Dr. Juliet Iwelunmor is the Associate Director for Global Health and Dissemination and a Nigerian-American medical professor at Washington University School of Medicine. She established the “For Youth By Youth” Health-Art Initiative in order to improve the acceptance and durability of evidence-based interventions in international contexts including youth. In this interview, Iwelunmor, who bills herself as a “Light for Public Health” leader, talks about how she uses art, poetry, and storytelling, among other forms of expression, to promote healing and transformation by putting people first. She also discusses how she advocates for improved healthcare practices and preventative measures.
Tell me more about yourself and some of your past achievement.
My name is Professor Juliet Iwelunmor. I am a professor of Medicine, an associate director for global health and dissemination at the Washington University in the Saint Louis School of Medicine. I was born and raised in Lagos Nigeria, FESTAC town in particular. I spent all my childhood in FESTAC. I went to secondary school in Nigeria-Federal Government Girls College in Benin. And against my will, my parents sent me abroad even though it benefited me in the end because I didn’t get to finish secondary school. So, I am still angry about that. I have never healed from the fact that I didn’t get to SS3. They took me at SS1. Can you imagine? But, so I am not healed yet. Anyway, I think maybe all of that led to hunger to come home because I felt that I always had this unfinished business or something, right? You know, I had some unfinished business around something at home. So, eventually, I did high school in the US. My first degree in the US, when I eventually had the opportunity to do what I wanted to do for health, all roads led to home. So, I was lucky not to be paired up with a Phd. My Phd mentor, who happens to be Nigerian also, Professor Collins Arenbuwa and so really, our first, meeting was oh, I booked a ticket, you are going home to study health. And so, when I came home, ironically, that time coincided with me visiting my Aunty, Helen, at the hospital and I remembered going there and saying how is this a hospital? Everybody used to tell me I changed. That this is how Nigeria has been. I kept on saying, this doesn’t make any sense. What do you mean this house, it was a house, is a hospital? For somebody with end stage diabetes to be in that kind of place, because even when you enter, you see her like with maggots and everything then you are wondering, she needs better care, she needs better help and you are telling me this house is doing that.
Long story short, my aunty did die from something that could have been prevented. My dad lived with diabetes all his life and everybody was angry that we could have done something. So, you know a 18-19 years old just with that hunger like why are people dying from things that we could actually prevent? And so, when it was time to then eventually start my own research, it just made sense to really come back home. I connected with folks at LASUTH, then came back to do child malaria. I was part of the first group that bought Malaria rampage diagnostic test back in 2007 or 2008 just to study. My issue is that there are always tools, there are preventive tools for any health outcome that you can think of.
Malaria, for example, has rampage diagnostic test kits that many people don’t even know that you can purchase and get a sense of whether what you really have is malaria before you start taking medicine. Once people see symptoms, it is malaria. They want to start getting medicine but sometimes, it may not be malaria. That’s what my research actually found. That sometimes for children, it may actually not be Malaria. So, we ended up overdiagnosing and giving too many things. Meanwhile, we should be studying, treating other things that the child may be going through.
Let me take you back, I went to the UN, spent two and half years at UNESCO. I was in charge of culture sector response to HIV and that’s where I met Chris Lhidero actually. We were trained to think about what role can culture play in everything and luckily, my portfolio was HIV/AIDS and so what role can culture play with HIV? So, I connected with Chris Lhidero. In fact, I tracked him down online and he’d just done a short video on rape. So, I thought he would be a good person to partner with to do a short video on HIV and he did. I was able to help fund a small video that he then came to UNESCO and showcased because it was good to be able to say health can be married with community to do something different. When we created that short video, it got a rousing applause with UNESCO. We want to bring HIV self test to Nigeria but we don’t want to be the ones bringing it.
It was important for us to build it, build it with young people and then roll it out, so we did pilot implementation, and so, in fact our baseline or example, maybe online 1 in 5 youths had tested. By the time we finished that pilot in 6 months, 90 per cent of youths had self tested. So, you can imagine that yes, there are opportunities to do home grown solutions. Home grown solutions that young people themselves can do and if you roll those home grown solutions out, chances are that people would pay more attention to their health and that’s what we found out when we did that work then. And so, it makes sense that for all diseases, if we can do that was for HIV, it could be replicated with Cancer.
We can go to High Blood Pressure. It’s been rampant. It’s killing people you know. Many people don’t even know their numbers; they don’t even know what hypertension is or pre-hypertension. Can we create ideas together that will increase more awareness for blood pressure, stroke? 1 in 3 deaths in Nigeria is from stroke whether we like it or not.
By the time people are dying from stroke, that’s the first time they even discover they have high blood pressure. So, we could do better; we can actually use music and it’s actually happening. Hip hop stroke in the US. They use music to train children, especially black children. So, if you think of the US system, children tend to live with their grandparents. Children tend to live with older relatives, so, what if you went to schools and trained children to recognize the symptoms of stroke through music that they love? You know, jazz? You know they connect with actual hip hop producers. In Olajide Williams name, they connect with actual hip hop producers and those children learnt about BEFAST, Balance, Eyes, Facial Dripping, Arm weakness, Speech and Times score. They learnt about that and so when you then go back and talk to them, they were able to know what those symptoms are such that, if they see it in their grandma, they see it in their grandpa even in their parents, they can quickly activate emergency and get them care.
