Dimakatso Gumede, CSIR Researcher.
Only a handful of people in South Africa have mastered Stem Cell reprogramming and Dimakatso Gumede (34) is one of them. As the CSIR’s candidate researcher of the Bioengineering and Integrated Genomics Research Group, she works on creating disease models of the innate immune system to study unique African gene variants that lead to elite controllers that naturally control viral load levels without antiretroviral therapy.
By using induced pluripotent stem cell technology, the CSIR research group also creates“mini liver”models in order to determine the adverse drug affects in the South African population.
“The African population is known for its genetic variation, which often affects the way in which an individual responds to particular medication. For example, while an aspirin may work effectively for 70% of the population, it is possible that the remaining 30% may experience adverse effects. Therefore, as part of CSIR’s Bioengineering and Integrated Genomics group, we are looking to create effective and personalised medication for those who do not respond positively to the drugs that have been distributed for the general population,” says Gumede.
Gumede, who is a PhD scholar of the University of Cape Town (UCT), recently submitted her doctoral thesis. She studied the role of a gene mutation that causes skin and lung fibrosis, using a scientific method called induced pluri-potent stem cells. This approach produces any cell type in the body, such as skin or lung cells, which, in this case, provides insight into how an inherited dermatological condition is associated with lung fibrosis – a condition caused by uncontrolled scar formation that affects the organ and air sacks.
However, this was not Gumede’s original project. Initially, her PhD project was on cardio genetics, and she was working with the late Prof. Bongani Mayosi and Dr. Gasnat Shabooden at the UCT Hatter Institute for Cardiovascular Research in Africa.
“While I was busy with my initial research project, the late Prof. Mayosi suggested that I shift the focus of my project to the study of a rare genetic condition that is associated with lung, skin and muscle fibrosis. I was excited because not only was it a ground-breaking research project that would serve as a massive breakthrough for the South African medical science sector, but it would also provide me with the opportunity to apply my cell biology expertise,” says Gumede.
With the assistance of Prof. Susan Kidson and Dr Robea Ballo, Gumede focused mainly on the cell biology of the rare skin condition in question. She learnt a great deal about reprogramming skin cells into pluripotent cells to understand what causes this gene mutation, how this rare skin condition develops at cellular level and how or why it affects organs such as the lungs and muscles and prevents them from functioning properly.
“I discovered that the gene mutation that causes this condition accelerates cell division, which contributes to fibrosis in the affected individuals and is also associated with cancer progression,” says Gumede.
Further, according to Gumede’s Principal Investigator at the CSIR – Dr Janine Scholefield, her ability to not only master but, explain highly technical and advanced science in isiZulu and Sesotho is what makes her so highly prized at the CSIR.
“She has mastered the craft of communicating her work fluently in isiZulu, Sesotho and English which is so important. With science and technology shaping our lives daily, it ought to be accessible to all, especially young people wanting to pursue a career in science. Having a young black woman who is at the top of her game and is able to make the work we do relatable is what will continue to inspire young girls entering the science field. It also makes her even more invaluable to the CSIR and the scientific community at large” added Dr Scholefield.
With the skills that she has gained, she aims to use her PhD to further establish the stem cell platform for precision medicine, drug screening and, possibly, commercialisation in the CSIR. She also intends to use the stem cell and genome engineering platforms to find new approaches to eliminate HIV reservoirs in infected persons and, hopefully, also contribute in finding key therapeutic strategies that resolve excessive scar formation in heart and lung conditions, which are a great burden of disease worldwide.
Reducing the risk of medication related deaths in Nigeria
‘As long as we have clinicians who hide the name of prescribed medication from their patients; the rate of duplication of therapy, adverse drug reactions and drug-drug interactions will continue to increase. Patients have the right to know the medicines prescribed for them’ –Adaku Efuribe
As we clamour for universal health coverage and achieving the UN SDG goal3- Ensure healthy lives and promote wellbeing for all at all ages. There is one simple step we could take to help improve the health and well- being of Nigerians; we need to bridge the gap of lack of integrated healthcare and patient centred care using a multidisciplinary team (MDT) approach. We need to put the patient at the centre of care and utilise pharmacist knowledge and input if we must prescribe legally and safely.
The rate of medication related deaths due to overdose, adverse drug reaction, drug- drug interactions can be reduced through medicines reviews and medicines reconciliation.
‘As long as we have clinicians who hide the name of prescribed medication from their patients; the rate of duplication of therapy, adverse drug reactions and drug-drug interactions will continue to increase. Patients have the right to know the medicines prescribed for them’
Medicines reconciliation is a process whereby patients’ medicines are reconciled as they move between different stages of healthcare, from primary – secondary care interface.
Pharmacist led medication review tend to be more in-depth ,capturing all the essence of patient centred care as it offers more time for the patient to ask medicines related questions which enhances concordance.
