What is your guiding principle?
My guiding principle is to be focused, to be fair to all and to act. If you act, you may act positively or negatively. From acting negatively, you correct yourself and it leads you to act positively. If you don’t act that is the crime. So my main guiding principle is that I must act and I must try as much as possible to be fair to all.
What would you describe as your greatest challenge so far?
The greatest challenge I had was becoming a doctor. My father was an engineer and some how he felt I had the ability to toe his line and study engineering. I wasn’t interested in engineering, I wanted to do medicine. At that time when your Dad tells you that you must do something, it is going to be difficult for you to say no. It was challenging but eventually, I was able to convince him. His advice then was that if you have decided to study medicine, but when you do it, make sure you get to the highest possible position in your chosen career.
How big a challenge was handling the aftermath of the Dana plane crash?
Ah! That was a crisis period; most of the bodies were deposited in our mortuaries. Another set were deposited in mortuaries within the state. Lagos State decided to challenge it by preventing mass burial. Lagos State was focused on ensuring that everybody could claim its body and to ensure that the body that had been claimed by the family really belonged to them. So it led to the Government directing LASUTH and the Chief Coroner of Lagos State that everybody as much as possible had to be identified. We had the knowhow but we lacked the equipment. So we had to send the tissues out. The process of taking specimens from relations wasn’t that much of a problem because each member of family felt it was a done deal and after taking the tissues they were going to get their bodies almost immediately. But after we had delivered the tissues and we had sent, we couldn’t control the time so we now had to wait for the lab overseas and that was the most critical period where people expected so much of us. They kept coming on a daily basis to demand for their bodies and we kept telling them the results are not available and it got so bad at one point that people actually brought machetes demanding for their bodies. But somehow, with a lot of persuasion and discussion… and I must thank the Executive Governor of Lagos State because he actually scheduled two meetings with every member of the family, allowed them to talk and gave his advice and with that, we were able to calm their nerves. So when the results eventually came back about six to eight weeks later, most of the bodies were identified. Some that were not identified and that’s the general rule; there is no way you can identify everybody. We were able to somehow manage. If there are ten and you have identified eight and there are two families, by exclusion you can actually tell which two belong to each. But everybody came out satisfied eventually.
What would you describe as your greatest achievement as Chief Medical Director so far?
My greatest achievement so far is developing a positive attitude among the workers here. When I came on board, if you trace the history of LASUTH, it started from a cottage hospital, to a general hospital, before it transmuted into a teaching hospital. And it carried on staff . Although when I got in here, the previous CMD had done a bit, but when I got here, I found that the most challenging thing I had to do was to change the attitude and then to make things even easier for me, the State started the ‘service charter’. The state service charter is a charter that tells every parastatal, institution and ministry that the customer is always right. The most challenging aspect of that is to change the attitude of the people. In the hospital you have doctors, nurses, physiotherapists. If these people have the wrong attitude, then you will not be able to deliver service effectively and efficiently and in a friendly manner and so we have started the process. When you entered you saw we have a service charter table with people in uniform. We have trained them and reports we are getting from our patient is that the attitude is changing, and that I think is one of the greatest things I have achieved.
What are your plans when you eventually leave office?
(Laughs) That is hitting me below the belt. I know leaving the office as CMD is eventually going to happen. I have choices: settlement into private practice or go back to the university and teach. I am waiting for Gods guidance.
In the resolution of conflicts with management and government, is there an alternative to strikes?
Well you know that strike cuts across all the professional bodies in Lagos State and trade unions are established to look after the interest of their workers and their members and most times you can pre-emptively abort strikes by communication and that many times had been explored by the government- be it Federal . I am part of crisis resolution and I know that before strikes when we are getting notice of the strike we quickly try and get into dialogue. But when strikes eventually occur, it means that the dialogue has failed and personally I believe that if you work in a health institution, you should not subject your clients to danger, you should not expose them to risks. In a hospital setting, even if you have to go on strike, it should not be a total strike. I was fortunate to be in the UK about a year ago when the medical association wanted to go on strike and I got into the country a day before the strike was declared. The day after, I saw the news rosters of how emergencies will be covered during the strike to avert loss of lives for those who will eventually come to an emergency situation. That is the song I sing here to all the striking workers. That look, go on strike, nobody can stop you from going on strike if you feel strongly, but don’t paralyze the hospital. To an extent, I think it is sinking in. During the last strike of the medical association, the casualties were covered, the intensive care was covered, the paediatric emergency was covered and the surgical emergency was covered. During the strike of the other unions that happened a few weeks ago, to a lesser extent, the laboratories were covered for emergency purposes. You cannot rule out the possibility of strikes ever, but what you can do is to actually prevent them by engaging in dialogue. But sometimes the demands that are made are not within the power of the institution or the powers that be, because sometimes they are policy matters that may need a group of people - Executive council to deliberate on and actually approve or not. When such strikes occur, you begin to wonder whether there is something more to it than meets the eye.
