Thursday 17 November 2011

3 As of Healthcare

Health is a state of complete physical, social and mental well-being and not merely the absence of disease and infirmity. The WHO in defining health has left a lot of loose ends which by taking a close look at the distribution of disease across the world has rendered this definition rather inept. By this definition,its rather tempting to believe that Nigerians are generally UNhealthy.
Globally,with rising population, which as at 2010 stood at a staggering 6.8 billion, diseases have not had a better time in their existence. Using our dear Nigeria as a case study, i hope to highlight some very basic aberration in our healthcare system.
I work for a system that has been politicized in every facet. i work in a system where i see infirmities which are supposedly 'rural' in a place as 'urban' as Lagos. i work in a system where the staff is overwhelmed and can hardly cope so end up delivering shoddy service to the public.
As a 5th year medical student, i was told that there are 3 qualities of a good healthcare system; the 3 As meaning good healthcare should possess 3 key qualities. It must be AFFORDABLE,AVAILABLE and ACCESSIBLE. A first glance at this sentence already shows our healthcare system is incredibly flawed in Lagos. Lagos in this context being a reflection of the nation.
Affordable healthcare means that the average citizen can conveniently pay for services rendered or to be rendered in a government hospital. With majority of these citizens living below a dollar daily, this assertion is definitely fiction. Even when the registration and consultation is free to the public, most of these indigent people cannot afford the prescribed medication. i volunteer at a church clinic that manages chronic non-infectious diseases like hypertension where drug use is the cornerstone of management and eventual prognosis of the patients. This is a clinic where no fee is charged for registration and consultation and occasionally medication. Word has spread quickly in the vicinity about the clinic and the free-of-fee service rendered and within a short period the clinic has been swamped with prospective patients,all seeking free health care. The clinic copes for a while but being a charity,it burns out rapidly and even though the manpower wanes in number and efficiency, they try to keep up but the medication stock runs out equally. The result is that most are sent home on verbal advice and counselling on the need for medication,with skyrocketing blood pressures. Eventually, the not so lucky or fortunate ones develop preventable complications like strokes and cardiac arrests and die. Healthcare is however very affordable to another class of Nigerians, they patronize Victoria Island based hospitals where they get prompt attention at exorbitant costs and they seem to be thriving in health because of access to the best medication and not necessarily the best doctors. These seemingly wealthy class also have access to foreign hospitals and doctors, again making the average Nigerian entirely hopeless.
Availability; let us make a clear distinction between a building and a hospital. Most government 'hospitals' are merely buildings. The buildings are there but they offer very little in terms of quality healthcare. This is not because the manpower is not available but because of a failure on the part of the government. A practical example; i once admitted an adult who was feeling dizzy and i could not check something as basic as his blood sugar level at the time of consultation. Not because i didn't know it was a baseline investigation, but because an Accident and Emergency room did not have a glucometer. The intellect is available but the tools are not. I also once has a child who was hypoxic (lacking oxygen) in this same emergency room and we had to ransack the entire hospital to get a cylinder of oxygen. The hospital is really not available in the real sense of it. Note that this is a far cry from the rural areas of Nigeria where not only is the 'hospital' unavailable but the building itself is not present.
Accessibility; some years ago i worked with a federal hospital as part of my mandatory internship. Most of the time, we got referrals from other tertiary institutions in Lagos (Lack of Bed Space was the recurring decimal) and it was stunning the tales you got from the patient relatives. I was once told that one of the hospitals was so overwhelmed that the doctors started admitting and re-hydrating patients on the floors and chairs and benches. Relatives guarded these floor spaces keenly and promptly resisted any attempt of putting another sick person in these spaces.
It speaks volumes about the sensitivity of the current and past governments to the plight of the laboring public. To say that a city as cosmopolitan and urban as Lagos with a severely arguable and questionable population of 18million,has only 2 teaching hospitals is obscene. It is insanity and it is utterly shocking. These 2 teaching hospitals are bound to be overwhelmed. The few General hospitals are not having it easy also. The patient load crumbles the existing system. In a society where the maintenance culture is virtually non-existent in the first place,the additional burden of having an infinite number of patients depending on the sparse facilities completely crumbles the system. 
The solution is as simple as it is complex....
The government must understand that it has failed at all levels. A key responsibility of any responsible government is to provide healthcare for its citizenry. How the government goes about ensuring and funding this should not be the concern of its citizenry. 
Again,practically, Honorable Dimeji Bankole was accused of looting 10billion naira, Otunba Gbenga Daniel allegedly looted 58billion naira as Alao Akala allegedly misappropriated a cool 25billion naira. Legislators,legally,earn more than 500million annually in Nigeria. Nigeria wants to invest 4billion dollars in Indonesian refineries. Allison Diezani-Madweke allegedly bought a mansion for 25million euros. Governor Joma allegedly 'borrowed' 18bilion naira. Erastus Akingbola allegedly stole over 47billion naira from a Nigerian bank. Our NSA's office gets running allowance of over 500million annually to tell us Boko Haram has bombed us several times. Ikuforiji of Lagos House of Assembly allegedly missed 7billion naira. Nigeria earns 4trillion naira from crude oil sales to the USA annually. Note the number of times i had to write the word 'allegedly'. The  list is endless. This doesn't sound like a nation that has a paucity of funds. 
Until this government and the many more to come understand that Health and Education are Siamese twins that must be handled with utmost importance,care and attention, there will not be progress. Until we allocate more to health and education than politicians earn annually we will remain in the past. Until we get our acts together instead of bringing 50million naira cash in steel boxes for 360 legislators as bribe to pass 3rd term bill,we will remain jokers.
Will,is the only element we lack...Corruption on the other hand is our fondest pastime.
  

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