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Posts Tagged ‘Health systems’

In the midst of the frenzies of the forthcoming elections, it is imperative to warn Nigerians that our votes can either make the difference between a suicide attempt or a decision to live life “more abundantly”.

By Kingsley Obom-Egbulem

Nigerians added another term-“Toxic Politicians”  to their political lexicon recently. Thanks to the Economic and Financial Crimes Commission(EFCC), who decided to dare and “ look Medusa in the face” and release what they call “list of corrupt politicians” that must be barred from contesting the 2011 election.

I was particularly impressed at the metamorphosis the list has undergone, especially since the media began analyzing its legal, political and moral implication. For me, the name “Toxic Politicians” will forever remain apt  until perhaps, our political system stops producing and throwing up individuals with toxic tendencies.

Toxic according to the Encarta  Dictionary, has to do with something poisonous: “something relating to or containing a poison or toxin ;deadly: causing serious harm or death”. Does this describe some of our politicians? The answer as always, is blowing in the wind!

And so, for any right thinking people, there is the need to start looking at our politicians from a different perspective especially when you realize that your vote can actually be a suicide attempt or a decision to live a good life depending on who you chose to vote into office.

Let’s try and paint the picture better so we can start making up our minds where we want to be in the next four years, courtesy of our votes.

Nigeria got hit by cholera this year. While the affected states were wondering what hit them, the disease had claimed over 1500 people out of the 38,000 cases recorded. It took the efforts of the United Nations for us to know this.

In many developing countries, cholera remains a disease only discussed in the classrooms of medical schools. But the giant of Africa is  battling with it and with casualty figures that compares only with that of countries like Haiti. Perhaps Haiti would not have appeared on the cholera fact sheet if not for the devastating earthquake it suffered earlier this year. So, how do we explain the cholera embarrassment in one of the world’s largest oil producing nation?

Cholera;humans struck by a preventable disease.How can we prevent such dehumanisation with our votes

Jonathan:can his Goodluck save Nigerians from these needless yet endless deaths?

Lets remind ourselves that cholera is not a natural disaster. It is not like the Tsunami or Hurricane Katrina that nature unleashed on the world within the last six years.

If my knowledge of integrated science serves me well, cholera is an acute and often fatal intestinal disease that produces severe gastrointestinal symptoms and is usually caused by the bacterium Vibrio cholerae.

We were taught that virtually the only means by which a person can be infected by cholera is from food or water contaminated by bacteria from the stools of cholera patients. Prevention of the disease is therefore a matter of sanitation. So, we can safely say that cholera occurs where there are poor access to safe water and basic facility…and do not forget that we are living in the world’s largest oil producing nation.

I love to think along health lines. Somehow, I  chose to see things from the health point of view-i.e. the health implications of several actions and pronouncements. So, one can easily decode how I interpret some of the  hollow and pedestrian political jingles  currently running on our radio and TV.

Each time I see the jingles of Atiku, Gusau, Jonathan and IBB, the questions that keep running in my head are obvious: “What did you guys do about these common diseases currently whipping out Nigerians especially in your part of the country? How do you ensure I don’t die of preventable diseases when I vote you in for the next four years? How would a vote for you ensure that I don’t die before my 46th birthday “celebration”?

With cholera harassing Nigerians and claiming the lives of children and women in their thousands lately, Im afraid that we may just be giving a nincompoop the mandate to wipe us out for another four years. The children, men and women who died of cholera in all the affected states in the north did not know they would die this year, let alone of a preventable albeit curable disease like cholera.

For the dead children, would it be fair to say that their parents voted in a governor; men and women who gave them bread and bags of rice in exchange for their  votes  only to turn out to be the ones who caused their death? How do we tell the ghosts of these children(whenever they starts haunting us) that their parents voted men who lacked basic understanding of what to do about taking care of their people.

I’m bothered!

