Zara Modibbo, Aisha Wanka, improving healthcare for African women

Zara Isa Modibbo and Aisha Nabila Wanka have been on similar journeys for three decades before they really met on a quiet afternoon in Lagos where they engaged in a deep conversation about healthcare, Africa and their own independent struggles that had led to a deep passion to improve women’s health for African women. This is when they decided to create a seat for themselves on the table for discourse, to become an integral part of the solution to a growing problem, to take all their years of intense studying and exposure to some of the world’s best medical schools. So together, they built Débbo Africa.

During their years as clinicians in different hospitals across Nigeria, they experienced personal and professional challenges while navigating the health sector, particularly as females. This led to the idea of providing a channel where healthcare is brought closer home to women, a platform where they can get qualified health advice at their convenience by female specialists who oftentimes are more understanding of women’s health issues.

Débbo Africa is an integrated and trusted platform for quality personalised diagnostics, focused on cancer, sexual/reproductive health, and infectious diseases, also providing virtual consultations for females, by females. Their women only space in Lagos, Nigeria caters to adult females, providing a safe space for cancer screenings, general health checks and mental health counselling, among many other benefits.

Débbo proffers end-to-end personalised medical diagnostics and virtual health specialist consultations on gynaecology, reproductive, mental health, diet and nutrition, among others. They host fire-side chats, book clubs, group counselling sessions, and fitness classes among other activities in their serene lounge. Also offering a subscription-based service called the ‘Débbo Tribe’, where members are part of a community with access to discounted services and additional benefits.

Zara Isa Modibbo

Managing Partner, Débbo Africa

Modibbo is an award-winning Laboratory Medicine Specialist, a Fellow of the West African College of Physicians and a Clinical Microbiologist who has contributed to African healthcare and medical research for almost two decades. She is a graduate of the University of Maiduguri, Borno medical school in Nigeria, and London School of Hygiene and Tropical Medicine UK. She has also received training in Global Health and Epidemiology at the Harvard School of Public Health Boston, MA and is a member of the Global Virology network.

In her last role at 54gene, she served as the Vice President of laboratory operations, overseeing the setup of its laboratories including COVID-19 testing centres in several locations across Nigeria. She is a visiting consultant at the Murtala Mohammed Specialist Hospital in Kano state where she sets up and coordinates global studies in areas of antibiotic resistance and other areas of infectious diseases, and a board member for Clean Tech Hub, a renewable energy innovation centre.

In the last few years, Modibbo has partnered with global researchers at the Bill and Melinda Gates Foundation, Cardiff and Oxford University in the UK to successfully set up and conduct international studies focused on infectious disease research with particular emphasis on the spread of antibiotic resistance across African and South-East Asian countries.

Modibbo is passionate about women’s health and has published several papers on cervical cancer screening in Nigeria, including the first randomised control trial in West Africa on Human Papilloma Virus self-sampling, to revolutionise uptake of screening across Africa. In 2010, she received a Future Nigeria award for excellence in public service.

She loves to be educated through travel by visiting cities of ancient history and spends most of personal time with her family and mentoring young girls in STEM on career choices.

Share your childhood influences and effect till date

I grew up as the daughter of a well-known diplomat, who passed away when I was just 9 years old while he was serving his country. This led me to be brought up by my mother for the rest of my life, who despite being from a family of legendary career women, had only graduated high school before she met my dad and became the wife of a diplomat. As my circumstances had changed from affluence to the reality of life’s struggles, and through observing my mother’s journey as a widow, I realised very early the importance of educating the girl child so that she could weather any storm, and be financially independent, not just for herself, but for her family and community. I have been bred through many experiences, but this particular one has certainly made me self-motivated and created within me a longing for knowledge that leads to impact.

What are your dependent struggles?

Every stage of my life has had its share of struggles. Something I have learnt through the years, is to use these struggles as opportunities for growth. One struggle that has been a constant in my life has been finding the right balance between work and home. The term work life balance has been a myth for me but certainly a necessity for finding fulfilment, especially with my inherent nature not wanting to lose one for the other. Being fortunate enough to find passion in what I do brings me closer to finding a way to a healthier work life integration model and this is something that I cherish dearly.

Why the choice to improve women’s health?

