Maternal healthcare must be affordable

Dr Naheem Ekemode was the Director, Lagos state Hospital Management Board before it was dissolved under the Fashola administration. He tucks almost five decades of experience under his belt. The UK- trained Obs/Gyn specialist  discusses with Lipstick on why maternal healthcare should be a priority.

There is an ongoing campaign with the aim of legalizing abortion in Nigeria through the back door under the pretext of fighting maternal mortality.

We frown at a lot of things that the religions are against but we don’t look at certain modern realities and this question of abortion comes under that. When I was doing my postgraduate training, Britain was one of the first countries that legalized abortion and they had a lot of reasons for that. Those reasons are not peculiar to Britain. Since I was going to work in their maternity unit we had to sign a contract that said when you are there you will be able to carry out abortions.

And if you refused?

Then you will not get the job. For instance the Irish were against it so they had problems. There were a lot of legal battles and as a result when you are competing with an Irish in a gynaecological post they are disadvantaged. The reasons why they legalized abortion was that there was a lot of quackery. They had lots of unwanted pregnancies.

People were reckless and they had a big social problem. You have to look at the reality at that time. You had a lot of young girls; they got pregnant and they could not get it terminated so Britain had to take the bull by the horn. Two, they had a lot of complications out of abortions that were not done properly- infections, perforations of the womb, excessive bleeding and all these led to a higher mortality rates. They studied it and found the only way was to legalize abortion.

Should that be recommended in all countries? If it worked in Britain, does it mean it will work here?

It had to be recommended. You didn’t just go and have one just like that. The GP will recommend you then the gynaecologist will look at it and assess the situation and sometimes they even have to bring in a psychiatrist to assess the psycological situation and so on. At least two or three doctors will have to sign.mnb1

At that time (between 1975-1980) Britain was about the only country in the whole of Europe that legalized abortion so you found there was an influx from Europe and even the oil-rich Arab countries. We had to counsel the patients.

When I got to Nigeria I was walking along the corridors of power. The government at that time agreed that there was need to legalize abortion but both the Christians and the Moslems were strongly against it.

But is there any real scientific link between quack abortions and high mortality rates in Nigeria?

Many cases were even rushed to my hospital in those days with a quack almost pulling out the intestines of a patient bleeding heavily. Government did not legalize it but closed their eyes to it. They didn’t witchhunt the doctors that were doing abortions. They give doctors free reign to operate but when you run into trouble they will quote the law for you. They don’t screen and that to a great extent reduced the effect of it on the maternity rate. The government realizes that it is a thing that should be done.

Shouldn’t there be more emphasis on maternal healthcare in the first place?

Access to maternal services is limited. It is probably indicative. There are few government hospitals compared to the number of the masses and when you talk of the masses they are living in the rural areas. These kind of services are not readily available. In the villages you will find babalawo that will take care of all the babies. He does not have training; he does not know his limits and as a result cases that should be referred in good time or for caesarean sections eventually die there- all sorts of complications.

In the cities still the number of hospitals are not enough and government hospitals now are not cheap. You have a lot of traditional birth attendants who are non orthodox medical practitioners- herbalists and so on even in the cities.  When government realized people go to these people for maternal services they had to give them a board.

They assess them, give them training, basic hygiene to avoid infection. Many of them put their hands in when delivering. And then to know their limitations. Someone who has had one or two babies they can look after  but when you have complications they are supposed to refer them to the hospital. They are now being encouraged.

But people have been giving birth before Western medicine

They were giving birth but in an unorthodox way. Labour is natural. You see some farmers, they take their delivery themselves in the farm. It is not all labours that will  go on fine. When they have complications, how will you know? Pregnancy-induced hypertension, malpresentations, breech, transverse presentations, placenta previa, bleeding and all that; they don’t know all these. They don’t know how to identify them in good time and what to do. A lot of people have died. They take normal delivery but for those who take complications, there will always be stories. They will say it is witchcraft.

But there are also an unprecedented number of malpractices taking place in highbrow hospitals. How do you explain this?

Some of the regulations laid down for these hospitals are a little bit tough to execute and the kind of staffing that are necessary are unaffordable to these hospitals so in order to cut corners, they employ unexperienced ones. The big hospitals with big names charge high but cut corners and as a result such complications arise.

For example in my clinic I see all my antinatal patients by myself and monitor their delivery with my 47 years experience. I have three generations of patients. I deliver the mother, then deliver the daughter. Thank God for the stamina but that’s the only way. If I should employ a gynaecologist with my experience I have to pay through my nose. I do a lot of almost free medical services.

We have a lot of socio- economic problems as far as that is concerned.  The insurance scheme is supposed to fund some of these but you find they are all out to make money. This funding that is supposed to be generated to help run hospitals are not there all the time.

What should government be doing that could actually work?

There’s a lot of work to be done. You have to go back to the basics. It is like a pyramid. 3-5%- tertiary healthcare (teaching hospitals and so on); then about 20-25% for secondary healthcare (general hospitals). 65-70% forms the base of this triangle and supposed to be for women and children. It takes care of them from the grassroots, protects them, gives them maternal services, child welfare services at that level.

When you are able to effect a good primary healthcare service you find that you are taking care of 65% of the community. There is the need to have in every ward a maternal unit that should take care of basic delivery. When it gets complicated they send them to general hospitals. The primary healthcare must be well funded and well executed because that is the bedrock of healthcare and when you have efficient primary healthcare and these services are accessible and affordable then you find that you have effective healthcare delivery.

Is that not the same as Lagos state claims to be doing?

There is a little bit of confusion. The state government manages secondary and tertiary units. The primary units are managed by the local government. These local governments- if managed very well- their funds are supposed to come directly from the Federal. Unfortunately the calibre of people who would marry this primary healthcare should be educated people who know their onions.

You find that it is these honourables who hardly have school certificates managing it. There are structures being being all over the place and they are somewhat well equiped, but the correct kind of staffing in key.
Source: Vanguard