Dr. Francis Faduyile, an associate professor in Pathology and Forensic Medicine at the Lagos State University College of Medicine (LASUCOM), is the new the President of the Nigeria Medical Association (NMA). Faduyile, who is also a consultant pathologist at the Lagos State University Teaching Hospital (LASUTH), discusses his motivations for taking the new position, his programmes, the root of the current strikes rocking the health sector, in this interview with APPOLONIA ADEYEMI
What motivated you to go for the presidency of the Nigerian Medical Association (NMA)?
After having the opportunity to lead the Nigerian Medical Association (NMA) in Lagos State some years back and contributing my quota, I think I have some other things to do at the national level. Importantly, we see that we needed the NMA to be patient and public-centred. Although, majority of our activities are geared towards how to improve health generally, but we want to also improve how we take care of Nigerians as the most important thing that we want to do.
I have observed that there are so many gaps between what is desired and what is on ground and I think with my administration we can have a major improvement to reduce the gap so that the health of the populace can generally improve.
For example, the National Health Act (NHA) that was passed some time ago and signed, was moved by the NMA in 2014. The NMA had to stage a walk for the bill to be signed by the Senate. It’s only in Nigeria that the Constitution did not prescribe what the government needed to do for the populace in terms of heath.
In the constitution it said that the government should take care of the health of the populace. That is all that is in the Constitution tying the government to our health. The details are not spelt out. Hence, you can see successive governments coming and paying lip service to health and we need to put things in place. That’s one of the major motivations that spurred me to contest for the position of NMA president.Dr. Francis Faduyile, an associate professor in Pathology and Forensic Medicine at the Lagos State University College of Medicine (LASUCOM), is the new the President of the Nigeria Medical Association (NMA). Faduyile, who is also a consultant pathologist at the Lagos State University Teaching Hospital (LASUTH), discusses his motivations for taking the new position, his programmes, the root of the current strikes rocking the health sector, in this interview with APPOLONIA ADEYEMI
Still talking about existing gaps, apart from the delay in implementing the NHA, what are the other things you desire for the populace
Generally, we have to pursue seriously, the issue of Universal Health Coverage (UHC) because out-of-pocket payment for health is outdated.
There is none of us who receives salary and keeps an amount or a particular percentage for ‘in case I fall sick,’ I can fall back on that. So, it means that anytime we fall sick we have to scramble anywhere to get money and God forbid if you need that money within a short period of time and you don’t have it, a lot of things can happen.
So, what we want to do is to make sure that we strengthen the National Health Act (NHA), which has two components – one per cent of the Consolidated Sovereign Fund, by that law is supposed to be sent to the NHA and 50 per cent of that money will go to the National Health Insurance Scheme (NHIS). Fifty per cent will go to the National Primary Health Care Development Agency (NPHCDA).
Primary health care (PHC) centres
For example, most diseases can be taken care of at the Primary Health Care (PHC) centres and in Nigeria PHCS are in shambles. In many of them we have buildings; we don’t have personnel to manage care provision and even the personnel that are there are inadequate.
Most doctors are not seen at that level; even the nurses are not there because the government has refused to put money in the place. Most of the people who are working there are poorly paid. We have seen so many states that within six to eight months, they have not paid the personnel at the PHCs. Consequently, you see gravitation towards the centre, which is the Federal Government-owned facilities because the government manages to pay salaries monthly, but the Federal Government can only take care of tertiary health centres, where they do highly specialised care.
Most of these diseases that become complex could have been taken care of at the PHCs if they had been seen early. Hence, what one could have used N1000 to take care of would end up with millions of Naira.
So, we need to see and encourage government to put money in health and ensure that the personnel working in those rural areas are well remuneration. In fact, the NHA states that those people working in rural areas should have further incentives beyond their counterparts at the federal level.
Similarly, we need to educate the public because most of our people don’t understand the implication of going to the PHCs for treatment. Rather, they go and meet the charlatans and quarks around and many times complicate their cases. We need to do proper orientation and change the views of people towards orthodox medicine.
