To: Gov. Chimaroke Nnamani

 Bedford Nwabueze Umez, Ph.D.

 Your Excellency, Gov. Chimaroke Nnamani 

Re: Supporting the Health Care System in Enugu State(*)

It is an exceeding pleasure to welcome you to EnuguUSA convention, 2003. Thank you for coming.  I am optimistic that your presence will make some substantive difference, and that this convention will yield some meaningful results in Enugu state. Ndewo! 

In this letter, I will briefly present, as I view it, the theme of this convention.  In so doing, I will explore what some consider health problem in Enugu state, present some contributing factors to this problem, and then ask Your Excellency for more support in eliminating them.

 I. THE THEME OF THE CONVENTION & THE GOVT. CONNECTION

Supporting the health care system in Enugu state, as Your Excellency understands, is among the primary objectives of this convention. To me, this objective is commendable; it delves into the taproots of the two powerful Igbo maxims, namely, "ndu ka aku" and "ndu bu isi."  In deed, the convention theme, "health is wealth," is a reflection of those two Igbo axioms.  Because "ndu ka aku" [i.e., life is more important than wealth] and because "ndu bu isi" [i.e., life is the key], it becomes obvious why men invented government, in the first place, to protect, preserve and maintain "ndu" (life), rephrased as "life, liberty and property," in the language of John Locke.

Your Excellency, my decision to write you is based on this understanding that the primary role of any government is to protect, preserve and maintain the life of its citizenry.  But before the details of this letter, some caveat is understandably in order.

Caveat

Your Excellency, my experience as a writer has taught me several valuable lessons; among them is that sometimes, good intentions of a writer can be misconstrued or even be twisted to score some diabolical, political points. Accordingly, I must make my intentions crystal clear at the outset to prevent any misunderstanding.

Specifically, this letter is not an attack against your administration; it is not a criticism of you or any person, for that matter.  This letter is simply a modest effort on my part to appeal to you and your administration to invest more resources - financial and human - in our health care system.  Once more resources are committed to our health care system, there is no doubt that the present health problem in Enugu state will be eradicated.  Accordingly, I ask that this letter be treated as a genuine effort by a fellow compatriot who is seeking more support for our health care system. Now, the details.

II. EXPLAINING THE HEALTH PROBLEM IN ENUGU STATE

Your Excellency, the health care situation in our state is, to say the least, very unfortunate. There is a serious health care problem in our state, and if adequate measures are not taken soon, it will lead to a major health crisis.  Of course, your administration did not create the situation; the situation is largely inherited from previous governments; and as such, I only ask that you help improve it.  Below are some of the conditions that spell health problem in Enugu state and Nigeria,(1) writ large.

Limited Access to Medical Care

So many citizens of Enugu state do not have access to basic medical care. Potent medications capable of saving lives are mostly unavailable, especially to the poor.  Many have no access to any scientifically proven treatments or drugs for various diseases and infections.  Today, a substantial number of our people rely on "konka-mixtures" of some sort by the native doctors and the local herb manufacturers whose medicines are, as we know, scientifically untested, un-sanitized, and even dangerous to human consumption. As such, mortality rate among the masses in our state keeps on rising by leaps and bounds. The alarming death rate in our state, especially in rural areas, is simply heart breaking.

In addition to the untested, un-sanitized "konka-mixtures," it appears that some of our hospitals are buying and dispensing fake drugs from "unregistered sources" as reported below:

"NATIONAL Agency for Food and Drug Administration and Control (NAFDAC) yesterday indicted the authorities of University of Nigeria Teaching Hospital (UNTH) for purchasing drugs from an unregistered source---Director-General of the agency, Dr. Dora Akunyili, said investigations showed that the Adrenalin (a heart stimulant), muscle relaxant and intravenous infusion drugs administered on the patients, both children and beneficiaries of the corrective heart surgery sponsored by the Kanu Heart Foundation, were purchased from unregistered pharmacy shops in contradiction of a directive stipulating that all drugs for government health institutions are to be procured only from the manufacturers or accredited distributors."(2)

 Your Excellency, this report is troubling, and should be painstakingly looked into.

 Unequal Distribution of Medical Facilities

Health facilities are unequally distributed in Enugu state. The location of the medical facilities is often based on political factors or physicians' choices rather than where the most deserving patients live. A hard look at our health care system will reveal that in our state medical facilities may range from one facility per 5000 people in some local governments to one per 30,000 in other local governments.  Hospitals are clearly lacking in rural areas.  In fact, medical facilities are concentrated in cities, leaving rural areas without medical coverage.

