Sunday, September 23, 2012
By PETER AGBA KALU
The Nobel Laureate Albert Einstein whose famous theory of relativity, E=MC2 (energy equals mass multiplied by the speed of light squared), changed the world science and ushered in an entire new generation of scientific applications was a Germany Jew, who migrated to America. Andrew Grove, Time International 1997 Man of the Year, the in-tech impresario was a Hungarian who migrated to America penniless as a refugee, but he went on to make Intel the Silicon Valley powerhouse whose microprocessors run 90% of the world personal computers at the end of the 20th Century.
We can go on and on to show that most great nations are made great by the combinations of factors among which are the contributions of great minds who immigrated to that nation. Or are you not aware that Steve Jobs’ biological parents immigrated to United States from Syria? Among the inventors that the US-based magazine, Popular Science, published about upcoming Class 2014 young inventors in American universities is 18-year-old Chaimaa Makoudi who invented solar panels supercharged with quantum dots. Her family moved to the United States from Morocco in 2004. Another is 18-year-old Nikita Khlystov who invented a magnetic space sail. He is from Germany. Others are Benjamin Song, a 16-year-old who invented urine test for colon cancer, Daniel Wang, 18, who invented energy harvesting wallpaper, and Nolan Kamitaki, 17, who invented computer simulator for flu outbreaks.
They are all from Asia and they are all schooling in America making enormous contributions to that great nation. So, today, we have the American story in Dr. Shabihul Hassan, an Indian medical practitioner who came to Nigeria in 1972 with his dad when he was just nine. He has resided in this country for 40 years and, today, he is running not only the most modern hospital in the nation, called Dr. Hassan’s Clinic and Diagnostic Centre, Maitama, Abuja, he is about to answer our dream of turning Nigeria into a world destination for medical tourism.
In this first interview ever granted any Nigerian newspaper, he told ASPIRE the many life-saving interventions his organization is making, and their plans to even touch lives in many more ways than one. Excerpts:
Do we now call you a Nigerian?
I consider myself a Nigerian, my friends consider me a Nigerian. I still have an Indian passport. So, Nigeria is home; India is also home for me.
Have you procured the necessary documents?
Well, formally, I am still an Indian citizen. I have an Indian passport; but Nigeria is where I have always been. This is where my friends are. For me, this is where home is.
But you married an Indian?
Yes, I married an Indian who was born in Nigeria. My wife’s parents came to Nigeria in the late 1960s and they left a few years ago. She was born here. In fact, she has only been to India only two or three times, since she was born.
That’s incredible! Then, she too is more of a Nigerian?
What have you been doing here in Nigeria over the years?
I am a medical doctor; so I practice medicine. I have a hospital here in Maitama District, Abuja. It is a 65-bedroom hospital. We have all the medical departments. We have very good doctors from India, Nigeria and many other countries. It is a blend of different nationalities.
Before you opened this hospital, which other things were you doing? You have been in Nigeria for 40 years?
I was working at the Maiduguri Teaching Hospital. I later left the university to set up this hospital in Abuja in 2005.
How long has your father been in Nigeria?
My father has been here for more than 40 years. He completed his 40-year stay in this country in January this year (2012). In fact, it was on the 26th of January, which coincidentally was the Indian Republic Day. The High Commissioner of India gave him an award for his various contributions. He trained many children all over the country.
He trained many students?
He trained many students starting from 1972, when he came to Nigeria, till 2008 when he retired. His students are in many towns and cities, in many ministries and parastatals are here.
What was your father’s profession?
He was a professor in mathematics, he retired in 2008.
In which university?
University of Maiduguri. I came here as a child with my dad. You know when you stay in a place and spend all your childhood and all your days there, it becomes your home. My friends and every body that I know, every body that I care for, every body that cares for me, are all here. I have been travelling to India every year and I have gone to many other countries in the world, but that basic quality of friendliness and tolerance of the Nigerian people, is something that appeals not just to me only but also to many foreigners.
In fact, we, foreigners, at times joke among ourselves because many of us complain that the Nigerian economy is bad, that there is corruption, this and that; but we refuse to go home. Even those who go home come back or want to come back; be it Indians, Bangladeshi, Pakistanis and others, they love Nigeria and would always want to stay or come back to this country. This is because there is something in the Nigerian people. Nigerians are very friendly people. I am not saying this to your face as eye service. No. But the truth is that I love this country. I grew up here. For me, this place is home. I appreciate that personal touch between the Nigerians of all tribes. Foreigners live in this country as if it is their home. There are countries where foreigners are treated as second-class citizens or where people look up to them as being superior. But here in Nigeria, foreigners don’t feel like foreigners because Nigerian people are very down to earth, friendly tolerant. This is a wonderful quality. This is true because I know those who always want to come back. They love this place.
How often do you travel outside?
I travel outside once in a year, but, sometimes, it could be twice in a year. I do keep in touch with my family in India. It is a huge, big, extended family and we talk to them on the phone often. So, we are very much in touch with my people in India. I grew up all my life here, but I have been very much in touch with my family back home. I respect the extended family.
Let me ask you a personal question. Looking at the huge investment in this hospital, which runs into hundreds of millions of Naira, how did you, as a former lecturer, come up with the funds to set up an investment like this?
You don’t do this kind of investment in one day. I started this clinic in 2005. I started with a small clinic in Wuse, Abuja. At a point, it became essential for me to expand the hospital with the assistance of those who assisted me; the banks for instance. It has been a step-by-step process; it is not a one-day affair. Development in business, as in other life situations, is a step-by-step process, and not a one-day process.
Do you think, with people like you in this country, the issue of medical tourism, which makes people to go abroad, especially India, Britain and America, for medical treatment is still necessary?
