Anybody familiar with the Paediatric Unit of the Murtala Mohammed Hospital in Kano cannot easily forget the sterling performance of Dr. Yashua Alkali Hamza, who toiled all through her days as the Head of the unit to make sure that patients that came her way get the best treatment. Now on her own and providing high quality medical care as the Medical Director, Childcare and Wellness Clinics, Wuse 2, Abuja, she is piqued that a vast majority of the Nigerian populace is still at the receiving end of the appalling medical services in the country.  

 

YASHAU is of the view that notwithstanding the many problems authorities have to contend with, Nigerians should be provided with qualitative medical services such as is obtainable in India and China. As the country Director, Maternal Health Champions Programme (MHCP), she is involved in the empowerment of health workers with requisite skills and experiences required to uplift the healthcare sector. And this, she says can be feasible only if Nigerians insist on the best.

 

  “I believe that those saddled with the responsibility have to always strive for the best and aim at world standard. There is a reason for establishing world standards and those other countries that Nigerians go to have done their best to achieve it. If they could do that, why can’t we?

 

  “As citizens, we have to demand the best from our leaders because it is only a small percentage of the populace that can afford to go outside the country for medical treatment. But why should this be so? Those countries that people go to, why can’t we strive to be like them? I agree that there are private hospitals in Nigeria with state-of- the-art equipment, but people need to push for that same level of excellence in public facilities as well. The policy makers, the patients as well as the healthcare providers – all of us have to insist on the best, what is higher than the status quo because that is the only way we can improve.

 

  “Countries such as India and China also have huge population and other challenges. Yet, one of the countries Nigerians go to for medical treatment is India because they have a very good healthcare system and their population has not impeded their quest for quality healthcare. So, a large population shouldn’t be a deterrent.”

 

  According to Yashau, researches have shown that Nigeria is capable of establishing world standard healthcare system. And only focus and ridding the country of corruption are all that is required. “We have to do what is right in the sense that every intervention should be evidence-based. We shouldn’t be doing things haphazardly. Things should be planned in a certain way for the desired outcome. Whatever we do should be very clear. 

 

  “If our resources are fully and well utilised, Nigeria won’t be where it is today. Nigerians deserve the very best but if this is not done, then you end up having the kind of horrible maternal and child mortality rate we have.

 

  “Nigerians should not get used to the way things are; it isn’t right to allow public health facilities operate as they do. Maternal health is crucial though a lot of people have done a lot of intervention in this area. But the fact that Nigerian women are still dying shows that there are a lot of problems with the way the intervention is carried out. So, we have to do targeted interventions that take care of different dimensions and not just the supply side, which is the hospital. We also need to take care of the demand side and the issue of decision-making, service delivery and all that. For me, looking at healthcare in a holistic manner and not accepting the status quo and striving for excellence should be the goal of every policy maker, every citizens and every health care provider.”

 

  Yashua, who is satisfied that she gave her best during her stay in the Kano Hospital said those who believe Nigeria is one of the worst places to be a mother shouldn’t be faulted.

 

  “Yes, there are often sensational headlines aimed at grabbing people’s attention concerning the state of public medical facilities and we should agree we do have a public healthcare problem, especially when it has to do with mothers and childbirth problems. It is very risky giving birth in a lot of countries and Nigeria is no exception. The challenge should be how to move forward and ensure that every mother is taken care of because the discrepancy in maternal mortality between developed and developing countries is huge. 

 

  “Infant and neonatal mortality are preventable. Many of these things can be prevented with good quality healthcare and an enlightened populace. These problems have always been there but how do we move forward from the rhetoric?”

 

  Comparing her experience in both the public and private medical sectors, she says: “In some ways, it’s been very similar and in some ways very different. Working in the public sector has afforded me the opportunity to come in contact with different kinds of people and different kinds of illnesses and diseases. It has also enabled me to learn first-hand how these diseases affect people. It has definitely prepared me for the private sector. 

 

  “In the private sector, however, things are a lot calmer. The inequality is huge because at the public side, you have so many patients being attended to by just one doctor and the patient time is short. The ability to really practise the way you want is curtailed because of the number of patients.

