Dr Abiodun Fatade

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What are your guiding principles?

Well, like you know, medical practice and entrepreneurship in medical practice is a tough one. It is tough in the sense that you are working or playing in a very difficult terrain; when you look at accessibility to fund, when you look at infrastructural development. It is like there are so many odds that you have to battle with but the key things that will keep you going is that you must love what you are doing- the love for the profession is key. It is the love that will keep you going, otherwise if you are sitting on the fence, once you meet an obstacle, you will run back. What follows is that there must be commitment. You must be committed to what you are doing and you must believe in what you are doing - you believe in yourself and you believe in what you are doing. So that if you believe you are on the right path, even when the obstacles come, you will keep going. It will push you and once you are convinced that you are on the right track, the sky is the limit. And I also say that you pray about it, because that is the only way. You still need divine intervention to push you on. So those are the guiding principles- the commitment, the love and believe. Believe in yourself; if you don’t believe in yourself, then there is no point - you can’t move forward and there is nothing you can do that will be successful.

What would you describe as your greatest challenge?

The greatest challenge I will say comes up during the entrepreneurship years, not even in the medical school. Of course as a resident doctor or as a medical student you know you have to sit for exams so you can’t run away from it. Yes it is tough but other people are there too and if it is the area you have chosen to go, there is no going back. You have to keep pursuing that. The challenge there comes on and off. Actually the real challenge is when you come out and begin to practice. When you begin to practice, little challenges will come - How do I face this situation? How do I solve this case? But still those are not the big challenges. Those are small challenges that you can resolve. The biggest challenge is when you are on your own and you are setting up a practice. That is when the biggest challenge will come in. How do I get the funding? More especially, the area where I am which is radio diagnosis. It is capital intensive. How do I convince people that what I am doing is right? How do I raise the funds to buy this equipment? That is where the challenges come in, knowing fully well that with the country where we are, access to funding is very limited. More so as regards healthcare, no bank wants to fund them. It is only recently that some banks now want to fund healthcare. I can tell you about four to five banks in this country that will tell you “No! We don’t fund healthcare”. Because they feel that the growth of healthcare is very slow. They will rather fund something that will bring them return in 90 days, but that is not in healthcare. No healthcare business will bring you return in 90 days and of course you look at the interest rate at which you can access the fund. How do you transfer that to the patient? Those are the challenges. Let’s say you even get the money or fund where by you put all the equipment together and then you think of power and infrastructure. If you are not careful and you put your equipment direct on national grid which fluctuates, when the power comes high, the equipment is blown up. Those are the challenges. How do I now solve this? Do you run on 24hrs with generator and you use NEPA power as backup? How many generators will you buy? Will you have to buy one and buy another to back up that one? These are the challenges and of course you look at the service you want to provide, the type of clients you want to see. No matter what, even if your patient is paying 100 naira, when they come, they expect the service to be optimal. You can’t tell them sorry, I don’t have money to buy diesel so we can’t put on the AC for you or sorry my generator is down. They will simply ask you why you are doing the business. If you know you are not ready then get out of the business. So those are the challenges that actually will come and those are the greatest challenges that I would say I have faced.

What is unique about Crestview Radiology?

If you look at our website, we have one thing that keeps us going and that is: we want to do the best investigation, using the best equipment and being carried out by the professionals. Those are the things that we want to do. When we came in, we discovered that all over the country, we were still doing things the traditional way. When they take X-ray and they are processing it, they still deep it in chemical and then you go and dry it and patient is waiting for 1 or 2hrs to get a chest X-ray done. We looked at it that No, we can’t continue to do things this way. We have to move to another level and so we started digital radiology. We were the first center to start digital X-ray in the country. When we were about to start, people didn’t give us a chance. They said it is not going to work because there is no power. How do you want to do it? NEPA will spoil your equipment. How do you want to get the right technical people to back you up? But we said no. That we believe in it and we started and I can tell you today that there are a lot more centers going digital, but we started it. We try to be ahead of others in terms of technology. We want our operations to be technology driven and we didn’t stop at that. Now again we have a platform which is called Tele-radiology platform - in which case we can report studies done remotely in any part of the country right from Victoria Island. We have some clinics that are linked to our platform. All they need to do is when they carry out the study, they just click a button and it will appear on my computer here and I will see the image. I will report it and send it back to them. All they need do is just print out the report. That is another level and with that, clinics in remote areas can have the benefit of having a professional report all their films; instead of a lot of people doing the studies and they are putting the X-ray up and they don’t know what is there and they are treating the patient blindly. We feel that in this country that era should belong to the past and that’s why we are saying that here in Crestview we are using technology, using the best practices and using the professionals to achieve what we want to achieve and the quality of our images can speak for us. The quality of our report can speak for us. There are so many people who also carry out studies. When you put up the studies you feel like throwing it into the trash because you think they are cheating the people. That quality should not attract any fee. That means they are not doing it right and we feel that instead of criticizing those people not doing it right, you lay an example for them. Let them see and then the rest will be history.

