Lagos State Commissioner for Health, Dr. Jide Idris speaks to Gboyega Alaka on the new Cardiac and Renal Centre, which he says is state-of-the-art and rare in this part of the world.
The new Cardiac and Renal Centre is no doubt a welcome facility; tell us about it.
To start with, cardiovascular diseases and Renal diseases, that is heart diseases and kidney diseases, are classified under what we call non-communicable diseases. You would also recollect that the World Health Organisation, WHO, three years ago, declared that this category of diseases have attained an epidemic proportion, such that cardiovascular diseases were declared to be the leading cause of death worldwide. Even as a government, we ourselves have seen this in the course of our activities in the state. Lagos state is populated by about 22 million people and having attained the mega-city status, there are challenges that come with it; both the positive and negative. The negative has to do with the influx of cultures and lifestyle from across the globe. So we had designed strategies to address these issues.
Let’s talk about the standard of the facility. Nigerians would like to know how well they can trust this new hospital.
All the equipment are state-of-the-art and designed to provide that specialist care. I’m talking of that cutting edge special technology services that Nigerians travel out of the country to access. It’s a 3-floor building. The ground floor basically is for heart patients and kidney problems. There you can have 24 dialysis patients for people with renal diseases. The people who are diagnosed here are people whose illness have reached that advanced stage, called end stage renal disease. And there are only two ways these are managed. One is by dialysis, which is not a definitive management. Dialysis helps to cleanse the blood of the toxic wastes, the kidneys would have effectively cleansed if they were functioning normally. But like I said, it is not a definitive treatment, and is very expensive. Also you need to do it a minimum of three times a week. The major cure is through a kidney transplant. And you have to get a donor who has a functioning kidney, and whose kidney matches yours, so your body does not reject it, before they proceed with the transplant proper. That facility is there to take care of all of that, aside dialysis.
On the first floor, it is mostly heart patients they see. Here we have the CT scan for diagnosis; it has echo, more like ultra-sound for the heart that can do more detailed investigation concerning the blood and the vessels. They have the ECG and the echocardiography and they can do all sorts of tests for you there. On that same first floor is the high-dependency unit; more like intensive care, where patients can be monitored intensively. They also have other facilities for training. There is a lecture room, with a screen, which is linked with the theatre on the first floor, so that while you’re operating, everything is relayed to the theatre and you can teach the students in the process.
That means the centre is a veritable facility for the training of medical students as well.
Oh yes. On the second floor, we have the cardiac catherization lab. Basically it’s a huge state-of-the-art equipment. It can take x-rays; it can process the blood vessels from the veins, the heart and everywhere, to see whether there is a blockade or to see where the problems are. And if they see anything, they may not necessarily have to open up your body. They can pass the equipment through your system and open up the blockade. Where they cannot do that, and a require surgery, we have two state-of-the-art theatres, on that same floor. So we can carry out diagnoses and definitive treatments. You can also use the facility to train different categories of health workers: doctors, medical students, residents who are training to be consultants; we can train nurses and doctors on how to care for those who are on intensive care; we can train other health workers and sentries. All that is part of the package.
You said the government had designed a strategy to address health issues in the state. How did this facility fit into that design?
Now going back, we did not just decide to put up the facility. We had to start from the bottom. We had a strategy as a government to build infrastructure, to do primary health care, we do healthcare financing, we do health promotion and disease prevention. Health promotion and diseases prevention is very essential, because they are very crucial to cardiovascular diseases and renal diseases. These conditions arise as a result of risk factors of the people, which may be due to lifestyle, habit or diet. He I’m talking of your eatery habits, the Chinese restaurants, and co. Most of these foods are very high in salt, high in fat, high in so many things that you should not just take for granted. All these things predisposes you to having heart problems, because if you have too much fat, the fat could be deposited in your blood vessels and if it gets too much overtime, it can start narrowing those blood vessels, so that blood cannot flow properly. And if this happens, the heart is going to have to beat faster to pump the same amount of blood and if your heart continues to do that for so long, the heart is going to become weak and may not be able to pump as much again. That’s what is called heart failure. Again, if the fat blocks the vessel, this deprives the heart of oxygen and nutrients, and that part of the heart where the vessels supply can die. This is what is called heart attack.
