‘We Achieved our MDG in Maternal Mortality in 2012’

Looking back at how the health sector has fared since 1999, Rukevwe Ugwumba, Special Adviser to the Governor on Health Monitoring and a doctor, says “I’m very pleased with where we are today”. Ugwumba boasts that maternal/infant mortality rate and HIV/AIDS prevalence rate are the lowest in country courtesy of huge investments in health by Governor Emmanuel Uduaghan. She says, “this governor wants his legacy to be that a woman did not die during childbirth  

Dr Rukevwe Ugwumba ,Special Adviser to Delta State in Health (2)

Dr Rukevwe Ugwumba ,Special Adviser to Delta State in Health

May 29 marked 15 years of democracy in Nigeria. What progress has been made in the health sector in Delta State between 1999 to date?

I’m very, very pleased with where we are now in Delta State. We are fortunate to have consistent democracy in the last 15 years. And luckily for us, our commissioner for health who became the Secretary to the State Government (Emmanuel Uduaghan) later became the Governor of Delta State in the person of Dr. Emmanuel Eweta Uduaghan. And so, you can see that someone who’s been interested in health has been progressing through the ranks and I think one of the greatest achievements in our health sector is the tertiary institution which is the Delta State University Teaching Hospital, DELSUTH, at Oghara. I know it was conceived when he was commissioner for health and it was built by the previous administration; but it was completed, equipped and commissioned in 2010 under the present administration. Why I want to start with the tertiary institution is because I think it’s one of the things that we need to shout about because of the achievements of this tertiary institution.  I mean this is a government institution that is able to offer renal transplant. I don’t think any other government hospital is doing that. And of course the subsidised rate for dialysis which people are aware of is making our health care very accessible to the average and even low-income people. And so, this is really meaningful for the human capital agenda which is one of the three points of this administration’s agenda namely: peace and security, infrastructure development and human capital development.

Now, human capital, I think, is probably one of the most important because this is renewable capital.  If you have very good quality human beings, I think things can really be very different. And so, starting from the beginning when a woman is pregnant is when the health of the human being starts. This administration thought about it right from the beginning, talking about all our policies, to enable us harness this huge human capital: which is a healthy human being, and of course, an intelligent and skilled human being. This government has done a lot, going back to the tertiary institution which is Oghara Teaching Hospital. The administration conceived the idea that it wanted a centre of excellence and also a medical school. It’s very difficult to achieve both easily because of the huge cost to the government.

And so, you realise that, to get that, you need to bring in experts from the Diaspora. And Delta State is the only state where almost every specialty in the teaching hospital has foreign-trained doctors. They were recruited from the Diaspora directly and they were matched with their salaries so they can be retained. And of course the idea is not just to make the place nice but to actually transfer technology and train and teach people. Our radiology department, for instance, has the best, most sophisticated type of equipment. We are talking about a 64-slice CT scan, which is the same anywhere in the world. And we have what we call tele-medicine – tele-radiology, tele-pathology whereby the images that we take, we can send immediately to United States, England. Of course, we have the MRI which is again one of the best in the world. The MRI is very specialised for neurons which are the brain, spinal cord and those kinds of muscular skeletal issues because it’s relatively a vascular; and very few places have it. With that, you can do a lot of sophisticated operations and even detect very early brain tumours.  This is in addition to different types of X-ray, the mobile, the ultrasound, all that. So, our radiology unit is one of the best in the country.

Our laboratory services, it’s actually second to none. For you to be able to do a renal transplant, there are many things that have to work together. Synergy of all the departments is actually a test of the functionality of the hospital. Then you need the best reagents and best equipment with everything working in synergy.  Then talking about the other services: hip and knee replacement, even the brain surgery, neuron surgeries for brain tumours, we have the best probably.

 

Tell us how the recent renal transplant breakthrough was achieved at DELSUTH, Oghara?

The breakthrough was achieved this way: the governor realised that in a year, we donate certain amount of money to give medical assistance to Deltans who require assistance. And we found that before long, the money is finished, millions and millions of naira, because of people going to India to get a kidney. Many of them come back dead for various reasons or die not long after such trips and that showed that there was a huge gap that we needed to block. The Governor started consulting and we realised that we could actually do this; and so he got some partners from South Western University, Texas. We sent some people to the university to train for this surgery; they came in and inspected our things. So that’s how they now set a date to have the renal transplant done. And so a date was set and everyone came on board. That’s how it was done.

The two patients didn’t pay a dime because this was the test cases meant to show that we can do it.  There have been unprecedented flow of patients and we have scheduled another three to be done any time from now and these people will not pay more than two million naira. But this is the cheapest anywhere in the world and this is how we plan to do renal transplants every two, three months for people who are on the waiting list who have good matches. And I’m very, very proud that the people who have undergone the kidney transplant are very healthy; and so, this is a huge achievement.

Apart from the successful renal transplant, what other facilities or services make the Oghara Teaching Hospital tick?