So, how do we avoid these anomalies? How do we guard against the grim picture that our health sector connotes? I really don’t want us to reproduce that frightening  albeit gory images that have come to represent the Nigerian health sector. We can write an endless volume  trying to do that. But let me illustrate that if you are a Nigerian, living in Nigeria, you are expected to die at the age of 46 or 47.And just in case  you are way past that age, you are doing extra time or simply spending “dying minutes.” It sounds distasteful, no doubt! But that’s the truth.

IBB;

Atiku;

With incessant strikes by doctors as well as an untamable fake drug market, “the Nigerian health sector” in the words of former health minister, Professor Babatunde Osotimehin “is characterized by lack of effective stewardship role of government, fragmented health service delivery, inadequate and inefficient financing, weak health infrastructure, mal-distribution of health work force and poor coordination amongst key players.”

This is no doubt a recipe for continued drop in our life expectancy as any system so described can only create a big market for casket makers and undertakers.

So, how do we ensure that we use our votes to prolong our lives and live healthy lives? How do we ensure that we don’t vote for men and women who often escape sneak out of the country with our money to extract a tooth or change their glasses while leaving us at the  mercy of business centers masquerading as private hospitals or abattoirs presented as government hospitals? How can we end the feeling of knowing that sometimes you can die of a disease not necessary because the disease is terminal but because it infected you; a Nigerian living and trapped in Nigeria and there is no capacity or resources to treat the disease?

In May 2009,I woke up to a shocking reality and I’ve not recovered from its impact. It is an issue I know so well, but it has never been  so graphically presented the way Paul Thorn did .

I was at a satellite meeting organized by the Lilly MDR TB Partnership at the 62nd World Health Assembly in Geneva, Switzerland. The meeting was organized to provide a platform to share experiences among countries battling with Multi-Drug Resistance TB(MDR-TB) and those who have not only conquered TB but have also contained MDR-TB.
Paul Thorn, a Briton living with HIV, who also describes himself as a MDR-TB survivor (having been successfully treated of multi-drug resistance TB he contracted while on admission)was one of the speakers at the session.

“I’m alive today because there is cure for MDR-TB”, he said. “But most importantly, I’m alive because of where I was born; because I’m Briton. The British government have made provisions to ensure that no one dies of TB or MDR-TB. But many people in poor countries infected with MDR-TB will die not because they have MDR-TB which is a treatable disease but because they have governments that cannot show leadership in tackling critical public health challenges”.

That statement got me thinking seriously about my nationality and the need to get involved in health debates in Nigeria by advocating for a health system  that works with the hope of increasing the life expectancy of Nigerians.
No doubt, Paul Thorn would have died if he were in Nigeria. Those who should know won’t debate the fact that we don’t have what it takes to correctly diagnose MDR-TB let alone treat it. Need I say God help you if you get infected with MDR-TB here.

But the focus of this discuss is not TB or MDR-TB. It is about using our votes wisely in the next election to  ensure we live healthier, longer lives and ensure that our health system works. For this to happen we need to ask intelligent questions and demand intelligent answers. Armed with these questions we need to start engaging those aspiring for political offices…those  whose posters are now creating eyesores in  several towns and cities; those whose boring radio and TV jingles are offering wish lists for which they cannot articulate how they intend to achieve the promises on the wish list. Some have carefully stayed away from selling a health agenda.  We need to be sure of what they want to accomplish within the health sector.

We can’t overstate that health wise, there are no sustainable plans for today’s children let alone those of tomorrow. The aspirants are coming at us lamenting what mess we’ve found ourselves in, but with no alternative visions, no ideologies and no programmes that offer the voters clear choices about their future. No political party in Nigeria can boast of a clear road map to improve the health of Nigerians except the fact that most of them have successfully branded themselves as the ultimate platform to grab power.

A situation where someone is running for public office and does not have an idea of what to do about the health sector is suicidal. A president, governor, law maker or local government chairman who is not bothered of health bill or cannot read the National Strategic Health Development Plan Framework(NSHDPF) for instance is a disaster about to happen and we must nip that with our votes.

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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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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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