Welcome to Geeky Nigeria’s Exclusive interview series.
Today, we are honoured to host Dr. Maimunat Alex Adeomi. A renowned primary care physician, global health expert, and the Founder of WMen Leading Change.
She has over 16 years of experience in strategy planning, program management and health system strengthening. We’re going to have an insightful, conversation today and Dr. Alex Adeomi will be sharing her expertise on Global Health Perspectives, Health Systems and strengthening service delivery and education.
She will also give us a rundown of her personal life, her journey, and the lessons she has learnt which we can also learn from her. so, you’re welcome to the show.
Could you please introduce yourself?
Like you said, you’ve already given a bio about me, but I’ll just add and say my name is Maimuna. I had been called to help deliver a retained placenta. So, basically retained placenta is a situation where a woman gives birth and the placenta doesn’t come out after 30 minutes and you would have to either manually or surgically remove it, hopefully you don’t have to surgically remove it.
I was called to do that without electricity, without surgical gloves without a blood bank, and without any means of transportation.
So for me, I figured I was not going to just sit there and wait to practice medicine on that individual level, but really focus on health at the population and system level.
So I then went to pursue a master’s, I did an MBA actually, which was a combined master’s of healthcare management and public health.
That began my journey and it has been quite interesting getting to where I am today, where I’ve done a couple of fellowships, certification programs and global health work in Ghana for training and engagement.
Now that I have currently established my own entity, I’m working to continue to help strengthen health systems globally.
Not just anything that impacts Nigeria but globally because for me, as I said, I want to influence healthcare upstream, not just at a clinical level or at an individual level. So that summarizes my Professional and somewhat personal journey to date.
Okay. so I’ll like to know what inspires your work?
That’s a great question. and I think it’s an important question for anyone to be asking at any point in time; its know you why, know you’re a north star. So for me, what inspires my work, especially the work that I do today, and like I said, there’s a very interesting journey, is that need for wanting to do more and wanting to live a life of impact.
It wasn’t enough that I would sit and they bring a patient to me, and these are real-life stories, and we don’t have anti-snake vaccine then, or, you know, the medication and a patient dies because of complications of snake bites on your table and there’s nothing you can do, or they bring a patient into the emergency room and because you don’t have access to blood and they don’t have money to buy the essentials, you just watch them either bleed to death or die with your hands tied.
So for me, it wasn’t enough. I couldn’t sit and just say “well, it’s the system, I can’t influence the system”.
I’ve always wanted to believe that there’s something we can do and that’s why I began this journey or this pursuit of wanting to influence health care more at a system level and upstream and helping to address what we call some of the social determinants of health, that health is influence.
It’s not just about going to a facility to receive care, but do you even have the education? and are you literate enough to understand that you have a health issue? Or in the case of women, do you have the agency to make a decision regarding your own health, do you have the means?, do you have a facility within driving distance to you?
Do you even have transportation to get to the health centre? Are you healthy enough? And as a child, are you nourished enough to have, you know, enough adequate cognitive development
So, all of those things are the myriad of factors that for me was really intriguing, that I wanted to influence healthcare at a broader level.
Something else that drives my work is just this passion for equity and justice. That it’s not fair, It’s not right, that things are the way they are and that there is a need for me to do something.
So, Influence programs and initiatives that strengthen health systems in various countries, whether it’s to improve maternal newborn health or to improve primary care or to support the supply of oxygen at a facility because they don’t have access to that, I do a myriad of things really.
It’s all about how to make sure that people have access to health and there are no barriers as much as possible.
Looking back on your journey, are there any personal challenges that you have experienced in your career?
That’s a great question. Challenges in my very interesting journey…
So I’d say the major challenge that resulted from that is I didn’t really have a template or mentors who had gone ahead of me and who had done what I was doing, so it almost felt like I was charting this path.
I was following this very unconventional path, different from all of my mates or the things we said we wanted to do.
