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Nnamani�s hypothesis for Surgeon-General
KENNETH UGBECHIE
THE governor
of Enugu State, Chimaroke Nnamani, is a medical doctor. In fact, a specialist
obstetrician and gynaecologist. His sub-speciality is in maternal and fetal
medicine. Nnamani trained and practised in Nigeria and in the United States. As
an undergraduate medical student at the University of Nigeria, Nsukka (UNN), he
was a precocious student, showing flashes of brilliance.
Ask Professor Jonathan Azubuike, the
president of the 25-year-old National Post-graduate Medical College of Nigeria.
He was Nnamani�s teacher many years ago at the university. Azubuike, himself, is
an authority in paediatrics. One of the best in the country. He tutored Nnamani
and Peter Odili, the governor of Rivers State, both alumni of UNN.
Recently, precisely on September 16, 2004,
at the 22nd convocation ceremonies of the College, Professor Azubuike humoured
the audience when he audaciously announced that he taught Nnamani and Odili. The
audience didn�t quite catch his drift. So he went further. "But I taught them
only paediatrics not politics. I don�t know where they got that from". This got
the audience rocking with laughter. I guess they picked up politics on their own
out of the university. But it doesn�t matter now. The truth is that the
Professor�s students are professing politics now. And they are doing it well.
Even though six governors were to be
festooned with Honorary Fellowship awards of the College that day, only Nnamani
was physically present. Others sent in representatives. One or two were not
represented at all. This is not the thrust of this essay. But it is in itself
instructive. An empirical reflection of how much importance our leaders attach
to health. Invite the same number of governors to the birthday or even the
burial of a colleague�s parent, uncle or spouse. They will all march, hotfoot,
to the place. Of course, with their retinue of aides in tow. I just wonder why
some of our leaders cannot get over this hang-over of jamborees. Why they did
not drop this banally base trait of elevating and celebrating inanities on the
day they took up office.
Never! Here we are talking about health.
About scholarship. About life and living; about humanity and its values. They
shunned the occasion. You bet some would have said: National Post-graduate
Medical College of Nigeria? Who the hell are they? If they have lost their
stethoscope, they should say so. I will personally travel to Israel to shop for
stethoscope for them.
But they needed more than stethoscope.
They needed the governors� presence. For indeed, their presence would have
afforded them the opportunity of knowing more about this unsung but very
strategic institution. That it is not an equivalent of ICAN, COREN, or even the
Nigerian Law School. That the College is an extension of the university where
further training and skills are imparted on the doctors. That, to use the words
of Azubuike, the hospital are our classrooms. Our products (fellows) can move
straight to the university (medical school) to teach undergraduate medical
students. The governors needed to be there to get more insight into the
state of health and its challenges from the mouth of those who should know � the
practitioners. I was personally disturbed. Equally worried was Professor
Azubuike. And he voiced it.
Nevertheless, Nnamani more than made up
for the absence of his colleagues. When he stood to speak, it was with candour
and elegant locution, even authority. He spoke like someone with a full grasp of
the state of health in the country. Using Enugu State as reference, Nnamani gave
a synopsis of the health sector capping it with a prognosis of his vision for
health in his state and Nigeria.
He drew applause as he took the audience
through a mental tour of the various transformations he has wrought in his
state�s healthcare system. The highpoint of his espousal was the proposition for
the office of Surgeon-General of the Federation. That was not his first time of
mooting such idea. At various fora, at different times, Nnamani has consistently
canvassed for the appointment of a Surgeon-General for the country. If such
proposal is accepted, it will form part of the inevitable constitutional
amendment.
But why a Surgeon-General when there is a
minister of health? In simple term, a Surgeon-General is the highest medical
public officer in a country. Unlike a minister of health, he must be a medical
doctor with proven years of consummate practice. He is the link between the
government, the people and the medical profession. Unlike the minister of health
who may not be a medical doctor (the current minister of health is not a medical
doctor), a Surgeon-General must first and foremost be a high-ranking medical
practitioner with a back-to-back knowledge of the challenges in primary,
secondary and tertiary healthcare delivery.
While officials of the ministry of health
may not find the appointment of a Surgeon-General convenient, there are gory
statistics to suggest that the nation badly needs drastic health sector reforms.
Nigeria has about 10 physicians per 100,000 people. Canada has 229 per 100,000
while the United States boasts 250 per 100,000 people. Over 70 per cent of
Nigerians live below the poverty line or less than $1 (N140) per day. These
people, mostly in rural areas do not have access to medicare. By the current
rating of the World Health Organisation (WHO), Nigeria ranks 187th out of 191
countries in health performance.
There are many more. About 55,000 women
die every year from pregnancy-related complications. Neonatality rate is as high
as 35 per 1000 with about 170,000 neonates dying every year. While WHO
recommendation for developing countries is 11 per cent of total annual budget
for health, successive Nigerian governments find it hard to squeeze out as
little as three per cent. Even at that, the trend is that what is budgeted is
never released. This has created serious paralysis in the entire healthcare
delivery system.
Now the nation is in dire need of someone
to spring its healthcare out of the realm of red-tape, out of the path of
partisan politics. That someone must be a professional running his office
professionally, stripped of all the feathers and furs of civil service. That
person is the Surgeon-General. In the United States, he is the one who holds the
professional compass for all health-related policies of government. In Nigeria,
such person should be able to take a proper audit of the health sector; the
policies, the manpower, quality of capacity building for the practitioners with
the aim of achieving a strategic balance for sustainability.
This issue cannot really be over-emphasised. There is
something awfully wrong with healthcare in Nigeria. It is an emergency that
requires the attention of a surgeon, a true professional. And that surgeon is
the Surgeon-General of the Federation.
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