When you retire from active practice, what are your plans?

There are two ways to look at it, when I retire from Crestview or from active practice. What I want to do is sit back and see what I can do to improve the practice of radiology in this country. I want to sit back and say okay the rest of the younger people that are coming up, they shouldn’t go through the stress that I am going through. What can I do to help them access fund? What can I do to help them to know these are the best practices? What can I do to promote the practice of radiology and bring it to a level that is at par internationally? That should be what I will be working on; with that I can do it from my bed room. I can attend meetings and see how we could bring in not just investors but professionals from all this international bodies to come and train and invest in radiology in this country, so that at least a young Radiologist will feel proud that he is practicing radiology in Nigeria. He doesn’t have to emigrate and run out of the country because the facilities are not here. We want to see what we can do to improve the practice. So even when I retire, i want to work for radiology and I want to practice radiology. I want to see to the growth of radiology in Nigeria.

Can you compare the importance of ultramodern equipment and a competent doctor in the practice of radiology?

Even though the two are important, but if the brain is empty and you spend one billion dollars to purchase equipment, that equipment is useless. What I will suggest is develop the brain, the professionals and the key people who are going to work. You have to train them properly to be able to use that equipment. Train them properly to be able to interpret the results. Then any equipment can always fall in place. Don’t also forget that equipment become obsolete easily. You may buy equipment today and in another 3 to 5 years it is useless. So I would rather invest in building the brain than invest so much in equipment without people to run it. And that is the scenario that you see in most of our government hospitals all over. Government buys the equipment, they install it, and there is no body to run it. After 4 to 5 years, it becomes obsolete. I think people should rather look at - okay lets train people. If you train them they will have a sound and trained mind. Even if you give them equipment that is obsolete, they can make a sense out of it. But if you give a dullard or zero brain one (1) million dollar equipment, he is not going to make anything out of it. That is why we are saying that when they get properly trained, then equipment can fall in place. But if you go and buy the equipment without training them, it is zero. They will come back and spoil that equipment because you didn’t train them on it. That is why we have redundant equipment all over the country because the emphasis had been more on the equipment than on the personnel and unless we make a U-turn and begin to train the people, that trend will continue. And don’t also forget that the people buying this equipment; they are probably buying it because they will make something out of it. The truth is they are not carrying the end users along. Do you actually need this equipment? What is the equipment that you need for your operation? But they are not going to ask them that. The next thing is you will just see a truck driving into the hospital and say oh they said we should deliver this. Go to some government hospitals. There are equipment’s still in the crate that are not installed for the past five years. That is a waste. Because somebody wants to sell and somebody has made money out of it. Why don’t you carry along the people who are using it so that they will know that this is what we asked for and not give them what they may not need? If you give them what they do not need, they won’t use it. If you give them equipment that none of them is trained to use, it will rust in the crate. That’s it.

Is anything being done as regards the regulation of the practice of radiology in Nigeria?

It has been a great concern to all of us in the profession. Quackery is actually rampant when it comes to ultrasound practice. As I am talking to you, so many people who did not touch the four (4) walls of anything medical are doing scan in some areas in Lagos. It is like you said, unregulated. We have our professional bodies: we have Association of Radiologists of West Africa and we have Association of Radiologist in Nigeria. We also have Association of Private Practice Radiologist. In all these associations, what we try to do is to enlighten the people about the differences that exist between center A and B. So that people will know where to go and also to enlighten the government to say that there must be a policy or legislation in place to check all these things. We are also working in an advisory role with HEFEMA (Hospital Facility Accreditation and Monitoring Agency) of Lagos State to be able to draw their attention to the fact that there are a lot of people practicing out there who shouldn’t be practicing and to also let them know the dangers that is inherent in this. Because an ultrasound machine looks like a toy, everybody thinks they can do it and that is why there had been a lot wrong of diagnosis. In addition, we are also trying to conduct training for people, because quackery doesn’t stop with only the people who are not doctors. There is also wrong use among even the doctors because a lot of doctors are not trained in the use of ultrasound and are doing it. I rank them as a quack because you are going to make a mistake and your mistake could be deadly to people. We are carrying out these programs and enlightenment campaign so that people can know where they should go and not just walk into any scan center and do a scan. Because cost is involved, most of this quack centers are rather cheap. But then you can use your own money to go and buy death in those places. So people need to be aware of these. People need to be properly trained. That is why we are carrying out training from time to time and enlightenment so that people can know this is the proper practice and what the other fellow is doing is not proper practice.

