How we have sustained health care services at FMC, Abeokuta —Musa-Olomu

In this interview, Medical Director, Federal Medical Centre, Abeokuta, Ogun State, Professor Adewale Musa-Olomu, speaks with Sade Oguntola on how the hospital has been coping with at least 10 health workers leaving its services per month, high electricity bills, among other challenges, yet ranked the best FMC in the country. Excerpts:

MEDICAL Centre (FMC), Abeokuta, was established in 1993 with a motto ‘for excellence in service’. How has the hospital achieved this in its area of jurisdiction?

We have been able to do even far better than what we thought initially. Let me cite an example, during the era of naira crisis, a patient was shot in the chest and the bullet narrowly missed his heart. It injured his lungs and the bullet finally settled around his spinal cord. He bled so profusely and we thought that he was not breathing again. They rushed him to this centre. The governor came to visit him and within four hours, we brought him back to life. Within the first hour of arrival, we had transfused over 10 pints of blood. All hands were on him, including our surgeons and he walked out of the hospital alive and well.

Secondly, a person with a crushed right leg was brought in a few days ago. Initially, we thought of amputating the leg, but eventually decided to preserve it. The surgery was successful and the man is doing well on bed. We have done a lot of things like that since FMC Abeokuta started performing the function of an experienced teaching hospital.

In terms of serving the community at large, we are also expanding our tentacles to almost all the nooks and crannies of Ogun State, through medical outreaches. Recently, the office of the SDGs, in collaboration with the federal ministry of health, built six mini-hospitals and mother-and-child hospitals at Ibafo, Itori, Ikenne, Iperu and Ajebo.

The federal ministry of health wrote us to take over these hospitals. Each hospital has about 180 beds, you can imagine the enormous responsibility assigned to us. If we have not been performing well, such huge responsibility would not have been given to us. So, we have been able to meet the demands of the people far beyond Abeokuta.

At the outset of your administration six years ago, you had a nine-point agenda, how far have you gone in achieving them?

When I took over in 2017, one would not take the hospital for a general hospital, although the hospital has been in existence for almost 24 years. There was no X-ray machine, no ultrasound machine, no medical oxygen and out of 10 theatre suites, only one was partially working. There was nothing in the laboratories and no drugs in the pharmacy. If 10 medications were prescribed, hardly would a patient get one.

Similarly, water scarcity was a perennial challenge. Happily, the picture is quite different today. I can tell you that presently, we have permanently solved the issue of water supply to the hospital. In fact, few days ago, the General Manager of Ogun State Waterworks visited us and assured us of 24 hours supply of potable water. Initially, supply of water was interrupted by road construction.

In addition, Ogun-Osun River Basin Development Authority (OORBDA) promised us two giant solar-powered boreholes. One has been established. With these, we have permanently solved the issue of water scarcity in the Centre.

Since the inception of the hospital, we have spent millions to purchase oxygen from BOC and other oxygen producers. Fortunately in the recent time, we successfully established oxygen plant that will fill at least 50 giant cylinders and 100 small cylinders (bull nose) daily. We are piping oxygen to about 350 beds. In addition, fhi 360, through the Global Fund, has promised to provide liquid oxygen supply for the hospital. Already, we have signed the MoU for it. They will be training and interacting with us on how to sustain the supply of liquid oxygen to our numerous patients.

To boost our practice, the hospital services had been fully digitalised in such a way that when you come to the hospital with any complaints, within one hour, you are out because the system is electronically-controlled. It is just that we are not making noise like other centres, especially about the digitalisation of our services that has boosted our IGR. I met an IGR of about N40 million per month; it is close to N250 million now. This is partly because we have blocked all the loopholes and we have purchased more sophisticated equipment.

Presently, we have quite a lot of equipment in the Radiology department. We can boast of five 4-D ultrasound machines, two digital X-ray machines and a mammography machine, fluoroscopy machine and two functional 64-CT scan machines. Hopefully, in our 2024 budget, we plan to have an MRI machine purchased, too. When established, it will be possible to quickly correct surgically some cases of stroke within six hours of occurrence. This will save these patients from permanent damage to the brain and some other parts of the body.

In addition, we have acquired quite a lot of equipment in other specialties, including the ECG and ECHO machines, ophthalmology and optometry equipment and dialysis machines. We have also established different sub-specialists such as cardiothoracic, neuro-surgery, dental, dietetics, among others.

