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What enriches you? Empowers you too? What questions are you also asking yourself, for yourself first and no one else? Some issues are etched in my mind as priorities these days. The numbness with senseless murders for one, from people who resort to guns rather than love or even words. Even the thought of Enough isn’t helpful when another violence is around the corner and we keep doing nothing or staying numb to death. The state of health of all people, young, old, and how to ensure they live well sustainably, another urgent priority. Yet for these priority issues, I am beginning to see that there is yet another epidemic on the horizon. The idea of being alone and having no one to run to.

The US surgeon general recently shared a report on this, including the scary fact that loneliness and social isolation increase the risk for premature death by 26% and 29% respectively. This is equivalent to smoking 15 cigarettes a day, something that many of us will never do, knowing its consequences. Yet why is our world a lonely place for so many and how can we ensure that we build social connections that have structure (i.e number of relationships), function ( i.e reliance on others for needs) and quality (i.e positive, helpful or satisfying relationships)? It for these reasons and many more that I loved attending the opening of Korede House yesterday.

Known as a third place, Korede House is a home away from home and a space where communities can be formed for example, to provide vital insight and energies necessary in our common battles against loneliness. It doesn’t force itself into any mold that exists. Rather on its own, Korede House celebrates the possibilities of becoming when minds are rested, reopened and renewed to consider all the connections that make us whole. You will connect deeply in this house. The walls alone, require and insist on your attention. You will listen deeply too. Not just for the purposes of hearing someone speak, but for the clarity such speaking can usher as a mirror into your own. Of course you will rest deeply too. The house is designed first for rest. Not on a superficial level, but the kind that makes you whole, re-centers you to your essence, while ushering joy as you recover yourself for yourself. When you walk through the house, moments of sweetness will engulf you, for the thought and care each space provides. Korede House is on the cutting edge of real social change, solving the core problem of loneliness and social isolation, one room at a time.

Thus, a third place such as Korede House, is one way of participating in the future we want where the burden of loneliness is eliminated. It’s provides a cohesive vision of what we hope such a future can look like, one where our abilities to imagine such a future will be stretched beyond what we think is possible. Yet, in understanding, in seeing common elements, in trusting our perceptions too, Korede House functions as an exemplary antidote of what the US surgeon general is advocating that our society wants and deserves today, tomorrow. Keep Korede House and their bring goodness vision in mind, with any attempts at achieving a future where loneliness is no more. See more here: Korede House

Congratulations Ronke on the opening of Korede House!

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What public health does not need, is people unwilling to exact the truth. Those unable to look beyond the mirror, to illuminate life for those we serve. So these words are not written to impress. Not even written to note all the ways we let the public down. Rather we will put people back into the center. Lines will speak of the ways the public participated. Moments when voices pierced the silence around. Those that led gently to light. Those that exposed the wounds of injustice. We have tried to communicate. The public would rather conquer. We pounded consultation to a pulp. The public mocked the lumps of sugar in our throats. Sweet words never led to basic needs. Not yesterday or tomorrow. So we ask now that the public participate. However they see fit. Moments of despair. Those of hope. Whatever the public wants we will try though broken or whole. We only ask that you watch us closely. There is hope still preserved in things full of light.

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Ben Okri has a poem, “I sing a new freedom” that ended with these worlds: “children of the stars…ought to amaze.”

I agree and as part of our recently concluded STAR designathon which ended this weekend, I reminded students of STARS about why all of them are quite simply

Amazing

Brilliant

Celebrated

Dominant

Elevated

Famous

Genius

Hero

Icon

Just

Kindle

Lead

Major

Noted

Outstanding

Prominent

Quest

Renowned

Stellar

Talented

Unique

VIP

Worthy

X-factor

Youthful

Zenith.

