As of Monday evening, 31 cases of monkeypox had been recorded in seven states.
No case has been recorded. Suspected cases were reported.
But do you agree that it has become an embarrassment to the government?
Why is that?
Because from knowledge of public health worldwide, what we know is that there will be outbreaks. Interestingly, what we don’t know is where and when it will happen. And what has made it so common now is the ease of communication. The world has become a global village. If someone has an infection in China today; tomorrow, it can be in Nigeria. And during the incubation period, anyone can carry the infection around and you will not know. There is always an incubation period for every infection and during that period, that person may not manifest evidence of that infection and will infect other people and that is what makes it more difficult and more challenging. Another factor is global warming. New diseases which never existed are now coming up and the social media has made the mass media to pick information more easily. In a village, we lost 17 people to Lassa fever in Fuka (in Niger State) and nobody knew. So, the GSM and social media have made news travel faster but it has also created unnecessary panic because even when it is not monkeypox, people will get scared. The current episodes we have have not been confirmed. So, when it is confirmed, you may be shocked that not all the cases are monkeypox.
How soon do we expect a definite diagnosis of monkeypox?
Well, the confirmation is being processed by Christian Happi, a professor of Molecular Biology and Genomics in the Department of Biological Sciences, and the Director, African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, and should be out by Saturday. The beauty of his work is that if it is not monkeypox, he will let us know what it is. It might be an old infection, a new one or monkeypox.
You said in a statement last week that test samples were sent to Dakar in Senegal for analysis. Isn’t it an embarrassment that we can’t do the tests in Nigeria?
The usual practice is to send out double samples because you really want to be sure. So, we sent out samples to the World Health Organisation’s recognised laboratory in Senegal and we also have one here being processed by Prof. Happi at the Centre of Excellence for Genomics of Infectious Diseases. We will then look at the two. But from the information from Prof. Happi’s lab, his technique is even more advanced than the one in Dakar.
Many are of the view that if the monkeypox had been better managed, it would not have been this severe. Would you say it has been well-managed?
First of all, the monkeypox is not even severe. We have not recorded any mortality. The few people that have it are recovering so that is not even a severe infection. Secondly, we know that when people have infection, they run to places where they can get a cure and that also makes it spread. If someone has an infection today, he may decide to come to the National Hospital in Abuja, believing that he can get a cure. On his way to the National Hospital, he will board a public vehicle, sit with people and infect them; he will enter the National Hospital, pretend to have an ordinary fever and then infect other people. I think this is what complicates infectious diseases.
It is said that most viruses don’t have a cure. Monkeypox is also a virus. So, how is it being managed?
Not all viruses are incurable. However, many don’t (have cures). We have vaccines for some while we don’t for some others. For monkeypox, there is no vaccine and there is no treatment. So, we give them supportive treatment, make sure they are given analgesics, treat their fever, treat their infections and the body’s defence takes over.
Health is on the concurrent list. So, who should be blamed for the spread of these infectious diseases?
I don’t want to be involved in a blame game. What I think needs to be done is to assign responsibilities. The responsibility for early detection, diagnosis and response is a collective one. What we need to do, and which this administration is doing, is to build a resilient system across all tiers of government, from primary health care to secondary and then tertiary, where even with one case of infection, we will be able to pick it and respond appropriately. It is when we are not informed early that we get into trouble. In Fuka, we had lost 17 people before we got to know (about the cases of Lassa fever there). The meningitis outbreak in Zamfara was on for almost three months before we got to know about it. So, rather than blame state governments, I will rather appeal to them to notify us on time. Secondly, state governments need to spend more on health and build up human resources and also revitalise their systems.
In the last year and a half, we have had Lassa fever, meningitis and now monkeypox. What is causing all these and will you say these epidemics have been managed properly? Who should take the blame?
