WELCOME ADDRESS BY THE MEDICAL DIRECTOR OF OGO OLUWA HOSPITAL,BACITA TO DISTINGUISHED MEMBERS OF THE M & E TEAM COMPRISING REPRESENTATIVES OF PHARMACESS, COHSASSA AND HCHC

DATE 20/06/2014

VENUE CONFERENCE ROOM, OGOOLUWA HOSPITAL,BACITA

OCCASION 14TH M & E ENCOUNTER

Dear Sirs and Mas,

It is my great pleasure, delight and privilege to welcome you all our distinguished guests in the Name of the Lord of Ogo -Oluwa Hospital Bacita, the management and staff of the Hospital and the entire communities benefitting from HCHC program in our region here.

Thanks for making it again as you keep on relentlessly helping Provider Hospitals to grow with your periodic visits for monitoring and evaluation. We deeply appreciate your tenacity of purpose and dogged adherence to the idea of promoting quality medical care across board in all Provider Hospitals.

At your last visit on6th August 2013, an address was read in line with our tradition of documenting for history significant events and experiences in between two M & E encounters.

On that note we present the changes that have taken place in the past 10 months. We present the performances, the utilization, the challenges faced and our own considered opinions and viewpoints on the way forward in a less tempestuous, less burdensomeand less irksome manner

ASSETS

Human capital assets remain our most significant assets.There has been significant labour mobility in the past 10 months – the period under review – contingentupon the socioeconomic and sociopolitical situations in the country. Our clinical staff comprising Doctors and Nurses have been more affected than other departments.For reasons of seeking places for further academic training, to marriage,to family pulls and pressures some of the Nursing staff too have had to go. But, without fail, through our many contacts spread nationwide, we have been able to get suitable replacement.The consequence of that is that we now have 78 staff members comprising.....

  1. Medical Officers....5 up till recently, now 4
  2. Nursing department 12
  3. Pharmacy department; 1 NYSC Pharmacist, 5 Pharmacy Technicians,2 Assistants
  4. Laboratory Dept..... 4 Lab Scientists, 1 NYSC Lab Scientist and 4 LaboratoryTechnicians.
  5. Health Information Management staff 8......
  6. Nurse Assistants and Interpreters 17......
  7. IT Department … 6
  8. Security Dept 13

Total 78

Our total staff strength of 78 draws monthly salaries that outstrip Capitation payment.

Because of our referral status we see complicated cases, both HCHC and private. For the same reason, utilization has not abated. We are busy 24/7 as clinical demands continue. Virtually all of us have to multitask as demands are enormous.

The Medical Officers are going through surgical skills hands-on on common surgical and obstetric cases and emergencies. Our Nurses are trained to handle clinical events that, ordinarily, are not assigned to them in other places because of significant improvement in health seeking behavior of enrollees in the past 7 years. This, by itself, is a significant plus for the scheme for which we are all grateful to God. But what many appear not to want to factor in to this achievement is the sacrifices and toiling of health care providers in Ogo-Oluwa Hospital, Bacita by night and by day to bring this about. The frequency of enrollee visits is even too much in some instances and this is driven by their understanding (or misunderstanding) of this scheme as one entitling them to free drugs which they should take maximal advantage of.

We are training our Nurses to be ‘supernurses’ because of shortage of medical manpower in the rural areas where, unfortunately,disease burdens are heaviest. This training responsibility that we bear has been internationalized in the past 3 years as Littoral University and Pinnacle University PORTO NOVO Republic of Benin have been sending batches of their students to us for this purpose.Recently, we got a request from Kings University PortoNovo for 25 students to come for 3 months COBES training here beginning in July this year. This opportunity of international networking is most warmly welcome as many useful outcomes are realizable in the partnerships being birthed by it that benefit medical care in the West African sub region.

Also, some non-medical students come for Internship for variable period e.g Gloria Ngoforo from Federal Polytechnic Bida and Mrs. Abigael Aremu from Odewale Ibrahim Paramedical Technology,Fajemirokun

Our I.T. Department has created a Cybercafé and a Computer training center. It has developed training programmes from which some staff of Ogo-Oluwa Hospital, students of Goshen Schools and sundry other individuals in the community have started benefitting in order to increase computer literacy and competences. This is contributing to the development of human capital in this region.

