Dr Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc
My patient
My patient returned from a recent trip to the USA for treatment of a brain tumour. He had refused treatment here in Nigeria because of that inherent fear of dying. ‘Oh, I do not want to die on the operating table in Nigeria’. ‘Doctor, even if you can do the operation, what about the after care? Finally, ‘Can you trust the nurses? So, off he went and then sought to see me on his return.
His money
The shame of course was that the tumour for which he spent millions of Naira was still inside his head! The doctors in the USA (and it could be India or Germany!) had just removed a little bit and sent him back home. Or perhaps his money ran out! One can never get to the truth in these matters. Regardless, this is no longer my problem and he might have to return to the USA for further treatment as necessary.
Other people
I wrote recently about the situation in Thailand. The government asked neurosurgeons in one of its hospitals to supply a list of equipment they would like to have. They did and were pleasantly surprised that the government bought everything! No expenses spared. The government also provided the equipment and the support required by going directly to the manufacturers and not through middle men (with no middle names!). This made many of the manufacturers set up businesses in Thailand to support the burgeoning neurosurgical practice. Today, you would be hard pressed to find a government official (even the King!) or a medical doctor (a Chief Medical Director!) going abroad for treatment.
Secondly, private individuals stepped up and donated equipment, theatres and even built whole hospitals for the community. Not for profit, you see, but as a social responsibility for the rich blessings bestowed upon them. They sought to enrich their community with good health. Do you understand this?
Our people
Compare with our government officials who pay lip service to the reversal of medical tourism but are on the first flight out when they fall ill. The National Health Act and all policies are quickly forgotten. You see, for as long as each person feels his own life is more important than that of the collective, we cannot make progress. Secondly, the Ministers of Health and Governors buy equipment for Nigerian hospitals and then keep them to rot in underground garages. Directors of health parastatals use money earmarked for health projects to travel to Dubai for shopping sprees and medical check-ups.
If only
If we had been building sustainable programs in health, we would be there by now. Government would still not be planning to fix healthcare in 2017 by bringing in Universal Health Care (UHC), National Health Agenda (NHA), National Health Gazette (NHG) and the National Health Act to stop outbound medical tourism. Together the three are part of a new focus in the ministry and government to stop medical tourism. Together, they are bound to fail without real commitment and desire to ensure that we can treat anyone and everyone, anywhere and everywhere, at the point of need, right here in Nigeria.
The truth
According to the World Bank, over $1bn is being spent by Nigerians on medical tourism abroad annually. In paying lip service, the same Ministry talk about focusing on maximising optimal use of available resources, the provision of specialised care for Nigerians and changing the direction and destination of medical tourism. The Minister of Health, Professor Adewole says, “We will make our teaching hospitals work and do public -private partnerships that focus on derivable benefits.” "We will equip the hospitals and other public health facilities as well as re-orient the medical and health personnel to adopt positive work attitude to ensure quality and efficient healthcare delivery to our people. We will boost the capacity of our health workers to enable them render accurate diagnosis of diseases and sustain the training and retraining of staff." For one, sacking resident doctors is not the way forward.
Yes, we can
The political leaders lack confidence in healthcare facilities established by them and prefer to go abroad for treatment. Aside the lack of confidence in the health sector, previous President of Nigeria Medical Association (NMA), Dr Osahon Enabulele, argued that the major reason for the medical pilgrimage includes persistent negligence and under-development of the health sector. Dr Rilwanu Mohammed of the FCT Primary Health Care Board, says that more than 210 primary healthcare centres exist in Abuja but only 30 % are actually operating. Dr Ben Anyene of the Health Reform Foundation (HERFON) chastised government officials on the wastage, saying: ”This is all waste of resources, let us fix the system, if we do that things will work in this country, then nobody will travel. Why should we go to Dubai or India to have treatment? Why can’t we do it in Nigeria? We have Nigerians that can render these services.’’ Medical tourism can only be curbed when the healthcare infrastructure, equipment and personnel, are well developed.
A reversal
“Reversing Medical Tourism: strengthening local capabilities, and encouraging foreign collaborations”. This is the theme of a conference coming up at the Covenant University in Ota (20th July 2016). Organised by Dr Wole Kukoyi, the Medical Director of Ace Medicare Clinics, it promises to showcase the talents in Nigeria providing a high level of care comparable to standards achievable in many other countries.
The conference is totally dedicated to efforts by various stakeholders in mitigating or reversing this unfortunate trend. Discussions will focus on how to identify and promote local capabilities and develop manpower locally. Colleagues from diaspora and organisations outside the country will also collaborate to achieve this important national task.
A real need
There is a need to improve the quality of healthcare delivery in our country; restore the confidence of citizens in the health sector, and, more importantly, create the enabling environment for the Nigerian medical practitioners in the diaspora to return home and also boost Nigeria’s medical tourism. An improved health sector will, no doubt, reduce the huge cash flight which the current exodus for medical treatment and go a long way to boost the ailing economy. We all need to invest massively in the provision of quality, affordable and accessible healthcare services in Nigeria.
Finally
Some Nigerians, whose patients or family members have either suffered complications after being treated or died in Indian hospitals, have complained of the medical treatment in India and observed that the medical treatment in India falls below their expectations. Yet, as much as 50% of the medical tourist trade still rush to India.
Perhaps, that is where my patient is headed next!
