FMC Lagos employing retired specialists, says CMD

The Chief Medical Director of Federal Medical Centre, Ebute Metta, Lagos, Dr Adedamola Dada, in this interview with Sodiq Ojuroungbe, explains measures being taken by the hospital to retain health workers and how health insurance can reduce quackery.

Brain drain (japa) is a very big issue. How is the Japa syndrome affecting your facility and services to patients?

For us, we are expanding our services. And you can go round to see that we are expanding our services. And that is because once there is a problem, we don’t believe that we should fold our hands and let the problem overwhelm us. Rather, what do we do? We try to think through the problem and find a solution. One of the solutions that we have found is that in this city of Lagos, we have a lot of people who have the required skills, who are still strong, and who are retired; retired specialist consultants, retired nurses, and all the rest of them. So what we have done is to actively encourage these retired people out of retirement.

And then the second thing, as I said, is to create an enabling environment, a good environment, so that even those who are staying will prefer to stay with us. And that is what has been happening.

People are resigning. Some people are resigning. But I can tell you categorically that the impact has not been too severe on us. And that is not because people are not resigning, but it is because we have been able to design programmes and alternatives to ensure that we are in a position to replace some of these people who are resigning. Yes, it is a problem in the system, but we must not allow ourselves to be overwhelmed by problems.

In terms of numbers, like, how many of these retired nurses or doctors have you called back?

We’ve called back quite a number of them. If you are talking in terms of specialists alone, almost half of the specialists in my anaesthesia department, almost half of them are retired, and they are still strong, and they are still working. But you find out that in many other places, they probably have reduced the number of surgeries they are doing. But our own number, the number of surgeries we are doing, has not reduced. In fact, it has gone up. That is because we have been able to attract these specialists and experts who are still strong, who have retired to come back into practice, provide an enabling environment for them, and understand their need and their capacity.

This is happening in all departments. If you go to the gynaecology department, if you go to the surgical department, if you go to the paediatrics department, we have a lot of these retired specialists who are still very useful to the system, who are still very strong.

They are offering these services and they have nowhere to go because they are not going to Japa.

So, it also gives us a great deal of stability and capacity to plan ahead. So these are the challenges. We also recruit the new ones, but even if those ones go, we have a strong foundation formed by these people. These retired people are always there to offer the service and give us the leverage that we need to be able to attract newer hands to come and support them even if somebody resigns.

There’s no doubt that people are leaving. But what we have done is to create a hard core of those who will not leave.

The cost of IVF (In vitro fertilisation) treatment in Nigeria is expensive. How best do you think the government can come in to assist couples?

Like I said earlier, we are a hospital whose decisions are data-driven. One of the things that we found out from the data that is coming out is that we have a large load of patients who actually have these challenges (infertility). So, working on that, we have discovered that even if only 50 per cent of the patients that we have, who have these challenges, advanced to the level of seeking treatment via IVF, we will be able to hopefully crash the cost of IVF in the country by almost about 50 per cent. If we are able to do that, we are a government organisation; it, therefore, means that the government has been able to reduce the cost using the concept of economic volume

We have more volume. And because we have more volume and we are treating more patients, we’re going to be able to get the consumables and the inputs at a better rate than those who are doing it outside, and then we’ll be able to crash the cost.

IVF treatment is expensive and not really that accessible for average Nigerians. This is fuelling quacks and extortion of helpless couples desperately in need of children they can call their own. How best do you think some of these issues can be tackled by the government?

It is not just IVF care that quacks are getting into. Quacks are getting into very many spheres of healthcare delivery chains and services. If you are looking at Ophthalmology, quacks are getting into ophthalmology practice. Quacks are getting into orthopaedics practice. I’m sure you have heard of the traditional bone centres. Quacks are getting into delivery services, they’re getting into paediatrics. They’re getting everywhere.

One of the major things that we need to do which I know that the government is doing is to ensure that people have access to health care through the national health insurance scheme. I am sure you are aware that the national health insurance scheme has been made compulsory for all Nigerians. So, there is access. Once access is created and people don’t have to pay at the point of need, you just find out that fewer and fewer people would actually approach these untrained hands for their care because evidence abounds that usually what happens with this untrained hand is that they even complicate problems.

My own dissertation as an orthopaedic surgeon; when I was in my fellowship at the National Postgraduate Medical College, was on traditional bone centres and the complications that they cause in the healthcare system. And the result of that dissertation actually showed that a lot of havoc is caused by this group of people because they are not trained. Many of them cannot even recognise complications.

But once we create access, which this government is doing, then you find out that many more persons would approach the orthodox healthcare services and just naturally this other group would go down.

You have come up with a strategy to tackle the issue of brain drain in your hospital. How best do you think the government can actually handle the problem looking at the prediction that the country may lose 50 per cent of healthcare workers by 2025?

I have never believed in prophets of doom, and I have never premised my own strategy and plans on negativism. I always look at the positive side of things. I don’t believe that 50 per cent will leave in 2025. And in any case, we are producing. We are producing newer doctors and we know some of them are leaving.