It is not all tears in spite of challenges

Prof Chris Bode is a consultant Paediatric Surgeon and Chief Medical Director (CMD) of Lagos University Teaching Hospital (LUTH), Idi-Araba. Bode spoke with CHUKWUMA MUANYA on the many challenges faced by the foremost hospital and what the management is doing to overcome them.

There are usually long queues at LUTH and patients most times have to wait forever for surgery or get attended to. Why is that and what are you doing to address the situation?
I am happy you raised that question. It is one of the issues that we are discussing at the ongoing retreat of the hospital. They are challenges of growth in the hospital. Hitherto people were not coming, our bed occupancy was low, surgical rates were low and the hospital attendance was low because if you recall in the past several years we were almost always on strike or this or that is not working. In 2017 and 2018 did you or have you heard of any such thing? But we are gradually overcoming those challenges through proper negotiations with the unions. Then facilities are quietly being restored.

We don’t have power failures in LUTH anymore because since December 2017 our Independent Power Plant (IPP) has been working. That complaint that people used to say there is not light is over. We are excited about it because the gas-powered generating plant is working. It is IPP, we have 24-hour electricity now. These are indices of growth. Our water supply is good. We bought several new ventilators into our Intensive Care Unit (ICU), High Dependency Unit (HDU). Our stroke unit is working and so many facilities are working that people are now beginning to repose their faith and confidence in the hospital again. This has translated to increased attendance, increased bed occupancy; increased number of surgeries and this has begun to stretch our facilities. If you are the owner of the facility, you have to expand. So it is in the pipeline for us to build at least 60-room consulting rooms so that more patients can be seen per unit time.

We want to expand our Accident and Emergency (A&E) unit. If you get to the A&E unit you will see that the waiting area has been refurbished. Stanbic IBTC last month refurbished and rehabilitated the whole place. The services and facilities in LUTH are comparable to anywhere in the world. You need to visit the place. Remember there was a time our theatres were shut down, we even lost accreditation. Today it is comparable to anywhere in the world. It is a work in progress. We can’t fold our hands and say government has not given us money.

We need to look inwards. Go to the Advanced Fertility Centre/In Vitro Fertilisation (IVF), their rate was 52 per cent pregnancy per cycle last year. That is as high as anywhere in the world. If you achieve 30 per cent, they call you Baba. We are having triplets, twins, and singletons quietly. Those things are working the way they should. Emeritus Professor Osato Giwa-Osagie is the head of the IVF centre. We are now doing a lot of trainings with international collaborators through telemedicine and exchanges. Laparoscopy is working. We have an endo-laser suite, which is working now. Operations people will go for $10,000 in Dubai, you can do it for less than $1,500 here in LUTH. It is because of these kinds of things that make us happy to be working here.

There have been so many complaints on poor attitude of the health workers especially nurses at LUTH and that SERVICOM is not effective at the hospital. Why?
SERVICOM is an acronym derived from the words SERVICE COMPACT. Compact is a formal agreement between two or more people. In this case SERVICOM is a Service Compact (Agreement) between the Federal Government including all its organs and the Nigerian people.

From time to time in anywhere people interact, there will be frictions, there will be misunderstanding, there will be misperceptions, there will be true wrong doings occasionally, and they are inevitable. Or have you seen anywhere where human beings interact that they won’t have problems? Even in the United States, things are happening in their polity. Things like that happen. The correct thing that will help society most is to look for somebody responsible in that kind of organization who will say ‘I noticed this done by so and so person on so date.’ If that organisation now fails to call that person to order and query that person and investigate the circumstances, then you should persecute that organisation. That is what I see that is missing till now. If I know the person that is complaining, I do not even mind going to him and say, ‘I heard that you are not satisfied with the services in the hospital where I work.’ I will make amendments, that is what leadership does everywhere and I am sure that is not different in your organization. Even if that person gave me a call, I will say, ‘hold on. Give me an hour, I will investigate it.’ It would have been better for us. To make judgment based on what has not been formally notified is not good.

Undermining the public confidence in the healthcare sector is part of what drove us to this edge that Indians now capitalise on Nigerian health sector. When somebody has a boil, they will tell you, ‘you will die. Look, Nigerians cannot treat you.’ Then Nigerians will spend N100 for what they should spend N10 and then can even go and die there because they are being exploited. That is my plea to Nigerians and the press. We need to work together, understand ourselves. We do not want negative perceptions in the healthcare sector. It may seem as if we do not value the good things that are beginning to happen in the healthcare sector. The reason is that we work in this place.

We are doing well to those who could have died from critically ill conditions, to those who have undergone daring operations that we succeeded. We are quite about it because it is what we do every day. We save babies who would have died. If we are doing hundreds of that every day and somebody notices a problem somewhere it is only fair to use your mighty sword to disseminate good things about us. They are selling India and other countries to us and they are making more than $1 billion out of Nigerians. They are even giving people money saying, ‘refer patients to us.’ That is what we don’t want. But like I said, I am yet to get a single notification or complaint. Get that to us and I will investigate it.

