The Chief Medical Director of the University College Hospital (UCH), Ibadan, Professor Temitope Alonge, in this interview by SADE OGUNTOLA, speaks on the challenges of the present and the vision of his leadership for the foremost hospital.
The University College Hospital (UCH), Ibadan, has come a long way. How would you describe the journey from 1951?
In readiness for self rule, in preparation for the independence and expansion of the British empire, the colonial government set-up two commissions to look into higher education in the West African sub-region.
The issue of University College Ibadan was subsequently agreed upon and on the recommendation of these two commissions in 1948, the University College Ibadan was born.
The principal of the college, Kenneth Melamnby had the task of starting off a university in the Sub-region with only three faculties as foundation faculties. These were Faculties of arts, science and medicine.
The faculties of arts and science had very little problem taking off. But there was a fundamental flaw with the faculty of medicine; there was no hospital of a teaching standard that could look after the clinical training of medical students that would be coming after their MBBS1 or the basic sciences training.
It was on account of this that a committee was formed. It comprised of members from Serra Leone, Gold Coast (now Ghana) and Nigeria.
In fact, the representative of Nigeria at that time was Reverend Israel Oludotun Ransome-Kuti and so the idea of having a teaching hospital whose standard was equal to the University College London was mooted.
The British government after meeting with the representatives in London in 1952 came up with their submission. It was that the Nigerian government should source for funds to build the teaching hospital that would take care of the clinical training of medical students that the University College Ibadan was going to produce. And Dr Kenneth Melanmby came back to Nigeria disappointed that he could not source for funds.
Now, there was the pronouncement made by the Governor General of Nigeria in 1952 that a teaching hospital to be called University College Hospital, Ibadan, was going to be established. Its purpose was to train healthcare professionals and from this teaching hospital will emerge other health care professionals to go and look after the healthcare needs of the country and the West African subregion.
This particular clamour for a teaching hospital led to the promulgation of the act setting up the UCH in August 1952 by the Act of Parliament in Lagos.
Of course, the issue of funding for the establishment of the teaching hospital became a major issue. First it was proposed that on account of funding difficulty, the University should be mainly bungalows in structure.
But then, if it was going to be equal to what obtained in London, and if the degrees that were going to be awarded was going to bear University of London, that was not going to be appropriate. So the idea of bungalows was jettisoned.
Then, came the issue of siting. There was a plan to site the University College Hospital in the main campus of the University College Ibadan. However, looking at the location and the proximity of the University to centre of town, the Ibadan municipal government frowned at the idea and opted to have the UCH in the centre of the town.
While this was going on, the first set of medical students admitted into the University in 1948 had to be shipped out to London to complete their clinical posting. They were 12 in number.
The subsequent set was however transferred to Adeoyo Hospital for their clinical posting. While searching for an appropriate hospital, the military hospital in Eleyele was disapproved because of its size.
It was generally agreed that Adeoyo hospital was more appropriate, therefore, a lot of renovation work was put into the Adeoyo hospital which is currently the Adeoyo Maternity hospital in Yemetu, Ibadan.
For instance, its radiology department and laboratory department were upgraded so that these medical students could have proper teaching. Also, some of the graduates of the Yaba Medical school, the first medical school in Nigeria, now came to complete part of the workforce that was making waves at the medical school at the then Adeoyo hospital. One of those early workers is still alive and he is Emeritus Professor Theophilus Ogunlesi.
Of course, the then minister of Health and Social Services, Chief S. L. Akintola was nagged frequently by his colleagues in the cabinet because of his persistent appeal for more funds to be released for the construction of the UCH, Ibadan which began in 1954.
His persistent appeal was a matter of discussion in cabinet meetings, so much so that one of his colleagues in the cabinet referred to UCH as the million dollar crying baby, always looking for more money.
Its carcass was completed in 1956 but the finishing and equipping was delayed and so, on the visit of the queen for an official assignment in 1956, she drove through the road from Mokola to this current site.
By 1957, both the construction and equipping of the hospital had been completed. So from April 1957, the staff began to move from the Adeoyo hospital centre to the current centre.
The first department to move was the department of Ear, Nose and Throat. The first clinic in the new hospital was held by late Professor F. D. Mattson of the Department of Ear, nose and throat.
This movement was captured by a senior registrar in plastic surgery at that time in person of late Professor Orishajalomi Thomas who described the movement from Adeoyo to the current site in UCH as “the exodus of a genesis”, that is, were are migrating or moving away from one site and we are beginning at another site.
So for 60 years, the mandate of UCH has been to train people and provide excellent clinical services not only for the local people but also for clients and trainers from across Nigeria and the West African Sub-region.
