Views and comments,profiles and efforts of Nigerian doctors living and practicing overseas.
JOHN NWOFIA: interventional physiatrist & rehabilitation specialist
For a Nigerian running a thriving private medical practice in the United States, Dr. John Nwofia certainly have scaled several high huddles ahead of being certified by the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The fascinating truth about these achievements is that he was actually prepared and toughened ahead of time for these challenges at the University of Lagos medical school.
“If there was one thing I was sure of it was that I wasn’t going to practice in Nigeria, so I had set my mind and eyes to practice overseas right from my days in UNILAG.”
That dream was so compelling that he started pursuing its realization less than eighteen months after graduation. He stared his post medical school training in the United Kingdom, in Orthopedic Surgery, from May 1990 until his move to the United States in June 1994.
He completed an internship in Family Practice at the Henry Ford Hospital in Detroit between June 1994 and June 1995. He then completed a residency in Physical Medicine and Rehabilitation at the Schwab Rehabilitation Hospital/University of Chicago Hospitals program between 1995 and 1998 where he served as a chief resident in his last year.
His years at Schwab Rehabilitation Hospital and the University of Chicago Hospital were critical deciding moments as those years were just all he needed to make up his mind about becoming an entrepreneur and still practicing physical medicine at its best.
“I am specifically trained in the areas of electromyography, as well as diagnostic and therapeutic spinal injections hence my area of interest is in the treatment of spinal disorders and chronic spine related pain management with the implantation of Spinal Cord Stimulation leads.”
Armed with this capacity, Nwofia founded Pain and Spine Consultants Incorporated, a private practice he started in 1999 in the south Nashville area. In 2002 the office was moved to its current facility in Brentwood (Cool Springs). Pain and Spine Consultants Inc. currently has four clinics-one in Brentwood, one in Nashville as well as in Lebanon and Smyrna and Nwofia provides leadership for this team of mostly Americans as Medical Director.
Pain and Spine Consultants Inc. according to Nwofia is concerned about patients suffering from spinal and musculo-skeletal conditions as well as physical disabilities. “And the unique thing about what we do is to provide none surgical care of all spinal and musculo-skeletal conditions focusing mainly on returning the impaired individual to full function as soon as possible with emphasis on prevention of further injuries.”
Like some Nigerian doctors practicing overseas, Nwofia visits his home town, Aguleri, in Anambra State regularly on medical missions and his feedback from the last medical mission is a warning every Nigerian can’t afford to ignore.
“Three out of every five adults we met had undiagnosed hypertension and diabetes and that is not good for the volume of disease burden the system would have to cope with in the future. I think we should actually be spending less money detecting and preventing diseases other than the millions we spend on treatment”.
Excerpts of the Interview
In this interview, Dr.NWOFIA, shares his views on health care in Nigeria and the challenges of running a private practice in the US.
What is your opinion about the Nigerian health system especially with your experience overseas?
It is hard to make a justifiable comparison. Nigeria remains a 3rd world country with more human resources than most other 3rd world countries. America spends about 10-15% of its expenditure on healthcare while Nigeria spends 3% or less. Now, if the 3% spent would get to its destination, we may have something. At this stage we are fighting for quantity of care while the quality keeps deteriorating. Cuba is a 3rd world country with western world care standard. They made the best with what they have because the leaders have remained consistently committed.
You run a thriving private practice in the US with a couple of American doctors in your employment. What have been your experience, lessons learnt and your biggest challenges?
Anyone with a practice, whether a small or large one, will face some unique challenges. The experience can be rewarding once you pass the growing pain period. Doctors are not taught to be managers. You learn that on the job and on the run. At some point, when the practice can afford it, one can hire a professional to do the administrative part. But until then, you have to delve into it and learn along the way. You are forced to learn about contracts, employment laws, hiring and firing and how to protect yourself. America is almost unique in its situation. You have to practice defensive medicine. In the end, the goal is to be able to meet your obligations to your patients, yourself, your family and your staff. If we can achieve that, then there is no better reward.
At what point in your career did you decide to leave the country and what was the major attraction?
I never really saw myself practicing in Nigeria as I was finishing medical school. It is very sad when you look at it. I knew I could not be a general practitioner, knowing the situation on the ground. I also knew I could never take the abuse the resident physicians go through under the specialist consultants in Nigeria. I remember when I was in the UK, about 18 months after our graduation, I counted 42 members of my class were resident there. This did not include a similar number that had left for the US.
If you are to advice the president on health or you are the minister of health, what would be your major policy decision?
