Echoes of Sani Abacha

Brigadier Sani Abacha (as he was then) in announcing the coup that brought Major-General Muhammadu Buhari to power on December 31, 1983, laid several cases of failure at the door of President Shehu Shagari, on the basis of which the generals decided that terminating the second republic was a patriotic and soldierly act. One of the alleged cases of failure was the state of our health delivery system. Abacha said that the hospitals had been turned into “mere consulting clinics.” It was that bad.

When Buhari returned to power as president on May 29, 2015, he did not find a vastly improved health delivery system in the country so many years later. He should be the first to testify to that because when he took ill, he had to place his health and his fate in the hands of a British medical team that, according to his senior media adviser, Femi Adesina, he has used for 40 years. The implication of that statement is that even if our doctors could handle his case, he is not about to abandon his trusted medical team in London. He has since been back to London a few times for check-ups and to receive the expert medical assurance by his doctors that all is well. As I write this, he is in London for a check-up after the international conference on education.

A country bears the moral responsibility of the health of its leader and ensures that he receives the best medical care available anywhere in the world. After all, the leader of a country bears the burden of that country. He thinks for the country; he plans for the country; he decides the direction of its economy as well as its social and industrial development. We expect a man in that pressure cooker of an office to enjoy a robust health. A healthy president is, by extension, a healthy country too. No nation jokes with that. The absence or the inadequate availability of modern medical facilities compels some third world country leaders to seek medical help outside the shores of their countries. It has enormous implications.

When a leader travels abroad on health matters, it raises the fear that his ailment is so serious it is beyond the knowledge and the capacity of available local modern medical expertise or that the country’s health delivery system is so badly broken that the hospitals are beneath consulting clinics. Either interpretation or the combination of both heightens the blood pressure of the nation. Buhari had promised to end medical tourism. But by the cruel twist of irony, he became a medical tourist himself, not by choice but clearly by our health delivery system that is unable to deliver.

Therein lies the challenge of fixing our broken health delivery system.

Quite often wealthy Nigerians who travel abroad to seek expert medical attention are embarrassed to see that the expert who attends to them are fellow Nigerians. Such people won’t return for lack of modern medical facilities in the country. Our doctors go on strike almost every year to protest the pathetic state of these facilities and the wretched pay and working conditions under which they are expected to give of their best to pull the sick back from the gates of the afterlife.

I had hoped that given his experience with our rather wretched health delivery system as president, Buhari would recognise that fixing the national health delivery system is a personal challenge and begin the arduous process of tackling it so that his successors as presidents would inherit a health delivery system the nation and its people would be proud of. And save the country the anxiety of its president receiving medical attention abroad. It does not seem likely. I can hear the clock ticking, taking us to the end of his administration, raising the prospects that nothing would dramatically change soon in this vital sector. Herbalists and quacks need not fear: their shrines would not be empty of their desperate and despairing clients.

It would be naïve, foolish even, for anyone to deny that this country has had a long history of a health delivery system that has neither adequately served its leaders nor the people. If you excuse the hyperbole consistent with the traditional attempts by military men to validate their rationale for a coup, you would still be left with the bare fact that Abacha was right. At the time, our health delivery system was below par even at the regional level. However, one could argue, and not unreasonably, that if the hospitals had been turned into mere consulting clinics within only four years and three months of civilian rule, then the generals who ruled the country from January 15, 1966, to October 1, 1979, did not quite rise to the challenges of our health delivery system either. Under them, the rich hopped into an aircraft for an overseas medical tourism to treat the boil on their noses; and the poor beat the path to the herbalists. It is still the same today.

The challenges in the health sector are enormous; and so, have been the hypocritical and wasted attempts in the past to improve the health delivery system. So far, every such attempt became a victim of what is euphemistically referred to as the Nigerian system: policy mortality and summersaults. Given its enormous wealth and human resources, Nigeria should be the medical hub of the West African sub-region to which other ailing nationals would flock in a lucrative medical tourism.

It is not. The low-level rich Nigerians go to India and the high-level rich Nigerians go to Europe and the United States.

Let me cite two cases that should churn your stomach. Long, long ago, (you have to write English like that in a country that hates record keeping) the federal government decided to build five centres of medical excellence located in Lagos, Zaria, Enugu, Ibadan, and Maiduguri. Each centre would devote its resources and expertise to the treatment of one particular major health challenge. The Enugu centre, for instance, would treat heart diseases.

Implementation, as is often the case in our country, began with the award of contracts for the buildings and the importation of the sophisticated equipment needed in the laboratories. The equipment arrived when the buildings to house them were not ready. Eventually, the buildings were abandoned in various stages of incompletion.

When Professor S.K. Gyoh became the chief medical director of the University of Jos Teaching Hospital, he followed the trail of the one located in Jos and found that the building in some parts had reached the third floor before it was abandoned. A huge tent had been erected to shelter the imported equipment. When Gyoh opened it, he found all the equipment were in a parlous state of total decay. They had been there under the rain and the sun for some 20 years. The same fate, I am sure, befell the other four centres. They died and carried our dreams into eternity.

When Abacha became head of state, his wife, Miriam, used the Family Support Trust Fund and donations from the public and the private sectors to build the gleaming modern hospital with the state-of-the-art medical facilities she called Hospital for Women and Children in Abuja. Abacha did not live to witness its formal commissioning under decree 36 of May 19, 1999. I regard it as the best attempt yet by the country to rise to the enormous challenges of the health of women and children, given our high child mortality rate. Abacha’s worst enemies cannot but give some credit to him and his wife for this, even if grudgingly. The hospital has since been renamed the National Hospital, Abuja. It is a national medical pride although I hear that the worm of poor funding and inconsistent policies is beginning to borrow itself into it. Let’s pray against it.

President Obasanjo decided to take the hospital to the next level. He set up a 17-man Presidential Committee for the Future of the National Hospital, Abuja. The committee made up mostly of medical experts was headed by Professor Akinkugbe. It was tasked with producing the blueprint for turning the National Hospital into a world class standard equal in almost every respect to that of Hammersmith Hospital in London. It was a tall ambition but not taller than the capacity of the Nigerian state to fund the radical transformation of its health delivery system. It would be the apex of our medical training and health care delivery system. Except that it did not become one.

The committee did its work and submitted its report to the president. Nothing came of it. The report must be tired by now of peeping to see the light of day between file covers. The most charitable thing one can say about the work of the committee was that Obasanjo did not intend to do anything about making the hospital the centre of our healthcare delivery system. It was a ruse. And once more, what appeared like an honest decision to upgrade our health delivery system went nowhere.

We are a sitting duck. The voice of Sani Abacha echoes. It should make us shudder over what if….