, at least they have made enough to reward their efforts.

Seye Abimbola: I’m wondering what is there for science in Nigeria… There’s a lot that never happened, despite enormous early promise in Nigeria.

Simon Adebola: There is hope. New minds, fresh minds, need to be trained, we need a reorientation. Science as you know has flourished even when repressed. Galileo, Einstein. It is the commitment that we should hope does not dwindle. The value is in service that would drive a pursuit of excellence, creativity, and better ways of doing things…

Seye Abimbola: In medicine, if we look back to the days of Osuntokun et cetera, they somehow did not, and I suspect due to a lot happening on the political front in Nigeria, manage to build that critical mass that could help sustain scientific productivity. Those guys did and published a lot of great work, good, world class studies and it just didn’t trickle down the generations…and I’m wondering, what can we do?

Simon Adebola: I hope there can be mega research institutes that will represent a focus on excellent research, openness to innovation, and economically sustainable models where research and innovation lead to productivity and development. I also think scholarships and studentships focused on solving the actual needs in the continent are a crucial need – these should come first. It is just that the selfishness can be acute and sometimes crippling, but we can’t deny the need to keep building capacity.

Seye Abimbola: We are presently finishing up the Build AfReCa! (African Research Capacity) paper for the journal Science. Build AfReCa! Is a very young network of young scientists, mostly Africans in the Diaspora, mostly students trying to work towards improving research capacity in Africa…

Simon Adebola: We need more and more of that, aggressively driving knowledge growth.

Seye Abimbola: We put out a survey in the last quarter of last year to assess the needs of young scientists from Africa and why they might not work in Africa and what might make them want to work in Africa, and their general geographical spread. At this stage, it’s essentially advocacy, creating a voice, an image, some advocacy for the need for funding, coordinated funding for young scientists in sub-Saharan Africa, funded to do great work on the ground in Africa

Simon Adebola: I think that is crucial and greater seriousness with African journals. We need the equivalent of The Lancet, BMJ and NEJM (New England Journal of Medicine) on the continent…In fact one could talk to some of these journals to help grow stronger journals with greater visibility on the continent.

Seye Abimbola: We will need to work with the model like PLoS (Public Library of Science). It would be nice to have a PLoS Africa…. PLoS is absolutely open access, and online with a good Impact Factor…The tricky bit is that it will be online, but again, internet access in Africa is getting better by the day…so, that can be done.

Simon Adebola: …and daily digests can be sent by email or even SMS gateways alerting of papers of interest…

Seye Abimbola: …the first place to go when looking for good studies from Africa.

Simon Adebola: I am sure we can get funding for that…The Library is online, you register and select your interest. Each time a paper of interest to you appears, based on your selection, you get an SMS with basic info on the paper.

Seye Abimbola: The journal will need an editorial team, a peer reviewer bank, et cereta.

Simon Adebola: This is the kind of aid they should be interested in giving Africa, not more money for corrupt leaders…

Seye Abimbola: Good. Maybe we should put a proposal together…

Simon Adebola: I think we should…once we have the back end defined well, and teams in place… and even though it costs, we can start with donor funding and once we have a critical base of users, we can work on different models to make it work. This would make research awareness go up greatly…

Seye Abimbola:  Thanks. It’s been a great conversation, and I’m tempted to blog excerpts from the conversation on NT.org

Simon Adebola: Thanks. Please feel free to do that. It’s been a huge pleasure on my part.

The recent Boko Haram incident, and the way muslims in Northern Nigeria reacted to the 2005 Danish cartoons of Prophet Mohammed (PBUH) by setting churches on fire suggest that we must have been breeding this kind of people, and we are probably more capable of breeding them with possibly little outside influence than we presently imagine.

A series of troubling but interesting events happened in close succession, within the space of two years, when I was a student at Obafemi Awolowo University, (OAU) Ile-Ife. For those who are not very familiar with Nigeria, OAU is arguably the most Yoruba and also possibly the most politically active and intellectually progressive of Nigerian universities.

