Why NMA still rejects invitation of Chinese doctors to help manage COVID-19

Dr. Francis Adedayo Faduyile, President of the Nigerian Medical Association (NMA) and Associate Professor/Consultant Pathologist, Department of Pathology and Forensic Medicine, Lagos State University College of Medicine/Teaching Hospital, Ikeja, Lagos, in this interview with CHUKWUMA MUANYA, shed more light on why the association still rejects the importation of Chinese doctors to help the country manage the novel Coronavirus (COVID-19, insisting that Nigerian healthcare professionals were not yet overwhelmed, in spite of the fragility of the system, and are not bereft of ideas as well as the technical expertise needed to manage the disease.

The Chinese government has been helping Nigeria on several fronts until now, but its offer of a 15-man medical team to support Nigeria in the fight against COVID-19 has been strongly resisted by the NMA. Why?
Thank you for this opportunity to make further clarification on the ongoing national conversation, especially on the arrival of Chinese medical personnel.

You would recall that prior to the arrival of the Chinese medical personnel and following the news of their invitation by the authority, the NMA, as the custodians of the health of Nigerians, raised pertinent scientific observations and reservations on the way and manner the federal government arrived at its decision.

One of the key issues raised was that Nigerian healthcare professionals were not yet overwhelmed, in spite of the fragility of our healthcare system. The health personnel have not at any time raised concerns about our inability to treat our patients. Also, we have not seen any major gaps or deficiencies in the management of our patients.

Moreover, the government has not at any time requested from us, difficulties seen pertaining to the treatment and management of this infection in the country. We felt that rather than addressing obvious decadence, including the deficiency of basic tools and appropriate protective equipment, poor welfare packages and lack of any form of insurance for frontline workers, the federal government was busy preparing to receive the Chinese under the guise of donation of consumables and Personal Protective Equipment (PPEs).

In Nigeria, we are not bereft of ideas as well as the technical expertise needed to manage COVID-19.

Nigeria, our healthcare professionals and relevant government agencies were being commended for efforts at containment of COVID-19 by the World Health Organisation (WHO), apart from the commendation we got in the swift containment of Ebola virus infection in 2014.

It is, therefore, not surprising that our sister associations and other critical stakeholders in the health sector, including the Pharmaceutical Society of Nigeria (PSN), National Association of Nigerian Nurses and Midwives (NANNM) had also raised similar concern and advised government accordingly. This can only point to the fact that NMA and other stakeholders were not carried along.

There are also ethical and legal issues regarding when and how a foreigner can practice in any country.

We must stress that the invitation of these medical doctors was not at the instance of the Nigeria government, but an extra condition to supply the medical consumables and PPEs. Earlier, a Chinese philanthropist, Jack Ma, had donated medical equipment and consumables to 54 African countries, including Nigeria, with no conditions.

At different times, we were told different versions of the activities the visitors would be involved in. The most disturbing was when the managing director of China Civil Engineering Construction Corporation Limited (CCECC) stated that they would be treating Chinese nationals in their employment. This is against every known professional regulation or control and as well a diplomatic breach. It casts a lot of aspersion on the professionals in the host country.

Importantly, let me state that the NMA is never against donation or assistance of any form. In fact, we have openly appreciated individuals and corporate bodies in the country and Jack Ma for their donations and collaborations. We are also not averse to sharing of knowledge and experiences, but we pointed out to the government that the different Information Technology (IT) platforms can be utilised through teleconferencing, Skype meeting, zoom meetings, especially with the increasing use of telemedicine worldwide, and this is currently ongoing at organisational and corporate levels, as technology has made the whole world a global village.

But the minister of Health insisted that they have not come to practice in Nigeria, but would only treat Chinese nationals resident in Nigeria after a 14-day quarantine. How far with the situation?
The NMA is a professional association and it is our responsibility to ensure Nigerians get the best possible care even amidst epidemic and the current pandemic, while also ensuring that best practices are adhered to, including extant rules and regulations guiding the practice of medicine in Nigeria.

This is the primary reason the NMA fervently canvassed for the reconstitution of the Board of Medical and Dental Council (MDCN) in 2018 so that medical practice would be well regulated in this country, and we continue to appreciate President Muhammadu Buhari.

The truth is that one would not be wrong to hold the view that the authorities are yet to properly inform Nigerians on the intent of bringing in these 15 “medical experts” from China. If it is true that they are in Nigeria to treat the staff of CCECC, have they involved the MDCN and other regulatory bodies in order to subject them to proper scrutiny in accordance with the Medical and Dental Practitioners Act and other extant laws, that their status could be verified? Are there Nigerians among the workforce of CCECC and what would be their fate?
You are also aware that the federal government, regarding these guests, has given different explanations. It must be clear to us all that no country allows foreigners to come to its territory, jump on their citizens or any patient and manage without being regulated. It is a diplomatic breach to come and treat even your nationals in another country.

