 You're welcome back. We're glad to know that you're still there and this is the breakfast show on Plus TV Africa in case you're just joining us and we did promise you that we're going to do a little bit about health this morning even though every Thursday we talk business mostly but today they say health is wealth and so we're going to be concentrating on that aspect of your wealth which is health and our area of concern today is that the US based cardiology professors are helping Nigerian cardiologists and patients to bridge the gap. What that means is what you're going to get right now and how it's going to help us and what the program stands for. Everything we need to know we're going to talk about on the show this morning. We have to my fire right left rather. Okay I've forgotten my hands. Dr. Shaii Bolorun Duro in interventional cardiologist Nova Cadio vascular care. I know her I'm sure heart and vascular institute Virginia in the USA. Good morning and welcome to the program. Thank you very much. And we also have Dr. Obinaya Emerole in interventional cardiologist as well and president cardiovascular education foundation chairman cardiology division atrium health nevescent Georgia. I hope I got that right. Good morning. Welcome to the program. Thank you very much. Okay. Thanks for having us. Yeah when we hear cardio we're thinking our hearts we're thinking about people who slump we're thinking about some dangerous things and all that. Before we go into the program that you're doing you're having with our cardiologist in Nigeria and all that. Let's try to have an insight into what cardiovascular health is in first place. Where do I start from? I wish our democracy were like this you know take the other guy and not let we not take all. Okay let me begin with you. Yeah heart disease is one of the leading causes of death all over the country. You know the the most important risk factors for heart disease include high blood pressure, diabetes, high cholesterol, cigarette smoking, being overweight, lack of exercise and and also heredity you know some some of the genes that we have. The most common symptoms are shortness of breath, you know getting tired easily, chest pain, chest discomfort, swelling of the legs or leg edema and sometimes passing out or blackout spells and for a few unfortunate people sudden cardiac death. What we try to do is to educate everyone, educate people to be aware of the symptoms so that they can seek medical attention early. In general we would encourage a heart healthy lifestyle which includes avoiding smoking, exercising regularly, eating a diet that is healthy fruits, whole grains, vegetables, maintaining a healthy weight, keeping an eye on your blood pressure. Normal blood pressure is 120 over 80 so avoiding hypertension, keeping an eye on your blood sugar, getting adequate treatment if you have diabetes, keeping an eye on the cholesterol, ensuring that you don't have high cholesterol and then if you do notice any symptoms chest pain, getting short of breath easily, having fluttering of the heart, palpitations, developing leg swelling, developing the dizzy spells or blackout spells to seek medical attention early. See your family physician or primary care provider. Sometimes they'll do a history and physical examination. They may want to do an EKG, an electrocardiogram which is a recording of the electrical activity of the heart and then depending on what they find you may need to be further evaluated by a heart disease specialist, a cardiologist. Oh well it sounds like we need to go back to school to find out because when you went reeling out the things that we need to do you know exercise, you have to eat healthy, you have to do that and I was like how many of us even know that? You know you talked about also visiting a family physician. Those are very un-Nigerian kind of things you know. How many families have physicians that take care of them? How many people even want to go to the hospital in the first place and all that? And he mentioned exercises. An average negotiator will say are we not having enough exercise by just trekking and by just jumping buses and all that? How deliberate should we be about for instance the exercise part of it? So I think the concept of exercise is very very underestimated and it's the biggest thing that you could do in terms of making yourself live longer and have a better quality of life. Now we're cardiologists we're focusing on healthy lifestyle but the heart is not just isolated it's not just oh my heart is good means that my brain can be bad so it actually affects the whole body. Okay so what we're talking about reduces the risk of impact on your heart, the brain, the kidneys, the lifestyle, your quality of life, your knees eventually if you get obese messes up your knees, your quality of life long term. So that impact of exercise is underestimated and that's what I want to emphasize from your question. So the American College of Cardiology recommends 150 minutes of exercise a week of moderate intensity exercise. So moderate intensity means getting your heart rate up means you know you're actually getting up and actually taking a walk at least 30 minutes you know walk or something like that and then increasing it. So yes we do go through stress yes we do try to you know get out of our houses, take the bus, take the train and everything like that to get to work and all of that or whatever it is that involves getting to work or going about your normal activities but being intentional about it so waking up early and taking an extra walk or one or do something or you know do some exercises press-ups pull-ups whatever it is but just being intentional about that 150 minutes of moderate intensity exercise not which is different from what you're doing chasing the kids or doing out your regular stress that we deal with every day. Okay you've heard that I have to be deliberate about it. Okay now you're working with cardiologists in Nigeria and all that but before we go into what you're doing with them let's let's get to know you say you have a foundation and some other things give us a brief history about this foundation and how you got to connect with the Nigerian cardiologists before you started doing what you're doing now. Okay the the name of the foundation is Cardiovascular Education Foundation and basically our objective