By Sola Ogundipe & Chioma Obinna

Since his appointment in 2011 as the Chief Medical Director, Lagos State University Teaching Hospital (LASUTH), by former Governor   Babatunde Raji Fashola, Prof David Adewale Oke has raised the bar of healthcare delivery in the state through his expertise, wealth of experience, vitality and determination.

Even as he steps down at the end of his 8-year tenure, Oke, an alumnus of the College of Medicine, University of Lagos, has left an indelible mark of achievement in the snow of healthcare delivery in Lagos State.   In this interview with Sunday Vanguard Heath crew of Sola Ogundipe and Chioma Obinna, he gives insight into his 8-year tenure and expectations for the future. 

Excepts:

*Oke

Early days

I started in January 2011 and have served eight years which now appears like a flicker in my eyelids.   I started hopeful, wondering if I would achieve anything remarkable.

The first four years was under Governor Babatunde Fashola and I was also given opportunity for another four years under Governor Akinwunmi Ambode. I owe a lot of what I have done to both of them.   I must commend their efforts in trying to put Lagos State on the world health mark because if you are talking about health in Nigeria even in the West Africa sub-region, Lagos state will rise above every other state or perhaps countries.

I took over from Dr Femi Olugbile, a known Psychiatrist after he was appointed Permanent Secretary. I must commend Dr Jide Idris who was my schoolmate and assisted me in making sure policy issues were adequately handled and successes LASUTH had during my tenure were made possible through him to the Governor of the State.

Challenges

LASUTH started as a cottage hospital in 1985 and gradually through the years graduated to a General Hospital and finally became a Teaching Hospital in the past 10 to 15 years.

The main challenge was infrastructure. Most of the buildings were bungalows and   there was space constraint. The state took up the challenge. I must also remember what our most esteemed former governor, Ahmed Bola Tinubu, did because without his pioneering efforts we will not be here.

What he did was to take the bull by the horns and renovate some of the hospital buildings,

The Bola Tinubu Diagnostics Complex was one of them. The Bola Tinubu Wards – a four-storey building that served for Medical/Surgical Emergencies and the Paediatric Emergency. The challenge was how to increase capacity but we just managed what we had.

Today, as we speak, we have completed renovation of the hospital laboratory which comprises the microbiology department, chemical pathology department, and haematology department. We have a modern kitchen, all the toilets and wards renovated.

When I got here, it was DEUX project that was running the ultra-modern lab, but after about a year, DEUX shut down and it was as if I knew something like this was going to happen.   I focused on renovating the moribund laboratory I met on ground, I was able to make adequate budgetary allocation and made sure that we got the funds released to buy all the equipment required.   I made sure we had a fairly useful laboratory that aided consultant and doctors in providing quality services in the hospital.

During my tenure, I was able to ensure that the Bola Tinubu Laboratory came back in good shape. And it is now being run by a Philips Consortium and now they have all the modern radiological equipment required. They have two CT Scanners, two x-ray machines, digital mammography machines, about six to eight ultrasound machines, and an ECG machine.

In the next couple of few weeks, they will be setting up a sleep machine where patients with sleep disorders will be admitted. There is a machine useful for the management of elderly people that have osteoporosis. Before the end of the year, they will have the MRI which is the ultimate for radiological services.

Critical Care Unit

The ultra-modern critical centre opened three years ago has 12-14 beds that offer full intensive care on the ground floor.     We have units that perform dialysis and an ultra-modern theatre that enables a teleconference, meaning while an operation is going on, if the surgeon needs assistance,   he can be connected to another doctor anywhere in the world and the surgeon there can be consulted directly and vise versa.

The private wards allow doctors to bring in their patients to attend to them because they can get the best of care there.

The BT Complex has sent me a proposal for a private wing. The advantage is that doctors can see their patients there without going too far and earn enough money.

Shortage of doctors

Part of the reasons we have shortage of doctors in LASUTH is the brain drain syndrome. Not just the doctors, even more nurses are going than the doctors. And the machinery of government runs a bit slower than the rate at which they are leaving.   The replacement process is a bit slow, but this has been observed and a lot of deliberation has gone into it even at the level of the Ministry of Health.

The Commissioner of Health made moves to motivate every member of the medical team so that we can sit and meet and determine how to improve things and see what can be done to retain them either by increasing their salary or extending the age of retirement because the doctors and nurses that are leaving are the younger ones.

A doctor retires at 60 when he is still very useful.   If at 60, such doctors no longer leave because they have their roots here, their families planted in Nigeria and grandchildren here. Very soon we will have that as a means of taming the brain drain thing. Salary structure at one point or the other will have to come in.

Free healthcare

Civil servants, their wives and four children should enjoy free health. Destitutes and any retiree will enjoy free health. Anybody below the age of 12 and above the age of 60 is entitled, but it drains revenue.   It is a promise made to the public. The Lagos State health insurance is mandatory for all civil servants, I happened to serve on one of the committees which is trying to midwife it and I am sure that very soon it will start.

Industrial action

When I came in, there was a big crisis that lasted about three months. The doctors were sacked.   It was like an unending crisis but the government under Fashola resolved it aided by Tinubu. Since then, we have continued to engage the Unions and the doctors’ association. I was a unionist while a Resident in LUTH, I have gathered a little bit of experience and I discovered that the best thing is to run an open door policy for unionists. I discovered that 90 per cent of the problems is solved when you communicate.   Union issues can be solved through communication. When you communicate and you talk, and you shout, you discover that the anger is calmed.