Again you are taking me to the blame game. We have suffered a delay in notification and that is why we are having the spread. Meningitis is a common problem. As a medical student, I managed meningitis; I did a Lumbar Puncture. Meningitis occurs and it is treatable but to identify it on time, you need a strong health system. You need a doctor, a nurse, medical social workers, pharmacists and others working together. If they are all in place, they will easily identify meningitis and treat it and then advise the family on how to manage it and ensure that it doesn’t spread. But when you have this gap, you will lose the first and second cases and then they spread; that is why we are having these problems. What it signifies is that there is a disconnect between the various components of the nation’s health system. We can achieve more when we work together better. But what is also happening is that we have strengthened the federal (system) and the states’ (systems) are weaker. For instance, at the federal level, we have over 300 surveillance officers or disease inspectors trained to detect diseases. We didn’t have this before. So, what has happened is that we have enhanced our capability to predict and detect infections because of this group of officers and when it happens, we dispatch them immediately. They were never there before. These are products of the handling of the Ebola outbreak and what we are trying to do now is to make the Federal Government absorb them and then we dispatch them to all the states so that they will be on standby, ready to identify any outbreak and notify us appropriately.
Nigeria has been importing vaccines since 1991 when the production lab at Yaba folded up. Do we blame these incessant epidemics on the inability of Nigeria to produce its own vaccines?
Well, not really. There is no vaccine for Lassa fever and there is none for monkeypox. So, we cannot really blame these outbreaks on lack of vaccine. But the vaccines could have helped us in other areas. I think the fact that we did not reactivate the vaccine centre is a major blunder. Nigeria was exporting vaccines in the 1960s, 1970s and even in the 1980s, and then, we said we wanted to renovate the lab but we never did since 1991. But this administration is committed to making things right. We have signed a joint venture agreement with May and Baker and in the next two years, that lab will start functioning.
Will the Ministry of Health be working in conjunction with the Ministry of Interior to ensure that cases of monkeypox do not come in through our porous borders?
We don’t believe monkeypox was imported into Nigeria unlike Ebola. I think we had an edge in the treatment of Ebola because it was already ravaging Liberia, Guinea and Sierra Leone and so, Nigeria was waiting for it in case it came in. And then, we had one case of importation and it was very easy for us to circle that one case and thank God for First Consultant Hospital that was able to raise the alarm, even though, it came two days late. We lost people, but it could have been worse. If Patrick Sawyer (Patient Zero) had driven into Nigeria, and headed straight to Lagos University Teaching Hospital, it would have been disastrous. In the course of driving through Idi Iroko and heading to LUTH, he would have been in contact with about 1,000 people and that would have been disastrous. But he came in by air. He was ill and then went to First Consultant Hospital, a private facility, which limited his contact (with other people). That happened to be our saving grace.
Is it true that the failure of the Federal Government to release the money required by various ministries has hampered many of your programmes in the Ministry of Health?
That is not true. I can speak for my ministry and I can say that apart from receiving money, the Federal Government also released N3.5bn for us to use in tackling measles and we are mounting a nationwide response to measles so that we will not have an outbreak of measles next year.
Is measles a threat? After all, children receive immunisation against the disease.
Many people don’t get immunised against measles and we are beginning to see it among six to nine year-old children. So, what we want to do is to vaccinate all children so that measles will not be a problem.
Health is in the concurrent legislative list, whereas many states are cash-strapped and unable to even pay salaries. Will there be an emergency financial intervention for the states affected by suspected monkeypox disease?
Well, that is for Mr. President to determine and not me. I think when states were given bailouts, the emphasis was on salary. It wasn’t stated that all the money should be spent on salaries but they were asked to clear their backlog of unpaid salaries. If there is a need for an intervention in the health sector, I am sure the Federal Government will be willing to assist.
It has been said that one of the biggest problems in the health sector is the inadequate number of doctors and yet many doctors find it difficult to secure placement for ‘housemanship’. What is your ministry doing about this?