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I have been speaking about sustainability for a long time. I woke up to to a phone call this morning that asked if I could speak on it to a group in less than 30 minutes. I said yes ( because I have been thinking about this topic for a long time) and proceeded to create a presentation in 30 minutes. During the presentation, I was mesmerized by the person speaking. Granted it was me, but the words that seem to come to me, came from places I tend to ignore about why this topic truly matters to me. I have written failed grants about it. Dreamt about it. Thought about writing both fiction and non fiction on it and well it is at the heart of why I keep this blog in the first place. The idea of something, anything that lasts. Not for publications or accolades, not even for funding, but because I care deeply about why things should last. I found myself speaking about people now dead who championed this issue. I spoke about papers from 1990 on this issue. I shared my dreams and new ideas soon to be birthed this year about it, but above all I realized why I care deeply about this work.

This urgency to give meaning to sustainment is the source and meaning of my work these days. It continues to help me dream, widens my ambitions with any health issue that remains a persistent source of inequities, reminds me often that I will fail because people don’t understand it, yet still I will rise. I want to believe this fever for all things sustainment will break one day, and I too may end up saying that things never last for a reason. All the things I do these days, all these writing are both my guide and hope. Every single thing I keep is reminder of the very thing I continue to seek. What am I seeing, what is seeing me too, and how I tell it’s story is the reason I know I need to reach beyond myself this year. This work is out of this world, like the very air that I breath. So I close by claiming it, naming it, as I prepare to intensify, what may seem impossible, with my biggest dreams still.

My plans for sustainability are beyond me, but I will dream, be ambitious, embrace the dip, and still rise. Amen.

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Are you sure, sweetheart, that you want to be well? This question has always haunted my spirit. It’s from Toni Cade Bambara’s novel, The Salteaters. It is also apt for today. That and what does being well mean for the public’s health, from a social justice lens, radical wellness too and not from experts alone, or those who have credentials, but from you the general public and with your fiction or nonfiction?

Who are your go to references for being radically well and how do you even begin to define wellness for yourself? Of course it led me down a rabbit hole, one where I am now obsessed with how people, those in fiction and non fiction, those with expertise and none, define what they mean by wellness.

I have been struck by the myriad of ways people define wellness, especially those focused on people of color. It matters to me these days that for the public, we define what wellness means, not just from what the dominant literature may tell us, but from everyday people who continue to struggle with answering the question: ‘Are you sure, sweetheart, you want to be well.’ So, from what I gathered from the Bettina Love’s profound book ‘We want to do more than survive’ wellness is:

A choice

A type of freedom that comes when you let go of your fears and move your anger into a space of healing.

Wisdom and being well is hard work.

Part of social justice work.

An inner life that refuses to be treated less than human.

Being vulnerable.

Finding the roots of your own Black Joy, Black love, and humanity.

Choosing to see ourselves beyond illness or disease.

Having an inner self that can be quiet and enjoy life.

Recognizing the pain of our ancestors knowing the beauty and resilience of that pain lives on in us.

Knowing who you are regardless of what is thrown at you.

Integenerational.

Different for different people.

Healing that is unrecognizable to White people and different from them.

Being your best self while fighting injustice.

Fighting racism with life, grace, compassion.

Having mental space and freedom to dream, give hell, and retreat to one’s community of love for support, fulfillment, and nourishment.

Being whole.

Bringing your full self.

Joining others in the fight for humanity and antiracism in love and solidarity.

Confronting internalized White supremacy, sexism, homophobia, transphobia, Isamophobia, fat phobia, classism, ableism, and the rage that comes as a result of these hateful ideas.

Keep doing more than surviving with these radical wellness definitions in mind.

Keep Professor Love’s approach to wellness in mind.

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Each day, nearly 28 women die from cervical cancer in Nigeria. Angela Akumuo, my sister-in law, was one of them in the summer of 2021. She was 53 years old. Her death, like those of many women who continue to die from cervical cancer in Nigeria and globally, could have been prevented. It was also discovered late. She lived in pain for years, and died within 3 months of finally opening up about her illness. There are so many effective evidence-based tools to prevent, diagnose or treat cervical cancer. Research too, with the field of dissemination and implementation science, my chosen field of study. Yet, why are women, like my sister in-law, in the prime of their lives, still dying from cervical cancer in Africa?

