If Isidore Obot, MPH’84, could ask for just one thing to improve public health in Nigeria, it wouldn’t be better hospitals, more health clinics, or improved sanitation--although all these things would help. What public health in his country needs most, says Obot, is a stable democratic government.

Obot’s wish may be coming true. The country’s first popularly elected president in 20 years, Olusegun Obasanjo, is scheduled to assume office in late May. With Obasanjo’s election have come the first inklings of optimism about the country’s future in a long, long time. "My hope is under the leadership of the new president things will change and improve," says Adetokunbo Lucas, SM’64, a native Nigerian and adjunct professor of international health at the School.

With 110 million people and vast oil reserves, Nigeria has the largest economy in West Africa. But rampant corruption and embezzlement of public monies by a succession of military governments have caused the collapse of Nigeria’s once vital economy and ruined much of the country’s health care system. "Things are so bad," says Lucas, "they cannot get any worse." He ticks off the problems: the health care system is poorly organized, doctors cannot find jobs, and the basic necessities for providing care aren’t available. In many respects, Nigeria remains better off than many of its neighbors as measured by standard health indicators. Yet the infant mortality rate was an estimated 78 per 1,000 live births in 1996 compared with the U.S. rate of 7 per 1,000 live births that same year. Malaria and diarrheal disorders abound. Tropical diseases such as river blindness and guinea worm plague those in rural areas. Unenforced speed limits and drunken driving laws makes traveling hazardous. Though the AIDS epidemic hasn’t hit the country as hard as many other places in Africa, public health workers say the prevalence of HIV infections in Nigeria is on the rise.

Oluranti Aladesanmi, an MPH student at the School this year and a doctor trained in Nigeria, says that most Nigerians do not have access to health insurance. By the time he left the country seven years ago, even in an emergency a surgical patient needed to guarantee payment of the necessary supplies and medications. If the patient or the patient’s family didn’t have the money, the hospital turned them away. "By the time I was about two years out of medical school, in the mid-1980s, it was that bad. Basic access to emergency services were nonexistent," he remarks.

Aladesanmi says that in the early ’70s, most government health care programs actually worked fairly well. "Initially the country had funds from the oil industry. Eventually people began to embezzle the money, and money meant for health programs never got there." As a result, he says, health care professionals are increasingly demoralized. Doctors trained in Nigeria have few options, and many have left the country. Aladesanmi says the U.S. has offered him professional development he never could have obtained in Nigeria. Besides, he doubts he could have earned enough money in his home country to support his family.

Obot returned to Nigeria after graduating from the School in 1984 and co-founded the Center for Research and Information on Drug Abuse in Jos, a city in the center of the country. Obot says alcohol presents the most harmful substance abuse problem in Nigeria, which is made worse by the lack of drunken driving laws and no mandated age for legal drinking. Obot’s own research has led him to conclude that excessive drinking often leads Nigerians to visit prostitutes, which in turn has helped spread HIV. Currently, Obot is at Johns Hopkins, studying substance abuse. He plans, however, to return to Nigeria in August. He says his choice to go back home is a matter of relevance--of wanting to make a useful contribution. Obot is guarded in his comments about the new government, saying only that he hopes the new regime will take an active interest in public health.

Like Obot, Michael Egboh, MPH’94, went home. He runs the Nigerian office of Pathfinder International, a nonprofit organization based in Watertown, Mass., that supports reproductive health and family planning programs. Egboh’s work for Pathfinder has focused on educating rural communities about harmful behaviors and on teaching village heads, healers, and birth attendants about HIV and birth control so that they can likewise instruct other community members. Despite government indifference and resentment from people clinging to traditional beliefs, Egboh feels his and Pathfinder’s contributions have helped. "If we can start making changes, and at the end of the day I have been part of that change, I will feel satisfied," he says. Egboh sees potential in the newly elected government, if only because international relief agencies that refused to work with the previous administration have already returned to the country. A bit incredulous at the quick turnaround in western attitudes, he says it’s like Nigeria has ended a war, and now everyone is coming to see how they can help.

Nigeria has advantages over many parts of Africa, emphasizes Jason Weisfeld, MPH’77, who assists the Federal Ministry of Health and The Carter Center in Atlanta with the Nigerian Guinea Worm Eradication Program (NIGEP). Though past governments have misused its profits, the country has the eighth largest oil fields in the world. Weisfeld notes that, unlike many Africa regions, Nigeria has an effective communications system, and its roads are in relatively good shape. A network of teaching hospitals exists, and perhaps most importantly, he says, "the talented human resources to work with in Nigeria are impressive."

Weisfeld says that the guinea worm eradication program typifies the frustrations of Nigeria. The first active search for guinea worm cases in 1987 found 755,000, the most reported for the water-borne parasitic disease in any country in one year. Education and the establishment of safe drinking water practices quickly brought the numbers down. However, in the past several years progress has plateaued. Weisfeld cites past governments for the withdrawal of funding by western donors, the departure of the Peace Corps, and fuel shortages that make travel difficult. He says that he certainly has hope that there will be changes to bring about improved working conditions and facilitate work efficiency in Nigeria. Hope has been a frequent casualty in recent Nigerian history, and Weisfeld is somewhat cautious. Until it takes office, the new regime is an unknown, one capable of destroying fleeting expectations.

-- Judy Silber