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Lynn Schuchter, MD, program leader for Penn's Melanoma Research Program says 2011 was the “year of melanoma,” one in which two important new agents were approved by the FDA (the first in over 40 years). It was in 2011, cancer research for melanoma began to make a significant difference for patients with advanced forms of melanoma.

2012 is emerging as a year in which researchers and clinicians are taking these new clinical approaches to the next level.

The two key areas are therapies targeted to specific genetic mutations and immunotherapy.

Dr. Schuchter and other melanoma experts at Penn believe we are only beginning to understand enough about how melanoma cells grow and spread to develop effective new treatments based.

Dr. Schuchter opened this year’s Focus On Melanoma Conference with an update on melanoma treatments and advances in melanoma research. Last year, the introduction of the drug vemuranefenib was the first big piece of news. Vemuranefenib works by inhibiting BRAF gene activity in the approximately 50% of melanoma patients who in whom this gene is "broken." The drug is powerful, producing often dramatic responses in patients with advanced melanoma, but it almost always stops working after a period of six to 18 months. This phenomenon --in which patients respond well to a drug for a period of time only to see the cancer come back or start growing again--is called resistance, and is one of the most perplexing barriers to developing effective, lasting cancer treatments.

Cancer researchers are beginning to understand the amazingly complex mechanisms by which cancer cells become resistant.

In the case of BRAF inhibitors, this occurs when the melanoma cells in essence take a detour--an alternate pathway that allows them to avoid the STOP growing and dividing sign they encounter when BRAF activity is inhibited. The goal now is to combine the original drug, vemuranefenib, with other targeted agents that block these alternative pathways. A major clinical trial in which vemuranefenib is used with a drug known as a MEK inhibitor is showing very promising results, and will be featured at the 2012 meeting of the American Society of Clinical Oncology (ASCO). This is one of what will be many clinical trials aimed at overcoming the problem of resistance with targeted therapies in malignant melanoma. A surprising, but welcome finding in this trial, is that the combined therapy is not only superior to vemuranefenib alone but the incidence of side effects, especially those related to skin problems, is significantly reduced.

Immunotherapy is the other very promising area in treating melanoma. Researchers have known for a long time that the immune system is active in trying to seek out and destroy melanoma cells—while on the other hand the melanoma cells are effective in hiding from the immune system. New therapies are focused on making melanoma cells more visible and increasing the level of immune activity. Last year's new agent in the immunotherapy arena is known as ipilumubab (ipi). The drug works very well for some patients, often resulting in delayed responses, meaning that in the first several weeks of therapy, the melanoma will actually grow--but then begin to regress and sometimes disappear completely. Ipi also stimulates an auto-immune response that can cause a wide range of side effects, ranging from colitis to endocrine problems to inflammations of the skin and liver.

The current goal for ipi is to understand in advance which patients should receive this drug and when. Right now, ipi is only approved for late stage melanoma patients and for a limited course of therapy. For melanoma patients at high risk of recurrence, researchers are very interested in finding out whether this drug can be effective as additional therapy once primary cancer treatment is completed (know as adjuvant therapy) -- or whether it can be used as maintenance therapy. A big question is whether ipi can be successfully combined with BRAF inhibitors— Currently they are given sequentially.

New insight in the ways in which the immune system interacts with melanoma cells is also opening the door to developing new agents and approaches to immunotherapy. PD-1 is an antibody similar to ipi which has been shown to be very active in early trials--without the autoimmune response. Another technique that is being successfully used to treat leukemias is now on the cusp of being used for melanomas as well. This involves extracting t-cells from the patient, "supercharging" them in the lab and then injecting them back into the patient--another example of an emerging new therapy that is both highly tailored and personalized.

As Dr. Schuchter said in concluding her remarks, "These are not conversations we were having nine years ago when we first started this conference. We have a lot more to do, but these are exciting times."

Watch all of the presentations from the 2012 Focus On Melanoma Conference here. 

Learn more about treatment for melanoma at Penn in Philadelphia.

Christine Wilson, cancer survivor, shares her experiences from the Abramson Cancer Center’s 2012 Focus On Melanoma Conference In this blog, she recaps the conference. You can view the conference in its entirety, including presentations here.

We all know that our skin undergoes changes as we age, but does the aging process affect the environment in which melanomas live and grow?

According to research underway at The Wistar Institute, the answer is yes.

Ashani Weeraratna, MD, work focuses on the role of a specific enzyme known as Klotho which functions as a kind of anti-aging molecule. When we are young, we have lots of Klotho, but by the time we reach our 40s, it has almost disappeared from our systems.

