By Gloria Onwuneme, medical student, University of Nottingham, UK
Dr. Ike Anya is a consultant in public health medicine, writer, honorary lecturer in Public Health at Imperial College London, cofounder of Nigeria Health Watch and cofounder and principal consultant of EpiAfric, a public health consultancy in Nigeria.
Dr. Anya obtained his medical degree at the University of Nigeria (1995), before eventually moving to the UK in 2001. Here, he obtained a Master’s from the London School of Hygiene and Tropical Medicine, before completing the Southwest England public health training program in 2008.
Outside of his health-focused ventures, Dr. Anya is a co-founder of the TEDxEuston series and a member of the Council of the Caine Prize for African Writing.
When did you first decide to become a doctor? Why?
That’s an interesting question. I’m in the process of writing a memoir about becoming a doctor in Nigeria in the 1990s. This led me to thinking about when I made that decision, and I realised that it’s not clear to me. I enjoyed playing with my doctor’s set as a child, as I’m sure many children did. I remember going to hospitals as a child and being fascinated by the smells and sounds. I went to King’s College, a boys’ school in Lagos, where there was a sense of competition and an unspoken expectation that you go into medicine, engineering, or law. I was drawn more to the biological and physical sciences, and I also liked looking after and taking care of people. Although I had liked the arts as well, it wasn’t something I’d considered going into vocationally.
How/why did you choose the medical school you attended?
I was only considering two universities: my first choice and the one I went to, University of Nigeria, and the University of Ibadan, where my father had graduated from, and which was the oldest one in the country.
What surprised you the most about your medical studies?
Everyone knew and expected that medicine would be tough, but I hadn’t quite bargained for just how tough it would be. Before then, I was passing exams with flying colors, but medical school was the first time I ever failed exams. There was also a dreaded exam halfway through the course, the 2nd MB exams: only half the year would pass, and much of the other half would wind up leaving the course at that point, while others had to repeat the year. It was really intense, really high-pressured. I also hadn’t quite understood the breadth of medical specialties.
What information/advice do you wish you had known when you were beginning your medical studies?
The importance of taking better care of myself emotionally and mentally. I would have wanted the awareness that failing one exam wasn’t the end of the world. I was quite hard on myself: I would have also given myself permission to enjoy my other interests more actively—I enjoyed literature, but I used to think I should only focus on medicine. But having all those other interests then has stood me in good stead in the years that followed.
Why did you decide to specialize in public health?
If you’d said to me in my final year of medical school that I would become a public health physician, I would have laughed at you. At that point, I was thinking of psychiatry, or internal medicine, or pediatrics. I think I may have discounted public health because of how statistics and epidemiology were taught: I found the lectures very boring and dense.
I think two things ultimately led me down the path to public health. One was that following graduation, all Nigerian students are required to do a year of national service. I was posted to a rural northern Nigerian general hospital. While I was there, in the mid-90s, the city hospitals in which I’d trained, HIV was fairly well-known in the community and we could provide supportive treatment, although anti-retroviral treatment wasn’t available to us. In villages, however, people would contract the infection in the cities and come back home to die! For me, who’d grown up on a university campus in southern Nigeria, a lot of things surprised me about living in this traditionally Muslim town in the north, including the fact that there were two brothels in this small town which were fairly open about their business.
In any case, I started a campaign of going to talk to the sex workers and their clients about HIV, and how to protect yourself. I remember running into conflict with the town head, who summoned me to say I couldn’t go around talking about sex and condoms. It was an interesting lesson for me, because even in that conversation, the fact that I was a doctor and had that status made negotiation possible. It introduced me to the political and health education aspects of public health.
While this youth corps experience made me consider public health, a lot of people discouraged me from it, saying things to the effect of: “You haven’t yet done proper medicine, and now you want to go off and do public health, which isn’t really medicine.” So I went to work in the National Hospital in Abuja and was among the first set of staff in a hospital that had been built to high international standards by the wife of President Abacha, the military dictator at the time. I was enjoying working in nephrology as a senior house officer, but I was once again confronted with the bigger issues.