Hospital tourism or medical tourism started few years ago; and I realized that many of the people, who were traveling out of this country for treatment, go to India. I am also the panel doctor for the Indian High Commission here. So, I was actually involved right from the beginning. When the government of India facilitated the travel of people, by making visa cheaper and easier, especially the new ambassador has been very helpful, in achieving this. He has gone several steps ahead to see that whoever needs to be treated outside the country, that things are facilitated. As the Panel Doctor to the High Commission for many years, I was involved in the process. We have been seeing people, but only those people who would not be able to get the treatment they are looking for within the country would be given special visas to go to India, to get the required treatment and come back.
But all along, my dream has been to build a hospital here so that people don’t have to travel outside this country for medical treatment. This is one of the main reasons for building this hospital here. This is a 65-bed hospital. It is a big hospital. All the necessary facilities are here. In fact, since we started this hospital, there are so many diseases for which
people used to go outside the country for treatment, especially to India, that we are now effectively treating here. People no longer travel outside for such treatments. Such patients are now referred to us to handle. We are doing things step by step here. There are delicate surgeries that we are now doing here, in this hospital.
We have started doing Laser surgery for hemorrhoids, which even is no done in many places in India. It is a very advanced surgery. We do the surgery here; there will be no bleeding, no pain. In two hours after the surgery, you could go home. This type of surgery used to be one of the messiest surgeries, a surgery that patients were afraid to do. People preferred living with hemorrhoids all their lives, just because there is so much bleeding, so much pain. You stay in the hospital for many days; sometimes weeks. But now we do this surgery here in less than 30 minutes, using laser surgery. After the operation, the patient just stays for two or three hours and goes home; no pain, no bleeding. This is an example.
We are setting up our molecular diagnostic laboratory, which probably will be the first of its kind in Nigeria. We will do advanced DNA testing. We brought in a South African company to organize a seminar about three months ago. Many of the diseases for which people travel outside Nigeria for treatment can be well treated within the country. It is just a question of the people having confidence in the system. I grew up here, I know the people in the medical circle here. Nigerian doctors are very good doctors.
They enjoy very good reputation across the world. You will be quite surprised to hear that there are more than 30,000 Nigerian doctors in the United States alone, and these are not doctors doing small clinics. These are doctors in very good positions; proper specialists in various areas of medicine. They are in the Middle East, U.K., U.S.A.; all over the world, holding respected positions. Specialists of various kinds who are products of Nigerian universities.
Within the country also, there are very good doctors today. Sometimes, they may not have access to as many facilities as they would like to have; but that not withstanding, many of the diseases for which people travel outside Nigeria for treatment, can actually be properly treated within the country. It is just that sometimes, some people don’t have confidence in the system as a whole. But for some of them, because they have the money or can afford it, they prefer going abroad for treatment. I thank God that people have a lot of confidence in me. I get patients from all over the country on daily basis. People come from Port Harcourt, Lagos and other places. They will land at the Abuja airport and I will pick them and treat them. For the outpatients, they will fly back with the evening flights. So, when I tell my patients that their sickness could be handled here, that there is no need for them to go outside the country, they usually agree to be treated here. The whole idea is just to make them have confidence in the system here. So, there are practicing doctors on whom people have confidence.
This thing (pessimism against Nigeria’s health care system) will ultimately thin down. It is just a matter of patience and time, but one cannot predict it. It started at a time when the economy went down.
Things were not as good as they used to be as in the good old days of Nigeria. When I was a child, the Nigerian pound was stronger than the British pounds sterling. That was an era when education was almost free here, when health facilities were far better. So, there was a stage that things went down. But then, the potential is there and the confidence will eventually come back. What I am trying to do here is one by one; we are talking on things for which people go abroad for treatment. We are just doing that gradually. We are also in the process of building a bigger hospital. It is going to be a 300-bed hospital.
Here in Abuja.
Have you acquired the land?
Everything is on ground. We are working on it now. We are going to call it India-Nigeria Friendship Hospital. We had discussions about this with our embassy that is the Indian embassy; and with the appropriate authorities in the country. By the time the hospital is ready, Nigerians will not have to go outside the country for treatment, as long as it is something do with medial success.
This has been my dream. I love this country and I grew up here. I know that this country has the potentials. Nigeria has huge potentials to become a hospital tourism destination. In New York, in New Delhi, in London, and in many other countries, you meet Nigerians who are holding good positions in those countries, I want to see the day when patients will come from Cameroun, Congo, Gabon, Tripoli and other African countries to Abuja to look for medical treatment, rather than people going from Nigeria to other countries for treatment.
You made me glad with what you have just said about Nigeria becoming a medical tourism destination. But when will the DNA testing be in full swing here?
We are in the process and we are hoping that within 8-12 weeks we will start. Meanwhile we are training our staff. Some of our laboratory scientists have gone to South Africa for further training. In fact one of our female laboratory scientists will also be in South Africa in the next two to three weeks to contribute to the training of our lab scientist there. The head of our laboratory, Dr. E.C. Okala, who is also the President of the National Association of the Laboratory Scientists, is the most experienced lab. scientist in this country. So, we already have a very advanced laboratory.
We do all kinds of tests here. We also get referral tests from other hospitals and clinics from other places within the country, from other towns. But we are taking these things a step further. By the time, we start doing DNA testing at an advanced level, we will be in a position to be able to detect some diseases, long before they manifest. Yes, diseases, such as diabetes are diseases that could be insidious, that is developing silently until they begin to disturb a patient.
