Spine Fixed In Abuja

Tuesday, 27 May 2014

PEDIGUARD

PediGuard for accessing the pedicle safely in spine operations

PediGuard uses electrical conductivity differentiation at its tip for assessing bone versus soft tissue in order to improve the safe positioning of pedicle screws. PediGuard not only warns of impending medial breach but also is the only real-time device available to non-radiographically detect lateral breach.

About the PediGuard® platform

Co-invented by Maurice Bourlion, Ph.D., Ciaran Bolger, M.D., Ph.D., and Alain Vanquaethem, Biomedical Engineer, PediGuard is the world’s first and only handheld device capable of alerting surgeons to potential pedicular or vertebral breaches. Real-time feedback is provided via audio and visual signals. More than 20,000 procedures have been performed with PediGuard on all continents. Several studies published in peer-reviewed medical and scientific journals have demonstrated that PediGuard presents an accuracy rate as high as 97.5%, doubles the pedicle breach-detection rate, limits radiation exposure by up to 73%, decreases by 15% the average time for pedicle screw placement and provides a 3-fold reduction in neuro-monitoring events.

In the Chaput study, because of the use of PediGuard, the number of fluoroscopy shots was able to be reduced by 30% compared to a standard drilling probe while maintaining a 97.5% accurate, safe screw placement.

Spine surgeons’ increasingly greater reliance on fluoroscopy during procedures exposes the entire OR team to dangerous radiation:

The average spine surgeon will receive the maximum allowable lifetime exposure of radiation for classified workers within 10 years of practice (Ul Haque, Shufflebarger et al, 2006);
The radiation exposure in spine surgery has been found to be 10 to 12 times greater than the radiation exposure during other fluoroscopically assisted non-spinal musculoskeletal procedures (Rampersaud, 2000);
The highest amount of fluoro intensity is needed for spinal procedures (Orthopedics this Week, 2010).

Co-founded in 2009 by Pierre Jérôme and Stéphane Bette, former executives at Medtronic Sofamor-Danek and SpineVision, SpineGuard’s primary objective is to establish its FDA-cleared and CE Marked PediGuard® device as the global standard of care for safer pedicle screw placement in spine surgery.

SpineGuard’s PediGuard® Device Reduces by 30% Spine Surgeons’ Radiation Exposure from Fluoroscopy While Maintaining a 97.5% Accurate Pedicle Screw Placement During Lumbar Spine Fusion:Prospective, randomized, controlled study results published inSpine

Believe in Nigeria as we publish our results of spine operations

Reporting good outcomes
There have now been 3 articles published on surgical treatment for spine conditions in Nigeria. The reports are from Lagos and Abuja. And there are many more to come as surgeons embrace reporting of their management of patients with spine and spinal cord problems. Previously, almost all the articles have been on conservative or non surgical treatments and the fear of surgery in Nigeria had driven many patients to other countries.

But, with the increase in expertise and improvements in safety in surgery on the spine, more patients are being treated locally. Doctors reporting their results will also help in improving local confidence and expertise. Everybody and especially Nigerians will benefit.

Promoting quality of care in Nigeria

Many cases of effective and efficient management of cases of spine problems abound in Nigeria. Patients do not need to continue to troop out to other countries in search of quality of care. At least for spine, we can now boast of the capability to manage most cases of spine problems to very high standards in Nigeria. There are surgeons in Sokoto, Enugu, Abuja, Lagos and Ibadan making huge strides in providing a quality care. Some are also in our public hospitals. As usual, lack of information on what is available locally impairs access to good care.

Spine: Plans for Abuja

You need to know that the future is bright, for patients in Abuja with spine problems. This is because there are trained surgeons in Abuja offering specialised spine care with a full surgical team backup and all the necessary equipment. Neck and back pains can be conveniently managed in Abuja and Abuja is set to be the destination for Nigerians with spine trauma and degenerative diseases.

There are also competent nurses and physiotherapists to manage patients following operations. Those who cannot be operated upon or who do not need an operation can also be helped by injections, physical therapy and advice.

Believe in Nigeria

At least in the management of bone and spine diseases: We can treat patients confidently.