Governor Ambode actually approved an increment and some allowances. Unknown to him, there are two categories of consultants in LASUTH. There are the honorary consultants engaged by the College of Medicine and there are others engage by the State Ministry of Health. So when the largesse came and they paid those employed by the Ministry of Her, and for months the honorary consultants did not get paid, they kicked.   But as soon as the Governor came back from China, the crisis was resolved and they are now enjoying the salary and allowances.

Ayinke House

Ayinke House is not directly under LASUTH, it is under the Ministry of Health but I can tell you the good news. The Chairman, House Committee on Health, visited to see ongoing projects in the hospital because he felt that Ayinke house was a project domiciled in LASUTH but when he came I made him understand that it was not under LASUTH.

He went for around there and it is almost ready but there some financial issues but he told me that it is almost sorted out.

LASUTH helipad

When we built the Critical Care Unit, we had in mind people who are very sick.   So the Governor said what if someone gets injured in Lekki and there is traffic, and the ambulance cannot even navigate such traffic, he said the best approach was to build a helipad.

Don’t forget there was a helipad there during the time of Governor Buba Marwa but it was not as glamorous as this. The Critical Care Unit was built and the Governor said there should be a helipad and he chose the space in front of the critical care and surgical emergency.

What is causing the delay is that we have to be registered on the map, the NCA has to come.   We have done trials. The helipad is ready but it has to be registered.

Medical Missions

When I got to LASUTH, the first mission I organised was cardiac surgery.   I wanted to make a statement that we can have cardiac surgery here. We invited doctors from Apollo Hospital, India.   We had a patient who had what would have led to a heart attack and she needed an open heart surgery and we operated on her.   Although, we lost money doing it but we did it and she is still alive. It turned out not to be as successful as I wanted it because people were not rushing it. I thought after that I made noise people will come but there was no way you will have cardiac surgery under free health. The government will run down.

So it suffered for some time until we got about three patients who could afford it. Then we invited two other experts from India to come and run cardiac surgery and most of the patients survived.   The last one we did was partly sponsored by the Governor.

We did about 12 patients in the CCU. We nearly lost one.   We gave out pacemakers. Apart from the heart, we have done renal missions but that cumulate to our own local surgeons performing the surgeries.   We have done about 4, we lost a patient. We have done many eye missions.

We have this partner from South Korea. Every year, they come to LASUTH and have been doing 100 cataract surgeries every year since I became CMD.   I must thank the Head of Ophthalmology, Dr Idris, for his efforts. The last one was done a couple of months ago.

Increased capacity

One of the things I did as CMD, was that I felt that there was a need to increase capacity, the Mission was supposed to bring these surgeons here so that our surgeons could also develop some skills. For that to happen, the Mission must be regular.  When I realised it was not going to be regular, I decided to go to India which offered us hands-on training. A few doctors who went to the US who did not have their certification to practice could not touch a patient but watch.

So I went to India with a couple of my consultants and within a week we had been to seven hospitals and Apollo was one of them. In the process, we were able to train two cardiothoracic surgeons who are now working in LASUTH.   All the women who got trained are employed. We now have a female urologist; we have a female paediatric surgeon who was trained by LASUTH because I promised them we were going to employ them after training. I made sure they are gainfully employed.

Recently, we sent a group of residents to India to have hands-on training. They are back now and that will continue, particularly because the chairman wants to broaden that area, get more people involved.

Attitude of medical staff

We have done a number of trainings. Every month, we give prizes to good workers.   I give as much as N25,000 to encourage them but that has not changed them. Every three months I identify one worker. We have bad people but we will continue to train them.

Experience after 8 years as CMD

The saddest thing is that at this stage of our development, 90 percent of our patients still pay out of pocket.   The National Health Insurance Scheme has not really served us the way it should. In Lagos state, the free health programme has helped to reduce the pains.   The other is infrastructural problem. There is nowhere in the world where you will use a stethoscope and make your diagnosis. Medicine has advanced with hardware equipment, like echocardiography, MRI machines and these are very expensive.     What Lagos state has actually gone ahead to do is PPP. The sad thing is that people are coming from abroad, to establish big hospitals here but they are expensive because there is no monitoring. Some of them are even incompetent.   What they are doing now is to appoint Nigerians as the chairmen of their hospitals but I am not sure whether the process is thorough enough to ensure that the right people come in. And even when they come in, they should engage Nigerian doctors.

Way forward

I am aware the indigenous hospitals owned by Nigerian doctors are competent and expensive.   I am not sure whether insurance covers them. I went to India, what I discovered is how to make equipment cheaper.   Get the companies to come and assemble in Nigeria. What we have now is equipment that is fully built and so the customs charges and airfreight are inhibitory.

Then, encourage Nigerians in the Diaspora to come in. Give them land and loans that are interest-free that will enable them to come home and give back to the country to also reduce deaths. In India, these things are done. That is why many of the Indians went back home.

Legacies

I have to some extent, become a role model for many of the doctors.   I have built capacity and provided equipment. I hope in the future, this LASUTH will be the LASUTH of my dreams where there will be a tall building with offices that will be occupied by consultants, boardrooms, kitchen and a place where doctors will come in and feel reluctant to go home. And attend to patients faster and better.

After LASUTH

These eight years have been happy years but very stressful.   I want to go back to my professorial chair and for months or years and get used to chatting with my students and then see what develops.

By the end of December there will be another CMD who I can work with for a week or two.   But there are certain things I have put in motion which I hope he will complete when he comes in. The 10-storey building, it will be a thing of joy if the doctors will be coming from there.

The second one is LASUTH masterplan.   I have seen the plan and it is going to be a wonderful experience.     It is supposed to be a 5 to 10 years development plan. If that is done, other things will fall in. There will be more space, more workers mean more patients and more patients mean more revenue generation.   So it is a plus, plus. I have told them when all these things are happening they should invite me to sit at the back and share part of the glory.