Researchers have also found that Klotho is expressed in primary melanomas, but rarely, or in very small amounts in metastatic melanomas.

The presence of Klotho appears to inhibit metastases, while its absence, promotes them in malignant melanomas.

The goal of Dr. Weeraratna's research is to determine if putting Klotho back into a patient's body will help inhibit metastases--with the ultimate hope that this could be developed as a preventive measure.

Watch all of the presentations from the 2012 Focus On Melanoma Conference here. 

Learn more about treatment for melanoma at Penn in Philadelphia.

As  part of efforts to make qualitative healthcare affordable and accessible to inhabitants of Ondo State, the state government under the leadership of Governor Olusegun Mimiko plans to inaugurate a N6 billion modern Medical Village along Laje Road, Ondo West Local Council.

The Medical Village, which comprises of a 100-bed Mother and Child Hospital, Gani Fawehinmi Diagnostic Centre, Trauma Centre; General Hospital, Call Centre, Emergency Medical Services (EMS) Hospital, Heliport, staff quarters, staff school, shopping mall, and sports centre, is set to be opened to the public before month end.



The diagnostic centre with state-of-the-art medical equipment such as Magnetic Resonance Imaging (MRI), CT Scan, mammogram, auto analyzer, among others, and named after the late human rights activist and lawyer, Gani Fawehinmi, has been functional since February 2011.

Commissioner of Health, Dr. Dayo Adeyanju, at a recent media tour of health facilities in the state said Mimiko was motivated to set up the Medical Village because of the success the state recorded with the Abiye safe motherhood project in reducing maternal mortality ratio by 15 per cent in one year, between 2009 and 2010.

Adeyanju told reporters that the state is poised to set the pace in achieving the Millennium Development Goals (MDGs) 4 and 5 by reducing child and maternal mortality in the state by 67 per cent and 75 per cent by 2015.

The World Bank had in 2008 before the advent of Mimiko’s administration declared Ondo State as having the worst maternal and child health indices in the South West zone.

Adeyanju said the Abiye safe motherhood project, partly sponsored by the World Bank was launched in October 2009 and piloted in Ifedore Local Council with a mandate to develop sustainable, equity-based healthcare services that will provide universal access to the people.

The Health Commissioner said the Abiye project was a bold paradigm shift from what obtained previously because it sought to bring qualitative and effective services to people where they live, work and play.

He said healthcare service in Ondo State especially at the Mother and Child Hospitals under the Abiye safe motherhood programme is free for pregnant women, children under five, and elders above 70 years.


Adeyanju said: “The entire Medical Village costs a whole lot. The trauma centre alone is almost N4 billion. The Mother and Child is close to N700 million. Then Gani Fawehinmi Diagnostic Centre is another N700 million…For us in Ondo State this year, our budgetary provision for health is N8.9 billion. When you look at that against the total budget, we have not even achieved the World Health Organisation (WHO) recommendation of 15 per cent for health budget, which explains the reason why there is a lot out-of-pocket expenditure for health. That means if you and I fall sick, we will still have to pay from our pocket because government provision is not adequate.”

Medical Director of the Mother and Child Hospital, Akure (MCHA), Dr. Lawal Oyeneyin, said a baseline survey before the Abiye project was instituted showed among other things that only about 16 per cent of pregnant women who register at the public health facilities come back to deliver there.

To address the anomaly, Oyeneyin said the state started voluntary registration of all pregnant women in the locality.

He said the MCHA was set up as part of the strategies of the Abiye safe motherhood project to address the phases of delay contributing to maternal and child deaths in Ondo State and factors militating against achieving the MDGs 4 and 5.

The medical director said the MCHA was commissioned to mark the first year anniversary of the Mimiko administration on February 27, 2010 as the premier purpose-built state-of-the-art, 100-bed facility dedicated to the care of pregnant women and children less than five years of age, offering free tertiary level health services.

He said that having recognised the four phases of delay predisposing to maternal and child death, strategies were then instituted against each one.

The medical director said the delay in seeking qualitative care when complications arise was addressed by assigning each of the 50 health rangers that trained community health extension workers to track at least 25 registered pregnant women till delivery even if it meant visiting them in their homes. He said to facilitate communication, individual mobile phones on a toll free caller-user group platform were provided for the pregnant women and their care-givers.

Oyeneyin said the delay in reaching care when decisions are taken to seek care was addressed by equipping each ranger and health facility with means of vehicular movement and evacuation of patients ranging from customized motorcycles to tricycle and four-wheel ambulances and speedboat ambulances for riverine areas.