Since we are not indifferent to what is happening out there beyond the four walls of the Hospital, we have been led to take on a writing ministry. We allow divine inspiration to bring forth books that address relevant moral and ethical issues within our national polity. Many of the ills plaguing us are traceable to the abysmal level of unrighteousness, corruption and lack of the fear of God that is all too well known and acknowledged by most adult Nigerians. Three new books have been released between your last visit and now. They are titled:

  1. The Just Shall Live By Faith
  2. Bribery and Corruption
  3. Fear

Four other books are already in the Printing Press titled

  1. Righteousness Exalts A Nation
  2. Divine Health
  3. Longevity
  4. The Pursuit of Joy and Happiness

A people cannot move beyond their level of morality.Immorality in various forms has been the killer of previous civilizations in human history. Many inter twining factors in the social matrix where we live can directly or indirectly, negatively or positively impact this work. The degree of ease or unease, speed or slowness with which processes of delivery of medical services are carried out, fulfillment or frustration that health care providers may experience in their work,etc, all have their springboards from the attitude and mindset of people generally. Habits die hard.But, even when that is recognized, efforts must continue to draw our collective attention to the attitudinal overhaul needed to move us together forward.

Our website for accessing our publications and work is

We have added to our non human assets the following

  1. Equipped Conference Room
  2. A good and growing Library
  3. Procurement of an X-ray Machine
  4. I.T.Cyber Cafe and Computer Training Center for general upliftment and capacity building in the community
  5. One more oxygen concentrator
  6. One more vacuum extractor in the labor room
  7. One more nebulizer
  8. One more suction machine
  9. Inverter to power the laboratory
  10. Facility upgrade in the Hospital building

Between your last visit and now, I have had the privilege of attending two great professional conferences. The first was in India where I was one of the 29 Nigerian private medical practitioners attending an International Federation of Rural Surgeons Conference hosted by the Association of Rural Surgeons of India between 21st and 24th November 2013. We Nigerian delegates went as members of ARSPON, Association of Rural Surgical Practitioners of Nigeria. We were introduced to laparoscopic surgery and some techniques of doing some surgical procedures. It was a highly enlightening trip

Recently, I was in Port Harcourtin April 2014 for the national conference of the AGPMPN[Association of General Private Medical Practitioners of Nigeria].I attended the two days pre conference workshops on BLS[Basic Life Support] and Hospital Management & Administration Training for Medical Directors

I had the opportunity of interacting with many of my colleagues (contemporary and junior) that produced fruitful engagements. One of the fruits it bore is the presence of a colleague’s son, Dr Nonso Oguonu, who came all the way from Nsukka for surgical skills acquisition. He is the 4th Medical officer here making us 5 Doctors right now. It is certainly not an easy thing to draw and retain skilled man power in the rural environment. Life is seen as too dull,drab and dreary, slow and ‘sleepy’ to excite the young professionals who have taken a look at the rural place. And yet the rural population boasts over 70% contribution to our total national population and also notoriously contributes the highest figures in disease burden, morbidity and mortality statistics.As a consequence of these, rural populations need more skilled professionals in larger numbers than the urban dwellers. But alas, the reverse is the case.

It is not surprising therefore that pressures are excessive on the relatively few skilled hands available.In having to multitask and trying to meet the challenges of administering care to the teeming masses, a few things give naturally.If we do not manage this delicate scenario well, all sides will get frustrated and health programmes will be botched. I hope to dilate on this a little more when I comment on the way forward.

We are in the farming season now and surgical demands are waning. We have also been able to convene a meeting of village/community heads and other stakeholders on Wednesday 18th June 2014 in the ongoing continuing effort at bridging the gaps of understanding on matters of relevance to the running of this noble scheme. It is going to continue from time to time. Certainly we all have to continue to educate and be educated as the scheme keeps evolving and enlarging.

From the encounters with colleagues it is obvious everywhere that where significant ruralsurgical interventions are taking place,giving basic lifesaving surgical services,Ketamine/Valium/Largactil anaesthesia is still the in-thing. That there is an embarrassing dearth of trained anesthetists and anesthesiologistsnationwide is no longer news.

SKILLS

Skill acquisition is unending. We are keying in into all opportunities of skills development as occasions permit. Regularly we are going through internal staff education and reeducation on various aspects of corporate, organizational needs, demands and operations. Several short lectures have been given in the recent past as downloads from the Port Harcourt experience alluded to earlier. We have covered such topics as

-Basic life support

-Staff discipline – code of conduct for hospital workers

-Team building

-Training and developing hospital staff

-Enforcing discipline and order in the hospital

-Conflict resolution

-Code of ethics for leaders e.t.c

Processes

SOPs have been reviewed and updated. Intradepartmental training to carry along new staff via SOPs is a regular exercise though, for some, learning is slow.

