In this report, TADE MAKINDE x-rays the health sector in the country and its many problems reporting that until the authorities did the right things Nigerians would continue to lose their lives in cases that were avoidable.
PROFESSOR Olufisan Taiwo would have turned in his grave while the JOHESU strike lasted. At the Obafemi Awolowo Teaching Hospital, Ile Ife, Osun State, where he worked, he lived to save lives. Even when many of his colleagues went on strike he worked. He wasn’t attracted to medicine for the money; his passion was to save lives.
In the year 2000, during a nationwide strike in the health sector, the pediatrician visited wards, treated patients and worked tirelessly, while his colleagues stayed away from the hospital. From ward to ward, he single-handedly attended to patients unlucky to be caught in the strike.
“He dressed wounds, and virtually spent time attending to patients. Our home became a clinic as those who couldn’t be attended to at the Teaching Hospital came there. He worked till daybreak and never rested. Of course we were worried, and we told him to take it easy, but he wouldn’t hear us,” his son, Dolapo Taiwo, told Sunday Tribune. Not long after, Professor Taiwo slumped and died of a heart attack.
Many practitioners in the health sector in Nigeria would rather not be in Prof. Taiwo’s shoes. As long as government was not ready to iron out labour-related issues affecting health workers, then it must be a case of “no pay, no work.” What then are the issues driving health workers, like other labour groups to strike actions on a regular basis.
Funding
Dr Victor Adeyefa, Belgium-trained medical practitioner, said part of the problem is lack of funding by the Federal Government. Reminiscing on how good things were in the 70s and 80s, he said government support ensured that standard equipment were available in all teaching hospitals nationwide.
“Deliveries then were N30. In fact, we were paid N400 each month and it was worth much, We even took it upon ourselves to pay for one or two mothers if they couldn’t pay on time or were not able to pay at all. We were only interested in saving lives and successful deliveries. What we have now is that doctors are mostly interested in carrying out Caesarean Sections (CS) because of financial gains.
“CS was N3,000 then, but it’s now N120-150,000. Even when it is not necessary, many doctors and matrons advise husbands to start saving money ahead for CS. Hernia operation in the 80s was N500, but it now ranges from N30-40,000. How many people can afford this amount of money now? What that means is that those who can’t afford to pay good money will continue to die. Lack of funding is the bane of the decay in the health sector. As long as doctors want to work, but the tools are not available, they will devise ways of survival. It is a natural thing,” Dr Adeyefa said.
Wages/ego tripping
For Dr Laniyi Ogunsanya, a family physician and consultant based in the United Kingdom, ego tripping played out in the last JOHESU strike. Dr Ogunsanya who spoke with Sunday Tribune on phone from his UK base said it was a bad development in the stories surrounding strike actions in the country.
“A nurse wants to earn same pay with a doctor; a laboratory attendant wants to be paid same salary as a Chief Medical Director; but they don’t take their time to acquire the standard academic qualifications. This is unrealistic. Here, an average British sees hospitals as his or her own and will do everything to ensure that free health is available for everyone. Their medical board, which monitors activities of every health practitioner, and takes them up whenever they fall short in their duties, involves civilians, someone from the district, apart from doctors, nurses, etc. Because everybody is involved in how their health institutions are managed, that is why the sector is thriving here. Health is free here, even for non Brits, but it is not free in all the categories.
“If Nurses, laboratory assistants, matrons can observe public holidays, close from work at 4/5 p.m. every day, which doctors don’t, you shouldn’t expect the same pay or perks. In a country where doctors are not paid regularly, but a councillor earns N120,000, while a young doctor earns less than N100,000, there will be protests,” he said.
Infrastructure
Since allocations to the health sector have continued to decline with successive governments, the result is now being seen in the decay, and outright lack of facilities. According to Dr Ayeyefa, sometime in 1981, when he was working at Ile Abiye Hospital in Ado Ekiti, a pregnant woman was rushed in. The baby was already passing excreta while still inside the woman, so it was suggested that she be taken to Akure.
