Japa: Our specialists are leaving in droves – Chief Medical Director, UUTH

Emem Bassey is a professor and the Chief Medical Director of the University of Uyo Teaching Hospital, Akwa Ibom State. He is a former commissioner for Health and a professor of gynaecology and obstetrics. He was first appointed in 2018 and reappointed for a second term last year. In this interview with Aniefiok Udonquak, he spoke about the challenges facing the teaching hospital including how the ‘japa’ syndrome has affected UUTH among other issues. Excerpts:

What key challenges did you face when you assumed office?

When I came on board in 2018, the biggest challenge we had was infrastructure. Then we had many others, including the challenge of power; the challenge of old and ageing medical equipment, the challenge of human resource, especially the nursing staff; and of course, the challenge of finance. What we were receiving as allocation was not enough; our Internally Generated Revenue (IGR) was poor. So, as management, we have tried to address those challenges. But now, we can score ourselves quite high because starting from the main gate to the hospital, that is a new gate. We have done a lot of work- we have done quite a number of roads, even though we have not totally completed them, we have decent roads within the hospital. We have been able to complete all the projects that had been started by our predecessors, so as we speak, there is no abandoned project here, we don’t have any single abandoned project in this hospital. The laboratory block, the school block we have completed. We have started some new projects, the accident and emergency remodel completed and another extension which is ongoing. We have completed the molecular laboratories. The isolation ward is ongoing, the ante natal extension has gone far, nearly complete. The only building the hospital does not have any control of is the maternity extension that was undertaken by the Niger Delta Development Commission (NDDC), while I won’t say it is abandoned but the pace of work is rather slow and is not commensurate because the Commission has been building it for years. We have not seen the contractors on site for almost one year now. In terms of infrastructure, we have started new ones. We have lots of collaboration, as we speak now, there is an advanced diagnostics centre coming up built by the Nigerian Sovereign Investment Authority (NSIA). So basically, I can say to a large extent, we have completed all major projects.

How serious is the issue of brain drain as it affects UUTH?

It is a dynamic thing. Even this January, we have seen more than 20 people who have gone. It is more common among nurses, doctors, physiotherapists and radiographers. These are the people who are really going. But most importantly, I am not too worried because we see a lot of young people looking for jobs. If the ease of replacement could be made, then it should not be an issue. When they go out, some of them will come with better skills, some will even remit money to the economy, so it is not that bad perhaps, if we can manage it well. In terms of human resources, we have been hit by the brain drain. We may be better in a way because some of our key people are still around. Unlike in many facilities, what we have been trying to do now, the government has also been magnanimous allowing us the free hand to bring in quite a number of young medical staff, even though some of them you are bringing in and some are leaving but I think more of them are staying than leaving especially the new ones. We have also tried to use a lot of retired medical staff especially among the nurses and the medical consultant. We have quite a lot of retired people who cannot ‘japa’ people who are retired but not tired. We have quite a lot of them in the system and that has helped us.

Can we have an idea of the number of patients that come to the teaching hospital daily?

We have multiple specialties across the board. It is a multispecialty hospital, we have all the specialities, but unfortunately, we are also hit by the brain drain. Whereby a lot of our consultants have left the hospital. We have about 200 consultants, in various specialties. The number of doctors, resident doctors, medical officers is close to 400, the number of nurses is about 600. Collectively we would have about little over 200 staff members. All the clinics, we have outpatients, paediatric outpatients, emergency, we have the public health clinic, gynae, HIV, it will be too low to have 600 patients a day. When it is high, it can be up to 800 patients a day. I would say on average, we see about 800 patients on a daily basis across all our clinics.

What about power supply?

In terms of power, after we finished addressing the challenge of infrastructure, power was the next challenge that we had. Again, I am happy that as of this year, we have to a large extent tackled our power challenge by being able to bring in a dedicated line. So, since January, we are enjoying near constant power supply. Even Though this year, we are going to consider a hybrid, by bringing more solar power installations. Unfortunately, we are going to be affected by the new tariff structure and the band A classification because the power we are enjoying we are going to pay for it. At one point we were spending about N50 million on diesel monthly. If you look at how much diesel we use, about 1500 litres of diesel every day. If you do the mathematics, 1,500 litres at N1,800 multiplied by 20 days, not 30, remember that some weekends we may use as much, that is already N54 million. So, we were spending at least N60 million monthly on diesel and our total Internally Generated Revenue was not up to N100 million monthly. That affected us adversely but I Think it is a little bit better now, diesel is less than half now that it was because of this dedicated power supply line. Though the dedicated line has its challenges, the low voltage, it may not power some certain equipment. I think in terms of power, we have done well. We also will try this year, being intentional that all the emergency areas are powered by solar. So the way forward is a hybrid system. So, for the next two years, we will try to spend more on solar power because we may not be able to pay for the current energy tariff.

Has there been any improvement in the monthly allocation?

I think our allocation has seen some improvement and also there is an improvement in the IGR. When you now understand that ever since the price of the naira against the dollar crashed, and things went up, we have not been able to increase our hospital bills. So we are working in an environment where people don’t have money. I think it has to do with the fact that people don’t have money here. Smaller hospitals have higher IGR, so it is the environment that we are working in that it is affecting us. Almost 40 percent of our patients that come her cannot pay bills. So, we are forced to everyday grant waivers and when things become expensive, you are already coming from a situation where people cannot pay bills, we could not increase our bills. The government has done well but we have not been able to generate commensurate revenue because of where we are.

Do you have to detain some patients for them to pay their bills?

We are not a detention centre. We will not discharge you but many of them have absconded and when they run away, you cannot stop them. When people are in an emergency, which most of the people do. What you will see is that people will come from distant local government areas, passing government health facilities in their local government area and come here and sometimes they may not come with up to N5,000. Five thousand naira? One blood bag itself is almost N5,000. The blood bag is N5,000. The blood is supposed to be free if you have a donor but you have to pay for the screening and the person needs about three or four units of blood and yet the person comes to the hospital with less than N5,000. They need to do an operation which may cost up to N200,000 and yet they have less than N10,000 and this happens every single day in the hospital. So, in terms of the finances, I would not say we have done very well based on the environment that we have found ourselves and the solution to that is a social insurance scheme. I am very happy that as of Wednesday last week, Governor Umo Eno at the state executive council, has approved the state insurance bill but it might take time to implement it for it to begin to have the benefit. But if people have insurance, that is the one thing the country needs to look into. We are looking at insurance coverage for less than 10 percent of the people. In terms of equipment, we have been very intentional in trying to modernise our equipment, this year by the Grace of God, we will be able to actually buy some equipment. We have a budget line that will help us buy a lot of equipment. I am very grateful to President Bola Tinubu because we got a budget line for some equipment. What this means is that we will buy a new MRI, we never had an MRI machine and we are going to buy a new CT scan machine, the one we are using is like 13 years old. It breaks down more than it works these days and the cost of maintenance is too high.