Great pleasure to read from you Dr Shehu. Talking about motivation, I must confess that it has passed through different perspectives over time. As it is common with everyone, we grew up to find ourselves in school. That seems to be where self consciousness begin. Motivation then were related to doing well and hopefully getting into whatever life held after that level of education. That idea seemed to characterize me to my A-levels.

In the University, I started having a Spiritual dimension to my motivation. In other words I began to feel the consciousness that I was created for a purpose and central to that purpose is the need to please my creator. My challenge at this stage was that I saw the need to excel academically and spiritually as nearly mutually exclusive. Hence I was laboring to strike a balance and believing that they come one after the other. By this I meant I would do all that is academic and later in life I will resign from that into what is spiritual. So life was divided and in conflict.

My current phase is the phase where I now understand that "it is God at work in me both to WILL and to DO of His good pleasure". The fundamentals of this phase are simple but profound. I came to understand that not only was I created for a purpose, God is also the one who works out that purpose in me. The difference at this stage is that there is no more personal me or a spiritual me. The ONLY question I am concerned about is WHO is at work in me. From eating, through playing to practicing medicine or preaching, I now understand that all must be done in the ENERGY of God in my life.

So when I am in NMA I am asking God for direction and seeking to understand His mind. When I am going to class I am conscious of being God's vessel who is simply conveying Him to class to deliver a lecture. When I am seeing a patient, despite my intelligence and expertise, I am conscious now of the fact that I am no longer working for my pay but standing proxy to allow that patient to feel a divine touch through my care and tenderness.

By the same token, I am not just a head of my family to Lord things around but I am God's representative in the household-first to care, nurture, train and provide for the family. I am happy to note that I am now 26 years married this year and God has blessed me with a happy home and godly children.

Yet by the foregoing I am not suggesting a passive, laid back position that only engender mediocrity. But just think about this way-assuming God is a Medical Doctor-how will he practice? What will be His productivity in research? How compassionate will He be? So the answer to your question it is not a matter of right or wrong activity, rather it is a question of WHO is at WORK in YOU.

From that perspective my ONLY motivation is to PLEASE GOD in everything - from home through classroom to the laboratory, bedside, office, pulpit and to where no one else knows me. So brother Nathan, be passionate about what you but be sure you are not doing it for yourself. I no longer live just to earn a living; I now live only to make a meaning. Thanks

Dear Madukwe, my pleasure meeting you on this platform and thanks for your question. I am not too sure if there is a total dearth of peadiatric information at the rural level. The challenge is that it may not be immediately appreciated as paediatric information because it may not be tied to the presence of a "Paediatrician". What the Paediatricians and health policy makers have done over time is to do all that is possible to domesticate knowledge in relation to children's health to simple algorithms that less skilled health workers can apply.

For instance Community Health Extension Workers (CHEWs) who are the frontline health workers in rural areas are trained on two instruments. One is called the Standing Order and the other is the Integrated Management of Childhood Illnesses (IMCI). Beyond this the National Primary Health Care Development Agency (NPHCDA) is also coordinating the implementation of the minimum ward health package of the FGN under the Maternal Newborn Child Health (MNCH) scheme. So if you reflect you will appreciate that many of these services are on ground.

Having said all of these, we do have weaknesses in our national health system that is not allowing us to reap the full benefit of these measures. Some of the challenges include our deep seated superstitions around illnesses, result in high patronage of herbalists, weak supply chain management systems that often result in stock out of essential drugs in many government facilities at the community levels, weak supportive supervision and stewardship accountability that will make a health worker to spend more time farming than seeing sick patients and weak referral systems.

The idea of health care delivery is one that is interdependent. Hence levels of health care have their expected scope of operation. If referral is strengthened, we will have a seamless movement from one level to the other without any observed limitations of one level against the other. I am happy to note that community based systems are currently being expanded to deliver on more ranges of basic health care services.

Thanks