Dr Nabie Nubari is head, Health and Community Development unit, Center for Environment Human Rights and Development, CEHRD, foremost non-governmental organization committed to improved living standard in the Niger Delta. In this interview with National Point’s managing editor Constance Meju, he highlights challenges faced by people in the rural communities in accessing health services. Excerpts:
Dr Nabie Nubari
Doc, how would you describe the state of the health system in the country?
Generally speaking, the health system in the country is in a deplorable state that we expect at least an emergency in that area reason being that, the administration is not being administered the way it should be. Ideally, we are supposed to have a primary healthcare system, a secondary healthcare system and a tertiary healthcare system. Incidentally, the primary system is in existence in its little way but the secondary is completely in a backseat because the secondary healthcare system is supposed to be a link between primary and tertiary where, people will come, attend the primary healthcare then, if there are issues that cannot be handled at the primary level, they will move to the secondary center which, is supposed to be manned by at least two to three doctors. Regrettably, that is not the picture we have.
That is something like general hospitals?
Yes. Incidentally, they do not only exist in dilapidated structure without a personnel and where there is personnel, if you have a doctor and a nurse, you may not have other facilities like a lab, you may not have staff that should make it a team and then other things that should be there to make the place at least functional-lighting system and all that-all those are not in place. And manpower is also very low in the system we are talking about. So, that is that. Now, because the secondary system is not working, the tertiary system is being overwhelmed and is also not as efficient in what they should do. For instance, one is not supposed to the tertiary system; maybe somewhere like UPTH or BMH with complaint about malaria. These are things that should be handled at the primary level. The tertiary hospital is supposed be a referral hospital, where you go, supposed to be less crowded, that is how it is operated in developed countries because, as you go there, you know you have kidney problem, heart problem, and you are directed to where you should go.
That is specialized need?
Yes and you have manpower saved and time in the sense that the time spent waiting for a doctor will be less. But here, it has turned into both primary and secondary because somebody will go there just because he is having fever. It is not operated like that in a developed society. And the funding is also poor. The hospital funding is actually not what it should be. But generally speaking, the challenge we now have, why our system is poor, is because the tertiary hospitals are supposed to be granted autonomy but in most of the state tertiary hospitals, this autonomy is lacking and because of that they are not functioning maximally.
The autonomy, is it still supposed to be funded by the federal government?
The autonomy, for instance, the state tertiary hospital, if you want them to be optimal the way they should be, they should be granted autonomy. In an autonomy, what happens is that the chief medical director, CMD can source for manpower from anywhere to make the place work and the person is paid from within. For instance, in BMH, they don’t have plastic surgeon, neurosurgeon, so many of these specialists and it is not because you do not have those surgeons in the state but, most of them are not from the state. And because there is no autonomy, the CMD cannot engage anybody to come. But if there is autonomy, the CMD can engage somebody to come in and by so doing, you have efficient services going on.
So in a nutshell, the state of the healthcare system in Nigeria is in a deplorable state going from funding of facilities as a system, the structure,to manpower capacity lack, and lack of motivation because a situation where somebody works in a hospital and is being paid hazard allowance of N5000 in a month and you expect him to risk his life that is dangerous, compared to a National Assembly member who is going home with N1.2million a month for newspapers allowance , the gap is such that motivation is also lacking. So we are talking about revitalizing the structure, enhancing the already existing structure, enhancing existing manpower capacity building and motivating the already existing manpower you have so the place can offer optimal service. The problem is multi-sectoral, from the structure, the manpower and remuneration and motivation that is lacking.
So what are the implications of these for us?
The implication is that the healthcare delivery to the populace will be sub-optimal because a situation where somebody is supposed to have a particular kind of service and someone knows what to do but does not have the equipment to do so, that person (patient) may be sent to India when the thing can be done in Rivers State, which is putting untold hardship , untold stress to getting a service that can be delivered within the environment. In some instances, you see that the poor keep dying from services that they would have benefitted from which is only available to the rich as the poor cannot afford it. You find that referrals would have been reduced and so also, medical tourism.
But currently, the poor hardly gets access to good healthcare because they don’t have the means of travelling outside. You saw what happened during Ebola. Because they could not travel out, look at the number that died. That is a typical picture of what happens. But in a situation where the structures were extended to keep these services, the millions of dollars that are budgeted for health are assigned to health, most of the services would have been available and both the rich and the poor would be able to access healthcare. So, the poor keeps suffering.
The implication is that one, our healthcare delivery will be sub-optimal; two, you find that you spend more time in the hospital just to access healthcare. Go to BMH, before you see a doctor-you can get there by 8am and you see a doctor by 2pm because personnel is less and the availability of materials to deliver are also limited. One person, one nurse may be taking the blood pressure of over 60 persons so before it gets to you, you would have spent three hours. So, prolonged time in accessing healthcare and sub-optimal healthcare delivery are the effects of the poor state on the people.
