“We are exposed to a lot of risks during our work” | Two Nigerian doctors speak on Lassa Fever, the health system and Nigerian doctors

We’re barely a month into 2018 Nigeria has recorded 16 deaths from 61 confirmed cases of Lassa Fever across the country.

Health workers are most times secondary victims who get infected while treating patients with disease. Between 2005 and 2018, the infection claimed over 40 health workers in Ebonyi according to the state chapter of the Nigerian medical Association (NMA) – the most recent being Dr. Ahmed Victor Idowu, who died treating a child.

Idowu died in Irua, Edo at the age of 30.

It was in this sense that we caught up with Idowu’s colleagues, who spoke extensively on Lassa Fever, the health sector in Nigeria and possible solutions to a system that’s far beyond called flawed.

Both doctors names have been withheld.

Doctor 1

What led to his death?

Lassa Fever.

How many Nigerian doctors have/might have been affected by this outbreak?

I don’t know for sure but, from those that were tested and seen to be positive, I believe three doctors and a nurse.

Ahmed was one of them, the other from FERTHA Abakaliki. There might be more, maybe some who were not tested and cause of death unknown.

Considering that a colleague just died, how have you been coping with the spread?

This is where the meat of the matter lies.

Personally, I apply more cautionary measures when attending to patients… Use of gloves, handwashing and the like. But this is not all that is needed in tackling an epidemic like this. Lassa Fever is something that is dealt with on so many levels.

The doctors have a role to play, the nurses, the lab personnel, the hospital as a whole, the government, the news agencies, the populace. Everyone has a role to play in curbing the spread of an epidemic, hence our outcry.

Are there special hospitals/centres for them? And do hospitals reject them?

Yes, there is a specialist center for investigating the disease and also for management of patients. That’s the Irrua Specialist center. Asides that, federal medical centers and teaching hospitals can be outfitted to provide initial resuscitative measures for affected patients.

But currently no such hospital asides the Irrua Specialist center is equipped to manage to outbreak.

The specialist center is a 22 hospital bed center for Lassa Fever but information I have says they currently have over 27 patients and have had to provide makeshift accommodations for patients.

And yes, oh yes, many hospitals are rejecting patients. Currently some hospitals in Abuja have closed down their casualty rooms to avoid taking in patients.

Then you mentioned that media coverage for the disease is quite low. Why do you say that, considering basically almost everyone knows about the disease? What kind of coverage do you expect?

This outbreak didn’t start last week, no sir… It started as early as the first week of January or even earlier.

My classmate who died, managed a paediatric patient suspected of having the virus as early as first week of January.

“Almost everybody” does not know about this outbreak, We expect a lot more people to know of this new outbreak. Many people don’t know, they don’t know what lassa is, how it can be contacted, what to do when it is contacted.

We want to see more coverage on the matter.

Has NCDC, the Ministry of Health or other relevant authorities come in to address the situation?

In 2016, during an outbreak, the ministry of health gave a press briefing on the matter.

I have not heard of any such press briefing from them to that effect this time around.

Maybe you can tell me if I missed such a briefing.

If they did, and I have not heard it, then perhaps, that should tell you one or two things about coverage.

How would you describe how the government treats doctors? In the light of the N5,000 hazard allowance you mentioned.

I don’t want to talk a lot on this because it brings me a lot of pain.

But let me highlight that Nigerian doctors are amongst the lowest paid doctors when you compare with hours put into the job. Doctors in the United Kingdom make as much as 100,000 pounds per year.

Let’s stick to a painful truth.

We are exposed to a lot of risks during our work, risk of contracting nosocomial infections, needle prick injuries that predispose to HIV, Hepatitis B and the likes.

No matter how careful you are as a doctor, accidents happen on occasion. The occasional blood splash, needle prick, patient vomitus or urine landing on you, the glove tearing during a procedure.

And all we get paid is N5,000 per month as hazard allowance.

Let me put this into focus for you.

Let’s say a doctor treating a patient with Lassa fever is exposed to the virus, he has to be placed on an antivirus called Ribavirin… This drug costs 14,000naira.

Does this make any sense? Does N5000 make any sense as hazard allowance?

Let’s stop misbehaving in this country please.

