“Ndụm bu Ijem” — My life is my journey | Chisom Obiezu-Umeh
My journey of self-discovery has not always been straightforward. As a child, I wanted to become a fashion designer, then a medical doctor, but as I got older, I found my passion for advocacy and activism.
Growing up in Nigeria, I witnessed first-hand the debilitating effects of a non-responsive health system and its implications on health outcomes. Similar to other African countries, numerous lives have been lost from curable and preventable medical conditions. Some contributors to these inefficiencies in the health system include a lack of essential primary healthcare services, the persistent brain drain of the health workforce, and avoidable medical errors in health facilities. “You have to make a deposit before we can treat this patient” is what many of us Nigerians are greeted with when we first enter the health facilities, even during cases of emergency. All of these issues which remain pervasive in the Nigerian health system facilitated my decision to practice medicine. I liked the idea of being a part of a profession focused on helping others regardless of circumstance, with an ultimate desire to transform healthcare delivery in Nigeria, along with improving access to healthcare for individuals and communities in remote regions.
In August 2014, I was fortunate enough to move to the US after my secondary education in Nigeria to pursue a Bachelors degree in biology (pre-medicine concentration) from Clarion University of Pennsylvania. As an undergraduate, I served as an Intern at the Northwest Pennsylvania Rural AIDS Alliance, where I gained a critical understanding of the rural healthcare delivery system in the United States and barriers to care faced by people diagnosed and living with HIV infection (PLWH). In addition to this experience, I co-founded a Model United Nations chapter at the Clarion University, where I had the opportunity to step into the shoes of an ambassador of a United Nations member state to debate, discuss and develop feasible solutions to real-world health and social issues. These experiences helped me realize that achieving better healthcare goes beyond the walls of the hospital to address the social determinants of health. I think of this as, watering a plant and expecting the crops to thrive in poor soil conditions. While watering is important, hydration cannot completely compensate for the underlying soil condition.
Upon many months of self-reflection, I finally summoned the courage to tell my parents about my career change from Medicine to Public health. “You are such a disappointment,” my parents said, as I attempted to explain to them the shift in my career path. Fast forward to six months, I chose to take a risk and pursue an MPH degree at New York University College of Global Public Health in 2016. Following my first semester of the MPH program, I served as a Graduate Research Assistant on an NIH-funded international project titled ‘Task Shifting and Blood Pressure Control in Ghana (TASSH)’ under the mentorship of Dr. Gbenga Ogedegbe. The goal of the TASSH project was to evaluate the comparative effectiveness of the provision of health insurance coverage (HIC) alone versus nurse-led WHO-PEN program targeted at CV (cardiovascular) risk assessment and hypertension control plus HIC, on blood pressure (BP) reduction among patients with uncontrolled hypertension in Ghana. I also assisted with writing sections of NIH grant applications and gained extensive experience in conducting rigorous assessments on the effectiveness of health interventions and implementation science research. Specifically, I worked on developing a practice capacity survey that was used in a study conducted in Ghana and Nigeria to assess the capacity, readiness, and overall implementation climate of HIV clinics to integrate evidence-based practices for hypertension management. The findings from this study are still being used to develop tailored strategies for integrating evidence-based practices into HIV clinics in Lagos, Nigeria. Not only was I able to deepen my understanding of the complexities of global health research in low resource settings, but I was able to build lasting connections that opened up the next chapter in my career.
In May 2018, I landed my first professional role as a research coordinator of a UG3/UH3 Phased study, under the auspices of Dr. Juliet Iwelunmor, to develop and implement “Innovative Tools to Expand Youth-Friendly HIV Self- Testing” (I-TEST) for at-risk youth in Nigeria. It has been a whirlwind of excitement and a continuous learning experience. On the I-TEST project, we successfully engaged over 5,000 young people all over Nigeria through participatory approaches, such as open challenges (i.e. crowdsourcing) and entrepreneurship training, that resulted in significant uptake of HIV testing and STI testing among young people in Nigeria. In my capacity as a research coordinator coupled with my graduate training at NYU, I have been repeatedly exposed to the grant writing process, from ideating to proposal writing to receiving the NOA and executing the proposal in real-world settings. I have also experienced in real-time, the impact grant writing and funding has on improving population health and health care practices and policies in low-resource settings. For instance, the TASSH study responds to the severe shortage of physicians in SSA by shifting the tasks of CVD risk assessment and management of uncomplicated CVD risk factors, from physicians to nurses. On the other hand, I-TEST demonstrates the scale of untapped impact of youth engagement in developing youth-friendly HIV preventive services in Nigeria. It also shows that if young people are provided with the platform, training and support to share and implement solutions in ways that resonate with them, HIV testing uptake among youth can improve dramatically. All of these were made possible through grant writing!
In summary, it is my hope that grant writing can be my contribution to addressing the gaps in health systems and health infrastructure not just in Nigeria, but also across other low and middle-income countries. I plan to continue investigating how and why evidence-based interventions implemented in low-resource settings succeed or fail to be sustained (in the absence of external funding) while pioneering ideas that introduce innovative approaches to research. Today might be HIV or CVD and tomorrow might be Covid-19 or another disease or hot topic. One thing I will hold myself to, is that I will take each new beginning, trust in the journey and follow it through to the end.
Currently, my parents’ views about my career change have definitely changed for the better. To the extent that my mother cannot stop telling everyone how amazing public health is and how much of a difference it made in her child’s life.