How are you managing the internal rivalry which is now increasingly evident in public hospitals?
The rivalry is really there. I have travelled to quite many places and there is no doubt that the leader of a team has to be somebody who has a broad based idea or knowledge of virtually every area in the hospital. In the medical curriculum there is a course when I was still actively teaching (I was actually in charge) we call it basic therapeutic skills and this exposes the medical student to all aspects of work in the hospital: nursing, physiotherapy, medical social services- so to have an idea of what and what. You can only make good judgment if you have some sort of information. The agitation that any member of the medical team can be the director, because that is the only way I can put it- because the name is medical director or chief medical director - is really high now. In my opinion, I think somehow the leadership had failed to move people along- that’s my opinion. If you are a leader and if you are seen to be a leader, you should also move the people who are being led by you along. So when you demand for something, you should not demand only for yourself, you should demand for them too and say look this is what I demand o, but in the same vein I think this also should be given to them in whatever proportion you think it is. But to a large extent this hasn’t been and you now discover that they have fractionated the medical team and everybody now feels I have to fight for myself and in the process they now say if I can fight for myself and achieve this why can’t I be the head of the team. I think that is the origin of all this, but I know now that there is a move to refocus. The leaders are now talking to themselves and saying we are not doing this thing exactly the right way and I hope that eventually we would able to sit down in a round table conference with every other member of the health team and discuss this issues so that we can chart a way forward.
How is LASUTH working to stem the tide of medical tourism in Nigeria?
LASUTH is one of the youngest teaching hospitals in Nigeria and has taken giant strides. First of all people go for medical tourism because they want to be properly investigated. They want to know that I have malaria and not typhoid and for that you need a beautiful diagnostic lab which we have - The Bola Tinubu health diagnostic lab. It is a PPP (Public Private Partnership) intervention at the instance of the Executive to give you cutting edge technology in diagnosis. We have X-ray, CT-scan, MRI. We have a very modern lab that can easily diagnose most of these things. So if you now diagnose the condition, then you need expertise to treat it and to a large extent we are developing capacity. Our intensive care unit is four bedded and the main one that looks after the state hospitals. There is an intensive care unit in LUTH, but because of the policy of Lagos state, we find easy access of our patients to our intensive care unit. It’s fully equipped. It is fully manned by nurses, by doctors and by which ever cadre of staff that is there but it is too small we need to make it bigger and the government is aware of this and we are looking to possibilities of expanding it. In fact we have another one at Gbagada. The other aspect is also to increase the confidence of the Nigerian populace. This medical tourism has been going on for years and to an extent some people feel it is a status symbol. I am aware that some patients go to terrible hospitals abroad and end up getting their conditions further complicated and eventually come back worse for their situation. I am not saying the hospital there are not good, but people who want to go for treatment should be directed by somebody who knows better but because they feel I have to go to A,B,C and somebody will say Yes, there is this hospital and a lot of people use it to make money and so a lot of them who go are not really getting value for their money, in fact they are getting the negative aspect. Once we increase the confidence, once everybody now knows we have the facilities. For example, the burns and trauma unit at Gbagada is fully equipped not just to manage ordinary burns but extensive burns. The second plane crash, the one that was going to Ondo State, the burns patients there were treated at the burns and trauma unit and a few of them were discharged- those who didn’t have too many multiple trauma. So by the time we talk about these and resound it over and over again, am sure with time people will learn. Now the other thing is Lagos State has setup a hospital in Gbagada too that is the Cardiac and Renal hospital and this is focused on cardiac and kidney care. Total Cardiac care (medical & surgical) and total Renal care (medical & surgical). If you look at a cross section of people going abroad for one problem or the other, you will find that the heart and the kidney probably account for nearly 50% of these cases. Once that is grounded and entrenched into the systems, automatically people are going to go for it. The only thing is that it can’t be free. You cannot have that kind of treatment free because cardiac surgery is expensive anywhere you go to. But those who can afford to go to London or India; if they are paying 10 thousand dollars for surgery in India will find it a lot cheaper to have it done here. This hospital will be manned by competent Nigerians who trained virtually everywhere abroad and have the right skills and experience to manage the place. So by the time that sets in and it is fully grounded, then others would spring up. You can’t have free health on cardiac or kidney care. They are too expensive. But you will discover that if you stay in Nigeria, all your relations are here with you. If you leave the country you can only go with one or two people. You are going to stay in a hotel, in a very foreign environment that might even have a negative impact on your recovery. So those are the advantages of having your treatment at home. So the Lagos State is focused on that.
