Prof. Aaron Ojule is the Chief Medical Director of University of Port Harcourt Teaching Hospital (UPTH) he was at the middle of the battle during Ebola outbreak in Rivers State. In this exclusive interview with Paul Obiajunwo, he said Ebola was a war fought by all. He also spoke on his achievement, challenges of Nigeria health sectors and other interesting issues
You are on your second tenure as the CMD of the UPTH what would you say is your achievement so far
In my reappointment as the CMD of this hospital, I was asked to list some of my achievements, I assumed duty on November 9, 2009 I’m in my second tenure as the Chief Medical Director of this hospital. When you talk about my achievements then you should look at the bed capacity of this hospital. Before now, it was 110 beds but today we have 840 beds, that’s because we have added new units and services. If you look at it, is about 60% increase in bed capacity, we have completed and furnished new paediatrics block. We have also completed and furnished Nuclear Medicine Building, male and female Dental ward and so many of them. I have 38 projects completed and on-going under my administration in addition to other things we have done. Under my administration, which is still on, the hospital did not lose accreditation of any existing training programme. All departments and programmes due for re-accreditation were successfully re-accredited such as General surgery, internal medicine, paediadrics and Gynaecology and so on.
Some of the projects are capital intensive does that mean you are getting more allocation from the federal government and other donors
One thing is to get fund another thing is to utilize it properly. There is nothing extra-ordinary that we are doing, except that the little money we get from government and what we generate here we ensured that it is properly utilized. Also we have been able to attract partners to come and help us do one or two things in addition. But to a large extent the money we are using is government money and we were able to utilize them.
Do you still need government assistance and in what area
We believe that the new government will take a critical look at the health sector, because as we speak a big public hospital of this nature has several challenges that are making the hospital not to run well. And I know as a journalist people have complained to you one thing or the other about the hospital. It is not because we are not aware or because we don’t want to do anything. It is because of the challenges we have and some challenges government has. However, I want to commend government on what they are doing but I believe that things can get better and it can only be better if government inject more money into the system. When you travelled abroad and you see hospitals, there is nothing stopping us to get our hospitals to that standard. By making those services we see abroad available and keeping the environment clean.
And you believe that by doing that people could trust our health sector
Yes, it is about process, because of such issue we started amenity ward, for those who can afford it, to give them the ambiance and services they need as to reduce capital flight. Now, there is no body to fund it due to economic downturn. So, what we are doing is to source partners through public, private partnership. It is not to say that the health sector has not improved, the health sector in real sense has improved over time. Whether they like it or not we cannot deny the fact that the health sector has improved. When you travel to African countries for seminar to meet other colleagues you will know that Nigeria is far ahead of other countries. There was a programme under President Obasanjo, where government took time to re-equip many of our Teaching Hospitals. Of course, UPTH was one of the beneficiaries. Government gave N2 billion each to these hospitals and bought equipments and others, that alone revolutionalised the health care system in Nigeria. There is an improvement in our health sector but the problem is we have not gotten to where we should be. We want to get to where we would be compared to the hospitals in Europe, India and Israel. We have not gotten there but we have made a lot of improvement.
What is the difference in those hospitals abroad and ours?
The major difference is in terms of technology and equipment, over there, their buildings and environment are clean; they have constant electricity and water. But here, we are struggling with the basic things, there is no water, no electricity, the hospital management struggle and when you go to hospital and you did not see these basic things you will not be happy. But in abroad they have gone beyond these challenges. We need money to acquire new technology and to train people to know how to use the equipments and those thing cost money. That is the difference, we the Nigerian doctors if we operate in those environment we are like super stars. Nigerian doctors are professionally qualified, like here, we train doctors and that is our special mandate as a Teaching Hospital. In times of manpower we don’t have problem.
The doctors of this hospital were fully involved and one of them was infected during Ebola Outbreak? Yet some people said the outbreak was political, what really happened?
