‘Funding, planning for healthcare delivery should be devoid of politicking’
What are the challenges in training healthcare professionals in the country?
THE first thing is the problem of planning. If you are in a system training this number of doctors and as the doctors are graduating, they are not getting jobs for two years, no internship jobs, there is a problem with our system. Not only that, doctors want to do residency and they can’t enter into the residency-training programme for five years and eventually they give up and go abroad. Are you aware now that Britain has opened its doors? They are giving health professionals visas on arrival. So, there is a need for planning. How many medical schools do we have? How many doctors or nurses are being trained in these schools? What are the capacities? How many spaces do we have for House Jobs? How many spaces do we have for residency? How many spaces do we have for them to become consultants? There should be a flowchart.
We need to have proper planning and it should not be dependent on which political party is in power. It should be something set to run as a civil service policy so that things are not reduced to chaos. That is what civilized societies do.
The second aspect is funding. The Federal Government should realise that everything costs money. Not only the government, even parents and members of the public must know this. For example, if you want to go to Harvard University to study Medicine, tuition is over $60,000 per annum. Our students here pay anything between $100 to $200 per annum in public universities. You want to access education, some are paying $60,000 but you are paying $100 or $200; there’s no way you can have quality. What the Federal Government should be looking at is, how much does it cost to train a nurse in the University of Ibadan? Maybe, it’s going to cost $40,000 equivalent or maybe two or three million naira a year. That money should be made available or that nursing student should pay those fees. Most families cannot afford this and this is why we should develop a system of loans or scholarships. But so long as we are not paying competitive fees that should be paid, we are going to have rundown dormitories and educational facilities and we won’t be able to offer world-class education.
If you move on the campus of Harvard or any top university for that matter, anywhere you go, you can access the high speed Internet. Nothing comes free and that is why you find now that most of our leaders will either have their children in private universities or they will send them abroad. They know what happens abroad. You go to a dormitory in a public university, you find six to eight students in one room.
Funding should drive the system. Families should pay based on what they can afford. So, there is a need for sliding scale put in place. Those who can afford to pay more should pay, but those who can’t afford can pay what they can afford according to their ability.
Then, there must be a system in place to monitor and evaluate. If I stand before students to give a lecture, the students should evaluate my lecture. We evaluate them by giving them examinations. Everything – quality of teaching, productivity and others – should be evaluated. On a regular basis, people should come to this place and see what we are doing. The monitoring and evaluation system of healthcare delivery should be there so that things don’t go to the dogs. So, when you are building a system, there must be a system in place for evaluation and sustainability. We must sustain the system and then ensure it improves.
Do we have enough doctors in the country right now?
We don’t. In my opinion, every healthcare centre in this country should have one doctor; and not just a doctor but a trained family physician.
Medical tourism is still taking away our resources…
It is so sad. But this Coronavirus (COVID-19) pandemic is an eye-opener. This country can afford to have one world-class hospital in each geo-political zone. Each zone should have at least one hospital that offers everything needed.
If you have a hospital where there is no running water in the tap and there is not constant electricity supply, it is not world-class. We don’t even have the basics. People can’t access healthcare. For example, one of my tailors was diagnosed with cancer. She was told to go and bring two million naira ( for an operation. She did not have the money. Most people don’t have health insurance. That’s why people go for local herbs and drink concoctions. We need to have world-class centres so that when a person is sick, you won’t think of going abroad.
The University College Hospital (UCH) should be supported to become a world-class hospital once again. UCH is the first and foremost hospital in this country. I was born in this hospital. My parents were not even living in Ibadan then but they travelled to Ibadan because they were informed about the quality of care in UCH. Then, UCH was ranked number four in the Commonwealth. People were coming from Saudi Arabia and other countries for treatment in UCH.
A lot of people with mental illness are roaming the streets. What are factors responsible for this?
This is because their social support structure has broken down. The family is fed up. There are a lot of people with mental illness who you won’t see on the streets because their family is still caring for them. When you see them on the street, the family is fed up. That is why we need good social welfare services. Interestingly, in many big cities in the world, London, New York and others, you have people with mental health challenges, drug substance problems living on the streets. So, it’s a big social problem in the world. But possibly the problem is worse here.