What has been the situation after the commencement of operations at the present site of the University College Hospital (UCH)?
Majority of the early settlers, those we can refer to as the initial set of staff, that populated the departments were mainly from the UK and the clinical practice that was on ground was nothing short of what was obtainable in the UK. These standards were maintained across all the departments and the etiquette and culture of excellence brought the hospital to limelight. The hospital was ranked among the first five or six in the Commonwealth in the 1970’s. Over the years, however, things changed and the things that changed were not only the structure, but also people because, unfortunately, most people did not imbibe the culture of Ibadan, which had been passed down by those you can refer to as the early settlers in Ibadan. When most of them left the shores of Nigeria, either for reasons of retirement, old age or transfers, unfortunately, those cultures have not been carried on even though we met a few of those habits.
When you do a ward round very early in the morning, the patients’ bed are clean, neat and the nurses are waiting. At the end of the ward round, you will go and have a cup of tea or coffee and a sandwich at the current site occupied by the office of the Director of Administration. That was the point where we sit to have tea and coffee with our consultants and the work flow and work plan were well laid out; teaching environment, clinical services impeccable.
What is your take on the controversial burial site within the hospital?
It was an Ibadan Municipal Council thing. We do not know the details; we were just told that it is a graveyard for someone many decades ago. The history of the hospital does not give the name of the person that was buried there. What we see is just a place fenced round and there is nothing else to show who the person was. We initially thought that it was a transformer, but it turned out not to be a transformer.
How did you get to know about it?
I did make enquiries and a previous staff of the hospital confirmed that it was a grave yard. But we do not know who was in the grave yard,
There is no identity whatsoever and the hospital has left it so. Why this?
Well because it must have been there for more than 50, 60 years and so it must have decayed by now.
But what do the rumour mills say about it?
Most people do not know it exists.
Where exactly is it within the hospital?
Well, if you do not know where it exists then you will probably not worry about it.
But now that we know…
Now that some of us know where it is, we do not worry about it because majority of the people do not know what it is and where it is.
Why is it positioned at the centre of the hospital?
So it seems to me, but I really do not have an idea. It is curious.
It is a mystery…
I am curious just as you are, but there is very little one can do out of curiosity for issues that are technically beyond one’s control. Some day, I will find out the identity and if I do, will get across to you.
What were the other UCH cultures back then?
There were cultures of confidentiality, not leaking patent’s information and people coming to work early. In fact, there was a healthy competition as to who was going to come to work first. Under the ramp where the consultants’ cars were packed, at 7am, the ramp was technically filled up. And the ramp remain filled up until about 8.30pm to 9pm because after the clinics, the consultants are in their offices conducting researches, doing bedside teaching, taking residents on ward rounds, writing papers and there was no clamour for amassing wealth or living in big high rising buildings. These were not the cultures of Ibadan. It was then just primarily a place where you wanted to do the best for your patient; where you wanted to have international acclaim for your work. The publications that came out from UCH were just amazing; they were world class and that probably attracted people like the late Professor Olatunde Odeon from the United States who was a world class neurosurgeon. So, the clinical acumen, clinical teaching, etiquette and culture were just unique. But over the years, unfortunately, with poor historical background and whatever, we have gradually moved off from the foundation of what UCH was meant to be.
Could you ascribe this to brain drain, change in work environment or priority change?
It is a multitude of problems: one of the issues that made the transfer of the culture difficult to comprehend was the exodus of a lot of our teachers on account of the brain drain syndrome in the 1980’s and early 1990’s. When that happened, a lot of departments were depleted of top ranking staff and the departments, in looking for accreditation, employed anyone that came by who had the basic qualifications. But unfortunately, this was not the Ibadan culture. In those days, people who came down from England or the UK with fellows of the Royal College of Surgeons were not allowed as consultants. They were actually given senior registrar positions, but they had to undergo, at least, two years of training before they could be given substantive consultants. That was the level of toughness in getting to Ibadan as a consultant or lecturer.
But the reverse is now the case when you come back after training abroad…
Anyone who comes in now, with or without the experience of the Ibadan mainstream work etiquette is appointable and gets appointed. But in those days, a lot of our teachers came down with the Fellow of the American College of Surgeons, Fellow of the Royal College of Surgeons. They have to work as senior registrars for a period, ranging from one to two years, to get to know the disease pattern and understand how things work here and the culture. It was not derogatory, but was actually to let them know how to fit it. But, like I said, things have changed and thoroughness, the strictness of getting things done rightly has been overrun by other issues.
