Trauma Care in Nigeria

Trauma

Trauma is a strong word, used by doctors to describe a catastrophic event that has had an adverse effect on either the physical, physiological or mental makeup of the human body. In the context of this article, trauma causes physical damage to the body with significant wounds, shock, pain, disability and a high potential for death to occur.  This definition is often associated with trauma medicine practiced in emergency rooms. And traumatology is the branch of surgery dealing with trauma patients and their injuries. Trauma is now recognised as a disease entity; the 5th leading cause of death in all ages and, the leading cause of death in those less than 30 years of age. Therefore, it is decimating the young; society’s potentially most productive people. We need to gear up, ready to confront this endemic menace. Trauma is predictable. It happened yesterday, it is happening today, and it will happen tomorrow. The time to act is now.

The Golden Hour

In emergency medicine, the golden hour is the first 60 minutes after the occurrence of a major multisystem trauma. It is known that the victim’s chances of survival are greatest if he or she receives definitive care within the first hour. The first aid can be provided at the site of the injury by members of the emergency medical services, the police and other trained personnel. The golden hour can be summarized by the 3R rule of Dr. Donald Trunkey, an academic trauma surgeon, “Getting the right patient to the right place at the right time.” For this, you need the emergency medical services.

Emergency Medical Services

All trauma care is emergent but not all emergency care is trauma. Emergency rooms and departments treat ill and injured people, while dedicated hospitals handle the most severe, life-threatening blunt force and penetrating injuries. Emergency medical technicians and specially trained paramedics transport complex injury victims to centres where a sophisticated and highly trained interdisciplinary team of health care professionals provides the services needed to save that person’s life and prevent further disability or physical deterioration. The Federal Road Safety Corps (FRSC), the Civil Defence Corps, the Police and other members of the armed forces have been doing a great job in the absence of real paramedics in Nigeria. They need to be commended and now trained further, so they can respond even better.

Ambulances

The average hospital ambulance in Nigeria is used to carry corpses rather than the sick. They also ferry nurses and doctors and run errands. Most of our ambulances are not equipped to save lives during transportation of the sick or severely injured. Proper ambulances must be equipped to provide intensive care support to the patient. Air ambulances are also only available to some private organisation in Nigeria. We should introduce this service once trauma centres are available.

Trauma Centre

Rescue workers assisting victims after a bomb blast at the UN House in Abuja on August 26.Below some UN Staff grieving over the incident many of them yet to recover from the trauma.Who is providing trauma care for them??

We do not have one designated trauma centre in Nigeria. Our suggestion for Nigeria to mitigate major trauma due to natural or manmade disasters include the setting up of trauma centres.

Trauma centres were outcomes of the emergency medical service system (EMS) built by the United States (US) military in Vietnam in 1970. Trauma centres play a critical role in saving the lives of those seriously injured in everyday accidents and assaults. Further, trauma centres are uniquely positioned to respond to emergencies of mass scale, such as another terrorist attack, when compared to general hospitals based on their resources, constant state of readiness, extra capacity, and strong healthcare facility connections with the local and regional emergency care community.

Trauma centres are specialised medical facilities that are specially equipped and staffed by suitably trained personnel to manage all forms of trauma. They reduce death rate and so many countries are increasing their number of trauma centres. Trauma centres dedicate extensive staff, physician and faculty resources 24/7, sothat seriously injured patients have the best possible chance of survival and least residual disability. They provide support to other health care providers in their region to optimize the initial care of the injured patient prior to transfer. So, there must be prompt action by government and the private sector to set up regional trauma centres to cover the whole country, especially the ‘hot spots’ such as Abuja, Maiduguri, Jos and Bauchi.

Categories of trauma centres : There are different types of trauma centres designated as Levels I, II, III to level V. The different levels indicate the specific needs of the local area and trauma centres can even be in a local government level. A level I category is the highest and most sophisticated trauma centre and can be located to cover a whole geopolitical zone.

Trauma Team

The Federal Minister of Health, Professor Onyebuchi Chukwu is a professor of Orthopedics and a trauma surgeon. He would be one of the key people responsible for managing trauma cases coming to his hospital. Other surgeons such as neurosurgeons, general surgeons, plastic surgeons and other doctors including anaesthetists are part of the trauma team. This team also includes nurses and other paramedical staff to ensure a good outcome for the patient. They should all interact seamlessly and effectively in the hospital setting of a dedicated trauma centre or facility. There are specialised services critical for managing the trauma patient.

National Blood Transfusion Service

This service is in existence in Nigeria but not widely known. The organisation must create wide awareness and links with public and private hospitals so that it can be called upon in a simple and effective way. A concerted effort must be made to attract donors to ensure a robust service delivery. They also need a special reserve of personnel, funds and resources (blood and blood materials) in a major emergency.

Trauma Training and Simulations

There cannot be a trauma centre and excellence in trauma care without the training of staff. These people including the first responders to the scene of a disaster, the emergency services and the trauma centre staff need training appropriate to their levels. The type of training includes the following: first aid, basic life support, advanced trauma life support, definitive surgical trauma course and specialist training for particular conditions such as brain and spine injuries.

