The Launch Hour: Ike Anya, Author, Small by Small

Ike Anya is a prominent figure in both the medical and literary worlds in the United Kingdom and Nigeria. An alumnus of King’s College, Lagos, he completed his degree in Medicine in 1995 at the College of Medicine of the University of Nigeria. Ike teaches public health at Imperial College, at Bristol University and the London School of Hygiene & Tropical Medicine as an honorary lecturer.  He sits on the epidemiology and black and ethnic minority health section councils of the Royal Society of Medicine. He is co-founder of Nigeria Health Watch, EpiAfric, TEDxEuston and the Abuja Literary Society. In his debut novel, Small by Small, described as “A small miracle of a book. It entertains with delicious storytelling…” by  Chimamanda Adichie, he recounts training as a doctor amidst the social and political upheaval of 1990s Nigeria. Ike has published in The Guardian, Huffington Post, Granta, Catapult & Eclectica and in the anthology of essays by Nigerian writers on Nigeria, Of This Our Country.


Chimamanda Adichie, a friend and childhood neigbhour, told me when the Granta piece was being prepared for publication that your piece is very good and you are going to get approached by agents and publishers asking if you are working on a book, you must say yes.  As she predicted book agents started approaching me when the Granta piece was published asking to have coffee and lunch…”


Given your literary talent, how did you find yourself in medical school? Were you at any point distracted and tempted to go and study English instead?

I was born into a middle-class Nigerian family and attended King’s College Lagos. During my time at King’s College, it seemed that Engineering and Medicine were the primary career choices for each successive class including my peers. A few arts inclined ones went into Law, like the former chairman of the Nigerian Bar Association, Olumide Akpata, who was my classmate. A handful of colleagues who could draw read Architecture.

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On my part, I didn’t consciously decide to study medicine; it was more about the prevailing career options at the time. There wasn’t a specific moment where I thought, “I want to study medicine” or “I want to be a doctor”. It simply happened.

In a way, it was similar to how I ended up at the King’s College. My primary school had a tradition of sending the best-performing male primary six students to King’s College each year. As one of the best students, I assumed I would proceed to King’s College and I did after passing the entrance examination and interview. 

I went to university in the late 1980s. Those days were a period of a seeming literary drought between the generation of writers like Chinua Achebe and Wole Soyinka and the subsequent wave of Nigerian authors receiving global attention like Helon Habila and Chimamanda Adichie. During this period, very few books and novels were being published in Nigeria. So writing never seemed a plausible career, it was for me, more of a hobby. Also at school, I didn’t find Arts subjects as competitive as the sciences. I excelled in subjects like History, English and Literature, and it almost seemed inevitable that I’d score the highest marks even with little effort. On the other hand, I found coming top in the sciences was more demanding, with fierce competition among the students.

In what key ways has medical training in Nigeria changed, from the period you captured in “Small Book” compared to now?

When I was a House Officer, (and I wrote about this in Small by Small)I was working for a doctor conducting research, and there was uncertainty about whether they had received ethical approval or obtained patient consent. Today, nearly every major hospital has an Ethics Committee and there is the National Ethics Committee. This is a positive development. However, challenges persist, including strikes and inadequate resources. The recent strike resulted in doctors going unpaid for months, which is a concerning issue.

Five years ago I had the privilege of working closely with certain Nigerian states, including Lagos, during a simulated exercise of an infectious disease outbreak in West Africa. I was impressed by the Lagos State Ministry of Health’s meticulousness, as they had a quite comprehensive list of health facilities in the state, even the smallest clinics in slum areas. Health workers regularly visited these clinics to collect immunization data. This showed significant progress that often sometimes remains hidden from public view.

So what I can say is that it’s a mixed picture—Nigeria has made progress in some areas, stagnated in others and many challenges persist.

What’s the most significant lesson you took away from medical school in Nigeria, aside from earning your medical degree?

One of the most profound lessons I took away from medical school in Nigeria was how to cope with failure. I had to take the Paediatrics exam three times, which ultimately delayed my graduation by six months. The circumstances of my failure were a significant shock. Despite thorough preparation and high performance in most aspects of the exam, the examiners in the clinical long case accused me of cheating and gave what was called a “veto mark.” This was a first-time experience for someone who had consistently excelled in previous exams. This challenging period taught me resilience and the importance of picking oneself up when you encounter adversity. This resilience later proved invaluable when applying for jobs in the UK, because in the process of looking for a job, whatever knocks I received, I could say, “okay, fine.” then pick myself up and keep going.

