PROFESSOR PAUL OMO-DARE – A PIONEER AND SCHOLAR OLU OSINOWO
Professor Paul Omo-Dare was one of the first few Nigerian surgeons to practise Paediatric Surgery as a specialty in Nigeria in the decades spanning the sixties and the eighties. It was he, along with a few other colleagues that have to take credit for the development of the specialty in this part of the world. His interests went beyond his specialty and he was also a foremost art historian and a proponent of the incorporation of Yoruba Medicine into orthodox allopathic Medicine. He adduced incontrovertible evidence (from the Ifa literary corpus) and Yoruba stone and terra-cota carvings of antiquity to prove that the Yorubas had the sound scientific knowledge of the genetic basis of keloid formation. In some studies on keloids, he went on to show scientifically the dominant recessive nature of the genetic predisposition to keloid formation. Professor Omo-Dare was so fascinated by Yoruba literary and sculptural expressions that he used photographs of the Esie soapstone carvings of the Igbomina people of Kwara State of Nigeria as cover pieces in the West African Journal of Surgery which he founded and edited. In Yoruba art and oral traditions, he was able to find a common thread uniting both with orthodox medicine in a unique way that brought to the fore the fact that Africans of old had scientific insight which had stood the test of time, and is still relevant, even today.
Key words: Keloids; Paul Omo-Dare; Yoruba medicine; Ifa literary corpus.
INTRODUCTIONThis tribute to the late Professor Paul Omo-Dare is neither intended to be a biography nor is it written to eulogise the man. Principally, this is to highlight his contributions to our understanding of keloid formation amongst the black population of the world and his illuminating work showing that by studying the Ifa Literary Corpus, it was possible to see that even in ancient times, the Yorubas had an accurate insight into the genetic basis of keloid formation1,2.
Professor Paul Omo-DareProfessor Paul Omo-Dare was a graduate in medicine from the University of Birmingham in the United Kingdom (UK). He also trained as a surgeon in the UK where he obtained the Fellowships of the Royal Colleges of Surgeons of England and Edinburgh respectively. In recognition of his latter works, he was awarded the Doctor of Medicine (M.D.) and Master of Surgery (Ch.M.) degrees from his alma mater. In Nigeria, he was elected to the Fellowship of the West African College of Surgeons (FWACS) where he was Fellow #135; he was also elected to the Fellowship of the National Postgraduate Medical College of Nigeria in the Faculty of Surgery (FMCS).
Omo-Dare’s professional career spanned about two decades at the Lagos University Teaching Hospital (LUTH) and the College of Medicine of the University of Lagos, Nigeria where he was also Head of the Department of Surgery and Deputy Provost. In this period, Omo-Dare made contributions in several areas of knowledge. Apart from his contributions to the surgery of the urethra in the paediatric age group, his works have illuminated our understanding of the problem of keloid formation in people of African origin1,2,3,4.
The Problem of Keloids in The Black PopulationThere are several reports in the world literature which show that keloid has a pronounced family clustering and point to the possible existence of a hereditary factor in its genesis5-8. However, the mechanism of inheritance had not been clearly defined and some early workers in this area came to a wrong conclusion that it was inherited in an autosomal dominant character5. The work carried out by Omo-Dare at Igbo-Ora in Western Nigeria in the seventies investigated the family pattern of occurrence of keloid in this rural town with a population of nearly 30,000 people. It aimed at determining the role of inheritance, if any, and the mechanism of its operation in the aetiology of keloids1.
In a previous epidemiological study in this same rural town, 75 of a randomly sampled sub-population of 1,317 were found to have keloids9. For this study, detailed inquiry was made into the family history of each of the 75 people in so far as they related to the formation of keloid scars after injury. In order to study the mode of inheritance, pedigree charts were constructed from the data thus obtained. Each member of the pedigree was represented on the chart as a keloid/or a non-keloid former.
Fourteen (18.1%) of the 77 mothers, in the families studied, were found to be keloid formers while eleven (22.5%) of the 49 offsprings of these keloid formers were also afflicted by the lesion. It was therefore concluded that there was no statistically significant difference in keloid incidence from one generation to another in this group. Observations had shown that environment did not appear to play an important role in the differences in keloid incidences in family pedigrees in which individuals have keloids and those in which predisposition to the lesion was not found in the rural population. As no significant difference was found in the keloid incidence between male and female offspring, it was concluded that the predisposition to its genesis is autosomal in character.
Comparison between observed and expected incidence of keloid in the offsprings of different mating patterns, indicated that the genetic mechanism operating in the formation of this lesion is recessive in character1,2.
