Hello, am Ayoola Shonibare a Consultant Urologist and Kidney Transplant Surgeon with over 25 years experience. I was a key member of the team that performed the first Kidney transplantation in Nigeria in March 2000, and has since performed about 65% of all the Renal Transplantation cases in the country to date. I also performed the first Paediatric Kidney transplant in the entire West African sub-region on 7th August 2009 , and the first kidney transplant at the University Teaching Hospital Ibadan in 2009. I supervised and actively supported the first Kidney Transplantation at Lagos State University Teaching Hospital in November 2015.For my profile, visit <a href="http://dokilink.com/pub/dr-ayoola-shonibare" target="_blank">HERE</a>You are welcome to ask me questions by posting it in the comment section below. I will do my best to answer your questions on Wednesday, 10th August 2016 at 2pm.
Dear Dr Shonibare, let me first thank you for taking time out to be on Meet The Guru.
1. What has been your motivation?
2. In your view, how can we reverse medical tourism?
3. What would you consider your greatest achievement so far?
4. What is your advice to young and upcoming doctors?
1. Motivation
My motivation has always been to provide quality healthcare to Nigerians, majority of whom are deprived of what should be a right of every citizen rather than the privilege of a few.
2. Reversal of medical tourism
This is a multifactorial problem which will take several decades to reverse. There is need for ; a) injection of capital in the sector - both private and public b) introduction of universal health insurance c) restoration of confidence and trust in the local healthcare delivery system - need for reorganisation and restructuring of healthcare institutions , introduction of solid management systems , introduction of standard operating procedures / protocols , emphasis on pleasurable patient experience c) attraction and retention of highly talented doctors and nurses back into our healthcare institutions, particularly Nigerians in the diaspora d) investment in formal continuous training and retraining of clinical and non clinical workforce e) offering affordable , accessible high quality care.
3. Greatest achievement so far
This is work in progress and I am yet to achieve what would be considered greatest achievement - the journey has been a long one and hopefully it will materialise soon ; A contributor to building world class accessible ,affordable high quality care to mass market. However to date, it would be the pioneering work of Kidney Transplantation in Nigeria - Adult and Paediatric.
4. Advice to young and upcoming doctors
Dream big , be patient , persistent and persevere . The Nigerian healthcare system is near collapse and it provides every young doctor the opportunity to make a difference by being innovative and entrepreneurial. Doctors need to think out of the box so as to make impactful change in the system, rather than coasting along.
Ayo is indeed the father of kidney transplantation in Nigeria, for all his efforts at developing the art of kidney transplant in Nigeria he deserves to be honored as such. Keep the flag flying my boss as I also learnt about kidney transplant from you.
My dear Prof , friend , esteemed colleague. It has been a great honour and privilege to have worked with you as a team, and successfully pioneer Kidney Transplantation at UCH Ibadan. Collaboration is key to success in the health sector and I sincerely hope the younger clinicians and nurses will continue to collaborate so as to achieve greater heights than our own generation.
I was taught that for acute renal failure, dialysis is advised to protect the kidney from irreversible damage, is it always true?
Acute renal failure requires prompt and appropriate treatment of underlying cause in order to prevent progression to chronic renal impairment. The function of dialysis in this instance is to temporarily excrete accumulated toxic waste products ( urea , creatinine etc ) whilst waiting for the treatment of the underlying cause of the failure to take effect. There are specific clinical indications for dialysis and it is not the dialysis which protects the kidney from irreversible damage, it is the treatment of underlying condition. And if the underlying condition is not treated then you can have acute tubular necrosis progressing to cortical necrosis.
Sir, what are the prospects, and challenges facing renal transplant surgeries in Nigeria with respect to the current economic realities. I will also like you to share ur experience of using laser beam to treat renal and bladder stones and what you need to have more centres in Nigeria.
The current economic realities are real and we are truly in recession. Majority of patients are not able to afford cost of Renal Transplantation and situation is not likely to improve soon. I believe government will need to intervene and subsidise care by supporting dialysis care, surgery and immunosuppression drugs. And the existing centres need support so as to build robust systems and do Transplants on a large scale. Costs will come down when centres are able to do large number of cases so there is need for formal training of vascular / urological / transplant surgeons.
I do not have laser facility in my clinic but this is the procedure of choice for most ureteric stones using ureteroscopy plus laser. Bladder stones can also be treated with Cystoscopy and laser. Minimally invasive stone centres can be set up in Nigeria but it is essential to have the following ; a) injection of capital to buy Renoscope , Ureteroscope , Cystoscope , Laser machine , etc. b) Investment in training for various techniques c) Training managerial personnel / Operator to run centres.