Cape Town: Is it time to lean on the fat?

How addiction hobbles our chances

Walking through a cancer hospital to the department where you are receiving treatment reveals a world of great suffering, the unerring will of humanity to survive, the purveyance of hope for which the only currency of purchase is faith that could waver depending on prognosis, pain, confidence, or despair; it is a teaching and humbling moment.

How I have wanted to walk out of that hospital and snatch a cigarette from the lips of a young smoker totally oblivious of what cancer does to the body and how the odds one faces with cancer depends of what it is, where is has been found, if it has spread and if there is a body of knowledge and expertise available to give you a chance to survive.

Then, I do not have to walk far to realise how much of a hold tobacco and nicotine has over people. As at a designated area near the entrance of the same cancer hospital, you will find patients undergoing cancer treatment huddling in corners for another drag of the poison already killing them. They give themselves no chances at all, and if they come through, good for them.

This is obese in plain sight

In Cape Town, there was something we could not unsee, when we stay in Cape Town, we try as much as possible to walk everywhere and everything is within walking distance. Even on days I did not seem to have the strength or the capacity, I made my daily 10,000 steps.

Walking alongside us or coming into view from our vantage point of observation was someone carrying just that extra extra bit of weight on their hips, their bellies, and usually both, then arms and thighs; sights to make you catch your breath.

What you cannot deny is there is an obesity problem which should be registering somewhere in the South African healthcare system. There cannot be any aesthetic value to wanting to tip the scales until the springs broke.

How you address this obvious health crisis will no doubt require tact, wisdom, and some innovative policy initiatives, it should not be ignored. You could see people who could barely move, some were panting every few steps and I cannot put a statistical value on those who might have already acquired diseases of the heart, the kidneys, the pancreas, the liver, and other related serious health problems because of this excess weight.

The fast in fast-food is weight

One other observation we made when we were in Muizenberg, some 25 kilometres from Cape Town, with long stretches of beautiful beaches that more deserted than walked, was the number of delivery bikes that attended our estate at all hours, as if most did no home cooking, but relied on fast food. We do most of our cooking, from quick preparations like stir fries to slow cooking activities, it is about the willingness and timing.

In town, the fast-food outlets are full, taking orders for tables and takeaways for patrons and the ubiquitous delivery bikers, God forfend we dignify those places with the moniker of restaurant. They offer you something to masticate and swallow, but none of it is of value to your body and if you do not work it off, it sits somewhere in your body and accumulates in fatty tissue.

Maybe the new miracle weight-loss drugs might bring respite to the South Africans we saw and give them a fighting chance, but it also must include some desire and the will to do something about it.

While everyone is free to celebrate their bodies and love who they are, while not being shamed for what they have become, we need to square the circle between feeling good and being healthy. That will not come by lying to be nice.

Hospital: That was brutal

What a start

Wednesday could only have been termed brutal in more ways than one, I returned home from the hospital and just went straight to bed to sleep off the feeling.

It was my biennial check-up, the one I was prepared to go for a month ago, only to realise that it was a month later. I got my appointment card and called an Uber cab to take me to the hospital and that is where my physiological problems began.

The Uber driver in the quest to cut out traffic ran into road blocks and other traffic that the 40-minute leeway I gave to getting to the hospital was being eaten up that I was getting anxious. The journey only takes 20 minutes, I arrived, just in time.

The pressure of the world

Then through the labyrinthic corridors to the Out-Patients’, I wended my way, half-hobbling and almost reduced to panting when at the reception I realised that I had forgotten to put my appointment card and treatment journal in my pocket. Though I did not need that to identify myself, I was at that point flustered when I was directed to sit in the waiting area.

Minutes later, I was called in for a weighing and blood pressure assessment. My weight has been going down, but the numbers that came up for my blood pressure were astronomical, both the systolic and diastolic measures in the 3 figures.

We tried the other arm, but I was already in a state, the numbers did not radically change. The nurse opined as did the doctor later on that certain patients have a white-coat syndrome that heightens their blood pressure in a hospital setting and that hospitals are rarely the best place to take blood pressure measurements.

A doctor I miss

I did not think I had a white-coat syndrome, I have known the inside of hospitals from the day I was born, there had to be other factors. My little sleep, the Uber ride, my forgetfulness and any other factor that is as yet undetermined. I did measure my blood pressure in the relaxed setting of my home yesterday and the numbers looked within the ranges of normal.

I was meeting the doctor for the first time, he introduced himself as a registrar, I have lost count of the different faces that make up this department. The head of this department when I first attended this hospital some two years ago, an affable and friendly man with a gentlemanly mien and comforting bedside manner had retired and was out in Burma doing charity work. I last saw him in October and he was the one who suggested I had a big do for my 50^th birthday.

Then I had had the opportunity to research the incoming head before I met her in the middle of the last year, we got on quite well. However, as the new doctor began to go through my notes, his apparently calming assurances left me in more discomfort and anxiety than I have ever felt meeting consultants in the last 8 years.

The whole works and working over

Maybe it was a confluence of events, but by the time I had seen a few more unpronounceable names to do with my liver, my kidneys, my gall bladder and my bile ducts, none of which on further research back home presented an alarming set of circumstances, I felt like I had gone in for acne and ended up in intensive care.

He was being thorough, at least that is what he told me and invariably, my drug regime might be modified in 6 months’ time based on cost, and I have a battery of tests to follow, bloods, liver scan, cognitive impairment and a ‘non-judgemental’ review of my sex life. Then he put my numbers through QRISK to determine my susceptibility to cardiovascular disease within the next 10 years and having stopped smoking 33 years ago, I was denoted an ex-smoker rather than a non-smoker; technically, he was right and thorough, if not pedantic. It was the full works and brutal.

I took copious notes and at the end, we did not even have a customary handshake before he was out to pick up the notes for the next victim, sorry, patient.

That was brutal

I put in my prescriptions at the pharmacy and joined the long queue at the phlebotomist’s, where a bit of gallows humour appeared to lighten up the day. When someone asked if they had lunch breaks, I quipped as to whether vampires ever took breaks from bloodsucking.

When I finally got home, I just went to bed, too much had happened in such a short day. Yes, it was brutal, by all standards. I am not looking forward to meeting this doctor again and it is probably nothing to do with him, I was just completely ill at ease chatting to him.

Decade Blogs - Oyedeji Aderemi - Killing Ourselves Softly

Decade Blogs

Another doctor I successfully persuaded to contribute to my #YourBlogOnMyBlog Series commemorating my Decade of Blogging, who goes by the portmanteau English-Yoruba name of GreatIse [Great Work].

Blog - To Celebrate My Decade of Blogging

Indeed, I am proud to have such a brought spectrum of people from all walks of life, of all ages, accomplishments and in professions too diverse to mention.

Dr. Oyedeji Aderemi in the midst of the suffering and pain he encounters daily on Nigerian hospital wards brings a great sense of perspective, humour, humility and groundedness that enlivens Twitter with good humanity.

He is a friend to two very wonderful friends of mine and I look forward to meeting him in the not too distant future.

He blogs at iseoluwa.blogspot.com, and his Twitter handle is @greatise.

Through the eyes of a doctor in Nigeria, GreatIse brings us round to understanding what the Nigerian problem is, a clear diagnosis of we, the people presenting the symptoms of total chaos, disarray, dysfunction and an avoidable mortality rate. Our morbid reality might just reveal some truths about us. Read and reflect.

Killing Ourselves Softly

I think we are too angry as a people, and we direct our anger and bitterness towards the wrong people since the root cause of the problem is beyond our reach and sometimes when we find ourselves in their presence, we are mute, overawed by their presence and the power they wield.

That said, I started thinking some days ago about the state of my nation, and the continuous shovelling of the blame down the throats of our leaders. I decided to step back and take a second look and I started seeing that we, the followers, are the major culprit. But too many political talks out there, so I shall eschew from saying much about politics and my nation Nigeria.