To overcome the delay in receiving care on arrival at a health facility, the medical director said 11 new health facilities were constructed and five existing ones were renovated; and all were optimally equipped and appropriately manned with healthcare professionals trained on safe delivery practices.

The delay in referring care from where it is initiated to where it can be continued or completed, according to Oyeneyin, was tackled by putting in place a functional two-way referral system with the construction of an apex tertiary care facility, the MCHA, to be able to attend complicated cases referred from the basic and comprehensive health centres as well as from the general hospitals, free of charge.

The Health Commissioner further stated: “Why we are investing hugely in the Medical Village is because in one year of operation of the Abiye and Mother and Child Hospital, we succeeded in reducing maternal mortality (MM) by 15 per cent between 2009 and 2010.

“So if you reduce by 15 per cent in one year that means by 2015 when we will be reviewing the MDGs, we must have reduced MM by 75 per cent. I might sound boastful but let me be modest: We will achieve the MDGs in Ondo State. It is unfortunate that they said Nigeria is among 40 countries that will not achieve MDGs. But we will be the saving grace for Nigeria because when we achieve MDGs, Nigeria has achieved MDG as far as we are concerned.

“In one year we registered 1,217 pregnant women and we have additional 2,600 registrations. Within this period, one patient died. The patient did not register with us but came in during labour. But we considered that as part of our statistics because mandatorily in Ondo State, there is what we call confidential enquiry into maternal death. You must report all cases of maternal death because it will enable us to track the number, and two, for better planning and policy formulation.”

Adeyanju further explained: “When the governor assumed office, he met ill-motivated workforce, poor infrastructure, poorly managed health sector; generally, very poor health indices. You will understand from the perspective here that Mimiko, being a medical doctor, had been a two-time commissioner for health in Ondo State, as a result, it is expected that he will do everything possible to revamp the health sector.

“So, he made a promise that he will provide exceptionally qualitative health care for the good people of Ondo State where they live, where they work and where they play…For maternal mortality and under-five mortality, they form the vulnerable group.

“Our investment in this category of people is deliberate, which is basically to improve the human development index.

“In Ondo State we know that there is usually the rural/urban disparity in terms of maternal mortality and under-five mortality. Sometimes the disease burden is in the rural area but the facilities are usually located at the urban centres, which informed the fact that when we wanted to reform our healthcare we took off from the Primary Health Care (PHC) angle.

“Besides the fact that the governor himself is a grass root man, he understands quite clearly that we must go to the rural area, which was why we launched the Abiye Safe Motherhood programme. Abiye literarily means safe motherhood, making pregnancy safe. It is a Yoruba word that says when you go in, you come back safely, when you are pregnant you deliver safely. But beyond that, Abiye is a wish, it is prayer in the sense that we must reverse the totally unacceptable but ever increasing maternal mortality.

Source:ngrguardian

Bill Barbour, 63, of New York, is an avid cyclist who was diagnosed with prostate cancer in May, 2011. Always active, he wasn’t ready to let treatment for prostate cancer slow down his life, or his participation in his favorite activity, cycling. Bill chose to have proton therapy for prostate cancer at Penn in February, 2012, and today he is cancer-free, and looking forward to riding with the Abramson Cancer Center cycling team in the Philadelphia LIVESTRONG challenge this August.

Watch Bill tell his story about before and after cancer treatment.

I was diagnosed with prostate cancer in May, 2011. Last fall when my doctor recommended I start to consider treatment options for my prostate cancer, I immediately thought about the effects that the popular treatments for prostate cancer may have on my cycling. Cycling plays a significant role in my life, so I sought the advice from a fellow avid cyclist who had undergone treatment for prostate cancer. He related that he wasn’t able to ride for an extended period after his treatment.

My thoughts turned to the negative impact that such a layoff from cycling would have on my physical conditioning. It takes top physical conditioning to ride the distances needed for my frequent group rides and for my daily commute to work. I wanted a treatment option for prostate cancer that would minimize any reduction of my cycling activity, and I began researching various treatments for prostate cancer.

I quickly learned about proton therapy for prostate cancer from the excellent book called You Can Beat Prostate Cancer by Robert Marckini. After reading it, and doing some more research on my own, I felt that proton therapy, was not only as an effective treatment for my prostate cancer, but it was also a treatment that would allow me to maintain my active lifestyle.

