Dr. Edwin Okoroma MD, FAAP, FACC, FMC Paed, FWACP
Towards Improving Paediatric Health Care in Nigeria
The President, National Post Graduate Medical College of Nigeria, The Chairman,
Faculty Board of Paediatrics, Medical College of Nigeria, Distinguished Fellows of Sister
Faculties, Fellow Paediatricians, Distinguished Ladies and Gentlemen.
I am deeply honored to be given the opportunity to deliver the 2009 Faculty Day
Lecture. I am thus privileged to join the list of illustrious speakers who have addressed
this body. I thank you.
Let me congratulate the new fellows of the Paediatric Faculty of the Nigerian Medical
College. I used to be a part of the system and therefore know what is involved in
obtaining the fellowship of the faculty. You should be proud of your achievement as it
has not been easy. When I was asked to submit a photograph that will be published in
the brochure for today’s event, I chose to submit a photograph I had taken when I
attained a somewhat similar height in my professional dreams, the fellowship of the
American College of Cardiology. This explains the youthful appearance in the picture
and the lack of grey hair that you see today. It is my way of sharing the joy and
happiness of today with you. I would also like to congratulate your spouses, children
and parents who no doubt contributed to your success by their encouragement and
sacrifice by being denied your company or attention when you were struggling to
complete your project or paper on time for the examinations. Today, I am sure they will
agree their sacrifice was worth it. However, I believe that for many of you, the
professional challenge is just beginning. The mere fact that you have persisted to
achieve this goal suggests that most of you will aim higher, albeit at a slower pace. We
wish you well.
When the invitation to deliver this lecture was extended to me, I was at liberty to
choose a topic of my choice, as is the policy. Selecting a topic was not easy seeing that
I have been away for almost two decades and did not wish to speak on a topic that
might not be too relevant to present day paediatric practice in Nigeria. It probably
would have been easier to pick a purely clinical subject like rheumatic fever, which I
have been interested in since my fellowship days in cardiology or another topic in
general pediatrics. However, as Professor Adekile pointed out two years ago at this
lecture, one of the daily habits of most Nigerians in diaspora is thirsting for information
on the mother country by browsing the internet. It should not surprise you to know that
sometimes we outside the country get to read some Nigerian news before those who
are here at home. Much of what one reads about the health system in the country has
been depressing and seems to be getting worse by the day.
Some recent headlines include :
“ Poor health care system : Nigeria’s moral indifference”
“ Nigeria’s dismal infant death statistics”
“Corruption in the Nigerian Health Sector :Time to right the wrongs”
“ A breakdown of our primary health care system”
“ Cash before treatment in Nigerian Hospitals”
“Nigerian Health Care System has failed”.
The list goes on and on.
Many of us in the medical profession are no doubt saddened by such screaming
headlines, but the truth must be told. There is no doubt that the Health Care System in
the country in this observer’s view has been going on a downward spiral for the last
several years. After my training, I returned home with great enthusiasm and joined the
system in 1975. I met an equally enthusiastic and dynamic group at the University of
Nigeria Medical School : Drs. Kaine, Theo Okeahialam and Joe Azubuike, and later
with the late George Izoura, we tried to build a vibrant department. Each and everyone
of us visited other medical schools in existence then in the country in one capacity or
the other and enriched our experience to the benefit of our students and patients. My
post as the National Secretary of Pediatric Association of Nigeria in the mid 80’s gave
me additional opportunity to see other parts of the country and exchange ideas with
fellow paediatricians. It was an exciting time. The highlight of each year then was the
Annual Conference of the Paediatric Association. We always looked forward to
attending them and meeting older founding fathers of the association who never failed
to attend. There was always A. Antia, O. Ransom Kuti, B. Ajenifuja, A. Animashaun,
Charles Effiong, W. Kaine, JB Familusi, Theo Okeahialam, James Obi to name but a
few.
Gradually with the succession of military coups and the change of governments, health
care started to slide. One recalls how the spokesman of one such new government
gave the poor condition of hospitals in the country as one of their reasons for staging
their coup. He described the hospitals as mere “consulting clinics”. Sadly at the end
of their own regime, the “clinics” had lost their consultants as hospitals became more
deplorable because many of the consultants had left the health care system. I believe
the late 80’s and early 90’s marked the beginning of the accelerated decline in the
health care system of this country. From what one reads now, it seems that successive
governments have continued to be indifferent about the state of health care system as
long as they and their families continue to seek medical care outside the country.
