Doctors treating Covid-19 patients without protection on suicide mission – Eze

Doctor Laz Ude Eze is an Abuja-based public health specialist, a Sustainable Development Goals (SDGs) consultant and media practitioner. In this interview with PAUL OKAH, he talks about his efforts in health awareness campaign, treatment of cancer patients, and why many doctors treating Covid-19 patients are on a suicide mission, among others.

How have you championed health awareness campaign?

I am a medical doctor with specialisation in public health policy and management. I am also a sustainable development consultant. I can also describe myself as a humanitarian with extreme passion for good health, quality education and sustainable community development. I do a lot of paid and unpaid jobs in promoting my passions. As a part of my efforts to promote health literacy in Nigeria, I initiated the #TalkHealth9ja weekly radio show on Wazobia FM Abuja and was the producer of the show for five years (2014-2019). Bigmo was my partner and the main host of the show for four years, while Willy Willy hosted for a year. From last year, we started the, Nigeria’s first and perhaps the only Pidgin English Health Blog. Also, I am Nigeria’s country coordinator of the West African Network of Emerging Leaders in Health Policy and Systems (WANEL), the secretary of the National Advocates for Health (a group of 26 eminent Nigerians leading high level advocacy for delivery of quality of quality health care in the country). Until recently, I was the executive director of the Pink Oak Cancer Trust – Nigeria’s first Cancer Treatment Fund. I have worked on malaria, HIV, immunisation, maternal and child health as well as reproductive health programmes. On education, I founded the Okposi Education Initiative with some friends in 2011, and we have been making modest efforts to promote academic excellence in our community. I also built a block of four toilet facilities to a primary school in my community and donated sanitation materials to four primary and two secondary schools between 2018 and 2019. Last year, I established the Testrogen Innovation Hub in Abakaliki to promote innovation, ICT and learning. I want to be remembered as someone who did his best to better his environment and added positive value to millions of lives.

What would you say is the problem with Nigeria’s health sector?

The problems of the health sector are many, but I can summarise it by saying that the major problem is because the political class sees health more as a charity than an economic and security issue. The citizens also wish away health issues with the ‘it’s not my portion’ or ‘God is in control’ language. It is no news that Nigeria’s health sector is very weak and its performance is sub-optimal. This should change and we all have responsibilities to help make our hospitals work well for everyone. The health sector in Nigeria is grossly underfunded. Budgetary allocation is very low, and not even all the approved budget is released and not all the amount released is efficiently utilised. Nigeria is supposed to dedicate at least 15% of the national and state annual budgets to health, but it’s currently below 5%. Despite the low funding, there’s a lot of inefficiency in the management of the available resources. We should have achieved more even with the meagre resources spent so far. The Covid-19 pandemic has made the gaps in the health sector more obvious especially to the non professionals. I hope we begin to take health more seriously going forward.

Do you agree that doctors value money over human lives?

I do not agree. Those who went on strike were largely because their hospitals could not provide personal protective devices they needed to work. Others declared strike because they were physically assaulted by patients’ relatives (like in Ebonyi) or law enforcement agents (as reported in Asaba, Delta states recently). Any doctor or health worker seeing patients this period without adequate protection is on a suicide mission. Five thousand Naira as hazard allowance is ridiculously low. I am glad the federal government has reviewed it upwards for various categories of health workers. However, the implementation should go beyond the approved three months because health workers are always exposed to health hazards. States should do likewise.

Are Nigerians accessing enough health insurance?

No; only about one out of 100 Nigerians has any form of health insurance.

Every Nigerian deserves to have health insurance coverage. That’s what we call universal health coverage; it makes it possible for every citizen to access health care without financial difficulties. There are some policies around that but the implementation has been very discouraging. There’s no political will yet to make this a reality for all residents of Nigeria. The 8th National Assembly passed a Bill that made health insurance mandatory but the President withheld assent. The 9th Assembly is working to re-enact it. Hopefully, it gets presidential assent this time. With universal health coverage, there will be more private sector investment in the health sector. More persons will be able to have access to quality health care and our health indices will improve.

Do you think Nigeria can achieve the SDGs target?

If Nigeria continues with its current approach to development, we will not get close to achieving any of the Sustainable Development Goals. The national budget still spends over 70% on consumption and we are producing very little. The economy still depends on crude oil despite the mouthing of diversification done over the years. The country is the world’s capital of multi-dimensional poverty, extreme hunger pervades the land, health care delivery is poor, quality of education is largely abysmal, gender discrimination is prevalent, and many lack access to potable water while sanitation is very poor. These areas constitute SDGs one to six, with a decade of implementation to go. I can’t see any serious traction yet. Many governors don’t even understand what the SDGs mean and some of the people they appoint as SAs on SDGs think it’s about travels and speaking grammar.

How do we move forward? We must create awareness about the SDGs and localise them. Our local governance policies should be aligned with the SDG targets and a monitoring framework should be developed and implemented to track performance. Beyond the government, everyone has a role to play in achieving the SDGs, especially young people. Recently, I organised a hang-out for young people in Ebonyi state on the SDGs. It was neat for 30 persons, but more than 100 signed up euthanasia for 12 hours. It shows young people are enthusiastic about the SDGs. So, we must leave no one behind.

