Health Tech Newsletter 2nd Edition- A Path to Healthcare Interoperability

By: Adedeji Adeniyi

CEO’s Welcome Message

Hello There, Happy 62nd Independence Day celebration Nigerians . I wish to welcome you and our readers all over the world to the month of October, which typically marks the commencement of the final quarter of the year and signals our descent to the end of the year. Since this is our last publication for the year, I wish you and yours happy holidays on behalf of I and my team. May this truly be a December to remember.

The past quarter shaped up to be a very eventful one. As predicted, during this period, spurred by the commencement of new academic sessions in the UK and US, our industry witnessed another mass exodus of talents. Like most companies, we struggled with retaining some of our top talents to the sweeping brain drain that is

ravaging every sector of our economy. As a result of this, we have pushed back the launch of the GeneSys 2.0 release. Delay they often say is not denial. Whilst we are still working behind the scenes, perfecting things to ensure you have an optimum beta experience. You can sign up here to join our beta community waitlist. It is on a first-come, first-served basis, so hurry up and join the train!

We have curated quite the compendium of interesting, relaxing and informative content across the intersection of health and tech that’s certain to keep you engaged.

I wish to thank my team who have had to work on very steep and demanding deadlines to make this edition possible and most especially our guest contributor. You have our debt of gratitude. If you have any enquiries or are interested in making any contribution, we can be reached at editorial@genesys-health.com

We welcome you to kick back, chill and relax while you unwind to our second edition of health tech insider during the public holiday. Once again, happy Independence celebrations.

Cheers,

Ayo-Olagunju Muna

By: Adedeji Adeniyi

The Economic Outlook of the National Health Insurance Authority (NHIA) Act 2022

On the 19th of May 2022, President Buhari signed into law an act to repeal the National Health Insurance Scheme Act of 1999 and establish the National Health Insurance Authority. A laudable move which seeks to ensure that every Nigerian enjoys universal health coverage. According to the new Act, every Nigerian by law is mandated to get health insurance, an improvement

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Written By Oise Ajayi

from the previous act whose purpose was providing health insurance which entitles insured persons and their dependents the benefit of prescribed, quality, and cost-effective healthcare. Some key provisions of the new act include:

Administration of the NHIA

The NHIA will be overseen by a governing council made up of a chairman, the Director General of the NHIA who will serve as secretary, representatives from organized labour, one representative of a civil society organisation focused on health activities and one representative from Federal Ministry of Health, Federal Ministry of Finance, Nigeria Employers Consultative Association and the Armed Forces, respectively. Some of the key objectives of the NHIA now include:

Health Insurance Schemes

• Improving and harnessing private sector participation in the provision of healthcare services.

• Promotion, regulation, and integration of health insurance schemes; and

• Assisting the authority in achieving universal health coverage for all Nigerians

The act provides for states of the Federation and the Federal Capital Territory to establish and implement State health insurance and contributory schemes to provide access to healthcare for all residents. Residents as defined in the act includes employers and employees in the private and public sectors with 5 employees and above, informal sector employees, and other residents of Nigeria. The scope of coverage shall be the minimum prescribed in the Basic Minimum Package of the National Health Act, 2014. Employees of the government are also not left out as the NHIA is to establish similar schemes for employees of Ministries, Departments and Agencies of the Federal Government.

The act also provides that individuals may participate in private health insurance schemes, as long as the individuals also participate in state mandated health schemes. However, these individuals will be exempt from free coverage as a vulnerable person under the act.

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Basic Healthcare Provision Fund

The act provides that the NHIA in conjunction with states will provide the basic minimum health care package to all residents in Nigeria. In providing the general guidelines for the operation of the fund, the NHIA is required to:

make regulations on accreditation, quality of care and complaints handling collaborate with State Health Schemes and State-owned Institutions to accredit and enlist primary and secondary health care facilities in line with the criteria stated in the relevant regulations provide for the administration of an ombudsman to handle enrolees’ complaints

State Health Schemes shall be responsible for disbursement, management, evaluation, monitoring, and implementation of the fund in their respective states.

Vulnerable Group Fund

The act provides for the establishment

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of the Vulnerable Group Fund (VGF), to subsidize the cost of provision of healthcare services for vulnerable persons in Nigeria. The act defines the “vulnerable group” to include children under five, pregnant women, the aged, physically and mentally challenged and the indigent as may be defined from time to time.

Accordingly, the sources of funding available to the VGF include;

• The Basic Health Care Provision Fund

• Health insurance levy

• Money that accrues to the VGF from investments made by the Governing Council

• Government allocation

• grants, donations, gifts, and any other voluntary contributions made to the VGF

Outlook/ Recommendation

We commend the president for signing into law this act that seeks to guarantee every Nigerian, access

to basic healthcare services in the country, provided by the state. The government has been trailing this course in the past through various programs and laws but healthcare coverage under the NHIS has remained extremely low/poor, at somewhere around 3%-10% of Nigeria’s total population. For context, at an assumed populace of about 200 million people, only about 6 million Nigerians were covered under the previous national health schemes. With this new act however, the Federal Government is reiterating its commitment towards achieving universal health coverage in Nigeria and ensuring all Nigerians have access to affordable but quality health care services. The act even extends further to provide free coverage for the vulnerable group which includes children under five, pregnant women, the aged, physically challenged and mentally challenged Nigerians. Given the current state of the economy, this is a very welcome development.

According to the WHO, at least half of the world’s population does not have access to the healthcare services they need and many more are pushed into poverty due to health-related spending. On the home front, the cost of healthcare

has become increasingly worrying and Nigerians constantly live in fear of being one major ailment away from poverty. This act seeks to change the narrative for Nigeria.

While we applaud the efforts of the Federal Government towards providing quality and affordable healthcare for all Nigerians, questions on how the Government plans to implement this act must be brought to the fore.

In the 2022 budget, Nigeria had a NGN711.3bn allocation to healthcare, just 4.30% of the total planned expenditure, far below the 15% agreed upon signing the Abuja Declaration. In other countries however, this rate hovered around 10%-12% and many of these countries still find it difficult to provide affordable healthcare for its residents. The case of Nigeria is even more peculiar with a very poor ratio of doctors to patients. Low to middle income earners who cannot afford private health schemes are forced to show up at existing healthcare centers at unnecessarily early hours of the day if they are to get attended to by healthcare professionals and even then, it still often remains a struggle to get any decent bed space in the hospital should one find

themselves requiring admission.

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It is imperative that beyond repealing the previous healthcare act and introducing a new one, there are plans and programs that involve the training and retention of these professionals, improved remuneration, and above all, the establishment of more standard healthcare facilities to attend to the ever-growing population in Nigeria. Emigration of healthcare professionals has created a gaping hole in Nigeria’s health resources and is set to worsen even further as these professionals seek better working conditions in other countries.

While we applaud the efforts of the government towards ensuring access to quality and affordable healthcare for every Nigerian, we opine that the previously existing private health schemes should have remained an option for employers and their employees who do not want to participate in state health insurance schemes. As it stands, employers who choose to provide

private health insurance schemes for their employees outside the state health schemes will bear additional costs. A major concern in this regard remains the ability of the government to effectively manage the state health schemes and unfortunately, confidence in the government is at an all-time low.

The overriding economic benefit of this act is the provision of quality and affordable healthcare services to all Nigerians, with special provisions for all who fall under the vulnerable group. We recommend that the government continues to chart this course until a reasonable proportion of Nigerians can receive quality and affordable healthcare.

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Making digital record portability a reality

The cornerstone of making patients’ electronic medical record portable is interoperability. Interoperability refers to the ability of different information systems, devices, and applications (systems) to access, exchange, integrate, and cooperatively use data in a coordinated manner, within and across organizational, regional, and national boundaries (HIMSS, 2020).

The information sharing offered by interoperability allows for more coordinated, efficient, costeffective and data-driven care, improving the quality of care.

Digital record portability speaks to the ability and ease of being able to move your digital records from one provider to another.

Life happens, and as Thor said, the only thing permanent in life is impermanence. Patients can change their medical providers for various reasons, and whatever

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the scenario, the medical record being theirs, they should be able to move it to their new provider. As logical and straightforward as this sounds, especially in the case of hardcopy medical records, this is not often the case, due to a whole lot of reasons we would rather not get into.

The importance of being able to port your data can be practically seen in the instance of the mobile service providers, where a customer can easily facilitate a switch from one provider to another while retaining their phone numbers.

At Genesys Health, we have taken the next step in democratising patients’ access to their digital medical records, empowering them with the ability to port their records. Through our innovative ‘Patient Record Release’ feature in GeneSys v2.0, a patient can appropriately consent to release their entire medical records or

By: Adedeji Adeniyi

portions of them to suitable 3rd parties and are afforded the ability to revoke such consent on-demand.

This would enable hospitals within the Genesys provider network to offer medical record portability to their patients. For patients, it would mean they can easily, securely and seamlessly port their records from one provider to the other, within our provider network.

This feature is a huge leap in the advancement toward achieving an interconnected healthcare ecosystem. Patients can update their information; consent/authorize the release of their information with one click, and healthcare providers can view all the data in one place.

The process is compliant with the Health Insurance Portability and Accountability Act (HIPAA) guidelines on information sharing, which ensures security while permitting patient access rights based on their willingness to release

(Staff, S.H 2016). We have created a system in which the patient grants permission for the provider or administrator to view their entire medical history, but that provider or administrator cannot share any information with anyone else.

This provides a way for patients to be more involved in their care without compromising privacy and security.

For example, a patient via GeneSys can consent and authorize the release of a part of their entire medical record for research purposes, while still protecting other private health information. They can indicate the period of the medical record to be disclosed and the date upon which the consent is revoked, which automatically withdraws access to the data.

Digital patient record portability has long been a key component of the modern healthcare industry. Advances in innovations such as the “patient record release” feature have made it increasingly possible for providers to work together and

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share data. The ability to efficiently manage and securely share data between different health care providers while adhering to data privacy has a significant impact on the value you will derive from it.

We have always had a focus on building the capabilities to secure patients’ data and provide patients autonomy over their data while achieving seamless data sharing, and we are welcome to a growing number of organizations leveraging our EMR’s patient record release features for this purpose.

If you would like to learn more about how GeneSys EMR can help you, please contact our customer sales team via email at sales@genesys-health.com. We are always happy to talk!

By: Adedeji Adeniyi

HEALTH CARE IN THE TRENCHES: THE LIFE OF MAKOKO RESIDENTS

Healthcare in the Trenches – ‘Trenches’ according to colloquial use and street lingo is used to describe a rural and poor community, often akin to a ghetto or slum and there is no better place to experience this definition epitomised, than Makoko. Our trip gave us a brush with the daily reality of this less privileged and underserved community.

“Yevo! Yevo!” resonated as we rowed past the residents of Makoko, that is how we were addressed. Yevo in their local Egun dialect means ‘Oyingbo’ which itself is a Yoruba word used to describe a caucasian person or more aptly in this context, a foreigner. Makoko is an inner city slum, located in the Oworonshoki axis of the most populous city in Africa. It is an informal waterfront settlement with more than a third of the community built on stilts along the Lagos Lagoon. Do not be fooled by the waterfront description as there is nothing picturesque about it. The water is characterised by its blackish colour and foul pungent smell. This sprawling community is home to over 350,000 people

who lack basic human and social amenities such as; a good road network, electricity, pipe-borne water, education, and healthcare amongst other deficiencies. What could be the ‘Venice of Africa’ now passes as the ‘largest floating slum’ in the world. The very unattractive nature of this community makes it very attractive for CSR projections and NGOs looking to deliver aid and interventions. As a result, this community is often in the spotlight and in some cases, they have become a target of unscrupulous elements looking to score cheap CSR points with ulterior motives. Despite the publicity these interventions have brought to the community, the quality of healthcare remains largely unchanged.

Hope shone its lights on residents of Makoko in 2012 when the Doctors Without Borders (DWB) built the first floating clinic in Makoko. However, this light was snuffed out when the clinic was shut within barely three months. In present-day 2022, the community can count the number of healthcare facilities on one hand. We visited Makoko to find out how their living conditions affect people’s access to care, as well as how the COVID-19 pandemic

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disrupted things and its effect on their community. What we found will shock you!

Residents of Makoko practice communal living, with no less than 10 persons sharing the same living space, amidst an unsanitary environment and over congestion. Owing to the less than desirable living conditions, their environment is an ideal breeding ground for malaria, dysentery, respiratory diseases and communicable diseases. The swampy and narrow nature of the community makes it accessible only by a canoe, their definition of the popular ‘Lagos traffic’ is boats colliding with each other unable to move until one boat goes back. These unfavourable conditions create a lot of challenges for healthcare providers, as they have to grapple with accessing this community at the risk of their lives and providing care in an unsanitary environment.