So, now you know that spine problems should no longer be a reason to travel out of Nigeria. We need the confidence of the people and their trust to move us further forward.

SPINE: Fixed in Abuja
ABUJA is SPINE capital of Nigeria

1 comment:

Obi17 July 2013 10:32

Information is key. People do not know about the services now available in the country. Even among healthcare providers, there is lack of useful knowledge about these services. Many patients end up suffering in silence because their HCPs are unable to refer them to able specialists because the HCPs do not know of these services. Another thing is cost. Many who need these services cannot afford them. I'm very much interested in implementing the successes of Aravind eyecare in India. They were able to subsidize cataract surgery for the poor through some innovative approaches. The rich paid normal rates and profits went to subsidizing for the poor. They also started manufacturing lenses which saved importation costs. The lenses were same in quality as imported brands, but much cheaper as materials were sourced locally. Do you think we can implement this business model in ortho-neuro care in the country?
Reply

Surgical treatment for spine diseases in Abuja: Early outcomes study

Abstract

This study seeks to review the short term outcomes of patients with spine diseases treated in Abuja. We reviewed early morbidity and mortality. A second part of the study evaluated the patients’ perceived outcomes. This may help in presenting the current state of management outcomes of benefit to patients and relatives.

Materials and methods
The study is a review of prospective data of patients operated in a private specialist hospital in Abuja. The clinical notes of all patients undergoing surgical intervention for spine disease in a single year (January to December 2012) were obtained and relevant demographic and clinical data extracted. A research student (A.I.) then telephoned all the patients to ask them about their outcomes and the success of the operation. The telephone calls were made in January 2013. The patients were asked their opinions on the outcome of the operation, perception of quality of hospital care and whether they would recommend others to have their operations in Nigeria.

Results
48 patients were admitted for spinal procedures including surgery in 2012. There were 50 procedures performed. Two patients had an additional operation within the year. There were 21 women and 27 men. The age range was from 28 to 78 with a mean age of 54 years. About 40% of the patients were aged 28-50 and 60% were aged 51-78 years. The diagnosis was degenerative disease in the majority and trauma in 7 cases, metastatic prostate tumour in one and Tuberculosis of the spine in another case. All operations were performed safely and no intra-operative complications occurred. There have been a total of 5 deaths. Three patients with severe spinal cord injury died after discharge due to poor rehabilitation and care. Overall patients rated the operation a success in 87% of cases. Majority would have the operation in Nigeria again.

Conclusions
Spine operations are being performed safely in Nigeria. The morbidity and mortality is low and outcomes are satisfactory. Patients were satisfied with the early results of their operations. This may help in reducing the exodus of patients to other countries for spine care.

Keywords: Abuja, Anterior cervical discectomy, cervical spine traumatic instability, Lumbar, Nigeria, Operation, Outcome, Spine, Surgical fixation, Trauma

Because YOU need to know

It is important for doctors and most other professionals to have a directory of specialists they can call for help. You need the numbers and contact details of some people on speed dial. Just in case.

Some of my patients had been to several hospitals before finding their way to me. Some have been to as many as 5 different hospitals looking for an orthopaedic surgeon, brain surgeon or urologist or any number of specialists. Meantime, many have become permanently injured or died as a result of this merry go round. Do you need examples?

Take my own personal example. My mother died several years ago. Shortly before she died, we realised she needed kidney dialysis. So we started asking around. And driving from one hospital to another for information on where dialysis and a specialist could be found. Alas, by the time we eventually discovered a place somewhere in Ikeja, Lagos, she had given up the ghost. Now, that was over 15 years ago. Sadly, not much has changed in the last 15 years, except of course you consider the deterioration, change.

A doctor died recently and he may have been helped if the right person and the equipment were at hand to save him. Apparently, he had been coughing up blood. He needed a specialist to look down his lungs to see what was bleeding and perhaps sort it out. Sadly, since help was not forthcoming, he died, drowning in his own blood. Other doctors have died in similar circumstances simply because they and their colleagues have no clue as to where help can be found. Even within their hospitals!