Women’s health is massively underserved, about 50% of women who know they require medical attention have reported being unable to access healthcare. As a woman myself, I have witnessed these barriers firsthand both as a clinician and as a patient. Barriers such as time-consuming processes when trying to access healthcare, lack of a skilled female staff to take intimate samples and distrust of the quality of reports. We tend to have so many things on our plate while trying to balance our lives with family and work obligations, taking care of others, but barely having time for self-care. Many symptoms are pushed aside until they become worse and important screening tests are hardly done, this is further emphasized by diseases like cervical cancer despite being 100% curable when caught in its early stages, it remains the second commonest cancer in Nigerian women after breast cancer. Unsurprisingly, we have one of the lowest uptakes to screening globally.

Is it challenging to propagate this message in the north? How are you breaking though?

Quite frankly it is challenging in every part of the country and in many parts of Africa as well. Health awareness is one of the biggest challenges, and leveraging technology to spread awareness to many parts within North and other parts of Nigeria that would have otherwise been difficult to reach is a useful tool. Utilising virtual medicine provides them with care in the comfort of their homes without having to navigate distant travel or pay additional transport costs. The simplicity of our system and the fact that we have specialists that can speak the local dialects helps to break the communication barrier.

The reception has been really good, the cultural norms of our northern society leads to a certain level of comfort and trust when women are brought forth to provide healthcare to other women.

Tell us about setting up Debbo Africa and what it stands for

Débbo means “woman” in the fula language spoken across Western Africa. It is for women, by women, specifically set up to bring safe and reliable healthcare to the African woman.

What have you observed and learnt personally and professionally in your years of being clinicians in several parts of Nigeria?

Personally, the exposure from meeting with people from different ethnic and religious backgrounds has taught me that we are more similar than we put forth, and sometimes being human is enough. Some of my closest friends, mentors and teachers could not be more dissimilar from my background but have all played a significant role in my success story. I am also a strong believer that the clinician makes the hospital and not the other way round, the best doctors are able to create impact even in the most difficult situations.

How does Debbo Africa operate and why this method?

We operate an end-to-end model that enables women to get all their problems solved under one roof. Our female only space in Lekki, Lagos enables women to get all their tests or screenings done by qualified female professionals in a non-hassle safe environment. Post testing, we discuss each result and provide them with simplified health information to help females make better life choices. Virtual consults are available for any woman who has a specific ailment that needs attention, and we have a wide range of female specialists across Nigeria that have partnered with us to provide this service. This enables us to take care of women in all states of Nigeria. We understand that not all issues are solely medical and thus have incorporated mental health and lifestyle plans into our model. We also provide an individualised approach, not every woman is the same, we treat every client differently taking into account their own specific modifiable and non-modifiable risk factors. Early diagnosis leads to better health outcomes, and we are here to ensure that every woman trusts us to provide the care she needs.

How has the reception been so far?

We have celebrated so many firsts since we opened our doors, women who have had their first ever cervical and breast cancer screenings either because they simply did not know where to go, or they were too shy to discuss with a male practitioner.

It has been really heartwarming seeing all the support we have gotten since inception. The HeForShe and women supporting women community have been a strong support for us during this journey.

How have you partnered with global researchers at the Bill and Melinda Gates Foundation, Cardiff and Oxford University in the UK?

Over 5 years ago while I was still at the National Hospital in Abuja, we embarked on a study on the ‘Burden of Antibiotic Resistance in Neonates from Developing Societies’ (BARNARDS) with Cardiff University UK. At this time, the study was being funded by the Bill and Melinda Gates foundation and I served as the Nigerian program coordinator. The study was across several countries in Africa and South-East Asia. Subsequent to the 1st phase of the study, we have published several papers in Nature Microbiology and the Lancet, to mention a few. During the same period, through the Global Challenges Research Fund Cardiff University UK, we also studied the determinants of stillbirth in one of the largest public hospitals in Nigeria and disseminated the conclusions and recommendations from that study through animation to the stakeholders and the general public.

Presently, I am collaborating with the Ineos Institute at the Oxford University UK to commence a follow up BARNARDS study to further identify factors that lead to the transmission of resistant bacteria in early life.

Share on publishing the first randomised control trial in West Africa on Human Papilloma Virus

In 2017, I conducted research in collaboration with the Institute of Human Virology Nigeria and DDL diagnostic laboratory in Rijswijk Netherlands, to study Human PapillomaVirus (HPV) self-sampling as a means to improve uptake for cervical cancer screening in Nigeria. This was the first study in West Africa that had conducted a randomised trial to test concordance between physician-collected and self-collected samples using molecular diagnostics methods. The study reported a significantly improved uptake in screening and that the samples were adequate for molecular testing of HPV. A couple of years later, the findings from this study were incorporated in a systematic review and meta-analysis by the International Agency for Research on Cancer in Lyon France (IARC) to recommend the addition of self-sampling to the WHO screening guidelines to reduce the burden of cervical cancer.

