Monday, 22 July 2013

Why Nigerian Doctors Abroad Want To But Can't Always Return - U.S. Based Doctor

Dr. Abdulrasheed Abassi recently led six U.S. based doctors to the free health mission organised by Senator Babafemi Ojudu and provided healthcare services to about 8,000 residents of Ekiti Central Senatorial District.

What is your perception about healthcare system in Nigeria?
I think the biggest problem is the healthcare personnel. After seeing the way we attended to them, the people were complaining about the local medical doctors’ attitude.
What do you think is responsible for this?
It is partly structural and partly selfish. We have laws in the U.S. that protect patients and ensure they are treated like humans that they are. The selfish part is that we see patients as the source of our livelihood so we must respect them and show compassion. If I don’t do that as a doctor, a patient can sue me or complain to the state health board. U.S. is a country of rule of law.
Must we have that legislative premise before our doctors can be compassionate?
Good point. I wish our local doctors will realise they might be the patient tomorrow. I must admit they are poorly paid and do not have the ideal operating environment but they should not take this out on the patients. It is in our culture to be naturally humane. But so many things demand our compassion which we don’t do. You see an accident victim and turn a blind eye. This is why we need the appropriate laws that compel us to be humane.
And unfortunately, our lawmakers are not making the right laws. Let’s go back to your perception of the healthcare For whatever the government might have done, they have achieved nothing. This is the opinion of my colleagues also. It appears we are the first set of medical doctors the people have ever seen. They may have structures and equipment but as long as these do not translate into better healthcare delivery, it is nothing.
On the first day, we did glucose check for more than 500 people and for many of them, it was their first time. This test should be standard. None of the 500 people have ever been tested with any Oximeter before. In fact, none of the local doctors have seen it before.
This is an equipment that costs just about $500 (there are affordable versions that costs just about $50) but which can tell if someone is about to have a heart attack.
What’s your reaction to that?
It is shocking and it is good Senator Ojudu has promised this would happen annually. So we have seen some pitfalls that we would correct the next time.
What are those pitfalls?
The medications; we ran out of our American medicine just after two days. We need to ship more drugs and do that on time so we can avoid the NAFDAC and Customs. Senator Ojudu provided money for us to buy drugs for all the other days. It is disheartening. If Senator is someone without the connections he has, the person will be frustrated and may leave and the people continue to suffer as if there is no helper.
That is why I appreciate the commitment of Ojudu. He is never discouraged and listened to advice. Also, we will hold more lectures, especially for the School of Medicine in Ekiti. We want to involve as many medical students as possible and also want to hold more public enlightenment because education is key. Your team is not the first to hold medical mission in Ekiti but it is so different. Why? I noticed that too and I think it is because we are foreign doctors.
The previous missions did not provide free drugs. People were given prescription to go and buy. Now not many can afford to buy and even those that could buy ended up buying substandard drugs. The drugs we bought in Nigeria were like a second choice because American drugs were far superior. We could not even get the list of all the medicines we wanted.
Almost all drugs in Nigeria are manufactured abroad, so why the differential quality?
The statement I made is a statement of fact and not a guess. American drugs are superior to all. 80 per cent of drugs used all over the world are manufactured in US but unfortunately, Nigerians decided to be patronising China and India. These are countries with substandard drug regulations compared to the U.S. Paracetamol that is made in China for Nigeria is different from the one made in China for U.S. because U.S. expects a certain standard that won’t be compromised by anyone.
Does it mean the fault lies with our own regulatory framework?
Oh yes. We do not even have any regulatory framework.
Shouldn’t the rescue of our healthcare system start from there?
I think we must start with a structural education. Brain drain has cost us so much. If we can revamp out healthcare educational system like it used to be, then healthcare practitioners can come together to formulate the needed regulations. Our regulatory framework is as good as our local healthcare providers including doctors, pharmacists, pharmacologists, physiotherapists, nurses etc. If we have good pharmacologists, we can manufacture our own drugs.
Ekiti state has a lager rural community compared to the urban centres, would telemedicine not be a good option?
I know Nigerian governments love to spend an anything that cost huge money but make no mistake; Telemedicine in Nigeria will be like applying lipstick on a pig. At best, it is a stop-gap option, even in U.S. We have seen many diabetic patients here who do not even know they are diabetic. We gave them drugs to last one month and see a doctor thereafter. Who will attend to them, if we do not have healthcare professionals? It is good for us to continue what we are doing but who will follow up with the patients? We don’t even have constant power supply yet. If I am having chest pain, I cannot pick the phone and call an emergency service and expects an ambulance in no time.
Good education that can give us competent healthcare providers is the way to go. Both U.S. and Canada have 125 medical schools that produce 17,000 doctors annually but the medicare organisation has said they need to produce 24,000 early. So, they can plan to use technology to fill the little gap.
What other things did you notice?
We saw tons of critical cases. I am concerned the people consume salt too much. So many people here are walking around with excessively high blood pressure, almost nearing stroke level and they don’t know. You can almost count on your fingers the number of people with normal blood pressure. The government must invest in a lot of public enlightenment. And they confessed to this. We also have not taken into account some changing dynamic in our environment.
Due to technological advancement, we live more sedentarily and this is giving rise to more lifestyle diseases. It is good most of their foods are organic but they eat them at the wrong time, in the afternoon and night. They are better eaten in the morning so they could be burnt off before night.
In terms of policy, what’s your advice to governments?
They need to invest in public health by improving sanitary condition and invest in preventive health too. We don’t want to become a medicalised society that focuses on management of diseases but we want to focus more on prevention.
You have been talking about what government has to do, what about Nigerians like you living abroad?
I belong to Association of Nigerian Physicians in the Americas. We are always eager to come in and help but we need contact and access to the power brokers. There are many doctors who were mad at me because I did not tell them about this programme. They wanted to come because this is their home. I am talking of guys who are my mentors and with fantastic ideas.
Is the access that difficult to get?
Certainly. We made attempt about 10 years ago from Yale University School of Medicine. We got control of 50 haemodialysis machines to be donated to Lagos University Teaching Hospital, Idi Araba. The then Chief Medical Director, Professor Oke, refused to accept it unless half of the machines were donated to him. And that is just one story. What we resort to doing was to donate to organisations that are interested in healthcare delivery in Nigeria, like the Goal Foundation.
These NGOs have a lot of negative experiences trying to help Nigerians. This is why what senator Ojudu has done is commendable. He is not perfect but at least, he provided us the access and helped us fulfil our desire to help our people. Our services are rendered free but Ojudu sponsored the trip, feeding, accommodation and drugs. I want this country to change for the better and would love to work with likeminded people. We always say things cannot get worse but trust me, there is always a new definition of ‘worse’ because we always adapt to whatever condition is thrown at us. America is a near-perfect society but we speak out all the time. Nigerians must cry out against bad leadership.
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