Dr. Mustapha Alimi is the newly appointed Chief Medical Director of the National Orthopaedic Hospital, Igbobi, Lagos. In this interview with ZAINAB ONI, he bares his mind on the state of the Nigerian health sector and sundry issues. Excerpts:
As an administrator in the health sector, what do you advise the government to do to put an end to frequent strikes by doctors and other health workers?
Industrial action in the health sector has been occurring for long, and we appreciate government efforts in trying to address it once and for all. The public health sector is losing confidence of the public because of the lack of stability in the health sector. So, we want a holistic address that will put an end to all these issues such that we can have four or five years of no industrial action.
Some people, out of sheer ignorance, believe that if you are taken to the National Orthopedic Hospital at Igbobi, you will have your legs amputated. What is your take on that?
It’s one of those old wives’ tales about the hospital. You see, it is a shame for a person living in Lagos and other cities to say that, because I feel that it is an excuse to give Igbobi a bad name. Currently, orthopaedic services have gone way beyond that. It is now geared towards limbs salvaging; that is saving the limbs and not removing it. But the issue is that if you see amputations that take place at Igbobi, majority of them are caused by the victims themselves.
There is what we call an amputation drive cycle, where Mr. A sustains a simple injury, he comes to Igbobi, there is a fracture detected, the fracture is treated, he goes back home. Mr. B sustains an injury, he does not come to Igbobi. Rather, he goes to the traditional bonesetters, who are so many; he ties the limb, does all his things, the limbs start to change colour from fair to brown to black.
He now realises that the limb has degenerated, he tells the bonesetter that he will go to Igbobi, the bonesetter will tell him not to go because they will cut the limb. But what he has done is to generate a bad limb; the leg now becomes gang and green, it starts to decay, the patient becomes septic. At that stage, the patient will now rush to Igbobi, after he has really developed sepsis; the leg is now gangrenous. At that stage, the patient’s priority is not now the limb, but the patient’s life.
Remember that when Mr. A came, the priority was the limb because his life was not under threat. But now, the priority is no longer the limb. The priority is the life and the limb has gone gangrenous and it will be amputated. Now the traditional bonesetter the patient went to in the first place will now be boastful that he told the patient that at Igbobi, the patient’s leg would be cut off, forgetting that he was the one that generated the problem from inception. So, that is the amputation drive cycle.
What are the challenges facing the Nigerian health sector in terms of infrastructure and manpower?
Manpower training is barely just out of the rudimentary stage because to train manpower, you have to have super manpower to train manpower. So, we don’t have local super manpower. A lot of doctors are really committed to training now; so, they take their money, they go out of the country to get trained; by the time they want to come back, there is no infrastructure to practise.
So, we are having a situation where those that want to come back have to come back with their own infrastructure. They come back, they build their hospital, they provide the power, they provide the water, equipment. So, they have to now come back with their own hospital system to be able to practise what they have been trained in. So, as much as you still have that, your manpower level will only rise to a medium scale. It will not go beyond that point.
Some private universities have been running medical courses, as a health practitioner, how adequately equipped do you think these private universities are in running medical courses?
Well, the truth is that I don’t have enough knowledge of the private medical schools in Nigeria, to be able to comment, but if you are talking about state-owned institutions, there are some medical schools that are superb, like the Lagos State University Teaching Hospital. Their medical students are very well trained. Training of medical students actually requires a heavy funding but even the Federal Government, because of the economic situation, is coping with it. So, I don’t know about private schools that are running medical training, how they are doing it, because if you want to run a medical training, you must have a teaching hospital. So, which teaching hospitals are we talking about now? So, like I said, I don’t have enough information to be able to assess their level of performance.
Observers say most of the medical equipment in Nigeria are obsolete, how do you think this supposedly obsolete equipment can be replaced to help us catch up with the rest of the world?
It is simple, if equipment is obsolete, you then buy new ones. But to buy these new ones, we need funds; the funds we are talking about are in pounds, dollars, euros, in foreign currencies. The question is: what is the state of our currency to buy new equipment in foreign currency? Medicine is rapidly evolving, and without training or updating the knowledge of the personnel and updating the level of facilities and equipment, you will just be lagging behind; which is not good for the country.
How can Nigeria catch up in the world of medical science?
The truth is that we have to liberalise private medical services. If we look at the Indian model, the private practitioners were given reasonable loans, with, like 20 to 25 years moratorium. They were also given tax rebates and they were asked to pay very minimal interest. That way, they would be stable because the hospital is not what you will start today and start making profit tomorrow. So, that way, they were able to provide a reasonable health, they will be able to fund equipment, provide health, not at high rate and you can now update your equipment and infrastructure. But if you don’t provide those loans, you won’t catch up.
