"SARS CoV-2... A CALL FOR PARADIGM SHIFT IN THE NIGERIAN SYSTEMIC DEGENERACY"-

  THE HEALTH SYSTEM AS A CASE STUDY

   (By Asaju Felix Taiwo, M.B.B.S- DELSUTH)

Over the past few weeks, the global equilibrium has shifted to a frightening state of perturbation and unascertainable degree of entropy; as things have fallen and are rapidly falling apart and are no longer at ease…The centre tellingly looking like it can no longer hold!

Like a thief in the night  SARS-CoV-2 or Corona Virus Disease- COVID -19 ,so named by the International Classification and Taxonomy of Virus ( ICTV), crept in with its 'proboscis' of destruction, seeking to put the ecosystem ecosphere to a stiffening  standstill, piercing and sapping the body and soul of the global community's Faunas ; the black and the white, the young and the old ,the strong and the feeble alike. The emergence of COVID-19 has suddenly equalized the empirical inequality amongst the elite, the burgeois and the proletariat.

Like the perilous "Great black Plague" of over 670yrs ago which nearly decimated the human race before solution was birthed ,COVID - 19  caused by a specie of Severe Acute Respiratory Syndrome related Virus( SARS- CoV -2), has plunged the international scientists, public health physicians and other medical personnel into an endless stream of sleeplessness ,restlessness and of course, cerebral exercises all in a concerted bid to bringing redemption back to human race via various decisive  and interventional approaches. After all ,decision and intervention they say are the essence of action ,reflection and conjecture are the essence of thought ,and the essence of medicine is synthesizing  these in service of others. Sadly, it is a conflict of reality with the Nigerian situation relative to the international communities.

In every nation of the world where true governance is operational ,I mean where there exists legitimate marriage between political leaders and the citizenry, adequate practical approaches are being discussed and pursued in earnest; hospitals are being stocked with requisite working tools including Personal Protective Equipment ( PPE); life saving gadgets as well as training/retraining and  recruitment of make -shift health workers;  empowerment of research laboratories with a view to enabling them undertake the urgent tasks of Disease Surveillance, Case detection, Contact tracing ,Disease notification, provision of supportive care for confirmed cases  and focused research and trials on probable therapeutic and ameliorative options like vaccines.  In fact ,launching of colossal anti- austerity measures aimed at relieving the potential resultant economic backlash from the menace is being witnessed as well.

There is no gainsaying that those nations so designated as the world powers, ( including their European contemporaries) owing to their political and economic dominance are among the worst hit by the conundrum of COVID -19.  It may even interest you to know that Italy ,a nation whose current situation is almost at the break point ; crying out for succour and looking up to the sky for redemption prides herself as one of the best ranked nations in terms of health care indices. In fact, the world's highest number of health workforce as well as the highest doctor - to - population ratio of 1: 240  is held by Italy ( According to World bank data /WHO reports ,2019 and 2020 respectively).

Despite this interesting fact, they are still not free , they are still grappling with the manacle of the pandemic, death toll is still alarmingly in the ceiling, health workers are still inundated by work load and some even paying the ultimate price necessitating the fast tracking of the graduation of medical students to augment their manpowers. The narrative is not different with the UK where the government seeks to recruit over 250,000 more health care providers despite boasting of a physician-to -population ratio of 1: 350.....The Nigerian situation? Hmm , it is nothing but a disgraceful anathema.

NIGERIAN SITUATION.... AN ANTITHESIS :

Describing the health care system of the country as being shambolic is simply sounding euphemistic. In moving forward, a critical assessment of the status quo is sine qua non. Hence, we must be adumbrated with the prevailing situation of the health system which is rather a staleness of hope, stillness of confidence, crescendo of despair and diminuendo of certainty as we will see.

The inverse square law and retributive justice;

The recommended physician - to - population ratio by WHO is 1:600. Agonizingly, what obtains in Nigeria is shameful 1:6000 at present. Here is the shocker ,given the number of registered doctors the ratio could have been a better 1:2,500 . Where they are?...Saudi Arabia, UK, USA,South Africa and even Namibia. Yes, you heard me. Painfully ,a minister( disappointingly, a physician ) once remarked, "Nigeria has too many doctors, and is not suffering from brain drain". What can be further from the truth?

Our population is currently being served by a meagre estimated 40,000 physicians as against the required number of 301,000 to achieve the WHO's recommendation based on our population projection.

Nigeria is  the 11th ranked country with worst Health Indices in the world ,and 3rd worst in Africa , only behind Egypt and Morocco ( WHO report, 2020)

Infrastructural decadence or outright dearth thereof in our health facilities is to say the least, egregiously sickening. The physical conditions of our health institutions can make the cure of a disease even more grievous than its endurance....Aso clinic right under the nose of the Commander -in - Chief  of the Armed Forces, has gulped up  a cumulative sum of #10Billion over  a five - year period thus; #3.94 Billion in 2015, #3.87Billion in 2016, #331Million in 2017, #1.03Billion in 2018 and #823.4Million in 2019 yet, cannot even boast of a functioning X -ray machine let alone a mechanical ventilator, meanwhile the total budgetary allocation to all the 16 Federal teaching hospitals catering for millions of Nigerians  over this same period of time is deplorably lower. How then do you expect these teaching hospitals to be operating optimally? If the foundation be weak what can the righteous do? The country as it stands today barely has up to  300 Mechanical ventilators ( a mechanized device which provides respiratory support to patients in distress to maintain oxygenation).