Is the minister, as a medical doctor, carrying the NMA along?
There is no doubt about the minister’s membership of NMA as a doctor. Though as an appointee of government, he must be seen to carry out the responsibilities of his office always according to the dictates of his boss, however, it is pertinent to note that those responsibilities include ensuring stakeholders are carried along in critical decisions that impact the health, well-being and livelihood of Nigerians.

Coming back to your question, I must say (and like I have said several times) that the minister of Health and other relevant authorities have done so well so far. Perhaps the busy schedule of the minister did not allow him the luxury of time to fully interact with all stakeholders in the health ministry.

It is good to let you know that some of us are already working together towards the containment and management of this scourge in our country.

What is your position on alleged plans by French doctors and some European and American pharmaceutical firms to conduct clinical trials of COVID-19 drugs and vaccines in Nigeria and some other African countries?
Clinical trial could be simply described as the scientific bedrock for evidence-based therapeutics. So, clinical trials are desirable, especially in a situation like the COVID-19. Usually, it is a continuous process and there will always be the need as long as humans and diseases exist.

However, it is governed by ethical principles and one of the key ethical principles in research is the Principle of Justice. A critical element in this is sharing burden and benefit. For me, it is not ethically right (or sound) to leave your country or region to the African continent to conduct trials of a vaccine for a viral disease, a pandemic like COVID-19, which epicentres are in other continents as of today.

There is no justification for such.

Another big issue is that of accountability for funds and materials donated by individuals and organisations towards containing the virus in Nigeria. Are you (NMA) involved in the disbursement? If not, are you tracking the spending? What are you doing to ensure that the monies are used for purposes they are meant?

Well, the NMA is not involved in anything that has to do with disbursement of money. More so, it is difficult for us to be involved in tracking the donated funds, considering the obvious.

However, as critical stakeholders, we are doing our best through advocacy to ensure the culture of accountability and prudence in the health sector, especially during this pandemic. It is important to note that we have set up strategies, with the full involvement of our state/Federal Capital Territory (FCT) branches, to identify current gaps that resources may be tailored appropriately, with periodic monitoring and evaluation.

Medical doctors, nurses and other health workers are at the frontline of this war and they are at most risk of contracting the virus. What are you doing to ensure their welfare is taken care of and motivate them towards putting in their best?

The welfare and wellbeing of Nigerian doctors and other healthcare professionals should not be toyed with at any point, especially this critical period. Unfortunately, the Nigerian government has neglected this over the years, leading to worsening statistics in respect of brain drain. The NMA has been at the forefront of advocating for the improvement of emolument and general welfare of the healthcare workforce.

In case of the COVID-19, aside from the provision of sufficient and appropriate PPE, I have been emphasising the importance of motivating the medical and health workforce in the course of interacting with the authorities, these include adequate incentives, insurance coverage, training and retraining, among others.

We will continue to impress it on the government to do the needful.

Some schools of thought have rated the country’s efforts at containing COVID-19 high. Do you agree that the country has done well so far?
The government, stakeholders and indeed healthcare professionals have done so well, considering our weak health system and the fact that we are dealing with a novel virus with so many unknowns, and the support of private individuals, corporate bodies and the religious organisation has been phenomenal.

So, working together with determination to defeat a common enemy of the world in spite of obvious numerous challenges is the secret. I say kudos to our health workforce for their resilience and dedication.

One thing we seem to have all agreed on is the fact that we are not testing enough yet, though the testing capacity is improving by the day. Also, the issue of basic tools, sufficient and appropriate PPE, incentives and insurance for medical and health workforce must be urgently addressed, going forward.

What is your take on the use of chloroquine to treat COVID-19 and as a doctor would you recommend it?
Like I said earlier, for any pharmaceutical device/product or drug to be used in clinical care, it must have undergone established scientific processes. That is the rationale behind clinical trials of drugs and pharmaceutical products.

This is important to establish safety, efficacy, dosing and other parameters because you do not want to inflict harm on the patients. It is after adequate data from trials that the scientific/medical community can now make a pronouncement on the acceptable use of such drug.

To answer your question, chloroquine or hydroxychloroquine has not been approved as a treatment of COVID-19. I am aware that many researches on this are going on.

When a person with COVID-19 dies, would the body still be infectious? If yes or no, how is it supposed to be disposed?
Could it be deposited in the mortuary with other bodies or is there a special way of burying them?
Like the body of a person that died from Lassa Fever or Ebola, the body of someone that died as a result of COVID-19 is highly infectious. Because of this, the body cannot be deposited in the mortuary with uninfected bodies.

Therefore, the burial is the responsibility of the state/government and there is established protocol for doing that. A trained burial team does the burial. The importance of this is to prevent transmission to family members and mourners.
Most viral infections leave the survivors with adverse effects, like most survivors of Lassa Fever are left with hearing problems and some other issues. What are the fallouts of surviving COVID-19?

