Kana: Why wanaging pilgrim‘s health demands in Saudi Arabia can be tasking

Ibrahim Abubakar Kana, a Consultant Ophthalmologist is a National Commissioner, representing the Federal Ministry of Health (FMH) on the Board of the National Hajj Commission of Nigeria, (NAHCON). Since 2011, he has been associated with managing health demands of Nigerian pilgrims in Saudi Arabia. Deputy Abuja Bureau Chief, MOHAMMED ABUBAKAR, who is on the media team of NAHCON for the 2016 hajj, had an interview with Kana on the challenges of the job and other related issues.

What has been your experience managing health demands of Nigerians from diverse backgrounds?
I HAVE grown from being just a member of the Medical Team to heading the Federal Medical Team and now I am the Chairman of the National Medical Team. So, I have a lot of experience, which I shall be using to handle the welfare of the Nigerian pilgrims generally.

Interestingly, one of the biggest challenges is not even medical. What I have found most challenging has to do with administrative and other social issues. As you observed, we deal with people from different backgrounds. Now, take this scenario. Here is this “big man” from Nigeria going to Saudi Arabia. He would want to enjoy all the privileges he is used to getting back home, which is practically impossible in Saudi Arabia.

On the other side are those people that have never travelled out of their localities, but who now find themselves in very advanced societies like Saudi Arabia. Some of them have never seen or used the kind of toilets they have in Saudi Arabia. Some have never seen an elevator before, much less an escalator. So, combining all these together with the harsh and crowded environment, the different culture and lifestyle, make the whole thing huge, but we thank God for being able to handle it all the same.

How would you assess the 2016 Hajj exercise, as compared to the previous ones?
Personally, I think we are fortunate to have achieved a lot of improvement in Nigeria, and the only way we can sustain such is by maintaining a team, which should comprise hajj administrators both at the national and state levels. We must aim at engaging certain people for some time, because if you keep changing team every year, it means that the system would be started all over again on a yearly basis. In the past few years, we’ve had a steady administration, which has helped us improve on some of our past mistakes. For instance, it would be pretty difficult for a journalist covering our activities for the first time. But if he had been to hajj before, he would perform better, based on his past experiences. Indeed, his style and manner of reporting will be different from that of a first-timer. The same applies to those managing the pilgrims. So, though there is a lot of improvement, but I still believe we can do better.

From your experiences, are there specific illnesses that usually afflict Nigerians?
The pattern of illness presentation has not changed significantly in the last six, seven years. If you check our data, the common illnesses that patients present have mainly to do with fever and malaria. Then body aches and upper respiratory infection. They also present with hypertension and peptic ulcer. This has been the pattern for many years. In the case of malaria, it is not surprising, as we are coming from an area, where mosquitoes often bite us, and so our immunity is strong. But the moment you are in Saudi Arabia, with all the rigours and trekking, your immunity drops, which gives room for malaria. The body aches also have to do with the trekking and stress. For instance, someone not used to exercising regularly, suddenly compelled to undertake long treks will definitely feel it.

There are so many pilgrims coming from different parts of the world, and so, there is contact with people coughing, sneezing and all that. This, I believe causes the upper chest infection. It was the bid to aid our ability to effectively address all these issues, which informed introduction of the National Medical Team. In the past, each state of the federation had its own medical team. So, we were all working at cross-purposes and in a disjointed manner. While at the federal level, we were trying to cater for everybody, the states catered for their own people. But we discovered that over the years, the states were not living up to expectations. They were not taking medical issues seriously. But after airlifting pilgrims, I think the most important aspect of pilgrims’ welfare is healthcare. So, this is why the Federal Ministry of Health takes this matter very seriously and why we have membership on the Board of Hajj Commission to address these issues.

This year, we decided to stop the old system and introduce a change, which is part of the reform process we are introducing into the medical affairs. We intend to unify all the medical teams into one single team. There are a lot of benefits behind the initiative. Firstly, on the issue of screening and awareness creation, we now take responsibility centrally. All we need do now is develop a module for training and awareness creation to the States Welfare Agencies for the pilgrims. Secondly, as part of the module, we should also create room for screening of pilgrims to ensure that it is done seriously.

We have learnt over the years that when personnel from the states undertake the screening, there is usually favouritism. For instance, if I work in the Government House, and a Commissioner or a Deputy Governor comes, I’m not likely to screen his wife thoroughly. But if someone is sent to do it from the National Medical Team, he doesn’t know her. So, he is likely to treat her as just another pilgrim. Consequently, we won’t be having fears of miscarriages and such things, as we experience in Saudi Arabia.

Again, the Saudi authorities have not been happy with Nigeria, as they have consistently said that they deal with only one medical team in every other country. So, how come Nigeria has 37, 38, and even 39 medical teams? Each of the 37 states, including the Federal Capital Territory, has a medical team. The National Team and Armed Forces make it 39. This affects the coordination between Nigeria and Saudi Arabia, which has written to the states to stop operating illegal medical teams.

What is the mortality rate for the 2016 hajj and its possible causes?
This year, when we set out, one of our objectives was to reduce to the barest minimum, cases of morbidity and mortality amongst Nigerian pilgrims.

This year, we have recorded 22 deaths. But in every recorded death situation, we ensured that we conducted verbal autopsy, to ascertain the root cause of that death, especially those that died quietly in their rooms, as well as, those that collapsed along the roads or in Haram (Grand Mosque).