Coronavirus has exposed abysmal state of Nigeria’s health sector —Professor Ozoilo, MDCAN President

The Coronavirus pandemic, otherwise known COVID-19, is taking its toll on the world and Nigeria inclusive. In the interview with ISAAC SHOBAYO, the President of Medical and Dental Consultants’ Association of Nigeria (MDCAN), Professor Kenneth Ozoilo, speaks on the pandemic and the way out of the logjam.

 

The outbreak of coronavirus was like a thunderbolt to the world, Nigeria inclusive; what is your perception of the whole scenario?

The outbreak of the coronavirus disease in Wuhan, China towards the end of last year was unprecedented and took the medical community globally unawares. Despite the fact that the Chinese were able to contain it by March this year, it has spread globally and achieved the true status of a pandemic. It has brought devastation and death, with attendant social and economic disruption on a scale that has not been seen since the Black Death.

It has humbled some of the best organised and well-funded health systems globally, from Italy, Spain and Greece to the United Kingdom (UK) and the United States (US). The US, currently the epicentre of the disease in the world, has seen daily increases in both diagnoses of new infections and mortality, with the loss of in the excess of 1,000 patients in the past 24 hours. This is despite the enormous resources available to the health system in that country, both before the pandemic and in their current response effort.

Nigeria has not been spared the pandemic with new diagnoses being made on a daily basis even though severity of illness has remained mainly mild to moderate and mortality has remained comparatively low.

Nevertheless, mathematical projections suggest that barring any hitherto unknown mitigating factors, there is a likelihood of a spiking of both infection and mortality given the experience of other more endowed countries so far.

The outlook for sub-Saharan Africa is grim. It is estimated that there might be records of millions of infections with mortality in the region of hundreds of thousands before the pandemic is brought under control or runs its course. The only practical means of avoiding this and deflecting this grim forecast is for rigorous preventive measures and immediate identification, isolation and treatment.

 

What is your assessment of the government’s efforts towards arresting the pandemic?

In this wise, we in the Mediacl and Dental Consultants’ Association of Nigeria (MDCAN) commend the rigorous response by the Nigerian Centre for Disease Control (NCDC) and its Chief Executive Officer (CEO), Dr Chikwe Ihekweazu, for the vigour with which it has responded to this pandemic. No doubt, the proactive steps taken so far have contributed to the measure of success achieved in the response efforts for now.

Also, the Lagos state government’s promptness deployed to contain the outbreak, especially the isolation tents which have been erected in such a short time space is commendable and recommend to other states for emulation. The Federal Ministry of Health, led by Dr Osagie Ehanire, displayed responsiveness and constant engagement with the general public in the provision of information and health guidelines. And we commend the Federal Government and President Mohammadu Buhari for the difficult yet necessary decisions that have been made in the effort to contain the disease. In particular, the sit at home order and the lockdown of the states of Lagos and Ogun and the FCT are difficult, but highly needed, if there is to be any hope of containing the disease to these hotspots and preventing a more ferocious spread.

 

Do you think Nigeria has enough manpower and facilities to handle the situation in case it spread beyond what the country is experiencing now? 

It has been repeated enough that this pandemic has exposed the abysmally poor state of the Nigerian health system. This has arisen from chronic neglect and underfunding of the sector by successive governments, and refusal to look into concerns and advice of the health care practitioners over the years. We have repeatedly lamented the poor conditions of service, poor infrastructure, lukewarm attitude to effecting reforms that will make the sector accessible to a greater majority of Nigerians and the ravages of brain drain in the sector, but all these have fallen on deaf ears over the years.

It must be abundantly clear that the sorry state of the health sector in Nigeria today is not necessarily a reflection of lack of funds, but rather the choices that we have made, and the things we have prioritised over health. The current pandemic must, however, be seen not as a time for lamentations, but another opportunity to make the right decisions about what truly matters to us a people, and how to begin to correct the ills suffered by this sector in the past.

 

Based on reports in some of the health institutions in the country, it is like health personnel are not too enthusiastic to handle victims of the pandemic, probably due to lack of protective materials and other facilities. What is the position of MDCAN on this?

Information reaching us from different chapters in institutions across the country do not portray a positive picture. Frontline personnel in most of our institutions do not have enough supplies of personal protective equipment such as gowns, gloves, masks etc, putting their lives in great danger. The little that is available is rationed and deployed in an ad hoc manner that makes nonsense of the concept of universal precaution. These items are meant to be available for use as a matter of routine and not only after a diagnosis has been established. Furthermore, going by the natural history of the disease, transmission occurs prior to onset of symptoms, meaning that protection is required from healthy looking carriers and not just those who are already down with the full blown disease.

