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Archive for the ‘health policy’ Category

By Kingsley Obom-Egbulem

When you invite any government official to a public function, over 95% of them often come with prepared speeches and you can actually predict the content of these speeches. They are rehearsed, usually not flowing from the heart and read in the most boring and nauseating manner. And because those they are talking to already know what the speeches contain, everyone is in a hurry for them to finish. They will condemn very obvious ills-which almost everyone in the country have condemned. They will tell you what have been “earmarked”, “eyemarked” by government to address it and they will tell you “plans are underway to address it” and it is usually soon.

That was the scenario that played out at the 50th anniversary celebration of the Nigerian Medical Association. In his speech read by his representative, the Minister of state for Health Alhaji Suleiman Bello, The acting president, Goodluck Jonathan said “the Federal Government will no longer be interested in funding medical trips for its officials abroad.

Jonathan said the funds used for such trips have led to loss of the nation’s scarce foreign exchange through unbearably rampant trips abroad  by officials seeking medical care.(Everyone  knows this sir!)

He said the money will be channeled to developing tertiary hospitals to international standards.

This indeed is another nice statement which any Nigerian would want to applaud. But would this ever happen? (Sir,we dare you to make real your words and stop reading empty speeches!)

What a frown:Can Goodluck frown hard enough to end the needless waste of pubic funds on medical treatment abroad?

Before Jonathan’s “speech”(I think that’s what it is-a mere speech) the national assembly (perhaps for want of what to say on this ugly trend) had asked government to do something to stop public officials from seeking medical attention abroad.

Part of their words as published by Thisday:

“The House of Representatives has decried the culture of affluent Nigerians seeking medical services overseas. It said the trend was not only detrimental to the improvement of health care services locally but a drain on the nation’s scarce resources at this period of global economic recession. It has therefore tasked the Federal Ministry of Health to set in motion all necessary machineries that would enhance the full implementation of the 2009 budget in the health sector so as to elevate the quality of medical services available in the local health institutions and discourage what has now become medical tourism by the Nigerian elite.”

The first question you want to ask is why would public office holders continue to make statements which even babies know they lack the least political and moral will to bring to reality? One way to demonstrate seriousness on this matter would have been for Jonathan to tell us that “the minister of finance and the accountant general of the federation have been instructed not to approve any budget meant for medical trips oversees and any requisition for such expenditure must be approved only when it certain that NO HOSPITAL OR SPECIALIST  IN THE ENTIRE COUNTRY WOULD EB ABLE TO TREAT SUCH AILMENT”. Only then will Nigerians know that he means business!

We are all aware that the issue of medical trips abroad especially by public office holders is more than just seeking for quality health care; it is another opportunity to say “thank you” to some big shots and sacred cows for being good men and women of the government.

Another question we need to ask is how many of these public office holders would want to pay for medical treatment abroad when they leave office and probably have spent all the money they stole while in office?

Medical trips or medical vacations(like it has been coined lately) is an excuse used by these men and women to steal money. Very few of them actually go to these hospitals for medical attention. Despite all the  negative noise about Nigerian hospitals we still have great hospitals here and doctors  who are not just first class brains but are even sought after by foreign hospitals abroad as consultants.

Liyel Omoke:was allegedly flown abroad in March after sustaining an injury on his wrist and neck in an auto crash

In 2009,while investigating a story on the contribution of the Niger Delta Development Commission (NDDC) towards improving the health of people in the Niger Delta, I got a shocker. I gathered that following several bogus claims of people wanting to go abroad for illness such as “Consistent and recurring migraine” which their doctors here have confirmed that they would better off treated by a specialist in Germany of Israel. As if that wasn’t enough ,the patients  will insists that the medical bills be paid through them especially  in cash for disbursement to the hospital oversees.

No doubt, the continued financing of oversees medical trips by government is becoming an embarrassing injustice every Nigerian must stand and openly condemn.