Look at the state of cervical cancer in Nigeria and many other African countries and you’ll understand. With an estimated population of 206 million individuals, Nigeria has over 56 million women aged 15 years and above who are at risk of developing cervical cancer. Most cases of cervical cancer are caused by human papillomavirus, with 67% attributed to HPV 16 and 18. As a result, the government recommends screening for cervical cancer from aged 30. Young girls and women are recommended to get vaccinated as well from age 9. Yet less that 10% of eligible women are screened and 14% of girls are vaccinated. Is it any wonder that cervical cancer remains the second most common cancer among women in Nigeria, also one of the most preventable? 

In 2020, nearly three years ago, the World Health Organization (WHO) and 194 countries, pledged for the first time to eliminate cervical cancer by pursing three key steps: vaccination, screening and treatment. A recent costing exercise by WHO for the Nigerian government’s strategic plan on prevention and control of cervical cancer estimated that $18.1 million will be needed to fully immunize Nigerian girls at $3.98 per girl aged 9-13 years, $919 million will be needed to provide 24.8 million screening services and 2.2 million pre-cancer treatments, while $59 million will be required for cancer diagnosis, treatment and palliative care. Right now, Nigeria dedicates 5.75 percent of its budget to health with about N81 billion naira (roughly $100 million dollars) to health care services, all of which are insufficient to help the country reach its global goals for cervical cancer elimination by 2030. The cost of vaccination, screening and treatment remains an obstacle for many Nigerian women and girls. So, it’s no surprise then that Nigerian researchers and key stakeholders are turning back to Nigerians themselves to find innovative ways to lead the national response to eliminate cervical cancer. 

Enter For girls and women by girls and women. This new crowdsourcing program led by myself and researchers at the Nigerian Institute of Medical Research led by Dr. Oliver Ezechi and the University of North Carolina, Chapel Hill, led by Dr. Joseph Tucker, is the latest from our, for youth by youth group, that has spent the past five years working to promote HIV self-testing with Nigerian youths themselves using crowdsourcing open calls, 48-hours designathons, month-long innovation boot camps and subsequent implementation of finalist programs in community settings. Crowdsourcing allows large number of people to become involved and engaged in developing solutions to health issues. Our program, now in its fifth year, boldly displays how Nigerian youth themselves can be partners and leaders with HIV prevention interventions and not just beneficiaries of interventions designed by researchers alone. Interventions created by the group, has led to an increase in HIV self-testing from 29% at baseline to 90% at 3 months follow.

We are striving to repeat the same success but this time with HPV vaccination among girls and HPV screening among their mothers or female caregivers. We know that the thought of cervical cancer may strike fear in people’s heart, producing a deep sense of powerlessness. But it is possible to act against it by partnering with us to lead the design and implementation of HPV campaigns, particularly HPV vaccination of young girls and HPV screening of eligible women. Our crowdsourcing open calls will be launched in Nigeria this January and it is our hope that through our program goals, Nigerian girls and women can become prime leaders in designing, implementing and evaluating interventions that increase uptake of HPV vaccinations and HPV screening, while eliminating cervical cancer as we know it.

Angela Akunmo may have died from a disease so preventable. However, through the launch of the crowdsourcing open calls for HPV campaigns for girls and women by girls and women, her death will not be in vain.

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What makes for knowledge? How is it acquired? And how should it be used? I have been grappling with this notion ever since I arrived at the place called home. I came to teach, but I found myself being the student more than the teacher. I found myself asking questions internally and also doing so externally. Is knowledge only knowledge when it comes from the West? What about the rest? Don’t they have knowledge of their own to contribute as well? Who gets to decide when knowledge should be for everyone? Is it those that published it faster or those yet to publish it at all? I ask these questions because the field within which I work in, the one called implementation science is so full of knowledge. So full of power too. But do knowledge and power go hand in hand. Is power even a stable entity?

