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?

Tuesday, 6 March 2012

On yellow fever, yellow cards, Nigeria and South Africa

The recent refusal of entry and deportation of about 125 Nigerians who had arrived Johannesburg, South Africa aboard ARIK Airlines from Nigeria on Friday has caused a lot of comment in Nigerian news and social media circles. According to most of the accounts, the Nigerians were refused entry into the country because the South African Port Health Authority had concerns about the validity of the yellow fever vaccination cards that the Nigerian passengers were carrying. The Chairman of the House of Representatives on Diaspora Affairs, Abike Dabiri-Erewa called the action of the South African authorities on Twitter as “unacceptable, pathetic, degrading, unfair and un-African”

 A number of issues were raised by the passengers, the Arik Airline spokesperson and Nigerian commentators, suggesting that the refusal to accept the yellow fever certificates was politically motivated. Some of the passengers argued that they had in the past been allowed into South Africa with the same documents, and the airline said that “many passengers have been detained and refused entry in recent months,"

The press statement issued by Arik said South African health authorities gave the reason as incorrect or unrecognised batch numbers on the documentation which is mandatory proof before entry and described the protocol as "irregular and obfuscating” and accused the authorities of arbitrariness.

Interestingly, there was no official statement from the South African port health authorities, thus allowing even more speculation. Online commentators however pointed out that vaccination cards were openly on sale at Murtala Mohammed airport in Lagos, arguing that it was not surprising that the South Africans were sceptical about the documentation.

Whatever the truth around the motivation of the port health authorities, it is evident that our port health systems in Nigeria are not as robust as they ought to be. Putting in place effective travel vaccination processes that satisfy international standards is not rocket science, given the relatively small numbers of people that need them. Leaving the politics aside – there are some incontrovertible facts from a public health perspective. Nigeria is one of several countries at risk of Yellow Fever transmission; South Africa is not (see WHO updated 2011). Vaccines like all other medicines have batch numbers and a date of manufacture and expiry. The reason for this is that in order to track potential contamination – every single batch must be traceable. So it was only a matter of time before the yellow card printing businesses at Murtala Muhammed International Airport were found out.

While we may argue about the high-handedness of the South African response, the truth is that this entire episode could easily have been avoided if the right thing was done by Nigerian travellers. It is interesting to note that not one of the travellers have actually come out to claim that they indeed received the yellow fever vaccine! The crux of their argument seems to be that since they have got away with using the cards in the past, this legitimises the cards as authentic.

This controversy once again throws into the spotlight, the weakness of our arrangements for communicable disease surveillance and control in Nigeria. In addition to the public health benefit for South Africa, vaccination primarily protects the individual being vaccinated. The poor perception among the Nigerian population on the benefits of vaccination is worrying. Vaccines remain one of public health accomplishments of our times. Without starting to boldly address these issues, it is difficult to be as vocal as we ought to be when foreign countries call our systems, processes and documentation into question. Maybe the Ministries of Health and Aviation will surprise Nigerians and set up a functional travel health clinic at MMIA to serve Nigerian travellers, else it is difficult to justify what the Port Health Authorities at our airports actually do.