Dr. Dayo Adeyanju is the Commissioner for Health in Ondo State. In this chat, he speaks on how Nigeria loses more than $2 billion annually to India through medical tourism, explained in details the management of deaths arising from the consumption of local gin (Ogogoro) in Irele community, while outlining the gains of the state’s deliberate investments in the health sector.
By Olufemi Ajasa
What is the state of Ondo State’s health sector ?
When we came in, under the leadership of Governor Olusegun Mimiko, all the indices indicated that Ondo had the worst health status with our maternal mortality standing at 745 per 100,000 live births. So, as a responsible government, we decided to launch the Abiye project and built Mother and Child Hospitals to reverse the trend. So, between 2009 and 2012, the maternal mortality dropped to 317, and, today, we have come down to 187.
These services are completely free and we have done this by partnering the traditional birth attendants and mission homes, where we found out these deaths were occurring.
The Abiye project was followed by Ondo State Routine Immunisation to keep babies safe even after birth and till age five. And, today, we have sustained the state free of polio consistently for the past six years, and what that has earned us is that the two times that the Bill and Melinda Gates Foundation’s Immunisation Leadership Challenge held in Nigeria in partnership with the Governors’ Forum, Ondo came first and the award earned us $500,000 for 2013 and 2014.
We established that with 15-chamber dialyses so that we can take care of the people’s kidneys including another programme we tagged Community Kidney Care. Apart from this, we also have what we call First Aid Support Team (FAST) which is to sensitise the communities on what to do when accidents occur. The Gani Fawehinmi Diagnostics Centre is also aimed at eliminating guesswork by health workers.
All these culminated in the establishment of Nigeria’s pioneer University of Medicine aimed at training medical doctors who can sustain these initiatives and to ensure that, across the globe, doctors can get trained on our Abiye project, trauma, Mother and Child Hospital, so that they can be replicated across the country.
Why the free health services?
The health of the citizens should be a priority for every government. We have significantly increased our budget to cater for the Abiye Safe Motherhood programme. One way we have been able to manage resources is that we don’t just give out money, we only pay for results. We don’t pay for the number of drugs you need or the amount of syringe you will be needing; what we do is to look at the number of say children under age five that you have seen, number of pregnant women you have attended to, number of normal deliveries you have done, number of those operated upon and then we calculate. We don’t throw money around. That is one way we have been able to strengthen the program and achieve results, and its working for us.
With the decline in Nigeria’s financial fortunes, do you think all these are sustainable?
Let me begin by saying that Nigeria’s problem is mainly poor orientation and not necessarily the fall in oil prices. In the first instance, how can Nigeria believe that oil is the biggest source of revenue? Let me tell you, Nigeria’s total budget for 2014 was N4.3 trillion based on oil revenue. But do you know that Google alone recorded about N5 trillion as turnover for the same year. Does it mean that Google is richer than Nigeria? In fact, I will suggest Nigeria shuts down its oil so that we can think because for now we are not exploring other avenues.
In Ondo alone, we are sitting on the largest bitumen deposit in Africa and, in fact, the 4th largest in the world. And below the bitumen is stock fish but we are not really working on its exploration because the Federal Government seems contented with oil. The political will is a major determinant of the success of any administration.
The real thing we are enjoying here now is the political will of our governor. So, in spite of the dwindling revenue in the country, we have ensured that our Mother and Child Hospital must be running, Abiye must not stop and Agbebiye must not stop. They are very critical, because if a child is infected with polio, he will have permanent disability and that will affect the future of the child and the state as a whole. So, dwindling resources is not an excuse.
Where do you expect Nigeria to concentrate its efforts?
If am asked what should form the priorities for President Buhari, I will suggest only about three things, which should all focus on human development indices, that is, health and education. A healthy nation is a wealthy nation and that is the way productivity can be increased. As we speak, Nigeria loses more than $2 billion annually to India through medical tourism. You can imagine what would happen if such huge fund is retained in our economy.
As a country, what is the preparedness of Nigeria to stem health hazards?
We only start doing something when we are already facing problem. If you notice, Ebola is back in Sierra Leone and Liberia, but, like our usual unfortunate culture here, we won’t put measures on ground to prevent it from coming here again. Between the last Ebola case in Nigeria and now, what have we put in place to prevent further outbreak? What lessons have we learnt. This should have given us the opportunity to put structures in place. The community outbreak committee, the facility management and state rapid response should all be in place. By now, we should have diagnostic laboratories for infectious diseases in the six geo-political zones.
How did the authorities manage the mysterious deaths caused by local gin (Ogogoro) in the state?
The reason we were able to manage the situation was because we took advantage of our developed health structure and quickly activated a rapid response team. We embarked on an active case search and then immediately assisted those who were still alive. The real deaths between the time we intervened and the time they were curtailed were not more than 10.
We all know the normal way of producing local gin is through the fermentation of palm wine but some greedy brewers who sold in bulk resorted to the deadly short cut of using ethanol in place of fermented palm wine since they believed it was easier to use it to produce larger quantity of the gin.“ Ethanol, when mixed with water and other things used in making the gin, ends up producing Ogogoro with methanol, which is a poisonous substance.
Some of them deliberately put methanol so that the drink would be more alcohol-laden and all these caused the ethanol poisoning experienced in Ondo and currently being battled in Rivers State. If not for our efforts, the death rate would have been far beyond the recorded figure.
How about the beliefs among indigenes of Irele community that the deaths were caused by their angry god, Malokun?
It is important we set the records straight so that people will not continue to believe that a god was angry with the people and took their lives. The deaths didn’t occur in Irele alone, there were three other communities that had nothing to do with the Malokun in Irele, yet people died.
Some people might have stolen something from the shrine which they said they sold for N35 million, but the closest relationship the belief could have with the deaths was that when nemesis caught up with these people, they went to celebrate it with Ogogoro which had methanol poisoning in it. So it is not that the people died because of the god’s anger but because they took the methanol poison put in Ogogoro.