We are practicing medicine in a depressed economy – Bello
As a young boy, Sunday Ohiwere Bello dreamed of becoming a banker. But a change of school made him realise he could better in science. Today, he is a haematologist at the Lagos University Teaching Hospital, where he is a part of a workforce that have dedicated their own lives to save other lives in spite of the uninspiring work environment, lack of decent work tools and platry and inconsistent salaries.
As the world marks, World Health Worker Week, Bello sits down for a chat with Ifeoluwa Olokode about his humble beginning, the challenges he faces on the job and the importance of blood donation.
Please tell us about your background and how you got into this line of work.
My name is Bello, Sunday Ohiwere. I’m from Edo State. We were 14 children in my family and I’m number 9. I’m from a family of peasant farmers. From the 1st to the 8th child, their education ended in secondary school for one reason or the other. But I gave myself a challenge and told myself, “I’m going somewhere.” So I had to do extra work. I was in SS2 going to SS3 when I picked up some past questions and discovered that I cannot pass this exam (in my current education state). if I tried it, I’ll end up like my siblings. So I left that school for a private school. But to support my education I had to do farm work. I lost one year during that transition. Before my move to a private school, I was a commercial student and had dreams of being a bank manager. But when I made the move, I found I was doing better in science subjects. So I decided become a science student.
How I became a lab scientist? In my village people used local herbs when they fell sick and sometimes developed some complications. So I decided I wanted to become a doctor so I could take care of my family. Being a science student I was working towards medicine but when I got into university I found out another course which is the backbone of medicine, Medical Laboratory Science. Because if we (Medical Laboratory Scientists) give wrong diagnosis, the patient will be treated wrongly. If a patient who is anaemic comes to the hospital and the Lab Scientist doesn’t do their job correctly, the doctor would say this patient is okay and not in need of the transfusion. Red blood cells are oxygen carriers and if red blood cells are reduced, hypoxia will set in. This means the patient is slowly dying of oxygen deprivation and will eventually go into a coma. I discovered that this course is very good and decided to study Medical Laboratory Science at Ambrose Ali University in Ekpoma, Edo State. I fell in love with the course and I’m presently practising the course.
Please tell us about your work. What is your day to day like? Are you involved in the collection of blood?
In Medical Lab we, have 4 departments. Molecular Biology, Histopathology, Chemical Pathology, and Hematology & Blood Serology. I majored in Hematology & Blood Serology. In Blood Serology, we study antigen and antibody complexes and interactions. In hematology, we study the causes, prognosis, the treatments and preventions of blood diseases. So we must know the normal to tell the abnormal. I am currently in the Blood Bank practising Blood Serology. What we do in do here [in the Blood Bank] is to ensure safe blood transfusion and it starts from the point of collection. So we have different units and the journey is thus, when the blood is collected in Donor’s clinic, it is sent to TTIS for screening. The units of blood have passed various tests and tested negative for diseases are then sent to the Compatibility Unit. We are the same species but not the same blood group. We might be the same blood group but have different rhesus factors.
It is in this compatibility unit that blood is tagged and arranged systematically. In the Blood Component Unit, we produce Blood components like fresh frozen plasma, platelet concentrate, packed red blood cells. Blood collected from donors must get to the component unit in less than 6 hours because the longer blood remains whole, the blood components degrades. The different blood components must be stored at different temperatures and conditions. Not all patients have the same issues. Anemic patients should be given packed red blood cells not whole blood. If you give an amenic person whole blood, you have further diluted the person’s circulatory system and that can lead to iron overload. If a patient has uncontrolled bleeding and needs FFP, give FFP not whole blood. After the bleeding is controlled with FFP, then you can transfuse whole blood. Transfusing whole blood into such a patient is like pouring water in a basket. Cancer patients need platelets.
We are seeing an increase in requests for blood components. In the past we received maybe 100, 200 a month. But now we receive requests for about 800, 900 for blood components like platelets, Fresh Frozen Plasma (FFP) and packed red blood cells. That has really helped in patient management because often times you’ll discover that some patients who need platelets does not need blood. But in the past they say give fresh blood which the patients doesn’t require. If the patient requires FFP, give FFP, if the patient needs platelets, give platelets. This makes the patient recovery very fast.
