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Medical Tourism In A Time Of Cancer

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I got this question a lot as family, friends and colleagues found out about the breast cancer diagnosis. I had no convincing answer. Even to myself. It was left to be in a country where I had no social structures at a time like this.

I did look to the familiar for a biopsy. School, work, love, conferences and life in general made the UK and US more logical choices for me. I asked trusted friends for help arranging a biopsy so I could be efficient. While I waited, work sent me to Berlin – my first visit ever to Germany. Germany’s medical care is legendary and so I thought, ‘why not?’

After meetings in Berlin, I left for a clinic in Wiesbaden, a small town outside Frankfurt popular with Nigerians with ties to Julius Berger. Exactly one week after the sample was taken, I got the result: triple negative breast cancer (TNBC), fast growing aggressive cells. If breast cancer is a western, TNBC is the baddest villain, but I did not know that then. Who even knew there are types of breast cancer? There are some things we never want to have to know.

Within 10 days, I was back in Wiesbaden for the next important step – staging. For this I needed a Positron Emission Tomography (PET) scan that would determine what stage the cancer was in, which would in turn determine treatment. The PET scan produces detailed three-dimensional images inside the body by detecting radiation given off by a radiotracer – a dye of sorts injected into your veins (or inhaled/ingested) which helps doctors determine cancerous cells because these mutated cells use up glucose at a faster rate than normal cells. Nigeria got its first PET scan machine only in 2022, thanks not to the investment of any federal or state government, but a private oncology centre in Lagos. How have our oncologists been determining cancer staging and treatment without this machine?

Shivering under the blanket thoughtfully provided by the hospital as I waited for the tracer dyes to diffuse through my body, I wondered: cold or nerves? I slept through it, out for the entire process immediately I stretched out on the machine.

The good news was: cancer was at stage 2 and had not spread and TNBC responds well to chemotherapy. The recommended treatment plan was 16 rounds of chemo, then a lumpectomy to remove the tumor, and then 5-6 weeks of radiation. Bad news: I had to move fast, travel was not recommended (presuming I was an heiress with a private jet and could fly in and out for chemo) because of how miserably sick chemo makes the body and weakens the immune system. Buying the drugs and getting them administered at home was also not advisable though it was a possibility. Keeping track of the white blood cells count, ensuring organs are coping, this was where care could slip. Could I start right away?

Of course not.

Abuja – Dakar – New York – Wiesbaden.

Tell family. Tell colleagues. Tell bosses. Then I was ready. Sort of.

Factors influencing decisions

No one in my family had a valid EU visa at this time. Germany was alien, the language and people unknown. There was no one to call, to say ‘check on her’ or ‘make pepper soup and take to her’ (that was soon sorted out!). But the advice to get started without delay gave Germany an advantage despite the well-meaning pressure to consider the US or UK. I had introductions to experts in TBNC across the world within hours – all standing by and ready to assist.

But two things helped me feel more comfortable with Germany. One, if I moved, the doctors would want to do these tests all over again…I did not feel I had the time, energy or money.

Second was health insurance. Until it kicked in (it never did; thankfully the organization I work for was supportive), I would be paying out of pocket and US medical costs were easily 4-5x higher than Germany. So, Germany it was.

The seeds of Germany’s health care system were sown on the eve of the carving up of Africa, with Bismarck’s 1883 Health Insurance Act. It was the first social health insurance system in the world. Today, Germany boasts of being within the top 20 health systems in the world spending 11% of GDP on health expenditure (€407 billion in 2019 or almost €5000 per person). Government funds 77% and the rest is private funded and everyone is covered. Everyone. Including refugees.

In addition to government funding, employees & employers fund up to 14.6% of gross wages, shared equally by the employer and employees and at the point of access a copay (this is where a patient is required to pay part of the cost) is required in some cases but not for preventative services such as cancer screening. Policy makers understand that prevention is better than cure and want zero excuses for those who need regular checkups. Germans who earn below a certain amount are compulsorily covered (88%) and private health insurance exists for high earners (11%).

The unemployed pay a proportion of their unemployment entitlements and for the long-term unemployed, government contributes for them. The German federal government is not directly involved in care delivery but uses laws and regulation to set quality measures and ensure that providers cannot arbitrarily increase premiums and copayments. Dependents and children are covered free of charge and special schemes exist for the police, military and other public service employees.

