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Why we’re building community clinics in South East –FNHE MD

‘How we built hospital from secondary school’

From Chidi Nnadi, Enugu

In the last six years, the Federal Neuropsychiatric Hospital, Enugu has witnessed rapid transformation that has made many who knew the hospital to marvel at the change.

From what could be called a make-shift hospital, it has joined the league of model hospitals even when the Medical Director, Dr. Jojo Onwukwe, said they were yet to hit the standard he has envisaged.

As the world celebrates the Mental Health Day, Dr Onwukwe explained the efforts they have made in upgrading the facilities, which they inherited from a secondary school. He also spoke of the 15 clinics the Federal Government is establishing in the South East zone, one in each of the senatorial districts, saying that the novel idea was aimed at bringing mental health care closer to the people.

Let us know when you started work at the Federal Neuropsychiatric Hospital Enugu?

I came to the Federal Neuropsychiatric Hospital Enugu in the late 1996. After the civil war, the Federal Neuropsychiatric Hospital Enugu was under the East Central State, but later under Anambra State and later again Enugu State. But the Federal Government took over the hospital in 1996, but that was on paper because the hospital practically started in April 1997. So, I came to the hospital on a transfer of service after my residency programme; my service was transferred from the Lagos University Teaching Hospital to the Federal Neuropsychiatric Teaching Hospital Enugu in 1997.

On your arrival, what was the psychiatric hospital you saw in Enugu?

Actually, in the first place there was no hospital so to speak; we met, like in the old system of psychiatry, a mad house. There were no wards, no gate, no link roads, everywhere was a farmland, the patients were sleeping on bare floor, there was no pharmacy, no departmentalization; everyday was clinic, it was just like there was no hospital. There was no lavatory for the members of staff and the patients, no water, no electricity, no power generating set, it was in a state of no social amenities with only dilapidated buildings. The Federal Neuropsychiatric Hospital Enugu was not a purposely built hospital. It was formerly New Haven Girls Secondary School Enugu. The then East Central State government had evacuated the students and brought in patients from the Eastern Nigeria Medical Centre. So, we started making efforts to build a hospital out of a secondary school.

So, how did you people manage under this difficult environment to take care of your patients?

These pictures I have painted here were before the Federal Government took over the hospital in 1996/97. When the Federal Government took over the hospital, the first medical director was Prof Ihezue; so with that we began to see federal presence, they started to make budgets, sending in money, and gradually buildings started springing up. So, we were able to have clinic days, Monday, Tuesday, Thursday and Friday. I was the person who made Wednesday not to be a clinic day for academics. So, we got a pharmacy, gradually a lab; we brought in light from outside, bought generating sets, put up buildings and other things that make the place become a full fledged hospital. We started converting the dormitories into wards, classrooms into wards, and teachers’ rooms into consulting rooms.

So what is your journey to becoming the medical director of the hospital?

When I came in I was effectively the only doctor on ground; Prof Ihezue and the other management staff brought by the Federal Government were at the UNTH for almost nine months. The whole administration was there, the management was sitting there; I was the only doctor on ground at the hospital here. I had 24-hour calls, I will see patients on emergency, I was also seeing patients in the wards; on clinic days I book patients for Mondays, Tuesdays, Thursdays, Fridays alone, all through 1997 and some parts of 1998. I was doing everything to sustain the place. There was no medical record and we created one and files started coming in. So, as the Federal Government took over the place, finances started coming in and we started making budgets annually and things started moving up. So, I started as a senior registrar one, later promoted to consultant two, later consultant one and finally I became consultant special grade one, that is the highest. Every four years one is promoted, so it wasn’t that fast.

In all, how many years did you spend before becoming the medical director?

I came in 1997, and it was not until 2011 that I became the medical director, which is 16 years of constant service in the hospital.

What are your achievements since you became the medical director?

Until I became the medical director in 2011, there was no administrative block; so I started the two-storey administrative block that is now housing all the administrative departments. Before now, you have to go from one department to another in different buildings, wasting man-hour; today, we are all in one building and this makes our work more efficient and conducive. I also started the e-library, which is very important for accreditation. The Federal Neuropsychiatric Hospital trains post-graduate medical doctors and nurses, so a functional library is necessary for the accreditation of school of psychiatric nursing and also mandatory for accreditation for doctors since we are training people to take their West African College of Physicians examinations in psychiatry and also the national post-medical college; so the library is important. I also started the School of Psychiatric Nursing, when I came in 2011, I pursued the accreditation and we got it, so we are having 100 per cent all the examinations. I also added the extension of their demonstration room; we have also created car parks in the hospital, done some erosion control and construction of a hall for lectures and other things that are at over 75 per cent completion level.

