After a successful career spanning 30 years in interventional radiology in the United Kingdom as an expert in the field of stroke care, Dr. Olu Obaro is set to return to Nigeria to bring his experience to bear on the health sector, especially in providing care for stroke patients. In this interview with Abimbola Akosile, he spoke on stroke care and important issues in the health sector.
How big is the issue of stroke in Nigeria to have informed your decision to relocate from the United Kingdom to help?
Stroke has always been a big issue in Nigeria. The problem is that people never paid attention to it. It is probably the second killer in Nigeria today but because it is not something that is emotive, like Ebola, for instance, and because of the immediate economic impact that people could see, people reacted. But actually stroke is causing more problems, because more people are afflicted with it, with the economic consequences. I doubt if there is any family in Nigeria that hasn’t had somebody or known somebody close to them that’s had stroke and therefore come into real-life contact with the economic, psychological and social consequences of stroke. It is a huge problem particularly given our lifestyle.
What aspect of our lifestyle is more striking in terms of its connection with stroke or cardiovascular diseases?
Lack of exercise, the kind of food we eat which lead to diabetes, and some factors that are probably more hereditary in the black race. Statistically, we hear one in four blacks have hypertension, which is a major cause of stroke. When you add all these together, they affect the blood vessels - can narrow them, block them and deprive the brain of blood supply, in addition to some instances where the blood vessel actually ruptures and bleeds into the brain. There are two major types of stroke - infarct and haemorrhagic stroke. A haemorrhagic stroke results from blood bleeding into the brain, and infarct is what results from the brain being deprived of blood because the blood vessels have been narrowed or in some instances, the problem has arisen from the heart and because of irregular heartbeat, blood clots are thrown into circulation and block vessels. The area of the brain beyond that blockage is deprived of blood supply and goes dead.
Lack of exercise, the kind of food we eat which lead to diabetes, and some factors that are probably more hereditary in the black race. Statistically, we hear one in four blacks have hypertension, which is a major cause of stroke. When you add all these together, they affect the blood vessels - can narrow them, block them and deprive the brain of blood supply, in addition to some instances where the blood vessel actually ruptures and bleeds into the brain. There are two major types of stroke - infarct and haemorrhagic stroke. A haemorrhagic stroke results from blood bleeding into the brain, and infarct is what results from the brain being deprived of blood because the blood vessels have been narrowed or in some instances, the problem has arisen from the heart and because of irregular heartbeat, blood clots are thrown into circulation and block vessels. The area of the brain beyond that blockage is deprived of blood supply and goes dead.
Why is the issue not taken serious until it gets to that point where there is no return?
A big problem is ignorance. Most people don’t take their blood pressure and a lot of people are walking around it. A lot of people think if you have high blood pressure, you would have a headache. It is not true. In some instances, the only time you would know you have high blood pressure is when you have nose bleeding. Nose bleeding is because the pressure in the blood vessel is too high, and because the blood vessels in the nose are quite thin, they rupture. Imagine that vessel in the brain. Precisely the same thing: if that vessel is in the brain and it ruptures, you have haemorrhagic stroke.
A big problem is ignorance. Most people don’t take their blood pressure and a lot of people are walking around it. A lot of people think if you have high blood pressure, you would have a headache. It is not true. In some instances, the only time you would know you have high blood pressure is when you have nose bleeding. Nose bleeding is because the pressure in the blood vessel is too high, and because the blood vessels in the nose are quite thin, they rupture. Imagine that vessel in the brain. Precisely the same thing: if that vessel is in the brain and it ruptures, you have haemorrhagic stroke.
There are some little signs that can point to possible stroke, which manifest as transient ischemic attack - short-term, little, fainting attack. You lose momentary consciousness and you regain. The underlying causes can be treated and can prevent you from having a major stroke.
Transient Ischemic Attack is one care pathway Stephen James Stroke Centre of Excellence is considering. We would start with preventive monitoring. If someone feels funny, you come to the centre for investigation. If you are diagnosed, appropriate treatment is given. Whether we like it, whatever we do, people are going to have stroke. So, it is being able to treat it as best as possible so that the post-stroke period recovery is as good as possible. And that will be accompanied with very effective rehabilitation.
