One often needs to look beyond the circumstances at home in Nigeria to understand the scale of our challenge. We have 17 Teaching hospitals, and a Federal Medical Centre in every state without a Teaching Hospital. During a recent visit to my alma mata – the University of Nigeria Teaching Hospital Enugu, I found many of the beds empty. I remember this was the case even when we were in Medical school – especially in our famous 140 bed medical ward. I often wondered why the beds in the premier tertiary care facility in Eastern Nigeria were empty.
As I made my way to “Bara” recently, I wondered if this would be the same. “Bara” (as it is affectionately called in South Africa) is reputed to be the largest hospital in the world, with approximately 3,200 beds. It is at the entrance of Soweto in Johannesburg. It is a teaching hospital for the University of Witwatersrand Medical School. Patients travel there from all over the country and surrounding African nations. The hospital employs almost 5,000 people, including 600 doctors and 2,000 nurses, and has about 10 km of corridors!
Walking around the corridors of the hospital with my South African colleagues on a “Grand Round”, it is impossible not to reflect on the health challenges in the South African population. But it is also impossible to miss the pride with which colleagues here have dealt with these challenges – especially that of HIV/AIDS. There are more people living with HIV/AIDS in South Africa than in any other country in the world. This is followed on the African continent by Nigeria. The difference between South Africa and Nigeria is in how they have responded (despite the initial politicization of access to ARVs).
Our grand round was led by Dr Alan Karstaedt, the Director of the hospital’s Institute for Infectious Diseases. He has been working at Bara since the first case of AIDS in South Africa was diagnosed in 1987. Despite efforts by the South African government to “down refer” patients to the primary care level, Bara still has over 5000 patients with HIV on its list. After the round we spoke in detail about how practice has changed and how every medical diagnosis has to be reconsidered in the context of a possible underlying HIV infection, especially now patients are living longer with access to ARVs. After eating lunch together at the modest “tea room” on the hospital grounds…I thought of asking Alan why he stays at Bara, but could not bring myself to ask. I guess the answer was obvious….a colleague for whom the profession remains a vocation.
Bara is a magnet for medics from all over the world, drawn to its wards for the invaluable experience it gives them. With an acute shortage of doctors, nurses in South Africa, one day in Bara can be as insightful for young doctors and nurses as one month or more elsewhere in the world. Despite its difficult history during the apartheid years and the challenging present the fact that this hospital works, and is literarily full every day is testament to the resilience of the country.
Public sector hospitals in South Africa get a lot of criticism from its population, as do ours in Nigeria. The anticipation of details of a National Health Insurance Scheme that will guarantee universal coverage for the population is on most people’s minds as the government grapples with the complexities of delivering health care to a population that has the largest differences between rich and poor in the world. But this is in effect no different from the challenges Nigeria faces. Ultimately, the planned National Health Insurance in South Africa will succeed or fail on one critical point – people’s confidence that they will get appropriate care in a public sector hospital.
Nigeria urgently needs to have an open debate about its public sector hospitals. Eighty percent of all health expenditure at the Federal level is spent on our tertiary care facilities. Yet, while I do not wish for any hospital in Nigeria to become the largest on the continent, but we want our hospitals to work, to serve the people they are there to serve. We want our brightest and best to stay in Nigeria to find their vocation and stick with it. We hope that our hospitals get their groove back, that they become real “centres of excellence” always working in the best interest of the people. I think of Alan’s illustrious career and wonder why most of the consultants in my clinical years at the University of Nigeria, Enugu had all either left the country, retired or just given up on the public sector. I think back to the inspiration we all drew from these colleagues and wonder where the colleagues in medical school at the moment are getting theirs from….
We will inevitable reap what we sow….
If you visit Johannesburg, pls do leave your fancy Sandton hotel and visit Bara…it will be well worth your time!
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