‘Nigeria’s health sector is lacking in stroke services provision’

Rita Melifonwu is the founder of Stroke Action Nigeria and Stroke Action UK. She is a thoroughbred professional with passion for stroke advocacy. A trained nurse and BSc holder in Science Education, she travelled to the UK and worked as a nurse at the Greenwich District Hospital in London. After some years of practicing as a registered nurse, she obtained an MSc degree in Nursing at the Royal College of Nursing and Manchester University. In this interview with GERALDINE AKUTU, she talks about the World Stroke Day coming up tomorrow, family and the health sector.

What’s your growing up like?
I must say that I had a happy childhood with my siblings, three brothers and a sister. I happen to be the oldest, too. My father was a strict disciplinarian who was a primary school head teacher before he became a civil servant retiring as a Permanent Secretary. My mother had a women’s institute in Enugu where she taught people to be seamstresses and bakers, so I got the opportunity to be a flower girl/ bridesmaid so many times which I thoroughly enjoyed. We lived in a long street in Enugu where most parents go to work in the morning and children go to school. After work and school, most of the parents engaged private tutors for the children so we were always busy. As children in the street, we did not really see much of each other unless we go to the same school, or, at home over the weekend if you did not go out with your parents. I felt quite early that this would not help us to develop good social networks, so I approached the local catholic priest to help us to develop group activity for ‘Block Rosary’. He made me the leader of the ‘Eze Street Block Rosary’ and five of us started to meet from 5 to 6 pm every evening. Before long, the Block Rosary membership increased to over 100 children and I was asked to play a different role: ‘help other surrounding streets to form their block rosary groups’. It was an exciting development linked to the churches, which the parents appreciated and supported. We played a key role in youth empowerment,contributing to the local Bazaar and church fundraising efforts. For some of us, the network has continued into adult life. This was my first lesson in advocacy, innovation and managing change.

What informed your decision to go into stroke advocacy?
As a child, parents took turns to take the children to school in their cars in the area where we lived. Families became good friends and neighbours. One of the parents was most active and covered when any other parent could not take their turn. Suddenly, when I was 11 years old, he had a massive stroke, became paralysed, bedbound, could not speak or walk. It was a terrible experience to witness and see an active man become helpless, unable to play the role of a father, husband or go to work. He died soon afterwards and his family was devastated.

Prior to this, I have never heard of paralysis or seen a paralysed person, so I wanted to know more about the cause. My research led me to the Cheshire Home for disabled people in Uwani, Enugu where the manager was kind enough to spend some time educating me on the issues and how they help the residents. I felt that I must contribute to this noble venture so at the age of 12 years, I became the first youth volunteer at the Home. My role was to assist two disabled young people (Geoffrey and Maria) to socialise outside of the Home by taking them out on the wheelchair to local shops, visit friends and go to morning mass / church once a week before I go to school.

It was an exciting time to learn about people with disabilities and the challenges they face in life. Before long, I recruited friends and classmates as volunteers in the Home and played a key role in their induction. I was extremely delighted when years later, Geoffery and Maria got married and I was one of the bridesmaids. I have since then had multiple experiences of stroke in the family: my father in-law, his father before him, my paternal aunt and maternal aunt. Put together, these made me to act on praxis – ‘informed committed action’ for stroke advocacy and support.

What were your initial challenges when you started Stroke Action Nigeria?
Although Stroke Action UK was established in 2000, 11 years before Stroke Action Nigeria was started in 2011, I had some challenges in Nigeria. I was at first unable to contact either medical personnel or people in the healthcare sector regarding the country’s stroke problems. They did not reply to my e-mails, and, they would not see me. So, back in London, I went to see the Nigerian High Commissioner who was very responsive, and he introduced me directly to the Honourable Minister of Health at the FMOH, Abuja. A memorandum of understanding was soon signed between the FMOH and Stroke Action Nigeria. The areas of collaboration within the MOU include running a “Power to Stop Stroke Campaign”, set up a Nigerian Stroke Reference Group devoted to understanding the country’s stroke problem, pilot a life after stroke centre, develop a national stroke strategy and a stroke register. This was wonderful, but there was so little money to do anything. I had to fund the “Power To Stop Strokes” campaigns myself and seek UK funding from the Medical Association of Nigerians across Great Britain (MANSAG) to help with the inauguration of the Reference Group, but with no Nigerian government funds available to support implementation, making progress has been a lot of hard work. These are of course disappointments.

How do you balance work and the home-front?
Balancing work and home life is somewhat challenging on week days as I am very busy in the Life After Stroke Centres in Onitsha and Abuja attending to the needs of stroke survivors, carers, at risk people and supporting my small team of staff to do the same. At weekends, I spend a lot of time at home for leisure, resting, and socialising with family and friends. Fortunately, my daughter is a very grown-up married adult and is totally independent.

Aside this, what else do you do?
I am the secretary of the Nigeria Stroke Reference Group (NSRG) which was inaugurated by the Permanent Secretary for Health, FMOH on behalf of President Muhammadu Buhari in September 2015. I am also a member of the World Stroke Organisation Campaign working group. This year, the global campaign theme is PREVENTION and we urge citizens to hold an awareness event to celebrate the World Stroke Day on October 29. Stroke Action Nigeria is holding events in Abuja, Onitsha, Awka, Asaba, Markurdi and Nsukka. I sit on the Board of Stroke Action UK and the Voluntary Sector Strategy Group in Enfield. I also participate in my local Age Group and Umu Ada of my village in Onitsha.

What is your take on the Nigerian health sector and what should be done to make it better?
I must say that the Nigerian health sector is lacking in stroke services provision. Stroke is now an epidemic in Nigeria and over 200,000 Nigerians have a stroke each year with 46 per cent of stroke survivors dying within six months and survivors ending up with severe disability. Stroke survivors are getting younger and younger, affecting Nigerians in their most economically- active lifespan. The Nigerian Government needs to invest in stroke services development, training for healthcare professionals in stroke care and collaborate with NGOs that support stroke survivors at the grassroots. I was appointed as an ASHOKA Fellow for Health in July 2017. I aim to proactively collaborate with the Ashoka Foundation and its partners to Make More Health for social benefits to stroke survivors, their caregivers and at-risk people in Nigeria. There are now some emerging stroke support organisations in Nigeria. My take is collaborative action for improved stroke care and support. The leaders of stroke NGOs should avoid self-interest. This is why the Nigeria Stroke Reference Group is set up as an umbrella organisation for key representatives of health and social care professional organisations, stroke support organisations, FMOH and the WSO.

What is your philosophy of life?
As health and social care professionals, we must ‘walk the talk’. To save lives, it should not be business as usual. We must be proactive, cost-effective and engage only in evidence-based practice. For me, there is nothing like ‘can’t do’. I believe in people being action oriented, having a positive mental attitude and fostering a can-do culture. This way we know that we are doing our best, and, if in the end things don’t work out as anticipated, we cannot blame ourselves.