Feat: The surgical team that performed the feat at University College Hospital, UCH, Ibadan.
By Tony Edike, Enugu
The University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla Enugu began in the early 20th century as a general Hospital for Africans built by the colonial administrators. It later metamorphosed into a General Hospital on the attainment of Nigeria’s independence in the 1960s. However, at the end of the Nigerian civil war in 1970, the then government of East Central State transformed it into a Specialist Hospital.
By Decree number 23 of 1974, the Federal Military Government took over the hospital, but left the management in the hands of the Council of the University of Nigeria, Nsukka. The UNTH became independent in July 1976 with the appointment of autonomous Management Board and has remained in that capacity till date and operating under the supervision of the Federal Ministry of Health.
The physical constraints at the hospital’s old site in Enugu made it impossible for expansion. Hence, the then Federal Military Government gave approval for the construction of a new complex for the Teaching Hospital at Ituku/Ozalla. Today, the new site of the UNTH is permanent and fully functional.
All services hitherto rendered at the old site were moved to the permanent site with effect from 8 January, 2007.
The UNTH has broad objectives of service, teaching and research. The hospital achieves these through provision of in – patient and out – patient services through highly trained staff, provision of clinical materials and training as well as equipment for research, provision of teaching facilities for training of students and other persons in the health delivery team and conduct and promotion of research on all matters pertaining to health.
There are nine training schools/programmes in the hospital viz: the School of Nursing, Midwifery, Medical Laboratory Science, Nurse Anesthetists, Community Health Officers programme, Post-Basic Ophthalmic Nursing. Others are Peri – Operative Nursing, Cardiothoracic Nursing and School of Health Information Management.
The movement to the permanent site was carried out under Dr. Anthony Mbah, the Chief Medical Director (CMD). The hospital encountered many challenges at the permanent site; while some were surmounted, many continued until the incumbent CMD, Dr. Christopher Amah, took over on May 17, 2011.
Before then, Amah, a pediatric surgeon, had served as Chairman of the Medical Advisory Committee, CMAC, of the hospital. The CMD, who completed his second year in office in May this year, recently reviewed the progress so far made by UNTH under his regime. “I met a hospital that was bankrupt with a huge debt burden bedeviling it due to poor funding, very wide income-expenditure imbalance”, he said.
“In terms of clinical services, delivery was very low both in volume and quality. A lot of clinical departments had lost accreditation for training of specialists due to lack of essential equipment in those departments. Our radiotherapy equipment, the only one meant to serve the entire South-east and South-south geopolitical zones installed by the Federal Government through VAMED Project, was yet to work since it was installed in 2006.
Again, an oxygen generating plant installed to make the hospital self sufficient in oxygen supply to the hospital was also not functional. There was nothing like Amenity/Private Ward in the hospital for patients that require such facilities. The hospital’s internal road network was in a state of dilapidation and disrepair”.
The CMD further disclosed that at the time he took over the management of the hospital, many of the staff unions were on strike and the morale of workers was very low. “Above all, the signature project for which the UNTH was known and designated a National Centre of Excellence – The Open Heart Surgery, and other sophisticated cardiothoracic surgeries, were abandoned for over 10 years. In fact, before the hospital relocated to the permanent site at Ituku Ozalla, the Centre of Excellence had packed up. The attitude of workers to their duties was very poor and this adversely affected the level of service delivery,” he added.
Assumption of office
Amah and his team reviewed the situation and resolved to embark on measures aimed at rebranding the hospital.
The management had to embark on a visit to all departments and units to make the workers buy into its vision of turning around the UNTH.
These efforts paid off as the management has achieved remarkable improvements in many areas even though, according to the CMD, “it is not yet uhuru”. The evidence is the increased turnout of patients in the hospital’s Accident and Emergency Department, General Outpatient Department, Specialists Outpatient Clinics, among others.
The number of daily clinical attendance has more than doubled and the hospital now operates in full capacity and sometimes under pressure especially in the Accident and Emergency Department where there are inadequate bed spaces due to overflow of patients.
Most of the patients accessing services at the hospital come from its catchment areas including the south eastern states and neighbouring states of South-south zone and the Middle Belt. Patients mostly access critical services like cardiothoracic surgery, neurosurgery, pediatric surgery and other rare areas not available in hospitals within the regions.
Amah and his team also rehabilitated most of the internal roads within the UNTH. The roads were asphalted through funds generated internally.
