Q1: Please tell us a little bit about your background
A1: My parents were in the foreign service, so I travelled a lot, I was born in the UK but came back to Nigeria, did my secondary school and University here. I finished from Ibadan (UI). I started doing my residency and then in 1995, things were getting a bit difficult and I realized that if I was interested in cardiothoracic surgery, I had to go outside for exposure.
So I left the country in 1995 to train in the United Kingdom, mainly in Wales (Swansea and Cardiff). I then worked in Aberdeen, Scotland before returning home in 2006.
I would say that after I came back, my focus had been initially purely public. However, when I began to see the limitations of the public system, I then began to explore gradually and I would say right now, I work in both public and private.
Q2: So for doctors practicing in Nigeria, what would you say is your greatest challenge?
A2: I will divide that into two sections: there is practice in the private sector and practice in the public sector. In the health sector, I think more will be public, you often have challenges of infrastructure and equipment’s, access to the right consumables, sometimes the basic necessities like power are not available and of course trained personnel.
In the private sector, things are done because there is a pecuniary advantage, something is in demand, people have this problem, we can solve it. So based on that, you can hire or recruit the right people, we don’t have that much in the public sector.
But I see the role for the public and a role for the private. Where there is a vacuum and there is a lot of economics, considering the law of supply and demand, people tend to meet their demand.
I have been back in Nigeria since 2006. What I have seen is that there is now a growing trend that more of these advanced interventions are being done more and more in the private sector. There is activity in the public sector, but it is nowhere near as much as the private sector. The public sector is important and needed because of the cost of these interventions. People need to be funded for these interventions. If it’s all entirely private, there is only so low the cost can go. The market woman on the street who needs an intervention, may not be able to afford to go to First Cardiology or Babcock, that person maybe has a valve that needs to be replaced and that person has a value to the society, so part of my challenge as a practitioner is seeing both sides of the coin. I see those in the public sector-masses of them - who need intervention but I see very different facilities able to attend to them. I see the masses on the other side who have money, most of whom will travel out, but a few of whom when the facilities are available, will stay. So at the moment, we have got to a point where we have facilities for many of these things, but we don’t have enough of an awareness as to what is available because we have so many more public institutions than private, the general concept of health is No, not Nigeria because the stories that people hear are largely negative. So based on that, the truth and confidence isn’t quite there.
Overall, I see a transition- 20 years ago, there was zero confidence, zero trust at all in the Nigerian healthcare. I see now where due to the efforts from various places - some public, some private, there is more available facilities, but we need to do a lot more now to get the information out there, so that if Mr X has a problem, the first thing he will do is go online and say okay, I have this problem, where can it be fixed? If all he is getting is information about centers abroad and the numbers and the results and he gets nothing at all about Nigeria, then he won’t stay in Nigeria. If, however he goes online and he sees information about Nigeria, maybe he sees pictures and stories about patients, he goes to visit such centers and likes what he sees, then he would go.
Q3: Considering that doctors are not allowed to advertise, how do patients or consumers of healthcare find specialists like you?
A3: My experience has been that if people have a good service, they will talk about it. In fact, many of our referrals are referrals from patient to patient. They tell each other, go to that place. Unfortunately, I must say this, one thing that has been hampering medical care in Nigeria, is the influence, sometimes negative of medical tourism companies coming into the country.
We are all human, we have doctors who are overworked and unequipped, and get patients who need an intervention. We have somebody who is representing a foreign firm that does medical tourism and they have offered to give 500 dollars for each referral that you give to them. Where is the doctor going to refer patients to? So unfortunately, we still have a lot of colleagues who are not referring to us but we have a few who are referring to us. But on the other side of the coin, we have many patients who are spreading the word. So with or without the medical referrals, they are referring themselves.
Q4: Is there a reason for someone that has cardiac pathology to travel abroad?
A4: If you know where to go in Nigeria, there is nothing cardiac that requires surgery that can’t be done at home. There are different centers in Nigeria doing various forms of cardio thoracic surgery. Cardio thoracic is everything in the chest. It could be the diaphragm, vascular injury, open heart surgery, close heart surgery. It is being done somewhere in Nigeria.
The focus is not just on a particular surgery. The focus is what is the spectrum of care we are able to offer. Because when the individual patients have one problem or the other, the patient wants to know if I have problem X, can it be fixed in Nigeria? Problem X could be open heart surgery, the different types, either paediatric or something else entirely. So what we are trying to do here is to encourage people to be able to source for things at home. It’s taken a while but almost everything we need to do can be done locally. Now, when will I ask a patient to go out? Not many conditions, for adults, I would say maybe things like heart transplant. For paediatrics, there are some particularly complex paediatric procedures that I might say, okay for now we are doing the simple to the medium difficulty paediatrics. The much more complex ones, certainly you are better off going to a center that does a lot of high volumes of those cases because the results are always better when you are doing a lot of something in particular. But generally speaking, most cardiac surgeries can be done in Nigeria. So it will only be a question of choice if you want to go out, the fact that something is available at home doesn’t mean that you must stay at home. If you got the money and you prefer to go out on holiday and it suits you because your family is abroad, why not? But if you are not opportune to do so or you want to make a choice, it is available at home.
Q5: Please tell us a little about Pacemaker Insertion in Nigeria?
A5: Pacemakers are pretty much routine and are not a big deal. Pacemakers has been around, I think as far back as the early 1980s in Nigeria. We have partly progressed from what we call the Epicardial pacemakers, where the leads were put on the surface of the heart to the Transvenous ones to where the leads go through the vein to the endocardium. So yes, initially, UCH, UNTH, LUTH were doing pacemakers, the old types of pacemakers, but 1990s onwards, there has been a lot of investments and a lot of facilities are now available, I would say there is a centre that does pacemakers in every geopolitical zone in the country. The problem is really awareness of the public and also medical colleagues.
There is the story of a patient who despite what I just told you about pacemakers, lives in Jos and has no idea about what is happening in the same country and his wife had a pacemaker implant in LUTH in the 80s but since then, she needed to have the pacemaker replaced and she had it replaced twice, she’s been going for pacemaker checks all in the UK. About two weeks ago, the pacemaker had reached possible end of life and the battery had to be replaced which is a very minor procedure. He had to write to the UK, get a quote which was about Nine thousand (9,000) pounds, he then asked colleagues and was referred to Ghana and was about to go there before some other colleague said it was available in Lagos. So he came to Lagos, I’ve just seen him this morning, I did his pacemaker and what he paid was easily a tenth of what he would have paid travelling to the UK and the convenience. He is there with his wife in a small hotel just down the road, they’ll be in Lagos for a few days and travel back to Jos. So rather than travelling out of the country, you can do medical tourism within the country.