What challenges do we currently face? (5)

While we have come a long way on our journey towards eliminating barriers to a healthy community, but we are still facing many challenges. I will only highlight five key areas: space, personnel, intelligence, self-sufficiency and access to genuine medicines.

Space:

Figure 1 The Health Centre, Mayo-Lope, Gembu, Taraba State

·        The current health centre as you can see in Figure 1 above, is an old building in relatively poor condition (e.g. leaking roof) which is unsafe, costly to repair (rectifying uses up member contributions), being on rental/short-term tenancy also risks our long-term sustainability.

·        It is also small and is not purpose-built as a hospital. We have received donated hospital beds, laboratory and diagnostic equipment (including mobile x-ray and ultrasound scan machine) that will improve our diagnostic capability but we are unable to install due to the limited space.  See Figure 2.

·        We also have delivery beds and other equipment that will support the provision of emergency obstetric care and staff with relevant skill, however, there is no available space for admission to enable us to commission this service, which is a major area of need for the community.

·        As mentioned above, we also want to expand the membership of the health cooperative to 1000 (and 10,000 longer-term), and so desperately need a larger space to be able to provide high-quality healthcare services that can meet the needs of all individual and sponsored members. See Figure 3, floor plan of the proposed new site.

Figure 2 Health worker training on operating and interpreting readings on pulse oximeter monitor

Figure 3 Floor plan of the proposed new site

Personnel:

·        We had challenges with our ability to recruit and retain health workers, improve patient safety, expand services, and increase satisfaction rates, thereby growing and sustaining our cooperative membership.

·        The cost of the health workers is by far the largest proportion of our cost, see Figure 4 and Figure 5. On average this is 75% of our cost.

·        Our remote location also makes it difficult to recruit and fill up personnel gaps needed for high-quality services

Figure 4 Total monthly cost compared to total monthly income

Figure 5 Monthly staff cost compared to other costs

Intelligence:

·        Effective use of electronic records (EMR) enables remote support for health workers on the ground to be increase responsiveness to the changing healthcare needs of the community and keep pace with global trends in healthcare quality and safety. Figure 6 shows the performance of the scheme produced using manually entered data on an Excel spreadsheet, valuable information for decision-making.  A full EMR can make real-time evidence-based decision-making a lot easier.

Figure 6 Performance chart

Self-sufficiency:

·        While we are on course to reach our target of 1000 paying and sponsored members by the end of September as shown in Figure 7, we face a major challenge in getting our members to renew their monthly contributions as shown in Figure 6 where Renewals only accounted for between 7% and 21% of monthly income.  The scheme can only achieve self-sufficiency with sustained contributions.

Figure 7 Growth in cooperative membership

Access to genuine medicines:

·        As I speak, we have a carton of medicine seized by NAFDAC undermining a key component of our business model of getting donated medicines from our partners to bring down the cost. This happened despite applying more than six months in advance without knowing the outcome. Figure 8.

·        There is no easy and effective procurement platform for genuine medicines in Nigeria, which is a major gap for the enterprising ones among us. Buying locally at the site of the health centre means higher cost and no certainty about the quality of what you are buying.

Figure 8 Medicine cabinet at Dechi Health Centre

Next time…


A step-by-step journey of how we got to this point and the challenges along the way.

To find out more: misaddiq@gmail.com

Colleagues, please listen to me before you STRIKE me!

Dear Nigerian Doctors,

Joint Health Sectors' Unions (JOHESU) were on strike for about one week last month (August 2013) shutting down public hospitals across Nigeria except for skeletal services rendered by you. But what worried me most is the stand of colleagues during the strike and the current threat that you too would use the same device that you largely condemned other health workers for using if the government agrees to the demands of JOHESU. (There were some words of reason and call to understanding from MD of FMC Gombe and CMD of Gwagwalada Specialist in the media).