If anybody tells you that Ebola outbreak in Rivers State was political that is fallacy, Ebola was real, we struggled over it to a level that one of our staff was infected. She was treated and she survived, so it was not political but real. I want to use this opportunity to commend the Federal government, the State government for all the actions and leadership they showed during Ebola outbreak. Ebola was like a war and all of us were involved as a nation. The team from the Federal Government collaborated with the state government and they showed a lot of commitment. The former President, Goodluck Jonathan and the former Health Minister Prof. Onyebuchi Chukwu showed a lot of commitment. The immediate past Governor of Rivers State, Chibuike Amaechi and the former commissioner for Health Dr. Sampson Paker also deserve commendation. So, there was a joining of forces from Federal to State, Federal government sent a delegation joined by the state delegation with the assistance of the foreign partners, like Doctors without border, WHO and others. We constituted a team and of course, most of the manpower came from this institution. And together with all hands on desk we were able to defeat Ebola.
But a lot of people accused UPTH of not being prepare to handle Ebola outbreak in Rivers State
Ebola is a special illness, Nigeria have not witness anything of that nature. You remember that when it started in the West Africa sub-region we thought it would not reach Nigeria. Then it landed in Lagos and everybody was shouting. Although, we were preparing people, telling them what to do in case anything happen in Port Harcourt. Don’t forget that when the outbreak showed up in Lagos we started training our health workers on the precaution to take because the most important thing about Ebola is prevention. When eventually we had an index case in Port Harcourt, it was a big battle and then the resident doctors were on strike. Some of our doctors happened to be treating the index case, remember a doctor that was practicing in Rumuokoro became ill, that doctor who was running a private clinic was married to one of our doctors. Because the Rumuokoro Doctor was our doctor, other doctors participated in his treatment; we have various specialists so the doctors in this hospital were invited to manage the infected doctor who is their colleague. Of course, they didn’t know it was Ebola, they were all exposed. That was why we were in the thick of it and when we realized and it was confirmed it was Ebola it was a big war. Again we hosted the diagnostic lab for Ebola, in initial cases we were sending sample to Lagos but later our own lab was setup. We were very seriously involved, anybody that said we were not prepared, then I may not know what the person mean by not being prepared. Because we were involved to the extent that we started producing our own hand sanitizer. Though, we didn’t have a lot of money but the sanitizers were produced according to the standard of WHO. And during that period many hospitals in town refused to take anybody that has a fever. They said it was Ebola but because we are government hospital, the apex hospital, we have to prepare to take anybody rejected by other clinics, these are some of our contribution during the outbreak.
Can you tell us what your experience is when doctors are on strike, especially at the point when their service is mostly needed?
Like today (Wednesday 10th of June 2015) I got a letter of indefinite strike from the Association of Resident Doctors UPTH branch that by midnight today they will be on strike. But I know that I was in their meeting this morning talking to them not to go on strike. What I told them is that look, even if what you are asking for is your right but the timing is wrong. Because we just had a new government which has not settles down. And we are aware that our President is a gentle man, he is an action man, and with his past record it shows that he has a listening ear. He doesn’t tolerate anything that is wrong and this kind of President if you tell him your problem and you convince him, he is definitely going to look into the problem. He is not a man who runs away from solving problem. I have pleaded with them to give this government time to settle down, I am not suppose to be in their meeting but I have to go because this nation belongs to all of us. When there is strike and the place is shutdown everybody suffers, especially the innocent Nigerians who have no other place to go to. All I am saying is that let them give this incoming government some time, the economy is bad. Despite that the new government is a listening government, they are morally upright and I believe President Buhari and his team will solve their problem but they need time to settle down.
People are complaining that 90 percent of doctors that attain to patients at UPTH are mostly student doctors how true is this allegation
Thank you for asking this question, one thing is that most people don’t understand how a teaching hospital runs. Many people are also ignorant of the categories of doctors that work in the teaching hospital. I think you are right, and as a journalist you should educate the people. Though, Part of our medical mandate is to train medical manpower. It is not only doctors; we have many training institutions here. But with regard to doctors we do training for undergraduates and training for post-graduates, undergraduates are people that are in university that want to have degree in medicine. And that is why we are teaching hospital, those people in the University for Undergraduate training, they are not yet doctors, they don’t have certificate. So if you want to call them student doctors they are really student doctors, they are not allowed to treat any patient because they are learning. They can never treat patients because they are not licensed, they have consultant who are teaching them. The consultants are specialists; we have the highest concentration of specialist in this state than in the entire states. We have 170 consultants in this hospital, when a consultant or a resident doctor is treating a patient the one you called student doctors have the right to stay around and ask question and observed. That is how we train them, before they can do anything they must be guided by the specialist, for you to treat a person you must have license, if somebody who doesn’t have a license and treats a patient that person is a quack. Now the mistake people make is that we also train post-graduate doctors, doctors who have first degree we will now train him or her to become specialist. The person can be an eye doctor, ear, bone and so on, and before you can be trained as specialists you must first of all qualify as doctor. If you go to private hospital or clinic out there and they are treating you, would you say they are student doctors? They already qualified as doctors with many years of experience, medicine is too large and for you to practice you have to specialized in one part of it, that is what makes that person a specialist.
