Prof Christopher Olusanjo Bode has piloted the affairs of the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, since 2015. A distinguished paediatric surgeon and fellow of the National Postgraduate Medical College of Nigeria as well as a fellow of the West African College of Surgeons and the Nigeria Academy of Medicine, Prof Bode began his impeccable career in 1982 as a resident doctor at LUTH and rose to the post of Chief Medical Director (CMD) in the prestigious institution. He bares his mind on LUTH at 60, state of medical practice in the country and other issues. He spoke with ADEKUNLE YUSUF and CHINYERE OKOROAFOR
Nigeria – a land of opportunities amidst challenges
There are so many opportunities here despite the challenges, which can make us do a lot if only we study them critically. And then we can sit and think of how people can benefit from the environment. There will always be problems. Even the America, London and Canada that we run to are not perfect. They have problems; they are still looking inwards for meaningful solutions to these problems. Like Nelson Mandela said, after you have thrived to climb on top of the mountain, you will come to realise that there are other mountains to climb as well. So that is life and it is our duty to solve those problems that make us better as human. Not when we just sit down and go to the church or mosque and keep praying without work; prayers allow will not solve problems. Prayers are not goals to be attained. God will not come down to attain those goals for us; we must use human resources and let God take the glory. That is my own philosophy about life and that is what has helped us to do what we are doing.
LUTH at 60 – the journey so far
6O years is a significant milestone in the lifespan of a man. So, any venture that we have embarked upon for 60 years is worth reviewing – celebrating what you have done well, recalibrating where you can do better and also for one to reappraise and plot a path for the next generation. A man who was born 60-years ago should be planning his retirement by now.
Quite a lot of very good things have happened here with many firsts. The first radiation therapy for cancer in West Africa started in this hospital. We built on that and now we have the best cancer center in Sub-Sahara Africa outside of South Africa. The first gastro ontological center with endoscopy in West Africa was started by late Prof Akin Adesola in this hospital. The first radiotherapy in West Africa was done by Prof Kofi Duncan; he is still alive, in his late 80s. He is a foremost oncologist, the first radiotherapist and cancer manager in West Africa. He was sent to England to learn radiotherapy by late Prof Oritsejolomi Horatio Thomas, foundation head of LUTH. The first dental school in Nigeria was established here. Many radiotherapists for cancer in Nigeria and West Africa are either trained here or were trained by those who trained in this hospital. The first In-Vitro Fertilization (IVF) was conceived here under the supervision of Prof Osato Giwa-Osagie and his team in the 80s and so many good things.
For me, I have been in this hospital for 42 years; I came here as a resident doctor, I didn’t train here as a medical student. I came in as a trainee specialist doctor in 1982 and I have seen the best, the growth, the stagnation, the decline and then the renaissance of services in this institution. Why do we celebrate 60? Many of those factors I have mentioned are worthy of celebrating. We must celebrate those who established this kind of concept. We should celebrate those who served meticulously, those who gave Nigeria an institution like this. This is a tertiary institution of service, training and of research. It has a lot of potentials which have not died, well kindled; we serve our region very well. It has stood its ground in the face of onslaught. For example, the recent onslaught of COVID19, LUTH stood as a vanguard in that fight and it was well recognised for it. So, from there we are building a lot. And then, we must celebrate those who have worked so hard as an example and a testimony for those coming behind because one song we sing obnoxiously in Nigeria is how all things are so bad. We sing that so bad that a whole generation of our children don’t believe in Nigeria anymore, which is calamitous, which is not good.
There are still good things in this country. There are good people in this country. There are selfless people who are serving tirelessly in this country; we must not because of some of the things we are yet to achieve fail to recognise those who are serving diligently and so meritoriously. If we do so, what is the hope for our country? White men are not coming back to recolonise us; we pray not. We all have to guide our lives and settle for the task, roll up our sleeves rather than seat on our hands and bemoan our faith and praying, only praying. Even the bible said faith without work is dead faith and that is where we are, we need to work the talk. There are lots of works to do which are opportunities. This is why we celebrate. We must also plot a hopeful future for those coming behind.
There was the need for infrastructural renaissance; we rehabilitated the modular theatre like I said before. Somebody said oh! In LUTH, we have between three and five stroke cases a day! If you are doing all these, CMD can you build us an acute stroke unit, and I said what was that? He said we have a dedicated place where we treat stroke as soon as they come in, it will improve the outcome. And I can tell you we discharge about 20 per cent of our stroke patients within 10 days now; it used to be less than 1 per cent before we built that unit. More of them survived. Multidisciplinary teams can come and intervene earlier. We treat them more aggressively. It is a 10-bed centre and it works well. It is called Acute Stroke Care Unit.
