A Nation On Its Knees

A Nation On Its Knees

By Ibrahim Musa

One can hate Malam Nasiru El-Rufai but cannot doubt his wealth of knowledge and enviable gut to display brilliance even in the most controversial manner. It was he who recently provoked a debate on the state of the nation healthcare, in his weekly witty column on the back page of Thisday newspaper, when he wrote under the title ‘No Health No Wealth’. The plethora of responses that greeted the said explorative piece in many online blogs goes a long way to tell a discerning mind that our health system is just a time bomb awaiting detonation. Although he had summarized most of the problems in a most graphic manner with abundant statistics and case scenarios, nothing has underscored the tragedy of this nation health system more than the events that ensued immediately post the latest condemnable terrorist attack on the UN headquarters in area 1, Garki Abuja.

It was sad to have discovered that with any minor challenge the failure of this nation will instantly manifest. Only a few hours after the news filtered that the terrorists attack had caused causalities in the range of 40-60 people in addition to about 10-18 recorded mortality, there was wide spread attempt at mobilizing people to come and donate blood for the victims, because according to the good Samaritans that were circulating such messages, National Hospital Abuja could not cope with the demand for blood to save the victims. This should not happened under responsible setting since Nigeria like most of the countries in the world had created National Blood Transfusion Services (NBTS), in which it sinks funds annually with the aim of providing safe blood transfusion services for its citizens. However, there we were as a nation distressed in need of just a few pints of blood to save the lives of the workers of the highest diplomatic office in the world. I don’t know why it had to happen always this way, but I presume things won’t work because we refuse to ask the right questions at the right time and the right place. At most if everyone out of those 60 victims would require 4 pints each, we will end up with a figure of 240 pints, by far a negligible number to shout out for help. Even if we were to provide 10 pints for each of them we will arrive at only 600 pints. A functional NBTS could take care of thousands of request before reaching breaking maximum, but the reality is that NBTS is just on the papers; on ground what we witnessed in Abuja is the norm, which we will live with its embarrassment for life. Had it been the casualty figures are in the range of Tsunami’s, I wonder what kind of sad story we would be discussing.

The issue is, blood transfusion service is too important to be left unregulated and poorly coordinated. The safety of blood to be transfused must be guaranteed through serial high tech but simple screenings to minimize the attendant risks of transfusion. As at this stage very few blood banks can boost of doing at least P24 antigen screening to beat down the window period of HIV. Ordinarily we should be in the era of Nucleic Acid Test (NAT) to be 99% sure that we are doing more good than harm to our patients, yet we are stuck in the primordial stage of screening late antibodies that appear only positive in an infected a would be blood donor, perhaps several months not lower than 3 months from the point of getting infected. That is how rudimentary and unsafe our blood transfusion practice is in Nigeria. And sadly, that was what we proudly offered our loyal citizens, foreign diplomats inclusive.

If in the seat of power, where one expects everything to be well coordinated, we are still dragging feet to get the most basic thing right, it is indeed an unfortunate situation. Why the need of setting up NBTS and its numerous dysfunctional zonal appendages if at all we cannot see or access its services. Like the usual Nigerian mindset such bodies are just created as a conduit to siphon what remains of the country’s lean resources. Nobody really care to audit their performance and appraise the desirability of continuing with the ventures. Mediocrity seems the hallmark of most of these institutions populated by round pegs in square hole. What do we expect from such a stalemate whose managers only specialized in making staccato noise with no workable policy or plan? I am tired of usual ranting and rhetoric with no action plan. From a pint of blood we can derive many products and safely keep them for a very long period of time for anyone in need. Presently, we are wasting the products since at best only a few blood banks have the wherewithal to extract few components and store them. Rare blood groups like Rhesus negative blood an albatross around our neck when it comes to transfusion medicine. And the solution to this barrage of self-inflicted problems does not require a rocket science. It simply requires an efficient, competent, accountable and transparent system. These are challenge that as a nation we failed to surmount in the past 51 years of our independence. Like a child with congenital anomaly we have woefully failed to thrive and still fighting a teething problems at an advance age when we should be planning how to manage an inevitable menopause. What a delayed milestone that has broken the Guinness book of record! By and large the staff and management of National Hospital must be commended for rising up to the challenge and acted swiftly to save those lives despite all the constraints faced by the lack of support from NBTS.

Another sad story that has entrenched itself in our healthcare system is the ugly monster of unregulated advertorials by unscrupulous traditional herbal practitioners. While the law of the country is categorical on prohibiting indiscriminate use of media to advertise ones medical expertise, which seemed to be complied with by most of the orthodox medical practitioners, the case does not seems working with regards to the unorthodox herbalists who hides under the cover of alternative medicine with a dose religious toga to swindle unsuspecting citizens huge amount of money by promising heaven on earth through various unregulated radio and Television adverts. National Food Drugs Administration and Control (NAFDAC) and Medical and Dental Council (MDCN) are hopelessly handicapped in this regard since the purview under which these atrocities are committed is not under their control. This is also a clear case of lack of coordination, because one expects the National Broadcasting Commission to be up and doing and up to the task in sanctioning the erring media outfits that defy its orders and allowed their platform for reckless abuse of trust to dupe its listeners. Media houses have a duty to protect their listeners. Even though I can’t claim full knowledge on how media effect theory works under the setting of ethnography but it is obvious that many listeners consume the information they get via such outfits as gospel truth. I was severally accosted by people who fell victims of such scams and even came down with complications of the usually unhygienic preparations and concoctions that have the tendency to affect ones liver or kidney, or rather due to the progression of the disease that flare up unchecked due to their being denied the right remedy by those who promise them a miracle just to get away with a chunk part of their savings. I once read a famous legal landmark judgment on Contract Law in a case of Carlill v Carbolic Smoke Ball Company [1893]. The said company lost a court case when it developed a drug against Influenza and went ahead to advertise that any person who used it and come down with the disease would win a sum of 100 Pounds. Carlill used it and got Influenza but the company refused to honor the agreement on a superfluous argument that it was a general offer hence could not be taken seriously. The court ruled in favor of the defendant based on so many considerations including the reasonability of the offer. Based on that ruling many principles of contract law were discovered that protects the consumer rights. It was based on that that misleading advertising is considered a criminal offence because of its tendency to deceive the average consumer. As Professor Simpson aptly puts it "vigorous advertising is essential to success in the field of quack medicine."  And the only way to check such excesses is by proper regulation and prosecution of erring cases to serve as deterrence.

Overall, although health is important considering its major role in keeping a productive population that would enhance economy with vibrant labor force, the relevance it gets when juxtaposed with other sectors that generate revenue for the country is at best summed up as trivial. The decay we observe now in the health sector is largely due to the absence of inter-sectoral collaboration and the lack of political will to create an ambient atmosphere for one. Rather than reactionary measures, the problems of our health system require careful and meticulous plan, well thought out and pragmatically implemented. What we are faced with now should not be misconstrued as a cause but a symptom of systemic malfunctions of the various organs of governance, hence treating the symptom without identifying the root cause will not fetch us a good result at the end. It is plausible that we begin to see health as an asset where everybody must invest and own a stake for the common good. The usual trend of non-concern and nonchalant attitude on what is transpired in public sector should be seen as far-fetched, in this information era where we have freedom of information bill as law. Medics argue that, ‘a stitch in time saves nine’!

NB: I wrote this piece on 27/08/2011, and it was published a few days after by Thisday newspaper.