What advice would you give to medical students and young doctors?
Well I was a medical student once, so I know where things can go wrong and my advice is this all work and no play makes jack a dull boy. At the medical student level, attend your lecture, attend your ward rounds. All you need is to sit down after all this- may be one or two hours on a daily basis and do focused reading. Attend the clinical sessions and seminars because you learn more from talking to people. A lot of people have the opinion that all you do is read. You can read and read the wrong thing; you can read and translate it to mean the wrong thing. Because as a medical student I have gone to seminars with an idea and when it is time for us to talk and I will say no, no, no, argument will come up and then you now go back and open the text book and realize that ah, I was reading the opposite and then with the seminar you will cover more ground and your understanding is better. Once you do that, then have time for other things - go and play tennis, once in a while go to parties because you need a balanced brain. Sitting down for 24 hours reading your books will not make you pass your exams. In fact, it can make you fail. People have gone mental in medical school, because of too much seriousness and they were not able to complete their education; people have been known to commit suicide. So you have to have a balanced life but you must be focused, you must be there to listen to the lecturer, you must be there to do the experiment, you must be there to look at the operations because a picture is more than a thousand words. If I see somebody carrying out appendectomy and I ask questions- okay what’s that? There is no way I will forget, but if I read the process in a text book, I will miss out some steps. So you have to be there as a medical students. As a young doctor you must assume you have started learning all over again. As a young doctor there is a phase where you have to do your house job -your internship and during the internship you are not given the full registration yet. You are given a preliminary registration. During the internship, you are supposed to now practicalize some of the things you have learnt in the class room and clinic and the only way you will be able to do that is when you are serious about it. If you attend your ward rounds, check all your patients result, do their blood pressure. When your consultant sees that you are very serious, in the theatre he might say go and scrub let me show you a few things. So just assume you are learning and then if you assume you are learning and you are modest and you don’t feel you know everything - but if you feel you know everything, you are likely to make dangerous mistakes. As a resident, residency is like investment of a period of your life, because after you cross residency you become a consultant. But what I have discovered is that during the residency training period, that is when doctors get married, that is when they have temptations of doing other things to make more money, doing moonlighting and things like that. Moonlighting may distract you to such an extent that you may fail your exams and the way the exams operate, you are in a training institution and you are allowed three opportunities after you have done your rotation. If you fail, then you will be told to leave. So you can only ensure that you complete the resident training if you are a bit more focused. These days libraries are not necessary again because there are E-books and there are E-libraries that you can get. As a resident you have to be competent you have to have the prerequisite clinical skills. That means you have to be there and ready to learn. When you become a senior registrar, you are almost there. You have to now teach; because if you teach, you practice and when you start teaching you discover a lot of other things that are unusual which builds up your knowledge as a consultant. As a consultant you want them to come and call you for difficult things and say ah doctor I have this problem bla, bla, bla, and you say okay, why don’t you try this? It is not because you are a genus, it is because you have the experience and you know you have been exposed to one case or the other. So once you invest in the period of residency and you come out, then you will be better for it. Then as a consultant you must not stop learning; in fact, you must now teach because when you become a teacher by your students you would also be taught so it is a continuous process.