Many years ago in Nigeria, people with certain kinds of ailments were assured of prompt and affordable treatment provided in some of the best hospitals anywhere directed or monitored by skilled men and women. Today, those skilled men and women still exist but the facilities available have steadily fallen behind what is available in the rest of the world.
In those far gone years, people who suffered from tuberculosis, leprosy or cancer were afforded free treatment in any hospital where they were presented for diagnosis and management. We have seen how even the availability of medications has become an issue in the past two decades. Worse still, is the fact that some of the drugs presented to victims of those conditions on behalf of a sympathetic humanity found their way into Idumota and Onitsha markets, and were made available for sale to those who had the wherewithal to purchase the drugs at a discount.
In the past several weeks, reports have emerged about how money available to certain Nigerian organisations charged with the provision of health support services disappeared into private bank accounts. The result? Many beneficiaries are denied their entitlement in favour of a few predators who want to live beyond even their dreams. Evidently, we do not even show love to our fellow citizens. But all that is a digression; the major plank of this essay remains that we lost focus along the way and essentially left the confused citizen alone to fend for themselves and feel their way around very unfamiliar territory.
The typical story goes like this; someone with a suspicious problem first visits a chemist or a health personnel in the neighbourhood. They get a prescription for some medication. Sometimes, the prescription is for a herbal mixture. After several weeks, there is no improvement and the person then visits a proper hospital.
Once at the hospital, he gets to see a doctor who examines the patient and recommends a battery of tests. These tests are conducted over several more weeks before they get another appointment even to have a biopsy taken. The confirmatory result takes a while to return its verdict. That could take anywhere from 10 days to three weeks or more. In the meantime, if the original growth is a cancer, it has continued to increase in size and complexity.
Now then, there is a diagnosis and what remains is what to do about it. All the counselling is done and surgery scheduled. If there is no industrial action involving any of the various health care providers, the operation goes ahead as planned and the growth successfully removed.
After several more days or weeks, the wound heals and the patient gets to be referred to another medical facility that can handle the next phase of the treatment. Such a hospital may be many kilometres away and could even take an entire day of travel time. Now, by the time chemotherapy is concluded, the radiotherapy machine, if there is one, would have stopped functioning mostly due to old age and over usage. The patient is then forced either to wait for the machine to be repaired, which may take their lifetime or go to yet another hospital.
Sometime in 2014, there was a particularly desperate time for many cancer victims in the Southwest of Nigeria. The radiotherapy machine at the Lagos University Teaching Hospital, LUTH, had broken down. A similar fate had befallen the machine at the University College Hospital, UCH, Ibadan.
In an entire land area, a quarter the size of the federation, only the machine at EKO hospital in Lagos was available to provide that service for so many people. The scenes of desperation are better imagined. Many hapless patients who were unable to afford that private service simply passed on early. Others were more fortunate for they then found their way to Enugu, at the University of Nigeria, Teaching Hospital. However, it is obvious that this kind of tortuous movement in pursuit of affordable health care cannot be sustained. Nor should that be the fate of hundreds of thousands of men, women and children who are stricken with this terrible disease.
As the nation’s population has increased, so has the number of cancer patients. There are a lot of hospitals now across the country and many adequately trained health care professionals. However, there are a lot of gaps in the system, the referral system is faulty and inadequate. Often, practitioners are not sure where to send their patients to because what held true yesterday may have altered today almost beyond recognition.
A doctor who has examined a patient reaches a diagnosis but that is not confirmed until he has a biopsy result in hand. What these people need most of all, therefore, is not sloganeering at the various campaign events or choreographed press conferences. It is a concerted effort to strengthen the infrastructure already available rather than seeking to build entirely new structures that now essentially stand alone somewhere like some orphan edifice. The reason for that is clear.
The fact that a new complex has been built somewhere may look really good politically or even in the eyes of the public. It is wrong, however, to assume that a specialist centre can evolve around such a facility. What is more practical is to situate such a specialist centre within a hospital that has its own native manpower already in place and is simply available to seamlessly absorb the new addition. That is organic growth and it is the way it has been developed in other lands. Nigeria cannot grow its health care system by doing it the other way. That would be much like driving from Abuja to Kano, using the reverse gear when you might as well go forward in a way that does not add to your physical discomfort.
What good can result from building a cancer diagnostic centre in Zungeru, because one prominent son of the town died of cancer of the throat? Why not place it within a specialist hospital in Minna which already has some personnel to whom more hands can be added? The new centre in the meantime is a full-fledged hospital in all but name. It would have its own regular doctors who will primarily attend to patients. It should also have wards for admission and treatment and even to conduct certain investigations. It must have modern imaging devices—ultrasound machines, digital X-rays, CT scans, MRI scans, fluoroscopy, angiography equipment and all of them with their full complement of staff.
Then there should be a department of radiotherapy which is different from the above in terms of staff and equipment and complete with radio-isotope facilities, able to conduct radionuclear scans and isotope studies. And then a laboratory with every specialty in place (morbid anatomy, clinical chemistry, haematology and medical microbiology), including histopathology and histochemistry. There should then be another department of nuclear medicine, a large field recognised even by some other Third World countries such as Iran and Cuba. Of course, there must be operating rooms also with their staff complement. If these are not in one place, you do not have an integrated cancer treatment centre.
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