What do you think is responsible for the nhigh incidences in the country?
The problems are poverty and lack proper of social welfare services.
Is mental illness hereditary?
Generally, there are some kinds of disorders that are common in certain families. But it is not everyone in the family who will manifest that illness. Everybody has a breaking point. Let me give you an analogy. Let’s say there are two young ladies. For one of them, her stress level to break down with mental illness is 20 loads of stress. Another person has 2,000 loads of stress to breakdown. They both start out life together. The person with 20 loads of stress has her parents living together, loving and caring for her and she has a supportive environment. She grows up and marries a man who is supportive. Even though she requires just 20 loads of stress to break down, she may never manifest illness. Whereas the person with 2,000 loads of stress could her parents who are divorced or separated, or there is a lot fighting in the house. She is tossed here and there, living with relatives and eventually marries a man that doesn’t care for her and so on. She will break down. Even though there are genetic issues related to mental illness, the environment has a strong component. It’s about nature and nurture coming together.
What can we do to address the menace?
I’ll suggest we start from the mother, even before pregnancy. Let mothers enjoy good health. Let them enjoy support from the society and families through pregnancy to when they give birth. Let them have a good place to have the babies. A lot of women still deliver at home under conditions that are not right. So, the baby may suffer a traumatic delivery and they may have some problems of lack of oxygen, which we call birth asphyxia, making them prone to mental health problems. So, a baby who suffers a traumatic birth is more likely to have mental health problem.
Somebody with a happy childhood is more likely to withstand stress than somebody who has had a traumatic childhood. Studies show that 50 per cent of mental illness starts before the age of 14 while 75 per cent start before the age of 25 years. So, most mental illnesses start in childhood. Childhood is the time to invest in protective measures.
It’s been reported that the University College Hospital is grappling with paucity of funds. How is this being tackled?
I strongly believe that UCH should receive adequate funding from the Federal Government. Also, the people that access healthcare in the hospital should have a health insurance so that they can pay adequate fees for the services rendered. This is the first teaching hospital, a flagship in this country. The Federal Government should be passionate in making it a 21st-century hospital through funding.
With the stigma associated with mental illness in the country, how did your parents react to your decision to study Psychiatry?
I had lost my father when I was very young and was raised by my mother. I’m the daughter of the late Lt. Colonel Victor Banjo who was killed in 1967 during the Biafra War. My mother was from Sierra Leone,a and was very broadminded. She told me that if I were interested in Psychiatry, she would encourage me. She said I was going to live with myself for the rest of my life and so it was important that I enjoyed my work.
However, I had opposition from other quarters. For example, my uncles urged me to study something more respectable such as obstetrics, gynecology, surgery or medicine. But from the moment I made that decision, I never looked back. I became a professor on October 1, 2008, about 12 years ago.
Your husband, Prof. Akinyinka Omigbodun is also a professor in the College. How and where did you meet?
I met him when he was a resident doctor in obstetrics and gynecology in this hospital. I was a medical student. You know, resident doctors teach. When we were rotating through O and G, he had to sign me up for a few procedures. He is a very decent and dignified man; he didn’t mess around. At some point, we became friends and the rest is history.
What is your vision for the College?
I have seen that there are a lot of talents in the College of Medicine and the University at large. I believe that, with the help of God, I can bring people together. One of my best skills is the recognition of talents and bringing people together to make something good. It is not about me, it is about us.
I have an agenda called the TOGETHER AGENDA. Each of the letters stands for one aspect of my planned focus. The first focus, which is T stands for togetherness through community conversations and collaboration. The O stands for optimising staff productivity and welfare. The G is preparing our students ready for the global stage. The E stands for espousing an international outlook. The next T means teaming up with UCH and other parts of UI. The H is for harnessing the power of alumni and E stands for enlarging our financial pocket. The R stands for reaching out to the community. It is very important that the communities around us feel our impact. Our research should impact the communities. In addition, leadership is important. I will be very transparent, accountable and inclusive. In the next four years, I hope to really see the College move higher.
Some of your predecessors ended up becoming the Vice-Chancellor of the premier university. Are you also aiming at that coveted office?
For now, I have a task at hand – to work and make the College of Medicine better. When that is done, we will see what God has in store for us.
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