Proton treatment at the Roberts Proton Therapy Center within the Perelman Center for Advanced Medicine in Philadelphia could not have worked out any better for me.

Through Hosts for Hospitals, I found a gracious family that opened their home in Philadelphia for me during my 8 weeks of proton therapy treatments. I acquired a bike and I was able to ride from my host’s home to my proton therapy sessions at the Roberts Proton Therapy Center in Philadelphia. Thanks to laptop computers and the internet, I was even able to bring my work with me, and never missed a beat.

Not only did proton therapy allow me to avoid a lengthy post-surgery layoff from cycling, I was able to regularly include cycling, something so important to me and my lifestyle, in my routine while undergoing my treatment.

During each ride I realized how fortunate I was to have gone from the prospect of not being able to sit on a bike seat to having the best seat in the house. I rode the scenic Schuykill River Trail, and I never tired of the great views of center city from the South Street Bridge.

Every pedal stroke reminded me that we are truly living in the age of advanced medicine and how important it is for those facing a potentially lifestyle altering treatment decision to consider proton therapy for prostate cancer.

Diagnosed with prostate cancer?

Have you or a loved one been diagnosed with prostate cancer?

Penn Medicine is one of only 10 centers in the United States to offer proton therapy.

Proton therapy treats prostate cancer with external beam radiotherapy in which protons are directed at a tumor. The radiation dose that is given through proton therapy is very precise, and limits the exposure of radiation to normal tissues. This reduced exposure leads to the possibility of decreased toxicity, side effects and complications for patients.

Learn more about proton therapy for prostate cancer in Philadelphia, and how proton therapy offers potentially less side effects for men with prostate cancer.

The use of currency notes could be one of the major sources of transmittance of diseases. Experts warn of the possibility that currency notes might act as vehicles for the transmission of germs, urging that hand washing and proper handling of notes is imperative for health.
The environment plays a critical role in transmission of germs to humans, serving as vehicles. Disease-causing germs may be transmitted, either directly, through hand-to-hand contact, or indirectly via food or other inanimate objects.

These routes of transmission are of great importance in the health of many populations in developing countries, where the frequency of infection is a general indication of local hygiene and environmental sanitation levels.

Paper currency is widely exchanged for goods and services in countries worldwide. The possibility that currency notes might act as environmental vehicles for the transmission of potential disease-carrying microorganisms was suggested in the 1970s. Paper currency is used for every type of commerce, from buying beverages at a local store to trafficking in sex and drugs. All this trade is in hard currency, with lower - denomination notes receiving the most handling because they are exchanged many times and without any particular consideration of the position of the person in payment.

Paper currency provides a large surface area as a breeding ground for disease-causing germs. Money on which these germs might survive represents an often over looked reservoir for enteric disease. In most parts of the developed world, there is a popular belief that the simultaneous handling of food and money contributes to the incidence of food - related public health incidents.

Over the last two decades, the possibility of currency contamination with microorganisms has also been observed among many professional groups, including food handlers. An investigation carried out in 1997 that involved swabbing and culturing from various coins and paper money randomly collected from doctors, laboratory staff and other employees at a New York hospital resulted in the recovery of many disease-causing microorganisms.

This suggested that without hygienic intervention, human occupational activities, especially those involving simultaneous money handling, could introduce the risk of cross – contamination to foods. Failure of food service workers to adequately sanitize hands or use food - handling tools (tongs, spoons, utensils or bakery/serving papers) between the handling of money and the serving of food could put food service patrons at risk.

An aspect of food service that frequently causes comment, is the way a food handler prepares the food, takes money for the purchase, returns change to the customer, and then prepares food for the next customer. Anything that gets on hands can get on money.

With a number of infectious intestinal diseases, a low dose of the infectious agent is capable of causing illness.

Scientific information on the contamination of money by microbial agents is lacking in most developing countries. Although till date, there is no outbreak of food-borne and other illnesses that have been associated with infection from money, the dearth of information on the extent of contamination of currency had contributed to the absence of public health policies or legislation on currency usage, handling, and circulation in countries like Nigeria.

Nonetheless a lot of people lose their lives every year in Nigeria due to the transmittance of diseases by different kind of pathogenic microorganisms. Certainly, the use of currency notes could be one of the major sources of transmittance of such diseases that provides platform for the growth of such pathogenic microorganisms.

Paradoxically, a study on the potential risk of handling Nigerian currency notes identified several microorganisms that are present on Nigerian currency notes.