As far back as 2001,late Human rights activist, Dr. Beko Ransome-Kuti, had openly condemned this injustice when he  said “it is  immoral for public office holders to use public funds to undertake medical treatment overseas, when they could transform the nation’s health facilities and take advantage of them.”

The magnitude of this immorality can be weighed from last year’s revelation from the Kano State government that it spends about N1.2 Billion annually to fund oversees medical treatment for public office holders. What happens to the ordinary people who have no access to such privilege and cannot even pay for medical services here.

For these unfortunate majority, their access to oversee medical trip remains the numerous medical missions

Medical Missions:one of the few opportunities for many poor Nigerians to get quality health care.

undertaken by foreign doctors to Nigeria. And you wonder again, our public office holders are destroying our health system, we are spending billions of naira paying their medical bills abroad while Nigerian doctors based abroad in partnership with their foreign colleagues  are coming to Nigeria to treat poor Nigerians. What an irony!

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One would have expected the issues to focus on drawing performance indicators and clearly articulating what should be the area of focus for the new minister,Nigerians have been busy debating whether or not a doctor should head its health ministry.

Since the acting president dissolved the inherited cabinet creating the need to constitute ” his own executive”,several professionals with a stake in the health sector have given reasons why someone from their own professional group should be the next minister for health.

The debates have been very pedestrian and equally laughable. Someone hinted the other day that even among doctors(those with a divine mandate to head our health ministry),it is not a clear cut acceptance:pediatricians feel they are better off since ‘we need to end or reduce the problem of child mortality’.The public health physicians would disagree,that they need a shot at the office so as to create a the right template for disease prevention and improve health seeking behaviors.Gynecologist would want to come and end maternal mortality.It may sound like a joke,but that is how  trivial the issue of  our health and the need or the right leadership have become.

The minister designate  for health Prof. Christian Onyebuchi Chukwu -who was confirmed by the Senate yesterday seems to have added to the pool of     debate.Im sure many of us would prefer he spends his time telling us what he intend to accomplish before he’s kicked out like the people before him?

Arguably,this debate may have steemed from the assumptions that Professor Dora Akunyili,the former NAFDAC Director General (who against public expectations accepted to serve as Minister for Information and Communication during the last executive council) would eventually be given the portfolio she deserves and….who knows, desires.But Akunyili is a Pharmacist and so the doctors wanst to speak out before they lose their “birthright”. She has since settled down having been retained as minister of information and communication.

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Mr. Mike Egbo is National Programme Manager for the Partnership for Transforming Health Systems( PATHS2)-a 5-year programme funded by the UK Department for International Development(DFID) to help Nigeria solve one of its major health crisis-the absence of a health system that delivers quality health care. Egbo argues that the Nigerian health system is like a car with a broken engine, we keep changing the driver with the hope that the car will perform;  but what we actually need is to fix the car”. Egbo, in this interview with Kingsley Obom-Egbulem speaks on the role of PATHS2 in putting in place a redemptive health system for Nigeria.

Nigeria needs a health system. But not everyone knows what exactly is a Health System and how it should work

We know about health and we know about a system-a system is an arrangement ;a procedure. It’s like a network; from the smallest clinic in the remotest village to a teaching hospital in an urban centre. A health system  is that system that enables a patient to move from that village if they can’t get the type of care they want to a General Hospital or for a comprehensive health care in teaching hospitals?

Egbo:'We need a health system not just buildings and a medical equipments'

What are the signs and symptoms you must see to conclude that a country has no health system ?

If you cannot get data or accurate data when you want them, it’s a faulty system. If you go to a hospital and you can’t get service’ it’s a faulty system. If you get prescription and the drugs are not there, it’s a faulty system. And if  doctors are always going on strike, it shows we don’t have a system because if we do doctors won’t be going on strike.

So, how can we understand the relevance of PATHS2 in the context of Nigeria’s health anomalies?

