Adaeze Odili Oreh is a Consultant Family Physician, Country Director of Planning, Research and Statistics for Nigeria’s National Blood Transfusion Service (NBTS), and Senior Health Policy Advisor with the Department of Hospital Services in Nigeria’s Federal Ministry of Health.
She has over 18 years of private and public healthcare experience and sits on the Governing Council of Pamo University of Medical Sciences – Nigeria’s first private university of Medical Sciences.
She is a Fellow of the West African College of Physicians, the Royal Society of Tropical Medicine and Hygiene and the Royal Society of Public Health. She is also a member of the White Ribbon Alliance for Safe Motherhood Global Strategy Advisory Group.
She is a Hodgkin Lymphoma survivor and won a Best Poster Prize at the International Society of Blood Transfusion 2021 Congress in Amsterdam for research which she led and coordinated on blood services in 34 tertiary hospitals in Nigeria during the COVID-19 pandemic. Also, she won another Best Poster Prize in the blood donation category at the 2021 British Blood Transfusion Society conference for research she also led and coordinated on the impact of COVID-19 on the Nigerian National Blood Service.
Oreh holds an MBBS degree from University of Nigeria, Nsukka and Master of Science (MSc) degrees in International Health Management from Imperial College and Public Health from the London School of Hygiene and Tropical Medicine; in addition to Leadership, Management and Public Policy certifications from Harvard Kennedy School of Government, University of Oxford Saïd Business School, Harvard Chan School of Public Health, University of Bath, and the University of Washington.
What experiences of your formative years would you like to share with us?
I grew up and spent much of my early years in Port Harcourt. My mother is currently a Supreme Court Justice, but while growing up, she was a magistrate, and my father was a medical doctor running his private practice at the Pamo Clinics & Hospitals. I am the first of four children, so even then, I was pretty close to my parents. Watching them, their zeal and commitment to work developed a work ethic in me. I therefore knew about the concept and value of work and how things don’t generally come easy unless you work hard for them. Also, I watched my mother mentor other women, as she served in the International Federation of Women Lawyers (FIDA), and as an executive with the Horticultural Society and other associations and societies. I observed her being mentored by older women. So as a young girl, I was exposed to the concept of hard work, mentoring, giving back and lifting others.
I have a close relationship with my siblings, and we exchange stories of the various experiences and challenges, including what we face at work – both my sisters are High Court Judges, and my brother is a manager in development finance. For all four of us, from this close-knit relationship and being exposed to work from our parents, we have all understood the concept of work. I do realise that this may not be the situation for people, as they may come from backgrounds where work is not emphasized or may have had challenges growing up or parental experiences.
Did your father becoming a governor affect you in any way?
Definitely there were certain moments when I felt that my life and those of my siblings would have turned out differently if we didn’t have the additional role of being children of people in the public eye. Occasions when people would try to give their opinion as to how we should behave or who we should befriend. I think that was one area of conflict I battled with. However, my mom played a major role in helping us achieve some sort of balance. First, they both insisted we studied for our undergraduate degrees in Nigeria. I got into the university before my dad was elected governor, and so I already had a life in Nsukka and Enugu before the transition to becoming the daughter of a state governor. Regardless, they allowed me live my life in the university. I lived in the hostel with my roommates for all eight years in medical school (what should have been six years without strikes), rode the bus from campus to the teaching hospital with my classmates, and was very familiar with both the Enugu okada routes and Ogbete market. That freedom allowed me to live my life as a medical student without any undue pressure and attention, and was a huge gift that my parents gave me.
Of course, there were moments when you would read something in the press, or someone would find out whose daughter you are, and all of a sudden, the conversation changes. Despite this, when I consider that where we are from in Rivers State is nowhere near the majority, it affirms to me the power of representation. Because I would think to myself “Wow! If this self-made medical doctor from Ndoni could become the governor of Rivers State, then there is nothing one cannot achieve with hard work and God’s grace.” This affirmation was so powerful for me, that even when I had those moments when the restrictions meant I could not be as free as my friends, there was still this thought at the back of my mind that there was a reason why we were in that position, and it was basically for service and for impact.
