Unlocking the shackles that restrain major advances in Medicine, Science and Technology in Nigeria By Prof Funso Komolafe

Unlocking the shackles that restrain major advances in Medicine, Science and Technology in Nigeria
By Prof Funso Komolafe

I would like first to thank the Faculty Board of Radiology and the leadership of the National Postgraduate Medical College of Nigeria for giving me this singular opportunity and honor to present the 40th Convocation Lecture of the College.
As the first Fellow to earn the FMCR by examination, in May, 1980, I feel particularly proud to witness the phenomenal progress that the College has made over the years through the unparalleled sacrifices and commitment of its leadership; leadership that cut across all Faculties.
Permit me, however, to pay special homage to some of the founding teachers who contributed to my training program in Radiology, all of who are now late:
Prof. Sulaiman B.Lagundoye, widely regarded as the Father of Radiology in Nigeria, Dr. Bayo Banjo, Prof. Ben Umerah, Prof.(Mrs) Elebute-Ladapo, Prof. Taiwo Kolawole , and foundation Medical Physicist, Prof. Fregene. Some of the external examiners in the early days include late Prof. (Sir) Howard Middlemiss, from Bristol, late Prof. Phillip Palmer, from Davis, California, and late Prof. Haroun Dahniya from Freetown, Sierra Leone.
May their souls rest in perfect peace (Amen).

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THE SIGNIFICANCE OF THE 40TH CONVOCATION LECTURE
40 is a very symbolic and significant number. In an individual’s life, it is seen as the year of transformation from youth to full adulthood and maturity, hence the adage:
“A fool at 40 is a fool forever.” 40 is also regarded as significant in the holy books. Moses was on Mount Sinai for 40 days and 40 nights, after which he was given God’s laws for living. He led the children of Israel for 40 years in the wilderness, before they finally arrived in the promised land.
Jesus Christ fasted for 40 days in the wilderness before He commenced His earthly ministry. After His death and resurrection, He interacted with His disciples and other followers for 40 days before His ascension to heaven.
The Koran defines the age of 40 as when a male or female attains the full strength in life, and the beginning of a new phase of life. The age of 40 also depicts the achievement of triumph after surviving a period of testing and trial.
If one looks back at the growth of the National Postgraduate Medical College of Nigeria, and the testings and trials it has successfully weathered in the past 40 years, I believe we can justifiably say that our College has indeed triumphed.
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HAVING GONE THIS FAR, WHAT SHOULD BE OUR ASPIRATIONS FOR THE FUTURE?
While acknowledging that the products of our training programs have made and are making tremendous impact on health-care delivery within Nigeria and even beyond our shores, in some cases, I wonder if we should not have advanced beyond where we are today.
I would like for us to explore the reasons why Nigeria is yet to be recognized as a country at the leading edge of advances in Medicine, Science and Technology, in spite of our internationally acknowledged high intellect and talent, and our teeming natural resources and endowments.
In the United States, for example, the percentage of Nigerians who are graduates is said to be 59%, ahead of South Koreans (56%), Chinese (51%), British (50%), and Germans (38%).
Many Professors of Nigerian origin are on the staff of American Universities, including Ivy League Colleges, at least one of which is headed by a Nigerian. Nigerians are also on the staff of several Science Research Institutes and in highly sensitive American scientific bodies, such as the National Aeronautics and Space Administration (NASA).

