Abuchi Okaro is the president of Bariatric, Metabolic Surgeons Society of Nigeria (BMSSN). In this interview with NGOZI OKPALAKUNNE, Okaro who is a consultant general, laparoscopic UGI and bariatric surgeon spoke on some of the challenges facing medical practitioners and patients in Nigeria; his society’s effort towards ensuring that patients access quality and safe bariatric surgical interventions in the country, among others. Excerpts:
What inspired your career in bariatric surgery, and how has your personal journey influenced your professional path?
I have been an independent practising consultant general surgeon and specialist since 2005; my initial interest in bariatric surgery began around 2003 and it has so far been nothing short of exciting. Bariatric surgery as a specialist area of general surgery has delivered to patients transformational impact allowing patients who have struggled with their weight to control their weight and become healthy.
This contrasts with my other area of expertise as a stomach and oesophageal cancer surgeon. Unfortunately, in this area of surgery, patients rarely survive more that 3 to 5 years due to high incidence of such cancers presenting late and therefore, are advanced at the time of diagnosis. A vast majority of surgeons like me in this area can eventually become disillusioned as a result of losing many of their patients over the years to recurrent cancers.
Bariatric surgery is different from that in this regard with most patients becoming long-term patients with very high levels of satisfaction certainty in the early years following their surgery. This combination of bariatric surgery being challenging technically and rewarding in terms of the patient impact/outcomes makes it very fulfilling as a specialist practice.
An important priority for us in our society involves opening up services in different regions and generating opportunities for patients to access treatment which is one of the reasons being a Nigerian and coming back to Nigeria has been interesting to establish this type of surgery to the patients or to the communities of Nigeria.
West Arica is a big area, patients we know travel to far distances to get treatment, this is in most part due to their confidence and trust in foreign healthcare facilities; the doctors and the nurses in the hospitals over and above what’s available in their local hospitals.
This raises the challenges for us in Nigeria and West Africa to provide healthcare options locally that are able to provide safe and reliable care; it’s also usually better to have your healthcare closer to home, for example the social support from say family and friends is more readily available, there are also logistical reasons. However, this must be matched with a high standard of patient safety and experience to make it both successful and sustainable.
To achieve successful and sustainable healthcare delivery in Nigeria requires a strong commitment, understanding and expertise merged to the appropriate level of funding, healthcare personnel-manpower and massive doses of resilience, which in a large part comes from team working with the right people, really it is a people thing, it has been so great news, l have spent fifteen years now at it!
There has been increase in the number of deaths among women due to breast and cervical cancers. As a medical practitioner, what do you think is responsible?
It is a complicated issue. It is a combination of public health issues as well as a specialist health issues because the specialist centres belong to the communities and public health departments.
Cancer is one of the leading causes of death globally, we must not forget that. But what l think in a country like Nigeria is that the public health doctors and epidemiologist are those best placed to explain some of the reasons for the perceived increase in the cases of cancer. They will look into any link to environmental and life style factors, this is very important. But, as a clinician, our focus has to be when a patient comes with a complaint or symptom, then we do everything we can to make a diagnosis in a very timely way without making many errors, misdiagnosis can sometimes be a major obstacle. But I think that we have to remember that sometimes making an accurate diagnosis in more instances as our technology and facilities improve can sometimes distort our view and lead to a false impression that a problem is becoming more common. Generally, in the spectrum of greater awareness, accurate diagnosis, high quality treatment with improvement patient recovery with return to normal health in the shortest possible time frame is a key priority.
What are some of the most significant challenges you face in your role as a bariatric surgeon, and what do you find most rewarding about your work?
The delivery of high-quality health care globally can be challenging and problematic, our set of issues are nothing specific to Africa or Nigeria because patients are more expecting, the funding is less, the diseases are more advanced sometimes. The technology sometimes is not at your fingertips and so, this can be a source of frustration to doctors and nurses, but specifically when it comes to Nigeria or Lagos for example there are some unique things of course one of them most importantly is information out in the public. The challenge of doctors or hospitals remain largely linked with patients not having good trust, so this is now more about our health care system that are dysfunctional and, in some instances, broken.
So, this becomes an immediate challenge, but l think if we look beyond a personal/individual perspective, doctors and hospitals will notice our patients are turning up and are willing and confident to access their medical needs locally. In such instances being able to offer an affordable high-quality healthcare locally becomes very rewarding and a fulfilling experience for both patients and providers. Our team’s experience at Euracare and certainly my own personal experience, positivity reinforces this code of practice. l have had difficulties and challenges in my practice of course, but we, over the years, have been able to adjust work to match the environment, this is important for sustainability. In addition, one must remain realistic about what can be done safely and what cannot be done safely so as not to be too over-ambitious or delusional. Wise practice therefore, comes with time and care really.
How do you build trust and rapport with your patients, considering the sensitive nature of weight loss and health?
It can be complicated and difficult at times, I work intentionally in my initial encounters with my patients to put them as ease early in meeting and therefore, generate trust. As I age and understand human behaviour this helps more, I think.
Patient-doctor trust and rapport begins really with your reputation. Patients these days are already versed with your resume before the initial meeting; so, aspects like your training abroad, the centres in the world you practice at and so on, helps.
This simple reason for this when you say for instance, practice both in UK and here in Lagos, is that there are systems in say UK that in large part means that over many years of practice bad or underperforming doctors would have weeded out through its checks and balances like regulatory and licensing authorities and real time clinical governance processes. It’s essential that doctors, nurses and hospital administrators are subject to robust governance structures that are based on real time day to day clinical activities linked to both in-patients and out patients, procedures, complications, deaths- that is the only way to keep data; such data exists in UK but not in Nigeria.
On how to generate trust and confidence, it is the patient that will tell, but l think, if it turns together well, then you have a good reputation as a medical practitioner.
As the president of the Bariatric and Metabolic Surgeon Society of Nigeria, what initiatives are you most passionate about, and how do you envision the future of bariatric care in Nigeria?
The Bariatric and Metabolic Surgeons Society of Nigeria, we are essentially experts or clinicians who are very devoted and committed to offering this type of care in the society and individual.
In terms of aims and objectives, in terms of the vision and of course the opportunities in offering this care, I think it is clear that obesity is a real problem in the world, not just Nigeria, Nigeria because of our high population and also the fact that more than 60 percent Nigeria population is below the age of 45 years of age; so, it is only fair to understand that good population of Nigeria is going to be overweight, if they are not over weight in child hood, they will have it in adult.
So, it is a real problem and unfortunately, obesity or being overweight links in to diabetes, sleep apnea and some other issues like arthritis and cancers and so on, it is a very huge problem and if this problem is solved, it will help the community and the population to be more productive and more economical for the country.
So, it is a massive problem, the problem is even worse because there is lack of awareness, there is a lot of uncertainty, a lot of denial, on many parts, men, women, parents, children even doctors, and that is understandable, as we now start to see evidence that obesity makes people live shorter and more unhealthy and possibly more unhappy life, in totality then we can focus, that it should be dealt with actively and that is one of the opportunities there, it is also challenging but also what the society and the clinicians want to do.
We are twenty years behind what Europe is currently doing or let us say America, but that is still fine as we have started that conversation; we will grow and evolve over time. The goal being to ensure patient gain access to safe evidence-based treatment and support in Nigeria
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