This is an interesting article written by Dr Douglas Okor, a Nigerian Neurosurgeon who recently completed his training in the United Kingdom.
A life of purpose
Going back to Nigeria for me was never an issue to consider – I always knew I would go back home to Nigeria. I was born a Nigerian not by accident, but for a purpose and I intend to action and fulfil that purpose. I am a man of courage and passion who understands the 4 Ds of success – Decisive, Deliberate, Diligent and Discerning – and my passion is “21st century health care for Nigeria”.
So it was that after my first 2 months in the United Kingdom, my zeal to return home in the future increased a 100-fold. Everyday, the thought weighed on my mind, that our people die and lose limbs from preventable deaths in staggering numbers and the question of who will do something was answered even before I left the shores of Nigeria for the United Kingdom – the answer was clear – I can, I should and I will.
After spending approximately 10 years in the United Kingdom and going through the rigorously challenging training to become a brain surgeon specialising in skull base and neurovascular surgery, I returned to Nigeria in August 2016.
I joined Mr. Biodun Ogungbo who also trained in the UK to run a private neurosurgical service in Abuja. The outfit is called Spine Fixed in Abuja (SFIA). The name says it all. Our vision is to develop and deliver bespoke, high end and complex neurosurgical services thereby making Abuja the “Hub for medical tourism in West Africa.”
Abuja is a lovely city, especially the central areas of Garki, Wuse, Maitama and Asokoro – generally very good roads that are well planned. The outskirt of the city however, is a different story. With the numerous estates, bad roads and poor planning, it is amazing how two diametrically different landscapes can be located in the same geographical enclave.
The first thing that struck me when I returned home was the sheer loss of faith in anything to do with health care in Nigeria by the average Nigerian – I always knew there was lack of confidence in the system but I did not realise it is as deep as I have come to now better appreciate. Speaking with members of the public I come across daily, they feel that our health care system had slid down to an all time low.
None the less, like I tell them, it is not enough to become disillusioned by the doom and gloom outlook. It falls on all our shoulders as Nigerians to take this as a challenge – patients, the public and health care providers alike.
At SFIA, we understand this challenge perfectly well and as a team, we aim to restore the lost confidence and reassure the Nigerian public. We seek to keep them informed of the present capacity on the ground in places like SIFA and the great heights we are going to in the near future.
We are based in a facility that has a 1.5 tesla MRI scan, a 64 Slice CT scan that can produce excellent CT angiogram images to enable management of neurovascular pathologies. Other diagnostic modalities are available here as well.
Our permanent team in Spine fixed in Abuja includes 2 brain and spine surgeons, an anaesthetist, 4 Nurses, 4 Physiotherapist, 2 customer service staff, a health promotion/marketing officer, an accountant, 2 domestic staff and an ambulance driver. We also provide neurosurgical services for other key private healthcare facilities in Abuja.
We manage level 1 patients (with stable cardiovascular and respiratory condition) within same facility. We jointly perform our neurosurgical procedures using another facility that has HDU, ITU and theatre capacity and equipment, using our ambulance for patient transfers. Many a patient, their relatives and collaborating health workers have attested to the excellent skills of Oga Galadima, our lead ambulance driver.
I am also currently collaborating in the training of neurosurgical residents in the National Hospital – joining up with Dr Charles Ugwuanyi, Consultant Neurosurgeon at the National Hospital and CEO of Wellington Neurosurgery Hospital (I also do consultations and provide technical support at Wellington).
I attend their handover teaching meetings and ward rounds at least once a week at the National Hospital. This experience has been very gratifying for me. It gladdens my heart to see how over the moon with excitement the neurosurgical residents are that they have the opportunity not just to learn technical neurosurgical “stuff” first hand, but also observe the dynamics of maintaining the soft- interpersonal skills of leadership, communication and teamwork amongst all cadre of health care providers with the patient being at the centre of everything we do.
It is quite interesting to find that most people, (especially the middle aged and the elderly) are surprised that I am a Brain Surgeon and are initially reluctant to consult with me. Even more interesting is how they all eventually fall in love with my persona once they go through the consultation with me. I half expected this anyway, as I am not your average medical doctor – with my non-conformist personality, look and style, I can understand their initial apprehension against the backdrop of our cultural expectations as Nigerians.
The local practice
Since I arrived, we have managed patients with varying neurosurgical pathologies, including complex spine cases, pituitary tumours, brain tumours, and intracranial bleeds secondary to ruptured aneurysms. We successfully drain large chronic subdural haematomas with local anaesthetic for patients who remain awake through the operation. We also do spine procedures in some patients with local anaesthesia achieving good acceptance by patients. This removes fear of spine operations performed in Nigeria since they are awake during the procedures.