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When Professor Wole Soyinka was awarded the Nobel Prize in Literature in 1986, the first sub-Saharan African author to be so honored, it brought tremendous pride to Nigerian academia and, I believe, to the entire black race. Why has a similar achievement not been replicated in the fields of Medicine, Science and Technology in the past 36 years since Professor Soyinka’s feat? One obvious reason is the limitation imposed by our sub-optimal infrastructure, key among which is our grossly inadequate electricity supply. In Literature and the Arts, producing high-quality work output must be challenging without steady power supply, but not impossible. In fact, working under candlelight or moonlight may sometimes provide the artist the soothing milieu for innovative and creative thinking, despite those ordinarily stringent conditions!
On the other hand, the researcher in Medicine and the Sciences is completely incapacitated by the lack of a steady power supply. Candle light or moonlight may be romantic, but will contribute little to the scientist’s research output.
In my 1991 Inaugural Lecture at the University of Ilorin, titled “MAKING SUBSTANCE OUT OF SHADOWS: THE CONSULTANT’S CONSULTANT”, which, among other things, highlighted the vital role of Radiology and Radiologist in modern medical practice, I touched on the issue of the constraints to science-based research in Nigeria.
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I predicted that unless the situation changed drastically for the better, the first Nigerian Nobel Award in Medicine or the Sciences would not be for work done within Nigeria, but done in a developed economy outside her shores.
Although I made this prediction 31 years ago, sadly, nothing has changed. The question is: why are we static or, more accurately, why are we retrogressing?
In the 70s and early 80s, Nigeria could boast of many flourishing manufacturing plants and agro-allied industries. Similarly, the standard of equipment and the quality of care in our tertiary medical centers were also very high.
The wide disparity in the standards of industrialization and tertiary medical care between the situation in the late 70s and the present is paralleled by the massive decline in the value of our currency during the same period.
I recall that in 1979, when I was preparing to travel to the U.S.A. to conclude my Radiology training, at the University of California, Davis, I purchased one dollar for 69 kobo. Today, one dollar sells for over 600 Naira, an incredible, unimaginable decline of almost 90,000%!
Because of the strength of our currency in the 70s and early 80s, the acquisition of top-of-the-line tertiary medical care and research equipment was the practice in
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Nigeria, with standards comparable to what obtained in the best places in the world.
I will illustrate this assertion with two anecdotal experiences I had in 1979. I had virtually completed my Residency at U.C.H. Ibadan, and was sent as a Visiting Senior Resident to the University of California, Davis Medical Center. On my arrival in the Department, I was surprised that an old model angiography machine was in the process of being replaced. The new model was equipped with automatic table-top shift system, which was designed to obtain images in segments along the course of vessels, starting from the large vessels in the abdomen to the peripheries. The table-top movements were synchronized with the flow of injected contrast material, to obviate the need for multiple doses of contrast injection. I was very familiar with the capabilities of the new machine, since the angiography unit I had used for many months in Ibadan, possessed similar features. Although the Department in Davis had more units of each item of equipment than we had in Ibadan, the standard of equipment was comparable between our two centers.
The Department at Davis however had an edge over Ibadan in the possession of​

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two functioning CT machines, while the only CT unit at U.C.H. was still lying in its crate as at the time I was leaving for California, because the room to accommodate it was not ready! Talk of poor administrative planning!
It turned out that the unit remained unused for so long that it was considered no more serviceable, and was eventually returned to the supplier. Replacing it got caught up in inflation, such that the first functional CT unit at U.C.H., (and the first in Nigeria), was not installed until 1987.
My other anecdotal account relates to the quality of our Nigerian training. In the Department at UC Davis, Sacramento Medical Center, all general Radiological procedures were performed by Senior Residents, each assisted by a Junior Resident, and the schedule of duty was drawn out by the Chief Resident.
Not long after my arrival, I was assigned to perform a renal angiogram. As a Senior Resident, and in accordance with the usual practice, I was expecting to lead the procedure, and be assisted by a junior Resident. Apparently, to save me from possible embarrassment, since he was not sure how competent I was, John Livoni, our Chief Resident, decided to pair himself up with me, so that he would lead the procedure, and I would assist him.
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Our patient was a lady in her late forties. John attempted a right femoral artery approach, using the standard Seldinger technique, but failed after repeated attempts. When he was getting frustrated, he asked the attending nurse to make a call to a Staff Radiologist (Consultant) to come to our rescue.
At that point, I demanded that we swap places, and I took over. I said a short silent prayer, palpated the femoral artery, infiltrated fresh local anesthetic, made my incision, and successfully punctured the artery at my very first attempt. I then inserted the guide wire, followed by the catheter. Within a few minutes, I had selectively catheterized the renal artery and acquired the necessary images. By the time the Staff Radiologist arrived, the procedure was over!
The quality of training and the experience I had received and acquired in Nigeria had undoubtedly paid off.
Before I left California for Ibadan, my boss in Davis, Professor Phillip Palmer, unknown to me, had sent a written assessment of my performance to my Head of Department in Ibadan, Professor S.B. Lagundoye, which he kindly and proudly shared with me on my return, and gave me a copy for my records.

