Like other health challenges, we should not rule out post-COVID-19 symptoms – Chigbo
Nnenna Nina Chigbo is the national president, Nigeria Society of Physiotherapy (NSP), the umbrella organisation for registered physiotherapists in Nigeria and the diaspora, where she offers leadership to over 5,000 practising physiotherapists and acts as a bridge between the old and the young. She is also the Education Director for the World Physiotherapy-International Physiotherapists in HIV/AIDS, Oncology, Hospice and Palliative Care, and received the inaugural Nnenna Chigbo Educational Leadership Award in recognition of excellence in the advancement of global education in oncology, HIV/AIDS and hospice/palliative care rehabilitation during the 2019 World Physiotherapy Congress in Geneva, Switzerland. In 2010, she was awarded the prestigious Hubert H. Humphrey Fellowship granted by the Fulbright Scholarship Board under the US Department of State which earned her a Global Health Fellowship at the Rollins School of Public Health, Emory University, Atlanta, Georgia. Chigbo also received the prestigious International Haemophilia Training Center Fellowship which she concluded at the Christian Medical Center, Vellore, India. She has served as a guest researcher with the National Centre for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Unit of the Center for Disease Control and Prevention (CDC) in Atlanta, Georgia. In this interview with GODSGIFT ONYEDINEFU she spoke on a number of health-related issues including the need to effectively manage post-COVID-19 challenges in Nigeria. Excerpts:
Wednesday, September 8 was marked as world physiotherapy day. What relevance does it have to our environment?
The theme for this year is Long COVID and rehabilitation. Long COVID occurs when people have recovered from COVID-19 but are still experiencing certain symptoms. It is termed post COVID-19 condition or long COVID-19. We have a lot of survivors in Nigeria, all glory to God. We need to educate them on the possibilities of living with long COVID and offer rehabilitation services which has been established as a strong component of the management of COVID-19. Persistent symptoms would affect the quality of their lives and invariably productivity. Three major symptoms described by the World Health Organisation are shortness of breath, cognitive dysfunction commonly called brain fog and fatigue. Other symptoms noticed include persistent headaches, chest pain, muscle ache, anxiety and depression. Physiotherapy can manage these symptoms with minimal or no side effects. It was in this respect that we had a virtual lecture via zoom on Wednesday 8th September where we discussed the topic, ‘Leveraging on Rehabilitation in Long COVID management’. Attendance was fantastic and encouraging. With the quality of participants and deliberations, we are convinced that we are on the right path to healthy living in Nigeria.
What role did your members play in tackling the COVID-19 menace in Nigeria?
In 2020 at the onset of the pandemic, we set up a 20 man committee with membership from across the 6 geopolitical zones to coordinate our response. We embarked on massive Public enlightenment campaigns, data collection and documentation including mapping of physiotherapy facilities to determine capacity to handle patients with COVID-19, capacity building for our membership, health Community mobilization especially as regards the non-pharmacological preventive measures, protective care of membership, collaboration with health institutions within the country and at the international level, coordinating research collaborations and advocating for inclusion of physiotherapy into the mainstream response in Nigeria. Some of our members got infected and while at the isolation camps, they initiated chest physiotherapy and prescribed aerobic exercises for the other patients. They received support from us in form of documented materials and counsel. Some physiotherapists were recruited as part of the medical team into isolation centers and patients at those centers experienced wholesome care.
Are there sufficient employment/job availability for physiotherapists?
Sufficient employment and job availability are two different things. There is not sufficient employment but the job opportunities are there. The government needs to do the right thing. We have trained just over 6000 physiotherapists to attend to over 200 million Nigerians. More so, more than half of this number are either abroad or on their way out because of very poor remuneration, poor conditions of service and unemployment. Sadly the standard ratio should be 1:10 that is 1 physiotherapist to 10 Nigerians. You can now estimate how many physiotherapists we need in Nigeria, yet the few we have are not all employed with just about 1000 employed in government hospitals. Hospitals that should employ 70 physiotherapists to man 700 bedded facilities have less than 10 physiotherapists. Have we looked at primary health care in Nigeria? If the government is serious about taking healthcare to the masses then each of the 774 local government areas in Nigeria should have a health facility with at least 2 physiotherapists domiciled there. With this one step, the federal government can take more than 1500 physiotherapists off the unemployment bracket at once.
What is physiotherapy doing that the common man would understand?
The Nigeria Society of Physiotherapy (NSP) is the national professional association representing both Nigerian-trained and foreign-trained physiotherapists practicing in Nigeria. The NSP was admitted as the sole representative of Nigerian physiotherapists at the world body (World Confederation for Physical Therapy now World Physiotherapy) in 1967 and has maintained that status. According to the World Health Organisation, physiotherapists assess, plan and implement rehabilitative programs that improve or restore human motor functions, maximise movement ability, relieve pain syndromes, and treat or prevent challenges associated with injuries, diseases and other impairments. They apply a broad range of physical therapies and techniques such as prescribed exercises (movement), ultrasound, heating, laser, manipulations and other techniques. They may develop and implement programmes for screening and prevention of physical ailments and disorders. The World Physiotherapy, which is the sole voice of all physiotherapists in the world says in addition to the above that physiotherapists are qualified and professionally required to provide consultation within their expertise and determine when patients/clients need to be referred to another healthcare professional, determine the outcomes of any interventions/treatments and make recommendations for self-management.
How does one develop career path in physiotherapy in Nigeria?
First you need to graduate from an accredited physiotherapy programme and get licensed by the Medical Rehabilitation Therapists’ Board of Nigeria. Then as a qualified physiotherapist, you need to choose an area of interest either in the academia or clinical practice, and in a particular specialty. For academia, MSc and PhD in a chosen specialty in the university is required while for clinical practice, residency programme in physiotherapy offered through the Postgraduate Physiotherapy College is required. In academia, you can rise from a graduate assistant to the rank of professor while in the clinic, you can rise from physiotherapist to the rank of Director in a specialty.
To what extent is Doctor of Physiotherapy studied in Nigeria and since when?
The National Universities Commission approved the Doctor of Physiotherapy program in 2018. Four universities have got approval to start the DPT – Kaduna State University and Chrisland University have already commenced while University of Lagos and University of Nigeria are about to commence. Many others are at the stage of approving within the universities before reaching out to NUC for approval.
Does DPT qualify physiotherapists to do the job of physicians?
No, it doesn’t. The scope of the physiotherapist has expanded but it is not encroaching on that of the physician. In fact, we complement each other to achieve wholesome care for patients.
There is role description that is why even in the United Kingdom where physiotherapists have rights to prescribe medicines to their patients they have not taken over the job of physicians.
Are there specialty areas in physiotherapy?
Yes. We are specialising in different areas in line with international best practices. Some are Neurology/ Mental health physiotherapy, Paediatric physiotherapy, Orthorpaedic physiotherapy, cardiopulmonary physiotherapy, Geriatric Physiotherapy, Oncology/Palliative care physiotherapy, Women’s health physiotherapy, Sports physiotherapy. In the nearest future, many more will come up
Is your society planning to have a Postgraduate college like the other medical professions?
We already have a Physiotherapy Postgraduate College running and producing specialists in the areas I mentioned previously. They are working and delivering excellent health care to Nigerians. What we need now is for the federal government to assume ownership of the college and begin to remunerate them for services rendered. Already, in our scheme of service, there is provision for this specialist cadre; so, we are calling on the government to do the needful.