The residents address these challenges by facing them head-on and taking responsibility for their healthcare through unorthodox and ingenious means. To tackle the challenge of accessibility, they formed a cleaning group that routinely engages in community

clean-up which frees up the pathway for easy and unhindered passage by canoes, which poses the steepest challenge during the dry season, making passage difficult due to the low tide. They also resorted to building smaller boats which are lighter in weight and best suited for mobility in their peculiar terrain. To tackle the challenge of hygiene, their routine community cleaning serves the dual purpose of making their environment more sanitary for rendering care and also helps in keeping them less susceptible to some diseases. Through the cleaning group that was formed, they also participate in user education, educating residents on the need to maintain a clean environment and proper waste disposal techniques.

Despite these efforts, when the residents eventually get access to medical care, the quality is usually poor. These challenges are majorly the reasons for the shortage of medical personnel, talk more skilled ones, which is going to be even further compounded by the brain drain we are experiencing. They often rely on CHEWs ( Community Health Extension Workers) who are assigned to the community as

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part of some outreach mission or the few from the community, who have received such training. Despite being branded as hospitals, the healthcare centres in Makoko (the few of them, barely 2 that exist) fall below the standard of being referred to as clinics. They barely have the skilled human resources, nor the basic amenities and equipment to adequately deliver primary care, yet the residents have no alternative

as healthcare payments are outof-pocket and their means of livelihood being subsistence fish farming, accounts for their meagre income. Their ‘hospitals’ like their houses are built on stilts, which means they have sufficiently high clearance, as they have to be well above water level. This would be very challenging for someone that is sick or heavily pregnant to access and they often stack boats on each other

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to provide a platform to support the ascent. Healthcare in Makoko is a horrid experience, which peaks at giving birth, as it is often a game of chance. The conditions described make it ill-suited for this endeavour, however as they are faced with little or no option, they often embrace it as their reality. In the eventuality of birth complications or lifethreatening emergencies, they would have to go all the way to Lagos Island maternity, LASUTH or LUTH. Imagine such an eventuality happening on a windy stormy night. They would have to battle through environmental challenges, and then financial challenges as they often lack the means to pay out-of-pocket.

Well, nature they say has a way of evening the odds. One would think that amidst the poor living conditions, ailing and lacking infrastructure, waterborne and communicable diseases will be

brewing in this community. On the contrary, as recounted by one Mr Gowon Idown, a CHEW at God Bless by Faith Hospital, their disease prevalence is majorly malaria. He told us that the Makoko community did not record a single case of COVID-19, attributing it to their rugged nature from birth and the immunity they’ve built over time, though one can argue they were not exposed to sufficient testing. He recounted experiencing a measle outbreak recently, but it was quickly contained by quarantining the infected. Although we cannot further correlate this by data, It is believed that they are immune from viruses and diseases because of their deity ‘Sangbato’ and the smoke from their smokehouses used in drying fishes.

The three pillars of an effective healthcare system are; access, quality and cost. Makoko residents are on

the lowest rung of the ladder because as can be deduced from their ordeal, they barely have access to care, the quality is derelict and they are too indigent to afford anything beyond the standard currently afforded them. Suffice it to say, healthcare is non-existent in this community.

The Experience

Fade: Overall, it was an eye-opening experience, I think I was more scared of falling in the black water not even for the fear of drowning because I know either our tour guide or someone from the surrounding community will rescue me, but the fear of getting submerged in it or worse still ingesting the water.

Fiyin: It was a first-time experience being at Makoko and I can almost relieve the excitement I felt on the canoe ride en route to the hospital facility. I also feel proud of myself for being a part of the team that partook in the field trip for this report

Fun Facts

Yahoo our tour guide: Makoko, despite being situated in Lagos metropolis and bordered by Yaba and Ebute Metta, a city where Yoruba is its predominant language,

Amilo Precious

By: Adedeji Adeniyi

Health economic evaluation of digital nursing technologies(DNT).

The revolution of the world and the constant change in the direction of technology is now the order of the day.Processes, procedures and most activities in different fields and disciplines are now been digitalized. Nursing is not left out,as one of the most important professions that is vital to human life, the need for digital upgrade is paramount for better results.

Digital technology enables immense amounts of information to be compressed on small storage devices that can be easily preserved and transported. Digital technology has transformed how people communicate, learn, and work. It involves the programming and processing of activities and procedures into portable devices to make work easier. The increased use of technology has no doubt made nurses more

Digital nursing technologies(DNT) is the incorporation of technology in the rendering of holistic and optimal nursing care to enhance precision, facilitate efficiency and help in the giving of timely care to clients they include; wearable devices such as heart monitors , sensors for checking vital signs, automated IV pumps, smart beds, electronic health records.

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efficient and helps them to carry out their work with ease. Digital nursing technologies(DNT) is the incorporation of technology in the rendering of holistic and optimal nursing care to enhance precision, facilitate efficiency and help in the giving of timely care to clients they include; wearable devices such as heart monitors , sensors for checking vital signs, automated IV pumps, smart beds, electronic health records. With digitalization comes increased cost of healthcare, also putting into consideration the benefits gained from using digitalized nursing technology.

Just like in other fields, economic evaluation is needed to ensure that profit is being made and quality work is been done . Profit in healthcare is slightly different from Economics in general because healthcare is aimed at improving health outcomes before other factors. Economic evaluation is defined as the comparative analysis of alternative courses of action in terms of both costs and consequences. Thus, the core tasks of an economic evaluation are the identification, measurement, valuation and comparison of the costs and consequences of the alternatives under consideration. (Huter, Krick & Rothgang, 2022)

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Health Economic evaluation is the process of measuring cost effectiveness (in health care). It measures two parameters cost and outcome (the effect). Economic evaluation is a comparative analysis (i.e. it compares two or more different options), It compares in terms of their costs and their consequences. Health economic evaluation of digital nursing technologies (DNT) is important to provide information that helps avoid undesirable developments and implementations as well as increase the chances of success of developed applications. A simple cost analysis usually focuses only on the financial costs of a particular intervention. A full economic evaluation measures the value of an intervention in terms of the value of benefits not achieved because resources were not spent on alternative options.

in delivering care. Clinical trials measure health care outcomes to determine the effectiveness or efficacy of health care interventions. With unlimited resources, this is all the information you need to decide which intervention to use. Just choose the option that works best for you. However, given the limited resources, we also need to know whether the intervention is cost-effective. In other words, what is the cost-effectiveness?, there is a measure of the cost and effect

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between cost and effect, cost in terms of how expensive procuring this digital nursing technology is, how much clients are willing to pay for it and how much the government is willing to put into the health sector. While for the outcome, it looks at the effect of these digital nursing technologies on health, it should be geared at positive health outcomes for the clients and the delivery of optimal care while ensuring safety for the

clients. If the cheapest option is also the most effective, it is clearly the most cost-effective one. In this situation, the cheapest option is described as dominant. However, the decision of which intervention to choose is less clear when the cheapest option is the least effective but is is important to note that economic evaluation is not simply a matter of measuring costs of interventions and then choosing the cheapest option. (Goodacre & McCabe, 2022)

According to Virginia Henderson definition of nursing, the First Lady of nursing, The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery (or to peaceful death) that he would perform unaided if he had the necessary strength, will or knowledge and to do this in such a way as to help him gain independence as rapidly as possible.

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Dr. Jibril Abdumalik ASIDO FOUNDATION

WORLD SUICIDE PREVENTION

Suicide is the act of intentionally taking one’s life. The number of reported cases appear to be on the rise globally, and this is an increasing source of great concern. The prevalence is rising and social media platforms further amplify reports of suicide and suicidal behaviours.

Young people are especially susceptible, as it is reported to be the second leading cause of death (after accidents) for youth aged 10 to 34. The World Health Organization (WHO)

estimates that more than 700,000 individuals die by suicide every year. What this means in practical terms, is that somewhere on this earth, a precious human life is lost to suicide every 40 seconds. However, suicide is ALWAYS preventable. It is a tragic but avoidable loss of life. It is in furtherance of efforts to mobilize the world towards preventing suicide, that the WORLD SUICIDE PREVENTION DAY of September 10th was designated. It serves to remind the world that there is still tremendous work to be done in preventing suicide.

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How Can Suicide Be Prevented?

Learning the warning signs, fostering prevention and resilience, and committing to societal change can assist in preventing suicide. The first step toward suicide prevention is identifying the warning signs of suicidal behaviour. While some suicide deaths are impulsive reactions, 80% of these persons would have given some signs of their intentions before carrying it out.

1Mental illhealth – especially Depression is a significant risk factor for suicide, and the persistent feeling of sadness and mood swings, as well as entertaining thoughts of suicide (suicidal ideation) may be a red flag.

2Another warning sign is when a person begins to withdraw from others. The individual prefers to remain alone and avoids friends and social activities. They also lose interest or pleasure in previously appreciated activities.

They may express feelings of hopelessness and a lack of desire to continue to live. They may utter statements such as ‘what is the purpose?’ ‘Everyone will be better off without me’ etc.

Some may suddenly increase their consumption of alcohol and drugs to drown their sorrows, and they will express what they are trying to achieve with it. This should be seen as a warning that the individual is not coping well.

A critical red flag is a history of previously attempting to harm themselves, or attempting to take their own lives.

1. Such individuals should not be left alone; please, ensure that someone is with them through such dark moments.

2. Inform them that you are concerned about them. Prepare yourself to listen to them rather than preach long lectures and admonitions. Display no alarm or judgmental behaviour. Ask precise questions to determine if they have specific plans and actions to harm themselves.

3. Ensure they seek professional mental health care from a qualified professional (psychiatrists or clinical psychologists). If there are underlying mental health

issues such as depression, this can be identified and properly treated.

4. Lastly, we all have a role to play, as individuals and as a community. Public awareness and education can be employed to understand suicide and other mental health challenges, and reduce the pervasive stigma at the community and societal level.

The media also has a role to play in this by avoiding the gory details of suicide. While it is essential news, reporting such sad occurrences should be guided by best ethical standards. The reportage should seek to give information on risk factors and recommendations for help-seeking. Emphasis should be on the fact that individuals who are

Concerns should not be disregarded if you identify any of the above in a close friend or loved one, and you feel the

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depressed or who may be feeling suicidal can recover and turn things around in their lives – with professional help and treatment.

Nigerian Policy and Suicide Prevention

Nigeria currently lacks a structured national suicide prevention policy or strategic direction, while still operating an obsolete mental health legislation, known as the ‘Lunacy Act of 1958 (Modified from the Lunacy Ordinance of 1916).

Furthermore, while attempted suicide is globally recognized as an obvious cry for help, Nigeria criminalizes attempted suicide, and such individuals are liable to be punished with imprisonment for one year. This situation needs to change for the better. It is in the light of the foregoing, that the Asido Foundation strives for a Nigerian Society where every citizen enjoys optimal emotional wellbeing. A major strategy for achieving this objective is to disseminate accurate and comprehensive information on mental wellness, and especially suicide and suicide prevention. The Foundation has been organizing an annual Suicide Prevention Rally

on University Campuses since 2019 to commemorate World Suicide Prevention Day. During such rallies, members of the Asido Campus Network and other volunteers visit all halls of residents with a music caravan to spread messages about how to prevent and recognize suicidal tendencies, and how to help. We also know that shame and stigma are significant barriers to seeking for help.

Thus, we launched an anti-stigma campaign in 2020, and we invite you to please visit the Asido Foundation website and sign up to support the #unashamed campaign via www. asidofoundation.com/unashamed. We need open conversations so everyone who needs help can freely come forward without shame or stigma.

The Asido Foundation intends to hold street rallies across Nigeria in September 2022, to commemorate world suicide prevention day. The aim is to create awareness and encourage empathy, support, and treatment for affected persons before it is too late. The Foundation seeks to raise awareness about suicide prevention by providing community members with the basic knowledge and strategies of suicide prevention.

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Furthermore, the organization plans to hold social media events, such as a Twitter space, where the general community and professionals can share stories and basic knowledge about suicide and suicide prevention. By doing this, the foundation hopes to reach a broader range of individuals with accurate information, to improve knowledge, attitudes, and perceptions about suicide. It will also address the psychosocial impact on affected families, friends and colleagues of persons who died from suicide; and how we can support them.