Stroke is a degrading disease. An adult used to cleaning a child’s urine and faeces suddenly now becomes the one to be cleaned up. It takes a lot of effort and commitment. The problem is so big that we cannot afford not to do anything about it. Stroke care is expensive, but what is more expensive than stroke is the cost of doing something to contain it.
What’s your assessment of stroke care in Nigeria at present and what gaps do you hope the centre can fill?
Having lived in the UK and seen attention paid to stroke patients and comparing it to what happens in our environment, you know that there’s just no understanding of stroke management. My wife and I have personal experience. My father-in-law had stroke and we struggled to get the best hospital in the country. The gap was so much. We had to bring in things from the UK, we couldn’t find local suitable physiotherapist, of course there was no occupational therapist; there was just no coordinated attempt at management. We had to direct things from the UK. No, for the country we are supposed to be, this ought not to be. So we would come and set up a centre, with support from the government, because it is expensive. But we will come with a concept.
Having lived in the UK and seen attention paid to stroke patients and comparing it to what happens in our environment, you know that there’s just no understanding of stroke management. My wife and I have personal experience. My father-in-law had stroke and we struggled to get the best hospital in the country. The gap was so much. We had to bring in things from the UK, we couldn’t find local suitable physiotherapist, of course there was no occupational therapist; there was just no coordinated attempt at management. We had to direct things from the UK. No, for the country we are supposed to be, this ought not to be. So we would come and set up a centre, with support from the government, because it is expensive. But we will come with a concept.
Our goal and we don’t think it is too ambitious, in the next five years, is that there should be one centre of excellence in each geopolitical zone, as a starting point. Nigeria will be 200 million by 2020. If now we have 160,000 cases of stroke every year, imagine what that will be, and our population is galloping. Unless we make strategic plans to deal with this problem, it will only get bigger and we will get overwhelmed by it.
Until this sort of momentum you want is galvanised, do you think individual pockets of care for stroke in the country can achieve anything?
You need to start something and other people can then see what can be done and then build on it. This isn’t something the private sector alone can do. It requires government intervention, fund wise, but not management, because if you leave it for the government to manage, it will never fly. All over the world, projects like this, when you have too much government in management, it doesn’t work. But as part of government social responsibility to the people, you have to provide these services for people to engage.
You need to start something and other people can then see what can be done and then build on it. This isn’t something the private sector alone can do. It requires government intervention, fund wise, but not management, because if you leave it for the government to manage, it will never fly. All over the world, projects like this, when you have too much government in management, it doesn’t work. But as part of government social responsibility to the people, you have to provide these services for people to engage.
What is it you envisage about this stroke centre of excellence?
We have got a site in Gudu district in Abuja. The design is done to build it. We have got a temporary site, with complete building, where we are going to start hopefully in the next six months. We are relocating from England, because we are connected to this, to our country. We have benefited from it, and we want our country to benefit. We have moved from concept to execution, from thought to action. It has to be done. It is fitted with modern laboratory equipment for preventive diagnosis, and also we will set up domiciliary service for those who already have stroke. We will employ physiotherapists, occupational therapists, from abroad, who have the skills, and they will train our local doctors. So in two, three years’ time, we will have a bank of Nigerians who are very well trained. We don’t have the skills locally.
We have got a site in Gudu district in Abuja. The design is done to build it. We have got a temporary site, with complete building, where we are going to start hopefully in the next six months. We are relocating from England, because we are connected to this, to our country. We have benefited from it, and we want our country to benefit. We have moved from concept to execution, from thought to action. It has to be done. It is fitted with modern laboratory equipment for preventive diagnosis, and also we will set up domiciliary service for those who already have stroke. We will employ physiotherapists, occupational therapists, from abroad, who have the skills, and they will train our local doctors. So in two, three years’ time, we will have a bank of Nigerians who are very well trained. We don’t have the skills locally.
What sort of relationship do you hope for between the proposed centre and the Nigerian hospital system, in terms of referral?
I believe when the centre establishes itself, people will see the need to refer people there. I know there is a problem with hospitals referring but patients themselves will be asking to be referred
I believe when the centre establishes itself, people will see the need to refer people there. I know there is a problem with hospitals referring but patients themselves will be asking to be referred
SOURCE: THISDAY
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