How are you mentoring girls in STEM?

This started during NYSC, when we started visiting public schools and teaching secondary school students maths, science and ethical principles as an after-school program and has evolved to visiting orphanages that housed internally displaced children and offered them tutoring to enable them write WAEC.

One of my personal projects is identifying talented girls in senior secondary schools and mentoring them on how to make the right career choice within the science track, helping them identify the best schools for them and guiding them on how to apply for scholarships. I have also taken some early career female scientists and provided them a platform to get into masters and PhD programs in some of the best universities globally. In Q2 of this year, I will be launching a more formal program that provides mentorship to women and girls on intentional living.

How can healthcare in Nigeria be better improved? What do you wish for?

If we can fix the primary healthcare and emergency services, it would solve more than half of the healthcare problems we currently face. The foundation of a building needs to be sturdy for the rest of the building blocks to be placed brick by brick. Costs for healthcare services should be tiered in a way that basic access to healthcare is provided without compromising on quality regardless of who walks through the door.

How can the exodus of medical practitioners be curbed?

Majority of those that left fought to stay and many would return if things got better.

The infrastructure in our hospitals need to provide a better platform for doctors to thrive, lack of equipment to diagnose or treat, lack of facility to conduct research that leads to medical innovations and treatments. Not being able to provide oxygen to patients in need or perform emergency surgeries for the lack of blood or power can be really traumatising.

It did not help that so many young doctors waited for years to get into residency programs within the country, but nothing was forthcoming. After studying for so many years in the university, going through a one-year internship and another year of NYSC, having to continuously wait for the system to provide you a place to train as a specialist and then become appointed after training can be quite disheartening and discouraging.

Better healthcare for patients, and better working and training conditions for doctors will go a long way in starting dialogue for the return of some of these very well trained and highly sought after practitioners that have left.

Having studied and worked abroad, what can we learn from first world healthcare systems that can better ours in Nigeria?

At the moment, some of the strongest economies are facing massive healthcare challenges, so there are many lessons to be learnt from each country’s model.

The one thing I would like to say is that Nigerian medical schools have graduated some of the best skills globally. While travelling to many of these schools and hospitals I tend to meet fellow Nigerians as clinical leads or professors in some of the best places.

Health financing with strong governance is one key factor in ensuring that we have the right infrastructure in our hospitals, and I also strongly believe that accountability and responsibility for actions plays a big role in creating checks within any system. Ensuring that standard operating procedures (SOPs) play a big role in daily operations across board is also a key to successfully implementing a high quality of international standards.

If you have any advice for the federal government, what will it be?

Health is wealth, and it is therefore critical to find the right balance for health financing. A country that cannot solve the health issues of its growing population cannot thrive economically.

Quality emergency care cannot be overstated, having a serious road traffic accident cannot be predicted, nor can the hospital one is taken to, because at that time all that matters is proximity, so emergency services in all regions should therefore be prioritized to have the same standards.

Lastly, I do not think the system can take more doctors or skilled healthcare workers leaving the country, therefore this should be a matter of national anxiety.

With your experience with covid centres, hearing that there are a few people diagnosed to have covid in recent times in Nigeria, what do you have to say about this?

The very nature of corona viruses means that it would keep mutating and spreading over time, but this doesn’t mean it causes a pandemic as it did earlier, this is unlikely to recur.

Viral infections are spread easily, and it is not surprising due to the end of year celebrations and holidays that a resurgence is seen. Infection control principles should not be discarded, hand hygiene and cough etiquette as a basic minimum should still be a normative rule to reduce the spread of infection.

How is your partnership together going?

This partnership was written before we met, the coincidence of our backgrounds and our journey in the medical field is too similar to brush aside. We both share the same values and ethical standards while both having a deep passion for women’s health.

Our prayer is for our partnership to continue to be aligned towards the common vision for Débbo Africa.

Concluding words

Débbo Africa is here to change the narrative for health outcomes in women.

For everyone who has taught me, studied with me, supported me, believed in me and prayed for me – thank you.

