Dr Ummu Muazu Mayana is co-founder of Horizon Health Network (HHN). The UK-based Nigerian Paediatric Chemical Pathology expert shared her childhood experiences and career progression with Mohammed Subair.

IN the North back in the days, it?s rare to see a girl-child go to school, even less of studying Medicine at the university, how did you achieve this?

Today, in families like mine across Northern Nigeria, formal Western education for the girl-child is actually the norm rather than the exception. Such education is further enriched by religious studies, community-building activities and practical entrepreneurial exposure.

However, I went to school about a decade after Nigeria gained independence, where the typical girl-child in my community did not pursue higher education. Not many parents allowed their female children to seek Western education, for fear that it was unfamiliar and could be damaging to their faith and morals. I was the first female in my family to go to secondary school and eventually, among the first female medical doctor in the old Sokoto State, before it was split into Sokoto, Zamfara and Kebbi.

The elders in my family had their reservations regarding Western education, then, often taught by Caucasian English expatriates. But they believed I had a strong grasp of my moral, religious and cultural identities and could see the benefits of mixing with diverse groups of people, given that many of the leaders in my family were scholars themselves.

Perhaps, unsurprisingly, I stayed local in Sokoto for most of my education. For primary school, I went to an Anglican Church school called St Paul?s, which was later renamed Muhammad Bankanu School. I was transferred to Capital School in my final year of primary school, where most of the teachers, except for our Religious Studies and Hausa teachers, were of European or Asian descent. Throughout my primary school education, I also attended Islamic school every evening. For secondary school, I went to Federal Government College, Sokoto, where my father had worked as a Bursar. Then for A Levels, I started off at Ahmadu Bello University (ABU), Zaria, where I completed a term of Basic Studies before returning to Sokoto University, later renamed Usman Dan Fodio University, to finish my pre-degree in science. I went on to complete my MBBS at the same institution in 1988. I had just started my postgraduate training in Paediatrics when I got married and relocated to the UK.

Why did you move abroad?

My move abroad was due to personal circumstances.My husband and I intended to make it temporary. Unlike today, where many Nigerians move abroad in search of better opportunities, Nigeria was actually a great place to be, despite some early signs of deteriorating living conditions.

Up until the early 1980s, many of the foreigners working in our locality had a popular saying that ?if you don?t make money in Nigeria, you?ll be poor for the rest of your life?. The naira was strong, and there were lucrative job opportunities at the time. Foreigners, including Europeans, Asians and people from other African countries, and Nigerians from all tribes lived within the same communities. We all enjoyed a system that worked, and Nigerians residing abroad were returning to Nigeria to access education and healthcare. Unfortunately, despite the abundance of wealth and opportunity in Nigeria at the time, we Nigerians failed to put our resources to work in a way that invested in our country?s prosperity and future.

What motivated you to opt for medicine?

I left secondary school, unsure of what I wanted to do career-wise, but, with a good understanding of what I enjoyed in my secondary school days, namely: Mathematics, cooking and reading. Unsure of the applications of Mathematics in the real world, and fearful of taking my joy out of cooking by creating structure around it, I decided science was a logical space to explore.

So, Medicine turned out to be the best option available to me, given my grades, interests and university of choice at the time. When it came to specialising, I chose Chemical Pathology, including Paediatric Chemical Pathology and inborn errors of metabolism to combine my interest in metabolic basis of disease and paediatrics. I kick-started my training with an MSc from the University of Leeds after which I did the specialty national training programme, for which I was awarded the Fellowship of the Royal College of Pathologists in London, and a certificate of completion of specialist training by the PMETB

How did your early exposure shape the woman you?ve grown to become?

Both my early exposure and experience growing up played a huge role in shaping who I am today. The saying ?it takes a village to raise a child? is apt in describing how I grew up. As I reflect on this question, I picture my mother weaving mats, baskets and clothes of multiple colours and shapes. The raw materials, each holding their own story, were carefully woven together to form an artful whole. Today, I?m not so dissimilar from an artful whole, a tapestry of raw materials woven together by the hands of my parents, uncles, grandparents, community leaders and parents of my friends. I was nurtured by elders who were well educated, compassionate and skilled at navigating social, political, business and community dynamics. They held themselves and others to a high standard, and to this day, they inspire much of my curiosity. They taught me to never apologise for my being and till today, I carry this with me each time I find myself in an unfamiliar space. I continue to navigate life with a determination to excel in whatever I choose to do and with strong foundations and a brimming toolkit, I have confidence in my ability to continually impact the world in positive ways.

