Tuesday, 13 March 2012

In dire need of an Emergency Medical Service

When as a child my mother returned from a trip to Cairo, I asked her if Egypt was more developed than Nigeria. She asked me what I understood by 'development'. I was surprised she was asking me what seemed like a no-brainer and went on to answer the question the best way I knew how. I asked her how the roads were, and if they had modern buildings etc. This was my understanding at the time of what 'development' meant. Now, I think I have a bit more insight into what this term means. In light of this, can I ask you, our esteemed readers at what stage of development do you think our country is - if there is no functional emergency medical service in the country. To make the question simpler - if driving on Ahmadu Bello Way in Abuja and you see a major motor accident - what number do you call? If you cannot answer this for Abuja - tell me if you think there'll be a number in Jalingo, Abakiliki, or Birnin Kebbi - all state capitals in our once great country.

Last week, some newspapers (Leadership, Vanguard, Daily Trust etc) reported with a lot of fanfare that our Federal Ministry of Health is partnering with the Israeli government and is sending a delegation of doctors from the University Teaching Hospitals of Abuja, Jos, and Maiduguri to Tel Aviv for a 2-week training course. This has been apparently facilitated by a group called YBF Nigeria, the training arm of PlusFactor International Ltd (no website was found).

But really? After all the bombs, the continuous stream of accidents on our roads....all they can really do is send a group of colleagues on a 2 week training programme to Israel? Yes - the Federal Road Safety Corps have ambulances dotted around the FCT - but these are manned by drivers! If you expect any of these to render first aid...think again! Secondly, and more importantly - an emergency medical service - contains 3 words that are critical;

1. It must be available and accessible in emergencies.
2. It must be led by medical professionals.
3. It must be a service - integrated from the point of patient collection, to the nearest hospital with all the
    emergency care facilities i.e a fully functional surgical theatre.

So far in 2012, 52 years after independence there is no functional "Emergency Medical Service" in Nigeria. Terms like ‘The Golden Hour’ and the ‘Platinum Ten Minutes’ that define Emergency Medical Services all over the world are practically irrelevant in Nigeria. It is a well-accepted fact that a patient who receives basic care from trained professionals, and is transported to the nearest healthcare facility within 15-20 minutes of an emergency has the greatest chance of survival. EMS is an essential part of the overall healthcare system as it saves lives by providing care immediately.

So, how have other countries at a similar stage of development dealt with this - where governments fail. I looked at India - and forund this fascinating service called Dial 1298 Ambulance. This model works on the principle of cross subsidisation, where the ambulances are are made self sustainable by charging the end user a charge which differs based on the choice of the destination. A patient going by choice to a private hospital pays the full charge, while a subsidized charge is paid by a patient going by choice to a government / municipal hospital. Free service to accident victims, unaccompanied unconscious individuals and victims of mass casualty incidents. Listen to the fascinating TED talk by the Founder here.

So.....if our government has failed what of the private sector in Nigeria - renowned for its entrepreneurship? So you can imagine my excitement when I found this advertisement in "Businessday" recently.

I looked through their website and looked up the services they offered. These are listed as:

We offer the following services to Corporate Organizations and individuals:
> Dispatch Services
> Air ambulance services
> Events Stand by
...it was immediately obvious that this was not really the type of emergency medical service I had envisaged it was. No wonder it was being advertised in Businessday. So, the struggle continues. Nigeria remains in search of an emergency medical service - any takers out there?


Ugo Okafor said...

All our major motorways or express-ways need Accident and emergency centres that can perform emergency operations as well as stabilize accident victims.

Judy said...

I would like tickle your sense of humour with this real life story. In an effort to establish emergency meddicalservices in Enugu, series of meetings were held by ateam comprising of doctors, radiographers, policemen and r road safety corp. The road safety man was asked what an ambulance driver should do in case of trafic. He answer was "join the traffic"
A lot of people arealready tinking of establishing EMS in Nigeria.I know ANPA is working on it seriously. On this note I ask Nigerian doctors in the US to join this organization and make a differnce.
I would like to mention a man who wants to do the right thing but no one guides him. He established a non profit organization - foundation for the poor - to help the poor and needy. He raises momey fom "bouyant" elderly women mainly and uses the money to hep patient's pay bills. In the past 1 year he bought a wagon and designated it as an ambulance to transpot sick people. It doubles up as a hearse sometimes. In adition to this he checks on vulnerable elders. To make my long story short,eople think about this but do not have the resources to start.

imnakoya said...

