 Thanks for staying with us. We have this topic that I talked about earlier. Hospitals, Sean Hippocratic, Oath and Law in treatment of gunshot victims. And our guest this morning is Dr. Tuye Mabawando, Public Health Physician and publisher CEO of HealthNica. Good morning and welcome to the program, Dr. Good morning. Nice to see your face. Yes. Thank you for joining us. Did I get your name correctly? Let's try it again. Mabawando. Yeah, it's alright. Okay. I passed that test. Okay, now let's get to know what the Hippocratic Oath is. Let's start from the Hippocratic Oath. Before we go into the topic why we're talking about jettisoning this Hippocratic Oath. Yeah, the Hippocratic Oath was actually administered on to every doctor worldwide at induction. When you pass and you not become a doctor, you have to take the oath. The oath means that you have to do your duty without biases of race, color, religion or whatever. You have to actually give yourself to the care of your patients and to do your duty dispassionately. That is what the Hippocratic Oath is. Hippocratic Oath puts patients at the center of care. Okay, it puts patients at the center of care. It's patient-centric in a way and allows you to do your duty without molestation, without political concentration, without cultural or any concentration at all. So the ultimate game of the Hippocrates who was actually the first physician in Greece there in the temple, what we call it the temple of Apollo, was this in Greece time, was actually to invite into every medical practitioner that's tenants, that's Greeks, that discipline to practice the profession without fear of evil. Okay, so right now the problem is that hospitals are not adhering to that. Okay, let me not use hospitals. Doctors are not adhering to that because if I say hospital, it might sound like it's something else. The hospital didn't take the oath, it is the doctors that took the oath. Now hospitals or doctors are not adhering to this oath. What does that say about the medical profession and the well-being of the people who are supposed to be taken care of by these doctors? That's a very simplistic conclusion and it's worrying when we are depressed, at level of depressed and media, when we all say that doctors are not adhering to Hippocratic oath. So very simplistic because again, for Hippocratic oaths to function, there are conditions, there are situations. Now, what you're talking about gunshot victims, let's look at the stakeholder in this, in this, in caring for gunshot people. One, we have the society, the police and the law. Okay, on one side. We have the patients and the relatives at the second pillar and we have the hospital, doctors and the health system as a third part. Okay now, if you look at it, most of the things that happens to doctors or that happens at level of the hospital flows from society. It has to flow from society, either the law or the police or experience. Okay, those are the clear contents, you know, exactly what happened. Now let's look at this gunshot victim. We know that gunshot necessarily doesn't mean that the person is an accidental gunshot. Ambrobas, thieves, police, ascentage, discharge can lead to gunshot injury. Okay, for the doctors, we don't know where it's coming from. But the experience in the past has been that police will harass you, you know, will hurt you, will fight you or treat you so badly with gunshot injury. And that experience has led to the initial demand that, okay, if you are having gunshot injury, bring your police reports. Now, the new act that was enacted, you know, mandated us to take care of people with gunshot injury without police reports. We've heard we are going to do that. But look at the scenario. If police are the ones responsible for the gunshot injury, are they going to do, you know, are you going to get them to even take the person to the hospital? Because they are supposed to bring the person to the hospital. We're not going to be on the road looking for people with gunshot injuries. Now, look at our society. People tend to quote other countries as their example. Look at our society. The ambulances are not working. You have public ambulances that can pick gunshot people and then start reviving them before they get them to the hospital. The ambulances are not working. Now, the first thing is that, for those gunshot people to the hospital, when you bring them to the hospital, the first thing doctors can do is to give, if within this capability, because you are a part of refer, within this capability to try to treat, okay? Now, if those guys involved are called guys, or in a decent environment, who gives protection to doctors that is treating the person with gunshot injury? And the, you know, the act also stipulates that you must ensure that the person can, you must report to police within one hour, or is it two or one hour, yes, after you have recited the person. Apparently, it has been that all police stations is like from here to plus TV, okay? Or they do the precinct. They don't know that Nigeria is a country of large landmasses. Where, in fact, you have to drive many hours, many hours to assess police. If by the time you get to the police station, you may not even have access. Look at what's happening in Kathmandu now. At four o'clock, we'll get to the police station. Okay, if you want to treat gunshot injury. How do you contact the police station? So now, look at, use Kathmandu as an example again. If you're used to pick the person in, and the other members of the budget enter the hospital to retrieve their person. In that case, what do