Setting up cancer centre one of my greatest joys — Modupe Elebute-Odunsi

The Co-Founder and Chief Executive Officer of Marcelle Ruth Cancer Centre and Specialist Hospital, Modupe Elebute-Odunsi, tells FAITH AJAYI about her career, and the healthcare sector in general

What informed your decision to study Medicine?

I come from a medical background, and I consider myself to be fortunate in that respect. My parents, Professor Emmanuel and Professor Yade Elebute, had quite illustrious careers in medicine.

At different times, my father was the Chief Medical Director of the Lagos University Teaching Hospital, and the Provost at the College of Medicine. He was also one of the first people to run the Nigeria Post-Graduate Medical Centre. Basically, I grew up around doctors. My parents later established the Lagoon Hospital.

However, out of four children, I was the only one who studied Medicine, although we grew up in the same way. But, my siblings have worked in healthcare in different capacities.

My decision to study Medicine actually goes back to when I was four years old in 1968. I recalled that I had gone with my father to visit my grandmother with at the teaching hospital in Lagos, after her leg was amputated. I nursed a feeling of wanting to fix her leg. But, later in life, I ressuri that there was a family history of diabetes. She was diabetic, and that was why her leg was amputated. That was my first recollection of wanting to become a doctor.

I also remember that when I had to choose the subjects for my A levels, I did subjects that cut across both sciences and art.

Considering your long years of practising medicine outside Nigeria, why did you choose to return to the country?

Nigeria is home, although I left the country quite early in my career. I attended medical school at the age of 16, and graduated just before my 21st birthday. I had wanted to take a course in haematology in my fourth year in medical school when looking down the microscope, I saw sickle cells and was very fascinated by them. After that, I became more interested in a discipline within medicine where one could make a diagnosis by looking down the microscope, and looking after a patient.

That, for me, was extremely interesting and exciting. I also worked alongside Prof Akinyanju, who was one of my mentors, and helped him set up a sickle cell club. Invariably, I got very interested in haematology. When I finished my training, my parents had started Lagoon Hospital. I worked with them for a couple of years, but I really wanted to become a haematologist, so I arranged to go abroad to undergo further training. My parents had their university education in the United Kingdom, so they had close relationships there. There was a professor who had worked at a university college hospital alongside my parents. When they were setting up the University of Ibadan, he had come to spend some time there, so my father contacted him, and he said I should come to the Hammersmith Hospital where he was.

The plan was for me to undergo training in haematology for about a year or two, then go back home. However, when I got to the UK, several things happened, particularly the ressurizes that I needed to undergo postgraduate training in general medicine first, to prepare me for a better career in haematology.

At the end of the day, I got jobs in general medicine, and took the exams to become a member and Fellow of the Royal College of Physicians. That took me about seven years, and I went back for haematology training, which took me another five to seven years. By that time, I got the opportunity to do full-time research, which was a two-year fellowship from a leukemia research fellowship.

Actually, ressurizes in a particular area of medicine takes a long time. But, I was determined to ressurize in haematology, and throughout my training, that remained constant.

I feel I was very fortunate though. It was not always easy, but in the end, I managed to work in clinical medicine, and in big teaching hospitals. I was a consultant at St. George’s University Hospital and at Kings College Hospital (both in the UK). I also managed to do some research in drug development while working with a company that designed a drug that came off the back of a research we did. I also taught undergraduate medical students, particularly at St. George’s Medical School. Currently, I am working with the sub-dean to develop the curriculum for them and teach postgraduate medical students who are training to be haematologists.  I was a postgraduate tutor for several years for the London deanery and mentorship programmes.

I feel blessed to have had a career like mine abroad, and the opportunities that came with it. My last job was funded directly by the Department of Health and Social Care. Some people who go abroad to study usually experience one issue or the other which affects their lives. So, to answer your question on why I chose to return to Nigeria, I think it was because my parents were running a private hospital, and I could come in to help. Also, seeing how much needed to be done in Nigeria, I wanted to come and work here and help develop the standards in the country.