I do not want to talk about the security situation of the State I live in, the spate of kidnappings of medical personnel and the killing of a senior colleague recently. Is it the pain and the sadness of my patients or the way healthcare costs as further impoverished them, the tales of many lives lost on bad Nigerian roads and the inability of the existing health infrastructure to give them a chance to live?

Two years ago, this year a dear friend died following motor vehicular accident injuries she sustained that the hospital failed to manage appropriately. The faces of patients I have lost due to none availability of appropriate medical equipment still haunts me occasionally, I remember each face, and it is not enough to tell the stories of men and women rendered barren, the families torn asunder and the orphaned children. The many abandoned children and the elderly dependant ones thrown into the bush because their family members believe they are evil!

While we die due to the non-availability of required equipment, we die from lack of appropriate manpower, bad road networks, fear of what the police will say if we help a gunshot wound victim and from our greed! Yes our greed kills us daily; it kills the unborn child, the pregnant women and the ailing elderly! The young energetic ones are not left out, amputated limbs that could have been salvaged. We kill ourselves in instalments also, daily with our habits, valuing the show of affluence over good health. It is our choices that kills us one choice at a time, daily we stare death in the face and we know it not!

This is supposed to be a happy write up to celebrate a man I have never met nor spoken to as I type this, but one with a passion for his country.

Sigh! I watch my sons play and I keep asking myself, does Nigeria have anything to offer them in terms of security, healthcare and education? So here we are, our health sector is in a shambles, our politicians jet out for medical treatment, the poor populace dies in droves, oppressing each other as they plunge to their deaths, oblivious that they aid in killing one another; one choice at a time.

Decade Blogs - Roundup IV

I’m still here

I cannot have wished for more support and the honour showered on me with the 28 blogs that I have already shared on my #YourBlogOnMyBlog Series commemorating my Decade of Blogging. Four weeks with just one more week to run in what I thought I might struggle to get blogs to run until the end of December 2013.

Blog - To Celebrate My Decade of Blogging

Yet, it has been a rather busy week that straddled the turning of the year from 2013 to 2014.

One news story on Twitter about profligacy in Nigerian politics unleashed a torrent of tweets that I collated into a blog with a backstory and context notes.

Blog - Nigeria: The leaders whose success and joy is the pain of many

A demonstration of the gift that I have come to know I possess was the poem that I crafted in 4 tweets over 12 minutes, the last verse of the Walk Away! poem coming much later. Then a New Year’s Day blog recognising the gift and desire to do more with it.

Blog - Walk Away!

Blog - The Gift

Funmi Iyanda gave a keynote address to a youth event challenging them to think differently if we are to change Nigeria and make it a better place. I added an introduction, put in some links and made some callouts to pertinent things she said.

Blog - Funmi Iyanda: Write your own ending. Shape history

This was very good news, after months of indifference bordering on criminality, the system and institutions responded to the cry of dying HIV/AIDS sufferers who had been prescribed substandard drugs by government agencies.

NAFDAC withdrew all the drugs manufactured by one company nationwide, replacing them with drugs that hopefully will arrest the decline in health brought on by the usage of the poorly manufactured drugs.

Blog - Nigeria: Presumed Substandard Tyonex HIV/AIDS ARV Drugs Removed From Circulation

Our lives

The theme this week about life, pursuits, times, friendships, rights and history.

Here, for your pleasure are four weeks of Decade Blogs. To everyone who has honoured me in finding time to write for #YourBlogOnMyBlog, my thanks and more. I would find the words of appreciation and gratitude, eventually and they would still not be enough.

Decade Blogs – Week 4

Decade Blogs - Dupe Killa - The Broken Ones

Decade Blogs - Kola Akinola - My Friend

Decade Blogs - Chioma Agwuegbo (Chuka) - 10 Years

Decade Blogs - Henry 'O'Jew' Olamiju - Greatness - A Life Waiting Us

Decade Blogs - Olu Ximena - The Trade

Decade Blogs - Editi Effiong - Dear religious people, let's kill all the gay people

Decade Blogs - Saratu Abiola - On Nigeria and Why Writing Matters

Decade Blogs – Week 3

Decade Blogs - Sira Sokari - Writing is the Liberator

Decade Blogs - Abubakar A. Musa - Challenging the humanity in us

Decade Blogs - Japheth J. Omojuwa - The Power of Purpose and Persistence

Decade Blogs - Mister Mobility - Not all those who wander are lost

Decade Blogs - Annie Emmanuel - Loyal To A Fault And Daring To Do

Decade Blogs - Akin Oyebode - How Will You Measure Your Life?

Decade Blogs - Ayo Oyalowo - What exactly are we looking for?

Decade Blogs – Week 2

Decade Blogs - Monike Charles-Binitie - Taking the leap

Decade Blogs - 'Seyi Shimoshi - On Faith, Fiction and Friendship

Decade Blogs - Raymond Inkabi - Ten Years Of Blogging

Decade Blogs - Blossom Nnodim - The Guardians of the Future

Decade Blogs - Pearl Ijeoma Ezeokeke - The Employer Atrocities of She

Decade Blogs - Ikhide R. Ikheloa - This life, London, tribes, and the Internet

Decade Blogs - Bisi Alimi - 10 Years of Blogging

Decade Blogs – Week 1

Blog - Decade Blogs - Babatunde Rosanwo - The Market‏

Blog - Decade Blogs - Waffarian - Just Another Day

Blog - Decade Blogs - Emeka John Okoye - Welding Relations

Blog - Decade Blogs - Chikere Ezeh - Exhuming Blogs of Old

Blog - Decade Blogs - Nkem Ivara - The Power Of Words

Blog - Decade Blogs - Tolu Oloruntoba - Royalties at the end of a river

Blog - Decade Blogs - Feyi Fawehinmi - Daddy 2.0

Ìrírí - How our brotherly love could have blossomed

Pre-term brothers

Just a few minutes ago, I ended a conversation with my father that took us down memory lane with comparisons of realities of life that left me in surprise and shock bordering on rage.

There were many stories but the one I never knew was about my half-brother who before he received a given name experienced the misfortune of being born into an avoidable situation exacerbated by systemic failures in Nigeria.

My half-brother and I were born over 40 years apart, in literally similar circumstances but in different lands. We were both prematurely born, he arrived at just over 7 months, I arrived in 6 and a half months, somehow, we were delivered in maternity homes without facilities to cater for the prematurely born that we had to be moved to better equipped hospitals and that is where our stories begin to diverge.

Our separate lives

On the cold morning in 1965, after I was born, arrangements were made to move me to a major city hospital where as my father recounted to me, I had all the hallmarks of royal treatment – spacious, well-ventilated room, with nurses and medical personnel at my beck and call, I did not lack for care, comfort or succour – I am 47.

My half-brother, let’s call him Ìrírí (Yoruba for experience) was born in Ibadan which at one time was famed to be the largest city in Africa along with many firsts.

He was rushed to University College Hospital (UCH), Ibadan the premier teaching hospital in Nigeria where a philanthropist had previously donated 6 incubators to the Paediatric Unit to cater for premature birth.

Five of six, down

Ìrírí arrived to find that five of the incubators were out of commission but was fortunate for a few hours to have the only functioning incubator temporarily vacated for him to at least have a fighting chance to lay claim on a Nigeria of our dreams.

However, alternative arrangements had to be made for Ìrírí, so when he had stabilised, the decision was made to transfer him to an incubator installed in the private practice of one of the UCH consultants, also in Ibadan.

Ìrírí made it to that practice but at the same time, he became an everyday Nigerian at the mercy of too many things out his control. The incubator was vacant and available but the public electricity supply was down and as if fate had colluded to deprive Ìrírí of an inalienable right, the backup electricity supply could not be provided because the generators will not start.