Your Excellency, at this juncture, it is very important to commend you for not only ranking health care delivery among the top priorities in your administration, but for creating several health care centers in several Local Governments in Enugu state in your first term of office.  I believe many have benefited and will continue to benefit from them. In this second term, it will be more refreshing to see Your Excellency create more, as you promised.(3)

Condition of the Few Existing Medical Facilities

It is obvious that the few existing medical facilities/centers in our state are in serious trouble. Several hospitals in Enugu state are not capable of treating minor injuries let alone performing surgeries, and many health centers lack effective medicines. Medical equipments are not serviced as often as needed and some of them are simply out of order.  Today, numerous health facilities in our state have deteriorated to the point of despair and hopelessness. A visit to the University of Nigerian Teaching Hospital (UNTH), once considered one of the best hospitals in Africa, will make my points clearer.

Shortage of Doctors, Nurses and Medical Staff

In Enugu state, especially in rural areas, the number of qualified health care workers is insufficient to meet the demands of the public health system. Many towns do not have resident medical doctors or registered nurses to treat the sick.  As such, the citizens in those areas rely on some quack doctors and crude, native doctors for their treatment.  Your Excellency, the situation is simply a desperate one.

III. SOME CONTRIBUTING FACTORS TO OUR HEALTH PROBLEM

Frequent Trips to Foreign Countries for Medical Treatment & Checkup

Your Excellency, it is apparent that some of our leaders, elites and rich people have abandoned health care delivery in our state. Frequent trips to foreign countries by the rich, the elite, and scores of government officials for medical checkup/treatment, and now the new trend of sending their pregnant wives to foreign countries to deliver their babies, spell, in capital letters, abandonment of health care system in our own state and Nigeria.  Why spend millions of Naira traveling to foreign countries for medical treatment when such millions can build and maintain world-class hospitals at home? Your Excellency, does this make any sense?

At this moment, I must pause again to give Your Excellency a well-deserved credit in this regard. The news we heard during the early period of your first term of office that you refused to travel abroad for a medical treatment was refreshing. I was very impressed. It shows that you know quite well that our medical facilities will handle all kinds of health problems, if they are maintained. We need more leaders and elites in our state to start thinking like you in this regard because today, as Your Excellency knows, a substantial number of them still squander millions of Naira in foreign countries for the sake of medical checkup/treatment and/or to have their wives deliver babies in those foreign countries.

Inadequate Infrastructures

Your Excellency, the health problem in our state is being exacerbated by some infrastructure problems. Impassable roads and poor transportation networks in so many towns and villages impede travel to health facilities and the delivery of medical supplies. As your Excellency recognizes, so many towns in Enugu state have never known tarred roads since the history of man; their roads are filled with red dust and deep holes, making travel from those towns to cities almost impossible, especially during the rainy season.  How do we take the sick from such rural areas to medical facilities in the cities when the roads become impassable?

Similarly, several towns have never known electricity to this day, and those towns with electricity tragically experience power failure almost on a daily basis. Your Excellency, it is obvious that without electricity, hospitals will not function effectively.  For instance, a patient in operating room could die when power fails, and vaccines will lack proper refrigeration, which in turn, will render them unusable.

Your Excellency, it is obvious that phone and fax services do not exist or are unreliable in so many local governments and towns.  As such, communication problem frustrates all efforts to communicate throughout the network of health facilities. How can one call emergency/ambulance services in the case of health emergencies when there are no phones?  How can one quickly contact police in a life-threatening situation when there are no phones or when the existing phones annoyingly malfunction almost all the time?

In addition, some towns and villages in Enugu state do not have access to safe water.  In fact, numerous towns and villages lack access to any sanitation facility. It is obvious that lack of access to clean water and sanitation facilities complicates oral administration of medicines and also contributes to rapid spread of diseases in those towns and villages.

Mass Ignorance

Your Excellency, mass ignorance is a big contributor to health hazards in our state.  For example, ignorance has left a sizable number of women and young girls poorly equipped to avoid risky, sexual behavior. Millions of our young women are dangerously ignorant about HIV/AIDS and other sexually transmitted diseases. Driven by economic need, many tragically turn to prostitution.  Worse still, some of these women and young girls cannot compel their clients to use condoms.

Mass Poverty

One of the tragic effects of mass poverty in our state is disease.  The poor and the children are often the victims of denied medical care.  In some hospitals in Enugu state, payment is demanded first before any medical treatment is given, the urgency some health situations demand notwithstanding. Accordingly, poor people often resort to unscientific, untested, un-sanitized local herbs and medications, which often result in many preventable deaths and disabilities in our state.  Worse still, the poor is often driven into deeper poverty due to sheer greed and wickedness. In trying to buy medicines from their own meager pockets, sometimes they only succeed in lining the pockets of others who callously exploit their ignorance by purposely selling them anything in the name of drug.  The crushing effects of poverty in our state are simply alarming and frightening.