To reinforce these measures, the Asido Foundation launched a helpline for emotional support and professional intervention across Nigeria. Anyone, experiencing emotional distress at any time, can

reach out to this line [+234(0)902 8080 416], via call, text, and WhatsApp, for our services. It is manned by an administrative respondent who will then reach out to one of our volunteer mental health professionals, to call back and speak with you as soon as possible. In conclusion, the journey towards a mentally healthy Nigerian Society, that will truncate the rising cases of suicide and suicidal behaviours is long and arduous. But with commitment, and contributions from all stakeholders, individuals, religious organizations, the media, community leaders, mental health professionals, not for profit advocacy organizations such as the Asido Foundation, and the government at all levels, we can achieve significant progress.

ASIDO 1 »SUICIDE PREVENTION WALK

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Healthcare of the Future in Emerging Markets

The healthcare sector has been at the forefront of innovation for many years. Medical practitioners can better care for patients and save lives through innovative technologies, some of which will not just improve healthcare; they will also cause enormous disruptions in it. The quick changes we see in healthcare in emerging nations, like; China, South Africa, Nigeria, and India to mention a few are a result of these trends. With 5.6 of the 7 billion people on the planet residing

in emerging economies, many of these individuals want access to high-quality, inexpensive medicine to become healthy or maintain their health, and it is projected that in the coming years, top emerging markets will double their spending on medicines. Emerging markets are countries or economies that experience considerable economic growth and possess some, but not all, characteristics of a developed economy. These markets are countries transitioning from the “developing” phase to the “developed” phase.

However, the future of healthcare in these areas will not only be determined by the advances we aim to make; it will also be moulded by how we react to and foresee the difficulties and effects of each significant advancement.

So, what is the future of healthcare, and what does this mean for the people living in the region?

Digital Healthcare

Digital healthcare, the interpolation between digital technologies and health innovation to promote health care and well-being will play a critical role in shaping the future of healthcare in developing markets. China is one of the countries looking at how digital care may be used throughout the entire healthcare value chain. For instance, Tencent, a social media powerhouse, is expanding its chat and payment services to the healthcare industry, while Baidu, China’s wellknown search engine, now allows online appointment scheduling. The first “cloud hospital” in China, utilizing cloud computing, big data, and the Internet of Things, opened in Ningo in 2015. The hospital serves as a platform that links nearby clinics, doctors, hospitals, pharmacies,

and insurance companies. It will be interesting to see if the initiative can assemble the necessary number of actors to deliver on a scale. Nevertheless, these healthcare programs are likely to continue.

In addition, researchers have created a novel portable ultrasound that plugs into a laptop to keep medicine mobile, and SMS technology can check malnutrition in rural Ghana. This is to show that some of the latest innovative technologies are also available in developing nations. According to a PWC analysis, mobile health has the potential to save more than 1 million lives in sub-Saharan Africa over the course of the next five years, not to mention the rest of the world. Emerging markets will be affected by digital health technology, which will be used to track results, speed up recuperation, and use user experience to improve patient care in the future. Mobile technologies and inexpensive sensors can be used to keep track of patients and link diagnostic data to outcome data. More patients and doctors will be able to track clinical results because of connected ecosystems and userfriendly, cloud-based software.

Diagnosis Using Deep Learning

Deep learning, a sophisticated form of machine learning, is frequently employed in fields like robotics and cybersecurity. But it is also starting to gain traction in medicine. Some ailments can be diagnosed with 90% accuracy and specificity using deep learning technology.

These systems also function incredibly quickly. Hospitals in emerging markets could assist more patients in receiving appropriate care more quickly with their assistance. In regions where there is a physician shortage, diagnostic artificial intelligence (AI) is particularly promising.

Only a few pilots and test cases of AI in healthcare have recently been conducted in Africa. For instance, a multinomial logistic classifier-based system is being used in South Africa to plan human resources, specifically to forecast how long health workers may remain in the public sector. An AI planning tool is being created through cooperation between researchers and a social enterprise to optimize the scheduling of community health workers (CHWs) in African areas.

A start-up in Nigeria named Ubenwa is utilizing machine learning and signal processing to enhance the diagnosis of birth asphyxia in lowresource environments. AI was used in a study by Bellemo et al. to identify diabetic retinopathy in Zambia, and the results were significant and encouraging when compared to human evaluations. In identifying referable diabetic retinopathy, it demonstrated performance that was clinically acceptable. In Tanzania and Zambia, pilot trials investigating the use of a computer-aided diagnosis of pulmonary tuberculosis from chest radiographs used the CAD4TB software from the Delft Institute.

The outcomes are intriguing because CAD4TB’s performance held up well against that of human specialists.

The usage of AI in Nigeria has benefited pharmaceutical businesses as well. Five high school students created an app to detect fake drugs in Nigeria using MIT open-source software. In 2018, their brilliant concept gained attention after winning a Silicon Valley competition. Adebayo Alonge, a pharmacist with training in Nigeria, won the grand prize of the Hello Tomorrow

Global Challenge 2019 for his AIhyperspectral platform for certifying pharmaceuticals.

The future of health care in emerging markets will be strongly shaped by predictive analytics. IBM’s Watson Health has made inroads in developed markets, assisting oncologists at the Mayo Clinic in the US in making more accurate cancer diagnoses by employing cognitive learning algorithms to review hundreds of diagnostic scans. Moving on to international applications, IBM employed a comparable system in hospitals in South Africa to help manage hospital staffing and relieve severe staffing shortages. IBM announced the creation of IBM Health Corps in April 2016 to use Watson to address healthcare concerns in emerging markets.

Social health determinants are also very vital, do you realize that social influences might affect your health? Even more so than genetics, environmental and economic factors can have an impact on your physical and emotional health. Healthcare providers can consider these elements during diagnosis and therapy with AI’s assistance.

Data analytics tools can identify links

between social factors and health issues that doctors might overlook. By using these services, doctors may get a more complete picture of your health and then recommend the best course of action.

Surgery Microbots and Robotic therapy:

3d rendering hospital surgery - room with C-Arm machine and surgery robot. Credit: PhonlamaiPhoto

Soon, hospitals everywhere will be filled with robots. Now, microbots are assisting surgeons in tight spaces. These small robots can carry out delicate tasks where human hands might be too shaky. It can be difficult to operate on the eyes and remove some malignant tumours. Compared to handheld instruments, microbots provide greater flexibility and better precision. With this technology, surgeons may carry out intricate surgeries more accurately and safely.

Robots can be useful in more fields than just surgery. In hospitals across the world, robots are now being used for both physical and psychological therapy. People who are paralyzed can regain their ability to walk with the aid of wearable robots, or exoskeletons, and intensive physical therapy that could last about 43 weeks depending on the severity of the spinal injury.

To keep patients company, hospitals like Medstar Hospital Washington Centre, St. Elizabeth Healthcare, Standford Hospital, First Affiliated Hospital, Smart Field Hospital, and Wuhan Vulcan Mountain Hospital to mention a few have pleasant robots on staff in the United State of America and China respectively. Even people with mental health problems like depression can benefit from these interactive digital friends. A human companion cannot be available around-the-clock in hospitals, but therapy robots can.

3D-Printed Body Parts

Manufacturing is just one application of 3D printing’s potential. The medical community could 3D print artificial teeth, limbs, and even organs. The transplant procedure is streamlined as fresh organs are grown from patient

cells using 3D-printed building blocks. You would not have to be concerned about your body rejecting these body parts because they are made from your DNA. The conventional transplant procedure can be replaced safely and effectively with the help of this technology. Most recently, the Unbroken Rehabilitation Center had its first bionic prosthesis installed on Mykhailo Yurchuk, a serviceman who lost an arm and a leg defending Ukraine. Now Mykhailo can move his fingers again because he got a new arm.

It should be noted that the adoption, advancement, and application of these emerging technologies indicate the direction of healthcare in emerging markets. These technologies are vital to the growth of the region’s healthcare industry, even though they are still in their infancy there. However, they

3D Heart Printing Technology

Credit:Devrimb

are now in use on a global scale, and the results so far are encouraging. Their usefulness will increase as more hospitals accept and enhance their utilization.

In developing economies, some of these technologies might seem futuristic, but they will soon be a part of our daily lives. With the use of these and other disruptive technologies, the healthcare sector in this segment will become safer and more effective. By 2030, industry and clinical practice will change because of the growing impact of emerging countries putting more emphasis on providing widespread access to highquality, cheap medical treatment. However, industry actors will need to change the way they do business, set up their organizations for innovation, and leverage supporting technology if they want to succeed. Even if they are complicated, obstacles and difficulties can be surmounted through establishing innovative partnerships. The ability of the sector to disrupt and revolutionize how healthcare is delivered internationally will depend on how enterprises develop and flourish.

enhancing the future of healthcare in developing economies. As seen by the existing use cases, it is a practical instrument for addressing health issues, cutting costs, and enhancing health accessibility and quality. Evidence-based decision-making and application of this innovative technology in healthcare should be used, not just a desire to experiment with innovative approaches. The adoption of legislation and regulations that will regulate the use of this technology in healthcare and safeguard users is also necessary for these nations.

In conclusion, the opportunities that emerging technologies present hold enormous potential for altering and

Written By: Adedeji Adeniyi

A peak into the Implementation of hospital management information

With so many experiences in the implementation of a full-blown Electronic Health Record systems, the adventure into one of our most recent clients situated in the most populous Local Government Area in Lagos state Nigeria, it was a facility that commenced operation fully in 1992. It is a facility keen for growth and excellence as her track records show the enthusiasm for greatness with strides it took by being enlisted in SafeCare program in 2011 from level 0 and moved progressively to level 4 in 2016 under the supervision of PharmAccess, Netherlands. The hospital is currently one of the healthcare providers enlisted on the Lagos Pilot Health Insurance Scheme, an initiative of the Lagos state government in partnership with PharmAccess.

Written By: Adeyinka Adenikinju

doctor and his patient talking while reading medical record on a computer at doctor’s

The implementation commenced after a long wait following the typical sales cycle for being awarded a contract for the implementation of an Electronic Health Record for top tier hospital which could be years. One must say the implementation is one in which the got a very good and commendable management backing which translated to a proper management drive where leadership and exemplary action was the trademark for other users of the system to adopt and follow.

vThe organization had a hierarchy of communication channel which allowed for feedback and communication flow from top to bottom of its staff, the Chief Operating Officer being process specialist was also instrumental in adjudging standard processes that were to be accepted as part of the reengineering stage carried out for the implementation. His very knowledgeable role shone bright as an additional factor favouring

adherence properly backed by the executive management of the facility.

The early days were a bit awkward with the users as expected, the resistance to change of a work custom or way of working set in as expected in most environment. The users would usually feign being busy, as they were simply scared to face the reality of change initially. The breakthrough can be attributed to the integration of our wonderful implementation team actively on-premise and the adequate leadership from their department -a live wire of our success; the Service delivery department.

The personality of the implementation team was endearing to the users and soon they realized it wasn’t just a look of being new and naïve but a genuine empathy and willingness to come down to the level of whoever was willing to give them the chance to teach and guide them through.

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The service delivery department gave the needed strategy of a product champion approach (which ensured that each user unit or team had a select individual who learnt and understood how to use the system) these individuals became the easy go to person for their colleagues and built confidence in the users’ use of the system.

The users, as accustomed with bespoke systems, usually came up with “new requests” which were not captured during business requirement elicitation. These were tricky situations as implementing these requests; though giving the users the sense of robustness and flexibility in achieving the tailoring to their particular process but has the obvious adverse effect of derailing the project timeline which leads to loss in the time value apportioned to the implementation of the system. One might say if

these “new requests” were but a few, it would not have been that tricky, but the reality of freedom allows for the user to feel free to express imaginations and ideas and if not properly reviewed and made to understand already existing features that solve these needs, might just lead to duplication of features.

The maturity of the users with system over time has been a joy to behold, the efficiency with using the system and achieving desired needs aiding massive collaboration with users and partner organizations has also been one to gladly reflect on. But for the necessity of the running cost of implementation, it has been pleasant ride and experience with thanks to all parties involved.

This is just but a peak of my overview of the implementation; though a very vivid narration of the implementation journey and its

By: Adedeji Adeniyi

A Path to Healthcare Interoperability

By Ayo-Olagunju Muna

A Path to Healthcare Interoperability

The Johnsons are your typical middle-class Nigerian household. Femi and Linda have been married for 5 years and have had relatively successful careers culminating in their being property owners. Prior to owning this property, they formerly resided in a rented apartment within the suburb of the Ajah axis in Lagos, Nigeria which is about 24km from their offices at Victoria Island. As with

most cosmopolitan cities around the world, the cost of living is usually high and usually compensates with high-earning job opportunities. As such, it is not an alien practice to see people work in major cities, where the economic prospect is richer, and reside on the outskirts of the city, as a strategic cost-cutting approach.

