Lady Dora Is Back!!!!

The world that Dr Da Vinci lives in a very, very strange world.

A world that is willing to pay her more to model for a day, than to work as a doctor for a month.

Dr Da Vinci knows therefore that none of the women that give her the most inspiration will feature on any of the 'Most Inspirational Women's' list's online.

Admittedly, at this very moment; Dr Da Vinci is in the lab, wearing Kate Moss jeans and there are several magazines with Naomi Campbell, Tyra Banks, Jennifer Anistion, Angelina Jolie, Beyonce, Paris Hilton and Kim Kardashian splashed across thier covers outside her clinic. She appreciates the value of music, fashion and celebrity, afterall Andy Warhol is one of her favourite people of all time, so perhaps she too,contributes to this ridiculous celebrity-obsessed culture.

The definition of the term 'female role model' has changed so much over the past few decades that the women who metaphorically burnt their bra's to liberate us, I expect, would be aghast if they could travel through time and experience the so-called post-feminist era that many of them fought tirelessly to create.

That said some see this hollywood-tainted army of walking, talking plastic figurines as the future. The future of art, the future of music, the future elite......the world of science fiction, has taken it even further than that, you'll know what I mean if you've seen the movie Surrogates.

And of course I acknowledge the fact that we have now female surgeons, prominent female politicians, females on the boards of fortune 500 companies, female presidents/prime minister's and that women are allowed to be creative and appreciated for thier work. We only have to compare the experiences of George Eliot and JK Rowling to appreciate that we as females have come along way, even though it's a world that our bra-burning suffragettes may still find objectionable.

However, today I would like to talk about one of the many women that inspire me. She does not have her own line of lingerie or her own talk show, she has not, to my knowledge realeased any sexually explicit music videos, she has never made the GQ magazines list of sexiest women, she has not posed semi-nude for FHM and does not get paid millions of dollars to perform for terrorsist's.


Without further ado or pseudo-feminist commentary, allow me to introduce you to:


Dr Dora Nkem Akunyili


Dr Dora Akunyili is the current (since December 17, 2008) Nigerian Minister of Information and Communications. She is a pharmacist and governmental administrator who has gained international recognition and won hundreds of awards for her work in pharmacology, public health and human rights.

She entered the public eye in 2001 when she took over the National Agency for Food and Drug Administration and Control (NAFDAC) of Nigeria after a World Health Organisation survey revealed that more than half the drugs on sale in Nigeria were counterfeit or sub-standard. Nigerian hospitals were using fake and contaminated drips, surgeons were using fake adrenalin to re-start the heart, anaesthetists were
giving sub-strength muscle relaxant to patients in their operating theatres; many
of her countrymen and women were fighting killer diseases like malaria and tuberculosis with fake drugs cynically packaged to look like the real thing. As a pharmacist she had always been aware of the problem, indeed, her own diabetic sister died from what Dora is convinced were fake insulin and fake antibiotics.

Her responsiblity was to root out these fakes, to defeat counterfeiters, to close down the importers and end bribery, in an effort to eliminate the large scale corruption that was ruining the health and taking the lives and the hopes of so many.

Within a mere six months of her appointment this remarkable lady had closed down the vast open-air medicines market in Kano for three months while her officers confiscated £140,000 worth of fake drugs. She built a new team of female inspectors and pharmacists. She began to prosecute importers of fake drugs. She upgraded premises and she upgraded laboratories. The public applauded, but the counterfeiters fought back. They fire bombed NAFDAC offices, trashed the NAFDAC laboratories and sent death threats to her and her family. They even shot at her and her family in their car – a bullet grazed her skull, but she survived.

But since her appointment there has been a drop of at least 50% in the quantity of fake drugs on the market and many now owe their lives to her fearless campaign.

Dora Akunyili is revolutionary, she is fearless, she has intergrity, she is loyal, she is diplomatic, but is also ruthless operating with an almost messianic zeal.

Dr Da Vinci has been waiting and watching the results of Mr Jonathan's cabinet re-shuffle very carefully and is extremely, pleased to hear that Dr Dora is back in the new cabinet to continue our fight against the con-artists, fraudsters and swindlders that threaten Nigeria's stability daily.

