What government should do to curb medical tourism - Danbauchi

Solomon Sulei Danbauchi is a Professor of Medicine and foremost Northern Cardiologist in Nigeria with over 23 years as a medical practitioner, lecturer and humanity enthusiast. He recently spoke with Halima Oji on issues of healthcare, the way forward and how nepotism drove him out of Ahmadu Bello University Zaria. Excerpts:
 
You are known as the first Northern Nigeria Cardiologist, how do you feel being a pacesetter?
Honestly, I began this career with no such mission in mind. For me, I saw an interest that was triggered by the consultants in internal medicine during my housemanship and igniting a desire to also contribute to this field in Nigeria. The privilege to train many other respected cardiologists is priceless. My dedication is to serve humanity.
I remember vividly when I returned to Bauchi state after my youth service and was attached to the Government House clinic as the doctor to the governor, I emphatically told the director of medical service that I will remain at Bauchi specialist hospital and do rounds and if there was an emergency at the Government House then someone should give me a call and that was it till the day I left.
This profession has afforded me close relations with the high and low; ex-governors, ministers, business tycoons, traditional rulers; actually I have served the Zazzau Emirate as the personal physician to the Emir, Alhaji Dr. Shehu Idris for more than 20 years. And I have travelled to so many countries all thanks to being a cardiologist.       
 
There are various heart conditions, which are the most prevalent in Nigeria and why?
The structure of the heart can be affected by many things. Heart diseases or cardiovascular diseases can be affected right from the womb and at various stages in one’s life. There are many heart conditions such as; congenital heart disease, hole in the heart, heart attack, hypertensive heart disease, rheumatic heart disease, peripartum cardiomyopathy fever, idiopathic cardiomyopathy, cardiac arrest and etc.
A baby born with congenital heart disease or a hole in the heart, these are caused by a number of things; infection, genes, drugs, metabolic problems, radiation even diabetic can affect the development of a child.
Hypertensive heart condition is the most common in Nigeria and across a wide age group. Hypertension is actually a function of the heart and the blood vessels; as the heart pumps blood, the vessels have a way of containing pressure from the heart. At a time when this mechanism goes off, the blood pressure goes up and remains high without reduction then one is said to be Hypertensive.
Unfortunately the heart will eventually get hit by high blood pressure. Hypertension apart from the heart it can also affect the brain causing stroke, the kidney, large blood vessels etc. 90% of its causes are unknown.
However there are 9 risk factors divided into 3 unmodifiable and 6 modifiable. The unmodifiable includes; family history, aging and gender with men mostly at risk. The modifiable are hypertension, diabetic, high cholesterol, smoking, inactive lifestyle/obesity and high salt diet.     
Then we have a group called the idiopathic cardiomyopathy. This has unknown causes and they are also common in Nigeria.
Also rheumatic heart disease follows rheumatic fever which is caused by a group A streptococcal infection. A sore throat in a primary school pupil and two weeks later, palpitation, the heart is beating and one can see it through the ribs, if it goes untreated then the heart gets affected. It mostly affects young children.
Then there is an entity that affects only women and predominantly in Northern Nigeria amongst the Hausa tribe who observe the traditional postnatal hot bath called “wanka Jogo” known as peripartum cardiomyopathy fever.
After 5-6 months postnatal the woman is bloated, coughing, having difficulty in breathing and can’t sleep. She comes in with a classical example of a cardiac failure without any other causes but the rigorous hot bath.
 
So in general everyone can be affected by one heart disease or the other?
Yes. And with the life expectancy rate in Nigeria put at 50 - 54 years, those between the ages of 40 - 60 are at greater danger of a cardiovascular disease.
 
What exactly is heart attack and cardiac arrest?
Heart Attack is one entity that is coming up at an alarming rate. It is different from a cardiac arrest. A heart attack occurs when a blocked artery prevents blood from reaching a part of the heart, affecting the normalcy of that part which then suffers. The longer one stays without treatment the greater the damage.
There are two types of heart attack; small and large heart attack. A victim of a small heart attack has a good chance of surviving. While Cardiac arrest on the other hand is triggered by an electrical malfunction in the heart that causes irregular heartbeat, when the pumping action is disrupted, the heart cannot pump blood to the brain, lungs and other organs and seconds later a person loses consciousness and has no pulse. Death occurs within minutes if the victim does not receive treatment. They are linked however, sudden cardiac arrest can occur after a heart attack or during recovery of a heart attack.
In general terms Heart attack increases the risk of a Cardiac arrest or you may say Cardiac arrest is commonly caused by Heart attack.
Sadly Nigeria is not prepared for this as doctors here only see one case in months if any. Unlike in the UK where people suffer from heart attack daily, just as Nigerian doctors see hypertension cases. But the pointers are too strong to ignore. But my worry is the lack of functional intensive care unit to attend to such cases when they do arise.  
So what are the various treatments available?
It depends largely on what type of heart disease one is affected by. For a child with either a hole in the heart or disarrangement of the blood vessels outside the heart, some are so oppressive that you must do a palliative operation; no drugs therapy will work or repair it to normalcy, only a surgical procedure to close the hole. The success rate is high due to the level of technological advancement and expertise and can be done here in Nigeria at 2million to 2.5million naira.  
Rheumatic fever can be treated and controlled; antibiotic is very effective. But once it affects the heart then a surgery is needed to replace the Valve grand.
For hypertension, a very good control of the blood pressure in a patient will help prevent a heart failure. Control the blood pressure because when it hits, the heart can never revert to perfect shape, one will have to manage the condition with medication. Unfortunately the situation will continue to depreciate till the heart finally gives up.
Important to note is that not all heart conditions require surgery whether major or partial. Most heart problems can be treated through drugs; the right medications. Also if its alcohol or smoking that is the cause one simply needs to stay off it, one can recover from minor damage.
 