Their new home is strategically situated on the outskirts of town, approximately 140km from their

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offices, more than 5 times their regular commute to work. The absence of a metro means the commute would have to be made via road. The heightened insecurity and the ongoing road repairs along that axis make the commute even more precarious and challenging. They decided to reduce the frequency of this journey by getting an inexpensive self-contained not too far from their offices, while they journey home only on weekends and public holidays. Their plan had kicked in, and this was their new normal. On one of such weekend trips, tragedy struck, as they were involved in a ghastly auto crash on their way home. They were rushed, both unconscious to the closest hospital within proximity

of the accident. Femi’s unique hospital number was gotten from his phone’s emergency details. His details were used to cross-reference Linda’s details, being his next of kin. The attending physician was able to access his consolidated medical history, which revealed him to be diabetic and his wife was 4-weeks pregnant. They were equally able to access their blood groups and other associated histories. The readily available nature of their medical histories impacted and informed decision-making regarding the quality of care they received and of course, the hospital was able to comfortably proceed with the treatment since they were equally able to

determine they both had valid health insurance and their insurers had been contacted as required. When they were stable, they were both taken to a diagnostic centre, for a CT scan, the result of which was automatically sent to the requesting hospital, upon availability.

While the hospital part of The Johnsons’ ordeal might have sounded a tad bit fictional, considering our immediate healthcare environment. However, the scenario described is purely factual and is the reality in the UK, US and some other developed countries and this is possible simply due to interoperability. Interoperability

within the context of healthcare is the ability of multiple, disparate systems to share, interpret and use healthcare data cohesively within and across organization bounds, towards improved healthcare delivery and population health outcomes. The scenario described above is one of the most simple and basic use cases of interoperability in healthcare, yet we can easily see how the exchange of data and the ability to meaningfully use this data between various players within the healthcare value chain translated to improved and optimum quality of care. The caretakers could determine the appropriate treatment plan, having full visibility of the Johnsons’ medical history promptly. The caretaker could render the best possible care, without any limitations, knowing fully well both patients are insured and they are certain to get paid for their services. Cost savings could be achieved by

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not having to engage in redundant tests and superfluous processes. It will help with improved disease surveillance and monitoring, ultimately leading to population health benefits. These are just a few of the benefits of healthcare interoperability. We are in a digital age, which is marked by the proliferation of the internet. The ubiquity of the internet has made the information exchange of data of various forms and kinds possible and the continuous advancements in technologies have made it even faster. The ability to take advantage of these technologies to improve human life and endeavour, especially in healthcare service delivery, is critical to achieving sustainable growth and development, especially in developing countries like Nigeria (Akintunde et al., 2019). The availability and ondemand accessibility of health information, when required, is essential in determining the quality of healthcare service delivery. This brings about the practical need for health information exchange, meaning various health systems would need to interface with each other, exchanging on-demand data that is understood by the receiving systems. Several considerations

have to be examined because communication is not limited to two systems, but between multiple complex systems. Keeping it simple, let’s assume we are looking to facilitate health information exchange between two different systems; A and B, integration can address this. You would need to write custom codes to facilitate the bi-directional exchange of data between both systems. A fairly simple solution to a straightforward problem. However, when you add other systems to the consideration, integration is no longer a viable solution. At 2 systems, they needed just 1 bidirectional connection, the effort required was lesser and the cost was low, the problem compounds with

Figure 1: Integrating 2

Additional system. With 4 systems, 6 bidirectional connections will be required and 10 bi-directional connections would be required for 5 systems. Since all the systems are now connected, If there is a change in one of the systems, it would

mean a change in all the systems. This approach is very complex and extremely expensive making it not sustainable in the long run as it births another problem known as the quadratic cost problem – The number of bidirectional connections increases quadratically, not linearly, with each integration of a new application, which would easily balloon the cost. The quadratic cost problem can be addressed by standards, which would help

difficult to share because it’s sensitive, requiring a high level of privacy and security, yet the inability to access it when it’s needed has the potential to negatively impact care (IBM, 2021). Having determined the need for a connected healthcare ecosystem that facilities information sharing, and interoperability as the only means of achieving this on a large scale. It’s often said, the journey of a thousand miles starts with a step, and a vision often precedes this journey itself. Nigeria has to have a strategic vision for healthcare interoperability that examines where we are, how we want to achieve it, key success milestones and the eventual outcomes Let’s outline a possible path to achieving healthcare interoperability incountry.

Figure 1: Integrating 4 system

towards interoperability. In software, standards are a set of rules, that enable information sharing in a uniform and consistent manner across any system. They are approved and published by an authoritative organization (TechChange, 2021).

Over the years, health data has always been challenging to access and share securely. The nature of health data creates a paradox: It’s

Written By: Adedeji Adeniyi

Governance & Regulation

Findings reveal that Nigeria’s health tech legal and regulatory framework is nascent. There is no sole regulation set aside to guide the operations of healthcare tech vendors in the country. On the contrary, what exists is several pieces of legislation that are aimed at regulating the operations of orthodox medicine providers. Some of these include; the National Health Act (NHA) 2004, Patients Bill of Rights (PBoR), Freedom of Information Act (FoI Act) and Cybercrimes (Prohibition & Prevention) Act 2015.

sufficiently protected by extending the coverage to their digital health records. For information exchange to thrive, patients would have to be guaranteed a high level of security, transparency, accountability and protection, to comfortably embrace e-Health. Patients are becoming more aware of the value of their data. Hence, regulation needs to be lucid in terms of ownership, consent and release, data sharing, use of data, and security and privacy concerns. NDPR, being a subset of the UK GDPR sufficiently addresses these concerns from a sector-agnostic perspective. The slight drawback is that this regulation is not specific to the health sector and it focuses more on Personally Identifiable Information (PII). Drawing learnings from the Health Insurance Portability and Accountability Act (HIPAA) 1996 and Health Information Technology for Economic and Clinical Health (HITECH) Act 2019, we need a regulation that serves the dual purpose of protecting a patient’s health information specifically and additionally regulating the operations of the health tech industry. The inclusion of this regulation, coupled with the existing ones

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would ensure a robust and enabling regulatory framework, which is indeed a prerequisite to achieving healthcare interoperability as it would help in building the muchneeded stakeholders’ trust and confidence in the process.

authorized users across multiple locations, which is central to information sharing. The use of EMRs has to be mandated by legislation to encourage increased adoption beyond the obvious benefits the providers stand to gain from them.

Adoption of EMR

Paper-based records are still the mainstay in this part of the world when it comes to documenting patients’ medical encounters. With electronic medical records still in their infancy and having no regulatory backing, the majority of clinics, hospitals and healthcare facilities are still heavily reliant on manual processes and paper-based records. Paper-based records are a major hindrance to healthcare information exchange as they are accessible only by one person at a time in a particular location. The world has advanced beyond this general limitation through the adoption of digitization and penetration of the internet.

Electronic files allow information to be accessed and shared simultaneously and securely by

With the passage of the modified National Health Insurance Authority (NHIA) Act and the operationalization of various State Health Insurance Schemes, it presents the enablement and incentive to mandate the use of EMR by providers for empanelment into the schemes.

Since infrastructure challenges are part of the limitation behind the adoption of EMRs, the regulators need to be more pragmatic in setting a cut-off phase for its adoption.

Standardization

To facilitate intersystem information exchange, there has to be a common denominator across all the systems. In this case, more aptly put, a common vocabulary. This is what standardization seeks to address.

Written By: Adedeji Adeniyi

System A stores and sends data in an agreed format that can be processed and understood by Systems B and C. There are 2 types of standards that are responsible for this; semantic and syntactic standards. Semantic standards help applications establish a common vocabulary. However, despite the common vocabulary, there might still be the underlying problem of a lack of comprehension (i.e. they cannot understand each other). This is where syntactic standards come in. Syntactic standards help applications establish a common grammar, thus understanding each other.

The standardization that needs to be achieved far exceeds the semantics and syntax standards required for health information interchange. Several aspects of the orthodox health industry itself need to come to terms with standardizing aspects of its operations. For instance, hospitals currently have an endless list of service tariffs they maintain for each insurer. This makes the process of medical billing very complex. The US addressed this with Current Procedural Terminology (CPT) coding. Standardized billing would help promote transparency and curb insurance fraud. It would

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spur innovation amongst insurers as they no longer compete majorly on pricing, translating to better value for the patients.

A standards definition committee comprising of policymakers and technocrats representing all stakeholders in the healthcare ecosystem would need to be established. The health data standards to be defined cuts across; vocabulary/terminology, content, transport, privacy and security, and identifiers. Extensive work has already gone into developing some of these standards, which are already operational in the West, some of which we can adopt, whilst we leverage the rest as a base for defining our unique standard. Some of these standards include; ICD-10, CPT, HL7 CDA, and HL7 FHIR.

The major output of this standardization exercise is to get all stakeholders within the health care ecosystem, especially the health tech vendors to adhere to their various implementation. The output of this roundtable dialogue would achieve the dual aim of standardizing and sanitizing the health tech space, setting the true foundation for healthcare interoperability.

Incentivization

The key to achieving interoperability lies not merely in the adoption of EMRs, but their effective utilization. Despite mandating its use, the healthcare industry has been operational and managed to thrive without the need for EMR, so it would be a huge culture shock for the physicians, especially the more experienced, older-generation ones, who struggle to come to terms with its usefulness.

termed Meaningful Use (MU).

To accelerate adoption, the government would need to find a way to creatively incentivize stakeholder interest and participation. Despite the technological advancements in the US and the early proliferation of technology in their society, they still had to incentivize participation, to record the 95% EMR penetration rate they currently boast (Sonal & Jawanna, 2019). From their experience, regulation ensured that every doctor, clinic, and hospital had an EMR, but it couldn’t dictate if and how well it was used, which would counteract their interoperability goals. They recognized this early enough and developed a program

The Meaningful Use program had as its primary objective the capture, exchange and reporting of specific clinical data and quality measures by the physicians such that it counts towards the data sharing goals of their healthcare interoperability roadmap. Another thing the MU program was able to achieve was sanitization of the various EMR products. Any vendor/product that failed to meet the defined standards was not certified for participation in the MU program. Physicians could use only Certified Electronic Health Records Technology (CERT). Essentially, they had to meaningfully use the CEHRT.

These clinical data and quality measures were broken down into stages, for ease of conformance, giving rise to 3-MU stages. Financial incentives were given to providers that conformed to each of the stages, while penalties were awarded for non-conformance. Bringing this home, we can adopt a similar approach to the MU program. The incentives can come in the form of increased insurance enrolees and penalties can likewise come in the form of reduced enrolees. Realistic timelines for achieving the MU goals

need to be set, factoring in our general computer literacy level and infrastructural challenges.

Written By: Adedeji Adeniyi

Create an interoperability roadmap

This is the final and crucial stage toward our journey to healthcare interoperability as it builds upon the gains from the earlier phases. At this stage, we would need to draw up a detailed interoperability roadmap, which would define our strategic interoperability vision and goals. This process would involve multisector stakeholder participation and collaboration between, the Federal government, State governments, development partners, the private sector and patients. This roadmap is meant to lay out a longer-term set of drivers and policy and technical components that will achieve the outcomes necessary to achieve the vision. The process of drawing up the roadmap would start with a review of the outcomes and impacts of the activities from the earlier phases to wholistically shape its development and improvement. It would have three main sections; the “Drivers”, which are the mechanisms that can galvanize the development of a supportive payment and regulatory environment that relies on and deepens interoperability. The next is the “Policy and Technical

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Components,” which are essentially what stakeholders will need to implement in similar or compatible ways to enable interoperability, such as shared standards and expectations around privacy and security and a section that finally speaks to “Outcomes,” which serve as the metrics by which stakeholders will measure the implementation progress. Each of these sections will include specific milestones, calls to action, and commitments that will support the development of a nationwide, interoperable health IT infrastructure. The roadmap is intended to be a living, breathing document. As such, it is expected to accommodate changes based on the completion of the milestones and the realities of the operating environment. Below is the roadmap adopted by the US toward their healthcare interoperability journey

The path outlined to achieving this is not the sole path, nor does it need to be followed in this exact order, but one thing is certain, all the steps here need to be undertaken at some point during the journey. Whatever path is chosen, it is a long and arduous one that requires concerted effort, heavy stakeholder dialogue and collaboration and strong political will, to bring it to reality.

The Journey to achieving a truly interconnected healthcare system is a huge one and a feat when achieved would certainly strengthen our health system, putting it almost on equal footing with the West and stimulating our economy in several aspects, among other several benefits.

