‘I would have ended up as wristwatch trader, bicycle repairer’
Professor Jesse Abiodun Otegbayo is the Chief Medical Director (CMD) of the University Teaching Hospital (UCH), Ibadan. The Professor of Medicine/ Consultant Gastroenterologist and Hepatologist studied medicine at the College of Medicine, University of Ibadan from where he bagged MBBS in 1989. Although born in Sekondi, Ghana on December 17, 1961, he hails from Otan-Ile in Obokun Local Council of Osun State. Otegbayo, who became UCH CMD in 2019, clocked 60 last Friday. In this interview with ROTIMI AGBOLUAJE, he spoke on his humble beginning and suggested ways to improve health care services delivery in Nigeria
What is your assessment of the medical situation in Nigeria now compared to when you first started decades ago?
There is a decline in the quality of health services from the time I started practising as a doctor and now. But recently with the advent of COVID-19, the inadequacy in our health sector was exposed and the government of the day took a bold step to make what they called Special Interventions in the health sector. Some amounts were released to almost all the tertiary healthcare institutions to upgrade our system to be able to cope with emergencies and critical care like ICU and laboratories.
In fact, about N980m was spent on each of these hospitals. With that, we are now going in the right way to improve our health care system. If the trend is sustained, it will be better for us. One of the challenges we are having in the country is sustainability of good programmes. We should not make it a one-off intervention; rather, it should be persistent one.
If we can increase our budgetary allocation to 15 per cent that the African Union agreed in 2001, to which Nigeria is a signatory, it will greatly improve our healthcare system.
What steps will be appropriate to reclaim glory of our health institutions in the country?
Restoration will come in three ways. First is the working environment. You need to create an ambience that is conducive. People want to wake up and be happy that they are going to work. When you go abroad, these are the first things you will see that will entice you. Second, we need to equip the hospitals. Standard equipment must be in place. The medical tourism we are talking about is not due to individual’s skills, but because of the equipment they have that can identify the diagnosis to aid treatment. The third is remuneration. If you have a salary that cannot take you home, you are not likely to reject better offer.
What are the challenges of running tertiary health facilities in this COVID-19 era?
One is the unavailability of the equipment you need to operate with. A doctor wants to do a diagnosis, but there is no equipment to do the investigation. But like I said, we are getting some financial supports in recent time. Another one is workforce. Some of our people require training and retraining, but because of inadequate funding, when they demanded training, we declined. Training is not free. We cannot train and retrain our staff because of funding. If the funding is available, we won’t have much problem.
What roles should government and individuals play in having good healthcare system?
Healthcare system is divided into three: primary, secondary and tertiary. As it is today, the primary and secondary are dysfunctional. Mainly, it is the third tier of the healthcare that is having some measures of attention. What we have neglected, which is the basic heath care we usually refer to as primary healthcare, is the most important because most diseases start little. They start mild! At that point, a lot of them can be taken care of at a cheaper rate. But when they are not functioning, our people are helpless. When they get there, they won’t see competent staff.
For instance, in Ibadan here, whatever happens to our people, they come straight to the UCH. And we wonder what other healthcare facilities are doing. Because of this, we get overwhelmed most times. We get overloaded. The population of London is over eight million, but they have 12 teaching hospitals. Here in Ibadan, as at 2006, the population is over three million and we have only one teaching hospital. Meanwhile, it has not been expanded in terms of facility. It is the number of the wards we had on the day of turning of sod that we are still having.
These are some of the challenges we have to overcome to raise the people’s consciousness that they can get health services in their comfort zone. The economy is not working optimally. Many people go for alternative healthcare, not because they don’t know that orthodox medical care is the best for them, but because they cannot afford it. They cannot even afford the N2, 500 for registration, when many are living below poverty line. Many earn below N100 per day. How do you want such individual to pay for N2, 500 registration fee?
UCH was recently adjudged the best teaching hospital in Nigeria. What is the secret?