Your Excellency, in light of the current health problem in our state, and granted that your administration ranks "medical facilities in Enugu State second to education in order of priority,"(4)  your government should do more.  Below are a few suggestions.

IV. HEALTH CARE SYSTEM IN ENUGU STATE: THE ROLE OF THE GOVT.

Your Excellency, let me begin by first commending the medical mission executed by the EnuguUSA in December 2002.  Vigorous and passionate were the efforts of the team to heal the sick in our state.  As the record indicates, several sick citizens of Enugu state benefited during the period of that mission and more will benefit next time around. However, once-a-year medical mission cannot provide permanent solution to our health problem. Put differently, feeding a few who are hungry with some fish will simply feed them for one time, but long term solution to their hunger lies in teaching them how to fish so that they can feed themselves for years to come.  Medical mission once a year to treat a few who are sick is basically a snap shot of the entire sick population in our state.  Building and maintaining effective health care facilities and hiring qualified medical staff to run them - the responsibilities your administration should take the lead - are equivalent to teaching the

 hungry how to fish; in fact, they will provide permanent solution to our health problems.  For your administration to take that lead, here are some specific suggestions.

First, your administration should budget and spend more money on health care and health education in order to deliver health care products and services to the people who need them.  Just as "good soup na money," building and maintaining effective health care facilities and hiring well-qualified medical staff to run them also need money.

Second, traveling abroad by some of our leaders and elites for medical treatment and checkup must be thoughtfully looked into; in fact, they must stop.  It is very clear that we have the resources to build capable hospitals in our state.  Your Excellency, there are so many leaders and elites in Enugu state who count in millions of Naira, yet they would not build good hospitals and staff them with qualified, able doctors, modern medical equipments and strong medicines.  Instead, they use that money to fly abroad for medical checkup or treatment.  Needless to say, our money is being used to create and maintain better health care systems in foreign countries while our own health care system is left to decay.  This is not rational.

My Governor, invite the rich and government officials to a series of health conferences. Use the weight of your office to appeal to them to start building and maintaining super hospitals in our state because the money they are sending abroad for medical treatment is more than enough to build and maintain world-class health facilities in our state.

To facilitate building of more and better medical facilities, Your Excellency should consider employing the "eminent domain" of the state, by providing lands free to those willing to build and maintain excellent health facilities in our state.  Encourage the rich to build more hospitals in our state as they build hotels. Frankly, for now, we do not need more motels/hotels; we need more and better-maintained hospitals, staffed with qualified medical personnel.

Third, our infrastructures, e.g., the roads, transportation, electricity, clean water supply, should be seriously looked into. Without adequate infrastructure, health care facilities and equipments cannot operate effectively.  Your Excellency, what bothers those in my camp is that there are so many leaders and elites in Enugu state with well over a dozen private cars, yet they would not, as public servants or politicians, take the initiative to build good roads in Enugu state. There are some of them with gold bathtubs, but could not think for a second how to ensure that there is clean pipe-born water or a regular supply of water in our communities. Your Excellency, our priorities must be revisited. We count on your administration to providing these infrastructures, especially in those towns and villages that NEVER had such infrastructures since the time of the early man.

Fourth, reducing inequalities in health care distribution is paramount. The distribution of good health facilities within Enugu state is grossly unequal.  Your promise (5) to continue building more primary health care facilities, targeting all parts of our state -- the most vulnerable part of the population, in particular, is very encouraging.  This offers the best approach to addressing disparities in health care delivery throughout our state.  We must enhance the responsiveness of the health system to the legitimate expectations of these people in rural areas; our rural dwellers are human beings and are citizens of Enugu state; they are entitled to the basic health coverage.

Fifth, our people need proper health education. As Your Excellency knows, few African governments or leaders address HIV/AIDS and other sexually transmitted diseases seriously.  This attitude needs to be changed. It will be in the best interest of the Enugu people if your administration will consider educating our people on how to prevent AIDS, and other sexually transmitted diseases.  Because repetition is the master of studies, consider including the issue of AIDS in your weekly radio address.  Better still, consider including health education in all our school curriculums - from Elementary school to university.  In fact, as a medical doctor, we rely exclusively on your expertise and leadership in this regard.

Sixth, development of new medical technologies is necessary.  We need them for testing new drugs and new local herbs before they become available in the market.  To achieve this, more medical research should be encouraged and funded.  Above all, the medical staff needs more rigorous education and training.

