Ahmad Salkida
22 June 2008
Maiduguri — The University of Maiduguri Teaching Hospital (UMTH) is bursting at the seams and its facilities are obviously overstretched. The reasons are not far fetched: the host community Maiduguri, is cosmopolitan and borders three countries namely, Chad, Cameroon and Niger.
The situation contradicts the initial mandate of the institution which is to teach, conduct research and offer specialized services as conceived 25 years ago when it was established.
The hospital parades 356 nurses, 22 pharmacists, 216 doctors, comprising of 69 consultants, 125 registrars and 22 medical officers, most of whom have the mandate to teach, research and offer specialize services, but they had to deal with numerous cases. For instance they had in 2007, scrutinized 196, 845 laboratory tests, 223, 697 radiology tests and tending to over 84,787, with unconfirmed number of HIV/AIDS patients, that the hospital manages.
Sources at the General Out-Patients Department (GOPD) of the hospital disclosed that about 74,626 persons were treated in 2007 alone. However, these figures are conservative as some persons get treated without being officially registered. However, 80 per cent of the cases which according to the institution, should have been the responsibility of the Primary Health Care, are taken by UMTH, further compounding the problems of the hospital.
Further checks at the clinics, wards, laboratories, theatres and teaching sections of both the Medical and Nursing students in the hospital indicate profound human traffic. Although additional classrooms, halls and laboratories are being provided, yet the congestion remains.
The situation is the same at the Obstetric and Gynecology Department, as well as the Presidents Emergency Program for AIDS Relief (PEPFAR) clinics for those living with HIV/AIDs, where the affected persons jostle for the available anti - retroviral drugs.
Speaking on the issue, Chairman, Medical Advisory Committee (CMAC) of the hospital, Dr Alim Gamace Madziga, reaffirmed that the hospital has had bed occupancy of almost 90 per cent to 100 per cent in the last 3 to 4 years, and up till now, if you go to the wards, you will hardly find an empty bed space and this has been a recent turn around in a teaching hospital like this because as you are aware, a teaching hospital is a tertiary health care centre. That is to say, there must be primary, there must be secondary and then tertiary health centers", the CMAC explained, giving an analogy with a pyramid:
"A pyramid has a tip and a broad base, where the broad base is a large number of people and the tip with probably one or two people. But now, this pyramid has been inverted, the teaching hospital is suppose to have a few number of cases, a Consultant is suppose to have a few number of specialized cases that have gone through all the stages of health care" said the CMAC. Adding that many factors like the incessant industrial strike in the health sector at the state level translated into the kind of congestion that was experienced.
"He stated further, the perception of the public, regarding our services that they are relatively inadequate is really not true, because, the services and the facilities are over whelmed, so they will be perceived as inadequate. Let me give you an example, if you come for an intravenous Angiorography, specialized X-ray for the kidney, you are given a booking of about 3 months because all the dates are filled up by people. So that person goes home thinking our services are poor", he said. That these constrains have not made their mandate to fail but only affected services; where a doctor is expected to examine a patient for one hour but does so in 30 minutes.
As far as standard is concerned in the country, the UMTH is said to remain one of the best with one of the lowest charges, said the Head of the Public Relations unit of the hospital. According to him, "the influx of huge population into the hospital cannot be a yardstick to measure standards as long as the people are treated satisfactorily by doctors," said the PRO.
Also in the view of Dr Hyedima Garga Bwala of the Retainership G.O.P.D and Amenity Services of the UMTH, the population crisis does not seem to take a turn on the quality of care, the only problem is that, it affects research because people do not just have time for the research; they spend so much time attending to a lot of patients. "And this is at the expense of the staff, the laboratories, and the services provided", said Dr Bwala, adding that, the hospital has been upgraded through the VAMED project with high-tech machines to facilitate the treatment of complex cases like liver, brain problems, kidney and cancer. The Federal Government/VAMED modernization and re - equipping of hospitals prospect has injected a new live-wire to the Hospital. The acquisition of state of the art facilities have improved on health care delivery/ services, so much so that to travel abroad for medical attention is now a matter of choice but not necessity.