The bacteria isolated were Streptococcus species, Staphylococcus aureus, Eschericha coli and Bacillus species. The fungi isolated were Aspergilus niger, Aspergilus flavus and Rhizopus species. Most of these isolated micro organisms are pathogenic to man.

Streptococcus specie, although a normal flora of the nose, stomach and skin, is a group of Gram positive bacteria. Many strain of this specie have been implicated in infectious diseases of human, including scarlet fever, sore throat and streptococcal pneumonia. Most of these diseases were leading causes of ill-health and death. Escherichia coli are an inhabitant of human intestines. The organism comes to the environment through faecal contamination. It is known to cause bloody diarrhoea.

Staphylococcus aureus is among the important bacteria that cause disease in humans. It causes various supportive or pus forming diseases such as boils, folliculitis, scalded- skin syndrome. Staphylococcus aureus can produce disease in almost every organ and tissue of the body, especially in people whose body defensive mechanisms have been compromised, such as those in the hospital. It also causes Staphylococcal food poisoning.

In a 2012 study carried out by Uraku, A. J.; Obaji, P. I. and Nworie, all from the Ebonyi State University, Abakaliki, Ebonyi State, entitled: “Potential Risk of Handling Nigerian Currency Notes” and published in the International Journal of Advanced Biological Research, it was revealed that a significant association between bacterial and fungal contamination and the condition of the currency.

Of importance also was the finding that higher rates of microbial contamination were found on the dirty/mutilated notes used by beggars followed by hawkers, market women, bus conductors and lastly bankers.

The researchers wrote:”This finding has very important health and economic implications, especially in underdeveloped and developing tropical nations of the world and particularly in Asia and Africa” because the climatic and environmental conditions of the tropics favour the thriving of many pathogenic microorganisms, and in the face of underdevelopment, inadequate water and sanitation, crowded living conditions, lack of access to health care, and low levels of education, a greater proportion of the populace, particularly the poor, become highly susceptible to infection and disease.

Dr Abiola Okesola, a consultant clinical microbiologist, University College Hospital (UCH), Ibadan, Oyo State, corroborated the increased risk of infection from currency notes due to its frequency of changing hands and handling pattern.

According to her, the hands normally carry a normal flora, which can easily be transferred to the currency notes just as the germs that are present in the environment.

Dr Okesola, who noted that the most prevalent microorganisms on the hand are bacterial in nature, stated that the germs could only cause diseases when they have avenue into the human body.

She stated: “If the person handling the currency notes has injuries on the skin and the skin is broken, then the germs can easily enter into the body. When the person’s immunity level is low, it can cause an infection. But if the immunity is high, the infection can be aborted.”

Nonetheless, Dr Okesola declared that many people do not develop infections as a result of handling currency notes because of their high immunity status. “We only have few cases like conjunctivitis or Apollo occurring when someone touches a contaminated currency note and with the same hand touch his or her eyes.

However, there is  need for personal hygienic practices like washing of hands as ways of reducing contamination from handling currency notes.

According to her, much as people cannot do away with handling currency notes, imbibing the culture of proper hand washing with soap and water before eating or touching any part of the body would help.

She stressed that government should also do more to create awareness on proper handling of currency notes-not crumpling the notes, putting money underneath brassieres or socks as well as write on them.

Source:tribune

Despite recent medical and pharmaceutical advances, over 1500 women still die daily from pregnancy or complications related to childbirth. The statistics are even worse for children, 22,000 of whom die daily before their fifth birthday, 41 per cent occurring during the neonatal period, that is, the first 28 days of life. The bad news for developing countries is that at least 98 per cent of these deaths occur in them. Africa is the worst culprit, with Nigeria leading the way. For years, Nigeria's global ranking in maternal and infantile mortalities has hovered between second and fifth positions.

The reasons are not far-fetched: Far too many pregnant mothers reel in poverty, illiteracy, poor nutrition, and poor sanitation, while governments provide inadequate health care and health education owing to ineffectual leadership, poor governance, and corruption. These factors increase delays in seeking, accessing, reaching, and referring care, which eventually lead to deaths from preventable and treatable conditions.

In 2000, world leaders established Millennium Development Goals 4 and 5 for reducing child and maternal mortality rates to one-third of their 1990 levels and set 2015 as the target. But according to various studies, the slowest improvements have occurred in Africa as a whole and Nigeria in particular. This is confirmed by a recent study, sponsored jointly by the World Health Organisation and the Bill and Melinda Gates Foundation, which pinpoints Nigeria as the second worst case in neonatal deaths. The study concludes that it may take countries like Nigeria some 150 years before they could meet up with newborn survival rates in the USA or the UK!

