Nigeria lags behind on healthcare — Ulu
Anuma Kalu Ulu, the Nigerian-born US-based geriatrics and family doctor was in the country for his yearly medical mission. Ulu was nominated for the “2009 and 2010 CNN-Heroes Award” for his philanthropic work.
He spoke to journalists on medicare delivery in Nigeria and its challenges among other issues.
You have been in practice for many years within and outside Nigeria, could you tell us what we are not doing right in terms of comparism?
A lot of things that we do in the country [Nigeria] would land someone in jail or make one lose license to practice in saner societies that stick to standards of the profession.
Of course there is no basis for comparism with what obtains in the U.S. A lot seems to be wrong with the nation’s medicare in our country. In reality if I want to be frank I will say there is no medicare system in our land. And, this is sad given the human and material resources that abound.
You have to experience the two to appreciate the profundity of the abject divergence. If I begin to expound the discrepancies, commonplace medical practices in America may sound Utopian, outlandish and even quixotic to a retinue of the medical staff in Nigeria especially those who have not had the opportunity of traveling to other climes. You could imagine how surrealistic this will appear to the average non-medical Nigerian. When juxtaposed with the comparatively rudimentary, rustic and anachronistic medical practice that we have in Nigeria, you will understand that we need a paradigm shift to even contemplate a footing in contemporary medical delivery. I am not just throwing brickbats from afar. I trained here before traveling abroad, and since I obtained my further training throughout my sojourn in Trinidad, Australia and finally the United States in 2004, I have been returning to do free medicare, at times up to three times a year, all self-sponsored, and without the fanfare as the goal has always been a surreptitious delivery of care to the needy. I thus stand in better stead to compare as I have marinated in the two almost diametrically-opposed medical scenarios.
When compared to world standards, we really do not have any medical delivery system in Nigeria. The system is replete with malpractices and shenanigans that will be considered culpable offences in America; but here they are meted out to patients with brazen impunity. I believe some practitioners know the right thing to do but getting away from the shackles of a corruption-enabling environment has proved herculean to them and most just capitulate and would rather fall for everything rather than stand for something.
We cannot even divorce the health care system from the general malaise of the Nigerian state as the government, which has predilection for white elephant projects to the total dearth of a robust health delivery system, is missing-in-action when it comes to health care delivery. The bane of medicare in Nigeria is a stifling lack of medical education to the populace in general and to the medical staff to some degree. In the absence of these milestones, issues like superstitions, innuendo and outright fallacies hold sway and militate against effective medical care.
Grand-fatherism is practiced in Nigeria where doctors assume an inordinate posturing of tin-god deification and haughtily marshal out to the rest of us the prescriptions they deem fit for our maladies without our contribution. Doctors do not make their contact numbers available to patients and patients’ relatives and ward nurses would gleefully tell you they cannot give you the doctors’ contact, yet you are under their care. Every step we take is questioned; at times, arrogantly, but we always have to show humility and burnish the image of our hospitals by remaining inviting, smiling, unprovoked and professional.
In fact, as I said earlier the system is rippled with many practices that would land a medical staff in any other clime in jail or a situation where he or she would lose license. There is no checks and balances here and I believe that some people might know what to do, but because of self-aggrandizement or the need to make profit beyond the need to serve, then they get derailed.
What is the main problem with medicare in Nigeria?
The main problem in Nigeria is lack of medical education about what you’re suffering from or what you’re going through.
You ask doctors which medication you are giving me. They would not tell you; they would scrape the names and tell you to just take it; what do you know, what or why do you want to know? You ask them what is my diagnosis, they can’t tell you, they will just tell you, ‘Why do you want to know, did you go to medical school?”
The situation is sickening. So, lack of information, medical information to the populace is the greatest bane of Nigeria’s system.
When it comes to matter of health, the government is missing in action. They are more interested in spending billions to build stadium instead of building the state-of-the-art hospital. At times, when they build such hospitals like former Governor Akpabio did in Akwa Ibom State, the running of the hospital makes it difficult for the masses to avail themselves of the services. They make it so elitist that it destroys the purpose for which it was built because they are trying to prove that theirs is bigger but the intention to serve is not there.
