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During a visit to Nigeria late in September/early October, Jide Akintunde, Managing Editor, Financial Nigeria Magazine, and Director, Nigeria Development and Finance Forum, sat down with Olurotimi Badero, a Nigerian U.S.-based interventional cardiologist, nephrologist and peripheral vascular specialist to discuss his amazing, superlative training in medicine, becoming the only doctor in the United States or anywhere in the world to have full specialist training and certification in nephrology and cardiology. Dr. Badero is Executive Director, Cardiac Renal & Vascular Associates.

Jide Akintunde: There is a string of professional titles to your name. What is your training?

Olurotimi Badero: By training, I specialised in internal medicine, cardiovascular medicine, invasive & interventional cardiology, nephrology and hypertension, interventional nephrology & endovascular medicine, nuclear cardiology as well as peripheral vascular interventions. Putting all that together, I would like to think of myself as an interventional cardio nephrologist as well as a peripheral vascular interventionalist.

JA: How did you come about this extensive training?

OB: I came about this training as a result of the things I had to go through in the United States and also because of my personal quest for knowledge. I started from one specialty to another, and kept looking for answers. I have a passion for patient care; and a passion for creativity. When you put that together, a rare opportunity is born. The ability to make a difference between sickness and health is one of the greatest forms of wealth and  
that doesn't stop as long as you continue to strive to get better.
    
For me, it was just a continuous process of trying to get better, staying the course and finding the things that really define who I am and what I really want to do to make a difference in people's lives.       

I've always been a competitive person right from childhood. I attended St. Mary's Private School where I skipped 4th grade due to my academic performance; and then Federal Government College, Odogbolu, Ogun State, for my high school education. In my fifth year, I, alongside some students, won a nation-wide science quiz competition in the country and that heralded a quest for professional dominance. That marked the beginning of a journey for me. One that will eventually lead me down the path of medicine. I gained admission into University of Ife (now Obafemi Awolowo University) to study medicine. I really didn't want to study medicine, but my dad, who was a great man, wanted me to be a physician.

When I graduated from medical school, I moved to the United States where I began my specialist training, first in Internal Medicine at State University of New York Downstate Medical Center, in Brooklyn which was a three-year programme. Following the completion of my programme, I proceeded to Emory University School of Medicine in Atlanta, Georgia, for a two-year Fellowship in nephrology and hypertension. Following completion of my Nephrology training, I returned to State University of New York Downstate Medical Center for another three years of Fellowship training in cardiovascular medicine. Upon completion of my general cardiology training, I gained admission into the prestigious Yale University School of Medicine for two fellowship training in invasive & interventional cardiology as well as peripheral vascular intervention, a fellowship training I completed with distinction.

I then returned once again to State University of New York Downstate Medical Center in Brooklyn for yet another year of fellowship training in interventional nephrology, dialysis access care and endovascular medicine. Altogether, I spent ten years of continuous post-graduate medical training which I later found out was unprecedented. I currently specialise in seven different areas of medicine. I am a Fellow of the American College of Physicians, a Fellow of American College of Cardiology, a Fellow of the American Society of Nephrology, and a Fellow of the Society for Cardiac Angiography and Interventions.

JA: Perhaps you would like to elaborate more on your personal motivation for the pursuit of this incredible professional excellence, particularly because Nigeria is noted internationally for the conflicting profile of churning out con artists, some of the world's best professionals, and inept political leaders?

OB: I learnt very early in life that a goal without a plan is only a wish and that there is no testimony without a test. The only time that success comes before work is in the dictionary. I also learnt from my dad the value of hard work as well as perseverance and not letting the moments define you but defining the moment by embracing the challenge. I remember when I was in primary school, I would be top of the class on many occasions, but my dad was never really satisfied. He always told me to do better. I couldn't understand why he wanted me to do better when I was scoring around 96 percent on average.

One day, I summoned up the courage and asked him why he wasn't completely pleased. He said, “Even though you were top of the class scoring 96 percent, the fact that you didn't score 100 percent means that based on the standard of your school, 96 percent was good enough. I want you to get to the point where you tell yourself '96 percent is not good enough for me' and start to set your own standards.”

I learnt from that early age to set my own standard. That is where my motivation actually came from. I am aware that some people get involved in activities that don't uplift the image of Nigeria which in actual fact happens in many countries in the world as well. However, there are equally a good number of people who have done Nigeria proud.

For example, the first-ever black neurosurgeon in the United States was a Nigerian. The man who discovered the post-concussion syndrome amongst NFL (U.S. National Football League) players is also a Nigerian.    

Nigeria has produced very brilliant minds, not only in the field of medicine, but also in science and technology, music, arts and in other fields. That is always refreshing to see and hear about. I believe there are a lot of other young people in Nigeria today who are doing marvelous things that the country needs to recognize. And there are Nigerians that will still do greater things than we have done. We shouldn't only hear about the negative things Nigerians do but recognize the good things they do as well because that's a platform for motivating the younger generation.