Apart from the migration, then came the government support. Do not forget that UCH was the only teaching hospital from 1957 and gradually the numbers increased. Now, we have about 54 teaching hospitals and federal medical centres; what we call tertiary healthcare service provider and we are all sharing from the same purse. Therefore, the budget has been stretched thin and it has become impossible for UCH to get the same again.
Second, in the early days that I was talking about, patients did not pay for a lot of services and doctors did not scramble to look for blood bottles. You get to the wards and the bottles were available; syringes are available. You go, you bleed your patient, take the blood sample down and the equipment were still optimal and so you could get blood results. Not only was it available; you have a phone call, if the result was abnormal but all of those things have changed. Equipments are old; they are obsolete. We had a revolving fund which was to salvage the disaster, but now you have to go and pay before you get bottles because they are not available. Blood samples are sent down, the doctor have to go down to pick the results, which was not the pattern at that time. But now we have introduced the Laboratory Information System in which we have uploading of laboratory results so that you do not have to go down to get such results.
Finally, the general milieu in the country about money comes first and money takes priority over every other thing has more or less removed our focus from what and who we should be.
At inception, UCH was christened the crying baby. Is the college hospital still crying?
Paradoxically, UCH is still crying; no longer a crying baby, but it is still a crying adult because what has transpired now is that we struggle with the other 54 teaching hospitals, federal medical centres and other agencies of government for funds. These funds are no longer allocated or appropriated on needs assessment or on clinical outputs or service orientation or the size of the hospital. It has a lot of political motivation and, unfortunately, political correctness plays a lot of part on how much fund is appropriated and how much money is actually released at the end of the day.
So, with a huge establishment like UCH, with 64 departments and about 44 wards, you will expect that allocation of capital votes will be in conformity with either the need assessment of the hospital, the output, both clinical service, research and training, but those things are not even counted. Even the papers of the so-called budget proposal that we write are not looked into. Most times, we just get an envelope and you are asked to go and spend the envelope within the limit of what is there for projects that sometimes are imposed on you or projects which you never put in your budget proposal. UCH, by virtue of its size, is at a big disadvantage because we have to first maintain infrastructure and maintaining these old structures is not as easy. And then apart from maintaining them, you have to keep up the standard and then to maintain our position at the top. Getting to the top is not difficult, but maintaining your position at the top has been a tough struggle.
What is the current position of UCH?
UCH is still the best teaching hospital, the best training centre and the preferred option for residency training and for clinical service delivery. We are top-heavy in terms of intellectual property; we have some many departments that do not exist in other hospitals. We are the first department to have a nuclear medicine department where we do both therapeutics and diagnostics service delivery services; we have the first palliative and hospice care looking after the end of life, not only as in patient, but also as outpatient basis. We are the first hospital to have a geriatric centre which is the first in the whole of Africa as a continent and the centre has about eight different units upgraded to a department. Within the spate of five years, we have treated close to 30,000 elderly people who had registered from various parts of the country and, at the moment, we are moving on to the geriatric rehabilitation which is called the long term services.
UCH has also resuscitated the open heart surgery programme. We are the first teaching hospital to have a catlab, a modern day catlab comparable to any other catalab in the world. We are still the preferred location for post-graduate training in neurological surgery because of the intervention of the likes of Professor Temitayo Shokunbi.
What will you say is the selling point for the hospital?
Aside from the clinical services, we have the first total Quality Management Department. It is an umbrella that embraces the clinical care audit. This department is unique in that it has 32 statisticians that collate data in the hospital every day and, based on the data that we collate, we are able to know areas of intervention and we go ahead and intervene appropriately. When the department started, we looked into data collection in the emergency department, causes of death in the hospital and we were able to identify the time we had more deaths in the night in the Emergency Department. We then looked at the roaster of the nurses and we found that the people on night duty were the younger ones who had very little experience and they were fewer in number. As soon as that trend was reversed, the mortality plummeted.
We have also been monitoring the causes of death in the hospital since 2012 and we record this on a yearly basis. In 2014, the commonest cause of death was stroke and in 2015 and 2016, we went to town and did outreaches and we discovered that in Ibadan metropolis among the adult population, 30 to 35 per cent of the people had hypertension and most of the deaths from stroke were hypertension stroke or hemorrhagic stroke and it was easy for us to then begin to campaign, asking that those who have hypertension will spend only N350 to buy their medications, whereas if they had a stroke, they have permanent disability.
Now that it is evident that UCH has virtually taken over the major task of health care of citizenry in the South West, what steps has it taken to bring the governors of the states in the zone to lend helping hands and support its operations in order to continue to provide excellent care?
