Mother, daughter war against COVID-19
Ngozi Onyia is the founder and Managing Director of Paelon Memorial Hospital (PMH). A trustee of many organisations, the 1982 graduate of the University of Ibadan is a Fellow of the West African College of Physicians in Paediatrics. She holds an MBA from Lagos Business School and is certified from the International Society of Travel Health. On the other hand, her daughter, Unoma Grant, is the Chief Operating Officer of PMH. She graduated from the University of Cape Town in 2009 with a Bachelor of Science in Mechanical Engineering, then went to the Lagos Business School in 2016 and the Pan African University’s Enterprise Development Centre in 2018. She is a healthcare administrator with over 11 years experience leading transformation in complex organisational structures, as well as devising and implementing successful strategies during start-up, growth and crisis phases.
In response to the global COVID-19 pandemic, the Management of PMH opted to convert its Ikeja branch to a fully dedicated COVID-19 treatment centre. In this interview with TOBI AWODIPE, they shared experiences of being at the forefront of fighting the pandemic and stepping up to provide COVID-19 care, tackling vaccine hesitancy, unending brain drain and the future of healthcare sector in Nigeria.
Ngozi Onyia:‘Medicine Is My Calling, My Ministry’
You have been in medical profession for almost four decades now, take us through your journey briefly?
When I applied to University, I had the option of choosing three courses. I only had one choice, medicine! I qualified as a doctor in 1982 from U.I at 22. In my first year of medical school, I became born again and an active member of the Ibadan University Christian Union, from Feb 1978 to June 1982 when I qualified. When we qualified, the elders of the fellowship laid hands on us and we were commissioned as co-labourers with Christ in God’s healing field. For me, medicine is my calling, my ministry.
I worked for a couple of years (1983-1989) in NITEL, got married in 1984 and had my first two children in 1985 and 1987. My Dad had made my husband promise (also at the altar) that he would ensure I undertook a specialist training and I started my specialist training in 1989. I trained as a paediatrician at the Lagos University Teaching Hospital and I qualified with a Fellowship of the West African college of Physicians (FWACP) in Paediatrics.
Life happened to me in the course of this training and in 1994, my last child Patricia was born with the CHARGE Syndrome, a rare congenital condition. She was an expensive child to have, so I had a reality check and left LUTH to return to my job in NITEL; a job that came with health benefits for my dependents and I. Leaving LUTH meant turning my back on a career in academia, a life long dream.
After five more years in NITEL, I took on what turned out to be my most memorable job, Company Medical Adviser of Nigerian Breweries Plc. (NB Plc.) from 2000-2010. My time there can be likened to the growth spurt of a person; it was the period of my greatest personal and professional growth. I honed my skills as a clinician in LUTH, especially as I only passed my Part 1 exam at the third attempt (young mother of two small children), but my personal growth was mostly in my NBL days. There, I built a strong and formidable network locally and internationally; I also got an MBA from LBS during that time.
Nigeria is still dealing with a second wave of the COVID-19 virus. Overall, how effectively would you say our healthcare system has tackled this pandemic?
COVID-19 is a respiratory viral infection and like most respiratory viral infections, after a while, it will burn itself out. Viral infections on the average last for one or two weeks and then they are gone. Most patients are no longer infectious after two weeks and 81 per cent will recover; 19 per cent will become seriously sick, 1-5 per cent critically ill. At this point, the sick are suffering after effects of the infection, but are no longer infectious.
The pandemic dealt a blow to our struggling health sector, especially practitioners in the frontline. How better can we protect others going forward?
I will say the entire healthcare system is struggling and not just the workers. Our healthcare is extremely fragile, and yes, the pandemic dealt a huge blow and shook our very fragile healthcare system to its core; we need to fix the entire system. A lot of things require fixing in our country, sadly.
In my opinion, the most important thing we need to do is get healthcare economics and financing right; it will enable us train and retain personnel, acquire equipment, drugs, reagents, consumables and everything else we require to strengthen it.
You founded your hospital over 10 years ago, what informed that decision and how has this journey been like for you?
PAELON is an acronym coined from the names of my third child I referred to earlier PAtricia ELozie ONyia (25/05/94-11/11/03). Being her mother for nine challenging, yet enriching years, impacted me greatly. I accessed healthcare in three countries across three continents and the lessons I learned further refined my already above average work ethic that I learned from my hero, my first love, Dr Francis Uzoma Kwentua Ogeah, my Dad, who was a clinician par excellence. He owned the first private hospital in my hometown Asaba that he ran from 1972-1996.
