Seeing Is Not Believing -By Dr Loretta Oduware Ogboro-Okor

We see them. We love them. They are very attractive. Like the Greek Sirens, they lure not just men but also women, to their deaths more often than not. Aside their individual luring, we watch the centripetal force they exert on our society as well – using the Achilles heel of our national landscape which I call an “overdose of external validation”. Our society, in our blind celebration of materialism and all things superficial, lacks depth and we rush towards them the way bees are drawn to pretty flowers. Sadly, unlike the bees, there is often no honey at the end of an encounter with them.

They are most of the big, beautiful rugged, air-conditioned gigantic hospitals in Nigeria with no true human capacity to deliver safe and effective healthcare services to those who rush to patronise them. They have pseudo-capacity. They may have a long list of Professors on their websites or on the plaques as you enter the hospitals. Some of them even trained in world class institutions with a litany of alphabets after their names. In other words, they have all the recipe that appeals to our skewed value chain because we do not understand the true meaning of a functional multi-disciplinary team (MDT) health care provision organisation or system.

For us to determine if a healthcare facility is truly meeting its target, it must first be clear which cadre within the healthcare system it is functioning at. Is it a primary, secondary, or tertiary healthcare provision facility? Primary healthcare centres, the bed rock of preventive medicine are those provision facilities embedded within the very fabric of our communities. They should be the first responders to our population’s healthcare needs. Thereafter, Primary care centres send the cases they cannot manage to the Secondary level of care which in Nigeria are our Specialists and General Hospitals.  The Tertiary healthcare level are the big Teaching Hospitals and their equivalents. In Nigeria however, our healthcare provision lines are blurred. We have many Private Hospitals who claim to treat all things under the sun. We see a Private Hospital being run by an Ear Nose and Throat (ENT) Surgeon, who then runs ante-natal clinics and takes deliveries. It will be acceptable and safe if the specialists and midwives in these areas are brought in to do their share of these service provision in Obstetrics by the ENT Surgeon. However, most times in our clime the multi-disciplinary team (MDT) approach does not happen. The ENT surgeon does it all.

The people know no better. The hospital is beautiful. It is rugged with air condition…. What is more? There is a doctor that wears glasses with sometimes, a General Medical Council (GMC) number, inscribed on a plaque behind him or her to tell a superficial story of competence. Tell me, in England where you acquired that GMC number, would you be allowed to come from the realm of ENT to do Gynaecological Surgeries or even Caesarean Sections? Hold your answer as a reflective stimulant for later. Enter, the huge structures with gigantic list of ‘laudable services’ that they provide. Is there a multidisciplinary team (MDT)? Let me explain what I mean by this multi-disciplinary team (MDT) that is recurrently assailing your eyes in this write up. You see, there are many people who work to make healthcare delivery safe and effective. First and at the centre of this list is the Patient. Then you have the specialists and the entire support system. I will better explain this with an example:

A 65-year-old Diabetic and Hypertensive man with Brain Tumour. This kind of patient’s care will best be managed by healthcare professionals with adequate capacity and skill in what they do as a team and not necessarily by big fancy structures. Even the multi-million-dollar equipment will on their own, not treat the patient. The Internal Physician (blood pressure specialists) will first treat this patient and make sure his blood pressure is controlled. The Endocrinologist (doctors that treat conditions arising from special chemical glands in our bodies) will make sure they control his blood sugar. Then the Brain Surgeon will assess the Brain tumour working with imaging from the Radiographers and Radiologists (technicians and doctors that do all the special x-rays as well as imaging to look inside the body) to determine the size of this tumour and decipher how to approach it during an operation. Pre- the operation, the Anaesthetists (doctors who take away pain and cause us to sleep during operations) will also review this patient. These Anaesthetists also double in some places as the Intensive Care Unit (ICU) doctors also known as Intensivists. ICU is where critically unwell patients or patients who have had big operations are cared for one on one. Then, the people I call the pillars of health care at all cadres must be involved in the planning for this patient’s care. The nurses, the theatre nurses, the ICU nurses, the ward nurses they must all be carried along. Care of patients after an operation is even more important and crucial than the actual operation done by the surgeon and his team. In the long term, nurses, physiotherapists, the porters who transfer the patient from point A to B, patient relatives and everyone else will join hands in ensuring the safe and optimal care for this patient who is at the centre of it all. This list is by no means exhaustive and this, my dear readers, is a glimpse of what multi-disciplinary team (MDT) in healthcare means.

Now that we understand the concept of multi-disciplinary team (MDT) care, do we still think that quality and safe medical care is a direct function of grandeur buildings and luxury environs? Does it also, look like a one man show? Absolutely not. “Effective, optimal and safe healthcare” is directly proportional to a high level of human capacity – skill, passion and humility in team working. Our Teaching Hospitals in Nigeria, still have the best skill mix for a semblance of proper MDT care. Unfortunately, in most cases, there is a lack of the right attitude and proper equipment to function as a cohesive team. Our institutions are weak. Processes and guidelines are non-existent. There are no time bound frameworks or Clinical Governance. Significantly, many of us lack a sense of urgency and an understanding of our limitations with reference to what we do. We have no respect for the value of human life. We ascribe our dilemma to poor pay, poor working conditions, and a whole host of many other poor things without thinking about our own “poor mind-set and poor attitudes”. It is worthwhile for us to ponder that if push comes to shove, which Chief Medical Director, Governor or President in Nigeria can beat their chest that the healthcare facility closest to them can save them?

We see them. We know them. As a society we must begin to develop the mindset that will generate a counter centrifugal force to our externally propelled validation of things especially as it portends to healthcare. We must begin a movement of internal validation and human capacity building if we want to save us from ourselves. Many beautiful healthcare institutions exist across the world with matching top-notch human capacity, staff skill and MDT cohesion. However, check out their histories and how they started. They did not put their carts before their horses. They first placed value on the lives of their population. Simply put, there is no need having a 1.5 Tesla MRI Machine which is top of the range to make a tumour diagnosis, when you do not have proper ICU care, or the MDT skill mix and attitude to keep the patient alive even when you manage to operate the tumour. There is no reason to take out a Brain Tumour and then let the patient die from a bed sore that develops and becomes grossly infected post operatively. The staff and human capacity in our healthcare eco-system, need to be optimised and domesticated to our unique needs without compromising world class healthcare delivery standards. We must understand that it is neither grand architectural designs nor flashy interior décor that will turn our healthcare sector around. Rather we need human capacity building, cohesive MDT working and improved value for human life because as one of Nigeria’s foremost Neurosurgeon says, “the Nigerian Patients are worth it”.

Dr Loretta Oduware Ogboro-Okor is the author of the book, My Father`s Daughter