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Healthcare system in the eye of the storm – Part 2

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The Guild of Medical Directors (GMDs) and the other health professions in the land should make that list. This way, comprehensive and professionally articulated concepts and principles will be put in place in the short and long term to survive the present challenge and prepare the nation for a possible future demand as it should be. Through these bodies, networking to reach the people they represent for mobilization, distribution of palliatives, etc. will be simplified. Rather than the above, our private practitioners appear sidelined and seem to have been considered not a potent force and of minimal use in the whole exercise. Their relevance and significance is being underplayed as has been observed in both the spoken and body languages of government in their characteristic manner.

We are often so quick to forget. When Ebola came, it was first diagnosed in a private hospital and it took the brevity and uncommon courage and professionalism of late Dr. Ameyo Adadevoh to prevent further spread of that deadly disease even though it cost her her life. She died in the process. She sacrificed her life for the rest of Nigerians. Most of the Lassa fever cases we have recorded in the country first visited private hospitals where they were managed and later referred to designated centres on the manifestation of characteristic symptoms. Many others in private settings have in like manner laid their lives. We certainly do not wish to continue to sacrifice the lives of private practitioners as their own contribution to keep Nigeria healthy. They are worth more in service than that. They should therefore be adequately protected and treated with the dignity they deserve as citizens and professionals.

Their roles cannot be wished away and their capacity cannot and should not be limited to being prompted to have a high index of suspicion and refer patients unceremoniously. Doctors are still doctors and until they degenerate to treating human beings like you will treat a millipede that strays into your compound, they owe the patient due diligence and reasonable care. For the few minutes it might take to triage and refer, anything can happen and so, they need to be protected like any other front line officer in the field of battle. Anybody properly trained in basic infectious disease control and prevention and protection can do this as long as he is appropriately kitted. Every second counts with an infectious case.

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In the case of the Millipede, all you need will be a long stick to remove the straying arthropod, but certainly, not with a fellow man. It is not many times that spot diagnosis of the patient is possible or accurate as to permit a command and control referral to the nearest isolation centre. Depending on the stage of the diseases process, the symptoms may not be initially suggestive, only to progressively evolve into overt symptoms. Different degrees of proximity and contact cannot be ruled out between the patient in an emergency and the doctor, nurse and others. It is good at a time like this to have a high index of suspicion but best to be protected even as your suspicion is highest. If the healthcare giver must approach the patient by any measure of closeness, he should wear a PPE therefore.
  
Often times our leaders lose sight of the fact that the structure, composition and operation of the Federal Capital Territory, Abuja does not represent or reflect the character of every part of Nigeria. They forget that Abuja is not Nigeria. They forget that to a large extent, there is no other part of the country like Abuja. Examples cited with Abuja are not a true representation of the Nigeria experience. Only the private sector players who are distributed all over the country and are present everywhere can tell how in some locations, the only available medical help will be a private facility and the nearest isolation centre or ambulance service may be 12 hours away. In some instances, transportation may only be available once or twice in a week. Empowering the private sector empowers the nation. You do not count the miles until the journey is over.

Nations which are given to readiness have been known to build isolation centres in 9 days to contain the menace of the pandemic as in the UK. Some have converted whole international conference/exhibition centres to functional hospitals in readiness to mop up the spillover from existing hospitals as in the USA. In other spheres, naval hospital ships were deployed to salvage the bad situation. In each of the above scenarios, the emergency facilities were built to support overstretched and overwhelmed existing hospitals. It is a war that has no battle front and one that has no pattern. Everybody involved ought to be ready at all times wherever he might be. From the available figures of tested population, positive cases, contact tracing, isolation, treatment of the overtly ill, recovery rate as well as the record of new cases, we are doing great, and to the extent that our judgment remains limited to the narrow population tested, we will be seen to still be doing well. However, if testing centres were to remarkably increase in number and capacity and more Nigerians get tested as we have seen elsewhere in Germany and America, etc., our figures are bound to dramatically summersault.

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Taking it a step further from here, available data monitored from other countries reveal the virus to have a great propensity to be spread to the point of overwhelming systems and cities hitherto considered the very best healthcare systems in all ramifications and particularly, Italy and America. In America, the state of New York comes to mind.
  
While I commend the Honourable Minister of Health, Dr. Osagie Ehanire and his team from the Federal Ministry of Health, the Federal Government and all the State Governments for their vigilance and tenacity so far in managing the situation of the corona virus infection in the country, I also thank every individual, humanitarian organizations, local and international for their goodwill in charity donations of aids towards the fight. The fight is on and there must be no stopping, no looking back and no slowing down. In the face of the nature of the enemy, we must prepare for the worst while expecting the best.

