By Professor Olusanya Adejuyigbe
RECENTLY, the Obafemi Awolowo University Teaching Hospital Complex, OAUTHC, recorded a landmark by performing the first successful laparoscopic surgery in a government owned hospital in Nigeria, utilising a medical team comprising only Nigerian doctors.
As one of the first generation teaching hospitals established by the Federal Government to provide qualitative health care delivery to its people, OAUTHC has a visoin to be a leading centre of excellence in every clinical, training and support service. Its mission is to be in the fore-front of comprehensive health care delivery in Nigeria.
But several years down the line, has this health institution fulfilled its role of providing affordable cost- effective integrated healthcare service designed to secure improvement in the physical, mental and socio-economic well being of the people of Nigeria?
In this interview with SOLA OGUNDIPE, the Chief Medical Director, Professor Olusanya Adejuyigbe, speaks on the challenges, successes and future expectations of the healthcare institution. Excerpts:
What are the challenges facing the OAUTHC?
We inherited structures that were not designed for tertiary institutions because, contextually, this institution was founded on the expectation that we would utilise the existing structures and since then, there has been need, both in the care and complexity of services we render that has necessitated the need to upgrade what is on ground and, if possible, build new ones.
The end result of that is that in the last few years we had to put in place structures to meet the challenges of increased patronage and popularity of services.
The maternity hospital is the same we have been using since inception of the medical school and teaching hospital is the one inherited from the state with few modifications. Definitely it is outdated and there has been the need to put up a modern facility that will take care of pregnant women and their new born babies.
When we started, some of the specialities we have now were not in existence. Our needs, at that time, were fairly modest, but now we have some specialities in various branches. Examples are open heart surgery and laparoscopic surgery. These would require new facilities, so there has been the need to improve on our infrastructures.
Government has approved our various budgets but we face tremendous challenges in getting the funds released. The government should please appreciate what our immediate needs are and make available to us funds needed in executing all these projects.
Does this health institution have what it takes to make people at the top, public office holders such as President Goodluck Jonathan, patronise your facilities with confidence?
I’ll tell you that 95 per cent of people travelling abroad are not going strictly for medical reasons. I cannot say we have all the infrastructure and personnel on ground to take care of all medical conditions, but there are variety of reasons why people choose where they go. Many people go not for medical reasons alone and sometimes they will not want to voice out why they go out for the treatment.
For a better illustration, many women decide to have their babies abroad, not because babies cannot be delivered in Nigeria, but they might want to increase the likelihood of wanting their babies to acquire foreign passports in future. And that is not medical reason.
The truth is that our expertise and equipment are currently underutilised and if public office holders partronised us, it would have been an advantage in that it will give the local people a sense of appreciation that the President, Governors or Senators and their wives come here for treatment. By doing that, they will know what next we are in need of. We would have a dual advantage of being appreciated and our leaders will see the need to invest more in local infrastructure and human resources.
For instance, we do renal transplant here but our people still go to India for this same treatment and the reason is that culturally, our people are reluctant to donate part of their bodies even to help a dying relation. In India they will only pay and get a kidney of unrelated person which has a reduced chance of survival in them. Although they will survive the post-operative period because they will be on heavy doses of appropriate drugs but down the line the consequences will show.
Recently the Minister of Health said a restriction had been placed on public office holders going abroad for medical treatment, yet government officials still rarely patronise local health institutions. How do we rationalise this?
Only our leaders can answer why they travel abroad for medical treatment but I can assure you that trying to protect oneself is a personal issue. We have managed some Governors, their families and notable personalities in this hospital but that does not mean they cannot patronise us more.
How much is the budget you are talking about now and what would be adequate budget to finish these projects and make them functional?
This year, the budget we have is N405 million. Last year, the government did not release up to N410 million. Ideally, if the left over balance is given we would have completed some of the on- going projects we have started either buying equipment or building structures.
Each year, we now have projects which we have started with approval without such projects being completed because what they gave is not enough to complete them. Contractors will also complain that the bills of the previous year are no longer valid.
This year, we have a lot of projects going on in this hospital and our fear is that if we are going in this way, it may be difficult to catch up.
When the Executive failed to give you money at the right time, why were you quiet?
We were not quiet. There are periodic records given to appropriate government officials who are monitoring and supervising some of these things. They know what is happening but sometimes the solution may be beyond the immediate supervisor because he himself is in the same straight jacket because the money is not with him.
Is it an issue with the Central Bank of Nigeria?
It is not only the CBN. It can speak for itself, but I believe it is when they are instructed to pay that they will give out the money. From our interaction with CBN locally, we realised that whenever our money is credited into our account, we can spend as per amount released earlier into the account, we can spend by approval.
I don’t think there is any supervisory agent that does not know the plight of various parastatals under its provision. We tell them our problems and whenever documents are needed we show them and they collate it and forwarded it to another arm of government.
Where do the Minister of Health and Commissioner of Health come into the picture?
They supervise us and make us follow government policies. Our money is not released through the Ministry but directly into our account through the Central Bank of Nigeria.
Do they speak on your behalf?