Ìrírí rests

So, Ìrírí mustered all the strength he had to survive, he wriggled and writhed, panted for breath, desperately hoped that his heart will hold out and many other organs that were not fully developed for earthly experience strained at the limits of their ability without the support they all needed – after trying so hard, they decided this earthly experience was not worth it.

There, Ìrírí drew his last breath bidding the earth farewell but leaving a most indelible mark on the lives he has touched for the short while of just about 36 hours that he was with us – over 40 years after Akin was born in England, Ìrírí could not survive similar circumstances in an independent Nigeria in its 6^th decade.

Time, manner and place

Then my father drew comparisons between Ìrírí and myself; as a poor student just about to take up a job in a sorting office for Christmas, I was born just 2 days after they had moved house, my mother’s labour probably brought on by the stress of moving house, I had the best of facilities provided at no cost at the behest of the government and here I stand.

Back in our home country of Nigeria, everything had to be paid for and it made no difference to the outcome, the experience was harrowing, the prognosis was dire and either as a microcosm or snapshot of the Nigerian experience, the short life of Ìrírí exemplifies so many things that are just not right with Nigeria.

The premier teaching hospital in the country had 5 out of 6 donated incubators out of commission, this does touch the matter of pre-existing incubators or what might have caused a philanthropist to make those donations.

Murder by proxy

Then the matter of usage and maintenance that led to the failure of the incubators that none of the management thought it prudent to either seek new funding from the donor or go on a fund-raising drive which contributed to the murder-by-proxy of Ìrírí.

I do wonder what the philanthropist would have felt if he learnt that the equipment he donated to the hospital had fallen into disrepair that the purposes for which the incubators were acquired could no more be served.

Then think of the many like my dear Ìrírí whose experience of this world was truncated by a system that serves nothing but rank incompetence, mismanagement, corruption, malfeasance and worse.

It ought not to be so, but that is one of the realities of Nigeria today.

Dear Ìrírí, Rest in peace, my half-brother, Nigeria did not deserve you.

Hospital: Bloody routines

Bloods for viewing

It was the ritual of bloods again today which presages my second appointment with my consultant this year. The meetings now seem to have stretched from quarterly to almost every 4 to 5 months though this was to allow for my consultant taking his holiday this year in July rather than August as he did last year.

This might well be my last major medical appointment in the Netherlands before I leave the country for a somewhat uncertain future to places yet undefined but I have lived dangerously enough to be sure that things will turn out fine and my outlook as I sort out the confusion from the direction will lead to a presently invisible but definitely better end.

Handled with efficiency

As I made for the hospital allowing for just under 3 weeks for the bloods to be tested, I found myself at the end of a queue over 20 deep but handled with the efficiency you will not find in the poorly managed supermarkets we ply in the Netherlands.

They had opened an extra registration desk and had all the 6 blood-letting temporary wards fully staffed even though when I saw I was being served unsupervised by a trainee, I held my breath long enough not to panic at the possibility of a mishap.

I only had two forms listing the blood tests that needed to be done requiring 7 vials of blood and it almost made me faint when the man next to me had what numbered like 6 forms, I did not bother to think of whether he’ll need a transfusion after giving blood.

Don’t stop flowing now

For the first time, I watched the needle go under my skin and after the second vial, the blood ceased to flow, in my mind I prayed I will not have to suffer another puncture wound for blood as she deftly manipulated the needle till the vial seemed to fill up with great reluctance.

At the seventh vial, without it getting to a quarter full, the flow stopped and nothing could be done to take any more blood from that puncture, after surveying the vial, she decided there was enough for the tests as she removed the needle and covering the prick incision with cotton wool then labelled the vials before sealing my arm with tape.

As I am wont to do, I walked round to the chapel office to see if the catholic pastor was in, unfortunately, he wasn’t and I really have not seen him for nigh on a year.

Appreciation

In three weeks, the tale of the bloods will be revealed and maybe, just maybe I will know unto whom my medical records will have to be transferred when I leave the Netherlands.

If anything, the quality of medical care I have received in the Netherlands has been sterling and amazing, I would not know if I can been assured of this standard of care in any other country and it is a primary concern that has featured in considerations of going to Africa – the honest truth is I do not expect to see anything near the quality I have grown accustomed to here.

Editorial: Lifting the burqa on identity and ignorance

Where the burqa belongs

The matter of the burqa though religiously sensitive needs to objectively thought about in its proper contexts. A number of European and Western countries have promulgated laws or are in the process of creating legal situations where the burqa is banned in public places.

In Islamic countries where the chastity and dignity of the woman is presumably preserved by the total cover-up with slits for the eyes, a see-through net or grille it is traditional and customary for women to be invisible as recognized individuals and personalities.

In more conservative settings, the women would have to be chaperoned by male members of their families to be seen in public and their identity is derived from who accompanies them.

Western societies have no such customs and this type of extreme modesty is rather alien to the concept of individual identity and the representation of personalities.

Where the burqa does not belong

The face is the first object of identification, communication requires eye contact and people, especially adults have the responsibility for acting as free moral agents with verifiable particulars of identification to access all sorts of services especially those to do with security, law enforcement and business transactions.

It means such open societies just do not have the means or the latitude to accommodate these alien customs because it abridges human-rights in terms of having a clear identity in the public space as it disrupts the sense of security people have by facial recognition of those within their space.

The civil liberties advocacy for the right to wear the burqa in open societies that require facial identification as a verification of identity simply holds no water wear no alternative system of identification exists to verify a covered face belongs to a particular person, it burdens such societies with impossible hurdles and impacts on the sense of equality we all have.

Whilst the preservation of right to religious observation is apparently sacrosanct, that of customs that go against the grain of easy identification cannot be so. The burqa just does not belong in free societies.

Unhealthy burqas of ministers of health

Health ministers would be expected to have the medical health of their fellow citizens as paramount with the aim to facilitate access to good, affordable and accessible healthcare to all.

For all their erudition, expertise and organizational ability, we expect that whatever they do will attract the greatest commendation of respect and praise of their service and one can dare to hope that they would avoid being embroiled in controversy.

It was bad enough that a health minister in Nigeria did not see the medical emergency of fake drugs and substandard drugs being dispensed in Nigeria’s University Teaching Hospitals suggesting only his predecessor was directly addressed and informed of the matter.

However, when somewhat progressive countries end up with health ministers in that kind of mould, a greater disservice is done to the people who deserve better than that kind of cack-handedness.

In South Africa it was the health minister in Thabo Mbeki’s presidential tenure who advocated the use of beetroot garlic and herbs for the management of HIV and AIDS that she earned the embarrassing world-stage moniker of Dr Beetroot as the medical situation in South Africa was allowed to grow into an epic emergency.

She has passed but the baton seems to have been handed to the health minister of the world’s second most populated counted and the largest democracy.

Donning the burqa of crass ignorance

Whilst health ministers are entitled to their moralities and values, they are not put in their positions to preach to the adherence of some moral code and alienate others on grounds that have no professional or medical basis.

It therefore comes as a shock beyond words when the Indian Health Minister at a HIV/AIDS conference he was attending said that “homosexuality is a disease which has come from other countries.”

It is hard enough listening to people propose that an element of human nature has a particular racial or regional progeny in their quest for a sense of cultural purity but to hear such stuff from a health minister is really beyond the pale.

There is every reason to expect this person to walk the plank before their pronouncements validate and promote the persecution of others on all grounds predicated from a false and illiterate medical perspective, one can only be filled with trepidation at what might result from this statement in a country where the matter of rights are not as sure and in others where India is supposed to serve as an example.

We need to lift the burqa on this kind of intellectual arrogance which is portends to have moral underpinnings but is stark ignorance expressed by one who should really know a lot better.