Why the choice of being a medical doctor?
Well, for me, I was initially confused. The choice of a career was left to me to decide, and so I was torn between Law and Medicine. Again, it goes back to watching my parents. Frequently, I would visit my dad in the hospital, and I would see how he interacted with patients and their families, and how he offered care. So, to see people who had recovered from illness was amazing to me. On the other hand, every time I was on vacation, I would take up a role as a most unqualified personal assistant in my mom’s chambers, generally trying to keep things neat and orderly in her office while not being in the way of her staff. When court was in session, I would sit and watch the proceedings, and it just looked like this amazing interaction between the lawyers, the defendants, the plaintiffs and of course the judge. I saw my mother in another light at those times, and it was simply beautiful and powerful. So, I was torn between Medicine and Law. However, by the time I was rounding up my SS 1, I had to make the decision, and so I opted to go into Medicine basically because I wanted to be involved in the hands-on process of caring and healing. I have never regretted that decision, and so I would say I was called to Medicine.
Take us through your foray into blood services
My foray into blood services began in 2009 when I was invited to take on a project coordinator role for the blood services in Abuja, Niger and Nasarawa states. At that time, the blood service was a product of a collaboration between Nigeria’s federal government and the United States government, primarily to provide blood services and to address the HIV/AIDS epidemic.
Over the years, there has been increasing emphasis on the role of research for policies that affect and impact lives positively. The Department of Planning Research and Statistics was never a core department of the blood service from inception, but with everything happening with the Covid-19 pandemic, there was a sense of urgency that this was something that was critically needed, and so I presented a proposal to the new CEO of the National blood service. I would say this is a clear example of opportunity meeting divine ordinance because the CEO apparently had that department in mind. I was invited to be the pioneer Head of the department and my responsibilities include strategic planning, partner coordination, monitoring and evaluation, and information communication technology for all the states and zonal blood services across the country. My role is quite vast, but I have a solid team with very enthusiastic and dynamic young people, who are willing to contribute to make an impact in blood services and the health sector. I am also glad I have a very supportive top leadership which makes it very worthwhile.
Are you burdened by the exodus of medical practitioners from Nigeria?
Well, it is very apparent for medical doctors and other healthcare professionals, it is a system-wide issue because these professionals live in our communities and experience the same challenges that are pervasive in our communities. For example, the security challenges for doctors may be heightened because we often have to work hours outside the norm because of call duties and shifts. You have doctors and nurses who may be returning home after emergencies, surgeries or other work-related reasons at 1 am or 2 am. Over time, the risks they are exposed to may get to a point where they weigh their options and are pushed to other countries that have attractive offers in place for skilled professionals. I wrote a paper on this several years ago and again last year with another colleague Dr Tijani Salami.
There are other environmental factors that push professionals outwards, for some it may be the remuneration that is not comparable to western countries, or it may be access to education for one’s children or career growth opportunities. Pull factors are those factors in countries like US, UK, Australia, South Africa, or Canada which are the current top destinations for our healthcare professionals. We, therefore, need to look at it from those lenses regarding those situations that drive our professionals to leave and see how we can build an environment that encourages our professionals to either remain here or seek to return.
Beyond attracting Doctors to come back home, what exactly do we need to get right with the healthcare system in Nigeria?
For a very long time, we have neglected our primary healthcare delivery system and basically what that means is that for many individuals, adults, children, the elderly, the most common ailments such as chest infections, diarrhoea, malaria, and so on, cannot be treated within their communities at the primary or first level of healthcare. We have 774 local government areas in Nigeria and thousands of primary health care centres. However, not many people across the country have direct access to a functional primary care centre where they can go to get immunisation for their children, or where women can get antenatal and reproductive care, or where common health conditions can be treated. Because of that gap, what we see is that many of our general, district and teaching hospitals that are designed for more advanced level care, teaching and research purposes are flooded with people who are suffering from conditions that could have been addressed effectively in functional primary care facilities. Therefore, these higher-level facilities designed for high impact diagnosis, treatment and innovation which should have been referral centres of next resort are bugged down giving basic healthcare services, and this is not an efficient use of resources. This is why despite some advances in the Nigerian healthcare space by several talented and deeply committed colleagues who have made significant contributions, as a country, we are still short of our potential, primarily because we have not efficiently harnessed our health system.