Is this facility available for people who may want to do regular body checks?
No. It is a tertiary facility. It’s a referral hospital and if you allow just anybody to walk in, the people there would not be able to the job for which they are paid. They are performing specific expertise functions. The man, who is going to open your blood vessels, is not going to sit down and start asking you questions. As a government, we have the primary health care centres, we beef up the general hospitals, which are the secondary healthcare centres and LASUTH here is a tertiary health facility. 70% of the illnesses that you come across in this state can be treated at the primary health care centres. It is where they cannot take care of them there that you’re referred to the secondary facilities (the general hospitals); and is only if they cannot handle them there, that you’re referred to the tertiary facilities. Even at the teaching hospital, they have limitations, and that is why this facility (the CRC) is an annex of the teaching hospital and they can refer cases there. And here they don’t waste time, because by the time you get there, it’s an emergency or a difficult situation that requires serious diagnostic procedures.
The governor also said the place is open to patients even from the sub-region. Would that means that it is also a veritable income earner?
Oh yes, it has the potential to earn income, because not many facilities of its kind can be found in this part of the world. Take the cathlab (catherization lab) for instance. What we used to have in those days is much different from what we have now because of technological advancement.
There is also that part about the government providing free treatment for indigent Nigerians in need of treatment at the centre; how do you hope to accomplish that, considering that Nigerians like to take advantage of opportunities irrespective of their economic status?
The people managing the facility are doing it as a business. They’re going to pay the salaries of those recruited; they’re going to pay for consumables and several other things, so they have to make money. What we’ve done is to reach an agreement with the management that a fixed proportion of those people that are referred there from LASUTH will be treated free. They must also be certified to be indigent, and we have criteria for determining that. But if they’re more than ten percent, the state government will take care of the extras.
Can you give us a statistics of the rate of cardiac and renal cases in Nigeria, and how it prompted this facility?
Like I told you, it’s a continuum. We started with advocacy and sensitisation, telling people what hypertension is, what diabetes is, what kidney disease is; what can cause them; what kind of lifestyle can lead to them. Take for instance kidney diseases. There are many things that we do and take for granted in this part of the world that can lead to the situation. Take simple abuse of analgesics for instance. If you take too much of panadol, paracetamol, alabukun without recourse to proper dosage, they have effect on your kidney. Then also all the concoctions: paraga, alomo and all the likes, can affect your kidneys. I can tell that that is why we’re beginning to see all sorts of kidney disease cases today. Meanwhile the people don’t know. So what we did was start our screening exercise programmes, and from that, we discovered that about 30% of the people were hypertensive, which tallies with the global statistics. By the way, hypertension is a form of cardiovascular diseases. Worldwide, about 15 percent of the people have cardiovascular diseases. Now imagine that 10 percent of Lagos’ 22million people have this disease. That is about 2.2million. Still talking about kidney diseases, there is a serious shortage of resources in terms of where people can be treated. I don’t think we have more than 50 centres where people can go do dialysis in the whole of Nigeria. And about 30% of those are in Lagos and about 80% are in the private sector. So we still have a shortage of dialysis centres for people who need them. Now juxtapose that with our huge population of poor people, who cannot afford dialysis two times a week, not to talk of a kidney transplant.
Quoting the governor, ‘job done;’ but don’t you foresee the problem of pressure on the equipment, considering that this is the only facility of its kind in a country of 180million people?
Yes. I did say that by the time the facility is fully functional, it will be completely overwhelmed. And that’s why we need many more of it. By taking this step, we have shown that it is doable. It’s also an incentive for private organisations who might be interested to come in. I also know of a few states that are already taking a cue from Lagos state and are ready to replicate it.