Acknowledgements

The BBC news website writes about giving powers to the New South Wales police concerning criminalising burqas by reason of the fact that it hampers the identification process in crime investigation and law enforcement. After a BBC documentary five years ago, I wrote a blog about the Unhealthy directors of Nigerian Health and yesterday, the Indian Health Minister took on the mantle of Dr Beetroot of India.

Editorial: Cancer of the mind

Lazy newspapers

The editorial today is derived from a number of health scares that made the Nigerian social networking headlines within the last 24 hours all to do with how the big C – cancer can be contracted.

From Twitter with a URL that linked to a 234Next.com online newspaper story the eye-catching title was ‘Grilled meat can cause cancer' and then through Facebook to a news story on The Nation Online Nigeria it was ‘Beware! Oral sex causes mouth cancer, Fed Govt warns.’

I will not contest the fact that the function of the newspapers is to inform, but when it comes to health scares, they might well be literate but they are far from numerate, their copy fails to apply reason and the thinking that informs their dissemination of that news story lacks objectivity as they plumb the depths of sensationalist incomprehensibility to produce unbelievable headlines.

Undeserving experts

The blame however cannot be placed entirely on the newspapers even though they are probably best advised to give health scares a wide berth just as readers are supposed to resist the urge to charge as bulls to the matador; propagating these stories until they go viral for the want of an appropriate term and an urban legend is born.

On the matter of grilled meat which is a delicacy called suya in Nigeria the medical expert on the occasion of World Cancer Day proffered that “Cancer cells thrive in an acid environment,” and with that seemingly categorical statement suggested, “A beef based diet is acidic, especially when burnt, so avoid suya and processed meats.”

The assertion about cancer cells was quite quickly debunked by doing a search on the most outlandish statement on Google which lead to http://www.snopes.com the website that pricks urban legends and provides incontrovertible fact over fiction, fable and fallacy.

Facts off course

The statement was false, it was attributed to Johns Hopkins University and circulated via email to the many gullible readers who passed it on without verifying the claims, it was so serious that Johns Hopkins University released a comprehensive email completely rubbishing each one of the claims including the one the medical expert with all the authority of a forum made for public consumption.

Now, indeed there are dangers in practicing oral sex and there is medical or scientific study that suggests the presence of the Human Papilloma Virus (HPV) might well make people susceptible to types of oral cancer.

Experts at quackery

That piece of information coming from the Chief Dental Officer of the Federal Ministry of Health was welcome and useful, however, when the expert veered off into the moralisation and societal consequences of the use of the mouth, she had tangentially departed the commonsense bounds of scientific rigour and defaulted to a quackery of the most impressionable kind reminiscent of snake-oil merchants and street-corner confidence tricksters.

The greater concern is if on the one hand medical experts cannot be trusted to properly validate studies through basic research and verifiable facts and on the other hand they fail to appreciate their limits of the expertise before delving into social commentary that has no basis in incontrovertible truth, fact and unimpeachable scientific data, we find ourselves at the mercy of seemingly esteemed professionals operating as quacks.

The cancer of the mind

In essence, not only do we face the danger of cancer in whatever form attacking the body; a cancer of the mind even leaves us more vulnerable to risk-prone, hardly meticulous and assuming people whose guesswork and absence of logic in the process of medical diagnosis might be more fatal than a double tap.

It is then no wonder that Nigeria suffers a serious health crisis if those with ultimate responsibility cannot ensure they get their facts right before they scare us witless with laughable fables.

Blacks after slavery

On a more educational note, I came across a link to a PBS documentary about Black in Latin America narrated by the esteemed Professor Henry Louis Gates, Jr. who finds global fame in being the black man who on identifying himself as the owner of his own residence still ran afoul of the law in God’s own America.

He expounded on how slavery took Africans to Hispaniola, Brazil, Mexico, Peru and Cuba and where the black race after slavery stands today and in comparison to the United States of America. The whole series makes really compelling viewing as it draws you in and the shocks you.

One rather interesting refrain suggested that long-term relationships were rarely formed in many cases between races but somehow sex appeared to be colour-blind. One should take the time to carefully view every single episode and if well-disposed a contribution to the service would also be welcome. You can find the homepage at Black in Latin America | PBS

Acknowledgements

The 234Next Newspaper piece titled ‘Grilled meat can cause cancer’ appeared in February and the news story published yesterday by The Nation Online Nigeria it was ‘Beware! Oral sex causes mouth cancer, Fed Govt warns.’

The Time Magazine did publish information about the study Oral Sex Can Add to HPV Cancer Risk in April 2007 and so did the BBC with the title Oral sex linked to mouth cancer as far back as February 2004; with a BBC3 documentary aired in January 2011 that stuck with the substance of the report.

The findings of the study itself were published in the New England Journal of Medicine with the title Case–Control Study of Human Papillomavirus and Oropharyngeal Cancer downloadable as a PDF file in May 2007.

The Snopes website debunked the “Cancer cells thrive in an acid environment” assertion by publishing the full false email attributed to Johns Hopkins University and the each point in that email for further rubbished by the university in a publication titled - Cancer Update Email -- It's a Hoax! And this as far back as April 2009.

The Henry Louis Gates arrest controversy as documented by Wikipedia, the free encyclopaedia is just what it is.

Nigeria: NaijaLeaks Yar'Adua should have been in a hospice not in office

In a hospice not in office

The drip feeding of WikiLeaks US Embassy cables continues apace with the release yesterday of ones that pertain to Nigeria that have been conveniently named NaijaLeaks.

Two of the cables created in June 2008 and in February 2009 relate to the health of the late president Umaru Musa Yar’Adua who sadly died in May 2010 after a rather secret but prolonged chronic illness.

Whilst it was public knowledge that the President then had serious health problems, the cables reveal the extent to which his health was seriously impaired that he probably should have been between a hospital and a hospice with extensive respite care rather than running Nigeria as Executive President.

Gathering information from various sources, the US Ambassador painted a picture of a man who had “began experiencing symptoms of acute renal failure in late 1999”, was promptly put on dialysis treatment for 3 days a week in the afternoons by his German medical experts and somewhere in 2001 or 2002 received a kidney transplant from the Minister of Agriculture Ruma.

Extremely frail, really ill

His term as the governor of Katsina State commenced in May 1999 and it could be said that from the time he was diagnosed to the time of his demise in May 2010 he probably did not have the requisite recuperation time necessary for a person who had undergone such radical medical procedure and treatment.

Taking a transplanted kidney would have meant that he would be on anti-organ-rejection medication and steroids that would have seriously compromised his immunity leaving him a man of weak health, the result of which included visible facial discolouration.

Further evidence of his weak health was documented by the Ambassador as “she observed him up close, noted that he was extremely frail, more soft spoken than usual, his skin was extremely drawn, teeth were extremely tarred and his involuntary cough had increased”.

“He appeared to weigh no more than 130-140 pounds (63kg max) (which for his height would have left him unhealthily underweight), his skin was very taunt, his handshake was weak, voice was fainter than on previous meetings, his eyes were deep set with dark circles underneath, and his teeth were also very badly tarred”.

Hardly a picture of rude health, one would say; it no doubt affected his ability to govern as his energy levels were very low, he was regularly breathless and he had office hours that ran from 10:00AM to 3:00PM, though, we were given the impression that this was an effective, able and honest governor worthy of assuming greater office in Nigeria.

Healthcare delivery inadequacies in Nigeria

The cables contain the detail which does not need to be repeated in this blog but there are more interesting issues that the cables reveal.

The fact that most Nigerian hospitals bar one were not adequately equipped for the treatment of people with chronic kidney disease, that equipment had to be ordered specially for his treatment and this had to be moved to different locations as his needs warranted.

The fact that his doctors who apparently were specialists were seriously deficient in knowledge and expertise to manage his condition effectively that they had to go abroad for medical courses to bring them up to speed, despite that fact that we have so many university teaching hospitals in the country.

Whilst the source of information could not be corroborated, it was suggested he had lung cancer and foreign specialists were of the opinion that the treatments requiring chemotherapy and the expertise of oncologists was not available in Nigeria to help the president.