Health funding in Nigeria

In Nigeria – the federal health budget covers part of the funding required for health insurance under new National Health Insurance Authority (NHIA) law enacted in 2022. The idea of a health fund is to act in a similar way as our pensions do – i.e., contributions from employees, employers, government (e.g., N4.4 billion was allocated to NHIA to cover retired military) and investments. Just like arrangements must be made for those who will retire, arrangements have to be made for those who will inevitably need medical care. It is not clear though, at least not from the agency’s website, how much the NHIA has in funds, what it spends annually, what it generates and who has access.

Health has never been a priority for Nigerian government and policy makers. For the first time since the Abuja Declaration of 2001 where Africa Union members pledged to dedicate at least 15 percent of annual budgets to health, Nigeria’s 2023 health budget got as high as 5 percent of the budget. High recurrent expenditure and corruption ensure that there is always too little to invest in building our medical facilities and expertise.

This is why Nigerians have to migrate when they are ill, increasing the financial and emotional resources required to get better. India, Turkey, Egypt, United Arab Emirates, Ghana etc. have become havens for Nigerian patients. Several factors dictate where patients go for health care outside Nigeria: family, budget, medical referrals, visas and expediency. Improving the health sector requires detailed research and assessment of medical tourism needs and costs in order to prioritize government interventions – until then, Nigerians will continue to seek better health care wherever they can.

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Seven prime ministers in a decade: What Nigeria can learn from Britain’s chaos

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Prime Minister

By Dr Toju Ogbe,

The resignation of British Prime Minister Keir Starmer, less than two years after leading the Labour Party to  a landslide electoral victory, was dramatic, yet reflected a pattern we have become familiar with in recent British politics.

Also read: Abolish state of origin: A prerequisite for true national integration

Starmer now joins a procession of fallen prime ministers stretching back to 2016 – from David Cameron to Theresa May, Boris Johnson, Liz Truss, and Rishi Sunak.

None of these prime ministers was ousted through military intervention, popular insurrection, or a court order. Rather, each was ultimately brought down by the same political system that elevated them to electoral glory.

To the casual observer, the rapid turnover of British Prime Ministers in the last decade may appear chaotic, or even a symptom of political instability. Some argue that the British electorate has become ungovernable.

However, beneath the apparent chaos at Westminster lies an uncomfortable truth that African democracies would do well to examine, particularly Nigerians who wonder why our democracy has delivered so little despite almost three decades of uninterrupted civilian rule.

The turbulence of British politics over the last decade, presents an important lesson on democratic accountability beyond successful elections.

Once the prime minister is deemed a liability by their own political party, the mechanics of accountability are activated. The daggers are quietly drawn and the ruthless pressure to resign begins.

Every poll and survey on public opinion is closely monitored, local election results are taken as a referendum on leadership. Cabinet resignations begin to gain momentum and backbenchers get restless.

Once the news media smells an internal uprising, they amplify scrutiny of the prime minister, subjecting every move – speech, public appearance, political misstep etc to relentless examination.

Pressure gradually mounts until the prospect of bitter internal leadership challenge becomes impossible to resist. The Prime Minister falls.

For every British Prime Minister, winning an election is merely the beginning of examination, not the end. Political survival lasts only for as long as the prime minister maintains the confidence of his party and the parliament.

This is the muscle of British democratic accountability; a political culture that prioritises institutional survival over individual ambition. Starmer recognised this reality in his resignation speech:

“The question my party is asking now is whether I am best placed to lead us into the next general election. I have heard the answer of my parliamentary party to that question, and I accept that answer with good grace.”

That closing sentence alone is a masterclass in British institutional democracy. The party spoke. The leader listened. The correction comes from within.

 

Nigeria presents a strikingly different political logic.

Nigeria on the other hand, presents an interesting contrast with a different political logic and culture.

The notion that a governing party would overtly interrogate the performance of its own leader and engineer a transition to someone better equipped to maintain public confidence, is in most cases politically unthinkable in Nigeria.

Political parties in Nigeria do not coalesce  around ideological principles; rather, they operate more as electoral instruments organised around powerful individuals.

