A w(h)ealthy Nigeria and 2020-20 (Part 1)
The saying ‘health is wealth’ is hackneyed. In the sane, serious and wealthy nations, health matters are taken seriously for the wealth and strength of these countries, in fact their very survival depend on their health. Elections can be won and lost on how a government handles health issues. Little wonder that, combined with the other well developed sectors, these countries are rich and well developed -oil or no oil. Our leaders and the rich are ferried abroad for all ailments imaginable to receive expert management. The other day long before the big one came, UMYA had his ‘seasonal allergic rhinitis’ managed in France; others go to the spas at Ibiza to lose weight!
Health is associated with strength, happiness, joy and longevity. Everybody deserves to live a long, healthy, active and happy life. Given the choice all men would prefer good health to wealth but I dare say this may not be true with the average Nigerian, at least going by the way and manner he (and his leaders) handles issues related to his health. The average Nigerian would forgo his health to make money and then spend the money he has made to restore his health back. In some cases a combination of poverty, ignorance, inaccessibility, religious belief or the sundry may make a choice impossible yet these factors are not excuse to forgo good health. Good health is conceivable, desirable and attainable.
Nigeria has one of the worst health indices despite the oil wealth and human resources. The infant mortality rate is at a record level and at this pace (Northern) Nigeria may yet be the last to fully eradicate poliomyelitis from the earth surface. Check out what health means to WHO and the developed world; Nigeria is a sick nation indeed, no pun please. Health is the state of complete physical, mental, emotional and social well-being and not just the absence of disease or infirmity. We deserve to be seeded as the foremost country in the world where the ‘doctor’: patient ratio is highest yet the statistics are scary. Here every man on the street is a doctor in one way or the other. The caveat is most are not conditioned in the rigours and demands of an acceptable scientific or medical tradition- orthodox or alternative. We are in a select and peculiar league; we are too casual with our health! Hence our men pay with a ridiculous life expectancy of 47 years while the women pay theirs in our high maternal mortality rate of 800-1500 per 100,000! Malaria is still a major cause of death. The morbidity and mortality statistics may be a sad commentary on our poor super- and infrastructure but they reflect more on our attitude to health.
Most Nigerians are not health conscious or choose not to be, we are literate but uneducated in health matters. Ignorance and poverty are the biggest diseases ravaging the land, so we succumb to the preventable diseases like gastroenteritis, post-partum hemorrhage and vesico-vaginal fistula. So much myth is woven around common ailments and routine procedures. For example polio vaccination is condemned by the ulamas in the North; crude oil is used for all diseases in the East, and amongst the Yorubas paronychia is treated by immersion of the lesion in early morning stool while jedijedi is the universal diagnosis. Potions of jedijedi are used in specialties as diverse as neuropsychiatry, endocrinology, gastroenterology, obstetrics and rheumatology. (The Yorubas are an interesting bunch despite the education). Skin bleaching and ‘beauty’ are identical twins, obesity is synonymous with good living while philandering is sine qua non of manliness even in this era of the almighty HIV. Measles and injections in any form are mortal enemies.
Every year the universities and other higher institutions of learning graduate thousands of personnel in the medical and paramedical cadre but this is still a drop in our ocean of need. The dearth is worsened by the ‘brain drain’. Some of our best brains emigrate to the West, Middle East, South Africa and other countries solely on economic grounds. A colleague just left for, wait for it, Swaziland. The severe hemorrhage is enough to kill the polity but we trudge on; our dermis is too thick, the homeostasis is overstretched. In a country of 140 million potential patients with about 30-40000 orthodox medical practitioners in both public and private sectors, we have a ridiculous doctor: patient ratio of 1:3500. Nigeria spends her money to train the experts she needs badly then force them out to be picked, dusted and exploited by outsiders. It is a general malaise. The vacuum left by the dearth of qualified practitioners is rapidly taken over by the charlatans, quacks and con-artists prowling the streets or parading their elixirs on teevee. Ours is a planless, normless and lawless society all because government has a laissez faire attitude to our well being.
Alternative or complementary or traditional medicine is those treatments and health care practices not taught widely in the medical schools, not generally used in hospitals, and not usually reimbursed by medical insurance companies. The approach is holistic and preventive. It includes but not limited to acupuncture, ayurveda, chiropractic, herbal medicine, homeopathy, naturopathy and yoga. It constitutes the primary source of health care for the majority here and in the other developing countries. The ratio of traditional health practitioners to the population is much greater than that of the orthodox medical practitioners to the population. This could have been a good news but for the fact that here the charlatans hold sway. Their practice is uncontrolled, amorphous and an all comers affair. The basic scientific tradition of observation, hypothesis, experimentation and verification is lacking yet we sit on a treasure trove of flora. Except in the villages, the high cost of this form of health care has further reduced the accessibility of this practice thus hiding the potentials. Meanwhile the demography is changing. Alternative medicine is like a diamond in the rough.
