My visit to UNTH – a dream deferred

I was recently in Enugu, and visited my medical school – the University of Nigeria Teaching Hospital (UNTH).  I had lunch in the residents’ common room with a colleague from our medical student days who is now a senior registrar (the final stages of specialist training). I’ll call him Emeka for the purposes of this blog. Emeka has to stay in the system, so to allow me a forthright account; I agreed to keep his name anonymous. 

Chikwe: Bros how are things in UNTH

Emeka: My brother, this place has stood still in time. Yes, it is true that we have moved from the old cramped, Coal camp location to the permanent site in Ituku Ozalla, but apart from that, little else has changed. While we have more space for ourselves and the patients, the distance from Enugu has come with its own challenges. There is so much potential here but sadly as you can see all around you very little progress.

Chikwe: How has the leadership in the hospital been in the recent past?

Emeka:  Don’t even ask! This place is in dire need of new and fresh leadership. At the moment, as Nigeria is voting for new leaders, we too are in the process of electing and selecting new management as Dr Mba’s tenure as Chief Medical Director comes to an end in May.  The past eight years have just been “business as usual” in UNTH. As the world changed around us, we are stuck in the past.

Chikwe: Ah! Those are strong words oh!

Emeka:  Yes oh. There is a raging battle between colleagues of Enugu State extraction and “the rest of the country” for who will produce the next CMD. The two camps are split down the middle and not a single doctor of Enugu state origin accepts a new leadership from the other camp or vice versa! The Enugu state camp has nominated Dr Ozoemena of Surgery while the “rest of the country” nominated Dr Obidike of Paediatrics. There is hardly any discussion among our apparently highly intelligent colleagues on the vision of these two colleagues for this once-great institution. Not a single colleague has crossed the ethnic line publicly! Not one…

Chikwe:  Well, finally it is the Federal Government who will appoint the CMD. Maybe it is best to appoint from outside the hospital for the sake of peace.

Emeka:  Maybe, but we saw what happened when Prof Gomwalk was appointed as VC in UNN, because of a similar challenge at the time.

Chikwe:  But Emeka, let us leave the politics of UNTH leadership. How is clinical care? How is our Centre of Excellence for Cardiology.

Emeka:  My brother – the centre is in a coma. You remember all the open-heart-surgery we saw in our days as medical students; all that is history.  The centre is almost history. Prof Aghaji has left for Abuja too. You must have heard that his brother passed away about a year ago. The fence of his house fell on him! Nigeria…my brother life here is not easy oh!

Chikwe:  Wow…but what of every day practice?

Emeka:  We are hanging in there oh. We all seem to be going through the motions. There is absolutely no motivation among colleagues.  We come to work, do the best we can, prepare for our professional exams with whatever materials we have and then we all go to our private hospitals to work in the evenings.

Chikwe:  But how are the patients that make it to Ituku Ozalla?

Emeka:  Chikwe, it is not easy here. The place is so disorganised and patients suffer a lot, a lot! They have to walk around all over the hospital. Every small item has to be paid for independently, so patients walk around from the laboratories to the pharmacy to the wards and then start afresh. Patients suffer incredibly! You do not even want to hear about the quality of the food patients are served. Our colleagues in surgery have to struggle for hours to get theatre organised for a single case.

Chikwe:  I saw an accreditation team here for the pathology department, is it a routine visit?

Emeka:  Ah…noo! The whole department lost its accreditation since 2005, so no candidate from UNTH can go for the professional exams in pathology. As the accreditation team is here, colleagues in the department have been running around collecting materials from everywhere. They actually had to borrow a fire extinguisher from the PEPFAR office! Once the team leaves, we return all the equipment and pray for the best! Naija no easy my brother…

Chikwe:  And what is this I hear about medical students? Over 400 students in a single set! That can’t be true, as we were hardly up to a hundred in one set a few years ago.

Emeka:  Chikwe times have changed. I pity the students because there is no way they can get the training they deserve. There are hoards of them in every ward. The medical school’s accreditation was lost when the Medical and Dental Council of Nigeria found out about the numbers and this has now been restricted to 150 per year moving forward. But, the medical school is now desperately seeking means to reduce the numbers in existing sets. But yes….that is what we are dealing with!

Chikwe:  But how are the professional exams? Are our guys passing and making progress?

Emeka:  The pass rates for all the professional exams have always been historically poor from UNTH, and we are always quick to blame ethnicity. But Chikwe honestly I am not sure oh. Sometimes a set of colleagues go to Ibadan for exams and not a single one passes, at best a handful. We moan a bit here and there…but nothing changes. I have not been there myself, but I hear that Lagos University Teaching Hospital (LUTH) is changing, and even University of Ibadan (UI), but here in Enugu we are in the wilderness.

Chikwe:  What of all the consultants?

Emeka:  You want to get me into trouble? Let me pass my Part 2 first oh! Very few of them are dedicated to patient care in UNTH. Almost all of them have thriving private practices across Enugu. The distance to Ituku Ozalla has also led to patients preferring to see these consultants in town, even if it costs a bit mor
e. Go around Enugu, and see for yourself. Almost every major hospital is managed by UNTH consultants. Some of us registrars have our own too, else we work with our consultants. The struggle continues.

Chikwe:  But Emeka, there must be some good stories from UNTH. It is the University of Nigeria after all, in all its pride and glory!

 Emeka:  Yes oh, there are a few bright lights. Do you remember Dr Oguonu in the children’s’ emergency ward? He was a registrar in our time. He has shown an amazing dedication to his job, and has tried to ensure that there are systems in place to support the management of emergency cases that come into casualty. It is now the case that patients resist being transferred out of casualty! But you know our country. Other colleagues are getting jealous and there is grumbling in the system about the parallel systems being set up. So you see, even when one tries to be innovative there is opposition.

Chikwe:  So what are your own plans? Do you plan to stay here after your training and grow?

Emeka:  You must be joking. This place will kill my soul. There is no joy here, no energy, no motivation. Nobody really cares. We do the least we can to keep the system moving…we have a big name and a rich history, but that’s about it. Maybe the new leadership may turn things around but I cannot wait…once I get my Part 2, I am out of here. There is so much to do with the profession we have Chikwe. We owe it to Nigeria, and to humanity. UNTH will not provide the platform I need, so I will go and look for the right one or create it.

Chikwe:  I am with you Emeka but if this is happening to the pre-eminent public sector health institute in South East Nigeria, what hope is there for the rest of the health sector?

Emeka: The politics here is too much. I can’t do it. You guys all left the country and now you come back to ask all these probing questions and make all of us feel bad.

Chikwe:  No Emeka, we are all guilty….we all are. We hope that change will come but some of us  have to be the change we seek.

Emeka: E go better… my brother, e go better.

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

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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