What was growing up in the North like? Were there challenges in accessing education during the time you grew?

We grew up in an era when Arabic and Islamic Education was prioritised over Western education. But like I said, my father was a Bursar, who was well educated, and knew the importance of being exposed to other forms of education too. There was nothing wrong with the quality of education in Nigeria, per se. When we moved to England, we actually found that students from Nigeria and Ghana spoke English as fluently as the Brits.

As we?ve spoken about education already, perhaps we can shed some light on employment, given that they are strongly linked. In my early career, there were many job opportunities but navigating the job market was sometimes a challenge, particularly as a woman. This was the case both in Nigeria and the UK, but for different reasons. For my husband and me, much of our training took place in Europe and finding jobs that enabled us to pursue our professional careers in the same geographical region, especially given that we had no additional family support within the UK, was difficult. Ultimately, my husband and I spent the first 10 years of married life working in different places, protecting weekends for family time. We built resilience and resourcefulness through this process, which continued until my husband pivoted from Breast and Oncoplastic Surgery to general practice. By the time I completed my specialty training, we had found a work-life balance that enabled us to set strong foundations for our marriage and our children in their formative years. As a newly specialised chemical pathologist, there were no consultant posts available locally. Rather than relocate, I took up an honorary consultant post which allowed me to continuously improve my professional skills and be a present wife and mother (including taking up a role as a primary school governor at my child?s school). I worked in various hospitals within a 45 miles driving distance until a post came up at the University Hospital Birmingham. I worked there until my retirement from clinical practice last year. Nowadays, I commit my full time to HHN.

Your career spans 30 years as a medical doctor across the UK and Nigeria. What are you bringing home to improve Nigeria?s healthcare system?

Although I have only worked in Nigeria and the UK as a clinician, in the last 30 years I have been fortunate enough to experience multiple healthcare systems beyond these geographies and beyond my role as a clinician, gaining insights into how patients, policymakers, entrepreneurs, community leaders and clinicians interact with healthcare as a system and as a service. I have learned that each healthcare system has its own unique challenges, and that no system is perfect. This makes it more important for patients, their families and communities to build their voice and agency to ensure the system they interact with, adequately supports them when they need it most. In terms of Nigeria, specifically, I grew up in a time where access to quality healthcare within the country was unproblematic. Having witnessed the breaking of the system, I have some idea of what it takes to reverse some of the damage and feel an increased sense of responsibility to be a part of the solution rather than exacerbating the problem. What further strengthens this sense of responsibility is that many foreigners nowadays have dubbed Nigeria as the African country that is ?too hard? to penetrate and operate in. They therefore seek alternative opportunities in Rwanda, Kenya, South Africa and the like. I feel like if Nigerians like us do not invest in rebuilding a Nigeria that once served them, no one else will. The agency point is also important in the Nigerian context and especially for medical tourists who are often taken advantage of in their most vulnerable moments. Nowadays, third parties, whether individuals or companies, are often used to support Nigerians in navigating the healthcare system at home as is the case with many other sectors. The secondary effect of this is that when Nigerians travel abroad to access healthcare, they do not have first-hand experience of navigating their healthcare system, let alone an unfamiliar one abroad.

How is Horizon Health Network (HHN) different from other healthcare facilitation services?

HHN was established to formalise, streamline and bolster a healthcare facilitation service that we had been providing to friends, family and acquaintances over the course of a few decades. Generally, Nigeria?s healthcare infrastructure has weakened with time and more Nigerians have been forced to seek medical care abroad as a last resort. Part of the work we do is designed to strengthen Nigeria?s healthcare system so that our people have access to quality healthcare at home as well as abroad, introducing a higher degree of choice as to where and how they access healthcare services.

