Patients lament service quality, medical staff attitude
Disgruntled care providers, poor services
By Azoma Chikwe
In the evaluation of quality health care delivery, variation exists between developed and third world countries in terms of facilities, service delivery, patients/staff relationship and waiting time for treatment. Despite the difference that may exist in the evaluation of quality service delivery, patients all over the world are increasingly concerned about their health and are demanding improved service delivery.
The assessment of quality of service delivery in public hospitals had traditionally been based on cure. Some aspects of care such as interpersonal dynamics which involve: Patients’ satisfaction, patients /staff relationship, quality service delivery and waiting time for treatment are often ignored. Quality service delivery has been a recent issue in Nigerian public hospitals /
Impact of strikes on the system
An interesting scenario played out in 2014. After a strike that lasted about two months, all resident doctors in Nigeria were sacked; the industrial action was then called off and the doctors were re-instated. The action which cut across public sector hospitals in Nigeria continued for over two months despite the ongoing Ebola outbreak at the time, probably the most important health emergency faced by Nigeria in recent times. Doctors’ unions insisted on continuing the strike despite on the president, to call it off.
After the issues were resolved and the doctors went back to work, it did not take a soothsayer, given the pattern of preceding years, to predict that a strike by non-medical colleagues in the health sector, would follow. JOHESU, the main body representing non-medical staff in the health sector went on strike in November 2014, leaving most public hospitals barely functional. Again, appeals by many Nigerians fell on deaf ears. Many patients suffered the consequences. Despite the discontinuation of their salaries by government, the strike continued. This pattern reinforces a continuing cat and mouse game relating to relative status and pay between doctors and other health sector workers in Nigeria. The interest of the patient never featured in these discussions.
When Prof Onyebuchi Chukwu was appointed Minister of Health in 2010, he stated as part of his “Action Push Agenda for Health” that one of his top priorities would be achieving “team work and industrial harmony”. As is the practice by government, a committee was set up ; The Presidential Committee on Industrial Harmony in the Health Sector. It had 42 members with Justice Bello Abdullahi of Zamfara State as chairman. The committee produced a draft report which was not released. In 2013, another committee was set up; this time, it was termed the Presidential Committee of Experts on Inter-Professional Relationship in the Public Health Sector to end “unhealthy rivalries” among health care professionals. It was led by Alhaji Yayale Ahmed, former Head of the Civil Service and its terms of reference included a review of the draft report of the Bello Committee to produce recommendations for implementation. The Ahmed committee submitted its report in December 2014 and some of the health sector unions rejected some of its recommendations.
While the government can go on setting up further committees, at the end of the day, there are some tough decisions to be taken, which is what leaders are elected to do. Now is the time for the President to study this report and make firm decisions for the health sector. Government cannot continue on the path of granting each union their requests, even if it is unreasonable, because it wants to prevent or end a strike..
For all these strikes, there is an assumption that whenever the actions are called off, patients will return. This same assumption was made for many years by staff of NITEL and NEPA. Strikes by health care workers are slowly and irredeemably destroying Nigeria’s public healthcare system. With increasing access to India health care, no one who can afford it stays in Nigeria for serious ailments. At the same time, there is increasing interest and funds being devoted to raising the quality and lowering the cost of delivering health care in the private health care sector. What this means is that patients are getting used to seeking their healthcare outside the public sector, in the same way that we got used to making phone calls through private sector suppliers when NITEL failed. If patients do not attend public sector hospitals, then governments will have to consider alternative ways of delivering care. One option may be re-thinking the tax funded model of health care delivery completely.
Apart from the introduction of user fees, the principal structure of how we deliver health care through the public sector has not changed since independence. We have a tax-funded system, including user fees with very little regulation or quality assurance across the various tiers of government. Tax-funded models for the delivery of services in Nigeria have failed across all other sectors and there is no reason to expect that it will function in the health sector. The failure of successive governments to deliver services to the population, means that expecting a tax-funded social model of health care delivery to work in this country will not work. And no – we are not suggesting privatization! There are several other ways of using public funds to deliver health to the poor other than directly funding and managing hospitals and clinics.