You said some diseases could be handled even before they manifest…
Yes, you can prevent some diseases at their early sages if detected early. Preventive medicine is the future of medicine. We have already started doing trials in our advanced laboratory. The company that is assisting us set up our laboratory has been here and we have been there. So, we are exchanging training visits with them. Apart from the head of our laboratory that knows these things, we want to make sure that some other staff of our laboratory are well trained in these things. We know that when we start there would be a rush, we will start getting requests from around the country.
So we want to be properly positioned to take the load. We will also have requests from scientific institutions within the country, including the advanced centres in Plateau State, the national agencies that will be cooperating with us. We will all be doing these together. We don’t want this to be done as a laboratory in a private hospital. We want the laboratory to be a reference point; where, ultimately, other lab-scientists from other hospitals will be further educated. We want to be able to disseminate medical information. Medicine is not a monopoly of one person. I don’t want this to be a situation where everybody will be praising my hospital alone.
I strongly believe that the quality of education that has been given to Nigerians in this country should be put in the development of the system. It should be put into education. There are people in this country who have big, strong, potentials. People make efforts on their own all over the country. By the time their efforts come together, there certainly will be a big change.
A lot of people in this country, even in Abuja, don’t know that you exist. So I want you to tell me, the various departments you have in your hospital and if possible tell me the type of equipments you are using?
The truth is that with the exception of some very advanced surgeries like open heart surgery, kidney transplant, I will tell you that contrary to what people think, all surgeries are done in Nigeria, not just in my own hospital but also at the National Hospital, Abuja, at the various private hospitals, big ones in the country and at the various teaching hospitals around the country. So, if anybody feels I am doing this alone, no. This is not right. This is being done in other private hospitals in the country. There is a wave of people that do go outside the country, but that does not necessarily mean that the facilities are not available here.
But in Abuja, where our hospital is located within the diplomatic enclave in the city, we try to convince people that many of these medical problems could be handled here. For instance, people have been going abroad for things like fibroid. Fibroid operations are done all over the country. We do a lot of fibroid here. But like I told you, the relationship of patient to hospital is a relationship of confidence. We try to convince people that many of the illnesses for which they go out for treatment could be handled here, and most often, they agree with me and have their treatment here. I can tell you that, we get people from all over the country for fibroid operations now. We are also doing prostate operations here; people who have enlarged prostate, we treat them here. For fibroid, we do so many here.
We treat hemorrhoid with the new laser or infrared techniques and which has become so common. People come from all over the country for it. General surgery, we do them a lot. You know that disease patterns is not any different here than in any part of the world. Of course, there are always a few diseases that are specific to some areas. But we have a good team. A very good, very dedicated good team. From day one, as you walk into this hospital, you must have noticed that it does not look like a hospital.
That is true; even the smell of the place, is unlike a hospital…
Yes, it is unlike a hospital, my office does not look like a consulting room.
From day one, my concept of a hospital is that there should be a personal touch. We have reduced administrative bureaucracy to a minimum. When I started this hospital, I was seeing patients, even before their personal folders, are prepared. Now, the place is too big for me to manage it that way. In fact, even now, if a patient comes in and wants to see me, we don’t compel them to open a folder or file before I see them.
I see them, finish everything; paper work can be done after. Personal touch is very import -ant in a hospital. These are the things that make people to have confidence in a hospital. People walk in here; they don’t feel intimidated. We make them comfortable from the beginning. In this hospital you find people of various nationalities working here.
You personalized the relationship between the doctor and the patient?
So often, the doctors and the patient are on phone…
Not just about health issue alone but also to discuss about other personal matters…
Yes. Exactly. They call us. Sometimes, there are days my phone will receive over 500 calls a day. Sometimes, people complain that I don’t pick their calls; sometimes, it is not possible, but we don’t say no. I have trained all our doctors in such a way that people should go the extra mile. It is not a question of patients just coming to get treatment, pay and go. We train our doctors in such a way that there should be a personal touch. You should receive people with a smile. It is not every disease in the world that is 100% treatable, though all diseases have a cure. But there are diseases you know that, okay you have come to a dead end, but the difference is made when you treat the person kindly. You talk to the person; you explain issues to them. This is another thing that we do; to all our patients we explain the medicines we give to them. We train our pharmacists, our nurses on good human relations.
Our patients don’t go to the pharmacy counter to collect drugs or medicines. From the finance and administrative point of view, it is convenient for everybody to go to collect medicines, but I have not allowed that to happen. Every new manager who comes to the hospital asks me why don’t I change this, I have always told them ‘no’.
The medicine is collected from the pharmacy by a nurse, taken to the patient; then the nurse will now explain to the patient how the drugs will be taken. Before then, I had already explained to the patient the kind of drugs that I prescribed for him and the possible side effects of each medicine. These little things are necessary. Medical practice is about communication between the doctor and the patient. The ultimate healing is in the hands of God.
There are no new medicines that are used all over the world; but the idea is that you know that there is a divine hand in the healing of the individuals. So, if you know that God has a hand in the healing process, you have to do what God expects you to do. First of all, you have to be kind to the patient, you have made a diagnosis, you have to explain to the patients that ‘look, this is the diagnosis.’ If it is a bad one, you have to do it in the best possible way, so that the impact is eased. So, we try to go the extra mile, you know, not just practicing medicine the way it is taught in the medical school.
Accepted that you have praised my country, Nigeria, as a wonderful place, but sincerely, are there problems you are encountering, because the authorities are going to read this? We want to make the environment friendlier for men of ideas like you, to come and contribute in uplifting our nation, Nigeria.
Well, I thank God that I have not met any obstacles from the Nigerian authorities or from the ministry or from any quarters at all. Technically, I have not had any obstacles, but I am aware that in the private sector, people do meet obstacles, and I think that either way we see it; people tend to complain about the government. That the government is not doing this or that. But I believe that all the responsibilities should not be shouldered by the government alone. You just mentioned the example of the United States; their system runs on the shoulders of the private sector. The best hospitals in India are owned by the private sector.