JA: I learnt you have the distinction of being the only doctor in the United States to hold specialist qualifications in cardiology and nephrology. Why did you find it necessary to acquire these qualifications, and what difference is this going to make in managing heart and kidney diseases?

OB: That is an excellent question. The heart and the kidneys are very closely interrelated. We learnt that in medical school. The heart is a very fascinating organ as well as the kidneys. The heart pumps blood all over the body to supply basic metabolic needs. Twenty percent of that blood volume goes through the kidneys. That tells you why the kidneys are very important. The heart and the kidneys are so closely linked, that whatever happens to the heart, affects the kidneys and vice versa. That is a major concept emerging in medicine now called cardiorenal syndrome and renocardiac syndrome because we are now recognising the interrelationship between these two organs.

While I was in training at Emory University School of Medicine as a kidney specialist (and by the way, Emory has one of the most intense Nephrology training programmes in the United States), I quickly found out that the commonest cause of death for the patients that died was heart disease and not kidney diseases. And we were doing a great job taking care of these patients but ultimately they died from a disease I didn't have much control of as I would have loved to. That was a challenge I had to embrace being someone, whose decision to be a physician was to make a difference. I realized it was very difficult for me to make that difference, albeit we were taking care of patients and they were living longer.

So that set the stage for me to decide if I wanted to explore ways of becoming more effective. I started toying with the idea of going back to specialise in cardiology because I really wanted to get to the bottom of the problem. This meant another three years of specialist training in cardiology. I was initially discouraged by some of my friends at the time who felt I was spending too much time studying. But for me, the value of knowledge is worth the time one spends in acquiring it. And there is never a time that is too late to acquire knowledge.

My training in cardiology as well as nephrology gave me a 360 degree view of a patient with a near total approach to their disease state. I think it puts me in a better position to actually treat these patients. I realized quite recently I was the only one with such formal training, holding certifications in both fields. I currently hold certifications in six different specialties in medicine.

JA: As a practicing physician in Mississippi, what similarities and or contrasts would you like to make between the local population and Nigeria, looking at cardiovascular diseases from the standpoint of public health and their prevention and management?

OB: I will start with the similarities. The northeastern states of the U.S include New York, New Jersey, Maryland, Vermont, Pennsylvania, etc. The southeastern states include Louisiana, Alabama, Mississippi, North Carolina, Florida and others. The south bears resemblance to Nigeria. I think that probably stems from the history of slavery. The southern people have a deep-rooted culture like we have in Nigeria. Their foods are kind of similar and their utilization of healthcare is not quite like you have in the northeast. There are still inherent myths that physicians have to navigate while treating these patients especially in the black community. The southern soul food, even though tasty, can be unhealthy at times from the cardiovascular stand point because of the fat and high sodium content which predisposes to hypertension and heart disease. But there is no denying the southern hospitality and the warmth of the people, just like Nigerians generally are.
    
The big difference is the obesity rate in the southeast. They have some of the highest obesity rates in the country. Mississippi used to have the highest obesity rate in the U.S. Not sure what the statistics are now, but it's almost approaching 40%.

I would argue that our obesity rate in Nigeria is on the rise as well because of the westernization of our diet and lifestyle. Many decades ago, there weren't as many cars in Nigeria. People trekked and walked which was good exercise. There weren't as many elevators either but it's not uncommon nowadays to find private 3-storey homes with elevators. People don't like to walk or exercise. When you live a sedentary lifestyle, you are at increased risk for cardiovascular disease. Hence cardiovascular disease in Nigeria may be fast becoming close to what you have in Mississippi.

Cardiovascular disease remains the number one cause of deaths since the 1950s; and in women it's even worse. One woman dies every minute from cardiovascular disease in the world today. It's an equal opportunity disease that doesn't discriminate on the basis of sex or race. There are more than a million women living with cardiovascular disease in the world today.

What is also fascinating is that most men would call 911 when they are having a heart attack. But a woman is likely to wait 20 more minutes to call 911. That, as you know, is related to many things. Your wife, whom I happen to know well, is a very loving woman like most women in this country and in the world and they take care of everyone in the family before themselves. In Nigeria where we don't have an effective first responder service, this can be quite a tragic situation. We don't have the necessary medical as well as ancillary services to combat this growing problem.  For example, I learnt one of my former teachers at (OAU) Ile-Ife, who was a cardiologist, recently passed away from a heart attack when he could have been saved if the teaching hospital had a cardiac catheterization lab.

JA: In terms of management, are there things you would like to emphasize with regard to cardiovascular disease in Nigeria?  