Is there any teacher or professor you cannot forget, someone you remember quite well, and why?

There was a lecturer called Dr. Val Chikwendu, young and bright who taught us Pharmacology and Medicine. He was very conscientious. What easily marked him out for me was that he read very widely. Sometimes in ward rounds, consultants would fire questions at us and humiliate us if we failed to answer. Dr Chikwendu was different. His manner was gentler and his questions were not just about Medicine. Sometimes he would ask about literature or poetry, or politics or something else entirely. So, that often gave me a chance to shine. I was drawn to him. But I also just liked the idea that he had a deeper aspect to his personality beyond Medicine.  I think Medicine alone can be fairly boring.

Who’s been the bigger influence on you? Your mother or your father?

It’s challenging to distinguish a greater influence between my mother and father. They operated as an indivisible unit and displayed a high degree of unity. Together, they embodied the qualities of integrity, public service, contentment with what they had, and a strong Christian faith. These all left a lasting impact on me.

When did you leave home for good? And what do you think is the biggest lesson you took away from home?

The most significant lesson I took away from those years was the importance of being content with what you have, upholding integrity and nurturing a strong sense of passion and ambition for the common good. I also learned the value of maintaining a critical perspective, not merely accepting what those in authority or the crowd dictate. This lesson became evident during the Ali Must Go riots of 1977. These protests erupted when the military government introduced or increased university tuition fees. I can’t remember which precisely. The name “Ali Must Go” referred to Ahmadu Ali, who was then Federal Commissioner for Education. Some of the student leaders were declared wanted by the police but came to our house to eat and hold meetings with my father. This experience taught me at a young age that just because the police declared someone wanted, it didn’t automatically make them a wrongdoer or pariah.

That was a bold stance to take during military rule.

Indeed, it was. It instilled in me the notion that the government and people in authority aren’t always right; sometimes, they make mistakes. I vividly recall the first time I realized I had been raised with a different perspective compared to many other Nigerians. We were in our first year at university, and there was a heated argument in class. To settle the dispute, someone invoked the words of the Vice Chancellor, saying, “The Vice Chancellor said this and that.” And I responded “but the Vice chancellor may be wrong!” The reaction from my classmates was utter shock. They looked at me as if to say, “Look at this first-year student challenging the Vice Chancellor’s judgment.” Nonetheless, this experience reinforced the importance of questioning and critical thinking, which aligns perfectly with the principles of public health.

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Is there anything you remember about your first job? An experience that you cannot forget.

One unforgettable aspect of my first job was the sheer exhaustion caused by periods of intense work without sleep, sometimes lasting up to 36 hours. When on-call duty was busy, you’d simply take a quick shower and continue working. I didn’t even know it was physically possible to stay up for 36 hours without sleep. How can I forget that discovery? I remember the camaraderie among the house officers. We came from different medical schools across Nigeria but we bonded very well.  When you often find yourselves up at 2 a.m. trying to set an IV line, that creates a strong bond.


How can Nigeria start to build universal health coverage small by small?

In some ways, it has already begun. Certain states are making more progress than others. …People often forget that when we talk about poor health systems or healthcare, it’s not universally subpar. Even within struggling hospitals, you can find pockets of excellence”.

Who’s your best boss ever? And why?

I have two strong contenders for the title of my best boss. The first is Dr. Zainab Imam, who was a registrar at the National Hospital when I worked there. She was an exceptionally conscientious and patient-focused doctor. She repeatedly said that juniors could call on her at any time for advice without hesitation, which made us feel secure, especially when we were on-call. This really influenced me and later as a consultant. I made sure younger doctors on call or other staff knew they could call me whenever they thought they needed to, even if seemingly over a minor issue.

The second contender is Dr. Angela Raffle, my first consultant in the UK. She had the remarkable ability to transform every experience, successful or not, into a valuable teaching moment. She encouraged me to think critically about my interactions and experiences and, more importantly, to empathize with the perspectives of others. She once asked me as I returned to the office after a meeting how it had gone and I said “awful”. She told me to catch my breath and then come over and tell her why I thought the meeting was awful & what I could have done if I had been chairing it to make it better

How did you end up working in the health system in the UK?

I had a mentor and lecturer named Kevin Fenton during my time at the London School of Hygiene. He was the only black lecturer to teach me and naturally, black students like me gravitated towards him. I vividly remember seeking his advice regarding my career.

