Question: What is the core mandate of UITH?
Just like the core mandate of tertiary institutions, one, it has to do with training. We are involved in training of medical personnel, doctors, nurses, laboratory scientists, pharmacists. All medical personnel can be trained here in UITH. We have all the scopes for the training. Also, we are involved in research. It’s a core mandate of the teaching hospital. And, of course, community service. That is very important. I’d say it’s the most important, and that is the one that almost everybody knows. But, at times, in fulfilling that mandate of service to the community we are overburdened because we are a tertiary hospital. But, at times, we do primary, we do secondary and we do tertiary services.
Question: What do you think is responsible for the over burden of the tertiary hospitals, UITH as a case study? What is wrong with the primary and secondary health cares?
We don’t have strong secondary health care. If you have very strong functioning general hospitals, for example, they will handle majority of the cases that come and it’s only those that can not be handled that will be sent to… you know. There are a lot of things that the hospital may not handle based on the equipment they have and based on the capacity in terms of personnel. So, base on that they can refer cases and it’s a normal thing. We are supposed to do the other way round too, somebody refers to you. When they are leaving, you refer back to them. Often times, because of the workload and all that, we just leave like that. We are supposed to send them back to those that send them to us.
Question: Still on UITH core mandate, you said research is an aspect of the core mandate of UITH, what milestone has the hospital recorded in the area of research?
Well, there is a lot of research activities going on. And, I would tell you that in the university, the UITH makes a very major contribution. That is to say if you go to University of Ilorin and you look at the publication for a particular year, and you now say ok ‘what is the contribution of people from the University of Ilorin Teaching Hospital?’ it’s major. It’s so much. Because we are also lecturers. We are lecturers in the university but because of the peculiar nature of medicine as a discipline, you know, if medicine has so many parts, if you are teaching medicine in the University, you must be attached to a teaching hospital. If not, there will be no approval to have medicine in the university. So that is why we have teaching hospital at the university. The teaching hospital is a laboratory, so we are primarily employed by the university to produce medical students, but medical students cannot be produced inside the university. All the rotations, everything is going on here. They are students of University of Ilorin but everything that is done for them, in terms of training and teaching and learning is done here because this is the laboratory. This is where the patients are. This is where the equipment are. This is where they have to get the experience. They may have lectures in the university, it’s possible. But the training is here. Naturally, lectures and seminars will be where the training is going on. We have our lecture rooms that are very close by. They don’t need to take transportation. They just walk across, take their lectures, leave, walk to the theatre, walk to the ward, walk to the lab and that is how the training goes on and on.
Question: Within the last two years, what feat has the teaching hospital achieved, may be in the area of special surgery or any other?
I’m sure you remember the separation of conjoined twins. It was done here. We had quite a lot of assistance from also the Kwara state government in buying one of the major equipment and we were able to achieve that feat with the cooperation of so many people. The team was a multidisciplinary team. Of course, you know, it has to be so to be able to solve the problem. The radiologists were there, the surgeons were there, the pharmacists were there, the psychiatrists were there. It’s a teamwork and that was why it was highly successful. The lead was professor Abdulrahman who is a paediatric surgeon.
He had the support of so many other specialists, octors and nurses. So that was the major feat. Medicine had its own approach to advertisement, there are lot of things about medicine that if you’re not careful about advertising it could go wrong. But it’s easier for people to see us and talk about us than for us to talk about ourselves. It was a major feat because that was the third attempt in separating conjoined twins in the University of Ilorin Teaching Hospital. This was a very successful one because we’ve built on past challenges —I won’t call that failure. I won’t call that failure because we needed to,.. you have to put everything in context. The level of infrastructure as at that time. You can’t compare it to now. We have moved ahead so much in infrastructural development in the teaching hospital.
Question: I’m sure you’ll be doing follow up on health condition of the separated twins. How are they?
They are doing well. I think when they were a year old, not too long ago, they showcased them. They came here and the management board of the teaching hospital gave audience to the team. They came during the management board meeting and the management acknowledged them and say we should write letter to them and thank them.
Question: Were there any special thing that was given…?
There was a donation from one of our very highly motivated well wishers. …Foundation, facilitated by a centre for Democracy, Development and Research. Sorry I’m not putting it in the right order. This is an NGO of the Chief of Staff to the President, Prof. Ibrahim Gambari. This organisation has helped us so much. They also gave a donation to the family, to the children, even for the next five years. They placed money to be given for the upkeep of the children. Also, as at the time this surgery was done, the parent were not employed, the CMD had employed both the father and the mother. Today, they are employees of the UITH, in a way to empower them, to make sure that the children realised their potentials, because hitherto in our society, those are the ones they are called the lucky children. Just like in the geopolitical zone . If a lot twins are evil, conjoined twins also are evil. But the way things are, improvements in standard of living, development in medical infrastructure, these children can be anything in this country. They can head this country. They can rise to any level because they have been separated and now they are normal.