Trauma Incident Plan

Every hospital or medical facility treating trauma patients must have a Major Incident or Trauma Incident Plan. This is also called a Disaster Plan. It helps with protocols and guidelines in management so that they are not caught unawares when a sudden disaster occurs and patients start piling up. Major disaster plans such as these are multifaceted but include the following: triage, management and command structure, information systems, list of emergency personnel to call, access to extra equipment and specialist materials, extra funding, etc. The command structure is vital for effective coordination. Also individuals have ‘action cards’ to assist them in carrying out their specific roles during the disaster management. Simulations and dry runs are carried out regularly to test the readiness and understanding of staff of their specific activities and responses during an accident. The Federal Government must create a PRESIDENTIAL TASK FORCE that will design a blue print, break through bureaucratic red tapes and make trauma centres available and operational in the country as a matter of urgency.

Wake me up, please

Well, you only need the light when it's burning low

Only miss the sun when it starts to snow (lyrics from Passenger...Let her go)

One day a florist went to a barber for a haircut. After the cut, he asked about his bill, and the barber replied, 'I cannot accept money from you. I'm doing community service this week.' The florist was pleased and left the shop. When the barber went to open his shop the next morning, there was a 'thank you' card and a dozen roses waiting for him at his door.

Later, a cop comes in for a haircut, and when he tries to pay his bill, the barber again replied, 'I cannot accept money from you. I'm doing community service this week.' The cop was happy and left the shop. The next morning when the barber went to open up, there were a 'thank you' card and a dozen donuts waiting for him at his door.

Then, a politician came in for a haircut, and when he went to pay his bill, the barber again replied, 'I cannot accept money from you. I'm doing community service this week.' The politician was very happy and left the shop. The next morning, when the barber went to open up, there were a dozen politicians lined up waiting for a free haircut. 

That is politicians for you! They take and plunder even where there is none! It has been said that politicians and diapers are closely related. They are both full if it.

Define Stupid

The meaning of stupidity is, knowing the truth, seeing the truth and still believing the lies. Only politicians will blatantly ignore the truth staring them in the face and proceed regardless down a path of sure destruction. Simply because it benefits them personally and certainly not the people who chose them to serve.

Okay, where am I going with this?

On healthcare

Many years ago, doctors in the UK came to Nigeria and specifically the University College Hospital (UCH) in Ibadan for their clinical training. They came here for short periods to be skilled in clinical examination and tropical medicine. The UCH was affiliated with many universities in the UK and produced fantastic doctors.

Many of the English doctors were extremely proud of the association with Ibadan and wear the connection as a badge of honour. Recently, one, a man in his 70s reminisced thus (he did his pre-clinicals in UCH London). ‘Back then in UCH London, they gave you the choice of doing your clinical either in UCH London or UCH Ibadan. Most of us preferred Ibadan because it was a much better place for clinicals. You were better trained’.

Over the years, we have deliberately and methodically destroyed our educational and health care systems due to corruption and opaque thinking. The stupidity is actually galling especially when one realises that many of our leaders have been in an aeroplane before! They have travelled times too numerous to mention, to hospitals abroad without any iota of shame. 

Compare his with what happened with the former President of South Africa, Nelson Mandela. He was treated and kept alive by his country men until God decided it really was time for him to die. At no point was it a status symbol for him to go and die abroad! Not so with our leaders in Nigeria, who run to the UK or USA for medical check ups and to treat common cold. Of course, the only reason being it affords an opportunity to further rape the treasury.

It also brings to mind the recent brouhaha following the comments of the USA Presidential aspirant, Mr Donald Trump. He was reported to have said, ‘Look at African countries like Kenya for instance (and Nigeria too for that matter!), those people are stealing from their own government and go to invest the money in foreign countries. From the government to opposition, they only qualify to be used as a case study whenever bad examples are required. In my opinion, most of these African countries ought to be recolonized again for another 100 years because they know nothing about leadership and governance.’

Dreams

Why would a commissioner of health, a governor or whoever, think it sensible to hoodwink the Nigerian populace by bringing poorly trained and incompetent foreign doctors to work in our hospitals? The truth is that no foreign doctor worth his salt will leave a lucrative job in his country to come here and work for peanuts! Therefore, the doctors from Bangladesh, Egypt and wherever are likely not the best at their chosen fields. The best are already gainfully employed! They may not even be what they claim to be. We saw examples of that in the Indian hospitals currently operating in the country.

We do not have the health care system of our dreams because we still have clueless people in charge. People who kowtow to the status quo! They continue window dressing crap instead of making real changes. They sometimes say the most stupid things believing it’s what we want to hear instead of getting on with the real job.

Seriously, some of our people in positions of power personify what Donald Trump was talking on a daily basis. It is said that, ‘it is better to keep quiet and let people think you are stupid, than to open your mouth and confirm it’. Erasing all doubt! Now, where is that pencil?

