Transforming UBTH for optimal service delivery

_Professor-Mike-IbadinProf. Michael Ibadin is the Chief Medical Director of the University of Benin Teaching Hospital (UBTH). Ibadin, in this interview with MICHAEL EGBEJULE, spoke on the number of issues ranging from the challenges encountered and efforts in transforming the hospital for optimal service delivery. Excerpt

Do you have any challenge facing the hospital particularly following the successful stem cell transplant and total blood replacement carried out in the hospital?
Yes, there has been some lull in activities, not because we are not capable of repeating the same thing that we did before but remember that stem cell transplant is not cheap. On the average, it costs about N5 million per patient. Mainly drugs constitute this cost, which takes N2.5 million on the average. There is no way we can compromise on that because you must supply the drugs. You need drugs to remove the immunity before you transplant and you need drugs to sustain the patient in an enclosure for another 100 120 days. The other thing that is making it expensive is the power supply. After the transplant, the patient is kept in a nearly airtight room and he has no direct access to people. The place runs solely on a generator. What we have done now is that the hospital takes part of the burden.

Recently, somebody came from Kaduna for a nine-year-old child that is being proposed. We have another one who is 15 years old.

Incidentally, it is not everybody that is qualified for a transplant that can get it. There are factors used in selecting the patient, otherwise, it will fall. So, we have to be careful in the selection of patients. If the patient has had a common transfusion, or he/she is too old, it will not also work. The closer the donor is to the recipient, the better. If you have an intending recipient and there is no close donor, then we will not agree. These are not things you can buy in the market. The patients and their families must be prepared to overcome these challenges. For the new patients that have just come, we will do everything to ensure that the transplant goes on very fast. The older ones on total red blood cells replacement do not need to be announced to the public. Activities are going there.

UBTH sent some Medical staff abroad for specialist training in open-heart surgery and renal transplantation. It appears that these specialized services are yet to take off. What are the factors militating against their take off?
For the renal transplant unit, the surgeon and physician have been trained, the other support group, the nurses can be trained locally. The training for the nurses require is no more difficult than the training for the nurses working in Intensive Care Unit (ICU) and I have offered to send them to wherever they want to go for training. As a way forward, I have now challenged them openly.

The impediments for the renal transplant, they told me yesterday, have nothing to do with Management. If Ilorin, Ife, and Kano can do it, there is no reason why Benin cannot do it. I think they have now bought the idea. I have gone ahead to now say, the first five patients will be transplanted free of charge at no cost to the patient.

We want to send a message that we are capable of doing it, but there is one challenge, which we cannot solve for the patient. The patient has to solve that for himself, that is to source for donors. Kidneys are not sold on the shelf neither can they be bought in the market or abattoir. It must come from a donor. For now, we can only do living donors. The closer the donor is to the recipient, the better. It is the responsibility of the intending recipient to look for a donor and that is where the problem always comes from.

Yes, they are very enthusiastic but when it comes to the issue of a donor, they begin to withdraw because most people are not willing to donate their kidney, probably because of cultural beliefs. You now ask me, why is it that they go to India? The laws in India are rather very loose. You also have commercial donors in India; Even Nigerians go there to donate their kidneys. The laws governing organ donation in Nigeria, even though they are not straight jacketed, they are not really there.

There are certain things that you cannot do within the confines of your ethics. So, you will not be able to harvest a person’s kidney for sale, as it would be unethical and unreasonable. This is one area we might have challenges. Secondly, a lot of the patients that require transplant are not suitable for transplant; either they have been dialyzed for too long or they are too old, too weak or their compliance has not been good enough and the vessels are no longer vessel to another. If the vessels have been destroyed, there is nothing anybody can do. The failure rate will be high. As a result of that, the patient needs to be carefully selected.

For the open-heart surgery, we have already purchased the machine at a cost of N24 million. It is in the theater waiting to be put to use. All the required personnel have been trained. The challenged we have has to do with the consumables. We are unable to source the consumables in Nigeria, but it will interest you to know that they are available in Ghana. We made an arrangement to get the consumables through Ghana, but we needed to visit. Actually, the Board of Management gave an approval for me, and Dr. S. Okugbo to travel to Ghana and work out the logistics. At the point we were about traveling, there was an Ebola virus disease outbreak, so the visit was shelved. Now that the Ebola episode has subsided, we might visit Ghana. So, those are the issues.

Recently, UBTH introduced public health lecture series. What does it tend to achieve?
We set it as an innovation. Of course, you know the hospital has a number of mandates. As a tertiary health institution, we are involved in treating patients, research and also have a number of training schools. We also have the corporate social responsibility to impact on our environment to make ourselves relevant to the community where we serve.

The public lecture series focuses on the common disease conditions in the society that are either misunderstood or people have negative concepts about. We get our medical experts with requisite knowledge to give lectures on these diseases in common and simple language. The target participants are usually a mixed audience. So far, we have had lectures on Cervical Cancer delivered by Prof. E.P. Gharoro: Sudden Death, delivered by Prof. A. O. Obasohan; Reducing the Burden of Breast Cancer delivered by Prof. M. I. Momoh and Hepatitis B by Dr. C. Omuemu. These are common challenges out there but what people think about them are really different from what is obtainable here. The essence of the lecture is to create an interface between the hospital as a provider of service and knowledge and the public so that the knowledge gap and misconception could be addressed.

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