There are also projects funded through capital budgetary appropriation. According to the CMD, these include a two-storey administrative block, building for Open Heart Surgery and other sophisticated cardiothoracic surgeries and medicine. Others are building for Nuclear Medicine and other Ionized Radiation Therapy, building for Schools of Nursing, Midwifery, Post-Basic Nursing programmes among others.
The radiotherapy facility, installed in the hospital since 2007 but never put to use due to vandalisation and other reasons, has now been rehabilitated and put to use; it is the only one available in the South-east and South-south for the treatment of cancers.
The abandoned oxygen generating plant was modernized and put to use.
Open Heart Surgery
This super specialized art, which earned the UNTH the status of National Centre of Excellence in cardiothoracic surgery and medicine some years back, was abandoned for almost 10 years. The Amah administration has now provided a dedicated facility for resumption of open heart surgery. This was done with internally generated revenue in collaboration with international partners, The VOOM Foundation USA, as well as equipment support from Education Trust Fund, ETF, from the parent University of Nigeria. The UNTH resumed the abandoned open heart surgery in March 2013.
About 25 patients were said to have benefited from open heart surgery conducted by a team of foreign and local health experts at UNTH. Open heart surgery was first conducted in UNTH in 1974 by a team of foreign and local experts led by the late Professor F.A. Udekwu and that was the first ever in Black Sub-Saharan Africa. Many more open heart surgery was done in UNTH including the Kanu Nwankwo Heart Foundation of 2003.
Thereafter it was suspended due largely to the movement of the hospital to its permanent site which had no facility for it until Amah administration broke the jinx in March this year. This was done in line with the Jonathan administration’s quest to stem medical tourism overseas by Nigerians estimated to have gulped N250 billion annually.
The open heart surgery is highly subsidized. For instance, open heart surgery that costs over N2 million overseas, is performed by UNTH at less than N500,000. This has been made possible through the contributions of the hospital’s international collaborators and philanthropy of some well-meaning Nigerians.
An open heart medical mission has been slated for December. In addition to the team from VOOM Foundation, the International Children Heart Foundation is going to launch a Pediatric Open Heart Surgery programme at UNTH, the first of its kind in Nigeria, Amah disclosed.
Already, VOOM Foundation has done three missions and they were rated as very successful and it has returned Nigeria once again on the list of countries in Africa and the world where open heart surgery carried out and this is acknowledged as a major effort in curbing medical tourism out of the country.
The Minister of Health, Professor Onyebuchi Chukwu, who commissioned the Open Heart Surgery/Intensive Care Unit facility at UNTH in March and witnessed one of the surgical operations, was appreciative of the efforts and had pledged government’s support to the hospital.
One of the beneficiaries of the open heart surgery conducted in March, a journalist, Mr. Ihemegbunem Okafor, showered praises on UNTH for the excellent medical services he received and declared that, with the modern sophisticated medical equipment acquired by the hospital, “UNTH is on track as the National Cardiothoracic Center of Excellence.” Okafor, diagnosed to have tumour called myxoma in one of his heart chambers, is one of the 25 patients that had been successfully operated by experts at the hospital.
“I was admitted on March 18, 2013, I had no choice of a ward of residence but I was allocated a suite at the private suites where I stayed till I was discharged on March 27, 2013. While on admission, I was in good hands to the extent that the dieticians took record of my choice of food. My suite had everything to make me comfortable. There was a refrigerator, a cable television, an air conditioner and a ceiling fan. The windows and doors had mosquito nettings while there was a standby electric generator that supplied light anytime there was public power failure.
“One week after I was admitted, the doctors confirmed me fit for the operation and, on March 20, 2013 I was wheeled into the ultra modern cardiothoracic theatre. The theatre has the state-of-the art equipment that can compare with the best anywhere in the world. The consultants, doctors, nurses, anesthesiologists and physiotherapists, true and dedicated professionals, successfully carried out an open heart surgery on me on March 20. After the surgery, I was wheeled into the Thoracic Intensive Care Unit (ICU). The Chief Medical Director, Dr. Christopher Amah, personally congratulated me on my successful surgery.
“At the ICU, I was treated like a new born baby and all the medical personnel handled me with utmost care like a fragile object. The physiotherapists were on hand to teach me how to walk again. With the help of God, the quality of care and medication I received at the ICU helped me to recover quickly and four days after the surgery, I was moved back to the private suite. The nurses at the private suites celebrated my return to the ward with shouts of Alleluia and praises to God.