At that time, I planned to go & work for organizations like the World Health Organisation (WHO)  or Doctors Without Borders after completing my Master’s degree. Kevin asked if I had considered specialist training in Public Health. I said “I looked at the Faculty of Public Health website but the training programme takes five years!” Kevin chuckled and wisely said, “Five years will pass quicker than you imagine. And with that additional training, you’ll gain broader and deeper specialist skills. Whether you choose to stay in the UK, return to Nigeria, or work with the WHO, you’ll be equipped to drive real change. If you opt for just a Master’s, you’ll find yourself implementing other people’s ideas and visions, which will frustrate you”.

This advice resonated with me, and during my training, it became evident he was right. In my third or fourth year of training, I noticed some of my classmates who had ventured to work for international organizations were returning to begin specialist training programs, recognizing the need for further training. Ultimately, Kevin’s wisdom led me to my unexpected path into the NHS, a journey I hadn’t meticulously planned.


Can you share your experiences with starting and managing initiatives like Nigeria Health Watch, Abuja Literary Society, and TedX Euston?

I really like this question. It’s a lesson I often struggle to impart to younger people. Things often don’t happen suddenly. I look at some of the things I’ve been involved in starting, like Nigeria Health Watch, Abuja Literary Society, and TEDxEuston. People come to me and say, “I want to set up something like Nigeria Health Watch,” and I try to explain that we never set out to build these things in that way. They started and grew organically. TedX Euston was just Chikwe (Ihekweazu) and I coming back from TEDGlobal in Arusha in 2007, really excited about the experience  and saying,  “Why don’t we organize a small event like this in London so that friends and family and colleagues will understand why we are so excited.” There was no intention to have another one after that single event. We did everything from our pockets; it was all very ad hoc.

That morning, we were arranging chairs in the hall; the night before, we were making name badges and conference folders till very late. The event ended at 7.30 pm, and people wouldn’t leave; they just kept talking and talking and some started asking “where are we going for dinner?” “when will the next one be?” We were like, “What next one?” “This one nearly killed us, and you are talking about the next one.” Some of them said, “We will help you; we will volunteer,” and that’s how the team started. If we had thought very carefully about building TEDxEuston, we may have concluded we didn’t have the resources and never started. So I say to people now, “start wherever you are, with whatever you have, in any way that you can.”

If you say, “I’m passionate about female education,” you can say every first Sunday of each month, “I will gather two or three friends who are interested in the same topic, and we’ll have lunch and think about what we can do,” As you keep going, like-minded people will join you, offer resources, offer support, and that’s how you grow. But if you want the fully made product on day one, you’ll never start. And I think that’s a challenge in these days of social media, the result is so amplified that people just see the outcome and have little chance of learning from the journey.

Someone recently emailed me, noticing that I have been actively involved in promoting my book. She inquired if I could share any advice on this matter. When I shared my approach I was surprised at how eagerly she embraced it. To be honest, my approach is quite straightforward. I do my research and reach out to any individual or institution that might have an interest and see if they’d host an event related to the book.

It’s a bit reminiscent of the approach we had during TedX Euston. Typically, when reaching out to potential event hosts, about 50% of the people you approach simply ignore the request. Another 30% tend to decline, and 15-20% express interest but require some time to consider it. Ultimately, only about 5% end up agreeing to host the event, but you take that and keep trying

How were you able to get Segun Aganga, the former Minister of Finance, to speak at the very first TedXEuston?

There was a news article in a UK paper around the time we were planning the first event which identified him as the most senior black executive at Goldman Sachs in Europe (before he was invited to Nigeria to work as the Minister of Finance). We didn’t know of him, but that article brought him to public attention and I thought he might be a good speaker but we didn’t know anyone who knew him. Chikwe said to me, how are you going to get him? And I said don’t worry. I googled Goldman Sachs’ email address, so I got the format and I sent about six of the same emails to different variations of his name. Five bounced back and one went through, and I guessed that was the correct one. After a couple of follow-up emails with still no reply,  I googled to find the switchboard for Goldman Sachs in London and I got a number. I rang it and asked to speak to Mr. Aganga’s assistant. I didn’t ask for him because I knew if I did, all the barriers and questions would come up. I was put through to the assistant immediately. I told her of my previous emails and why I was calling.  Over a few weeks, I politely kept pushing for an answer. At a point, I think she felt her professional integrity was in question because I said to her, we have been on this for over a month, we appreciate he is a very busy man and may not be able to do it, but all we want is an answer. Yes or no? And at that point, I could sense her thinking, as his PA, I should be able to get a Yes or No for these people. That’s a simple thing. It’s my job. So she said, very well, Dr. Anya, you will have an answer one way or another by next week. And the next week she rang me and said he wanted to have a phone conversation with me before he made a final decision. We spoke for about half an hour & he agreed I often tell this story as an example of some of the ways you have to keep being persistent and resourceful.