PATHS is Partnership for Transforming Health Systems. The word Partnership shows that we all have a role to play- government-the donors, the private sector, the nonprofit organizations and the media in  Transforming healthcare from the poor state  that it is now to an optimal level, making sure that a system exists where people can get data and information about diseases and what they can do about it, making sure that government is responsive enough to provide what they need to provide to make the health system work, where the public and private sectors are working together, where the donors have one plan- not several vertical programmes.

Are the problems in the health sector basically that of funding?

I think it’s  more of a governance problem.

Why did you say that?

Because Nigeria is a rich country. We are rich enough to provide financial and technical assistance to other African countries-even some Asian and Latin American countries. So, it’s the wrong attitude to governance. We have had years of military rule  such that nobody paid attention or took time  to put in place systems. We have so many  uncompleted health infrastructures but nobody is looking at attitudinal change.

What are some of the expected changes at the end of PATHS2?

At the end of PATHS2 we would have succeeded to the extent that government is no longer depending on donors but are putting our own money on health care and that a system will be in a place and there will be a connection between the local, the state and the federal and that the communication would be both ways-top down and bottom up.

What does that translates into-as far as improving the health of the people is concerned?

What it translates to is that within their community, there is a system where they can get health care services, they don’t have to go too far. Drugs would have been made available. The doctors and the nurses would have been trained and knowledgeable. If they are not able to get services within their domain, there is a referral system that takes them to the next level. There is a logistics system that helps them get to the next level.

What do you see as an impediment in actualizing this very lofty picture?

Attitude is a major impediment and if we are not able to change the attitude of Nigerians and government both at the federal and state levels, if we are not able to carry out the kind of campaigns and social mobilization towards attitudinal and behavior change, if we are not able to make our people and our leaders responsible and see health as a major issue, then it will be a big problem. Also, if politicians decide they are not going to assist to make it work. Currently, health is not critical part of the seven point agenda and if at that level they do not see health as  important then it’s an issue because a healthy nation is a wealthy nation.

Nigeria's Minister of Health,Prof Babatunde Osotimehin:Would he bequeath a redemptive health system to Nigerians?

Despite these problems, are there any states you want to single out as doing well?

Of course there are some best practices within the states as far as good governance in relation to healthcare is concerned.

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Dr.Bode Falase is a Senior Lecturer and Consultant Cardiothoracic Surgeon at the Lagos State University Teaching Hospital(LASUTH).He currently heads the Cardiac Centre in LASUTH which arguably is the only cardiac centre in the country. “We have done 13 heart surgeries in Nigeria and can still do more”, Falase assures. He spoke with Kingsley Obom-Egbulem on the state of cardiac operation in the country and  the pioneering efforts of the LASUTH Cardiac centre.

A surgeon at work in one of the opeating theatres in LASUTH:source:LASUTH

Dr Bode Falase:"We can do heart surgeries in Nigeria"

An open heart surgery:source digitaljournal.com

Do Nigerians know a place like this exists?

There are a lot people dying of heart disease who shouldn’t have died if there were enough funds to procure heart operation. We have the facility here and the human resources to do heart surgeries in Nigeria.

Not everyone would believe your claim.

It takes a well equipped operating theater and an intensive care unit(ICU) as well as nurses trained to care for patients who have undergone heart operations within the ICU. Of course you need a team of professionals for the surgery. You need a cardiothoracic surgeon(someone like myself),a cardiologist who is interested in the case, an anesthesiologist ,about three to four nurses trained  to assist during cardiac operations and you need a perfusionist and I can tell you that we have in LASUTH the only working Cardiac Clinical Perfusionist in Nigeria. We have all these personnel and the equipments to do cardiac surgery here.

Why do  people still travel overseas for heart operations. It  seems they  don’t know there is a cardiac centre in Nigeria or it is a vote of no confidence or the usual preference by Nigerians for anything foreign?

