In defence of Nigerian doctors (2)
Recently I wrote a short article detailing the challenges medical doctors are confronted with in Nigeria, in response to insinuations in some quarters that Nigerian doctors are poorly trained. One commentator went as far as saying that Nigerian doctors are useless. “Garbage in, garbage out”, claimed another. Some of the adjectives which have been used are rather unprintable. Surface examination of serious problems in the health sector tends to support these perspectives. However, a more serious study paints an entirely different picture.
The Okada experience tells the sad story of detereorating healthcare in Nigeria. Established in 1992 in a small Edo town, the Igbinedion Hospital and Medical Research Centre (IHMRC) housed the first extracorporeal shock wave lithotripsy equipment in Nigeria. This specialist equipment is used to conduct nondrug, noninvasive treatment for kidney stones in the upper urinary tract, an illness which is also called nephrolithiasis. Specifically, it can shatter stones measuring up to 2 cm in diameter into fine fragments that can then be passed in urine. It is certainly not the only treatment modality for kidney stones.
Medical treatments are also proven to work for some kinds of kidney stones, whereas those which cannot be treated by shockwave or which are resistant to shockwave, may be surgically removed percutaneously or through open surgery. Indeed, some patients will require more than one session of shockwave treatment. Open surgeries have fallen out of favor in advanced societies though they remain the mainstay of treatment here. Surgeries conducted through small incisions made on the skin cause significantly less morbidity, including short length of hospital admission. Hence nephrolithiasis is not a death sentence. Patients who present early can have kidney – saving nephrolithotomy operations.
Shock wave treatment for nephrolithiasis is a day case procedure. You walk into the doctor’s office and walk out on the same day. You pass the shattered stones in urine. At Okada, due to the remote location of the place, it was a 2 day procedure for majority of the clients. Please bear it in mind that the centre catered mostly to the political and business elite, as its fees were beyond the reach of most people. Sadly, the centre shut down lithotripsy procedures in 1998. The reasons are not farfetched.
You see, kidney stones are rare in this part of the world. It is mostly an affliction of protein consuming populations in developed countries. Protein cannot be stored, unlike fat and carbohydrates. The excess waste from protein breakdown is urea which in high concentrations and the right internal milieu, will eventually crystallise into renal stones. Okada failed because it could not generate sufficient revenue to maintain overhead costs and remuneration for specialists and other staff. Only 32 patients were treated in 6 years, in a total of 51 sessions. Each session cost only a little above $600, or about ₦15000 at a time when federal minimum wage ranged from N550 ($25) to N1500 ($168.18) in 1995 and 1997 respectively. A similar centre in Canada treated 2000 patients and charged a little more than $2000 over the same period. A US hospital charged about $9000 and a UK centre charged about £1700.
Today, it will cost patients more than ₦750, 000 per session to obtain lithotripsy treatment in a private facility in Abuja. Those requiring more than one session will spend more than a million naira. The least important factor here is the cost of lithotripsy equipment. Poverty remains a huge limiting factor. That and the rarity of nephrolithiasis counter the argument of planning which some have put up, to the extent that we can plan our way out of this quagmire. What is the minimum wage in Nigeria? Can Nigerians afford health insurance that gives everyone options for good quality health care? How about out – of – pocket payments? It costs the UK NHS £2, 000 of taxpayer funds per session to offer the procedure to UK residents. Those who aren’t covered generally pay more to afford the treatment.
Americans spend between $10,000 and $17,000 per session of shockwave treatment, funded by monthly premiums and marketplace insurance plans. Private insurance can easily cost 200 dollars a month in premiums, and cannot cover all medical costs. An individual paying $20,000 for a medical procedure may be able to get their insurer to offset perhaps three – quarters of the costs (Say your out – of – pocket limit is 5000 dollars for a plan year). Those on Medicare or Medicaid must have paid payroll taxes in their working years – 12.4 % tax (6.2% social security and 1.45%) shared equally between employees and employers since 2013. Self employed folks shoulder nearly all the burden. These taxes amount to thousands of dollars per annum for individuals eligible for publicly financed health insurance in the United States. More than 20 percent of US annual budget goes to Medicare, Medicaid and other Healthcare items. In a manner of speaking, there is really no freebie in Freetown.
The Nigerian budget allocates barely 5 percent to healthcare expenditure. 20 percent of 6 trillion naira will be something a little above 1 trillion naira – still insufficient to afford universal healthcare coverage for majority of 180 million people. Even in developed societies, good healthcare costs money. We probably should have planned to be a rich nation since the seventies, when oil first boomed. But we didn’t. We can make an effort; this will of course happen only if our policy makers understand that financing healthcare is more an urgent task than a routine matter. What we are doing presently boils down to training medical professionals for rich countries. Na the koko be dat. Mek I rest this mata.
Featured Image: Simon Davis/DFID