My Dad’s influence, my Christian sense of mission and my innate qualities led me to the establishment of Paelon Memorial Clinic that is now Paelon Memorial Hospital in 2010, after I left NBL, with a vision of redefining healthcare in Nigeria. My network provided the initial capital I required, including generous trade credit from suppliers; my first set of clients was from my network.
On the whole, I would say it’s been challenging, but very rewarding; I’m not sure I would have wished it otherwise. I have been able to realise quite a few of my dreams; I enjoy working. I love being a doctor, that’s all I’ve ever wanted to be and that’s all I am.
You have been in the forefront of the private sector fight against the pandemic since last year; tell us how this battle has been for you and your staff?
The work that has earned us the greatest attention has been the fight against COVID-19. This has increased our visibility in the healthcare space, locally and internationally, as we also treated a lot of foreign nationals. To date, we have managed about 3000 patients and through us, many lives were saved for which I am grateful.
We were an existing hospital with existing patients; some of whom we knew would get infected. There were no special COVID hospitals, so we realised that if our patients fell ill, they would require care, so we prepared as best as we could. This was a novel disease and nobody knew much about it; I don’t think any of us expected it to last this long, the last pandemic was more than a 100 years ago. We just prepared to look after patients in a way that would protect staff, non-infected patients while caring for infected patients, so we did the best we could.
We were following electronic media, social media, seeing what was being done in other parts of the world, trying to copy when there was a wheel, and invent one where there was none; we were learning on the go. In February 2020, we had a town hall meeting where we reminded ourselves that turning down COVID-19 patients (or any patient indeed) was not an option for us.
Management promised to provide all that was required to treat patients safely, (policies, training, triaging, engineering control, PPEs). Despite the challenges posed by the breakdown of the global supply chain with prices soaring out of control, we kept our promise. We constructed a holding bay outside the hospital as part of our engineering controls.
In April 2020, we put out a notice to announce the temporary closure of our Ikeja branch (a purely business decision), and the son of our first known COVID 19 patient, suggested that we convert it to a treatment centre with a promise to help. He kept his promise and together with some others, (again, my network as my net worth, and after seeking approval from Lagos State Government) we opened The Ikeja Paelon Protection Centre on June 6, 2020.
The Lagos State Government has rolled out vaccination plans for residents, but many are reluctant to take it for a variety of reasons. What is your take on this?
Vaccine hesitancy is not unexpected given the kind of negative rap that vaccinations have received recently on social media. It is a global phenomenon, worse among black people. Given our history, we are understandably less trusting; given to myths and fables. It is unfortunate that people consider social media as gospel truth; anybody can write anything and it goes viral. The genuinely ignorant and the mischievous alike are responsible for this and we all know bad news sells fast. The more terrifying the story, the more it spreads.
Everyone is now an expert on phases of clinical trials, vaccine production and all kinds of things that were previously the preserve of highly trained scientists. Vaccines, one of the greatest public health interventions, have been around for over two centuries. We have vaccinated our children for decades without questions and suddenly, we now want to know how vaccines are made. I believe confidence will be built when more people are seen taking the vaccines with few or no side effects.
I took the vaccine over two weeks ago and I have had no side effects. We are conducting a self-funded small research on blood clotting on the Oxford AstraZeneca vaccine, because soon after I took the vaccine, I decided to check my D-dimer level, a test that indicates one’s propensity for forming blood clots and it was fairly high. As I did not know my pre- vaccination levels, I could not attribute it to the vaccine. So, we decided to carry out a self-funded cross-sectional study on pre and post vaccine levels of randomly selected people and we will publish our results and data very soon. We need influencers to join in the campaign. My Pastors, Godman and Bolarinwa Akinlabi came into the hospital for a routine health check on the day Paelon staff were being vaccinated and I asked that they be vaccinated too. Thankfully, they trusted me and received the vaccine; they have posted their vaccination cards on social media with positive feedback. This has to be a battle of winnings hearts and minds.
Vaccination is the safest and fastest way to achieving herd immunity and getting back our lives. The desire for an immunity passport for travel will be another reason why people will accept the vaccine. On another note, the earlier the government involves the private sector in vaccination, the faster we will achieve herd immunity. The private sector has traditionally been the preferred and trusted provider of healthcare for over 60 percent of our population, we cannot expect this to change now when trust is so crucial. Government must learn to see itself as regulator and enabler, not as competition of the private sector. It was also disheartening to see a letter purportedly signed by an official of the Federal ministry of health alerting the public about the supposed importation of fake vaccines from China. It amounts to throwing fuel into the raging flames of distrust and uncertainty.