It is stating the obvious when one says that health care costs money. The WHO and
OAU have however recommended the allocation of at least 15% of any country’s
national budget to the Health Sector. But what have we had over the years in Nigeria?
With an ever growing population, the percentage of National budget allocated to Health
still hovers between 2 —5 % only. This year it is 3.3%. Sadly out of this merger
allocation, the various hospital management boards have also failed to utilize them
properly as I believe their priorities have oftentimes been misplaced. We have noted
with dismay, the lack of prioritazion of needs, with constant strikes by workers being the
consequence. This starvation of funds has not been limited to the Health Sector alone
as the Education Sector which I was also closely associated with suffers the same if
not worse fate.
Despite the frustrations which we have faced, and continue to face, I believe we should
and must carry on with measures which will
sustain our interest in patient care regardless of whether the government funds us well
or not. Although I have not been directly involved in the Nigerian Health System for
that last 2 decades I have maintained contact with my home base and like Professor
Adekile, continue to cherish and appreciate the warm reception and I believe, respect I
get whenever I meet with them, individually or collectively. During these 2 decades I
have had the opportunity to work in a country which has been similarly blessed with
natural resources like Nigeria but which unlike Nigeria has utilized these resources for
the benefit of all its citizens.
The following slides illustrate stark differences between Nigeria and Saudi Arabia in
facing up to some health issues that relate to us as paediatricians.
Infant mortality rate
Under 5 mortality rate
Percentage of immunized children at 1 year
Average life expectancy
Although Saudi Arabia has a significantly smaller indigenous population of around 25
million, and Nigerian’s population is hovering around 140 million there is no doubt that
it takes the welfare of its citizen more seriously than Nigeria does.
It is common knowledge that health care is free for all citizens of Saudi Arabia. I mean
completely free. All a patient has to do is present to the hospital. In some instances,
even if the patient is unable to go to the hospital by himself, an ambulance from the
nearest hospital to his house will go to fetch him and then return him home after
receiving the necessary treatment. One has been particularly fortunate as well to be
working during all this period in military hospitals which, I believe, are better funded and
provided for than Ministry of Health hospitals. Of course we do not expect the Nigerian
government to provide full free medical care to its citizens, and quite frankly neither do I
advocate that, but at least we would like to see more funds allocated to the Health
Sector which would bridge some of the gap illustrated in the slides I have just shown.
Let the government provide adequately equipped and funded hospitals and the citizens
will pay for their care.
In the face of this financial starvation what can we do to maintain if not improve the
health care system? I would like to share with you some of my experience during these
2 decades which I believe, have contributed in improving children’s health care in our
corner of Saudi Arabia. If we can implement some of these concepts, which by the way
are not new, I believe the same results may be achieved here.
Data Collection
In this day and age of explosive information technology, ownership of a personal
computer, be it desk top or lap top cannot and should not be regarded as a luxury but
as a necessity. I am sure among us in this audience, there are those who have 2 or
more of these gadgets: the desk top, laptop or net book, supported by an array of flash
drives. We should put these to good use.
I believe the only way we can obtain accurate statistics in our speciality is to begin
collecting and storing data on various components of pediatric health issues by our
selves. Two years ago when Professor Adekile spoke on this platform, he encouraged
the new fellows to start collecting data that would help them in their quest for research.
I will go even further by stating that there should be a policy on compulsory data
collection into a national bank or registry, if no such policy is already in existence.
This national registry could be located at the Faculty secretariat and should be
accessible to all who may want to retrieve any information from it. Take for example the
case of measles. According to the WHO, measles is the 5th commonest cause of death
in Nigeria. How were these figures arrived at or were they merely extrapolated? Do we
really know how many cases of measles occurred in various regions of the country
last year ? What was the mortality? Much as we accept the limitations of hospital
based statistics, it is still better to have them than not have any statistics at all.