National Health Insurance Scheme (NHIS)
We need to also see that the NHIS has more enrollees. Presently the subscriber percentage in Nigeria is less than five per cent and it means that over 95 per cent of the people depend on out-of-pocket payment. What we intend to do is to pressure the government to see that it gets more enrollees from the federal government and to also advocate to the states to start their own health insurance schemes. For example, the Lagos is starting it’s own health insurance in June. That is an effort in the right direction. By the time more people enroll in it, it will help at emergency level. We want to make sure that the NHIS has more coverage.
If you remember, the Abuja Declaration stated that from the budget of every African nation, a minimum of 15 per cent should be earmarked for health and I can tell you that year in year out Nigeria has not gone beyond 15 per cent.
Most times, Nigeria has not gone beyond six per cent. Most times it is five per cent. So, we want to educate the public; we want to tell the government to do the needful.
We want to make more healthcare personnel, doctors, nurses and others to work at the PHCs. Also, we want to see that we are able to take care of quackery.
You ascended the presidency of NMA at a troubled time when health workers under Joint Health Sector Unions (JOHESU), are on strike and your first set of activities was to inflame an already bad situation by warning federal government not to address JOHESU issues. Why did you choose to aggravate the situation, rather than being conciliatory?
I don’t totally agree that I inflamed what was on ground. What we did was to affirm international best practices. I have had an interview before that press release in which I stated that the NMA wants to have a harmonious relationship with everybody in the health sector. However, it should be known that there are some standard.
Our brothers in JOHESU have this false believe that they can collect any amount they want and we can collect any amount we want and I say no. Anybody who is working in a place knows the level that he or she is, the responsibility that he or she is doing, the time that he or she is putting, among other things.
In health, the take home of a consultant in a colonial era was close to the take home of a high court Judge. The chief consultant is at the level of supreme court judges, but today I can tell you that it is a far cry to what is on ground.
At that time, relativity of a doctor, other graduates including nurses are ratio 5 to 3 to 1. What it means is that if one is collecting N1,000, other graduates of the same level will be collecting N3,000 and a medical doctor with a Bachelor of Medicine, Bachelor of Surgery, (MBBS) will be collecting N5,000, but today, the ratio has been blunted that it is about 1.5 to 1 to 1.8. It means that all of us, irrespective of responsibility, line of duty, time that is put into work, have not taken effect.
Anywhere in the world in health institutions, there is relativity. A doctor should know that at a particular level based on his responsibility, this is what he collects.
Similarly, a pharmacist or nurse should know that at this same level, this is where they fall into. That is how it cascades down. By the time you are now saying who is possibly a level 12 or a typist or a secretary who is level 12 should be on the same scale you know that certainly some things are wrong.
What we are saying is that relativity is sacrosanct. We are not opposed to others asking for salary increment, but if you increase their salary because of that ratio, that though had been blunted, please do same across board. But by the time the health workers say that they want to collect the same amount, the same baseline at the same level with medical doctors, we will say no. It is not about inflaming the situation; it is about insisting on best practices.
There are specifications for different jobs and it is important for us to know that there is no single person in the health team that is not important. We appreciate what health workers do.
Secondly, we ought to also know that when there is any litigation in the hospital the person that goes to face that charges is the doctor. So, there is so much responsibility on that doctor. Thirdly, when they come together, you have the nurses, the pharmacists, the dieticians; so, you can see that this is just a gang up against the doctors and it high time we expect the government to disband that amorphous group. If it is about nurses, meet the nurses; if it is about pharmacists meet the pharmacists; if it is about cleaners meet the cleaners. It is only in Nigeria that you have such things that are playing out in JOHESU.
Side effects, barrier to family planning
Available data shows that one in four pregnancies in the country is unplanned for. Experts say using family planning would prevent them as well as save lives. APPOLONIA ADEYEMI reports
Mrs. Teniola Fadairo, 54 years, a mother of four had set out to embrace family planning (FP). As soon as she got married in 1985, at the age of 24 years, she conceived without delay, prompting the delivery of her first baby two years after, prescisely in 1987. “It was the preference of spacing the arrival of the next baby that made my husband and I to embrace FP after the birth of our first baby, Mrs Fadairo told the New Telegraph during a field trip to the Lagos Island Maternity last week.”