Ondo State is about to inaugurate the first ever Trauma System in Nigeria - it comes with a Trauma Center and upgraded A&E units at hospitals in the service area, Call Center (to dispatch and track crew in the field), and fleet of ambulance and extrication crew, all manned by trained personnel.

ProHealthNigeria said...

Emergency medical services is completely non-existent in Nigeria. It's a really sad situation considering the vast resources the country has.

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Rudraksha said...

Great post!! very informative.
Thank you very much for such a lovely and informative post.

Omorogbe Osazee Moses said...

Nice post! I am a paramedic in UBTH Emergency Medical Service. I mean, i'm a well trained paramedic in the UBTH School of Paramedicine where the national standard curriculum by the Department of Transport and National Registry of Emergency Medical Technician both from USA was used as a guide in my training. Though i have graduated and working in the hospital's ER, i constantly wonder why the country hasn't seen the need to pass the EMS act into law that every state must have. Ambulances, not hearse, are supposed to be manned by health care providers known as Emergency Medical Technicians which have three levels; Basic, Intermediate and Paramedic which is the highest level. Sending doctors to Israel is not such a bad idea but not recognizing the fact that paramedics who are the head of the prehospital team are suppose to be incorperated is a sign that such motive is self centered. However, we must recognize that anybody even the elites can be involved in both trauma and medical cases at home or on highways. We need funds for better and higher training, procurement of ambulances and to kickstart a better EMS. Let's learn from Ghana's EMS. EMS will work in Nigeria if there's allocation to it and funds directed at fostering the prosperity of this undeniable necessity are well expended. I still believe in Nigeria. HAPPY NEW NIGERIA!!!

olatoyosi said...

I am so happy to see something being written about the issue of emergency medicine. It has become my dream to be part of that team that will help Nigeria on that issue. I am currently a pre-medicine student with a strong interest in emergency medicine. I am also studying public health. I recently read about CRI but the question is "how accessible are these new ambulance services to the underserved populations?" how does having clinics in abuja, port harcourt and lagos attack the problem? how is the clinic at lekki accessible to someone in Igando? These kind of questions arise and they show that there is still a long way to go concerning fulfilling that need in Nigeria

Beth Frink said...

It's quite annoying to think that even ambulance services have to be very limited and are more of a luxury than a commodity. Sure, it can be a business on its own, but it has to have some affordability.

Rachel Grieves said...

I'm surprised that in the longest time, the Nigerian government has not in the slightest bit done anything regarding this matter. Shouldn't it be their priority to provide the necessary medical services to their constituents?

Omoregie Jeffrey said...

I am so glad we have started talking in this direction, I am a medical doctor working in ubth emergency room. Emergency medicine is really a big project, but achievable if we're serious. It consist of the pre-hospital and hospital segments. The pre-hospital part involves mainly the paramedics, which ubth has started training, and have even graduated the 3rd set.
For the hospital segment we need doctors and nurses trained in emergency medicine, this part is lacking in the country, there is no emergency room in nigeria covered by an emergency medicine trained doctor or nurse, the closest we have is traumatologist.

As to what their going to isearel to do, I don't know. The shortest training programme for emergency medicine is a diploma, and that takes two years. While to train doctors to become emergency medicine consultants it takes a 4-5yr residency programme depending on where their doing it.

My advise to the government is to train specialists in this field, and encourage the paramedic programme by funding it.

Mitchell Sexner said...

I totally agree that the development status of any city or state does not depend only on the physical well-being of the place itself but instead on its entire system as a whole. A city or a state could be very beautifully structured in terms of its architectural designs and its surrounding landscapes, but if it fails to offer a citizen-friendly system like a good medical and healthcare system, financial accessibility, education system and many others, then it would be considered as a poorly developed place.