How can Nigeria start to build universal health coverage small by small?

In some ways, it has already begun. Certain states are making more progress than others. It’s important to realize that building universal health coverage isn’t an insurmountable task for Nigeria. The reason we established Nigeria Health Watch was to showcase that when one state excels in a particular aspect of healthcare, we need to examine how they’re achieving it. Are there lessons that other states can learn from them? People often forget that when we talk about poor health systems or healthcare, it’s not universally subpar. Even within struggling hospitals, you can find pockets of excellence.

For instance, consider the pediatric departments. In all the hospitals I have worked in, the pediatric department tends to be better organized and more stringent in their approach to standardised patient care. When I was a house officer, in pediatrics, we had strict rules like not staying in our rooms when on call; we had to be in the ward until the call ended. I have observed similar dedication in other places. This, I think, partly stems from the fact they are dealing with children who are often more vulnerable patients and require extra care. So, it’s interesting to ask, what if other departments took cues from pediatrics and applied similar principles, how would that impact the healthcare system?

When did you start to write seriously, and what factors shaped your path to becoming a writer?

I recall my first experience with writing was when I was about eight years old. We were driving on the newly opened Enugu-Port Harcourt Expressway, a road that significantly reduced the travel time from Nsukka to Abiriba, our ancestral home. I was so taken by this smooth journey that I grabbed a piece of paper and a pen from my mother and wrote a rather elementary poem about the expressway. I proudly showed it to my parents, and they praised it. I took it to school, and even my teacher thought it was so good, he made the class memorise it and recite it at school assembly. Receiving such validation as an eight-year-old probably marked the beginning of my writing journey

My reading habits also played a significant role. I was a precocious reader from a very young age and consumed a wide range of literature. I read Chinua Achebe’s “Things Fall Apart” when I was about five years old, and I always read extensively, including books some would consider inappropriate for a child.

I remember reading the African-American classic, Roots by Alex Haley which tried to trace his family roots back to Kunta Kinte from The Gambia. I remember it was published in 1976, the bicentennial anniversary of US independence when I was about six. My father had brought back a pile of big books from a conference in the US. I sneaked into his study and started reading them, including this fat one which was Roots. This early exposure to literature was an important part of my writing journey and my dream of one day being a published author. I was the Editor of The Mermaid, the school magazine at King’s College Lagos and won the Adeniran Ogunsanya Prizes for the best graduating student in History and English. At school and university, I had poems and articles published in the Nigerian newspaper The Guardian.

But when I started studying Medicine, I started to believe that I would not have the time to write books as a doctor.


How did you end up getting published in a prestigious magazine such as Granta and eventually writing Small by Small?

I didn’t submit the piece to Granta. I met Ellah Wakatama then Deputy Editor of Granta at a book reading by my late beloved friend Binyavanga Wainaina & the three of us went on to dinner and spent six or seven hours in a restaurant talking about Africa and literature. She remembered me when they were doing a themed issue on Medicine and called to ask if I could recommend an African writer to contribute. I asked if I could send a piece that I wrote a while back. She was initially dismissive but asked me in an unenthusiastic way to send it but also to remember to send her some suggestions for potential contributors. I think it was about half an hour later, she rang me to say, we loved it and we want to publish it. That was People Don’t Get Depressed in Nigeria and that was the first unexpected angle.

The second was Chimamanda Adichie, a friend and childhood neigbhour, telling me when the Granta piece was being prepared for publication, “You know your piece is very good and when it’s out, you are going to get approached by agents and publishers asking if you are working on a book. When they do, you must say yes. I said “but I’m not working on a book and she said “Shut up, just say yes” As she predicted, publishers and book agents started approaching me after the Granta piece was published asking about working on a book & asking to meet to discuss it.

At the end of December 2012, I realised I had interest from about three publishers and two agents. Just based on a 3000-word essay in Granta. And I remember thinking, some people have written 6, 7, 8 fully completed manuscripts, but can’t get any agents to look at them. They can’t get any publisher to look at them. And you, based on 3,000 words in a magazine, you have all these people interested. If you don’t do something with this opportunity, you will never be forgiven.

One of the interested publishers asked me to write a book proposal so they could commission me. I had no idea how to write one so they sent me some good examples to guide me. I wrote two versions of the proposal, and they said it wasn’t good enough. They asked me to write another and then I thought, why am I spending the little time I have outside my day job trying to describe the book I want to write when I could use it to start writing the book so they can see? So I asked my boss for six weeks of unpaid leave to go and write.

