How to reverse brain drain, medical tourism, by Obaseki
Prof. Darlington Obaseki is the Chief Medical Director of University of Benin Teaching Hospital (UBTH). Obaseki in this interview with CHUKWUMA MUANYA, shares the secret of how to achieve industrial harmony in healthcare sector.
We were told about a 1000 doctors have left the country in the past few months and government hospitals like yours are currently having problems with recruitment. How do you ensure that these patients get the best of services with less number of doctors?
The country does not know what we are facing. Right now, the health system in Nigeria is nearly collapsing if we don’t tackle this issue of doctors’ emigration frontally. We are training doctors for other health care systems elsewhere in the world. The government of Nigeria spends lots of money to train me to where I am today and I went abroad for training. I never felt inferior to my colleagues; in fact they kept asking me if I trained in Europe and I would say ‘No, I trained in Nigeria.’ They didn’t believe because of the quality of training and education the federal government gave me almost free of charge, but I think there needs to be a major discussion on doctors leaving Nigeria.
There are some factors involved – there is the push and pull factor, there are things pushing them away. So many of our doctors will tell you insecurity, many have been kidnapped, and they want to go to a country where they don’t have to worry about light or water
You can’t overestimate the depth of crisis facing this country. Here, there is a cardiothoracic surgeon and the one that is supposed to do heart transplant. There are only two of them. If we lose them, that programme will crash. It is beyond me, it is beyond UBTH. It is a national crisis that should be attacked at the national level. I don’t have the figures of doctors that have left; the worst part of it all is they will say they are coming back. Because we can’t easily replace them, we give them benefit of the doubt. Why will anybody want to go to the dessert, Saudi Arabi, a kind of society where there is no freedom the way we have it here? To tell you, it is desperation not just about money
However, so many of us had the opportunity of travelling out. I have been out of the country, but I didn’t run away. I was on training for three months in Switzerland and I know how the western world operates. The environment is better, the working tools are there but there is always something missing, we are just like an insignificant cog. With or without you the system runs. But here, God has blessed some of us. Nigeria has been good to some of us but many people don’t see it that way.
At the cancer unit, we were told that the Linear Accelerator machine, one of the major equipment for cancer management, has been down since 2017. Why haven’t you been able to bring it back to life?
We set up a dedicated cancer ward just for cancer patients – about 40 beds only for cancer patients where we have dedicated and trained specialised cancer nurses, oncologists and pharmacists inside the ward. Two different centres have requested that we show them what we are doing. Cancer chemotherapy drugs are very expensive. Most times, when you buy one, you won’t use all of it but you are not allowed to keep it, so you have to throw it away and buy another one next time.
So what we did is, we set up a machine there, what we call micro dosing, that allows us if we buy one drug, we can share it among five patients. So that has crashed the cost of getting these drugs to cancer patients. We are the first center in Nigeria doing this and we can’t allow this go down. It requires a special chamber.
The linear accelerator – the cancer machine, has been down since I came on board. I have done a lot to try to bring it on. That machine was the only one taking care of the whole of the South-South of Nigeria, people come from all places to take treatment here. It broke down about seven years ago. Last year, I went to Dubai and I met the manufacturers. I even got a letter from Sweden and they agreed to give us two new machines and also promised to remove the faulty one and give us the latest model.
That was in January last year and they also agreed that they would spread the cost of payments over five years. Somebody just paid one-fifth of the amount. But COVID-19 happened so now we are back, looking for somebody to fund that. We are trying to get to the Federal Government but we’ve not been able to succeed. We are working on it, because like the one in LUTH it is a self-sustaining model. The volumes are there. We have done the business outlay, that N1 billion we will make it in one year. But to just get somebody to take the risk. I have met more than five different groups of investors I have a business case. I am a pathologist. My area is cancer so it is something I am passionate about and we are working on it.
We want to congratulate you on the innovations that have happened in this place, will you say these innovations have increased the number of patients and what has been the impact on the hospital’s revenue?
The question you asked is very pertinent, how has all these translated to increased confidence in our system by variety of increased patronage? To answer your question, we are overworked, the greatest problem I have with my staff now is not whether I care about them or whether I provide things for them, it is for them to slow down because the work is too much.
That is the problem, so in terms of Internal Generated Revenue (IGR), when we came on board in 2017, our IGR was N100 million, now, it is about N300million per month. We are the busiest teaching hospital in Nigeria and we are very confident about that.
The only hospital I probably will suspect that is close or better than us is probably Kano with a population of 20 million, but most other hospitals don’t even come close. So, we are very busy. If you come to our accident and emergency unit, at times it is like a market, so it is very challenging carrying this burden, it is also a burden but we have to do it
At a time many institutions are crying for funds to develop their facilities, you seem to be thriving. How do you manage this?
People have been asking me where I get the money used for these projects. I don’t think I know myself, but we have a plan. When we came on board, we sat down for three months and came up with a plan, we decided to focus on six areas; patients satisfaction, manpower training and development, staff satisfaction, research and technological innovation, inward medical tourism and lastly funding. If you go to the plan, we wrote how we intend to make money to fund all these beautiful things, but beside that, what I want to say is, it is all about efficiency of utilisation of resources.
