Hospitals have no right to reject victims of gunshot wounds - Minister

Minister of Health, Prof. Onyebuchi Chukwu spoke to journalists in Abuja recently on several issues cutting across his score card, the recurring strikes in the health sector, medical research…

Office of Surgeon General of the Federation… Well, the President has in principle accepted that there is a need for a Surgeon General. But you know there is a distance between principle and practice. Obviously, now that the President has accepted that there is indeed the need for the position, it means we need to begin to go to work and at the end of the work, I believe that an appointment is going to be made. What is that work? We need to draw up the core responsibilities of the Surgeon General having accepted that in principle.

Mark you; the NMA have been asking for this for decades, it is not a new thing. I however think there are areas where we actually have some lacuna. Take for instance; we have been talking about government sponsoring public servants for treatment abroad. Presently, we have a mechanism in the public service, it is either the ultimate approval is given by the Head of Service or is given by the Secretary to the Government of the Federation depending on whether you are a core civil servant or a political appointee like a minister.

But government is beginning to feel that there is the need for an office that is removed from politics that may even require the Senate for instance, approving or maybe the whole of the National Assembly to which everybody will know we can direct such request and such office should be able to say 'why can't this be treated in Nigeria?' why must it go outside, there are places where this can be treated so that is possibly one of the functions of the Surgeon General if it is eventually approved as a position.

The other field, which I am sure, you are all aware of as part of the media is about controversies that have arisen in trying to implement some of the positions of our constitution. When the constitution says that either the president or governor could be relieved of his position if indeed he is no more of sound health, the question here is: Who decides that a governor is of sound health? There may be the need for such an independent office established by the constitution or by law that should be able to handle that.

So, these are some of the reasons why we feel that there is a gap to be filled, but how it is going to be filled is the debate over the years. And also remember the question as to whether the minister of health ought to be a medical doctor or not why can't he be someone who read English or who read mass communication or who read history.

For you to have such, then you must be like other countries that have an office that is independent, that handles some specific issues and matters of public health professionally so that the minister's concentration is on purely political and administrative decisions. So, I believe now that the president and the government have accepted in principle, what now remains to be done is to begin to work out the details, and if it is going to require a law, obviously, it has to go to the National Assembly. So, you need a draft bill.

On divergent views about the office… Well, I am not aware of any bill, but that is not to say that there is no such a bill, but presently I am not aware there is a current bill or a draft bill before the National Assembly on the issue of Surgeon General. I don't lay claim that I am aware of everything, but there is no Executive Bill. Obviously, if there is an executive bill, the minister will be aware. I guess that when the time comes for public hearing, it is likely that the federal ministry of health will receive an invitation. Normally, in matters that will affect a particular sector, the National Assembly has always invited the ministry responsible for that sector to attend public hearing. So, if that is so, we have an opportunity as the federal ministry of health to make our views known.

So, that is one. The second thing is that it is good to look at any bill even now that the President has accepted in principle and if he now says let's move to the next stage and begin to prepare a bill that will be sent as an executive bill that will be sent to the National Assembly, certainly as we are drafting it there won't be any conflict. Like in the United States of America, where there is a Surgeon General, he actually reports to the Assistant Secretary for Health, which is the equivalent of minister of state. So, if you are going to report to the minister of state, how is that going to conflict with the job?

I don't think so. I believe we should be able to draft it in such a way that there should not be any conflict with the job of the minister of health. On the other aspect of how does it relate in terms of harmony; I don't think so, as long as the job that is given to the surgeon general is the job that ordinarily a particular group handles. Assuming the bill says it is for doctors, then it must be that the functions are those that ordinarily, doctors decide. Even today, the people that advised that someone should go abroad or should be sponsored for treatment are doctors. When you go to hospitals, the person that refers you for treatment is a doctor; I don't see how that conflicts with other professions. But let's not jump the gun, let us not preempt, the President has accepted in principle, we are to await his further directives.

A crisis-free health sector… Well, I guess you are talking about peace amongst health practitioners, because there can never be peace in the health sector. This is because we deal with sicknesses, accidents and so on. But if it is amongst ourselves, yes, it is possible we can have peace and I think the process has been on. You have to know that peace is not something you can achieve easily otherwise go and ask in the Middle East. It is not as easy as that, but I think we are making progress. Some of the issues are gradually abating, but there are some thorny ones and I think the President has stepped in by setting up his own Presidential Committee of experts to look into the matter and ensure that there is greater harmony amongst those who work in the health sector. It is not that we may not have areas where people may clash.

As long as there are just two people in a particular room there is always bound to be disagreements whether they are identical twins or husband and wife. But what we are saying is that it shouldn't be to the degree we have today where sometimes the primary purpose for hospitals being established is hampered.

Victims of gunshots… Well, there is no problem with the Nigerian police. Both the Inspector General (IG) of police and the Minister of Health have independently said that on no account should any hospital reject someone with gunshot wounds except when that hospital doesn't possess what it takes to handle such a case. For instance, we know that not every hospital can manage an injury in the chest or in the brain, but it is the duty of that hospital to stabilise the victim and then refer. But you cannot reject a patient just because he/she is a victim of gunshot wounds. So, that is clear, no hospital, no doctor can do that.