Many doctors and healthcare practitioners remain so myopic that they see no further than their flat noses. Some do not know about the services and specialists around them who may be able to get them out of a jam. Few doctors can list the names and telephone numbers of 10 specialists in 10 different fields. The implication is obvious. If the people, who are supposed to know, do not know, how will the poor patient and their relatives fare? Yet, the problems we face are sometimes too close and personal. The recent deaths should emphasise that we are mortal and destined to suffer the same as the patients we treat and oh, so mistreat. It could be you and you may not be able to get a visa to ‘Sokoto’ in the time it takes to die.

We need to know

I attended a meeting of radiologists in the recent past. They were giving lectures on breast cancer and uterine fibroids. Unfortunately, the lecturers, seasoned radiologists, were poor in the content of their delivery. They were busy quoting the literature and old textbooks that the audience could be forgiven for thinking they were back in the university. What we needed was: what is the condition, how is it managed, can you manage it, where are you based and how many have you treated. Following that, what are your results and outcomes so that we can send patients to you? We need to promote what can be done and what is being done in Nigeria so patients know where to go for succour. Too many people are being killed by ignorance and charlatans for us not to care.

Be selfish

Being informed and knowing what is available locally is vitally important. We have to become obsessive and completely selfish in our approach to gaining information and knowledge. Information is power and critical health information can save lives and money. Know what is happening around you, who is new in town and what skills they possess. Also, what new services are now available in your local area? Try and see further than your nose: just in case.

Healthcare Directory

The solution to all this is pretty simple. What is needed is a healthcare directory with information as to who and what is where. Who are the specialists, specialist hospitals and specialist equipment and services in each local area? You need to know who is available and close by to help. We need to know what is available and achievable in Nigeria. Nigerians need information to help reduce the carnage in the health industry.

The Ministry of Health Initiative

The MOH initiated the process of collecting information about skills and services in Nigerian hospitals recently. This long term project hopefully will bear fruit in promoting and educating Nigeria. The beauty of the initiative however lies in the number of deaths and disability it will potentially prevent. It should be actively supported by all hospitals.

The Abuja Healthcare Directory

The Abuja Healthcare Directory was created in 2011 and is updated yearly. It contains the names of many of the hospitals in Abuja. It also contains the names and telephone numbers of a few specialists and specialist services in the FCT. The directory is a small contribution in improving access to vital healthcare information. It provides easy access to specialist services and hospitals. Patients and their relatives can now go directly to the hospital where the needed services can be provided without having to waste time going around in a circle. The Nigerian Healthcare Journal is an online portal that carries the directory and so information can be accessed via laptops, mobile phones and the like. It is also available in hard copies.

Other websites exist and more local directories need to be developed. It is our collective responsibility as doctors and healthcare practitioners to participate actively in these endeavours of both the government and private parties. The Nigeria Medical Association, Guild of Medical Directors and the Association of General Private Medical Practitioners of Nigeria must all take a lead in supporting and promoting these ideas.

Because we simply need to know!

Thursday, 9 May 2013

Surgical treatment for spine diseases in Abuja: Early outcomes study

Abstract

This study seeks to review the short term outcomes of patients with spine diseases treated in Abuja. We reviewed early morbidity and mortality. A second part of the study evaluated the patients’ perceived outcomes. This may help in presenting the current state of management outcomes of benefit to patients and relatives.

SPINE: Fixed in Abuja

Hajiya Zainab walked into my clinic in real pain. I said walked, didn’t I? She actually waddled in and could not wait to sit down. When she sat, she leaned on the left cheek and stretched out the right leg. This was done to ease her pain. She said the pain in the leg travels from the back in shock-like sensations, arriving at her ankle like a succession of locomotive trains.

It turns out she has low back pain and right leg pain. The pain is caused by pressure on the nerves in the lower back due to arthritis. The bones wear out following years of wear and tear. It leads to new bone formation which then encroaches and presses on the nerves. This pressure on the nerves, lead to pain, which shoots down the leg. The leg pain is sometimes called sciatica.

