On the 1st of October 2010, there was a bomb blast right next to Eagle Square, at the heart of the Nigerian Government, then there was another one, inside Moghadishu Barracks, Abuja at the heart of the Nigerian military, shortly after another inside the headquarters of the Nigerian Police in Abuja and finally, when it appeared that Nigerian State institutions were no longer able to arouse the desired attention, they struck the UN in the heart of Nigeria's capital. The consequences of this for Nigerians is being well and extensively analysed in various media, much more competent to do so than we are. But the one conclusion we can draw from this is that security cannot be bought with big contracts, cannot be provided by soldiers on road blocks, not by CCTVs all over the city, nor by armoured tanks and assault rifles. Relative security can only be achieved by firstly targeting the root causes, and secondly by diligent, well managed, proactive, intelligence co-ordinated with an effective response force. Sadly, you can buy this off the shelf.
Another thing you cannot buy off the shelf is an emergency medical response service!
If we showed our gross incompetence in the area of security in preventing the blasts, our incompetence in the emergency health response was even more glaring. Look at the images below from the Nigerian press, taken following the UN blasts, and kindly note the complete absence of anyone resembling medical personnel, look at the the chaos around the ambulance, the state of the patients being carried away....and remember this is not Aba, Jalingo or Ogbomosho (nothing against these beautiful cities), this is Abuja, the capital of Nigeria, 8th largest producer of oil in the world, self acclaimed Giant of Africa, recently re-branded as a great country, with great people.
A lot has been made of the fact that Nigerians responded in masses to calls on radio and social media to go out and donate blood for the healthcare provided by hospitals in Abuja. The question that has not been asked is why this was necessary in the first place. We have a National Blood Transfusion Service, funded by our taxes.Their HQ is on 39 Abidjan Street, Wuse 2, a few minutes from most hospitals in Abuja. Is it really not rocket science to have blood reserves to manage emergencies. And what if there was a really large incident, with more than the 100 people affected here? What would we do? Blood did not run out after a day, or two, it ran out after an hour! Compare this to the South African Blood Service. Right on their front page they tell you the blood supplies they have available for the entire country, at any point in time. At the time of writing this - it was for 5.2 days!
A lot of kudos has to go to the Minister of Health, and the Minister of State for Health for trying to lead the health response themselves after the incident. While Prof Chukwu tried to co-ordinate the health sector response, Dr Ali-Pate was one of the first at the National Hospital in Abuja. Yet, all they had to work with were their mobile phones, as there is no "Operations centre", anywhere in the Nigerian health sector to manage medical emergencies. There is in fact NO MEDICAL EMERGENCY SERVICE in the nation's capital, Abuja. As the incident unfolded, hospitals that did have ambulances sent them to the scene, the Nigerian Red Cross rallied its troops, The Federal Road Safety Commission deployed its ambulances (you will find them, manned by drivers, at different corners of Abuja), to the scene. But the lapses were there for all to see. Patients were carried in ways that can cause more harm than good, no competent personnel was available to provide appropriate emergency care before evacuation, chaos reigned. Nigerians will know that our ambulances are better designed to transport the dead than the living. And as if the tragedy of the acute response was not enough, the UN decided that it was unsafe to continue managing the sick at our premier medical facility and had most of the severely ill evacuated to South Africa.
And to the final point - communication. A day after the incident, probably in recognition of the failure in communication of the health response, we noticed the Federal Minister of Health was on Twitter! he had just joined on the 8th of August. There is no way to confirm if he personally was tweeting, or if the Twitter account is also managed by colleagues from PATHS2 currently managing the Ministry's website. But at least he recognised the importance of communication at this time. When we @Nighealthwatch asked him who was leading the health response, @FMOHNigeria obliged us with this response ...."Overall control for health response by me. Incident site control by HMSH/Corp marshall FRSC. Nat Hosp response by CMAC". Since then ...he has been off Twitter....until yesterday's tweet - "Latest on UN bldg: 22 dead - 11 UN staff - 10 Nigns, 1 Norwegian(f); 117 injured-27 on admission, 1 of these in Nat hosp & various other hosps. But for now, he appears busy leading all the very important people on tours to visit the injured at our National Hospital.
We must as a priority for our country, set up emergency medical services in at least all the state capitals in Nigeria. And yes, there is the money to do this. If we can build an 8-lane express way from Abuja Airport to the city and buy 3 new presidential jets, we must have the money to do this - its all about priorities. No, it is not good enough to buy ambulances, or even to put a few telephones together in a call centre as done by FRSC. It must be a MEDICAL service, managed by a multi-disciplinary medical team that can provide emergency medical services from the point of incidence to the intensive care unit. It must be integrated into existing trauma services in the country. We must have a simple, nationally recognisable number to call.....like 999! We must train the colleagues, exercise and test the system, and make it work. The good news is that none of this is rocket science! They already exist in most other African countries from Accra to Johannesburg to Cairo! The bad news is that this is Nigeria, and despite all our outcries - we can almost bet, that there will be another major incident or accident, and the medical response will be exactly the same...or worse.
Professor Chukwu - prove us wrong. Take it to the next Federal Executive Council meeting, next Tuesday. They will listen!
....Nigerians follow OUR Minister on Twitter @FMOHNigeria
5 comments:
When I heard of blood running out i had to go like 'what?'. I don't even want to think of the spectre of AIDS and untested blood....
Docs, I don't know how you manage to remain positive or should i say believing that things will change. I applaud your tenacity and try and emulate your faith that there are a few good men out there.
The pronouncements and actions by government officials in the aftermath of the bombing have not inspired confidence in the populace that the government & civil society can rise appropriately to the challenge of home grown terrorism. There appears to be no strategic thinking/planning across the board despite months & years of warning about terrorist activities at home and abroad. The chickens of this lack of imagination are now coming home to roost. Nigerians and the government need to organize and think long & hard about how to henceforth deal with these acts of wickedness & inhumanity. There has been a lot of negative emotional outbursts of name-calling & scapegoating with no concrete evidence of who the real culprits are. To me this is a distraction from what really needs be done.
The honourable minister may table the issue of emergency medical response at next Tuesday's FEC as you suggest. But I submit that a whole-system anti-terrorism approach is what is needed at this time. Emergency Medical/ Health Response measures are only a piece of the jigsaw puzzle. What about post-emergency care- acute hospital care, disability prevention and rehabilitation, psychosocial support, re-integration of victims and their dependents into mainstream society participation- employment & economic empowerment, whole system capacity building in security services, health and allied health services, planning & designing of the built environment to ensure good access, exit and that structures are build to withstand blasts etc, etc
We gotta be much more imaginative in our thinking and actions unless we want the criminal minds to always be steps ahead of us!
I felt I should flag this post again. After all the noise that followed the Abuja event, it appears like people have gone quiet again. All they vowed to do... Well at least, any update about setting up emergency service unit to cover Abuja - at least to co-ordinate operations? OR are we waiting for another emergency?
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