As I was writing a memoir set in Nigeria, I wanted to come to Nigeria, to be in a place where the sounds and smells and images would help jog my memory. I had only six weeks and with Nigeria’s erratic electricity, I couldn’t risk losing even one day of writing. I was in that conundrum when my friend and fellow writer Ike Echeruo (his excellent debut collection of short stories Expert in All Styles was just published by Farafina in Lagos) proposed a solution. He lived in Accra, married to Indira, a Ghanaian, and they said “Why don’t you come to Ghana?” The environment, food, and sound are very similar to Nigeria’s but there’s constant electricity. This was in 2013. He found me a retreat spot up in Peduase Valley Resort, a stone throw away from the Presidential Lodge in Aburi, where the final diplomatic attempts at preventing the Nigeria-Biafra war were made. In that serene historic spot, it was like everything was bottled up and I was just pouring it all out, the words flowed


What kinds of books do you enjoy reading, and what are you reading currently?

I enjoy reading a wide variety of books, fiction, non-fiction, and medical writing. I particularly appreciate good fiction with a strong narrative, an engaging story and beautiful language, writing that teaches me and illuminates. I admire authors such as Chimamanda Adichie, Patrick Gale, and Jowhor Ile for their compelling storytelling and humanity. As a doctor who writes, Abraham Verghese, author of “Cutting for Stone,” inspires me the most because his writing reflects a profound understanding of humanity, emphasising the personhood and dignity of every character. Reading his two early non fiction books about his early days as a doctor in the US convinced me that some of my iwb stories might be compelling. I also enjoy reading popular fiction, even what some might consider “trashy” from time to time, depending on my mood.

Currently, I’m reading two books simultaneously. I’m dipping for the second time into Arinze Ifeakandu’s beautiful “God’s Children Are Little Broken Things,” a collection of short stories that without drama or fanfare presents a Nigeria that is in many ways very familiar and in other ways completely unfamiliar. I am also reading Anna, by Amy Odell. It’s a biography of Anna Wintour, the renowned longtime fashion editor of Vogue who is seen as somewhat of an enigma.

Where do you like to holiday in the world?


What is it about Abiriba that makes it your favorite holiday spot?

Abiriba feels like home to me, a place where I can walk barefoot and connect deeply with the surroundings. There’s a sense of grounding, knowing that twelve generations of my family have walked on these paths. Recently, my father shared a story about some land being divided among extended family members. The land had once been seized from their neighbours in battles that established Abiriba and that land is in my family because my ancestor fought in that war and received it as part of the spoils. Hearing that history gave me goosebumps.

In Abiriba, I can be completely at ease and clear my mind. I don’t have to think about anything, and I can stop anywhere to eat and drink. It’s a place where I experience a profound sense of freedom. This connection to a specific place is important, as we are increasingly recognizing in the fields of public and mental health.

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Where do you see Nigeria in 10 years, and is there an opportunity for a significant turnaround from the current trajectory?

Since the EndSARS movement in October 2020, I haven’t really read a Nigerian newspaper. I briefly re-engaged when Peter Obi emerged as a Presidential Candidate. EndSARS affected me deeply because it coincided with the global lockdown, which exposed afresh to me the glaring inequities and inequalities in the world. As the COVID-19 vaccine became available, I felt so helpless knowing that my elderly parents in Lagos were surrounded by death, with no access to vaccines while all around me in the UK people were blithely rejecting vaccines or expressing preferences for certain brands. And the way it quickly descended into every country for itself was so depressing for someone working in global health

It was such a stark reminder of the world’s unfairness where mere accident of birth determined who had access to lifesaving vaccines or not. Even when the Director-General of the World Health Organisation asked wealthier countries to delay second doses until global coverage reached 40 percent, they ignored the plea, without even trying to provide justification.

This, coupled with the ongoing issues in Nigeria, left me feeling profoundly pessimistic.

But we can also look at some bright spots. As I said, I worked closely with the Lagos State Ministry of Health and  I witnessed real progress. The new coordinating Minister for Health is a senior colleague that i have the utmost respect for, so I’m hopeful on that front.

But I also believe that Nigeria needs a fundamental transformation, a shift in values and in the way things are done. Small actions, with everyone doing the right thing in their own way, might be the way forward. I am hopeful that things might improve, but the challenges are substantial and the road ahead is long.


Small by Small can be ordered from: and Amazon.

It’s also available from most bookshops in the UK and Nigeria.

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