But words coming out from the majority of leadership of the Nigerian Medical Association (NMA) and from colleagues in the medical profession were very coarse to say the least. In engaging with the discussion about other health workers you find people saying/writing things like “anti-doctors”, “our enemies” “eliminate”, “fight-to-finish” and so on. That there were some skeletal services provided by colleagues during the time of the strike was more to frustrate the strike of the other health workers than it was about genuine interest of patients or the general public’s health. A friend quoted the following on his blog said by a lady which seem to capture the position of most people on social media except of course the striking health workers:

‘I am asking you if you would take your pregnant wife to a hospital to be attended to by a nurse. I know you won’t. A nurse is a nurse. If you are admitted in a hospital she will nurse you, but not treat you. Everyone that goes to hospital wants to see a doctor. A doctor checks you and tells you what is wrong and prescribes what you will take. If there is an injection, the nurse will do it. But if you need an operation, a doctor does it. If you need drugs, you go to a pharmacy and get it. A pharmacist is dealing with drugs, not patients. When you have a drug unit, give it to a pharmacist to head, not a doctor. When you have a laboratory, give it to a laboratory technician to investigate samples on doctor’s orders. Don’t give it to a doctor. When you have a ward with patients, a nurse is who you need to administer drugs on doctor’s orders and to nurse the patients. But when you have a hospital, you have to give to a doctor, not a pharmacist or nurse or what have you. I know everyone is important in a hospital, but a doctor is the doctor. I am sure you don’t want a nurse operating on your wife.’

This understanding of leadership is rather curious. It seem to suggest that we agree that leadership should be about control and therefore power over the resources of particular spaces based professional knowledge.  Should it follow then that since Mine and Quarry Engineers know more about cement production they should not allow Dangote (who is not an engineer) as their CEO? Leadership is much more than knowledge and control of resources. Leadership especially in delivering public services is first and foremost about responsibility and accountability.

The question is what are our health institutions for?

For example, looking at Teaching Hospitals and Federal Medical Centres because they form the battlegrounds for most of the inter-professional disputes. Could the CMDs/MDs as the CEOs of the scores of tertiary hospitals bring forward any verifiable data about the core purposes of their hospitals?

Are these centres supposed to reduce preventable deaths? How much of that has each achieved in 2012? How much more could they have achieve? How much did it cost the society?

Are they supposed to reduce suffering? How much of that did our hospitals achieve in 2012? How much more could they achieve and at what cost the society?

Are these centres supposed to produce future health workers? How many do we need and how are they filling in the gap and at what cost to the society?

Are they supposed to produce knowledge through research? What do we know about the many things that are killing and maiming us and what solutions have they managed to produced and at what cost?

All indicators are suggesting that our health is deteriorating as the health budget sour in Nigeria. Here, one might argue that increasing spending on the health sector is damaging our health and reducing our survival?

What exactly is the purpose of our health institutions?

My position is not that the JOHESU strike is justified or in the interest of Nigerians and not because they will genuinely offer better results. But that the current framing of what leadership is within the health sector is rather cynical. And that need to be thoroughly worked out before embarking on another endless and meaningless cycles of strikes and counter strikes.

Building a Health System from Bottom Up

Building a Health System from Bottom Up

This was first written by me on 13/08/12 with the title “How do we fix our health system IV?” From the title it can be seen that it is a fourth in series of reflections on our health system. Earlier parts are posted on my blog http://misaddiq.blogspot.co.uk/.

Health is too important to be left in the hands of doctors only! Provocative? Yes and deliberately so. Hopefully, this will nudge all those hesitating to join in the debate to say or write something.

Who then should fix our health system?

