Environmental health and equity: A conversation with Dr. Adedolapo Fasawe

In this episode of LSTM in Conversation, Dr. Martha J. Chinouya, Director of Global Health Studies and Reader at LSTM, engages in a conversation with Dr. Adedolapo Fasawe, Mandate Secretary for Health Services & Environment in the Federal Capital Territory (FCT), Abuja. Together, they explore the intersection of public health, environmental stewardship, and global health leadership.

Dr. Fasawe shares her journey from LSTM alumnus to a high-impact leader in public health and environmental policy in Nigeria. This episode delves into her work addressing health inequalities, her strategies for strengthening health systems, and the role of women in shaping global health narratives. The discussion highlights the importance of partnerships, innovation, and resilience in addressing pressing health challenges, with insights on how LSTM has influenced their careers and visions for a healthier world.

Transcript

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Welcome to LSTM podcast. And today we've got Doctor Dolapo fasawe. My name is Doctor Martha Chinoya, and I'm a senior lecturer in global health, and I also the director of the Global Health Program as LSTM. It's a pleasure to be hosting Doctor Dolapo Fasawe Today, who is going to talk to us about her journey from LSTM and beyond. Doctor Dolapo graduated and is an alumni of LSTM. She graduated in the Diploma in International Health consultants in 2010. She has had a brilliant and amazing career spanning so many years, and is currently the mandate Secretary for Health and Environment for the federal government of Nigeria. So maybe just to start off, tell me about your journey. Say joining LSTM. Why did you come to LSTM? It would have to start with my journey in life. I chose to study medicine because I just wanted to help people. I was a natural born carer of people, so there was out of medical school, graduated with honors, so I had an array of choice of specialist and I met the fabulous Vicky Doyle, who took me through my application. And I'm not only an alumni, I won an award in 2010 for the best project and presentation for that year. Wow, what has your project on? It was a group of people in downtown Liverpool, halfway home, and the government was trying to empower them, rehabilitate them, and put them back into society, ex cons, kids who've abused medication and are just recovering Like a halfway home sort of and the project was, are we ready to move on, I remember clearly, or do we ever really move on? And I took the research very seriously. Spoke to the guys. We did our interviews, group work. We visited the centers. Everybody had a plot of garden to farm. Some wanted to be tailors. They were being taught skills pushed into the society. Conclusion of the project was, have we moved on, or we are moving on? Our conclusion was you never really move on. You need support for the rest of your living life. That was our project. Ah, that's amazing and amazing, and congratulations for winning the the best Project Award. I'm really interested about that time at LSTM and the support you got for you to be awarded such an award. It was kind of like an epiphany, a eureka moment. Yeah, I used to think everyone abroad was socially secure looking at not only the physical and infrastructural determinants of health. I assumed that everyone living out there, their Social Determinants of Health and Human Development Index was up there. Remember my story about patients not being able to pay their bills? Yes, it was somewhat similar, and that was like, oh, this is a global situation. It's not only for a developing country. I think that's really interesting. What you're saying that you were working with people who are disadvantaged in Nigeria, and you come to Liverpool, and you also meet people who are disadvantaged. So what are you doing now? What are you working on at the moment. So right now, I am the mandate Secretary health services and environmental services in the federal capital, territory of the country that is a Bucha, and my mandate really is to ensure that health is available, audible, accessible, and that we improve our health indices, maternal and neonatal mortality rates, quality of life, prevention of diseases, increase uptake of immunization. Talk about reproductive health, which is something that we tend to shy away from around here. Talk about reproductive health and it became obvious that we were having poor outcomes from the slum, the densely populated areas and the low socio economic areas of Lagos state. And, you know, more cases were coming out of there, and it was basically due to lack of health promotion, lack of education, lack of information. And I realized government we we usually talk at people, give policies, tell them what to do and what not to do. And I instituted a way whereby we could have a two way discussion, communication. Tell them what to do. They give us feedback. I moved into environment. I was the general manager Lagos State Environmental Protection Agency for four years when I was called back into health by the federal government. I now said to them, do you have an environment department, they're like, yeah, we have waste management units that works really well. Management is different from the environment. Mm, hmm. And I was asked, what is the environment? I started talking about desertification, flooding, erosion, vegetation, high temperatures, cutting down trees indiscriminately how it affects our health? I was asked if I could create the environment Secretariat, seven months on, we're still trying to find our feet, but for the first time, there's an environment Secretariat in the FCT. So that's how I came about to be health and environment. I am hoping that when environment is set up and can stand on its own, there will be an Environment Secretary, because it's a whole lot of work.Martha, it is. Wow. I'm fascinated about what are the key lessons that you brought from LSTM that are driving you to be doing what you're doing? So first of all, that issue of dialog and communication, I learnt it from LSTM, the cohorts, the group that we worked with in a halfway home, had a totally different notion from what the state the government was doing to help them. They didn't say it as help. And I realized the importance of communication, not just administer a questionnaire you have to hear back from the people you're dealing with. My group actually took some of them out for dinner of our walk so that we could get more information from them. And that was a life lesson. It was like, boom, you can't help people without talking with them. You have to hear from them. There has to be a two way feedback mechanism, and that is what has shaped my career in public health and in the environment. Right now, it would shock you to know that an average medical doctor here, including me, before dabbling into the environment, kind of thoughts, global warming, climate change, they're all natural things that would happen anyway, no matter what we do. Until I started studying, people do not know, and you wouldn't know. You don't know until someone asks you or talks to you about it. So communication is key, very key. That's what I took out of LSTM, thank you for that answer. What challenges are you seeing in in your