Would you say there is hope?
I am one of those eternal optimist that believe that once there is life, there is hope, but what we really need is strategic thinking on how to organise our various systems not just the health system. The challenges and implications of a weak healthcare system make it more apparent, and in the background of a global pandemic, even more urgent.
Once we are able to strategically focus on the repair, recovery and optimal use of our resources in the primary, secondary, and tertiary healthcare systems and be clear on the expectations from each level of care, we should see things turnaround. We cannot neglect the fact that a substantial number of our population live in rural areas. For as long as there is poor access to health for a major proportion of people by virtue of where they live our health indices will continue to be poor and the country will continue to contribute an enormous burden of disease to the rest of sub-Saharan Africa.
What role can the private sector play in the desired change in Nigeria’s healthcare system?
I’m one of firmest proponents of public-private partnerships. And I don’t think that the public sector can achieve the necessary reform alone without collaborating with the private sector. This is because the private sector has substantial reach, access to resources – financial, human, and technological resources. There is enormous potential for training and astute management thinking that is critical to looking at how we can reform our health sector from a business perspective. Not a business for profit perspective per se but a business for productivity perspective that will lead to improved health outcomes. So, I’m not one of those people that is terrified about the role that private sector can play in helping to turn around the health and social development sectors in the country.
Share on how you survived Hodgkin’s lymphoma
Every day I live in gratitude because about 17 years ago I was diagnosed with Hodgkin’s Lymphoma. This is a cancer of the blood, and primarily affects the lymph nodes which are like a drainage system within the body’s circulatory system. So here I was, a recently graduated doctor, had completed my house job, recently got married to the love of my life who I met in UNN, and had just had the most adorable baby daughter. When I first noticed the lumps under my arm, I thought it may have been because I wasn’t draining properly following poor positioning during exclusive breast-feeding. After more than 24 hours, the lumps were still there, and the medical doctor started thinking of likely causes. I then thought that perhaps it was tuberculosis because of several patients who I had managed prior to this, and so I started carrying out tests. Every colleague who saw my test results advised I go for a second opinion, and that got me really worried as my blood tests were off the charts. At this time, the swelling was no longer just under my arm alone, and after more invasive tests like biopsies of my lymph nodes and bone marrow, I was diagnosed with late-stage 2 Hodgkin’s lymphoma. This was especially devastating because around the same time, Lynden David Hall, a prominent British R&B singer had died from it. I asked myself what the odds were. This was a celebrity in the UK with access to the best of health care so what are my own chances? But I was able to dig down and hold on in faith that my own story would be different. Eventually, I had to start the treatment and of course stopped nursing my daughter to begin several months of chemotherapy. I lost my full head of hair, and even my eyelashes. So, I would like to say I was one of the early wig pioneers.
This experience was towards the end of my youth service year, but I was adamant that I would continue working, and so, I would take the treatments on weekends, sleep through the effects of the chemotherapy and then be back at work on Monday. It was a very trying time, but I had substantial support from my family – my husband was incredible, and my parents and my siblings were amazing, basically standing in the gap and giving my daughter all the necessary care and attention. I would say she got a lot of love in those months and so I’m very thankful that I came out of that experience and survived. But one thing that it emphasised for me was that if I went through that ordeal given my profession, family background, and the resources that I had, what would be the fate of someone who did not have access to any of these? Because even before the treatment started, the rounds of investigations and tests that needed to be done were all paid out of pocket. For millions of Nigerians, they are just one diagnosis away from poverty or worsened poverty. So that moment solidified my commitment to improved access to basic, quality health care.