With health workers you get more health facilities irrespective of the purpose such facilities serve. Many of our health facilities are probably damaging health more than they are helping to ameliorate health problems. Does the health worker have a vested interest in disease? Yes in lots of case in our setting. This may sound unreasonable because of the discourse about the ethics of the medical professional. But a critical eye will reveal that there is no incentive for the typical health worker to do something to stop increase in disease burden. Almost everyone I know has a story about their experience with our health facilities. We have stories about open-and-close, diversion of patients to private hospitals, fight over ownership of patients especially in peripheral hospitals. Recent media report about a ‘doctor’ removing someone’s kidney in Bauchi should still be fresh in our minds. Even public health professionals fall short when it comes to working to address the many health problems we face. ‘Perdiemitis’ and ‘work-chops’ have dominated the psyche of everyday practitioner, especially in this era of proliferation of international NGOs.

Health is too important to be left in the hands of bureaucrats either! Our institutions have grown too complex and had become the substance of attention rather than the vehicle to govern the sort of social relationships that are necessary for a strong health system. Our different ministries of health and health agencies have their own agendas and often totally different from the initial role that they were set out to perform. If you shut down the ministries of health across most part of the country the main people that will shout are the employees of such ministries. It will have very little impact on the health of the public. The recent battle of wits between Lagos State government and NMA is a good lesson in this regard even though Lagos is on the next street when it comes to public services compared to other states. Are these institutions therefore really part of our health system? They focus on their visions, missions, strategies and other managerialist jargons that do not mean anything to even the workers in the health institution not to talk of the sick or dying patient.

With health maintenance organisations (HMOs) you end up paying very high for the lowest quality of care available. Their key concern is their bottom-line and not your health. So also, the different health insurance institutions who will charge you all they can get as premium when you are healthy and use the money to find out ways to refuse you the health care you need when you are ill. Evidence from countries that have adopted health insurance whole sale have shown the system to be retrogressive and had not stopped people from paying out of pocket for health services at the time of need.

In Nigeria, almost all our health strategies and plans were developed by people that are related in one way or the other with the medical industry and heavily influenced by external bodies that lack the slightest understanding of the social context of our health problems. Health Ministries are run by the elites of the medical profession and their patronising politicians. Any surprise then that our health system don’t work for us? The politicians will ensure that the elite clinicians get the cathedrals and latest toys they want while they the politicians get to sign ‘juicy’ contracts in the typical Nigerian way.

Where then do we turn to?

Fixing the health system is a task for every single one of us. Each individual or groups of individuals affected by a health problem are the experts of that problem. What others can do is support them in addressing the problem based on what the index individual or group felt meaningful. Because it is a task for everyone it often ends up being a task for no one especially with a severely disable (read: refuse to be able) state. Therefore, fixing our health system is a political issue rather than a technical one. I have avoided the typical technical approach to defining the problems in the last 3 series deliberately so that this point is adequately highlighted. Oddly, the only promising group that can potentially do the job are politicians. Not the typical Nigerian political class though, but the numerous genuine grassroots political activists that are already volunteering their time and resources in solving different social problems in our neighbourhoods. What is needed is a more organised way of going about it. Health systems that work across the globe do so because it is taken up by genuine politicians who are interested in bettering their societies.

Currently, in the dominant discourses about health systems, politics is often analysed as barrier to technical solutions developed by ‘experts’. Our technical documents are dotted with talks of ‘lack of political will’, ‘political interference with the plan’, ‘political instability preventing implementation’ etc. as the problem. However, evidence suggests that rather than a barrier politics is necessarily an integral part of any meaningful health system globally. The German wellness funds, the UK National Health Service, the Ghanaian rapid rise in coverage of health insurance, the Costa Rican health and social security system are all excellent products of political action rather than some technical prescriptions.

The model - A health savings collectivity

This is about building communities and establishing trust using health as the basis. Based on my engagement with people during this fieldwork and generally, I have come to understand that they can do extraordinary things when health is the issue of concern. Someone said to me nobody wishes even their enemies ill-health. The stories I shared about some of my interviewees especially the extraordinary risk taken by one of the Achaba during the recent curfew in Kaduna in the earlier series highlights this point.