is to advance cardiovascular education, training, patient care and research in Sub-Saharan Africa. So about 10 years ago a group of us you know got together and looked at the challenges that really we are facing Sub-Saharan Africa in general but Nigeria in particular just because that's where most of us come from and we noticed there was an increase in the burden of non-communicable diseases especially cardiovascular disease but at the same time the one there wasn't enough specialists in the field of cardiovascular care and some of the few that we had that we had in the country we are we are emigrating and we decided to see how we could help you know build up capacity in the country to help with the training of the specialists in in the field that would take care of the patients and we also looked at the the training that was being given the education to identify where there were gaps that we could work with the people training the doctors here to to bridge the gaps so so we came together and formed a nonprofit called cardiovascular education foundation that's registered both in the US and here and and we partnered with the Nigerian cardiac society we also developed collaborations with some of the local teaching hospitals and and what we do in in terms of programming we have a virtual didactic lectures over zoom and then we've established relationships where we discuss patients that that you know they have difficulties with and we'll see if we can come up with solutions and then we have a hands-on training missions where we rotate people they come they work with the physicians here especially in some of the more advanced subspecialties within cardiology where we have a cardiac catheterization laboratories for people who need cardiac catheterization which is a procedure where a small tube is inserted through one of the arteries to the heart and we take x-ray pictures to see if they have blockages that are causing chest pain or causing a heart attack and we can open up those blockages by the insertion of stents so we've we've been involved in training some of our local physicians to to provide these services so that you know people who have a heart attack here can get you know world-class care and our goal essentially is to train the manpower within the country and bring the standard of cardiovascular care in the country to what would be expected anywhere in the world and of course there are resource limitations and we have to work with our local collaborators to develop what we would consider best practices for the limited resources that we have in our environment yeah it's funny that he ended with limited resources because I was thinking about a wider scope because when you train the cardiologists in Nigeria the training of the people is one thing getting the people to even access what they what kind of knowledge we're imparting on them is another thing I don't know your level of interaction with the people the patients or would be patients or the society that needs to get information about this cardiovascular health is there any form of interaction or is there anything in the offering that you want to begin to do to bring it to the conscience of the people thank you very much that's a great point and that's exactly why we are here we want to focus on so where interventional cardiologists we train and practice in the U.S. but just giving some background I went to medical school here in Nigeria in University of Laurin he also trained in Nigeria also so we understand our unique limitations in Nigeria and so given those unique limitations in Nigeria the goal is to ensure that we not only affect the physicians we want to make it to three phases it was to affect the physicians we want to affect the patients individually and they want to affect the community because it's multi-fisted so what happens in an environment that succeeds in getting reducing life you know reducing mortality from cardiovascular disease is you build a systemic structure that actually helps this get better so when my family member you know has chest pain you know they should know that okay look it's not oh you lie down take time and pan at all but actually okay well this is something concerning do we need to communicate at that point to get you to the hospital and then what kind of hospital do we want to get you to you know when my family member tells me oh look one side of my face is getting getting weak or I can't speak or I can't hear them very well like is that a stroke and then and that's not going to come directly from just training the physicians we're training the community and that's why we're here want to make sure the community understands what those risk factors are we've talked about treatment we've talked about what we're doing in terms of training to be able to get a stance a coronary stance to be able to get a pacemaker if you're a pacemaker to be able to get a defibrillator if you need a defibrillator which is what we're developing in the local institutions in the hospital in the country we've gone to quite a few institutions in the country developing that system and not just doing these things for patients and then the patients leave but actually training the people on ground to do it because we want to like not just give you a fish but teach you to fish so create a system where these hospitals can walk independently and then also we bring resources from the U.S. and then and then you know we have partners we bring stuff and you know to donate them to these sites but the idea is speaking to the public speaking to everybody right now it's like when you we want to know these risk factors we want to know okay what happens when you when somebody has chest pain when your family member is having complications or loses consciousness you know what are the things to look out for and then where do you take them to and when you take them there you know what would happen and that's that part where that's that process we want to try to implement and then just making sure that everyone is aware and then just being more heart healthy so one passes out in front of you it's not the time to find the person and say oh yeah let's pour water on him or let's find him you know yes we want to figure out why he's passing out but now we know on the news we see that everywhere we're seeing in sports we're seeing that people having