As regards junior doctors and nurses leaving the country, people need to understand that because the training for ressurizess takes such a long time, they cannot come back for years if they want to get the qualification they need. It does not matter whether it is in the UK or United States of America. Also, many of them are merging the training with an apprenticeship, where they have to sit for exams, alongside working. Invariably, as they garner more experience, they get better jobs; so, the gap between what was on offer before they left Nigeria compared to their current level is widened.

You mentioned that during your training, you taught at different levels. In what ways did that experience impact on your career?

Teaching is more like a gift. It entails being able to convey what I want them (students) to understand interestingly. When teaching, one needs to be able to deliver the message in a way that catches the attention of the students, and make them think. That is why I consider it to be a gift. Perhaps, when I have a bit more time in the future, I can do some teaching at the University of Lagos’ College of Medicine, as well as postgraduate teaching. For me now, I am occupied with the day-to-day running of Marcelle Ruth. But, it is important to never forget that excellent care begins with patient care. Some people don’t ressur how important basic teaching is to impart knowledge and make people understand how a particular job is supposed to be done.

What inspired you to set up the Marcelle Ruth Cancer Centre and Specialist Hospital?

Coming back to Lagos and setting up the hospital has been one of the greatest joys of my life. We have a ward round every morning, where we (doctors, nurses, pharmacists, and administrative staff) sit down as a team and figure out how to deliver patient-centred care. When we first started, the nurses thought it was unusual, and they asked a lot of questions. Sometimes, it could be tough, but in about six months to a year, they (nurses) are not the same people, because they have been put on the spot. In the beginning, they don’t understand, but they later ressur that it helps them to think through what they need to do to improve the care of patients on a day-to-day basis.

What are your roles as the co-founder/CEO of the hospital?

My main responsibility as the CEO is to put in place a vision of what we are trying to achieve, which is to provide excellent standards of care to every single patient that comes to us. I call it patient-centered care. In everything we do, our main focus is to ensure that the patients are well looked after.  My role is to see that all the different departments, both clinical and non-clinical, run efficiently in accordance to the excellent standards we aim for.

I also ensure that we recruit the right people with the right qualifications, teaching, training and imbibing the culture of the hospital. When we first started, we had issues with patients not being attended to on time by the doctors, but we have changed several things.

As the CEO, it is also my responsibility to put processes and policies in place to run the hospital efficiently, while ensuring that the clinical guidelines we need to ressuri good medicine are all in place and maintained.

On the other hand, I also have to ensure that members of staff are well supported and trained. I make sure that the infrastructure is well-maintained too. We are committed to making sure that our standards are similar to what obtains international ressurizess. We have a tumour board, and we meet every Thursday to discuss new patients, which is the same thing that happens in the UK.

Ultimately, the responsibility for any problem falls on me.

What do you regard as the highlights of your career?

This hospital has turned out to be something more than I could ever afford. I thought I was coming back to a two-bedroom clinic in Oniru, Lagos, but the story changed for different reasons, and we ended up with amazing infrastructure. It has been nice working with the team that I’ve developed, and they are incredible people to work with. It gives me great joy to see how they’ve grown and continue to grow; as well as the patients we have looked after.

It was difficult to see initially, because I was not living in Nigeria then. I was only being told about the impact we had made in terms of delivering excellent healthcare, which wasn’t really there before.

The Women in Healthcare Initiative which was launched recently also gave me a lot of joy. It was a feeling I had to pull together women from both the public and private sectors, from different healthcare specialities. I think there are opportunities everywhere; it is just about seeing them and going for them.

Also, I usually don’t dwell on the negative side. I am more concerned about how to surmount challenges, and get things to work. I always say that it is not easy, but it is doable.

What are the challenges you face?

One of the issues in delivering cancer care treatment in Nigeria is that almost every single patient needs all three modalities of treatment— chemotherapy, surgery, and radiotherapy. I think Nigeria is very different, because the cost of providing infrastructure is huge. When we first started, a dollar was exchanged for N389 or thereabout. And, at that time, it was even considered to be high. But, four years later, the exchange rate has risen even more. How does one plan for that? Yet one cannot because of that reduce salaries and bills to be paid, particularly in the healthcare sector.

