The case for specialized medical universities

I consider this a special privilege and high honor to be invited to deliver this Seventh Professor Adetokunbo Babatunde Sofoluwe Memorial lecture.

I am, indeed, very grateful to the Vice-Chancellor of the University of Lagos, my great friend, Professor Oluwatoyin T. Ogundipe, FAS, and the Senate of the University for giving me this unique opportunity to deliver this lecture in honor of a rare breed academician and an unforgettable former Vice-Chancellor of the University of Lagos.

When I was invited by the Vice-Chancellor to deliver the lecture, my first meditation was to speculate as to why I may have been considered worthy to deliver the lecture. I thought hard, and indeed for several days, until I remembered that I was a joint applicant for the post of Vice-Chancellor at the University of Lagos when Professor Sofoluwe was appointed to that position.

The late Deacon Gamaliel Onosode (of blessed memory) was the Chairman of the Governing Council of the University at that time.

Interestingly, I was the only external candidate, searched from outside the University of Lagos among the five scholars that were short-listed for the interview. Some of the others I can vividly remember were: Professor BabajideAlo, former Deputy Vice-Chancellor at the University of Lagos, and Professor AyodejiOlukoju, former Vice-Chancellor at Caleb University.

As we all sat in the room waiting to the called for the individual interviews, we cracked jokes among ourselves and exchanged pleasantries with each other, not minding that we were being called for a competitive interview.

Indeed, that was the first time I was meeting the other colleagues, and not being a member of the University of Lagos community, it was evident that they were meeting me for the first time. Yet, it appeared as if we have known each other for many years.

I remember vividly, that not knowing what to expect in the interview, I had gone with up to three huge boxes of documents, certificates, publications, books, and testimonials. And, my great friend, Mr. Charles Omonaide, former Public Relations Officer at the University of Benin, had helped me to compile the documents, and actually wheeled the boxes to the waiting room where we sat.

As soon as we sat and organized the boxes, Professor Sofoluwe asked me jocularly: “what are in these boxes?” I immediately answered him boldly “these are my documents, publications, and testimonials”.

He laughed loudly and shouted that the era of Professor Chike Obi was being re-invented at the University of Lagos. He then told the story of how Professor Chike Obi (the renowned Mathematician) was being invited to be interviewed as a professor at the University of Lagos, and because he was controversial and he knew he will have some obstacles in the interview, he decided to come to the interview with all his documents. These, he carried in several trunks of boxes.

Professor Sofoluwe then retorted that my presence with those documents was the second time he was witnessing a huge collection of documents for an interview. We all busted into laughter, and thereafter all of us who participated in that interview have remained friends from then until now.

I would like to reflect at this juncture and to make this an important observation for emphasis. My experience has been that when individuals participate in competitive positions in this country, they become enemies and foes for a very long time.

The cohort of participants in the 2010 race for Vice-Chancellorship at the University of Lagos remains in my experience, one of the very best I have seen for a long time. Since that event, we have come to respect each other, to be friends and to cherish each other, with the clear understanding that it was only a contest for which the very best of us won the day.

Indeed, I met with Professor Sofoluwe and Deacon Gamaliel Onosode at a workshop organized for principal officers of Nigerian Universities by the National Universities Commission (NUC) in Abuja two weeks after the VC selection took office.

The three of us immediately embraced and hugged each other, and we shared good moments together in that workshop. I can say with great confidence that my interactions at the University of Lagos for the race for Vice-Chancellor is one of the most edifying and indeed, one of the most profound experiences I have had in my life as an academic, something I will cherish for all time.

Mr. Vice-Chancellor Sir, Distinguished Guests, Ladies and Gentlemen, the true narrative and accolades about Professor Sofoluwe will never end.

He was a man with a golden heart, a selfless and patriotic Nigerian with a focus on achievement of specific goals, a hard-working academic who attained several laurels in his field of Mathematics and Computer Science, an unforgettable architect of modern UNILAG, a people-centered Vice-Chancellor, and indeed one of the most profound Vice-Chancellors this country has ever had. He left when the ovation was at its loudest point.