 

  “But in the private sector you have time to do that and to be really focused and give as much to patients. On the other hand, it shields a doctor from the very real threats of illnesses that afflict ordinary people everyday. I believe there is a huge discrepancy in how healthcare services are distributed, as those who need them the most have least access, which is a very unfortunate thing. Ironically, those who probably need it the least are the ones to get vaccinated; they are the ones that are well nourished. 

 

  “The discrepancy is much in the public sector because sometimes patients have to wait for hours to see a doctor and sometimes they don’t even get to see the doctor. But in the private sector, there is immediate access to doctors and they get care easily. 

 

“I think it is more or less a policy issue. It is very well known that the numbers of available doctors are not enough for the population. The sitting of doctor is a factor probably because those in rural areas are not likely to have doctors and other healthcare personnel. The decision by the various level of government to employ is at their discretion and sometimes the process takes a long time.

 

 “It’s very important for policy-makers to realise that the need in the public sector is really great and it is something that has to be addressed so that people can get the type of access required. The quality of care is also important.”

 

  Could the problem be that of poor funding? “I think it has to do with everything. The funding could be better but apart from that, it has to be directed at areas where the most impact can be made. Things should be done in an organized and proper manner. 

 

  “For instance, people talk about building hospitals, which is very obvious, but it shouldn’t just stop at that. It should also be about equipping these hospitals and getting the right personnel.”

 

  The experiences she gathered while in the public domain, she says, have been of tremendous help. “They have been rich and very fulfilling. I rose up to the rank of the Head of the paediatric department and that was where I actually started. In many ways, being in the public sector has turned me into the kind of medical practitioner I have become. I still do volunteer work and participate in policy discussions in an advisory capacity. I sometimes go back to do some clinical work as well as training of healthcare personnel. 

 

  Shedding light on why she chose to be part of the Maternal Health Young Champions Programme (MHYC), which is implemented by the Institute of International Education (IIE) and funded by the Harvard School of public health, she says: “It is about mentorship. What this programme does is to identify emerging young maternal health champions— young people who have distinguished themselves in terms of passion and commitment towards maternal health issues. They are paired with in-country mentors, who handle them for a period of nine months. They then go back to their various communities with a small grant to implement ideas that would improve maternal health.

 

   “We have had the first cohort of champions and they are doing fantastic work. One of them is pushing for a blood donation campaign and as you know, haemorrhage is one of the leading causes of death among women who have given birth. We have some of them who are working with midwives and others working on attitudes of healthcare personnel because that is one of the deterrents to people attending hospitals. We are very happy with our champions. This particular cohort will end in September and we are looking forward to another set.

 

  “I think it is important that we empower young people to understand what the problems are; especially the issue of maternal health and health generally. So, by creating that passion and commitment, the younger generations are already being equipped with the power to make needed changes.”

 

  On whether any tangible progress is being made on the issue of maternal mortality, she says: “It is very difficult for anyone to think that he/she has all the answers and solutions. When you sit down to discuss with people, you would be surprised at the knowledge you get. I think one of the trends is that of community advocacy; that of empowerment for community members to enable them take the decision that impact positively on their lives. I think there is more awareness now because of the efforts of various groups of people. So, more people are accessing healthcare and going early to hospital. But we have to make sure that if they go to the hospital, they get what is required.

 

  “So it is not just to create demands, we have to make sure that the supply side is very okay. A lot of people are also accessing vaccination services, which are lifesaving. A lot of people are aware of malaria control measures, which are helpful like insecticides treated nets, environmental control and early hospital attendance to ensure that the ailment is taken care of quickly. I think there is still a lot of work to be done though because in spite of all this, we still haven’t made a dent in the system. There is some progress but there is still a lot of work to be done.”

 

  Would she consider an offer to serve in the public service again? “I believe that I am contributing my best to the public from where I am now. I participate in a lot of policy discussions and I participate in a lot of discussions with NGOs in order to make things better. I have done a lot of public health research in different universities around the world and I feel that I am in a very comfortable place presently. I think I will continue to contribute as I am doing now from wherever I am and as far as I am concerned, I haven’t left the public sector; I am still there.”

 

ADAMU ABUH

Guardian