Hajiya Zainab had lumbar canal stenosis. This means there was pressure on nerves in her lower back. The pressure was due to thickening of the ligaments in her back and new bone formations, causing narrowing of the canal through which the nerves supplying her legs go through. She was therefore advised to undergo an operation to remove the pressure and free her nerves. At the time of discharge, following the operation, she practically danced out of the hospital.

Mrs Adisa, an 82-year-old woman presented with a long history of progressive deterioration in her level of function and immobility. She had been wheel chair bound for over 7 years on account of this problem. This pain in the neck and the various problems with numbness and weakness affecting both arms and legs is caused by arthritis in the neck. The medical term is cervical spondylotic myelopathy: A real pain in the neck. On examination, she had weakness in all muscles in the arms and legs and was unable to stand unaided. Her MRI scan showed advanced arthritis in the neck and she was asked to undergo the operation.

This was carried out and after 5 months of physiotherapy, she was able to walk with the aid of a walking frame. Now, she can at least help herself a little bit and reduce the burden on the family.

Mr Ojukwu is a 65-year-old man married with children. He was previously active and dynamic, a community helper and contributor to many societies in the community. That was before his hands and legs stopped working.

It all started like a joke. Initially, he had some neck pain which the doctor diagnosed as arthritis. Slowly the pain in the neck started shooting down the arm into the fingers. If he moves his neck a certain way, a sharp electric sensation radiates down the centre of his spine. Then, numbness started in the hands and feet. He also complained of an unpleasant ‘drawing sensation’ in his arms and legs.

He required an operation to remove the pressure on the spinal cord. This was performed uneventfully and he went on to make a good recovery. He has become ambulant and able to cater for himself with minimal assistance from the family.

Mr Ode, suffered a neck and spinal cord injury following a road traffic accident. He was paralysed immediately due to damage to his spinal cord. He was recovered from the scene of the accident and transported to hospital in good condition. There he underwent an operation within a few hours, which removed the pressure on his spinal cord. Six weeks later, he was able to walk with the aid of a nurse and using a walking support frame. He has since recovered even more function and back to work.

Medical tourism to other countries

There are some illnesses such as spinal cord injury requiring immediate medical attention that cannot wait for the flight to other countries. The colossal sum of money spent abroad could therefore be used to equip more local hospitals in Nigeria to perform even more in delivering care. Supporting the local hospitals and ensuring that it has both personnel and equipment may be the difference between life and death. Develop your local hospital and help prepare them to be able to help you when it really matters. Anyone proudly strutting off to India and other countries is truly a big fool. That you can afford to travel to other countries is simply not the issue. Many have gone to other countries and return dead despite colossal sums of money spent.

The key issues are that such medical tourism is eroding the fabric of our own health services and further depleting the nation of medical facilities and expertise. It demoralises local medical practitioners and increases the brain drain. It reduces training of medical students, further creating substandard and poorly trained doctors to look after us all in the future. It simply creates a vicious circle we must break free of.

Promoting quality of care

Many cases of effective and efficient management of cases of spine problems abound in Nigeria. Patients do not need to continue to troop out to other countries in search of quality of care. At least for spine, we can now boast of the capability to manage most cases of spine problems to very high standards in Nigeria. There are surgeons in Sokoto, Enugu, Abuja, Lagos and Ibadan making huge strides in providing a quality care. Some are even in our public hospitals. As usual, lack of information on what is available locally impairs access to good care.

Spine: Plans for Nigeria

You need to know that the future is bright, for patients in Abuja with spine problems. This is because there are four trained surgeons in Abuja offering specialised spine care with a full surgical team backup and all the necessary equipment. Neck and back pains can be conveniently managed in Abuja and Abuja is set to be the destination for Nigerians with spine trauma and degenerative diseases.

In fact, there are several big foreign companies such as Medtronic and Covidien now coming to Nigeria to collaborate and support local practitioners. Others such as Infax Nigeria Ltd and Implants International, UK have long been in the game and helping to prop up our failing spine. So, now you know that spine problems should no longer be a reason to travel out of Nigeria. We need the confidence of the people and their trust to move us further forward.

We promise to do our best to make ABUJA the SPINE capital of Nigeria.