We differ from other healthcare facilitation services in that we give our patients direct access to HHN?s in-house clinicians for expert guidance, options appraisals and support in navigating unfamiliar healthcare systems. Our wraparound service is also unique and is designed to ensure the patients? needs are appropriately addressed. Together with the fact that we pre-vet our network of healthcare providers, these features prevent our patients from having to shop around before they find a health provider that can fully address their needs.

But how does this facilitation service help in improving healthcare system in Nigeria?

Education and mentorship are baked into our facilitation service, raising the standards and expectations of healthcare, whilst increasing the agency of patients with regards to their health. Our services reward actors in the healthcare space who put quality patient-centred care at the forefront of their practice, and forge collaborations between stakeholders to drive systems change. The continuity of care aspect of our offering in particular works to support patients and exceptional Nigerian healthcare providers in the long term.

Having spent decades abroad, what do you miss most about Nigeria, and what excites you about working more closely with the country?s healthcare sector again?

I am proud to be Nigerian. Although I have lived in the UK for longer than I lived in Nigeria, most of my family still resides in Nigeria and I visit between one and four times each year. Each visit envelopes me with a sense of belonging and community, reminding me of how much I miss my friends and family. In terms of what I miss about Nigeria that we grew up in, it is a Nigeria that works for all. Some of the characteristics of the Nigeria of old were safety, access to basic amenities, harmonised communities and vibrancy. I hope my generation gets to see the youngsters of today describe Nigeria in such light again, but rather than replicating a Nigeria of the past which also had its challenges influenced by colonial rule, we can preserve the positives that have emerged over time. When it comes to realising such a vision, every Nigerian needs to do their part, starting from where they are with what they have. For myself, the healthcare sector is a sensible starting place, given that it is an industry that I know and understand intimately, having been exposed to most parts of it at various levels, from numerous stakeholder perspectives and across different countries. I am excited to build and revive relationships across diverse contexts and backgrounds, facilitating continuous two-way knowledge transfer. I am also pleased to see such excitement in our stakeholders who have validated the value we deliver.

What advice do you have for young Nigerian doctors and healthcare entrepreneurs looking to make an impact in the industry?

I?ll mention three and each is likely to sound familiar as they are titbits I have held onto since childhood.

The first is to be curious in the widest sense. Whether you travel or not, expose yourself to diverse contexts and stories. Read widely and sign up for opportunities both within the healthcare sector and beyond. There?s a lot of interconnectedness nowadays and creative solutions often arise at intersections.

The second is to seek out and build with others. Surround yourself with people who exemplify characteristics, knowledge or exposure you are in awe of. Build and nurture a network of inspiring individuals of diverse backgrounds, local and international. If you are not sure where to start, take some risks and apply to participate actively in events, internships, societies and the like.

Finally, cultivate high standards, discipline and a sense of accountability. Have a clear vision for personal, professional and systems development. By this, I mean you should have a clear understanding of where you want things to be directionally without marrying yourself to a specific course of action. Just be obsessed with a problem and open-minded and resilient enough to trial and test several solutions.

How do you spend your leisure time?

Time spent with my family remains my favourite thing to do. I also invest a lot of time in my education. In the last few years, my educational focus has been developing my knowledge and application of the Islamic sciences. In my Quran studies, I am now learning the Arabic language, I?ve progressed to an advanced level of recitation and am currently on the third of ten styles of reading.

Generally, I have a passion for adding value to people, places, communities and systems. So much of my leisure time is spent seeking out, embracing and immersing myself in opportunities to participate in community activities both in the UK and abroad. I love convening people and cooking for them, listening to the stories that shape them and being a small part of their individual and collective journeys. Sometimes I spend my time in a more structured way and have both founded and participate as a member of various impact-driven associations. I also have initiated several charitable projects to support access to quality health, housing and education particularly in rural parts of Nigeria.

How would you describe your career growth? Would you say you have found fulfillment?

Although unconventional, my career path has been fulfilling in many ways. I was able to do something I enjoyed whilst making a positive difference and investing in my personal growth. I was also able to balance this with presence in my family life, community involvement and education, all of which are important to me.

Any regrets?

No, I don?t regret. Each challenge I have faced has presented an opportunity for me to explore a new direction and learn something new. The most enriching experiences I have encountered in life have been in light of challenging situations. (Sunday Tribune, excluding headline)

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