‘Nigeria Needs Good Malpractice Control Bureau’
In this interview, Dr Jemitola Soji speaks to Adedayo Adejobi in the health sector and how they can be overcome
My many frustrations as a trained medical doctor Yes, I qualified as a medical doctor at the UCH Ibadan, but decided not to practice initially probably because of my frustrations. I was one of those unlucky not to qualify to study medicine. Actually the two major professions I had in mind were Aeronautics and medicine, but engineering had a bit of an edge. I was science and I had my degree so I went for medicine, and since then it has been nice, interesting, and the studies were good, as I enjoyed myself. Most of the cases we saw and dealt with in Medical school have been everywhere. People died so much as a result of a high mortality rate. Unfortunately, the mortality rate as at 1998 in UCH Ibadan was too high. I graduated 1998, so I was there from 1992 because there were a lot of strikes in between as at that time. People were dying needlessly from preventable conditions. It was so frustrating for me and I didn’t like that, and so I think that is one of the main things that took me off the medical turf for a while. It’s not interesting that we have a system that leaves little rule for creativity.
A friend of mine whose wife was in labour for 18 hours got her womb removed for not being properly monitored. I don’t know why they allowed her die, I don’t have the authority to go and investigate. Medically, it is improper because she wasn’t monitored; she was in pain, thus distressing her womb leading to removal due to the bleeding, which means she can’t have a child again. A dead baby was delivered by cesarean. Every medical person knows that if you are still bleeding after four months, seriously it won’t work. My friend and his wife went home and came back to complain, but if we had a good malpractice control bureau in this country, whoever is in charge would not be allowed to practice. If you are informed about you rights and what you are entitled to even as patients, things that this would not happen. There are instances you go to see a doctor and he writes a two minutes review and write a prescription for you. You get treated for malaria three times in a month it is ridiculous, how can you be treating the same thing. If you know that you see a Doctor and you don’t understand the message he is passing across, you have the right to ask the Doctor questions or if the Doctor writes a prescription for you and you cannot read it, you should know what drugs you are taking. If you know your right you can demand them; you cannot seat back and say no, if you say no the person knows that you could not recognise your right.
Although things are changing now, but then I was really frustrated. When a person comes with a set of symptoms, you look for a certain set signs and based on those two, you diagnose. The treatment has already been outlined so where is the creativity? But things are changing, as modalities of treating new diseases are evolving, with people changing their approach to medicine. In what key practical ways are you filing this gap and what are you doing to make a difference?
I am providing useful information, because the right information at the right time to the right person can save lives. Gathering information making sense of it and providing intelligence so that people can make informed decisions. When you know a cause, you know the best course of treatment. The questions I seek to answer are-Is this the best way health care service can help in a particular area. Are these the best ways to train our medical personnel to deliver the best health care? There are countless instances where people have been misled with nurses or lab technicians operating as Doctors and giving false information. If there was a resource where you could find out that this person is authorized and accredited to perform, I think that will make a significant difference.
What we have done so far is practically gather information on what health care services are available in the country, where the healthcare providers are, thus identifying the people who enjoy the services. We are about 65 along that part. We have data for the whole of Nigeria. My 65% is not of Nigeria, but 65 of the potential data in Nigeria. What are the challenges of solving the problem with the KTN Campaign? There is a handful of informality in the Nigeria health care centers. There are places that are not registered that provide health care services, there are places that are registered but have gone out of business. We have done our due diligence of the formal sector to about 90%. When it comes to the informal sector, there is a lot on that. We are also trying to bring on board the traditional practitioners, even that is a grey area than even the orthodox medicine to start with, and that is why I said 65% of Nigeria.
That is one angle; another angle we are also approaching is the KYN campaign. It knows what your health status is till-date and the impulse behind that is “prevention is better than cure”. Although it is a common saying but it is a fact. Let’s consider a woman who has cervical cancer, if she is diagnosed of it now she has a legion. She has indicators for 2, 5, 8years in advance depending on what kind of cancer it is. If it was caught in that period you have a simple out-patient procedure and the person is done.
But a woman who has cervical cancer now, if not diagnosed until she start showing symptoms 5 years down has complications, if you are going to treat her it would be a long time treatment with surgery and sometimes might lose part of the body like the womb. The longer it takes the more the chances it has to spread. The KYN campaign is about you finding out about what condition you may have even if you are overweight. That way it pre-disposes you to some certain conditions that can avoid hypertensions, diabetes and the likes. If you knew that now you could do something about it. You go for annual screenings, when you are sick you get tested for another thing while you are been treated for that. But why wait till then and why not make it a little more interesting and encouraging to go tested. The KYN now brings more element of fun to it, you do medical test and also provide family funding for the whole family. What are the advantages of the KYN campaigns on policy formation?
The KYN gives data of what the current status of people are and it can help to formulate the right policy decisions in guarding health care on locality bases till it gets to the national level. During the KYN event we realised that there is high need in some health conditions, in which you can deploy the right health professionals to that area to optimize them. Individual Policy makers, government and the private sector can use information to drive the wide health care choices. In the big picture, what is in it for the common man on the street? The common man generally avoids Doctors because they can’t afford it, so we make it a fun thing for them to do by coming to find out where they are right now and by knowing how best there health can function more. They get immediate value, although with longer time value healthcare service, what they would receive would be more tailored to what they require.
In terms of costing, it is a benefit that we offer cheaper than anywhere else you can get it.
We are targeting the poor, the middle class and lower class who mostly are tested for free.We had plans to deliver our services for free but we didn’t get enough funding that was why had to charge, even the one we charged was less than half the normal prize done anywhere else and you only pay for the test, you won’t pay for the consultation, product and services that you received. What is the role of the government in the areas of policy formation? For instance, the data that we are gathering can be used to make informed policy decisions, rather than arbitrary news statements like ‘‘we want to reduce maternal mortality by 50%’’ when they don’t know what the causes of the mortality are and the particular areas they have stronghold. Information is key to key policy formation.
Nigeria is not the only country affected by maternal mortality. Unfortunately, we do not have data to back the decisions that we make or even track the progress we make. If you want to reduce maternal mortality to 50%, you need to be armed the actual figures of last year and the figures for this year, and then compare the difference you have made in reduction.
We have a body saddled with that responsibility, but they are not effective. Whereas everything is about getting that data unbiased, accurately which can be used to form informed policy decisions and also track progress. Are you saying Nigeria doesn’t have medical intelligence? I don’t think we have accurate medical intelligence. What we have is distorted medical intelligence, and there are many factors that contribute to that. Some of it is lazy data gathering, false reporting, some are not even capturing at all. We have covered 65% because there is a lot of informal practices’ going on. There are nurses who prescribe out of the kitchen and even Doctors that prescribe at home out of the hospital setting, people seeing traditional healers, Herbalist, or juju men.
People are doing self-medication like going to the pharmacist and getting treated ,so there are lots of data un-captured, and if you don’t treat that data you can’t get an accurate picture of what is actually on ground. What we have is a distorted skilled profile of the health statistic of the country.