At what point would a person in need of treatment be rejected by hospital
Well, it depends on information, we are government hospital, and Government established this hospital to treat Nigerians. The people have a social contract with government and the basic function of Government is to protect life and property. And your life is the greatest possession you have, so government takes the maintenance of life very seriously. That is why health sector is an essential service, you cannot be sending somebody to government hospital and you would be turned away. We are under oath from government not to reject any body. We are the apex, if we reject the person where do you want the person to go to. What happened is that because we are government hospital, I have told you the effort we made to expand the bed capacity. However, we have a limited bed capacity, at some point in time everywhere will be filled up, there is no time we are not oversubscribed. When it is filled up, if it is our labour or emergency ward and then you have new person coming in, if you are in my shoe what would you tell the person. We have a standard rule that when you come to the hospital, a doctor will evaluate you and talk to you. And if it is something that need prescription he will do that. But if after seeing you, it is something that you need to be admitted and everywhere is full what do you want me to do. You will go and look for space elsewhere; we can invite the person when we have space.
When a patient say he don’t have money to pay after treatment, as government hospital how do you handle such matter
Because many Nigerians are not handy, we have many poor people in the society that is why as government hospital we try our best to make sure that service delivery does not shutdown. That is the major reason why I begged these doctors not to go on strike because it is an ordinary Nigerian that would suffer. Especially, those that don’t have money, now, when people come to the hospital the first concentration is not money but to save life especially in emergency. That is not to say that we don’t collect money but the focus is not on money but to save life. However, to save life we need certain basic input, we need consumable to keep the hospital growing. What we charged people is a discounted price because it is government people. Government pays the salary of everybody, all the building is owned and maintained by government. The amount of money that government is spending to run the hospital is much; our salary bill is close to N500M every month. If we ask people to be paying, so that government can stop spending many Nigerians cannot afford it. The money people are paying here is cheaper than the private hospital. What surprises us is that even in this discounted fee many Nigerians were unable to pay and by then you would have rendered some services and when you say pay your money he or she will say I don’t have money. At that point what we do is to appeal, begging them to link their parent or relatives. There are some difficult ones who will tell you that they don’t have anybody and the people that brought them to the hospital would run away. We have also set up what we called an indigent patient fund so that the privilege ones can donate. When we have this kind of challenge we can put hand on the indigent fund. But many Nigerians are not contributing to it, we go to churches and other organizations asking them to contribute but the response are not the way it should be. But we have some catholic organizations that have been so faithful contributing to the fund. There are funny situation where you have treated the person and he was unable to pay his or her bill. And when you have another person waiting to take over his bed then it became necessary that he pays to make space for another. We try our best that we don’t maltreat them but at the same time if you don’t accept money the hospital will shutdown. So, we try and make them see reasons through the help of Medical Service Department. It is also a specialist department they know how to trace the family of the patient even if it is visiting their village to plead them to see reason to pay something if they cannot afford the whole bill. One thing is certain, we cannot deny somebody treatment because he or she doesn’t have money but because we have treated the person he should pay something. This hospital is a common heritage for all Nigerians and everybody must contribute to maintain it. Let me also use this opportunity to appeal to well-to-do Nigerians to help and contribute to the indigent patients’ fund, a hospital like this need many things we cannot continue to struggle. Companies should come here and contribute as part of their social cooperate responsibility. Life is the greatest assets to possess, once your health is poor you cannot enjoy life any longer and you cannot equate anything with life.