Saturday, August 30, 2003

National Hospital is Sick!

Aminu Mohammed & Shuaibu Gimi

Elegance. Functionality. Service. These are some of the concepts that come to mind when one comes in close contact with the National Hospital Abuja (NHA). Built by the Abacha administration, commissioned by the Abdulsalami Abubakar regime and equipped with N3 billion worth of facilities (by the Abacha regime), the 200 bed hospital aptly fitted the description of its former chairman, Professor Osato F. Giwa-Osagie when he labelled it "a befitting institution for Africa’s largest country."

But not any more. For, like many other national monuments and assets before it, the NHA is on its way to antiquity, unless otherwise it receives a desperately needed "emergency treatment." And its latest problem have nothing to do with its notoriously high charges that have put it way, way beyond the ordinary Nigerian for whom it was ambitiously conceived.

Revelations about the current ailment of the hospital came from powerful and well-informed sources from within the hospital itself. First to break the egg was no other than the respected Association of Resident Doctors, National Hospital Abuja, branch via a letter to the Secretary to the Government of the Federation, dated 7th August and titled: "Imminent Collapse of the National Hospital, Abuja." Then followed another letter by the Senior Staff Association of Universities Teaching Hospitals, Research Institutes and Associated Institutions (SSAUTHRIA), NHA, branch, also addressed to the SGF, dated 26th August and titled "National Hospital on the verge of collapse and notice of strike." Both letters worded in strong language identified poor quality of service, broken down equipment among their causes of concern. One of the chilling revelations of the SSAUTHRIA letter went thus: "There are not even enough nurses to cover the wards such that one nurse on night duty is expected to cater for 10 – 20 patients. She will serve drugs, give injections" make patients comfortable check intravenous fluids, give oxygen, monitor vital signs etc and then write report."

The equipment that have broken down, according to the resident doctors are magnetic resonance imaging machine, computerised tomogram CT, echocardiogram SD850, and fluoroscope machine. The others include the linear accelerator, which is said to be the only one of its kind in the West African sub-region, auto analysers, audiology machine, render planner and brachtherapy machine. This is quite enough to cause a decline of service which is now the major feature of the hospital. Ostensibly to make the hospital viable and efficient, the government decided to contract a foreign firm to manage it and the plan was to contract an Asian firm but the present administration of Chief Olusegun Obasanjo decided to engage the services of a British firm. The prevailing situation, however, indicates that either the foreign managers are not sufficiently committed to the job or lack the relevant skills to, at least, maintain the hospital at a reasonable standard.

The hospital, whose initial name was National Hospital for Women and Children was about the biggest project executed under the auspices of the Family Support Programme, a brainchild of Mrs Maryam Sani Abacha. As at the time of the death of General Sani Abacha, the hospital was almost completed.

Therefore, the government of General Abdulsalami Abubakar ensured the completion and commissioning of the hospital which at the beginning promised a lot of efficient healthcare services to the people. A document on the conceptual and operational frameworks of the hospital contains that it was meant to ensure "excellent management of the alarming death toll of our women from pregnancy-related problems-anaemia, ante and intra-partum hemorrhage, breast tumours, cancer of the cervix, the scourge from Vesico-Vaginal Fistula (VVF), advanced/improved child healthcare and other general with sub-specialty services are incorporated in this medical centre of excellence."

To enable it live up to its tag, as the centre of excellence, the hospital was provided with, perhaps, the finest electro-mechanical and electro-medical systems like magnetic resonance imaging, computerised axial tomography, linear accelerator for cancer radiation therapy, ultra-sonography dedicated for obstetric and gynaecology as well as ultra-sound with cardiac option.

In a release made available to Weekly Trust by the Hospital Unions, the IHG has a record of failure in managing hospitals as evidenced in the case of the International Diagnostic Centre and is only interested in reaping from where it does not sow.

For instance, Weekly Trust authoritatively gathered that the IHG personnel are only seven in number and a whopping sum of N600 million is spent on them annually while the entire staff strength of the hospital which is 938 has N700 million spent on it annually. In addition, there is a British consultant at the hospital who competent source said was a staff-nurse in her country and is receiving N3 million annually.

Apart from the question mark on the competence of the British personnel in managing the hospital, some of them are over-aged for the medical jobs which warrant their retirement. Sources at the hospital confided in Weekly Trust that one of the IHG staff, is about 70 years old and has not been practising for 16 years while another one is almost clocking 75 an age which is practically impossible to bring out the best of a doctor.