The fact that the kidney transplant could only be performed in one hospital in Lagos, Nigeria even if there was adequate secrecy and protection of information about his health to be able to do so.

6 years after the original transplant, that kidney was failing and there were plans to conduct another kidney transplant which should have happened in Nigeria if there were any progress in specialist healthcare development, but there was none and he failed to exploit that opportunity to prevent raising additional fears about his condition.

He should have resigned, retired and refused

In essence, whilst he continued to make appearances he allowed his sharp intellect and mind to work well ahead of his physical and physiological abilities.

A smarter man would have resigned all offices to attend to the important matter of his health but it was observed that his remaining in office albeit as a figurehead allowed for faceless handlers to hold the reins of power and effect official activities in his name, chief amongst whom was his wife.

The reading of the cables casts him as a stooge, the benign face of more sinister and nefarious backroom activities of his clique of confidants who must have persuaded him of the need to remain in office against the advice of his medical staff who would be worthy of being struck off medical practice registers and disgraced if they had not duly warned that he was literally at death’s door.

This leaves one rather perturbed that President Olusegun Obasanjo may not have been aware of how seriously ill this man was before he was tapped to take on the role of presidential successor.

Everyone knew the truth and told a lie

The premier construction company, Julius Berger had been involved in construction of the dialysis units, arranging the installation of the equipment and on many occasions provided the transport President Yar’Adua needed to visit his medical experts abroad.

Royal Dutch Shell in Nigeria was also privy to activities needed to boost the president’s health or at least offer the semblance of healthy ability when in truth that was quite lacking.

It had to have been an open secret in the Federal Executive Council that for all that the man could do, his mind would have been preoccupied with seeing through the next hour talk less of the next day but we never really got a good idea of his incapability until he left for Saudi Arabia in November 2009 and we were informed that he was suffering from acute pericarditis.

In all, the man was at death’s door, retiring from all the pressures of office and the refusing to assent to the greedy entreaties of his wife and the cohort that saw personal gain in propping him up would have brought him back from the brink – if the idea of a sense of duty were proffered, it would have been foolhardy at best and downright recklessly careless.

You cannot short-circuit recuperation

It beggars belief that his wife could have thought that he would be able to run for reelection in 2011, it does take your breath away that she and those others of the “Katsina clique” had none of his interests at heart, along with his evident folly, they and I must include the ex-President pushed the man through death’s door; he suffered an untimely death.

I look at my own circumstances and remember that whilst my mind was way ahead of what my body could do, up to 3 months after chemotherapy I was nowhere near the energy levels required to do everyday things with any efficiency or alacrity.

At 11 months after chemotherapy, my immune system is still building up to what can be termed normal, fatigue still sets in quite frequently and each day, to do something new is a great achievement.

For their own good against his

Umaru Yar’Adua should have left public service in 1999 and taken good care of himself, he should not have sought reelection as governor of Katsina State in 2003 and definitely should have declined the offer to take the office of president when he was being considered in 2006 and selected in 2007.

When he realised he might need another transplant, he should have vacated office, no one is compelled in to stay in office at all costs and definitely when your health is failing and the wise thing was to allow for proper recovery by recusing oneself from unnecessary pressures, especially one as onerous as the office of the President of Nigeria.

In essence we were done a great disservice by the whole governing elite of Nigeria who allowed a very sick man to continue in office against all good judgement. It is a travesty that none of the people involved in this atrocious and disgraceful cover-up have been held to account whilst the foreigners who knew the truth worried about Nigeria’s ineffectiveness in global issues and unbeknownst to us all, we were the world’s laughing stock.

Never ever again

In old-time Russia, even their many comatose presidents never had the global lens focused on them to the extent that it was public knowledge whilst the official bulletins conveyed a lie.

This however calls for a number of legislative corrections to Nigerian politics; the passing of the Freedom of Information Bill; a public record of the medical health of all Nigerian leaders and a radical overhaul of healthcare provision in Nigeria with some attention paid to specialist medical expertise in kidney ailments and cancer treatment.

More importantly, this must never happen again in Nigeria, never ever again.

Sources

Viewing cable 08ABUJA1016, S/NF) NIGERIA

Viewing cable 09ABUJA203, NIGERIA: UPDATED HEALTH INFORMATION ON PRESIDENT

The Cables with interesting parts highlighted

First Cable in 2008

S E C R E T ABUJA 001016

SIPDIS NOFORN

DEPT FOR AF/W, INR/AA, INR/B DOE FOR GPERSON

E.O. 12958: DECL: 06/01/2033 TAGS: PGOV PINR KDEM KISL SOCI NI

SUBJECT: (S/NF) NIGERIA: xxxxxxxxxxxx Ref: a. ABUJA 320 b. ABUJA 799 c. ABUJA 972

Classified By: A/Pol/C Heather Merritt, reasons 1.4 (b, c & d).

¶1. (S//NF) SUMMARY: xxxxxxxxxxxx contended that Yar'Adua began experiencing symptoms of acute renal failure in late 1999, and traveled at that time to Mainz, Germany, to consult with kidney specialists. xxxxxxxxxxxx claimed, that in 1999, German doctors told Yar'Adua to undergo dialysis treatment, and that a dialysis unit was subsequently installed in his private Katsina residence in 2000.

According to xxxxxxxxxxxx when Yar'Adua's condition worsened in 2002, he traveled to Saudi Arabia to receive a kidney transplant. To ensure his body would accept the transplant, Yar'Adua took steroids and other medications which in due course reportedly caused the discoloration that we see today on the President's face. Moreover, xxxxxxxxxxxx averred that Yar'Adua's poor health reduced his capacity to govern and, correspondingly, his political influence in the North.

xxxxxxxxxxxx also alleged that during Yar'Adua's tenure as Katsina governor his wife, Hajiya Turai Yar'Adua, persuaded Yar'Adua to divert millions of dollars of public funds from the Katsina state treasury into private accounts.

(Note: We have heard of similar illicit enrichment attempts by Mrs. Yar'Adua now that she is in the Villa as well as scarce allegations that President Yar'Adua had engaged in corruption while Katsina governor. End Note.)

On the political front, amidst current rumors of President Yar'Adua's failing health, the northern political elite appears increasingly concerned that in the event of Yar'Adua's untimely demise, the presidency may return to the South.

END SUMMARY.

¶2. (S//NF) xxxxxxxxxxxx spoke with PolOff May 26. xxxxxxxxxxxx said that Yar'Adua began experiencing symptoms of acute renal failure in late 1999, after traveling to Jeddah, Saudi Arabia for the lesser pilgrimage in Mecca. Upon returning from Saudi Arabia, xxxxxxxxxxxx claimed, Yar'Adua traveled to Mainz, Germany to consult with kidney experts.

According to xxxxxxxxxxxx the German specialists instructed Yar'Adua to promptly go on dialysis treatment. xxxxxxxxxxxx stated that the German-based Julius Berger construction company, which had significant financial ties to the Yar'Adua family (through the President's elder brother Shehu Yar'Adua), was contracted to set up a dialysis unit in Yar'Adua's home in Katsina.

Doctors from Germany were brought to Katsina to train local physicians in dialysis operations, though, xxxxxxxxxxxx asserted, Yar'Adua also retained the services of German kidney specialists in Wiesbaden, making frequent trips there between 2000 and 2002.

¶3. (S//NF) Following a 2001 visit to Saudi Arabia, xxxxxxxxxxxx said, Yar'Adua's condition worsened, and he was diagnosed with chronic renal failure. Upon returning from Saudi Arabia, Yar'Adua's dialysis treatments become more rigorous, xxxxxxxxxxxx confided, and his dialysis machine was moved into his private bedroom. xxxxxxxxxxxx maintained that Yar'Adua likely received a kidney transplant in Saudi Arabia in either late 2001 or early 2002.

xxxxxxxxxxxx also claimed that Yar'Adua's dialysis machine was removed from his Katsina residence in 2002 and that discoloration was evident on his face at that time, which he assessed was the result of Yar'Adua taking steroids and other medications to enable his body to accept a transplant. xxxxxxxxxxxx rejected notions Yar'Adua suffered from Churgg-Strauss syndrome.