Death to con-artists, fraudsters and swindlers. Long live Lady Dora!

All Eyes On Jonathan

Dr Da Vinci, is still optimistic about Goodluck, even more so since she spotted an article in today's independent.

It's just over a week since he dissolved the entire cabinet and investors are watching subsequent developments extremely closely to ascertain which direction Mr Jonathan is steering Nigeria.

As the names begin to leak, Dr Da Vinci becomes increasingly encouraged. The direction seems to be towards reform......

I'm focussing particulary on his choice of Mr Olusegun Aganga, a London-based managing director at Goldman Sachs. His inclusion appears to signal the acting president's intent to move ahead with critical banking reforms and bring in new-blood to what was seen as Yar'Adua's failing administration.

The nomination of Mr Agang – who heads up Goldman Sachs' hedge fund consulting services in London – comes as Nigeria is set to test its strength with foreign investors with a planned $500m debut global bond.

Dr Da Vinci thinks this is an excellent step in the right direction and believes that the Nigeria diaspora holds enormous potential,some of which Mr Jonathan is already tapping into.

In earlier posts,Dr Da Vinci has spoken at length about the various ways the diaspora can contribute to Nigeria's development and hopes that this is a trend that will continue.

Good Bye Doctor Crippen

http://nhsblogdoc.blogspot.com/: Farewell Dr Crippen, Godspeed


Dr Da Vinci does not know who Dr Crippen is, but it feels like we have been friends for a very long time.

He was one of the first doctors on the medical blogosphere.

I started reading your blog as a medical student, now a doctor with several years experience, it remains one of the first pages I check after my email every morning.

You may not have an MBE or an excellence award Dr Crippen. You may not be a 'Patient Dignity Champion' or sit on any bureaucratic leadership boards.

But you have been instrumental in fighting for the rights of patients and doctors, you have been our voice for the best part of the last decade and for that Dr friend, I salute you.


“By far the most dangerous foe we have to fight is apathy - indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self satisfaction”

William Osler quotes (Canadian Physician, 1849-1919)


I wish you a fruitful and enjoyable retirement. I hope you get to take on new hobbies, see new places, hear new points of view, learn new skills and generally make the most of this new and exciting phase of your life.

Kudos To You! And thanks again.


Dr Da Vinci.

In Support Of Dr Kim Holt

Excerpt From The Times (02/10)

David Holt said his wife, Kim, a consultant of 25 years' standing, was "in shock" after the world-famous hospital advertised her job recently without even telling her.

"She couldn't believe it," he said. "She was speechless. This kind of behaviour completely blows out of the water any belief in the hospital's good faith, or their ability to change the oppressive culture Kim has experienced."

The move is the latest in a string of cases where the NHS's promises to protect whistle-blowers have proved false.

The inquiry into the Stafford hospital scandal has heard how medical staff who tried to warn of fatal failings at the trust were threatened into silence by NHS managers.

This month, a London consultant, Ramon Niekrash, won an employment tribunal case against Queen Elizabeth Hospital, Woolwich, after he was victimised for raising concerns about cost-cutting.

Dr Holt's MP, Lynne Featherstone, has said that colleagues who supported Dr Holt are being "bullied" and "pressured" by the hospital.

However, further staff have come forward to speak of serious problems at Great Ormond Street.

In December, Great Ormond Street promised to reach a "swift and amicable solution" with Dr Holt after a damning NHS London report largely vindicated her criticisms of the child abuse clinic in Haringey, for which Great Ormond Street provided the doctors.

Dr Holt has spent the last three years on "special leave" since warning – more than a year before Baby P came to the clinic – that she and other doctors there were dangerously overworked and a child would die unless action was taken.

Dr Da Vinci is once again fuming! A brilliant physician working at a world renowned centre with a global reputation in her speciality is being hounded out of her job!
Her crime? Raising concerns about the safety of her patients.

At a time that we are desperate for peadiatricians Dr Holt; a gifted and experienced peadiatrician has been on 'leave' for a whole THREE YEARS.