Then, what is the solution?
Medical doctors have to change the orientation of putting profit first. They have to reorient themselves to think that they can serve first and along with the service, they can also better their lives. I don’t believe in government thing. I have been neck deep into this. I have been trying to get sponsorship. I have approached many corporate organizations and governments but they are not friendly.
What is your take on migration of doctors abroad?
It is worrisome and that is where government must wake up rather than pay endless lip service. With this constant migration, the fragile health system will become comatose if the trend continues. But my prayer is that there are people like me who would say even when the desirable is not available, the available will become desirable. I went to Methodist College, Uzoakoli. Our house motto was ‘Play your part well, there the honour lies’. So, you play your own part well and pray that somebody else plays his part. And when you see that a journey of a thousand miles starts with a step, you cannot because you think that the job is so herculean decide not to do anything.
Like in my village, when I started the programme in 2004, 90 per cent of the people had hypertension and we used to have stroke like 10 to 15 people a year which was attributed to somebody not killing goat before laying foundation and all sorts of traditional beliefs. Four years into my programme, it reduced to like 20 per cent.
Six years down the line, there was only a time that we had two strokes and one of them happened to be my mother. My mother died at 84 years and she was taking blood pressure medication for over 20 years. What I am saying is that the little I did in my village, Obiene-Ututu, in Abia State was able to make an impact. And it is still making an impact.
People are relatively healthy there now. We just had a medical mission in one of the villages and the result was awesome. If all the others I know did same in their respective communities, you can imagine how much healthier a wide area of populace would have been now? In my recent medical missions, I exported the care to Obinofia Nde Uno in Ezeagu LGA of Enugu State as well as Akpugo community and the profundity of the services rendered and the consequent health revival has been reverberating since then.
As an emergency room physician in the US, I preside over numerous live-saving innovations. People for instance die at home here, as like dying in terms of death in Nigeria, with no breathing and no circulation, the type that will attract a shroud in Nigeria and two cotton balls to the nostrils and relatives wailing, but in the US they are brought by the ambulance personnel in active cardiopulmonary resuscitation initiated by family members and taken over by ambulance personnel, then brought to me as emergency room doctor where I immediately endo-tracheally intubate the patient, start IV access including peripheral and central access and then institute life-saving medications and fluids, and electric shocks as needed. I have personally brought back up to 100 people to life in my career as above, with no neurological sequelae. Most of the doctors doing this and more in the US are Nigerians. Can this be done in Nigeria by me and other doctors who are not waiting for optimization, yes, but ready to sponsor such hospitals other than government or corporate organizations or even wealthy individuals who would rather fritter away money on investitures and fanfare? How many casualty room doctors can incubate and start a central line and do lumbar punctures in Nigeria without waiting for the anesthetist to come and do it, or the surgeon, where such exists? How many people have come in to a typical Nigerian hospital with acute stroke, unable to maintain an airway, and are left un-intubated, subsequently aspirate, develop aspiration pneumonia and die, like what happened to my mother in 2011? When these people die, their corpses are whimsically seized until relatives pay the last penny, not minding that their cares may have been delayed for tardiness in payment, usually occasioned by abject paucity of funds. I think it’s time we wake up from slumber in our medicare delivery system.
Are you planning to put up a hospital in your village?
Yes, my intention is to build a state-of-the-art hospital in Nigeria, specifically in Abia State and which I will run with the same standards and parameters that you have in the U.S., but more tailored towards the less-privileged because part of the hospital would be non-profit and I will provide for people who cannot afford it. Of course, the people who cannot afford such standard will not be willing to travel abroad to seek medical care. And it is interesting that only N2 billion will give me that state-of-the-art hospital, including evacuation helicopters that we call medical and air ambulance. The only problem is that some preachers might run out of patronage when the hospital takes off.