I think most people don’t know this Centre exists. This is the first and only Cardiac Centre in Nigeria. I stand to be corrected. It was equipped by the Lagos State government. We have done 13 heart surgeries since it was set up two years ago. And before I took over I had come here on Cardiac mission with some foreign cardiothoracic surgeons and we did several surgeries here. The equipments were here and the patients all doing well.

Does that mean you were poached from oversees or what?

I went to study abroad and after my studies, I decided to stay back and work and have been here on some cardiac missions twice and  I said to myself, why can’t we have something sustainable and permanent that can not only make cardiac surgery accessible to many people but also make it affordable?  A heart mission is supposed to jump start the process. But we  must have facilities and systems in place to continue. The cost of Cardiac surgery abroad aside the direct medical cost include  return air tickets for the patients, an accompanying  relative, a doctor from the referring hospital here, hotel accommodation and feeding, daily subsistence allowance-all of these puts the cost of the surgery at about N4million.So we are saying that amount can be used for as many patients as possible and we still achieve the same results but this time the results are spread among many patients and the center is kept running and active.

So, why do people especially foundations involved in raising money for heart operations still go abroad?

People will still go abroad, they have a right to access care anywhere  provided they can afford it. You can’t stop them. But  there are many people who can’t afford heart surgery even here let alone abroad..and the cost of one heart operations abroad can pay for two or more people like that here. So, we are saying, let’s extend help to these ones by doing the surgery here since we have what it takes to do it and we have done it and still doing it.

How many people do you  currently have on your waiting list who require heart operation?

I don’t like keeping people on waiting list when I am not sure when help would come. Here people die  while on  the waiting list and I hate to see that happen. I am hoping that some companies or  foundations will come and say we have this amount of money how many operation can you perform with it? And I can assure you if we have money for 10 operations today we will do it.

You said you have all the human resources, all the hardware needed for a heart operation so why do you keep saying you  need money. Why not just go ahead and do the surgeries?

At the time this centre was set up, we had a lot of consumables, drugs and other stuffs needed for post  cardiac surgery care and so on. The drugs cost money, even providing the care cost money and government have taken the first step to provide these materials then. But we have used them up for the surgeries we did. So, for any other surgeries  to take place we have to restock  and these are basically what we are saying. But there is a comparative advantage and that is; you can never compare the cost of doing heart surgery here and elsewhere whether it is a private hospital or overseas. Here we can save more lives with the same amount spent on surgeries abroad and that is the leverage we want Nigerians to explore in saving the lives of fellow Nigerians.

First published in News Digest International

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Patients in a hospital ward:How many them will not live due to negligence?

Patients in a hospital ward:How many them will not live due to negligence?

By Kingsley Obom-Egbulem

Like most people, we all went into 2009 with so much expectation. If you are a Christian in a country like Nigeria, in line with the usual “prophetic declaration”, your pastor must have given the year his or her name, thus changing the year 2009 to “ year of endless harvest”, “year of sweat- less success”, “year of soaring on eagles wings”, and this popular one, “year of laughter”.

I am not too sure what the year was called in my place of worship. But whatever name we called the year, was almost eroded by a terrible news we got less than one week into 2009.

“Have you heard the sad news?”,that seems like my happy New Year greeting that morning. I had just settled down to business that day which incidentally was my first day at work in 2009 and my colleague, who must have suspected my need for some updates sauntered in and announced the unexpected news. “Sister Nwugo died last night”.

You can imagine the reaction that followed the bombshell.

Nwugo Okoye was until her death, the Head of Corporate Communications at Etisalat-one of Nigeria’s mobile telecommunication companies. Before moving to Estisalt, Nwogu  had worked as Manager in charge of Internal Communications at MTN, this was after over a decade of robust practice in the advertising  industry.

She was good!

Nwogu’s fruitful and vibrant life was cut short after a failed Myomectomy ( an operation done to remove  fibroids while leaving the uterus intact).