I often look back home to the UK as a model for Nigeria to follow especially in terms of healthcare policy, but incidents like this show that corruption is indeed endemic is every society and requires people to unite and take a stand against it!

In Nigeria, the Flying Doctors Nigeria continue to work with the government to develop the healthcare system. We also encourage an open culture of reflective learning in our own organisation; reviewing and examining each step of every mission.

I am thankful that I am in the position to do this. Every doctor should be able to look at the structure of their organisation and constructively critisise it with a view to improvement. We are our patients advocates. This is our raison d'etre.

This is true patient centred care.

The Home Birth Nightmare + Maternal Death In Nigeria

In the UK, home births are the fashionable thing to do. The propaganda tells women they should experience the birthing process without nasty little interventionalist doctors and midwives, in spite of the fact it takes very experienced midwives off of the ward and down winding, isolated country roads, to the front rooms of some times quite high risk women who have decided the 'natural' birthing option.

That said many ladies opt for a home birth after they have experienced labour once or twice, it is usually quite quick and they have been judged by an experienced consultant as low-risk by looking at age , family history, co-morbidities etc. Other ladies have had pretty bad experiences in hospital and have since developed an aversion to them. This is also very understandable.

This is not to say that women should not have a choice over how and where they give birth. I would hate to insinuate that. But in my experience the NHS is often too understaffed to provide that personal one2one service that a home birth requires without posing a risk to the ladies birthing on the ward. Furthermore, if complications arise at the home birth, it becomes a horrible nightmare. The worst kind of nightmare......or so I thought, pre-Nigeria.


Managing obstetric emergencies is going to be a large part the work of the Flying Doctors. This is why every doctor that works with the service must hold a full MOET qualification or it's equivalent.

The 'nightmare' situation I described in the UK that occurs when home births go wrong, pails in conparision to what we face in Nigeria. Despite having some of Africa's most skilled obsteric surgeons and midwifes, we are faced with a lack of beds and equipment.

In Nigeria 59,000 women die during or soon after childbirth every year. This maternal mortality rate is the second highest in the entire world! The country is home to 2 percent of the global population, but 10 percent of all maternal deaths take place here.

The task before Flying Doctors is to try and reduce this number by providing rapid, cost-effective transport to the RIGHT facility for these critically ill ladies who develop complications during childbirth.

The homebirth nightmare I described in the first few paragraphs experienced when I worked in the UK is a very different kind of beast to the one we experience in Nigeria. I dare say, it's like comparing a squeaky mouse to a howling werewolf complete with a full set of fangs.

The true solution to the problem can only come from a joint effort from not-for-profit organisations like the Flying Doctors, government agencies, doctors/midwives and hospitals with international support.

This is an issue that our team at the Flying Doctor continues to help tackle and we remain hopeful and optimistic that the our shocking maternals mortality statistics are set to improve in the near future.

Stem Cells And The Dawn Of A New Era

I have developed a somewhat romantic relationship with my stem cells.

The sharp contrast between the patient, contemplative, snail-paced world of research and the rapid, consummate, expeditious world of acute medicine; makes a lot of people think you are either a researcher or an acute medic, very rarely both.

There is no trial and error when you are diagnosing a pneumothorax next to a busy road or when a child is gradually turning blue before your eyes. Unlike in the laboratory, you can't throw the cells away and try it another way. You HAVE to keep the pressure on that wound in the back of the helicopter even though you are tired and your arms hurt, you can't try again the next day, there are no spare parts in the deep freezer.

But for me, this antithesis seemed to have helped me grow; both as a physician and as a person. I've had time to reflect, to study and to write. At first, the time spent waiting for the centrifuge to stop spinning, for my PCR to process or painstaking filling at 96 wells with 10 microliters of PBS+TRYSPIN was boring to me.

However, I have learned that things don't always have to be adrenaline-fuelled to be amazing.

When my christian and muslim friends/family learned that I was doing stem cell research they expressed a great deal of concern about the ethical implications of my work. There has been a lot of controversy about stem cells research, so in this blog posting I hope to clarify some of the presumptions about stem cells and stem cell research and explore some of the associated ethical issues more closely.