Obafemi Awolowo Hall (popularly called Awo Hall) is well known as the most politically active, hilarious, fun loving and liberal residential hall within the university. Awo Hall also has a long standing tradition, dating back about twenty years or more, of the free screening of pornography videos in the hall’s TV Room every Friday evening. There is incidentally a make shift mosque just across the lawn from the TV Room in what used to be the kitchen attached to a dinning cafe where students used to eat when the Nigerian government provided free food for university students. The tradition of Friday evening porn predates the existence of the make shift mosque, which according to the university was even an illegal creation in the first place. Suddenly one Friday evening the leaders of the Muslim group in the hall stormed into the TV room and seized the DVD player. The incident eventually degenerated into a free for all fight that resulted in a two-week university closure.

There was another occasion when a girl was beaten up for dressing “inappropriately” while visiting the hall (Awo is a male residential hall). The muslim brothers retreated into the mosque after the onslaught and they wouldn’t allow anyone who wasn’t a muslim to approach for questions and a demand of apopogy. They held sticks and other weapons, prepared to attack the uninvited. It was strange and scary. I had to step in, having been a rather good friend of the Awo Hall mosque as I had been spotted entring the mosque to take part in prayers, and having subsequently attracted a couple of the more senior members of the mosque who tried to convert me to Islam, albeit unsuccessfully. Thankfully, we were able to get them to apologise in the long run, an act that eventually that brought the mattter to rest.

A third one occured when a girl was married off to a fellow student by fellow students within one of Mosques in the university without the knowledge of either party’s parents. The girl subsequently decided to cut off all communication with her family. After several weeks of failed attempts at reaching her, the girl’s parents had to visit the university to confirm what had happened to their daughter. She had been transformed from a regular muslim lady to one that covers her face, she was already pregnant and she wasn’t going to see her parents when they eventually visited.

I once had a “friend,” a Nigerian who told me that he would kill me in the event of a holy war! He wasn’t joking.

Mild as these incidents were, what they show is that for these to happen in the liberal south, at the very bastion of southwestern Nigeria liberalism, you can imagine what possibly goes on in the north where some states already practice the Islamic Sharia legal system.

I don’t think that Umar did what he is alleged to have done simply because he is from a rich, privileged family or from northern Nigeria. He simply had good access to radicalising influences, or is it the other way round? There are thousands of Nigerians, I’m sure, who would go the same way if only they had the same kind of access Umar Farouk Abdulmutallab had, and we should not be oblivious of this important fact as we discuss this unfortunate incident.

It was particularly shocking because the United Kingdom does have a reputation for science and rationality that is hardly equalled elsewhere in the world. The experience however made it less shocking for me when I got to Sydney, Australia and found lots and lots of alternative practices, with all sorts of interesting and grand names, structured to deceive and confuse with legitimate science. However, I doubt that like in the UK, any is funded from the public purse of Australians.

Two weeks ago, I met a black woman from Jamaica (although born in London and raised in Auckland). She was the first black person I walked up to and spoke with in Sydney, and the first and only person ever to have referred to me as ‘brother’ in the restricted black folk sense of the word. It was rather strange. I had never been a ‘brother’. There are not many in Australia.

We got on the bus together. She had studied ‘alternative/complimentary medicine’ in her youth and had also received training in homeopathy. Much of the rest of the trip was spent discussing the claims of homeopathy, during which she argued that homeopathy was much like vaccination. I was so mad, but out of courtesy I had to change the topic immediately. It reminded me of Raymond Tallis‘ 2007 Sense about Science annual lecture where he said:

…and this is how it is with junk science that borrows the terminology of science, without any sense of its true meaning, and of the massive interconnected hinterland of facts and concepts and even uncertainties behind them.

…and so we have treatments such as ‘reflexology’ which expropriates a well-established, indeed central, concept in biological science, and uses it to label treatments that have no biological foundation whatsoever.

…and ‘homoeopathy’ which, being in Greek, one of the languages of science, sounds very scientific but is based on magic thinking that would shame a six year old child.

…they domesticate terms by uprooting them from a complicated nexus of hard-won concepts.

Whenever I see those Sydney shops or offices, what comes to mind is how successful alternative medicine practice/movement is in Nigeria as well, and how they feed on pretty much the same sentiments. I reckon it must indeed be a universal phenomenon. Thankfully, we are not yet at the stage where the Nigerian government will fund an alternative medical practice, but I bet we are not that far either. I am almost certain of it that the movement will soon have a ’scientific’ arm made up of people trained as much as to be able to throw terminologies around but not quite as much as to have any deep, nuanced understanding of them.

