Dr. Anuma Kalu Ulu, is a Nigerian–born medical practitioner based in the United States but who was on medical mission in Nigeria recently. In this interview with CHIOMA UMEHA, he takes a critical look at a number of health issues in Nigeria. Excerpts:
You have been in practice for many years within and outside this country, could you tell us what we are not doing right?
There is really no basis for comparison, everything we are doing here is wrong. I have to be frank. Some of you may have had the opportunity to travel and see what obtains in other climes. I trained here before I travelled, and since I travelled and got my further training, I have been coming here to practise. So, I stand in a better stead to actually compare and say based on world standard, we really don’t have anything here that is called a hospital or medical delivery system. The system is rippled with many practices that would land a medical staff in any other clime in jail or a situation where he or she would lose license. There is no checks and balances here and I believe that some people might know what to do, but because of self-aggrandizement or the need to make profit beyond the need to serve, then they get derailed. However, as I said earlier, I mean I can expound this if you want; there is just no medical care in Nigeria.
Can you explain further?
In my own medical missions, I have tried to emphasise medical education. Medical education simply means letting the populace know the basic thing they need to know about their medical care, even before they go to the doctor. I’m trying to develop a system where I can put this into a structure where people get informed about medical education. It is also relevant for the medical staff because I don’t know if some of them are doing what they are doing deliberately or inadvertently, but it is hurting the system and the populace. So, people are misinformed here and they go into hospital without any clue. Then there is this god-fatherism in Nigeria where doctors are so imperious and think that they know it all and would not even entertain any question. In other climes, doctors are the least in the totem pole.
In Nigeria, patient’s relatives run away from the wards when doctors are doing the rounds but over there, we doctors, run away when patient’s relatives come because they would ask us questions and they can pin you down and ask you anything they want. The main problem in Nigeria is lack of medical education about what you’re suffering from or what you’re going through.
You ask doctors which medication you are giving me. They would not tell you; they would scrape the names and tell you to just take it; what do you know, what do you want to know? You ask them what is my diagnosis, they can’t tell you, they will just tell you, ‘Why do you want to know, did you go to medical school? I have had personal experience; when people go to hospital, especially when I paid for them to go and get treatment; I called some of the doctors who did not even take my calls. Doctors don’t give out their numbers here. So, lack of information, medical information, to the populace is the greatest bane of Nigeria’s system. Also, the populace believes in a lot of myths and superstitions.
In a country like Nigeria where practising doctors are struggling to survive, how do we help them?
Nigerian doctors need reorientation. I mean there has to be reorientation within the doctors because if they see medicine as a profit-oriented thing, then I don’t think they would go far. In my own situation, I am not putting profit as the foremost thing; but if it comes then it becomes a consequence but not the reason. They have to reorient themselves to think that they can serve first and along with the service, they can also better their lives. I don’t believe in government thing. I have been neck deep into this. I have been trying to get sponsorship. I have approached many corporate organisations and governments but they are not friendly. They are not amenable to this kind of innovation. And that is why I decided to start on a smaller scale, to show what I can do before going to somebody’s doorstep to I say I am the one that did this and can make it better with your financial support. That is my main trust right now.
What is your take on migration of doctors abroad and implication on the health system in Nigeria?
With the recent migration, the fragile health system will actually become comatose if the trend continues. But I am praying that more people would return to the country. There are people who have similar intentions to what I have but they want the system to be holistically complete before they would come down. They want a better security, the kidnapping and armed robbery to stop. However, even America is not a perfect system but they want a better system. They said they want good roads, stable electricity but if they keep looking at all these things, they will never come back. This will continue to promote brain drain and there would come a time that everybody wants to go and the people left would just try to do any ad hoc thing to survive and then, the health system would become comatose.
Like in my village, when I started the my medical mission programme in 2004, over 90 per cent of the people had hypertension and we used to have stroke like 10 to 15 people a year which was attributed to somebody not killing goat before laying foundation and all sorts of traditional beliefs. Over four years of my programme, it reduced to like 20 per cent because the people were compliant. Six years down the lane, there was only a time that we had two strokes and one of them happened to be my mother. My mother died at 84 years and she was taking blood pressure for over 20 years.
How do see incessant strikes by doctors here?
It is not right for doctors to go on strike because when two elephants fight, the grass suffers. When they go on strike, it is the people that suffer. Many people might die. Although the medical care is not optimum, the little they do has been able to sustain some people to some extent. So when they go on strike people lose that little ability to sustain life. I really don’t understand the root of the problem but this also dovetails to my initial statement that when it comes to healthcare government is missing in action because they are not living up to what they are supposed to do. But also doctors have to have a system whereby they absorb this kind of shock so that they can continue to provide continuous medical care because at the end of the day, it is not the government officials that would suffer. Most of them would travel abroad for their medical care, even for something as little as ear pain. So I do not subscribe to them going on strike.
From your experience there, what should be done to improve medical diagnosis in the country?
I trained here. During our training, we had little opportunity to be exposed to some of the diagnostics equipment. Most of the diseases like heart problems we called them then western diseases. We only read about them but we never used equipment like ECG to train. It was actually the first time I went to Trinidad to work that I started experiencing these things and practising them. Infrastructure is a problem and then the scope of training is also a problem because there isn’t equipment to diagnose.
Apart from abject lack of facilities there is also dishonesty. In Nigeria, people talk about scan and it is only ultrasound they are talking about and it is the least we use over there now for diagnosing pregnant women. We have CT scan, bone scan, MRI scan, etc. In Nigeria somebody is sick, you go to the hospital and they do HIV, full blood count, they do ultrasound and they will say they have finished all the investigation but found nothing. Misdiagnosis is really a big problem because of lack of facilities. Do you know that as a doctor in the U.S., we refresh every year. There you have to get certification. But in Nigeria, somebody after graduation would go to Mbaise, in Imo State and open a hospital and start being imperialistic. No checks and balances. No improvement in career because he or she is not doing even continuous medical education.
Another thing about misdiagnosis is that doctors will not admit that they are not God here in Nigeria. In America, the ability to be employed as a doctor depends on when you know your limitation. So, when our doctors learn their limitation and treat patients like people who are not just pedestrians but people who should have minimum idea of what they have, the misdiagnosis would be history.