Collection of health data should be required of ALL hospitals and clinics, be they
government or private. Department heads should be made to provide data on common
health issues on patient care: hospital admissions, discharges, deaths and their causes,
out-patient clinic attendance etc. From these we observe whether there are any
regional differences and if so what the cause(s) of such differences could be. We will
also learn the monthly or yearly trends of any particular issue. Take for example the
case of polio. Nigeria is one of only 4 countries in the world still harboring the virus. Are
we making any progress towards eradicating this disease? With data coming from the
36 states and the Federal Capital Territory Abuja, policy makers will have a better
understanding of where and how to channel whatever resources the government
provides.
In Saudi Arabia, it is a policy to prepare and submit departmental monthly reports
detailing patient related statistics: clinic attendance, admissions, deaths, staff
movement, policy generations, attendance at both national and international
conferences by staff and other
health issues. These reports are submitted to the hospital administration which
forwards them to Medical Science Directorate (MSD) of Ministry of Defense and
Aviation which in turn forwards them to the Ministry of Health. From the information
contained in these reports, regional and national trends are tracked and hopefully
influence their budget allocations among other things. The following illustrate what I
mean:
Collection and documentation of such information requires dedication and diligence.
Each hospital’s Quality Management department makes sure of every department’s
compliance with this policy.
I would like to suggest that all departments should be equipped with functioning desk
top computers to be manned by computer literate secretaries if these are not already in
existence. Once appropriate software are installed in such units, all that needs to be
done thereafter will be to feed the data on daily, weekly or monthly basis. Such data
can then be collated at the end of each month and forwarded to the national registry for
storage and yearly review. Also data can be retrieved whenever the needs arise. It
could also be an easy source of information for our young fellows who may be
interested in research. Much as our government can pretend, like the ostrich, that all is
well, when presented repeatedly with poor statistics I believe they will act. I hope I am
not being too naive.
There is also a MSD policy that every patient on discharge should have a written
summary that must be completed within 7 days of discharge. This is usually the
responsibility of the resident supervised by his consultant. Similarly every death has a
report which is written and presented by the consultant at the monthly mortality and
morbidity meeting. Autopsies are not performed routinely for religious reasons. These
death reports serve as our CPCs. By asking questions like “ could this death have been
prevented or delayed?, we audit our selves and learn from our mistakes. I remember
in 1984 or there about when Theo Okeahialam, as head of our department at UNTH,
started our mortality meeting which was then held promptly at 8:00 a.m. every Friday. I
do not recall however that these were written down. I will encourage you to ask this
question as you discuss your weekly or monthly mortalities.
Job Descriptions
There are positions in the medical profession which we aspire to attain from our student
days: from House Officer (interns) to different levels of Resident, to Registrar, Senior
Registrar, Consultants and Senior Consultant. One of the things that have positively
affected patient care
in our system is Saudi Arabia is the existence of job description for all these positions.
Everyone knows where he fits in.
Description of each position begins with the job title. It includes the main responsibilities
and all activities of the post. Who is he accountable to, in other words who is his/her
immediate supervisor. Even the consultant is accountable to someone, in our case, to
the head of the department who in turn is accountable to the medical director. What are
the minimum qualifications needed for each post and finally what are the job
expectations of the post?. Is there room for growth in the post and who appraises the
individual when it is time to move forward. For each post there are objective criteria for
assessment.
For example, how many years will these our young fellows expect to work as senior
registrars before they can attain the post of a consultant, 1 or 5 years? Existence of
documented job descriptions that are available for review by everyone should reduce
to a minimum frustrations, favoritism and cronyism while enhancing work attitude
resulting in better patient care. Much as we all know that our Federal Government
has sacrificed excellence and merit on the altar of federal character when it comes to
appointments, we in the Faculty should rise above such sectionalism and appoint
qualified individuals on merit to appropriate posts. Indeed, there are some of us who
believe that the rot in Nigerian today began with the implementation of the so called
federal character wherein square pegs are put in round holes. Often posts and positions
are now zoned according to geographical location. People are appointed to positions
where they have little or no clue as what to do, but get appointed anyway simply
because they come from a particular area of the country or belong to a particular
political party. Is it any wonder that we are in the mess we are today?! Such individuals
feel no obligation to their jobs but feel accountable only to their mentors or god fathers.