Surely, Professor Sofoluwe is not the only Vice-Chancellor of the University of Lagos or of any University in this country that has passed on to higher glory. But the University of Lagos, including its full Alumni Association, has chosen to honor this man in perpetuity, this being the Seventh Annual Memorial lecture held in his honor. He has to be special, very special, not only to the University of Lagos community but to the rest of the Nigerian Nation.

As a Professor of Computer Science, Sofoluwe became UNILAG’s 10th Vice-Chancellor on January 30th, 2010. Unfortunately, he died in service in May 2013 while still working actively for the University.

The mass media reported that he slumped around 7.30 p.m. in his office at the Faculty of Sciences. He was rushed immediately to the University Health Center and subsequently transferred to the Lagos University Teaching Hospital at Idi-Araba, where he was pronounced dead.

His death was dramatic and a great surprise to many students and staff of the University who had seen him earlier in the day. He was reported to have died from “sudden cardiac arrest,” a phraseology that is now too well known to many Nigerians. But the important question is: “could something have been done to prevent his untimely death?” Or put differently, could the Nigerian health system be better positioned to prevent “sudden cardiac arrest” or better still effectively treat it when it occurs? No doubt, the present state of our healthcare system appears to repeatedly fail many Nigerians at the critical period when it matters most.

In thinking about the topic for this lecture, I ruminated on the circumstances under which our dear Vice-Chancellor died and wondered deeply what can be done to improve our moribund healthcare system radically? This presentation attempts to answer this concerning question and for the sake of brevity, my lecture can also be titled: “Changing the archetypal medical education for transformational health care.”

The title was chosen to highlight some of the shortcomings of our traditional approach to the medical education in Nigeria; an approach that I strongly believe has hampered our country’s ability to deliver a health care system that focuses on the prevention of illnesses of the type that resulted in the untimely death on of our dear Vice-Chancellor.

The theses and recommendations in this presentation were informed by my unique experience as the founding Vice-Chancellor of the first Specialized Medical University in Nigeria (University of Medical Sciences, aka UNIMED).

Distinguished Guests, Ladies, and Gentlemen, the purposes of this memorial lecture are to first identify the major challenges in the delivery of comprehensive and high quality health care services; and next share my firsthand experience of developing a non-traditional health sciences educational curriculum at UNIMED to address these challenges.

In Nigeria, changing established dogmas and doctrines concerning the training of healthcare professionals is daunting and certainly not a tea party. As such, I will highlight in this presentation some of the difficulties experienced in this process, and also share what we have done to confront these challenges.
Challenges within the Nigeria’s Health Care Delivery System

It is now well known that Nigeria has one of the most difficult and obstinate health care systems in the world.

Not only does the country have extremely high rates of communicable and non-communicable diseases, but it also has some of the highest disease-related morbidity and mortality in the world. In 2001, the Health and Development Dialogue (Health Development Dialogue, 2001) described the Nigerian health care systems as “sick, very sick and in urgent need of intensive care¨.

It is blind, lacking the vision of its goals and strategies; it is deaf, failing to respond to the cries of the sick and the dying; and it is impotent, seemingly incapable of doing things its neighboring states have mastered.¨

Similarly, the World Health Organization summary index of performance of health systems released in 2000, placed Nigeria in the 187th position out of 191 countries surveyed, and described it as “dysfunctional, ineffective, under-capitalized, costly, and inaccessible.” (WHO, 2000). Since these periods, nothing substantial has changed.

Our healthcare challenges continue to be compounded by the absence of a coherent national health policy and health reform agenda, inadequate healthcare financing mechanisms and the lack of a political will for addressing the problems of ill-health and poverty in the country.

To be continued tomorrow

Professor Okonofua is Vice-Chancellor, University of Medical Sciences (UNIMED), Ondo, Ondo State. He delivered this keynote address at the seventh Professor Sofoluwe memorial lecture, organized by the Alumni Association of the University of Lagos, recently.