I was speaking with one of my friends from way back and we talked about how I landed here and I said, you know, when you finish medical school in Nigeria, you’re supposed to do residency. I was already writing my exams in school. I said, I wanted to do pediatrics but when I finished my house job, I said Internal medicine.
So anyways back to your question, for me there really weren’t any role models locally for me, at least within Nigeria and my immediate environments. We’re just really looking at,okay, health at a holistic level that I had access to they’re probably there but it wasn’t discussed even at the medical school level.
Then just talking about health, yes, you can be a physician, but there’s so much more you could do. You can try to influence health at the system level. You could be a researcher. You could be a scientist. But they’re really weren’t any templates for me to follow.
So, I did struggle and I won’t say the struggles or the challenges are over. But how I’ve been able to overcome them is by a series of opportunities.
So first of all, I went to do my masters in Scotland for a program that was a unique. It wasn’t common then to do a dual MD, I said MD MBA MPH type.
So I took a chance to go studying that program and they also opened doors of opportunities for me.
I got an opportunity to go work in Ghana because I got married and moved to Ghana there. I went to work in the very core north of Ghana with a non-profit organization, really delving into health at the community level.
So I took on risks and challenges whilst I was there, Got the opportunity to go do a global health fellowship in the US.
Till date, I still don’t remember applying, but maybe it was in that pursuit of wanting to know more, wanting to just understand how to continue to improve on myself as I was charting this new path that I first heard the term global health, I didn’t even know what I was trying to do.
Then I just knew I wanted to influence health at a population level which wasn’t necessarily public health and the only route to them was public health. That’s when I got introduced to the concept of Global Health.
I read the book by the late Dr. Paul Farmer, who is considered one of the pioneers of global health, and it’s called Mountains Beyond Mountains. And I thought well this is what I want to do. This is the kind of life I want to live. This is how I want to show up as a physician. Yes, treating patients, but really influencing health beyond that, and that again continued this journey. I went back to Ghana, worked in another organization, then moved to the US.
So it has really been a lot of learning. I’m growing and ceasing opportunities to chart that path. That’s why one of the things I am really committed and passionate about is mentorship.
Mentoring people and letting them know that if you have a passion, you have a north star, find people that have done that. And if you don’t find it, chart your path, but still find a support system, that is really important.
So I’m grateful for all of the mentors and the support that I’ve received along the way and the privilege it is that I’ve also had to continue to expand my knowledge and expertise.
Thank you. so much. I was just about to ask you about the role that mentors have played. So it’s important to know that. You more or less started this journey on your own, but I’m still going to ask you a question in that line, knowing that this was like a fresh path for you, with no one in particular charting this course that you could follow, I’d like to know. Are there people that you’re currently mentoring or people that you’re playing mentoring roles for?
Absolutely. So now part of giving back is I participate in a lot of mentorship either with groups or institutions.
So, for my alma mater where I did my master’s, University of Aberdeen, I’m part of a mentorship program that they run where we get assignments. And it’s been a great experience We have, got to mentor people from Norway to Sierra Leone to Ghana.
So, for me, that has also been I know beneficial because as a mentor you also gain from the experience. I mentor a lot of people who reach out to me. Personally, one thing that is obvious is, at some point, there’s only so much you can do in terms of one on one mentorship.
So I engage on LinkedIn a lot. Because for me, I’ve had access to mentors directly or indirectly from learning about their work and the content they put out there on social media, so I try to do that to hopefully inspire people.
I myself with one of my good friends started a platform called ‘Public Health in Real life’ and what we do is, we try to do programs where, you know, our motto is celebrating unsung heroes in the field and highlighting key public health issues and then inspiring the next generation.
So now I do that on a larger scale by putting content out there, having people connect to me on LinkedIn and various social media handles. And everywhere I find myself whether it is on a job or part of a group, I just open myself to mentorship as much as I’m physically able to just with time constraints.
You’ve worked in over 40 countries. So, I’d like to ask, can you share some moments that you experienced while working with these countries?
That’ll be a tough question to answer because it doesn’t mean I’ve been influenced by all of the countries I’ve visited.
