{INTERVIEW} Why Doctors Should Not Always Be Blamed For Misdiagnosis – Idris Omede

All over the world, many patients die annually as a result of medical errors. This comes mostly from incorrect medical diagnoses. In Nigeria, there is a higher rate of death resulting from this. In an interview with WINIFRED OGBEBO, the Kogi State Commissioner for Health, Dr. Omede Idris, discusses the situation in Kogi State and how doctors are more often than not misrepresented.

As a commissioner for health, what are the prospects for health in Kogi State?

Part of the mandate of the state is to provide health care services to our people. To that extent, the state has its own policies on health. It has its own departments, agencies and parastatals as well as health facilities that render those services. For instance, we have the hospital management board which is saddled with the responsibility of managing our secondary health care facilities which are spread across the 21 local government areas of the state. We have the state action committee on AIDS which is saddled with HIV issue. We have the college of medicine now in the state university and to ensure that the students do not suffer any stagnation in terms of clinical activities, one of our hospitals which is within the vicinity of the university environ is being upgraded and renamed Kogi State Teaching Hospital in Anyigba. The committee set up on the issue is working hard to ensure that the basic things are made available for the medical students especially in the pre-clinical areas.
The state assembly was also able to pass the state primary health care development agency bill into law. As we speak, an appointment has been made for an executive director to head the agency. We are moving in to ensure that the primary health care works and having the primary health care development agency in the state will give more impetus, more activities within local governments in terms of primary health activities. We believe very well this will actually prop up the achievements, and upscale of many primary health care elements within a local government and that will naturally improve our health output and impact.

What are the health indices in Kogi State?
Though a clear health survey has not been done, we are using some of our sentinel health, particularly areas that we are using for midwifery service scheme from the point at which it came in, before it came in and when they came in. We are very sure of the records that we get. The maternal mortality at the centres that are designated midwifery service scheme at the local governments is very low.
In fact, we have not recorded any mortality in terms of maternal death in those sites since the scheme came on in 2010. The child, infant and under five mortality are there but statistically, the figures are not static. One is not specific about the figures. What we are trying to do now is to actually do a survey on some of those things and put the data tools in place to be able to get those figures appropriately. But you need to really have a committed workforce to be able to get some of those things.
So in terms of health management, we are trying to ensure that the records are properly kept for the purpose of planning and programme interventions.
Our immunization rate is about 80 percent, in terms of routine immunization. It is interesting to note that we have been polio-free since 2009. Just last year, from January 2012, there was Nigeria governorship immunisation challenge which was put together by the Nigeria Governors Forum and supported by Bill and Melinda Gates Foundation for performance in immunization activities. All the indicators that we presented for the purposes of checking on immunization activities were successful. We did very well at the end of the day. Kogi State came third in that challenge award. Nationally, we were the first in the north central state, which was a factor attributable to the political will and financial commitment of the state government and practical immunization activities for the purpose of sensitization, advocacy and upscale of immunization activities and polio eradication.
That award was well-celebrated in the state and we will continue to work hard to ensure that we retain that position and also improve on our immunization activities across the 21 local government areas of the state. A lot of strategies are being put in place to ensure that our routine immunization continue to soar high so that we don’t have incidences of missed children during immunization within the age bracket. We will continue to match into all programmes, our own local programmes as well as national programmes. We have just finished our measles campaign which is in tandem with the campaign for 19 northern states and FCT, and it was a huge success. We did not have any complaint of adverse effect and the turnout was very impressive.
So for immunization, we are not lagging behind, but we will work hard to be one of the top states in the nation.

One of the factors fuelling medical tourism is lack of confidence in our health sector, which includes the issue of incompetence by some medical doctors. What is your view on this?
There are so many factors attributable to medical tourism. We talk about an enabling environment for even the practitioners to do what they are supposed to do. For anybody that knows his onions or his job, he will feel frustrated when he does not have that enabling environment in terms of infrastructure, in terms of equipment to render the services he is supposed to render. You see people dying in your hands for things that you feel you can do. It’s frustrating and painful. Under such kind of circumstances, the expert may not really want to be on ground to keep on hanging even when they have made some attempts to rectify some of those things. So once those things are not there, the people will look for where to get those services. However, that is not to say that every medical tourism out of this country is really called for. Also, we see it more or less as a jamboree for some persons to move out and whatever.
In terms of competence, I’d like to say that the competence of doctors in this country is not in doubt, right from their training and whatever. What is in doubt is that attribute of getting what you need to work with. You’ve heard over and over again that our doctors outside the shores of this country in wherever they practice stand tall among their peers and if they are not competent, they couldn’t have gone there to stand tall. It simply means the issues are not that of competence but the available materials and equipment to make the work easier.
Diagnosis is a factor of the knowledge, the training, the experience, the skill and the use of equipment to help the diagnosis. So if you have done all the ones normally you are supposed to do and your equipment are not giving you the best of result, why because they are not appropriate for it, definitely, you cannot blame misdiagnosis on the competence of the practitioner but on malfunctioning or non availability of the specific equipment that are supposed to be used for such kind of a thing. So these are areas that we have always called on government and we are still calling on the government. For instance, in Kogi State, we are working very hard now. A construction is already going on in the acoustic and imaging centre, a laboratory and X-ray services. It is going to be a state-of-the art kind of laboratory outfit for diagnosis and all kinds of sonographic and urological equipment are going to be there.
So when you have things like that and then you have appropriate manpower, then it is easier to first and foremost, make your diagnosis. It is better on patients because we are in a place that is a highly trafficked environment; Kogi State, Lokoja is a transit route between the north and south and so many people across the place. So most times, why you talk about high mortality from illnesses is because of the time delay, moving person from one point to the other and then getting the right care. If we have the right kind of interventions here, you don’t have to start rushing to Kaduna or Abuja, we can see what we can do in this environment for the patient.