Closed UATH spine unit stirs con­tro­versy

Daily Trust - - HEALTH - By Judd-Leonard Okafor

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Barn­abas Io­ever, 27, is left help­less af­ter the man­age­ment of Univer­sity of Abuja Teach­ing Hospi­tal, Gwag­wal­ada stopped his sched­uled spine surgery and dis­charged him.

UATH de­nies dis­charg­ing him, in­sist­ing it re­ferred him, though there is no record of a re­fer­ral.

Io­ever was dis­charged April 3 af­ter un­spec­i­fied “dis­cus­sion” be­tween UATH man­age­ment and Dr Ahidjo Kawu, con­sul­tant orthopaedic and spine sur­geon who was man­ag­ing Io­ever, Daily Trust has learnt.

Pos­si­ble clo­sure of spine pro­gramme at UATH had been in the off­ing but it came to a head when the hospi­tal man­age­ment in­structed “me to dis­charge a pa­tient who needed surgery ur­gently,” Dr Kawu said.

Io­ever was ad­mit­ted into the hospi­tal with an in­jury to his spinal col­umn late Fe­bru­ary af­ter his com­pany ve­hi­cle crashed on a run to deliver soft drinks in Kano.

The sec­ond bone in his lower back was frac­tured, ac­cord­ing to an MRI scan he un­der­went in March.

Its cov­er­ing as well as nerves at the base of the spinal cord were com­pressed, in­clud­ing those that nor­mally send and re­ceive mes­sages be­tween the lower limbs and pelvic or­gans—blad­der, rec­tum and in­ter­nal gen­i­tal or­gans.

UATH Chief Med­i­cal Di­rec­tor, Dr Peter Alabi, in­sisted Io­ever “must have been re­ferred.”

“If he was not re­ferred any­where, we will ask who­ever [the] con­sul­tant was man­ag­ing him and find out ex­actly what must have hap­pened,” he told Daily Trust in re­sponse to ques­tions.

Io­ever wasn’t re­ferred to any other hospi­tal. Since his dis­charge early April, Io­ever “is still at home and se­ri­ously in pain,” says his brother and carer Robert Io­ever.

“He can­not eat well, be­cause if he should eat, he must defe­cate, and the process of pass­ing out stool is very, very dif­fi­cult. He can­not sit up, much less stand up.”

He passes urine through a catheter line in­serted into his ure­thra, just be­fore his surgery was can­celled. Now his fam­ily is con­sid­er­ing le­gal ac­tion to com­pel UATH to pro­vide care.

Io­ever has be­come the lat­est vic­tim of stran­gled re­la­tions at UATH that af­fected its six-year-old spine surgery pro­gramme, which didn’t take off for the first two years af­ter it was cre­ated.

An­other pa­tient Toyin Ayinla was last to un­dergo spine surgery be­fore the clo­sure.

His surgery on April 1 was in­ter­rupted with threat of stop­page in the wake of de­ci­sion to im­ple­ment the clo­sure, sources say.

Ayinla in­jured his spine in Oc­to­ber 2010 af­ter at­tempt­ing to push a cam­paign ve­hi­cle out of mud us­ing his back.

He un­der­went man­age­ment at Univer­sity of Ilorin Teach­ing Hospi­tal for over a year but his move­ment prob­lems re­mained.

“Even to bathe my­self be­came dif­fi­cult. But now ev­ery­thing is okay. I bathe my­self, I walk, I do ev­ery­thing now,” he said on his way to a phys­io­ther­apy ap­point­ment at Unilorin Teach­ing Hospi­tal.

The spine unit has gar­nered me­dia head­lines since it went op­er­a­tional four years ago, and sources in­di­cate pub­lic­ity sur­round­ing it may be rea­son for its com­ing un­der at­tack.

“People close to the chief med­i­cal di­rec­tor con­vinced him that the head of the spine unit is try­ing to po­si­tion him­self to be the new chief med­i­cal di­rec­tor,” said Dr Kawu.

UATH was short of in­stru­ments re­quired for spine surg­eries, forc­ing a col­lab­o­ra­tion be­tween the unit and the firm Spine and Sco­l­io­sis.

In one col­lab­o­ra­tion, equip­ment for cer­vi­cal surgery, es­ti­mated at $236,000—some N50 mil­lion— and do­nated by US-based DePuy Spine Inc to Dr Kawu to op­er­ate on in­di­gent pa­tients in Nigeria af­ter he com­pleted a fel­low­ship at the Sco­l­io­sis Re­search So­ci­ety at the New York Hospi­tal for Joint Dis­eases were held back by a cus­toms agent in La­gos for nearly a year.

They in­clude 78 im­plants and 419 in­stru­ments do­nated af­ter a coun­ter­part fee of $500 was paid, Kawu told Cus­toms in a protest let­ter in July de­mand­ing the equip­ment be re­leased.

On re­lease, the equip­ment were dis­trib­uted among six orthopaedic hos­pi­tals, in­clud­ing UATH.

Dr Alabi claimed no knowl­edge of pre­vi­ous use of spine surgery equip­ment, which was re­ported widely.

“We didn’t have any link with any­body to bring us any equip­ment that was seized by Cus­toms. A par­tic­u­lar con­sul­tant in this hospi­tal was in a deal and I don’t know how he ended up with it,” Dr Alabi said.

Asked whether he re­ferred in par­tic­u­lar to Dr Kawu, he said, “If you want to sug­gest that, I don’t know.”

The equip­ment have been used for free surg­eries since then, though pa­tients still pay for anaes­the­sia and theatre use, knock­ing down cost of ma­jor surg­eries by four-fifths.

UATH man­age­ment has since in­sisted Spine and Sco­l­io­sis, which sells im­plants to pa­tients and sup­plies in­stru­ments, stop its sup­ply, in­sist­ing they will ac­quire their own set.

“What they couldn’t achieve in six years, now they want to in one week. All the pa­tients that re­quired [spine] surgery are be­ing turned back and left to their fate,” said Dr Kawu. “The bot­tom­line in this saga is ego and greed.”

One source told Daily Trust that among rea­sons for clos­ing the pro­gramme was con­cern that UATH could lose out on fund­ing if its surgeons con­tinue to use pri­vate equip­ment sup­plies to cut the cost of surgery on pa­tients.

But Dr Alabi in­sisted UATH was “not putting any hold on spine surgery.”

Surgery to cor­rect spine de­for­mity in Ummi Salma, 9, cur­rently hos­pi­tal­ized at UATH, is to hold at Niza­miye, which do­nated its fa­cil­i­ties free for seven days.

Barn­abas is still home with his spine in­jury, wait­ing and hop­ing.

Pae­di­atric ward at UATH, where closed spine unit stirs con­tro­versy over pa­tient care

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