She went into the theatre certain she would make it. She could afford to have the surgery done anywhere in the world. But she chose to have it here. Was it a gamble? Did Nwugo commit suicide by opting to remove  a disturbing fibroid here in Nigeria –a simple surgery  many other women have had and came out successfully in Nigeria? Was she just another addition to the growing list of medical accidents we all have to put up with in Nigeria?

Less than ninety days before Nwogu’s death, somewhere in  London, Omoye Bode-Alabi had gone for an even more complicated surgery. Considering the nature of the surgery, she didn’t want to gamble, or so it seems. Unlike Nwugo, Omoye never thought she would make it. “I had to settle all outstanding issues, my will, and other issues that needs to be resolved, something just kept telling me I wouldn’t  make it; so I didn’t want to leave any problems when Im gone”.

Omoze made it. She is still alive , hale and kicking.

A public health physician recently said that in resource-challenged settings like Africa, more patients are likely going to die  in hospitals due to medical accidents occasioned by negligence than the impact of the illnesses they are suffering from. This, according to the doctor, is a global fact, even if it appears  questionable and only applicable to developing countries.  But is this a rule in Nigeria or an exception? Can this pass for a rule that must be obeyed by hospital users and people who will have cause to see any doctor and be eventually admitted or it is an exception we should not bother about?

In the wake of the June 12 Celebration last year, a few Nigerians in Lagos were mourning and preparing to bury one of the best female voices on radio -at least in the last decade. Adetutu Badmus, former  Radio Nigeria Network news caster, fantastic compere’ and gifted voice-over artiste had her voice on over half of all the radio commercials produced in Nigeria. She had just moved from Radio Nigeria to LTV 8 as Head of Programmes and Content Management. Many of us were already looking forward to a revival in that stations programming policy and consequently its quality of programmes. All of our dreams suddenly turned into nightmares.

Tutu died in the labour room of a tertiary health  institution in Lagos, less than a year after her wedding.

Again, did she commit suicide by opting to have her baby in Nigeria since she could afford to have the baby abroad?

Incidentally, Tutu’s service of songs was officiated by Gbenga Adeoye ,a Pastor with the Seventh Day Adventist Church, who lost his wife a year ago in circumstances similar to that of Tutu. Adeoye said the doctors who attended to his wife  had a case to answer. Though they’ve buried their mistake, Adeoye believe “God will judge them for their negligence”.

Dr. Badmus, Tutu’s elder brother said he is not just sad that he lost his kid sister , but that he is sad that his sister died a needless albeit avoidable death. And being a doctor himself, he certainly knew the undercurrent of Tutu’s death.

Without  casting aspersions on our health system or passing a vote of no confidence on our medical personnel, truth is: we are fast building a health system that swallows its patients.

It is becoming dangerous not to have some working understanding of basic diseases and possible therapies and (depending on your faith),a team of prayer warriors or Alfas interceding on your behalf before seeing any doctor these days. You may end up being a cadaver( a corpse good only for teaching medical students in teaching hospitals) if God doesn’t show up on your behalf and avert an accident or negligence.

Three of my friends lost  their dads to this chain of medical accidents and it continues to form their attitude towards medical care in Nigeria.  The first one, her dad suddenly started convulsing(or so it seems)and was about to kick the bucket. He was taken to the hospital and they found out after some tests that his  blood sugar level had risen far beyond normal. He was immediately  given some medication to bring down the sugar level at last close to  normal. But the drug had an adverse effect on the man .He was given more than he required. He lost his mind and was like that until he passed on less than two weeks after.

The other two are similar even though they were in separate hospitals that were hundreds of kilometers apart. They both had hypertensive dads who were also diabetic .And in both cases, their dads had malaria  and were rushed to the hospital after some days of trying to find out what exactly was wrong. They were admitted immediately they got to the hospital and were infused with dextrose because they hadn’t much energy, food and water in them due to severe loss of appetite. Nobody bothered to know their medical history or find out whether they were diabetic or not. Can you believe that?