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Written By: Chefkoks IG: @chefkoks__

THE SYMBIOSIS OF PEOPLE AND CULTURE ON CUISINE

The symbiotic relationship between culture and cuisine negotiates our identities, cultures, and environments. The cuisine is more than just a collection of ingredients, cooking utensils and dishes from a geographic location. While these elements are undoubtedly critical to establishing a culinary identity, they do not, on their own, form a cuisine. Shared traditions and beliefs are equally responsible for each cuisine’s uniqueness and identity. The global sharing and blending of cuisines have been a dynamic aspect of the food industry since the beginning of time. This is because cuisine, like other cultural elements of society, has geographic, religious, and so many other influences that shape its development. Elements of cuisine may shape events or celebrations that become cultural norms or may be assimilated into another culture, becoming intrinsic to it and then work to shape or drive agricultural demands and practices. A cuisine gives us a way to express and establish customs (what is eaten, when and with whom) from simple meals to celebrations and ritual meals. Beyond just nourishing, what we eat and with whom we eat can inspire and strengthen bonds between people, communities and even countries. Some cuisines’ beliefs and practices are religious-based. Take for example Muslims around the world during Ramadan fast which is believed to be the month during which Quran was given from Allah to the Prophet Mohammed. During this period, Muslims fast during

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daylight hours and eat before dawn and after sunset. Also, orthodox Jews and some conservative Jews follow dietary laws, popularly referred to as a kosher diet, discussed in Jewish scripture. The dietary laws, which describe the use and preparation of animal foods, are followed for purposes of spiritual health. Many followers of Buddhism, Hinduism, and Jainism are vegetarians, in part, because of a doctrine of non-injury or non-violence. Abstinence from eating meat in these traditions stems from the desire to avoid harming other living creatures. In Nigeria, most Christian dominations pick the first month of a new year to fast to usher in the new year in God’s hands and pray for their various heart desires.

One can say that there is no closer relationship than that of a family unit. Although the cuisine is often selected with some attention to physical need, the values or beliefs a society attaches to potential cuisine items also define what families within a cultural group eat and how they eat it. This in turn helps to discover attitudes, practices, and rituals surrounding cuisines, shedding light on our most basic beliefs about ourselves and others. A cuisine is influenced by culture, and once developed it exerts influence on the culture of its land of origin as well as on any outside cultures which it may encounter. Nigeria, for instance, is a region that brings together a fusion of culture and cuisine. Each tribe and ethnic group have its cultural dishes which differ from one another. For example, if we look across our three major tribes; the Yorubas are known for their love for spicy and oil-rich dishes, while the Igbo infuse vegetables in almost any delicacy and the Hausas largely depend on their cultivated farm produce –

which is majorly grains and its derivates - as their source of food. We are also heavily rich in food cultures like flavours, local staples, and local spices. We are blessed with vegetation and abundance in variety. Staples such as peppers, okra, leafy vegetables, meat, eggs, soups, fish, rice, cassava, plantains etc. are used daily in some form or fashion. Soups are a staple here and recipes, as per custom are usually passed on from generation to generation. Despite the influence of colonist, tourist and immigrants on our cuisine, the root of its gastronomic origin remain indigenously unique to our region. A lot of people are of the notion that you can not have a balanced meal variety using our staple ingredients but I bet to differ. Below is a weekly menu to help kick start your trust in our staple ingredients.

Written By: Adedeji Adeniyi

Written By: Peter Owolabi

PLEASANT PINEAPPLES

Like Piet Hein said, “love is like a pineapple, sweet and undefinable”, so anytime is good for it. Such as now!

Anans comosus referring to Pineapple is a perennial plant of Bromeliaceae family, which produces an edible fruit and is believed to have originated in the Brazilian rainforests and were initially harvested by the native tribes and spread through South and Central America. Spaniards called it “piña” due to its resemblance to a pinecone. After importing into Europe in the 16th Century, it was grown extensively in greenhouses as it became extremely popular, hence the English added the word “apple” to the end of piña, to associate it with a pre-existing delicious fruit. After this, the pineapple spread to Africa, India and other tropical areas by the Portuguese, as penned by the Britannica.

Growing a pineapple from the severed top of a wellripened and healthy looking fruit available is arguably the cheapest and easiest way to begin. The crown is planted in a small hole in the garden or farm which takes about six to eight weeks for root formation. Being xerophytic in nature, their roots do not like to stay wet as the soil is required to be well drained with a dry side at a pH level of 4.5-6.5 with erratic wetting schedule possibly with a mixture of N-P-K fertilizer of 5-5-5 or other equal

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amounts while adhering strictly to the manufacturer instruction.

It takes about 2 to 3 years for the maturity and harvesting to take place, and one can detect a ripened pineapple through it’s aroma. As one sniff it, a ripe one will have a fresh, inviting smell. If it feels hard, it probably isn’t ripe. It should have a bit of push when pressed, while ensuring it’s not too soft. Bright looking and greenish leaves can indicate plucking should be easy. A pineapple should feel weighty as it denotes the amount of juice it possesses.

From the fore-going, it is necessary to lay a foundation on the awareness of pineapple so as to inform on the benefits in consuming it, because like Davin Turney said “ when life give you lemons, sell them and buy a pineapple” as it reveals that the spiky looking fruit has it’s inside bounded with sweetness. Here are five salient benefits of consuming pineapples:

REDUCTION OF STRESS AND BLOOD PRESSURE:

As a result of possessing a high level of Vitamin B6 (11% of the DV) and Potassium (4% of the DV) and many other vitamins and minerals, pineapple enhances the ability to deal with stress efficiently thus allowing the vessels of the brain and blood to relax and ease tensions as it propels the proper circulation of blood without restriction all through the body.

STRENGHTENING THE BONES:

There are a lot of bone disorders in the world today, an example is the arthritis and rheumatism among others, but with the presence of Vitamin C at about 88% of DV of the daily requirement, coupled with Manganese and Bromelain in Pineapples, serving as a bone and connecting tissue strengthener prevents osteoporosis as it possesses anti-inflammatory properties, which is effective in relieving and suppressing Osteoarthritis as it protects against the degrading of cartilage tissue. It is however

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recommended that kids and adults should eat pineapples regularly for healthy bones.

TREATS COLD AND COUGH:

Still on the huge amounts of bromelain and Vitamin C, pineapple is presented as a good remedy to colds, cough and nausea. This fruit contains enzymes that reduces inflammation and clears excessive mucus in the respiratory system. Pineapple fruit juices are best fit in clearing nasal congestions so next time you have respiratory inconveniences, be sure to try it out.

IMPROVES MENTAL

HEALTH:

Pineapples with their inviting smell and sweet taste triggers a happy mood, a lovely feeling and an unending memory which in combination with it’s wealth of nutrients and compounds renews the mental state hence keep the body going.

So I am just here for pineapples because they pleasantly fix everything.v

IMMUNE SYSTEM

BOOSTER:

Vitamin C which has the highest DV in the fruit combats cell damage as it improves the body immunity as it reduces the risk of virus and bacterial inflammation from the strength received from the vitamin and other minerals like Manganese which propels the production of enzymes.

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By: Adedeji Adeniyi

Written By: Fiyinfoluwa Sanwo

Regulatory and Privacy Concerns in the adoption of medical devices using AI

From faster diagnoses to robot-assisted surgeries, the adoption of AI in healthcare is advancing medical treatment and patient experiences and fast becoming part of our day-to-day lives.

And the emergence of wearable healthcare technology and the massive data collection raises considerable concern about the rise in regulatory and privacy violations.

And according to researchers in 2020, a survey showed that 45-60% of patients agree that AI will lead to more abuse of personal data.

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How are regulatory and User Privacy Violated?

The power of big data analytics is so great that in addition to all the positive possibilities, there are just as many new privacy concerns being created. Here are some of the most significant regulatory and privacy risks:

1. Identity Concealing could become impossible:

With so much data, and with powerful analytics, it could become impossible to completely remove the ability to identify an individual if there are no rules established for the use of anonymized data files. For example, if one anonymized data set was combined with another completely separate database, without first determining if any other data items should be removed prior to combining to protect anonymity, it is possible individuals could be re-identified. The important and necessary key that is usually missing is establishing the rules and policies for how anonymized data files can be combined and used together.

2. Privacy breaches and embarrassments:

Written By: Adedeji Adeniyi

The actions and decisions taken by AI solution providers as a result of big data analytics may breach the privacy of those involved and lead to costly embarrassments or even worse. Consider that some wearable device retailers have used big data analysis to predict intimate personal details such as the due dates of pregnant shoppers. In such cases subsequent marketing activities resulted in having members of the household discover a family member was pregnant before she had told anyone, resulting in an uncomfortable and damaging family situation. Retailers, and other types of AI solution providers, should not take actions that result in such situations.

3. Obfuscation of sensitive data could be defeated:

If the Obfuscation of data is not done aptly, big data analysis could easily reveal the actual individuals whose data has been concealed. AI solution providers must establish effective policies, procedures, and processes for using data obfuscation to ensure privacy is preserved. Since big

www.genesys-health.com

www.genesys-health.com

data analytics is still relatively new and evolving, most AI solution providers don’t realize there are risks, so they use data obfuscation in ways that could breach privacy.

4. Few (if any) legal protections exist for the involved individuals.

Many AI solution providers as well as individuals still have no clue of the provisions available to address privacy risks as explicitly required by existing data protection laws, regulations, and contractual requirements. While the Nigeria Data Protection Regulation (NDPR) provides a legal framework for the use and exchange of electronic data, National Information Technology Development Agency (NITDA) through the National Centre For Artificial Intelligence And Robotics (NCAIR) and others, have recently expressed concern about the privacy risks

Is there a possibility of data privacy with AI?

To address these concerns, some research efforts in the United States have been directed toward developing techniques to train AI systems while preserving privacy and helping users preserve their privacy. One of which is Federated Learning proposed by McMahan et al, which allows developers to train neural networks in a decentralized and privacypreserving manner.

The ideology behind their work is that neural network models to be trained are sent to the mobile devices which contain the usersensitive data and use The Saccharomyces Genome Database (SGD) locally to update the parameters. To bring this back home, among the many privacy protection methodologies and tools that can be leveraged in Nigeria in the absence of an AI policy, is the Data Protection Bill at the National Assembly which proposes the establishment of a Data Protection Commission with enforceable powers and a code of practice that ensures a rights-respecting data governance framework for Nigeria.

However, a National Policy on AI is critical for the country and therefore it behoves the Nigerian government and other relevant stakeholders to think carefully about how this policy can be created to support an AI economy that will maintain standards like algorithmic accountability, data protection, explainability of decision-making by machine-

learning models, and the protection of the citizens’ human rights from infringements, etc. The formulation of this AI policy requires an understanding of how AI and other related technology developments can be used to achieve Nigeria’s national goals and help solve a myriad of local problems ranging from food security to healthcare.

Bottom Line

The future seems to be moving towards greater data collection. However, AI service providers that choose to use big data analytics must determine the associated privacy and information security impacts before they put analytics into use.

Written By: Adedeji Adeniyi

Written By: Oghenewoke Atariata Oncopadi Technologies Ltd.,

SARCOMA

Cancers that forms or activates in soft tissues (such as muscle, tendons, fat, blood vessels, lymph vessels, nerves, and tissue around joints), and bones are commonly referred to as sarcoma. There are over than 70 types of sarcoma; however, some of the most common

types of sarcoma include: Kaposi sarcoma, undifferentiated sarcomas, dermatofibrosarcoma protuberans myxofibrosarcomas, etc. Therefore it is important to note that treatment for sarcoma depends on diagnosis of the sarcoma type, location and other factors.

RISK FACTORS

There are no known cause of sarcoma but the factors that increase the likelihood of this type of cancer include;

Family history

While history of anyone in the family previously diagnosed of cancer tends to increase the risk of cancer, some syndromes can be passed from parents to offspring such as: Li-Fraumeni syndrome (TP53 mutation), von Recklinghausen disease, Gardner syndrome, Nevoid basal cell carcinoma syndrome, Tuberous sclerosis, Werner syndrome; tend to increase the risk of sarcoma.

Radiation therapy for cancer

Radiation therapy for any previously treated cancer increases the risk of developing sarcoma later.

Chronic swelling (lymphedema)

Lymphedema is swelling caused by a backup of lymph fluid that occurs when

Written By: Adedeji Adeniyi

the lymphatic system is blocked or damaged. Having lymphedema in the arms or legs for a long time, increases the risk of type of sarcoma.

Exposure to chemicals

Certain chemicals, such as Thorotrast (thorium dioxide), vinyl chloride, or arsenic, can increase the risk of sarcoma that affects the liver.