So by giving patients the components they need, patient outcome is faster and better?
Yes! The patient comes out of the sickness quicker. That has really helped in the patient management a lot.
So are you doing any seminars or awareness to help clinicians know that?
I think that last year around May/June or there abouts, our department organized an event where all the Management Doctors came. Our HOD and Dr Ogbenna talked about components and their proper usage, when it is needed so you don’t need to ask for whole blood. Practically, abroad, you don’t see them asking for whole blood. They ask for platelets or packed (red blood) cells or whatever the patient needs. So that’s what we are trying to go to. I think last week again they had another meeting, another training with the nurses because we found that when it comes to the issue of FFP (fresh frozen plasma), if a patient is probably O-, A- or B-, and we don’t have that particular (blood) group on hand, we can actually give AB+. We discovered that most of the time, the nurses are afraid that how will I give AB+ to a patient that is O-. So last week, some of our senior registrars here went to have a meeting with them to teach them and give them lectures about the compatibility of (blood) products and I think that has helped a lot.
In addition to the challenges we have, we are clamoring for voluntary donors. It is our biggest challenge. We need a way of publicizing it so people can see the usefulness (of donating blood). Because it is very painful if there is an accident or an issue where this person needs to be resuscitated by transfusion. If they finally make their way to the hospital and the blood bank is empty. It is so painful. You’ll see patient dying because there is no blood. So (we need) voluntary donors not commercial donors because if you have a voluntary donor, you have healthy, safe blood. Because (voluntary donors) will tell you the truth unlike the commercial donors who will hide some important information just to make sure that they get the money. But someone who is a voluntary donor will tell you the truth. During blood donations, there is a clerking session. We have to clerk donors before they are allowed to give blood. During the clerking session we ask the donors if they are on drugs, we check their weight, ask them the last time they donated and other questions. But a commercial donor, when asked these questions, might not tell you the truth. Also, they will donate more frequently than they should. Ideal donation frequency for males is every four months, for females, every 6 months. Females can donate twice a year, males 3 times a year. With that we have safe blood to transfuse. If people donate more frequently than they should, the blood loses iron and platelets. If you are preparing platelets from such blood, you will not have a good platelet yield compared to somebody who gives time. The person who give time between donations allows their body to replenish (nutrients). Sometimes we need platelets but don’t have donors. We need need quality, ,not just quantity. Without quality donors we cannot have blood components.
How are you aware of global standards? Do you attend international conferences? How do you communicate with your peers across the world?
This is another challenge. There is no systematic process of training and retraining. There are always changes in the industry. These changes happen frequently. If I’m trained this year, that doesn’t mean there won’t be new information at another training next year. There is no budget for training and retraining, all trainings and conferences we go for are self-sponsored. There should be a systematic arrangement for yearly trainings. When people go for trainings and update themselves, they can come back and update other people. We also have to look at how international trends and standards suit Nigeria’s unique geo-political circumstances.
Nigeria is currently experiencing a brain drain of health workers. A lot of doctors, nurses, medical lab scientists, amongst others, are leaving the country. Why are you still here?
The truth must be told, we are practicing medicine in a depressed economy. It’s all about passion, money isn’t everything. A lot of people are leaving because the pay abroad is better. But they will pay you with their right hand and collect with their left hand. My passion for joining this profession was not to give service to other counties. I’m interested in impacting my own country. That’s my primary reason. Me still being in this country is because I have a passion for my people. It’s not like I haven’t been tempted to leave but if everyone leaves the country, who is going to take care of the country? We live Nigeria to take care of people in other countries, what will happen to ours?
What would you want the general populace to know about your work and how would you like them to support you?