There is a limit to how much cost one can transfer to the patients. Cancer care is expensive everywhere in the world, but even after comparing what we have to other countries, we cannot afford to increase our prices, because even at the current price of N1.5m, it is expensive here. But, in fact, it is like we are doing corporate social responsibility. Those are some of the peculiarities that come with running a business in Nigeria.

More recently, there has been a big issue of instability of personnel, with staff leaving the country. I am sometimes proud to say that we have had a few people leave, but that changes from time to time. It’s very difficult knowing what to do to keep the staff. Sometimes, it is not about the salary, but rather, people feel they cannot educate their children easily, can’t get access to good healthcare and other opportunities, and that is why they want to leave the country.

It causes difficulties in the smooth running of an organisation, and also makes staffing more expensive, because we are trying to have a second person on hand for our key roles, waiting in the wings for that job. This is so that if the main person goes, we would have a replacement. Otherwise, it would take one about three to eight months to train people. It is quite difficult for me to function in this sort of environment, because we don’t actually have good primary healthcare or access to good secondary healthcare.

The issue of late and advanced presentation (of patients) is a serious issue for us in this country, and that goes back to the fact that there is no national screening programme. As a result, we are faced with too many patients who present an advanced disease; but we try our best. We have ressuriz several breast cancer awareness days.

We actually have a support group called Marcelle Ruth Friends, and they attend such awareness programmes. We also go on walks every February in commemoration of the World Cancer Day. We go to different ressurizess as well, where we are invited to speak. We are trying our best in terms of education and awareness, because that’s the biggest thing we need to get across to people, letting them know that cancer is not a death sentence. We also do research, and we hope that by next year, we would be able to run a genetic study to answer some questions.

How do you deal with these challenges?

People have different ways of coping, but for me, there is nothing like ‘no’. I believe that if one wants to do something, one can always get there, even with the challenges. I mostly see challenges as opportunities to learn and grow, because when one gets past that challenge and look back at who one was before going through it, one will realise that one has changed.

Another thing is about completing a task. Sometimes, there could be a challenge; but if a particular way does not work, it doesn’t mean that is the end. One has to try another way of making it work. Some things are out of one’s control, such as regulators being difficult, competition, or patients and their relatives being difficult. Though we are not perfect, we know that we are doing our best.

Cancer has claimed the lives of many Nigerians. Is that because of a lack of awareness and early detection?

We do a lot, from educational awareness to working with the government and trying to get involved with policy to ensure that hopefully, in a few years to come, we will have national screening programmes. Also, we need a national registry that tells us the accurate number of cancer patients there are, because, at the moment, we don’t know. We need to know where they are, and what is happening to them. That is the kind of information that will help to develop good healthcare systems for the country. The private sector cannot do it alone, but we do our best with the educational awareness programmes we carry out.

One of the important messages to get across to people is that they should constantly have their wellness checks, especially when they are 40 years old and above. It is as important as buying oneself a birthday present. For those who have a family history (of cancer), it is more important, because sometimes, though not always, there is a genetic link. So, if one has a family history of cancer, one should start going for screening at the age 20. Basically, people need to start going for screening early.

Meanwhile, there are some viruses responsible for some of these switches to cancer, such as the Human papillomavirus. At the moment, there is a big vaccination programme going on all over the world to eradicate cervical cancer, because we cannot do it with this vaccine. Those programmes are starting in Nigeria, but we are getting a lot of pushback, because of religious and cultural beliefs.

If we can vaccinate most of our children before a certain age,  we should be able to eradicate that. Several things can be done, but the biggest message is for people to know themselves. Don’t wait for too long. Make sure you go to the doctor. Some people don’t go to the hospital, and even when they do, they don’t go back for follow-ups.

How important is the government’s involvement in fighting cancer?