Here is an excerpt from an advertorial on the popular Doctor Akintunde Ayeni of Yem-Kem International Nigeria Limited:

…he [has] invested resources – time and money to visit renowned herbal homes in India, China, Australia, Japan and Pakistan. In similar vein, [practitioners] of alternative therapy in those countries visit him, here in Nigeria, to exchange notes. The result of these research efforts is manifested in the emergence of our three products namely (1) Blood Cure, which a blood purifier and immune boosting herbal medicine (2) M & T Capsule which is an effective herbal medicine for all chronic fever and (3) Energy 2000 which is a powerful herbal medicine for sex ability deficient patients.

The words again: ‘research’, ‘immune’, ‘capsule’, ‘doctor’, ‘discover’, et cetera. It is also interesting that Australia has its place among the visibly oriental countries that Akintunde Ayeni has visited.

John Diamond, who before his eventual death had his hopes of cure from cancer falsely raised by several alternative medicine practitioners did put what would be my summation very beautifully: “There is in reality no such thing as alternative medicine, just medicine that works and medicine that doesn’t…There isn’t an ‘alternative’ physiology or anatomy or nervous system any more than there’s an alternative map of London which lets you get to Battersea from Chelsea without crossing the Thames.”

So how do you define medicine that works? Well, the same way that Artemisinin made its way from the fields of central China to clinics everywhere chloroquine resistant Malaria is treated.

Evolution is not just a biological concept. It occurs in all facets of life. It is neither merely a human phenomenon but is common to all life and even sometimes to non-living things as we manipulate them to suit our own evolution. I believe the aim of all evolution is to increase the chances of survival and to improve the quality of that survival.

I will not pretend to fully understand biological evolution by natural selection as it is a concept that requires some serious study to be fully apprehended. Moreover, there are many theories as to the processes involved and as to the actual members of the supposed ancestry of modern Homo sapiens or Homo sapiens sapiens and our said relationship with this ancestry.

What is certain is that fossils have been found and probably many more will be. If these findings are real, as I am apt to believe they are, and not forged, then these so called human species from the early Australopithecus to the late Homo must have existed. The facts speak for themselves. Whether what is propounded from these findings is correct is another matter entirely. Science itself evolves as more information becomes available. Many of the theories that reigned back in the day are now obsolete. The Earth was once believed to be flat and suppuration was once thought to be essential for wound healing.

Faith that is true does not deny the facts. It seeks to offer the truth about them. This is where controversy should arise if there are dissenting views and not over undeniable facts. Creation science has therefore given room in creationism for the facts presented by the fossils. This young-earth creationism and non-traditional old-earth creationism does not deny the facts but offers possible explanations while maintaining belief in creation. Their theories are Flood Geology for young-earth creationism and the Day-Age and Gap theories for old-earth. Traditional creationists, I believe, still stick with creation without entertaining the possibility of pre-historic man’s existence.

I believe that all life as we now know it was created by God at a time that the earth was without form and void or unoccupied. I believe that all of mankind as it exists today is from the first man and woman – Adam and Eve, both of whom were created by God and did not evolve from a lower life form. Adam was formed as a man and he came to life when God breathed into his nostrils. He formed Eve from the rib which he took out of Adam and thus set humanity into motion. They only needed to procreate thereafter.

They both started as intelligent beings capable of social interaction. I believe Lucifer was cast down after his rebellion before this creation or re-creation if you choose. This may have led to the destruction of the world which existed then and probably had all these pre-historic creatures such as the so-called ancestors of man and dinosaurs, fossils of whom we see today. Hence, the earth became formless and vacant.

I can understand adaptations such as a weight-lifter building muscle and having his/her bones become more sturdy or the loss of such muscle mass in times of starvation. I can also understand an increase in my skin pigmentation when I’m exposed to more intense sun rays and a return to my normal complexion when I’m back to less ‘radiation’. I can even understand how long powerful arms and curved fingers, features that made australopiths agile in trees became less pronounced in Homo who did not need to be a good climber.

