INTERVIEW: Health Minister, Prof. Adewole Speaks To ALEDEH On Monkeypox, Health Unions, Ban On Private Practice And More…

Nigeria’s Minister of Health, Prof. Isaac Adewole, has shed more light on the outbreak of Monkeypox virus in the country.

ALEDEH recalls that the dreaded disease broke out first in Bayelsa, Southern Nigeria before suspected cases of the virus was reported in Rivers State, Akwa Ibom, Cross River, Ekiti, Lagos, Enugu, Nasarawa, and Abuja.

On October 16, a  monkeypox patient committed suicide at the Niger Delta University Teaching University, Okolobiri, Yenagoa Local Government Area of Bayelsa State, Southern Nigeria.

Reacting to the development in an interview with Nigeria’s burgeoning online integrated media platform, ALEDEH, Prof. Adewole said the Monkeypox virus has created so “much scare” because of the way the media has handled the outbreak of the disease in the country.

The professor of Gynaecology and Obstetrics who had a chat with Sulaiman Aledeh, the publisher of www.aledeh.com.ng, also spoke on the last industrial action by the health unions, the alleged ban on private practice by doctors working with the Federal Government, kidney merchant hospitals and much more.

Read the full text of the interview below:

Excerpts:

MANY WILL WANT TO KNOW DEVELOPMENTS SO FAR ON THE MONKEYPOX OUTBREAK?

Well, it is unfortunate that the monkey virus outbreak has created so much scare such that one of those infected even committed suicide and I think it’s the way the media has handled it. The media has gone into archives and brought out terrible photographs that were not even sure came from monkeypox infected people, scary pictures that give a wrong picture of the outcome of this disease. There are two variances of monkeypox virus. There is the Central Africa type and the West Africa type. The West Africa type is mild and I and my colleagues believe that we are probably dealing with the West Africa type which is mild and we have not recorded any fatality so far and many of the cases do not look typically like monkey virus infection. So far we sent 17 cases to Senegal for obvious reasons it’s a WHO reference lab. In this century one of the things expected of any country is open it with respect to an infectious disease outbreak.

We have a lab here that can do it, we have a fantastic person in Professor Christian Happi. His laboratory is far more advanced than even the WHO lab and according to Prof. Happi, some of the WHO reference folks even trained under him. But it’s our obligation to also send samples to the WHO. The WHO will tell us if it is monkeypox or not but the African Centre for Mixed and Infectious Disease will tell us what exactly it is, even if it is not monkeypox, it will tell us what it is, which is far more advanced. It will also enable us to trace the origin of the virus. His (Prof. Happi) technology is more advanced but by obligation, we have to send it as well to WHO reference lab in Dakar and Happi’s lab.

The blood test came out earlier which revealed that 3 out of the 17 are positive. The four cases from Lagos are negative and we are expecting more results. 12 cases are negative and that tells us clearly that not all the cases are monkeypox infection.

HOW WELL CAN WE STOP RUNNING THE NEWS OF MONKEYPOX OUTBREAK WHEN IT IS NOT YET CONFIRMED?

What we have now is that everybody is a media person. What you need is just a camera and internet access then you can create a scare. Someone said if it is not monkeypox what is it? and I said it is still suspected monkeypox virus infection until we say it is not. So for some of them, they are still suspicious, that is the way medicine or public care will react because we do not want to bury anything. We will treat them as monkeypox until we are such it is not or until we confirm what it is. We will maintain a high level of public hygiene, we will quarantine them for public health safety also to calm people down.

DO YOU HAVE COLLABORATION WITH ANY MINISTRY OR AGENCY TO CURTAIL THE SPREAD OF THE MONKEYPOX?

Well, the first thing we will do is to address the emergency, if it is spreading then we need to work with them. Fortunately, the international health community is adopting a concept of one health which is born out of the realization that infection in plant, animal, and man share the same relationship. So we are looking into the concept of one health. There is a project which is looking into that, we are working with the Ministry of Agriculture, Environment, and Health. The project is funded by World Bank and WAWHO, we will partner together and set up many joint mechanisms for addressing many of these infections as you know monkeypox is a zoonotic, and it’s an infection that is permanently resident in animal, but once in a while they jump the animal man barrier, when they jump this barrier they infect human beings. But it is also because we invade their territory logwood, build new settlements, build new roads and move into the territory of these animals, some of them are infected. The name monkeypox came because it was found first in Apes and now we know they are also found in some animals like the rats, the rabbits. I quite agree with you that part of the long-term strategy will be work with the environment, agriculture, information and culture, media and increase the level of awareness and let people know that when we move out to invade then we run some risks. Lassa fever is also essential that it is an animal infection. The animals harbour a lot of these viruses and when we go there in the process of killing them when they are alive, we get infected.

WHAT IS THE NEWS FROM THOSE THAT WERE INFECTED?