Additionally, xxxxxxxxxxxx explained that the raised patch of skin often noted by observers on President Yar'Adua's right hand is not connected to his kidney ailments, but instead the result of a serious car accident Yar'Adua sustained in 1999. According to xxxxxxxxxxxx after Yar'Adua's car accident, his physicians removed some tissue from his buttock area to graft to his injured, and badly disfigured hand.

Abuja 00001016 002 of 003

¶4. (S//NF) xxxxxxxxxxxx contended that Yar'Adua "always" craved power, dating back to the days when Yar'Adua first contested and lost the governorship of Katsina state in 1991. Indeed, xxxxxxxxxxxx remarked, Yar'Adua's politically prominent family "bred" him to assume office in the future.

However, xxxxxxxxxxxx asserted that throughout Yar'Adua's administration in Katsina, his performance suffered due to his poor health, which contributed to his constant fatigue, and to "an inability to govern." Whereas Katsina state commissioners and permanent secretaries routinely worked twelve-hour days, xxxxxxxxxxxx said that governor Yar'Adua himself entered the office at 10:00am and returned home around 3:00pm each day.

According to xxxxxxxxxxxx Yar'Adua seemed disinterested in engaging in the requisite politicking that is the hallmark of political relations between elected leaders and power brokers in the North, and Nigeria generally. Yar'Adua's disinclination to travel while governor, even to neighboring states to meet with the northern political elite, also perpetuated his political isolation.

¶5. (S//NF) During his tenure as governor of Katsina, xxxxxxxxxxxx maintained, Yar'Adua appeared deliberative and ruthless in managing the affairs of his state. While intelligent, Yar'Adua, according to xxxxxxxxxxxx neither tolerated disagreement nor insubordination. xxxxxxxxxxxx noted that Yar'Adua ultimately relied on a handful of confidants, whom xxxxxxxxxxxx considered sycophants more than dispassionate consultants.

xxxxxxxxxxxx said that Yar'Adua, paradoxically, routinely ignored the counsel of even his purportedly trusted advisers, preferring instead, to make his own decisions. In so doing, xxxxxxxxxxxx said, Yar'Adua had been assessed by some other northern elders as both an unimpressive leader, and an irresponsible one.

¶6. (S//NF) xxxxxxxxxxxx suggested that while Yar'Adua served as governor of Katsina, Yar'Adua's wife Hajiya Turai Yar'Adua, manipulated him into diverting millions of dollars of funds from the state treasury into private Yar'Adua family accounts. xxxxxxxxxxxx alleged that Yar'Adua used these stolen funds to construct a lavish private residence in Katsina and to finance family vacations to the Middle East and the UK (Ref A).

Though xxxxxxxxxxxx acknowledged that Yar'Adua as former governor had built primary and secondary schools in Katsina, xxxxxxxxxxxx criticized Yar'Adua for failing to properly fund the training of teachers for those schools. As a result, xxxxxxxxxxxxx said, unlike in the past, under Yar'Adua's two terms as governor, Katsina students consistently failed to meet national standards in math and reading assessments. xxxxxxxxxxxx said that for Yar'Adua, "it was all about the spectacle of governing."

Even the roadways in Katsina, xxxxxxxxxxxx said, may have been impressive, particularly when compared to the deplorable road network in other parts of the North, however, xxxxxxxxxxxx alleged that while the roads had been built, the contract costs were egregiously inflated and the excess funds were siphoned. xxxxxxxxxxxx said some Katsina road contracts had been given to non-existent, "ghost" companies, which were secretly "owned" by Turai Yar'Adua.

¶7. (S//NF) COMMENT: xxxxxxxxxxxx allegations of Turai Yar'Adua's contract-related corruption in Katsina also seem credible in light of similar claims previously reported by the Mission since she became the First Lady (see Ref A, for example). xxxxxxxxxxxx perspective may help shed light on President Yar'Adua. As reported (Ref C), we believe the President has two sides: one, for international consumption; and the other, which turns a blind eye to certain rule of law issues, particularly as it pertains to his wife.

Then-governor Yar'Adua's unwillingness to engage in the necessary politicking to build a broad base of support in Katsina may have been relatively insignificant against the backdrop of insular Katsina state, or even northern regional, politics. However, as president of a diverse nation, with competing regional interests and powerful patronage networks, Yar'Adua's continued political isolation (even within the North) may illustrate, to an extent, why even today Yar'Adua has not fully succeeded in truly stamping his authority on the PDP or the Presidency.

¶8. (S//NF) COMMENT CONT'D: Certainly, Yar'Adua's health remains a cause of concern for northern power brokers, especially in light of the possibility that Vice President Goodluck Jonathan would constitutionally be next in line for the presidency in the event of Yar'Adua's demise, although we doubt the northern elite would allow this to transpire.

Opposition presidential aspirant Muhammadu Buhari (All Nigeria People's Party) told PolOff May 13 at his Kaduna home that given the North's trepidation of power returning to the South (if, for instance, Yar'Adua cannot complete his term), Buhari feels vindicated in his insistence on challenging the President's election.

Buhari intimated that members of the northern political elite have begun visiting him to affirm their allegiance to him, and to support him as he continues to contest Yar'Adua's election at the Supreme Court (see Ref B). Buhari noted that, in light of news of Yar'Adua's troubling health, some northern power brokers now believe fresh polls (wherein Buhari emerges the victor) might be the best way of ensuring that the North retains the presidency.

End comment.

¶9. (S//NF) xxxxxxxxxxxx END NOTE. Sanders

Second Cable in 2008

S E C R E T 09ABUJA203

NOFORN SIPDIS

DEPT FOR AF/W, INR/AA DOE FOR GEORGE PERSON

E.O. 12958: DECL: 01/26/2034 TAGS: PGOV PREL PINR NI

SUBJECT: NIGERIA: UPDATED HEALTH INFORMATION ON PRESIDENT YAR'ADUA (C-AL8-02520)

REF: A. STATE 6401 ¶B. 08 ABUJA 2525 ¶C. 08 ABUJA 2517 ¶D. 08 ABUJA 2222 ¶E. 08 ABUJA 2165 ¶F. 08 ABUJA 2147 ¶G. 08 ABUJA 2141 ¶H. 08 ABUJA 2123 ¶I. 08 ABUJA 2104 ¶J. 08 ABUJA 2065 ¶K. 08 ABUJA 1822 ¶L. 08 ABUJA 1016 ¶M. 08 ABUJA 962

Classified By: Ambassador Robin Renee Sanders for reasons 1.4. (b & d).

¶1. (S/NF) INTRODUCTION.

Ref A requested updated information about the health of Nigerian President Umaru Musa Yar'Adua. We note that our GON and private contacts continue to state that President Yar'Adua is managing his known health issues -- chronic kidney problems -- and is not suffering from something more serious.

The Villa also continues to keep a tight hold on any information concerning his health and has been cautious about any indications on travel outside of Nigeria, to avoid additional concerns. As a result, attempts to gain specific and/or verifiable information on his condition, prognoses, medication, treatment options are limited.

The Ambassador's last personal dialogue with him (Ref. C), in which she observed him up close, noted that he was extremely frail, more soft spoken than usual, his skin was extremely drawn, teeth were extremely tarred and his involuntary cough had increased.

He was, however alert and could carry on a sophisticated conversation. We have also reported, ref. B, recent extensive critical comments by a Villa staff member on the impact of the President's health on the country's governance. What is clear is that the President's health is a matter of growing concern, particularly on the minds of the northern Nigerian elite.