In answering that question, I don’t think the award came because of what is happening now. Rather, I think it is my predecessors’ efforts that earned UCH that award. No administration starts achievement from beginning to the finishing line; we build on it. The only thing I think we have done is to build on what we met on ground. That sustainability is key. We don’t allow what we met on ground to decline or deteriorate, but we are building on it. So, all the past and present efforts are responsible for the award.
Omicron is ravaging the world. What will be your advice to Nigerians on how they can stay safe?
It is the same thing we’ve been talking about, either with the Delta variant or the traditional one that has been ravaging the world. We must observe the non-pharmaceutical measures that have been talked about: avoid large gathering, washing of hands, using of face mask and social distancing, among others.
It is important to know that all this conspiracy theory about vaccines is not true. People should take the vaccine. Now, it has also been shown that taking the booster dose after you’ve taken the two jabs of AstraZeneca or whichever one, the third they say also protect against the Omicron strain. And I think anybody who has taken the jab should go and take the booster, while anyone who has not taken it should go and take it because it’s protective. It’s been shown to be protective. That’s my advice to Nigerians.
Clocking 60 is a thing of joy. Could you let us into your background?
I was born in Ghana. I had my primary school at St. Peter’s Primary School, Ghana before we returned to Nigeria in 1969. While returning to Nigeria, my father became a pastor and my mother a deaconess. The church’s tradition at that time was that the pastor’s wife must not work. They were expected to live in the Mission House. My father died when I was in Form Two. You can imagine what that means for a woman who was a full housewife. We were eight children, and I am number four. As God would have it, I changed my school from Ila-Orangun to another one in my hometown. It happened that one of my uncles who was very rich, Chief Bayo Otegbayo, had his house next to the secondary school where I was. At the end of the term, when I was in Form Three, they were giving prizes and using loud speakers to call names of the winners. Fortunately for me, my uncle was at home that day and he heard my name repeatedly. I collected nine prizes. I was the best overall student in physics, chemistry, biology and some other subjects. So, he was impressed. He sent for me and asked me to sit on his lap. He said he could see that I was an all-rounder. He encouraged me to study medicine. Before that day, I never thought of medicine. I never thought of what I was going to do with my life. He said he was going to change my school, and that was how I started attending Command Secondary School, Kaduna.
I finished secondary school in 1983 and gained admission to the University of Ibadan that same year. Six years after, I became a medical doctor. When I was a student, I used to see some doctors called consultants and I said I would like to be like them, due to the authority they wielded. I enquired on how to be a consultant and they told me I had to come for Residency. I had that in mind and during my NYSC scheme, I started studying for the first phase of the examination to be in the Residency. During my service year, I passed the examination and I became a Resident Doctor in 1992. Five years after, I became a specialist. Again, I saw people called professors during my Residency and I thought I would like to be one of them. I also made enquiries and I learnt I had to be an academic staff and God helped me. Like they say, the rest is history today.
What were your expectations when you set out as a medical doctor? Did those dreams manifest at the end of the day?
I had dreams and expectations. I wanted to be a physician. In fact, I wanted to be a cardiologist, a heart specialist, which I never became. By the time I got into Residency, for one reason or the other, I wasn’t able to do Cardiology because there were too many people there. The Chief Resident then said some of us who just passed examination should go to GIT, Gastroenterology, but none of us was ready to go for reasons best known to us. But after sometime, when the man refused to promote us, I decided to go. I believed it was God’s design.
Initially, what I had in mind was to be a doctor and after graduation, I would look for a village where I could practise.
But as I proceeded in the medical journey, my dream changed, based on what I saw around. My environment changed my disposition to what I wanted to become in life. There is no dream I have in life that has not been fulfilled.
When you came on board, you promised to transform UCH. How have you fared in this? What are the high and low points of this administration?
If I had my way, I would have asked you to do an assessment. Do your investigations on how UCH was when we came in and what it is today. Part of what we have done is that, when we came in, most of our patients were going out to buy drugs. But I said there must be a way to break the problem. So, we started a cash-and-carry pharmacy (CCP). Now, we have three cash-and-carry pharmacy points.