Firstly, let me state that there are a lot of issues that are being researched regarding COVID-19. On the issue of fallouts of surviving the disease, it is clear for now that those with chronic health conditions, such as heart diseases, lung diseases, pregnant women and the elderly are more prone to develop severe COVID-19. Those with heart or lung disease may develop further complications relating to these organs.

As I said, research is still ongoing.

Some people say survivors are left with damaged hearts?
It is not true that survivors are left with damaged hearts. The health consequences of COVID-19 depend largely on the severity of the disease. The virus affects mainly the respiratory system, but in severe cases, other organs may be affected, like the heart or kidney or what we call multi-organ dysfunction. So, it is a factor of the severity of the disease and the involved organs.

However, there still exist lots of unknown that are being researched.

China, India and some other countries have looked inwards by using herbal and natural medicines to manage COVID-19? Why can’t we look inward?
Let me remind you that as at today, a lot of information is out there to the extent that some Nigerians are of the opinion that gingers, garlic, drinking of hot water, traditional or herbal concoction, etcetera, could cure COVID-19. These, among other factors, have contributed to late presentation to healthcare facilities and designated centres.

I must stress that over 95 per cent of the infected would recover either with drug usage or not; hence critical researches must show the efficacy of the many claims that they are potent.

My advice is that Nigerians should adhere to medical/scientific instructions for us to win the battle against COVID-19, most importantly, the lockdown directive, physical distancing, hand and respiratory hygiene, amongst others.

You are from Ondo State. What is the situation of COVID-19 in Ondo and how would you rate the performance of the current leadership in containing the virus?
Generally, in my assessment, the current Ondo State administration has not performed up to expectation, especially in the health sector, and the statistics are there to show.

To be specific, let me remind you about the decision of the state government relaxing the measures in place for the containment of COVID-19 for the purpose of Easter celebration. What that tells you is that most likely the governor did not seek professional and scientific advice from stakeholders, including the state branch of NMA. Thank God he withdrew the directive following an alarm raised by NMA and others.

Interestingly, the third case of COVID-19 was announced on Easter Monday. Presently, he has ordered a curfew between 7pm and 7 am. I keep wondering the scientific basis for this or what the curfew is intended to achieve when there will be maximum interactions during the daytime.

The index case in Nigeria was announced on February 27 and as at April 4, the Ondo State government said it was planning to establish five isolation centres in the state, despite its experience with Lassa Fever that is endemic there.

There was a move to set up isolation centres in each of the senatorial districts and one wonders the basis for this too. Does the government see the isolation centres as a developmental programme? Do they know the necessary precautional measures needed to be adhered to while setting an isolation centre and the other logistics issues as well as staffing?

A government that is not endowed with the luxury of specialists’ complements should concentrate its activity at a centralised area where all logistics issues can be easily dealt with. This is a clear indication of the preparedness and readiness of the state.

How best can the country contain this virus?
Nigeria, unarguably, has a weak health sector. We must make sure, at all cost, that we do not have a full-blown community transmission in the country, in view of the experience of countries with strong health system being overwhelmed in the face of full-blown community transmission.

The best way to prevent the transmission of the virus at this stage is an effective lockdown, even with its attendant pains on the populace. It is the same people who will complain if we allow this time to slip in our hands and get to the exponential phase of infection.

We must ensure massive screening and rigorous contact-tracing to take all infected into isolation and to be treated accordingly. The public must adhere strictly to physical distancing and avoidance of public gathering of any form.

The NMA will be embarking on validation of mass screening kits in the next few days, so as to help in the preliminary investigations, which will guide against stigmatisation and being able to pick those infected as early as possible. We shall strengthen ongoing strategies that have proven to be effective elsewhere. We must continue to monitor and evaluate these strategies with the aim to improve on them whenever the need arises.

Others include intensification of the awareness campaign, community engagement and risk communication, the opening of new isolation centres with the full complement of equipment and properly equipping existing health facilities across the country with adequate PPE, review and approval of better welfare incentives for medical personnel, transparency in the management of allocated resources and involvement of all stakeholders.

Of course, scaling up the current lockdown, if the need arises, remain sacrosanct.

Nigerians are suffering because of this lockdown, so how best can the government ensure the people do not die of hunger and the virus?
It is good for me to state that the current lockdown is for our collective good. However, I am aware of emanating security challenges that have been allegedly linked to hunger. So, the best way to cushion the economic effect on individuals and families is to ensure the diligent and transparent implementation of the social intervention measures announced by the President. We must ensure accountability by relevant authorities of government in this regard.

Fortunately, the President, during his last broadcast, directed relevant ministers and agencies to work out enduring economic policies. We hope the concerned ministers/ministries, departments and agencies would come up with tangible strategies very soon.

Also, the security agencies must be at alert.