What is the role of Crestview in stemming the Medical tourism tide?

That is an area is of concern to everybody in the medical profession and I think the medical body have a role, individuals have a role, but more importantly, the government have the greatest role. What do I mean? There must be legislation in place to prevent people from just coming into the country and scavenge your people and transport them to another country. It is very wrong. In Ghana you can’t do it. If you say okay you want to move patients because the services are not in the country that I agree with you, you can move them; but how can you move patient for services that are available in this country. It is wrong and it is government that can put legislation to stop this. The Nigeria Medical and Dental Council also has a role to play. Let them set clear cut standards on who should practice and make it effective. Yes! They have who should practice in Nigeria but out there, there are so many doctors that are not recognized to practice in Nigeria and they are practicing openly in Nigeria. All the people that parade themselves and are coming from Asia and all over the world, how many of them are licensed by the Medical and Dental Council of Nigeria? But they are practicing. The Medical and Dental Council of Nigeria shouldn’t turn their eyes like they don’t know that they are there. The government should not turn the other eye as if they don’t know that they are there. They all know they are there. Unfortunately, Nigeria Medical Association doesn’t have the power to arrest. It is only government that has the power to arrest. If you see the figures rolled out by the Central Bank governor - what goes out of this country for medical tourism amounts to billions every year. You know where they go to? India, UK, Germany. If government can spend half of that money to develop the health care sector here, nobody will go out. These people that are coming in here, have a government that is supporting them. Their government has a pool of funds for them and they make it easy for them to access the fund. They encourage them to go outside their country to go and invest in healthcare and they support them with the fund e.g. an Indian will take a loan at 3% interest and you in Nigeria will take the same loan at twenty (20) something % interest. How do you want to compete with the guy? You can’t. The government of India forced all these companies- equipment manufacturing companies. If you want to set up in India, yes we will give you land, we make it tax free but you must not sell above certain prices and that is why equipment is very cheap in India compared to Nigeria. But their government didn’t stop at that, they told them they can only sell to companies or hospitals in India. It is not for export. So I can’t go to India and buy a machine and bring it here. They won’t allow me. That is what the government backing is doing. Because I am sure, if they allow everybody to go in there and buy, the price will jump up because they know that the market is outside. The same equipment that somebody will buy for ten (10) million naira in India, that same equipment they will sell it for twenty (20) million naira in Nigeria. It is that bad. Because of this government support, that is why their healthcare has developed to a stage where you see big private hospitals. Because they have access to fund, they can equip their hospitals, they can employ the right professionals, but you can’t do that with the interest rate that is available here. How do you want to do it? Our government is not setting up a stabilization fund for healthcare, even some few banks that says they encourage healthcare, what interest rate are they offering you? It is the same interest that they are giving every other person, nothing extra. With that, we can’t cope. Government needs to come to our help. It is government policy that can stop this medical tourism. Look at the other time, about thirty (30) something hospitals from India came to Nigeria to come and do exhibition. You will think it is an exhibition of a product that is different. It is an exhibition for people to come to our hospital in India - we will do these and these for you. What is the place of Nigerian hospitals? And the worst part of it, they were consulting openly and they were even announcing it on the radio- free consultation, bring all the sick people. Openly on our radio and we have a government that can’t stop that. They were in Federal Palace Hotel and you need to see people bringing in all their old and ill patients, even on wheelbarrow, on wheelchairs and this people were openly consulting and what were they telling them? They were giving them how to get to India, how to process coming to India. Even very terrible cases that you know is terminal, you are still saying bring to India and collect the money. Somebody needs to regulate all this. The Federal ministry of health can’t claim ignorance because this people were announcing it on the radio and on the television.

What is your advice to young and upcoming doctors?

Not to lose hope in the profession (laughs). If you look at it, there is that low interest coming in now. A lot of people are like oh even if I finish my medical practice, do I want to practice in Nigeria? or I want to go out. They shouldn’t lose hope. There is still a bright future for this country. We have not tapped up to 30% of the potential in the healthcare sector in this country.They should stay focused. Nobody will come from outside to change the situation for us. The change has to come from us: Nigerian doctors and all the other people that are Nigerian. We are the only people that can change things by ourselves. Nobody will come and change things for us. If anybody comes in and say we want to set up hospitals so that we can help your people, they want to help their pockets. But you and me would feel fulfilled if we help our people to reduce maternal mortality and the death rate and also help them to improve accessibility to healthcare, then you will feel fulfilled. But for us to wait for somebody from outside to come and do it for us, it is not going to happen. So the upcoming people should stay focused, they shouldn’t lose hope. There is still a lot to be done and at the end of the day all of us will be happy. They should also know that in this country you can practice and be happy. It is not only when you go out that you are happy. The should believe, have faith in the profession and stay focused.