Take for example a context where research isn’t prioritized? Is this context the same as one where research is prioritized? Are they even on the same playing field as equity would imply or should we level the playing field for everyone. The limits and complexities of knowledge is my keep for today. That and who owns the right to it. I spent the week in a place where many have never heard of implementation science. Yet once shared, resonates with their worldview. I did what was expected with my lessons, stuck to the script like a bee on a honeycomb. I shared all the information that all the powers in the field recommend. I used key resources from key institutions to frame all the information I shared. Yet, when I finished, I felt like we where just beginning. I felt like I needed to now learn how they would do it here. I felt hungry for knowledge for my own sake. Anything that I could digest in the way that my lecture did of how they would do it here.

Here is a place after all that created literature authors wanted to read, or music, musicians wanted to play. Fela Kuti is a household name on his own with his own genre of music the West didn’t have until he arrived. The same goes for Chinua Achebe or Wole Soyinka or Chris Okigbo and their style of literature. This place birthed it’s own giants unprepared to do what the West prescribed. Not when they knew what would work for their own context.

Of course they knew the script of the West. Knew what it entails to dance to the tune of those who first hunted. But what happens when the empire decides to strike back. What would they bring to the field? I don’t expect lions to watch the hunters forever. They know how the story ends. These days, I look forward to them choosing to fight back on their own terms. And after my lecture, I was prepared to see what they would do. And these lions delivered.

What I learned, in other words, is that knowledge is not a simple process of gathering and dispensing facts or just sharing and eliciting information. I also learnt that knowledge does not lie solely in the acquisition of more facts or information. Rather, knowledge like anything else, art, music, literature, is vast and thus cannot be confined to any one place or person or group or continent in any single method. Not when it belongs to everyone.

Of course we have never heard of this field called implementation science, some said. Yes I am curious to learn more, others said. But what of here? What about what we do here. I smiled. Now they are are prepared for the fight. All I ask is for the hunters to get out of their way. See them roar too. For knowledge after all, is for everyone. That’s the gift I got now that my week has come to an end. The gift of seeing lions prepared to fight their way even in a field they have never heard of until this week. Implementation science should look in the mirror often so as not to be taken by surprise from lions on the prowl. Either way, they are ready to tell the story their way. They expect a struggle. Life is full of struggles after all. At least they would have tried. I have tried and failed many times, still I tried. That to me is the gift worth sharing. The power of struggle. The power too of lions finally telling the story of the hunt, their way. Thank you my hosts for a wonderful week and to all the lions I meet, I look forward to reading your stories.

Some lions ready and eager to tell the story their way. What a week. Thank you, thank you.
Thank you NIMR!

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Zora Neale Hurston described research as a ‘formalized curiosity.’ One that involves poking and prying with a purpose. I have been blessed to call research my job. To engage in this formalized curiosity full time is the best gift I have ever given to myself. Many take it for granted, but I know what I am capable of. Whether it is about remote ischemic conditioning or crowdsourcing youth interventions, if it requires poking and prying with a purpose, I’m all in. Which is why of late, I have been wondering what else can I use my research skills with.

Clearly, it has taken me to the world of literature, black literary scholars to be precise, from the eyes according to Zora, to light according to Audre. There are some books on becoming dreamers, books on why my future depends on me remaining curious and of course books about tracks along dust roads or the fire in my head. I see this phase of my research as intentionally trying to uncover all that I can about the world in which I dwell in. Research now has taken me to places I never imagined, reading words, I never expected. In some instances, I have been carried away, whether is with a list focused on dreams that never end, or a list of why chasing butterflies matter. In other cases, I found myself writing things that seem harmonious in my head, to the point where I recite them to myself, as if on a stage for spoken words only. These dances in my head, unleashed through words in this blog is my attempt at surrendering to chance, surrendering to what I intend to do for me. To research things I want to for my own pleasure. To think I have been on this journey for over 2 years now seems surreal. The future also seems very uncertain. But for today, I’ll rather remain curious, remain compelled to do this formalized curiosity work Ms Hurston described as research.