I wish and I am sincerely hoping that the intervention of your newspaper will touch the hearts of the governors of the South West states. We have, on many occasions, extended our appeals to them for support as it is done in other parts of the country. In other geopolitical zones, tertiary institutions are supported in one way or the other by the state governments. But at UCH, we have not enjoyed such from any of the state governors in South West geopolitical zone. This is unfortunate because I believe all these governors are educated and well-travelled and they probably should know better.
But as part of our own private initiative, this management, in 2012, began what is called the Indigent Fund where we opened an account, even though everything is now in the Treasury Single Account (TSA) and some of us contribute money into this account every month. From there, we were able to assist staff of the hospital and we have enjoyed a lot of complementary services, even before 2012 by the Lola Daisi Foundation who, on quarterly basis, release N500,000 to indegent patients, particularly those who come in with emergencies and they cannot afford it. We also had another endowment by Dr Sola Kolade of the Vine Branch Church who also gave us substantive amount of money to begin to give what we then refer to as revolving indigent fund for emergency department as well. All these are private interventions, but there is none from any of the state governors.
In fact, the hospital named Owens Dialysis Unit after the Ondo State government, but till date, it has never enjoyed any patronage, neither has it enjoyed any funding from the state government. The special care baby unit was named Oyo State Special Care Baby Unit. I do not even know if the current government is aware that we have such a project named after the state. So what baffle us as an establishment is why the South West governors do not have any interest in supporting UCH, particularly Oyo State, bearing in mind that 80 per cent or thereabouts of the people that we see both at primary, secondary and tertiary care level are resident in Oyo State and some of them are actually from the neighbouring south western geopolitical zone.
What is the management doing to arrest the ugly trend recurrent strike in the health sector had affected quality of service?
This, for me, is actually a national matter because local issues are easily resolved, but national issues need to be addressed. I believe that sincerity must be exhibited by government and that sincerity must be cordial; it must be on both sides. First, I believe that the various unions should give government, at least, two to three years of moratorium to table all their grievances, one after the other and let them be addressed within that period of time. The sincerity on the part of government is that if there is an issue that cannot be resolved, let it be so stated that it is not going to be addressed so that it does not become a suspended strike because you never hear that strikes are called off; they say it is suspended and then they can wake up tomorrow and say that we are restarting the strike that was suspended because some issues of 10, 11 years ago are still been revisited. So, if government is very sincere in sorting it out once and for all, then they can make progress.
But in doing so, there should be a moratorium period, where those issues are being addressed where government continues to carry on with the negotiation, service continues and, if after three years there is no headway, then the whole country will know. But you cannot be working and going on strike at the same time. There must be a time to say, ‘look let us cut off this issue and sort it out while work goes on. Let there be a discussion in Abuja between the Ministry of Health, Ministry of Labour and the union leaders and the Ministry of Finance and then we keep doing our jobs’. I believe that is the best way to put an end to this matter, rather than pretend that it does not exist and then nothing was get done at the end of the day.
In essence, you are saying that strike actions have not help our healthcare delivery system…
It has taken away confidence from a lot of patients because many of them will just be reporting for care and suddenly there is a strike and for every strike action, lives are lost. Let us be very frank and unfortunately once the strike action is over, the same staff that go on strike still get paid and the lives that are lost cannot come back. So, I believe strongly that government can take steps to try and address the issues while negotiating and there should be a complete embargo on strike actions while the negotiation subsists.
To many people watching from a distance, some cadre of health departments seem to be overstretched in terms of personnel. In some units, there are few doctors, in some very few nurses. Will this not contribute to medical errors?
That is very true. At the moment, we are overworking a lot of our staff. I have a lot of nurses who cannot cope because they did not expect the kind of workload they met in UCH when they resumed. The same thing goes for the other healthcare worker. Unfortunately, we have a running battle in getting people employed because of government embargo and we also have a lot of challenges with the Federal Character Commission (FCC), both at the state House of Assembly and also at the FCC itself, where when we write letter, it is routed through the Head of Service, these are vetted. It is as if we want to employ professionals in our houses. These professionals are healthcare workers who are supposed help their colleagues. If you are denied the privilege of employment or they do not get captured under the IPPIS, there is very little you can do as an administration in trying to alleviate the suffering of the patients because what it means is that patients probably stay longer before they get seen and when they get seen, there is a very high probability for errors to occur. And we just pray that we do not have catastrophic errors and so a lot of these problems have to do with embargoes on employment and these embargoes unfortunately are beyond the reach of the administration.
and then