I have argued in the earlier series that individualism does not work with health, some collectivity is essential. Ideally this should be state-lead. However, we have a withdrawn state. Furthermore, all the potential candidates that give sense of collectivity in our setting (e.g. religion) have failed in one way or the other. Family is too small a unit to balance out savings and needs (not risks as insurance people would like it). Therefore, some innovation is needed. As I argued in the first series it is necessary to evolve (1) a set of mutually agreed values (in this case with respect to health) that govern our relationships and safeguard our rights outside our immediate families, and (2) a set of agreed ways of enforcing our agreements.

The ‘savings’ in the subtitle may suggest funds as essential element of this health collectivity but that need not be the case. The most important value is reciprocity – people willingly agreeing to actively take part in solving each other’s health problem. Reciprocity should remain the basis of assessing success not the size of the savings or contribution of individual members or the collectivity. Money should be treated in this regards for what it really is, which is essentially a medium of transaction to be used in translating – trust, empathy, solidarity, remorse, difference, loyalty and whatever values defined within the collectivity as important and also as a means of enforcing these values.

Under this arrangement groups can be formed in our communities consisting a minimum of 20 households (the higher the better up to a limit – familiarity is also important) to agree to share the total cost of illness of any of its members. Members are to contribute based on means and not some fixed amount as in health insurance. Members know each other well enough to be able to understand what amounts are within the means of each member and which member is not able to contribute at all and should be exempted from paying but allowed to benefit from others kind help. Those that are not able to pay can contribute in some other ways depending on what works for each group. My experience have shown that majority of the people appreciate kindness and try to reciprocate in one way or the other. I come to understand from my interviews that people in the area where I am working (a predominantly Muslim settlement) prefer to go to a Christian missionary hospital in the town because they are attended to and have their problems addressed before they are asked to pay. My interaction with the hospital reveal to me that although some people do default, but the majority come back and pay and that the numbers that are defaulting are not high enough to prevent the hospital from running their services effectively.

In the first place this collectivity is purposefully set up as a vehicle to prevent individuals from exposure to the financial inadequacies that prevent meaningful action to solve health problems. It is prepaid so that members do not start looking for money at the time when they needed to focus on the best course of action. It is a collective effort so it relies on much more than the sum of capabilities, resources and networks of individual members. It is a sort of mutual assistance scheme that is founded on health needs.

Members of each collectivity hold regular (monthly, fortnightly) meetings and make their own decisions with regard to the design and funding of benefits, as well as their constitutional arrangements. Besides providing the money to meet health expenses, members can also use their capabilities and other resources within their network to directly solve the health problems, mitigate it from its root cause, and address structural issues that lead to the problem in the first place. There is huge incentive in the form of savings to motivate the group to work towards a lasting solution to the health problem as the benefits are tangible. Multiple collectivities can form mutually beneficial partnerships in solving some problems. Ideally the collectivities should be based on geographical proximity but with increase sophistication and depending on the sophistication of its membership geographical proximity may be done away with.

As each group address one problem and move on to another, knowledge and experience is generated and shared and subsequent similar problems can be addressed more efficiently.

There are lots of barriers to setting up this type of system and one is sure to meet with political resistance from the state. However, as I have mentioned above, building a health system is a political action and therefore adequate preparations can be made for backlash. What do you think?

Muhammad Saddiq

13/08/12

How do we fix our health system I?

This is the first part of series of personal reflections on how to address the problems with our failed health system based on critical look at current efforts and empirical observation of real places. What we need is not more hospitals, health workers, medicines, technologies or medical equipment but rather (1) a set of mutually agreed values that govern our relationships and safeguard our rights outside our immediate families, and (2) a set of agreed ways of enforcing our agreements. Some key institutions have tried to play this role in Nigeria with limited success. I will comment about a few starting with what dominate our discourse especially on social values in Nigeria – religion.

