It’s hard not to hate Nigeria’s Assemblymen with their budget of N150 billion for 469 men who keep us dying and a national health budget of N260 billion for the 169 million of us…
In the year 2000 I took the Hippocratic Oath upon my induction into the medical profession. I swore to respect my teachers and the training I got as well as to honour my obligations to society. Being induced into the ‘fraternity’ of doctors, it is sometimes difficult to lash out at malpractices by members of the field, but the oath yet compels me to do the very thing. But our duty as human beings in every profession is to fulfil our obligations to the best standards with conscience and commitment, or quit.
On my way to Nigeria this May, coming to eagerly witness the transfer of power, I flew through Dubai. As I interacted with various Nigerians I met at the airport – something I try to always do to get to know people better – I was shocked to discover that (perhaps by coincidence, though unlikely) every last one of over six Nigerians I happened to talk to were on their way to India for one form of medical therapy or another.
Upon reaching Nigeria, I observed on DSTV the repetitive advertising of some Dubai Health City or the like.
Nigeria is a patient farm. It is no news that billions in foreign exchange is harvested from Nigeria every year in the patient drain to Asia, Europe and the Americas. Travelling abroad for health care is no longer a thing of only public officials and the affluent, but now a routine for all and sundry who raise funds by any means to sojourn to wherever they can afford for ‘better care.’
We are all too familiar with the cases. Here are a few personal ones: a colleague’s dad was being treated for prostate cancer without proper investigation. Turned out his prostate was in normal condition and he rather had a different, undiagnosed terminal ailment. A friend’s breast cancer X-ray was not labelled and the biopsy specimen also got misplaced. There was no way for her verify if her cancer was estrogen receptor positive. A man I just met who was being treated by a supposedly best cardiologist in a ‘best’ hospital in Lagos. The doctor for some reason was giving him largactil for his heart condition. He ended up with pericarditis and ran to Israel for surgery. A friend’s wife with abdominal pain was treated for typhoid. Near the point of death she ran to India and was diagnosed with end-stage liver cancer. They opened and closed her, seeing “it was too late to operate,” and she died on the return flight. I was being treated for typhoid by one of my teachers. I got emaciated and terminally weak. Fortunately a brother’s colleague took me over, said all I had was malaria. Gave me choloroquine and I lived. Several people I know on admission have died with no adequate blood thinners and post pulmonary embolism anticoagulation. The cases are too many to recount.
The problem is multidimensional.
The Nigerian government over the years has made worse of a bad situation. Medical training has plunged; government hospitals have largely failed to develop and remain poorly funded and equipped with under motivated, perhaps undercompensated staff prone to strikes. Below are some of the issues that need serious and urgent redress.
Quality Control, QC
Whereas in the ‘developed’ and serious world, the government institutes QC practices with routine visits to Health care institutions and laboratories to inspect facilities, test equipment, reagents and re-evaluate personnel, Nigeria hardly does so. QC is a fundamental necessity for consistent delivery of quality care.
QC extends to regulation of service providers. Medical doctors post-graduation in Nigeria are left to literally expire. In serious countries, there are biannual and annual recertification exams. If you fail to prove your upgraded competence in latest practice your licence to practice is suspended.
Malpractice and Penalties
Apart from routine monitoring of Health care records to investigate care providers, there needs be clear and popularized patient report points where patients who suspect they or their loved ones have been poorly managed can report and the reports will be thoroughly investigated. Hospitals and clinics must have ethics departments that conduct internal reviews. Additionally the legal framework for dealing with cases of malpractice must be strengthened and penalties enforced.
Upgrading Tertiary Health Institutions
Nigeria can afford to have at least one fully upgraded and modern equipped tertiary health care centre in each state. In the United States you have over 60 such facilities per state. These centres should be upgraded to the capacity to handle the most complex medical emergencies usually flown to India. With government subsidised, standardised tertiary facilities, Nigerians would be accorded the best care on time and will save capital used to purchase tickets and pay for equal health care abroad.
Professionalism and Personnel Responsibility
Common with almost all fibres of the Nigerian fabric, hospital personnel have largely forgotten their obligation to patients. Life has little value and patients are looked at as ‘sick’ and expendable. It is necessary health personnel renew their commitment to the divine responsibility they are entrusted. Physicians need not be reminded or forced to revise and update their medical knowledge. All personnel should take it upon themselves to provide the best care possible at whatever cost rather than seeing their profession as just another job.
Health Insurance and Emergency Medical Aid
The habit of turning back patients, especially emergency cases till payment is confirmed is inhumane and practically criminal. The federal government must as a necessity instruct all hospitals to never delay treatment for emergency patients. Till a health insurance system is fully in place, it is the responsibility of the government to reimburse hospitals who may have treated an emergency patient who is incapable of settling his bill. Benevolent cum government and business health insurance for all Nigerians is an urgent necessity.
Primary and Naturopathic Health Care
Primary Health care is the most valuable and cheapest branch of the Health sector. Proper investment and focus on this sector will drastically reduce the burden on the crippled Health sector allowing better optimization of what is available. Proper monitoring and integration with federal level investment in research into local and international naturopathic remedies will further reduce cost and burden.
The benefits of our government finally upgrading our Health sector are too numerous to mention. It is time we did.