“I knew she wasn’t going to make it to Akure alive because of the distance, so I instructed that she should be wheeled to the operations room. There was no light, no sterilisers, among other necessary things, but I had to improvise by using gin and fire to sterilise the tools because it was an emergency. Germs from unsterilised tools, if used during operations, can infect open wounds and cuttings, and eventually kill a patient. The operation was successful and the boy is an accountant now. It was Dr Segun Mimiko that protested to Governor Adekunle Ajasin then, after hearing that we performed a surgery using lanterns, while Rotary Club later bought a generator for the hospital. We need water and power.
“A shocking experience confirmed to me that we can do what we know is good, but those in positions don’t do it for unknown reasons. A military officer came to me on referral for urgent treatment. This was at another government hospital. I told him I couldn’t work on him because we didn’t have water to sterilise tools, wash clothes, clean wounds, etc. He said: ‘is that the only problem? I said yes. He said; ‘don’t worry. There will be water.’ To my surprise, water was pumped to the hospital just few minutes after he gave the assurance, and for the hours the operation lasted, it didn’t stop. Few hours after the man was successfully operated on, water stopped flowing from our various taps. The patient was not a governor or Minister; he was just a military officer.
“Another one. I went to UCH in 2007 for CTScan (Computer Tomography Scan). Another patient came for same scan and was called in as soon as I finished mine. He had a lump in his throat and could barely talk. This man had been coming and going to the hospital for weeks, but he wasn’t able to be attended to until that day that I was scanned. When he was finally to be attended to after me, the machine developed a major fault. It would have been a dangerous thing if that had happened while he was under scan. Anyway, the man was rich and had an Insurance policy in UK, so he flew to London. My brother, the man died over there. The time wasted in Nigeria while he was being pushed around just to be profiled to undergo a scan test was enough for the lump to grow and become deadly. Why can’t one just go into a hospital and be scanned immediately?
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Solutions
Dr Kayode Obembe, a Consultant for the National Health Insurance Scheme, is sad that it took decades for Nigeria to embrace health insurance scheme. According to him as far back as 1962 a Bill on the scheme was presented, but nothing happened until 2005 when Chief Olusegun Obasanjo made it compulsory for federal civil servants to register for the scheme.
“Even then, they were nonchalant about it, saying that they wanted their money and would manage themselves when it came to it, but the president stood his ground because he saw the huge benefits in the programme. Obasanjo threatened not to pay their salaries if they did not register. Now they are enjoying the benefit as many of them now can’t afford the high fees that health services cost.
“Sadly, Nigeria has not been able to get it right fully. It’s only at the federal level that we have a bit of success. When Obasanjo did that, his plan was to encourage the states and local governments to follow suit, but what do we have? Leaders who have continued to play politics with health of Nigerians. Most governors see it as a federal government initiative and always have reasons not to make it work at the state, or even local government levels. They usually complain of lack of funds. In Nigeria where political rulers are only interested in the next election, what we presently have is what will continue.
Infrastructure
Another issue of importance is infrastructure. According to Dr Adeyefa, Nigerian doctors are good and performing well in other parts of the world.
“Nigerian doctors are not motivated by money as is being painted; they only want a good working environment. Because government is not providing it, they will continue to go on strike, or travel to countries where there are better medical facilities. And that will spell doom for poor Nigerians who can’t afford the already high cost of health services,” he said.
Deregulation
As strong as argument for better funding of hospitals is, Dr Ogunsanya believes that in practical terms it won’t succeed as much as deregulation.
“I suggest that governments should stop funding the health sector and liberalise it,” he said arguing that:
“If the sector is weaned of government interference in any form, remunerations will be attractive. Health sectors are funded with tax and those who pay these taxes are always watchful that they are well utilised. If that is done, health services will be available everywhere. It won’t matter whether one is in Saki or Ilesa; you are able to receive prompt and good service. Because same standard will apply everywhere and it will be cheap.
Unfortunately all the problems associated with the health sector in Nigeria are well known to the authorities concerned, what is however lacking is the will power to make a change. The question is: who will make the change?
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