Of course, they both passed on ,one of them died less than 48 hours after being admitted.

Another pathetic case was that of a patient-an old  man ,who was diagnosed of hernia. He needed to be operated upon. The surgeon wanted to make it snappy  and get it done with in  no time so he could attend to other personal perhaps more important matters. To achieve this,  the patient  was generally anaesthetized-this was to put him to sleep and save him from experiencing the pain of the surgery while it lasted.

But it back fired.

The patient  responded  badly and the complication that arose was not bargained for. Considering  the age of the patient, and the fact  that he was also diabetic, some medical experts believe that he should have  been  locally anaesthetised. By this, the pain would only been relieved around the part or region of the body where the surgery would be carried out while the patient remains awake to see what was going on. That would have reduced the amount of anaesthetics in the old man’s system and consequently the length of time he would have spent out of this world.

The good news is that this patient is alive today and kicking-thanks to the hospitals massive investment in ultramodern medical facilities.

It is still too early to forget  that renown Attorney and human rights activist, Chief Gani Fewinhimi also had a taste of these of these medical accidents. Our beloved Senior Advocate of the Masses and of Nigeria, still flies in and out of London for treatment.

Fawehinmi  is scared…yes scared for you and I who may not be able to fly abroad like him and the president when we are about  to join the  growing list of  victims of medical accidents in Nigeria.

Gani, a living  legend and a firm believer in the future of Nigeria and its potentials, had to escape for his dear life to London contrary to his patriotic principle. Gani had been on  treatment for pneumonia  in a highbrow hospital on Victoria Island.

Gani’s treatment was informed by a misdiagnosis. He go to know this when he arrived London mid last. After several  checks in London, he was confirmed to be down with cancer and had to be placed on cancer treatment. It is not clear how much damage the initial misdiagnosis had done on his health, but the truth is: if Gani had died in Nigeria before he was flown abroad chances are that doctors in that Victoria Island hospital would have told Nigerians that he died of pneumonia. And we may never get to know the truth. Never!

If this could happen to the likes of Gani and even the president(before he had to run to Germany)what then is the fate of other Nigerians?

Millions of medical mistakes are mostly premised on wrong diagnoses. Leading most times to unnecessary surgery and sometimes failed surgery which may lead to death.

In cases where the diagnoses are right, negligence and lack of respect for the patient is said to be the main enemy and when this enemy shows up in the course of treatment someone has to pay the price most times it is the ultimate price.

How do we stem the tide of medical accidents in Nigeria? How do we ensure that doctors are held responsible for negligence when a life is lost needlessly in their hospitals or clinics? How can we even prove these cases in the first place? How alive is the Nigerian Medical Association(NMA)and indeed other bodies regulating medical practice in Nigeria to the responsibilities of ensuring patients protection and standard of practice?

The Lagos State government stirred the hornets’ nest last year when it passed the Corona’s bill into law .The law ,among other things was supposed to (at least, on paper) keep doctors in check and put an end to questionable deaths of patients in hospitals. Of course the law also contained aspects considered injurious to medical care-aspects which well meaning doctors say can prevent them sticking their necks to saves lives already at the brink of death.

For now, one reality we cannot run away from is the fact that many Nigerians have died (and would still die)simply because their cases were poorly handled in hospitals. Some have gone unnoticed  and in the case where the victim is a prominent person, some questions may be asked. But like all cases, no one will be held responsible or brought to book. How can we end this  unusual epidemic  confronting ignorant Nigerians and their families lost to medical accidents? How long will doctors continue to bury their mistakes while pilots die with theirs?

Too many questions. When would the answers come?

Kingsley Obom-Egbulem, a social entrepreneur and communication specialist is Chief Creative Officer, Health Communication and Development Initiative(HCDI),Lagos and Editor-In-Chief, MANHOOD Magazine.

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