Nigeria’s healthcare sector consistently suffers brain drain yearly, how best can we stem this?
Focus on healthcare financing and economics. All successful healthcare systems are driven by insurance. We need to get health insurance right in order to raise the quantum of capital required to fix our healthcare system. A well-funded system will train and retain healthcare personnel, will provider for requisite infrastructure, equipment, consumables, drugs, reagents and so on. It will lead to backward and forward integration of the supply chain-health training institutions, pharmaceutical manufacturing, equipment manufacturing and so on.
We need to encourage our HNIs to invest in healthcare to encourage FDI. Government should provide infrastructure, investment friendly policies; tax breaks for the health sector and cheap asset financed loans. Dearth of healthcare personnel is a real threat to the system and I know given a choice, most will prefer to stay back, but realism, self-interest and survival instinct moves people away from the seemingly hopeless situation here. Medicine is said to be the most difficult course of study, yet a young doctor, five years into practice earns $500 and commutes by okada. Same doctor gets to the UK and earns 10-15 times more and has access to good credit to purchase a brand-new car, what do we then expect?
In your opinion, do you think the government is doing enough to deal with all the challenges facing the health sector?
Certainly not. We have heard high-ranking government officials saying some doctors should become fashion designers and another saying we have enough to spare and so we can export them; like Nero fiddling whilst Rome burns. I hope this pandemic will change the narrative and finally get the government to do what it should. I must acknowledge that a few states are making headways with Lagos taking the lead. I would like government to be more democratic and less autocratic. Decades of military rule have done great harm to our psyche, the leaders and the led.
How would you say Nigerian women are faring in the medical world today?
I think women have done relatively well in medicine, particularly in academic medicine and in the civil service. In private healthcare, less so, but we are hanging in there and pulling our weight.
‘Women Have Always Been A Strong Part Of HealthCare’
As COO of this hospital, what does your day-to-day job entail?
I am responsible for ensuring the implementation of the hospital’s strategic initiatives. On a day-to-day basis, this translates into the supervision of all non-medical staff, overseeing branding, public relations and procurement, as well as ensuring the maintenance of our facility. I like to practice what I call “management by walking around” as this allows me to catch wind of and resolve small incidents before they become big problems. Most importantly, it gives me a chance to interact with all the employees to ensure that they feel safe, happy and motivated.
Running a mega healthcare outfit with hundreds of staff cannot be without its own challenges, what are some of the issues you have (had) to deal with and how did you manage?
Most of the issues that I’ve had to deal with are not unique, but are staples in most businesses in Nigeria. However, what’s unique to our industry (healthcare) is rapid brain drain; our healthcare workers are relocating out of Nigeria in large numbers with no end in sight. For now, there isn’t much we can do about the drain, but we have put a number of measures in place to ensure that we do not have a shortage of healthcare workers, including having a large pool of locums and running internship programs that allow us to overstaff without exploding our overheads.
A problem that is unique to us specifically is that our management team has been and is still mostly made up of women. This was a problem when the organisation was smaller as very few men were able to work in an organisation with all female bosses. This led to a 97 per cent female workforce, which gave the impression that we are a mother and child hospital (which is not the case). We are a general specialist hospital and so, I’ve worked hard to ensure that we are more inclusive in our recruitment policies and we now have a more diverse workforce.
What are some major highlights and achievements you have recorded in recent times?
We have achieved a lot in the last 10 years, but the two that stand out to me the most are: SafeCare Accreditation: Out of 1,985 previously assessed hospitals across Africa, in 2016; PMH became the first hospital in SafeCare’s history to be awarded five stars. We were reassessed in 2020 and have been re-awarded five stars. We were not only the first hospital in Africa, but remain the only hospital in Nigeria to be awarded so.
Secondly, COVID-19 Response: In less than two months, we repurposed, equipped and converted one of our branches into an approved treatment centre.
How did you manage the pandemic?
At the start of the pandemic, a middle-aged lady died in our ICU from COVID-19 after being rejected by several hospitals. It was clear to us that there was a potential crisis on our hands; this pandemic was real and there was no way to determine who was going to be ill and who wasn’t.
Healthcare workers are the soldiers in times of health crises, and we have a responsibility to rise up during a pandemic to protect and save as many lives as we can and so we did just that. After we set up our centre, we developed management protocols and shared them with our colleagues in West and East Africa also managing the pandemic.