SIGNS AND SYMPTOMS

Early detection of sarcoma as with any other cancer is very important for better treatment outcome and below are some of the signs and symptoms of sarcoma:

A lump that can be felt through the skin that may or may not be painful

Exposure to viruses

The human herpes virus-8 and Human Immunodeficiency Virus (HIV) can increase the risk of sarcoma.

Bone pain

A broken bone that happens unexpectedly, due to a minor injury or no injury at all.Others include Abdominal pain, Weight loss etc.

Written By: Fiyinfoluwa Sanwo

Overcoming Mental Health challenges with Telepsychiatry

Good Mental Health is more than just the absence of mental illness.

It can be seen as a state of mental health that allows a person to flourish and fully enjoy life.

We all experience down times in life. The ability to cope with negative experiences varies greatly from one person to another and, in large part, determines whether people enjoy their lives.

been an increase in concerns about the mental health of a generation of young people. But the pandemic may represent the tip of a mental health iceberg – an iceberg we have ignored for far too long. While mental illness may not be as easy to see as physical illness, it can severely impact a person’s quality of life.

With the emergence of the COVID-19 pandemic, there has

Treatment for mental illnesses can make a significant difference. While mental health treatment is available, barriers to care remain. In some cases, asking for help still comes with a stigma.

Services may be too far away to reach regularly. Whatever the reason, not everyone who needs help receives it. Health care providers face the challenge of expanding mental health treatment to reach those in need. Telepsychiatry is a powerful tool for expanding mental health services in many settings, including hospitals and emergency departments.

Since many of the factors that shape mental health – for better and for worse – are not biological, they can be changed. To do so, it is essential to identify and understand these factors:

Self-assurance

This is the value we place on ourselves, our positive self-image and sense of self-worth. People with high self-esteem generally have a positive outlook and are satisfied with themselves most of the time.

Affection received

People who feel loved, trusted and accepted by their parents, peers and others are far more likely to have good self-esteem. They are

also more likely to feel comfortable, safe and secure, and are better able to communicate and develop positive relationships with others.

Confidence

Youth should be encouraged to discover their own unique qualities and have the confidence to face challenges and take risks. Young people who are brought up to have confidence in themselves are more likely to have a positive attitude, and to lead happy and productive lives.

Family breakup or Grief

Separation or divorce or the loss of a parent or sibling is extremely painful. Finding ways to cope and adjust to the changes brought by these events is critical for everyone, but particularly for youths. How grief is handled can affect young

Written By: Adedeji Adeniyi

people negatively for years to come.

If children are having difficulty coping, professional help is recommended.

Difficult behaviour

When people are unhappy, they either internalize their unhappiness or act out. The latter usually appears as bad or difficult behaviour, such as using abusive language, being aggressive or violent, damaging property, stealing, lying, refusing to comply with requests or expectations at school or home, or displaying other inappropriate actions. If such behaviour is serious and persistent, the young person and his or her family might require professional help.

or drug abuse) can directly affect brain chemistry and contribute to mental illness. More commonly, poor physical health can affect self-esteem and people’s ability to meet their goals, which leads to unhappiness or even depression.

Physical ill health

Diseases, injuries and other physical problems often contribute to poor mental health and sometimes mental illness. Some physical causes (such as birth trauma, brain injury

In such cases, receiving the best possible treatment for both the physical problem and the resulting psychological consequences is key to optimal recovery to good mental health.

Abuse

The mental health of abused children is at great risk. Abused children are more likely to experience mental disorders or mental illness during childhood and into adulthood. Abuse may be physical, sexual, psychological or verbal. It may not always be evident or easily recognized. Regardless of the form it takes, abuse cannot be tolerated. Children need to be protected from abuse and helped to overcome its negative effects. Abuse can cause feelings of low self-esteem, lack of self-confidence, depression, isolation and anger, all feelings that impair a child’s chance to lead a happy life.

have documented the benefits of virtual care, including stroke care, radiology, and cardiology. Digital technology allows patients and providers to connect remotely, which can reduce the cost of care, increase access to care, mitigate workforce shortages, and play a vital role in preventive care. Psychiatry is one of the top specialties for telemedicine. It is fast becoming an important part of mental health and psychosocial support services. It can be a way to educate and disseminate information; an aid in screening and diagnosing; a conduit to treatment and care; and a tool for training and supervising mental healthcare workers. With digital technology, the human trends in behavior can be tracked, which can help accurately formulate interventions.

Digital technology for mental health: Different fields in recent times

Among the promising digital interventions in use is telepsychiatry. Telepsychiatry is a viable, reasonable option for providing psychiatric care to underserved patients or those who lack access to services. Telepsychiatry can help clinicians provide mental healthcare from a distance in realtime by using interactive, 2-way, audio-video communication (videoconferencing).

Written By: Adedeji Adeniyi

Most healthcare facilities do not have psychiatrists readily available to handle patients suffering for mental health issues, but hospitals can leverage telepsychiatry to fill that gap. Telepsychiatry can be an invaluable tool for addressing mental health emergencies such as these.

Suicidal ideation:

Millions of people struggle with active or passive suicidal thoughts every year. Regardless of how suicidal ideation manifests, people must have access to mental health care. Emergency departments can make care more easily accessible to people struggling with suicidal thoughts via emergency Telepsychiatry.

Homicidal ideation: Homicidal ideation may exist with serious psychiatric and behavioral problems and warrants prompt attention. Through telepsychiatry , a physician can quickly evaluate an individual experiencing homicidal thoughts and determine if they require hospitalization or another form of emergency treatment.

Acute agitation:

Agitation is a characteristic symptom of psychiatric disorders, such as bipolar disorder and schizophrenia. Someone experiencing severe agitation or anxiety may need emergency care. A psychiatrist can connect with a patient experiencing acute agitation using telepsychiatry to help them calm down and decide whether a pharmacologic treatment is necessary.

Severe depression: Severe depression can significantly impact a person’s daily life. Pervasive feelings of sadness, isolation and physical symptoms are all common with major depressive disorder. If depression becomes severe enough, the person may experience suicidal thoughts. In this case, emergency treatment is necessary, and telepsychiatry can help.

Severe anxiety:

Severe anxiety can cause people to seek emergency treatment. For example, panic attacks can send people to the ED. While emergency rooms likely need to rule out other causes of symptoms like chest pain, they may not have the resources available to help someone address the mental health concern.

Telepsychiatry can be that resource.

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Severe adverse reactions: Psychotropic drugs can cause severe side effects for some people, ranging from mania to violent behavior. In some cases, these adverse reactions are life-threatening. Telepsychiatry helps move patients out of the waiting room for a fast evaluation when there’s little time to spare.

TELEPSYCHIATRY BENEFITS FOR PATIENTS

The usage of telepsychiatry can spur significant advantages for patients such as:

Access to care: Nigeria has a shortage of psychiatrists and psychologists. Most comparable countries have more mental health professionals. The practicing psychiatrists in Nigeria are unevenly distributed throughout the country, creating a huge need for mental health professionals. This lack of access leaves millions of people vulnerable and without adequate access to mental health care. Telepsychiatry allows patients to remotely connect with mental health care providers

regardless of their location.

Convenience:

Telepsychiatry not only provides a necessary service to people who cannot otherwise connect with mental health professionals, but it also offers a convenient way of accessing that care. Patients do not have to drive for hours to reach a crowded facility with long wait times. Similarly, they do not have to wait for hours in a crowded emergency department that does not even have a readily available mental health professional. Telepsychiatry allows emergency departments to connect patients virtually with trained, available psychiatrists who can assess them and efficiently coordinate their next level of care.

Better outcomes:

Studies have shown telemedicine can improve patient outcomes. Receiving care, especially in an emergency, is vital for people struggling with their mental health. Expanded access to mental health care services is a significant step in improving patient outcomes, and Telepsychiatry can play a role in that expanded access.

TELEPSYCHIATRY BENEFITS FOR CLINICIANS

Overcrowding in emergency departments may make it challenging to provide the best care possible. However, by shifting mental health care to remotely available psychiatrists, physicians can better manage patient loads in busy emergency departments and deliver high-quality care. Trained psychiatrists available via these services can reduce the wait times for patients with mental health concerns and help the in-person

team determine the appropriate treatment. Coordinating care can bring down unnecessary hospital admissions, keeping more beds available for patients who need them. Clinicians and hospitals can also benefit from the use of telepsychiatry.

We can’t always change the factors that influence our mental health, but we can get support to make them more manageable. Many mental health professionals are trained to help us better understand our unique background, identity, and experiences that shape our mental health, and help us create a plan to care for well-being amidst the challenges we face.

A SOUND MIND

Written By: Peter Owolabi

“

Lao Tzu rightly said

“He who knows others is wise; he who knows himself is enlightened”

Mental health awareness has been a major topic of this decade which have seen millions of people in depression caused by the rat race for financial independence while following the rule of the pay per hour, as men, women and youths get hyper busy daily, with little or no time to have a retreat or renewal breaks to ensure the maintenance of sanity which aggravating high blood pressure and numerous illnesses, all resulting from a bad mental health. To set the ball

rolling, mental health refers to the emotional, psychological and social being of an individual. The status of the mental health determines how stress is handled, relationship is guarded and also the making of healthy choices. Having understood this, the salient point is how to have a sound mind (mental health) as it relates to having a bar gold and guarding it, so also mental health is golden. The following tips are directed at having and maintaining a sound mind;

KNOW YOURSELF:

This is strictly studying and understanding one’s own emotions, desires, abilities, strengths, weaknesses, turn offs, way of thinking, temperament and a slow but steady discovery of one’s entire self, with a lot of introspection, talking to others, reading widely as well, you’ll know more and more about yourself each passing day because like Lao Tzu rightly said “He who knows others is wise; he who knows himself is enlightened”

DO WHAT YOU LOVE:

A lot of homo sapien on the Earth surface today are tied up doing what they are not passionate about where their purpose is not found which makes them give less than their capacity because “when you do what you love, you do not feel the pressure” said Manushi Chhillar. This is solely for happiness as what you love to do not only bring about contentment but the encouragement to keep going.

TAKE BREAKS:

Helen Edwards said,’ in this game (of life), everyone needs a break to refuel, recharge, and jump back in full throttle” because taking a break can lead to breakthroughs.

Breaks are not necessarily to be off work while not ruling that out, it might me a time to remember good memories as laughter relaxes the body and as well reduces stress; go for hiking/sight- seeing; few hours of refreshing sleep; exercise which are trusted mood improvers; having a time to swallow nutritious meals and plenty water.

LISTEN TO GOOD MUSIC:

Music in itself is life as it nourishes the soul like food does to the body. It improves the state of the mind and individual outlook on life. As the mind becomes quiet, music ignites the revival as though the bush is burning as the fire consumes the chaff, in like manner, Music consumes the weaknesses of the mind. And if the mind is strengthened the body is as well.

SPEAK UP:

This shows strength not weakness as a problem shared is half solved and in the multitude of counsels, there is safety. Visiting a doctor for checks and advice can be reviving, to keep your mind sound. Conclusively, you are what you are, so ensure you keep your mind healthy so as to ensure a healthy life. You are what you feed your mind.

Written By: Adedeji Adeniyi

LYMPHOMA

Written By: Oghenewoke Atariata Oncopadi Technologies Ltd.,

Lymphoma is a type of cancer that first appears in the lymphatic system.

The human body has a network of ducts, nodes, and capillaries called the lymphatic system is responsible for removing and transporting extra fluid from the body. It is also a component of the body’s immune system.

It also has between 500 and 600 lymph nodes. A buildup of lymph fluid, bacteria, or other organisms, as well as immune system cells, causes these nodes to expand in reaction to infection. Even while your body’s lymphatic system usually serves to protect it, lymphocytes have the potential to develop into cancer.

Lymphoma is a type of cancer that first appears in the lymphatic system. It is a form of blood cancer.

RISK FACTORS

Anything that increases the chances of having cancer is considered a risk factor; the causes of cancer are yet to be fully determined, but risks factors for lymphoma include;

Age

With most occurrences occurring in persons in their 60s or beyond, getting older is a significant risk factor for lymphoma overall. But younger people tend to be more susceptible to various kinds of lymphoma.

Lymphoma (NHL) than women, while some forms of NHL are more common in women. The causes of this remain unknown.

Race, Ethnicity, and Geography

NHL is more prevalent globally in industrialized nations, with the United States and Europe having some of the highest rates. Certain infections that are more prevalent in various regions of the world are associated with certain forms of lymphoma.

