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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.

    Opinion

    Ondo monarch calls for tourism investment to boost Nigerian economy

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    Tourism Investment in Nigeria

    Adeleke Adegbite-Adedoyin, Owa Ale of Ikareland, urges Nigerian leaders to prioritise tourism investment for economic growth and cultural preservation.

     

     

    The Owa Ale of Ikareland, Adeleke Adegbite-Adedoyin, has called on Nigerian government leaders to strengthen the country’s tourism sector, highlighting its potential to drive economic growth.

    Addressing attendees at the 2024 Olokemeji Tako-Tabo Festival in Ikare, Ondo State, he urged federal, state, and local governments to promote tourism as a sustainable source of employment and revenue generation.

     

    Also read: Ondo Governor celebrates Ulefunta festival to drive economic growth

     

    Speaking at the annual festival, which drew visitors from within Nigeria and abroad, the monarch underscored the economic and cultural benefits of tourism, describing festivals as vital for fostering local pride and identity.

    “Our culture is our pride. Government support in tourism investment would not only generate revenue and employment but also enhance our economy,” he remarked.

    The Olokemeji Tako-Tabo Hill, the festival’s focus, holds cultural and historical significance as a symbol of resilience and protection for the Ikare people, dating back to times of inter-tribal conflict.

    The monarch lamented that Nigeria often overlooks its heritage in favour of Western influences, stressing that cultural preservation is essential for national identity.

    Highlighting the growing interest in Yoruba cultural festivals, he praised the community’s dedication to revitalising local heritage, which he said was evident in the large turnout and enthusiasm at this year’s festival.

    A tourist, Peter Ijigbo, also spoke passionately about the cultural importance of such festivals. “Despite my faith as a Christian, this is our heritage, and we cannot turn our backs on it.

    I visited last year, and this festival has always been a spiritual and cultural sanctuary for us,” he said.

    The Olokemeji Tako-Tabo Festival and similar events in Nigeria offer promising avenues for both economic growth and cultural preservation.

    With strategic investments and support, Nigeria’s tourism sector could serve as a significant pillar of the national economy, providing jobs, fostering community engagement, and celebrating the country’s diverse cultural heritage.

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    Opinion

    Stakeholders urge sustainable tourism plans for Nigeria

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    Sustainable tourism in Nigeria

    At a World Tourism Day event in Abuja, stakeholders called for sustainable tourism plans to protect Nigeria’s natural and cultural resources, support local economies, and enhance visitor experiences. They stressed the importance of clean environments, such as Jabi Lake, to boost tourism and create economic opportunities, while minimising environmental harm.

     

    Stakeholders in Nigeria have emphasised the need for sustainable tourism strategies to protect the country’s natural and cultural resources, boost local economies, and improve visitor experiences.

    This call came during a press briefing held to commemorate World Tourism Day in Abuja, following a clean-up exercise at Jabi Lake.

     

    Also read: Nigeria eyes N12.3 trillion tourism gains by 2032, 2.6 million jobs expected

     

    The event was organised by the Eco Club, in collaboration with Jabi Boat Club, Jabi Mall, and Jabi Park.

    World Tourism Day, observed annually on 27 September, highlights the significance of tourism and its social, cultural, political, and economic value.

    The theme for 2024, *Tourism and Peace*, underscores the role of tourism in fostering global understanding and reconciliation.

    Speaking at the event, Aisha Yusuf, Creative Director of Hayche Network and Senior Special Adviser on Sustainable and Accessible Tourism to the Executive Director of Tourism Volunteer Network, advocated for sustainable solutions to maintain tourism in Nigeria.

    “We need to create awareness about sustainable tourism and take ownership of keeping our environment clean,” she stated, calling for both individual and government action to protect destinations like Jabi Lake.

    Omoefe Tawiyah, Managing Director of Platinum X Media and organiser of *Abuja I Believe*, highlighted the economic benefits of a clean and well-maintained Jabi Lake, noting its potential to attract significant tourism investments.

    He remarked, “If properly cleaned, Jabi Lake will become a key destination for tourists and boost the Federal Capital Territory’s economy.”

    Phil Roberts, Executive Director of Tourism Volunteers Network, urged for turning Abuja into a tourism hub. He highlighted the need to enhance infrastructure tourism, which complements natural beauty by developing facilities that attract and sustain tourists.