sudden cardiac death where they fall down they die or they pass out yes you might be able to some system resuscitate them quickly with cpr which is the most important thing to do in that kind of situation but for some people they might pass out and they may not even go into the minority cpr then we've had cases where those people eventually get to get to be to do procedures here in Nigeria locally because part of our training also involves us sharing cases so we have cases that we know where those kind of patients are not coming into the hospital locally and then we do do for the walk-up I find out that they had life threatening issues that would have been very preventable and very easily treated if they're diagnosed um a number of cases come to mind where locally we find that out they get a defibrillator they become completely okay or I'll give one story which is very which really touches me um and I give this story because um I'm I'm relatively newer too I joined this group a few years ago so I haven't been here 10 years um but um but you know since I've been here um you know we started off in in the U.S. where you know we do the zoom conferences and we have hundreds of cardiologists on the zoom platform across the world mostly from Nigeria where we're discussing the up-to-date standards of care things that we do in the American College of Cardiology conferences and the you know our interventional conferences we're discussing what should be done how you think of a patient how to manage a patient and so we've been doing that and we do that um every year and we have a few sessions um over a few months about um where we do like eight hour sessions with cardiologists all about brainstorming and all that one of the things that one of the benefits of that is that local cardiologists present their cases and then they've seen to show the things that they've done the changes that they've made over this time frame um so the case I'm going to bring up is a very important one that I learned from last year was my um you know the team of our team came in and there was a patient whose heart rate was 40 for many for over a year she basically was in the house not doing anything and um you know it's what we call complete heart block which means that the upper chamber of the heart and the lower chamber of the heart do not communicate effectively so the lower chamber of the heart is doing its own thing the upper chamber of the heart is doing its own thing normally there should be a communication there should be a similar transition that makes them in synchrony but that wasn't happening now in the U.S. when that happens it's quickly detected we patient gets a pacemaker quickly and then they're back to you know at least in a few months and they're back to their life and then they feel open about but this lady was basically bed bound was just within our house couldn't do anything for over a year definitely over a year no much longer I can't give you the specifics right now and then until we came and we started like wow she complete heart block for over a year and then they did the procedure and then the team did the procedure the pacemaker was inserted she feels better she's back to a great life so these are things that you know we don't know and the community would not know unless they seek to blame it on village people well yes why things that happen is not my portion you know that kind of stuff so that was that was really for me was really important because it's showed that difference of suffering for over a year and and then of course you know you have the heart attacks you have a chest pain you come in you have a heart attack we have facilities here in Lagos even over in some places in the country also where you go in immediately and you get revascularized you don't have to drop dead at home but you have to know what the symptoms are we have to know what the signs are we have to know where to take these patients to and get these resources done okay while we're talking about this we need to also know the peculiar challenges that you face in Nigeria in trying to do this whether to educate the people or to um empower the cardiologists in Nigeria and all that we're hoping that policymakers are also watching this program to see what needs to be put in place a lot of people a lot of doctors complain that in Nigeria the facilities are not there so working in Nigeria is a very very difficult task and some of them want to just go to where everything is ready you know everything is there they can do that so what are some of the particular challenges you find in Nigeria that you think good policy can make better um from from a policy perspective i would say that the in the greatest challenge really is health care financing i mean uh modern health care especially modern cardiovascular care is expensive is an expensive commodity somebody has to pay and most people are not able to afford the the care so so if we are talking about pacemakers we are talking about cardiac surgery we are talking about stents we are talking about catheters all of this would the procedures will cost millions of naira the equipment is expensive the consumables are expensive even if the providers are donating you know their their services free of charge just paying for the consumables and the equipment costs a lot so in in terms of uh you know the the broadest policy challenge i think that um the policy makers should really look at developing an effective national health insurance program not just what we have now that pays for the minimal preventive care you know but but a health insurance plan that would you know pay for the care for people who are having heart failure who are having heart attack who are having advanced illnesses and that way the people can access the care that they need and that way the younger health care providers are not frustrated and disappointed and are not seeking to to leave the country now from from our point of view though i think one of the things we also do is to focus on prevention focus on early detection focus on treatment of risk factors um you know trying to basically uh get people before they get to the advanced stage of the illness where we are they need a a lot more of the expensive invasive and interventional procedures and and to that end we'll work with the Nigerian cardiac society to increase