you do? Let's say police or army, you know, they go, got hold of the, of those bandages, and they were shot. And then they, they, they modified themselves in the hospital and you are treating. The other band, no matter the bandit will come to the hospital, invade the hospital and do whatever they want to, like, with anybody they see there. Where is the protection for those doctors that, or these health workers that are working in that hospital? They are not providing protection for them. Okay. Even to communicate to the police station, there's no even hotline that says that whenever you see a case of gunshot injury, this is, if you cannot call on time, please call us, put record on, send an email, upload the picture on display. I mean, it will not have sufficient interaction to be able to find different modalities of reporting those cases. Now, you want doctors to just come, to dump the person and work away. The second thing is that the police can, I can only take over the person, when the person is, when you say the person is stable, when the medical director says the person is stable. Now, why you are treating the person? You are going to incur money. You are going to, you know, because at the end of the day, we're talking from experience. When you incur the money, you have to compensate the person who pays you. When you say that you are saving life and not supposed to be paid, the police will not pay you. The government will not pay you. There's no insurance company there. The family will run away. So the doctors will perpetually be in charge of taking care of the patient, paying for the patient, nurturing the patient, providing security for the patient. So now, how do you want them to be here? Let's face it. Gunshot injuries are not just simple injuries. It requires a multi-disciplinary approach to get treated. A doctor may see somebody, it may appear to be a shot into the abdomen. You never know. The spleen might have ruptured, the kidney might have ruptured, the organ might have ruptured. You have multiple injuries that you need multi-specialty. Where do we have multi-specialty in a private hospital in this Nigeria when you move away from Lagos? So now, the big question is that the doctor will look and say, listen, I can give this thing, go for care elsewhere. And people will interpret that to mean rejection. It's not always rejection. So the narration is quite skewed. And people prescribing severe punishment for doctors in trying to treat a gunshot injury with that, I will consider compensation. I don't have to recruit the money as a tribute to the hospital and to even create a seamless communication between the police and the health worker. What I mean by seamless communication is if I cannot visit the police station because I'm busy, is there a phone call that I can do? Is there a place I can send an e-mail? Is there a place I can upload? Is there a security for me when I'm treating this patient so that this is a criminal? The other thing would not come and grab the patient and shoot and kill other people and place a gunshot injury. So I don't know why we just look on a very fragile foundation and environment and expect the law to work. Well, I don't know about a lot of other states, but I do know that Lagos State has emergency lines, not modern one, that people are supposed to call in case of emergency. I can see this as an emergency. What is your level of interaction with these lines when it comes to these kind of cases? And, you know, just talking about interactions, when this law, when this directive was given by the authorities, maybe the presidency or the governor and all that, people who made the pronouncements that you can treat without police reports, what was your level of interaction with the authority to say all these challenges that you're churning out this morning and what was their response like? Because the general notion is that, okay, you were comfortable with it and that pronouncement was made. We didn't hear much about doctors saying, these are our challenges. You need to address it because that is what it should be. But it was quiet and everybody just assumes that, okay, it is going to be happening and it's not happening. So what is the level of interaction with those in authority to air your concerns like you're airing now? Now, where you make a law? I suppose before you make a law, you have to follow all the stakeholders involved. Before you make a law, you have to listen to the perspective you want the law to work. The stakeholders are not just doctors alone here. The stakeholders even involve the public, the police, okay, and the ambulance system. What you're talking about, let me just refer you to what you mentioned because it has an emergency number. I guess you drive around Lagos and you can just validate this point. How many ambulance points with ambulance have you seen around Lagos at the same time? Okay, so I will leave it at that, okay? And then I also want you to try and interact with these numbers that is being bandied about, you know, to hope that it serves the purpose you're seeing and it's actually very responsive like Riley pointed out. Now, when you are making law, the first thing is public engagement of the stakeholders, okay? Now, to what extent, when the public engaged? To what extent were the medical institutions engaged? To what extent were the communication system engaged? Even the ambulance people engaged in duty with this, okay? Now, if all these scenarios are raised, are being raised over and over, even now, even if it has not been raised before, this is not the