What I’m yet to understand though is how these phenotypes translate into the genes for expression in generations in the distant future or how organisms from distant phyla or classes could have been related in the past however distant that past might be. Homo sapiens sapiens may therefore someday evolve into some species yet unknown once we can no longer interbreed and thus become reproductively isolated, right?

My limited understanding however does not repudiate the possibility of biological evolution. I in fact tend to believe that the power that makes it possible for mankind to be perpetuated by procreation such that only one man and woman needed to be created, and that fertilization produces a mass of cells which becomes an embryo, fetus etc., that such power can also cause organisms to evolve to higher life forms.

I am therefore not afraid to believe biological evolution could have taken place sometime. I however believe Adam was not a product of this process. I also think it is paradoxical to believe God has power to create the world we live in and to do all we believe he has done, indeed to say he is both omniscient and omnipotent and yet deny the possibility that he could carry out something as simple as biological evolution – at least as simple as the naturalists or Darwinists have portrayed it.

I will end by conceding that just as the scientists have insufficient information to make incontrovertible conclusions from their findings, creationists may also have insufficient information to refute the theory of evolution by natural selection save to say Adam was not a part of it. This refutation in the extent to which it can go is based on the bible which I must say, we have not yet fully understood. The scientists work ceaselessly to improve their assertions. Creationists must also seek to understand the bible better.

I must add that I also do not believe that man as we know him now, being the most complex of species, will evolve into any higher life form. I believe everything the bible says about our origins and our destination.

Oluwafemi Owagbemi
OAU Teaching Hospitals,
Osun, Nigeria

This was the first thought that occurred to me last year when during the heated US presidential campaign I saw John McCain and Barack Obama on the TV, apparently appealing to the American religious conservative right, both of them at the Saddleback Church, engaged in what could hardly pass for a mild debate moderated by the pastor, Rick Warren. I remember thinking to myself: the only other place where this could possibly happen is right here in Nigeria.

It is in my experience quite safe to assume that by being a Nigerian, you are simply religious by default, until confessed otherwise, and that you believe yourself to be a creationist even without having as much as a half-hearted look at the evidence for evolution by natural selection. With this premise, I have discovered what has become for me a most favoured pastime, which is to bring up the theory of evolution and Darwinism and related scientific concepts easily associated with atheism, agnosticism and all sorts of ungodly tendencies to spark up discussion amongst colleagues in Nigeria.

I hope we could have one such exchange here on NigertansTalk. Painfully, competing and admittedly often more pressing issues generally trump whatever space we might have for science in our politics and national life.

In the discussions that have resulted, I have found that roughly half of the people I’ve encountered fall within the category I refer to, for the purpose of this post, as “the fundamentalist,” and the lowest watermark of such argument will be: “I would cease to believe in the existence of other planets and solar systems and galaxies if I find a remark in Bible (or the Qur’an) that so much as suggests that the earth is all there is in the universe.”

The other half are about equally divided into three groups: “the open minded” (“Well, it seems there is some good evidence that I’ll have to spend some time to consider more carefully.), the “I don’t give a damn” (“Whatever it is, I don’t think it matters.”), and “the malleable,” those that get convinced after a lot of discussion, only find that they have reverted to creationism at the next encounter (“What you said the other day, I really don’t think it can be true.”).

There is an American student from Texas here, with whom I’ve had two long and interesting discussions on evolution and creationism. She is an avowed creationist and a Christian, and like most of my Nigerian friends, she possibly couldn’t accept that being a Christian and an evolutionist at the same time are not fundamentally conflicting positions. For her, they are simply mutually exclusive: the exact same argument that my Nigerian friends would make.

It actually got me wondering how similar Nigerians must indeed be to Americans in this regard and why would that be? It is for me, as for most scientists a persistent puzzle as to why Americans are so religious and how creationism is so widespread and evolution is taken with so much negative seriousness in the US. I could easily explain the situation in Nigeria. I was never taught the theory of evolution in primary or secondary school, although of course more because there were no teachers to teach it than because there was a legislation against teaching it.

