Hammed Ninalowo is a United States-trained Vascular and Interventional Radiologist with subspecialty in interventional oncology. He is the first U.S.-trained physician to offer the full spectrum of vascular and interventional radiology services in Nigeria. In this interview with C, Ninalowo speaks about access to minimally invasive therapies, medical tourism and how the medical sector can move forward in Nigeria. Excerpts:
You performed the first liver bypassed surgery without cutting, which is the first of its kind in this part of the world, how does it feel to be the first healthcare organisation to bring this procedure to Nigeria?
It is exciting to be able to perform the first trans-jugulars intrahepatic shunt (TIPS) procedure in Nigeria. With various techniques such as angiography, angioplasty, stenting, thrombolysis, embolisation and ablation, we are happy to provide an alternative procedure for patients, one that is favourable for the patient.
This is the first TIPS procedure successfully performed in sub-Sahara Africa, otherwise known as a minimally invasive liver surgery carried out in EuraCare Multi- Specialist Hospital in Lagos, Nigeria.
The procedure is about creating a bypass; it is basically a liver bypass which is done by an interventional radiologist. A stent graft (tube) is paced to bypass the obstruction in the liver, bridging the portal vein and hepatic vein and the benefit is no cutting or major surgery is involved, but we do it in a tiny hole in the neck where the entire procedure is done instead of having a major surgery and the patient can go home about 12 hours later.
Other conditions can be treated with this procedure because it is applicable in any patients with a history of liver disease band portal hypertension which may be caused by Hepatitis B infection, alcoholic liver disease and non-alcoholic fatty liver disease.
For me, it is quite an achievement because I never taught I could achieve something like this in my early career in Nigeria. I did this procedure in my second work trip to the country, so it is quit laudable to do it in the country because I always ask myself a question: if I don’t do it, who will do?
Interventional radiologist right now at the complex level; we just do not have a lot of people in the country practicing this. So, it is a big achievement for me, much more achieving because I was able to treat a girl who does not have her life for over three years; could not go to school over five years but now would be able to say I am going back to school to get my education back and that is the achievement.
What is vascular and interventional radiologist?
Vascular and interventional radiologist is a sub-specialty of radiology where we use minimally –invasive image –guided techniques to diagnose and treat diseases using the least invasive techniques in order to minimise risk and improve health outcomes.
Through interventional radiology we can get anywhere in the bodies with minimally invasive image- guide technology and do things that were previously unimaginable. However, all patients can be treated in interventional radiology.
In western countries; IR is involved in the care of nearly every patient taken care of by any other specialty, we collaborate with other physicians to diagnose and treat primary disease and address medical or surgical complications.
Other disease conditions treated by interventional radiology are enlarged prostate, infertility in women opening up blocked fallopian tubes, vascular problems of the arteries and veins including narrowing or enlargement and also stopping internal bleeding in patients of trauma, car accidents, bleeding from any source of the body, more of this can be done.
What do you think can be done to have more of such surgeries carried out in Nigeria?
There are so many very talented Nigerians doctors that have left this country recently and the reason they leave is because they are forced to and not respected by the system. And then, there are very competent and young doctors in America and London that they have come to Nigeria to increase the level of medical practise in the country.
What Nigeria could do to have more of this type of surgeries and not only the Trans- jugulars Intrahepatic Shunt (TIPS) procedure like we did? There are things that are not available in the country, instead of referring patients to India or other countries. It is better Nigeria grows its healthcare sector to the point where you could call one Centre in Lagos, Ibadan or Abuja to ask if this treatment is available before patients are transferred.
But frankly, most of my colleagues will not take the risk I am taking now to give back to the country. And there is the reason of insecurity, no power supply to do their work and even if they have the skills, there is no equipment to do the work.
The Government can make it easier to get loans in the healthcare sector. But it is unfortunate that we could only get loans that have 20 percent interest rate. You can’t treat people in medicine that way not alone improving medical care with the interest rate that high.
We need the government to make things easier in the health sector and people also need to stop looking at medicine as a cash- cow how much will I get if I put into it. Obviously, we are not asking for free money but we are asking that, make special provision for medical practitioners to be able to get loans that are reasonable so we can take care of people.
Investing in the healthcare, collaboration and partnership will expand the sector. One hospital can’t get all the expertise needed in this country; working together with the tertiary institution, private hospitals is the only way is forward and not backward for this sector.
What are some of the challenges introducing an innovative procedure like this to Nigeria?
One of the biggest challenges is the supply chain to do my work; I bring in supplies and bags when I am travelling which is not really ideal in a sustainable environment. I have talked to a lot of manufactures in America and Europe to come sale products to us in Nigeria, but they basically say we cannot come to Nigeria because your country is too corrupt and it is very hard to register products and it is almost impossible to do business in Nigeria.
Until the Nigeria government start looking at regulations to make things easier especially for the field of medicine where it is so unique that is very hard to get these products any other way than to bring them from outside the country for now.
Government should put regulations in place to give individuals special privileges to bring these products, get these manufacturers, and make the regulations more lenient for manufactures to come into the country to sell us this product so we can take of our own people because people are dying every day from just incompetence of people who are unwilling to make things easier for us.
It is estimated that about N400 billion is being lost to medical tourism in Nigeria. To what extent do you think your coming back to Nigeria will arrest or control it?
This is not what one can do alone but requires teamwork. Many people are already doing a great job. I think with medical tourism, we will do basically what we one can bit at a time. But what is more important is we are the experts. We could do very complex things in Nigeria; we need to let patients know that these treatments are possible in Nigeria.
It is also possible to provide the care at the same level or even better than they will get in places like India or America even in some cases. But what we are doing is trying to practise at the same standard that is used in America for people like me coming back, and if we continue to show results and then let patients know that these treatments are available locally, I think we could change the tide of medical tourism in Nigeria and we actually want to reverse it.
We want people to come to Lagos for medical treatment. I am personally on a mission to provide minimal invasive, intensive care and improve minimum intensive care to patients here in Nigeria and this has been my personal mission for the last decade. And now, I am starting to realise that dream even very early in my career and really there is no much that will stop me from making this happen at this moment.