I’ve visited a lot of countries, because you can have projects and have managers that get to be the field staff or the boots on the ground. But I’ve had a lot of rich experiences from Being in South America , Europe , Asia, doing all this work in different places, Middle East, of course of science.
But also maybe the most recent ‘x field experience’ ,as we call it, that I had was… Because of everything else, you get to understand the system, you see and you know your why? And coming from where I come from these things are not strange. The challenges are not strange, but something that made me realize that there is still work to be done is; the last time I sat in setting healthcare systems in Nigeria during NYC was 2007. And now I go to the field 2021, 2022 and I still see the same challenges.
For me, I’m like ,the work continues, but back to your question about maybe one experience that really sticks with me, because there are plenty. I was on the field in Morocco for a mission, It was an educational mission because I worked in health workforce training and education in Morocco and usually what we do in the organization I worked with then is, they would screen the patients before they select the patients who are eligible for surgery on cleft lip and palate.
And I’m not sure if you know, cleft palate is when a child is born with like an opening on the lip and sometimes on the palate. So you’ve probably seen those, that’s what the cleft lip and palate is, but this baby was born and had both cleft lip and palette and, if it’s just the cleft lip, yes, it still limits a lot of functions but at least they can feed, there’s just a cleft that shows there, overtime It affects speech.
But when its a cleft lip and palate, it’s bad. There is a hole at the roof of the mouth that doesn’t fuse during the embryo stage. Then the child can’t feed. The child is at risk of malnutrition and starvation and infections, and all kind of stuff.
And of course, who are the people who are most affected?, those who don’t have access to healthcare systems, or who are not knowledgeable enough about the conditions.
So, we had gone to the field and during screening, I just walked to that area and I saw this mother who was holding her baby that couldn’t qualify for surgery because of a cleft palate.
So our team of dentists were going to try to fashion like, I’m up to rate or something to just close that place. And the baby could feed but the baby was crying and you could just see how tired the mother was.
Don’t forget. this is Morocco. I don’t speak Arabic. My friend was minimal at best.
So I couldn’t even really communicate with the mother, but I just walked in there and I don’t know why I walked into that specific room and I saw him, I just said, Okay, can I hold the baby? so, I held the baby and I just started walking with the baby and the baby slept.
Somebody now took a picture of it. I didn’t even realize. I was just holding this, I think between three to six months old baby, but of course, the baby was small for its age and malnourished.
And they said the mother said “God bless you for what you’re doing, you’ve come to help us” , and I was like, I’m not even there. The, baby didn’t even qualify to receive surgery but was just there to get something to ease the condition.
And what makes that story even more interesting is, that I did write a post about it on Facebook, I believe I had just received a call from home that my son was sick and that he had strep throat and I felt helpless.
But I just walked into that room where I was able to help another mother and this was at that time, where they were talking about Covid and it was spreading, anyways, long story short, that showed me the power of human connection and the fact that you can do and be anything, you can be a mother to many more people than you biologically birth or in your environment.
And that again, back to the social determinants of health, sometimes you might just need to give encouragement or be there to support somebody, to reduce any barrier they have in accessing health care or to make healthy decisions and that left a very profound impact on me because it was beyond going there to do something for a patient or to train a provider. It was helping a mother who was in that vulnerable state.
And interestingly, the baby’s name is Jana, which means heaven in Arabic. And at that point, you just feel like, this moment of like, heaven touching earth, with the baby sleeping peacefully and that has left a very profound impact on me.
You spoke extensively about the healthcare conditions in Nigeria. And I would like to ask; what do you see as Nigeria’s greatest strength in healthcare and what do you think needs the most attention?
That’s a very loaded question, I do like the fact that you’re asking about what the strengths are because I think a lot of times we want to focus on the challenges and really finding solutions right?
Understand your strengths and where the opportunities are because that is how you’ll be able to address your weaknesses and whatever threatens the system.