Pain... real pain

I will assume that you have suffered pain before. Not emotional pain but real pain. Physical pain that made you cry. Of course, you can remember what happened: no matter how long ago it was.

My pain

For me, I had a most horrible toothache in 1990. The tooth was rotten, infected and wobbly and oh, so painful. It hurt so much that the whole side of my face was red and inflamed. It was as if someone had a blow torch inside my mouth. I took overdoses of the readily available drugs and was even rubbing Paracetamol in my mouth, all to no avail. In the morning, I was the first in the dental clinic, with the singular ambition to get rid of the tooth, by any means necessary. They wanted to save the tooth by performing root canal therapy the next day, but I was not having it. I insisted on an immediate operation and removal of the offending tooth. Yes, I have a gap that meat slips through now, but, believe me, I have no regrets.

The professor’s pain

The professor came to my clinic one fine day. He was in serious pain. His back and both legs were so painful you had to pity him. He had severe arthritis in the spine with pressure on his nerves. He did agree, easily, to an operation on his back. He was in that much pain, he proceeded to have the operation without telling his wife, in case she attempted to persuade him otherwise! He would gladly have subjected himself to an amputation, if it would relieve the pain.

Different strokes

You may think that the professor and I are wimps, who cannot withstand a little pain. But, the pain we had was worse than that of labour. Of course, men also have a higher pain threshold than women. Especially black men, like me: except of course, for my mother in law. She is 80 and suffers from arthritis in the knee. She actually needs a new knee but will not have one, because her pastor says not to. Apparently, she cannot die with an artificial implant in her body. So she bears the pain, daily, every single minute of it. She is one tough cookie and I do not think they make them like that anymore. Sadly though, because of the pain, she does not wish to live long. When you wish her long life, she vehemently refuses to say Amen.

The fact is that everyone copes with pain differently. How are you coping with your pain? How are we managing pain in Nigeria? How should we be managing pain?

How are you coping with your pain?

Understanding your pain and being able to tell the doctor exactly how it is affecting you is important. That means knowing what is happening to your body and how, when, why and where. The way pain is influencing your mood, sleep and life in general is also important for the doctor to understand.

There may be things you can do to make your pain bearable. Talking to family and explaining things to them is important so they can give necessary support. Avoid unnecessary and dangerous drugs, concoctions, processes and procedures, that are unproven and may be harmful is important. Some people have allowed themselves to be scarified in different parts of the body without the pain being solved.

Do some physical activity, if possible, and consider others such as breathing exercises, body scan therapy, physiotherapy, massage, acupuncture, and physical exercises and aerobics therapy. These are known to have many benefits. Apart from improving physical health, other benefits include stress relief, improving sleep and additional benefits from socialising.

How are we managing pain?

Not very well it seems simply from anecdotal experiences. The commoner drugs such as Paracetamol and Ibuprofen, Diclofenac are sometimes misused and abused. There are other drugs such as Amitriptyline, Carbamazepine and Gabapentin which are also not often used to the maximum dose before being substituted. Drug combinations also do not take into consideration, the mode of action and duration of action of the drug. This means that the same types of drugs are used instead of drugs that work through different mechanisms, thus making pain relief more effective. We also have an irrational fear of the pretty strong pain killers due to ‘possible’ complications. The inability to use the drugs in safe mode cause many doctors to avoid them. A patient with terminal cancer was once refused opiates because of the fear of addiction! We do have some drugs but lack easy access to more serious pain killers.

How should we be managing pain in our patients?

It is important to listen to the patient and understand their pain. The history is vital to determine how the pain is affecting their lives and the importance of the pain to them. Pain can be acute or chronic and both can lead to psychological, physical, emotional reactions in the individual. The pain can also be the horrible ‘nociceptive’ pain (the type pain suffered by my mother in law) or the even more horrible ‘neuropathic’ pain (the type of pain suffered by the professor) due to problem with the nerves. Determining which kind of pain it is or whether it is mixed is important. There are different drugs for each type of pain. Before drugs of course, you need to make a firm and solid diagnosis of the underlying cause of the pain. Remove the cause and pain goes away, avoiding the need for drugs!