In medical school in Nigeria at the time, we didn’t learn anything about management, leadership, business, or policy-making in healthcare. As staff in a newly-built hospital which, despite its beautiful buildings and world class equipment, had its own problems, I started becoming interested in these aspects: which decisions make health institutions work? That bolstered my decision to finally specialize in public health, and I applied to do a Master’s at the London School of Hygiene and Tropical Medicine. While there, I had to resign from my job in Nigeria when my study leave was suddenly revoked.
My next plan was to return to Nigeria to work for an international NGO until one of my mentors, Professor Kevin Fenton, asked if I’d considered the specialist training program in public health, given the questions I’d been posing in class. He proposed that, regardless of what I wanted to do next, in Nigeria, the UK or internationally, I would go further with the skills I could pick up from the training program in public health. I said I had looked at it, but it was five years—he replied that five years would go quicker than I thought. I applied and got into the program in the Southwest of England, benefiting from the public health community there which cut across the NHS, local government, and academia. By the time I was nearing the end of my training program, fellow graduates from my Master’s programme who’d gone off to work for NGOs had come back to start the same pathway. At the end of it, I became a consultant at Hammersmith and Fulham through various reorganisations, subsequently becoming Acting, then Deputy Director of Public Health. I then moved into local authorities in 2013. I was very involved in identifying ways to increase the uptake in immunization, which we managed to do.
While training as a public health physician, I did some work for the Southwest Health Protection Agency, which was focused on blood-borne virus prevention; the resulting guidelines became adopted nationally. I led the group responsible for writing the first pandemic flu plan for Bristol back in 2004. As a consultant, I was also the North West London public health lead for planning for the 2012 London Olympics, which exposed me to working across different agencies and organizations around planning and delivering major events.
Has being a public health consultant met your expectations? Why?
Absolutely. It is the career I was made for, because it combines so many different things: advocacy, activism, epidemiology, an understanding of the human and social aspects, and a chance to make a change on a large scale.
What do you find most rewarding about being a public health consultant? Explain.
One of things I enjoy most is the variety of what you’re called on to do. One day, I’m talking to headmasters and headmistresses about immunization in schools. The next, I’m trying to persuade councillors to fund a meeting or an initiative, or talking to local hospitals about clinical service improvement.
What do you find most challenging about being a public health consultant? Explain.
In medical school, you have a fairly traditional view of what medicine will be like, in that you expect to see patients. Making that switch from clinical medicine to public health, and not having that direct patient contact on a daily basis, is a bit of a challenge. I am, however, ultimately happy with this. When I’m asked about if I want to go back to clinical medicine, I explain that I look back on my clinical days as some might look on their schooling days: with fondness and nostalgia, but not with a wish to go back.
We warn incoming public health trainees to be aware of the long timescales experienced, as compared to clinical medicine. At the end of a clinician’s week, you can count how many patients have been seen, how many ward-rounds have been done, how many clinics have been run. Your work is very quantifiable. At the end of a public health physician’s week, you might find that they have attended two meetings, read a number of reports, and worked on a few report drafts. Of course, all of these may contribute to work which will have results in 6 or 9 months, with great impact. But making the switch to appreciating this can be difficult at the start.
What’s your typical work-week like?
At the moment, I’m more or less self-employed, so it varies from day to day. I’m mostly in Nigeria for projects and clients. Sometimes I’m working on my memoir. I still do some teaching at the London School of Hygiene. Furthermore, I lecture at Imperial College London.
Tell me more about how you got involved in EpiAfric.
From running TEDxEuston and the Nigeria Health Watch blog on the side, Chikwe [Ihekweazu] (my public health colleague) and I were becoming more and more convinced that we needed to do something on the African continent. As people who had initially trained and worked in Nigeria, then gained international experience as public health consultants, we felt we had a unique blend of skills and experiences that could make a difference.
We settled on working on the four C’s which emerged from our skills, which are conferences, courses, consultancy, and communications. Based on this, we started drafting what the organisation might look like and a business plan. After not making much headway looking for investors, we were advised to look at what we were willing to put up ourselves, and to approach contacts who believe in our vision. Chikwe moved back to Nigeria and started us off in 2014, and have gradually been growing ever since. It coincided with when the Ebola crisis first hit Africa, which in some ways presented an opportunity for us to prove ourselves.
