“DECLARE THE PAST, DIAGNOSE THE PRESENT, FORETELL THE FUTURE”

TEXT OF LECTURE PRESENTED BY DR ADEDAMOLA DADA (MBBS,FMCS,FWACS,FMC.Ortho,FICS) MEDICAL DIRECTOR/CEO, FEDERAL MEDICAL CENTER, EBUTE METTA, LAGOS AT THE INDUCTION CEREMONY OF THE 4TH GRADUATING SET OF AFE BABALOLA UNIVERSITY MEDICAL SCHOOL ON THURSDAY, 18TH NOVEMBER, 2021 AT THE PTCF BUILDING, ABUAD.

Protocols

First, let me thank the authorities of the Afe Babalola University, Ado-Ekiti especially the Vice-Chancellor and Principal Officials of the University including the Provost of the College of Medicine and his team for this invitation to deliver the graduating lecture to the 4^th Set of Medical graduates of the ABUAD Medical School.

This program elicits some degree of excitement in me as I remember with nostalgia how my mother shouted with joy at the mention of my name during my own “swearing in” as we call the induction ceremony colloquially.

I also acknowledge the presence of my brother – the Registrar of MDCN; Dr. TAB Sanusi and his team and of course my mentor – Dr. Kayode Akinlade, a man that is a blessing to many young people and many good causes and also my brother CMDs – Dr. Kunle Ajayi of FETHI Ido-Ekiti and Dr. Kolawole Ogundipe of ABUAD Multisystem Hospital (AMSH)

Most importantly however, permit me to appreciate the founder of this University and this Medical school- Aare Afe Babalola who continues to astound even into very old age. Aare has conquered his generation and he is showing our generation and indeed future generations what nation-building is all about. When you educate a mind-you educate a nation. It was in fact the father of our Art (and science)- Hippocrates of Kos in Ancient Greece who lived between 460BC and 370BC and died at the age of 90years who said ‘’ that which is used, develops. That which is not used, wastes away’’. We thank Aare for using his talents, his intellects and his resources to develop this university and especially this medical school and just like the father of our profession who started the Hippocratic school of medicine which was a school of thought- As long as this university lives, Aare’s name will remain with us and on our lips for ever and ever.

Next are the eighty-five graduating students of today. But today is not just about you alone. Yes, we acknowledge your great efforts at graduating from a fantastic medical school like ABUAD where everything works and where particularly, there are no ASUU strikes- I have gone round the hospital and I can say clearly that you have trained at a hospital comparable to any other one anywhere in the world using world class facility and you are therefore well exposed and well trained for the new world. But today is also about your parents-maybe in fact more about your parents, because I remember like I said earlier, my own parents were over the moon when I became a doctor- those parents have helped you to achieve your vision and today is also about your teachers who have imparted the great art and science of medicine in you, sometimes at great personal sacrifice.

I therefore congratulate you and congratulate your parents especially and also your teachers, families and friends. I welcome you to our profession where there is no working hours- A doctor is on duty for 24hours in a day and a doctor is ever willing to suffer discomfort for the sake of his patients. Right from the time of ages- the sacrifice, the compassion and the understanding a doctor gives are many times as important as the treatment you will offer to your patients. Indeed, as you have found out during your training here, treatment is about the art of gaining the confidence, the affection, the respect and even the love of your patients.

All these translates into the trust that your patient has for you as a doctor. If that element of trust is lost or absent –then, I am afraid, you may cure your patient of his disease but you will not heal your patient of his condition. It is therefore not about the money. It is about the dignity with which you practice the very noble profession you have chosen to practice for life. It’s a lifetime profession because a doctor never retires. His patients who have trusted him for ages, who have confided in him the deepest secrets of their health and even the deep secrets of their families, their situations, their businesses and of their lives. Secrets that must never be divulged even after their deaths.

Patients would come back again and again and again to their trusted doctor and very frequently where that bond is strong- only death which is inevitable, retires a doctor or retires the patient. And therefore like Donald Berwick MD said-‘’ Those who suffer need you to be something more than a doctor; they need you to be a healer….You must take your white coat off. You must recover, embrace and treasure the memory shared…of the dignity in each and every soul.’’