However, rays of hope are emerging as new health facilities focus on reducing maternal and child mortality rates. In the forefront of such facilities is the Mother and Child Hospital, Akure, which the representatives of the World Bank and the United Nations Children's Fund have described as a model not just for Nigeria but also for Africa and even the world. Although originally conceived as the apex of the now famous Abiye (Safe Motherhood) Programme, it has since taken a life of its own, attracting patients beyond this base and even beyond the state. More importantly, it has reduced maternal and child mortalities much faster, and at rates higher, than comparable facilities in Nigeria and beyond. And it has been able to record these achievements by maximising costs and the utilisation of resources. Today, the MCHA is a tourist attraction, in addition to being a pregnant mother's dream hospital.

To better appreciate MCHA's contributions, a tour of the facility and an appraisal of its operations are necessary. This appraisal is based on four visits to the hospital, the most recent of which were on August 20 and 21, 2011, and on extended interviews of the Chief Medical Director, Dr. Olawale Lawal Oyeneyin, who provided invaluable historical, policy, and statistical data. The appraisal also benefited from several conversations with Ondo State Governor, Dr. Olusegun Mimiko, who created the MCHA as the apex of the Abiye Programme. A World Bank finding, before he assumed office, that Ondo State had the worst maternal and child mortality rates in the South-West made the programme's implementation the more urgent.

Construction work on the MCHA commenced within three months of Mimiko's assumption of office and the hospital opened for business by the end of his first year in office. According to Oyeneyin, "the MCHA is a premier, purpose-built, state-of-the-art, 100-bed facility dedicated to the care of pregnant women and children less than 5 years of age". Its primary objective is to provide qualitative and critical medical interventions to pregnant mothers and babies in order to reduce maternal and child mortalities in the state by 50 and 30 per cent, respectively, by the year 2013.

The MCHA was designed, equipped, and staffed precisely to achieve this objective. The main hospital building is a sprawling, comprehensive, and integrated facility, housing ante-natal, labour, post-natal, neo-natal, and paediatrics wards. In addition, there are an out-patient clinic and a casualty room. Strategically located around these units include an intensive care unit; anaesthesia unit; operating theatre; pharmacy; a blood bank; laboratory; radiology; and a dietetics department. There are also service units, including general administration, accounts, internal audit, stores, transport, tailoring and laundry, and maintenance departments.

The hospital's staff strength has also increased from a handful at the beginning to 250 permanent staff 18 months later. This includes 16 doctors (nine in obstetrics and seven in paediatrics), 95 nurses, 40 health attendants and 50 janitors. According to the CMD, "aside from the janitors, we operate at a staff strength hovering between 50 and 70 per cent of the optimum".

What has been attracting attention to the MCHA is the use to which the facility has been put by this relatively small group of dedicated staff, the outstanding results achieved so far, and the vision and dedication of relevant actors. By September 4, 2011, 12,963 pregnant women and 16,877 children (3,611 as paediatric inpatients) had been registered and treated. 6,952 safe deliveries had been conducted, 1,196 by caesarean section. With an average of 20 deliveries daily, the MCHA is now the busiest maternity centre in Ondo State and one of the busiest in the country. Twenty per cent of patients are non-residents of the state, a testimonial to the hospital's increasing popularity and its safety perception index.

The 47 maternal deaths encountered so far yielded a maternal mortality ratio of about 680 per 100,000 deliveries. This is less than the national average of over 800. Even much less is MCHA's pre-natal mortality rate (that is, losses from about 7 months of pregnancy to the first week of birth) at 66 per 1000 births, about half the national average. Compared to older facilities, such as university teaching hospitals, the MCHA is clearly ahead of the curve in reducing maternal and child mortality rates.

These achievements have drawn universal applause. It is only appropriate to give the last words to some of the hospital's numerous visitors. Shreelata Rao Seshali, Social Development Specialist, The World Bank: "I did not expect to see such an efficient and excellent hospital today, so I thank you for this experience. This is a tribute to political will teamed with professional dedication". Margaret Hempel, Director Ford Foundation Group: "This is an impressive facility that will help women here and around the country". Dr. Ogunbayo, Nigeria Governors' Forum, Abuja: "Highly functional and impressive hospital, clearly well thought out". Moshe Ram, Ambassador of Israel: "The most impressive hospital I've visited in Nigeria". Finally, Professor O. Akinkugbe, Emeritus Professor of Medicine: "This is revolutionary, well thought out, and a glowing testimony to team work. Congratulations".