In recent times, how many state governors do we know of who performed poorly in
their states but were still appointed federal ministers? One is not surprised that such
ministries headed by such individuals are often beset by problems or at best not
functioning properly.
I believe if everyone is aware of the job description of the position he is aspiring to attain
and then gets it on merit he will work hard at it and this should reflect in improved
patient care.
Policy and Procedures Guidelines
Policy and Procedures Guidelines (PPGs) should be available in every establishment
be they government hospitals or private clinics.
These are designed to establish uniformity and norms in practice, discipline in our
profession and checking professional misconduct. Much of our medical practice today
in Nigeria are like oral tradition that are handed from one generation to another much
like our folklores and we know what happens to these over time. Policy and Procedures
Guidelines are intended to document acceptable practices for every one to read and
follow. They may be revised from time to time as the needs arise.
For example, what is the accepted paediatric age in Nigeria?. In other words, who are
our patients?. Is there a written document that specifies the age limit of paediatrics in
Nigeria or are we following the age limit in Britain which I think is 15 years? In the
United States where I trained, pediatric practice extends to 18 years of age while in the
country where I currently practice paediatric coverage ends at 12 years of age. Once a
child reaches the age of 12 years, he/ she is considered an adult and must, by policy,
be transferred to internal medicine for continued care.
Another example involves working hours. What are the official working hours of our
establishment, be they private or government owned? Specifically, what are the official
working hours in our hospitals, 7:30 A.M. —3:30 P.M , 8:00 A.M. —4:00 P.M.? Is there
provision for lunch period, if so how long? Or is it left to the discretion of the employee?
These days it is not unusual for workers to report to work after 9.00A.M. that is if they
choose to report to work at all on that day. If at the time of employment, a new
employee is given the guidelines,( PPGS) to read as part of his orientation, he will know
what constitutes the policy of the institution in which he is employed. If he thereafter
reports to work later than the stated time it should be obvious to him that he is breaking
the institution’s policy and therefore should not be surprised if disciplined for such an
infringement. No one should be considered above the law in this regard.
Policy and Procedures Guidelines should spell out the purpose of our practice, define
the policy of the clinical departments and describe responsibilities and authorities of the
different members of the department. We had earlier talked about job descriptions of
the different members of the unit. Policy and Procedures Guidelines should define the
relationships between various members of the unit. There is no doubt that cohesion
between members leads to better performance and by extension to improved patient
care. There should also be in existence policy and procedure guidelines for disciplining
those who break established rules and regulations. For example
when I was in Enugu several years ago, a certain house officer of mine was required to
perform lumbar puncture on a child we suspected had meningitis. True to his character
he refused to carry out this procedure until after his lunch. I had to do it since it was not
prudent to wait till after his lunch. Fortunately, he was a house officer and I had to sign
him off at the end of his 3 months’ paediatric posting. Needless to say he had an
extension of his posting. Supposing he was a resident, or even a registrar? At that
time, to the best of my knowledge, there were no written down policies for dealing with
such acts of insubordinations. There should be written down policies to deal with
unprofessional misbehavior.
Patient Education
One of the most underated and underutilized modalities for improving health care is
patient education. While this may be practiced in one form or the other in some
hospitals, it needs to be strengthened in order to achieve the desired goal of reducing
infant and child mortality. When we look at the top 10 causes of death among Nigerians
and more specifically death among the under 5s according to the WHO figures that I
had shown earlier, we observe that some, measles, whooping cough and tuberculosis
are preventable through immunization while diarrheal diseases, malaria and HIV/AIDS
can be reduced by enhanced patient education and awareness.
I shall buttress my call for renewed efforts to strengthen patient education by focusing
on 3 issues which are predominantly related to paediatrics. These are immunization,
diarrheal diseases and breast feeding.
(i) Immunization
As I have just mentioned, measles, whooping cough and tuberculosis are on the list of
the top 10 causes of death among Nigerians and are preventable through
immunization.
For any successful immunization program, effective vaccines must be available and
patients must come forward to receive them. From the comparative figures between
Nigeria and Saudi Arabia, we note the deplorably low level of completion of
immunization at one year of age to be 10 —15% in Nigerian children while that of Saudi
Arabia is approaching 100%. Studies from different regions of the country have
revealed some reasons for this low immunization rate. These include non-availability of
vaccines at the centers, reluctance of parents to receive the vaccines, high rate of
default due to socioeconomic reasons and of course ignorance about the need for
vaccination.