Question: Can you remember the exact year the separation took place?
In the year 2021. It was around May.
Question: Talking about modern equipment to suit your core mandate, is UITH there? Do you have the state of heart equipment? What and what do you need?
We still need quite a lot of medical infrastructure but I must tell you that in the last two years, what we have gotten we never thought may be in the next ten years we will have gotten it. The equipment were cutting especially in the laboratory. As far as the laboratory is concerned, we are very fully equipped. One of the key things in medical diagnosis is what we call molecular diagnosis. Molecular diagnosis is picking that thing at the molecular level because that is where it starts. Something happens at the molecular level, at the level you cannot see with the naked eye, and then it now comes up at a stage that we can see it . Now we can make molecular diagnosis through PCR machines. We never had that in this hospital. Because of that, there are lot of research works that could not be done here. Not only was it not available here but in the whole country. So those are the positive aspects of the COVID-19 pandemic. It helped us in building more capacities, especially infrastructure in the laboratory. The PCR machine is one machine that you need for epidemics, infections and all that because it tells you exactly what is there. We have many other machines but they cannot do that molecular work. Now, the hospital has four PCR machines.
Of the four, three at real time while one is conventional. These are equipment that are… When the pandemic broke out in December 2019, then of course in February 2020, when the first case was identified in an Italian engineer who came to work in Ogun State, the whole country didn’t have up to 10 PCR machines. I learnt it was may be 7. Now, Kwara State alone has 7 PCR machines because we have four in the teaching hospital here. The university has 2 and the state ministry of health has one. That of the state ministry of health is what we call a gene expert health machine; very useful in diagnosing tuberculosis. Tuberculosis can not be diagnosed through the conventional means. So the gene expert machine can be coupled to do molecular work. So when the pandemic broke out, most of the gene expert machine, there are some components you can add to them to make them do molecular work. And that was how we started. All our COVID-19 tests were done by the state at Sobi Specialist Hospital, Ilorin.
Question: Simply, in Nigeria, do we need more hospitals or more equipment?
I would say both because access to healthcare is still a problem. There are a lot of people that need to go to the hospital but when they look around in terms of distance, cost and so many factors, they will say ok let me buy paracetamol. So we need more hospital in terms of access so that you come out from your house and it wouldn’t be too far to have access. You can imagine if we have the general hospital, we have the maternity wing. The maternity wing is like a teaching hospital.
t’s for teaching, we are not doing much of clinical work there. If for example we have like 3 or 4 of these tertiary institutions around, it’s not good to cluster them. You should have tertiary hospital serving so many secondary centres. But for now, we are the only tertiary healthcare centre. The general hospital can do some secondary, they are build purposely for primary and secondary in the sense that we should be receiving… If you go like UCH Ibadan, they strictly follow the guidelines. There are certain complains you’ll present there and they will tell you to go. And they are doing that in good faith so that you don’t waste your time because you get there, there are certain complains and nobody pays attention to you. Or they give you an appointment: come in three months. By the time you are given a 3 months appointment. If you also check our history, how we started, we started as a general hospital, in the centre of the town. So we have to make access easy for people so that they could have access.We still need more hospitals, but we need to equip our hospitals that we have. One of the reasons people( doctors) leave the country is also the fact that they don’t have job satisfaction. People have trained abroad, they are well exposed and when their colleagues are reporting things they can’t report those things. There are some research you can’t do because we don’t have the equipment. There are some publications we can’t attempt because they will say which centre. So people have an edge over us because of lack of infrastructure. In the laboratory we are very equipped. We are trying, but we can get more so that, you know, medicine has so many specialities and sub-specialities and that is the way to develop. You get to a level you say in the eye, my own work is just on the retina while retina surgeons like Prof. Mahmud in ophthalmology is a retina. So we sub-specialized because we have been at the general level for a long time and now we need to move on. That’s a way to develop. There are still general surgeons, they do general work.
Question: I want to go back to that COVID-19 era. You told us that the hospital played a major role. What is it that you contributed majorly?
You know the pandemic is a worldwide thing. It came at a time we were not prepared because ordinarily we were having challenges.
