Nigerian Medical Conference Update

Traditional Nigerian clothing
and head wrap, similar to
what I saw at the gala

The Nigerian medical conference I went to last weekend, put on by the Association of Nigerian Physicians in the Americas (ANPA), was incredible. I truly felt welcomed by the Nigerian medical community, never more so than at Saturday night's gala and banquet. Everyone was dressed to the nines - including many people in traditional Nigerian clothing - and there was fantastic food and dancing to African music. My friend Nneka and I left around 12 p.m., and the party was apparently just getting started!

But of course, while the gala was fun, there was so much more to the conference - so much substance. The first day's symposium focused on women's health. There were three presentations that especially made an impression on me. The first was on bleeding disorders in women, and it focused mostly on Von Willebrand Disease. One of the researchers in the lab where I am actually works on this topic, and presented her most recent findings a couple of weeks ago. So I was familiar with the disorder. (I had previously never heard of it.) Apparently, it is a cause of postpartum hemorrhage, and a factor in maternal death in Nigeria - which is a huge (and preventable) problem in the country.


Another presenter focused on the issue on maternal health in Nigeria, specifically how much progress has been made in achieving the Millennium Development Goal #5 (which has to do with improving worldwide maternal health in specific ways by 2015). She quoted some statistics that were just horrible, including:
- 358,000 maternal deaths in 2008 (and she said most of those occur in the developing world)
- 50,000 maternal deaths in Nigeria in that year
- the majority of those deaths are related to hemorrhage and hypertension, which are completely preventable given the proper medical care and proper medical access (which she said were very much lacking in rural Nigeria)

There were two Nigerian Ministry of Health representatives who were at the conference, and they took exception to this presentation on maternal health. One of them got up during the Q&A and (in a very emotional way) blasted the presenter for not giving Nigeria credit for the strides it has taken to improve maternal health and for focusing on the negatives. So the whole thing got very political, very quickly. Which made my Nigerian friend Nneka a bit uncomfortable, but I found quite interesting - to see different sides and perspectives on an issue, both the outside and the inside view. (The presenter was Nigerian, but had come to the United States at age 2, so was not seen to really have a true "Nigerian" perspective.)

The other presentation I found to be especially interesting that day was on breast cancer, and was given by a professor from the University of Chicago. She talked about cancer in general in the developing world, and how it is so much more likely to cause death because of the lack of adequate diagnosis and treatment, as well as the prevalence of ER- breast cancer (which is an especially lethal type of breast cancer) in younger African and African-American women.

The Day 2 seminar that I went to focused on the Foreign Corrupt Practices Act (FCPA), which is federal U.S. legislation that was enacted in 1977. The purpose of the seminar was to educate the Nigerian physicians on how to appropriately do business between Nigeria and the United States without running afoul of this law.

The FCPA basically prohibits bribery, aka "corrupt payments," to government officials in order to gain some sort of business advantage, influence decisions, obtain/retain business, etc. That sounds simple enough, but the law is actually very complex. And it is made all the more tricky because corruption in Nigeria is a big issue - according to the presenters (who were all lawyers), Nigeria ranks 134 out of 178 on a world-recognized corruption perception index.

What makes the law so difficult, in part, is that these improper payments can include charitable donations, political contributions, and other non-monetary gifts such as travel, entertainment, and food. Also, the definition of a government/foreign official is very broad - it can include employees of state-owned companies, which in many countries where health care is partially or completely public, includes physicians of state-owned hospitals and clinics.

Apparently, the U.S. government is pretty serious about enforcing this law, too. The presenters included a list of fines that several major companies had paid, and they were in the hundreds of millions of dollars.

One thing I found especially interesting was that while the law is very detailed, there is still a lot of gray there, which is complicated by local practices. For example, one Nigerian physician brought up the issue of gift-giving, which is a cultural practice in Nigeria. One of the lawyers said that if the gifts were of little value and not likely to influence decisions, it's OK. For example, giving away a notepad is fine; handing out a gold watch is a no-no. That's a pretty clear-cut case. But where do you draw that line?

Another interesting aspect that an audience member brought up was that while the United States has this legislation, other countries - such as China - do not. Which allows them to go in and basically develop monopolies in the area, because they aren't held to the same legal/ethical standards.

A troubling facet of this presentation was that according to the presenters, there is a huge number of pharmaceutical and medical device companies that are being investigated under this law. I guess this isn't really surprising, but it is indeed troubling.

After the conference was over, I sent thank-you notes to the president of ANPA and the chair of the Chicago/northwest Indiana chapter of ANPA. I received responses within hours, from both of them. Both men thanked me for the feedback, welcomed me to any future ANPA events, and encouraged me in my future medical career. I was even invited to participate in medical missions to Nigeria at some point!

I've always thought of myself as going to Latin America in the future, and I still intend to do so. But after this conference, I have definitely developed a new interest in Africa as well. I would love to visit there, as a start. Now if only flights were just a tad more affordable ...