The Sad Reality!
It was my lifelong dream to add the highly respected prefix “Dr” to my name. The journey to achieving this feat, I must admit, was not smooth. It was very tedious and emotion laden; right from getting university admission for the study of medicine to the actual completion of the course, emotions flew. After spending about three years on the course, I began to ask myself such silly questions as “am I sure this is the right path for me?’’ Regardless, I never relented on my medical dreams.
There was abundant joy indeed when I had my induction ceremony and was ushered into the medical world. Now, I must confess, the compulsory one-year internship after my induction was an eye opener to the numerous challenges where health care delivery in Nigeria was concerned.
As a new intern, it was routine to hear my senior colleagues repeat times without number that the worst and most challenging disease is “Financial Constraint”. This statement I initially found quite absurd, however with time I got to understand its true meaning. Most citizens shy away from proper hospital care where I am from due to lack of funds. They would rather patronize the traditional “Herbalists” or resort to self-medication with their very shallow medical knowledge. Those who eventually make it to the hospital end up being held back by the hospital’s management after adequate treatment due to their inability/failure to settle the accumulated and huge medical bills given to them.
Strictly speaking, it may be unfair to blame these patients, considering the country’s current economic recession. Worse still, inflation has set in and is affecting every commercial activity in the country. Prices of most goods and services have doubled. Many people are consequently found to shun ‘expensive’ orthodox medication and instead self-medicate or patronize traditional medical homes.
Besides, we generally have poor health seeking habits in my country of origin. This can be attributed to the poor knowledge of various clinical conditions and of course, the lack of funds. A number of patients’ relatives I interacted with during my internship program felt clinical investigations were unnecessary. About 80% of them saw the numerous investigations requested by medical doctors as the hospital’s master plan to extort money from them. To say that a lot of them were clueless about the use of clinical tests/investigations is an understatement. I discovered that very few patients’ relatives actually knew what their wards were being managed for.
So, it dawned on me that talking medical jargons in the presence of patients and relatives was in no way beneficial. Strange as it seemed to my colleagues, I started taking time out to converse with the patients and explain in lay man terms their clinical conditions as well as carry them along on every step taken to resolve their wards’ medical issue. Many of them thereafter became more open to carrying out clinical investigations; they were ever ready to pay for the clinical tests because they now understood the significance of those investigations.
The federal government in my opinion has also contributed greatly to the challenges of health care delivery in the country. It is evident that the health sector is not a priority to them, judging by the meager percentage attributed to the health sector each year. This, I must say is quite disturbing as the health sector is arguably one of the most important sectors in the country and our leaders have woefully failed to recognize this.
The National Health Insurance scheme (NHIS) established by the government to help its citizens get health care at affordable costs has failed in its objectives. The scheme suffers restricted coverage as it is still limited to the public sector due to lack of commitment and political will. After interacting with a few patients on the scheme I got to know that only a few clinical requirements were actually covered by NHIS. Most of the patients complained bitterly and were tired of using the National Health Insurance Scheme.
Coming home to where it hurts the most, medical doctors in the country are grossly unappreciated. Little wonder why most medical graduates seek greener pastures in foreign countries. There is an obvious lack of incentives for medical practitioners in the country. Young Doctors are frustrated with working conditions. They embark on industrial strike actions occasionally with no impressive results. Infact, instead of the government reaching an agreement on their demands, they are either threatened with the no work no pay tactic or in really bizarre cases, sacked.
It is no news that the medical profession has been invaded by quack doctors with no medical qualifications whatsoever. Some of these quacks even have hospitals that have been set up for years. They end up causing more harm than good. This usually leads to several preventable deaths all in the bid to make money at the expense of innocent citizens’ life.
The human resources available at most government hospitals are way below standard. The few doctors employed take on more responsibilities than they can handle which ultimately leads to doctors’ fatigue and poor health care delivery. This situation is very disheartening, considering that there are many doctors out there desperately seeking employment at some of these hospitals but have been declined; all in the process of cutting cost.
It would be incomplete to talk about the challenges of health care delivery in my country without mentioning the illegal circulation of fake drugs within the country. The use of these substandard drugs has led to quite a number of deaths especially in the past few years. It is extremely frustrating to medical doctors to observe no improvement whatsoever in their patient’s clinical condition after several days on medication and the cause is attributed to the use of fake drugs.
It is a common saying that “Actions speak louder than words”. Yes, the recent economic recession has created big holes in many pockets. Surprisingly even the rich complain bitterly about the current high cost of living. But this, in my opinion should not lead to preventable deaths. There is a need to take necessary steps to put an end to this.
The truth is that, to combat these challenges effectively, each and every one of us including the patients, doctors, the federal government as a body and even employers have collective roles to play.
First, in order to improve the health seeking habits amongst citizens of the country, citizens have to be rest assured that they can handle allocated hospital bills without having to break the bank, and that they would get standard/optimum health care. It is common knowledge that my country is a rich nation blessed with numerous natural resources, but the corruption deeply seated in its roots has brought about gross mismanagement of these natural resources and funds. There should be a system in place to ensure transparency in the handling of our gross income and expenses in various economic sectors. This would put an end to the diversion of public funds into personal accounts and lead to redistribution of surplus funds allocated for use in some sectors of the economy to other more important sectors such as the health sector. To achieve this end, our leaders need to realize that a healthy nation is a wealthy nation.
On a second note, the National health insurance scheme should be privatized with proper monitoring of its progress. Employers should be directed to set up functional health insurance schemes for their employees and Government should make it mandatory. This would help alleviate the burden of financial constraints borne by working patients in hospitals.
Our Doctors should be accorded their due rewards/benefits to reduce the level of frustration experienced by them. In the past it was argued that medicine was a humanitarian service characterized by payment (reward)or no payment (no reward). I do not agree with this statement because doctors also have bills to pay and despite being service providers their services should not be trivialized with the humanitarian and no payment syndrome.
The Agency for food, drug administration and control must intensify its efforts in breaking the chain of fake drug circulation. The federal government should also allow them operate and ensure justice and fair play without fear or shielding/favoring whoever is caught in the business or web of fake drug production.
On a final note, these health care problems would never be solved without the collective actions of those involved, the federal government, the medical practitioners, The agency for drug and food administration, as well as the patients. It would be really great for my country’s health care system to stand tall with unequalled standards and it would also be a great delight to boast about my country’s health care system to foreign colleagues alike in the nearest future.