We have noted a considerable up-tick in what appears to be behind-the-scenes machinations and backroom dealing, most notably the recent reconciliation meeting between former President Obasanjo and former VP Atiku and Atiku's pending official return in March to the ruling PDP, former President Babangida's sudden return to the political scene with a string of public pronouncements, and Kwara Governor Saraki's machinations to possibly be a PDP candidate in 2011.

¶2. (S/NF) If Yar'Adua were closer to "death's door," we would expect more of a political power struggle publicly to break out drawing in these traditional "Godfathers" of Nigerian politics, as well as newer groupings including Kwara State Governor Saraki (and Governors' Forum chairman), some of the other Governors (e.g. Niger and Kaduna), and some members of the "Katsina clique" who have gathered around Yar'Adua.

All these groups have a shared interest either in maneuvering VP Goodluck Jonathan out of assuming the presidency, or in assuring that his power as President was strictly circumscribed and that he appointed a strong Northerner as his VP. (We note there has been a speculation of a Yar'Adua demise in February 2009.

Thus, this has not happened and he may either not be suffering from a terminal disease or could -- as other leaders have done in the past -- hang on longer than we anticipate.)

¶3. (S/NF) Yar'Adua began a two-week vacation on January 26 (to date he still remains in Abuja and his vacation is scheduled to end on Monday, February 9). However, official statements from the Presidential Spokesman indicated that he would pass the two weeks in Lagos, Cross River State (at the Obudu Cattle Ranch) and at his home state of Katsina.

There is widespread speculation, however, that the Villa may be using the guise of a "vacation" to hide medical treatment. On January 27, Kwara State Governor Saraki insisted to Ambassador that Yar'Adua will not/not leave Nigeria during his vacation; however, we believe that he is most likely receiving clandestine medical treatment in Nigeria during this period.

Ambassador was told by two key contacts, Shell VP for Africa on January 27 and Information Minister Akunyili on February 2, that experts from Germany have been brought in to oversee the President's treatment.

END INTRODUCTION.

¶4. (S/NF) Information below on the health of President Yar'Adua is keyed to Ref. A questions:

¶A. (c) overall health

A 1. (S/NF) DIAGNOSES: Despite continued statements by the Villa spokesperson that the President is not in poor health, several individuals xxxxxxxxxxxx and First Lady Turai Yar'Adua) have admitted privately to the Ambassador that he suffers from acute kidney disease (Refs. C, G, H and others).

We continue to hear press and blog reports that Yar'Adua suffers from lung cancer, although this is generally from sources further removed from the Presidency. xxxxxxxxxxxx is the only credible source who confirmed that he heard reports of lung cancer. xxxxxxxxxxxx is not close to the President and has access to tertiary information at best.)

On October 27, First Lady Turai Yar'Adua told Ambassador that Yar'Adua did not have lung cancer, but admitted that he suffered from long-term kidney disease and from asthma (Ref. G). On January 27, Kwara State Governor Saraki, a medical doctor by training, told Ambassador that Yar'Adua is "not at death's door" and that he is learning to cope and manage his energy levels better, leading to an improvement in his energy and breathing since the September 2008 timeframe.

xxxxxxxxxxxx a contact xxxxxxxxxxxx at the German Julius Berger company said that Yar'Adua is steadily weakening and going downhill, noting that although he is "not in danger of dying soon," his ailments were serious and chronic. Other media outlets, such as the online news site "Sahara Reporters" have reported several conditions: Churg Strauss Syndrome and/or lung cancer along with kidney disease.

In a follow-up meeting with Information Minister Akunyili on February 2, xxxxxxxxxxxx told the Ambassador that Yar'Adua remained extremely weak. xxxxxxxxxxxxx noted that when xxxxxxxxxxxx last met with him it was at the residence and not the office as he has substantially reduced his office hours to conserve his energy.

xxxxxxxxxxxx said Yar'Adua told xxxxxxxxxxxx that he really wanted to go out of Nigeria for "a rest" but given the uproar over his September 2008 trip to Saudi, he was compelled to stay in Nigeria to avoid more speculation on his health. xxxxxxxxxxxx added that Yar'Adua's current strategy is to have meetings planned well in advance so he can rest up in order to be able to have enough energy to complete the session.

xxxxxxxxxxxx

A 2. (C) PAIN:

Most of Post's information concerns his lack of energy and fatigue; however, information exists in other channels regarding pain management.

A 3. (s/nf) health improved/worsened, changes in appearance: We believe that Yar'Adua still remains weak and as physically fragile as he was in November-December 2008. Ref. C contains Ambassador's observations during her meeting with Yar'Adua on the margins of the December 19, 2008 ECOWAS meetings.

Ambassador noted: he coughed more extensively as he delivered his speech on becoming ECOWAS Chair, he appeared to weigh no more than 130-140 pounds, his skin was very taunt, his handshake was weak, voice was fainter than on previous meetings, his eyes were deep set with dark circles underneath, and his teeth were also very badly tarred.

Over the past several weeks, Yar'Adua has made few public appearances. Despite this, he was able to carry on a sophisticated conversation. His most recent appearance was at his daughter's marriage on January 25, 2008, to Bauchi State Governor Yuguda. Although we believe these appearances were meant to calm public anxiety, they actually tended to renew suspicions about his health.

Based on pictures and TV coverage of these events he appears pale and weak. He continues to lose weight and he coughs and appears at times to have difficulty breathing when he talks. U.K. diplomats told us January 28 that they have seen reports that Yar'Adua wears make-up for public appearances and padding to hide his weight loss.

A 4. (S/NF) RESTRICTIONS TO ACTIVITY/SCHEDULE: Yar'Adua's schedule, since assuming office in May 2007, has never included long days or late night appointments (Ref. M); however, it has clearly been severely restricted since late Summer and appears to be more so since late December 2008.

President Yar'Adua has made few international trips since assuming office, including missing the September 2008 UN General Assembly meetings. xxxxxxxxxxxx contact of the Mission shared his risk-analysis paper with us in late 2008 (Ref. B, q.v.), in which he complained that Yar'Adua's restricted office hours are "taking a heavy toll on governance."

He also noted then that the President "works for limited hours, often can't keep scheduled appointments, and cannot undertake rigorous national tours." On xxxxxxxxxxxx told PolCouns that Yar'Adua's health has improved "a bit" since last fall; however, there has been no positive impact on his ability to meet the demands of the presidency. (This comment dove tails with Saraki's, who also indicated that Yar'Adua has had a slight improvement.)

A 5. (s/nf) Yar'adua aware of his diagnoses/prognoses: Although the spokesman for the Villa continues to maintain that Yar'Adua has no serious health problems that hinder his ability to carry out his executive functions, the President's wife admitted his serious kidney ailment to the Ambassador.

We do believe that those around him may be jeopardizing his well-being for their own political gain. We note that, in conversations with other foreign diplomats, the First Lady has indicated she is looking forward to Yar'Adua running for a second term in 2011.

A 6. (C) NAMES AND SPECIALTIES OF PHYSICIANS: Adamu Banye Barau serves as Chief Physician to the President. Barau applied for a U.S. visa in April 2008. xxxxxxxxxxxx Barau planned to travel to the U.S. to purchase medical equipment. In addition, we know Hussaini Yakasai Munir serves as a Villa medical officer.

(NOTE: Munir applied for a visa in mid-January to attend medical training in North Carolina from February 2-14. Specifically, he will attend Advanced Cardiac Life Support, Cardiac Stress Testing, Overview of Cardiac Catheterization, Non-Invasive Management of Myocardial Infarction, and Advances of Echocardiography at Ladan Medical Center, North Carolina under Dr. Mohammad Lawal Garba.) We also know from several sources that German specialists do come in and out of Nigeria as they are, xxxxxxxxxxxx, transported by the German Julius Berger company.

