| Health care in Nigeria - The way forward (Part 1) |
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| Sunday, 21 December 2003 | |||||||||||||
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I would like to start this article with some statistics. The source is the Economist fact book for 2004.This will give us some perspective of what we are dealing with. Life expectancy for males in Nigeria is 51.1 and 51.8 for males and females respectively. The crude death rate is 13.7. Health spending as a percentage of Gross domestic product is 2.2% and hospital beds per 1000 of the population is 0.9.This means that the ratio of Nigerians to hospital beds is 1 bed for 1,000 people roughly. In my opinion primary health care should be the foundation of our health system. Prof Olikoye Ransome Kuti did a lot of work and laid the foundation in the late 80's and early 90's.A proper primary health care system would encompass Adequate water supply, Nutrition, Health Education, Immunization, Diarrhea management and HIV education among other things. The secondary health care system involving our general hospitals would also be able to take care of communicable and non communicable diseases and would get referrals from primary. The tertiary which include teaching Hospitals, Specialist hospitals like Orthopedic as in Igbobi and Dala and the federal Medical Centers would be theoretically at the top. I however believe that what is more important is adequate coordination of care and ability to go from one center to the other as you need. Now Medical education including Physician, Nursing and Physical therapy and other allied medical fields have to be adequately funded but also regularly audited . The funding should not be just by government but should also include Private entities including Companies, Individuals and Alumni organisations. These would involve sponsorship of Lecturers, Visiting Fellowships and building of Libraries also endowing Professorial Chairs. Decent Libraries would also need to be built and stocked with internet Connectivity. Also Library to Library data base involving institutions in Africa and the World at large. This can be achieved through our membership in organizations such as UNESCO and WHO. Also the practice of underpaying members of staff and external examiners should be stopped. Curriculum of our Medical and Nursing schools should also begin to include courses in basic business and resource management. I would suggest that by the clinical years the faculties of Business and Administration should assist to provide at least 6 hours of lectures a year in these basic things. Also before you become a medical consultant you should at least have a 2 week course in ASCON (Administrative Staff College) in Badagry for a refresher course. Basic sciences are the weakest link in Medical Education in Nigeria. The Ashiru's, Dosekun's. Olumbe Basir's and Onuaguluchi to name a few were giants in this field. Apart from Prof Ashiru most of the others are retired. We lack enough teachers in Anatomy, Physiology, Biochemistry and pharmacology. Gone are the days of the legendary Scotsman Alaistar Smith and his colorful pneumonics in Anatomy. One way to reduce this may be to have joint appointments in Surgery and Anatomy and Physiology and Medicine.This has been done in UCH. One of my mentors Prof Shokunbi currently holds the Chair in Neurosurgery and Anatomy. However what needs to be done is to encourage more people to go into these fields. The reason why people need to be financially encouraged is that in those field there is no money to be made because you take yourself out of treating patients and charging consultancy fees. It really affects the decisions of several medical students as per specialty since they also have to feed their families. Traditional Medicine has to be adequately recognized and given attention to. Unlike the Chinese who have made Acupuncture a worldwide phenomenon we have not been able to adequately harness the heritage passed down to us from our ancestors. At this point in time it is not too late to involve our traditional healers, physicians, botanists, Pharmacists and zoologists in establishing the taxonomy of all our medicinal plants and animal products. The phramacists and botanists will help to determine the pharmacognosy and pharmacokinetics. An illustrative example is the Orin Ata Chewing stick that Professor Fadulu was able to isolate the anti-Sickle properties of . We have a lot of Sickle cell disease patient whom would benefit. If we are not careful i have the feeling that like the Yam Pounder invented by Makanjuola in Ife, Orin Ata would soon be compounded by some clever Pharmaceutical company and sold to Nigerians. This brings me to Health care law especially patents and intellectual property. A personal anecdote i was a Surgical Registrar in the early 90's training under Prof Lawani retired Prof of Urology in UCH. He invented a troker and cannula for Suprapubic Cystostomies. This is a kind of instrument that aids in putting a hole into the bladder to relieve people who can not make urine. If he had a patent he could have sold the idea under license to a medical instrument company. Anyway if it gets sold Prof should remember me. Also we treated a lot of burns with honey which meant we did not need all those very expensive wound healing ointments and drugs imported from abroad Focusing on research that directly affects a lot of our people should also be done. These includes conditions such as Malaria, Tuberculosis and sickle cell disease. Most of the World class research in Malaria is no more done in Nigeria due to lack of funding. The University of Bamako in Mali has done a lot of the genetic research into the malaria genome and are working on the vaccine. It is not that they are better than our researchers but they are certainly better organized. The irony I suspect is that they read the work done by Nigerians such as Prof Salako, Sodeinde and Onuaguluchi. We also need to train physicians and Nurses and other health personnel how to write proposals for research and apply for grants from local and International organizations. This art is being lost. This is the first in a series of articles which I hope would be my humble contribution to the way forward.Dr Olumide Ogunremi is an attending physician in internal medicine in St Louis, MO and the host of The Village Doctor Forum
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Posted by Robot| 13.11.2005 09:15