So now with the pandemic it became more challenging for us. There was a time that even to get the things you needed, you couldn’t get them because of the lockdown. Masks are everywhere now. All those have changed because our people have been using them now. So the challenges are not much. COVID-19 treatment is free. In this hospital, we started testing about a year ago when our laboratory became ready. Before now, we were sending our specimen to Sobi and it would take like a week to ten days to get them back. In all we have 346 COVID-19 wards/patients. Out of these 346, 153 of them were positive. We wouldn’t know it’s COVID until we have sent out everything.
The clinical symptoms alone would not make it to say this is COVID. You suspect COVID and it’s when you do test you now know that this is COVID. We admitted about 346 but 153 of them were positive. We had about 147 that were negative. Then, there were some inconclusive results. We had 25 that were probable COVID. Then 21 cases were inconclusive. We had 76 deaths among these cases and we started our own laboratory here in July last year. That’s about a year. So now, we don’t need to send specimen anywhere. Before now, we keep somebody in the ward for 10 days and be managing as COVID. All the consumables are being used. The masks, the gowns, gloves, everything because you don’t know what it is, it’s only when they say it is negative that you now move the patient out. It was more expensive then. But now, before even he moves to the ward we have a diagnosis because all the facilities are here. So we can’t take you there and say you’re negative and bring you out. Also, we have a dedicated ward. Before now, we closed down one of our wards. The female surgical ward one.
We closed it down and we’re using it as COVID ward. Because COVID came as a pandemic. It took everyone unaware. Now we have our own COVID ICU. We have to take over their breathing, circulation, feeding. Such can only be managed in the ICU. And we have a COVID ICU where we can do everything that needs to be done. We have 10 beds in the COVID ICU and we have 10 beds in the COVID isolation ward. So now the last time we admitted somebody in the COVID ward was about 2 months ago. We had a corper from the Yikpata camp that came and was breathless, and was tested. He was positive and was admitted there. Since then, we’ve not had any patient who have tested positive to COVID. We think it’s weaning. People should still not through everything because it can just break out again. It doesn’t announce itself. Viruses have a way of changing their forms and all that. But we are happy that immunisation is quite, Kwara was adjudged as one of the best in terms of coverage of immunisation. With that, there is what we call herd immunity, when you see disease comes into a place, many people get exposed to it. And so we produce anti-bodies which get to fight it naturally. So the disease will not have that effect; I mean, if we are to compare COVID in May 2020 to now. The first time I went to Sobi to go and see, because our staff also came down —about 120 of our staff have COVID.
At a time we lost count because COVID had some stigma to it. Unfortunately, at times it’s like that in science and in life. The disease will make people ashamed. There was also stigma. People would have COVID and would not want to disclose. There was a time some staff got sick and when we were asking what happened they would not tell us. With our own record, we had at least 120. At a time, some of the departments had to shut down temporarily because a lot of people then were isolating at home. Like in surgery, at a time we had more than 10 people who were positive. They were isolating at home. Our response was good. We never shut down the hospital because of COVID. Some people did but we never did that. At time, we scaled down.
Question: I know that some of these teaching hospitals claim to specialise in certain areas. For example the OAU. What’s the area of specialization of this teaching hospital?
For example, paediatric surgery, because of separation of the conjoined twins. Yes. In kidney diseases, we have also done kidney transplant here. In infectious diseases, we have done it here. We have over 150 specialists in different areas in this hospital. People who are doctors who have gone for training and they have areas of interests, we have them. In terms of manpower, we have enough. Because there is no specialist you’re looking for that you won’t found them here. From children diseases, heart diseases, cancers, there’s nothing that you won’t find here but the limitation we have is usually infrastructural development. Our resident doctors are… about 2 years ago, we employed close to 100. We have over half of those left now. And the employment system now is a bit different. It’s highly centralised. You have to get approval from about 7 organisations before you can be employed. That’s why at times you have delays in employment. If you don’t get approval you can’t employ.
Question; What advice can you give to personnel in the health sector?
Quite a lot of doctors, especially the senior ones who are leaving. It’s not only the monetary benefit. Some, it’s because they are not practicing their specialty. You can imagine if you’re a cardiac surgeon, you’re a heart surgeon and you are not able to operate. You can’t do that because the facility are not there. Even, the hospital where you’re working does not have a facility to do heart surgery. There are many other things as a heart surgeon you can do, but the main thing that a heart surgeon wants to do is to operate on the heart. So if you are not able to do that you may not be happy. Some are leaving because of that. Then, of course, the state of insecurity in the country is pushing a lot of people to go outside. Like I said, infrastructural deficit, self-actualization. People get to a level, they won’t be able to solve problems, they won’t be able to do a lot of things and that doesn’t make them satisfied. Of course, the pay also. The difference between the pay structure of doctors here and other places. All these are some of the factors.
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