After counseling by health workers, she adopted the intrauterine contraceptive device (IUCD) which was inserted in her uterus through the vagina, she disclosed.
An IUCD is a small, “T-shaped” contraceptive device which is placed in a woman’s uterus (womb). It is also known as the IUD, loop or copper coil.
IUCDs are made of flexible plastic with a coating of thin copper wire. It has one or two soft threads on the end. These thin threads hang through the opening at the entrance of the womb (cervix) into the top of the vagina.
An IUCD works by stopping sperm reaching an egg. It does this by preventing sperm from surviving in the cervix, uterus or fallopian tube. It may also work by stopping a fertilised egg in the woman from implanting in the uterus.
Relating her experience about the IUCD, Fadairo said: “I was not feeling fine when I was using the IUCD; I was not comfortable with it at all. I did not feel pain or discomfort, but I was experiencing some discharge from my vagina.
“After some months, I went back to the health facility and informed them about this. Although, they assured me that it would be over soon and that I would feel normal again, but I insisted that it should be removed.”
When the medical doctor on duty at the private facility where I sought the service, checked me and asked if I wanted to continue with the IUCD, I said, “No,” and it was promptly removed.
Fadairo who abandoned the use of FP due to the highlighted discomfort, later had three more children, using natural method only throughout the period of her reproductive years. “I thank God today that things went well. It was not by my power,” she told the New Telegraph.
For another housewife, Mrs Tayo Olubi, also a Lagos resident it was a different scenario. She got pregnant four months after the delivery of her first child. Olubi who did not breastfeed her son exclusively found that she had become pregnant four months after delivery.
She was not only confused, but had challenges coping with nursing the first child and going through another pregnancy at a time that it was too close to the previous one.
Convinced that she could not cope with this challenge, she visited a traditional medicine practitioner who prescribed a local herb with which the pregnancy was terminated. Within days of administering the herb, the five months pregnancy was terminated leading to days of profuse bleeding. Although, she was rushed on emergency to a nearby public health facility, Mrs Olubi died before getting help in the hospital.
The World Health Organisation (WHO) defines family planning as a voluntary measure that “allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods.”
FP enables couples and individuals to exercise their rights to determine whether to have children, when and how often to have children, and when to stop; and provides information and services to act on the right. This is vital to safe motherhood, healthy families and prosperous communities.
Contraceptive use remains very low in Nigeria. The Guttmacher Institute (GI) estimates that in 2013, only 16 per cent of all women of reproductive age in Nigeria,15 to 49, were using any contraceptive method, and only 11 per cent were using a modern method—levels that remain virtually unchanged since 2008.”
Besides, available data from GI shows that in 2012, about one-fourth of Nigeria’s 9.2 million pregnancies were unintended —a rate of 59 unintended pregnancies per 1,000 women aged 15 to 49.
According to the data, more than half (56 per cent) of these unintended pregnancies ended in an induced abortion; 32 per cent ended in an unplanned birth and 12 per cent in a miscarriage.
Based on the highlighted statistics, it is very clear that abortion arising from unintended pregnancies remain high in spite of the restrictive abortion laws in the country. In Nigeria, abortion is legal only when performed to save a woman’s life. Still, abortions are common, and most are unsafe because they are done clandestinely, by unskilled providers or both.
However, these unnecessary abortions could easily be averted if Nigerians of reproductive age use FP services which experts said could help prevent unintended pregnancies as well as space births for mothers, a measure that would boost their health.
One of the major problems hindering the implementation of FP is the barriers that are making women not to uptake services, said Dr. Ejike Oji, chairman of the Advancement of Family Planning (AAFP).