All the Nigerian patients who go to India, they don’t go to government hospitals. They go to fantastic private hospitals built by individual efforts. I think that government should encourage individual efforts. I think that the government should encourage the private health sector here, more than it is doing now. The people I met in government are aware of this. In fact, the authorities here are generally 100% on agreement on this: that the private health sector at the state level, at the federal government level, should be strengthened.
But in strengthening it, it should not only be at the level of the big corporations. This should go down to the grassroots. I am talking about fresh medical graduates. By appointing graduates with an MB, BS degree, for example. The fresh graduate does his housemanship, does a bit of practical training for extra 1 to 2 years here. He may then decide to open a hospital in his hometown or village or anywhere.
This is where government should give him financial support. He does not have the collateral to collect money from the bank to buy land or build his hospital. He is a professional; if he builds a hospital in his hometown, he will make money and at the same time help the society. He will do what people expect the government to do. So, such medical graduates should be helped at whatever level, starting from the bottom. When that is done, that is when you will see the health private sector very strong.
My hospital is located in the heart of Maitama. Now this hospital alone cannot serve every body. There are other very good hospitals in Abuja, in Lagos, in other big cities. But if you want the health sector to be really good, there should be good private hospitals, right down to the district and village levels. There are many doctors who would like to do this. Doctors who are from those villages and towns. But you see the struggle for too long. They spend many years before they are able to set up a hospital. By the time they have funds, they don’t want to go back to their villages again. They are already settled somewhere, in another town. These doctors can be given soft loans so that they could acquire a building or land in their own hometowns or in their own villages to set up their private hospitals.
They should be given incentives that will make them settle in rural areas, in fact to the extent that they wouldn’t want to go to any other place. There could be special incentives for such doctors. This will strengthen the private health sector, right at the grassroots. I think there are many more things that can be done, but ultimately, I believe that the future of medicine in this country lies with the private sector. It should be regulated so that there will be no malpractice, but it should be regulated with understanding. Not to regulate to the extent that the individual will get frustrated. Professionals should be encouraged
Could you suggest ideas, on how the health sector could be moved to the next level? I understand that getting loans by doctors is not easy in this country.
I think the system of getting loans is not any different from other countries. I can tell you something; I am closely in touch with the members of the Nigerian Medical Association, the Medical Council. Some of them are my classmates, my friends, you know – they are doing their best. You know, the public see these people from a distance, as if they are not doing anything.
They are doing and making a lot of impact. But, believe me, the future of the health sector of this country is in the hands of individuals. In India, our health sector peaked, it was not the government that did it, it was individuals who did it. As long as the authorities are not creating the enabling environment, the health sector will find it difficult to grow. The government should make the procurement of loans, by the medical professionals easy.
The Nigerian Medical Association is doing a lot. These are educated people; they know what the problems are, as far as the health sector is concerned. The association is governed by very educated, very young, very dedicated people. The same is applicable to the medical council. There is a limit to what the government can do. It was different in the 1970s when the government was dong everything. But things have changed now that the government is down. It is the individuals that, ultimately, will take the health sector forward.
How many doctors do you have in your hospital, what is your workforce?
We have visiting consultants; we have other doctors who work full time. All in all we have over 150 people working in this hospital.
Sunday, September 16, 2012
NB: This reflection is for general readership, but will have particular significance for Christians
“Get behind me, Satan.” (Mark 8:33)
Wouldn’t you hate to hear Jesus say these words to you? You can just imagine the look on Peter’s face when Jesus rebuked him. He must have gone from a beaming smile to a forlorn frown in a matter of seconds.
Did Peter love Jesus when he said: “You are the Christ”? Yes! Did he love Jesus when he urged him to avoid the cross? Yes! Peter loved Jesus with his whole heart on both occasions, even though the first response came from God, and the second one didn’t.
If it was hard for the great St. Peter to recognize the difference between godly truth and ungodly temptation, what hope could there possibly be for us? Sure, there are times when it’s not hard to spot the influence of the devil. But what about those times when we feel we are being sincere and honest, but we’re still wrong? What about those times when we say something out of a good motivation, but it ends up being the wrong thing said at the wrong time?
The first thing we need to do is admit that we don’t always get it right. We’re going to make mistakes and hurt people, even when we have good intentions. There will even be times, humbling though they may be, when our good intentions end up serving devilish purposes. Praise God for his mercy and patience!
Second, we need to know that the Holy Spirit wants to teach us how to live. St. Paul tells us that no matter how inscrutable the wisdom of God may be, “we have the mind of Christ.” This means we really can learn how to discern spiritual things (1 Corinthians 2:14, 16). Over time, Peter learned how to discern God’s voice. He learned how to sort through his intentions and be a clearer instrument of God’s grace. We can, too. Just keep telling yourself: “I have the mind of Christ. I believe that the Holy Spirit is my guide.”With this little statement of faith, you can develop the gift of discernment.
“Lord, show me your ways so that I may discern your will.”
Saturday, September 15, 2012
Google's Motorola unit faces being forced to recall its Android tablets and smartphones from Germany after losing a patent lawsuit against Apple. The case relates to one of the innovations at the heart of an earlier US case in which Samsung was defeated by the iPhone maker. The dispute focused on the iOS system's bounce-back list feature which Motorola was found to have infringed.
Apple has to formally request a sales ban before it would come into effect. Google has not issued a statement, but is expected to appeal.
The ruling was issued at a court in Munich on Thursday.
Google had challenged the validity of the patent which describes a way to make a list react as if it was on a rubberband when a user scrolls beyond its end. The search giant has also filed a separate challenge against the intellectual property with the European Patent Office.