V. CONCLUDING REMARKS

Your Excellency, in this letter, I have voiced the sentiment of my fellow members of Liberating the African Mind, LAM.(6) At LAM, we believe that Africans have the ability to think and use their God-given brains to improve their lives.  To start thinking, Africans must start comparing their progress with the progress of others in everything they do because without comparison, the mind sometimes does not know how to proceed. We, Africans, must compare the initiatives in other countries considered "developed" or "civilized" with our own initiatives.  By comparison, I am convinced that we will know why some countries are considered "developed" while others are considered "underdeveloped."

Your Excellency, in our comparative analyses at LAM, we discovered that the number ONE problem facing Africa is that a lot of African leaders and elites have yet to THINK about what makes the countries we call "developed" and "civilized" developed and civilized. Many Nigerian leaders and elites, for instance, have yet to give serious thought to the OBVIOUS fact that American leaders and their elites, Japanese leaders and their elites, Swiss leaders and their elites, Canadian leaders and their elites, French leaders and their elites, German leaders and their elites, to name just a few, do not have any bank account in Enugu state or any state in Nigeria; they do not come to Enugu or any state in Nigeria for medical checkup and/or treatment; they do not bring their pregnant wives to Enugu or any state in Nigeria to deliver babies; they do not buy lands or houses in Enugu state or any state in Nigeria.  Simple logic has revealed that what makes these leaders and their countries " civilized," "developed," "lands of opportunity," and "lands for delivering babies" is that they invest their own money - public or private - in their own banks and health care systems, knowing that a rat does not labor for a squirrel.

Therefore, I ask, in a somber tone, that you use the weight of your office to persuade our leaders and elites in those series of health conferences to start doing the right thing - i.e., to start investing, in a collective sense, their money in our state.(7)  It is called "charity begins at home" and not abroad.  Investing our money in our state/country is the panacea to all our problems; it will create so many jobs, reduce hunger, reduce violence, improve our infrastructures, give us better health, longer life span, and ultimately move us from the so-called Third World to Second or First World status.

Your Excellency, to better understand the significance of "charity begins at home" and not in foreign banks, and therefore, start reaping its fruits, we must start listening to one another more.  By listening to one another, we are more likely to work together, and if we work together, we are bound to do the right thing.  Doing the right thing, e.g., investing our resources in our own communities, of course, guarantees development.

My Governor, it is in that spirit of listening to one another and working together that I write you.  In such a spirit of cooperation and mutual attack against health menace in our state, I am convinced that Your Excellency will give the suggestions herein your utmost consideration. I thank you immensely for taking the time to come to this important convention.  Above all, I thank you for reading this letter.

May God give you more wisdom to improve the lives of our people!

 NOTES

 (*)This letter was delivered at the EnuguUSA convention, Washington, DC, August 22-24, 2003, by Dr. Umez.  Umez is a Professor of American Government, Lee College, Box 818, Baytown, Texas, 77522, and the Founder of Liberating the African mind, LAM.  His latest books include, "Educated" to Feel Inferior [2003], and "Nigeria: Real Problems, Real Solutions" (2000). To secure any of the books, write Umez at: umez@umez.com or phone him at: 832-731-7061 or 281-425-6368.

(1) It must be emphasized that Enugu state is not the only state in Nigeria with health problem. Throughout Nigeria, there is, in a general sense, health problem.  Accordingly, this letter can as well be sent to all the Governors in Nigeria as well as the President of Nigeria.

(2) For details, see "NAFDAC indicts UNTH over fake drugs procurement," http://fr.allafrica.com/stories/printable/200307300320.html

(3) For details, see http://www.enugu.gov.ng/healthhome.htm

(4) http://www.enugu.gov.ng/healthhome.htm

(5) See http://www.enugu.gov.ng/healthhome.htm for the Governor's promise for more health facilities in Enugu State.

(6) Liberating the African Mind, LAM, is created for the sole purpose of providing concrete solutions to African challenges.  Motto: "For Africa to develop, African mind must be liberated." Web site: www.LiberateAfrica.org.

(7) I have written to President Obasanjo to summon a National Economic Summit in Nigeria with the main objective of asking our leaders and elites to start doing what other leaders and elites of the countries we call "developed" are doing in their respective countries, namely, investing their money in their own countries.  To date, that has not happened.  I am appealing to you to do the same in Enugu state as I appealed to the Igbo leaders and elites in the last world Igbo Congress, September, 2002, Houston, Texas.  "Charity begins at home" is the ONLY practical solution to solving most of our problems, nothing more, nothing less.