They need a sustainable plan. And I mean sustainable. Everyone has ideas that seem to change with each government. There is no one easy fix for the healthcare situation, but if we took a plan, followed it fully and sustained it, we can move on to another. Grassroots care, for example, is one. N150,000 a year can treat 50 diabetic patients and obviate the need to spend N3million to buy the dialysis machine (to treat the 20 people that can afford it a year) that treats the avoidable kidney disease.
What informed your decision to specialise in physical medicine?
It was just a personal decision. I started with Orthopedic training in England and got tired of the calls and emergencies. I treat patients with rehabilitative issues and spine related problems. I now specialise in improving the quality of life as opposed to saving life.
“Doctors on strike” have become part of the lexicon in the practice of medicine in Nigeria. What do you consider the most pressing structural or systemic issue responsible for this anomaly?
Unfortunately we are still a long ways from reaching the end of this. When you have resident doctors and specialist doctors on the same salary structure, it becomes either unaffordable for all, or disenfranchising the specialists if the pay structure is lowered. In the UK and the US, when you are a resident physician, you know it is temporary and you do not complain about your pay. But then you know that when you have done your training and paid your dues, you will be compensated. The market forces determine the specialist physician’s pay while the institutions determine the trainee doctors’ pay.
The quality of education in Nigeria is said to be dwindling. What’s the implication of this on practice of medicine and the health sector generally?
It is obvious. In the end, the patient suffers. Everyone loses.
You’ve been away for over two decades. Can you share briefly, memories of your days in UNILAG and stint in Nigeria before you left overseas?
I always describe my stay in UNILAG as “ I fought hard to get in, fought hard to stay in and then fought harder to get out with my diploma”. In those days, if you graduated from the University of Lagos medical school, you were not scared to go anywhere. It was like nothing thrown at you could shake you anymore. Not that we were the smartest, but we had been toughened. As hard as it was, it was not without the special fun in Lagos. I think I would do it again .I was on call for a month (my 2nd month during houseman ship) in Cardiothoracic surgery. The other intern took a month long leave. I remember my day out. I felt like I had been released from prison. Literarily.
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JIMI COKER: Consultant General Surgeon and Coloproctologist
Though resident and practicing in the UK, it may be somewhat inappropriate to describe Dr. Jimi Coker as a Nigerian in Diaspora. And the reason is simple: he knows Nigeria inside out, and even contributing more to improving the health of Nigerians more than several doctors living and practicing here.
A graduate of the University College Hospital,(UCH) Ibadan, Coker visits Nigeria up to four times a year on large scale medical missions and he pays his bills most of the time. Not many people would find that funny. But it happens frequently and that has been the experience of Dr. Coker.
Currently a Consultant General Surgeon and Coloproctologist, Coker qualified as a doctor from the College of Medicine, University of Ibadan, in 1984. He went to the UK in 1987 for postgraduate training in general surgery. After completing his higher surgical training in North Trent and South Yorkshire, he was appointed Consultant Surgeon with specialist interest in colorectal surgery at Doncaster and Bassetlaw NHS Trust in 1999.
In 1999, Coker joined the Tropical Health and Education Trust(THET) as surgical instructor with annual visits to Northern Ghana for basic and emergency surgical skills courses.
In 2008, Coker was in Nigeria to conduct training for surgeons on how to use surgical staplers as a means of improving the quality of surgical operations in Nigeria.
The Nigerian health sector is definitely not one anybody would want to celebrate. But rather join the mourning party, Coker is making his contributions toward building capacity of surgeons so they can perform safer and better surgeries thereby improving the lives of Nigerians. These surgical trainings are often rounded off with series of free surgeries as part of a larger medical mission.
Perhaps, it won’t a bad a idea to hear from this man who “lives to operate” on what exactly makes for a successful surgery?
“The essential components of surgery which I believe contributes to the success of any surgical operation include good access and exposure to the part you want to operate upon, adequate blood supply, absence of tension, meticulous technique and above all ,good judgment on the part of the surgeon”.
Dr. Coker says though certain variables such as the regulatory environment, economic and social status of the people, standards of care and practice and prevalent diseases has a huge role to play in the quality of surgical practice.
“Some surgeries may be difficult if you are operating on parts of the body that are difficult to reach like in colorectal surgery in men. There is also the case of poor illumination which may even make it difficult to see very well what you intend to operate on. Such cases call for good judgment in other to come out successful”, Says Coker.
Editors Note:This Page is updated regularly.Readers are encouraged to send contacts or profiles of Nigerian doctors in diaspora.
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