Nigerians are now let to their own devices and here enters the auxiliary nursing system. For most Nigerians this is usually the first point of contact with orthodox practice albeit in the corrupted form. The clientele is large, cuts across board and the service is appealing because it is ‘cheap’. The average Nigerian prefers a luxury item to quality health care. Auxiliary nursing practice has metastasized to the inner cities and suburbia; it is no longer a rural affairs. The practitioners may be rendering some service in the rural areas and the slums because of government failure, but then these are where the depressing stats are coming from. They are usually barely literate and had had some contact with orthodox practice. They operate in ramshackle structures observing no aseptic protocol. But then microorganisms are not Nigerians, for example viruses do not take bribes to look the other way. Mismanagement and malpractice are the norm. Curiously the patronage is still teeming and there is an ‘iya agbebi’ or ‘aunty nurse’ on every street corner dipping her hands in very complex cases especially high risk pregnancies that will task the dexterity and acumen of even a consultant obstetrician. Grandmultips preferably with a previous scar are their turf. So the prevalence and incidence of VVF, post-partum hemorrhage, perinatal deaths, maternal mortality etc naturally balloon. All medical conditions are either staphylococcus or typhoid or malaria fever, and are treated as such. I have seen diabetic ketoacidosis being managed as typhoid fever and tetracycline used to ‘treat’ diarrhea in children! Medical litigation is sure in the diapers in Nigeria.
Others patronize road side drug vendors and the practice of one punch cures all is well known. ‘One punch cures’ are admixture of analgesics of various brands garnished with multivitamins and some antibiotics. Here the tedious routine of history taking, physical examination and investigations are waived. No working diagnosis please for a dose cures all! If one tries hard enough one could get ethical drugs from the compendium of drugs displayed on the wooden racks or trays in the hot tropical sun. To ensure a better penetration into remote areas of the slums, the women-hawkers take the pains to carry their drug wares on well permed hair. The sale of drugs at motor parks and molues is just too well known to the average city dweller. Chemists and drug stores are a degree ahead of this. Most are managed by folks that have not even the rudimentary knowledge of pharmacy or medicine. They settle for the comfort of cool well-lit perfumed rooms where all sorts of medical procedures are routinely performed with dire consequences. All tribes are guilty but our brothers from the East are far more notorious for this brand of health care. One wonders what Pharmacist Council of Nigeria is doing.
Multilevel marketing is a developing concept here. The average MLM person is an aggressive and smooth talking salesperson who knows all. You do not need to go to school to diagnose or prescribe. If only doctors and pharmacists had known this they would not have wasted precious years in the varsities! The products come from the Far East, the Americas, Oceania etc and they are expensive, far more expensive than conventional prescriptions. There is a gizmo for all conditions including halitosis, and every disease including hepatitis has a cure we are made to believe though we only read this in their literatures. As expected, there is no regulation. The system may have some yet undemonstrated good sides to it but it sure is more to the benefit of the marketers. Crass commercialism is disguised as health care! Again the patients suffer.
The mission hospitals of old are invaluable legacies of pristine Christianity and Islam. Not anymore especially with most (Pentecostal) churches today. They are too materialistic and only interested in maintaining healthy bank accounts at the expense of the flock’s collective well-being. Dr Segun Fakoya’s brilliant piece on Pentecostalism is a must read to properly situate this growing malaise. That faith and healing has some relationship is not in doubt but what happens in most church ‘clinics’ today may not be the type of health care that can take us to 2020-20. Some actively discourage engagement with modern medical practice. For example The Lord’s Chosen Assembly does not allow HAART in HIV positive patients and Christian Scientists do not take drugs. No problem with that but was it not that great physician Jesus that enquired: is there no balm in Gilead? Is there no physician there? And Luke was a physician too. Everyday orthodox practitioners come across especially bad obstetrics cases brought from these church-clinics. Their practice is unregulated, no sanction is in place.
Some ‘lucky’ terminally sick patients are hurriedly given donations by the government and corporate organizations while others are not so lucky. This is an indirect admittance of a failed health system. At other times, especially near election periods, politicians bring surgeries and medical services to the grassroots free of charge. It is all a ruse. NGOs come to the aid of the needy in some cases. Of note is the Kanu Heart Foundation that has put a smile on the faces of so many Nigerians.
The jewel in the crown of health practice is the orthodox medical system. In Nigeria this is beset with so many problems that make easy access so difficult. And 2020-20 is just a whiff away.
By Dr Abayomi A. Abdulwaheed