Treatment of spine injuries is a challenge in Nigeria. In this interview with WINIFRED OGBEBO, an expert, Dr Kawu Ahidjo, says progress in spine surgery,for which only two surgeons are employed by the federal government is slow.
Do we have doctors that can operate on spines in Nigeria?
Five years ago, we only managed spine problems conservatively. In the last five years, you see a lot of efforts by doctors of spine from different centres. But it falls below the demand by the patients we generate every day in Nigeria.
In our centre, for example, we get an average of one patient per day. Spine problems range from trauma and degenerative disease to infections and tumour. You are talking about 360 patients on average a year, and that’s those who even manage to get to hospital. We are not talking about those who will not get into hospital, those who will die at the scene of the accident, and those who will be taken to traditional bone setter.
There are issues we are not tackling. Do we have facilities to manage patients in our country? No, we don’t. Do we have the team to manage patients in our hospitals? No, we don’t. Do we have enabling laws for spine surgery in Nigeria? No, we don’t. Do we have post-operative care for our patients, for rehabilitation? No, we don’t. Do we have laws that will help these people when they come out of hospital to live normal lives? No, we don’t. Do we have job opportunities for these people? No, we don’t.
90 per cent of patients with spine trauma will die within one year after the accident. What is the major cause of death? Complications from this problem—they either die of respiratory problem or they die of neglect, or they are killed by their family, because there is no hope. They just lie on the ground, get bedsores, infections, because they can’t afford money to take them to hospital.
The last study we did in these parts, we look at how much it cost to manage patients in acute phase of spinal cord injury, it is $1,500 for 6 weeks in the last five years. You are talking about people who [live on] less than one dollar a day. Majority of patients are people who cannot even afford it. There is no medical care or health insurance for them, so a relative has to bear the cost.
You give them two options: how do you want me to manage you? Do you want me to give you your primary surgical treatment or you want us to manage you conservatively? They all opt for conservative management because the cost of managing them surgically is very expensive.
What exactly does conservative management of spine problems entail?
Put the patient in bed, don’t move the patient, let the patient stay there—that’s all. And you give them medication. So you hope that in 8 to 10 weeks the fracture will heal and you try to put them to sit. But between the first day and that 8 weeks you are going to manage these patients, there will be a lot of problems.
One, all the B’s will start happening - bladder problem (patient will develop urinary problem; bowel problem (some of the patients will not be able to pass stool on their own); blood problems (patients will develop DVT - a situation where clots form in the leg, flows to the heart and the brain, and the patient dies); breathing problems (because the patient cannot move, the muscles of the chest (are) paralyzed, he can’t cough, he develops pneumonia and before you know it he dies right under your nose.
But if you operated early, you can get the patient to go to a wheelchair and send the patient to rehabilitation early, so muscle development can start early and you can try to ambulate the patient early. These are things that have not been available in the last five years, but now they are becoming available, but they are very expensive.
Can you always guarantee that the patients you offer free spine surgery would always fit the category of being indigent? Could emergency situations overtake indigent status?
You screen patients based on two reasons. One, if I tarry and don’t do anything within the next few hours, even if this patient eventually pays, I won’t be able to get the result I want. We would go in and operate on such patients, even if they don’t have money. Even if they tell us they will pay and eventually they don’t, we don’t chase them around.
But there are patients that you are not under any emergency to manage them. If they can pay, fine; if they can’t pay, we will still manage them. It is very selfish to think if they don’t pay, we will not do it, because even if we don’t work, we will still get our own salary at the end of the month.
If you look at it from that point, as civil servants, you work or you don’t work you will get your salary at the end of the month. If you transmit that to your patients, it makes more sense to give him the service, whether he pays or not.
These equipment were supposed to have gone into use last year but didn’t. And there were patients who couldn’t benefit from it.
We lost quite some patients. You know, you give these patients hope that something is going to happen and eventually nothing happens. We told them we were going to operate on them, and when they waited for too long and discovered we were not helping them, they left. The worst part of it for me is when you look at the way we treat ourselves as Nigerians, we do it as if “I don’t care about you, you don’t care about me.” It is like there is no emotion about being a Nigerian, no empathy.
As doctors, most times we miss it when we demand that something must be available or else we will not work. Doctors go on strike over poor salaries and working tools, but immediately they increase our salaries—even if they don’t improve the equipment—we go back to work. .
Tell us about your equipment that was seized by the Customs
These equipments are to be distributed among orthopaedic and neurosurgical hospitals in each geopolitical zone. We have Enugu for the southeast, Lagos for the southwest, Abuja for the north central, Kano for northwest. In Sokoto too, because of the neurosurgical centre, we decided to give them one. The north east has nowhere where doctors can operate on the spine.
We are thinking that if we put it in different centres, the number of Nigerians that we will be able to operate on, will increase—that means more reach. it will also encourage these hospitals to train more people to use the instrument set, and then it will help crash the price to make it more affordable for their patients.
When the equipment was seized, what went through your mind?
Every day, I ask myself why did I come back? At every level, there have been obstacles—obstacles from people suspicious that these young people would be doing this; others frustrated that we will be making a lot of money. so we have to fight them; obstacles from people who think that this should not happen in this generation; obstacles from the society. It takes everything away from you.
But one patient you help brings the next patient. It is this continuous joy that you put on the face of people that gives you the zeal to want to move on. And this is the beauty of the job: that no matter what obstacle I face, the joy that I bring to my patients when I offer them something different from other people.
With the situation on ground, why did you opt to become a spine surgeon?
I became a spine surgeon because of my friend. I had a colleague who had a spine problem. At that time, the people managing her kept on telling her “don’t worry, just pray, you will walk.” And every day I expected to see this miracle. Eventually, she died in the hospital. It saddened me and I thought “ this is enough?”
So when Dr Halimi started to train as a spine surgeon, he left for Europe and when he came back, he said, “man, there is hope for people—I mean, I saw how they do it!” He provided opportunity for some of us. And then when I left for my first training, the first thing I saw was the commitment of people to saving human lives, treating human beings as humans, not like animals the way we treat our patients in Nigeria. I never saw people who abused patients, talked any how to patients. They showed dignity and mercy to them.
The equipment came after a fellowship training in scoliosis (deformity of the spine). We got it into Nigeria and trouble started.