Challenges

In an extremely busy center like here where physical, emotional and social pressures are piled upon young minds and where voices of gratitude, appreciation and encouragement for many heroic deeds done are not forth coming from significant parts of the population it lights the fuse of frustration and unhappiness is bred. Where a significant proportion of any work force is in that state, then, some things give. While many cases are won inspite of this, a few cases may be lost especially with regards to clerical demands. The challenge of enduring personal attention to enrollee or per enrollee/patient against the background of several other needy enrollees clamoring for attention is real.In having to perform multiple roles to provide multi disciplinary services some expectations may not be met along clerical documentation lines.

More than 90% of the time in the past 6months we have had to depend upon our Generators rather than PHCN for electricity supply. Paradoxically, when the services from PHCN are progressively worsening and that factor has damaged many of our equipment, machines and utilities, the PHCN bills sent to us to pay have progressively increased. We are paying more now for PHCN services that are non-existent most of the time. This also creates its problem for procedures like ultrasound investigation. It is frustrating for many women who are not able to wait long enough for PHCN to supply stable safe electricity. The unsavory experience that we had a few years ago when a part of our analogue USS machine got spoilt because of exposure to Generator power is still fresh in our mind as we had to get to Osogbo and Ibadan before we could get replacement for the damaged spare part which cost about a 100,000.00 Naira as at that time.

Recently, our 40KVA MIKANO Generator almost had its panel burnt because of overload as it is regularly over worked in trying to ensure continuity of services 24/7.Itsrepair and replacement for damaged part cost us quite some time and money. We have been advised by experts to get a 150KVA Generator because of the size of this facility and the number of electrically powered machines and equipment. This is to cost about Five Million Naira.

Communication with Hygeia officers is sometimes fraught with frustration particularly when network failure compounds difficulty at times when there are several emergencies or serious issues that have to be attended to at the same time. Attention span on each case for details may be curtailed by other legitimate clinical demands. This directly may produce a scenario where information is not complete because of what I usually refer to as clash between clinical and clerical demands. We do not controvert or debate the idea of the great importance of documentations at all. But when the work load is heavier than the staff on ground can carry, then sub-optimal performance is registered on such occasions. A big challenge comes when it is found that the only way HCHC leadership and officers react to this is to deny payment for such cases outright, legalistically even when the truth is ascertained and verified that such patients have been attended to and it costs the hospital the sweat of staff, the time, the material and other consumables that make patient management possible. It is like a mother who starves her child of food because she is angry that the child has not fully satisfied her. This certainly sags and saps the morale of the entire work force here. Certainly, there must be other options of getting all of us to move forward together apart from this use of “the big stick” to punish an “erring provider hospital”.

The program itself is biting many things at the same time and this certainly has implications for HCHC budget which must be revised upwards. In conditions of depressing morale for staff, the option of working in other places where health care providers are not this severely stressedbegins to be attractive. I have always canvassed the opinion that for verifiable cases of actual delivery of services, inspite of clerical inadequacies, penalty needs not be along financial lines. We do not need to throw away both the baby and the bathwater. We must together “make haste slowly” and remember that pragmatism must hold sway over idealism as we gradually increase in collective potential and capacity building to solve human problems as presented in the medical field

Another area of challenge is in the duration of admission for sick enrollees. We understand the background – a need to cut cost and be cost beneficial too. But a blanket administration of minimizing of hospital stay may not always apply to all patients. A Hygeia staff – case manager – should be re-installed to be the eye, nose, ears, hands, feet and mouth of HCHC on ground here to replace Mr. Goke Abiola who served in that capacity in the past. Medical practice and experience is a dynamic thing. The reality of clinical situation on ground is best appreciated by a professional on ground. The determination of how long a particular patient stays in the hospital is still a professional decision. For any provider hospital worth its name, it is not based on any ulterior pecuniary motives – trying to get more payment over patient management thereby keeping the patient on bed just for the sake of money. And one keeps wondering aloud. If medical practice is, as we all know, actually based on trust – trust to save life and not destroy life, why is the trust element discounted on matters such as this? And where trust is discounted for whatever reasons, why are ways out through checks and balances not found so that ethical and moral issues can be resolved justly? We also wonder why HCHC cannot agree to co-payment in such special situations where duration of admission exceeds a ceiling placed by the scheme. If HCHC permits this, as many other insurance schemes do, then patients can have full on-bed (in-patient admission) treatment until they are really well to be discharged and the patient will be most willing to pay the balance for the days beyond the ceiling placed by the scheme.

The economics of care are mounting. Many areas of leakages and wastages are incidental to the behavior of enrollees themselves. The disconnect between what is real, feasible relevant and cost beneficial in our present circumstances and levelof socio economic, cultural and educational development as rural communities and what is not fuels unnecessary bitterness, acrimony, opposition and false accusations which are all ill winds blowing no good to anyone in the network.