Oji who is also the chairman, Coalition for Maternal, Child and New Born and Adolescent Health Accountability in Nigeria (C4MAN), said, “The most important barriers we have seen are misconceptions. People feel that when they uptake FP services they won’t be able to have babies again or that something bad will happen to them.”
On the contrary, Oji described such claims, most of which were based on traditional and religious believes as misconceptions and myths.
On the issue of negative reaction to FP use in some women such as the one experienced by Mrs Fadairo who ultimately dumped FP, Oji said FP was such medical services that were personal. “What is good for you might not be good for the next person and that is why we are saying that practitioners must be properly trained to provide the services.
“You shouldn’t just go somewhere to access FP. You must be properly counseled. There are so many methods. It is during the counseling that practitioners will identify the one that is good for each person and give that one that is specifically for you and you won’t have any problem.”
When side effects were experienced, Oji advised clients to report to the facilities. Often, side effects could be temporary and often fizzle out, with normal situation returning. Sometimes, it may be necessary to change FP methods in individuals to address side effects, he added.
On the prevention of unintended pregnancies, he lamented that Nigeria’s maternal mortality rate is 576 deaths per 100,000 live births.
Every day about 111 women and girls in Nigeria die due to preventable pregnancy and child birth related complications (every hour five women die), according to data from the Nigerian Demographic and Health Survey (NDHS). Nigeria accounts for one in nine maternal deaths world wide
Thirty-four per cent of such deaths can be prevented by increasing access to and uptake of FP, he asserted.
Oji described FP as key in terms of child survival and women’s health. “What we are saying is that women should be able to space their children appropriately, limit the number of children they want and also not start their reproductive health production too early.”
Medical experts said pregnancies that are too early, too close, too late or too many carry extra hazards not only for the health of the woman but also for the child.
Previous research shows that the greater number of women that died during child birth in Nigeria is below 18 years. In fact they have the second highest number of deaths, estimated at 70 per cent, from pregnancy and pregnancy related cases.
A recent study by the United States (U.S.) Centers for Disease Control and Prevention’s National Center for Health Statistics also shows that using FP is beneficial and could stem unintended pregnancies.
According to findings of the study released on June 22, 2017, although, more than half of American teens had sex by age 18, teenage pregnancy and birth rates extended their two to 1/2-decade decline because of increased contraceptive use.
Most of the 55 per cent of teenagers who had sex by 18 used some type of protection, typically a condom, the study of more than 4,000 teenagers showed.
Some 80 per cent of teenagers employed a contraceptive method during their first sexual encounters, according to the study.
Consequently, medical experts are of the view that up taking FP services was in the overall interest of mothers and babies. It would not only benefit clients like Mrs. Fadairo, using FP could prevent unnecessary death in abortions such as the one that killed Mrs. Olubi.
Codeine: Lagos targets Mental Health Law, parenting
In order to effectively tackle drug abuse including that of codeine in the country, the Commissioner for Health in Lagos State, Dr. Jide Idris said the Mental Health Law that would address the menace in Lagos would soon be passed into law.
The law, which has gone through the Second Reading was however still in the process of becoming a legal document, said Segun Olulade, chairman of the House Committee in Lagos State House of Assembly,
However, while the state is still awaiting the passage of the Bill, Idris has urged parents and guardians to establish close relationship with their children and wards to enable them monitor the children with a view to notice change in their behaviour and attitude.
According to Idris, it has become necessary for parents and guardians to uphold uprightness in their children through the reward of good behaviour. He said if parents rewarded good behaviour and achievements among the youths, they would be of good behaviour.
Highlighting other things the Lagos State Government would do to address drug abuse, Idris said although, Lagos State Interministerial Committee on Drug Abuse was established in 1993, the body would be used to sensitise the public on the menace of drug abuse and illicit trafficking.
Already, he noted that the Committee has engaged in campaign in form of awareness programmes, rallies and lectures.
The commissioner for health said the established Rehabilitation Centres in the state would take care of people affected by drug abuse. “The Lagos State Task Force on fake and counterfeit drugs will monitor sales and distribution of pharmaceutical products in the state” while the Task Force would sanitise the drug distribution channels by sealing the unregistered premises in the state.