Religion has failed to provide these guarantees at least in the geographical location named Nigeria! This may not be a problem with religion per se but with how it is interpreted/perverted and practiced. That someone is religious or appears religious does not mean they understand the religion and therefore there are no guarantees that their actions will be guided by the true spirit of their professed religion. No need for examples here as all would have been betrayed by one man of god in the past or at least would have read or heard of several incidents of such. You may also think of some trustworthy atheist that you may have interacted with. So religion may not matter that much (I will return to the role of religion in the second part of this essay).

Neither have race, region, ethnicity, tribe nor clan guaranteed that your dealings are secure in this our seemingly stateless existence. Here again I will leave you the room to fill in the examples of the betrayals/broken promises from people you might have thought you can identify with on the bases of these categories. One needs to look no further than the fuel subsidy scandal to make up their minds.

Political parties were expected to play this role in our own version of democracy but we have yet to evolve such political parties in Nigeria. There are a few trustworthy people in all our political parties including PDP and there are many dishonest people in all of them including the opposition ACN, CPC, ANPP, APGA etc. Here again examples abound. Yesterday it was 200 cars for first ladies summit. The other day it was some wives’ of legislators from an ACN governed state attending course on ‘spouse support’ (whatever that means) in the UK on state’s resources. We do not need to mention the absurdity that is state sponsored pilgrimages!

Agreed, it is impossible for everyone to sign up on a set of moral principles, but it is very likely for a significant numbers to agree on a minimum set of principles that safeguard life, property, dignity and livelihoods (basic functions of state not provided in Nigeria). These are all we need. This significant numbers can also agree on mutually enforceable systems and work to actualise them at least among themselves and any others who want to deal with them. The need for this system is extremely urgent and it has happened even in places that have seen the worst forms of social turmoil. I will use the example of the poster child of statelessness – the modern Somalia.

To an average outsider Somalia is hell on earth. Well, Somalia is no paradise, but you may be surprised that the country enjoys higher economic growth and health and wellbeing in recent years much more than in the period preceding the dissolution of the state in 1991 and its performance on some key social indicators are far better than or at par with most countries in sub-Saharan Africa including our dear Nigeria! For example 20% of Somalia has piped water in 2010 compared to just 4% for Nigeria for the same year (Source: WHO/UNICEF JMP 2012). While this is sadly worsening for Nigeria, in Somalia it is actually improving. In the same report and this should shock you because it is about nutrition where Somalia is synonymous to famine, drought and malnutrition as painted by international media. Nigeria and Somalia are almost level at 41% (2008) and 42% (2006) respectively for children less than 5 years who are underweight! Taking into account the trends in the two countries one wonders who is ahead in 2012! These averages also mask the wide regional and socioeconomic disparity which is much bigger in Nigeria than in Somalia.

Somalia returned to the traditional Xeer (pronounced - hair) system following the collapse of the state. This system is based on clan groupings (Diyah groups) and the enforcement of rights is true restitution which is binding on all members of the clan shared proportionately. If a member of clan x steal a camel from clan y, then every member of clan y will contribute to procure two camels that will be paid back to clan x. If a member of a clan becomes notorious beyond control of the clan elders and keeps on offending, such member may be rejected by his clan (excommunicated) and therefore lose all protection, a very precarious situation indeed which is avoided by most. This is a caricature of a complex system but those interested in more details can research further. This system has enable industry and productivity in an area that would have otherwise descended into chaos (if Hobbesian theory about the natural state of affairs holds) without any functional central government for over 20 years now. There are other examples such as burial societies in most of rural Uganda after the cattle raids and the long periods of violence that followed (more on the Uganda example can be found in the book by Ben Jones - Beyond State).

