(32): Re: Misdiagnosing patients in the Nigerian healthcare system

The article last week on the above subject attracts a lot of attention, and I would like to share one of the reactions that provided another perspective, sent  by Dr Suleiman BM (mbskt@yahoo.co.uk ). Jameel

 

I decided to take some time out of my busy schedule to contribute on this important topic. First of all, I am a medical doctor. Wholly trained in Nigeria by the Nigerian educational and health system. I am a Pediatrician. Secondly, I have been a hospital administrator as a CMAC from February 2009 to Sept 2012. Thirdly I have been involved in the training of medical students during my fellowship years between 2003 and 2007. I hold two fellowships of the National Postgraduate Medical College of Nigeria and the West African Postgraduate Medical College.

The problem of misdiagnosis happens all over the world, no doubt. We are however more aware of our own immediate surroundings. If one is in the field of public health, he will recognise that virtually all African countries and most Asian countries have weak health systems and are therefore battling these problems.

One issue I have observed during my time as a resident doctor is the “quality” of students being admitted to study medicine. When the student is admitted because of who he knows, not merit, the result will surely be what we are now experiencing. But as a hospital administrator, I will tell you we see the quality of the products being churned out as house officers from our universities. Yes, I agree that the standards have fallen. But many are still good.

 

The bad ones are still few and with adequate supervision, you can polish most of them. Medicine is an apprenticeship programme. After you get the knowledge, you need to work with an experienced senior doctor to get the needed skills to practice adequately. That is where most of our governments have gotten it wrong when young graduates are allowed to function and practice alone without supervision. We do need to get back to the drawing board on the issue of adequate experience and on the job training.

We should not forget that all medical equipment are now essentially computers. One thing that is common with all computers is that they are shut down, not switched off. One big issue we face as administrators in provision of equipments in the hospital is constant breakdown because they are switched off many times a day by PHCN.

 

The health service sector cannot work in isolation. If power is not improved upon, we should forget about getting state of the art hospitals that are affordable. Go to Redington and Lagoon hospitals in Lagos. They are state of the art, but not affordable to generality of Nigerians. Have you ever wondered why hotel fare is more expensive in Abuja than in London? The government needs to generate power for us to progress; otherwise, progress will remain a dream.

However, more than 70% of cases presented to hospitals can be diagnosed by the bedside with minimal investigations. To me, the most important issue we need to address is with all of us Nigerians… attitude. We talk of empathy in healthcare sector as against sympathy. I was at the Nigerian High Commission in London on Monday. I saw a small Nigeria within London. Even the community surrounding the commission has not changed our ‘ways’.

We all need to work on our attitudes and love our brothers more than ourselves. I believe there is a hadith (saying of prophet Muhammad, upon whom be peace) related to that; “None of you is a believer until he loves for his brother what he loves for himself”, otherwise “your iman [belief] is not complete”. All health workers in particular need to change our attitude for our system to move forward.

I don’t know how many of us have been to a typical general hospital set up in Nigeria. I have worked in general hospital Katsina outpatient department as a young inexperienced doctor. I was presented with one hundred and fifty patients to see in one day. Even today, go and do a study in any general hospital. The story has not changed. I left general hospital because I could not cope with the work without cheating the system. I was feared for my iman. It is impossible for any doctor, no matter how good, to treat even hundred patients properly within one working day.

Like I said earlier, this is just a contribution, introducing the tip of the iceberg of the problems bedevilling the Nigerian health care delivery system. My advice, however, to all of us that feel we can contribute to the system is to go back home and see what we can do. I am in the UK for a master’s study. I will go back insha Allah when I finish. Some of us have decided we will remain in Nigeria and see what little difference we can make. And we can really do a lot.