Last year alone, we invested over N285 million to acquire modern equipment. The only challenge we have essentially is manpower, which we have not been able to circumvent.

Quite a lot of health workers have migrated to Saudi Arabia, UK and US. It is almost 10 health workers per month and it has grossly reduced our workforce. However, I must add that the one on ground are quite dedicated and efficient.

A recent report on Nigerian hospitals rated FMC Abeokuta as the best among others in its rank in Nigeria. How was this achieved?

Our patients and the community where we work have always been appreciative of our services, but we never knew that the outside world is also watching us. In fact, I was shocked when I saw that the FMC, Abeokuta ranked fifth and first among all the other federal medical centres in Nigeria. If you look holistically at that list, the others rated higher than us were UCH, LUTH, OAUTHC and UBTH. These are hospitals established almost at about the same time. You can imagine how old these teaching hospitals are, so they have acquired so much in terms of experience and have a lot of specialities and so on.

Indeed, this is an attestation to the dedication of the hospital’s management in terms of good leadership, sense of discipline and devotion to duty. The staff are well motivated and we do not joke with their welfare. We don’t joke with their training either. For instance, a radiologist is presently in Tanzania, learning about interventional radiology. We are sponsoring him with about N15 million; another person is also in India, learning about open heart surgery in adults and the younger age group. There are lots like that. All these are in line with the multiplicity of infrastructures and specialities in the hospital.

That is why, when our radiotherapy project is completed, patients, instead of rushing to UCH or LUTH for services, they will find it easier to come for care in our centre.

In the eight years my predecessor used, there was no year he completed without strike, some lasting for up to six months. I have completed the sixth year and there has been no single internal strike for a second.

How did you come by these infrastructures in the hospital?

I recollect approaching the ministers of health to help us increase our budgetary allocation and I was advised that the best thing is to interact with the House of Representatives members and to attract their constituency projects to our centre. Of course, these constituency projects will be immortalised in their names, their fathers and mothers or however they want it. Today, we have attracted many, including a cardiac centre, fertility centres (one at Ago Iwoye, Ogun State and another at Oyo in Oyo State).

For instance, the fertility centre under construction in Oyo and Ago-Iwoye was the constituency project of Honourable Abdulmajid Adesegun Adekoya. Similarly, our accident and emergency centre for children and an office complex building having about 100 offices for our consultants are also constituency projects. The office complex is about 80 percent completed. Last year as part of constituency projects, we attracted a 64-CT slice, radiology equipment, ICU equipment and ophthalmology equipment, all worth over N600 million.

How is the hospital coping with the emigration of health workers?

Well, we have envisaged that this is going to happen; that was in 2018 when we were opening up new areas of sub-speciality in our medical service, so we had employed quite a lot of hands. Of course, as these people left, we felt the effect, but we are still able to cope with running virtually all the departments and specialties. It is not easy, as consultants now have to do the work of registrars, even senior registrars now do the work of house officers. It is just very herculean. Some nurses presently run one shift, meaning that if they resume at work this morning, they will close work the following morning and it is becoming terribly unbearable. I have been pleading with them to please cooperate with us. We are expecting to get permission from the Federal Ministry of Health and with the permission of the Head of Service of the Federation to employ some 100 nurses and 100 doctors.

Energy has become a big issue in many government hospitals, how are you coping?

It has been a terrible thing; we use about 15,000 litres of diesel every two weeks in the hospital and then IBEDC also brings on the average a N15 million bill per month. The last from them was N13 million. The manager of IBEDC, due to our discussions, had prioritised the hospital in such a way that we usually have between 15 to 18 hours of electricity per day. This is augmented with diesel-powered generators. We also have solar power for some critical areas like radiology, neonatal centre and dialysis centre. However, I can tell you that it has not been easy.

A 15,000-litre of diesel costs about N15 million, as we are paying the contractors for it; the IBEDC also brings a N15 million bill that it expects to be paid within three to four days. Part of this energy bill we offset with our monthly overhead allowance, which is just about 30 percent of what is spent on electricity per month.

So far, the contractors know that their consignments of diesel will only be paid for in the next six weeks. By then, we would have generated some money internally before they come. Certainly, there is the need to increase the overhead to commensurate with what we spend on electricity for the hospital. Some private power companies that can generate power have approached us to help, but the best for us will be if we can generate the power we need by ourselves.