To make these points relevant to health, think of the things that damage our health in the communities we live in: sanitation, potable water, housing, peaceful, secure and serene environment etc. All of these require us to relate with others in order to meaningfully have them. Imagine if your neighbours decide to direct their effluents towards your house or turn your front yard into their refuse dump what options do you have? You may want to fight them – physically or through the authorities (depending on your physical or financial power), ignore/bear with it in the interest of ‘peaceful’ coexistence, or clear it yourself if you cannot bear and have the means. These are not hypothetical scenarios. I have seen several and had conversation with a few people living in these kinds of situation. I will like to share one:

A few days ago I interviewed a man living next to a mountain of refuse in an informal settlement that has developed very rapidly compared to when he first moved to the area about 30 years ago. Few years back, there were plenty of empty ‘neutral’ lands where people could just walk to and dump their refuse but as the area is increasingly built up, the few places left undeveloped are turned into dumpsites. And because they are fewer and fewer and serving more and more residents the places fill up quite rapidly. This particular refuse place is an un-built piece of land owned by another person who was approached to sell the place for N2million (a handsome amount for most residents of the area) but he refused because he is working to get enough money to build so he can move in with his family. The key concerns of my interviewee are that the refuse get scattered by wind and messes up the whole area and rain water washes off dirt from the place into the surface water. Since most residents in the area rely on well as their source of water for domestic use, the dirt ends in these water sources, contaminating them. Another concern was that of smoke from regular burning of the refuse which sends offensive odour and pollutes the air in addition to loosening the soil that renders their buildings weak with risk of collapse. My interviewee was however not willing to force the owner to sell because he thinks if the owner had the money he would have developed it and moved out of the rented flat where he currently lives with his family. After burning, the refuse shrinks and the remnants are bagged by children and sold as organic fertilizer to farmers. But this is not enough to clear the site as the rate of clearing cannot keep up with the pace of dumping.

Where do you begin to address this problem from? In our increasingly individualist society, the neighbours could not stop people from dumping because it is not their property. Stopping people by force may result in conflict which no one wants to add to their list of unending troubles. The owner could not stop it because he does not live near the site (Even El-Rufai of fame had to build fortified barriers to prevent people from accessing the green areas in some places in those days, imagine what it will mean for a poor person). The situation calls for some form of mediation which in normal places the state will come in. This is no normal country and that is why such a place exists in the first place. Calling in the authorities in our current situation at best can result in forcing the owner of the said land to sell it off at price that is below market value if it has to be immediate. A possible outcome is that a richer person that can develop the place will buy it and possibly develop it or just fence it and leave it to add value for him. This was not acceptable to my interviewee who empathises with a fellow poor man to the detriment of his and his family’s wellbeing. He told me during the interview that he just recovered from a bout of diarrhoea and vomiting that required admission at a high cost for him and that there is no month that will pass without a member of his family falling sick with the consequent strain on his meagre income. Will this approach have made the refuse to go? NO! The result here in the long run is just shifting the refuse to yet another newly developing neighbourhood as the first owner may collect whatever amount he was able to realise and buy another piece of land in another cheaper informal development where the initial problems are now recreated. Another possibility is that civil servants will force the owner to pay some bribes to avoid revocation which will set him backward in his plan to develop the place without addressing the problem at hand.

What if the community had a system that mediate relationships which is mutually agreeable to all the actors? No one will violet another’s right because they are protected and penalties are enforced. Therefore, no one will dump his refuse in another’s property without consent. Such system would have created an alternative way of collecting refuse and even a way out for the owner of this land to build a house for his family. There would have been a cleaner environment, another family in their own house living peacefully with their neighbours. All these would have improved their health and wellbeing without spending any kobo on hospital or medicine.

The second part of this essay will look at the major ‘social worlds’ that govern our current health system and some of the potentials they offer. These include: the receding traditional institutions; the legitimacy-seeking state; the highly influential but misapplied religion; and the ineffective but growing individualism.