Ifa Literary Corpus and the Genetic Basis for the Development Of KeloidsIn his address at the National gallery of Art, Washington, D.C., in January 1970, Dr. Ekpo-Eyo, the Director of the Nigeria Department of Antiquities, challenged the claims and widely held views that the so-called “primitive and developing people” of Africa had made no worthy contributions to the foundation and growth of knowledge10. This conclusion was reached because the researchers examined only the written literature without recourse to oral tradition and the art forms of the literature. It was this conclusion that spurred Omo-Dare to carry out investigations in Western Nigeria on Yoruba myth (oral literature) embodied in the Ifa Literary Corpus2, and on the terra-cotta heads (art literature) excavated from different groves in Ile-Ife, the religious capital of the Yorubas. This study provided the materials for the M.D. Thesis submitted by Omo-Dare to the Birmingham University, UK9.
Omo-Dare’s purpose was to find out the contribution, if any, which the Yoruba people of Western Nigeria had made to the body of world literature on keloid, which affects about 6% of the population9. Omo-Dare interviewed Ifa priests and analysed tape-recorded divinations chanted by these priests. He also studied ancient Yoruba art relative to keloids among the collections of archeological exhibits held in museums in Lagos and Ife. Ifa Literary Corpus, according to Abimbola11, is the most important genre of Yoruba oral literature. In form and in context, it is the richest and most complex literature, embracing broad themes concerning Yoruba thoughts and beliefs. Its cult is the best organized and most venerated among the Yorubas 2. Omo-Dare discovered that two chapters in the Ifa Literary Corpus called Osasee* and Ejiogbe# were found to be of relevance to keloid formation. These showed clearly that the ancient Yorubas knew about keloid and made some very important observations on its character and mode of presentation.
Osasee“The person for whom Osasee is cast
Is warned by Ifa that all the children he would have
Should not have facial marks;
Should he decide to give his children facial marks,
It implies that he does not want children that will please him.
The reason is that
If any of the children survives
His facial mark scars would be raised.
The only remedy is for him to leave his children
Without any facial marks.
Ifa also says that he should perform sacrifices for his children
Because they are going to be rich and important persons.
If he takes all these precautions, his children would survive,
And be comforters to him.
But he is warned not to give his children facial marks
So that the facial marks may not be raised.
This is the path through which Ifa makes his predictions
He said: "The kind-hearted would die
The wicked would die and go to the eternal sanctuary."
By this time next year
May we have a place to go
And eat maize gruel*
This Ifa divination was performed for Jenrola
Offspring of facial-mark artists in the ancient city of Ijumu.
"Could he possibly have children?" he asked.
He was assured that he would have children.
"What should he do?" he asked.
He was told to perform sacrifice with ten pigeons, ten cocks,
And ten "Oke"** full of cowries.
He was told that after performing the sacrifice
He would have children-
But he must not mark the children with facial marks.
He said that he heard what he was told.
When he had a child.
He went and gave it facial marks; for
He was perplexed:
He said that since he was an offspring of facial mark artists
It would not be proper for him not to give his child facial marks.
The child would not look like him.
He therefore gave the child facial marks.
When the child grew up a little,
The facial mark scars started to swell.
He was surprised, because his own facial mark scars were not raised.
In the end he became annoyed and killed the child.
On the second occasion
Because he had performed sacrifice on account of children
He had another child.
He wondered whether that child would be different from
the first one.
He took the child again and gave it facial marks
Thus he again marked another child with facial marks
And as the child grew up
The facial mark scars started to swell up.
He resolved to leave the child to grow up more
He thought that if it grew up
The facial marks would not be swollen any more
But as the child grew up
The facial mark scars remained elevated
The child was not well
The scars continued to grow
He was surprised that the child's facial marks did not look like his,
And he thought the child would become a bad child,
And grow up to be totally different.
He therefore killed it.
After about seven times like that,
He left the seventh one without facial marks.
Before the seventh one reached the age of maturity,
He started to have money
He had plenty of other good things.
Jenrola then called again on his Ifa priests
He said that it is true that he had lost many of his children
And now that one is alive
The only one that stayed
How could he have more?
How could he have more?
How could he have more children?
He started again to perform sacrifices and
His wife's prayers were again answered.
When his wife did have the child
He told his Ifa priests that since he was from a family
of facial-mark artists,
They should help him try their best
To make the child stay alike
He wanted it very much to have facial marks;
But when they marked the child with facial marks
The scars were swollen again.
They were frightened.
They started to perform sacrifices repeatedly.
Then the Ifa Priests changed their position
And went into the forest
Plucked the herbs of Ifa for him
And with it washed down the swollen facial marks.