We also did some renovations, rehabilitation and restructuring in our facility which are long overdue. Some of the pipes and sewage that were changed had been there since 1953, when they did turning of sod of this place. We were able to get support from the Federal Government through the Special Assistant to the President, Dr. (Mrs.) Adejoke Orelope-Adefulire. We were able to get the support by another initiative called UCH Health Foundation, with the mandate to solicit for grant, fund, donation and stuff like that. A businessman of repute, Dr. Toyin Okeowo, was made the chairman. Through him, we were able to attract the high and the mighty to support UCH. Dr. Orelope helped us and is still helping us.
At the central area, we are having five brand new lifts, which have been installed simultaneously. Before then, we had procured two, which have also been installed. There used to be problems with taking patients to the various wards, but that has been resolved now. Our ICU is like a five-star ICU. We have ventilators for each of the beds. We have patient monitors and dialyses machines in the ICU. We also have digital X-ray there. We are going to have one cardiac ICU any moment from now.
These are some of the things we have done. When I came, my mantra was patients’ comfort and staff welfare. Many other things are coming very soon.
The low point has to do with funding. This is because all the equipment are not manufactured in Nigeria and not even in Africa. We had to buy them with hard currency. UCH was the only existing tertiary healthcare in those days, but today, we have 56 tertiary healthcare and teaching hospitals. The focus of funding has now spread across the other tertiary healthcare facilities, and not just UCH.
Also, our budgetary allocation for the health sector is not up to the 15 per cent of our GDP we all agreed to. I think the highest we did was six per cent. That is why funding is key. So, we have to think outside the box. For instance, in 2019, we appealed to the head of The Redeemed Christian Church of God, Pastor Enoch Adeboye, and he donated some amount for us to buy dialysis machines. Someone hinted me that if he came to commission it by himself, we could get more. And truly, he came and he promised us more. Within a week, we got another dialysis. As at that time, we were down to two dialysis machines but today, we have six machines. NCC also donated an ambulance to us. We are having individual endowing our wards now.
You recently became the President of The Society for Gastroenterology and Hepatology in Nigeria (SOGHIN). What should Nigerians expect when it comes to care of stomach and intestines?
This is one role I tried to avoid, but my people insisted that it was me they wanted. Initially, I said no, as my current appointment may not allow me to perform as much as I would have loved to. This is because when I take up an assignment, I want to do it with all my mind and to the best of my ability. But they insisted. In fact, people I didn’t expect from Kano, Maiduguri and other states insisted that it must be me. I had to agree because it is an honour, when people, especially the senior ones, are saying you should lead them. Some of them are my senior colleagues and are older than me.
So, in the leadership of the association, I want to see us educating Nigerians about the diseases that have to do with the digestive system, which has to do from the mouth to the anus, the intestines, the liver and the pancreas. Hepatitis is a major killer that leads to liver cancer. We want to increase education and research in that area. We have already started, but until we finish, we may not know. And of course, we just formed another association, African Helicobacter and Microbiota Study Initiative, of which I’m a member. Prof. Smith from the Nigerian Institute for Medical Research in Lagos is the President. We’re going to launch it next year. We wanted to do it in March, but looking at COVID-19, we shifted it to next year. We are doing a research and I’m writing the ethical approval now.
We are going to do the baseline study of most diseases of the digestive system and disseminate the research and we are also going to collaborate. In fact, the European Helicobacter And Microbiota Study Group is sponsoring part of what we are doing. Some of our people went for conferences and they said there is no information about Africa. That was why the initiative came.
Finally, for years, we’ve been trying to inform government about the need to have a centre for digestive disease research, to be sited maybe in Abuja, where it would be a one-stop shop for care of diseases of the digestive system. It has been in the pipeline for a while, but I want to rejuvenate that struggle. If that is the only thing I’m able to do, I’ll be very grateful to God that I have a very impactful tenure. So, the bottom line is that we want to educate the people. We want to know the diseases of the digestive system that are common or prevalent in our environment. We want to do research in that area and how to alleviate them. Those are the things I would say Nigerians should expect from us.
How have you been managing increasing patient flow and decaying facilities?