Codeine is a short-acting narcotic analgesic prescribed by physicians most often used for the treatment of pain relief. Codeine can be highly addictive and provides the user with an overall sense of calm and feelings of pleasure. When codeine is used it enters the brain and causes the release of neurotransmitters that stimulate the reward center of the brain, leaving the user feeling intense feelings of well-being and pleasure. This kind of pleasure can lead to both psychological and physical dependence.
Some individuals use codeine for legitimate medical purposes, but over time develop an addiction problem. After prolonged use, an individual develops a tolerance for this substance and needs to take more and more of the drug in order to feel the effects. Someone who is addicted to codeine can begin to feel symptoms of withdrawal if they go even for a short time without using the drug.
On the role of the Lagos State Government, he said, apart from relying on the provisions of the Mental Health Law that would pave the way for the achievement of sustainable mental health for people in the state, the government would seal all unregistered premises with a view to limiting access to unwholesome and drugs of abuse.
Since 2015, Codeine has nearly overtaken Tramadol as the most abused opiate in Nigeria, said Idris, adding that thousands of young people in Nigeria have become addicted to codeine cough Syrup – a medicine that has become a street drug.
Nigeria government reports indicate that three million bottles are drunk every day in Northern part of the Country alone.
An investigative documentary, ‘Africa Eye’ launched recently by the BBC, the result of a five – month in – depth undercover investigation into the plague of addiction to cough mixtures across Nigeria, exposed major ills in the Nigeria Pharmaceutical Industry.
The documentary revealed how major Nigeria Pharmaceutical Industries were moving their legally produced products via back doors of their factories and into the hands of drug dealers who sell the dangerously addictive sweet tasting opioid for the price of a bottle of cola.
Other individuals become addicted to codeine and begin to use it to manage other problems in their lives, such as emotional pain or stresses due to the euphoric feelings it causes.
According to Idris, someone who becomes physically dependent upon codeine cannot stop the drug without supervision of a trained medical professional because of the following effects he/she will experience if stopped suddenly:
Mood symptoms from the abuse of codeine include euphoria, feeling of calm, depression, anxiety, mood swings, among others. Similarly, behavioural symptoms include drowsiness, decreased appetite and apathy.
The physical symptoms are constipation, blue tinge to lips and fingernails, muscle twitches, dizziness, fainting, nausea and vomiting, dry mouth, itching, rashes, urinary retention, hypotension, seizure, respiratory depression, decreased libido, seizures.
The psychological symptoms are hallucinations, delusions, memory loss and lack of emotions.
Someone who becomes physically dependent upon codeine cannot stop the drug without supervision of a trained medical professional because of the following effects he/she will experience if stopped suddenly craving for the drug, runny nose, intense sweating, chills, goosebumps, stomach cramps, psychosis, suicidal thoughts and hallucination.
Rehabilitation: Cases of codeine addiction should be referred to State Health Facilities for expert management.
Brai: Calorie-rich diet driving chronic diseases
Dr. Bartolomew Brai is the President of Nutrition Society of Nigeria (NSN). In this interview, he discusses the impact of inadequate nutrition: Low intelligence, stunting and wasting in children and factors that would reverse the trend in this interview with APPOLONIA ADEYEMI
What are the factors hindering this country from achieving adequate nutrition for the populace?
Number one is the enabled environment. The government may be talking about it but they are not committed to nutrition as such.
Now you see that international organisations like UNICEF have to come in to provide support.
Similarly, the World Health Organisation (WHO) and the rest of them are the ones that are giving funds and because the funds are made available that we have some level of activities.
This present administration made agenda for one meal per day for the school children.
A child who is hungry won’t be attentive in class even if he is awake, he will just be looking as if he is not part of that class because his attention is poor and he cannot concentrate on what is going on in that class, but with a meal a day, you see the children in class are alert, active and learn better.