They are getting well, some have been discharged, I think receiving cooperation from the media will calm down people.  Monkeypox is not even on my priority list.  On my priority list we have yellow fever, and the outbreak of yellow fever as a Minister, I expected it two years ago because we suspected that the level of immunity to yellow fever is low in Nigeria, so I was expectant, especially when we had it in Mozambique and the Central African Republic, I was scared. We’ve been talking, what do we do?  Though it’s not in Nigeria we started immunization, from Kwara we moved to Kogi so we can mop it up. Yellow fever is not as deadly as measles. We are starting measles campaign in the next couple of weeks across the country. We are working with international communities, WHO is in Nigeria with us and we hope we will put it under control.

HOW WELL ARE YOU COPING WITH CULTURAL PRACTICES?

Well, I think we are winning with respect to acceptance of immunization. We have been able to tell the world that immunization has nothing to do with fertility. Immunization is not an attempt to castrate, it’s an attempt to boost immunity, it’s an attempt to keep our children alive beyond age five, it’s an attempt to reduce our spending on health, it is also an attempt to make sure the future generation of Nigerians lives a healthy life.

IS THERE REALLY A BAN ON PRIVATE PRACTICE BY DOCTORS WORKING WITH THE FEDERAL GOVERNMENT?

There is none.

DID YOU HEAR THE STORY THAT THERE WAS A BAN?

Let me put the picture clear. Early last year government received petition from the Civil Society Organization complaining about the abuse of private practice, it was referred to me, I referred it to the medical council, obtained their advice, because of the legal implication bearing we also sent it to the office of the attorney general, we also offered advice, the rules, and ethics of the Medical Council of Nigeria, which is like the Bible, allows a doctor to do private practice outside official hours but the constitution of Nigeria (1999), does not allow anybody to do private practice apart from farming and when there is a conflict between any rule or police, the constitution supersedes, that’s the position, so in law even though nobody has raised a red flag, it is actually not allowed constitution wise and I don’t think it’s subject to debate but what government is concerned as of today is the abuse and in the cause of looking into the crisis in the health sector and other Ministries, government set up a committee, chaired by the Secretary of government two years ago to look into the incessant crisis intra and interprofessional rivalry which is a follow up the report by the committee and that committee came up with a lot of recommendations, they met several times that report came to FEC last week I guess and during the debate, government accepted some of the recommendations but on the abuse of private practice they decided to set up an expanded technical committee to look into the issue in totality and advice government.

YOU HAVE BEEN EXTRA BUSY AND ONE THING THE NATION WOULD HATE TO SEE IS A STRIKE ACTION. HAVE YOU BEEN ABLE TO PUT IN PLACE A BETTER RELATIONSHIP WITH THE HEALTH UNIONS TO AVERT A REPEAT OF THAT OLD WAY OF AGITATION?

We were actually taking many steps. One as a Minister we brought the Unions to the same room to talk. We have met twice, pharmacists, nurses, doctors and the leadership and I must also credit pharmacist Ameh Yakasie the current President of the Pharmaceutical Association of Nigeria for being a brick builder, Yakasie is concerned about bringing the various professional groups together, because it is in coming together that we can really offer effective services. I think one thing is clear when it comes to the focal person in the health sector, it is the patient, the Nigerian citizens and when we are concerned about the wellbeing of that person we will think less of the rivalry and to me that is the problem we face because people do not think about that focal person but more about myself. I was taught how to do vaginal examination by a midwife. I have trained nurses who took better leap than medical doctors, so it’s training and we must sink these differences and work together. Surprisingly there is so much antagonism against doctors by many of the nondoctors and sometimes at meeting I have challenged them “I am sure some of you have children who are doctors do you fight them?” and surprisingly there is no good answer order than for people to realize that “I have a son who is a doctor, I have daughter who is a doctor and I don’t fight them” so I think it’s high time we sink these differences and we will continue to talk and I have received several suggestions including setting up aggressive body and doing many things but I think the important thing is let’s continue to talk. I have also spoken to the leadership of the Nigerian Medical Association in the process of negotiating for a better condition of service we must do it collectively. There is no point negotiating with doctors today and then you have to deal with the nondoctors tomorrow, let’s do it at the same time but one thing that government has decided to do which has never been done to the best of my knowledge is to do job evaluation. The government took that decision at the last FEC meeting, a comprehensive job evaluation because you should really think less of your degree but more about what do you do? what do you offer to this nation? to me, that is where we should go. A comprehensive job evaluation will really put the government in a good position to determine what you work and what we pay. I certainly do not believe that a neurosurgeon should earn the same as a physician and then a consultant gynaecologist in Lagos or Abuja does not have to earn the same as one in Kastina or one in one in Ibadan, many things must be taken into place. Where you live, what services you offer, your workload and so on and so forth, all these must be factored into designing a pay or take home package of the healthcare practitioners.

YOUR MINISTRY JUST HANDED DOWN AN ALERT TO NIGERIANS ON SOME DUBIOUS AND CRIMINALLY MINDED HEALTH CENTRES IN EGYPT DEALING IN KIDNEY AND OTHER ORGANS THEFT. TELL US MORE PLEASE.