In the absence of a strong government with a culture of accountability, health sector workers will continue to hold the government to ransom. A doctor at a teaching hospital put it simply : “As long as my salary comes from “Abuja”, there is really nothing the CMD (Chief Medical Director) can do to make me work. The only reason I go to work, is out of a sense of duty, many of my colleagues rarely do.” While we are not suggesting that this culture is representative of health sector workers across the country, at the moment, there is almost no relationship between the health care services provided and pay; right now, we have a system without accountability.
While the new National Health Act offers new accountability mechanisms, such as standards regime for tertiary hospitals and the classification of health services as essential services; given the myriad of problems in the health sector, implementation will be challenging, as trust is broken.
Popular view has always been that there must be mechanisms for health sector workers to seek redress over issues other than strikes. Our fear is that it is almost too late: strikes have almost made the care provided in the public sector irrelevant to most Nigerians, as most patients now seek alternative sources of care.
Until the interests of the patient is the centre of health care professionals provide, striking for their own benefits will only take healthcare workers down a road of no return: the “NITEL” path.
Disgruntled care providers
According to a Consultant Surgeon, Dr Emmanuel Enabulele, “there are too many patients and few doctors. Nobody respects health workers, nobody regards them, people behave as if they don’t value them. At a place in Lagos, you don’t see a doctor like that, they will give you a card. Before you see a doctor, you pay some money. You need to see what patients go through to access treatment.
“Even to see a doctor in a teaching hospital is a big problem. Usually, teaching hospitals have emergency departments that work 24 hours. Then, every department has an an out-patient unit.Surgery department, for instance, has its own out-patient department and clinic days. Same for paediatrics, oncology, cardiology, obstetrics and gynaecology etc. They all have their out-patient departments and clinic days. That is the organisational structure, it is standard all over the world.
“So, seeing patients depend on the clinic days of the department, but the emergency room receives all patients and refer to the appropriate departments. If the patient is lucky to come on the day that the department that handles his case has clinic day, the patient can be refered right away. There are some departments, because of the nature of their specialty, they run out-patient clinic everyday, but different units, for example, Obstetrics and Gynaecology.
“In an obstetrics and gynaecology department, there may be up to 20 units headed by a professor or associate professor and each unit have their clinic days. But, you don’t expect a department like neurology to have clinic days everyday because of the low number of patients that need their services. This organisation is all right it is the standard organisation everywhere in the world. And each hospital has its own peculiarities depending on the number of patients they are handling. They do their organisation to fit them and position themselves for effective services.
“But that has nothing to do with what goes on in there. The first point to note is the attitude of the nurses and the level of disgruntleness. Patients are complaining because of quality of services delivered. Nobody that is sick will want to see a caregiver who is disgruntled and feel he or she is in the best of hands. The health workers are disgruntled because they don’t have enabling environment, poor remuneration, things like lack of hospital consumables like drugs, toiletries, soaps and even water to maintain a good environment. The morale of doctors with regard to remuneration is very important.
“Attitude of the caregivers, like the nurses. The rivalry between the doctors and other caregivers has been on-going and been there. This can only happen in government hospitals. You go to a disgruntled environment, what you get is a disgruntled service, where everybody is a liar. When you are disgruntled, you don’t undermine the system, but you are not ready to go the extra mile. You just do the best you can. This leads to braindrain and medical tourism. There is a cream of people that are benefitting from medical tourism.
“Brain drain started in Nigeria in 1994. Why haven’t we learnt since that time. If we have any opportunity to reverse medical tourism, it is now that Nigerians do not have foreign exchange to go for medical tourism. The government should put its house in order. We should listen to experts. Unfortunately, some of us who are activists, when we they get into govovernment, they look the other way. The worst offenders are the Chief Medical Directors who will not talk about what is going on because they are government employees.
“The country cannot continue this way, it cannot survive that way. The issue is not all about pumping more into system, it is possible the more money you pump in, the more corruption, and the more money is filtered away. The money should go into remuneration. It is about organisation and knowing where emphasis should be. People should know that things that matter most in a nation are schools, hospitals and factories.”