Firstly, let me explain what is so special about stem cells. Well, stem cells have the remarkable potential to develop into many different cell types in the body during early life and growth. In addition, in many tissues they serve as a sort of internal repair system, dividing essentially without limit to replenish other cells as long as the person or animal is still alive.

When a stem cell divides, each new cell has the potential either to remain a stem cell or become another type of cell with a more specialized function, such as a muscle cell, a red blood cell, or a brain cell. Stem cells are distinguished from other cell types by two important characteristics. First, they are unspecialized cells capable of renewing themselves through cell division, sometimes after long periods of inactivity. Second, under certain physiologic or experimental conditions.(Ref: http://stemcells.nih.gov/info/basics/basics1.asp)

Perhaps the most important potential application of human stem cells is the generation of cells and tissues that could be used for cell-based therapies. Today, donated organs and tissues are often used to replace ailing or destroyed tissue, but the need for transplantable tissues and organs far outweighs the available supply. Stem cells, directed to differentiate into specific cell types, offer the possibility of a renewable source of replacement cells and tissues to treat diseases including Alzheimer's diseases, spinal cord injury, stroke, burns, heart disease, diabetes, osteoarthritis, and rheumatoid arthritis.

Stem cells are largely divided into two categories: i) Embroyonic stem cells ii)Somatic/Adult stem cells

The term adult stem cell refers to any cell which is found in a developed organism that has two properties: the ability to divide and create another cell like itself and also divide and create a cell more differentiated than itself.They can be found in children, as well as adults.

Pluripotent adult stem cells are rare and generally small in number but can be found in a number of tissues including umbilical cord blood. A great deal of adult stem cell research has focused on clarifying their capacity to divide or self-renew indefinitely and their differentiation potential.

The use of adult stem cells in research and therapy is not as controversial as embryonic stem cells, because the production of adult stem cells does not require the destruction of an embryo.

The controversy, for the most part surrounds embryonic stem cells the central question comes at the intersection of two primary opposing viewpoints: the high esteem for human life and the right to it, on the one hand; and the desire to alleviate human suffering on the other. While these two ideas are not in themselves contradictory, in this particular case it is impossible to satisfy one without violating the other.

One evening , some time ago, I was working in the emergency room, when I heard news that a child had been badly burnt in a fire and the paramedics were bringing him to our hospital. Nothing prepared me for what I saw. In the UK, I think because junior doctors don't generally do as many nights/long hours we are shielded somewhat from these things.

I received my baptism of fire as the smell of burnt flesh filled my nostrils, screams from a hysterical mother pierced through my eardrums chilling me to my very soul, I helped assess the patient on ALTS autopilot as my trembling hands brushed against his hard, charred broken skin. He was only 4 years old. Children are fighters. He survived after over 5 months in hospital/burns unit. But the resultant deformity was devastating.

The stem cell research done in our lab, has helped to Japanese pharmaceutical company JTEC develop a novel cultured epidermis that can be used to save the lives of patients with severe burns and reduce the resultant deformity.

When 1 in 3 embryo's are lost due to chance anyway, is it is justifiable to use cells derived from an embryo with a 30% percent chance of developing into a baby to safe the life of this beautiful child, the victim of a catastrophic accident?


I have a 7 year old on the ward that needs a heart. She has a rare form of cardiomyopathy. She is native Japanese and therefore according to some research genetically superior to me. I'm in my 20's therefore by some standards have lived a good life. She hasn't had a chance yet. We are a tissue match. If her parents used these justifications to ambush me on my way home from work and steal my heart (of course this is an extreme factious example to demonstrate a point) for their daughter, everyone would say it was a crime.

Is this really tantamount to what we are doing when we kill embryo's for embryonic stem cell research?

Food For Thought.


For the record, my research is with adult stem cells and induced pluripotent stem cells. I have never used embryonic stems cells, but I do believe they have a role to play in medical research.

The Orthopaedic Surgeon Paradox

On the ward round today, I have a re-realisation about orthopaedic surgeons.