So where did COVID-19 meet us and will you say we have managed the pandemic well?
Well, in terms of management, we were not managing the pandemic; we were managing the effect of the pandemic on our lives. The reason is because most of the cases we had as Covid-19 positive by the time they presented, were neither here nor there because we were not really doing confirmatory tests. A lot of times what we even call COVID may not have been COVID and rather, the response in terms of COVID, the state and nation more of an emergency in the health system during that period, so we were able to cope not because …the people generally,the cooperation, the apprehension that followed this COVID helped so many persons to adapt to health saving behavior and adapt to the changes that we were meant to adapt. It is not as if our health system was so efficient. We were not that efficient or too powerful. We were not at all.
But did Covid-19 bring about any improvement to the availability of facilities in hospitals?
No it did not do that because, it was hijacked politically one, and in the hospitals, what they were going about was to host ventilators and things that are COVID specific. So, these things were provided. Hospitals were not built because of COVID because COVID Isolation centers were built. No hospital was renovated because they went to do COVID. It is only isolation centers that they actually worked on. They did not build any new hospital because they were fighting COVID, no, they did not but where they wanted to create isolation centers, they actually arranged. Those were the things they did.
You work on rural health. What have you observe as health challenges in the rural communities?
Yes,in the rural communities what has been the predominant problem in these areas is what the common man will suffer from. 70 per cent of the populace like the elderly, people from 60 years and above, commonly experience peptic ulcer, hypertension. And the reason for the peptic ulcer by the time we investigated, were drug related, drug induced. Because, when they come down with pain, arthritis and others, all they are told is go to the chemist and the chemist at that level, gives them what we call NSAD (Non-Senedial Anti-inflammatory Agents) and these are cancer causing drugs like Ibuprofen, Cataflan and all that. And incidentally, the chemist man, the way they prescribe is also dangerous because they prescribe drug for waist pain, drug for chest pain, drug for leg pain. Meanwhile, these are members of the same family with complex side effects. So because of that they have a lot of hypertensive cases, which are also common emanating from stress, the poor healthcare services that they access as these are things that should have been identified earlier before they come down to start having longstanding hypertension. Then, issues of airborne diseases, respiratory problems, diarrhea are common because of food contamination and personal hygiene.
So predominantly, for the elderly, we have more of peptic ulcer, hypertension among the Niger Delta population like in the Ogoni axis, the number of altered air quality from oil pollution, environmental pollution in skin rashes that is common within the area, chronic cough not responding to antibiotics because of prolonged exposure to air pollution and all that, these are predominant things that are common. But across the length and breadth of Rivers State, like the Niger Delta, the issue of air pollution is predominant. Cough, catarrh are common; people are aging faster because of the prolonged toxic effects of these pollutants that they are exposed to.
So what is government supposed to do to address these effects?
What of the things we propose is that government should have a modular health facility. A modular health facility is more like a cottage hospital with comprehensive services where, you do toxigenic screening such that people that are in this environment can actually be diagnosed because the problem that we have is diagnostic dilemma. Most times, people suffer from lung cancer but I have seen suffer lung cancer but they are treated with antibiotics.
That’s, they are not aware?
Because there are no diagnostic tools .You see somebody coughing blood, having issues with prolonged cough and most of them I will call pnuemoclosis accumulation of fumes and dust in the lungs, and because in most of the government hospitals you might not have any facility ,the only place they can access x-ray facility is if they go to BMH and getting there becomes a problem plus the time it will take to get to BMH .
The health problem of rural communities is age related-ulcer, hypertension; for the men there is a rise in cases of prostate related problems, urinary problems emanating from prostate enlargement. Now, breast cancer among the reproductive group is also an issue that that is also being undermined currently. Incidentally, cervical cancer and breast cancer have not been on decline except that the awareness improved. People are seeking healthcare more than they used to.But in the rural communities, the perception is that somebody poisoned their breast because they did not accent to sexual relationship. That is it, there is somebody, I have contact with more than five persons that died from breast cancer; when they first presented, they felt they were not symptomatic. I equally knew as a doctor and opted surgery to send the thing back but they refused. They have all died.
So there is need for enlightenment?
There is need for enlightenment on breast cancer, cervical cancer. **Diarrhea illness has dropped with use of campaigns that are on. The vaccine related illnesses having to do with diphtheria, whooping cough, polio, diarrhea, etc., have dropped because of the vaccination that is on-going. But respiratory and airborne diseases have not dropped because of the environmental pollution that is prevalent around the environment. Then peptic ulcer which is emanating from the drugs people are abusing is also a problem. Hypertension is still there because of the problems people are facing. Prostate cancer is also on the rise; prostate, especially for those in their 50s especially because of the cases they present. Then childhood illnesses because of the vaccines that are taking, child healthcare has improved mostly at primary healthcare centers…
To be continued…