Fantastic!  Our Neonatal Intensive Care Unit is second to none. I think we have the best in West Africa and one of the best in the world. There was a patient that needed to be transferred, I believe, from Abuja to the United Kingdom and when they made all the arrangement, she was advised to first go to Oghara instead of going to the UK. That was how the patient was transferred to Oghara and did very well. It is one of the achievements I’m very proud of.

Extending to that, the governor, in his wisdom, decided that we should give out free help lines, phone lines all over the state. When a premature baby is about to be born, the hospitals call to say that we are expecting this delivery, and this patient is going to be admitted at so, so time. Now, we can give them instruction depending on the quality of people there. So, they can maintain communication by phone; and that way, more babies will now be surviving. And even if they may not have the equipment at a certain level, they know what to do as a result of the communication; and, of course, we have the free ambulance services to transport them.

And then there’s the free service at the secondary centre which actually changed our statistics for maternal mortality. Another thing I’m very proud of which this government has achieved is the ambulance service of taking people from accident scenes to the hospital. A lot of people die on the road not necessarily by fracture but from internal bleeding as we’ve seen and so, the ambulance service actually makes a difference for victims of road traffic accidents which we know, kill most people more than sickness in Nigeria. So that is something that I’m proud of that was launched this year. There’s helpline and command centre where they coordinate it, and even now, people are using this helpline for emergencies at home, not just for the accidents on the road. This is what obtains in many parts of the world. People who have tested it said they got good responses.

 For the secondary centre, we have 64 hospitals and even, I would say, another tertiary institution, because the Mother and Child Hospital in Warri is really more than a secondary centre. It’s a 100-bed facility commissioned this year. The governor, because of the over-flow from the free maternal service, (the numbers have tremendously increased) felt we needed to build more centres. To refer to Oghara again, because we’ve provided all these services, and so many people are coming, our beds are always full. So the governor has now extended Oghara by 300 beds and they’ve drawn the design and work is starting right away. That’s huge.  Still on the secondary centre, you will realise that we are doing free maternal care, free Under-5 and free rural health care. And of course, Delta is one of the few states where we go round with our mobile clinic doing operations, carrying out surgeries, seeing out-patients, testing them.

Because of this, we now have a very good data for HIV in Delta State because we are testing all the pregnant women. All over the world, pregnant women are used as the indices for HIV status in the community. And because of our free rural health care our coverage is wide. Bill Gates Foundation has been very magnanimous in giving us free HIV/AIDS kits and many drugs to treat malaria, and there are so many other organisations like the UN, WHO and others that have given us a lot of support. So Delta State is not really alone in doing some of these things. If you show your data, you get a lot of support.  So going back to the secondary centres, the free maternal care created this need to build more hospitals. There’s another one going to be commissioned soon which is at Ekpan General Hospital. The 64 hospitals, some of them are not in great shape, and we’ve recognised that. Some of them have been remodeled to be world standard, like the Eku Baptist Hospital, which was also commissioned recently as part of activities for the 2014 Democracy Day celebrations. And so what the governor did this year was to send the House Committee on Health, with the commissioner and myself; we went round the 25 local governments and identified some hospitals, so that in every local government there will be at least two that are good enough. So we need to use a scale of preference and opportunity cost in a way that will save lives and this is what the governor is doing.

 I’m very proud of the fact that our maternal mortality ratio is the lowest in the country, and I would say maybe even in West Africa. I’m looking for single digit; I’m looking for zero where no woman would die from a preventable cause. In Delta State, we carry out Caesarean section for free. So overall, I’m very proud of our secondary facilities. All of them are not the same in terms of how they look, but the quality of service should be the same and we are interested in that. We have over 400 primary centres. WHO standard says, for every five square kilometre radius, there should be one primary health care centre and Delta State has over 400 at 18,000 square kilometres. That means we have more than double. Overall, I’m not as pleased with the primary health care because it’s under the purview of the local government which is not really under the state. So there’s a little bit of disconnect there which this government is trying to address because health is too important.

 

Dr Rukevwe Ugwumba ,Special Adviser to Delta State in Health (4)

Dr Rukevwe Ugwumba ,Special Adviser to Delta State in Health

 With all that the state government has invested in the health sector, how close is the state towards achieving the Millennium Development Goals, MDGs?  

Nigeria was given 250 for 100,000 maternal mortality ratio. In 2012, we got 226.  In 2013, we have 192 per 100,000. We achieved our MDG in 2012. So, for that, they didn’t give us a number per se for child mortality but reduced infant mortality. We have one of the lowest in the country. Preventable infection, HIV, we have the lowest in Nigeria, if not second lowest. The rate that they gave us, we even discounted it; they gave us point seven which is the national statistics. We have given ourselves higher. I think we’ve given ourselves two point something, still one of the lowest; because we are using so many things. Again, I can confirm the statistics to you. On malaria, we have distributed two million nets, which means most households have mosquito nets, treated nets. If you sleep under the net you don’t get malaria. Malaria is completely preventable. So, regarding the MDGs, Delta State is on top of it. This government understands the importance of health. This governor wants his legacy to be that a woman did not die during childbirth.

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