THE outbreak of COVID 19 is today one of the saddest realities for Nigeria, not because we could have been spared of the virus but because we weren’t wise enough to be prepared despite the obvious warnings and opportunities. That Nigeria’s healthcare sector is in shambles is no longer news; we all recall that during the military era, the state of our hospitals was always used as one of the significant reasons for military intervention. Unfortunately, each regime both military and civilian seemed to make the country worse than they met it. The issue of decadence in our healthcare system has been politicised so much that it has been used as a conduit for political permutations; military intervention; promotion of elitism and a funnel for endemic corruption by the political elite. Nigeria is blessed with smart, bright and hardworking people, and why this has not translated into tangible results still baffles nationals from other nations. If we take self out of the equation, wouldn’t Nigeria become a better place? The “I” and “my” mentality manifest in the nobles and political elites. They are not perturbed by the continued decadence in education and health infrastructure because they have resources to provide for their families, send their children to foreign schools, get medical treatment, then convert and indulge themselves on vacations abroad. They seem nonchalant about Nigerians bewilderment.
I left Nigeria at the age of 17 to go to the United States of America to study, and with all sense of modesty, I studied hard to become a well-rounded and well-grounded physician. In 2014, I brought a group of 68 medical professionals to Nigeria on a medical mission, and for the first time, I saw a glimpse of the decadence in our health sector. What was my experience: the smelling and dilapidated structures in government hospitals, unkempt, broken pieces of equipment littered everywhere, essential consumables were not available, neither did hospitals have critical personnel and equipment. It was nothing than being in a banana Republic. What informed my return to Nigeria after about 40 years sojourn in the United States? In the course of the medical mission and out of curiosity, I decided to do a random cardiovascular check on a few of the over 5000 patient that we treated. I was taken aback by the prevalence of cardiovascular diseases among the subjects. This grim reality made me realise that Nigeria was sitting on a time bomb. We lacked critical personnel and equipment to tackle the number source of death for non-communicable disease. As of that time, there was only one interventional cardiologist in the whole of Nigeria. Today, we probably have about five in the entire country. There was no resident cardiothoracic surgeon in the country who could do any heart surgery; neither did we have a single cardiac anesthetist. I left my private practice in the US were at the time, I grossed between USD8-10 million a year. I did because I was consumed with a passion for giving back to my country; I thought it would be a smooth sail because I brought with me advanced medical skills that we did not have in the country. I met with different critical decision-makers and people of significant influence at the top echelon of the country’s administration, and the corporate ladder. I shouted on the need to strengthen existing institutions because if any outbreak occured, their money or position might not be able to save them. One of my favourite statements was the 60 minutes’ golden rule, where I usually told them that what would kill them would happen within 60 minutes and that I didn’t care how much they had: they would have been dead before their private plane leaves the shores of Nigeria.
It has been six years now; all the sermon seems to have fallen on deaf ears. Most of the public institutions still lack essential resources. Everyone tends to be consumed by the dictates of self. We leave in a society that is grossly characterised by unnecessary self-centeredness and egoism. Unfortunately, most of what drives our elite only reveals shallowness of thought and vision. Otherwise, how can anyone in his right senses amass so much wealth and power, go to bed with eyes closed in a country where you do not have the facility for critical care, including cardiovascular care? How can we live in a country where our healthcare facilities are unsuitable for treating political elites and the upper-middle class?
With the outbreak of COVID 19, I am afraid that my fears may have come to pass. Just within 72 hours, we got the first casualty of COVID-19 victim, an ax Managing Director of PPMC. Two days afterwards, we heard that the Chief of Staff to the President tested positive to coronavirus infection. The son of a former vice president, Alhaji Atiku Abubakar, also tested positive, followed by the Bauchi State governor. Currently, there is panic within Aso Rock and among the political elite who hitherto thought they were invincible. With the Chief of Staff to the President of the Federal Republic of Nigeria and two sitting governors testing positive, then there is a need to be afraid. We need to begin to treat healthcare as a security issue. The current happening is asking us to resurrect common sense because it shows we are all vulnerable and that infectious diseases such as COVID-19 could wipe off the entire federal cabinet. Where are we going to run to? The places that used to be a safe harbour for the elite are currently overwhelmed by their own COVID-19 crisis. We need to put on our thinking caps and make healthcare a matter of national security. Not long ago, the wife of the president called the public attention to the Aso Rock clinic. Her statement, however, could not have graphically explained the level of decadence at that clinic. If the Aso Rock clinic that was meant for the president, vice-president and their families was in that state, then the state of public institutions would be unimaginable. My team was invited to come up with a proposal on how the place could be revamped. We went there on a fact-finding mission, and when we got there, I literarily wept for this country.
I told my colleagues that the Aso Rock clinic was unsuitable for treating even my dog, let alone my president and his family. It has been about four years since then. Aso Rock clinic is still what it is.
Going forward, I suggest that the federal government should declare a state of national emergency for Nigeria’s healthcare system. The government should work with the private sector to strengthen the existing institutions. The government should suspend initiative for establishing new programs in healthcare but should plough the money into revamping the existing infrastructure. The government should, as a matter of urgency, make intervention funds available to private healthcare facilities that have demonstrated competence and integrity in the area of critical care, cardiovascular care and infectious disease. Our public health institutions should be strengthened in the field of medical research. The government should allocate at least 15% of its annual budget to the healthcare and 5% of this amount should be devoted to medical research. The issue of absence of mandatory national health insurance scheme is an issue that defies all logic. The National Assembly should, as a matter of urgent national priority, enact an act that will make health insurance mandatory. When this is done, the sector will be able to attract investment, and the citizen will have access to quality healthcare. There should be a ban on government officials accessing health care and education abroad. If this measure is not taken, the situation will remain pathetic.
- Professor Adeleke (MD, FACC, SFNLI) is President/CEO, Tristate Healthcare System
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