NEB Podcast #71 -
Transcript
Interviewers: Lydia Morrison, Marketing Communications Manager & Podcast Host, New England Biolabs, Inc.
Interviewee: Adewunmi Akingbola, M.D., Founder of HealthDrive Nigeria
Lydia Morrison:
Welcome to the Lessons from Lab and Life podcast, brought to you by New England Biolabs. I'm your host, Lydia Morrison, and I hope this episode brings you some new perspective. Today, I'm joined by 2024 Passion in Science Award winner, Dr. Adewunmi Akingbola. Dr. Akingbola founded HealthDrive Nigeria's Community Hepatitis B Shield project, which combats viral hepatitis in underserved Nigerian communities through increasing awareness screening and treatment. Adewunmi, thank you so much for being here today with us.
Adewunmi Akingbola:
Thank you very much. It is my pleasure.
Lydia Morrison:
Yeah, we're so excited to have you visiting NEB and the campus today and to have you here to tell us about HealthDrive Nigeria and its mission. Could you share that with our listeners?
Adewunmi Akingbola:
Yeah, so I would drive, Nigeria is simply a non-profit initiative that is tasked or tasked with the responsibility of campaigning and increasing awareness about viral hepatitis in Nigeria. So our mission is simply to reduce the prevalence of viral hepatitis B in Nigeria because we discovered that... It's known that Nigeria has this hyper prevalence for hepatitis B, but we also discovered that there's very low awareness of the disease in Nigeria. And so the fact that there's an hyper prevalence and yet a low awareness of the disease just keeps encouraging and sponsoring the hyper prevalence. So our mission is to reduce that prevalence of hepatitis B in Nigeria.
Lydia Morrison:
Yeah. Can you share what motivated you to found to HealthDrive Nigeria?
Adewunmi Akingbola:
So I personally have a story. It's not my personal, I'm not directly involved, but it was a very critical experience that shaped my perspective and ultimately bettered my passion for tackling the maintenance of hepatitis in Nigeria. And it's the fact that when I was in medical school in my third year, more specifically, we had this clinical rotation. And when I was at the emergency, we admitted about seven patients. And interestingly, out of the seven patients, five patients had liver decompensation, second to chronic active hepatitis B infection. And what was even more shocking was the fact that the following morning when I went back to check on the patients, all five of them had passed on.
It was shocking, very shocking because even the way they looked the night before, they looked like they were already gone. Their urine was Coke-colored. You know Coke? It was Coke-colored urine. They had lost too much weight. They looked very sick with jaundice and it was bad. It was really bad. So I mean, it was very shocking. And then also that day, I started my gastroenterology clinic and then I went to the clinic and then out of every 10 patients that we would see, about several of them have been managed for hepatitis B. But I just saw how the patients will come in and the clinician would say, "Oh, how is your condition going?" Then the patient will answer, "It's going fine," that it's doing this, that it's doing that. And then out of 10 people, seven of them would be positive.
And even I as a medical student, I didn't even know about this disease or that medical student don't know, that means if that was supposed to be the most informed people in the country, we barely know about this disease, how much more people in the low to middle income communities? So that day I decided to do something about it, and then I kick-started HealthDrive Nigeria, called together some of my colleagues and senior colleagues and we started HealthDrive Nigeria.
Lydia Morrison:
So amazing to go from sort of that observation that there's a disconnect between the prevalence of this viral disease state and people's awareness of what's really affecting their lives a lot. I could see how that would be sort of shocking to a new medical student, someone who's new to practicing and to sort of see the lack of information that doctors are able to offer those patients too. You talked a bit, I think about why hepatitis is such a big problem in Nigeria, and part of it maybe is the lack of awareness, but what else leads to sort of the high viral spread levels that you see?