work in global health, the World Health Organization says a certain percentage of a country's national budget should be allocated to health and health issues. Very few countries of the world have been able to meet this criteria. Human Resource in health is a big challenge. policy, or we have a strong mission. You only give us aid where aid is needed, not where you feel like putting money in. You only come to assist when there's a gap, a square pole. We need a square peg right now, electricity, renewable energy is a big problem. Here. We are still burning fossil fuels, and we we can't depend on the national grid for power. I'm advocating for alternate energy. I'm advocating for solar for health. The European Union is supporting us. USAID is supporting us. Now, anyone who comes with a form of grants or technical assistance, I try to push them that way, because we have focused so much on communicable diseases, AIDS, diarrhea, polio and non communicable diseases, hypertension, diabetes, but we are not looking at the infrastructural needs to help us doctors do our work. I am strong on the social determinants of health and infrastructure determinants of health. So yes, from what I learnt in Liverpool, I understood that you could actually make grants work for you, not the other way around. You mentioned one of the challenges is, you know, the gender issue, and I would like you to maybe tell us a little bit how, as a woman, you've done so much to improve the health of others, given the context where women are not given as many opportunities as as we may want. There's so many I have heard from dabbling in development world and talking gender issues that educate a woman, you educate educate a girl, you educate a whole village or community. I have also heard no woman, no nation. I have also heard, and I know, by virtue of medicine and our anatomy that women are natural nurturers. We are natural caregivers, having women in position of leadership, what I tell all women, we can only do better if we drag more women up the ladder. And this is my driving force, and this has been my success story. When I go into any community I find women with or without a voice, educate them and teach them they have a voice. You will be surprised that we have conducted knowledge, attitude and practices, studies and have dealt with women alone to change situations, and when we do the pre and post assessments, it's amazing at the results. For example, indoor air pollution, cooking with fossil fuels, indoors, insecticide treated nets to prevent malaria, keep your environment clean to prevent cholera and other diseases. When we talk to the women, we have better outcomes. So I bring out other women to be my voice in this fight, in this global war against diseases and in preventing diseases, that has been my strategy, and so far it has worked. Now LSTM here is thriving to move forward building healthy lives around the world. What do you think the future of global health looks like? Collaboration, collaboration and collaboration. Can you explain the collaboration, collaboration, collaboration? Because that is what it is all about. Some people are well advanced. If you look at the I was watching something today on Instagram, a man had a renal transplant, the first renal transplant in the world, with the patients wide awake, talking with the doctors, they showed him his faulty kidney. They put in a new kidney, and said to him, Hey, Steve, you have new kidneys, and you do not have renal failure anymore. And he was able to say, yipee. And I thought to myself, in 1000 years, I didn't think this can be possible, but someone's done it, yeah, there are countries where you can't even do renal transplant, where you have to take the patient out of the country, or you keep them on dialysis. We only started doing renal transplants here in Nigeria a few decades ago, and it was well celebrated those who know need to start teaching those who don't know, and I said to her, she would have to unlearn everything she's learnt, and start over again, How did you get to the stage whereby it is taken for granted that once a baby is born, it has to be it's probably even against the law for the baby not to get its full immunization. How get there? That's what I mean by collaboration, okay, exchange, capacity building. Tell us how it's going on. Tell us how we can do it. And just listening to you and your experience as a woman and coming to LSTM and doing this amazing work. How do you think LSTM as an institution reaching out to the world. How can we encourage more students to come and join and be part of this collaboration that you're talking about. Alumni Associations all over the world, more people can then start to learn about what you have to offer and how you have helped people like us grow. If we have meetings, that's one two, offer scholarships. When you start to offer scholarships, have scholars. I went to the University of Michigan in the United States, gave a lecture last month, and they have this center called African Studies Center at every point in time, every year, they have about 25 scholars from African countries who are on full scholarship, doing research and publications with them. It's a mutually beneficial relationship. They get to lay their hands on data. Have access into various countries and various communities. It is hard to find the community of people who are not immunized out there, but you want to come here to do a study, they're all over the place. So it's mutually beneficial scholarships, exchange programs and alumni associations. And Do you happen to see other students from alumni from LSTM, because we've got on my program, we've got a couple of students from Nigeria. I actually sent one of my staff, Doctor Toluope Oluwole, and he was in LSTM, I think, in 2021 I told him about the course, and he did attend. And I have kept in touch with one of my classmates, Marcy. She was from Russia, I think. I would like to hear from you some key points that you would like to drive home to LSTM, our students and our listeners. What are the key messages? We've spoken a lot about a lot of things, but just wondering those three, three points, or if you can. So one, no education gained is wasted. Here I am from how many years after 2010 practicing what I learnt in a short course, 10 years, 14 years ago, that was because I in I put myself into the program. The cost was quite astronomical then, but I put myself into it, and what I have learned has helped me up till today. Secondly, having conversations like this is something even I would start to deal with my staff here, let people share experiences. From this conversation, I have come to understand that I have a lot of stories to tell, but I haven't had an opportunity or the right avenue to tell. The stories, and I know a lot of other people will have stories to tell that beneficial to a lot of us. So communication in different ways, and everyone is so warm, and they always wanting to help you when you say you're a student or you're a foreigner, and then on football, days better stay indoors. You stayed indoors. You didn't go out to watch football. After football, I run back to my flat because it's a wild party all night. Okay? So that you've been a wonderful guest, and you've got lots of Stories, like you said, it was an absolute pleasure.