Tech consultant Florian Mueller - who advised another tech firm recently involved in a lawsuit against Google - said it would be relatively easy for the search giant to revise its software to mean it no longer risked a patent infringement.
The basic version of Google's Android operating system displays a glow effect when a user reaches the end of a list. So, the firm could revise an adapted version used on Motorola devices to abandon their use of an added bounce-back feature. However, he added that if Apple posted a bond of 25m euro ($32.6m; £20.1m), it could now force the devices off shop shelves, and for an additional sum it could have them destroyed or recalled.
Motorola briefly forced Apple to stop selling some of its iPads and iPhones in Germany in February after a separate lawsuit.
While the ruling adds to Apple's patent victory tally, the firm's co-founder Steve Wozniak has voiced his discomfort at the fact it was engaged in such legal battles. "I hate it," he said, when quizzed by the Bloomberg about the fact that a jury had awarded Apple $1.05bn (£648m) in damages from Samsung.
Samsung might sue Apple over its use of 4G LTE technologies
"I don't think the decision of California will hold. And I don't agree with it... I wish everybody would just agree to exchange all the patents and everybody can build the best forms they want to use everybody's technologies."
Mr Wozniak is the listed inventor of several patents himself, including a way to use a computer with a video display.
Although the US jury's verdict was delivered last month, the judge has scheduled two further hearings to discuss device bans in the country, and must still issue a final ruling on the sum owed.
Samsung has said it intended to appeal. The Galaxy phone-maker's patent fortunes suffered another setback on Friday when a judge at the US's International Trade Commission ruled that Apple had not infringed four of its patents in a separate case. The technologies involved a method to call a number on a smartphone and ways to view digital documents. The judgement was a preliminary ruling, meaning it is subject to the review of a six-member panel of judges at a later date. Some analysts believe the Samsung might now opt to make use of its 4G technology portfolio to issue a further challenge. The new iPhone 5 includes a chip giving it access to high-speed data transfers on 4G LTE networks.
Speculation was fuelled by a comment by one of the firm's executives earlier in the week.
"We have several cards, such as LTE patents," Samsung's IT and mobile unit chief Shin Jong-kyun said. "But we are cautious since [Samsung] has business ties with Apple in the component sector."
The Hillsborough disaster occurred when 96 Liverpool fans died after they were crushed within Sheffield Wednesday's stadium during the 1989 FA Cup semi-final with Nottingham Forest.
The fans who died had been in two pens of the Leppings Lane terrace. Each pen was separated by fences, including an overhanging barrier designed to prevent pitch invasions. Each pen had a small locked gate that opened onto the pitch.
The report, compiled by the Hillsborough Independent Panel, said that despite obvious signs of distress, it was a while before the police fully reacted and launched attempts to rescue those who were being crushed.
"It is evident… that the safety of the crowd admitted to the terrace was compromised at every level: access to the turnstiles from the public highway; the condition and adequacy of the turnstiles; the management of the crowd by South Yorkshire Police (SYP) and the Sheffield Wednesday FC (SWFC) stewards; alterations to the terrace, particularly the construction of pens; the condition and placement of crush barriers; access to the central pens via a tunnel descending at a 1 in 6 gradient; emergency egress from the pens via small gates in the perimeter fence; and lack of precise monitoring of crowd capacity within the pens.
"These deficiencies were well known and further overcrowding problems at the turnstiles in 1987 and on the terrace in 1988 were additional indications of the inherent dangers to crowd safety. The risks were known and the crush in 1989 was foreseeable."
"The flaws in responding to the emerging crisis on the day were rooted in institutional tension within and between organisations.
"This was reflected in: a policing and stewarding mindset predominantly concerned with crowd disorder; the failure to realise the consequences of opening exit gates to relieve congestion at the turnstiles; the failure to manage the crowd's entry and allocation between the pens; the failure to anticipate the consequences within the central pens of not sealing the tunnel; the delay in realising that the crisis in the central pens was a consequence of overcrowding rather than crowd disorder.
"The SYP decision to replace the experienced match commander… just weeks before an FA Cup semi-final, has been previously criticised. None of the documents disclosed to the panel indicated the rationale behind this decision."
CUSTOMS AND PRACTICES
"Throughout the 1980s there was considerable ambiguity about South Yorkshire Police's and Sheffield Wednesday FC's crowd management responsibilities within the stadium. The management of the crowd was viewed exclusively through a lens of potential crowd disorder, and this ambiguity was not resolved despite problems at previous semi-finals. SWFC and SYP were unprepared for the disaster that unfolded on the terraces on 15 April 1989."
THE EMERGENCY RESPONSE
"Not only was there delay in recognising that there were mass casualties, the major incident plan was not correctly activated and only limited parts were then put into effect. As a result, rescue and recovery efforts were affected by lack of leadership, co-ordination, prioritisation of casualties and equipment.
"The emergency response to the Hillsborough disaster has not previously been fully examined, because of the assumption that the outcome for those who died was irretrievably fixed long before they could have been helped.
"It is not possible to establish whether a more effective emergency response would have saved the life of any one individual who died. Given the evidence disclosed to the panel of more prolonged survival of some people with partial asphyxiation, however, a swifter, more appropriate, better-focused and properly equipped response had the potential to save more lives."
THE MEDICAL EVIDENCE
"During the inquest, the coroner ruled that there should be a cut-off of 3.15pm on the day in relation to medical evidence, arguing that the fate of all those who died after this point had already been determined by earlier events.
"The panel's access to all of the relevant records has confirmed that the notion of a single, unvarying and rapid pattern of death in all cases is unsustainable. Some of those who died did so after a significant period of unconsciousness during which they might have been able to be resuscitated, or conversely may have succumbed to a new event such as inappropriate positioning.
