Hello, am Prof. Francis Abayomi Durosinmi-Etti the first full Professor of Radiation therapy and Oncology appointed by the University of Lagos or by any other University in Nigeria. I served as the pioneer Chief Medical Director and Chief Executive Officer of the National Hospital, Abuja. Through my position at the United Nations, International Atomic Energy Agency (IAEA) in Vienna, Austria between 1988 and 1995, I have been instrumental to the development of Radiotherapy in 45 developing countries of the world spanning Africa, Asia, Pacific, Eastern Europe and Latin America. I am a recipient of the prestigious National Honour’s award of the Officer of the Order of the Federal Republic (OFR).
For my profile, visit HERE
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, 20th July 2016 at 2pm.
Dear Prof. Durosinmi-Etti, let me first thank you for taking out time to be on "Meet the Guru" .
1. What has been your motivation?
2. What would you consider your greatest achievement so far?
3. The management of cancers are expensive. To what extent has progress been made regarding advocacy for its coverage by the National Health Insurance scheme (NHIS)?
3. What is your advice to younger colleagues?
Thank you Dr Osamiluyi and Dokilink crew for this “Meet the Guru “ on line interview. I will try and answer as many of the questions from you and my other colleagues as much as possible.
What has been my motivation?
I first got interested in the care of Cancer patients in 1969 when I started my Clinical posting as a third year Medical Student at the College of Medicine, University of Lagos. I observed that many of the Cancer patients we saw then presented in late Stages 3 and 4 disease where only palliative treatment was possible. Besides many of them died in rather pathetic and undignified ways. After my House job, I immediately joined the Department of Radiotherapy at the Lagos University Teaching Hospital as a Senior House Officer in 1973 from where I have been involved till date in looking after Cancer patients deriving my inspiration from the various technological and scientific advances in the field of Oncology. I feel continuously motivated by the improvement in many of my patients and the improved quality of their lives even when I know their prognosis is poor.
What would you consider your greatest achievement so far?
This is a difficult question since I have several achievements some of which rank among my greatest achievements. Let me list some of them as they cross my mind:
1. The opportunity to have had my Specialist training in Radiotherapy and Oncology at the Christies Hospital and Holt Radium Institute (University of Manchester), England. It is one of the oldest and world famous Cancer Institutes in the world.
2. The great opportunity I had to work at the International Atomic Energy Agency, (IAEA) an Agency of the United Nations based in Vienna, Austria for many years as the specialist in charge of all the IAEAs activities in Radiotherapy and Cancer all over the World. The position offered me the rare chance of contributing to the development of many Radiotherapy Centres in Africa, Europe, Latin America and the Asia and Pacific Regions. I had the opportunity to get the IAEA to provide Radiotherapy Machines and Training of, Radiation Oncologists Oncology Nurses, Medical Physicists, Dosimetrists, Therapy radiographers and Mould Room Technicians etc to various Teaching Hospitals in Nigeria, including LUTH,(Lagos); UCH (Ibadan); ABUTH (Zaria) etc., These people now form the main core of those running the various major Cancer centres in Nigeria today.
3. I was responsible for the establishment through IAEA support for the first Radiotherapy Centre in Ghana sited at the Korle-Bu Teaching Hospital in Accra. I coordinated the training of the major personnel running the centre today. I also served for one year as the pioneer Director of the Cancer Centre.
4. I was also privileged to be the Pioneer Chief Medical Director and Chief Executive Officer of the National Hospital Abuja.
5. I am also the FIRST Full Professor of Radiation Oncology ever appointed by any University in Nigeria . There are many more great achievements which I cannot list now and I want to use this opportunity to give all the Credit , Glory and Honor to God whose Grace made these achievements and others possible.
The management of cancers are expensive. To what extent has progress been made regarding advocacy for its coverage by the National Health Insurance scheme (NHIS)?
I agree with you. Cancer appears to be the most expensive group of diseases being treated these days. The financial burden is too heavy for even rich Nigerians and their families. For example, potentially curative treatment of a group of Breast Cancers (HER 2+) with some of the newer Targeted therapy drugs costs over Twelve Million Naira (N12,000,000). This excludes the cost of Surgery, Chemotherapy, Radiotherapy, Hospital beds and other basic and routine investigations. We are very fortunate that we have an Oncologist as the current Minister of Health and he has informed Nigerians that Cancer is one of the Health priorities of this administration. Various Cancer NGOs like CEAFON, Cancer Aid Foundation, Sebeccly Cancer Care; ABC Foundation, (Ibadan) Run for Cure; Cancer Aware; Breast Without Spots; Ego Bekee , BRECAN and many others are also contributing towards provision of financial and other support to the ever increasing cases of Cancer patients in Nigeria.
The Ag. Executive Secretary of NHIS has also assured us that the scheme would gradually include some aspects of Cancer care in its activities. I understand some patients have actually started benefitting from the NHIS.
What is your advice to younger colleagues?
