The President, National Association of Resident Doctors, Dr Aliyu Sokomba, tells TUNDE AJAJA the other areas government needs to address while fighting the coronavirus disease
The coronavirus disease keeps spreading to more states despite the efforts of government. Is there more government could do to contain its spread?
Talking about the spread of the disease, so far we have recorded 305 cases across Nigeria. If the figures are anything to go by, I think the response against the virus is yielding positive result, going by the projection that was initially made known to us. We had expected the cases to have risen way above what we have at the moment, but I think the government can do more.
What areas do you think should be improved upon?
One of them is the provision of the necessary protective equipment for those frontline health care workers that are offering their services to make sure the disease is contained. They need to be protected. At the moment, we do not have adequate personal protective equipment for those COVID-19 health care providers and that has continued to serve as a major setback for winning the fight against COVID-19 disease in Nigeria. Secondly, I think there is a need to motivate the people providing these services and this can be achieved if the government decides to provide some form of insurance for them. This insurance should be in place should any health care provider die while on duty. You would agree with me that this will further motivate them to do the best they can. People may not want to offer their best knowing that should they die from the disease their family would be left with nothing. So, insurance is important. The current hazard allowance doctors get now is N5,000 per month and we all know it should be reviewed. The Federal Government had indicated interest to review the hazard allowance and procure life insurance for doctors and other front line health care providers, but this has continued to remain an intention. We hope they would do what is required of them to get that to a logical conclusion now.
The effectiveness of government’s palliatives has become a matter of debate, what is your view?
I think ensuring that the palliatives they are giving to Nigerians get to those they are intended for is one other thing government can do to make the fight against the virus more effective. On Tuesday, the leadership of the National Assembly expressed concern over the way and manner the Social Investment Programme was being implemented, and the Speaker of the House of Representatives (Femi Gbajabiamiala) was asking specific questions as to the source of the list being used, the geographical coverage and how the list was arrived at and so on. So, if this form of palliative doesn’t get to the Nigerians who need them, it will become more and more difficult for them to comply with the stay-at-home directive, which is one single important tool we have at our disposal to contain the spread of this disease. I think the government needs to take it very seriously and implement it rightly.
From available indices, can we say we are approaching the end of this pandemic or the days ahead might be tougher?
While the pandemic lasts, we can only hope for the best and expect the worst. For now, I think what is needed is for us to do our best. We need to put up measures should it escalate beyond what it is now. There is need to have more isolation centres prepared in case there is a surge. So, whether we should brace for worse days ahead, what is most important is for us to continue to play our part to see that it is contained and with God on our side, the disease would be contained in the shortest time.
If it escalates, can our current preparedness manage the situation?
Obviously, the Nigerian health system is not prepared to handle community transmission. That is why we are praying this thing does not get out of hand. The health system has been abandoned for decades, so this is the result. Therefore, you do not expect a system that has not received significant capital input to give you such an output when the ships are down. I’m hoping and praying that it doesn’t get out of hands and I’m also hoping that the stakeholders would consider this an opportunity to retrace their steps, do what is needed and strengthen the health system to offer quality health care service to Nigerians.
The Federal Government had earlier released about N15bn coupled with the billions donated by generous individuals and corporate bodies, yet government has approached the International Monetary Fund for a loan of $6.9bn to combat the impact of the virus on the economy. Do we need to throw more money at the problem or we can do some things differently?
Yes, we have received so much money in donations for the fight against COVID-19 but ironically, we have not seen any changes in our hospitals. The last time I asked, no money has been released to hospitals for the fight against COVID-19, so it calls to question what the money is meant for. We are also worried, but we are watching as events unfold.
NARD has been talking about insurance for health workers for long. How urgent is it at this time?
This is a matter that should warrant us shutting down the hospitals, but because of the outbreak, it is not appropriate to do that now. Otherwise, nobody needs a soothsayer to know that health care workers should be insured. Do we have to shut down the system before government realises that this is a matter of urgency? Before COVID-19 came, Lassa fever killed six doctors in 12 weeks and I can tell you that a lot of doctors have lost their lives in the course of offering their services to patients and humanity. Actually, the best time to do it was yesterday but the next best time to do it is now. This is the time to get all health care workers insured. We don’t have to say it before government realises that there is need for that to be done. It’s very embarrassing that we have to get to this point. Life insurance for health care workers is something that should be taken with utmost seriousness.
Does your association have a policy sum it’s proposing?