Adewunmi Akingbola:
Yes. It's also a lack of access to screening, to testing and also unaffordability of the vaccines. Because hepatitis B disease is incurable. It cannot be cured. It can only be managed, it cannot be cured, but it can be prevented. But people that test positive for the virus, in fact, people barely have access to testing to understand what their status is at that point. The ones that do and get tested positive cannot afford the medications or do not even have access to experts management. With the gastroenterologists in Nigeria that can expertly manage the condition, they're less than 150 for a population of about 250 million. So there are very few.
And then also, the ones that test negative do not have access to vaccines and cannot also afford the vaccine. So it's a combination of all of these factors. Low awareness, inaccessibility to medications for experts management, inaccessibility to expertise, and also, for a larger percentage of people, unaffordability of the vaccine. So all of these factors have really enhanced the continuous spread and reduced and limited intervention to tackling the hepatitis B disease in Nigeria.
Lydia Morrison:
How has HealthDrive Nigeria tried to address some of these challenges?
Adewunmi Akingbola:
Initially, when we started, we first of all started to increase people's awareness about the disease, but I soon realized that... I could tell somebody about the disease today and then can get tested tomorrow and test positive. So I mean, awareness alone wasn't going to solve the problem, but it was a good starting point because it confirmed our thought process that people actually do not know anything about the disease. I mean, the fact that a disease exists that is hundred times more infectious than HIV, HIV, which is one of the most feared infectious diseases, and there is a disease that is hundred times more infectious than it. And in a room of 10 people, at least one person would have the disease, and people, they don't know about it.
Our awareness campaigns actually reaffirmed that thought process. And also we then moved to conducting free hepatitis B screening. So we did that the first, second time. And in the third time, I also realized that, I mean, even how myself could test the negative today doesn't mean that I wouldn't come in contact with factors that could lead me to become positive to contract the disease and factors like sharing needles, blades, and even very common factors, even cutting your hair in the barber shop because not all barbers practice hygiene.
So very common factors like drawing tattoos, and even for people that have a high viral load, they could actually transmit the disease through threats. Yes, exactly. So I mean, somebody could test negative today and test positive next week. So it does not still solve the problem. At best, it just makes people aware of their status at that time. Exactly. So then I started thinking, okay, what exactly can I do too that would be a solution, that could solve this problem? So since the disease is not curable, what I can do is we can try to prevent it as much as possible by encouraging people to take up the vaccines.
But I mean, the only way people would be inclined to taking up the vaccine is when it's affordable to them, is when they don't have to spend 25% of their monthly income on a vaccine. That's the only way. So I started looking for avenues to step down the cost of the vaccines. So I reached out to some pharmaceutical companies and then we eventually reached an agreement whereby if we have a large number of people interested in taking the vaccines, you could actually step down the cost of the vaccines to as low as 50% of its original price. So it was a good deal, a very good deal. So then we started by mobilizing people. So each time we had a vaccination campaign, we mobilized 200, 250 people at a time, and then we administered the vaccines and we do our best to make sure that they come back for their successive doses.
Lydia Morrison:
And so how many doses does it take to be fully vaccinated for hepatitis?
Adewunmi Akingbola:
Yeah, it takes three doses. So previously, the World Health Organization said that after one dose, we should give the second dose after one month, and then third dose after six months. But for countries that have the hyper prevalence, like Nigeria should be one month interval each.
Lydia Morrison:
So it's really hard to get someone to come back for one day each month for three months in a row, I would imagine. And I would imagine it's also very hard to make sure that you have the vaccines in hand to administer all those doses.
Adewunmi Akingbola:
Exactly. In fact, since our inception in 2018, there has never been a time where we started with a particular number and we finished vaccinating the exact same number, never been a time. If we start with 250, we end up vaccinating like 180, so it just drops per dose. So it's very concerning. But at least the fact that we were able to start something, we're able to vaccinate even that 180 people, it's something. It takes those people out of the statistics. There's this tagline that we've been using for World Hepatitis in previous years called Finding the Missing Millions, but each time we vaccinate people, it takes those people out of that Missing Millions statistics. So those people will never ever be included in that statistics anymore.