Internal dissent is often dealt with as betrayals rather than as part of healthy democratic engagement. Godfatherism and transactional loyalties shape political succession and leadership retention.

Once elected in Nigeria, there is an inherent assumption that a governor or president has a fixed two-term lease on power.

While 10 Downing Street is preparing to welcome its seventh Prime Minister in a decade, Nigeria, in contrast, has had only two democratically elected presidents during the same period – one of whom is still serving.

Social and economic conditions may deteriorate. Insecurity may worsen. Campaign promises may be ignored.

Public frustrations may become unbearable. Yet, incumbent governors and presidents often remain insulated from meaningful internal scrutiny and are even routinely anointed as ‘consensus’ candidate for second terms provided loyalties to godfathers, rather than the electorates are maintained.

The consequence is that loyalty, instead of performance is often rewarded at the expense of accountability.

This is not an argument for a revolving door at Aso Rock, as frequent leadership changes, by themselves, do not guarantee good governance.

Rather it is a case for making accountability an integral aspect of party politics in Nigeria.

Although the Nigerian presidential system provides for a fixed four-year term regardless of party confidence, political parties should however, be more than instruments for election campaigns, activated to simply retain or take over power every four years.

Electoral victory, should not be the ultimate goal, but the starting point of public service where democratic legitimacy must be continuously earned.

Equally important, political parties must develop the institutional maturity to honestly evaluate their own leaders. They must prioritise public interest and institutional credibility over loyalty to ‘Godfathers’.

The ultimate lesson from Westminster’s revolving door is clear: the true strength of a democratic system, lies not in the ability to produce leaders, but the capacity to effectively replace them, when they no longer command confidence.

Protecting failing leaders from accountability weakens democracy and political parties must ensure that no leader is more powerful than the institution.

Also read: Abolish state of origin: A prerequisite for true national integration

As political parties gear up for the 2027 general elections, the political class must decide what matters more: we can continue to reward blind loyalty and endure predictable decline, or discover the courage to demand accountability from those who seek to lead us.

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Chief Obafemi Awolowo and the fabric of Nigeria’s history and society

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Awolowo

By Sabella Ogbobode Abidde,

As a scholar, I have always wanted to edit or co-edit a book on the Big Ten of Nigerian nationalists, focusing on their lives, times, and generational impact from the nineteenth to the twenty-first century.

Also read: Abolish state of origin: A prerequisite for true national integration

An august list would include greats such as Aminu Kano, Herbert Macaulay, Nnamdi Azikiwe, Alvan Ikoku, Anthony Enahoro, Ahmadu Bello, Egbert Udo Udoma, Tafawa Balewa, Obafemi Awolowo, Eyo Ita, and Nnamdi Azikiwe. Two or more scholarly volumes would be ready before I bid farewell to my academic career.

But for now, this column briefly sheds light on a philosopher and mystic, who was also a political and economic giant: Chief Obafemi Awolowo.

His impact is multigenerational and wondrously woven into the fabric of Nigeria’s history, culture, and society.

Publicly available records indicate that the Nigerian nationalist movement began in the 1920s (Awolowo was born in 1909), so he had forebearers in the movement.

He later became one of the movement’s central figures, and by independence in October 1960, he had perhaps become the dominant personality shaping Nigeria’s political development and economic growth.

Awolowo was also a federalist. The first Premier of the Western region of Nigeria. The founder of the Yoruba nationalist group Egbe Omo Oduduwa.

He was the leader of the Action Group (AG), a political party and an opposition leader in the federal parliament, from 1959 to 1963.

A noted lawyer, author, journalist, and the founder and publisher of the Nigerian Tribune newspaper.

And in later years, under the first military regime, he served as the federal commissioner for finance and as vice chairman of the Federal Executive Council during the Nigerian-Biafran Civil War, 1967-1970.

Much later, Awolowo founded the Unity Party of Nigeria (UPN) and became the party’s presidential candidate in 1979 and 1983.

The consensus was that, on both occasions – especially in 1979 – the electoral body, acting at the behest of the then military regime, put its foot and thumb on the ballot-counting machines to the detriment of Awolowo.

In other words, those who voted didn’t count; the military counted and secured the votes for their preferred candidate.

Those officially sanctioned electoral irregularities, many Nigerians have asserted, partially account for why Nigeria has remained politically and economically miserable and socially chaotic in the years since.

