•I’m always anxious for the day to break, to see who is coming to consult me and what I can do to help
Biodun Ogungbo is one of the most charismatic medical doctors you will ever meet. Except you are told, you may not know that he is world class and a UK registered specialist in Neurosurgery. He is also registered by the Nigerian Medical and Dental Council as a specialist neurosurgeon.This Medical Director of Brain and Spine Surgery Consortium Abuja, shares the challenges of practicing neurosurgery in Nigeria with Stanley Nkwazema
Neurosurgeons are rare species in Nigeria with just about 74 for a population of about 180 million. Of the 26 accredited medical schools, only six offer Neurosurgery. In contrast, the total number of neurosurgeons in Japan exceeds 7,500, with 5,432 board certified and actively practicing neurosurgery. Japan also has almost 1,000 hospitals including 80 teaching hospitals capable of training doctors as neurosurgeons. As of January 2012, there were approximately 3,689 practicing board-certified neurosurgeons for over 5,700 hospitals in the U.S.A. The challenges are indeed enormous in Nigeria, says Biodun Ogungbo, one of the 74 neurosurgeons we have in this country.
Ogungbo was indeed well baked for this job. After his MBBS degree at the University of Lagos, he proceeded to the United Kingdom where he trained at James Cook University Hospital in Middlesbrough and Newcastle General Hospital. Further training at Western General Hospital in Edinburgh and the Walton Center for Neurology and Neurosurgery in Liverpool followed. Since his return to the country, he has been actively supporting medical education in Nigeria. He also has a passion for helping people with neurology, spine and stroke challenges, though, greatly constrained by the difficult business environment especially for private medical operators in Nigeria.
He talks about his background: “I had my secondary education at Jubril Martins Memorial Secondary School, Iponri, Lagos State and thereafter proceeded to St. Gregory’s College, Obalende, for A levels and then to the University of Lagos for MBBS. I did my Houseman-ship at the General hospital Abeokuta and my NYSC at General Hospital Ijebu-Ode. After NYSC, I went back to Lagos and worked with some private hospitals before I decided to go for postgraduate training in the United Kingdom, where I specialised in neurosurgery.
“I had my training in what was called the Northern Deanery in England, which consisted of Newcastle General Hospital and Middlesbrough General Hospital. At that time, you had to train at these two hospitals to get the complete training. After that, I continued with my training and fellowships. I went for Vascular Fellowship at the Walton in Liverpool and Brain Tumor Surgery fellowship at the Western General Hospital in Edinburgh, Scotland. Once I completed my training and fellowships I returned to Nigeria.”
Why the interest in Neurosurgery? Ogungbo said: “Interest in neurosurgery was not why I travelled abroad for further training. I actually travelled to train in trauma and orthopedics, but somewhere along the line fell into neurosurgery and everything else paled into insignificance. When I discovered neurosurgery, I was completely at home with it, quite happy and comfortable, something like yes, this is it, this is what I would be happy doing for the rest of my life.”
He fell in love with Neurosurgery within two weeks of resuming at the Radcliffe Infirmary, Oxford. “There was Christopher Adams, an excellent and exceptional neurosurgeon. He made neurosurgery seem so easy and after two weeks of working in that unit, I also thought it was easy because of the passion and interest. When I wake up these days, I am very excited to go to work. Many times, I can’t wait for the day to break and see who is coming to consult me and what I can do to help. For me, it’s akin to being a detective, where you know that once you put the pieces together, you can get the full picture and if you have a picture, then you will know exactly what you are doing. I find it very easy; hence it’s enjoyable and makes me love what I am doing a lot.”
He never wanted to live outside the shores of this country: “I didn’t even have it in mind to travel out but at some point, while working in private practice, I realised I was not giving my best. Yes, you can go set up a hospital and start general practice but I think if one is honest, there are times when you know that you are out of your depth. Once I came to that conclusion, I decided that it was best I train as a specialist. Then, I knew I had to travel out for specialist training.”
To Ogungbo, there are mixed feelings when he remembers his days at the National Hospital. “I had a very interesting seven months at the National Hospital. I would say it was both fascinating and frustrating in the same breath. But I was only able to withstand the frustration for seven months. I knew what I wanted to do, and for neurosurgery especially, when you have a patient, you can’t waste time while they are visibly deteriorating. Hence, it was always impossible and very painful for me to fold my hands and say we can’t do this or we can’t do that, because of so many different issues.
“I honestly couldn’t continue that way. It was either I close my eyes to the way or reasons patients are suffering or get out of the system and do it my way. So, it was better for my own sanity to practice neurosurgery my way. If I want to operate on someone now, I can arrange it without sweating buckets. It’s not that I have to wait until it’s my own operating day next week or we can’t do it because something else is happening in the theatre. For me, my patients are the number one priority. It doesn’t matter what else is going on.
“At the National Hospital, I couldn’t tolerate not being able to operate when I want to because it impacts on the outcome. The outcome has always been and continues to be the most important thing. I go to international conferences to present what I am doing and I need to stand up and say these are my results. And those results were dependent on getting good outcomes for patients. There is no way that you will go to a conference and say we did this number of operations but all the patients died because of PHCN, because there was no ventilator, etc. You can’t stand and say that. So, it was better for me to leave so I could create an environment that would give me the outcomes that I wanted for my patients. All public medical facilities in Nigeria have the same narrative. Doctors are constantly working with limited resources and improvising.”
Interestingly, Ogungbo feels one of the things hindering progress in Nigeria’s health sector is the lack of government commitment to healthcare. “There must be leadership from the top and that commitment must translate into proper funding because healthcare is not cheap especially tertiary healthcare. No matter how rich you are, you will lose every penny if you have a prolonged health challenge. Even people who are extremely rich will be prepared to spend the last penny to get a good outcome from stroke or cancer.
“Nobody can afford ill health. This is why Nigerians need to get it to the consciousness of the government that they must invest in healthcare even if for themselves in the first instance. They can even do it for selfish reasons; in case they fall sick but that’s being selfish in a positive way. Instead of thinking ‘I have enough money for my family and I to go abroad in case we fall sick’. Because whatever they build locally will still make an impact on the whole nation. And truly in some medical emergencies, the most valuable resource is time.”
Some of his most challenging cases have been patients with brain tumors and strokes. “I have had cases of brain tumors in very delicate areas that require a different level of skill, expertise, and equipment. In many situations, we have had people that are in dire straits that they can’t travel out (due to pain, disability or in coma). So, they need to have their operations done here and yet we cannot totally provide everything that they need in terms of personnel, equipment and that is frustrating.
“Neurosurgery is teamwork. It doesn’t matter how skilled you are, even the cleaner, nurse, and physiotherapist or anesthetist can scupper the operation. You need to have a full team but that full team only matures with time and that’s the kind of journey we had. Nigerian healthcare has become a healthcare of improvisation because many times, you don’t have the right set of equipment for certain procedures so you adapt what you have or is available.
“More often than not, you don’t have them because they are quite expensive and if you invest in them, you might not recoup the investment. The cost of healthcare has so gone up astronomically that people can’t afford it but they still show up expecting to be given the best, first-class care and it doesn’t work that way.”
He has the answer to some of the problems: “I think what we are hoping for is to start with primary healthcare. We must get that right. We must also make the National Health Insurance Scheme work. Secondly, hundreds of Nigerian doctors working abroad are quite keen to come back home, but regardless of how well trained they are, if they don’t have access to patients, if they don’t have the right support, even with nurses or physiotherapists and other healthcare personnel, they will not be able to deliver the quality of care that they want to deliver.
“If we can get the basics right; if we can get our primary healthcare sorted; then a lot of things will fall into place. It is not so much about having big hospitals because we have had big hospitals that have failed actually especially in the public sector. Big hospitals with all the required equipment, expertise and manpower from abroad, with all the skill and expertise available that hospital has failed and some have now closed down.
“This is why in trying to reverse medical tourism, we must make sure that our primary and secondary healthcare facilities are properly sorted. Such that people who go to our tertiary healthcare facilities are people who deserve to be there. Otherwise, our big hospitals are busy treating malaria and typhoid fever.
“Almost all of our new patients come by way of referrals from old and or existing patients because we are not allowed to advertise, so we only depend on the word of mouth referrals of satisfied patients and it’s encouraging to us to know that our work is appreciated enough for satisfactory referrals. We also do an audit and follow up on our patients even after one to two years to ask how they are. Every year, we call up our patients with particular conditions and ask them how they are, and consistently we have found out almost all our patients will come back again to do the surgeries here with us if the need arises. And these are people who have the means to travel abroad for their operations and treatments.”