first time I'm talking about gun shots in duty, okay? I've spoken about it as long as four years ago, even close to eight years ago, I can still get back to some of my clips in other television stations, okay? Are they not listening? Are they not hearing? So what is the assurance that, you know, cause people fighting who hurt themselves, you know, maybe they are doing their scores as they call it, and then they get it to the hospital. I am not trying to save the life. The other guy who came to the hospital, who is protecting the doctor? Who is protecting the doctor, okay? Now, as I'm trying to save the person, why give me just an hour to report to police? So what can I do in an hour, in reality? Okay, if I cannot get to police number, police station, what do I now do? You don't have an email. You don't have a dedicated line. You don't have an interaction in police contribution shifting. These are just the clear cut issues. How much are we now using this in the public, okay? Now, you see, you have a health system that is virtually broken, which you respect, okay? But what I mean by broken, if you're having about 20,000 doctors treating 20,000 or 50 million people, how else do you describe broken system? If you're in a place where attack that happens cannot be responded to, where the majority of the hospitals are in the center of the town, the rest, you know, you have to really go distance. Where even the competency of the workers are those extreme places. Most of those injuries, let's face it, happen at the periphery, the rural strangers of the nation, okay? Look at what is happening, the banditry and the killing happening in Kanduna, in Sokoto, all over the place in Niger Delta. These are places that you won't be able to see the presence of police. So, it's even such that, because again, the criminalization of that is important and you don't have to pay half a million, why? Okay, you said that I have to wait until the person gets well, you know, before the police can interrogate who is providing support and security. When the doctors incur a lot of money, a lot of costs, because of treating people like that, who pays? Why are you not looking at those things to encourage the doctors? If the police can say that they don't want to treat anybody who will pay, these are guaranteed for payment. A lot of things may change. The police says that once you have a gunshot, you will deploy one security officer with a gun to watch over you or to decide the person. You see a lot of things will change. A police says that, okay, if you cannot get us within one hour, you can get us within a day. These are other means of getting on. A lot of things will change. Doctors are not trained to be so hearted. We are trained to save lives. But make those laws and conditions conducive for us to interact and save those lives. That is what we're trying to do. I'm just concerned. I'm asking how much have you engaged, even if the government is negligent, they are making laws without talking to the stakeholders. On the part of doctors, how much have you engaged the government to make them know these things you're concerned about? Because they are making the laws, obviously they are not talking to the people. But when the law is not to your advantage, you have to speak out. How much have you engaged the government to make them realize these things they are not doing? You can actually guess the day, the afternoon from the morning. A lot of things that have to do with medical issues, how to get the best out of the health care system is up for discussion every time. How much of them have the government responded to. Secondly, the medical associations, different cadres of medical associations have been always promises they will do not. How long can you endure those promises? And then, I have not seen where the hypocrites have said that our judgment died instead of not treating the person. I have not seen where they said died instead of not treating the patient. Again, first of all, we must stay alive. What protection have you given to us? Listen, I had worked with it. Let me look at the background. I had worked with the state government in a public health system for 20 years before I left. One of my posts was in a children's hospital. The most popular children's hospital. And there, I can tell you, even in that hospital, when some families feel that they have lost their child unjustly, they will go to the hospital and we will get the police. I didn't hear the police station. It's always stories. It's not once, it's not twice. Okay? We can guess his... Go ahead, we can get you now. What it means exactly. Okay? These are the things, these are the contents, you know, we need to do something. You don't even protect the health worker. And you want the health worker who is not carrying guns you don't be paying his whole role by obeying Hippocratic code. Where the condition to obey the Hippocratic code is not optimal. Let us address those things. Doctors will do their work. We have been doing it. What is something you said simple but worrisome is that maybe I didn't get it right but that the numbers, even the emergency numbers that are given by the state government does not work in response to those calls that come on those numbers is not good enough. Is that what you said before I get here? What you can do is simply this. I challenge you to try those numbers at odd hours okay? Feed us back on your own risks. Odd hours, okay. Now, let's digress a little bit from just gone short wounds. There have been cases where people complain that even accident victims are taken