Other studies, some here in Nigeria, have shown the results of patient education on
compliance with clinic visits and acceptance of immunization of their children. In one
such study from Edo State, the compliance with completion of the first 3 immunizations
rose up to 80% when the parents were informed of and understood the benefits of
immunization. Since we all agree that a figure of 10-15% completion rate is not good
enough we must mount concerted campaign, with whatever method, to educate our
parents about the benefits of immunization of their children. The education method can
be by way of lectures/talks given during clinic visits in hospitals,
Institutes of Child Health, radio and TV, village meetings and other social gatherings or
through distribution of brochures and fliers. We must not miss any opportunity to get
our message across. Government must be persuaded to play its part by providing
vaccines at all times in the clinics. It should also be persuaded to offer some incentives
which will encourage parents to bring their children for immunization. One very
important motivation or incentive for parents in Saudi Arabia is the fact that for any child
to be enrolled in school at 6 years of age, he must produce a completed immunization
record that was filled as at when due, not one that is cooked up during school
enrollment. The result of this is that the parents are the ones who come forward for
you to immunize their children. The recently held National Child Health Week here in
Nigeria in which it was estimated that 30 million children would have been immunized is
hopeful development. Let us pray it will be an on-going exercise and not one of the
those political gimmicks that are forgotten soon after they are begun
(ii) Oral Rehydration Therapy for Gastroenteritis
Many of us here will remember the campaign in the mid 80s to introduce oral
rehydration therapy for children and indeed adults with gastroenteritis. Professors Theo
Okeahialam and Nike Grange, subsequently published a monograph on the subject. I
might add, that I still have my copy even in far away Saudi Arabia. Mothers were taught
the technique of preparing and giving the ORS, assessing their children for signs of
dehydration, when to start, how to give and how much ORS to give. It was a successful
campaign because most of the time then it was only severely dehydrated children who
presented to the hospital. That diarrheal diseases still rank high on the death list after
more than 20 years of ORT introduction means a lot of work still needs to be done.
We appreciate of course that availability of clean water is a pre-requisite for this to
succeed. However, the so called “pure” water is hawked everywhere in Nigeria today
even in villages. I am sure most parents will buy these to save the lives of their
children once we teach them how to use the sachets of “pure” water. We therefore
need to redouble our efforts in teaching mothers about this simple means of saving
hundreds of lives.
(iii) Breast Feeding
I used to pride my self when I first went to Saudi Arabia that most Nigerian mothers
breast feed their children, some up to 2 years. However, during my preparation for this
talk, I have come to realize that the trend has now been reversed despite having Baby
Friendly Initiative progam in many hospitals. I have come across studies from Jos,
Benin and Ibadan, to mention a few, which reported the incidence of exclusively breast
fed babies to be as low as 3% in some parts of the country.
In the Benin study the incidence was as high as 80% at the inception of the study but by
the 6th month the incidence was down to 20%. More worrying is the fact that most of
the mothers reluctant to breast feed their babies were those 20 years or younger .
The director of UNICEF, Ms Veneman, who was here for the launch of the National
Child Health Week in July reiterated what most of us paediatricians already know,
namely that “exclusive breast feeding for the first six months of life can have the single
largest impact on child survival of all preventive interventions”. She went on to observe
“that only 13% of children in Nigeria are exclusively breastfed from birth to six months”.
Certainly that is an indication of very poor patient education if not an indictment of the
health care system and calls for us reach out to mothers at any opportunity we have.
How can we rectify these shortcomings that I have highlighted through the examples I
have given? Simply by enhancing our patient education, not just on these 3 issues but
on other health issues as well. To achieve this goal, I propose that all hospitals and
institutions that give health care establish Departments of Patient Education and where
such departments are already in existence to strengthen them.
Indeed, Paediatric Association of Nigeria should set the example by establishing a
section on Patient Education at its head quarters, equipped with all necessary
infrastructure that will enable it produce and disseminate information on various
paediatric health matters. Certainly any brochure or flier that is put out by the
Association is likely to carry more authority and credibility than that put out by individual
paediatricians. Such publications aimed at patients must be translated into local
languages and written in a format they will understand. I know for a fact that this
program works because it has been functioning in my present hospital for the last
several years.
One of the reasons for the poor immunization rate noted in one of the Nigerian studies
was a high default rate. One way we have dealt with this in Saudi Arabia is for the
hospital’s patient relation’s office to call the parents to remind them of their
appointments. Virtually everybody in Nigeria today has a cell phone. At the time of
registration in clinics contact telephone numbers should be one of the required
information that should be recorded. If we want to lower death rates we must be
prepared to travel that extra mile.
Needless to say, our government must fulfill its own obligation to its citizens. Availability
of clean water should be the right of every citizen of this country. Since it has
undertaken to offer free immunization to all children, it should make vaccines available
at all times in all immunization centers. Several years ago there was the story in which
the supply of vaccines was contracted to a private individual in “high places”. The
vaccines arrived in this country only to be left for several weeks at the mercy of the
elements at their airport. Needless to say, they became useless. So government must
ensure that the vaccines it supplies have maintained the cold chain in order to be
effective when given.
Continuing Medical Education
Finally, the subject of continuing professional education, interests me as both an
academic and a clinician. For us to educate our patients as we have just advocated, we
must show that we ourselves have the knowledge to do so. In these days of information
explosion in medicine and other fields, it is important that we as clinicians have current
information in our areas of practice in order to deliver appropriate and relevant care to
our patients. How can we ascertain that this is the case? Simply by demonstrating
objectively that we posses the minimum information in current topics in our area of
practice. I am sure that many people in the audience, particularly those who are
American Board certified, are aware that, since the 80’s
I believe, Board Certification in Pediatrics and its subspecialties is now for a period of 5
years in the first instance. Thereafter, one must sit for recertification examinations. In
addition, one should show evidence of on-going or continuing education by way of
earning credit hours through attending conferences, seminars and annual meetings. To
this end, I am suggesting that our Faculty should establish committee(s) that will be
charged with drawing up policies that attest individual’s current knowledge. While the
idea of re-certification in Nigeria may still be a long way off, there should be a process in
existence now by which willing candidates can secure credit hours after completing a
designated assignment, be it by reading articles in peer- reviewed journals and
answering questions that follow such articles or by attending conferences, seminars and
workshops for which a specified number of credit hours have been allocated. Modalities
for calculating the appropriate number of credit hours for any activity exist. This is now
common practice in many countries. Even here in Nigeria this concept of continuing
professional education has already been introduced. During my last home visit in
March, I came across an advert by the Nigerian Bar Association, Lagos Branch
published in THISDAY newspaper titled “Mandatory Continuing Legal Education”. It
was to be a one day workshop and participants were to receive certificate / credit hours
granted by the NBA Institute of Legal Education. Even in Saudi Arabia it has become
compulsory, since the mid 90’s, to be re-certified every 3 years by the country’s Council
on Health Specialties. One must earn a minimum of 30 credit hours per year together
with evidence of malpractice insurance coverage and of course good health. So for a
renewal of license for a 3 year period one needs to show evidence of having earned 90
credit hours. Can we start something along these lines in our Faculty by at least
requiring that paediatric staff in Teaching hospitals and Medical schools show
evidence of continuing medical education? I am aware of course that Medical schools
have their own system of accreditation. Having been involved in both, I know they are
not the same.
workshop and participants were to receive certificate / credit hours granted by the NBA
Institute of Legal Education. Even in Saudi Arabia it has become compulsory, since the
mid 90’s, to be re-certified every 3 years by the country’s Council on Health Specialties.
One must earn a minimum of 30 credit hours per year together with evidence of
malpractice insurance coverage and of course good health. So for a renewal of license
for a 3 year period one needs to show evidence of having earned 90 credit hours. Can
we start something along these lines in our Faculty by at least requiring that paediatric
staff in Teaching hospitals and Medical schools show evidence of continuing medical
education? I am aware of course that Medical schools have their own system of
accreditation. Having been involved in both, I know they are not the same.