The way forward

Developing pain clinics and pain specialist services is important. A pain management team is an important group of people that should be in every hospital and are charged with managing serious acute/ chronic pain in patients. Cancer pain, post operative pain and pain without a firm diagnosis are all in the remit of the team. They have special ability and skills in diagnosing and treating pain with multiple arrays of effective therapies. The team is multidisciplinary and involves psychologists and psychotherapists as necessary. The team also has a wide variety of drugs at its disposal.

Their mission is to reduce acute and chronic pain to its least possible level, to restore physical functioning by increasing activity levels and to decrease the psychological impact of pain on the person.

Ask for the pain team in your local hospital.

5 comments:

sunday salami7 November 2012 22:35

Nice write up sir . We actually under treat pain, especially post operative pain. Most times the most junior member of the team is left to write the post operative treatment without clear guidelines on what to do.
Thanks for throwing more light on this topic,as an orthopaedist >90% of my patients have pain as part of their complaints so pain is my big enemy!!
Reply
biodun ogungbo9 November 2012 14:02

True talk. We under treat pain and this sometimes lead to unnecessary complications for the patient. We need to talk more about this and do more seminars on pain in collaboration with pharmaceutical companies.
Reply
shade24 November 2012 05:35

Very interesting article. I have been having this nagging pain on the left side of my body for about six years now. I can not lie on my left side, so most times I sleep on my right side or on my belly.

I have been to some hospitals and given some pain relievers like ibuprofen and diclofenac. No doctor has been able to tell me the cause of the pain. At first I thought it was because of my teeth. I went to see a dentist and was told my teeth can not cause such a pain. I gave up using the pain relievers about two years ago and decided to do some research myself.

Fortunately, I came across an orthopaedic discussion forum online last month. I found out the pain was from my hip because my legs are not equal. My left leg is longer than my right so I tend to put most of my weight on it. I had a fracture of the right tibia about 13 years ago so I'm thinking that might be the cause of the difference in lenght.

I have looking for an orthpaedic hospital in abuja when I came across your site. I am still looking for hopefully I might get one because I am tired of going to hospitals without result. Some doctors in Nigeria won't even listen to you all they do is just take notes and prescribe drugs. By the time you go there about three or four times they are tired of seeing you.

Please keep up the good work, I will definitely be following your blog. Thank you.
Reply
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Dinner with the devils in the health sector

There are two facts you need to know.

One

There are about 36 neurosurgeons in Nigeria and perhaps on average, one neurosurgeon for 5 million Nigerians. There are 4 neurosurgeons in Abuja (FCT) and 4 in Lagos. There are about 6 in Ibadan and 5 in Enugu. It is important to note that most of the neurosurgeons are in the big cities. This means that the vast majority of Nigerians especially in the rural areas have no access to neurological services.

Two

When I pray, I pray for good health, long life and prosperity. I do not pray for money.Money and material wealth are important for daily living but do not rule my life. The most important ingredient for a great life is actually abundance of good health. For instance, no amount of money is enough to treat stroke, spinal cord injury or cancer. Better therefore, to pray not to have any of these diseases! Better than just praying, is to actually, actively prevent them from happening to you!!

Sorry, I digressed

If there are 36 neurosurgeons in Nigeria and there are 36 states in the Federation; it would be great if each state had a neurosurgeon and full facility to offer neurological services: this ensures a nationwide cover. Then, access would be increased and these centres could build and develop for the future, increasing the training and yield of neurosurgeons for the country.

Each centre would need a fully functioning emergency admission facility, ward, staff, equipped theatre with necessary consumables and possibly an intensive care unit. The hospitals or at least the local area should also have capability to investigate neurological problems. This means access to a computer tomography (CT scan), magnetic resonance imaging (MRI scan) and x-rays facilities as necessary. The manpower requirements are vital as the staff need special training and orientation in neurology. Neurological diseases such as stroke and head injury require urgent management and often cannot wait till the next morning. Someone may die or be severely disabled as a result. You waste time, you lose brain is the common adage. You need staff to be on their toes all the time.

