Ikrama: Nasarawa has Spent N270 Million in Training of Doctors

Dr. Ikrama Hassan is the Chief Medical Director, Dalhatu Araf Specialist Hospital, Lafia. In this interview with Igbawase Ukumba, he reveals that the Nasarawa State government has spent over N270 million on salaries and on allowances in training doctors at DASH. Excerpts;

What measures are on ground in the training of doctors in Dalhatu Arab Specialist Hospital (DASH), Lafia?
Residency training is a very important component of a hospital, especially like ours which is designed as a teaching hospital. There are different components to what we do here; sick people come and they get treated.

But apart from services, we also do training. Nursing students before they become nurses do part of their training here. People in the laboratory and pharmacist also do part of their training here. We also have for doctors which is elaborate and comprehensive. The essence of this training is to provide critical mass of health manpower for us and other hospitals in the state; doctors, nurses, laboratory scientists. Apart from providing service, the training process itself strengthens health care delivery.

One of the major problems we have been having is turnover of staff in the hospital. Doctors will come and spend one or two years and they leave; reason being that there is no upward mobility for them. When you come as a fresh doctor with just MBBS, you will want to become a consultant naturally. So you want to work in a center where there is a training program so that as you are working, you are progressing to become a consultant. But if you are working in a center where there is no training, you don’t go anywhere. So when they come here, despite the fact that our salary is attractive, but after some time, you are not making any progress and they leave after a year or two.

So these are the reasons why we felt that we should begin to train. Now when we began to train, we did not have accreditation, we did not have the requisite requirement to train, so when we employ people, we send them out to other centers to be trained. Now we are being short changed in that these people will go there and be offering their services to those places while we pay their training fees and salaries. Like in the last five years, we have sent quite a number of people out for trainings in the various departments and the state government have spent over N270 million in terms of salaries and other allowances in training them and for those people to finish their training, we are going to spend again about N200 million.

It is those centers that are benefiting from it. But if we can train here, that money will be spent here within the hospital for the benefit of the people. So these are the reasons why we are doing the training ourselves; it will improve the quality of service and will ensure retention of healthcare manpower in the hospital to serve the state.

Again, accreditation is not at hospital level, it is at departmental level, this is the fifth accreditation team we have invited so far. We started with family medicine. We did pediatrics, we have done obstetrics and gynecology, we have done surgery and the fifth one is internal medicine that we are going to have. We are positive to get all of them and once we get accreditation in all these departments, we will start training our doctors here.

Is there any plan soon to start conducting in-vitro fertilisation (IVF), as well as Kidney transplant and dialysis?
Presently, we are already doing dialysis. We have started it for a very long time. It is one of the oldest units here in this hospital but of course, the machines are old and breaking down every day, but the state government has made provisions and we are waiting for delivery to replace the old ones. We also have a consultant here that deals with kidney problem and we are trying to equip him to utilise him maximally, and we offer services for all sort of kidney problems.

At the movement, we don’t do IVF but we have a proposal to start doing it sometime in the future, because it is a specialised area. We want to start training our staff on it. It is not just about getting the machines; you need to train your own staff about it. Already one of our consultants will soon go for the training and while she is there, we will now make arrangement to establish an IVF center. But it is capital intensive.

The general perception is that DASH is full of cases that should be treated at the Primary Healthcare Centers. How true is this anomaly?
Yes, that is very true. Majority of the cases we treat here are actually for Primary Healthcare Centres. It is historical, there was a time there was a complete breakdown of our healthcare system especially at the primary level, and to some extent at the secondary level, so people had lost confidence in the healthcare at that level and everybody wants to come to tertiary hospital. It is either they go to private hospitals or they come to DASH.

So you find a situation where somebody will wake up and feel slight headache and he comes straight to DASH. But now, our PHCs have been revived. The government has done a lot in reviving primary health centers and they have improved significantly. So the issue now is restoring the confidence of the people back; people should know that PHCs can handle headache, malaria, ulcer and the likes.

We encourage people to go there; it is only when PHCs cannot handle their case that they should be brought here. What we have now is that everybody wakes and want to come here, simple antenatal care that can be done at PHCs are brought here. So these specialists spend most of their time attending to headache and malaria rather than technical treatments like dialysis, IVF, heart disease. So that is why we are working with hospital management board and the government to create awareness by telling people to first access healthcare at PHCs.

Do you have facilities in the hospital to effectively take care of persons living with HIV/AIDS, diabetes and malnutrition?
For HIV/AIDS, this hospital is one of the prominent centers for treatment. From the beginning of the HIV/AIDS management in Nigeria, we started managing it here. It has been a very important center. We also provide mentorship to healthcare providers around when it comes to HIV/AIDS. Globally, people don’t die of HIV/AIDS again except you don’t come for your drugs. With drugs you can live a normal life for a very long time.

We also have a consultant for diabetes here who handles it very well. For malnutrition, which is mostly with children, we have four consultants and several young doctors. Normally malnutrition cases are handled by PHCs and from there to general hospitals. The cases we handle here are the ones that are very bad and we treat them very well here too.

There are insinuations that DASH morgue lacks personnel and equipment to effectively treat corpses under its custody. How true?
It is not true. We have enough personnel. When we say preservation of dead bodies, the misunderstanding is that people have it in mind that the only way to preserve them is to put them in fridges. You can preserve with chemicals.

If you put corpses in fridge, you have to guarantee 24 hours power supply, if not; it will get spoilt. Running on generators to preserve them will attract a lot of cost.
So, what we do in DASH, and in almost all hospitals across Nigeria is that we use chemicals to preserve corpses which is as good as that preservation in fridges.

Is the hospital in partnership with any foreign hospital in healthcare provision?
We are not yet in partnership with any foreign hospital; we have a number of partnerships with some nongovernmental organisations, especially with regards HIV, tuberculosis and some aspect of nutrition, also management of hypertension. We have those kinds of collaboration around and in a lot of research areas and all arms towards improving healthcare delivery system.

So we have collaboration in these selective areas. We are also in talks with other organisations and some foreign hospitals on how they can come to help DASH.