Dr Roger Olade, who is the Medical Director of Genesis Specialist Hospital in Ikeja, Lagos, is a medical professional with decades of experience in multiple specialties, including internal medicine, emergency medicine, critical care medicine, public health and occupational and environmental medicine. In this interview, Olade, who has spent about 20 years in the US, discourses the challenges of the Nigerian healthcare system, with the conclusion that Nigerians value their cars more than their health.

After practicing medicine in the US for decades, why did you decide to establish a specialist hospital in Nigeria?

Our main aim is to provide healthcare at a higher level and prevent a lot of people flying abroad for their healthcare. We want to make sure that people no longer have any reason to go India and South Africa.We are specialist in caring for patients with strokes and heart attacks. Sad enough, when people have these two health conditions, they cannot fly out. We are four in the partnership. And most of us are coming from the US.

When you compare American health care system with that of Nigeria,that of the Americans seem to be fairly stable. What has been done in the US that is lacking in Nigeria?

Rome was not built in a day. So, I am very positive on my outlook.

But the foundation for optimism seems not to be there in Nigeria.

Yes, it is not there. Bu it is not only in healthcare system we do not have solid foundation. The foundation is not there for a lot of professions. Our doctors might be inadequate as our computer engineers and architects. So, the educational system has become basically debased.

You think our educational system is responsible for our health woes?

Yes, I think the problem is from school .The education system is poor. There are no enough regulatory measures in place; no one is supervising the system. Students graduate without really knowing what they graduated in. It is the same way some of our medical doctors graduate without knowing what they graduated in. It is only in Nigeria we have computer scientists that did computer science in school without opening computer appliances while in school. Why do we expect the doctors to be different? Doctors are trained in hospitals where there are no equipment. But they still graduate. So, what kind of doctors do you expect to produce? You are only as good as your environment.

We have to go back to the beginning and know who is teaching our medical students. Sad enough, most of the good professors in medicine have left the country. And some of them who are in the country are basically into private practice. They do not have time for the students because that is just the system.

Of course, the only way the government can come in is to ensure that good professors around are well paid and it is worth their time to teach and transfer knowledge. The same goes for everything. Lecturers who sell handouts to survive because they are not paid, how are they going to teach? The system is a big problem.

But some experts have also blamed poor health expenditure for the poor health indices in Nigeria.

That is a government issue. That means that the priority of our government is not in our health. But what they do not know is that the wealth of a nation is connected to the health of a nation.

Again, there is a lot of waste in the Nigerian healthcare system. There is a lot of waste even in the 2/ 3 per cent annual health budget. Our health care managers buy expensive equipment that nobody knows how to use. They leave the primary equipment to go and buy sophisticated equipment.

With what I have seen in other places, what I will propose is that we should have specific centres for specialisation.Not every hospital should do everything. We should pick Federal Medical Centre (FMC) in Ondo State, for instance, to take care of heart diseases, and another in Benin for the treatment of stroke. So, if one has a heart problem, one should then be referred to a government heart centre in Akure. You know when you get there, the best equipment and heart experts will be there. And you will get the best care when you get there. Government does not need to buy heart equipment in every hospital, because it can never maintain them. Worse still, we do not have enough experts to manage them. So, if anyone is thinking that will be the direction.

But what are you bringing differently into our healthcare system?

What I am bringing different is to practice the way I practice abroad. Although we are small, we have all the equipment. We want to make sure that lives are not just lost unnecessarily. I am ashamed when I hear that Nigerians are flying to Ghana for healthcare. I can still stomach Nigerians flying to London and US for medical tourism. But when we start flying to India and Ghana for medical tourism, that means there is something wrong. They should rather be flying to Nigeria.

We are blessed. If you see how many accomplished Nigeria medical doctors are in abroad, you will agree with me that there is no reason our people should be flying to Ghana and India for healthcare. Nigeria spent $1.5 billion for medical tourism in 2014 in India alone. Do you know how much that would have impacted on the Nigeria economy, if we even keep half of that money? So, we are transferring money to Indians.

I am only a drop in a bucket, but I believe if others join me in doing this, the standard will eventually improve. The truth of the matter is that this is a private centre and everybody may not be able to afford it. But the government can make things easier by subsidising care, making it easier for us to bring down equipment and give low-interest loans. It is not like we just like to charge patients unnecessarily. The truth of the matter is that equipment is not cheap. We have to buy it with loans in Nigeria, where loans are in double digits.

Globally, preventive medicine is the order of the day. How are you fitting into this?

You are right .We believe that preventive medicine is the way to go; we are big in that.

But in Nigeria, we do not have that culture of preventing diseases. We only go to hospitals when we are sick. But it is better to go hospital when you are well because it is cheaper to do so. It prevents what we call ‘penny wise pound foolish’ syndrome. People do not like going to hospital even when they are sick; they delay treatment by staying at home. May be this attitude stems from spiritual and cultural beliefs. When you tell Nigerians to go hospital, they will think you are cursing them, or you are wishing them bad.

Generally, prevention is the best cure, because everything that happens to you starts small. Diseases are cheaper to treat, if you diagnose them early.

We encourage preventive medicine; we encourage that everybody goes to see their doctors every three months to check blood pressure, sugar level, among others. People take care of their cars more than they take care of their lives. Is it possible for you to drive your car for 10 years without servicing it and without changing the oil? But you expect your body to work without going for medical examinations. Just ask yourself:do I love my car more than I love myself? When you buy car, generator or any other machine, specialists will tell you that you need to maintain them, if you want them to last.The same thing goes for humans.

Some of your colleagues in the private sector have been accused of purposely mismanaging patients. How are you different?

I do not think they mismanage patients on purpose. I believe they do not know. If somebody has heartache, but goes to a hospital down the road, the doctor he may see may be a family doctor or a gynaecologist. Of course, where the doctor may be wrong is that he will not say ‘I do not know how to treat this health condition’. He will admit the patient and start trying his best. But remember that is not his area of specialisation. By the time he has done his best, lost time and things have gotten worse (he has obviously taken the patient’s money), it will now become ‘ let us send him to a teaching hospital’. That is why some patients die. Even here, we get referrals. We tell doctors call us and let us know the cases you have on hand. We can even guide you; get second opinion and refer patients early.

The public should also be aware of the area specilialisation of the doctors treating them. They can get to do this by asking their doctors ‘ what is your qualification? Are you a specialist in this area?’ Challenge the doctor to refer you early when he is not a specialist in the health condition you came with.

We do not deliver babies in our hospital.We treat cancer patients; we take care of patients with brain and heart conditions. We also do surgeries and take care of patients that need intensive monitory in our intensive care unit (ICU). What we do not do, we do not. I think this does not happen a lot in Nigeria.