Looking back however, I think not having been taught evolution in secondary school was indeed a blessing because then I was left to study it all be myself and so had the opportunity to weight the evidence against my knowledge of the Biblical account of creation which I was raised in, and was, as I still am, also very well versed in. I am almost certain that even if there were teachers, it is unlikely that any will teach it well enough to present the evidence and allow the pupils make up their mind.

My comparative anatomy lecturer in medical school after discussing all the interesting and beautiful evidence for evolution, ended the lecture by saying it was all crap, and that we should take none of it any seriously beyond the point of recanting (sic) them during exams. Might that be the reason: the lack of unbiased exposure to the basic tenets of evolutionary theory? Might this be what some Americans are protecting against when they say they don’t want evolution taught in their schools?

What do you think? Are you an evolutionist? Why, if yes, and why not if not? Were you introduced to the theory of evolution by natural selection in secondary school? What do you think the effect of that might be if you were or might have been if you were not? Do you think an evolutionist could at the same time “have a personal relationship with God?”

His former colleague and fellow professor of International Child Health at UCL, Andrew Tomkins reflects on his life in the Guardian UK:

When David qualified in medicine in 1947, one in four children in developing countries died before their fifth birthday. As a young doctor in a mission hospital in Nigeria, he established that effective treatment for such children should not revolve around hospitals but community-based healthcare and technologies, some of which he developed himself. His findings had a great impact on governments and agencies worldwide, and many have subsequently adopted that approach. He also set up training courses for medical staff and a charity, Teaching Aids at Low Cost (TALC).

These included a robust scale for weighing infants in the community, parent-owned Road to Health Charts and a simple mid-upper arm circumference (MUAC) tape for detecting severe malnutrition. He set up the Tropical Child Health Unit (TCHU) at the Institute of Child Health (ICH), London, which formed the basis for the present Centre for International Health and Development

Three missionary doctors working in the Wesley Guild Hospital in Ilesha, Nigeria, obtained research funding from the West African Medical Research Council and the Methodist Missionary Society to help tackle the limitations of traditional (western) clinical services when applied in the developing world. Andrew Pearson, David Cannon and John Wright recruited David to do the work and, in 1953, he set up an extensive health and nutrition study of 413 children in Ilesha. It was the first of its kind and produced very influential publications.

Earlier this year, a month after his death on 2 July 2009, bloggers at the Nigeria Health Watch invited Bryan Pearson, publisher of Africa Health to write an obituary of David Morley. He wrote about how the missionary doctors at WGH Ilesha had brought the problem they strove to solve upon themselves by increasing patient population “having negotiated a deal with their new regional governor, Obafemi Awolowo, to provide free health services for under 18s.” The full obituary is here. This is an excerpt:

A full longitudinal study was initiated and over the next 18 months all children born into the community were registered and then followed with monthly checks for a full five years. Growth charts were introduced (now utilised universally) and a special ‘Under Fives Clinic’ was initiated back at WGH. High protein weaning food was introduced. Mothers kept the children’s records (less loss than for hospital based records); Grade II midwives were taught to deal with 90% of clinical need and to refer the other 10%.

By 1960 outpatient attendance had reached 200 000 at WGH, 80% of whom were under 18 year olds. The first measles vaccine was trialled at Ilesha and Imesi-Ile in 1960.

 And thus the community-based health revolution was born. Quickly the Imesi-Ile population started growing at more than 9% per annum, and the first family planning programme (as it was known then) had to be initiated.

It is no accident that Olikoye Ransome-Kuti was closely involved and inspired by David Morley. Just a shame, that despite all Olikoye’s efforts, so little of what was learned from this landmark work of community-based prevention was adopted throughout the Federation. Many other countries did take heed, and probably millions of children have benefitted.

There are other obituaries from the Telegraph and the Independent both in the UK. I doubt that any Nigerian daily has reported his death or published an obituary. We are often far too caught up in our politics of misrule to have time for that.

It is well worth mentioning though that the special ‘Under Fives Clinic’ still runs as Wesley Guild Hospital under Oyeku Oyelami, (professor of Paediatrics and Child Health at OAU Ile-Ife) without regard for Nigeria’s numerous public holidays or strike actions, continuing to benefit thousands of children and their families in Ilesha and its environs.