Nigeria I would say is… we have a robust primary health care system, doesn’t mean it’s perfect, but it’s quite robust and that’s why you can’t see even during the covid pandemic where covid was ravaging in other countries and other continents, Africa was mostly spared, well, apart from South Africa.
People have different theories, they said, Okay maybe it’s genetics, it’s environment. I know, but, it’s really down to the fact that the health system has become resilient because of things like Ebola and cholera outbreaks, and all of that stuff.
So, there is this very rapid primary care system as well as disaster, pandemic response and preparedness that is in place.
It’s not perfect, but at least, it was in place to address some of those challenges and those things can be honest and leverage. And also Nigeria, yes we live in the tropics, so we have increased burdens of infections diseases, and all of that.
But on the flip side is there are certain things we don’t have to worry about in terms of health challenges with extreme temperatures and extreme weathers.
So that just means that there are certain complex things, we don’t necessarily have to deal with. There’s now a rise in non-communicable diseases as much
Then, the health system that we operate, again, not perfect, but it’s somewhat of a decentralized system but then they still power out like the national and the federal level with autonomy being At the state levels. and then the local government levels.
So it’s not like where everything is fully centralized and controlled, where states cannot respond individually to their own healthcare needs and their own health issues.
So those things I would consider as strengths, like I said not perfect, within those trends.
Also, the challenges, I would say the top challenges currently again is the system right now, not just in Nigeria, but in other countries, but I think in Nigeria specifically is the issue of brain drain.
Now, when you think about health systems the World Health Organization talks about the six building blocks of the health systems. I’ll simplify it with Dr. Paul Farmer’s model, where he calls it The four s Simplified model.
So the four S’s are; Stuff: That’s your equipment supplies, Medicines, space, your facilities. Your Staff: your health care systems and then your healthcare workforce, Your doctors, nurses, name it. Everybody that works within your health system.
Then your System: that’s your referral system, how you are structured, you know, data, everything.
All of those four things have to be balanced in order to have a strong health system. If one is out of work, Then your system is weak and in Nigeria with this brain drain where i don’t even know what the start is. But it’s mind blowing, we already had a low doctor to patient population ratio much less than what is recommended by the World Health Organization.
In another health agency we already had a low nurse to population ratio. Now, you are taking a turn for the worse. So that means you are skewing the health system. So that’s a major challenge within the Nigerian healthcare system.
The likes of Professor Dora of Blessed memory had done a lot of work and I believe they are still some gains from that to ensure the quality of medicines and supplies.
And yes, there was a time where it was a huge challenge for the Nigerian healthcare system.
But by virtue of hard work, I think there’s been some sort of sanity brought into that, it doesn’t mean there isn’t still work to be done in terms of quality medicine supplies and just the availability of it.
Covid exacerbated supply chain issues across the globe. So Nigeria, still has some of that in effect. And like I said about health workers and the brain drain, you don’t have enough health care workers, then supplies and overall healthcare financing.
Nigeria is one of the countries where health is mainly one of our expenses, because we don’t have universal health coverage or a very robust public insurance system.
So most people are still spending heavily out of pocket for healthcare and with the current economy that means more people aren’t able to afford drugs, which are increasing in prices, and access to health services.
So it’s affecting the quality and outcomes of healthcare. There are more complex issues but I wanted to be able to highlight those top three things
So what do you think Nigeria can do to retain its medical professionals and ensure the quality of healthcare?
Yeah. That’s another very loaded question, because there’s a lot that is going to have to be done and you touched on a very important factor. The why? Why people are even going into healthcare now as opposed to when we and our teachers and professors and mentors went into healthcare and you can’t really change or influence people’s motivation if you don’t influence the environment.
And also, what is going to be the benefits? Because as human beings, everybody wants to know what’s in it for them. That’s the fact of life. Everybody is working towards their own.
Even when people say, Oh, somebody is altruistic. There’s still something in it for the altruistic person because they are like, Oh, this person is a, Philanthropist, it’s very interesting, they give all they have, but there’s something in it for them because they feel good when they do that. So there’s always something.