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In the document, Prof. Palmer paid glowing tribute to the quality of our training. I have reproduced below excerpts of his assessment:
“ Dr.K … is every bit as good, if not better, than our own residents at the same stage
of their career.
I think you can be proud of Dr. K…… he has brought great credit to your Department
and your Medical School.
We have found him to be a good teacher with medical students and other residents,
and he has great potential for becoming an academic radiologist….”

I have gone to these details so that our convoking Fellows, their teachers, and
in deed our College leadership, can hold their heads high for the great achievements
that have been made. I believe, however, that we possess the potential to attain even
greater heights. Why have we failed to bring those potentials to reality?

VISIONARY LEADERSHIP AS A CATALYST FOR NATIONAL DEVELOPMENT
It is my view that the decline of Nigeria from where we were in the 70s to where we are today is not unconnected with the failure of our top political leadership, whose negative influences have filtered down to the lower levels of leadership and even to the followership in the general society.
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Our youths can hardly find positive role models with high values that are worthy of emulation, and so they devise ingenious and illegal ways to “make it.”
The catalytic role that a patriotic and visionary national leader can play in rapidly transforming a country from underdevelopment to achieving major technological strides and overall prosperity cannot be overemphasized.
Nigeria is a country that is richly endowed with numerous mineral resources, vast expanses of arable land, an almost flawless weather, and capped with highly talented human resources. Despite our potential for greatness, the lack of the right leadership has been our bane in almost the past four decades, ensuring that we have little to show for those potentials.
To illustrate the pivotal role of good leadership in a country’s development, I will use the experiences of two countries, namely Rwanda and the United Arab Emirates.
RWANDA
Rwanda is a relatively small, land-locked country in East Africa, mostly remembered for its horrendous Hutu – Tutsi inter-tribal war and genocide, which started in 1990 and ended in 1994, leaving at least 1 million people dead.
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President Paul Kagame, a Tutsi, was a military commander during the war, and contributed in no small way to bringing the war and the genocide to an end.
As President, Paul Kagame made phenomenal achievements in the stabilization of the country, first by pioneering the social system that successfully fostered reconciliation and unity between the two warring factions, so successfully that people no longer regard themselves as Hutu or Tutsi, but as Rwandans.
Some of you may recall that about a decade ago, a number of Nigerian State Governors (representing the “Giant of Africa”) visited Kigali to understudy how Paul Kagame achieved this feat of uniting his people, hoping to adopt his technique of dispute resolution, ostensibly with a view to uniting Nigeria’s diverse ethnic groups. Obviously, their mission was a failure, considering that Nigerians are probably more divided on ethnic and religious grounds today than they have ever been.
Along with uniting his people, President Kagame has brought national pride and dignity to them. In a recent incident, for example, he ordered the immediate and permanent deportation of 18 Chinese technical advisers for treating Rwandans like slave laborers.