26/07/12

Why we don’t want to understand what killed a man and woman in a car in Kano!
The recent death of a couple in a car in Kano highlights yet again one of our cultures in Nigeria of not wanting to investigate death. For some odd reasons in our society we do not want to conduct full autopsy to find out the cause of death even if the circumstances are unusual and even when it is obvious that there is 

some foul play. Not to mention contemplating legal action, this would have been considered a serious sign of faithlessness. We simply rationalise it as God’s wish. Chief among the reasons for this especially in the North to me is the fundamental misunderstandings of Islamic position on such investigation or reluctance to follow its guidance because of our stronger cultural views about death. As result homicides go undetected, avoidable deaths continue to occur and culprits go scot free.

It is understandable that emotions around death are strong and people dislike that their loved ones are not giving the ‘appropriate’ rites including it been done in time. There is also pressure from family and friends to leave things with God and not heeding to such counsel would have been judged as sign of weakness of faith or some form of disbelief. Everything around death presents a very strong need for closure and the longer it is investigated the more severe the emotional burden. However, again it is this same reason that should necessitate appropriate investigation to determine the cause, culpability and preventive measures. I think we can achieve true closure and the death would not have been in vein if it serve to prevent another’s loss.

How many homicides occur from road traffic accidents, professional negligence, industrial errors, environmental damage etc. without us knowing the cause and where fishy anyone being held to account? I will highlight some high profile cases that only became apparent to us when someone from outside had to wade in for us to understand what happened and for ‘victims’ of one of this cases to have some hope of restitution. The drug trial in Kano by Pfizer during the 1996 epidemic of meningitis that resulted in death and some impairment among children came to our attention only by December 2000, when The Washington Post published the result of investigation going on in America. Similarly, the worst lead poisoning disaster in recorded history, killing approximately 400 children in March 2011 alone came to our attention only because some doctors from the humanitarian organizations Medecins Sans Frontieres ("MSF"), also known as Doctors Without Borders decided to investigate. We would have simply continued to bury the death and do what we do for the impaired for only God knows how long.

I find the belief that investigating the cause of death as a sign of lack of faith absurd and the reluctance to hold people ( lay or professional) and institutions to account when liable even worse. I am not an Islamic scholar, however, I find it hard to reconcile why God will prescribe punishment for homicide and even detail compensation and how such should be dispensed with not wanting to hold the guilty party responsible. Investigation therefore becomes a matter of necessity since you cannot ascertain blameworthiness without it. My reading of this is that there is nothing wrong in investigating a suspicious or ‘mysterious’ death. It is mysterious only because we fail to investigate. If we do not learn from events, I do not see why this should not happen again. Or maybe we just wait for MSF to unravel this one too!

Investigation of death is the bread and butter of medicine. A lot of the medical technologies we take for granted today come about because some people try to find out what is killing them and do something about it. To me there is no difference between taking medicine for a fatal illness and finding out the cause of death of someone in order to prevent similar event happening to someone else, same with prosecuting negligence to avert another person’s grief.

In the case of ‘Man and woman found dead in car’ by Dailytrust (23/05/2012), even though medical knowledge have availed us with the means of knowing with greater degree of certainty why the couple died, a lot of what we know are mere speculations. We probably will never know for sure what really happened because we are not going to do a proper investigation. The excuse that the bodies are already decomposing so we cannot do proper autopsy is not acceptable. There is at least one theory that the death could have resulted from carbon monoxide poisoning. I am not a pathologist but surely two days after death there are chemical test that can at least exclude this. Leave the bodies aside, what about the car itself? Was any test done to assess the composition of the air in the car when the bodies were found? Are there investigations about other possibilities of other toxic emissions from the car? What are the similarities between the two recent incidents? I am not referring to the similarities that most women will want to observe! Lol! What if it is something we put in our cars every day, maybe some unwholesome car fragrance? There are lots of possibilities, but with intent and professional handling this can be unravelled and possibly save some lives in the future.

Generally, I think we need to be more serious about trying to understand things that are killing us.

New Starts...