All those things have to be done through national efforts, maybe championed by the Federal Ministry of Health. We are just foot soldiers to implement government policies, since we don’t formulate policies. What you’re talking about is centred around policy-making. But it is not my brief. It is in the realm of what policy makers have to do.
Were there people who served as your role models?
When we were medical students, we used to see how consultants carried themselves. In fact, at a point, I adopted the habits of some of them. Some of our professors used to smoke pipe, and I also tried it, but I couldn’t sustain it. But the likes of Prof. Oladipupo Akinkugbe really impressed me with his teaching, charisma, dictions, British accent, and things like that. I wanted to be like him. When I became a Resident, I read his CVs, publications, and so on. Prof. Temitope Shokunbi and others also served as my role models. Those are the people who impressed me. God also used Prof. Ayodele Falase to influence me.
Has there been any trying moment in your life?
Yes, that was when my father died. At that time, being his parents’ only child, we didn’t have any family around us. So, when he died, it was like the whole world crashed on me, as he was the only one we knew. Indeed, it was a divine design that my uncle took up my upbringing. I only knew him as Chief Otegbayo, our relation but no relationship. That was a trying moment for us. For a man to leave eight children with a widow, naturally, it wouldn’t be easy for any of them.
Can you remember any remarkable event while growing up?
The only thing I can refer to as remarkable is that God helped me to pass my exams at the first attempt and in flying colours. This is because if someone is being sponsored by people who are not his parents, it is very easy to say ‘go away.’
But if God is helping you and the person is seeing his investment yielding results, there is likely to be more commitment. I would see that as being remarkable. Otherwise, one would have been forgotten. To make it clear, even during my father’s lifetime, there was a time after my primary school in 1973, when my other siblings were also in school and there was no free education then. My father could not afford my school fees, and I had to stay with one of the church members. His name was Mr. Ezekiel, and he was a trader, dealing in bicycle accessories, wristwatches and also into repair of bicycles. So, I learnt that trade. At that time, people thought I was his apprentice, but I never registered as one. I stayed with him for three. I could fix any bicycle, as well as wristwatches, though not the digital wristwatches we use today.
One remarkable thing was that his children were going to school, but I would stay in the shop to sell and repair things. One day, I damaged the bicycle of one of his customers, while trying to repair it and the man had a short fuse. He was so angry.
Immediately he came, I knew I was in trouble and I was ready for it. After seeing the damage, he asked me to come close to him, but I knew from the tone of his voice that he would descend heavily on me. So, I didn’t go. He then threw a plier at me. If the plier had hit me as a small boy, it would have wreaked havoc on me. So, I ran away to my mother.
At that time, my father was not at home. He was attending a pastors’ meeting in Ilesha. So, the man came and reported me to my mother, who was calm. She told him that when my father returned, he would pay for it. When my father came back, they settled it among themselves. I didn’t know how it was settled. That was when my father asked me what I wanted to do with my life. I told him I wanted to go to school. I didn’t say I was going back to the man, I just told him I wanted to go to school. Maybe he would have taken me back to the man if I had said I was going back. When the time for examination came, my father took me to the Modern School in Ila-orangun. I spent one year there. I came first during the second and third terms. I was able to pass the entrance examination to Ila Grammar School. While in Form One, I was the best student. In fact, I won a prize of N10 in Mathematics, together with some books. Then, N10 was a big money. Unfortunately for me, my father died while I was in Form Two. The rest of the story is what I have said earlier. I would probably have become a bicycle repairer, a wristwatch repairer or even a trader.
In what way(s) have you been able to manage professional life with home and social engagements?
People say that you must find time for anything you have interest in, but I must say I don’t have much of social life. It is not a disease that I don’t have a social life. Most doctors don’t also have a social life. Only a few do, though I don’t know how they do it. You really need to be aggressive about your work before having a social life. This is because the workload is too demanding and it is so much that you want to rest during the little time you have. I don’t have much of social life, but concerning my home, I give glory to God that my wife is such a peaceful woman. She is a partner par excellence. She doesn’t give me trouble. Our children also don’t give us trouble. This has made it easy for me to go according to what I have projected for my life.