Recently, the American government promised to assist Nigeria with a N600 million package for the purchase of HIV/AIDS equipments but on condition that the hospital management be restructured. The Americans argued that the IHG is not contributing financially to the maintenance of the hospital and would therefore not release the funds to Nigeria under a foreign management.

Doctor I. B. Babaniyi is a consultant at the hospital and the chairperson of the Senior Staff Association who would rather not fault the American stance but appealed for time to see what the IHG can perform. She told Weekly Trust that the National Hospital has numerous problems ranging from poor quality of service, broken down equipments without maintenance, lack of training and research for staff, lack of welfare package such as insurance and gratuities for their colleagues who died in service among others.

With all these problems, it is evident that there is disquiet in the hospital and the intervention of the presidency to save the hospital from collapse is not only important but necessary. The staff have for the past three years been agitating for the implementation of the federal government’s approved HATISS 4 and the 22% increment to no avail.

Apparently worried by the delay in implementing these financial increments, all the unions at the National Hospital resolved to down tools as from September 2, 2003 unless their demands were met. In a face-saving situation, the secretary to the government of the federation, Chief Ufot Ekaette summoned all the stakeholders involved and promised to address all the pressing issues without delay.

This might seem as a temporary respite for the government but the core issues under contention are, the termination of the IHG 10-year contract which is seen as draining the hospital treasury with N600 million being spent on only seven British personnel annually while over 900 Nigerian staff are costing the hospital only N700 million each year.

The board of the hospital is also being accused of taking side with the IHG and this has generated a lot of anger on whether the board should be spared or be replaced by a new vibrant one.

There is also the issue of the proposed disengagement of staff and redeployment to other hospitals while the National Hospital is in dire need of additional consultants, nurses and other medical staff to beef up the present staff strength which is below what other teachings hospitals like Zaria and Ibadan are having.

For instance, the department of medicine has only two consultants, a cardiologist and a nephrologist who dabble into endocrinology, gastroeuterology and respiratory medicine which are not their specialised areas. Furthermore, departments like ENT, Oropaedics, chemical pathology and histopathology all have one consultant each which has forced registrars to be drafted as consultants.

The National Hospital is also lacking nurses as the present situation portends a great danger. The situation at the National Hospital is so terrible that one nurse attends to the needs of about 20 patients.

Doctor Babaniyi told Weekly Trust that apart from the danger of applying the wrong injection or drugs as a result of stress and pressure, it goes to show the state of our hospitals nationwide. "How do you expect only one nurse to attend to 20 patients at a time without pressure and stress which will lead to committing avoidable errors?" Babaniyi asked.

The government needs to provide enough funds for the hospital to be able to maintain additional staff to beef up the present staff strength and purchase enough drugs to enable patients to buy them from the hospital for fear of buying fake ones outside," Babaniyi advised.

On funding the nation’s health institutions, the director of research, Nigerian Institute of Medical Research (NIMR) Dr. Philip Uwadi Agomo lamented on the neglect from the Federal Government and called for adequate funding of hospitals in order to equip them with drugs and other medical facilities.

When confronted with all these issues, the chairman of the hospital governing board, Professor Babayo Dukku Musa directed our team to the office of the secretary to the government of the federation who according to him was competent to talk on the issues raised. Professor B. D. Musa said he could not talk to the press without consulting his employers and that the secretary to the government of the federation has promised to issue statements on the state of the National Hospital.

At the office of the SGF, the Special Assistant to the SGF on Media Affairs, Mr Terry Oyintola told Weekly Trust that the chairman of the hospital governing board is the right person to speak to the press and wondered why he was being evasive. He said the SGF had nothing to say on the National Hospital since there is a board put in place with a chairman who is not a civil servant. "He cannot claim to be gagged by the civil service rule which has barred public officers from speaking to the press without clearance.

Questions are, why is the chairman evading press interviews on the allegations levelled against his board and the entire hospital management? Is there any skeleton in someone’s cupboard that somebody, somewhere is trying to keep under cover?

Perhaps, there is a can of worms in the hospital which the general public whose money was used in building and equipping it should not know for now.?

Whatever the state of the National hospital is, it has clearly shown that Nigerians lack maintenance culture and this has affected all sectors which is making development virtually impossible.

But then, whether the problem is that of maintenance culture or otherwise, there are serious problems hindering the rendering of quality service at the National Hospital and unless urgent steps are taken to address them, it will just be a matter of time for the beautiful project in the health sector to collapse which will leave serious dents on this democratic government saddled with the responsibility of caring for the average Nigerian.

Ironically, the National Hospital Abuja was established to treat and discharge patients but from all indications, the hospital itself needs to be thoroughly diagnosed before it finally falls on its own sick bed.