The scars were still there,
But all the swelling
Turned into water
And dripped down.
It was just like a person with a lesion on the leg
A person with a bad leg,
Whose leg was swollen
But later burst open,
And the water dripped down.
The facial mark scars that remained were not swollen
But were like those on the father's cheeks
Who started to praise his Ifa Priests
While his Ifa priests praised Ifa-
Because that is exactly how Ifa priests employed their good voices
To praise Ifa-saying
"The kind-hearted man would die
The wicked would die and go to eternal sanctuary."
By this time of next year
May we have a place to go
And eat maize gruel.
Ifa divination was performed for Jenrola
Offspring of facial-mark artists in the ancient city of Ijumu
Making of sacrifice brings blessing
Neglect of sacrifice blesses no man
Travellers to Ipo
Travellers to Ofa
Come and find us amongst many children.”2
Omo-Dare posited that it follows that the only reasonable conclusion to draw is that Ife sculptors of the terra-cotta heads have been faithful to their models and that on Figs. 1 and 2 have been represented for posterity, lesions which conform to abnormal scarification marks of a keloidal type whereas, Fig. 3 shows no keloid.
On the evidence from these two neglected areas of literature, oral and art, there is an indication that the Yorubas had not only recorded their awareness of keloidal lesions, but had also described some of its now well known characteristics about ten centuries before its reputed first description in the literature by Alibert12 in 1816, ten centuries later.
Integration of Yoruba Medicine into Orthodox Medicine
With evidence adduced that Yoruba medicine had a body of accurate knowledge that could be of benefit to modern medicine, Omo-Dare now took the bold step of concluding that there was a case for integrating Yoruba and modern medicine13. This proposal generated a lot of debate and some researchers typified by Taye14 felt that Yoruba medicine was capable of standing on its own and thus argued against integration. Oyelakin Taye14, a philosopher from the Obafemi Awolowo University, Ile-Ife argued that given that meaningful development precedes integration, Yoruba traditional medicine could be developed on its own, its practices objectified and its services offered to humanity on its own independent of orthodox Western medicine. Taye14 argued that in order to preserve our cultural heritage, integration was <,/b>ot ideal.
Esie Stone Carvings of the Igbominas
Omo-Dare was very committed to the visual arts. During one of the meetings of the Nigeria Medical Association in Ilorin, he found time to travel to nearby Esie town to see the Esie stone carvings. So impressed was Omo-Dare that he put some of the pictures of the stone carvings on the covers of the West African Journal of Surgery that he edited. It was at his urging that I got interested in these soapstone carvings. This group of soapstone statues found near the village of Esie in Northern-Central Nigeria is one of the largest collections of prehistoric sculpture found in sub-Saharan Africa. The statues were found at Esie by people of the Igbomina sub-grouping of the Yoruba ethnic group when they settled in the Esie area some 300 years ago15. The origin of the statues remains unknown. Several areas of soapstone in the Nigerian Schist Belt are considered as potential source areas for the Esie statues. Mineral assemblages, textures, and compositions of talc, cummingtonite, and chlorite from some of the statues suggest a source for the statue soapstone from the Agbonda area, the closest proposed source area to Esie. However, mineralogic data from one of the statues are unlike any of the proposed source areas. Various studies of Stevens, Hambolu and Onabajo provide strong evidence that the soapstone statues were carved from local ultramafic rocks from Esie area15.