Yes, they do; they follow us to the National Assembly, which would agree with us, but at a higher or parallel level they would collate all that is needed and divide by what it is available. And there is also competing interest and it is those who are able to set priorities right that get whatever is being offered.
What is your own priority area in their hierarchy order?
We now have more experts in certain areas and we believe that if these services are adequately rendered, the health of Nigerians will be better thereof. For example, the maternity we have been using has been there for years and it is no longer adequate to cater for the number of pregnant women we now attend to now. We therefore decided to have a new maternity that will take care of the pregnant women and for them to be little comfortable after delivery.
The hospital being on a major highway always gets accident victims which has made our orthopaedic ward a trauma unit to the extent that we might not have beds for patients some times. When this hospital started, we had just two surgeons who are both late but today, we have seven .
The situation would have been better if we had about four hospitals of this cadre, serving our catchment area because at times we engaged in some areas that should be carried out by state, general or primary health centres. But the public will want to partronise teaching hospitals because of their belief that there are reasonable measures of expertise and equipment that will attend to them.
The more you get better, more people get even where they ought to be assisted, the facilities are not there. Teaching hospitals in this country serve as primary healthcare centre, general hospital, specialist hospital and tertiary health care centre. In addition to that, there are burden of municipal services we need to carry like provision of water, electricity, amongst others.
Where do you think OAUTHC should be as at now?
We should be here providing high quality tertiary health care in all specialist areas of medicine. We are able to do some but we are handicapped in some others where we have trained personnel. For example, we have our transplanting; they can do more with a little help particularly in funding of the processes.
It takes about N3 million to carry out and care for a patient who needs renal transplantation. As at today many of the patients who come to us cannot afford it and they are not happy. We would have been able to virtually do one procedure everyday if virtually everything is on ground personally. But there is no donor and people do not have money to carry out the surgery.You see a patient in your care wasting away in spite of the fact that you can help and it’s a big frustration.
Another is in the area of open heart surgery. We have established but we are yet to have the advantage because of the cost per patient which is quite exorbitant. Many of the patients are not able to meet up with their bills.
There is need for expansion of our infrastructure base to take care of increased patronage and personnel we have on ground. We have set up and provide a minimal heart surgery and recently our gynecologist did a minimal laparoscopy.
We are also setting up a cardiac care unit which is about 40 percent complete; we hope to finish it this year but I am afraid if balance of what we need is not released we may not able to finish it until next year.
What is the implication of this?
The implication is that your vision will be delayed but we pray that they will still be actualised. It is very frustrating because your people no longer believe you and it is also frustrating to the man at the fore front because he is handicapped.
But there is a greater danger in that Nigeria is not building a culture of providing a high healthcare simply because everybody believes we cannot afford it. Up to 99 per cent of what Nigerians need in terms of tertiary health can be provided in our current situation. If we upgrade our facilities regularly, encourage people to train and improve themselves from time to time.
Do we have enough hospitals to cater for us despite all these short comings or should we be thinking of merging hospitals?
We can do e-banking but not e-health because banking only involves figures without touching the money and still be credit worthy. There is still no subsidy for care giver and receiver in medical practice.
What is it about e-medicine?
E-medicine only allows me to do distance consultation and sharing of opinion. I can be here sharing opinion with my colleagues but you cannot be in Moscow and operating a patient in Ile-Ife. There will still be someone who will be on stand which is physical factor. Part of care is to share, talk to me, I respond and you share from my perceptive which is yet not mechanised.
On merging of hospitals, we do not have enough hospitals in the country for the kind of population we are having. We can debate on the type of hospitals we should have. There must be a health care centre closer to the people at the grass root level which they can access in case of emergency but that is not obtainable at the moment.
The success of many hospitals in Western countries is the decentralisation of health care; the people will have the opinion of someone who is trained and then transfer if there is any need for such.
What we need in Nigeria is building of bases because it is not everything that should end up in tertiary health care centre. We do not have enough of those lower health care facilities to meet up with the need of our population. I am not saying there should be hospitals in every senatorial zone or district but there should be a centre where can have access to high quality care.
How affordable are these medical practices?
We are affordable and as you know that we are not practicing free health where the recipients of care are not paying but that does not mean that nobody is paying. It is free to the person receiving but somebody is financing the giver. In some countries where such things are done the rate of taxation are usually higher than what we are paying here. Another limitation is that most of our inputs are imported, if they are manufacture locally after a long while they may be cheaper.
What will you like to be remembered for in this tertiary institution?
That I have increased the service base of Obafemi Awolowo University Teaching Hospital, Ile-Ife. People now have better and improved services both in quality and varieties than before.
What did you meet on ground and what have you done so far?
We have been able to establish a gynaecologic oncology unit, put up structure for organs transplantation, start minimal access surgery, start open heart surgery unit. In diagnosis, we are able to improve on what our laboratories are able to offer in varieties of tests that we are not able to do before now like Immunohistochemistry process. There is improvement in diagnosis we were not able to offer before now both in radiology and laboratory. Also we have ability to do DNA and paternity tests.