So, at least it's working and it's a very, very good initiative. So one thing we've also realized is that since we started, there's been a very significant awareness about hepatitis in the southwestern region of Nigeria. We've seen governments initiating hepatitis elimination committees, and we've seen other institutions, other non-profits, also including viral hepatitis in their medical outreach. So I mean, we used to have several medical outreaches, but most people just do for blood pressure, blood glucose and malaria. Do not include hepatitis B. I know that since we started our project, a lot of people have started including hepatitis B in their medical outreach because they now see that it's hyper-prevalent and also, it's possible to actually screen people for it. So since then there's been very good awareness about it.
Lydia Morrison:
Yeah, I wanted to congratulate you I think on the work that you've done already in increasing awareness because I think if people don't recognize what the problem is, if they're not aware of the problem, then it's really hard to prevent it. And the adoption that you've seen already in terms of interest in taking the vaccine with your vaccine clinics is obviously growing over time. How many individuals or how many doses of the vaccine have you distributed?
Adewunmi Akingbola:
I can say that we have vaccinated about 10,000 people. At least that's people that we started to vaccinate. So we do have an exact number of people that finished, but people that started, at least one dose is roughly 10,000.
Lydia Morrison:
I think That's amazing considering where you started. And then I also wanted to talk to you a little bit about the real numbers of infected individuals. You shared some statistics during your seminar today, and it occurred to me that they might not be a true representation of the infected population because it is so hard to get the diagnostic tests. And as you mentioned, they're not frequently rolled into other blood screenings that one might have done when they're having blood drawn and looked at. So I'm curious where you would estimate sort of the number of infected individuals or the size of the problem to be in reality compared to sort of those reported numbers.
Adewunmi Akingbola:
So if my experience, I think the reality is between either one in five people or one in eight people. For now, this statistic says about one in 12 people, but I don't believe that, that's the statistics from data that they can actually get. And most likely the data that it got will be from the urban areas, not in the rural areas, not in the low-income communities. And those are the communities that actually have a higher risk of contracting the virus and spreading it amongst themselves because they have no access to vaccines. They do not even like to visit the hospitals, and they're just there. And I've had opportunities to conduct pilot testing surveys in a few of these communities, and in one particular community, we screened just 24 people and we found six people to be positive of the virus. That means at least one in four persons in that community is likely infected with the virus. So it's a very massive and very significant problem. It's very significant problem.
Lydia Morrison:
Yeah, huge problem. How do you hope to see your project grow? How do you hope to see HealthDrive Nigeria grow and reach more numbers in the future?
Adewunmi Akingbola:
So first of all, we are looking at conducting a Screen & Shield Initiative, this 2025 for the World Hepatitis Day. So in this initiative, we want to try as much as possible to screen at least 5,000 people. So we conduct community awareness campaigns in communities across the country, but also we want to screen at least 5,000 people across the country. But again, another very important way by which we want to grow in HealthDrive is that we do not want to neglect the people that test positive anymore. I mean, most times when we find them out, when we speak to them, we tell them what it is about and we recommend that they visit the closest specialist hospital to them.
But I find out that most of them don't even take any action once they leave that place because there's a general belief that as long as something is not killing people, killing them right there, it can take the back seat. So one way we want to grow, we do not want to neglect that category of people anymore. We want to follow them up closely as close as possible, yet respecting their privacy and respecting confidentiality. So we want to try as possible to see how we can convert them into being managed by experts. So that is one. Also, people that we test, that we screen and are unvaccinated. For example, if we do this Screen & Shield Initiative, if we screen 5,000 people, if we find 4,500 people to be unvaccinated, which I think we will find, we need a form of, we even need an entity to follow up these people to get them to a stage where they started taking the vaccines.