I would start by Congratulating my younger colleagues for their courage and wisdom in choosing to specialize in any of the fields of Oncology – Radiation and Clinical Oncology; Surgical Oncology, Medical Oncology; Gynaecological Oncology; Haemato - Oncology; Nursing Oncology etc. With the newer all round technological improvements, they are going to have exciting challenges and professionally fulfilling time. I am aware that many new Private and Government owned Cancer Centers are already in the pipeline which would assist them in the ‘’Curative treatments’’ of those patients with early diseases particularly with the massive nationwide Advocacy by the various Cancer NGOs.
Nigeria has just 3 Radiotherapy Machines, with only a functional one presently at LUTH to cater for over 10million Nigerians that needs Radiotherapy treatment for cancer.
1) What are the efforts been done by the Federal Gov through the Honourable Minister of Health to increase the number of Radiotherapy machines in the country, and repair the faulty ones .
2) Some developed countries donate their older models of these machines to developing countries. Why hasn't Nigerian been a beneficiary to these kinds of donations?. Or do Nigerians collect these machines then sell them to other countries or use them in their private clinics?
3) We need more private public partnerships that will make Radiotherapy machines readily available to the people and also stable source of electricity to power these Radiotherapy machines as the epileptic power supplies in the country have been said to be the major cause of faults with these machines. What steps can Lagos state Gov, in particularly, should take to achieve this, especially in their new cancer centre.
4) Nigeria is planning on adopting Nuclear energy as a source of Electricity. What are the forms occupational hazards the Federal government should prepare for and do you think Nigeria is ready for commercial Nuclear use owing to the fact that the country lacks the facilities to treat radiation sickness.
5) Why haven't Nigeria started adopting Euthanasia as a form of treatment for incurable terminal cancers patients.
Thank you Dr Oluwaremilekun Etti for your many comments and questions.
Nigeria actually has Nine Megavoltage Radiotherapy machines with only 3 working at present. These are at LUTH, National Hospital Abuja and Eko Hospital which is a Private Hospital with a Cobalt-60 machine.
As to your first question, the Minister of Health is currently making serious efforts to repair or possibly refurbish all the faulty radiotherapy machines and the situation will surely improve shortly.
With regards to Question 2: It is not always a good practice to obtain a used machine whose history you may not likely know. Also you will usually have to bear the cost of dismantling it from the originally installed place and pay for the packaging, shipment to Nigeria, custom duties and clearance and reinstallation at the new site. Something would likely go wrong in about 75% of such cases.
I agree with most of the comments included in your Question 3. I am sure the Lagos State Government would have taken all these into consideration in the plans for their new Cancer centre whenever it comes up.
Question 4 was on the desirability or otherwise of using Nuclear Power for the generation of electricity in Nigeria. This is something I have advocated and recommended for adoption in Nigeria since 1989 when I was on the staff of the International Atomic Energy Agency (IAEA) in Vienna. Unfortunately this was not taken seriously by the authorities then while electricity generated from Nuclear Energy was in wide use in other parts of the world under close supervision by the IAEA. There are usually Quality Control and Quality Assurance procedures in place and the risk of overt accidental Radiation exposure is very small. I hope that Nigeria would introduce this as soon as possible to increase the electricity generation capacity in Nigeria with its attendant beneficial effect and improvement of our economy.
Your last Question 5 is on the use of Euthanasia for terminally ill Cancer Patients. I do not think anyone has the right to play ”God”. I do not think Nigeria or indeed any other country should encourage or adopt Euthanasia.
Congratulations Prof on your achievements in Radiology and Radiation therapy
.As a gynaecologist, one often gets frustrated when many Radiotherapy units are found to be nonfunctional. May I ask why radiotherapy has not been found attractive to private investors. Is it that the initial capital outlay is high? Is return on investment low or is maintenance of equipment difficult? Is there Government legislation against it?
Thank you Dr Ochuba. I share in your frustration regarding the non functional status of many radiotherapy centers in Nigeria. I wish to assure you that the current Minister of Health who is a Gynaecologist like you with special interest in Oncology has promised and is currently trying his best to see that the radiotherapy facilities in Nigeria improve drastically. At present Nigeria going by IAEA recommendations require at least 200 Megavoltage Radiotherapy Machines. Unfortunately the whole country has only 9 machines out of which only about 3 are functional as at today. This is very sad especially for the patients who require the services.
It is a pity that many potential partners in a PPP arrangement may not be aware of how lucrative the running of a Radiotherapy service could be. For example, a new Cobalt-60 radiotherapy machine which has capabilities for sophisticated treatment like IMRT or use of a Multi-leaf Collimator associated with Linear Accelerators cost under $2Million dollars. With each patient treatment overseas including Ghana, India, USA or England ranging between $20,000 to $60,000 per patient, you can see that with the high volume of Cancer patients in Nigeria, an investor will likely make his Capital investment back in Nigeria within the first 12 to 18 months and the profit can be very high .
Should you have potential investors, I will be very pleased to assist in giving you the detailed feasibility study and financial plans for the installation and operation of a good Cancer treatment center. Remember we need about 200 machines and we have only 3 functional at present yet our Cancer patients load on the waiting list keeps increasing everyday. Surely Nigeria will be better through our collective efforts if we choose to do so. Thank you.