That was a response to a need that they brought up to the management from the specialist workers; we didn’t know but they brought it. And that was how we responded to that. And that has been the kind of style that we have been using here. Before now, if they gave you a prescription at the eyes clinic and you had to go to town to get your pair of glasses. But today, we brought in a PPP partnership; within one hour, you can get your pair of glasses here in LUTH at comparatively cheaper prices. So it is a one-stop shop. Then our blood bank, LUTH was spending over N20million naira a month to service the blood bank. Then it ran down. It was inefficient. We didn’t have enough blood form for paediatrics cases, etc., but with the PPP that came in, they took over the place, rebuilt it and equipped it very well; we don’t pay a kobo to them. The hospital makes between N7-8million from that without paying any fees and everybody gets the blood they need these days. So there was efficiency introduced into that scale of system.
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Lagos with population of over 20 million needs a lot of critical care aids. LUTH used to be the only place with the Intensive Care Unit (ICU) where someone who may not breathe sufficiently or other vital organs are failing. When people come and we say there is no ICU bed because the ones we have are in use, it is as if we are giving them a death sentence: go and die. And while we were rendering our services at N250, 000 a week, you go to any private one outside, they were asked to pay N1million, N2million and more and deposit. How many people can afford that? During COVID-19, we realised that in the whole of Nigeria, we didn’t have up to 400 ICU beds. The federal government said we should build ICU spaces in every federal tertiary institution, at least 10 each. We saw that as an opportunity and what we did was to embark on the construction of 30 beds ICU; it is the biggest and best in West Africa. We are commissioning it next month. For me, that is the kind of way in which you can get to impact your system; people are embracing it, with 30 beds, of cause we will staff it well, we already have the manpower. If you want our 100 specialists, you will get them from this hospital on the same patient. It is a worthwhile investment.
Ambition for the future
We need to complete the infrastructural rehabilitation here. The hospital will continue to be relevant to the society. We are constrained by land, nowhere to build anything. I foresee that there would be a number of towers built here where services can be layered because there is nowhere to build again. The way we have gone electronically will assist a lot, and that is the way to go.
There would be specialisations and super specialisations so that this hospital will be a reference hospital, not just another tertiary institution; problems that can’t be solved in other places would find their way here. And with training and specialization that is already in place and with a lot of visionary leadership, the place can really become a reference centre for the sub-region because we have led in many areas. Lagos is advantageously positioned because there is nobody in Nigeria that can’t to get Lagos within one hour by flight. By the time you put good hotels around here, anybody can have their modularised treatment and get back quickly.
We have 250 hectares of land in Pakoto in Ifo area of Ogun state, we must take charge of it and build good meaningful structure there. Luckily, the railway line along that axis is going to be good, so that transportation between here and there will be stream less. There is no reason we shouldn’t build a robust annex there.
Why our doctors should practise in Nigeria
Our young doctors must dream beyond the present urge to just flee the country. They should think of what the country have done for them. It cost millions of naira to train one specialist doctor, when you aggregate the sum of money spent on teaching hospitals and divide it by the number of trainees we are having you will get an idea of what it takes. If that is it, what is coming back to the country? In good conscience if somebody have trained doctors with several millions and they just take off and go and be saying useless country, if we were so useless why are you not useless abroad?
We must teach our young trainees to recognize the value of the investment in them. The country deserves to reap the returns of that investment, both the capital and the profit. But you are running away with capital and profit to a country that has it more than us. So we shouldn’t use the left hand to point at us saying there is nothing good in this country, I object to that. I will say let them go, anybody that wants to go, let us train more to sustain the system and let those who go eventually think of what they can bring back for us. Some will come back and improve on what we already have, others can stay there and let our trainees come and benefit from them.
We too should also look for a good ambience in which we treat our health workers so that they wouldn’t flee the land. We must improve in security; take home pay and good working environment. What do they look for abroad? Good housing, transportation, security and better pay. We must improve the ambience generally for all Nigerians and not health workers alone.
If all Nigerians have health insurance, that money will take care of everybody and those who can’t pay. Less than 10 per cent of Nigerians are insured. If the money was there, and it is properly administered and it is judiciously implemented, there would be enough money to grow health care. The health care system we are running today subsidizes the cost of care we give. If cooking gas and petrol are all benchmarked on the international value, we can’t do healthcare like that. The cost of healthcare we give here is like 20 per cent or less than what I will charge internationally. They can’t pay the cost, so I just have to lower the cost and render the service.