How has it been living cancer-free? Any fears?
To describe that feeling, I will tell you what happened months before I became cancer-free. Halfway through the chemotherapy, I was informed that suddenly my body was not responding to the treatments despite an initial response. If there was a point when I would have lost hope, this was certainly it. But somehow, again, I was able to call on God and say ‘Father, you initiated the process and progress up to this point, and nothing is too great for you.’ And so, I just left it and intensified my praise. At the end of my treatment, I was given an appointment to get the results, but the doctors were running really late, and I was getting impatient when I heard a voice in my spirit, “You are here to hear about my power and what I can do; just wait”. And then I just sat down and decided to be patient and wait. The doctor came out and said “Let’s go into the consulting room”. Again, the human mind – I wondered, “Why is he suddenly coming out to call me in? Why am I suddenly being escorted? Is he about to break some terrible news?”
I had just pushed away those thoughts and questions when he said, “Dr Oreh you are in remission” I put my head down, tears dropped down my face, and I said “Father, I thank you.” That was all I could say because I knew it could only be God. I received 100% chemotherapy in Nigeria coupled with my Youth Service duties and an infant daughter. It is simply amazing what God can do when we put our faith in him.
Across the country, there are people being diagnosed with cancer, even now as we speak. You can imagine the impact of what that diagnosis can have on a family, but from my experience, I think the most important thing is to just approach it with faith. I am truly grateful because the outcome could have been different, and I am thankful because I experienced the love of my family in a way I had never experienced before.
When one finds themselves in such a vulnerable position – and I believe many of us have people going through similar experiences – you can never underestimate the power of that outstretched arm love and support from family, friends, even colleagues and community members that will help them soldier on through that difficulty.
What is it about surviving cancer that survivors need to know?
There is a greater appreciation that you have for yourself, for your body when you recover from something like that. It is very important that you treasure that temple of your body and do everything possible to make sure that you are eating right, doing the right things to take care of your body just in appreciation of that miracle that has happened, because cancer is something that is still being studied and researched. Despite the many advances in cancer management, many people have fallen from the disease, and so it is very important that those of us who have survived do not take our healing for granted. For me, I also regard survival as part of a bigger plan for humankind. For me, since my experience, I feel beholden to those who we know to be underserved – those on the fringes of society with minimal access to some of the necessities of life, health, and the social determinants of health. I, therefore, feel a personal responsibility to use my skills and training to do whatever is necessary to open doors of access for them for the things that will make their life better. Things like health care, education, and social development initiatives because I know that I was saved to do much more.
As a country, I believe that there is a reason why God made Nigeria so populous. Imagine the possibility of millions of people working to bring about positive change – so many possible heroes. Therefore, I am living a life of purpose. One thing that emerges from a lot of people who have had similar experiences to mine is that recollection, that remembrance that we were saved for a higher purpose.
In celebration of International Women’s Month, following the theme ‘breaking the bias’, what bias do you think needs to be broken?
The first bias that comes to mind is the bias of perception of what women should be and how women should operate in the world. In a lot of places, we are expected to be seen, look pleasant, and non-threatening, but we should not be heard, and should certainly not do anything to change the status quo. So basically, in many ways, women are expected to be invisible. So for me, breaking the bias means realising that as a woman you occupy space in this world, and therefore you have something to contribute either through your voice or by the work of your hands. You are empowered by God to effect positive change wherever you find yourself, so for me breaking the bias means breaking those gender stereotypes. Sadly, when people hear gender stereotypes, they often think that these stereotypes are perpetuated solely by the male gender, but this is untrue. Many times, we women perpetuate some of those gender stereotypes, and so we should accept that responsibility and be open to accepting our fellow women regardless of any differences. We should respect the skills and voice of every woman. Therefore, breaking the bias is encouraging other women to use their voices, contribute towards positive change, and not be doormats, floor mats, wallflowers and certainly not be invisible.