How can a patient get across his or her complaints to relevant authorities?
SERVICOM works. It does. I have facts to tell you that SERVICOM works. I was SERVICOM officer for four years. In one year we received over 400 complaints, which we had to handle within hours. Over 90 per cent of them were handled within 24 hours to the customer’s satisfaction because we know that the customer has the right to appeal to the Presidency, to go as far as the Presidency if they are not satisfied. So we need to put things in perspective. Things are beginning to work in the health sector. We want the press to help us, buy-in and disseminate that information.

There is a SERVICOM office in Accident and Emergency (A&E). Just go there, somebody will take down your complaint and they will track down whoever that is in charge of that department immediately. Do you know SERVICOM has tracked me down before? They said, ‘doctor! A patient you are treating complained.’ I stood up immediately because I know what SERVICOM means and everybody fears it. They will go there and track down the doctor. There are telephone calls you can make to SERVICOM and they will answer you immediately. They will track the person down until the patient says, ‘I am satisfied.’ That is how SERVICOM works. It is a beautiful thing. It is not to witch-hunt anybody. It is to make sure the customer in any public institution where government is paying is satisfied, is treated promptly, efficiently, correctly and without any expectation of gratification.

I headed it for three years and we did a study where we looked at the kind of complaints patients had. Surprisingly most of the complaints, about 44 per cent, were from patients’ relations not patients themselves. But another 44 per cent could have been solved with correct information transmission. You have a patient at the ward. You have been at work all day. You come to see your patient about 5:00pm. When you come at 5:00pm, you see the patient sleeping. You expect to see doctors all over the place. Doctors do not come during the visiting time; they have other things they are doing. The next complaint SERVICOM will get is that nobody has seen the doctor since morning. If my doctors, house officers, residents, consultants have seen the patient and treatment has been correctly prescribed and given. But by the time you investigate the complaint you will see that everything that needed to be done for the patient has been done.

So it was misperception. Our expectations differ from how hospitals run. When you go to a private hospital the doctor is all over you and they expect that here. No, that is the way we do things here. They do not need to start dancing around the patient. SERVICOM will go there and inform the person that, ‘you patient was seen at so-so time, this and this have been done and in fact the hospital is waiting for you to bring money.’ You will find out that the relative will just melt away because they do not want to spend money. But it has helped us to develop a culture where people know that somebody is looking, somebody can ask them questions. I, I am sometimes called by SERVICOM and they will ask me questions and I will explain because they have more power than me as far as that patient is concerned.

How about you Magnetic Resonance Imaging (MRI) and Linear Accelerator that have been breaking down frequently?
Our Linear Accelerator was given to us by VAMED. The Linear Accelerator was used to irradiate cancer. It was procured during Chief Obasanjo’s regime but after about 12 years the machine’s lifespan expired. We kept repairing it. If you recall there were seven of them installed in Nigeria that time. They all broke down. But through the workings of government, the present Minister of Health, the President, Minister of Finance, the National Sovereign Investment Authority (NSIA) and our interaction with them they are helping us. We told them that we have been treating over a hundred cancer patients daily until the machine broke down and we could not repair it anymore.They are not even manufacturing it anymore. We have been appealing to NSIA and they believe in our system that we will make good use of the machines and they will get their money back. They have given us $10 million and disbursement will start from next week (this week). I was there yesterday. To buy two linear accelerators because of the heavy load of patients we have and a brachytherapy machine that we never had before.

A brachytherapy machine places radiotherapy pellets in areas like cancer of the cervix, breast and prostate where external beam irradiation will not be effective. Brachytherapy is the treatment of cancer, especially prostate cancer, by the insertion of radioactive implants directly into the tissue. This is marvelous. It will blow us out of the waters.

We now have a treatment plan system, which is a CT machine. Ours will become a tourist haven for medical tourism. These are things people go outside for and it is going to be on Public Private Partnership (PPP) basis. Service maintenance contract for the ten-year duration is included in that money so that not if it breaks down tomorrow we will be looking for another money. That is the kind of package that we are getting. They will rehabilitate the bunkers that they have there.

There have been reports that the number of patients overwhelms the doctors at LUTH. That is there are few doctors compared to the high number of patients. Is this true?
No and no. In a place where you have over 200 consultants, over 450 resident doctors, over 700 nurses that is massive. How many hospitals can boast of that and the hospital is 800-bed capacity. So what we need to do, that is our target for this year is improved productivity. What we have we can leverage on it to service more people per unit time. These are not problems. If you look at what we are having before when we go on strike and government would still pay us. Those were problems. But now more patients are coming. Those are challenges of growth, which are opportunities for a good management team. These are the things we are really focusing on. Those were challenges not problems.

So poor funding is no longer an issue here in LUTH? Bode said: “Funds will always be problems. You can never get enough. You in the press, do you have all money you need? How are you successful? You manage. You say these are my resources, these are my targets and you trim and stream and make sure it works towards the objective of the hospitals. There is no hospital in the world that gets all the funds it wants even in Saudi Arabia.