It is no longer news that road traffic accidents and disease conditions such as diabetes continue to increase the number of amputees in the country. Statistics show that an estimated 1:6 percent per 100 (32,200) Nigerians suffer extremixity amputation.
Saturday Vanguard spoke to the Medical Director of the National Orthopaedic Hospital, Igbobi, Lagos, Dr. Mustapha Alimi on amputation and other issues affecting the country’s health sector.
Alimi who expressed concern over the rising incidences of late presentation of patients to hospital in this interview with Gabriel Olawale said failure to present early often makes it inevitable for most patients to lose their limbs as a result of delayed surgery. Excerpts:
Effect of frequent health workers’ strikes in Nigeria
Industrial action in the health sector has been occurring for long, and we appreciate efforts by the government in trying to address it once and for all. The public health sector is losing the confidence of the public because of the lack of stability within the sector.
So, we want a holistic approach that will put an end to all these issues such that we can have four or five years at a stretch without industrial action.
I always pray that there is no strike every day I wake up. The truth is that government is the largest healthcare provider and once the hospitals are not working, the cost of healthcare services increases by over 90 percent to those who want to get it and they will not get exactly what they need.
No private hospital in Lagos has the capacity of any government hospital. The private hospital may look attractive and more modern, but they cannot have the level of manpower and equipment that the government hospitals have.
What is responsible for late presentation of patients?
Late presentation is a compound issue. Some people are poor while others are poorly informed. Because a man is poor, he thinks of what is cheaper for him. He grows up in traditional setting where bonesetters will just tie bamboo to people’s legs to set the broken bones.
These bonesetters don’t know the difference between a flexible and a compound fracture, so they drive the cycle of amputation. Once the bone is broken and left for some time, it will stick together again. It is a natural process. What we do is to put the broken bone in a proper alignment and facilitate the process of healing.
But for a compound fracture which involves bleeding, if a patient presents to the traditional bonesetters, he is in trouble because they will put all kinds of dirty things around thb33it and tie it up. By the time they are doing that, the blood vessels supplying the leg have been cut off. All the leaves and other things they put on the wound contribute to infection.
In a few days, such leg would be dead and a patient that is fair in complexion will turn black. By the time such patients present to the hospital, there is little we can do, they are also broke because the traditional bonesetters would have collected their money. The patient believes consulting them is cheaper but it is not. The difference is that we give you a bill to pay a certain amount, but they (bonesetters) will collect the money in style gradually. At the end of the day, what the patient is paying is almost the same thing.
Is it true that Igbobi Hospital is notorious for amputation of limbs?
Speaking about Igbobi Hospital, 99.9 percent of amputations done is to save lives. Some people will tell you that if you go to Igbobi, your leg would be cut off, but those whose legs are cut will not tell you that when they presented at the hospital they were almost dead. When they were involved in an accident and sustained injury, and the injury was manageable, they didn’t come to the hospital, rather, they went to quacks, and bonesetters who created more problems. By the time they are landing at the hospital, the situation is already beyond redemption, so it is a choice between saving the limb or saving the life.
How can the challenges of infrastructure and manpower in health sector. How can they be addressed?
Manpower training is barely just out of the rudimentary stage because to train manpower, you have require super manpower to train manpower. We don’t have local super manpower. A lot of doctors are really committed to training now; so, they take their money, leave the country to get trained. By the time they want to come back, there is no infrastructure to practice.
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 hospitals, provide the power, water and equipment. So, they have to now come back with their own hospital system to be able to practice 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.
At Igbobi Hospital, we provide training for resident doctors, we also have a school where we train nurses for accident and orthopedic nursing. We have the school of Federal Orthopedic technology, we trained health assistance among other training school that we have set up with the aim of improving patients care and produce more local capacity.
In terms of infrastructure, we have been able to complete our modern theatre complex and consequently there is increase in our surgery output. We have also been able to recruit more specialists. We are doing much more than we used to do.
Our MRI and CT scan services have brought succor to many patients. Before, our patients use to go outside the hospital to have it done and this did not only take much time, it cost us so many thing such as man power because we have to get ambulance for the patient, one nurse have to follow aside the ambulance crew, but now that is within the premises, is one stop shop.
How are indigent patients managed at Igbobi Hospital?
Our services are not absolute free, what is free is the service of personnel. We bought the materials we use to provide emergency services and we need to stock it back for the next patient to access care. What we do is to give emergency patients grace. We won’t say bring money, we save lives first.
We have different categories of patients. There are those that don’t want to pay, not that they are unable to pay. We also have those who have funds but are unable to access it due to their involvement in an accident. There are also some patients that we refer to as unknown. They can’t even remember their own name. And we have those who are poor.
For those patients that are indigent, we have robust medical and social service that solicits funds on their behalf from donors and in fairness, we do have donors. People just walk to the hospital and settle the indigent patient’s bill.
We have people who donate regularly to the hospital almost every two weeks. Also, there are some patients we discharge as debtors but before a patient goes we must ask them to pay our money.
What drives Igbobi as a hospital?
Our mandate is to provide quality services at the lowest possible cost and let people feel happy. Our understanding is that when patients come to the hospital and feel happy and comfortable, then wellness has started.
The orientation that drives our staff is that any of them can be the next person lying on the patient’s bed. What we ask ourselves is that if I happen to be a patient, will I want to be in this environment? If the answer is no, then I should create an environment where if am a patient I will be happy.
We also try to reduce the waiting time between when patients are ready for surgery and when the surgery is carried out. We are trying to create wards where patients who come feel happy that they are sleeping.
How can Nigeria catch up with rest of 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 reasonable health, fund equipment, provide health, not at high rate and can now update your equipment and infrastructure. But if you don’t provide those loans, you won’t catch up.