There’s some sort of motivation for people and it’s hard to address motivation or to write a policy around it or a guideline around it. So you have to think about going back to how the society is structured and infused them South address that as part of more like long-term measures.
Now, for the immediate need, it’s really some of the stop gap mechanisms. The government has issued some you know, policies and guidelines where they are now limiting travel. I heard of a case, there was a plane full of doctors travelling to the UK and then they didn’t allow them either to board Orlando, something along that line. so they are basically blocking people from leaving, but that doesn’t change the motivation.
That’s more long term. You’ve heard of, you know, ministers of health or people talking about well, just train more. that’s the solution.
Well, if you are training more people are going into, it’s only leave you. It’s almost like a basket where you open the top and then everything is wasting. You’re not retaining anything.
So I think there are two ways to look at it. You have to retain the ones that are existing and then think about the pipeline of the new ones you are training. and that’s a lot more.
Like the motivation aspect, so, some of the immediate measures is just improve working conditions. There are many people who don’t have mates. Who at this stage of their lives, they don’t want to move.
Government has to work on working environment. Remuneration. Stop owing people salaries, whether it’s doctors or anything, as much as is able, and I think, you know, a lot of times,Yes, I sit here in the diaspora and I see things and that’s why I’m usually very careful talking about this because people like, look at you going to Japan but I left for various reasons and at the same time, Yes maybe you can see a Japan but this was even before Japan became a thing.
I went in pursuit of wanting to learn more and grow more because there wasn’t frankly any opportunity to do that back home. All of my work now, is centred in not just Nigeria, but like I said globally, and for that, I’m grateful, I’m grateful for the opportunity.
So for some people, people do that for economic reasons, for security reasons, but people are also looking for opportunities to better themselves, and sometimes the systems stifles people.
I know a doctor, and I’ll have to mention his name, Dr. Ademola Day. Brilliant, brilliant physician. You know, there are people that are like geniuses, this person is a genius. In any society, in any place. You will not want to lose that person. you would invest everything, you want to make that person comfortable.
And this is somebody who gave of himself. he was teaching us when we were in medical school, even as a student and he continues to teach generations, but he penned something on LinkedIn. I think it was earlier this year and that just shows the frustration he felt in the system, He wasn’t motivated.
Now, he’s doing wonders with the Royal College of Edinburgh. Royal College of London, studying research. He’s one of the foremost oncologists, I’m not saying in Nigeria, globally, but he was frustrated out of the system.
so that’s not a government’s thing per se, because it is people who make governments in those institutions where he was trying to work.
So we have to encourage people to stay by not limiting opportunities for growth and development, making sure that people are well paid because for some people that’s a motivation.
For security, nobody wants to work at, for example, I have a friend who was kidnapped on the way to work. She’s still there, but who who’s to say, God forbid, if something like that happens again?
So, yeah, people are leaving because of those kinds of reasons. So now, back to the pipeline issue, we talked about because that’s more long-term is, you have to think about medicine in a way that, Yes, it’s not just this pipeline of okay, you train, and then you go work clinically.
You can still be a medical doctor, Then be a physician. They’re medical legal people, like just really open opportunities for people to want to contribute to the society and that way it changes their motivation or makes people really about what their North star is.
So for the pipeline, from the primary school level from the secondary school level, You’re exposing people to the work that impacts health systems more broadly. You don’t stifle people. And then that way I think, This is where the educational sector comes in.
So it’s going to be a multi sector then within the community itself. I am a mother, I would want my kids to pursue parts that are profitable for them. Even though I’ll say, I want them to live a life of impact but at the same time, if my kid comes and is like I want to play an instrument, my first even though I live in, you know, in the diaspora, there are certain things I’ll say.
It’s like….you don’t want to be a doctor?, because, as per the natural thing for you is you want to know that your kids are okay? And that they’re pursuing economically viable routes.
So, you have to make all those other industries and all those other pathways meaningful and impactful and people can proceed with their purpose. So people are just going to medicine solely…..
Go to part 2 to hear more from this insightful interview with Dr. Maimunat.