The role of the pharmacist as a ‘drug expert’ is to complete medicines reconciliation and medication reviews especially for patients taking regular medication for long term conditions like Hypertension, Diabetes, Arthritis ,Asthma etc.
In a typical Nigerian Clinical setting (public and private), when a patient has contact with a clinician, most times, the patient does not have any interaction with a pharmacist. Integrated healthcare is a healthcare model where every member of the healthcare team contributes their own quota towards excellent healthcare delivery.
This true-life story about patient X shows the importance of medicines reconciliation:
Patient X is a 65-year-old man living in Sokoto, with a history of Hypertension; he takes amlodipine 10mg tablets daily. Patient X travelled to Lagos for a business meeting and he suffered a hypertensive crisis, he got admitted in a hospital in Lagos, his blood pressure was adequately controlled and he was discharged with two other antihypertensives. Patient X did not go through the medicines reconciliation process with a pharmacist or another clinician, so when he got back to Sokoto, he continued to take his newly prescribed antihypertensives in addition to the one prescribed by his doctor in Sokoto.Few days later, Patient X suffered hypotension (low blood pressure) and had a fall on the stairway at home, breaking his hip, which made his condition worse.
A consultation with a pharmacist during the discharge /admission process could have prevented duplication of therapy, and patient educated/informed about which medication to stop/continue and also side effects to expect. Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc. Annual blood tests are routinely checked because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.
Education and support for patients on multiple medicines
Evidence has shown that when patients understand the side effects of the medication they take, they are more likely to comply with the dosage regimen. A lot of work needs to be done in the area of patient education and information provided through medicines use reviews. The gains of patient centred care cannot be overemphasised, all medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes frailty comes into consideration for some elderly patients as well.
There has been a drive for more social prescribing, motivational counselling and interventions for patients who have suffered medical emergencies or patients with long term conditions. Evidence has shown that non-pharmacological interventions have a major role to play in achieving overall general health and wellbeing.
Integrated health care approach will reduce the risk of medication related deaths in Nigeria as well as enhance delivery of outcomes. Clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota for effective healthcare delivery. Pharmacists are part of the MDT and their expertise need to be utilised more across clinical settings in Nigeria to help prevent medication related errors and deaths. The role of the pharmacist in medicines optimisation, medicines reconciliation and patient centred care cannot be overemphasized.
Article by Adaku Efuribe: A clinical pharmacist & UN SDG Advocate, Adaku advocates for better healthcare systems. She is also a health and wellbeing coach.
Providing Affordable Healthcare in Nigeria Should Be Everyone’s Business
“It is my greatest desire that we improve the healthcare system in Nigeria and provide affordable healthcare for local communities at the grassroots so that people can have access to the care they need, when they need it, in ways that are user-friendly” – Adaku Efuribe
The 74th UN General Assembly took place in New York last September; high level meetings were held and Universal Health Coverage (UHC) was a hot topic for the week. As expected, Nigeria had a delegation of Government representatives, NGO’s and individual advocates who are working towards achieving SDG3 and UHC in attendance. So how do we implement new policies and what are the key drivers to providing UHC for all in Nigeria?
As an advocate for UHC/SDGs, I have been lending my voice over the years calling the Nigerian Government to action towards implementing UN SDGs agenda and achieving UHC.I have studied and participated in primary healthcare provision in developed economies and can say for sure healthcare provision is very expensive, but I believe we can up our game towards providing primary health care for everyone at the point of need.
Some developed economies have used the tax system to ensure their national health service does not run out of funds, a percentage of all earnings is taxed and put aside in a ‘pot’ to supplement the health budget. From a lay man’s point of view, just like the banking system, we all bank our money at different times and we withdraw money at different times, so for a contributory healthcare system, everyone will not fall sick at the same time, some will experience life threatening sickness at some point in their life, some would have long term conditions like CVDs, Diabetes, etc., while others would only go through emergencies or minor ailments/major diseases.
In Nigeria for instance, we have a few HMO schemes covering the organised private and public sector. The ‘common man’ on the street does not have any sort of health insurance whatsoever, which leaves them at the mercy of chance. In an unfortunate event of serious illness like cancer or organ failure, they find themselves in a situation where they cannot pay for medical services hence resorting to luck to stay alive. A lot of unavoidable deaths have occurred due to lack of funds to pay for medical treatment.
The public primary care providers are underfunded and the issue of corruption has eaten deep into the fabric of the healthcare system where funds allocated for medical equipment’s, pharmaceuticals etc. are diverted for personal use.
What plans does the present Government in Nigeria have to provide Universal Health Coverage and in so doing, contribute to the economic growth of the Country?
Sustainability can be defined as meeting the needs of today without compromising the needs of tomorrow.
‘As articulated in SDG 3, health is crucial for sustainable human development, both as an inalienable human right and an essential contributor to the economic growth of society. Health contributes to national development through productive employment, reduced expenditure on illness care and greater social cohesion.
