‘We are Meeting WHO, JCIA Standards in Federal Medical Centre, Umuahia’

The setting was very perfect. Professor Onyebuchi Chukwu, Honourable Minister of Health, had just concluded an inspection tour of Federal Medical Centre, FMC, Umuahia. The Minister in his remarks after the tour had highly commended Dr. Abali Chuku, Medical Director, FMC Umuahia and an ophthalmologist of international repute. Dr. Chuku is a seasoned administrator and the first Nigerian to bag the American Academy of Ophthalmology International Award is at the forefront of revolutionizing the foremost medical centre formerly known as Queen Elizabeth Hospital. Describe him as a round peg in a round hole, and you would have hit the bull’s eye. Dr. Chuku came to FMC, Umuahia with a wealth of experience, exposure and academic qualification, that no doubt, meet the requirements of him being capable of keying into President Jonathan’s Transformation Agenda in the health sector. He has brought vast exposure to the centre by introducing world standard practices to the hospital such as changing Nursing services from duty-based nursing to individualised-based nursing, where nurses relate with patients one-on-one. Staff of the medical centre are also being trained on AIDET which stands for Acknowledge, Introduce, Duration, Explain and Thank, an acronym for these stages of Customer Care areas. Ultra-modern infrastructure, state-of-the-art equipment, capacity building, invaluable innovations are part of the “Uncommon Transformation” going on at FMC, Umuahia. Naturally Dr. Chuku was in an expansive mood during the interview, after all he has been given a pass mark on his scorecard by the Honourable Minister of Health. The visionary who is driving the Transformation Agenda of President Goodluck Jonathan at the Centre gives a vivid account of what his Management Team is doing and indeed has done to take FMC Umuahia to greater heights. Excerpts:

Talking about your scorecard, what have you accomplished within this period?

Ok we now have an 88-bed new facility we said would reflect a three-star in-patient facility. We have furnished that and we have patients in it at the moment. We did promise them that we will have piped oxygen, piped suction machine and we will have monitors provided in each of the private rooms, and that we will make it suitable for any patient to feel comfortable. Not just having a hospital type of environment but an ambient environment that would be likened to a hotel. That we already have in place.

We have also moved on with our SAFE (Seek Area For Excellence) project. We have recorded a deepening of our SAFE project. We now have a cardiac-thoracic team that has been trained in India. We have the Urologist that has been exposed on TURP and he is doing cases already.

We have a fertility clinic that is now functional. Dr. Agwu Felix was trained on that under SAFE in India to provide invitro-fertilization. The ward is almost ready but he has commenced with the clinic services. We also have Dr. Ezeani who is providing diabetic care. FMC Umuahia has been said to be one of the best in the country. We have very modern equipment to back his practice of endocrinology and this is one of the few centres where the Glycated-Haemoglobin is used as an index for monitoring diabetic patients, we have quite a lot of other gadgets that we use to monitor these patients.

Apart from that, we have grown in our Family Medicine Department. We have recorded a lot of passes in the exams, we have created a Family Medicine Department in FMC Umuahia which ranks as one of the best in the country.

We have tried to remodel our theatre practice. We are one of the few establishments that are paying close attention to WHO standards on surgical safety. Even when the minister came, he actually asked us to prove our claim that we are already compliant and we brought the document and he was quite happy with us that we have been living up to that standard. We have done quite a lot of innovation in our theatre to make sure that it conforms to the WHO and JCIA accreditation standards. These are the things we are doing. Apart from these, we are also re-engineering our Nursing Service. Before now, we were doing what they call duty-based nursing but now we have changed to individualised-based nursing. Now our nurses own patients. They can identify patients that they can call their patients and they are expected to know everything about those patients say for instance in a ward of 20 where you have maybe about five nurses, each nurse will have about four patients. They will be expected to know each patient fully and that creates a better bond between that patient and the nurse and this is what we just borrowed from the exposure in the UK.

So, that this brings about a better care. We also emphasize on patients rights and out of the nine patients rights we emphasize mostly two basic ones namely the right to information and the right to emergency care. That virtually is what we have been putting in place for all our patients. We teach our staff that it is the right of patients to know who is treating them and what they are being treated for. These are the rights to information and then once a patient complains of discomfort or pain or is confused it is the duty of that staff to address that situation or find somebody that can address that and not to let the patient go until those issues are sorted out. So we believe that this has also improved hugely our perception to the public. Recently we have started a protocol which has been used by the Star Buck chain in the US – the curfew chain where they used to improve the customer care and it is called AIDET which stands for Acknowledge, Introduce, Duration, Explain and Thank. It is an acronym for these stages of Customer Care areas. We are training all our 1600 staff to be compliant to this AIDET protocol and we insist that every new staff coming in on employment must go through these training before we can engage them because we want staff that are patient-friendly that are customer-relation oriented so that we continue to change the perception of patients out there, that hospitals are not just where you come and be treated anyhow but it is also like a hospitality industry. Then there are other areas we are also trying to deepen like in our obstetrics and gynaecology. I have also told you about our in vitro fertilization, IVF. We have also improved our labour ward. We have modernised it. We have made it a lot neater, more friendly and it is a lot more convenient for our doctors to work in. The labour rooms are all air-conditioned and very, very comfortable and these have been provided at no extra cost to the patient. In the paediatric area, we have also put in place a lot more things like incubators and radiant warmer.

Everything you will need in order to meet up accreditation both West African and national postgraduates colleges. And we have been commended in various areas especially in our family medicine department. The West African and National Postgraduate Colleges have commended this family medicine as being one of the best in the country and that we are very proud of.

What about your dialysis unit?