What measures did you take to protect your frontline workers when the pandemic was at its height?
As part of the approval process for the COVID centre, we were rigorously trained by the HEFAMMA infection control team on how to keep our patients and ourselves safe. This included training on the safe use of PPE and handling of waste material; we took this seriously and enforced it throughout the treatment centre. We also provided accommodation for our staff working in the treatment centre, who were scared to go back home to their families after each shift and all these measures worked.
Nigerians complain of poor healthcare here, preferring to go abroad, do you think this is a genuine concern?
Sadly, I do, but not for the reasons most people think. Most Nigerian doctors are decently skilled, well-trained and well-intentioned healthcare professionals. However, most of them are underpaid and overworked (especially when compared to their colleagues in the West). For these reasons, the patients sometimes have to deal with stressed out and/or fatigued doctors who may be grumpy, impolite and occasionally make a judgement error.
Here, we strive to pay above market wages, however we are not able to pay our doctors as well as we would like to because of the high costs and low revenues that are typical in healthcare. To compensate for this, we do our best to ensure a favourable work life balance.
Medical quackery seems to be on the rise in the country. If given the opportunity to reform the medical sector, what would you do?
Thanks to HEFAMMA (Health Facility Monitoring and Accreditation Agency) this problem is not as big as it could have been in Lagos. The vetting process to practice medicine in Lagos is rigorous and leaves very little room for quacks to fall through the cracks. However, for those that do fall through the cracks, granting all licensed employers of healthcare workers access to a database of all registered healthcare workers and licence status would help ensure that hospitals only employ those fit to practice.
I will also educate the public on the dangers of using “freelance” homecare doctors and encourage the use of doctors from accredited hospitals only.
Health workers often go on strike, what can be done to prevent this from happening frequently?
Being in private healthcare, this is not an issue I have a lot of experience with, but I suspect improved and more consistent pay combined with well-maintained healthcare facilities and equipment will keep most healthcare workers happy.
What solutions would you proffer to revamp this sector for a complete turnaround?
I believe that the key to unlocking Nigeria’s healthcare potential lies in the underserved population of the country; getting them into the hospitals and receiving care is the first step towards revamping our healthcare sector. We need to start by increasing our national budget for health insurance to provide a more robust health insurance scheme for the Nigerian people and educate them on their benefits and entitlements. If the health insurance companies (public and private) are able to pay higher premiums for a larger number of people, then the hospitals will be able to provide a more robust service with more, and better paid healthcare workers, as well as shorter waiting times. The improved wages for healthcare workers will ultimately lead to “brain-return”, which (considering the number of extremely skilled and talented healthcare professionals we have abroad) will escalate the growth of the industry in ways that we cannot yet imagine.
In your opinion, how would you say Nigerian women have fared/are faring in the medical practice?
Women have always been a strong part of health care with roles like nursing being female dominated. However, in the past, a lot of these roles went under appreciated and were even sometimes looked down on. However, the industry has developed a very healthy appreciation for these roles and we are seeing directors of nursing in organograms on the same level as the CMO. We are also seeing rapid growth of female healthcare entrepreneurs, consultants and hospital administrators.
How are you coping combining medicine and your other essential roles?
As a wife and mother with a young family, juggling my family life with my busy work schedule is no easy feat but working so closely with an amazon (my mum) for so long, she has made sure to guide me on how to maintain a healthy work-life balance and to maintain a strong sound mind and for this I am eternally grateful.
For starters, I’ve been blessed with the most amazing and supportive husband, who does everything he can to ensure that I am able to be the best version of me in every aspect of my life. I have a phenomenal dad and great brother who are my biggest cheerleaders and are always on the phone with words or love and encouragement that will brighten me up on my darkest days. I have a large, loving and amazing extended family and we all make it a point to support each other; I will always have a place where my children are loved if I need to be away from them unexpectedly.
I have also been blessed with the world’s greatest nanny; she’s been with us from the birth of our first child and having her as part of our family means that when I’m at work, I can focus on work knowing that my children are in great hands. My team at work is made of some the best people you could ever hope to work with, they are driven, supportive, hardworking and fun people that can make the most stressful, gruelling parts of my day easier and dare I say, fun sometimes.
Last and definitely not least, I have an amazing and supportive group of girlfriends I get together with at least once a week to relax and unwind. My life is full of amazing people and with all the love and support I get from them, I am able to be a great wife, mother, daughter (in-law), sister (in-law), friend and colleague.
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