The Obafemi Awolowo University Teaching Hospital Complex (OAUTHC) is the first public tertiary health institution to carry out renal transplant in the country. Its Chairman, Matthew Urhoghide, wonders why many Nigerians are still seeking financial assistance to travel abroad for such treatment when they could do it at home at reduced cost. OYEYEMI GBENGA-MUSTAPHA met him.
ON 2002, the Obafemi Awolowo University Teaching Hospital (OAUTH) Complex, Ile Ife, Osun State, blazed the trail in renal transplant among public tertiary health institutions. Since then, it has done more than 12 other transplants. This is not its only feat. It has separated Siamese twins many times and also done cochlear implantation for the deaf or hard in hearing
OAUTH’s Ophthalmology Unit has also been up and doing. It uses techniques like the small incision cataract surgeries and is developing its Vitreo-Retinal Surgery unit. With over 250 laparoscopic surgeries performed since 2009 and a wide range of diagnostic and therapeutic gastrointestinal, respiratory and urological endoscopic procedures performed on routine basis, the hospital leads in minimal access surgery and surgical endoscopy. Open heart surgery in the Department has been done as well.
Yet, the hospital is underutilised despite having one of the best Nephrology Units in the country. The unit offers Haemodialysis and Continuous Ambulatory Peritoneal Dialysis, with the latter introduced in September, 1992 with the collaboration of the Renal Unit of the Manchester Royal Infirmary, United Kingdom and the Nephrology Unit of the University of Cairo, Egypt.
The institution has been training health care personnel for its kidney centre. A new kidney ward was opened in September 1992. The ultimate objective is to develop a kidney centre with comprehensive services that will include Kidney Transplantation. The Chairman, Matthew Urhoghide, a pharmacist, told The Nation during a tour that most modern equipment needed for nephrology care and renal transplant were available.
Availability
Urhoghide said setting up the kidney centre was a great challenge to management. Already the Federal Government has designated the OAUTH Complex as Centre for Renal (Kidney) care. All the sub-specialists: Nephrologists, Tissue Typing Officer, Renal Nurses, Renal Radiologist, Pathologist and Transplant surgeons were trained overseas in Manchester and Egypt to meet the challenges.
“Modern sophisticated diagnostic, haemodialysis and CAPD equipment give finest and accurate result in the management and treatment to kidney patients. The ultimate in renal replacement therapy is the kidney transplant. This hospital started to perform kidney transplantation from May, 2002. It has become routine procedure and all Nigerians are enjoined to take advantage of this highly specialised health care provisions.”
According to him, “The Federal Government has a transformational agenda for health; instead of our people going to access healthcare abroad, we should have specialised services in our hospitals. For instance, OAUTHC has the best facility in the area of kidney transplant. Most Nigerians are unaware that the teaching hospital as far back as early 2002 has done successful kidney transplant. There are other institutions that do kidney transplant in Nigeria, but they either depend on this teaching hospital or access foreign assistance. But for us, we are 100 per cent indigenous in kidney transplantation. Like Ilorin Teaching Hospital that does transplant, we take our specialists there to assist them.
“Again, ours is the only place where we have organ transplant theatre. Kidney transplant is not just taking someone to the theatre and harvest the kidney. The process that is required is that you’d use the right theatre and the specialists required are kidney surgeons. Before they can remove a kidney and replace it, there are other specialists, like the Nephrologists that must be present. We also have a Tissue Typing Laboratory where you first have to do some preliminary work of taking a part of the tissue, not necessarily the kidney, to match it with other person’s to see if the donor kidney will be compatible. Ours is the only hospital that has the Tissue Typing laboratory in Nigeria. Today, we’ve developed ours. We used to send samples to Egypt, but since our technology had improved and the specialists are in place to render such services, we have stopped sending samples abroad; rather, people send their tissue samples to us.
“More on daily basis, we now see Nigerians complaining of kidney diseases and asking for help. They would say they have opened an account and in need of N8 million to go to India for kidney transplant. The truth is that renal disease has become so rampant in Nigeria that we are looking at a statistic that one out of every 10 people has a compromised kidney. So, because of that problem, the government wants us to help Nigerians.”
Affordability
According to Urhoghide, it actually cost between N2.5million and N3 million to have a kidney transplant in OAUTHC.” The cheapest in India is about N7 million. The problem that goes with transplant in India, unlike when at home is that the patient has to be accompanied there. There is need to buy ticket for the person. By the time you are through, you have spent close to N10 million. But this is what we offer here. Medical services forbid advertising, but we need to create awareness on services that we now have here.
“In line with the objective of President Goodluck Jonathan’s transformation agenda in the health sector, we want to try as much as possible to reduce medical tourism because capital flight is involved. With overseas medical care, a patient spends up to two or three times of what is require here. It is no longer an excuse that the health facilities are not available here, actually they are. Instead of our political appointment holders going abroad or sponsoring people for foreign treatment, they can spend small fractions of the money and get the same services here in Ife. The benefit is not just in the wellness of the patient, though not less important, but also the wellness of the nation. Again, it can improve the economy of this whole community, Osun State and Nigeria as a whole. But before we can do that, people must be aware of what we can do. It is not the money we can make from it that is important but the value that we can add to human lives.”
Cost of haemodialysis
The Chairman said: “In every hospital in this country, up to University Teaching Hospital (UCH),s Ibadan, it costs between N30,000 and N40,000 to do a session of dialysis. Here, we charge N15,000. Why we charge that low is because of a tradition to charge the locals low to help them afford it. Again, we know that majority of the people who use this facility are not from here, but attracted by our lower prices. Besides transplantation, we also do endoscopic surgery, with minimal incision on the body. It is a highly specialised surgery and we have had 100 per cent success rate. What we do in teaching hospitals, unlike private hospitals, is that we don’t want a doctor to manage a patient; rather a full complement of the medical team. This makes wrong diagnosis impossible. Teaching hospital is indeed the place to go.”
Challenges of sustaining the kidney programme
Urhoghide said though the tertiary hospital is set and awaiting patronage, its success and sustenance largely depends on prompt payment. “The first challenge is raising the money for transplant; N2.5 million is much but N8 million for Indian care is far more traumatic. Second, we don’t have kidney donor readily. This is because the procedure is being done rampantly. By the time people come in and see what we are doing, it will get better. There was a time when people were so afraid to donate blood. But now, people freely walk to the Hematology Department to donate blood. We believe that after sometime, people will have the awareness and the humanitarian disposition to donate their kidney, because it can save anybody’s life.
“Somebody told us a pathetic story of how a young man was having kidney problem. The father wanted to donate his kidney, but after the tissue typing, they found that his kidney would not be compatible being far older than the young man. They tested the mother, and found that her kidney is just perfect for the patient. But the mother refused to donate her kidney. The marriage eventually collapsed because the boy died. Our people are ignorant that they can survive on one kidney. Someone can have one functional kidney that will carry him or her throughout life. We believe that if we are able to increase the public awareness, we will reduce kidney-related death rates in Nigeria.
“People are trouping to India, but they are not better than us. Our experts are everywhere including the United States where we have over 4,000 Nigerian specialists. People who have gone to India would tell you that even the environment is not better than what we have here,” he stated.