We now have four dialysis machines in our dialysis unit and we have been doing dialysis since then. We still have hope to increase the number to 10 in due course.

We have one now dedicated to HIV patients. So that is already on board. Again this is one of the hospitals may be the only hospital that has a cardiac team. In FMC, Umuahia, we have a rule; we believe in teamwork. We believe that no patient should be at the mercy of one single consultant. So we try to form teams, like the endocrinology diabetic and metabolic team. It is a team of well over 12 consultants all coming together. We have the endocrinologist. We have the family physician, we have the paediatrician who is interested in endocrinology, we have the community physician who is interested in endocrinology, we have the ophthalmologist also with that bias along with the pharmacist and everybody coming together to see these patients and in that way when the patients problem is identified you just refer him to the next consultant. They are all in the same vicinity; in the same room and that improves the depth of care and knowing that you have other consultants with you looking over your shoulder to know what you are doing, that means you have to deepen your knowledge, you have to know what you are doing because it is accessible to the entire team. So you cannot afford to put down things that are not evidence based and we emphasize that only evidence-based practice should be entertained in these teams.

Also in the cardiac-thoracic like I said this is about the only hospital where we operate this cardiac-thoracic team. So we have all these specialists that are interested in cardiac care coming together to form the team. And we had before now sent them to India for training even as we speak we still have one of our cardiologists in India being trained to provide the service of pacemaker implantation. Dr. Kelechi, who is still there, will finish in the next two weeks and while he is studying there, we are already getting our equipment ready for him to be able to practice once he returns. We have our C-arm and all the pacemakers are already in place. Once he comes with the collaboration of their partners we will be able to start these things we are doing and do them well.

How is your palliative team doing?

They have grown and they have also gotten some recognition from the South African Groups. So they have been to some conferences around to showcase what we are doing here and to our surprise what we are doing here is really unique with respect to the palliative care and we have been commended in various ways. People will not really appreciate that the little you do also would have some international acclaim. So that too is going on.

We have also noticed that the level of cleanliness has improved tremendously. What is responsible for this?

When we came on board we insisted that we will re-enact for better expression the “Shell Camp Appeal” or the British Council Appeal. You know when you walk into the British Council for instance you feel you have walked into the UK. It is surprising that even in Nigeria that kind of scenario can be created and we said if they can do it why can’t we do the same. So we started borrowing that. It’s just for one to pay attention to excellence, to pay attention to doing things the right way. So we insist it has to be clean, it has to be green and there is no better place for a patient to recover than one that is green, clean and neat and that is why we are doing that. And we have a facility manager though it is an in-house facility manager arrangement because we trained our own admin staff in line with facility manager protocol so that they can provide this service. We have two of our admin officers that we re-designated in that and their responsibility is to make sure that this facility works, that the facility is clean and green and they have been doing a wonderful work. Of course we have backed them up. We are providing the equipment: the lawn mowers, the grass cutters and whatever it is that they need. Apart from that we also have an outsourced service that we insist that we pay only when the job is properly done and facility managers also supervise this. So once the job is done it has to be certified that this has been properly done on daily basis before we pay and this I think has helped to keep our centre clean.

What informed the provision of TV sets in almost all the wards in the hospital?

Yes, we feel even though our patients are ill but we don’t want them to feel ill. We want them to feel as if they are just being treated in their homes and make the stress of illness less difficult for them to bear especially in the children’s ward, you know children are so fond of cartoons and they are scared of nurses too. So we are trying to do two things actually, not only to have the TV but to have scrub, that is uniform for nurses that are more children friendly. Scrubs that are more colourful like they do in US and this is something we are introducing so that the child on seeing the nurse will not get scared. Because they are already used to these white wears every time and it doesn’t go well for most children. So we are changing all that to make them feel more at home than in a hospital and that again is what we are taking across the hospital to make patients feel that yes even though this is a hospital but it doesn’t have to be all spirit and spirit type of smell, something more amiable.

The welfare of workers in any organisation is key to the realisation of organisational goals. What has your relationship with the workers been?

Yes, it has been good. Apart from the first five months we had internal squabble which we addressed we have never had any local strike in FMC Umuahia. Even some of the national strikes at times those are the things we might have addressed in the hospital and so many times we may not be able to join the strike but the relationship between management and staff has been very cordial and we have not had such issues. Also on the welfare needs we are not owing anything. We are not owing any arrears of anything, any allowance or whatever except the ones that have not been appropriated in the budget. But we have not had any issue as you can see from the responses you get.

What are your challenges in this centre?

The usual challenge just like in any other hospital revolves around cash (fund). Revolve around funding. Capital release was very poor. Last year we had only 32 per cent of capital released to us. So even when you budget and have something in mind when only 32 per cent is released of course you will not be able to achieve as much.

So this is one of the huge challenges. Apart from that because in trying to implement the SAFE Project which we said is Seek Area For Excellence you may have identified an area where you believe you can excel but because of inadequate funding we may not be able to push every staff into that area because we need money in order to retrain that staff, we need money in order to procure equipment to enable that staff to implement what he or she has [being] trained and if you provide training and you are not able to back it up with equipment it will just lead to flight of that skilled manpower out of our own establishment or even outside the country. Because if we provide that skill and they are able to practice like in Europe and you are not able to provide the equipment they may feel obliged to seek where they can fulfil that practice elsewhere. So it is necessary that enough funding could come into an establishment like this especially where we think we have found the way out to improve health services in this country through a broad name, or expanding of this SAFE Project to cut across virtually every establishment in the country because we believe that this is the key to improving our health care in Nigeria.

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                                                                                     Packaged by Tony Uzomah

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