From your explanation, in recent times, you would agree with me that the campaign against HIV has suddenly gone down because in those times, you would see a lot of campaigns against HIV even on jiggles and what have you. But recently, these campaigns have suddenly gone down. So, what do you think could be responsible for these?
Funding is a big one and there’re many other things. COVID is there, and there are many other things competing for people’s attention. In fact, that’s what people keep screaming about HIV, that COVID pandemic has come to suck every other funding. Meanwhile, Cancer is saying we are still here o, it’s not just HIV. Cancer is saying we are still here, High blood pressure is saying, you don’t even remember me. I am here. Do you understand? We are not even touching mental health, depression, suicide. They are there too. Do you understand? There are so many things that affects the community that we are saying enough is enough for the siderows with disease, enough is enough for HIV camp to sit in one corner. Meanwhile, people are probably struggling with cancer and they need help today. Enough is enough for high blood pressure. People are looking and asking what can we do? Meanwhile, you can probably learn lessons from HIV right and connect those two together for the community. I think what we are trying to do is bridge those siderows to say if you go to a community, it is really all you would see in a community not one or the other. How can we do better for the communities health and not just HIV or blood pressure.
I said it, in my household, sometimes I even forget about my aunty but I have seen diabetes in my household the same time as malaria. The same time as cervical cancer, the same time as stroke in my house, in one family, and I am sure, many other families can relate. It’s not a either or for us and that’s what we are saying that we need to do better to connect all of the illness together for the community and let them have a voice, not the experts only talking but the community that you personally you know people are dying everyday. Normally, globally, sometimes people are dying from diseases, people know what kill people but the solutions to how you prevent it in your bloodline, you don’t even know.
You probably heard your father died of heart attack but you don’t even know whether it’s in your lineage. You don’t even have an awareness for what you should do to prevent it for yourself and that’s what we are saying. We need to do better with communicating using medium and tools that make sense, using music.
Nigeria has Afrobeat. Nigeria is no longer waiting for clothes made in America alone. We are growing our own things but why is our health not grown here too? Why are we not connecting our health to those home grown solutions and bring in our experts, bring those prevention tools you know exist, whether it’s vaccines? In fact vaccination, it’s free. The government has been rolling out HPV vaccinations. Yet, some people are not yet vaccinated. Hepatitis B, Nigeria signed the Cairo Declaration. It’s actually free, yet many mothers are not taking it. For high blood pressure, maybe reduce salt, reduce maggi. That one is free. I don’t need a big science something to tell you to reduce your salt intake. It’s simple. I am telling you it’s free but people don’t know to reduce their salt intake. Do you understand? So my point is, sometimes, we just need to maybe think creatively about how we tell people, yes, reduce your salt. Should we do drama comedy?
Let’s just talk about your initiative for youth by youth program. Then, girls and women and communities by communities. These are like 4 in 1. What informed this initiative and what has been your experience working with mostly the youth because what you talk about mainly is youth.
So, I think Nigerian youths are resourceful. Nigerian youths are original. Nigerian youths have value. The other end of the thing is two-third of them are not working. Two-third of them are not in school. So, in other words, people have been screaming for brain drain. All our big people are leaving, forgetting that with the youth, there is brain gain. We can do things to help the youth actually take up the roles that many people are leaving. So, how can we harness the resourcefulness, the vitality, the strength, originality that is within the youth and use that for health? So, that’s what triggered the For Youth By Youth project. Well, we were going to come to do the HIV self test and it was supposed to be increasing the uptake of HIV self testing among youths. That’s what the experts said they wanted to do but it would be disservice to let it be only experts driven and so, intentionally, we branded ourselves as for youth by youth because we wanted it to be youth driven, youth led, youth inspired. So, imagine having a programme where you are willing to wait and sit behind and let the youth tell you what to do? It was tough because it is unheard of. You know usually, when I go to sceneries, they are like, come and tell me about health. They want to only hear from the experts. Nobody believes the youth have solutions. Meanwhile, it is the youth that are running afrobeat right? Nobody believes the youth can create startups. I know youths personally, not like made up. I know youths who have created startups getting funding from the US and they are not even 24. I know them. They are mostly Nigerians. And so, if you can see that ecosystem where I am watching, how can I even learn from these 24-year-olds about changing my own life because currently, I don’t have a startup. If you can see what they put into the work they do, you will be foolish not to listen to young people. They are the next generation; they are the ones actually going to make tomorrow better. So, it was important for us to say, take a step back for a moment and listen to them. What ideas do you think you can bring to us so that we increase uptake of HIV self testing.