Family History

One’s likelihood of getting NHL rises if they have a first-degree relative (parent, kid, or sibling) who has the disease.

Radiation Exposure

Gender

Overall, men are at increased risk of developing Non-Hodgkin

Studies show that several cancers like; NHL, leukemia, and thyroid cancer, have been linked to survivors of atomic bombs and nuclear reactor accidents.

There was a modest increase in the chance of acquiring NHL in patients

who have received chemotherapy and radiation therapy for other malignancies.

A Weakened Immune System

A weaker immune system increases the risk of NHL in a person. For instance:

1. Organ transplant recipients are given medications to suppress their immune systems to stop the new organ from being attacked. NHL development is more likely to occur in these patients.

2. Some diseases that affect the immune system e.g., human immunodeficiency virus (HIV), can increase the chance of developing NHL.

3. Children with genetic (inherited) diseases, such as Wiskott-Aldrich syndrome and ataxia-telangiectasia (AT), are born with impaired immune systems.

Breast Implants

A kind of anaplastic large cell lymphoma (ALCL) can occasionally develop in the breasts of women who have breast implants, albeit this is uncommon. The likelihood of this seems to be higher for implants with textured (rough)

surfaces (as opposed to smooth surfaces).

Body Weight

Research has shown that being overweight or obese may increase the risk of NHL.

Autoimmune Diseases

There has been evidence linking certain autoimmune conditions like: rheumatoid arthritis, systemic lupus erythematosus (SLE or lupus), Sjogren’s syndrome, celiac disease (gluten-sensitive enteropathy), etc., with an elevated risk of NHL.

Infection

There are several infections that can raise your risk of lymphoma development. This is due to a few factors:

1. Some viruses infect lymphocytes

2. Some infections cause an overactive immune system.

3. Some infections cause immune system deterioration.

SIGNS AND SYMPTOMS

What signs do lymphoma present?

Early stages of lymphoma do not usually present with any symptoms. However, swollen lymph nodes (around the neck, chest area, armpit, abdomen, and groin), persistent cough, fatigue, loss of appetite, shortness of breath, stomach pain, itchy rash, and fever; can be preindication to see a doctor.

Typically, lymphoma doesn’t have any early warning signals because the above symptoms are similar to those of other illnesses, making an

Written By: Adedeji Adeniyi

Adeyinka Adenikinju

How monitoring systems mitigate Hospital-acquired pressure injuries.

Hospital-acquired pressure injuries (HAPI) are serious, costly, and preventable conditions that affect more than 2.5 million patients each year and drive up the cost of healthcare in the United States by up to $11B annually (LEAF healthcare International, 2017).

For clarity on this topic, a clear definition and explanation of what Hospital-acquired pressure injuries and monitoring systems are would lay the foundation for a wider appreciation of diverse perspectives on the good and unexpected or should I say less desired takeaways from accessing healthcare in the hospital.

Though preventable, Hospitalacquired pressure injuries also known as Pressure ulcers or other names like bedsores, pressure sores, and Decubitus ulcers (from Latin decumbere, “to lie down”) (Physiopedia, 2022) occur most often after a person sits or lies in one position for too long.

The immobility cuts off blood circulation to specific parts of your body, damaging surrounding tissues, (Ramirez & Anthony, 2021). They range from closed to open wounds and are classified into a series of four stages based on how deep the wound (level of tissue damage) is with the stages being:

Stage 1: The first stage is the mildest and affects the upper layer of your skin. Here the wound has not yet opened meaning it hasn’t yet broken through the skin. If treated early, developing stage 1 pressure ulcers can heal in about 3 days (Ramirez & Anthony, 2021).

Fig. 1 Stage 1 of bedsore

Stage 2: in this stage, ulcers have a break in the top two layers of skin, clearly, the sore area of the affected patient’s skin has broken through the top layer of skin (epidermis) and some of the layers below (dermis). The break makes a shallow, open wound. If properly treated, healing from this stage can last anywhere from 3 days to 3 weeks (Ramirez & Anthony, 2021).

duration of 1 to 4 months to heal if treated (Ramirez & Anthony, 2021).

Fig 2. Stage 2 of bedsore

Stage 3 of bedsore

Stage 4: pressure ulcers are

Stage 3: in this stage, the ulcers affect the top two layers of skin, as well as fatty tissue. The sores that have progressed to the third stage will have broken completely through the top two layers of the skin and into the fatty tissue below. The best way symptom in this stage is a hole or crater-like nature. You’ll likely notice visible fat tissue but you won’t be able to see muscle or bone and may usually take a

deep wounds that may impact muscles, tendons, ligaments, and bones and are the most serious. The sores extend below the subcutaneous fat into your deep tissues, including muscles, tendons, and ligaments. In more severe cases, they can extend as far down as the cartilage or bone. This makes for a prevalence of infection at this stage. With proper treatment, the ulcer can take anywhere from 3 months to 2 years to completely heal (Ramirez & Anthony, 2021).

Stage 4 of bedsore

Written By: Adedeji Adeniyi

It thus interesting to patients to find out that they could actually acquire these injuries while accessing care for other conditions hence the focus of this write-up is on how to mitigate such injuries which form mainly on any skin that covers bony areas of the body like the buttocks, tailbone, heels, ankles, hips, back, elbows, shoulder blades, and back of the head (Ramirez & Anthony, 2021).

deep as a stage 3 or stage 4 wound) (Ramirez & Anthony, 2021).

Pressure Ulcers - Physiopedia

Fig. 5. Pressure Sore Areas

So, you know how serious this preventable situation can be, there are actually two more additional types outside the four stages of pressure ulcer formation described above namely Unstageable pressure ulcers (which are hard to diagnose because the bottom of the sore is covered by slough and eschar) and suspected deep tissue injury (which presents like a stage 1 or 2 sore on the surface but beneath the discolored surface, it could be as

Fig. 6. (A) Unstageable pressure ulcer

(B) suspected deep tissue injury

Implications of HAPI:

The implications of Hospitalacquired pressure injuries (HAPI) include a significant increase in healthcare costs, including the use of resources (dressings, support surfaces, nursing care time, and medications). Patients are not left out as HAPI has a significant impact on patients in terms of pain, worsened quality of life, psychological

trauma, mortality, and increased length of stay (Gupta et al., 2020). Hospitals get to lose revenues in terms of non-payment of claims where bedsores, were identified to have happened to patients who were on admission so there you have it, caregivers also do not want to be at fault for not preventing their patients’ Hospital-Acquired pressure injuries (Padula et al., 2015).

Research has shown that HAPI is preventable. Numerous interventions have been studied with varying degrees of efficacy. The strategy for preventing pressure injuries relies on three interdependent domains: pressure injury risk identification, pressure injury risk mitigation, and care team training (Miller et al., 2019).

What then are the needs to be met in preventing HospitalAcquired pressure injuries?

Mobility is Medicine;

The important recognition is that turning and mobilizing hospitalized patients is good medicine and cannot be overemphasized when you look at the complications of immobility of patients are well-established

and potentially devastating with complications like:

• Increased risk for deep vein thrombosis and pulmonary embolisms. Increased risk of gravitational equilibrium and orthostatic hypotension in the Cardiovascular system.

• Greater chance of hospitalacquired pneumonia and impaired pulmonary function in the Respiratory system.

• Greater danger of developing delirium, anxiety, and pain in the Neurologic system.

• More potential for paralytic ileus/ constipation and altered digestion in the Gastrointestinal system

• Deconditioning, muscular atrophy, and loss of coordination and balance in the Musculoskeletal system therapeutically beneficial turning and mobility require three things: Providing care for the right patient, at the right time, and at the right dose.

This means:

Written By: Adedeji Adeniyi

1. Turning/mobility protocols need to be customized to the patient’s individual care needs.

Patients at risk for complications of immobility should be prescribed a mobility protocol.

Mobility protocols should be personalized, not one-size-fits-all.

2. Turns should be provided in a timely fashion.

Turns should be provided as often as necessary to prevent complications.

Credit should be given for any adequate patient self-turns.

3. Turning/mobility interventions need to be “dosed” appropriately.

Each turn must be large enough (i.e., turn angle) to provide adequate pressure offloading.

Each turn must be sustained long enough to provide adequate tissue reperfusion time (LEAF healthcare International, 2017).

previously not possible and calls for disruption.

The solution

At a time when technology has brought about disruption in the healthcare space, coverage of these disruptive benefits continues to deepen in the space and Hospitalacquired pressure injuries have not been left out. Monitoring systems have now helped in mitigating pressure sores that would have been acquired in the hospital or elsewhere, and here is being referred to as the solution, but what are they?

Monitoring systems for patients are systems or devices used in helping healthcare providers to monitor physiological signals of their patient’s health. They can be made of sophisticated technology and are alternatives to the traditional management of patients and their health. they consist of a wearable wireless device like a bracelet with sensors that are paired with an application for a caregiver to access medical information (Nadar, 2021).

Evidently, manually handling patients to achieve these were

They are put to use when observing and in the measurement of patients’ health parameters such as heart

rate, respiratory rate, temperature, blood-oxygen saturation, and many other parameters of critically ill patients. These immediate data are key for making crucial decisions for effective patient care(Nadar, 2021).

The benefits of monitoring systems include eliminating the need for processing large amounts of data manually. The AI-powered system sends an alarm if the patient’s indicators begin to worsen or if there is a predicted threat that things are becoming dangerous. With the help of monitoring systems, doctors can save time and effort, and free up more beds in hospitals that can be occupied by patients who need urgent help. After analyzing health indicators with the help of AI, the system may suggest that a certain patient can be discharged and recover at home while receiving medical advice remotely. This allows

caregivers to focus on people whose lives are in danger (Cprime, 2020).

The use of monitoring systems specifically designed for pressure injuries has begun to make great strides, largely contributing to less burnout of nurses or wound care specialists. A look into one of them shows the deep thought put into the development as well as ensuring the success in the implementation of the prevention strategy for Hospital-acquired pressure injuries.

In this write-up, we choose to look more closely at the LEAF patient monitoring system with its unique selling point being that it is a continuous monitoring system for pressure injury prevention

Like most monitoring systems, it leverages wearable technology to not only help caregiver units

Fig 7. Konica Minolta SP1 patient monitoring device (Minolta, 2020)

Written By: Adedeji Adeniyi

create an individualized pressure injury prevention plan for each patient – it also helps the healthcare provider team stick to that plan with visual patient turn status alerts.

The LEAF monitoring system boasts as the first tool to measure the effectiveness of patient turning for pressure injury prevention as it measures more than just turn frequency; it also measures turn angle and tissue recovery time through the Integrated Position Technology

The LEAF System includes four basic components;

Wearable patient

sponsor: This is a lightweight sensor that attaches to the patient’s chest, monitoring whether they are sitting, standing, or lying down –on their left side, right side, back, or prone.

Wireless mesh

network: This consists of antennas placed throughout your unit to relay information from the sensors to the computer interface through a secure wireless network and data server.

User interface: Through the computers at both the nurses’ station and workstations on wheels, you can check the turn status for all patients being monitored, adjust care plans for, individual patients, and more.

Automatically generated reports: the system has the ability to allow caregivers to generate reports from the interface to show when patients were repositioned, as well as their progress toward mobility goals (Smith + Nephew, 2022). Other benefits of the use of monitoring systems as highlighted by the LEAF system now acquired by Smith+Nephew include;

• Helping Reduce Equipment Expenses

The analytical data from the system helps with:

• internal investigations of pressure injuries

• ability to help with litigation defense and

• Optimization of the workflow (LEAF healthcare International, 2017).

Though the LEAF system as well as other researchers have shown a drastic decline in Hospital-acquired pressure injuries with the use of technology (monitoring systems) certain disclaimers have been issued signifying room for more improvement and enhancement in the mitigation of Hospital-acquired

pressure injuries, still using LEAF as an example they cited the following;

The LEAF System is not to be used to alert staff of situations that would require immediate action in order to maintain patient safety. Be aware that there is a possibility of ambulation/step detection inaccuracy. Some patient steps may not produce enough movement to be detected by the System. Conversely, some patient movements may resemble the movement associated with taking a step and therefore be recognized by the System as such. (Smith + Nephew, 2022)

The other concern about the efficiency of use of the devices or system only in developed societies like in the United States is also a concern as to the efficiency of use in other climes.

Fig. 9 a wearable patient sensor

It would be nice for more research works to be done on the prevailing nature of Hospital-acquired pressure injuries in the Nigerian or African healthcare space, and the significant reduction with the advent of patient monitoring systems to help improve on the already great strides made

in this objective. Alas, and fear not, the caregivers would do their best with constant enlightenment and use of the strategies to ensure you don’t acquire pressure injuries when next and if you or your loved ones are admitted to the hospital.