We have a very vibrant works department with very young, brilliant engineers. Majority of the structural work we are doing in this hospital, unlike before when they were all on contracts, most of them are now by our engineers. We are utilising the little we have more.
Then of course, we are also getting more because there is more patronage, there is more money coming in. The bottom line is more efficient utilisation of resources and we are focused more on in-house utilisation of our manpower that is why we are able to do so many things.
What succession plans do you have in place?
I will tell you what next, sustainability. What we have been saying is that all these efforts have been a lot of work. It will be a waste if once I step out of this office; everything comes crashing down in a month or two. Succession planning, sustainability, bringing up clone leaders are what we are doing. So what next is internalisation of what we are doing, mentoring more persons, selling the vision.
We look out for people of like minds and bring them close, open up the space for them because they see everything I do and study me. There is transparency in the system, they see what I am doing and my dream is to have at least a minimum of 10 persons who, when I leave the office, can take up the position. But before then, hopefully, we would get a second tenure, because we are entitled to two tenures.
We have to do a re-evaluation of everything we said we would do, monitor them, see how well we have done and draw up a fresh plan.
We must always have a plan of action, because they said those who fail to plan, plan to fail. So we are midway into it, and we think that we have not reached where we want to be because where we said we want to be was clear.
UBTH had a vision before we changed it, the vision was in 1973 and it was very cloggy, so we now said our new vision is to be the leading provider of quality health care solutions in west Africa. What I tell my colleagues here is that, we know we are probably the very best and highest functioning public hospital in Nigeria now, but for us, it is not good enough to say we are the best by Nigerian standard.
When we came on board, we deliberated and said, in health care system, the focus is on the patient and they bring us to work. We have told ourselves that looking after a patient for a health care worker is very demanding, so the people looking after them must first of all be happy. We are very proud of what we are doing here, for example we have been on board almost four years now and there has never been a single strike. That is huge in Nigeria of today and we don’t underestimate that.
For most hospitals, the issue of constant power supply is a problem. It is even more crucial in a place like UBTH, with your ongoing massive computerization programme. How do you cope? How much do you spend on electricity on a monthly basis?
It is a big problem but we run a functional system. Since I came on board, I don’t think we have had a day without power in UBTH, even one hour. It is a lot of work and money; you can’t run a hospital without power. If light goes off for one hour in your hospital, somebody dies, it is as stark as that. If you look at it from that point of view, any hospital you see that there is no power is dangerous.
When we came on board, we focused on the basic things, power, water and consumables – things the doctors and nurses need to work with. Those are the basic minimum you must start with, if you can’t provide those things you aren’t doing well. Any hospital that cannot provide those should not be thinking of any other big thing.
So, for us, we had to invest heavily on generators. We have so many generators – over 30 industrial generators across the length and breadth of this hospital. We spend about 12-18 million naira on diesel every month. Benin Electric Distribution Company bill used to be 15 million every month, but since November, they have increased their tariff now and it is an average of N25 million.
So, for power alone, between diesel, minus cost of maintaining generators and running it, and electricity bill, we spend an average of N40 million a month just to keep power on. So it is challenging. Computerisation is not just the records, we have computerised our clinical services, and complete end to end from when the patient comes in to when they leave.
In that whole setting of a very busy clinic, if light goes off for five minutes and the computer shuts down you can imagine the delay it will cost – like an hour or two hours delay, so what we have done is to provide three layers of back up. The public power supply will store series of inverters that can keep those things on for an hour or more. So, there are three layers of backup, but to be fair to BEDC, they have really prioritised UBTH now, so we get an average of 20 hours of light a day unless they have a local problem, which they also respond to us fast. Since almost six months they gave us a dedicated line, so we have a very good relationship
That means your financial overhead is quite high?
Since I came on board we have not added the cost to the patient in our prices. All we have done is to increase the efficiency of our connections. For example, we weren’t charging for our oxygen before but we looked at it, we know how much they are charging a cylinder of oxygen in Lagos, so we just had to add money. But we are mindful of the impact on the patients.
Like I said earlier, it is about my people, not just my people, it is also about the economy. I am very much part of my society, I can’t be disconnected, so these are the things that push me to take some of the decisions. But it is tough, especially the COVID-19 year that made everything go up. This thing (face masks) we were sharing to everybody in UBTH, before the COVID-19, it was N500 for a pack of 50. At the peak of July last year it got to about N17, 000, yet, we never stopped giving it to our staff one day, because here, every decision we take is a life and death decision so you must have a way so must have a way to go about it.
What has been your relationship with your doctors, especially the Association of Resident Doctors that we don’t hear of strikes in UBTH these days? What is the secret?
Resident doctors and unions see themselves automatically as oppositions to managements across the country. That is the way they are constituted, so if you don’t oppose management, you are not doing your work as a union. But that has not been our story. These unionists, including resident doctors, are very reasonable people from my experience and personally my resident doctors are like my younger brothers and I brought up many of them.
What has helped me is that I play football that is why you see me skinny and every Saturday I meet them. We are also very proactive. We know what is bothering them before hand. Most times, they come to complain about one thing or another but before they finish, I have already sorted it out.
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