We were looking at the CXR of a child who had been treated under orthopaedics 11 months ago for a broken humerus (arm bone). The professor of paediatrics pointed out that at the time this child had his surgery there was a very obvious coin lesion in the upper zone of his chest. If this had been spotted then, the child could have been investigated thoroughly.We would have found out that the coin lesion visible on the CXR was cancer; as most coin lesions tend to be in this part of the world and he would have been treated according.

But instead the child was brought into the outpatients clinic nearly a year after this CXR was taken. He had, had an unexplained fit.

Today, he is dying. He has metastases in his brain and bone, his management is palliative.

Our professor pointed out to the team how typical this was for orthopaedics. 'They can't see beyond the bone they are fixing' he stated angrily shaking the CXR in the air. Same in the UK, I nodded knowingly, recalling the difficultly I had managing patients with medical problems on orthopaedic wards.

Most specialists have some kind of stereotype associated with them, perhaps none more so than orthopedic surgeons. One of the predominant stereotypes about them is that they’re into power tools and carpentry and things like that, and are less intelligent than other doctors.

The mistake described above I must say is extremely, extremely rare. Orthopaedic surgery is a competitive speciality that continues to attract the brightest young doctors and the coin lesion was small and poorly defined. It is very easy to crtisize other doctors when you have a retroscope. Hind sight is always 20/20. The orthopaedic surgeon was agast when he found out what had happened despite, reassurance from the radiologists about how difficult a call it was.

In the coffee room after the ward round I re-counted some of my favourites jokes about orthopaedic surgeons-in haphazard Japanese. Listed below:


3 orthopaedic surgeons took 55 days to do a jigsaw and were proud of their achievement.When asked why they were so proud they said because it said 2-3 years on the box.



At an orthopaedic meeting how can you spot the academic orthopaedic surgeon? He's the one who can just get his knuckles off the floor!


What's the difference between a carpenter and an orthopaedic surgeon?A carpenter knows more than one antibiotic!

How do you hide a twenty pound note from an orthopaedic surgeon? Put it in a text book!

How do you spot the orthopaedic surgeon's car in the car park? It's the Porsche with a comic on the back shelf!

What's the difference between a rhinoceros and an orthopaedic surgeon? One's thick-skinned, small-brained and charges a lot for no very good reason....the other's a rhinoceros.

What do you call two orthopaedic surgeons looking at a chest X-ray? A double blind study.


The definition of shifting dullness - an orthopaedic ward round.


Why do anaesthetists take an instant dislike to orthopaedic surgeons? Because it saves time

How do you get an Orthopaedic Surgeon to refer you to some one else? Ask him the time.

How many orthopaedic surgeons does it take to change a light bulb? Just one to write the ref feral to the medics saying 'darkness ?cause'

An elderly lady and an orthopaedic surgeon were travelling in an elevator together. The doors started to shut as the lady was trying to get out of the doors. The surgeon kindly put his head in between the doors so the lady could get out. 'Thank you very much' said the lady, 'but why did you use your head?'. 'I used my head because I need my hands for work' said the orthopod grinning proudly.

The list goes on...................................................


But despite the stereotype we owe some of the greatest scientific discoveries this decade to our orthopods. Have a look!


Sir Alexander Flemming

Trained in orthopaedics,named one of Time Magazines 100 Most Important People this Century for his discovery of penicillin, and stated; "It was a discovery that would change the course of history.


Sir Frederick Grant Banting, KBE, MC, FRSC

Orthopaedic surgeon and Nobel laureate noted as one of the co-discoverers of insulin.

In 1923, Banting and John James Rickard Macleod received the Nobel Prize in Medicine.


James K Styner, MD, FACS

An orthopaedic surgeon, practicing in Lawndale, California. He was instrumental in the development of the Advanced Trauma Life Support (ATLS) program which has consequentially changed the face of trauma care worldwide.


Shinya Yamanaka

A Japanese orthopaedic surgeon and stem cell researcher. He was recently awarded the Lasker award and was also named one of time magazines most influential scientists and well as my own personal demi-god when he changed the face of stem cell research forever by developing induced pluripotent stem cells.

Orthopaedic surgeons are probably the most influential and innovative specialists we have, just I guess it's still fun to have a giggle at their expense!