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Because of Kagame’s economic policies, Rwanda’s per capita growth averaged 7.2% in the decade before 2019. Unfortunately, the prolonged lockdown from Covid – 19, with resultant international economic downturn, reduced Rwanda’s GDP by 3.4%, the first recession the country suffered since the end of the civil war in 1994. Covid –19 has however been aggressively tackled, with 63% of their people fully vaccinated.
Under President Kagame’s leadership, the country has shown impressive indices of growth. Child mortality dropped by 67%, while maternal mortality ratio fell drastically from 1,270 per 100,000 live births in the mid- 1990s to less than 300 in 2019.
The entire primary school education and up to the first 3 years of secondary school are mandatory and free, with an almost universal enrolment.
Rwanda is focused on the development of Science, Technology and Innovation, and it is one of the fastest growing African countries in Information and Communication
Technology (ICT).
On the vitally important issue of corruption, President Kagame introduced stringent measures to prevent corruption in its various forms, including eradicating corruption in academics and promoting meritocracy. He instituted campaigns to change the attitude of young people towards corruption. He also actively encouraged the prompt prosecution of cases of high-profile corruption.
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Compare that with what obtains in Nigeria, where such high-profile cases drag on endlessly in the courts, sometimes for more than 10 years! Common grounds for prolonged delay in the determination of cases are that the initial trial judge has travelled, or has been transferred, or retired, and the case is therefore assigned to a new judge. The new judge will invariably begin hearing the case again from scratch, with numerous adjournments, until he too suffers the same fate, and the cycle continues ad infinitum.
In some cases, our courts agree to a phenomenon called “Plea bargaining”, which in my un-learned, lay-man interpretation, allows a man who stole 100 million dollars, for example, to approach the court “with remorse”, admit to stealing 60 million dollars, which he is prepared to refund. The court approves the refund, and allows him to go away with the remaining 40 million dollars, and to go home and sin no more!
In many cases, those high-profile persons choose to entertain the public to the drama of feigning sudden illness in court, or being brought to court on stretchers or in crutches, often backed with medical certificates issued by some unscrupulous doctors, sad to say. After the drama has been repeated long enough, the accused may then be discharged or end up earning Presidential pardon!
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There is hardly any doubt that the key factor that has shackled major advances in Medical and other Scientific research in Nigeria is the humongous amounts that our country loses daily through insatiable corruption.
Funds that should have been deployed for the procurement of state-of -the -art equipment, devoted to education, power and national infrastructural development are stolen with impunity by greedy so called “leaders”, who possess no iota of vision, conscience or patriotism towards Nigeria.
In contrast, the anti-corruption measures being implemented by President Kagame
are clearly succeeding, as Rwanda was ranked by Transparency International index
2015 as the least bribery prone country in the East African Community and 3rd least
corrupt in Africa.
Rwanda was also ranked the 2nd best country in Africa on the ease of doing business.
In the area of technology, Rwanda has made phenomenal progress, with wide adoption of technology. For example, because of its mountainous topography, Rwanda has adopted the use of drones for the delivery of medical supplies (e.g. blood and medicines) to rural, and not readily accessible communities. Drones are also widely used in Rwanda for the purpose of policing. The country has become one of the world’s leading countries in the versatile deployment of drones.

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In 2002, Rwanda proudly founded its national airline, RwandAir, with a flourishing fleet of 12 aircraft, which fly many routes, linking many important destinations, and has grown steadily since then.
As a reflection of her growing international importance, Rwanda successfully hosted the 26th Commonwealth Heads of Government Meeting in June this year, attended by more than 50 Heads of Governments, an indication of how highly regarded Rwanda has become.
Rwanda’s leadership has set goals for the country to attain a Middle -Income Country
status by 2035, and a High-Income Country status by 2050, and is pursuing those
goals vigorously.
Nigeria once had a “Vision 2020”, purportedly to bring Nigeria’s social and economic status among the best 20 countries of the world, including the generation of 60,000 megawatts of electricity. Year 2020 has come and gone with no concrete achievement to show.
Under the leadership of President Paul Kagame, Rwanda has clearly demonstrated national transformation and the unfathomable benefits of a visionary leader.

SHORT POWER POINT SLIDE INTERLUDE

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UNITED ARAB EMIRATES (UAE)
My second example, the United Arab Emirates (UAE), used to consist of 7
autonomous emirates, each with its own administration, with cases of bitter
border disputes between some of them. Their union into one country was through the vision and commitment of Sheikh Zayed Sultan bin Al Nahyan, then ruler of Abu Dhabi Emirate.
Although Abu Dhabi Emirate was the wealthiest, mainly through its rich oil resources, Sheikh Zayed sacrificed some of those resources to uplift several of the less well-off
emirates, uniting them into one country in 1971. Naturally, he became the first
President of UAE, and encouraged each emirate to determine her priorities in
development, with healthy competition between them, in a truly federal system.
Sheikh Zayed was of course a Muslim, but was far from being a fanatic. He allowed
the construction of churches and other places of worship in designated locations, to
meet the needs of the large expatriate population of the UAE. Even the magnificent
mosque named after him in Abu Dhabi has its doors widely open to tourists, as long as
they are decently dressed, allowing them to admire the amazing architecture, the
internal furnishing and the impressive array of chandeliers.

