Prof. David Anthonio Oke is an Honourary Consultant Physician and Cardiologist. He was newly appointed by the Lagos State Governor as the Chief Medical Director the Lagos State University Teaching Hospital (LASUTH). He is expected to bring to bear on LASUTH, a distinguished working career that will enable him continue the drive to entrench LASUTH as the gold standard among Teaching Hospitals in Nigeria. Before his appointment, he was the Head of the faculty of medicine, College of Medicine University of Lagos. In this interview with Chioma Obinna, Oke sheds light on a number of issues about the hospital that is generating concerns among stakeholders, particularly, the impact of the on-going industrial action called by the Medical Guild. He also gave a picture of what LASUTH will be during and after he leaves office.
Impact of the doctor’s strike: There are many problems but the immediate one is this doctor’s strike, it is really affecting the provision of services to the populace but that is being handled by the ministry of health and we hope within the next couple of days, it will come to an end.
When there is a strike like this, it will be wrong to think about the financial loss because that is there but we should be more concerned about the lives that we have lost. There is no way one can actually quantify that, it is enormous. What we have done here, through the good citizens of Lagos state who are in the Association of General Private Medical Practice, who came on their own and say, let the strike go on but we don’t want our people to die. Let us put something in place that will save people who are terribly in need of medical care. Patients who cannot stay beyond three days without treatment, like someone bleeding, somebody with Gastroenteritis so that we can arrest and stop them. They have been sending doctors to us on casualty in surgery, casualty inmedicine and casualty in paediatrics.
We have lots of problems with the paediatric end because children are special people and to set ordinary drip for a child takes a lot of things but few paediatricians are there. We are having lots of problems at the paediatric unit because children are special people. To set the drip for a child is not easy but a few of them are there. We have lost lives even with that in place. There was a patient who came in, it was a massive road traffic accident, skull fracture and things like that but that case needs much more intensive care like CT Scan which is not working because of the strike. In terms of lives or human cost, it is enormous. One cannot really put a price and these are children and men who could become governor of Lagos state in future or the President of Nigeria or somebody who could win the Nobel prize, you can never say, that is why you cannot quantify it.
Do you think both parties are handling the issue well?
When you negotiate, if I want X and the government is saying that I am paying Y, the essence of negotiation is for us to say, I will give you something more than Y and something less than X. Nothing can be gained if both parties are rigid and I think the government had gone one or two steps down the line much more than what they are offering and I only hope the other party will also sit and say let us resolve this strike because we too want to go back to work and then we can negotiate whatever is left. But I cannot really give you the position of things right now because the dynamics is beyond me. I am not a member of ARD or MDCAN but we have had discussions with them. I think from what I was told, something good will come out from it.
Solution to incessant strikes:
There is need for an on-going negotiation with the doctors or whatever professionals you are dealing with. There should be good communication. I think that is probably the key. So that this would be proactive and if you have a meeting with them on a regular basis which is what the governor is proposing, that he is not stopping short of paying whatever. He wants to establish a committee which will comprise of doctors and government officials. So, issues like this before it crops up to become a really thorny one, would have been addressed and solutions would have been provided. I think if that is put in place we will have less strike and may be, in the near future, there will be no more strikes.
The issue of no-bed- space:
When a hospital is full, it is full and if you go anywhere in the world and there is a full hospital, taking in a patient would open you to all kinds of risks. If you don’t have beds, where do you want to put the patients, on the floor? No. That is why, there should be a liaison between all hospitals that once you are full, another hospital won’t be full. Once a hospital is full there is nothing we can do about it. The way out of this problem should be, if we are full, we should refer to Lagos University Teaching Hospital (LUTH). If LUTH can take them, fine, because once the hospital is full there is nothing you can do. Abroad where they have facilities, if you are coming in, the ambulance is already phoning the hospital to alert the hospital that they are bringing in a patient and if such hospital is full, they are instructed to divert to the next hospital.
What are these risks? One, if I admit a patient that I cannot care for and he dies, the hospital and I can be sued. If I admit a patient and he is lying on the floor and somebody comes in and sees that we are admitting patients on the floor, that is bad to our image. You can only admit those you can care for. That is just the simple truth about medical services. And the fact that Ayinke house is no longer around, that created a decrease in the number of beds that we have for our Obstetric cases. A lot of these patients when they come, they don’t know the difference between O and G (Obstetric and Gynaecology). They just come to the hospital. But now that we don’t have Ayinke House, we refer them to Maternal and Child Care Centres at Isolo General Hospital or Ifako Ijaiye.
Latest on Ayinke House
The Ayinke house project, years ago, was discovered that it has structural problems and we don”t want to put patients in a building that has structural problems and the ministry of works came and evaluated it and they are rehabilitating the place now. In the next 18 months we should have Ayinke House back. It is temporarily not functional now.
Will Ayinke house do the magic?
Ayinke House looks after O and G patients and there are lots of women with obstetric and gynaecology problems. We have a make-shift gynaecology extension here which is so small but most of the core obstetrics and gynaecology patients are sent to Isolo for management, although it is a small place but, at least, that is the best we can offer for now.
Coroner Law in LASUTH
That is another big problem. Let me give you an instance, I remembered about five years ago, there was a patient who came into the hospital and died within 24 hours and the coroner law is quite clear on that. Anybody you cannot vouch for as in the cause of death, you must do a post mortem. That happens to be a Muslim and the family wanted him buried immediately. And when you are faced with such a situation, you go to a morbid anatomy and say please, I have a Muslim here who needs to be buried, can you quickly do a post mortem? But the family did not even want their father to be cut up. So I was going to the ward, and somebody pointed at me and said, that is the doctor in charge and about 18 people almost mobbed me. So, I have to quickly sign because I have to protect myself first. This is just fact of life. We still have issues concerning that. The law has to be obeyed. I think what we are going to do over the years, is to try and educate people because the people need to be educated that if somebody dies, it is good to do this to ascertain what happened to the patient. Conducting a post mortem does no harm to the dead, if he or she will reincarnate.These are things we need to do to balance issues. It is workable but it is not something that I think will work immediately. We have to use some degree of prudence and wisdom and, of course, pray to God that we can move forward. We want to know if actually the man died naturally without any human interference. Some times patients take doctors and hospitals to court. But the post mortem will either vindicate you or crucify you. If we are going to practice medicine the way it should, Coroner law should be applied to a coroner case. So, the issue of culture and religion also comes in and that is why I said there is need to educate the masses.