I think we were alerted by the office of the National Security Adviser. We receive advisories from LGF office and NSA and as we get them depending on the importance attached to it, we then alert various health agencies about this. I think the issue of harvesters of organs is not peculiar to Egypt and some other countries from the South-eastern Asian are also guilty. You complain of a headache, someone says you have appendicitis before you sleep and wake up your kidney is harvested and sold to somebody else. It is a peculiar thing. The alert was to let people know the risk they face when they go out but the good side is that it will also be a stimulus for us to develop our facilities at home because the best place to engage is within your set up and this administration is committed to that. It’s just that it takes one or two years to rebuild the system that has collapsed. The health system has virtually collapsed and we are rebuilding right from the foundation. In trying to rebuild the health system we want to start from the foundation and that’s how we came up with the concept of having a robust foundation. If you look at the APC manifestos it talks about you being able to access healthcare within a 5-kilometer radius. that means we need to have a network of facilities around and that is what about 80% of the people need. They do not need national hospital Abuja, they just need health facility to check their blood pressure, urine and have fever and headache test et al, those are the simple things they need and we can do that in the context of a primary health care. Fortunately we have done this in the past and they are about 30,000 of them across the country, we did a mapping and we said if 10,000 of this can work then we are fine, provided we have a way to make sure they are equitable and that’s how we came up with the concept of one PHC per political ward. A ward has about 10,000 people. If we have one per political ward to look after 10,000 people, we will give basic care to 200 million people and essentially they will be in the lower squinters, those who are poor and that’s what they need. It’s not our duty to invest in healthcare but we have to provide the leadership. Many states have taken it up. I was in Niger state last week, they’ve taken it up, last year they did about 40 and we went to commission one that we did in partnership with them in Fuka village where Lassa fever started in 2015. When we went to that village we discovered that there was a total breakdown of the health system and I promised the people that this administration will give you a PHC and we’ve gone there to commission it, they were quite pleased that last Friday they sent yams to me from the village.

HOW CAN DISSATISFIED PATIENTS REPORT SUCH TO THE MINISTRY?

Let me talk about pre-causes of dissatisfaction. The first thing that will make them be dissatisfied will be lack of adequate human resources and commodities, a dilapidated infrastructure. They know what is good, in Fuka there was an OPHC that was locked because it was infected by bats so they wouldn’t go there, even when they are not literates they know what is good, secondly, if there are no staff they won’t go there. But in terms of who they should report to, we are talking about sustainability, we are trying to foster a culture of ownership, trying to encourage a world ownership committee, let the people own the PHC, when they know the PHC belongs to them there will be management committee, if they are not happy they will report to that management committee, the management committee will oversee it and what we are also trying to do is to put pressure on government to approve the basic Healthcare provision fund, which will ensure that money will flow from central to the facility. The governor (Niger state) made a remark last week Tuesday, he said “I am so happy with this place but what borders me is if I come back to this place in 3 months time this pharmacy that is filled with drugs today will be empty” and I said, sir, that’s why we need sustainability, we wrongly assume that when we stock it today it’s there for life, no, they will use it so we must have a way to restock and the basic healthcare and provision fund has a provision for commodity, it has provision for maintenance so when there is any damage they can repair it but when there are no such provisions then the people can’t take money from their pockets, in short that’s when they start doing some sharp practices, they take money from the clients because they have to repair a few things but if we ensure that these funds go in and let them manage it, if anyone of them steal the money they will deal with it, all we need to do is to have oversight and I think that’s where management and sustainability will meet to ensure that whatsoever we do in terms of renovation survives beyond now because this is not the first time we are putting emphasis on PHC. What we will do to make a difference is to put in a sustainability mechanism, we will continue to press for that 1% of the CRF because that is what will give life to the PHC revitalization agenda

WHAT’S THE FUTURE OF OUR HEALTH SECTOR. WHAT ARE THOSE THINGS YOU’VE BEEN WORKING ON THAT NO DOUBT WILL DELIGHT NIGERIANS?

We are trying to put life into these institutions, we are starting with 8 of them, one in each geopolitical zone, we chose Zaria in the Northeast, Illorin in the North central, Ibadan in Southwest, Benin in South-South, Enugu in South East, and for political reasons and economic reasons we chose National hospital Abuja and LUTH in Lagos. Eight of them we are committed to putting life in them in the next 18 months. Each one of them will pick cancer because we looked at what are the causes of death when Nigerians go out and die outside, cancer is number one, number two and three is either kidney or heart problem, so we are asking these facilities to do cancer, and cardiac or kidney, so I think Ibadan will do cancer and cardiac, Illorin maybe heart and cardiac, Maiduguri is the only except as it is going to do cardiac and trauma, we know why they will have to invest in trauma,. What we are going to do now is to make sure we put life to this facilities so that we will not have cause to go out. We will continue to facilitate training and retraining and also ensure that we keep our best brains. Things are tough, there is a strong pull from outside but we will try and ensure we improve the environment so that our people will find it comfortable and convenient to stay around us.

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