‘We need to draw up the responsibilities of a surgeon-general’

Will the position of a surgeon-general, which the president has agreed to, not conflict with the office of the health minister?The president has in principle accepted there is a need for a surgeon general. But there is some distance between principle and practice. Now that the president has accepted there is a need, it means […]

Will the position of a surgeon-general, which the president has agreed to, not conflict with the office of the health minister?
The president has in principle accepted there is a need for a surgeon general. But there is some distance between principle and practice. Now that the president has accepted there is a need, it means we need to go to work. At the end of the work, I believe an appointment will be made. For the work, we need to draw up the core responsibilities of a surgeon-general. The Nigerian Medical Association has been asking for this for decades, but there are areas where we have some lacuna.
Take, for instance, we have been talking about government sponsoring public servants for treatment abroad. Presently, we have a mechanism in the public service: it is either the final approval is given by the Head of Service or the Secretary to the Government of the Federation, depending on whether you are a core civil servant or a political appointee, like a minister.
I think government is beginning to feel there is need for an office that is removed from politics, that may be requires the National Assembly approving, to which everyone will know we can direct such requests. And such office should be able to say, ‘why can’t this be treated in Nigeria, why must it go outside?’
The other thing is the controversy that will arise in trying to implement some of the provisions of the constitution. When the constitution says either the president or governor can be relieved of his position if indeed he is no more of sound health. Who decides if a governor is in sound health? There may be need for such an independent office established by the constitution or by law and should be able to handle that.
There is some gap but how it is going to be filled has been the debate. Remember the question as to whether the Minister of Health has to be a medical doctor or not. Why can’t he be someone who read English, mass communication or history? For you to have such, then we must be like other countries that have an office that is independent and handles such specific issues and matters of public health professionally, so the minister concentrates on purely administration and political decisions.
But we see instances in the proposed bill where there will be conflicts between that office and that of the substantive Minister of Health—and won’t the conflict that’s been between medical doctors and other health professionals continue?
I am not aware of a current executive bill before the National Assembly. Now that the president has accepted in principle and now says to move to the next stage and begin to prepare a bill, certainly as we are drafting it, there won’t be any conflict. Like in the US, the surgeon general reports to the assistant secretary for health, the equivalent of a minister of state. If you are going to report to the minister of state, how will that conflict with the job. We should be able to draft it in such a way that there is no conflict with the job of the minister of health.
As for harmony, as long the job given to the surgeon-general is the job that ordinarily a particular group handles. Assuming the bill says it is for doctors, then it must the functions that doctors handle. People who advise that someone should go abroad for treatment are doctors, the person who refers you for treatment is a doctor. I don’t see how that conflicts with other professions to be honest, but let’s not jump the gun.
When will there be peace in the health sector among health professionals?
The process has been on. Peace is not something you achieve so easily—ask those in the Middle East. Some of the issues are gradually abating, but there are some thorny ones. The president has stepped in by setting up his own presidential committee of experts to look into the matter and ensure there is better harmony among those in the sector. It is not that we wont have areas where people clash, but it shouldn’t be such as the degree we have today.
Why are hospitals still insistent on police reports before seeing gunshot victims at the cost of saving lives?
Both the [inspector-general of police] and minister of health have long said on no account should any hospital reject some with a gunshot wound, except where the hospital doesn’t possess what it takes to handle such a case. Not every hospital can manage an injury in the chest or brain, but it is the duty of that hospital to stabilize and then refer. But you can’t reject a patient just because he is a victim of gunshot. That is clear, no hospital or doctor can do that.
If there is anybody not obeying that, then he should be reported to the appropriate authority. In the case of federal establishments, administratively you can report to the minister of health, director of hospital services or permanent secretary. For all others, whether private, state or federal government owned, you can go further by reporting to the Medical and Dental Council of Nigeria, which will take the person before its tribunal.
Let’s report people and then you can hold the minister responsible if I refuse to do anything.
What are some positives 2013 can be remembered for?
For the first time in the history of this country, we have a curriculum to train paramedics. We have always talked about ambulance services, but when we really wanted to go into it, we found that some of the core people who will make any ambulance service realistic in any country never existed in Nigeria—the paramedics.
Now we have a curriculum approved by the National Council on Health and the National Board for Technical Education to be able to accredit any institution that will train paramedics.
Two hospitals are now doing open heart surgery. First was [University of Nigeria Teaching Hospital], which did about 50 open heart surgeries in 2013 alone—children and adults—and [University College Hospital, Ibadan] which started a few months. They used to do it more than a decade ago but for ten years nobody was doing it.
Why hasn’t research into drugs turned any corner apart from Niprosan?
It is not that we have not had any major breakthrough. Go to [National Institute for Pharmaceutical Research and Development] you will be proud to be a Nigerian. Part of the problem is how to bring industry so we can take research findings from the laboratory to the factory. That’s where we are now.
In February last year, I set up a committee to translate that. They have just recently submitted their report.
But that’s not to say we are where we should be in research. We are not funding research adequately, that I know, but that is also due to budgetary constraints. But my hope is what the president has said that we should try and find a sustainable way for the country to develop a national research fund. It is ongoing, and being led by the ministry of science and technology. At the Nigerian Institute of Medical Research, a lot is going on but again it is how to link their findings to industry.
Locally produced antiretroviral Tyonex has been at the centre of controversy amidst claims of adverse reactions and death. What’s the official stance on that?
There are companies that manufacture ARVs in this country. The laws of this country says to produce, sell or offer any drug, that drug must be registered by National Agency for Food and Drug Administration and Control (NAFDAC). Federal Ministry of Health has been procuring ARV for years manufactured in Nigeria, registered by NAFDAC.
We are aware Treatment Action Movement wrote us and said they suspected an ARV manufactured in Nigeria was responsible for the death of someone living with HIV. It is an assertion, the only thing we can do is to investigate. Already there is an interim report before the minister. In spite of the interim report carried by NAFDAC, directorate of food and drug services, [Pharmaceutical Council of Nigeria], directorate of hospital services, with international partners as observers, so far that drug has still met the same standards that made NAFDAC register. We had to go to the house of the late patient to collect the remnant of the drug. For a long time the family was not cooperating but from the letter the family wrote me, they have given NAFDAC the samples remaining from the pack the lady was taking. That again will be subjected to same tests. That’s why it is interim. But the minister has asked NAFDAC whether we suspend the use of the drug. NAFDAC three [four] weeks ago issued an order that the drug be suspended for now. We are not saying that drug is not ok, but it is just suspended for use for now pending when we conclude.
The letter I read today from the family is worrisome. There are many things that can kill someone. Even someone living with HIV, nothing says you can’t suffer malaria, meningitis, Lassa fever, or be involved in a road accident, explosion. We also have to be sure the death was related to the drug because the disease itself can kill. The records we have from FMC Asaba shows clearly this lady was also been treated for chronic renal failure. How do we know it is not the renal failure that killed this lady? It is only by autopsy. We have long written the family for an autopsy but they refused, they said they had gone ahead and buried the [patient]. They said they took the decision as a family. These are things we need to learn. When we are doing investigation, you should never bury. But we are trying to get an order from the coroner—if they say we can exhume the body, we will surely do it. We are going to take that case to the end. Let Nigerians know the truth. Nothing will be hidden.
But again, everybody must show some sense of responsibility. Going round attacking Nigerian officials offshore, writing rubbish about your country will not make us better. We must realize there are better ways to do things.