Stroke, dementia, others not death sentence — Ogunniyi

Professor Sola Ogunniyi, a neurologist, in this interview with SADE OGUNTOLA says that neurological diseases like stroke and dementia are not necessarily a death sentence, and that Nigerian hospitals are generally not elderly-friendly.

TELL us about your work in your decades of medical practice, and the contributions to medicine that individuals can tap into for better health.

The medical code of conduct does not allow individuals to sing their own praise. But, without being immodest, I trained as a neurologist, with a special interest in the epidemiology of neurological diseases. It entails looking at how neurological disorders affect people in communities, their distribution and determinants.

Although I started off working on epilepsy, over time I moved on and finally ended up looking at neurodegenerative dis eases, an area where I have made significant contributions in dementia. We have shown dementia to be a big problem in some communities in Nigeria. We’ve compared the dementia burden in Nigeria with the rest of the world and showed that it’s relatively lower than in other parts of the world.

When looking for reasons why this is so, we’ve shown that social isolation is not good in elderly people. When they are left alone, they are forced to think about other things that do not really matter and their brain function generally tends to go down. This tends to also predispose them to other diseases that may affect the brain.

Over time, we’ve shown that hypertension increases the risk of dementia, especially in elderly people whose blood pres sures are not controlled. They may be at risk of more forget fulness, reduced brain functioning and subsequent predisposi tion to dementia, which is bad.

We have shown over time also that when elderly people lose weight unintentionally, it may also be a pointer to the develop ment of some degenerative brain diseases like dementia. And so these are things that we can watch out for. Our goal has always been to prevent neurological diseases by making people aware of the predisposing factors and how disease can be treated. And in addition, those who have neurological disorders should seek help because people used to think that once you have a neurological disease, it is almost like a death sentence.

Why are neurological diseases not really a death sentence?

Before now, there were very few treatments offered for neurological disorders; but now, many neurological disorders can be treated. Aside from the use of medication, there are other modalities of treatment that can be employed like palliative care, psychotherapy, physiotherapy, occupational therapy to help individuals. Before now, doctors were like gods, but now if you make people aware of their problem, they also go back and read about it and they’re better informed, ensuring an improvement in their own health indirectly.

What is your group’s finding on the benefit of cognitive stimulation therapy in the care of dementia?

Cognitive stimulation therapy is a form of group therapy, reminding elderly people who may have some forgetfulness about things that had happened in the past. We’ve shown that it is very beneficial; it tends to waken their memory. The study was carried out over seven weeks; two sessions per week. All results have shown that individuals who have gone through this had benefited tremendously.

What has been your contribution both as a teacher and a researcher to human capacity building?

Over a span of 20 to 30 years, I have contributed to the train ing of over 60 neurologists at the University College Hospital, Ibadan. Some of them are professors now, so it makes me feel accomplished as a teacher.

As part of a group of researchers, we’ve also won grants to do a lot of studies and support people to get grants on their own. Back then as the chairman of the College of Medicine’s Research, Innovation Management Unit, support was given to the promotion of research ideas in younger individuals so that research grants are not only won by professors, but also by younger colleagues and lecturers. This has improved the webometrics ranking of the College of Medicine and I’m proud of that.

Looking back, if you had a choice, would you still have picked medicine?

I will do medicine any day. It is the most exciting speciality. I will not only do medicine but also neurology because perhaps it is the ultimate in human intelligence and the most challenging part of medical care that find very interesting.

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In your past 68 years of sojourning on earth, you certainly have one or two things to tell people about ageing. How can an individual age well, gracefully and finish strong?

That’s a challenge all the time because our lives are in God’s hands, but there is nothing as bad as having a very terrible life in old age. So, it’s important that we live well and live strong so that we can finish strong. That means you must live well, do things in moderation, keep your friends, seek medical attention when necessary and be thankful to God for what He has given you.

Eating well will help to avoid diseases, especially diseases that will bring the brain down, like dementia and stroke that can cripple individuals. And the best way is to be cautious in looking out for its risk factors like hypertension, diabetes, and be moderate in the things that we do socially.

Avoid smoking. If you have to take alcohol, do it in moderation and eat modestly so that you don’t get obese, and exercise as you get older. Exercise helps to improve brain activity and also bring life to muscles and the rest of the body.

Getting involved with your colleagues; you must have friends that you can talk to. By so doing, you help to stimulate each other, encourage each other and have people to discuss problems with. It’s important that as people get older, they must have identified physicians who can look after their medical challenges; people that know their medical history and who are willing to help them to get better in case they have any illness, because that’s something that can get people down. As one gets older, one cannot fight diseases as when one was younger; the immune system has become less active and bugs and all other infective agents become more vicious and they may cause more damage. If you don’t treat a medical illness in time, it may go on to hurt you in the end by leading to a more complicated disease. So, we need to be careful.

How elderly and disability-friendly are Nigerian hospitals? How can we make them better?

Most of our hospitals are not elderly-friendly, but things are changing. For instance, at the University College Hospital, where practisee, we now have a Geriatric Centre and that has made a lot of difference. You see elderly people who otherwise would have hated hospitals all wanting to come there. They see their colleagues, they sit together; they are given special treatment. They are also given subsidized care. But this is not the case in all hospitals in Nigeria. It is something that should be advocated that at least all regional centres should have geriatric care facilities. There should be ramps so that elderly people can move from one place to the other. There should be places where cars of people with disabilities and elder people can park to make it easy for them to get from their cars to the clinic places where they are going.

What is your advice for children and relatives on the care for the elderly, as well as prevention of stigmatization?

Families have a big role to play in ensuring that elderly people maintain their state of happiness and good quality of life. They have to assist them. The pension systems are not too good and it doesn’t cover everybody. Health insurance is also not universal at the moment. So, a lot depends on family members providing necessary support for elderly people. So they must identify the problems that elderly people may have and think of easy but not expensive solutions to meet them.

Take them to the hospital when necessary and ensure they

take their medications as regularly as possible if they have any medical ailment. They should be encouraged to use walking aids if they have problems with walking. Those having problems with vision should be helped to see an ophthalmologist and to have the right glasses prescribed, or even if it’s glaucoma to treat it before the eye is damaged. Appetite drops as we get older, the requirement is also less. But the one or two meals that the elderly people eat should be rich enough and beneficial to their health.

What should Nigeria prioritize in the healthcare system: Provision of equipment, finances and human capital for health or the revitalisation and reorientation of the healthcare system?

All these are equally important. If you don’t have the right equipment, you cannot function well. So, you feel inadequate. As a researcher, the availability of the right equipment for research that will be at par with what takes place in the rest of the world is also important. But at the same time, reorientation of the system and its overhaul is also important.

The attitude, in general, of health workers needs to be modified to make them more receptive and helpful to people who seek care. In a few hospitals overseas, we have volunteers assisting to direct people, especially older people who come to the hospital, where they need to see a doctor or which clinic they need to go to. We need more of things like that here.

These are people who do it because they have time in their hands and they don’t need the money. Such volunteers can help to direct people in hospitals, ensure that individuals who come to the hospital receive attention in good time and they don’t get misdirected between labs and pay points and places of service like physiotherapy, occupational therapy and so on.