Aisha Nabila Wanka

Managing Partner Débbo Africa

Ado Wanka is an accomplished Anatomic Pathologist and Cytopathologist who has a special interest in breast, gynaecological and prostate pathology. She is an alumnus of Ahmadu Bello University, University College London (UCL) and a fellow of the National Postgraduate Medical College of Nigeria. While still in medical school, Ado Wanka developed an interest in cancer biology and epidemiology, particularly in how cancer presents in the African population, the disparities in cancer biology amongst black Africans and other races, and how to make cancer diagnosis more accessible to patients in our communities. She subsequently pursued a master’s degree in Cancer where she focused on molecular alterations in soft tissue tumours and how they can be used to detect cancer in patients non-invasively.

Her residency program was in Anatomic Pathology where she specialised in Forensic, Cytopathology and Histopathology. As the Chief Resident, she was responsible for supervision of the training of junior residents and interns, and was the lead in tumour boards and other clinicopathologic meetings.

She has had extensive training in hospitals in the UK including the Queen Elizabeth Hospital, Birmingham and has experience with various aspects of Pathology including immunohistochemistry, Flow Cytometry, Fluorescent in situ hybridisation and other molecular methods of cancer diagnosis.

Ado Wanka’s interest in female health was first nurtured when she began her research in disparities in cancer amongst African women versus other races, and this has led to her researching and publishing several papers on genetic alterations in breast, cervical and endometrial cancers to better understand these differences and how they can be utilised to provide better health outcomes for African women diagnosed with cancer.

Prior to setting up Débbo, her most recent role was Laboratory Director and Head of Pathology at 54gene, where she established the Pathology laboratory, set up quality standards for research and clinical diagnosis and was responsible for administrative and operational oversight across all departments. As Laboratory Director, she guided entry into the diagnostic market and implemented College of American Pathologists (CAP) accreditation in the laboratory. She collaborated closely with other departments and provided clinical insights and guidance on research and other related activities.

Aisha learnt at an early age that the pursuit of knowledge, of whatever type, was important. For her, anything one learnt had to be propagated and actioned upon for the greater good. She learnt the value of giving back, of integrity, empathy, independence and responsibility. Aisha learnt to always appreciate her blessings and strive to be a source of blessing to others. All these values were ingrained in her actively and subconsciously by her mother and the community of female relatives and friends she grew up with. Her mother, in her own quiet manner, always endeavoured to uplift the lives of others, especially women, whether it be educating them or encouraging them in their small businesses. “At the end of my life’s journey, I hope to have made an impact in the same way my mother did and continues to do.”

Share your childhood influences and effect till date

I learnt at an early age that the pursuit of knowledge, of whatever type, was important. Anything one learnt had to be propagated and actioned upon for the greater good. I learnt the value of giving back, of integrity, empathy, independence and responsibility. I learnt to always appreciate my blessings and strive to be a source of blessing to others. All these values were ingrained in me actively and subconsciously by my mother and the community of female relatives and friends I grew up with. My mother, in her own quiet manner, always endeavoured to uplift the lives of others, especially women, whether it be educating them or encouraging them in their small businesses. At the end of my life journey, I hope to have made an impact in the same way my mother did and continues to do.

What are your dependent struggles?

I would say the weight of people’s expectations has always been something I’ve struggled to balance. It gets easier with time but at the back of one’s mind is the fear of disappointing others either personally or professionally.

Why the choice to improve women’s health?

When I decided to go into private business, the idea of having a women’s health practice came easily. As a young doctor, I’d often witness scenarios where a mother would bring her child to the hospital and in the course of treating the child, I’d discover she was also suffering from a physical or mental ailment, which she had brushed off because she had to keep going and be strong for her family. There are communities where a woman cannot seek health care without the permission of her husband. There are certain medical issues which women struggle with, and they are likely to be more open to female doctors than male counterparts. The idea that there are women in Nigeria, who although are aware of pap smears but shy away from going to get tested simply because they are not sure of where to get tested or they don’t trust the process, is disheartening.

We need to have a complete reset on the understanding of female health issues. It is only after de-mystifying health, can concrete progress be made.

Is it challenging to propagate this message in the north? How are you breaking through?

The North has wholly and enthusiastically embraced us. We may both be northerners but Débbo’s reach is nationwide and indeed in the next few years, across Africa as a whole. The concept of being a phone call away from getting medical advice, in the comfort of their own homes, is what appeals to most women. We’ve discovered that WhatsApp in particular, is a useful tool to engage a huge segment of the population as we can communicate with our patients via voice calls, video calls or voice notes. Our female only centre is designed to provide privacy and an ‘at home’ feeling, so that whoever walks in feels at ease and will unburden herself without reservation.