The truth is that there are highly educated and well trained Nigerian healthcare practitioners both within and especially outside of Nigeria. There are thousands of doctors, nurses, physiotherapists and researchers who are more than capable of resuscitating and nurturing our near comatose health care industry back to health.

Wake up, please

In conclusion, we need to develop our own system of safe health care delivery using indigent practitioners and our mass of personnel in the Diaspora. We have a teeming mass of skilled personnel outside the shores of Nigeria. Prepare a soft landing for them with attractive packages and they will all return home: after having been so highly trained by the host nations. Otherwise, we continue to lose them forever by not creating opportunities for them to contribute to nation building. It is also up to us to train and retrain the current generation, educate the future generation properly, if we are to achieve the glorious heights of the past.

I am off to sleep but please, wake me up when you are ready!

Mr Nicolas ODINUWE: My man of the Year 2015

Mr Nicholas Odinuwe: The man

A single act of kindness throws out roots in all directions, and the roots spring up and make new trees. The greatest work that kindness does to others is that it makes them kind themselves. Amelia Earhart.

You heard about the Governor who received treatment at a local hospital following a road traffic accident. He was patched up pretty well by the hospital. Of course, he later left the country to have things checked out by doctors abroad. Of course, he was told in no uncertain terms that he had a ‘job well done’.

In that situation, it would have been great, if the Governor returned home and instituted significant changes and improvements to the health infrastructure in his state. But, No! Not this Nigerian Governor. Alas, he is waiting, along with everyone else, for ‘God help us’. Forgetting, the Almighty has already given us the wisdom and the wherewithal to make our lives better for generations yet unborn. Nigeria is blessed in abundance.

The truth

Many of our patients who trust in the local system benefit though we still have a long way to go. Yet, we can only get to the Promised Land, by working together, to create the health care system capable of delivering quality of care, at the time of need.

Fools take a knife and stab people in the back. The wise ones take a knife and cut the cord: setting themselves free from the fools. Author unknown.

To whom honour is due

It gave us great pleasure to work with the Guild of Medical Directors FCT in 2015 when the organisation honoured four selected individuals from the local community who had contributed significantly to the practice of medicine in the FCT. The awardees honored by the Guild had advanced healthcare in the FCT immensely over the past few years and deserved recognition.

They had put their money, skills and expertise where their mouths are and made serious and credible efforts to reverse medical tourism from Nigeria. They were also active promoters of inward medical tourism into Abuja from Nigeria and the West African axis. Using them as examples, we actually hoped, may encourage others to see this as a very important contribution to improving health care delivery in Nigeria. Action they say, speaks louder than words.

One of those special people is Mr Nicolas Odinuwe

The wise one

Nicolas Odinuwe returned from a trip in severe pain due to a bad back. He had refused treatment in Dubai because he heard the operation could be performed in Nigeria. It certainly was not the money, for he is blessed. Nicolas believes in ‘Project Nigeria’ and promotes the nation in his speech and action. He walks the walk and talks the talk as a proud Nigerian. This is someone not impressed by white skin and not overburdened with colonial mentality. A man confident in his own skin!

On return to Nigeria and after his operation, Nicolas decided to build hospitals instead of uninhabited properties. He put his money where his mouth is and set up quality diagnostic and medical centres with state of the art equipment and dedicated staff. He is a patriotic Nigerian who believes that higher standards in practice will help stem medical capital flight and encourage giving back.

His investments are borne out of the recognition of the gap between the needs of the medical practitioners and the services rendered. He wants to bring health care in Nigeria to appropriate standards in tandem with global best medical practice. Just in case, he needs treatment in Nigeria, he now has great hospitals to go to. Just in case!

A man of many parts

Nicolas is the Group Managing Director & Chief Executive Officer of Zitadel Limited, one of the leading technical service companies operating in the Nigerian Oil and Gas Industry and also the Chairman of Zitadel Medical & Diagnostics Limited.  He holds a Master’s degree in Industrial/Environmental Microbiology from the University of Port Harcourt and is an Alumnus of Georgetown university School of Business.

With over three decades of management and experience in the field as QHSE Consultant, he has great pedigree and the financial muscle as a result of hard work. He sits on the board of many companies contributing and giving back in no small measure. In 2004 Nicolas was elected captain of the prestigious Air Assault Golf Club Port-Harcourt. He is also the current Publicity Secretary of the Petroleum Technology Association of Nigeria (PETAN), Pioneers of Nigerian content law.

Nicolas Odinuwe is my MAN OF THE YEAR 2015.

It was an easy choice for me and one I am convinced is well deserved. I hold him up as an example to all others who might wish to emulate his actions. Do not just criticise the situation in Nigeria. We seriously need people who dare to be different from the herd. We need right thinking and wise people of substance to cut the cord and break free.

Now, what are YOU going to do to bring forth an oasis of health? Just in case and especially when it’s your turn to fall ill. For it will happen, even to the best of us and the most religious too. That, you can take to the bank!