Tomorrow, I get to teach it for the first time in the place that birthed, named and framed me. I am grateful for everyone that paved the way. Thank you for this opportunity to learn to from you. That small girl many still see as a small girl is surely growing up ooh. I know so many see my motherhood to as a crutch. But know that all that is within me is stronger than anything and what is for me, will always be for me. So if destiny planned that I get to teach this at home one day, then I will say thank you. So thank you from the bottom of my heart for this great invite back to home to give my all to the thing that keeps giving my joy, this formalized curiosity I hope many can call their own too one day.

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I remember her smile like it was yesterday. She always smiled. She was tall and very beautiful. The look on her eyes was like paradise, always mesmerizing, always kind, always tender, always love. Her name was Selena and she was loved by so many. I share her story today, not to grumble, but as a reminder that research for me is people. The passion I feel for research has names and faces that I dare not forget and her story was my first experience at mental health trauma, turned domestic violence, turned suicide. We watched this in real time. We tolerated it too, with assumptions that it would go away over time. Selena’s life was cut short by someone else’s mental health issues and we are left to wonder, what more could’ve we have done.

So I write today, as a reminder that the world is truly an unkind place, people are dealing with a lot, and the familiar can be life threatening. My own awareness of being a researcher and experiencing the ramifications of what happens when evidence is not translated in real world settings is of interest to me. It may seem like we can never help everyone, I know. It may seem like research is uncaring, I know. It may also feel like we are only in it for ourselves. I know too, and agree that there are miles to go before research can truly be for the people. But we can try. I am convinced that if we do our part to ensure that evidence-based research is translated to real-world settings, then there would be no more stories like that of Selena and I would be celebrating her light, her life today and not reminiscing on all that life took from us. So it’s vital for me to write this to remind all of us that research is people and we should care for it, be vigilant and do all in our power to ensure that it remains that way. I also love and miss you Selena and may your soul continue to sleep in God’s bosom. Amen

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In a little over a year, now, our life as we knew it came tumbling down. We called her Angie or Angi and to know her was to know life. I am reminded again, that death should never have the final say. Not when those alive can continue the story of a live well lived. One that became a blessing, a symbol of persistence, and collaboration laced with empathy, though the pain of loss of her physical presence lingers. Since her death, I have been writing notes to her. I wrote other things too, like grants and stories and everything that would enable the pain to lessen. Yesterday, I submitted the 4th grant in her memory.

Cervical cancer came knocking furiously at my door in the summer of 2021 and since then I have been answering the call. Two things are clear to me: No woman should die from cervical cancer. And we must eliminate it period. It helps that there are polices for elimination. The 90-70-90 strategy for example which calls for 90% of girls vaccinated, 70% of women screened and 90% of women with positive results linked to treatment. The fact that such a policy with evidence-based tools exists infuriates me. The fact that we also know what to do about cervical cancer also makes me angry. Her death could have been prevented. I get it now. It’s the reason why I keep writing anything that would make her living more memorable.

I personally bear responsibility for her death, blame too. I could have asked more questions, checked in more often and maybe, she would have disclosed this in passing. I will never know why she kept this as a secret, not just from me but her mother. I will never know why she didn’t trust the health system long enough to truly take all the symptoms she was experiencing seriously. I only have questions, many that I know I will never have answers for now that she is gone. But for tomorrow and, beyond, I am willing to begin with trust, will to begin with listening, willing to learn and hopefully willing to work with any one to lead a concrete and path-breaking strategy focused on cervical cancer elimination. I expect the struggle to come. Many have warned us of it. But I close with this, at least generations will know we struggled, we did it our way too, so no woman would die from something so preventable. I have been dreading writing anything on the one year anniversary of your passing Angi. Dreading it because I’ll rather hear you say my name or ask about the kids or just simply chat about makeup or anything else your heart desires. So these little notes are all I have with the hope that someday, someone will asked how you died and I will be quick to say, ooh but you lived. You lived.

