Thursday 23 May 2013

Because YOU need to know



It is important for doctors and most other professionals to have a directory of specialists they can call for help. You need the numbers and contact details of some people on speed dial. Just in case.
Some of my patients had been to several hospitals before finding their way to me. Some have been to as many as 5 different hospitals looking for an orthopaedic surgeon, brain surgeon or urologist or any number of specialists. Meantime, many have become permanently injured or died as a result of this merry go round. Do you need examples?

Take my own personal example. My mother died several years ago. Shortly before she died, we realised she needed kidney dialysis. So we started asking around. And driving from one hospital to another for information on where dialysis and a specialist could be found. Alas, by the time we eventually discovered a place somewhere in Ikeja, Lagos, she had given up the ghost. Now, that was over 15 years ago. Sadly, not much has changed in the last 15 years, except of course you consider the deterioration, change. 

A doctor died recently and he may have been helped if the right person and the equipment were at hand to save him. Apparently, he had been coughing up blood. He needed a specialist to look down his lungs to see what was bleeding and perhaps sort it out. Sadly, since help was not forthcoming, he died, drowning in his own blood. Other doctors have died in similar circumstances simply because they and their colleagues have no clue as to where help can be found. Even within their hospitals!

Many doctors and healthcare practitioners remain so myopic that they see no further than their flat noses. Some do not know about the services and specialists around them who may be able to get them out of a jam. Few doctors can list the names and telephone numbers of 10 specialists in 10 different fields. The implication is obvious. If the people, who are supposed to know, do not know, how will the poor patient and their relatives fare? Yet, the problems we face are sometimes too close and personal. The recent deaths should emphasise that we are mortal and destined to suffer the same as the patients we treat and oh, so mistreat. It could be you and you may not be able to get a visa to ‘Sokoto’ in the time it takes to die.

We need to know
I attended a meeting of radiologists in the recent past. They were giving lectures on breast cancer and uterine fibroids. Unfortunately, the lecturers, seasoned radiologists, were poor in the content of their delivery. They were busy quoting the literature and old textbooks that the audience could be forgiven for thinking they were back in the university. What we needed was: what is the condition, how is it managed, can you manage it, where are you based and how many have you treated. Following that, what are your results and outcomes so that we can send patients to you? We need to promote what can be done and what is being done in Nigeria so patients know where to go for succour. Too many people are being killed by ignorance and charlatans for us not to care. 

Be selfish
Being informed and knowing what is available locally is vitally important. We have to become obsessive and completely selfish in our approach to gaining information and knowledge. Information is power and critical health information can save lives and money. Know what is happening around you, who is new in town and what skills they possess. Also, what new services are now available in your local area? Try and see further than your nose: just in case. 

Healthcare Directory
The solution to all this is pretty simple. What is needed is a healthcare directory with information as to who and what is where. Who are the specialists, specialist hospitals and specialist equipment and services in each local area? You need to know who is available and close by to help. We need to know what is available and achievable in Nigeria. Nigerians need information to help reduce the carnage in the health industry.

The Ministry of Health Initiative
The MOH initiated the process of collecting information about skills and services in Nigerian hospitals recently. This long term project hopefully will bear fruit in promoting and educating Nigeria. The beauty of the initiative however lies in the number of deaths and disability it will potentially prevent. It should be actively supported by all hospitals.

The Abuja Healthcare Directory
The Abuja Healthcare Directory was created in 2011 and is updated yearly. It contains the names of many of the hospitals in Abuja. It also contains the names and telephone numbers of a few specialists and specialist services in the FCT. The directory is a small contribution in improving access to vital healthcare information. It provides easy access to specialist services and hospitals. Patients and their relatives can now go directly to the hospital where the needed services can be provided without having to waste time going around in a circle. The Nigerian Healthcare Journal is an online portal that carries the directory and so information can be accessed via laptops, mobile phones and the like. It is also available in hard copies.

Other websites exist and more local directories need to be developed. It is our collective responsibility as doctors and healthcare practitioners to participate actively in these endeavours of both the government and private parties. The Nigeria Medical Association, Guild of Medical Directors and the Association of General Private Medical Practitioners of Nigeria must all take a lead in supporting and promoting these ideas. 

Because we simply need to know!


Thursday 9 May 2013

Surgical treatment for spine diseases in Abuja: Early outcomes study

Abstract

This study seeks to review the short term outcomes of patients with spine diseases treated in Abuja. We reviewed early morbidity and mortality. A second part of the study evaluated the patients’ perceived outcomes. This may help in presenting the current state of management outcomes of benefit to patients and relatives.


Materials and methods
The study is a review of prospective data of patients operated in a private specialist hospital in Abuja. The clinical notes of all patients undergoing surgical intervention for spine disease in a single year (January to December 2012) were obtained and relevant demographic and clinical data extracted. A research student (A.I.) then telephoned all the patients to ask them about their outcomes and the success of the operation. The telephone calls were made in January 2013. The patients were asked their opinions on the outcome of the operation, perception of quality of hospital care and whether they would recommend others to have their operations in Nigeria.

Results
48 patients were admitted for spinal procedures including surgery in 2012. There were 50 procedures performed. Two patients had an additional operation within the year. There were 21 women and 27 men. The age range was from 28 to 78 with a mean age of 54 years. About 40% of the patients were aged 28-50 and 60% were aged 51-78 years. The diagnosis was degenerative disease in the majority and trauma in 7 cases, metastatic prostate tumour in one and Tuberculosis of the spine in another case. All operations were performed safely and no intra-operative complications occurred. There have been a total of 5 deaths. Three patients with severe spinal cord injury died after discharge due to poor rehabilitation and care. Overall patients rated the operation a success in 87% of cases. Majority would have the operation in Nigeria again.

Conclusions
Spine operations are being performed safely in Nigeria. The morbidity and mortality is low and outcomes are satisfactory. Patients were satisfied with the early results of their operations. This may help in reducing the exodus of patients to other countries for spine care.

Keywords: Abuja, Anterior cervical discectomy, cervical spine traumatic instability, Lumbar, Nigeria, Operation, Outcome, Spine, Surgical fixation, Trauma