A 7-8. (c) who provides Yar'adua with reports on health and IS HE FOLLOWING DOCTOR'S ADVICE: We have no specific information, but we believe that his wife and other members of the "Katsina clique," such as Agriculture Minister Ruma, and possibly Kwara Governor Saraki (who is a medical doctor), are managing Yar'Adua's health strictly for political reasons, which seems to overshadow any advice he may be receiving from medical experts.

¶B. Procedures and treatments

B 1. (C) MEDICATIONS AND CHANGES IN MEDICATION: Information exists in other channels that provides suggestions on what Yar'Adua may be taking.

B 2. (s/nf) medical procedures/surgeries in the past year: Yar'Adua had a range of medical tests in Saudi Arabia in late August 2008, about which there is reporting in other channels. According to Leadership newspaper, between August 20 and August 31, 2008 he was at the King Abdulaziz Hospital in Jeddah.

We understand that, in 2001 or 2002, while he was Governor of Katsina State, Yar'Adua had a kidney transplant. The Ambassador was told on November 1, 2008 that Minister of Agriculture Ruma was the donor for Yar'Adua's transplant, but that the kidney now appeared to be failing. The individuals (lunch attendees at a Central Bank luncheon) maintained that Ruma's brother had traveled to Germany to determine if he was a potential match for a second transplant (Ref. E).

B 3. (C) ADVISED TO SEEK TREATMENT IN LAST MONTH: We understand that travel to Germany was being heavily considered by the Villa in December 2008, but given that it sparked renewed public concern about Yar'Adua's ability to govern, the President remained in Nigeria. This has been confirmed by xxxxxxxxxxxx

B 4. (S/NF) CANCELED OR POSTPONED ANY PLANNED TREATMENT:xxxxxxxxxxxx told Ambassador on December 22 that First Lady Turai Yar'Adua confided xxxxxxxxxxxx that Yar'Adua would travel to Germany for a second renal transplant between December 16 and January 1 (Ref. C).

Yar'Adua did not take this planned trip given public reaction to rumors about travel and concerns about his ability to govern. We have no information on whether this trip may be rescheduled.

¶C. Medical equipment

C 1. (C) EQUIPMENT ACCESSIBLE IN ABUJA: We understand that the Villa maintains a dialysis machine for the President's use in Abuja and from a credible source at Shell Oil Company that some additional medical equipment for the President arrived in December-January 2009. xxxxxxxxxxxx was more specific in a xxxxxxxxxxxx meeting with Ambassador, saying that Yar'Adua is on dialysis three times a week in the afternoons.

C 2. (s/nf) access to equipment to treat lung cancer: U.S. medical personnel operating in Nigeria believe it may be possible to bring chemotherapy drugs into Nigeria to receive chemotherapy; however, the only hospital which may/may have radiation equipment is Lagos Teaching Hospital.

In all, however, the American physician with whom we spoke on January 29 noted that both chemo and radiation therapy require a large cadre of trained specialists (from oncologists, to nurses and equipment technicians). However, Nigeria has little to no specialists in these areas. Due to the lack of local specialists, our medical source believed it would not be possible to receive reasonably adequate treatment in Nigeria.

C 3. (s/nf) access to equipment for surgery related to renal FAILURE OR LUNG CANCER: St. Nicholas Hospital in Lagos recently began performing minimally invasive transplants (including both removal -- important as all donors in Nigeria are "living donors" -- and transplantation) using equipment from South Africa.

C 4. (S/NF) NEW MEDICAL EQUIPMENT BROUGHT TO ABUJA: Press reports have circulated periodically that new equipment was being purchased (dialysis machines mainly) and online news site Sahara Reporters reported on January 22 that a contract had been awarded previously to one of Yar'Adua's brothers to build a 10 billion Naira ($64 million) "State House Clinic" at the Villa (advertised in the SUN newspaper on July 5, 2008).

Sahara Reporters maintained that the clinic was never completed, but that dialysis equipment and equipment for a complete Intensive Care Unit (ICU) was purchased. As noted in A6 above, Chief Physician to the President Amadu Barau is believed to have traveled to the U.S. in May 2008 to purchase medical equipment. The specific type of equipment is unknown.

C 5. (s/nf) surgical equipment and specialists in Nigeria to PERFORM KIDNEY TRANSPLANTS: The St. Nicholas Hospital in Lagos has a full transplant team. St. Nicholas has been performing renal transplants for approximately ten years, performing more than 80 of the 100 or so transplants that have been done in Nigeria.

To date, there remains no capacity in Nigeria to do HLA (human leukocyte antigen) tissue matching, although samples can be taken in Nigeria and sent abroad for testing.

¶D. Mental health

D 1. (s/nf) does Yar'adua seem sad, detached, distracted, IRRITABLE OR CONFUSED: xxxxxxxxxxxx both reported to Ambassador in December that the President was exhausted, but still very intellectually competent, and that the political haggling and pressure of putting together a new cabinet drove him to push for a vacation outside of Nigeria.

The political pressures of the cabinet reshuffle reportedly took a further toll on his physical wellness. At Ambassador's last meeting with him, he did not seem sad, detached, irritable or confused.

D 2. (s/nf) does Yar'adua conduct meetings/ is he alert and FOCUSED: Yar'Adua has delivered remarks recently at the January 12 Armed Forces Remembrance Day and the January 16 presentation of the 2006 Census to the National Assembly, as well as attended the highly visible wedding of his daughter to Bauchi Governor Yuguda on January 24. In these public appearances, he appeared physically fragile.

Ambassador noted in her December 19 discussions with Yar'Adua and observations of him at ECOWAS that he "remained focused and still showed intelligence, understanding and awareness in his dialogue." Others, from the Foreign, Petroleum and Information Ministers to the Central Bank Governor, have confirmed the same.

D 3. (s/nf) does Yar'adua use prepared notes/ do aides prompt HIM OR ANSWER FOR HIM: Yar'Adua spoke at the January 12 Remembrance Day events in Abuja without notes. In his December 19 interactions with Ambassador, he spoke without notes and without prompting from aides. We believe that he is still intellectually fit, even if we don't agree with his style of governance.

However, his physical weakness adds to the inability of his administration to do more on top of his slow leadership style. We judge that even if his health were not an issue, his governance and leadership style would likely remain slow and largely ineffective as a result of his personality, his lack of a political network of his own, and the fact that he chooses not to dictate decisions to his Ministers, even when necessary and/or expected.

Although he may not be up for days beforehand, he still chairs his weekly Cabinet meetings, which we still understand can run 3-4 hours.

¶E. Spread of health information

E 1. (s/nf) why are Yar'adua/family/advisors reluctant to DISCLOSE HEALTH INFORMATION: While we have heard the argument that Yar'Adua's quiet personality and his northern Nigerian culture are the reasons for his unwillingness to discuss health information, we believe that those close to him are motivated more by a desire to retain power.

His wife and several special advisors, such as Economic Advisor Tanimu Yakubu, we would put high on this list as they only have influence so long as he is President.

E 2.xxxxxxxxxxxx stage is missed. (This is a point the Mission raises regularly with GON interlocutors.)

E 3. (c) Reasons or motivations for those close to Yar'adua TO LIE ABOUT HIS HEALTH: We would characterize the behavior of those close to Yar'Adua more as avoidance, secrecy and disregard for what is ultimately medically best for the Nigerian President. We would add that the closed-mouth nature of both Yar'Adua and his wife, plus the influence of their religion are also factors.

In Yar'Adua's May 15, 2008 interview with the Financial Times, he admitted he is "a normal human being, who can fall sick," hinting at his medical condition. His wife admitted his kidney and asthma ailments to the Ambassador on October 27, 2008 without hesitation. So, his handlers do not directly lie, but just go to great lengths to avoid talking about it.

#. (U) This cable was coordinated with Consulate Lagos. SANDERS