Furthermore, other procedures we have done include simple and complex cervical and lumbar spine procedures (one patient with thoracic spine fracture from a road traffic accident, had posterior thoracolumbar instrumented fixation), craniotomy for resection of meningioma and transphenoidal resection of pituitary tumours – all with very good outcomes.
The team (The SFIA Family) have been absolutely fantastic and very open to learning the key principles of value for human life, patient safety and quality of service delivery. We have had so many meetings where we talked about continuous improvement of communication and team working skills pushing for an environment where initiative, innovation and creativity are encouraged – these discussions and associated actions have translated to improved working relationships amongst us and impacted positively on patient care.
It would be a blatant lie if I do not state the limitations within this system – issues with human capacity (skill, knowledge, competence and experience), materials & equipment, issues with generally poor quality attitude and culture. Despite these challenges there is massive potential with respect to what can be achieved in health care in Nigeria – especially within the private healthcare space.
I choose to let my actions speak to individuals and groups around, instead of pointing out their deficiencies and faults – this is working like magic, providing the kind of environment that fosters working together and seeking common positive and progressive goals. Maintaining the basic standards while managing the suboptimal human and physical environment in the short term is the way I’m playing the game at this moment. Things will definitely get better.
A practical example of what I am trying to explain about improvising in our challenging environment without compromising standards is how we have done a few transnasal pituitary tumour resection cases using the microscope (thank God we now have a complete transphenoidal endoscope set) and we had to use mini tampax tampons (in place of more expensive and not available nasopore) for haemostasis within the nose post-operatively – and it works perfectly well.
The future in a consortium
I have always believed that partnership, collaboration and cooperation are key elements required to expand the horizon of the Nigerian healthcare space – so, the SFIA team led by Dr Biodun Ogungbo and myself have been involved in meetings, discussions, advocacy programmes, promotion projects to facilitate working with individuals, groups and organisations with similar vision, mission and focus – together we all can once again build the confidence of the average Nigerian in our health care sector. We hope to facilitate a Brain and Spine Surgery Consortium throughout Nigeria.
It is therefore no surprise that Dr Ogungbo and I have granted several interviews at different times, individually or together to radio and TV stations, print and social media organisations – our messages have being centred around stimulating discourse about the Nigerian health sector and pushing the frontiers of health promotion, education, advocacy, team work and marketing.
We were part of the organisation of the ALL THINGS MEDICAL project in the NAF centre in Abuja – to promote the capabilities of the different health facilities in Abuja. Also, the Independence day jamboree co-planned and executed by SFIA and Lifebridge diagnostic centre on October 1st 2016 was epic. We had music, dancing, singing /rapping and topped it up with free neurosurgical consultations. This was definitely a hit!
One beneficiary exclaimed that it was a-never-event for him to see doctors and nurses working in such harmony and explaining difficult medical concepts in pidgin English and local languages with all the nice music in the background.
I was glad I got to attend important and interesting events here that bring together people of like minds. Men and women who see beyond the current challenges of our health care delivery system – people who are keen to make the difference they want to see. Two such events were the Future of Health and the Medics West Africa Conferences in September and October 2016 respectively. The Future for health programme looked at technology solutions for healthcare in Nigeria while the Medics West African Conference was a mix of health business and financing, leadership in healthcare, social media and health.
The Medics West Africa programme also played host to a large number exhibitors from all corners of the world. At that conference, I happily got 3 endoscopic telescope pieces for next to nothing price, to make a difference in the lives of our patients. However, on the down side, it was at this same event that my laptop and lovely leather bag were stolen. A nice ‘welcome’ back to my country from a fellow countryman and a small price to pay for the huge change we are going to make.
All work and no play
It has not just been work, work, work; I did some travelling as well. Almost every fortnight I find myself in one nightclub or the other – As most probably know my love for music and dancing knows no bounds!! I was in Lagos, Enugu Calabar and Benin – going clubbing in Lagos and Enugu. So far I have met up with some fantastic human beings (friends) – hanging out with these chaps now and again is massive fun I must tell you (most of them are not even health care professionals).
Abuja has a lot of relaxation/enjoyment spots. The “point and kill fish” plus ‘yahuza suya’ spots are a must visit for anyone planning to spend some time in Abuja. I’ve also fallen in love with the local yogurt blend (fura de nunu).
In all of this, one thing stands out. That is, the need for all of us, to re-dedicate our selves to providing top-notch health care to our fellow Nigerians, in a culturally integrated way that is founded on the team spirit and camaraderieship of every single health care provider irrespective of cadre or specialty because the Nigerian patients are worth it – this my dear friends is one way of us sustaining Nigeria’s health care revolution.