How to improve trauma care, emergency services in Nigeria response services in Nigeria

Irked by the high rate of mortality arising from accidents and other emergencies, stakeholders have raised concern on the need to strengthen and improve the state of trauma care and other surgical and medical emergency response services in the national health care delivery system.

They noted that it is imperative to provide adequate system for trauma care and emergency response in Nigeria and West Africa, to ensure a reduction in morbidity and mortality arising from accidents or other medical emergencies, due to delays in ambulance response, first aid and hesitancy in rendering medical or initial casualty care, including those resulting from concern over cost of treatment defrayment.

According to experts, trauma has become a global public health problem with Nigeria recording over four million injuries and more than 200,000 deaths yearly from road crashes, a major cause of traumatic injuries in the country’s environment. Further statistics from the United States of America estimates that there are 60 million injuries per year, as 30 million need medical care, 3.6 million need hospitalisation, 300, 000 injuries cause permanent disability with 145, 000 deaths.

The stakeholders, which included policymakers, senior government officials, academics, non-governmental organisations, healthcare professionals from various health and trauma-related disciplines, converged at the 2019 Trauma Conference organised by Trauma Care International Foundation held in Lagos with the theme: Trauma Care: The Way Forward”, to proffer solutions on improving the state of trauma care and emergency response services management in Nigeria.

Minister of Health, Dr. Osagie Ehanire, said trauma is the leading cause of mortality in individuals below 45 years of age worldwide, accounting for about five million deaths yearly, with the casualty figures and impact much higher in Lower Middle-Income Countries (LLMICs), like Nigeria, where causative factors are legend and response systems weak or non-existent. He said the social impact or loss of such figures is serious, as families, especially dependants of victims, are left more or less abruptly, without economic support, coupled with the huge cost of mainly out-of-pocket treatment of victims, which leaves many families bankrupt, hugely indebted and often destitute.

Ehanire, who was represented by the Medical Director, National Orthopaedic Hospital, Igbobi, Lagos, Mustapha Alimi, revealed that as part of efforts to reduce the statistics of casualties from road traffic and other accidents, the Federal Ministry of Health is collaborating with other Ministries, Departments, and Agencies of government and the private sector, to support the Federal Road Safety Corp and other responding entities to develop a robust all-embracing response mechanism to mitigate the damaging impact of trauma from accidents on citizens and the economy.

“A financing mechanism is also to be established to guarantee payment for patient transport and treatment, irrespective of victim’s ability to pay or his economic or financial status at the time of presentation. This is a unique Initiative that is to pool and organise assets of both public and private sector, to ensure reduction in morbidity and mortality arising from accidents or other emergencies.

In his keynote address, titled, “National Health Act and its Provisions for Emergency Care”, the Chairman, Senate Committee on Health, Ibrahim Oloriegbe stressed that trauma is the leading cause of death in the first four decades of life, and is also identified as one of the major causes of death on a daily basis in Nigeria.

Oloriegbe who was Represented by the Country Director, United States Agency for International Development (USAID) Global Health Supply Chain Program-Procurement and Supply Management (GHSC-PSM), Mike Egboh, said appropriate and timely care given early could significantly improve outcome of trauma care, as majority of Nigeria’s highways are without plans for emergency rescue operations either by state or non-state actors.

He lamented on the bureaucracy at the reception of hospitals and health institutions, he said which poses obstacle to saving the endangered lives of victims of accidents who are evacuated through the help of individuals close to the scene of the accident, just as in the case of persons with gunshot wounds, who are required to provide police reports before care is given by healthcare providers, as failure to provide the report may lead to victims bleeding to death or dying from other complications.“The Goal of Emergency Care for Trauma is appropriate and timely care, this can significantly improve outcome from trauma,” he said.

The Chairman disclosed that the Section 20 (1) of the National Health Act, which was enacted by the eight National Assembly in 2014, frowns at misconducts of health workers, as it provides that, “An healthcare provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason.” He further said anyone who contravened this section committed an offence and is liable to conviction to a fine of N100, 000 or imprisonment for a period not exceeding six months or both.

“By prohibiting the refusal of emergency care and penalising the refusal to provide emergency care, the National Assembly underscored the seriousness which it attaches to emergency treatment considering that it is about saving lives through taking steps to fulfill the right to life,” he said.

Also speaking, the Lagos State Commissioner for Health, Prof. Akin Abayomi urged all healthcare workers to ensure they save people during emergencies, despite the unfavorable circumstances they might find themselves.Abayomi, who noted the government’s actions on trauma care in Lagos State, lamented the state of public transit drivers who are not in the right mental health or under the influence of alcohol while driving.

Speaking about the conference, the Chairperson of Trauma Care International Foundation, Dr. Deola Philips said the focus of the conference was to define the way forward for trauma care and emergency response services in Nigeria and the sub-continent, against the antecedent, which portrayed the fundamental challenges of poor planning and lack of sustainability. She said the solutions would alter the narrative by facilitating the processes and systems that alleviate the burden of injury afflicting the individual citizens, as well as the government through viable principles that would improve stakeholder responsiveness, education of the populace and health care providers and the execution of innovative, indigenous and globally-accepted solutions with the provision of a veritable networking platform for trauma care.“These programmes are targeted at increasing the pool of skilled first responders, strengthening of existing health care systems and facilities with significant successes recorded.

It is a solution- based convention to emphasise the possibility of an absolutely adequate system for trauma care and emergency response in Nigeria and West Africa, as well as to generate answers innovatively which can be tailored to every level in the health care system,” she added.