Having a world class facility is one thing, having an up to per experts on ground to run it is another. Tell us of the staffing arrangement.
We have a shortage of very serious specialists in this country. We have very few cardiologists who can cater to the cardiac health issues that arise in the country. Ditto for nephrologists and urologists, for the kidney diseases. Besides, there are specific procedures that are required in diagnosing. Take for instance cardiac cathetarization. It’s a specialty called interventional cardiology. So we do not only use that machine to make a diagnosis, it can also institute treatment. And that’s special expertise. You need to have been trained in medicine; then you do a sub special in cardiology, and then a sub-sub special in interventional cardiology, before you can attain that specialty. There are very few of them in Nigerian. As a matter of fact, I don’t think they are up to five. And see the number of patients they need to see. The same with other four specialties you have in cardiology. Not to talk of urology and nephrology for kidney conditions. But what we discovered was that there are people, Nigerians, who are working in America or Britain, who have these expertises and we decided to attract them back with this kind of facility. And that’s why we have partnered with the group in charge now, the Renescor Team. They have the capacity to run the facility. It’s a consortium of people with the right expertise who are either in Britain or America; most of them, Nigerians. Not only that, we needed nurses who have specialty in intensive care. But part of the agreement is that there must be proper skills transfer to our people. So, they’re going to have a proper handshake with LASUTH, where they can treat residents, train medical students, and consultants who want expertise in certain areas can be trained, along with the nurses. We actually threw it open and organisations applied, and that’s how we settled for Renescor.
There is that brash habit of our medical personnel that even our own people complain about and which they say is non-existent in the foreign hospitals; what measures are you putting in place to make sure that does not rear its ugly head in this new environment?
No, that’s not likely. One of the significant points to note is that those people are coming over with a different culture. And it is that culture that they’re bringing over that they will automatically transfer to the new staff they employ. So this kind of thing will not happen in this facility.
As we speak, has there been any major operation carried out at the centre, be it cardiac or renal?
Even before we commissioned the centre, we’ve had over 160 dialysis sessions. Because we had to be sure all the equipments were working well. I also know that about four patients have been attended to in the cardiac catherization lab. And, no, they’ve not done a kidney transplant yet. That process is a bit long. We should get there within the next six months. Don’t forget you have to make the diagnosis, look for a donor, match the donor; and prepare the patient for the transplant. But if you’re asking whether they can carry out a successful kidney transplant or other major heart surgeries, I’d say yes.
What are the chances of children with hole in the heart?
Oh yes. With that cath facility they can repair a lot of them there, depending on the nature. Or they can make use of any of the other two theatres. A lot of the children with hole in the heart can be treated there. Some of them are minor while some are more complex. The complex cases, once they finish the operation, they take them to the intensive care section, where the nurses and other personnel will take good care of them.
Cancer. When are we going to get round to that?
Well if you look at that hospital in Gbagada, there is an undeveloped space not too far from the Cardiac and Renal Centre, earmarked for a cancer centre. There is a space where we’re going to have a full diagnostic centre, with facilities to support the projected Cancer Centre, the Cardiac and Renal Centre and all the other health facilities. We also have spaces reserved for hotel-styled accommodation, where people who come from afar can stay with their escorts, or even the experts we bring in can also stay.
Your message to Lagosians and indeed Nigerians regarding this facility and other health issues.
Adopt proper lifestyles; check your diet; no smoking; no excessive drinking; because all these things have their effects on the heart and kidneys. Go for regular exercises, so that you don’t get overweight, because all these predispose you to heart and kidney problems. Go for regular checkups and do what your doctors say. Most especially however, if you develop any of these conditions after taking all these care, be rest assured that you have a place in Lagos State, where they can carry out all the necessary treatment on you, without you having to travel out at high cost.
