By EBELE ORAKPO
Nigeria has lost and is still losing a lot in both human resources and finances due to lack of infrastructure. Hospitals which need 24-hour power supply have to rely almost entirely on diesel-powered generators despite the high cost of fuel. This in turn raises the cost of health care in the country.
In the health sector for instance, while India makes millions of dollars each year through what has come to be known as medical tourism whereby patients from different parts of the world are referred to hospitals in India for treatment, Nigeria, with some of the brightest and best in the medical profession is losing her professionals to countries that have infrastructure in place for them to work with.
In this chat with Sunday Vanguard, Dr. Ebun Bamgboye, consultant nephrologist, head, Dialysis and Transplant Unit, St. Nicholas Hospital, Lagos, speaks on the cost of doing a renal transplant and the average number of patients in a year. In Nigeria, the cost is $20,000 in the only privately run unit, while it is an average of $15,000 in the publicly run units.
CAN you give an estimate of the number of kidney transplant patients you have in a year in Nigeria?
On average, both patients that we transplant and patients who decide to go elsewhere, wonâ€™t be less than 50 in a year in this unit alone. And if you consider that there are at least 50 other dialysis units, you can imagine the number of patients who dialyse in those units and who because they donâ€™t have transplant facilities, are referred abroad. So I am certain that there canâ€™t be less than 200 (kidney transplant) patients per year and the average cost, if you go abroad to do a transplant, is about US$30,000 about N4.5million.
Now you realise that in order to save cost, most of the patients who undergo kidney transplantation abroad donâ€™t stay long enough for follow-up, is that not a problem?
Not only do they come back, most of them are ill-advised.
Donor and recipient
Unfortunately, you now have Nigerians who have taken it as their means of livelihood.
To refer patients abroad?
Yes, to refer patients. Not only are they involved in that, they are also involved in very unethical practice of actually helping them to look for commercial kidney donors. Not only are they doing it, they are actually cheating both the donor and recipient because they would collect a certain amount (of money) from the recipient and give only a fraction of what they have collected to the donor. Unfortunately, it involves people that one would have thought should not ideally engage in such things because it is completely an unethical practice which the World Health Organisation (WHO), the International Transplant Society and International Society of Nephrology have condemned. We now have what we call the Istanbul Declaration which frowns at organ trafficking, transplant tourism and trafficking of organs generally. They are encouraging member-countries of the United Nations and WHO to enact transplant edicts that forbid the commercial use of human organs.
Is there any penalty in place for anyone caught?
Unfortunately in Nigeria there is no transplant edict yet so that is why even if they are caught, there is no law to try them by. That is why the Nigerian Association of Nephrology has been trying to encourage the enactment of a transplant edict. We have passed the document to the government through the Federal Ministry of Health in the past and I think at the last meeting, we decided we were going to submit the same document to the current minister of health, whether that has been done or not, Iâ€™m not sure. But the unfortunate thing is that there are certain countries of the world that have more or less become pariah countries on account of this transplant tourism. They include countries like Pakistan, Philippines and to some extent, India. Even South Africa at one stage, there was an episode that was reported where they went and brought patients from Mexico, Jews from Jerusalem and then they came to South Africa to do the transplant. Eventually, the people who were involved were caught and they had their licences withdrawn. I think something similar should be done here. Right now, we are not one of the countries mentioned when it comes to such things but we need to prevent it from escalating to an extent where that happens.
We’re aware India is earning millions of dollars from transplants, do you think Nigeria stands to earn foreign exchange from the health sector as India is doing if the government can set its house in order by putting in place the necessary infrastructure?
Not just from transplant but from medical tourism. India has now become a very popular destination but I think what government should do is to encourage the development of infrastructure to support an active transplant programme in different clinics in the country because we have the skills and the knowledge. We have what it takes to do it.
How much do you think the country loses yearly by sending patients abroad for transplant
We have been talking about those going to India which is relatively cheaper. Some people go to the UK. In the UK, kidney transplantation is about 20,000 pounds (about $US33,000) per transplant. For those that go to the US, it is US$200,000. In South Africa, it is probably about US$40,000.
But it seems more Nigerians go to India than any other country?
Yes, because relative to the other countries, it is cheaper. You know India is to a large extent similar to Nigeria in so many respects. You have a wide spectrum in terms of quality of what you can get. You have some centres that are as good as any centres anywhere else in the world, you have some centres that are so poor that I donâ€™t think I can take my dog there.