In some cases, it not that they are poor but the children may not want to go to school; but when the school-meal programme is available, it’s an incentive. Based on the meal, they go to school because of the food and some parents also send their children to school because they know there is a meal waiting for them to eat in a day.
School-meal programme encourages school enrolment and school dropout will reduce and then it will help the learning of these children. It will help school children to learn better and perform better in school and of course lf you educate your populace you are investing in them and it will have impact on the economy in the future.
What is the economic implication of inadequate nutrition?
If a child is suffering from iodine deficiency, his learning capacity will be low and he cannot learn well. Such a child will grow up to be a problem. Number one problem he will have is poor education and because of this deficiency his work capacity will be reduced. So, we have both learning and work capacity affected and if work capacity is reduced, there is low productivity. That is economic angle and this will have impact on the people.
What can be done to improve the nutritional the populace and what should be the role of governments?
Well, we have a role to play in awareness creation. Some people have the food but do not know what to eat. The rich people you see visiting fast food outlets; that is where they eat.
Many of us have abandoned our local food. We have shifted to western diets and they are high in calories and fats and these are the diets that expose people to chronic diseases.
We talked about double burden of malnutrition now we have triple burden. We have under nutrition- not eating well, over nutrition-eating too much and the micro-nutrient deficiency, which we do not notice easily because it is in receding order but it is there. Also, we have abandoned our foods and vegetables and we do not take supplements in Nigeria. Besides, many cannot afford supplements.
Are these supplements in form of tablets or natural supplements?
Let’s not go there. The best approach is to eat your natural fruits and vegetables. I recommend that you eat fruits five times in a day. If you cannot, try to have them at least once or twice daily.
A large number of children in the country are being wasted, occasioned by poor nutrition. How did Nigeria get there?
Well, when it comes to under nourishment, when we look at the issue we can say that it could be as a result of poverty or lack of education. Even when there is food and people do not take enough, it could result to inadequate nutrition. In addition, wrong choices of food could also result to poor nutrition.
On hygiene, you can’t separate hygiene from nutrition because even when you have food and they are not hygienic enough it will still lead to disease conditions and when you have disease, the amount of food the body will assimilate will be very poor and will still lead to malnutrition. It is something that has been there in the system and it is not peculiar to our nation.
The only thing is that the attention we have paid to it is not the best over the years. If we can tackle it, it will help. For instance, we could focus on the girl child when they are in their adolescent stages, giving them the proper education so as to prepare them for motherhood.
Consequently, before and during pregnancy we take good care of their nutrition and health and that way we will have healthy children. The problem is that after the 1,000 days, once a child is not properly fed and after two years when the child is growing and becomes stunted, there is no remedy. A stunted mother is most likely to give birth to a stunted child so the cycle continues; hence, it becomes a generational problem.
What are the local food sources of iron and iodine?
The easiest source is the iodine salt. There is a policy in Nigeria that salt should be fortified with iodine. So, what we need to do is encourage people to take enough of iodine.
For iron, the easiest source is vitamin A, which can be gotten from liver, meat and beta carotene from fruits like orange and mango. Also, iron can be got from red meat, which some people run away from. However moderation is the key. Beans are also good sources.
The government will help by endorsing the fortification of some of our foods, which are endorsed by the Nutrition Society of Nigeria (NSN).
News16 hours ago
2019 ELECTIONS: Saraki, Dogara’s Supporters consider ADC
Metro and Crime16 hours ago
Remarkable achievement! Nigerian-American girl born without hands wins handwriting competition
News16 hours ago
Buhari, Obasanjo’s quarrel, good for Nigeria –Gen. Ikponmwen
News17 hours ago
Innoson chairman appeals court’s order declaring him wanted
Features16 hours ago
THE OREKOYA ABDUCTION: My wife gave herself up for me to escape –Suspected kidnapper
News17 hours ago
Oshiomhole: Buhari’ll win 2019 presidential election
News17 hours ago
EFCC grills ex-Kaduna gov over campaign funds
Metro and Crime19 hours ago
STF parades suspected gang of kidnappers’ in Jos