Azubuike: Our Plan is to Restore Confidence in Nigeria’s Health System

Dr. Osiatuma Victor Azubike is a Consultant Radiologist and the Medical Director, Federal Medical Centre, Asaba, Delta State. Amongst other sundry issues he raised, in this interview with select journalists, he revealed the hospital’s aim to reverse medical tourism in Nigeria, and restore confidence in the country’s health sector. Martins Ifijeh brings excerpts

The Permanent Secretary, Federal Ministry of Health, Abdullahi Mashi Abdulaziz, recently commended your hospital for some giant strides it recorded. What were those strides?
There is a lot going on for us. I basically feel that we should expand infrastructure and the human capacity of the hospital in order to meet the current health challenges of our nation. This hospital has a catchment area. We are covering Anambra, Imo, Edo and part of Benue States. Quite a large number of our patients are not from Delta State and we have a large spread.

Also, if you juxtapose the fact that a lot of people are going out of the country for medical tourism, you see that we have a lot of work to do to restore confidence in the health sector and also make people believe in what we are doing and reverse the trend. Instead of going abroad to spend that hard currency, you can spend that money here.

So that is what we have at the back of our minds in doing some of these things. In order to make a difference, we decided that we needed to create more of sub-specialties beyond the traditional surgery department, obstetrics and gynecology, pediatrics and internal medicine. There are a lot of sub-specialties in medicine that we have not developed and those are some of the things that are taking people out of the country. For example, in orthopedics, you find out that the main thing now is hip replacement, prosthetic surgery, and spine surgery. Before now, we just manage fractures, joint pain and road traffic accidents and all that, but we were not really doing any of these prosthetic and cosmetic surgeries, but recently we have started.

We started by training, that is, skill transfer, conducting and training personnel and interestingly they are mainly Nigerians practicing in the United Kingdom. We have to bring them down here to come and train our people, so we started training our orthopedic surgeons in hip and knee replacement, and today we can comfortably tell you that our people have successfully started doing knee and hip replacement in this hospital.

This is one thing that takes a lot of people regularly out of this hospital, either they go to India or the UK, you see an old man who cannot walk, the knee has stiffened and the waist, definitely he would be given a prosthesis so he can walk around and go back to his business. So, we are doing that now and we are able to train our orthopedic surgeons in spine surgery. We recently sent out our orthopedic surgeons for training and they would be there for three months and when they come back, we will bring in the surgeons from the UK who would watch our surgeons practice under guidance. That is what we are working on. So, those that take their people out of the country for spine surgery would stop. By the time people get to 60 years old, they complain of waist pain, we have degeneration of the spine and so these are the things taking people out of the country. We have been able to do this here in terms of building skills and capacity.

Look at an area like radiology, I am a radiologist and for about six years I was the only one here. From 2010 to 2016, I was the only radiologist in this hospital, but we have started to send our doctors out for training. Today, we have about five radiologists in the hospital, we are now working towards signing a Memorandum of Understanding (MoU) on Public-Private Partnership (PPP) by bringing Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) where we can diagnose some of these ailments and treat them here.

We have sent out our neuro-surgeons for training in Enugu and when they come back they are going to add to the capacity that we have and we will start doing some of these skull surgeries, like the borehole, evacuation of blood and fluid in the brain, brain tumor and all of that. These are some of the things that have taken out people out of the shores of this country. We are building capacity and in paediatrics, we are doing a lot, we are training our pediatrics, in our nematology, we are doing very well. We have successfully managed 650 grams babies in this hospital; some women with high blood pressure have a premature delivery, eight weeks, 13 weeks but we are managing them, such babies, here and they live despite all odds being against their survival.

These are some of the things we are doing. Also, in the area of infrastructure, we are building new facilities in this department. We are putting up a new relationship complex, two-story building to provide enough space for us to start a postgraduate training in radiology.