Permit me briefly, Mr. Chairman, to digress a bit. About a little over a hundred years ago, precisely in 1918, earliest documented case was February/March 1918 – an Influenza Pandemic now known to have been caused by the H1N1 Virus ravaged the world, starting from Europe and rapidly spreading through the entire world. Like its subsequent successors, it was known to cause cytokine storms and overwhelm the immunity of its victims leading to death. Unlike COVID, it affected mainly young people whose immunity were strong and about 500million people, a third of mankind were infected and 50million people, some even say 100million (3% of world population) died.

Certainly, the worst documented pandemic in world history. It was called the Spanish flu, not because it originated in Spain but reportedly because Spain had one of the worst number of cases and the Press in Spain reported it much more, because Spain had minimal involvement in the first world war, despite the fact that those who were involved in the war suffered more morbidity and mortality as a result of the movement of troops on tightly packed vessels.

It had 3 waves and the second wave was the most devastating. Treatment was essentially non-pharmaceutical. Nigeria, our very dear homeland was not spared. Documented medical history says that the condition entered Lagos, Nigeria on 14^th September 1918 via vessels from abroad and the disease rapidly spread and within the first 6 weeks, Lagos a town of eighty one thousand, nine hundred and forty one people (81,941) lost 1.5% of its population and subsequently rapidly spread to Ibadan, Abeokuta, Ilorin, Bida, Kano and Onitsha finally engulfing the entire country. About 500,000 Nigerians out of a total population of about 50-55million died and about 50% of this population was infected. A 100 years later, just when we were all preparing for the Christmas of 2019, we all heard of a strange virus in Wuhan, China and in no time, the entire world was engulfed and like they always say- Our lives have not been the same since then!

The first case of Covid was confirmed in Nigeria again in the same city of Lagos but now with a population of about 22million (Compared to 81,949 in 1918) on the 27th of February 2020 and expectedly it has gone round Nigeria. As at the time of preparing this paper, 260million people (compared to 500 million in 1918) worldwide have been infected and 5.2million (compared to 50-100million in 1918) have died. The reduced morbidity and mortality in this particular Covid pandemic is substantially due to the rapid development and improved methodology in the profession you are joining today. In Nigeria, we have had 213,175 compatriots infected, some of them, multiple times and 2968 deaths.

Dear colleagues who are joining us today- many of the dead are members of our profession who like us were at the forefront of the battle to save our country and our people and indeed the world from the scourge of this terrible germ- whom we did not take up battle with, whom we do not see but nevertheless took up battle with mankind and has been very devastating. In the city of Lagos alone and between the three months of October 2020 to January 2021, we probably lost more doctors and other health workers than we did in the two years prior, combined.

According to the Hippocratic oaths to which all of you will subscribe, recall and use to guide your professional and personal life at all time-all doctors everywhere on the surface of our earth are siblings. Therefore, as we remember today and always those colleagues/siblings of ours who have paid the supreme price in the course of serving and saving humanity and who have left their spouses and their children behind in the process of keeping faith with the physicians oath they swore and which you are also swearing today- I plead with you to take very seriously with sobriety and commitment the responsibilities and the duties of this oath as this will remain your guiding principle throughout your career.

You will also be evaluated on the basis of this oath. And for those of our compatriots who have paid the supreme price worldwide in the course of fighting this pandemic and fulfilling the physicians oath which says among others that, ‘’I solemnly pledge…that the health and wellbeing of my patients will be my first consideration’’– We use this solemn yet important events today to remember them and we pray that God grant them all and indeed all the victims of Covid worldwide, eternal rest. For our colleagues who have passed on in Nigeria, we will always celebrate your memory.

Medicine is a rapidly evolving profession with new methodologies and new discoveries. It is a lifelong profession of learning. To be a successful Doctor, you must be part of the new developments; you must continue to read regularly and maybe even every day to ensure you are not left behind. I trained in the late eighties and ended up an Orthopaedic and Trauma Surgeon.  I am presently a manager in the health system of our country, but before I got here, I was once like you – young, impressionable, exuberant and occasionally uncertain about expectations of medical education and life thereafter. I have gone round almost all continents in search of knowledge and personal improvement and development for that is the only way to keep in touch with the almost daily dynamics of our profession.