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Sheikh Zayed invested the wealth derived from oil and gas into the development of infrastructure, manufacturing, modernization of the country’s energy, education and health care, as well as the development of tourism.
The UAE government has made significant savings worth almost 1.4 trillion US dollars in the Sovereign Wealth Fund, essentially representing monies set aside for future
generations. Compare the 1.4 trillion dollars for a UAE population of 10 million people, with Nigeria’s Sovereign Wealth Fund valued at only 2 billion dollars for a population of 200 million. This calculates as a saving of $140,000 per U.A.E. child, compared with $10 for the Nigerian child, disregarding the debt burden that the Nigerian child will have to bear due to the huge sums that Nigeria has borrowed and is still borrowing from other countries and international finance institutions. Sheikh Zayed passed away in 2004, but continues to be regarded and revered as the father of the Nation. He remains hugely popular among young and old, nationals and expatriates, because of the indelible legacy he bequeathed on his country. Today the UAE is the hub of business and tourism in the Middle East, playing host to major international conferences and events, with a diverse and booming economy.

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In the field of science and technology, the UAE has commissioned a nuclear power plant, apart from the development of solar power and wind energy.
UAE has launched several satellites into space, for scientific data collection, managing natural disasters and monitoring the environment.
In 2021, to mark the 50th anniversary of the founding of the country, the United Arab Emirates successfully launched an unmanned spacecraft to Mars, the first inter-planetary mission in the Middle East.
The phenomenal development of the UAE in the relatively short time since it was founded confirms that there is hardly any limit to what a nation can achieve, given a visionary, patriotic and incorruptible leadership, with efficient management of its resources.
Similar examples of the catalytic effect of good leadership in a country’s advancement have been demonstrated in many other countries:
In Malaysia by Dr. Mahathir Mohammed, in Singapore by Lee Kuan Yew, in India by Mahatma Gandhi, and in China by Mao Zedong.

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Similarly, and closer to home, Tanzania’s rapid, almost magical, transformation was achieved by President John Magufuli, through strict discipline instilled on government officials, beginning with himself. In spite of his short-lived leadership, he bequeathed a legacy to his country that his successors will find very difficult, if not impossible, to undo.
Nigeria craves urgently for a selfless, resilient, patriotic, and visionary leader, whose vision is not beclouded by religious affiliation, ethnicity or by pecuniary gain.
Such a leader must lead by example, in public as in private life, and positively influence the followership, and restore our traditional values of honoring and rewarding honesty and integrity, while punishing nepotism and corruption in all its forms. The visible sincerity demonstrated by such a leader is bound to engender the development of an impartial and incorruptible judiciary, a selfless legislative arm of government, as well as lower cadres of leadership, and a resourceful and contented followership. We will then begin to witness the plugging of the channels of waste of our national resources, and their effective deployment. Then we shall begin to break those shackles that have restrained our development for so long.

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A SHORT ADMONITION TO THE CONVOKING FELLOWS
As I conclude this Lecture, it is only proper that I share a few words with the Convoking Fellows, as you are the reason we are all gathered here today. I recall with nostalgia sitting in a position such as yours at the first Convocation Ceremony of the College, held at the National Arts Theater, Iganmu, on 19th February, 1982, a little over 40 years ago.
I congratulate and rejoice with you and members of your family that the several years of toil, in the presence of so many challenges, have finally come to an end.
Although this ceremony marks the end to those difficult years, it is only the beginning of greater responsibilities and challenges. You must have observed during this Lecture that I am passionate for our country’s doctors and researchers in the Sciences to make discoveries that will launch Nigeria to international fame.
I have no doubt that some of you constitute our greatest minds, and are sufficiently talented to launch Nigeria to such heights, particularly when those restraining shackles I spoke about are finally broken by the introduction of good leadership.
On the other hand, most of you will find yourselves in regular patient care services in your specialties, of which research will inevitably be a part, even if less intensive.
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Whatever the nature of your next steps may be, you are bound to be leaders in one form or another. In discharging your leadership responsibilities, you must be above board, and must not permit pecuniary benefits to becloud your decision making.
I want to commend to you the words of a famous doctor, named Luke, and his lawyer friend named Paul, who both lived in the first century A.D. Luke warned in his writing:
“Watch out! Be on your guard against all kinds of greed; life does not consist in an abundance of possessions.”
In a similar vein, Paul wrote to his mentee named Timothy as follows:
“Godliness with contentment is great gain. For we brought nothing into the world, and we can take nothing out of it.
Those who want to get rich fall into temptation and a trap and into many foolish and harmful desires that plunge people into ruin and destruction.
For the love of money is a root of all kinds of evil”.