I would like the general populace to know blood is life. I would like them to encourage voluntary donors. If people make it a point to donate blood at least once a year, we will be able to have adequate blood for the country, and we will have quality blood. People should also be enlightened on blood components. Some hospitals still transfuse whole pints of blood and this is wasteful. A pint of blood can take care of 5 patients. LUTH does not currently transfuse whole blood except in conditions. We have enlightened doctors to the point that they know which component to ask for. If you have 3 patients in a ward, one requires packed red blood cells, another required FFP, another platelets. You’ll discover that one pint has saved 3 people’s lives. Therefore, it should be known that blood can be split into components. The right component should be given to prevent circulatory overloading. I would like people to know LUTH prepares blood components. However, we are struggling to meet the demand for blood components because of the scarcity of voluntary blood donors. We don’t want to create blood components from commercial donors. If we have 10 times the machines and other resources available but no whole blood, we cannot get blood components. Currently, LUTH prepares 80% of the blood components used in Lagos. We send blood components as far as Akwa Ibom. They come from far because it’s not something every hospital can do. You cannot prepare blood components without a donor clinic.
In what ways is your job connected to the overall health of the general populace that people may not be aware of.
As I mentioned, MLS is the backbone of medicine. Some people don’t know that to manage patient health, you need concise results from the lab. Some people do guess work. Some will look at a patient and say “it’s like this patient is anemic”. There is no “it’s like”. You should do tests to confirm if the patient is anemic or not. From tests, you can take a decision. Doctors shouldn’t treat patients without tests because from tests you can deduce what to do. There was an instance of a Nurse with an infection who was using strong antibiotics but the infection wasn’t going. She came in for a test, we did a culture and sensitivity test and found out the antibiotics of lower strength that she was ignoring was actually what she needed. She was using the wrong antibiotics with higher potency. The pharmacists dispense, the doctor prescribes and the Medical Lab Scientist investigates. Patients should have tests run before treatments should commence.
How can the community, decision makers and other health professionals support your work and create a better working environment for you?
Everyone involved in the care of a patient should have the wellbeing of the patient in mind. Let’s forget ego and self-aggrandizement. All we should be thinking about is how to make a patient well. There are many people involved in patient care: doctors, nurses, pharmacists, medical lab scientists. My role is to perform the investigation and produce test results. Doctors shouldn’t look down on Lab Scientists and say, “how can a lab scientist give me this report.” If we have the wellbeing of the patient, we’ll recognize we all have jurisdictions and limitations in our roles as health workers and look for ways to collaborate and harmonize. We shouldn’t look down on any health profession as inferior because all hands should be on deck and working towards patient wellbeing. Doctors, nurses and pharmacists should see us all as playing on the same team. Also, Lab Scientist should perform investigations with our whole hearts, to the best of our ability. Because if we let personal or professional disagreements come into our work, the patient will suffer.
The decision makers, there are some policies they make that will not help the growth of the profession. For example, if a health center is built and there are unfavorable policies, cost of those policies get passed down to the patient. The decision makers should be creating policies that will minimize the cost of healthcare for the patient.
For the community, patients should avoid self-medication and visit health workers as soon as possible. When I was doing youth service in a village, some mothers give their sick babies herbs, the babies become anemic and when the babies are very ill, they are brought to the hospital. By then it’s too late and the baby dies in the hospital. Then the mothers will claim the hospital killed their child. Sick people should be taken to the hospital on time so the right diagnosis can be given.
The community should also be their brother’s keeper. They should take care of those who may be living alone amongst them. Help them get to the hospital if they need it. I’m here in the lab preparing components that can save lives, but there is no way I’ll know who is sick in the community. That is why it is important for the community to take care of each other so they can benefit from my work here. For example, where I did my NYSC, the NAVY hospital brought down their prices so it was accessible to the community. If the community was unwelcoming or prevented the NAVY from building the barracks, they won’t have had access to this healthcare.
Also, culture and norms should be set aside in life threatening situations. There was a Muslim woman who was in destressed labor and needed C-Section but her husband wouldn’t allow the only doctor on call, who was a man, treat his wife. He insisted on a female doctor and there was none available. Unfortunately, the woman died. We were ready to render the service but the cultural and religious background killed the woman.
All these issues, if addressed, will make my work easier.