We are practitioners of a profession that is unrelenting in its search for improvements and a profession where we do not believe anything is impossible. Otherwise, on the day I was inducted into the profession- I never contemplated that unborn babies could one day be surgically operated and returned back to the uterus to continue its development, that a knee could be completely replaced and its functions restored normally thereafter, that robotic surgeries which would give better precision and outcome would become almost routine.

That the human genome would be completely mapped, that organ transplant would become routine, that precision medicine would revolutionalise cancer therapy, that robotic surgery would aid the performance of complex surgeries and may one day even retire surgeons and even the discovery and popularization of minimal access surgery- and now, the profession is moving into artificial organs so that waiting time is eliminated for those waiting for organ transplant, there is also the concept of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) which when perfected may have a profound effect on the way we treat diseases just like the messenger RNA technology has changed forever the way we make Vaccines and maybe even treat diseases and has allowed man to shorten the journey of 10years in Vaccine production to less than one year with the Covid Vaccine- this technology would yet have profound effects not just on infections like Covid but even on the treatment of Cancer because man has finally overwhelmed by sheer efforts of hard work and determination the twin effects of high inflammatory reactions and molecule instability that has held man back in putting to good medical use the mRNA technology until now.

It has in fact been touted as a development that may become a revolution in medicine. Yet, all of these and even more were pioneered, improved and reviewed by members of your generation. With them and therefore with you- Nothing and absolutely nothing is impossible. The future belongs to you, dear friends-stand up, be counted and join the revolution. Through the education you have had at ABUAD- you have all the tools you need and you must be part of this audacious generation that is disrupting conventional knowledge and innovating on things we thought were impossible. And so like Yvonne Thorton, award winning author and Physician said in 2003- I say to you today;

‘’ Whether you go into research, business, law, medicine, public service or education, neither you nor society can continue to survive or prosper simply by implementing what is already known. Somebody is going to have to come up with meaningful new ideas, creative new approaches and important new discoveries. Why can’t that ‘’somebody’’ be you?

Finally dear colleagues- the life of a Physician is a tough one. We are held to a higher level of professional standard and our works are very frequently brought under inquest.  The Medical and Dental Council of Nigeria (MDCN) which regulates the affairs of Medical and Dental Practitioners is a very serious organization.

From January 2017 to August 2021, the Medical and Dental Practitioners Investigation Panel determined that 120 registered practitioners have Prima facie cases of professional misconduct and referred them to the Tribunal.  The Tribunal determined the cases of 37 referred practitioners and erased three names from the register of Medical and Dental Practitioners in Nigeria and suspended from practice twelve practitioners  and admonished five others after conviction.

You must therefore learn from the get-go the importance of documentation. You must document clearly and fully even when you are tired. You must read the MDCN professional code of conduct thoroughly, understand it and practice it. Therefore, you must practice your profession with compassion and conscience, you must speak up on behalf of your patients and must not use your medical knowledge and training to abbreviate life or support injustice or human right violation. You are entitled to your professional fees but you must not exploit your patient or his or her situation. You must radiate dignity and confidence, avoid profit –sharing and know that in our profession every action of yours can be investigated and therefore you must at all times avoid infamous acts. You must practice with the highest ethical standards and know when to refer a patient to another expert. You must never ever take physical or emotional advantage of your patients, for our profession is one of trust and you must keep the secrets of your patients even after the death of that patient.

But the best advice is that of the father of medicine, Hippocrates of Kos who said;

‘’ As to diseases, make a habit of two things-to help, or at least, to do no harm’’.

This speech would not be complete without mentioning the current trend in country, which is brain drain. It is not news that many young doctors and even old ones are leaving in search of ‘’greener pastures’’. It is however important to remember that the development of a country is the responsibility of both the citizens and the government and like your Provost- Prof Laofe Ogundipe who graduated from University of Ibadan Medical School and went on to practice for decades in the UK realized a few years ago- ‘’West or East, home is the best’’.

I congratulate you, your parents, families, friends and teachers again and wish you all a successful and most fulfilling career.

Adedamola DADA, MBBS,FMCS,FWACS, FAO(Trauma), FMC.Ortho, FICS

Medical Director/CEO

Federal Medical Centre, Ebute Metta, LAGOS

Tagged: #ABUAD, #MDCN