Dinner with the devils in the health sector

There are two facts you need to know.

One

There are about 36 neurosurgeons in Nigeria and perhaps on average, one neurosurgeon for 5 million Nigerians. There are 4 neurosurgeons in Abuja (FCT) and 4 in Lagos. There are about 6 in Ibadan and 5 in Enugu. It is important to note that most of the neurosurgeons are in the big cities. This means that the vast majority of Nigerians especially in the rural areas have no access to neurological services.

Two

When I pray, I pray for good health, long life and prosperity. I do not pray for money. Money and material wealth are important for daily living but do not rule my life. The most important ingredient for a great life is actually abundance of good health. For instance, no amount of money is enough to treat stroke, spinal cord injury or cancer. Better therefore, to pray not to have any of these diseases! Better than just praying, is to actually, actively prevent them from happening to you!!

Sorry, I digressed

If there are 36 neurosurgeons in Nigeria and there are 36 states in the Federation; it would be great if each state had a neurosurgeon and full facility to offer neurological services: this ensures a nationwide cover. Then, access would be increased and these centres could build and develop for the future, increasing the training and yield of neurosurgeons for the country.

Each centre would need a fully functioning emergency admission facility, ward, staff, equipped theatre with necessary consumables and possibly an intensive care unit. The hospitals or at least the local area should also have capability to investigate neurological problems. This means access to a computer tomography (CT scan), magnetic resonance imaging (MRI scan) and x-rays facilities as necessary. The manpower requirements are vital as the staff need special training and orientation in neurology. Neurological diseases such as stroke and head injury require urgent management and often cannot wait till the next morning. Someone may die or be severely disabled as a result. You waste time, you lose brain is the common adage. You need staff to be on their toes all the time.

Armed with the desire to help and the foregoing information, how can the states without neurological services, ‘acquire’ their own neurosurgeon and thus, develop the practice as highlighted above?

Contact with the devil

You take a plan, proposal or an even just an idea to a director, commissioner, minister or a Governor. If you are lucky, they might reject it outright and be done with it. If not, they might reject it and then surreptitiously rebrand it, and implement it as their own creation. They may (very, very rarely) adopt the plan and move swiftly to implementation. Or of course, they may sit down with you and try to work out the sharing formula as you implement the program. That is crunch time.

Dinner with the devil

Our people in positions of authority appear to be ‘instinctively corrupt’ and do not seem to have the interest of Nigerians at heart. There is apparently systematic corruption inbuilt to fail Nigeria at every level. Many people now have a medical condition called ‘what is in it for me syndrome’. Everything must lead to some immediate monetary value for them and they seek all opportunities to defraud the treasury.

So, acquiring a neurosurgeon and setting up a neurological service, is immediately seen as a veritable means of acquiring wealth. Okay, so now they are wringing their hands and already calculating how much money might drop from this new venture to bring a practice of neurosurgery into being. In my short time since returning back to Nigeria, I have become aware of Chief Medical Directors who (when asked to buy equipments) procure cheap, refurbished, degraded equipment at huge expense and force the staff to accept and use them. They buy through their cronies or conniving middlemen (and never directly from the manufacturer!) in return for a share of the cost. So what if the equipment fails to work? It means the contract has to be re-awarded: more money to share!

At the expense of fellow Nigerians

There is a state in Nigeria which has employed foreign doctors as specialists in its hospitals. These people are paid in dollars for providing substandard care for the people. But, of course, some official is benefitting from the misery of the people. Take also the case of a hospital in Abuja. It was recently reported that the hospital is run by a business woman without any executive oversight by a Nigerian medical doctor. The doctors employed there are said to be ‘juniors’ and not the fully trained specialists they claim to be. They were also apparently hurriedly registered (under duress) by the Medical and Dental Council of Nigeria. Even though tales abound about this hospital, it is still in operation. There are Nigerian officials benefiting from the largesse of the hospital and therefore offering it protection. At the expense of the people!

Foreign fodder

Many Nigerian neurosurgeons and other doctors in the Diaspora are eager to return home to help. The few that have made the effort have been frustrated at the dinner table of the devil. The returning Nigerian doctors are not made welcome. Many are treated as foreign fodder, used and abused. It starts with the pressure from home based players in position of power who feel threatened and insecure in the face of new knowledge. There have been numerous reports of rejections and outright hostility from home based doctors. I even met a doctor whose life was threatened by another local doctor for thinking he can come back home and compete for patients. One doctor was reportedly attacked by paid assassins. Should we not be creating a favourable environment for these trained doctors to come in and contribute to the development of the health sector? Which we all agree is in shambles?

Coming back home creates more jobs for the average Nigerian. The doctors come back with skills and funds to open new practices, explore new ideas and new treatments. They can also increase the employment of nurses and other allied staff, thereby creating more jobs for youths. But to work in the public sector means dining with the devil. Yet, it also means some improved access to enhanced healthcare for the majority of Nigerians. The Diaspora can create more food at the table of more Nigerians.

Dessert at the devil’s table

The quandary is simple: To dine with the devil, lose your morality and succumb to the corruption: if it leads to the provision of the aforementioned services or to eschew corruption in all its ramifications and therefore, we continue as we were? Or is there a middle ground? Can you lose your morality, perhaps for a little while, in order to save more people? This means just eating dessert with the devil and skipping the main meal. Perhaps this is a bit more palatable and easier to digest?

Or perhaps do what the Indians have done, by opening mega private hospitals that provide cheap care for the poor and charge expensively, the rich, who end up subsidising health care. It also might open up the vista for medical tourism to Nigeria. Is this therefore the answer? That, the neurosurgeons, can open up private neurosurgical hospitals in part partnership with the public sector to provide services for the people. Of course, I have used neurosurgery for my analogy, but this could easily apply to other services and specialists that are sorely needed in Nigeria.

Menus please!