Many Nigerians still think Covid-19 is not real; does it have to do with poor sensitisation?

It’s unfortunate that some people still doubt it. It’s partly due to poor sensitisation and also due to lack of trust between the people and government over the years. Effective communication should be deployed to get the evidence-based messages on Covid-19 to the grassroots. Local government authorities should take responsibility and work with trusted channels which may include traditional institutions, religious leaders, and civil society organisations to implement behavioural change communication in the areas. From what I have observed, I will say the National Orientation Agency is not doing enough in sensitising Nigerians. It’s almost impossible for Covid-19 to have been prevented from Nigeria because no matter what you do, you can’t completely stop people from moving. Even if we had shut all borders and airports from January till date, people may still pass through the porous borders. As long as people are moving, there’s a chance that the virus will get here. Unfortunately, many Nigerians are gullible and even believe fake news more than the authentic stories or messages. Everybody should take personal responsibility and act right. We should all adhere to the NCDC and WHO directives.

Nigerians seem to have forgotten about Lassa fever; does it mean that Covid-19 is more deadly?

Lassa fever is more deadly, but Covid-19 is more infectious. From January to mid-April 2020, Lassa fever killed 20 out of 100 infected persons while Covid-19 killed three out of 100. However, Covid-19 has the potential to infect much more persons than Lassa fever. It means that the time it takes Lassa fever to infect 1000 persons, it may take Covid-19 same time to infect 10,000. So, in terms of numbers, Covid-19 will potentially kill more people because of its high infectivity. That’s why tough measures are being taken to contain the spread and prevent deaths. Ebola is also very deadly. However, we are not testing enough. We are getting to the end of April and Nigeria has tested less than 15,000 persons. It is simply because we don’t have enough capacity to test enough. The lack of capacity was also because the country failed to make sufficient investments in ensuring our medical laboratories are of high standards. But the good news is that NCDC and partners are gradually increasing the testing capacity since this outbreak began. So far, molecular testing laboratories have increased from five to 15 and more may still come on board. They have set a target to test two million people within the next three months.

Asides Covid-19, do you think we prepared for other health emergencies?

Nigeria does not have an effective ambulance service system for any kind of health emergency. Many have died because of this. State governments should go beyond procuring ambulance vehicles to making sure they are functional and used for the purpose of responding to medical emergencies. It is possible to achieve local production of medical equipment in Nigeria. However, the country is so used to importing almost everything. The government needs to provide enabling environment for a sustainable increase in local production of medical equipment.

States are making the wearing of face masks compulsory in combating Covid-19; is that practicable or necessary?

It has essentially become a nationwide recommendation. There is growing evidence that general use of masks may provide some protection against Covid-19 infections. Use of masks alone doesn’t give a 100% protection; so, we must combine it with other prevention practices like hand washing and social distancing. So, I believe it is necessary but the government should help to make it available to many who can’t afford to buy them. Lockdown without provision of palliatives to those who need them is more like a punishment and adherence will be difficult. Lockdown in itself is a necessary intervention to minimise spread but is not a magic bullet that will stop Covid-19. It can’t be effective if not associated with other control measures and provision of food on people’s table.

What lessons can we learn from this Covid-19 pandemic?

There are many lessons that can be learned. First, Covid-19 has shown that anything is possible and anything can wait. No one would imagine that Lagos and Abuja would be on economic lockdown for up to a month. No one would imagine that Nigeria would be placing travel ban on British and Americans from entering the country. The whole world is on standstill and Covid-19 now determines actions and decisions. Nobody saw this   coming.

Second, it has forced our political elite to sit at home and use Nigerian hospitals. The same hospitals they refused to upgrade have now become the cornerstone of their health care. No more medical tourism at least for the period of the pandemic.

Third, it has further exposed the weakness of our health system and made it clearer to the political class. Hopefully, they will engage experts to change the narrative and make efficient investments to improve the quality of health care in Nigeria.

Fourth, it brought to the fore the need to scale up local production of medical equipment and devices.

Fifth, it further exposed the unprofessional conducts of law enforcement agents. They had killed more than 20 Nigerians even when Covid-19 had just killed 11. It also exposed abuse of office by some governors. You may have read about the arrests and ban of two journalists “for life” by the Ebonyi state governor. Though the ban has been reportedly lifted, these are issues we have to fix about our participatory democracy.

Sixth, it makes the importance of medical research better appreciated. Everyone was asking for information and solutions. Hopefully, we make more investment in research going forward.

Your advice for Nigerians on Covid-19 pandemic and general health

To the Nigerian people, health is wealth. Let me reiterate a popular saying of my friend, Dr. Ifeanyi Nsofor – without health you have nothing. Let us follow the directives of the Nigerian Centre for Disease Control (NCDC). Let’s eat well, exercise well and seek accurate knowledge to guide our health-seeking behaviours. Covid-19 may be with us for a while. Things may never be same again. Let’s adapt to the new way of life and stay alive. May I also beg Nigerians to support the health workers, media personnel, law enforcement agents, and many others on essential duties during the lockdown period. We are in for a tough time, but we will succeed; let’s be our brothers’ and sisters’ keepers.

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