OB: Yes. I have met with my alma mater, University of Ife (OAU) and I have also met with Cardiac and Renal Centre in Gbagada, which is an annex of Lagos State University Teaching Hospital. I met with the staff at the CRC. I also met with the Faculty at (OAU) Ife, where there is currently no cardiac catheterization lab. Without a cardiac catheterization lab, you cannot diagnose the more acute cardiac problems like heart attacks. They don't have fully-functioning nuclear cardiology services to perform nuclear stress testing procedures that help diagnose the sub-acute heart conditions that lead to heart attacks. Devices like pacemakers and defibrillators are not available to manage some heart conditions. Patients needing dialysis cannot afford the catheters to perform these procedures in places where they are remotely available.  You'll agree with me this is a big problem for a tertiary and training institution like University of Ife (OAU).   However, having said all of this, I don't believe in dwelling too much on the issues without proffering solutions. I echo the mindset of being solution-oriented and not problem-oriented.

At Cardiac and Renal Centre, they have a wonderful facility there for dialysis and coronary care patients, and a cardiac catheterization lab. But it's semi-functional at this point, probably because of bureaucracy. These are some of the problems we have in Nigeria. It's not that we don't have the capacity to put the infrastructures in place, but after we put the infrastructure, there has to be a transfer of skills and knowledge. The first major laboratory and diagnostics centre in Lagos was put together by Indians, not Nigerians.

We have the technical skills, the knowledge base, and the patient population but there has to be a way to facilitate skills and knowledge transfer from doctors who have learnt the skills to manage these conditions. Without that happening, we are only a shell of ourselves. Currently, there is probably only one Interventional Cardiologist in Nigeria or at the most two. That is grossly inadequate to take care of patients in the varying states.

We have to rise together as a nation, both the private and public sectors, and put health into consideration because health is wealth. Life expectancy in Nigeria is probably around 52. In the United States, it is around 78. If a lot of Nigerians are not living beyond their early 50s, it tells you the workforce is shrinking.

I learnt a while ago, if you want to go fast you go alone but if you want to go far, you go together.

JA: What does Nigeria need to do, at least to stop losing its trained medical talents to foreign countries, and at best to be able to attract Nigerians abroad with your training and experience back to help lift clinical practice and the overall healthcare delivery in Nigeria?

OB: To answer that question, you have to get to the root of the problem and find out why people leave the country. I don't think you have a lot of petroleum engineers or bankers leaving Nigeria as much as doctors do. Brain drain disproportionately affects the medical field. The question really is, why is that statistic skewed?

Most university students want to work in the oil or banking industry. That isn't surprising, considering that those are some of the highest paying industries compared to the medical industry. I have a cousin who trained as a doctor but has never practiced before and is currently into oil and gas.  

I have tried to intellectualise the process of justifying spending so many years in school without a commensurate compensatory mechanism.  If you send your child to medical school, it is no brainer that you would have to spend more money because of the longer years of training. So here you are investing in this child but the return on the investment is not what you would expect compared to his colleagues. I must be fair to add that the situation is actually getting better with the pay rate now becoming more favourable.

I think the root of brain drain in the medical field is, first, poor economic compensation. Second, there is no strong structure put in place for effective training. We don't have many training programmes for doctors in Nigeria compared to the population. I don't know the statistics but I would say half of the doctors produced in Nigeria don't go on to specialist training and hence are not consultants. The doctors who eventually get higher pay are the ones in specialist training who end up as consultants.

I think if the compensation improves, people will come back. The other thing is safety and basic amenities that are involved in computing standard of living index. Uninterrupted power, communication, transportation, water as well as food. If these things which we take for granted are put in place, you'll see a reverse migration as well as foreign investors. It's a good sight to see more foreign investors in Nigeria than I did the last time I was here. That is refreshing because it signifies a trust that is needed for change.

JA: You were one of those boys who misled their friends in school. You played hard like everyone else, but then you were able to optimize the little time commitment to study as a gifted student, while others who were not as endowed continued to play and play. Are you still a player; or shall I say do you still find time to play, given societal expectations and the demand for your professional skills?

OB: In school I wasn't an ideal student. I will be the first to admit that. And guess what? I paid for it. I didn't attend classes when I should have attended classes. I guess I was still basking in youthful exuberance. I was quite playful. But as I became more mature and grew in my career, I realised that I was into something great. I had a rare opportunity to take care of people and achieve something great. I started getting more serious.

I got to United States and realised that you have to study. There is no short cut to success. There is no “let my people go” grades. You are not studying just to pass an exam, which is what we sometimes did back then in Nigeria. You are studying to apply your knowledge; you are studying to be functional. If you have knowledge that is not functional, it cannot translate into any kind of therapy. Within a practical framework, knowledge has to be functional to be able to impact the community and the nation.