What about scrapping our existing health institutions? such as the Federal Ministry of Health, NPHCDA, "Health MDGs Desk", NHIS and similar institutions at the state level. You think this is crazy? not at all.

The rate of increase in size and numbers of all these institutions are only match by the rate of decline in our health status. So, are this institution design to improve our health status?

My assessment is that these institution were not designed in the first place based on sound philosophy of health but are merely accidental inheritance and poorly copied organizations that did not benefit from thorough assessment of their role in our lives.

Why would FMOH be responsible for management of tertiary hospitals for example? the FMoH does not have a better financial system/capacity compared to this institutions, it does not have better managers neither does it have better technical competence? so, what is the advantage of having this institutions finances, board appointments, other procurements run from far away Abuja? And what is the business of FMoH providing services anyway? who are these services meant for and why? There is no where the targets of these hospitals have been defined and there is no system in place to know if these targets are been served. will have to stop here and continue later

A dupe’s encounter with “Dr. Sidibe”!

Part one

By the time you reach the end of the first part of this story and were unable to define Dr. Sidibe the more likely that you would have suffered the same fate with the dupe. I traveled to Bamako for a one week meeting of the West African regional network (WARN) of roll back malaria for another push towards the heated fight to deal a massive blow to one of worlds most deadly diseases malaria. In focus is the 2010 targets agreed by heads of states in Africa for reaching universal access to malaria treatment and prevention services. Two days into the conference, a colleague in the Nigerian delegation and I met a very friendly and welcoming Malian doctor from the ministry of health of Mali wearing a tag as a rule for all participants at the meeting with the name “Dr. Sidibe”. Dr. Sidibe is the God-sent savior you would like to have if you are Nigerian or from and English speaking country attending this kinds of meetings. He was all you would want to get in this place – understands English (a big relief for non-french speaking participants as only 5 out of 16 ECOWAS countries that are also members of WARN are English speaking – so you are almost always wearing the ear piece as only way of following what is happening in the meeting hall through hardworking but not so effective translator, Dr. Sidibe is also very friendly another very scarce attitude as every body is the who-is-who in the world of malaria (WAHO, WHO, UNICEF, PMI, etc) and would expect you to be the first to initiate communication and to be diplomatic, he is also generous and was even offering a drive round Mali for sight seeing when his driver is back from school and domestic runs for his wife in addition to promise of souvenirs for his newly acquired Nigerian friends. This is also a very attractive prospects for those that are familiar with “baba oyoyo” !

Dr. Sidibe introduced himself as a doctor trained in Mali, France and on his way to Cuba for additional training. He is specialist gynécologie and a key figure in Mali’s ministry of health. He had worked in South Africa and was on visit to Nigeria in 2003 to a conference he could not come up with the name immediately but with my prompting he remembered – ‘yeah SOGON’. At the conference in Nigeria, he met and made friends with a Nigerian doctor – now I can not remember the name. The Nigerian was very kind to him treated him like a prince in Abuja and bought him lots of stuff as souvenir for himself, his wife and children. So he feels indebted to pay back to his new friends from Nigeria. Dr. Sidibe offered to get me a SIM card of Orange Mali GSM network at FCFA 300 and was furious when I bought it at FCFA 3000 from the hotel reception. His friendliness is only matched with his voracious appetite at tea breaks, group lunch and cocktail dinners. He has the most robust servings among meeting participants and waiting for cocktails and dinners are observed with religious seriousness which is a little bit strange for me for such a well to do family oriented man and one with such deep pockets for gifts for his friends.

He actually kept his promise and brought me a souvenir of art work. A frame with crafted piece of wood in the center which I could not say what it is all about? But all the same it is made in Mali and it was a gift so I collected and thanked him. But why is the gift looking old and used and why is it not wrapped but enclosed in meeting folder. Well may be he removed it from his house and was on hurry and did not care to get a polythene bag or wrapping paper so he had to empty his conference materials and put the item in the file.