Omo-Dare and the Development of Paediatric Surgery in Nigeria
Nigeria is a vast country with a land mass of 923,768 sq kilometers, 4% of Africa's total land mass. It is the most populous country in Africa and has a population of 146,000,000 people (2006 census)16. One in every five African is a Nigerian and 45% of the population, approximately 66 million people, is below the age of 15 years. The beginning of paediatric surgery as a specialty in Nigeria, as indeed the whole of Africa, is hazy. According to Nmadu17, however, Prof. Paul Omo-Dare of Lagos University Teaching Hospital (LUTH) Prof. M.A. Bankole Obafemi Awolowo University Teaching Hospital (OAUTH) and Prof. Festus Nwako University of Nigeria Teaching Hospital (UNTH) were well-known as pioneer paediatric surgeons during the late sixties and early seventies. The non-Nigerian in their midst was Prof. J.H. Lawrie of Ahmadu Bello University Teaching Hospital (ABUTH). They all belonged to the Silent Generation, a cohort born between the years 1923 and 1942. Nmadu 17 at the 7th Association of Paediatric Surgeons of Nigeria (APSON) Annual Guest Lecture in Jos, Nigeria on 18th November, 2008 saluted these men for their great vision, doggedness and perseverance for their desire to practice the only specialty in surgery. They indeed worked “silently" but steadily and tirelessly. They set the stage, planned the plan and worked the plan to lead us to the present17. Genitourinary anomalies, undescended testis, ambiguous genitalia, bladder extrophy, hydronephrosis and posterior urethral valves featured prominently in paediatric surgical practice in most parts of Nigeria17. Genitourinary anomalies were second only to hernia as surgical conditions. In the management of genitourinary anomalies in the paediatric age group, Omo-Dare played his role going on to develop and evaluate a new method of urethroplasty and evaluated the posterior urethral diverticulum in the male in his publication in the British Journal of Paediatrics in 19683,4. By 2008, Nigeria had 53 paediatric surgeons serving a population of 66 million children and adolescents17. This comes to one paediatric surgeon for 2.7 million children. The British Association of Paediatric Surgeons(BAPS) recommends at least five specialist surgeons and one urologist in a specialist centre serving a population of 2.5 million. According to Nmadu17 using the British Association of Paediatric Surgeons’ criteria, present day Nigeria would need 1,584 paediatric surgeons and urologists. This is 30-fold what is on ground at present. At the current rate of certification of four paediatric surgeons annually, we may take another 28 years to achieve this, even without making any allowances for population growth, which at 3% would correspondingly be exponential. Despite the above, we still need to celebrate those pioneers of paediatric surgery in Nigeria of which Omo-Dare was one.
In this discourse, I have tried to present the late Professor Paul Omo-Dare through his works which he has left for posterity. Not only was he a pioneer paediatric surgeon in Nigeria, teacher and examiner, he also was in the forefront of dispelling the myth that Africans have contributed nothing to scientific knowledge. He showed through the examination of Yoruba oral and art literature that on the issue of keloids, the Yorubas had an exact scientific knowledge of the nature of the condition ten centuries before it was first described in western medical literature. It is only proper that we celebrate the man, his erudition and his studies that proved the prowess and the scientific contributions of the African people to world scientific knowledge.
- Omo-Dare P. Genetic studies on keloid. J Natl Med Assoc. 1975 Nov;67(6):428-32.
- O mo-Dare P. Yoruba contributions to the literature on keloids. J Natl Med Assoc. 1973; 65(5):367-72.
- Omo-Dare P. Reconstruction of the urethra for stricture: description and evaluation of a technique. J Urol. 1970; 103(1):69-74.
- Omo-Dare P. Posterior urethral diverticulum in the male. Br J Urol. 1968; 40(4):445- 50.
- Bloom, D. Hereditary of keloids. New York State Med. Jour., 56: 511, 1956.
- Geogerot, H. and F. Lamy, A propos d'une syphillise sur cheloide. Ann. Mal. Veneriennes, 9:363, 1908.
- Jacobson, F. The treatment of keloids at Radumhemmet 1921-1941. Acta. Radiol.,(Stockh), 29: 251, 1945.
- Schramex, M. Cited by Bloom, D. (1956): New York State Med. Jour., 56: 511, 1956.
- Omo-Dare, P. MD Thesis, Univ. of Birmingham, Birmingham, Eng. 1972.
- Ekpo-Eyo, E. Address at the National Gallery of Art, Washington, D.C. Topic Magazine 50:12, 1970.
- Abimbola, W. An Exposition of Ifa Literary Corpus. Ph.D. Thesis, University of Lagos, 1969.
- J. L. M. Alibert: Note sur la kéloide. Journal universel des sciences médicales, Paris, 1816, 2: 207-216.
- Daily Times, July 14, 1986.
- Taye O R. Yoruba traditional medicine and the challenge of integration. J Pan Afr Studies. 2009: 3(3): 73-90.
- Adeboye http:/boyexstonecarve.blogspot.com/.2008/12/stone-carvings.html. Accessed on 09 April, 2011.
- National and State Provisional Totals 2006 census. The Federal Republic of Nigeria 2006 Population Census Nigeria. Official Gazatte (FGP 71/52007/2500(OL24).
- Nmadu PT. Paediatric surgery in Nigeria: Past, present and future Afr J Paediatr Surg 2009; 6:137-42.
Fig 1. Terra-cotta head with keloidal scars. It was found by Frobenius in the Olokun grove, Ife, Nigeria in 1910.
Fig 2. Terra-cotta head with a cap and heavy facial scarifications (keloidal scars), excavated from the Grove of Iwinrin, Ife, Nigeria by Frobenius.
Fig 3.Terra-cotta heads showing facial scars which, in contrast to those in Figures 1 and 2, are represented by groove lines running down the face.