Our youths helped design the app that was never in our program. We didn’t even have an app. It was a youth that created it, text messaging of the result. It was a youth that created it, then we incorporated it into our clinical trial. In other words, our clinical trial became better because young people gave us ideas on what we can do to increase that uptake. Our youths said to make it a hygiene pack, girls like sanitary towels, boys wanted grooming kits. If you put the HIV self testing into this grooming that we like, maybe we would test. Those were the ideas we got from the youth and we incorporated them and true enough, young people tested. So, I think we are saying enough is enough to only see young people as just this passive recipients of the program. So, you just tell them come and take and they would write themselves there and move. We are saying No, we want them to be partners and leaders of health program.
You are a Professor of Medicine, practised in the US. What exactly is driving this desire to reach out to the community and dealing with the youth. What is driving this desire?
When they say young people should be mentored, they mentor them early. I think that’s what resonates with me. Even though I did my first degree, I remember leaving that first degree because I was not really sure about what I will do with life. As many young people are, you are graduating and you are like where am I going to end up? What am I going to do? What really happened was that I met a Nigerian Professor, connected with him, learnt about his world and his passion for culture, passion for home and I think that passion infected me too because it’s like ‘oh my God”, here is the person that is doing the type of things that I want. Then, you mean you can train me to also do it and his answer was, yes! So, you can only imagine I was either 21 or 22 with my first degree and he took me from Bachelor’s degree to a Phd. That’s rare. Mostly, they would tell people before you get your Phd, go get your Masters and then do that. He saw it in me before I even knew its in me. So, that’s the power of mentorship. If a young person can connect to a mentor early, who sees their resourcefulness, I said it earlier right, who sees your originality, who sees your usefulness, I am telling you the sky is your limit. What helped me was that an older person saw my resourcefulness, saw my originality and I didnt even know it was in me and he helped craft it in such a way that years later, he is still my most important advisor. He is still my most important advocate. He is still helping to shape the kind of career I want. That’s what mentorship does for young people, that, in fact, all these programs we have are saying we need to do better in connecting with young people, so that they see a 100 day journey start with a day. But often times, young people don’t even have a day, let alone 100 days. So, we need to connect better with that generation to say even if I meet you today, my hope is by the end of this conversation, by the end of this day, it sets you up for the next 100 days or set you up for the next 100 years of your life.
What are your plans to reach out to more youths? I asked because, most of these initiatives concentrate more on the city, Lagos. Meanwhile, I am from one community, one village in Nigeria where there might not be electricity. What are your plans to get more youths involved in the initiative?
Talking to Telegraph, talking to you that is in one bush like you said to help me spread the news. I can not do it alone. So. it is important for me to talk to people like you to help me spread the news because my sister in law that I said died, is from Jos. She was not even in a city. She is from Jos where, you know, people tend to forget a lot of people in the north for example and the issues they are going through. It is important that I always remember that because I need to know that whatever I am doing is not just talking to people in Lagos. It’s dead on arrival. I need to be talking to people in rural places. Some of my youth also created a text messaging service because some children in the North, some places don’t even have smartphones. It is still text messages and I got that from young people but I shouldn’t forget that some youth don’t have smartphones and it takes me talking to youth to know that.
A youth coming along to give me that idea; otherwise, we would stay where we are, knowing that there are other people we could not reach. So, I am for reaching as much as we can.
So far, what will you say is your assessment of the impact of health NGOs in Nigeria and what do you think can be done differently?
I think one of the things that ends up happening is often lack of opportunity, lack of funding, lack of exposure, lack of where do we begin; lack of how do we even roll out? I think what we are saying is we have a platform where we want to have an opportunity or engagement with NGOs that are involved in health. If you are an NGO that is interested in cancer, especially, cervical cancer or liver cancer, if you are an NGO that is interested in non communicable diseases or high blood pressure or stroke, if you are an NGO that wants to get to the bottom of HIV in a sustainable way, we are asking you to come along with us. It is not enough for us to have the idea and it ends. I think I always say this, 50 per cent of all these health ideas will never last. So, no matter how much I talk to you, if you bring all of us that do this kind of work together, half of us would be gone after two or five years. I need to remain. I need to connect with NGOs because they would be there long after I am gone and so, we need them to be carried along from the beginning not in the end for the program to last, sustainability. I need to plan from the beginning with people like NGOs, with young people, with communities and to learn and even listen about what they have been doing that worked or didn’t work and then even me, I have to be able to change. I need to adapt. I may have my plans but when I listen to you or when I learn from you, you will see that I will change those plans. It’s natural. When we are really in a relationship, you will rub on me and I will rub on you. Next thing, you know are my plans are changing. It’s natural but I also need to nurture what works with you, your asset. You are already the NGO that is there. You know how to bring community people together. I even want to mobilise for good, mobilise that asset for change. Our NGOs are always there, doing all they can to get people to be involved in health but they don’t have opportunities like this that even champion and celebrate them to continue to be resourceful and innovative. We have that opportunity in working so my local PI is in Nigerian Institute Of Medical Research. They are in charge of all the country’s researches. Many people don’t even know they are here in Yaba. They have been here for example. They were the first to discover HIV/AIDS in Nigeria. So, they’ve been here for a long long time. We need to do better in reconnecting with the community,reconnecting with young people. We should do better with that collaborations and ultimately, we need to do better with creating those home grown solutions from here and not just exports driving them to you.