We are also in receipt of reports from across the country to the effect that only few states and institutions have taken the pains to establish functional isolation centres. We want to reiterate that the opportunity to act is now. Waiting till an index case to occur, or for an escalation in the numbers so far diagnosed, is a grave error. We strongly advise that while this situation subsists, accident and emergency departments in all hospitals should put in place a system for screening and triage of ALL patients before access to the A and E floor and contact with large numbers of health personnel and other patients.

As can be gleaned from the experience in the Lagos University Teaching Hospital (LUTH), the University of Ilorin Teaching Hospital (UITH) and the University of Benin Teaching Hospital (UBTH), contact with even one COVID-19 patient will result in the quarantine of large numbers of doctors and other scarce health personnel desperately needed in the response effort for a period not less than two weeks. Some of these may come down with the disease and some may well lose their lives. Their protection with appropriate gear is, therefore, of utmost priority.

 

What about the testing centres?

This is another major source of concern. While we commend the effort of the NCDC in expanding the capacity of the country to test by increasing the number of centres that can carry out the test, we believe that more needs to be done in this regard. Given the population of Nigeria, it is very important that greater efforts be made to expand and further decentralise testing. Testing is not only critical to identifying and containing threats for further infection, it is also necessary for freeing up resources from cases that are suspected but negative, in favour of those who do actually need them. We are calling on government at all levels in conjunction with the health facilities and the NCDC to urgently ramp up measures to improve preparedness. And also state governments to urgently set up isolation centres and take meaningful steps to ensure that such centres are made habitable and sanitary. A situation where inmates of such centres escape because of discomfort from such facilities as has already been witnessed does incalculable damage to the whole effort. We very strongly recommend the makeshift tents being erected by the Lagos state government as a model to be emulated.  We strongly commend those Nigerians and corporate bodies that have made donations to the response effort. We wish to however strongly advocate that these donations be channelled into the four thematic areas of provision of PPEs, establishment of isolation centres, testing and treatment.  We caution that care must be taken to prevent dissipation of these scare and valuable donations on wasteful logistics and the like.

We call for the organisation and proper coordination of a volunteer corps to complement the efforts of healthcare providers. This is very important because the numbers have been depleted by years of unmitigated brain drain, coupled with embargo on employment, and given the fact that those in the frontline are also more likely to come down with the disease therefore further putting strain on an already overstretched system. The experience from other countries battling the disease bears testimony to this projection. Caution must be exercised in the recruitment of elderly retirees in this effort. We strongly advocate rather, that the thousands of young unemployed medical personnel, especially doctors and nurses, be utilized to fill in this gap.

 

In some parts of the country, the containment measures put in place are not strictly adhered to. What does this portend?

The general public is to comply with regulations, instructions and guidelines as published by the Ministry of Health and the NCDC from time to time. Success in confronting this challenge is a collective responsibility that requires effort and sacrifice from all Nigerians. We especially call on religious leaders to not only ensure that they comply with the orders restricting public gatherings, but to also preach the same among their adherents as a personal responsibility to complement the efforts of the government.

Reports have also reached us of security agents harassing doctors and other health personnel in the enforcement of the sit at home order. This is unacceptable. Certain services considered as essential in the society and therefore exempt have been highlighted by the president and others. It is particularly important to note that different categories of patients will continue to require medical attention, on emergency and non-emergency basis, quite apart from COVID-19. It would not do for Nigerians to survive COVID-19 only to die from otherwise avoidable causes.

We, therefore, call on the top echelons of the security apparatuses to ensure that their men appropriately situate their role in proper context, and most importantly not make the endurance of the mitigation efforts of government more unbearable than the disease itself. Reports of extra-judicial murder of innocent Nigerians must be investigated, the culprits held responsible and made to face the full extent of the law. I also want the government at federal and state levels to reciprocate the effort and sacrifice of all health workers by seizing this opportunity to address long standing issues with remunerations and working conditions, especially the hazard allowance of health personnel. This will also go a long way in not only achieving success in the current effort, but also in reversing the phenomenon of brain drain going forward. The challenge before us is arduous, but we believe that there is no reason to despair.

This is an opportunity to commence the rebuilding of our health systems and that process must start immediately. We must shun quick fixes in favour of lasting systemic solutions. Whatever investments are made into the Nigerian health system in response to this pandemic will be there for the benefit of Nigerians beyond.

 

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