The appropriated Health budget in 2020 is 4% of the GDP which is roughly one -fouth of the ideal , (15%) s contained in the National Health Act(2014). You want to know the implication ? OK, the government will only spend #2,000 on the health needs of each Nigerian for one full year, while contemporary nations of the world like the USA, Norway, e.t.c spend an average of $17.7 000 on each citizen. Isn't it laughable? No wonder we had to wait for a philanthropic supply of consignment from China to have PPEs yet a minister could spew out such an unguarded statement that Nigeria was prepared for COVID -19 which has now paid its uninviting visit with an extended courtesy visit to those living in the "glass house’’ and has left everyone of them panting and gasping for breath like a fish out of the waters.

The National Basic Health Care Funding Law proposed that 1% of the Consolidated Revenue Fund (CRF)be appropriated to Basic Health Care Funding ( BHCF) which according to the 2020  Appropriation Bill should amount to N103.3 Billion from N10.3 trillion CRF. To shock you, only 44% of this fund was released, leaving our Primary Health Care Centres suffocating. That is why that  grandmother in the village cannot access basic malaria treatment, that pregnant woman in your neighborhood cannot access basic Antenatal Care that she ends up dying from  avoidable complications of pregnancy. Now you will not be shocked to know why 20% of the world wide maternal mortality happens in Nigeria ( WHO report).

That the health sector has long been the "Cinderella" of national  budget appropriation which attendant effect has come to hunt us as a nation is appalling.

That our politicians travel out incessantly for medical tourism, abandoning the masses at the mercy of insalubrious health system and still fail to replicate or domesticate their experiences when they return is really bewildering.

I hope you can see why you should take your health issues personal and seriously particularly at this period of COVID -19 since there's no structure in place for health security of you and I.

But wait a little o,  I think we should briefly see this together as well;

"RELIGION ,THE OPIUM OF THE MASSES"

Before some bigoted fellow might want to come for my head in the defence of their religious leaders, kindly calm down or better still take a tranquilizing ‘’drug’” of rationality and objectivity, as am not prejudiced against religious leaders rather, I like us to have a through -and -through dissection of the distorted anatomy of Nigerian system so as to have a clean corrective surgery in our “theatre” of amendment.

Science, they say investigates, while religion interprets. Science teaches man knowledge which is power ,religion teaches man wisdom which is control and both are not rivals. But it still beats my imagination how many of those who are meant to exhibit brotherly altruism by seeking to protect their congregants at the very least at difficult times such as this, fail to understand basic religious exegesis let alone scientific reality. Or how do we explain the opening of worship centres housing hundreds of thousands of worshipers in the midst of highly virulent viral outbreak despite obvious shut - down of gathering of even fewer congregations in contemporary churches world over? Have you not fed fat enough on the credulousness of some members of yours, or, is it a mere show of stolidity or an outright defiance? If only their spiritual lenses would permit them to see through the prism of the physical realm, then they would know what multiplier effect such an act would cause to the transmissibility of SARS-CoV-2 in our communities.  The story in South Korea would lend credence to this.   

Meanwhile, even the holy book says " wisdom is profitable to direct". Having faith in God does not mean you should take no precautions.

Have they forgotten the biblical accounts ;

·         there was flood coming and Noah was instructed to build an ark which he did...That's being proactive

·         there was famine and Joseph stored up grains...He didn't wait to pray for spiritual grains. That's wisdom.

 
·         king Herod was going to kill our Jesus (of Nazareth ) but Mary and Joseph had to flee to Egypt. Isn’t that wisdom ? …The list is endless.

Casting aspersions an all manners of innuendos on the political leaders isn't enough. Our spiritual heads have got to do more.  "He who comes to the table of equity should approach with clean hands".

TO THE GOVERNMENT:               

This is not a time to continue taking sedating dose of gradualism .No! Wake up from your administrative slumber , shake off that perennial cocoon of reticence and act both in the interest of remote and immediate redemptions respectively thus;

(1) Declare a state of emergency in the health sector with a view to identifying the fundamental issues via the engagement of both indigenous and international experts and implement their recommendations accordingly .Their central focus would include but not limited to the urgent task of health  transformation through health policy review, robust health care financing to eliminate the rot in our health infrastructures.  