"It is not possible to establish with certainty that any one individual would or could have survived under different circumstances. It is clear, however, that some people who were partially asphyxiated survived, while others did not. It is highly likely that what happened to these individuals after 3.15pm was significant in determining that outcome. On the basis of this disclosed evidence, it cannot be concluded that life or death was inevitably determined by events prior to 3.15pm, or that no new fatal event could have occurred after that time."
DEFLECTION OF BLAME
"It is evident from the disclosed documents that from the outset SYP sought to establish a case emphasising exceptional levels of drunkenness and aggression among Liverpool fans, alleging that many arrived at the stadium late, without tickets and determined to force entry.
"Eight years after the disaster it was revealed publicly for the first time that statements made by SYP officers were initially handwritten as 'recollections', then subjected to a process of 'review and alteration' involving SYP solicitors and a team of SYP officers.
"Some 116 of the 164 statements identified for substantive amendment were amended to remove or alter comments unfavourable to SYP."
The panel also looked at the allegations of blame levelled against Liverpool fans in some newspapers, including The Sun.
"The documents disclosed to the panel show that the origin of these serious allegations was a local Sheffield press agency informed by several SYP officers, an SYP Police Federation spokesperson and a local MP.
"They also demonstrate how the SYP Police Federation, supported informally by the SYP chief constable, sought to develop and publicise a version of events that focused on several police officers' allegations of drunkenness, ticketlessness and violence among a large number of Liverpool fans. This extended beyond the media to Parliament.
"Yet, from the mass of documents, television and CCTV coverage disclosed to the panel there is no evidence to support these allegations other than a few isolated examples of aggressive or verbally abusive behaviour clearly reflecting frustration and desperation."
The 37-year-old, making his 700th appearance for United, tapped in from close range six minutes into the second half to inspire a victory that lifts his side into second place in the Premier League table, a point behind leaders Chelsea.
United recovered from seeing Javier Hernandez have a controversial fifth-minute penalty saved by Wigan goalkeeper Ali Al-Habsi by striking three times in 15 second-half minutes to decide the contest.
Hernandez turned in debutant Alex Buttner's low cross to make it two, before the Dutchman himself beat Al-Habsi too easily from a narrow angle. Substitute Nick Powell, also making his debut, completed the rout with a thunderous 20-yard shot.
The one negative note for the home side was some unsavoury chanting from a minority of their fans aimed at Liverpool supporters in the wake of revelations about the Hillsborough tragedy.
After the match a Manchester United spokesman said: "The manager has made the club's position very clear on this matter, it's now up to the fans to respect that."
For long periods United were well below their best, especially during a first half which Wigan finished the more convincingly.
But as the visitors' exhaustive pressing game began to run out of steam, Sir Alex Ferguson's side moved through the gears and then had the luxury of giving Robin van Persie a 20 minute run-out ahead of Wednesday's Champions League match against Galatasaray.
Scholes was at the heart of United's revival, pulling the strings with his laser-guided passing and well-oiled repertoire of feints and flicks.
There was more than one reminder that his tackling remains more than a little wild, but as he trudged off to a standing ovation 20 minutes from time, it was his goal that United fans preferred to remember.
The result aside, this was a landmark day for United. Scholes was making his 700th appearance in a United shirt and Rio Ferdinand his 400th, while Ryan Giggs took to the field for his 600th Premier League match. It was also Ferguson's 500th home league match - he had won 355 of the previous 499 (drawing 95 and losing 49).
None of it made pretty reading for Wigan, who had lost all seven of their Premier League matches at Old Trafford, conceding 24 goals and with just a lone stoppage-time penalty in 2006 to show for their efforts. And yet somehow there was hope.
Ferguson admitted in his pre-match programme notes that defeat by "little Wigan" had ultimately cost United the title last season.
And until Scholes broke the deadlock five minutes into the second half, "little Wigan" were threatening to do it all over again, as they tackled, battled, and denied their more celebrated opponents space.
United might have been ahead as early as the fifth minute, when Al-Habsi was controversially adjudged to have made contact with Danny Welbeck in the penalty area, but the Wigan goalkeeper went down to his left to deny Hernandez from the resulting penalty.
It was Welbeck who had the best of United's chances during a fragmented and frustrating first half, with the England striker creating and spurning a series of opportunities.
Wigan ended the first period on the front foot, with Ivan Ramis and, in particular, Arouna Kone spurning good chances.
And yet all that was forgotten within five minutes of the restart, when Michael Carrick spun on the edge of the penalty area and freed Nani down the right.
The Portuguese forward's low cross was spilled by Al-Habsi and Scholes was on hand to turn the ball into the net from six yards.
A second followed eight minutes later, Buttner reacting first as Giggs's attempted cross was blocked and steering the ball across goal, where Hernandez beat the offside trap to score. Buttner added a third, rampaging down the left and beating Al-Habsi from an apparently impossible angle, before Powell, minutes after coming on as a substitute, added a fourth.
Let me -- let me start. I want -- I want to -- want to start by thanking Elaine. Elaine, thank you so much. We are so grateful -- for your family's service and sacrifice, and we will always have your back.
Over the past few years as first lady I have had the extraordinary privilege of traveling all across this country. And everywhere I've gone and the people I've met and the stories I've heard, I have seen the very best of the American spirit.
I have seen it in the incredible kindness and warmth that people have shown me and my family, especially our girls. I've seen it in teachers in a near-bankrupt school district who vowed to keep teaching without pay. I've seen it in people who become heroes at a moment's notice, diving into harm's way to save others, flying across the country to put out a fire, driving for hours to bail out a flooded town. And I've seen it in our men and women in uniform and our proud military families -- in wounded warriors who tell me they're not just going to walk again, they're going to run and they're going to run marathons -- in the young man blinded by a bomb in Afghanistan who said simply, I'd give my eyes 100 times again to have the chance to do what I have done and what I can still do.