Nigerians on the average do not trust Nigerian doctors unless its dire – a pandemic maybe. What led to this?

Nigerians on an average do not only call on God until there is a problem… What led to this?

A prophet is not recognised in his hometown. Nigerian doctors are in high demand overseas and doing quite well.

This your question should be directed at Nigerians, i have no answer to it.

If you were the Minister, what would you have abolished? What would you implement? Basically what would you change?

First, i don’t know how to run a ministry but i am on ground and i know what’s needed… So the minister should come on ground and find out what’s needed.

If i were in his position, that Irrua Specialist centre for Lassa Fever needs to be expanded, and more hands made available.

Then a question needs to be asked and answered, “why does this problem always start from Ebonyi? What is it in that area that predisposes to this problem? Is it the rats? Is it the fact that there is no such specialist centre for prevention of spread and treatment of victims?”

Then answer all questions.

Every teaching hospital and federal medical centre has to be fumigated against rats and Personal Protective Equipment made available for handling such patients, also isolation wards mapped out for their admission.

Then a nationwide broadcast made as quickly as possible to educate people on what’s on ground and how to protect themselves.

And for God’s sakes, provide these Personal Protective Equipment for doctors!

These are your foot soldiers against this, arm them well… And, you can add For God’s sake again, do something about that Hazard Allowance… Its an eyesore. Reward your soldiers properly and they will fight better and eagerly.

Make the drug available in the hospitals… There is just one antivirus that works well, Ribavirin… Its efficacy is better if it is started early. Its expensive but thats what works.

Many hospitals dont have it, pharmacies don’t routinely stock it.

So the responsibility falls back on the goverment to make it available for treating both confirmed and suspected cases.

Then Ace, you mentioned a plan to leave? Do you still have that plan?

Let’s be honest.

I love this country, I wanted to be part and parcel of any development that would bring about the growth and greatness of this country.

My senior colleagues always laughed when I say this. They say, “write your international exams and leave as soon as possible, don’t be a fool“.

This country does not reward doctors properly for work done, does not care about our wellbeing, or our place in the health sector.

Whereas, other countries appreciate a health worker’s worth, appreciate your sacrifices, provide good conditions to work in, reward properly for work done.

Bros if na you, I bet you would be doing your visa application.

But I am still here… For now.

Is Nigeria at risk of losing its best minds, its best doctors? Using your colleague’s death and others in that light as example.

It has happened before, it’s happening again.

And not just through death, no no, doctors are leaving in droves.

The number of doctors writing license exams for other countries have tripled whereas the numbers writing the exams for Nigeria are dwindling.

The government is still sleeping on this. Doctors are leaving.

Doctor 2:

To the last question may I add that 90 percent of young doctors have been planning to leave before the incidence of lassa fever mainly because of the poor structure of our health system and the frustration it brings. There are a lot of issues wrong with our health system and its a representation of what’s wrong with in Nigeria today.

In reply to the third question, Dr Idowu was a colleague and friend. May his soul rest in peace. Amen. He was a very industrious, selfless, caring, principled and dedicated person. He was a devoted Christian and was who was tired of rot in the system and was for uprightness. He stood for what was right at whatever level he found himself.

Words actually cant describe him all perfectly. We are bitter because the system failed him. We understand the risks associated with our work generally and are not shying away from it. Just as you don’t send soldiers to war without weapons so also you shouldn’t send doctors to the ‘warfront’ without adequate protection and facilities. The rot in the health system is bad.

Our teaching hospitals and federal medical centres which should be the highest health centres are poorly equipped and managed. Time wouldn’t allow me to explain it all. In most tertiary institutions basic sanitizers and gloves are not made available routinely. They are not structured to deal with such epidemics and emergencies. As i speak to you many hospitals right now dont have protocols to deal with Lassa fever outbreak. Are they waiting for it to come first to their state or centre?? Are they waiting for a health worker to get infected first or die?

On our own part we try to be careful but how can I be too careful without the right things to provide protection.

There’s an outbreak of lassa almost every year. What has the Health Ministry set in place to battle it? Why only one center at Irrua in a country as big as Nigeria. We can go on and on but the summary is that the health sector needs to be taken seriously.

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