What are the major challenges?

Our main challenge is not essentially in infrastructure, but inherent in the case we are treating, what I will call the stigmatization of both the patients and the caregivers. Once you say that you are a psychiatrist in any gathering, people will look at you a second time to know whether you are okay because they would say they are like their patients. Because of that stigmatization we have in the budget of 2016, what we call advocacy and awareness programmed in the South-East zone. It became imperative for the South-East because the stigmatization we are talking about is in the zone. So, now if you are getting married to any family or somebody is coming to marry from your own end, you will ask them whether they have epilepsy, mental illness in their family because the Igbo man abhors mental illness, they don’t want to be associated with the mentally ill no matter what it is. The culture of the Igbo cosmology believes that mental illness is caused by the demons or either by somebody sending some juju to you or any kind of influence, that it does not just come like every other illness. So our duty now is to try to convince the populace that it could be like any other illness. Like many would ask, why are they not getting well, but at times we too would ask that some people are hypertensive, why are they not cured, some people have diabetics, why are they not cured; so mental illness by and large is manageable and could be controlled, but these are the major challenges.

What is the idea behind the three community clinics for the three senatorial zones of the South East region and the advocacy?

What we want to do is to channel into the mental illness project advocacy and awareness programme, that is, training, educating, talking to people and reaching to the grassroots population to tell them what mental illness is all about, to tell them the symptoms they will notice and observe in the patients and relations and they will know that something is wrong; not necessarily the naked people along the road. If you are hearing strange voices, thinking that you are the only right-thinking person on earth, behaviour considered impossible in the culture of the patient or the individual, some of these people might be hearing strange voices, being happy for no obvious reasons or unnecessarily sad for no reason. For instance, if there is something that can bring happiness, we expect one to be happy for some time and get back to normal situation, but not excessively being happy for days, or weeks, this is wrong. Number two, it’s having clinics established in three senatorial zones in all the five states of the South-East. This is aimed at pushing the treatment of mental illness to the doorsteps of the people. Now, after treating them in our hospitals, we want them to go back to their nearest health centre for continuous management. The next aspect is how to make it continuous because they are not going to be white elephant projects. We are going to send our nurses from the Federal Neuropsychiatry Hospital to man those places and we will be paying their salaries. Many of them have already indicated interest to go to work in their communities where the facilities are being sited. We will redeploy them and be paying them salaries from here. We are not going to hand them over to any local government or individuals, we will still be maintaining and controlling them and from time to time, we will be sending our resident doctors to know what is happening there. So our standard will be maintained while we control the centers. So, we pushed for the establishment of community clinics in the South East zone, which is our novel idea, and got it approved in the 2016/17 budget. As we speak, we have completed the three clinics in Enugu State, two in Ebonyi State, one in Imo State while we are hoping to begin those for Abia and Anambra states as soon as we get more funds.

What have you done in training and retraining of your staff?

During my first tenure and part of this second tenure, I have sent many people to ASCON in Badagry for training; people are going for workshops despite the meager resources we have at our disposal. We have also sent some staff to the United Nations Drug Centre for Substance Abuse for training.

There was a time the management of your hospital and the unions were in loggerheads, what is the situation now?

Yes, we had some crises sometime; there were series of petitions by the JOHESU members. I think it started with some people who were interested in the position of the medical director, people who do not want to follow the line of doing things, people who wanted the position by all means. Some people were instigating them and they started writing petitions that Dr Onwukwe should go, but it was the act of God that one day the JOHESU came to me to make peace and we made peace. I also appealed to their conscience and they realized it was not good and necessary to continue writing frivolous petitions, so they came back and we made peace and we are all savouring that peace now. And during the crisis in the hospital, the Minister of Health, Prof Isaac Adewole came personally and appealed to the JOHESU people to sheathe their sword; I think his coming to the hospital at that time did a lot of work because the JOHESU then saw the other side of their story. Today, there is complete peace and we are putting efforts together on how to further develop the hospital.

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