In the past, government had already made provision for life insurance. It was just bastardised along the way. If you check the Pension Reform Act of 2014, which repealed the 2004 Act, it is stated that all employers, not just of health workers, that have more than 10 employees should insure their employees to the tune of three times their total annual emolument. That provision was made by government itself and we didn’t even advocate for it. It seems that was done when government still had focus and foresight. It is a law. The law maintained that life insurance should be procured for all workers, not just health workers, but that has not seen the light of day. Therefore, if the government really wants to do it, that was something we had proposed in the past and that is a good place to start.
Apart from the raging COVID-19, Nigeria is dealing with Lassa fever, are we giving it the attention it deserves?
Unfortunately, at the moment, we are battling two outbreaks; Lassa fever outbreak, which started sometime in January, and COVID-19, which was discovered in Nigeria in February. It might interest you to know that Lassa fever has killed 185 people and has affected 951 persons. So far, coronavirus has killed seven persons while about 305 persons have been infected. Lassa fever has 19.5 per cent case fatality, which means that for every 100 persons that have Lassa fever, about 20 of them will die. Coronavirus has a case fatality of two per cent, which means that for every 100 persons that have the virus, two of them will die. By all standards, Lassa fever in Nigeria should be getting more attention, going by the case fatality and the deaths recorded so far. But you know how it is in Nigeria. The reason the world is talking about coronavirus is because in their own case, they do not have a more dangerous and virulent disease they are battling with. Therefore, they are talking about the one they have and we are following the trend, abandoning the Lassa fever that has been killing us before now. Apart from the government not paying attention to Lassa fever, even the media has abandoned it. So, while we battle COVID-19, we have to pay attention to other diseases killing our people. I’m not saying COVID-19 should be abandoned, I’m only saying we need to also pay attention to other diseases.
Perhaps the tilted attention to coronavirus is because of the way COVID-19 is transmitted.
Lassa fever is also widely transmitted as much as COVID-19. Though COVID-19 spreads by droplets, Lassa fever spreads by contacts. There is virtually little to no difference. If you come in contact with someone with Lassa fever, there is a chance that you would have it.
Your association initially opposed the coming of the Chinese health workers, but you seem to have changed your stand. What changed?
Our objection to the coming of the Chinese wasn’t emotional; it was based on facts and realities. Our insistence on the government not allowing the Chinese to come was based on the fact that they were coming without the requisite training and licence to practice in this country and the government was going to take the responsibility for their accommodation, their flight and other things, exhausting the little resources we have, while we the people who have been battling with the disease before now would be abandoned. We have several problems that have remained unattended to. But the government came out to say the Chinese were not coming to the country to treat patients, which addressed the problem of licensing. Also, the government clarified that the Chinese would be quarantined for 14 days, which addressed the question about their own status. Most importantly, the government has clarified that they (the Chinese) are coming to install some ventilators and share experience. So, if what government say they are coming to do is anything to go by, then, we have no objection to it. We were concerned about the service they were coming to offer to Nigerians and the implication of that, but since that has been clarified, we do not have any objection to their coming any further. All these would have been avoided if the government had carried us along from the start.
Some states don’t seem to be fully prepared for this and in a particular state, Lassa fever patients and COVID-19 patients are said to be kept in the same place. If you have to assess the preparedness of states apart from those that already have cases, are we fully prepared?
Before now, we have said that the health care system is very weak and this is largely attributed to the fact that it does not receive the sufficient funds it requires. In 2001, the World Health Organisation recommended that 15 per cent of the national budget should be allotted to health and it’s for days like this. It’s not when you have an outbreak that you start running helter-skelter. The Nigerian system is not prepared for anything. The system is very weak and our hospitals are glorified clinics. So, it’s not surprising that a state is compelled to combine Lassa fever patients and COVID-19 patients because they do not have adequate preparation, space and wards for them to be separated. All these are things we have to look into by the time the COVID-19 is over. We need to strengthen the health care system and put it back on track for it to be able to render effective and efficient health care to Nigerians. Even the State House Hospital that has gulped over N13bn in five years, if the report we are getting is anything to go by, is just a glorified clinic. We don’t seem to be serious. I hope this COVID-19 would make us to reposition the health sector.
Is there likelihood that the vaccine for the virus, which the world is waiting for, could come from Nigeria, given the number of scientists we have, the clinical trial that Lagos State wants to start and the potential of the Nigerian Institute of Medical Research?
Researches are very expensive, especially for a country like ours that cannot afford certain basic equipment for the front-line health care providers. I think the country does not have the capacity to fund any such research. Though, I have heard that some clinical trial research is going on using chloroquine, but we don’t have government’s willingness to invest in research. Until that is done, we have to wait for the research to be done elsewhere and then we can benefit from the outcome of such research.