These resources should be prudently deployed to the frontline operators across the country as already canvassed while we are expanding our capacity by building the specialized isolation units to mop up referrals from the primary centres.

These are largely primary providers, most of whom are private providers. By every yard stick of assessment, the Nigerian healthcare workers, the doctors and their team mates who have stayed back to defend their country are heroes. They are the champions of our healthcare system. They as well qualify to be tagged miracle workers. They have sustained the health of Nigerians mostly with bare hands. They are ready and willing and have ever remained on the front line. At a time like this, they not only deserve to be honoured, they should be celebrated. The rest of the world is celebrating theirs. We have a great country and we have the capacity to transform it into a great nation. Developing a strategic health system is the most viable foundation for this project. In the context of what is available, Nigerian doctors are the best things that have happened to Nigeria.   What we need now is not Chinese medical experts.

Until we assess their skill, competence and capacity when proven to be doctors, we cannot properly define them. If they finally pass for medical experts as Chinese doctors, trained in China on Chinese medicines, I doubt if they can truly, suddenly become qualified to earn that accolade in Nigeria without first being subjected to retraining. Even in the management of the COVID-19 condition, Nigerians in their DNA and genotyping are not Chinese and may not fit into procedures known to work for the Chinese. So far, the world is yet to produce experts in the management of the pandemic as it is still novel to all nations and people are still struggling and watching.

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We have the men and women in the country to do the job. They have the pedigree. They have been tested and proven in the past with Ebola and with Lassa Fever. Since we have failed as a nation to produce what we need and are ever comfortable depending on other nations for the importation of everything, we do not have a choice in accepting the donation from China but we do not need their doctors to fight our battle. Let it not be said that the great report that we have built so far and the potential that we have to sustain the good record if we harness our collective personnel and manage other resources well came as a result of the visit of the team from China. The evidence of the neglect of the health system over the years now stares us in the face.

Now that no one has anywhere else to run to outside Nigeria for medical treatment in the face of the lockdown, we are all here. Some Nigerians locked in by the lockdown who have never visited a hospital in Nigeria for treatment must be praying fervently not to have cause to see a doctor till the lockdown is knocked down. How far that prayer will remain answered we might not predict. It can only be left to the imagination what judgment those Nigerians that ever had the opportunity of leadership and who had the chance to positively influence our health system but looked the other way would be passing on themselves now.

Most of them treated the subject matter of developing our health system like they were building makeshift structures for people without value or a future. They carried on as though they may never need to access healthcare at home and so, built for lesser Nigerians. While our health system decayed, they maintained regular medical trips abroad.  It is said that once beaten is to be twice shy. Experience is also said to be the best teacher.

Life is not about never failing or never making mistakes but in rising from your mistakes stronger and better. It has been said that the mistakes of the fool destroys him but to the wise, they are the building blocks of greatness. We must choose to be wise and rebuild our healthcare system with the debris of our mistakes of the past. This is the only way we can have a story to tell that we will be proud of. This is the only way to have a testimony. Nothing leaves behind a greater legacy than coming from behind to breast the victory tape first.

We must not be the Nigerians we are known to be, who are given to selective amnesia. We forget so soon and we conveniently choose what we forget as long as we seem ‘favoured’. This is the bane of our leadership. We don’t seem to care as long as we are not the ones crying. We all seem to complain outside leadership but once inside of it, set new records in in questionable governance. Nation building is not about any man. It is about everybody. It is not about ‘I’. It is about ‘us’.

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The lesson of COVID-19 should unify us into a mentally and ideologically transformed people. This is the time to crystalize the worth of healthcare professionals in Nigeria. Nigerians now know that our healthcare system is in very bad state. What Nigerians don’t know is that healthcare workers in Nigeria are amongst the least paid health workers in the world. They have no insurance and they have no reasonable pensions after retirement.

At a time like this, hazards are catholic and commensurate hazard allowance is absolutely inevitable. Let us borrow what is good from others. It may not make sense to compare Nigeria to the USA. Given the judgment of providence on Nigeria/Ghana relationship in history, we should not be compared to Ghana also because we should have the edge over that country. Ghana however, is the closest example. At the onset of this pandemic, the government of Ghana swept itself into action, mobilized its entire healthcare force and charged them to protect and defend Ghana from the ravaging virus.

He reeled out bold palliative measures, incentives and hazard allowance including insurance plans for the healthcare workers he acknowledged to be frontline workers who risked their lives for the rest of the nation. Yesterday is gone. The future only holds a promise. The only time we have and can ever have to change the past that hunts us so badly is now. Let us as a government and people, having sincerely discovered our failures, think differently and act differently in order to achieve a different result for the sake of the teeming people of Nigeria and for posterity
Concluded.
Dr Ugwu Iyke Odo wrote from Port Harcourt.

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