So that's why we're currently ideating a solution that integrates artificial intelligence, more specifically the natural language processing with WhatsApp, because WhatsApp is very ubiquitous in Nigeria, a lot of people, even in low-income communities have access to WhatsApp. So we are thinking of integrating the AI into WhatsApp, and then whenever we conduct the screening, with their permission, we would onboard them into the WhatsApp bot that constantly sends them messages, ask them questions, and so the messages and questions will sort of lead to them taking their next step in their management, either presenting to the hospital to be seen by an expert of which the bot would also recommend closest specialty centers to them. And also for those that are unvaccinated, the WhatsApp bot's AI would ask them questions and converse with them to lead them to take their next step, also, and also give them information about the closest vaccination centers around them.
So that is the next thing for us. And as usual, because I mean, one of our principles is that we always want to focus on the potential impact rather than even the present barriers. So we know that, I mean, developing such a solution would be a little bit expensive. We're going to have to employ a machine learning engineer that will build the bot and build the language model. Yes. So we're going to do that. We're also going to do some marketing for people that have already been tested so that they can also join Android bots. So for now, we're just focusing on trying to do it as much as we can within our resources and our power.
Lydia Morrison:
That sounds like a really clever way to stay in touch with those individuals and to make sure that they're getting up-to-date information and reminders about their health. I think everybody has a hard time managing their own healthcare, and I'm sure it's more challenging in Nigeria where there are maybe belief systems in place where people are perhaps distrustful of the systems or hospitals or just don't have the means or resources to make use of them. So I think that sounds incredibly helpful and a great resource. So I can't wait to see something like that come to fruition for you.
The Screen & Shield project I think sounds really interesting because it sounds like a longitudinal study of a larger cohort of individuals, 5,000 people, will give you a lot of information about what real levels of infection are and what real levels of vaccination are across the country, and to help correlate sort of those two and how it spreads through populations. Sounds like very powerful research to be engaging in. So we'd be very interested to see how that all pans out. If someone is interested in helping your organization, supporting them either through time or resources, how would they go about doing that?
Adewunmi Akingbola:
Yeah, so I think it'd be very easy for them to reach out and then we can have a conversation. In the conversation we'd work out which areas that their support would actually fit into. But generally speaking, for the Screen & Shield project and also the App Mate project, that's a project that has to do with artificial intelligence. It's going to cost money to buy these testing kits, but the pins that we used to draw the blood, buy the swab, and also rent space, rent tables for each of the events across the country. So it's going to cost some money. Also, even the developing the AI model also cost money to also, I mean, so that's why financial support is very appreciated. But for the AI aspect, if anyone is as a machine learning company or can develop such model and integrated with WhatsApp without charging us, it would be eternally appreciated.
We would really appreciate it because it just makes our work very easy. We develop it and then we also test it. So in the testing, we're actually going to convert it into an implementation research whereby we're actually going to test and confirm its efficiency in linking those people to care, as well as helping them transition from their state to the next stage where they seek management and we intend to write up the findings and publishing it and publishing it there. So we would like support financially, technically, and every other form that anyone wants to support us with.
Lydia Morrison:
Well, our listeners can find the details about how to connect with you in the transcript for this show. And I just wanted to say one more time, thank you so much, Adewunmi, for being here with us today and for sharing the story of HealthDrive Nigeria and the individuals that it's reached.
Adewunmi Akingbola:
Yes, thank you very much. And please, if anyone wants to reach out, once you type my full name on Google, you'd see my emails, you see my Instagram, my LinkedIn, they're all easily accessible. So just send a message to me and I will reply you. I literally walk around the clock. Yeah, so thank you very much.
Lydia Morrison:
You're welcome. All right, listeners, think about the skills you have, think about the skills your network has, and be sure to reach out if there's anything that you can do to help.
Thank you for joining us for this episode of the Lessons from Lab and Life Podcast. Please check out our show's transcript for helpful links from today's conversation. And as always, we invite you to join us for our next episode when I'm joined by 2024, Passion in Science Award winner Samuel Ogunsola. Samuel launched the Shaping African Women in STEM program or SWISAfrica, an initiative that aims to inspire young African women to pursue careers in science, technology, engineering, and mathematics by sharing stories of successful African women in STEM.