We believe that universal health coverage (UHC), delivered through an adequately-resourced and well-governed health system, will be capable of addressing these and other health challenges. Universal health coverage must ensure equitable access to affordable, accountable, appropriate health services of assured quality to all people.
These must include promotive, preventive, curative, palliative and rehabilitative services. UHC must be supported by policies and services addressing the wider social and environmental determinants of health for individuals and populations’. Sustainable Developments solutions network
Key words for providing health systems that works!
- Well Governed Systems- Are there systems and policies in place that can be retained and continued
- Promotive- Do we have health promotion strategies in place to promote good health and wellbeing
- Preventative- Are we taking preventative measures seriously, screening, vaccination, reducing CVD risk through lifestyle management?
- Curative- When we fall ill or in times of emergency, do we have access to affordable healthcare, or does sickness lead to poverty?
- Palliative and rehabilitative services- For terminally ill patients, do we have plans for social prescribing and support? For people engaged in substance misuse, do we have plans for treatment, rehabilitation and integration back into the society
WHO uses 16 essential health services in 4 categories as indicators of the level and equity of coverage in countries: Where does Nigeria rank in the indicators?
Reproductive, maternal, newborn and child health:
- Family planning
- Antenatal and delivery care
- Full child immunization
- Health-seeking behaviour for pneumonia
- Tuberculosis treatment
- HIV antiretroviral treatment
- Hepatitis treatment
- Use of insecticide-treated bed nets for malaria prevention
- Adequate sanitation.
- Prevention and treatment of raised blood pressure
- Prevention and treatment of raised blood glucose
- Cervical cancer screening
- Tobacco (non-)smoking.
Service capacity and access:
- Basic hospital access
- Health worker density
- Access to essential medicines
- Health security: compliance with the International Health Regulations.
The Nigerian Government can do more to improve health outcomes and tackle poverty, by increasing coverage of health services, and by reducing the impoverishment associated with payment for health services. We can subsidise the payment for health services and provide emergency health care at the point of need by ensuring we are constantly reviewing our health policies and implementing proven international strategies. The Health budget does not in any way reflect the health needs of Nigerians, this needs to be reviewed.
As Individuals, if we take health promotion seriously, and change our lifestyle habits, then we can make changes that would reduce the cost of health as well.
Adaku Efuribe is an SDGs/UHC Advocate & Clinical Pharmacist with expertise in medicines management, integrated healthcare and health promotion.
GE Healthcare Launches Versana Ultrasound Machines to Drive Access to Affordable and Quality Healthcare in Uganda
GE Healthcare team displaying the Versana Premier and Versana Essential Ultrasound machines during the Uganda Society for Advancement of Radiology and Imaging Conference (USOFARI).
This innovative system is well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care
KAMPALA, Uganda, November 11, 2019- GE Healthcare has announced the launch of Versana Premier and Versana Essential for the first time in Uganda. The launch was announced during the Uganda Society for Advancement of Radiology and Imaging Conference (USOFARI).
Versana Premier is a world-class ultrasound designed for peace of mind, easy to use and easy to own. The Versana Premier ultrasound system can help deliver high-quality, personalized care, patient after patient, day after busy day. This innovative system is well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care. It also comes with local product and clinical training to help healthcare professionals gain comfort and proficiency with the system to enhance patient care.
Versana Essential is a complete ultrasound solution that healthcare professionals can learn to use quickly and productively. It enables confident clinical decision making for quick referrals and immediate clinical correlation to help scan a wide range of patients. The machine is designed with the growing medical center in mind, to provide the clinical capability and support they want without compromising the quality, reliability, and affordability needed.
Both Versana Premier and Versana Essential are part of the Versana ultrasound family, which comprises of solutions that help to empower care without compromise, balancing capability, affordability, and reliability. These innovative systems found within the GE Healthcare Primary Care Ultrasound Segment are well suited for general practice clinics, physical check-up centers, community health clinics, and other facilities offering basic medical care.
“We are excited to participate in this year’s USOFARI conference together with other private and public partners in an effort to continue providing the latest imaging solutions to enhance early detection of diseases and ultimately the most appropriate treatment for patients,” said Andrew Waititu, General Manager, GE Healthcare East Africa. “The launch of Versana Premier and Versana Essential is a testament of our continuous investment in innovations that help to drive access to affordable and quality healthcare for all across Uganda.”
Also Read Meet Mariatheresa S. Kadushi, Founder of M-afya, A Mobile App Providing Health Information In Native Languages In Africa
Universal Health Coverage (UHC) is part of the United Nations sustainable development goals, to ensure that every person, everywhere, should have access to quality healthcare. As part of its vision 2040 and the health sector development plan, Uganda seeks to accelerate movement towards UHC with among others, essential health and related services needed for promotion of a healthy and productive life.
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