But a doctor who proffered anonymity argued that standard should not be measured by how well maintained the wards and clinics are or the quality of food but rather, "how many patients survived and how many died, it is only through such statistics that one can measure the performance of a hospital in a given society."
Although Dr Bala Mohammed Audu, the Head Department of Obstetric and Gynaecology believes that standards as far as mortality vis-à-vis the high prevalence of pregnancy in this part of the country is concern is relatively fair. The 150 women that die every month out of 100,000 deliveries in the entire state are based on hospital deliveries alone, and in a state where 70% of women don't attend anti- natal and the few that go, only do that when they notice complications, is indicative of the fact that if they attend ante-natal care regularly during pregnancies and give birth in hospitals, we may not experience high mortality figures that we have today here and in other hospitals, "because about 60% of maternal mortality are caused by Eclampsia, which can be prevented by a simple procedure like taking blood pressure during antenatal care," he said.
For Dr Zainab Mustapha, a Consultant Radiologist, who could not spare more than 10 minutes for this interview because of her very busy schedule, her work load is increasing every day, a doctor hasn't gotten any time of his own, "nearly all the specialty clinics refer their patients here for investigations from simple to complex ones" she said. Adding that, going by the new imaging modalities and new equipments in her department "we have more reasons to see more patients".
Dr Mustapha while answering a question on the issue of the dearth of the CT scan machine which is the only one in the region, and the fact that the Magnetic Resonance Imaging Machine, apart from being too expensive takes 48 hours to boot, which many said, affects the treatment of emergencies, said that, "I don't think our charges are expensive, if you go to other teaching hospitals in the country you will find out that our charges are the lowest and the MRI does not take 48 hours, it was not booting, it becomes ready for use in less than 24 hours" she corrected.
For Dr Madziga, the way out of this present quagmire is for every category of the health system to do its own part, while he is optimistic like doctor Mustapha that, there will be more employment and expansion in the hospital to contain the ever-increasing traffic. However, the Borno state Commissioner of Health in a chat had said, the Umaru Shehu Ultra- Modern hospital built by the State Government alongside other hospitals spread within the state, when operational, will resolve some of the problems of health services in the state.
Members of staff who spoke to Sunday Trust however, expressed dismay at the chaotic situation that they contend with on daily basis, stressing that provision of effective health care at the local and state levels would go a long way in solving the problems. "We have been sensitizing patients on the need for them to talk to their leaders at the local and state levels, to provide the necessary facilities to cater for their day to day health needs. Governments are running away from their responsibilities of providing Primary Health-Care services to the people, leading to this kind of crisis in tertiary health centres".
According to the Chief Medical Director of the UMTH, Prof. Othman Kyari; there is a population crisis in the hospital and what is happening is a mere reflection of the problems in the wider society, where policies by governments particularly at lower levels are hardly implemented to the letter to impact on the well being of the general population and again, the quality of services and doctors here may be another attraction, he implied.
"In as much as many of the cases that are brought to the UMTH are supposed to end up at the primary health - care centers, we cannot ignore people that are in dire need of medical attention", he said, stating that "the hospital is adjusting itself to fulfill its mandate and as well, take some of the responsibilities of the scarce and obsolete primary and secondary health centers in the area." Referring to the horizontal structures at the Obstetric and Genecology and the Accident and Emergency wards being constructed among other extension services, he said that the UMTH aims at promoting the health of the people and enhancing the health sector.
For most of the doctors interviewed, the hospital is 'adjusting itself' at the detriment of members of staff and the mandate of the institution. They asserted that the trend if not checked immediately, may threaten the credibility of some departments and even the hospital as according to them, the standard of the hospital is at the edge of a precipice.
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