The problem is not really about inadequate doctors but the distribution of doctors. Over 60 per cent of the doctors in Nigeria are in Lagos and Abuja because the doctors are human beings and also do not want to go to rural areas. I think what we need to do is to offer incentives, such as rural posting allowance, that will really make them go there and will also ensure that schools that their children can attend, and other facilities that will make them want to stay there, are available. Otherwise, nobody will want to stay there without incentives. Also, we need to encourage state governments to pay appropriate wages as prescribed by the Federal Government. If they don’t, even if adverts are placed tomorrow, nobody will apply. But we are trying to offset that by using some temporary approaches. About a month ago, we signed a Memorandum of Understanding with Sokoto State and Usmanu Danfodiyo University Teaching Hospital so that doctors working in UDUTH will partner with Sokoto State and the state can then benefit from the huge human capital in UDUTH. UDUTH has over a thousand doctors, which is about three to four times the number of doctors in the employ of the Sokoto State Government.
With the different issues in the sector, ranging from lack of equipment to inadequate funding, which has led to increasing medical tourism yearly, is it not high time Nigeria declared emergency in the health sector?
If it is to make noise, then ‘yes’, but we don’t need to declare a state of emergency before taking appropriate measures and I think it is already happening. The government is already committed to improving the resources allocated to health. I started last year and I am convinced it will continue. No one can have enough. I want to have more money, but I want to assure you that the allocation for health will increase and with more resources, we will be able to improve on the situation. We are embarking on primary health care revitalisation in collaboration with the states. We have been supported by the Department for International Development, World Bank and European Union, and many states are taking this on as a major challenge.
Your ministry receives a lot of donations from development partners and non-governmental organisations. Do you think the NGO bill being debated at the House of Representatives will affect your sector?
Well, we do not receive money from NGOs. However, we receive from international agencies and development partners. You can’t call World Bank, Global Fund, United States Agency for International Development, DFID and others, NGOs
These days, top government functionaries, including the President, now travel abroad for treatment. Is it not an embarrassment to this country and this administration that promised Nigerians change?
I must blame the media and Nigerians. We do not wish our leaders well and because we don’t wish them well, Nigerian leaders have become very secretive about their health. A colleague of mine had an ailment and the next thing I read in the papers was that he had prostate cancer and had been admitted in an American hospital for cancer, which was false. Can you tell me if that man would be happy about such news? Of course not! Why do we wish our leaders ill? In any case, why would the media be speculating about his state of health? How would that sell the newspaper? But we are working towards improving the facilities at home. However, I think the element of secrecy is why many travel abroad for treatment. They want to protect themselves because the next report may even be that a minister is dead.
So, does it mean that our leaders will never receive treatment in Nigeria and continue to travel abroad under the guise of secrecy?
I will love a situation where they will want to receive treatment here. I am trying to encourage my colleagues to go to the National Hospital free of charge but I must be able to assure them that their privacy will be respected and that is my main task. Before you know it, someone will say ministers are ill and dying. Whereas if you go abroad, even when you spend your own money, nobody will report you and the newspapers will not even know (about it). So we must learn to promote confidentiality. It is a key issue in the Hippocratic Oath that you cannot disclose the nature of illness of your patient.
The wife of the President, Aisha Buhari, lamented furiously the abysmal state of the State House clinic, where she said there were no syringes, drugs and a functional X-ray machine. Why has that clinic been so dysfunctional despite its huge allocations annually?
Well, I wouldn’t know because I am not aware of its huge allocation, but certainly, the revelation by the wife of Mr. President is quite unsettling and I have called the Managing Director of the hospital. The hospital is not under me but under the Presidency, but as the minister of health, I intervened and I will be visiting the facility on Saturday to have firsthand knowledge of his challenges. I don’t want to make any pronouncements until I have been there and till I hear his side of the story.
Recently you said doctors in the public sector would not be allowed to have their private practice. What informed this decision?
That was not what I said. I said the government has decided to set up an expanded committee. The government considered the report of a technical committee to look into industrial relations within the public service and the committee started meeting about two years ago and so, it is not new. The committee submitted its report in September and it was brought to the Federal Executive Council. One of the recommendations was that the government should look into the abuse of private practice in the health sector and set up an expanded committee. The role of professional ethics allows a doctor to do private practice outside of his official working hours, but the 1999 Constitution does not allow anyone to do private practice apart from farming. So, the committee is looking into it because the government received a petition from some civil society organisations, accusing some doctors of abusing their privileges and positions and the government is bound to look into it.
…..Culled from Punch
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