So, if that is the position, what are we saying? If there is anybody that is not obeying that, then he should be reported to the appropriate authority. Certainly in the cases of federal establishments, you can report administratively to the ministry of health or to the director of hospital services or to the permanent secretary, health. For all other cases, whether they are private, state-owned or federal government-owned, you can also go further by reporting that particular doctor to the Medical and Dental Council of Nigeria (MDCN) because that is totally unethical and the MDCN will investigate and probably take the person to its tribunal, which has the same power as any high court in Nigeria.

So, I would have been happy if you had said, 'sir yesterday this hospital that is under the supervision of the federal ministry of health rejected a patient because of this.' We would take some administrative actions or even if it was a state, you can still complain to me, and then what I will do is to get someone to do a petition to me so I can send it to the MDCN, which will make sure such matters are investigated. But clearly in terms of policy, even during wars, doctors who are working for a particular group will be treating victims from the other side, even soldiers their own people have shot, how much more during peace times and civil times.

Health sector achievements and challenges in 2013… Well, I will just say a few because we don't have enough time at hand. Some of the things we have done, which I think should impress Nigerians include maternal mortality rate that has been reduced. For instance, the figure released by the National Bureau of Statistics shows that maternal mortality ratio has fallen from 545 per 100,000 to 350 per 100,000 live births.

It is also good to know that immunisation coverage in 2013 was the highest in the last 20 years and by the administrative data we have, it is 83 per cent immunisation coverage in Nigeria and this year we are going to do the direct survey to confirm that administrative data. So, this is the best figure we have had in terms of immunization coverage in the last twenty years. So, that is an important achievement.

Third, I am sure a lot of people will like to know about polio. We were able to reduce polio transmission by 50 per cent in 2013 with the hope that we should be able to drive it to zero. In the last four weeks, we haven't gotten a single case; we are hoping our dreams will come to be this year. Last year we also got rid of the type 3 poliovirus for the first time ever in the history of Nigeria. We have always had the two types; type 1 and 3 but finally we have taken care of 3. We now have type 1 to concentrate on, that is a good achievement all round. Now, we have eradicated guinea worm, we have also received our certificate from World Health Organisation (WHO), which we are going to formally present to Mr. President.

It is good development. It is the climax of more than four years we haven't received an instance of guinea worm in Nigeria. We are happy at least since 2010 we have not had a single case of guinea worm in Nigeria. It is a major achievement for any country. Then you look at it in terms of human resources, for the first time in the history of this country, we have a curriculum to train paramedics because we have always talked about ambulance services, but when we really wanted to go into it, we found out that some of the core personnel that would make an ambulance service to be realistic in any country were not present in Nigeria, people called paramedics. At least, we now have a curriculum approved by the National Council on Health. Not only do we have a curriculum, we have gotten the National Board for Technical Education (NBTE) to accredit any institution that says they are training paramedics, but this is happening for the first time in the history of this country. So, it is a good achievement. If you look at another thing that Nigerians have been asking, it is why do people go outside this country to seek medical treatment.

At least, we made some impressive outings last year. At least two hospitals are currently doing open-heart surgery. First was the University of Nigeria Teaching Hospital, which in 2013 alone did about 50 cases of open-heart surgery for children and adult, women and men and University College Hospital, Delta State University, which also started a few months ago. They use to do it more than a decade ago and for ten years nobody was doing open-heart surgery anywhere. Now we are doing it in this country. So those are some of the achievements that I think are important in 2013.

Absence of research breakthroughs … It is not that we have not had any breakthrough; go to the National Institute for Pharmaceutical Research and Development (NIPRD), which is just within the FCT, you will be proud to be a Nigerian. Part of the problem is how do we bring in industries. Just one week ago, they submitted their report and I told them that since it was in public I set you people up, you people come in the public so that the media will be there to present it. I told them it was a major achievement in the right direction. But they have, particularly in the area of phyto medicine. Phyto medicine is where you are not bothered about bringing out the specific compound of any substance that is active but taking a substance as a whole and saying this substance can cure. But now we are doing investigations to know what diseases it can cure, we are also deciding the dosage usage for the children and adults, we are also looking at what side effects it could cause.

The issue of Tyonex ARV drug… Well, as you know even in an ordinary parlance, when a doctor meets a road traffic accident, his treatment is a very methodical process. People outside may be shouting, 'give him oxygen'. But maybe it is not oxygen the person needs but work is going on. Yes, the first thing is that there are companies that manufacture anti viral drugs in this country, there is no doubt. The law of this country says for you to produce any drug and even for you to sell any drug or for you to offer any drug to any patient, that drug must be registered by a body called National Agency for Food and Drugs Administration and Control otherwise called NAFDAC.

What is government doing to eliminate Malaria? This is the first time in the country, under President Goodluck Jonathan Administration that we talk about eliminating malaria, not just controlling it. That is why for the first time, the name of that organisation, the division that leads in the issues of malaria, the National Malaria Control programme approved by the Council of Health is now know as national malaria elimination program. So for the first time, we are trying to see if we can finally eradicate the issue of malaria.