Note on desire:

A long desire. To see and be. Another encounter. Longer than the first. Two eyes locked. Or lips talked. These notes are for you. Though dead but living. Something tried. Your cervix, a thing. Follow its form. Learn it’s lines. Then see you. It takes a long time to see. Even longer to be.

Note on Something so small:

They need to know your name. Not the way you died. Not the cervix that caused you to die. Not the pain we fail to hide. Not the tears we still shed inside. About how something so small, can kill an Angel with all its might.

Note on Seed:

I will find you again. Not like a stalk , but a seed. Death is undeserving of you. Life resembles a birds foot. Only that we chose to soar, choose to fly above the pain your cervix caused. We know pain. But we also know life. And return to you not with fury, but with force, not when your death planted this seed.

Note on She lived:

I imagine someone will ask one day, how did Angi die? I will remind them again, of how she lived. How in life, she personified all our hopes and vision. For a better recognition of what the public envisions. For their health, like their life. We will neither reject nor denounce her cervix. Not when it reminds us to be careful. Reminds us to remember the power of endless beginnings. Reminds us to bear a responsibility to something. Or one day someone will ask the same question, wanting to know too, how we died or lived.

Some many fists are clenched and coming after cervical cancer (imagery from bell hooks). Thank you to a formidable and diverse team that got me through this last year. Our story keeps unfolding in ways only grace personifies.

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The first job I got right after my undergraduate degree was an internship at the World Organization’s InfoBase. It was for 3 months and I was assigned to work under Dr. Kathleen Strong. My first assignment, look through online databases for the burden of stroke globally. Then enter all the risk factors you see into the WHO Global InfoBase. It wasn’t the most high rewarding jobs, but I understood the value and did my best throughout those three months to help the group and their surveillance of stroke risk factors globally.

Nearly 16 years later, I am back to looking through online databases to make sense of risk factors for stroke. Hypertension is a dominant modifiable risk factor. So also is high salt intake and sedentary lifestyle as well as obesity. I worked with a group earlier this year to make sense of the role of salt. It seems simple that everyone should cut back on salt but yet the willingness to push this through mainstream is limited. There there are all the clinical approach to hypertension based on clinical assessments and strategies that rely heavily on resources. I don’t doubt their significance but the burden of stroke still remains high despite their existence. But really who cares and why am I reminiscing on days long gone. Well, it’s all coming full circle. Not sure what the universe is trying to do, but I’m a vessel and I love seeing what staying under his wings can do. This rise, this ride of my life is amazing. Stay tuned.

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The images you have of me. Mother, researcher, doing work in far away places. All of them are true. But those that are invisible. Everything hidden, under, and in between the lines like Toni Morrison’s invisible ink, are the bones that keep me tall and erect. One day, I will leave you hoping to see just how the story unfolds. What scenery passes through my window daily or whether i truly kiss the night air. Only that it would just be the beginning of the day in which all that I am to become, everything buried deeply within me, oozes forth like an ache.

I am possible, today, tomorrow, and forever, because I know my dreams, and my dreams go on dreaming, unbroken, unfettered, unafraid. They look to rivers and mountains, parks and creeks for inspiration that some call ambitious. Then they see struggles, all sorts of strife and pain lurking by the doorway, asking if we would like to come in. We do. Falling deeply into depths we pray will not leave us powerless. Not when we know what lies within us, all that cries out to arise from these depths we find ourselves in. We do, reaching for the skies above, hoping this wasn’t a dream. Dreams are always wasted if you don’t dream again. So we do, dreaming still that what lies hidden, everything under and in between the lines, remain unbroken, unfettered, unafraid, now that we touch all that aches within us.

My presentation today went well. We need more dreamers in global health.