Sad picture
The sad news about the sorry state of the nation’s health care delivery system is coming in torrents. Just as Nigerians are trying to get over the embarrassing shock that a certain school certificate holder, one Okpeh, got away with the falsehood that he was a medical doctor for nine years, they are being informed that the equipment in half of the country’s hospitals is out of service. A multinational corporation, General Electric, dropped this bombshell recently in Lagos. This, definitely, is an added strain on health care delivery, and it seems to confirm an earlier report by the World Health Organisation (WHO) that 50 to 80 per cent of medical equipment in low-income countries, including Nigeria, is out of service.
Over the years, the situation of the health sector has remained worrisome even to non-professionals. President Muhammadu Buhari, in his first coming as a military head of state in 1983, described the nation’s hospitals as mere consulting clinics. When General Sani Abacha took over more than a decade later, he said the same thing. And going by this report from outside the nation’s shores, not much has changed. The days, our hospitals were consulting clinics, many people believe those days were better than now’s view, at least, there were doctors to consult. They were well trained and had the zeal to work. They did not brazenly divert hospital materials and patients as is so pervasive today. Even if they had to do it, they were discrete about it, like people with conscience. In those days, there was the out-of-stock syndrome, but, today, it has been replaced by a deliberate and knowing predilection to patronise fake and substandard pharmaceuticals. Also, part of the problem then, and even now, was under-funding and, in some areas, misapplication of available funds, ill-trained personnel as well as a misplacement of priorities.
To worsen an already bad case, corruption has permeated the system and is threatening to suffocate what is left of the rot. Most of the equipment classified as unserviceable were, indeed, discarded as scrap in foreign countries. Unfortunately, some corrupt Nigerian officials will travel there, at state expense, to pay for their refurbishing and then bring them into the country as new. The situation would have been more tolerable if human lives were not at stake – the lives of the poor who mostly depend on public health institutions as they cannot afford the huge bills of of private hospitals. Ironically, those behind this mess are usually sponsored by government to get medical treatment abroad, their families inclusive, whenever the need arises, in what is referred to as medical tourism
Why the heart is most important organ
By Chukwunyere Akunna
The heart is arguably your most important organ after the brain, making sure that it’s operating at an optimal level. It is key to a life of health and longevity . The heart is a muscular organ about the size of a fist,located just behind and slightly left of the breast bone. The heart pumps blood through the network of arteries and veins called the cardiovascular system.
Facts about the human heart
The human heart is roughly the size of a large fist. The heart weighs between 10 to 12 ounces {280 to 340 grams] in men and 8 to 10 ounces {230 to 280 grams}in women. The heart beats about 100,000 times per day and {3 billon beats in a life time}
An adult heart beats about 60 to 80 times per minute
New borns heart beats faster than adult hearts,about 70 to 190 times per minute
The heart pumps about six quarts[5.7 liters} of blood throughout the body
The double-walled sac called the pericardium,encases the heart which serves to protect the heart.
Functions of the heart
• The heart pumps blood throughout the body via the circulatory system
• It supplies oxygen and nutrients to the tissues
• It removes carbon dioxide and other wastes
• The contractions of the atria and sends impulses to the purkinjefibres also called the “purkynjefibres”
Heart –friendly Foods
Foods that help build and keep the heart in good shape are: almonds, avocado, beans, blue berries, dark chocolates,garlic, green tea, oatmeal,olive oil,oranges, red wine, spinach, sweet potato and water melon
Heart exercises
• A brisk walk for at least 30 minutes a day
• Running
• Jogging
• Stretching
• Strength training (YOU can use weights)
Swimming (mostly recommended for those who have joint problems)
Regular exercises help you to;
• Burn calories
• Lower your blood pressure
• Reduce LDL “bad” cholesterol
• Boost your HDL “good” cholesterol
Diseases of a neglected heart
• Rheumatic heart disease
• Hypertensive heart disease
• Ischemic heart disease
• Cerebrovascular disease
• Inflammatory heart disease
• Peripheral arterial disease (pad)
Heart attack
Heart failure