We want to start training our doctors, so, the CT scan and MRI are coming in, we already have a mammography machine on the ground, we have three conventional X-Ray machines, we are building a new department for them.

We have our accreditation to train house officers and interns, even medical horsemanship, an internship in pharmacy and laboratory medicine. We do an internship in physiotherapy, radiography, and nursing. We do a residency in six areas: internal medicine, pediatrics, obstetrics and gynecology, general surgery, family medicine, and public health.

What have been the challenges?
Well, the challenges for me are the funding. Since the last three years, the president has done a lot, but still, as Oliver Twist, we will ask for more because more needed to be done. There are lots of infrastructural gaps and things to be done. Funding is key, without funds all these things we are saying and doing here cannot be achieved. Health is expensive; anyone telling you that health is cheap is deceiving you. Go to the United States, if you do not have health insurance you can hardly pay for anything in the health sector because it is expensive. That is the truth. MRI is about 400 to 500 million and it is not cheap.

Funding is important and if we can have more funding, it will go a long way to help us. The resource specialists are been developed now, but before now, they were not available. The pediatric and neuro-surgeons were not there, so we decided to train our doctors. It is taking time, it is like the incubation period for them to mature.

I was trained by this hospital for them to have a radiologist, I had to spend five years in Obafemi Awolowo University (OAU) Ife before I came back and this is where I am today. We have trained over 20 and we are training more. Because they are not readily available, so we train more, we take them, pay their salaries, pay their exam fees, we send them to University of Ibadan (UI) or to OAU, Ife and Lagos University Teaching Hospital (LUTH) and they then come back, and they form a team of your specialists. Secondly, we are spending time to train our medical officers to assume these positions.

Are you not scared to end up losing the people you are training to brain drain?
Beyond greener pastures of earning salaries, if you are satisfied practicing what you are doing, you are good. It is not everybody that goes abroad that is finding it easy. If you do a check of those medical officers that traveled abroad, many of them are not even practicing medicine. Many are not happy because they are not fulfilled over there, so they would rather take the shit they are being given there.

So if we train them and can provide infrastructure to work, I do not think they would go abroad. If they have a CT scan here and MRI and practice at the level they want to, do their research here and write papers, I do not think they would want to go abroad.

Have you tried PPP to address the gap in funding?
We are beginning to key into that. The government has asked and encouraged us to get the private sector involved in what we are doing, which is what we are doing now. Even if I have money today to buy a CT and an MRI, I would not buy it because of the cost of maintaining it. I may not be able to run it because I do not have the technical backup to run it.

So what are we doing with the PPP? What we are about to embark upon is to get very competent people who would buy this equipment by working in partnership with the manufacturers. When the machine breaks down, they fix it because we have paid, the downtime is reduced and they fly in the engineers that would service and make the machines available to us. So that is what we want to do. We are partnering with them to bring in the equipment, we cannot afford to buy and then most especially is the maintenance. If you have been around the country, in health institutions where we have MRI, they are not working; the ones in Benin and Enugu are not working, the only ones working are those of the private sector. So, we want to get those private people to come in and do what they are doing outside here- Install the machine and maintain it. Ours is just to use it and make sure the service is available.

But they come at a cost? One solution is the PPP, if I have a partner who has a technical backup, I will not saddle myself with the responsibility of how do I fix this machine, so I can face my clinical job and it is one way out. So if he or she can provide the machine and the technical backup, then for at least 11 out of 12 months, the machine is running and service is available.

But do you have the market?
Yes, we have the market. We have the clinical skills, but they have the technical knowledge, so when we bring our skills and the patients are there, the job will be done. But one thing we have noticed is that people do not like investing like that, they say health is not profitable because the returns are not fast?

If someone comes here and invests in CT or MRI, let’s say N1 billion or N800 million, he may not recover that money in 10 years, so the returns are not fast and quick. It takes a man or woman who truly is patient and is truly interested in helping the nation grow by investing his or her money. We know few that would want to invest and we are encouraging them.