And in the years since his passing, many of the so-called Awoists — men and women who claimed to be adherents and practitioners of his precepts — have fallen by the wayside.

They failed! By 1997, one rarely finds a school of politicians parading themselves as students of or members of the Awolowo Cathedral.

In the second decade of the twenty-first century, many politicians lack the impudence to call themselves Awoists.

The irony is that in the northern part of Nigeria, one can rarely find a pool of politicians who, today, adhere to the teachings and practices of Mallam Aminu Kano. And in the east, there are no more followers of Dr. Nnamdi Azikiwe.

Many politicians, from the east to the west, from the north to the south, and from the middle belt to the south-south, have done away with ethics, morality, ideology, or remaining faithful to their political parties.

Most no longer care about party manifestos or going to the State House, National Assembly, or the Presidency with the people’s burden on their hearts or shoulders.

In public or in private, participants in the Nigerian political and economic space think nothing about integrity, posterity, nation-building, or national interest. It is mostly about self-interest now.

That is what Nigeria has become! Many of the good, effective, efficient, visionary, and purposeful Nigerians are in hiding, while the audaciously corrupt are masters of the game, leaders at various levels of governance.

And we expect to change for the better? Heck no! It is a painful three-ring circus at all three levels.

I do not for once contend that the Federal Republic of Nigeria is a lost cause, a lost experiment, a lost entity, or a forsaken project. No! It can be saved; it can be brought back from the edge of the cliff.

And I also do not for once think that Nigeria should be partitioned into three or four separate countries.

Oh, no! I believe that sustained, first-rate, courageous, and visionary leadership can turn the Nigerian ship around. It is doable. This is not a hopeless country. It is not!

Many of the institutions Awolowo built are still going strong. Many of his policies have been proven right and correct. Many of his teachings have been found to be the appropriate panaceas for Nigeria.

And many of the physical infrastructure projects he built lasted for more than four decades.

And so, imagine where Nigeria would be today on the development scale – on the same level as Taiwan, South Korea, New Zealand, China, and Australia? Or the oil-rich Middle East countries.

Not having Chief Obafemi Awolowo as the president of this federation set her back three to four decades.

Examined dispassionately, his economic and political achievements have yet to be rivaled for several decades after his premiership of the western region, and neither has his commissionership (now minister) of the finance portfolio.

He was good, he was great, and he was miles above his contemporaries in the development of their various regions and in their generational legacies.

Without Awolowo’s policies, much of southern Nigeria – especially the western region — would perhaps be one of the least developed in today’s Nigeria.

Directly and indirectly, Awolowo was the man who made it possible for millions of Nigerians and their offspring to dream of and have a better life.

He promised, he delivered; he built and encouraged others, such as Michael Adekunle Ajasin (Ondo State), Lateef Kayode Jakande (Lagos State), Bola Ige (Oyo State), and Olabisi Onabanjo (Ogun State), to be builders.

If General Yakubu Dan-Yumma Gowon was the most consequential military leader Nigeria has ever had, Chief Obafemi Jeremiah Oyeniyi Awolowo, was the single most consequential leader and public figure beginning with his premiership in 1954.

Above all else, he was a family man, a good man, a good Nigerian, and a Pan-Africanist. He was better than most and far better than we thought. That’s Awo for you, a man who’s woven into our consciousness.

Also read: Abolish state of origin: A prerequisite for true national integration

Chief Obafemi Awolowo would have been 117 this year, but he died at 78 in 1987 at his home in Ikenne, Ogun State. Chief Hannah Idowu Dideolu Awolowo, affectionally called HID, was Awolowo’s “jewel of inestimable value.” He had said of her: “I do not hesitate to confess that I owe my success in life to three factors: the Grace of God, a Spartan self-discipline, and a good wife. Our home is to all of us, a true haven; a place of happiness, and of imperturbable seclusion from the buffetings of life.” HID was born in Ikenne, in1915 and passed in 2015 in the same locality. She was 99. It was a union and a marriage that lasted for five glorious decades.

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Abolish state of origin: A prerequisite for true national integration

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state of origin

By Nosa Ota Osaikhuiwu,

Nigeria stands at a critical point in its national development. Nearly sixty-six years after independence, our nation continues to struggle with divisions rooted in ethnicity, tribalism, and the outdated concept of “state of origin.”