There is no doubt in my mind that these requirements will directly improve health care
delivery to the patient. Physicians who are well informed and possess current
knowledge in their respective fields of practice are better able to give appropriate
treatment to their patients than those who have not bothered to keep up and have
remained relatively static since their graduation from medical school. As long as one is
in clinical practice, one should show objective evidence that one is up to date. After all
this is the era of evidence- based medicine. It is no longer enough to say, for example
during ward rounds that Prof. X or Y said this and that or for one to make such
statement as “in my experience” this or that happened. These no longer command the
authority they once did. They need to be backed by facts. I am sure that most of the
people in the audience are familiar with the grading system for quality of medical
evidence.
The onus should now be on the Faculty and the Paediatric Association of Nigeria to
start putting the wheels in motion by beginning with, at least, granting designated
number of credit hours to those who register and attend our Annual Paediatric
Conference, to organize additional conferences or recommending to our Teaching
Hospitals, State chapters of the Association to organize conferences on various
subjects. Those who demonstrate interest in continuing education should have
something to show for it.
I would also strongly suggest that the Faculty in collaboration with PAN should draft a
Policy and Procedure Guidelines on Continuing Medical Education. While they are at it,
the question of subspecialty training should be given serious thoughts. Several years
ago as part of the Faculty’s fellowship program, candidates were required to spend one
or two years of training outside the country. With the down turn of the country’s
economy in the late 80’s, this program was suspended and later completely
discontinued. I am not sure if it has since been restarted. If not, do we have any plans
for those among our current fellows who are interested in pursuing subspecialty training
in say, cardiology, nephrology, neonatology etc. If we remember that neonatal causes
account for about 25% of all childhood deaths, according to the WHO’s figures, we will
appreciate that Neonatology is one subspecialty that should receive preferential
consideration. I am told that there is already in existence a strong Neonatology
association. Should we make a presentation to the Federal Government through the
Ministry of Health, on the need to resume these sponsorships, hoping they will listen?
While there are qualified Nigerians both here at home and abroad who can mount such
subspecialty training, I believe we do not have the necessary infrastructure yet to
support such subspecialty training. So these our present crop of fellows interested in
subspecialty training must spend time outside the country in the mean time while in the
long term the government should be urged to establish and equip designated hospitals
as training centers for the different subspecialties akin to what it did in 1979 when it
recognized various hospitals as centers of excellence. With limited funds it is not cost
effective to duplicate these centers. Those renowned Nigerian neonatologists and
indeed specialist in other fields currently practicing in the country can be persuaded to
return home if the infrastructure is there for them to work with. Job satisfaction is still
very relevant in the lives of every physician!
specialist in other fields currently practicing in the country can be persuaded to return
home if the infrastructure is there for them to work with. Job satisfaction is still very
relevant in the lives of every physician!
Often times though, we find that the obstacles to improvement in health care delivery
lie within our selves. I remember too well, the hurdles and frustrations that we in Enugu
faced in 1979 when the Federal government recognized UNTH as the Center of
Excellence for cardiovascular diseases as it did other Centers of Excellence in other
specialties. We found sadly that the major obstacle to releasing the 100,000 naira
earmarked for UNTH lay in the Ministry of Health. In the end, they “managed” the bulk
of our 100,000 naira allocation by buying brands of equipment that they chose and had
not been recommended by us the end users. What little that was left of the balance had
depreciated so much over time that it did not have the impact it could have had if
released earlier.
Conclusion:
Chairman,Faculty of Pediatrics, distinguished ladies and gentlemen, I remain optimistic
and convinced that sooner or later these our governments, the federal, state and local,
will realize the merits of adequately funding health facilities in this country rather than
relying on their traveling outside the country to seek medical care. They may enjoy it
while in office but once out of office they become like you and me and some have paid
dearly with their lives for this mentality. You and I know that most of the time the
physicians who attend to them over there are low and middle cadre staff who do not
have as much experience or expertise as senior physicians in Nigeria who would most
likely attend to them here should they choose to be treated here. What this country
lacks and needs are equipment and infrastructure which most physicians cannot
provide themselves. I firmly believe there are Nigerian experts in every medical field
and that many, at least those of my generation, would want to practice here at home if
minimum facilities in their fields of expertise exist.
On our part as paediatricians in particular and physicians in general, let us continue to
demonstrate that we have the knowledge, discipline and are ready to deliver optimum
care to our patients if we have the necessary tools at our disposal .
I thank you for listening.