By Ayo Oke

Dr. Olutoyin Morenike Lawal is a Consultant Physician and Cardiologist at the University of Medical Sciences Teaching Hospital, Akure. Widely recognized for translating specialist cardiovascular expertise into large-scale preventive care, she has led innovative community-based screening initiatives addressing hypertension, chronic kidney disease, and diabetes in underserved populations. In this interview with Ayo Oke, she speaks on the national burden of cardiovascular and metabolic diseases, the challenge of early detection in low-resource settings, and how hospital-based expertise can drive population-level prevention.

How did your clinical and academic training influence your focus on cardiovascular and kidney-related health challenges?

My medical training and subsequent clinical practice exposed me early to the disproportionate burden of cardiovascular disease among patients with chronic kidney disease, hypertension, and diabetes. Working within a tertiary teaching hospital environment allowed me to see how late presentation and delayed diagnosis often determine outcomes, particularly in low-income and rural populations. Over time, this reinforced my interest in bridging specialist cardiology with preventive care and population-level risk detection.

What major gaps did you observe in cardiovascular and metabolic care during your clinical practice?

One of the most significant gaps was that preventive screening for hypertension, chronic kidney disease, and diabetes was largely confined to tertiary hospitals. This created substantial access barriers for rural residents, informal workers, and low-income populations. As a result, many individuals were unaware of their cardiovascular or metabolic risk until they presented with complications such as stroke, heart failure, or advanced kidney disease.

How did your work at the University of Medical Sciences Teaching Hospital address these gaps?

Through my role at the University of Medical Sciences Teaching Hospital, Akure, I designed and implemented structured community-based screening initiatives for hypertension, chronic kidney disease, and diabetes. These programs were deployed outside hospital settings to reach underserved populations who historically had limited contact with preventive services.

Under my coordination, cardiovascular and metabolic screening reached thousands of individuals, making it one of the most extensive clinician-led screening efforts conducted at the sub-national level during that period.

What were the outcomes of these community-based screening initiatives?

Screening outcomes consistently showed that approximately 38–45 percent of participants had previously undiagnosed hypertension, impaired renal function, diabetes, or combined cardiometabolic risk factors. From a public-health perspective, this was highly significant, as it revealed a large, previously unrecognized burden of silent disease within the adult population.

Importantly, individuals identified through the programs were systematically referred into appropriate care pathways, including primary health centres, specialist clinics, and teaching-hospital services, thereby strengthening continuity of care.

Beyond screening, what impact did your clinical role have within the teaching hospital?

As a Consultant Physician and Cardiologist, I served as the principal specialist responsible for the diagnosis and longitudinal management of approximately 2,500–3,000 cardiovascular patients annually. I also delivered and supervised advanced cardiac diagnostic services such as echocardiography, Holter ECG, ambulatory blood-pressure monitoring, carotid Doppler studies, and ankle–brachial index assessments.

These efforts contributed to a documented increase of over 60 percent in diagnostic throughput and helped reduce delays in cardiac evaluation and specialist referral.

Did your work include training and research responsibilities?

Yes. I provided structured supervision and clinical training for more than 40 resident doctors, medical officers, and clinical trainees, strengthening evidence-based decision-making and postgraduate training quality.

In parallel, I conducted original cardio-renal research, including studies on carotid intima-media thickness as a surrogate marker for cardiovascular disease in chronic kidney disease patients. This work contributed to early vascular-risk stratification approaches and has since been cited and applied by researchers in multiple countries.

How do you view the broader public-health implications of your work?

From a broader perspective, reaching over 8,000 individuals with a nearly 40–45 percent detection rate represents intervention at a scale capable of influencing population-level health indicators. Early identification of hypertension, diabetes, and kidney disease reduces long-term complications, lowers healthcare costs, and improves survival outcomes.

By integrating community outreach with structured referral pathways, these initiatives demonstrate how specialist-driven prevention can strengthen health-system capacity and reduce reliance on crisis-driven care.

What lessons can other regions learn from this model?

One key lesson is that specialist expertise does not have to remain confined to tertiary facilities. When clinical rigor is combined with community-based delivery and coordinated referral systems, preventive care can be scaled effectively even in resource-constrained settings. This approach is replicable and adaptable to other regions facing similar non-communicable disease burdens.

Looking ahead, what areas require further attention?

Sustained investment in early detection, health literacy, and integrated care pathways is essential. Cardiovascular and kidney diseases often progress silently, and without proactive intervention, the burden on health systems will continue to grow. Continued collaboration between clinicians, public-health authorities, and policymakers is necessary to maintain and expand these gains.