‘How Nigeria Can Save Foreign Exchange In Health Sector’

Prof. Chukuka S. Enwemeka is one of the leading physiotherapists in the field of photomedicine in the world. In this interview, Enwemeka, who was in Nigeria recently, shed light on his recent breakthrough in the field, and what Nigeria needs to do to save its dying healthcare system.

Introduction
I AM Prof. Chukuka S. Enwemeka. I am the Provost and Senior Vice President of San Diego State University, California, United States. In that capacity, I am the second ranking officer, behind the president of the university. So, I run the university and function as chief operating officer of the university. Because of my heavy administrative responsibilities, I do not engage in clinical practice anymore. But I did work as clinical practicing physiotherapist, and as physiotherapist, faculty person for many years. I rose through the ranks to become a full professor in 1993. Therefore, I have been a professor for the past 22 years.

I became a full professor at the University of Kansas Medical Centre, United States. I moved through the ranks to become the Chairman of Department and later Dean of Faculty of New York University Institute of Technology, New York, US; Dean of College of Health Sciences at the University of Wisconsin-Milwaukee and rose to become a Distinguished Professor at the University of Wisconsin-Milwaukee. I was there for about five years before my current appointment.

What is your area of specialisation?
My area of clinical specialisation was in orthopaedic physiotherapy, where I practiced for some time. But once I became a faculty person, I became assistant professor, associate professor and a full professor; I have to develop an area of research expertise.

I am known for what I have developed in the area of photobiology or photomedicine. This is essentially the use of light, use of lasers and LEDs to treat different diseases and ailments. For example, we were the first to show that red laser and Near-Infrared Lasers can be used to treat injury to skin, tendons and ligaments, and cause them to heal faster. Those tissues do not heal very well, especially tendons. We were able to show that you can speed up the healing process of tendons by applying red laser or Near-Infrared Laser to the tendon, and that it causes the healing to occur faster by doing three things.

First, it causes the quicker production of collagen. Second, it also causes quicker photopolymerisation and alignment of the collagen. Third, it helps to strengthen the collagen once it is perfectly aligned.

We then moved to that area of research to use lasers to treat diabetes, ulcer and wound. People with diabetes do not heal very well when they sustain injury, especially in the foot. The reason is because diabetes has a tendency to weaken the circulatory system. So, blood flow does not get to the extremities as well as it would in people who do not have diabetes. Because the circulatory system is weakened when they do not get enough blood, the area of extremities, when individuals have diabetes and have injuries, the wounds do not heal; they become chronic, worse and it could be so complicated that it may results in amputation of the limb.

It is a very serious problem everywhere in the world. What we have shown is that the same red laser and infrared laser can be used to treat diabetic wounds and cause them to heal when they will not respond to any treatment in the world. And once that healing has taken place, the wound does not even return. These are in studies we have published in learned journals over the years.

There is a third area of research for which I am known. That is the use of blue lasers and blue light to kill bacteria. In many parts of the world, bacteria are becoming resistant to antibiotics. So, the pharmaceutical industry has been developing stronger antibiotics to steam the tide of bacteria infections. But the bacteria have a repertoire of physiological mechanism for evading the antibiotics that have been developed, and thereby avoid the tactics of killing them. If we keep doing this, we will be developing stronger antibiotics, but the bacteria will keep evolving and mutating to avoid the new breed of antibiotics.

And people do not use antibiotics the way they are supposed to use them. There is antibiotics abuse. Any little thing, people pop in antibiotics. In many developing countries, many people do not even consult a physician before taking antibiotics. So, bacteria that would not have been resistant to antibiotics are exposed to antibiotics and over time become resistant to antibiotics.

But we felt that there is a need for a paradigm shift. We cannot continue to use the same method to attack bacteria .So, we came up with this idea that blue light can possibly kill some of these antibiotic-resistant bacteria, and we have published as many as 15 research papers showing that small amount of blue light can kill methicillin-resistant staphylococcus aureus (MRSA) bacteria.

Just this month, our most recent paper came out, showing that we can also kill salmonella enterica- bacteria that are pervasive, especially in poultry industry and often found among people that handle egg in poultry industry. It kills a lot of people in the world. The same thing happens with methicillin-resistant staphylococcus aureus. In October 2007, the Chicago Tribune published an article showing that people were dying from methicillin-resistant staphylococcus aureus in the US than from HIV/AIDS.

We have shown that small amount of blue light can kill them. And you do not need to radiate more than once or twice within seconds. In fact, in one of our longest experiments, it was about 10 minutes. And that was more than enough to clear the whole bacteria. This is a new technology we are trying to develop and we think clinicians may be able to use them in one way or the other.

For example, one major mechanism bacteria are transmitted from one individual to another is simple. The bacteria hide in the nasal cavity (nose). When you pick your nose, unknown to you, you pick the bacteria. The bacteria get into your finger and you drop them at the next place you touch.

The nasal cavity and armpit are hiding places for the bacteria. Imagine if we can radiate the nasal cavity and armpit to clear people who have these infections, they will not be able to transmit them.

Have medical professionals started using these researches?
Yes! The use of red and near infrared is now common in many parts of the world. For instance, the diabetes ulcer study we did was done in Brazil. I was the lead person. My colleagues are still using this approach to treat people in different parts of the world like China, Russia, and other Asian and European countries. In fact, even in the United States, the Food and Drug Administration (FDA) has approved the use of red and near infrared to treat certain conditions, including arthritis, pain of the head and neck origin and pain associated with low back pain among others.
One of the unexpected outcomes of our study of diabetic ulcers is that the patients also reported to us that they were pain-free, something we were not looking at.

As a physiotherapist, would you have been able to do this if you were in Nigeria?
Chances are there that I would not have been able to do what I have done so if I were in Nigeria. I think it makes a lot of sense to say directly that it would not have been possible because none of my colleagues in Nigeria has been able to do this level of work.

What advice will you give to Nigerian government to revitalise the nation’s healthcare system?
I think every discipline needs help. The level of care in the country is very low. Most nations have moved ahead from where we are in Nigeria. In fact, it could be argued that there was a time healthcare was better than what it is today. Our population has grown astronomically, but our healthcare system has not kept up with it. There are several things we can do as a developing nation that does not have the wherewithal to provide healthcare for our growing population.

First, the nation needs to emphasise preventive healthcare. It is cheaper, affordable and easier to implement. Preventive healthcare should be something every healthcare professional, not just the physician, should be trained to do. Nurses, physiotherapists, medical laboratory scientists, radiographers and physicians need to have the knowledge of preventive healthcare to educate the masses at different levels. There will be diseases. You cannot prevent everything. There are situations that will require special surgeries and care. Therefore, we need to strengthen our primary healthcare system at the grassroots, and strengthen our tertiary healthcare system, and strategically develop tertiary healthcare system in different regions of the country.

For example, in the Western region, there is the University College Hospital, Ibadan; University of Lagos University Teaching Hospital (LUTH), Lagos; Obafemi University Teaching Hospital (OUTH), Ife, among others. If these teaching hospitals are equipped to take care of most devastating diseases that cannot be handled anywhere else, we can save ourselves a lot of money.

Right now, hundreds of Nigerians travel to India, UK, Canada, United Arab Emirates and other developing countries to receive treatments for things that our teaching hospitals should be able to handle. This costs huge sums of money. We can save that foreign exchange.