Every day the people I meet inspire me. Every day they make me proud. Every day they remind me how blessed we are to live in the greatest nation on earth.
Serving as your first lady is an honor and a privilege. But back when we first came together four years ago, I still had some concerns about this journey we'd begun. While I believed deeply in my husband's vision for this country and I was certain he would make an extraordinary president -- like any mother I was worried about what it would mean for our girls if he got that chance.
You know, how will we keep them grounded under the glare of the national spotlight? How would they feel being uprooted from their school, their friends and the only home they'd ever known?
See, our life before moving to Washington was filled with simple joys: Saturdays at soccer games, Sundays at Grandma's house, and a date night for Barack and me was either dinner or a movie, because as an exhausted mom, I couldn't stay awake for both.
And the truth is, I loved the life we had built for our girls. And I deeply loved the man I had built that life with. And I didn't want that to change if he became president.
I loved Barack just the way he was. You see, even back then when Barack was a senator and a presidential candidate, he was still the guy who picked me up for our dates in a car that was so rusted out -- I could actually see the pavement going by in a hole in the passenger side door.
He was the guy whose proudest possession was a coffee table he'd found in a dumpster -- and whose only pair of decent shoes was a half-size too small.
But see, when Barack started telling me about his family, see, now, that's when I knew I had found a kindred spirit, someone whose values and upbringing were so much like mine.
You see, Barack and I were both raised by families who didn't have much in the way of money or material possessions but who had given us something far more valuable: their unconditional love, their unflinching sacrifice -- and the chance to go places they had never imagined for themselves.
My father was a pump operator at the city water plant, and he was diagnosed with multiple sclerosis when my brother and I were young. And even as a kid, I knew there were plenty of days when he was in pain, and I knew there were plenty of mornings when it was a struggle for him to simply get out of bed. But every morning I watched my father wake up with a smile, grab his walker, prop himself up against the bathroom sink and slowly shave and button his uniform. And when he returned home after a long day's work, my brother and I would stand at the top of the stairs of our little apartment patiently waiting to greet him, watching as he reached down to lift one leg and then the other to slowly climb his way into our arms.
But despite these challenges, my dad hardly ever missed a day of work. He and my mom were determined to give me the kind of education they could only dream of. And when my brother and I finally made it to college, nearly all of our tuition came from student loans and grants, but my dad still had to pay a tiny portion of that tuition himself. And every semester, he was determined to pay that bill right on time, even taking out loans when he fell short.
He was so proud to be sending his kids to college, and he made sure we never missed a registration deadline because his check was late.
You see, for my dad, that's what it meant to be a man. Like -- like so many of us, that was the measure of his success in life, being able to earn a decent living that allowed him to support his family.
And -- and as I got to know Barack, I realized that even though he had grown up all the way across the country, he'd been brought up just like me. Barack was raised by a single mom who struggled to pay the bills and by grandparents who stepped in when she needed help. Barack's grandmother started out as a secretary at a community bank, and she moved quickly up the ranks. But like so many women, she hit a glass ceiling. And for years, men no more qualified than she was, men she had actually trained, were promoted up the ladder ahead of her, earning more and more money while Barack's family continued to scrape by. But day after day, she kept on waking up at dawn to catch the bus, arriving at work before anyone else, giving her best without complaint or regret. And -- and she would often tell Barack, so long as you kids do well, that's all that really matters.
Like -- like so many American families, our families weren't asking for much. They didn't begrudge anyone else's success or care that others had much more than they did. In fact, they admired it. They -- they simply believed in that fundamental American promise, that even if you don't start out with much, if you work hard and do what you're supposed to do, you should be able to build a decent life for yourself and an even better life for your kids and grandkids.
That's how they raised us. That's what we learned from their example.
We learned about dignity and decency, that how hard you work matters more than how much you make, that helping others means more than just getting ahead yourself. We learned about honesty and integrity, that the truth matters, that you don't take shortcuts -- or play by your own set of rules, and success doesn't count unless you earn it fair and square.
We learned about gratitude and humility, that so many people had a hand in our success, from the teachers who inspired us to the janitors who kept our school clean. And we were taught to value everyone's contribution and treat everyone with respect.
Those are the values that Barack and I and so many of you are trying to pass on to our own children. That's who we are. And standing before you four years ago, I knew that I didn't want any of that to change if Barack became president. Well, today, after so many struggles and triumphs and moments that have tested my husband in ways I never could have imagined, I have seen firsthand that being president doesn't change who you are. No, it reveals who you are.
You see, I've gotten to see up close and personal what being president really looks like. And I've seen how the issues that come across the president's desk are always the hard ones. You know, the problems where no amount of data or numbers will get you to the right answer. The judgment calls where the stakes are so high and there is no margin for error.
And as president, you're going to get all kinds of advice from all kinds of people. But at the end of the day, when it comes time to make that decision as president, all you have to guide you are your values and your vision and the life experiences that make you who you are.
So when it -- when it comes to rebuilding our economy, Barack is thinking about folks like my dad and like his grandmother. He's thinking about the pride that comes from a hard day's work. That's why he signed the Lilly Ledbetter Fair Pay Act, to help women get equal pay for equal work.
That's why he cut taxes for working families and small businesses and fought to get the auto industry back on its feet.
That's how he brought our economy from the brink of collapse to creating jobs again, jobs you can raise a family on, good jobs, right here in the United States of America.
When it comes to the health of our families, Barack refused to listen to all those folks who told him to leave health reform for another day, another president. He didn't care whether it was the easy thing to do politically. No, that's not how he was raised. He cared that it was the right thing to do.