Also read: Celebrating Tunji Bello at 65…

If Nigeria is to become a truly united and prosperous nation, we must fundamentally rethink how citizenship is defined and practiced.

One of the greatest obstacles to national unity is the continued emphasis on state of origin rather than state of residence. Every Nigerian is first and foremost a citizen of Nigeria.

Yet our laws, government policies, and administrative procedures continue to classify citizens according to ancestral origin instead of where they actually live, work, pay taxes, and contribute to society.

It is time for the National Assembly to enact legislation abolishing the use of state of origin and replacing it with state or local government of residence for all official government purposes.

Equal Citizenship Through Residency

The proposed legislation should clearly define residency requirements.

Once a Nigerian has legally resided in a state or local government for a specified number of years and has fulfilled obligations such as tax payment and other civic responsibilities, that individual should enjoy the same rights, privileges, opportunities, and responsibilities as any indigene of that community.

No Nigerian should remain a perpetual “stranger” in any part of the country where they have chosen to build their lives.

Such rights should include:

  • Equal access to public employment.
  • Eligibility for admissions into educational institutions.
  • The right to vote and be voted for where they reside.
  • Equal access to government services and social benefits.
  • The right to own property without discrimination.
  • Full participation in local political and economic life.

 

Ending Institutionalized Tribalism

The present system unintentionally encourages tribal loyalty over national citizenship. Rather than identifying primarily as Nigerians, many citizens first identify with their ancestral states because government policies reward those classifications.

As a result, national discussions frequently become contests over which state or ethnic group benefits most from federal appointments, infrastructure projects, or public resources instead of focusing on what best serves Nigeria as a whole.

Replacing state of origin with state of residence would gradually change this mindset by encouraging Nigerians to invest emotionally, economically, and politically in the communities where they actually live.

Better Planning and Fairer Resource Allocation

This reform would also improve national planning. Today, millions of Nigerians live permanently outside their ancestral states.

Yet many official records continue to associate them with their states of origin rather than their places of residence. For example, a state may officially have twenty million people by origin, while only ten million actually reside there.

Meanwhile, another state may receive ten million migrants who require roads, hospitals, schools, housing, water, electricity, and other public services, but existing policies will not adequately recognize snd compensate for this situation.

Government planning should reflect where people actually live, not where their ancestors came from.

Using residence as the basis for census data, budgeting, infrastructure development, healthcare planning, educational investments, and revenue allocation would produce more accurate statistics and more efficient public spending.

Promoting National Unity

Many prominent Nigerians were born outside their ancestral states. Nevertheless, our current administrative system compels them to identify only with their ancestral origins. Nigeria should move beyond this outdated arrangement.

Citizenship should be based upon commitment to one’s community of residence rather than ancestry.

This reform would promote:

  • National integration.
  • Social cohesion.
  • Equal opportunity.
  • Economic mobility.
  • Meritocracy.
  • Reduced ethnic tension.
  • Stronger democratic participation.

It would also encourage Nigerians to see every part of the country as home rather than limiting their identity to ancestral boundaries.

A Call to the National Assembly

As members of the National Assembly return to legislative business, we urge them to make this constitutional and legislative reform a national priority.

The use of state of origin in official documentation, public employment, educational admissions, and government programmes should be gradually phased out and replaced with state or local government of residence.

Nigeria belongs to all Nigerians.

Our laws should reflect that simple but powerful truth by promoting equal citizenship, national unity, and shared responsibility rather than perpetuating divisions based on ancestral origin.

If we truly desire one united Nigeria, then every Nigerian must have the freedom to live, work, participate, and prosper in any part of the country without discrimination.

Replacing state of origin with state of residence would be one of the boldest and most transformative reforms in Nigeria’s democratic history.

It would move our nation closer to the promise of equal citizenship envisioned in our Constitution and help build a stronger, more united Federal Republic where every Nigerian is at home anywhere in Nigeria.

Also read: Celebrating Tunji Bello at 65…

Finally, I urge all Nigerians irrespective of their places of origin to join this call and reach to their representatives, senators, governors and indeed the president through phone calls, letters and online to support this initiative for true national integration and cohesion.

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