(2) Accord the necessary priority the health system deserves by setting goals within a time frame and pursuing them with utmost spirit of genuineness, sincerity and self determination. There is too much  in the vaults of this nation and so providing  government –owned multispecialty structures across the geo-political zones of the federation where sophisticated medical and surgical procedures such as Open Heart Surgeries,  Organ/Tissue Transplantation  Surgeries, amongst others, can be performed would not be a crime. This would checkmate medical tourism overseas and would ultimately improve over all human capital development back at home.

(3) An incisive and decisive inquest must be made into the menace of health workers' exodus in search for pastures green. Needless saying that an upward review of their remuneration starting with the ridiculous #5,000 hazard allowance must dominate any discourse else, the hovering cloud of disaster constant brain drain is going to wreck on this nation would be catastrophic

TACKLING THE MENACE OF COVID-19… AN IMMEDIATE APPROACH:

To think that it took Mr president several weeks to probably rehearse a nation wide address on COVID-19 and only to come out struggling and even committing a malapropism in the process should cast a doubt on his competence to protect you and I from what he seemingly doesn't know. Presidents and Prime ministers world over are seen at the frontline of the battle against COVID-19 scourge ; constantly leading their respective health teams and addressing their citizens from time to time. The converse holds true in our own country.  But not to worry, senility is real and Nigerians knew this so well when they went ahead re- (s)electing him the last time, depriving him of his much needed bed rest at home. Anyways, that is a story for another day lest I open up a ‘Pandora’ box which would be immaterial at this time of national tension.  

We have long expected certain conscientious and conscionable efforts from the government but going by what am seeing, hesitation and inaction have caused us sitting on a keg of a gunpowder from which only GOD could safe us. Well,these are viable suggestions, after all it is better late than never if only they would wake up and act:

 (1)STRICT RESTRICTION ORDER LIMITING MOVEMENT TO ONLY;

A. Procurement of life essentials and basic necessities such as groceries, medications etcetera.

B. Hospital visits by the sick and vulnerable citizens in need of medical care.

C. Movement to work places by those in certain indispensable professions of course, like the medical and security personnel.

(2) URGENT INSTRUCTION TO "NURTW"  TO STRICTLY  REGULATE THE NUMBER OF COMMUTERS TO 3 AGAINST THE USUAL 6  IN A COMMERCIAL TAXI AND THE EQUIVALENT IN A BUS.  This  sure will come with a hike in transport fares but its only a transitory and necessary sacrifice for the good of all, as it would limit social contact and infection spread. Nothing ventured, nothing gained.

(3)COMPLETE CLAMPDOWN OF MAJOR MARKETS EXEMPTING GROCERY ,PHARMACEUTICAL AND  ESSENTIAL COMMODITY  OUTLETS.

Strict enforcement of the above as well as anti- social and anti - religious gathering order must be achieved urgently. And the sit at home decree must be accompanied by anti -austerity measures so that hunger –induced mortalities would not be higher than that from COVID-19.

TO INDIVIDUALS:

COVID -19 IS NOT A DEAD END. Like every other respiratory virus ,it is mostly self-limiting, though more virulent and more infectious.

...KEEP CALM BUT BE SMART,

... INFODEMICS KILLS FASTER THAN EPIDEMICS,

...SEEK INFORMATION FROM VERIFIABLE SOURCES,

...EAT HEALTHY, USE YOUR HAND SANITIZER ( WITH AT LEAST 60% ALCOHOL CONTENT),PROTECT YOUR FACE IN THE MIDST OF COUGHING FELLOWS,

...AVOID UNHEALTHY LIFE STYLES,

...IF YOU ARE ASTHMATIC, DIABETIC, CHRONICALLY ILL , ELDERLY(i.e> 65yrs) , ON STEROIDS OR CHEMOTHERAPY FOR A CANCER ,BE EXTRA CAREFUL as your immunity is much lower and are more at risk of developing severest complications of COVID-19

 

TO HEALTH PERSONNEL:

Remember, you are still a human after all!  DO NOT touch without PPE! That’s my candid advice for you.

And to colleagues of Hippocratic calling , remember , if you endanger your ONE life, you have endangered the lives of 6000 people who depend on this ONE life for their care. Prevent over zealous exposure and stay safe as well.

"He who cures a disease may be the most skillful but he who prevents it is the safest physician"...THOMAS MULLER.

Everyone must act for the conquest of COVID -19 so that this sweltering spring of despair could give way for invigorating winter of hope that we may  sing together this poem of pandemic ;

 ”PANDEMIC SONNET"                          

This ain't the first time you've come to hunt us.

And it won't be the last either,

You thought you could break the species

But all you did was to bring us together,

You brought the world to almost a standstill,

But we never stood still let inaction take over,

Each one of us did the best we could,

And we'll keep on doing till your traces wither,

We may have our differences at times,

But when trouble knocks on our door we all stand one,

We may act selfish sometimes too,

But in catastrophe we refrain from helping no one,

All in all, thanks for reminding us to refrain from wildlife, sin and inaction,

Otherwise all we'll have left to do is mourn.

Dominique
Sissy3
Lalasticlala