Tell us about setting up Débbo Africa and what it stands for

Débbo means woman in the Fula language of West Africa. Conceptualising a name for the fledgling enterprise which was significant and conveyed the essence of who we are, was the first step in our journey towards establishing Débbo. Initially, we had thought about setting up a laboratory which specialised in female health only, but after consultations, we realised we needed to create a channel which encompassed all medical touch points ranging from raising awareness on health, to providing qualified medical personnel and diagnostics, catering to both psychological and physical ailments, as well as aftercare service. Débbo makes all these services easily available in a private and convenient manner. We are deliberate in the choice of doctors and other specialists we partner with as we want our clients to feel they are in safe hands.

What have you observed and learnt personally and professionally in your years of being a clinician in several parts of Nigeria?

Health care is a right not a luxury. Everyone is entitled to have the best medical care regardless of one’s socio-economic status. I observed that wherever I happened to practice in the country, that people were more likely to seek medical attention if they trust the system and that compassion and empathy from health providers goes a long way in reinforcing positive health seeking behaviour.

How does Débbo Africa operate and why this method?

Débbo provides medical diagnostics (laboratory and radiology), virtual consultations, mental health counselling (virtual or physical) and fitness sessions. We have a walk-in lounge that is strictly for females where we take samples for tests, conduct group counselling sessions and fitness classes. The physical space allows us to interact with our clients and provides that extra reassurance that Débbo is run by professionals and to also give faces to the names. We have virtual consultations, which are through phone calls, video conferences, voice notes or whatever medium is convenient for the client. This is because we want to make healthcare fast, accessible and simple. Health outcomes are improved when barriers to accessing qualified medical care are removed or simplified.

How has the reception been so far?

The reception has been overwhelmingly positive and encouraging. We always hear the phrase “it’s about time” or “why hasn’t this been done before” particularly with our virtual medical consultations. I have to acknowledge the role other women in business have played in guiding us and offering free expert knowledge.

What were your discoveries in how cancer presents itself in the African population?

Most of the studies on cancer are carried out on other populations but the data from these studies are applied in our population, with the result that some interventions which may work on caucasians for example, may not necessarily work on the African population. We have now realised that certain cancers, such as breast cancer in black Africans tend to present at a younger age, and may have a more aggressive course, resulting in death at an earlier age. Furthermore, Sub-Saharan Africa has the highest incidence and mortality for Cervical cancer than other regions in the world.

How can healthcare in Nigeria be better improved? What do you wish for?

Improvement in medical education by establishing more medical and allied health schools, entry to which is by merit, providing these schools with qualified lecturers, and required tools and establishing scholarships and other financial aid, are the first steps in improving our health sector. Our medical infrastructure needs a complete overhaul so that health providers are not struggling with basics like electricity and water while also having challenges with their medical equipment. The process by which medical care is obtained should be simplified and made more transparent so that patients know what to do at each point of their medical journey and not be made to feel that they must know someone before they are giving the attention they need.

How can the exodus of medical practitioners be curbed?

Health workers need to feel valued; they and their families make a lot of sacrifices, and they have to be better taken care of. Compensation and other benefits must be reviewed. Having access to training overseas where they can learn about the most up-to-date practices is also important, as they can then step down the knowledge. Additionally, the health system needs to be more transparent with regards to appointments of medical personnel in our hospitals.

Having studied and worked abroad, what can we learn from first world healthcare systems that can better ours in Nigeria?

It is a matter of prioritising the health of our people, especially women and allocating resources to the health sector. There are countries that are not as well off as Nigeria, but they have been able to make quality healthcare affordable and accessible.

If you have any advice for the federal government, what will it be?

I understand the struggles the government faces in terms of healthcare financing, but I implore each elected office holder to imagine a Nigerian health system where they feel comfortable for themselves and their families to be treated without resorting to overseas hospitals. The most critical issue right now is the exodus of home trained Nigerian medical personnel to other countries in pursuit of better quality of living for themselves and their families. The root cause of this mass migration needs to be identified and resolved with the utmost urgency. The primary health care centres in our communities should be adequately equipped and manned to provide first line treatment for the common diseases, thereby easing the pressure on secondary and tertiary hospitals.

How is your partnership going?

Dr Modibbo and I have known each other since we were pre-teens in pinafores. Our shared passion and goal to improve women’s health in Africa cemented our friendship and I couldn’t have asked for a better partner in this journey.

Concluding words

Débbo aims to provide reliable, safe and trusted medical care for African women.