We will be bringing you a series of articles intermittently over the next few months on Nigerians who have decided to challenge conventional wisdom, and deliver world class health services in Nigeria. This will not be about fancy buildings or hotel service; it will be about delivering quality health and healthcare.
We had heard that a few colleagues with complimentary skills had recently started a clinic in Lagos. We also heard that they had a gruelling schedule, literally flying to Nigeria from London, for 4 – 5 days every 3 weeks! So it was time to visit these colleagues to see what they were doing in Lagos. After driving around Lagos for a bit, we found the clinic nestled in a quiet street in Ikoyi . There I met Austin Obichere, one of the partners in D&TEC (Diagnostic and Therapeutic Endoscopy Centre) . He showed me around the practice, and shared the partner’s vision.
Before getting to that, let us deal with the definition of endoscopy –
Endoscopy is the examination of the body’s interior through an instrument inserted into a natural opening or an incision. Endoscopes include the upper gastrointestinal endoscope (for the esophagus, stomach, and duodenum), the colonoscope (for the colon), and the bronchoscope (for the bronchial tubes). Attachments to the endoscopes can take tissue samples, excise polyps and small tumours, and remove foreign objects.
The challenge with endoscopy is that you are completely at the mercy of the surgeon, classic information asymmetry. He alone understands what he sees when the scope is inserted into an opening in your body. They analyse what they see with trained eyes, and make a judgement whether what they see is normal and abnormal. If it is deemed abnormal, they then decide whether it is abnormal enough to proceed with a course of action, take a sample or decide to wait and see! Big decision for patients! I sat through a consultation with one of Austin’s patients. He gently obtained the consent of the patient for me to be present during the consultation, explaining that I was a colleague. He proceeded to explain the details of the procedure he was about to perform. He then explained the potential risks and benefits of the procedure, always stopping to re-assure the patient, and carefully taking into consideration any possible concerns she might have had about the procedure. Apart from the technical expertise delivered by the clinic, attention to bedside manners was central to the healthcare delivery, and this stood out during the consultation. In the same way that the “Customer is King” in a retail environment, the “Patient is King” in a healthcare setting, and health practitioners have a duty to ensure the patient gets empathy, as well as satisfactory clinical care from their doctor.
|Clean and appropriate infrastructure|
The three colleagues managing this Practice are surgeons who have practiced for several years in the UK, and in addition to general surgery have acquired rare expertise in using complex flexible tubes (called endoscopes) to look into the feeding pathway, the airways, the urinary and reproductive pathways of the human body in order to make a diagnosis, and where possible solve a health problem without the need for more invasive surgery! I asked Austin why they were putting themselves through this arduous regime of flights, and absences from their families. He spent the next hour filling me in on the disastrous stories of mis-diagnosis that had come his way, and stories of surgeries that had gone awry. At some point he said – he could no longer justify the cosy life of clinical practice in the West. At the same time, he felt that the circumstances in Nigeria were not ready to fulfil his other professional needs in this niche area. So he had to find a way to contribute to Nigeria without cutting his ties to his professional circles. It all came together when he linked up with two other colleagues; Abuchi Okaro and Ayo Oshowo, and they realised that in addition to having similar expertise, they also had a shared vision for Nigeria, and the rest fell into place quite quickly.
Was starting off difficult? Absolutely he answered, but hugely rewarding. There are several recognised ‘pre-cancerous’ conditions that if detected early and treated can alter the natural history of the disease, literally giving people a new lease of life. One can have a significant impact on people’s lives by getting this right. But on the other hand, start up costs for this specialist area were quite high, and there is a need to maintain extremely high standards of sterilisation for equipment that penetrate the human body in such depth.
But in addition to seeing patients referred to them, what else were they were doing to inform people and colleagues on the need and benefits of the rare clinical service they provide? Are they training other colleagues? Are they actually contributing beyond their own practice? Austin said that this was one of their key objectives and primary drivers. To achieve this, they were running a “masterclass” for medical colleagues in Lagos in the first instance. Reading through the Nigerian Guardian, I saw a report of the first of such courses, and knew that Austin had kept his word! They are also planning a series of health awareness campaigns to inform and enlighten the community on the risks of cancers of the gastrointestinal tract, and what can be done to detect and prevent them….a tube in time literally saves lives!
|Austin, Abuci and Ayo During a recent course organised for doctors in Lagos (courtesy of Nigerin Guardian)|
Why is this story so important for us? 10 years ago we published a paper in the Lancet that showed that 50% of all the members of 3 sets in our medical school (Univesity of Nigeria) had left Nigeria. We are sure this may be more in the region of 70% at present. While many in our parent’s generation returned to Nigeria, many Nigerian doctors have found this difficult to accomplish. There are a myriad of reasons for this, none of which are easily surmountable! For several reasons, the old model of coming back to set up a solo clinic or working at your local teaching hospital is unlikely to be attractive. We have to learn to be innovative about our return home. Our governments also needs to think innovatively on ho
w to attract some of its most valuable resources home. A solitary “Diaspora Desk” at the Ministry of Health, or signing MOUs with various groups is just not enough. Abuchi, Austin and Ayo have provided a small glimpse of what is possible. But it can be scaled, and it can be made easier.
It is simply amazing that probably the best endoscopy unit in Nigeria is not in any of the acclaimed centres of excellence that our Federal Government and its Vamed contractors has spent millions of dollars in the last 12 years refurbishing and equipping but in a small corner in Lagos managed by 3 Nigerians with little more than their skills, guts and perseverance.
The winners can only be the Nigerian people!
Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead