Dr. Azubuike Onyebuchi is the new Chief Medical Director, Federal Medical Centre, Umuahia. As he clocked 100 days in office last Thursday, he talked about ongoing plans to transform the hospital into a world-class organ transplant centre and other medical and administrative measures being put in place to make the hospital accessible for patients across Nigeria. Martins Ifijeh brings excerpts
You’ve spent over 100 days in office, how has the experience been?
This is a Federal Medical Centre (FMC) and I came from a teaching hospital background. So, basically, that concept of training of medical students and other health professionals might not just be as it is in an FMC. However, the core functions of a tertiary hospital which includes service delivery, training, and retraining of health manpower and research are also in FMC Umuahia.
What are the things lacking here and what have you done so far about them?
What I have done first is to re-motivate the staff. Before I came on board, most of the service delivery points lacked things they required to work. I understood from them that that was a major problem and they required me to change the narrative and make sure that all the things, logistics, consumables and supports that they needed to work with are provided for them and that I have tried to do. I also noticed that the working environment in most of the workplaces was dilapidated, hence workers did not have job satisfaction. I have tried to address that. I also noticed that their morale was low because most of them have been denied some forms of promotion, sponsorship or things like that that will motivate them to work better. We have sponsored some health professionals to both local and international conferences and promoting some people who have some backlog of promotion through the help of the hospital management.
What are the major challenges you have encountered so far?
We need more modern medical equipment to function like the CT-scan which you know is a very good radiological investigation for almost anything. We are working very hard to put that in order. The Intensive Care Unit where you take care of very sick people is not properly established and the equipment, we require to monitor people who are critically ill are not there. We have decided to work on those aspects and try to bring in as more modern things as we can to help our people. In the ICU now, we have new ventilators, new string pumps, new infusion pumps, new modern monitors that you can use to monitor patients who are critically ill.
We have also tried to provide for the cardiology unit a state of the art 2D echo machine that can look at you and tell you how your heart is functioning and that has brought a lot of relief to our cardiac patients and also job satisfaction for the cardiologists. They had to come here as a group to thank me for doing that for the department and it has helped them to save a lot of cost for patients who were formerly managed by not looking at their hearts. One had to tell a story of a patient who had massive pericarditis and was been treated as a case of cardiomyopathy, but with the aid of that 2D echo machine, they were able to look into the heart, pick the fluid and the patient got well and went home, but they were initially thinking it was cardiomyopathy.
So, without that machine, they would have been treating the wrong thing. So, we need more modern diagnostic machines to be able to make the correct diagnosis and of course, treat. We are also trying to renovate places that are bad. If you go to the maternity ward complex now, both the Obioma and Nkasiobi wards where incidentally I was born and my mother told me that the place has been like that since I was born and it was still like that for some time. I have completely renovated the Obioma and the Nkasiobi wards within my first 100 days in office.
If you go there, you’ll be impressed and be happy to send your wife there to get delivered of your child. We have also renovated the dental and ear, nose and throat complex. It was about collapsing when I came on board, but if you go there now the story has changed. That has motivated the staff as they are now happy to work. We are pushing ahead to lobby the necessary people both at the National Assembly and the ministry of health to get things here. I have been able to attract in the budget, a building of a modern accident and emergency unit, and an ICU. If you go to our accident and emergency unit, you feel sorry for the patients there because the place is overcrowded and overburdened by cases that hitherto should have been managed at the primary and secondary health care facilities. But because those systems of health care facilities have collapsed, the whole pressure is coming on the tertiary hospital. Sometimes you see patients lying on the floor. We can’t reject patients inasmuch as space is small. So, I’ve been able to attract modern building for such and it’s included in the 2019 budget and by the grace of God, once they release fund, we’ll take off and before the end of our first tenure.
The previous administration was applauded for an organ transplant, what do you intend to do in that area?
Yes, we have sustained what was done by the previous administration. I’ve had a renal transplant done after taking over as the medical director. We did not use the American partners; we used our own Nigerian partners and that reduced cost. So, we intend to consolidate on that and bring in more plants. Part of my long-term plans for this hospital is to have a transplant centre here not just renal transplant, but for other areas. It will include renal, cornea, liver and whatever things that can be transplanted will be done there. We are talking with our brothers and sisters who are transplant surgeons abroad and they said the best thing is to have a transplant centre.
What do you want FMC Umuahia to be like at the end of your tenure?
I want FMC Umuahia to be transformed from a Federal Medical Centre to a Federal Teaching Hospital. That’s what I’ll want to be remembered for and by the grace of God, we’ll get it from this president who listens to genuine concerns. I want the narratives to change from when people say if you are going to FMC, you are going to die, to a situation where people will now say, if you are going to FMC, you are going to get healing because the staff would have been motivated, retrained and their attitudes changed and the hospital known for patient-centeredness and patient-friendly hospital.
Are you comfortable with your staff strength, especially medical health workers?
I’m not comfortable. Basically, we’re lacking resident doctors. And that’s one thing we’ve tried to change. I’ve made the case for a waiver to take more health professionals and that waiver is getting attention at the Head of Service Office and I’m very sure that soon that waiver will be granted and we’ll employ more health professionals. The health workforce is obviously inadequate.
How do you tend to handle the issue of frosty relationship between nurses and patient?
It will be very unprofessional of me to stick out nurses for the attitude of our health professionals on patients. We’ve already started retraining our nurses, doctors, other health professionals and non-health professionals who are also working here to change their attitudes towards the patients. Without the patients, every one of us will be in the labour market. I’ve made this clear to them throughout my interactions with them. So, whatever we have to do to make our patients comfortable, we all have to do that. I’ve made them institute a regular training and collaborations with institutions abroad so that they come down here and have some in-house training for them to see the international practice of how a nurse should relate with his or her patients.
What do you intend to do to improve the internally generated revenue of the hospital?
With money, you can do almost everything you want to do. And increasing the Internally Generated Revenue (IGR) of every organisation is what every CEO must try to do. First thing is to improve services; make sure that clinical services are of high quality. That’s why I said we have to get the CT Scan and labs back to functionality. In the radiology section, we’ve refurbished all the x-ray machines, we’ve provided backups for the ultrasounds, we’ve resuscitated the mammograms so that all those services will be functional and once they’re functional and people know, they’ll access them and your IGR will grow.
Secondly, we’ve tried to block up all loopholes, automate our revenue collection system. If you look around, you’ll see wires and computers going around the whole hospital. The idea is to automate our revenue collection and reduce the physical involvement of individuals and block loopholes where people mismanage funds that we naturally should have gotten. So, with automation, I know that our IGR is going to go up. We also aim at creating more services for our people.
What are you going to do to checkmate the issue of diversion of patients by some doctors?
We are trying to automate the electronic medical records. With that, we will reduce the physical contact between health professionals and patients who had walked into this hospital willingly because everything you’re doing is going to be through the computer. If I see a patient, he is entered into the computer. He wants to go and get his drugs, the doctor keys in his prescription on the computer and he goes to the pharmacy, so there will be no prescription sheet to take away. That’s one diversion that will be reduced. If you’re supposed to be sent to go to the lab, it will be keyed into the system and you go to the lab and the lab will say the investigation you’re supposed to do, you go and pay, they’ll give you a computer-generated receipt, you come back to get your investigations done. That will reduce the lab forms being filled and taken away to outside labs in town. In terms of doctors diverting patients, once your name is keyed in the system, the doctor who is following you will also be keyed into the system. So, we’re thinking about that, we are also talking to the doctors that anybody who is caught diverting patients that have willingly walked into this hospital will be dealt with according to public service rules.