Written By: Adedeji Adeniyi

Increasing Exclusive Breastfeeding RatesThe Missing Link

By Dr Chioma Nwakanma-Akanno

“ ”

months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one-third during the second year of life, according to WHO. It is safe, clean, and readily available at the right temperature. Every parent wants the best for their babies, yet Nigeria has shockingly low exclusive breastfeeding rates. Nigeria’s rate has risen significantly over the past decade, from 17% in 2013, to 29% in 2018, and now 34% in 2021. This is good progress but still a long way from the WHO target of 50% by 2025. If evidence has shown that breastfeeding

“Baby must be hungry; give him breast milk,”

benefits both mother and child, then why are so many of our kids still not being breastfed optimally?

In line with this year’s theme of “Educate and Support,” I propose an underrepresented aspect of society where education can be employed to support women in attaining their breastfeeding goals, resulting in a peak in breastfeeding rates in Nigeria.

While studies have shown that formal education, effective breastfeeding policies, and babyfriendly hospital and workplace activities are important drivers of optimal breastfeeding rates, I would argue that the socio-cultural factor is an often overlooked determinant.

Do you recall a eureka moment when it suddenly dawned on you that a

long-held belief was nothing more than a myth? The following grief when you consider all the pleasures or chances that this misconception may have deprived you of? In my instance, I thought eating jollof rice before bedtime might create facial oedema (swelling). Growing up as a proper rice-loving Nigerian and learning that this was an old wives’ tale left me feeling deceived. These are milder examples, but generational myths can have more serious or life-threatening consequences in some cases. One such example is the practice of expressing and dumping Colostrum- the first form of breastmilk produced after childbirth, that some cultures deem filthy. As a medical student, I saw this for the first time during my Obstetrics rotation. I would have

disregarded this as a unique case if I hadn’t seen evidence indicating that it was common practice in various communities.

The World Health Organization’s 2015 breastfeeding policy brief cited sociocultural factors as one of the determinants of low breastfeeding rates. According to Apanga’s study review, sociocultural practices, traditional beliefs, and family pressures are major barriers to achieving optimal breastfeeding in West Africa . In North Western Nigeria for instance, it is normal practice in some communities to discard the first breast milkColostrum. Because this nutrientdense milk is said to be impure, new mothers must cleanse for 3-4 days with herbs before breastfeeding. Babies are offered goat milk, herbs, water, and honey during this waiting period. Breastfeeding is also delayed in babies who have had Uvulectomies because of the pain and potential infections. The commonly practised one is the early introduction of water to babies before 6 months. On the social scale, is the refusal by some women to breastfeed to prevent breast sagging. Sadly, these are just a few of some sociocultural impediments to optimal breastfeeding in Nigeria.

In a 2019 research published in the International Breastfeeding Journal, most participants alluded to the fact that they got most of their breastfeeding advice from the grandmothers and the traditional birth attendants. Birth rituals, traditional, religious, or family beliefs, and health seeking behaviours are all factors that influence breastfeeding initiation. We have a tendency to overlook the pressures prevalent in typical African settings. Sadly, a typical African home is patriarchal, which implies that the man, (even over the grandmother’s), has the last say on what activities are permitted in his home. While mothers, especially first-time mothers, may have some knowledge of recommended breastfeeding practices from Antenatal care classes, their ultimate decisions are heavily affected by their grandmothers and spouses.

These community influencers are an untapped resource that can be leveraged to inspire the support women require to achieve optimal breastfeeding, and by commission save more infant lives. This can be accomplished with the collaboration of the government, community leaders, and community healthcare workers. Antenatal care classes

provide an excellent opportunity to enlighten mothers, however, these classes should equally include the grandmothers and husbands. Hospitals can equally encourage or even incentivize partner attendance to antenatal classes. These classes can also be delivered to communities. NGOs, Community leaders, Healthcare workers and Healthcare centres, can collectively or individually innovate around solutions to scale antenatal classes. These include, but are not limited to, in-person or virtual classes, as well as community outreaches. When the men are well informed, they can support and enforce baby friendly practices in their homes.

Finally, many of these birthing rituals are usually done by the traditional birth attendants. Traditional birth attendants have always been present and assist in meeting the needs of many rural women regarding childbirth. Instead of trying to outlaw or condemn them, the government and relevant NGOs can collaborate with TBAs, equipping them with the right health practises to ensure the good health of mother and child, importantly also teach when to refer. Our healthcare facilities, which are largely understaffed and

inadequately equipped, have gotten worse as a result of the current brain drain from the healthcare sector. Healthcare funding and accountability are great pillars for health systems strengthening. Funding will guarantee prompt and adequate compensation for healthcare workers, as well as capacity building, employment, and retention.

The saying goes, “Information is power”, however if we have learnt anything from the existent issue, generated by misinformation and disinformation in our healthcare sector, it is that true power rests in fact-checked information. To ensure that no one is left behind in the effort to lower child mortality due to inadequate breastfeeding, arming our community influencers with this authority is a big step toward realising our country’s goal of exclusive breastfeeding.

Written By: Adedeji Adeniyi

Highlights From The Twitter Space

Written By: Adeyinka Adenikinju

Fig. 1 our surprise look as the Twitter space kept shutting down. (Image courtesy quotesGram)

On the 16th of September 2022, we had our second Twitter space titled; Does disruption have to come from inside or outside healthcare? It would have been expected for me to say it was a continuum of the hitch-free public sessions we were accustomed to; from our inaugural twitter space to our Webinar and extending down to this, alas it was disrupted with the space shutting down more than once.

You would say tech disruption has its cons and this may be one of them, right? But it all adds to the learning curve and established experience that makes us better people. Oh yes, we did successfully continue the discussion with our guest anchor Dr. Ronald Ikpe (@ronikpe) who is a social media consultant, a medical doctor, a health content creator, an EHR implementation strategist, a health podcaster, and a medical researcher.

He did start by defining disruption which in simple terms is about challenging the status quo which can be as a result of the unpleasantness of the current way things are done or even if a more efficient way can be looked into and in healthcare, it’s about challenging the status quo of how healthcare is being rendered. Most people associate disruption with technology because it is the most visible part of or enabler of the new process but innovation is an integral part of the disruption.

Back to the focus of whether disruption comes from inside or outside, he and others who contributed largely agreed that it was from both sides. He did say this could happen internally as a result of factors like loss of patients, loss of revenue, and loss of public acclaim will be forced to innovate and disrupt the process they already have on the ground to ensure that they stay competitive.

Competition is also another factor that contributes to the disruption emanating internally as well as shifting patient demographics is another factor that can push for the disruption for example when the age ranges of patients visiting the hospital become predominantly

more the elderly patients

For disruption coming in externally, whilst there are such actors, coming externally has its own downside, because most of them do not understand the health tech space, and such a disruptive attempt is most likely bound to fail unless, of course, they partner with healthcare specialist (internally) who understand the processes and standards. They have to partner with players within the space, this could be attributed to a major factor of why so many implementations fail as the internal collaborators were not carried along the planning process or they were not willing to disrupt the current processes.

With covid we did see a lot of disruption, we did see how people

Written By: Adedeji Adeniyi

became knowledgeable about telemedicine and adoption was at a very high rate at hospitals. Wearables also became a thing of trend, though the downside of that is who was gathering the data being collected by wearers of the wearables.

Organizational culture was highlighted as another critical factor for disruption as it ties in closely with change management; these can either be an enabler for innovation and successful change implementation if the work culture encourages innovation and change and vice versa if the work culture is otherwise categorizing one as healthcare needs disruption, ideal persons to probably disrupt health care, factors that push for disruption and he stated some notably disruption observed in the Nigerian healthcare space

Talking about the notable disruption that has happened in the healthcare space like in the pharmacy space, we now see people who use technology to facilitate the last mile delivery of healthcare like Mymedicines.com, in the health insurance space you see Wella health, Life bank making strides in the blood bank logistics and even in the increased adoption of Electronic Health Records with

www.genesys-health.com

a lot of benefits like continuous availability of patient record aiding continuity of care, better preservation of records, efficiency, etc. though with its own downsides like cost, training of personnel and usability issues, doctor burnout, etc. so it’s a continuous process until we get to the desired end.

On a larger scale, robotics, Precision medicine, and artificial intelligence especially when you consider diagnostics, reading x-rays predicting cancers.

The system will still be disrupted further with the big tech players venturing into healthcare; with the likes of Amazon, Microsoft, Google, etc. this shows the market viability

Questions arose from one of the listeners who appreciated the facilitator for proper coverage of the topic, and the first question was how could outsiders come in and contribute to the positive disruption of healthcare, the processes involved in the disruption, and the mitigation of side effect of the use of disruptive technology.

Dr. Ron’s response was to add some more flesh to the examples earlier mentioned, his approach was to talk

through some of the disruptions happening at the moment with a view of deciphering if they are from within or external of the healthcare space. He talked about looking at the brains behind the disruptions. For example, if he examined mymedicines.com, Pharm Adebakin being the brain behind it, as a pharmacist in the healthcare space she understands the problem, another look at Weller health; Neto is a medical doctor so he understands the healthcare space, Debo of Doctoora is also a doctor and most of the players in the HER space are proper technology specialist who partner with healthcare professional, so these examples prove the mix in the sources of disruptive healthcare being from both inside and outside healthcare.

He did mention that there is a role for everybody to play with the best route being partnerships and mergers. A lot of roles will need to be filled to cater to the skillset that will ensure the success of disruption in the healthcare space, the need for product managers, project managers, implementation specialists, etc. to ensure a successful implementation and development

of a product.

On the aspect of mitigating the negative impacts of disruptive technology, he pointed out the need for government to enact and enforces strong regulatory policies. Better design for EHR to help reduce burnout, multiple pieces of training to reduce knowledge gap which promotes easy adoption, and lastly, support from the government in terms of funding to spurn rapid disruption in the healthcare space preferably with the government being not involved in the utilization of the funds to allow for transparency.

Another question asked was if the Government support by funding could be a game changer especially in changing the tide of healthcare specialists migrating to greener pastures leading to a very poor physician-to-patient ratio in the country; he did respond by saying, interestingly a plus from the disruption, telemedicine has become an enabler in allowing healthcare specialists give access to care to their patient without distance being a barrier, a notable one is Gerocare which allows the monitoring of your elderly ones in their respective locations. But he did say there are systemic issues

Written By: Adedeji Adeniyi

that technology can not really solve, like not enough equipment, poor salary, no hazard allowance, the quality of education with reference to Nigerian Universities being on strikes for over six months, etc.

Contributions were also made on how proper enlightenment on the need for fundraising and grants for researchers in the healthcare space is important and the consequences of not fulfilling obligations by donor agencies and organizations as well as sponsors for the researchers could go a long way to encourage a culture the supports researches which will be of eventual benefits to the populace in the healthcare space.

Ayo-olagunju Muna did contribute by saying that disruption at a scale that would positively affect a large scale of people, with reference to the covid era was the witnessing of Covid 19 vaccines being produced in a shorter duration than the usual long time as expected to produce such vaccines being a disruption in the healthcare space. He also talked about the brewing disruption in the Nigerian healthcare space with the enactment of the NHIS authority act which if played out well could be Nigeria attaining the British NHS

level, as this would bring the need for interoperability at a nationwide scale and this need might be solved. He concluded by saying that disruption in the healthcare space will be a good CrossFit and perfect unison between the subject matter expert and the technical matter expert.

Another question that was posed to the guest facilitator was that “with funding, like mergers and acquisitions being on the critical factors or enablers for disruption in the healthcare space, the happenings in American healthcare space, could that also happen here in Nigeria too?” and He did answer in the affirmative citing examples like Weller health acquiring Wellbiz, Mpharma bought the majority of stakes in HealthPlus, and Rjolad and Lagoon Hospitals having new owners, and these are opening up the healthcare space for better funding and we should expect more as one of the other contributor mentioned.

He also added that the lack of collaboration of the key players in the healthcare space is the reason for the inertia in the position of where we are in healthcare and thus, he encourages more partnership in the forms of mergers and acquisitions.

In a conclusion, the necessity of interoperability which will involve the patients, caregivers, tech organizations, and policymakers, the need for inclusiveness of the public will be very helpful rather than limiting Government and key players’ partnering will go a long way in changing the narrative of our health care space.

And that’s a wrap kids!!!

He did conclude by saying disruption is a continuous process, data-driven, which is to be important, and relevant and not just for disruptive cases. The factors like government backing, funding, and collaboration among the players in the healthcare space, especially the small players make for a brighter future in the healthcare space in Nigeria

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