‘Lack of mentorship, bane of medical practice in Nigeria’

Dr. Oluyombo Awojobi is one of Nigeria’s foremost Rural Surgeons. Finding alternative means to sustainable energy, he has made a name for himself using recycled trash to power his hospital’s (Awojobi Clinic Eruwa ACE) equipment. He speaks about his motivation and the state of rural surgery in Nigeria.

What was the motivation to finding an alternative energy source?
We started with NEPA, which was impossible. Buying a generator to power our distiller was unaffordable. We even tried gas… and to think that this country has been flaring gas since 1957 and we can’t think of a way to pipe it into cities and homes tells you how much retrogression has happened in this country close to celebrating 100 years. We shouldn’t celebrate but try to see what we could do in the next five years.

Was it hard to convince staff to use the equipment?
Like with everything, if the pioneer takes the lead, there’s no reason why others can’t follow. They saw me fabricate them and I told them the reason I was doing so.
Since January 1987, when this clinic was just three months old, we hold meetings every last Saturday of the month. How much have we made and spent in the last one month and what was it spent on? We have always had positive balance because our expenditure will never be more than our income and we are all on salaries.
I’m on a salary of N250, 000 known and determined by others. My wife is on N200, 000. My colleagues on the same status earn at least N1.5 million monthly and they don’t do as much work.  Here we perform at least seven major surgeries daily. On my table there is the cashbook readily accessible to all and sundry.

You’ve delved into medicine and engineering, how easy is it to marry them both?
I decided to be a doctor so that I could take care of the family. In medicine, surgery, which is a form of biomedical engineering, is the closest to engineering. I got the engineering bit from my brothers. Engineering science is in the blood. Till date I’ve operated on thirty five members of the immediate and extended Awojobi family.

In your quiet moments, what goes through your mind regarding your experiences and aspirations?
My brother, Ayodele and brother in-law, Dr. Emmanuel Ozoro, of Comparative Education Study and Adaptation Centre at UNILAG, both died of frustration. They looked at Nigeria’s problems and wondered why we are where we are with all we have. But I’ve learnt from that. The more I see frustration in the community, the more I feel inspired to provide answers to those challenges. So much so that today, I could say that 90 percent of Nigeria’s health challenges, we’ve solved in this clinic. It pains me sometimes, why 30 years later we don’t have this kind of place spread all over the country.
People may say I’m able to do this because I’m a specialist. But that isn’t true because two or three years ago, a young medical graduate of a Nigerian institution, given a year’s training would be able to perform 80 per cent of the operations I am capable of doing. Presently, we have two young graduate doctors who perform up to 80 percent of what we do here. This has given me time to attend conferences and have more rest especially with old age setting in.
Hospitals should be able to take care of basic emergencies they encounter and that is what we are achieving here.

What is ACE about for you?
Our mission statement is ‘a private hospital in the public service’. Before a patient is treated, a lot goes into it before the patient sees the doctor. Back in UCH, we never bothered about how materials came to the theatre. Patients just came for surgery and we went to the theatre. We didn’t even know how much they paid. Being in Eruwa, I had to take all that into account.
ACE isn’t only for healthcare provision. It also includes infrastructure. Take the IV fluid, IVF, we give patients… I lost two patients in 1984 because there was no IVF. I then remembered that the UCH used to produce it. Using the UCH method, I began producing mine in July 1984. Consistently, since then we have produced it at 10 per cent the open market cost. So far, none of our patients has had any adverse reaction or died as a result of its use.

How much external support have you received?
The straight answer is none. Everything we’ve achieved here has been through what the patients paid. Today, we don’t owe anybody, individual or corporate a kobo. We’re not on the National Health Insurance Scheme (NHIS), where you are guaranteed some amount of money because of the enrollee. We declined being a part of it when it was introduced to us. Our fees are affordable, 60 to 70 per cent of our patients come from outside Ibarapa District of which Eruwa is the capital, because they know they’ll get good service at affordable fees.
We haven’t had any support, neither have we sought for support. We’ve had philanthropic donations even from people who want to remain anonymous. We’ve received a million naira from one such in 2012 who donated N250, 000 again last year. The British High Commission also donated a solar powered refrigerator in 1997 which we still use till date.
But the actual running of the clinic is done with what the patients pay.

How are you able to bring the prices so low and still render quality service?
With our salaries being realistic and open to all, everybody knows we aren’t cheating them. Whoever doesn’t like it can move elsewhere. So there’ll be no industrial action or people asking for more pay. If we want more pay, then we must work harder.
We are in the process of building a cancer centre so that people can come here instead of going to India and other countries. It has so far cost us N20million, all gotten from this clinic. For this project, we are soliciting for $2million in form of investments so that we can have it up and running.
Things like this are what have brought us goodwill. And, word of mouth has been most instrumental for our growth because by our ethics, we don’t advertise and I fully agree with that norm.

Are there times you are overwhelmed by the number of patients you have to see?
Yes, especially in the last one year. Whenever I get to the out-patient section of the clinic during my ward-rounds, I feel some depressive moments. Sometimes this place looks like a refugee camp.
The average waiting time for people to see Dr. Awojobi is 48 hours which isn’t at all complimentary and I say so with all modesty and sincerity because it shows the failed healthcare delivery system in the country.
What keeps me going is the presence of my junior colleagues who have left the city to come and work with me here and acquire skill and knowledge. I owe them a duty to pass these on to them. I hope to do so until I’m no longer physically able to do so.
I hope that the government will realize that all the things happening here can be replicated in six months across Nigeria. And, there are other practices that could be used for training. All you need are good doctors. Train a good doctor and the health system will be improved.
My first grandchild was delivered here last August by Caesarean section performed by a very junior doctor; mother and child are in perfect health.

How do you view rural surgery practice?
Rural surgery has come to stay in Nigeria. It is a fulfillment of the 1978 Alma Ata Declaration of the World Health Organization. It gives immense satisfaction to the rural doctor who in turn is held in high esteem by his community.

On a monthly basis, how many patients do you see and what is the most treated case?
We see an average of 4, 500 patients monthly. Common cases are malaria and other infectious diseases. Diabetes mellitus, hypertension and their complications are on the increase.

What has been the most efficient method for you, practicing as a rural surgeon?
Doing it the way all my teachers at UCH Ibadan mentored me. Lack of mentorship is the bane of the medical profession in Nigeria which has been unduly politicized.


SOURCE: https://www.dailytrust.com.ng/daily/health/15928-lack-of-mentorship-bane-of-medical-practice-in-nigeria

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