Dr. Chukwuemeka Nwaneri is a doctoral researcher in type 2 Diabetes at the University of Chester and The Wirral University Teaching Hospital Foundation Trust, Arrowe Park Hospital, Upton, UK, under the auspices of the Gladstone Fellowship. The Founder of Continuing Medical Education Consult in Nigeria, shared his passion for medicine and other sundry issues in an online interview with HANNAH OJO.
Can you look back and tell us what influenced the choice of a career in the medical profession?
My choice of career was solely influenced by my grandfather in the late 1980s. I was only a child when I used to see him treat sick people with local herbs and leaves. I was a very inquisitive child and asked for explanations on how those shrubs, roots and herbs worked to stop the illness; for example, a convulsing child or toxic effects of snake venom. My grandfather was so gifted and people travelled from far and wide to consult him. My interest developed from there. However, I was very good in science subjects and mathematics.
Let us into your Educational Background?
Before I join the University of Chester, I was a Research Assistant at the University of Dublin, Trinity College Dublin; researching on the EU-FP 7 project on Global Health. I have worked in Ireland in various clinical capacities, from Psychiatry to Emergency Medicine at various hospitals between 2004 through 2008. I was the Community Medical Immunization Officer with the Hibernian Healthcare, Ireland for a short time in 2009. I also worked as an Honorary Senior House Officer at King’s College Hospital NHS Trust, London in the department of Medicine for the Elderly, in 2005. Prior to this, I had worked in the Nigerian Health System as Medical Officer in different disciplines of Medicine in different hospitals.
With your experience practicing medicine in developed countries, how do you rate the Nigerian Medical line?
Nigerian doctors remain a force to reckon with. We are products of high quality trainings from highly rated colleges of Medicine in Nigeria. We are constantly asked where we trained and told that we have good skills, knowledge, etc. This can be buttressed by the fact that many Nigerian doctors work across the globe, from Australia, UK, USA to Canada. However, there is need to changing the concept of contracts and the award of such in the refurbishing of hospitals. All we need is to translate these new skills and acquisitions to the practice at home where standards are yet to be met. This will improve the healthcare and standardise care.
Most of the best brains in medical line practice abroad. What is your take on this?
This is not entirely true at all! Unsurprisingly, most of the best brains are in Nigeria. Our teachers are the best brains; our colleagues in Nigeria are the best brains. What you see is that many of us abroad are either people who have opportunities or those who failed to acquire training positions in Nigeria, as the training positions are very competitive. It is the enabling environment that makes the difference and supports transatlantic migration of healthcare workers. 1955 through 1975 witnessed an exodus of British doctors from the National Health Service to Canada. In 2008; droves of Canadian doctors began migrating to the United States. When the Nigerian environment becomes enabling, you will see the exodus of Nigerian doctors out of Europe and USA back to Nigeria, like the way the Israelites travel upon establishment of the State of Israel in 1948. The government has to encourage us to come home to help establish solid healthcare structure. The structure is not gigantic buildings and large offices but system structure.
Ignorance is a disease by itself. Sometimes people say it is the culture of the people that make them successful. However, culture is dynamic. The major difference is that abroad, medicine is practiced with standards, protocols and guidelines. Your services (as a doctor) can be reviewed, reproduced, critiqued and transparent. Patients are given medications or prescriptions to procure themselves from pharmacies or administered by hospital pharmacists. These medications are not fake products. Nigerians struggle with recognition of fake medications. Medications are not easily sold on the streets.
People are accountable to what they do. Doctors are accountable to both patients and governments. Patients have rights to know what you are doing and why you are doing so. There are complaints procedures which are transparent. If Nigerian patients are empowered as such, they can contribute not only financially but to the way they are treated. Again medical practitioners abroad undergo continuing medical education and development. In addition, annual appraisal and 5 yearly revalidations are carried out for all doctors despite your position in the hospital. These approaches help improve the skills and knowledge of all doctors. You can now see the reasons why Nigerian politicians and the likes travel abroad for health care needs. Even India has become a destination area for unwell Nigerian businessmen and politicians who cannot access Europe or America. Both the private sector and government should invest greatly in health.
How can government intervene in the situation?
Government can intervene directly by investing enormous resources in health and addressing the key issues in the provision of standardised healthcare by putting evidence into practice (setting up guidelines, protocols and standards of care practice), and updating equipment with newer technologies while also benchmarking them for performances. This will reduce the variations in the treatment of patients and improve outcomes. Indirectly, they can do the same by advocating for continuing medical education for our doctors. The health and education sector account for less than 35% of government expenditure in Nigeria. We hope to work with governments at local, state and federal levels to help contribute to education, training, research and development of our health professional and therefore, reduce excess mortality.
What inspired you to establish the Continuing Medical Education Consult (CMEC)? What has been your experience so far?
The love I have for Nigeria and Nigerians inspires me. The experiences acquired from other colleagues outside Europe particularly Asians in uplifting their home medical practice individually and collectively is another inspiration. I have been able to convince experts within my horizon to help impact their skills and knowledge to our colleagues back home in Nigeria. We have realised how difficult it is for government alone to provide these services. CMEC is a professional services organisation dedicated to providing high quality professional development to medical and other allied health care staff. We strive to be one of the leading providers of credible up-to-date programmes, trainings and short courses nationwide for doctors, dental surgeons and other allied health care professionals. We provide face-to-face on-site continuing trainings in areas of electrocardiography, emergency radiology, arterial puncture and arterial blood gas analysis, emergency ultrasound level 1, basic Life Support, advanced life support, advanced Trauma Life Support, etc. We will also run workshops on Article writing and publication of articles in Journals. We also hope to support the efforts of our dedicated lecturers and medical practitioners in Nigeria by running Master Classes in major clinical emergency conditions with the aim of improving standards of practice.
How affordable is the CMEC service module to the average Nigerian doctor?
The CMEC module has a global reputation for delivery of some of the best training courses in medical education particularly ECGs, ABGs, emergency diagnostic analysis and other investigative tools in Nigeria. We hope to make it affordable as possible so that every medic can be able to procure a number of courses or trainings. As a result of the cost effectiveness, we have participants who have attended our courses more than twice since its inception.
Many diasporians lament about the challenges of running business in Nigeria, what has been your experience in this regard?
One of the greatest challenges is cost and attitude change especially as it relates to convincing our doctors on the need for change in the approach to treatment. In the words of Richard Hooker in 1554-1600, “change is not made without inconvenience even from worse to better”. We hope to ameliorate this by seeking the support from government and the pharmaceutical industries. This is because our staff strength incorporates both experts from the best teaching hospitals at home and our international partners. The synthesis of their wealth of experience from the foundation of the high quality teaching and training delivered by CMEC.
Now that a new government is in power, what areas of reforms would you want to see in the health sector?
The most important area of reform in the health sector is in the area of emergency medicine and approach to critically ill patients. People who present in the emergency units with critical and emergency health conditions should be treated in the first 48 hours without asking for payments or with-holding treatments because of lack of payments. We also need to follow the ABCD approach and standardise assessment and treatments. For the past 15 to 20 years, healthcare has been dwindling and standards compromised because of funding politics, and lack of appropriate educational trainings. Politicians are trading off quality health care for their selfish political gains. I have communicated to the new health minister, Prof Isaac Adewole to implement the use of ECGs in all government hospitals as part of initial triage system for patients coming to emergency units with chest pain, or in fact in all those above 45 years of age.