Armed with the desire to help and the foregoing information, how can the states without neurological services, ‘acquire’ their own neurosurgeon and thus, develop the practice as highlighted above?

Contact with the devil

You take a plan, proposal or an even just an idea to a director, commissioner, minister or a Governor. If you are lucky, they might reject it outright and be done with it. If not, they might reject it and then surreptitiously rebrand it, and implement it as their own creation. They may (very, very rarely) adopt the plan and move swiftly to implementation. Or of course, they may sit down with you and try to work out the sharing formula as you implement the program. That is crunch time.

Dinner with the devil

Our people in positions of authority appear to be ‘instinctively corrupt’ and do not seem to have the interest of Nigerians at heart. There is apparently systematic corruption inbuilt to fail Nigeria at every level. Many people now have a medical condition called ‘what is in it for me syndrome’. Everything must lead to some immediate monetary value for them and they seek all opportunities to defraud the treasury.

So, acquiring a neurosurgeon and setting up a neurological service, is immediately seen as a veritable means of acquiring wealth. Okay, so now they are wringing their hands and already calculating how much money might drop from this new venture to bring a practice of neurosurgery into being. In my short time since returning back to Nigeria, I have become aware of Chief Medical Directors who (when asked to buy equipments) procure cheap, refurbished, degraded equipment at huge expense and force the staff to accept and use them. They buy through their cronies or conniving middlemen (and never directly from the manufacturer!) in return for a share of the cost. So what if the equipment fails to work? It means the contract has to be re-awarded: more money to share!

At the expense of fellow Nigerians

There is a state in Nigeria which has employed foreign doctors as specialists in its hospitals. These people are paid in dollars for providing substandard care for the people. But, of course, some official is benefitting from the misery of the people. Take also the case of a hospital in Abuja. It was recently reported that the hospital is run by a business woman without any executive oversight by a Nigerian medical doctor. The doctors employed there are said to be ‘juniors’ and not the fully trained specialists they claim to be. They were also apparently hurriedly registered (under duress) by the Medical and Dental Council of Nigeria. Even though tales abound about this hospital, it is still in operation. There are Nigerian officials benefiting from the largesse of the hospital and therefore offering it protection. At the expense of the people!

Foreign fodder

Many Nigerian neurosurgeons and other doctors in the Diaspora are eager to return home to help. The few that have made the effort have been frustrated at the dinner table of the devil. The returning Nigerian doctors are not made welcome. Many are treated as foreign fodder, used and abused. It starts with the pressure from home based players in position of power who feel threatened and insecure in the face of new knowledge. There have been numerous reports of rejections and outright hostility from home based doctors. I even met a doctor whose life was threatened by another local doctor for thinking he can come back home and compete for patients. One doctor was reportedly attacked by paid assassins. Should we not be creating a favourable environment for these trained doctors to come in and contribute to the development of the health sector? Which we all agree is in shambles?

Coming back home creates more jobs for the average Nigerian. The doctors come back with skills and funds to open new practices, explore new ideas and new treatments. They can also increase the employment of nurses and other allied staff, thereby creating more jobs for youths. But to work in the public sector means dining with the devil. Yet, it also means some improved access to enhanced healthcare for the majority of Nigerians. The Diaspora can create more food at the table of more Nigerians.

Dessert at the devil’s table

The quandary is simple: To dine with the devil, lose your morality and succumb to the corruption: if it leads to the provision of the aforementioned services or to eschew corruption in all its ramifications and therefore, we continue as we were? Or is there a middle ground? Can you lose your morality, perhaps for a little while, in order to save more people? This means just eating dessert with the devil and skipping the main meal. Perhaps this is a bit more palatable and easier to digest?

Or perhaps do what the Indians have done, by opening mega private hospitals that provide cheap care for the poor and charge expensively, the rich, who end up subsidising health care. It also might open up the vista for medical tourism to Nigeria. Is this therefore the answer? That, the neurosurgeons, can open up private neurosurgical hospitals in part partnership with the public sector to provide services for the people. Of course, I have used neurosurgery for my analogy, but this could easily apply to other services and specialists that are sorely needed in Nigeria.

Menus please!