What have you learned from running EpiAfric?
We have been on a steep learning curve ever since we recruited our first members. Learning to create an organization and maintain its focus has been very rewarding. What we’ve also tried to do is model the behavior we’d like to see.
What do you find most rewardingabout running EpiAfric?
We helped design a population health module for a health leadership academy in Lagos. Every year, we see light bulbs going off in the eyes of senior clinicians and medical directors. Last September, in the middle of one of my presentations, I remember one of them blurting out: “I’m going back to work on Monday, and I’m going to change the way we do our records!” Seeing that kind of immediate feedback is quite gratifying.
Organizing the Health Meets Tech hackathon in Lagos last July was quite a milestone, too, seeing teams come up with ideas that they are still working on and which have the potential to improve health in Nigeria. Working in Nigeria sometimes feels a hundred times more difficult when it comes to starting something new. But once a new initiative gets going, it is a thousand times more rewarding emotionally and mentally, because you are genuinely making a difference.
What do you find most challenging about running EpiAfric?
As with everything, it’s sustainability, and delivering on what we’d promised investors and ourselves. Obviously, Nigeria is not the easiest place to work, but we have a fantastic team, and we are beginning to establish a strong reputation.
On average: How many hours a week do you work? How many weeks of vacation do you take?
I can’t really say how many hours I work across my various projects. I’m very conscious of varying what I do, and making what I do fun. I joke that in the last 18 months since leaving my job in the UK, I’m the poorest I’ve been for a while, but the happiest I’ve been in a very long time. I’ve learned to make space for the things I enjoy while traveling both as part of, and outside of, work.
How do you balance work and life outside of work?
I read a lot: fiction, non-fiction. I love the arts, so I go to plays, art exhibitions, concerts, the opera. I’ve also gone back to uni, in a sense; this time it’s at the University of East Anglia, as I’ve been accepted onto the MA in Creative Writing (Non-Fiction). I’m hoping to try and finish my memoir.
What types of outreach/volunteer work do you do, if any?
A lot of my core work now is outreach/volunteer work. I started the Nigeria Health Watch blog with my friend Chikwe in 2007. We also started the TEDx Euston conference series in 2009. With the move of public health into UK local authorities in 2013, and the effects of austerity that people and organizations were facing, times and work became more difficult. It affected my health and I started thinking about what was important to me. The result of this reflection, besides founding EpiAfric, was to formalize Nigeria Health Watch to turn it into the organization and advocacy platform that it is today.
From your perspective, what is the biggest problem in health care today?
It’s probably matching the scale of healthcare provision with the ways in which populations are changing. With the ways in which technology is connecting people across the globe, people are more aware of what’s possible, and are also demanding more from their local health systems.
Where do you see medicine at large in five years?
I suspect there won’t be a massive change, but there are lots of interesting ongoing innovative initiatives. Innovation isn’t just about technology, but also about finding different ways to motivate people.
Where do you see public health in five years?
To be honest, I’m quite pessimistic about public health in the UK, which is partly why I resigned. With the move of public health into British local authorities, at a time when local authorities had experienced an almost 40% cut in their budgets, public health was being put in a very difficult environment. But I believe there are opportunities, with some individuals going beyond the pathway to public health consultancy. People are going into non-traditional public health institutions, and into the voluntary sector, to create change.
What is your final piece of advice for students interested in pursuing a career in like yours?
It sounds trite, but you have to put in the work. Work hard, learn, make use of every opportunity that presents itself. Networks are important; everything I’ve done has involved engaging people I met along the way and stayed in touch with. I don’t mean networks in the superficial sense: you have to give and receive. Never pass an opportunity to do a good turn.
About the Author
Gloria Onwuneme is a Danish-born Nigerian who’s studying medicine at the University of Nottingham, UK. She has a strong interest in neurology and psychiatry, and a growing interest in healthcare innovation and medical entrepreneurship. In her spare time, she reads a lot, jogs sometimes, and she (thinks she can) write poems.