He did it because he believes that here in America, our grandparents should be able to afford their medicine, our kids should be able to see a doctor when they're sick, and no one in this country should ever go broke because of an accident or an illness.
And he believes that women are more than capable of making our own choices about our bodies and our health care. That's what my husband stands for.
When it comes to giving our kids the education they deserve, Barack knows that, like me and like so many of you, he never could have attended college without financial aid. And believe it or not, when we were first married, our combined monthly student loan bill was actually higher than our mortgage. Yeah, we were so young, so in love and so in debt. And that's why Barack has fought so hard to increase student aid and keep interest rates down -- because he wants every young person to fulfill their promise and be able to attend college without a mountain of debt.
So in the end, for Barack, these issues aren't political; they're personal, because Barack knows what it means when a family struggles. He knows what it means to want something more for your kids and grandkids. Barack knows the American dream because he's lived it. And he wants everyone -- in this country, everyone, to have the same opportunity no matter who we are or where we're from or what we look like or who we love.
And he believes that when you've worked hard and done well and walked through that doorway of opportunity, you do not slam it shut behind you. No, you reach back -- and you give other folks the same chances that helped your succeed.
So when people ask me whether being in the White House has changed my husband, I can honestly say that when it comes to his character and his convictions and his heart, Barack Obama is still the same man I fell in love with all those years ago. Yeah. He's the same man who started his career by turning down high-paying jobs and instead working in struggling neighborhoods where a steel plant had shut down, fighting to rebuild those communities and get folks back to work -- because for Barack, success isn't about how much money you make. It's about the difference you make in people's lives.
He's the same man -- he's the same man, when our girls were first born, would anxiously check their cribs every few minutes to ensure that they were still breathing -- proudly showing them off to everyone we knew.
You see, that's the man who sits down with me and our girls for dinner nearly every night, patiently answering questions about issues in the news, strategizing about middle school friendships. That's the man I see in those quiet moments late at night, hunched over his desk, poring over the letters people have sent him, the letter from the father struggling to pay his bills, from the woman dying of cancer whose insurance company won't cover her care, from the young people with so much promise but so few opportunities.
And I see the concern in his eyes, and I hear the determination in his voice as he tells me, you won't believe what these folks are going through, Michelle; it's not right; we've got to keep working to fix this; we've got so much more to do.
I see --
I see how those stories --
I see how those stories, our collection of struggles and hopes and dreams -- I see how that's what drives Barack Obama every single day. And I didn't think that it was possible, but let me tell you today I love my husband even more than I did four years ago, even more than I did 23 years ago when we first met.
Let me tell you why.
See, I love that he has never forgotten how he started. I love that we can trust Barack to do what he says he's going to do even when it's hard, especially when it's hard.
You know, I love that for Barack, there is no such thing as us and them. He doesn't care whether you're a Democrat, a Republican or none of the above. He knows that we all love our country, and he is always ready to listen to a good idea. He's always looking for the very best in everyone he meets.
And I love that even in the toughest moments, when we're all sweating it -- (chuckles) -- when we're worried that the bill won't pass, and it seems like all is lost, see, Barack never lets himself get distracted by the chatter and the noise. No. Just like his grandmother, he just keeps getting up and moving forward, with patience and wisdom and courage and grace.
And he reminds me -- he reminds me that we are playing a long game here, and that change is hard, and change is slow, and it never happens all at once, but eventually we get there. We always do. We get there because of folks like my dad, folks like Barack's grandmother, men and women who said to themselves, I may not have a chance to fulfill my dreams, but maybe my children will, maybe my grandchildren will. See, so many of us stand here tonight because of their sacrifice and longing and steadfast love, because time and again, they swallowed their fears and doubts and did what was hard.
So today when the challenges we face start to seem overwhelming or even impossible, let us never forget that doing the impossible is the history of this nation. It is who we are as Americans. It is how this country was built.
And if our parents and grandparents could toil and struggle for us, you know, if they could raise beams of steel to the sky, send a man to the Moon, connect the world with a touch of a button, then surely we can keep on sacrificing and building for our own kids and grandkids, right?
And if so many great men and women could wear our country's uniform and sacrifice their lives for our most fundamental rights, then surely we can do our part as citizens of this great democracy to exercise those rights. Surely we can get to the polls on Election Day and make our voices heard.
If farmers and blacksmiths could win independence from an empire, if immigrants could leave behind everything they knew for a better life on our shores, if women could be dragged to jail for seeking to vote, if a generation could defeat a depression and define greatness for all time, if a young preacher could lift us to the mountaintop with his righteous dream -- and if proud Americans can be who they are and boldly stand at the altar with who they love -- then surely, surely we can give everyone in this country a fair chance at that great American dream.
Because in the end -- in the end, more than anything else, that is the story of this country, the story of unwavering hope grounded in unyielding struggle. That is what has made my story and Barack's story and so many other American stories possible.
And let me tell you something, I say all of this tonight not just as first lady, no, not just as a wife. You see, at the end of the day, my most important title is still mom in chief. My daughters are still the heart of my heart and the center of my world. But let me tell you, today I have none of those worries from four years ago, no, not about whether Barack and I were doing what was best for our girls, because today I know from experience that if I truly want to leave a better world for my daughters and for all of our sons and daughters, if we want to give all of our children a foundation for their dreams and opportunities worthy of their promise, if we want to give them that sense of limitless possibility -- that belief that here in America, there is always something better out there if you're willing to work for it, then we must work like never before.
And we must once again come together and stand together for the man we can trust to keep moving this great country forward. My husband, our president, Barack Obama.
Thank you. God bless you. God bless America.