You have mentioned heart surgery which would not be a welcoming conversation between patients and doctors because of certain reasons, where in Nigeria can it be done and the cost?
The National Hospital Abuja, Garki Hospital which is a Public Private Partnership also in Abuja, Enugu Medical center and University of Ibadan have successfully carried out heart surgeries in Nigeria. It is an expensive operation as the experts are flown in from abroad.
 
Just four hospitals to care for a large population. Is this why Nigerians prefer to go abroad for such surgeries?
Yes and for many other reasons. Medical tourism is a fad that has overstayed due to government’s inability to partner with the private sector to develop our health service. Prior to Babangida’s era, a few: Enugu Medical Center, University of Ibadan Teaching Hospital were carrying out heart surgery in Nigeria but was truncated.
Babangida’s government supposedly wanted to revive them but it never happened. Machines government ordered never made it to the hospitals. Then came the economy meltdown and many of the expatriates returned to their countries and our doctors migrated as well. The health sector was ignored, some dead or in a coma.
Today we see influx of our patients to countries abroad for even minor surgeries. Apart from the expertise we lack in certain areas, our intensive care units are glorified wards. No stable electricity supply, no heart-lung machine which is paramount to keep a patient alive till the heart is strong enough after surgery to take up its job.
Also that Nigerians do not trust their hospitals or the doctors and prefer to go abroad for this salient reason, no track record. Specialists/Surgeons abroad have their information online, you want to do a heart surgery or any kind of surgery in India or the UK, America or Dubai, with a google search, you get hospital information in detail; Surgeon’s file - number of operations he/she has done, success rate etc. those are not available here.
Note also the fact that an open heart surgery or surgery in general is a learning curve; you build your expertise over time. Modality may be on the high side in the beginning but it gets better. Those surgeons abroad have gone through the stages too. It’s a long process but I am glad that we have begun once again. This time God help us.   
 
 
What can Nigerians do in terms of lifestyle to help prevent the occurrence of a heart disease?
As per those known causes of heart diseases, a person must take the necessary precaution. If it is alcohol then stop taking alcohol. Have a healthy active lifestyle; stop the intact of salt, stop smoking, etc. Women need to consult their doctors before they conceive and also begin antenatal immediately they are pregnant to prevent any malformation in the unborn child. Thorough examination must be done of the baby after delivery. Technology is so advanced that through imagery can tell if there is a defect of the heart both in the womb and immediately after birth.
Poverty, ignorance and religion are very peculiar to Nigerians and their approach to life issues can trigger a heart disease.    
 
The health sector seems to be the least developed in Nigeria, what can be done to redress the situation?
We need to begin with attitudinal change; this is very important and pressing on all medical professionals. There will always be rancor but how we deal with these issues is what is defining. Everyone in this field is a specialist and must be respected as such, no need for the supremacy tussle.
The various unions of the medical profession are destroying what is left due to divinity of Nigeria’s health care sector. Doctors, pharmacists, nurses, scientists and etc. are custodians and must desist from using public health facilities – general hospitals/federal medical centers/teaching hospitals as bargaining tool to achieve certain selfish goals and ambitions.
This is a service driven profession that requires upmost responsibility and dedication at all times. Putting union demand above humanity will only get short term result; the government will never fully commit nor keep to the signed agreement under these pressures.
Then we address the issue of inbreeding; government must provide the necessary opportunity for these young doctors to travel across various countries and continents, work in a different environment and acquire new training and skills beyond what is obtainable in Nigeria.
The medical institution must be exempted from TSA. It is ill thought for the health sectors particularly hospitals to be a part of this policy. Certain medical supplies cannot be left till all the stringent stages to access fund are fulfilled. It wouldn’t allow our hospitals grow and be efficient and effective. Yes, block leakages and demand accountability but certain accounts must be left for management use. TSA will also affect getting research grants as the rigorous process to access the funds will kill enthusiasm.
Health Insurance Policy must be revisited and the laws review to fit modern changes. Enforce it to compel health providers to improve their services as no one will want the hassle and battle of court cases and millions in damages.
Also get health data in Nigeria to be accurate for effective management of the disease and control. Whatever is obtainable today I tell you is fake and incorrect. There are no true data on deaths, births, and other diseases. 
Importantly, government must stop allowing every state and institutions have a medical school. Improve what is obtainable or even shut down some. We don’t even have the financial resources/facilities to employ the lot we dish out these days.
Then provide the necessary equipment. Provide state of art machines and a lasting solution to the epileptic power supply. Hopefully that will happen soonest.
 
Why did you depart ABU Zaria after 20 years in service?
Sad to say, nepotism; I left because abilities were no longer of importance in position of authority. Our problem in this country since inception remains bigotry; it affects every sector of our economy and has crippled a once prestigious university such as Ahmadu Bello University Zaria. That was not Sarduana’s dream for Northern Nigeria or ABU.  Dedication to service over religion, ethnicity, gender, even political party should always supersede.

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