I don't study much naturally, but the fluidity of my mind is always iced in the quiet of my thoughts. My attention has a tendency to drift sometimes but it's much better now. I usually read once and try to grab as much information as I can. I guess everyone has something that works for them. I think the problem started when I was in high school. We were the first set of 6-3-3-4 educational system in Nigeria. I didn't want to spend an extra year in high school before heading off to college. So I told my dad to enroll me in G.C.E programme in my Form Five which he did. I had to study on my own as it was not allowed for us to take the G.C.E exams at the time and I certainly didn't want my teachers to know. I was in boarding school at F.G.C. Odogbolu then; hence, no tutorial classes. I started avoiding classes to go into an uncompleted building with some of my friends to study.

When the results were released, I had distinctions in all the six courses I registered for. So I thought I was invincible after that. I figured if I could study on my own and still do so well, I didn't have to attend classes. Looking back, that was erroneous on my part.  I wouldn't advise any student to do that. There is a lot you learn by being in class. When you learn on your own, you can't ask questions. The teacher always knows more than you, trust me, regardless of how smart you are.

I don't know contextually what the term “player” which you alluded to in your question means, but I can tell you right now, I play the drums in church. From that perspective, I am a drum player, in the church where I also happen to be the Assistant Pastor.

JA: Accept my condolence on the recent loss of your dad, whose funeral you are visiting the country to have. What influence did he have on you?

OB: This is a man that had a huge influence on me. My dad was a great man. Very insightful, and prophetic too. He had a humble background. He lost his dad when he was 9-months old and grew up with his mom in the village. He basically pioneered his own life. My last name Badero was actually his father's first name. He changed it to immortalize the legacy of a father he never knew. Such was his depth and insight.

He kept asking his mom to let his uncle bring him to Lagos. Eventually, he convinced her and his uncle brought him to Lagos. His uncle trained him to be a tailor but he was convinced that wasn't his calling. He eventually raised money through hawking salt and matches at Obalende barracks and put himself through school. He was one of 32 people selected in his office to study business administration at University of Ife (then Ibadan campus) and he placed first in 8 out of the 9 courses offered. He placed third in the last course which happened to be accounting. He used to joke and say that's why none of his children is an accountant today. He eventually rose to the position of Central Administration Manager at SCOA Motors.

My dad was very strict but also very loving. My older siblings all attended public schools. I was quite close to my dad. We often ate from the same plate growing up. He taught me how to pray every morning and every evening. Growing up as a kid, I was the only one who had the chopper bicycle in my village at the time. You can imagine how big a deal that must have been to a 7-year-old. Even though he wasn't particularly wealthy, my dad insisted I attend a private school which was expensive back then. I eventually attended St. Mary's Private School which was a catholic school run by Irish nuns. My dad took me everywhere he went. We travelled together. I remember on one occasion, we even had a motor vehicle accident together. I am quite grateful to him for the things he did for me. My younger brother, who passed away in my final year in medical school attended the same school as well.

I think that the kind of education and school one attends especially during the formative years can be critical to one's character formation, level of exposure in the future as well as self-confidence. Some of those friendships that I forged then are still part of my social support system today.

My dad also instilled in me the ability to self-believe. He showed me when I was 8 years old how to set my own standards. I asked myself sometime in the distant past, where do I get my motivation from? Ultimately, my motivation comes from God who is my essence. He loved us first even when we did not love him.

Highlights on Dr. Olurotimi Badero’s professional achievements    

Dr. Olurotimi Badero is currently the only fully trained and board certified cardio-nephrologist (combined kidney and heart specialist) in the world today.
     
In all, Dr. Badero completed an unprecedented 10 years of continuous post- graduate medical training and he is currently board certified and a consultant in:
1.     Internal medicine
2.     Nephrology & Hypertension
3.    Interventional Nephrology & Endovascular Access
4.     Cardiovascular Medicine
5.     Nuclear Cardiology
6.    Invasive & Interventional Cardiology.
    
He performed the first transradial cardiac catheterization and coronary angioplasty at Central Mississippi Medical Center.

Dr. Badero is a recipient of many awards including:
-     The Association of Black Cardiologists scholarship award for the Best Cardiology Fellow in the U.S.

-     The 2014 Mississippi Healthcare Heroes in the state of Mississippi.
-     He was also named one of Jackson, Mississippi's Best Surgeons.
Dr. Badero has authored many peer reviewed journals and he is currently on the editorial board of the International Journal of Nephrology & Renovascular Disease.
     He is a:
1.    Fellow of the American College of Physicians
2.    Fellow of the American Society of Nephrology
3.    Fellow of the American College of Cardiology
4.    Fellow of the Society for Cardiac Angiography & Interventions.
     
Dr. Badero is the Executive Director of Cardiac Renal & Vascular Associates, the Medical Director of St. Joseph Hospice, and he is on the global Advisory Board of the therapeutics experts on Thrombosis and Atherosclerosis, Merck Pharmaceuticals U.S.A.