awareness in the in the community basically educate members of the public about how to reduce risk factors how to recognize symptoms how to seek care early at the same time we have to um build an advocacy arm and reach out to the policymakers people in government people in academia people in private industry people in the nonprofit sector it will take everybody working together to build a healthcare system that would work for the citizens of the country you have something to add yeah i think um like um Dr. Marilia said and here's well put um yeah this is an issue that involves a lot so um you know we um started off here and then like you said you know there's this whole talk of the brain drain you know physicians um medical everybody you know trying to get out of the country and then do all that and so which obviously doesn't help the system but what we're trying to do is to transform that brain drain to a brain gain so the people who are coming here who are doing this procedures who are training from abroad and all of that are mostly people who did part of our training in Nigeria but mostly Nigerians the people that are there are people who have no link to Nigeria at all who are participating in this and giving talks and actually coming in person also but mostly people who actually are from here and then trained here and so over the time we've done that and then we've you know um tried to make an impact in that perspective so the goal is trying to like you know you bring back and then try to reinforce what we have back here and then try to develop that obviously you need the help of um and to partner with the the government to partner with you know the ministers of health my matter of whoever is um in the capacity to develop that um so and maybe even uh the the national orientation agency because you know information sensitization and all that maybe they will handle that yes yes so that's definitely what we're trying to do we're working really well with the Nigerian kind of society um the teaching hospitals across the country are really really invested in this we have um in in working together in developing what we have because we have the same vision we want to change um the healthcare delivery in Nigeria we want to make things better for our people I have a master's degree in public health because when I left here that was my focus like how do we improve the health of the public you know global health um and so this is part of the idea like getting people individually as a community as a system all together improving our health I think a lot needs to be done like uh Dr. Merrill said on working on the people to get to know the signs the symptoms how to prevent it and all that like I was joking um earlier on that it's like you need to go back to school and all but at this point let's assess the success story of this program that you're doing you've been here maybe not in Nigeria but you've been around for 10 years how would you um evaluate your success but um for that let's be partial let's come to Nigeria how would you evaluate your success your level of success in Nigeria I think um the the word that was used to to describe the program at the the ongoing Nigerian cardiac society meeting has been that it's it's been very impactful it's been very impactful um when we first started um the the cardiology trainees in the country the senior registrars did not really have um access to training in interventional cardiology in arrhythmia electrophysiology and in advanced imaging so so these are uh subspecialties within the field of cardiology that that the the training was um a little um deficient so so what we did was to work with the people here with the professors in the teaching hospitals and medical schools here to to develop a curriculum that has filled that gap and and so since we started what we have now is that there are several um Nigerian trained cardiologists who are able to do these procedures uh in different parts of of the country and so we've we've helped to start an interventional cardiology program at Lasut here in Lagos we've we've helped to start one at Cardio Care which is a private hospital in in Abuja that serves the north and we've also helped to support a program in Port Harcourt and a program in in Enugu so so i think it's really made an impact for a lot of the the young cardiologists and we can say that a lot of the people who are completing their training in Nigeria now are quite conversant with a lot of the procedures that are done all over the world and we've we've kind of demystified the field for them now a lot of patients also benefit from the training program just because we have you know consumables and devices that are donated so they can get these procedures at a heavily subsidized costs which otherwise um you know they might not be be able to afford so so while we are focused on education and training it also ends up being a charitable mission that that a lot of patients benefit from and then at the same time we work with the Nigerian cardiac society to to develop public awareness campaigns education and advocacy for the field of cardiovascular health i i see the level of success with the professionals has been great because like you said impactful but we need these impactful to also translate to what the ordinary man on the street will will also see about the kind of information they have about this so if you were to advise maybe media houses or NGOs and all that because a lot of people might be interested in making sure that their people are healthy they just want to carry out that information to the people what do you think this kind of people media houses NGOs those people involved in advocacy can do to make sure that this message gets to the grass through more okay great question thank you very much so addressing media houses and addressing you all stakeholders yeah i think it's uh it's important to to get the message out there now and getting the message out there involves bringing specialists like what you're doing right now to communicate the importance of preventive care which we don't really have as a culture you know that idea of okay look i want to get my baseline blood pressure measurement i want to get and then know that and keep an eye on it so i get a blood pressure cuff and i want to keep that at home i want to get know what my blood sugar