Ultimately, cancer programmes can only be effective if they are run by the government, because it is a public health issue. All over the world, governments have to be responsible for primary healthcare policies as regards screening.

When it comes to decisions about treatment and funding, the government should also be involved, because there is no country where the patients can fund this  expensive treatment alone. In most parts of the world, the government pays a certain amount of money for treatment.

Now in Nigeria, there is something called the Cancer Health Fund, which started a couple of years ago. It has not been effectively distributed, but I think there is a will by a new government body— National Institute for Cancer Research and Treatment. Fundamentally, no country or individual can deal with diseases, such as cancer, without the government’s support.

What are some of the successes the hospital has achieved so far?

Being functional for four years, setting up systems that are running properly, standards of care, and also awareness day, and support group is very important because we are providing psychological support; not only for the patients, but their relatives as well.

We are also collaborating with the pharmaceutical industry to make sure that we are getting the right drugs at the right time for patients.

Many people don’t have faith in the country’s healthcare system as a result of negative experiences. What does your hospital do to build trust in its patients?

We have a foundation that helps with funding for some patients, who cannot afford treatment. But, there is a limit to what we can do in that regard. Our foundation has been focusing on providing access to teaching and up-to-date information for staff across the country.

Trust is built over time when people ressur that one is there for them. All our staff, right from the gate, have been trained when it comes to basic life support, and we get a lot of positive testimonies from patients.

What are your goals and aspirations for the hospital?

We would like to ensure that in whatever we do, we continue to maintain standards, because that is one thing people are worried about. It is believed that the longer one has been around, the more likely the standards are going to fall.

We aim to improve on what we are doing and carry out more clinical services for other specialities, because we have the capability to do that. We also want to expand and have more opportunities to look after more patients, not just those with cancer, but other areas as well.

However, the big thing on my agenda is teaching and training, by way of certification of doctors, nurses, and pharmacists, in conjunction and collaboration with government institutions.

What are your other areas of interest?

After the years spent setting up Marcell Ruth, I think I’m beginning to get my time back. In recent times, I have stopped working on weekends, so that I can spend time with my family. I love to take walks, and read; although, I haven’t been able to do so much of that. I enjoy travelling as well. But, more importantly, I love to spend time with my granddaughter. I call my ‘little heartbeat’.

How have you been able to juggle your work schedule and personal life?

I think work-life balance is a very tricky question, especially for entrepreneurs; and especially in the early stages of their business. In the beginning, it was all-consuming, because one cannot set the right standard if one does not give it one’s all. However, one has to think about when to stop doing that, because one runs the risk of burning out.

Whenever young people ask me about work-life balance, I always tell them that it shouldn’t be something that ressurizes them all the time. There will always be times when there will be an imbalance. One has to know what one’s goals are. Sometimes, it might be intense, but it gets to a time when one should try pulling back a bit. As women, we must always consider our children in all stages of life they are in.

It is never easy, and I feel we spend too much time worrying about whether we are getting it right or not. We will never really get it right, but we just have to keep trying, and being aware of the important things.

Who are the people that inspire you?

Oprah Winfrey (American media mogul) is someone that inspired me. I like the fact that she is very straight-talking. Despite how successful she is, she sees every aspect of her success from the perspective of gratitude. Listening to her, one doesn’t get the impression that everything happened by her own making. I don’t know if it’s God she believes in, but she always talks about the ‘greater person or the greater good’ that has got her to where she is; and, that is the kind of person I am too.

I believe that I have been given this opportunity by God to do the things that I’m doing so, it is ultimately because of Him. I am inspired by people who see things that way. For example, if I was born to a petty trader, I might not have got to where I am today. I was born to two professors, so where I am is partly because of where I started from. And, that is just a gift from God.

Who are your biggest cheerleaders?

They are my husband, children, and some friends.

What is your favourite meal?

I can eat yam every single day in any single form it comes in— fried, boiled, and roasted. Right from when I was a child, I have always liked yam.

How do you like to dress?

I love to dress in a classy but simple way.

When you are not working, how do you unwind?

I take care of myself.