    “Abuja has numerous tourist sites, and Jabi Lake can become a major tourism destination with the right investment and infrastructure,” Roberts explained.

    The speakers agreed that preserving the environment is essential for sustainable tourism growth, which can contribute to job creation, economic development, and peacebuilding.

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    Opinion

    Nigeria’s 1,091 Tourist Sites Undergoing Revitalisation -Minister

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    Nigeria Tourism Gains by 2032

    Ms. Lola Ade -John, Minister of Tourism, has said that Nigeria has 1,091 tourist sites across the 36 States of the Federation, adding that many of these tourist sites are currently being revitalised.

    Ade-John, who stated this at a pre-summit webinar in preparation for the 30th Nigerian Economic Summit (NES#30), organised by the Tourism and Hospitality Industries Thematic Group (THITG) of the Tourism, Hospitality, Entertainment, Creatives, Culture, and Sports Industries Policy Commission (THECCSPC) of the Nigerian Economic Summit Group (NESG),

    highlighted the importance of domestic tourism to Nigeria’s future.

    She noted that these notable sites include Obudu, Ogbunike, Osun-Osogbo Grove, Kajuru Castle, and Yankari Games Reserve, which are improving in terms of historic architecture, wildlife conservation, and ecotourism efforts.

    She explained that the shifting of attention by the Federal Government to domestic tourism, would provide significant job opportunities for rural communities.

    She noted that in 2022, the tourism sector contributed 17.3 billion Naira to Nigeria’s Gross Domestic Product(GDP), compared to 7.5% of GDP in France.

    The minister further stated that Nigeria also hosts 814 festivals across 774 locations, offering rich cultural experiences.

    Ade-John underscored the need for investment in domestic tourism to revitalise communities, spur entrepreneurship, and generate revenue, noting that the sector currently supports 1.9 million jobs but has significant growth potential.

    In his welcome address, Mr. Udeme Ufot, Co-Chair of THECCSPC of NESG, emphasised that several factors have led Nigerians to favour domestic travel over international options since the COVID-19 pandemic.

    Ufot noted that safety and familiarity are key, as domestic destinations are perceived as safer due to better knowledge of local health and safety protocols.

    He stated that reduced international mobility due to travel restrictions and global conflicts have made local destinations more accessible and convenient, noting that economic considerations also play a role; including the pandemic and political instability which have affected livelihoods, making domestic travel a more affordable option.

    Ufot further expressed hope that the event would generate actionable recommendations to foster inclusive growth, potentially altering trade patterns, attracting investment and enhancing border stability across the continent.

    During the panelists session, Mr. Folorunsho Coker, Director General of the Nigerian Tourism Development Corporation (NTDC), spoke on the importance of public-private partnerships (PPP), community involvement, and sustainable funding models for promoting domestic tourism.

    He noted that domestic tourism is six times the size of international tourism and is essential for addressing employment issues.

    Mr. Obi Asika, Director General of the National Council for Arts and Culture (NCAC), discussed the role of media, arts, and culture in developing domestic tourism.

    He highlighted the need for collaboration between the public and private sectors to bridge capacity gaps and the importance of story-telling in attracting tourists.

    Ms. Sade Hughes, Managing Director of MIXTA Hospitality Limited, emphasised the impact of innovative real estate and distinctive tourism experiences in revitalising domestic tourism.

    She called for government investment in infrastructure and urged Nigerians to support local brands.

    Ms. Bolaji Mustapha, President of the Nigeria Association of Tour Operators (NATOP), stressed the need for government support in policy and infrastructure to develop Nigeria’s tourism sector.

    Ms. Adenike Macaulay, Chief Executive Officer of Wakanow, pointed out that the interconnection between music, art, and tourism and the importance of clearly defining tourism attractions to stimulate the economy.

    Ms. Omoyemi Akerele, Founder and Chief Executive Officer of Lagos Fashion Week and Style House Files, shared how they have redefined Nigeria’s tourism through fashion and enhanced Lagos nightlife, using fashion week as a tool for ecotourism.

    The theme of the webinar was “Domestic Tourism: A Powerful Tool for Rural Revitalisation and Economic Growth in Nigeria.”

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