Jigawa’s specialist hospital and the populist dilemma

Now, it has been re-built and re-equipped. The joke about “If you like, you can have a heart attack; we have a hospital that can revive you” is a, therefore, a statement about state of art quality of the medical equipment available in the hospital. The dilemma, however, is: to charge or not to charge […]

Now, it has been re-built and re-equipped. The joke about “If you like, you can have a heart attack; we have a hospital that can revive you” is a, therefore, a statement about state of art quality of the medical equipment available in the hospital. The dilemma, however, is: to charge or not to charge the people for its services.

Although the building was completed by the then military administration of Rasheed Shekoni, the hospital became another abandoned project before it could be equipped and put to use. It was forgotten by successive governments in the state, and every removable item was vandalised, until December 2007 when, while reading his maiden budget, Governor Sule Lamido declared that the hospital would be rebuilt to world-class standard.

Named after Shekoni, the hospital has been renovated and expanded, with four new departments added to the original plan. It has been fenced round and equipped to produce a hospital of the standard of a teaching hospital. Right now, it is said that it is only the Stella Obasanjo Women and Children Hospital, Benin City that is said to compare with the one in Jigawa. But while the Benin hospital is exclusively for women and children, the Rasheed Shekoni Specialist Hospital is an all purposes one, open to all.

The acclaimed uniqueness of the hospital rests on certain specific features. One is the quality of personal services. According to the Chief Medical Director of the hospital, Dr Salisu Muazu, while it is hard to come by 10 consultants in most general hospitals in Nigeria, the Jigawa hospital has 30 consultants on a part-time basis from all over Nigeria and abroad, including Ear, Nose, and Throat (ENT) specialists, a specie of medical personnel in short supply in the country. More are being engaged particularly from Egypt.

But it is the sophistication of equipment that the case rests more, the latest in modern technology from Europe. For example, it has what they call a combined laser therapy system, considered as one of the newest technology in eye surgery. The ophthalmology department also has a projection lens meter with projector and monitor as well as an ophthalmic echogram scanner.

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The gynaecology and obstetric clinic has a multidisciplinary ultrasound unit. The Accident and Emergency  unit has a monitor to check the vital signs of patients who are unconscious. In the paediatric clinic, the hospital has state-of-the art medical facilities which include radiant warmers and incubators, found only in teaching hospitals in Nigeria. The hospital also has a foetal monitor in the labour room which captures the graphics of a woman in labour—the movement of the baby, its position, etc.

The Rasheed Shokoni Specialist hospital also has a defibrillator, used in the treatment of cardiac arrest to reverse heart attack. Another special facility in the hospital is its equipment for the diagnosis of malaria and typhoid fever. According to Dr Salisu, a problem with typhoid fever in the country is that hospitals only ask their patients to go for widal tests which do not say anything much about whether typhoid is the problem or not. “But in this hospital”, he says, “we are going to reverse that kind of treatment. We have microscope that will enable us to go through the process and discover the specific virus”.

In addition, the hospital’s laboratory has an electrophoresis machine, which is used to diagnose haemoglobin problems. The machine is highly computerised with monitors and printers. The hospital, which has four functional theatres—is equipped with electrocoutry (diathermy) machines which are used in anaesthesia, during operations, to block bleeding.

To ensure constant power supply, the hospital is equipped with three standby generators, one of which is a 500 KVA generating set, powerful enough to keep all sections of the operating at the same time.

In situations where there is no need to supply all parts of the hospital with electricity, one of the other two 250KVA are on standby. A big problem for the hospital, however, is water supply. Presently, there is only one borehole, and it is not even adequate to water the hospital’s flowers.

The project is in two phases. The first phase of the project, which has been completed, cost the Jigawa state government an estimated N2.5 billion.

In the second phase, emphasis will be on staff housing, more equipment for the radiology department such as a computer imaging (CT) scan machine and a fluoroscopy machine—which scans through the urine system when a colouring material is injected and snaps a picture, detects occlusion and captures moving images of the body. Other projects in the second phase include the establishment of the Dialysis Unit under which would involve the installation of the Haemodialysis and peritoneal dialysis. These are machines for kidney failure and for kidney and bladder treatment respectively. Also in that phase are the creation of an intensive care unit and an orthopaedic unit. More equipment for the theatre—including a neurosurgery package and for both micro- and histo-pathology—for the laboratory, is also on included.

While many have not expected to see such sophisticated facilities accumulated in a state government-owned hospital—and in Jigawa State, considered to be the poorest in the country, for that matter—a question that has arisen is how to keep the hospital environment, its equipment and the level of services upbeat? In other words, there are fears. One of the pervasive fears is securing the equipment and other facilities from theft, given the way the hospital was completely vandalized previously. Some of the equipment are so small that anyone inclined to stealing them can easily pocket them. The current response to this is to outsource the security and maintenance services even though the company involved will have to recruit predominantly from the locals.

The second fear is sustaining the quality of services. According to Dr Salisu Muazu, some of the hospital’s departments like pharmacy, laboratory, theatre, and X-Ray would be operating a revolving fund arrangement such that, “At no time will there be an excuse that there is no money for medicine, reagents or no money to repair a broken down machine, etc”.

The third fear is the influx of those seeking medical attention from neighbouring and other states in the country. Would the influx such that would overwhelm and overstretch facilities too quickly?

There is a fourth fear in terms of staffing. According to medical experts, training specialists is a tedious process. Apart from the seven or so years it takes to graduate from a medical school, another four to seven years are required for a doctor to specialise. Again, while training facilities for specialists in general medicine, surgery, paediatrics, gynaecology and obstetrics are available in Nigeria, doctors have to go abroad for training in the other areas.

Then there is the biggest problem: to charge fees or not. In other words, the question of how accessible the hospital’s services would be to the people of Jigawa, where there is a government that claims to be an offshoot of the Second Republic People’s Redemption Party (PRP) and, therefore, an operator of its “Sawaba” manifesto.

Currently operating its outpatient department, the hospital charges patients about N50 for a registration card, an amount, some say, may not be affordable to many poor people. Although there would be some charges on services rendered, however, Dr Salisu says these charges would not be as high as what is collected by teaching hospitals. “There is almost free healthcare in Jigawa state. But free won’t be possible here. There will be charges but not like in teaching hospitals, just to keep the services going”, he says.

But in a country of unspeakable poverty and extreme deprivation, when is a charge low enough for the real commoner? Unlike in Europe and North America where Social Security stipends and the health insurance schemes appear to have responded somehow to the problem of affordability and access, this is not the case in most of Africa.

Although Jigawa State government operates a feeble Social Security policy, the radius is so narrow and the amount almost miserable. It covers only those who are severely physically challenged and receive no benefits from government.

Can the government, then, afford to charge for services rendered by the hospital or provide it free? Some people believe that if access to the hospital’s services is made free, people would abuse it and it will collapse. It will remain an on-going debate and no one knows yet what Governor Lamido’s regime would do.

A community elder in hitherto sleepy Dan-Masara Village where the hospital is located, Malam Hussaini, was not immediately concerned with the access question in an interview with Sunday Trust. Instead, he expressed their happiness because he believes it would provide their children with job opportunities.

“We had to forgo our farms to accommodate development [such as this]. But we are happy that our children and children and grandchildren will have the opportunity to be employed. Even our women are going to work there as cleaners. And now, instead of going into Dutse, we have medical care on our doorsteps”, he said.

But can the community have access to it?