looks like i can get blood i could actually wear one of these watches people carry phones around now that are expensive and they get watches that monitors my heart rates and all that and then actually gets me so much information about my health but having a vermin of anywhere we could communicate from platforms like this to everybody and say look um it's i know you have stress i know there are stressors in life and those stressors increase your risk of high blood pressure diabetes having a stroke shorting your life expectancy reduces the medium life expensive in Nigeria to be barely 50 whereas in other parts of the world it's 80 something so why is that happening why is there a 30 year difference in life expectancy there is a role that the community medical community has to play there's a role that the government has to play but like you mentioned media houses communication sectors should communicate this to everybody so that way when you're in your house and you're tuning the tv and yes you hear about things happening but you also want to say look no matter what happens in the world right now in the country right now what's most important to my kids is that i'm here to take care of them you know so that's what happened that's why that's that's how we need to process it we need to process it looking like look i have these children i'm stressing out to take care of them but to do that i need to take care of me which means i need to take care of my blood pressure which means i need to take my medications which means i need to eat healthy which means i need to drink more water which means i need to do all that and then we pass that out from this kind of platform so everybody on the streets hears that and everybody in the street starts thinking about that and now says okay look i need to periodically once a year go to a doctor and then do a checkup and then not just do it once and wait for but do it periodically so you know what exactly you have to work on and then keep working on that and then if that becomes our mantra if that becomes what we do on the street or become more health conscious and become more health aware that eventually affects our community that affects our useful life i mean think about this most people go to university and they finish university and then you know in their 20s okay and then they don't in their 20s and then how much time do you have of useful life if you're going to die your baby by 50 you know so how much useful life is that what happens to the next generation they haven't even had enough time to you know get that support grandparents actually help a lot in raising kids you know and then if they if they're successful and they still have income coming in because they have a good health that financially affects the community and then the next generation so yes we're talking wealth like you said health is wealth that's the definition of health is world right we being alive to live longer and then are having children and having grandkids and being able to contribute to them because you're healthy and you're not you know lying in a bed somewhere we're able to communicate and then help that next generation so i think that's the philosophical change that we as communicators need to pass across to everybody like let's change the way we think about our health when we talk next to generation let me just as a final question what are your hopes for the future regarding this program and the kind of intervention you do in in the various countries that you go to you must have learned lessons in the course of 10 years how do you intend to improve on this and make sure you even succeed more it's more impactful that let me use your word so just talk about before we wrap up yes i i think the the most important person the most important lesson i have learned is that collaboration is is going to be it's important for success so so it will improving the health care of our citizens and improving the health care delivery system will require collaboration from the health care collaboration between the health care providers the policy makers and and the citizens will continue with education will continue with training will will continue with helping to bring in supplies and buying equipment and we'll all learn from each other ultimately lifestyle changes that the patients make will probably have the greatest impact you know and just because of our resource limitations it's still going to be important to develop a heart healthy lifestyle avoid cigarette smoking that's probably the single most important thing that people can do to prevent heart disease lose weight if you are overweight try to exercise regularly develop a system for managing stress it's a very stressful environment control high blood pressure control diabetes control high cholesterol from our own point of view we will build a stronger relationships with the Nigerian cardiac society with the local medical schools and teaching hospitals and then we'll continue to work in building up the capacity here but ultimately the the policy makers have to develop an effective health care financing mechanism because if we don't have that and patients are unable to access care and the doctors the younger doctors are not satisfied they will continue to emigrate thank god you didn't say stop eating a bar but it healthy okay ladies and gentlemen um i do hope that you were there when while we're doing this and we've been talking with dr. shei and also dr. obinaya thank you so much gentlemen for coming on the program this morning thank you thank you very much for having us we've enjoyed it okay so tomorrow we shouldn't see somebody just slumming and what we know that we have to do is learn more about the signs and symptoms how to prevent these cardiovascular mishaps that we find every day it's not everything that you blame on village people sometimes you have to take the responsibility yourself so as we thank the gentlemen and as we try to wrap up we're going to just drop this quote for you and you have to see failure as the beginning and the middle but never entertain it as an end that is according to jessica herrin founder and CEO of stella and dot well this is how we wrap it up on the show this morning let's do it again tomorrow on behalf of the entire team of the breakfast here on plus tv my name is nyam gul agadji have a wonderful day