to hospitals and doctors do nothing about it. The first thing they ask you is who is going to pay for it and a lot of people have died because in an accident situation, sometimes it's just a good Samaritan as it were that will find you on the roadside and taken to the hospital and the doctors do nothing about it because they want to deposit, they want this and that. So what role does the Hippocratic code play in all of this and do you have a way of getting those doctors to do the needful? Now, it's going to be, you know, that will be not a common situation. I can show you, it will be a common thing that accident victims are taken to hospitals and doctors are not doing much. Now, I know that they will first of all in most cases because you know how human brain works is to show that the work force that is funding you is amplified and pushed at the dominant narration. Okay? Yes. Because I am telling you, I had worked in government for over 30 years before I left, you know I have gone to private state at any time when I was going to pick up pumps, what you do first is to actually assure that the blood stopped. Now, you need to be able to have experience of what goes on with those doctors and will help workers and hospitals to know that in reality no common is to do more. What about, because of course rightly so the issue of payment becomes important. Hippocratic code will not equip your hospital. Hippocratic code will not honestly find the drugs and consumables Hippocratic code will not pay I am talking about private hospitals now. Hippocratic code will not pay salaries, you know and buy fuel for the hospital. Okay? Now, each doctor says that I am treating you and I can give you copious examples if I have been a doctor for three decades I can give you copious example of what's the example where even that you take care of delivered, you know I bother the baby running away you have to be the one taking nursing the baby, calling police, taking the baby's home, where people that you know are injured, if I am able to run away they don't want to talk to you again for three months they are hanging on the hospital there. You know, these are experiences that you should feed into the system and look around to improve better the system. Okay? It's not an experience to wake up and castigate the doctors. So, for all doctors that ask for deposit for a client of accident teams, I am sure there are hundreds that will not bother even in government hospitals. And then, what is essential is that whoever brings, I have seen people that have brought it to the doctor don't worry, we will find a way. But when somebody is not talking it is important it is important that the doctor do the treatment. I am not saying that there are no doctors that will ask for this opportunity but there will be a very few in number. It should not be the domino narration that I can provide so I can castigate online. That will not be the domino narration. So, again, the question is that how do we now synergize and enhance those kind of positive narratives in this space? Our emergency system is non-existent. You can, when there is accident when there is water on land or anywhere look, you see our response system is actually, you know for instance in Lagos the emergency services that respond those groups, they respond they do try hygiene, they try to take two kilometers and you see quite a lot of interesting response. When the drink collided with bus we saw how the response was. When houses are burning, we saw what those guys are doing and doing what they're doing well. And the people there are still hand workers. When do you get this narration that doctors want to see that burn for the opposite? We should be careful of social media problems. Okay? Oh trust me doctor, this is not social media. Like you say, let me just take you on your words that some of these people there are a lot of people who will treat without asking for these things that I'm talking about but this is not social media, this is experience that doctors will tell you that you have to deposit something or sometimes you're just left at the door there and all your good Samaritan work is something else. So this is something we have seen but you have said that there are others that do not do that and I take that We will continue having the argument you will continue having the argument, you understand? And this is that you know all doctors always obey those hypocrisy codes fully I said that for one that does that there are 100 that want to do it that is my argument. Yes, that's what I'm taking, that's what I believe I'm taking that that is good but you said is social media, that's what I'm telling you this is not from social media. The narration is to accentuate that singular doctor that refused to do it and I said that no So rather, even if the singular doctor is not doing it we should be able to sit down and decide that what again, how do we improve this interface? How do we improve it? This interface and for me that's where I am How do we improve it? We can improve it by further investing our health system The first investment in health system is you actually human resources Now we are talking about the business we have to invest in our emergency response system Yeah, emergency response system is far and in between we don't have emergency system you can always say twice to that but perhaps you are a city dweller you see it, you express a bit of it then go to the remote area there's no emergency health system for me apart from Lagos where do you guys see us talking about emergency in the most maybe two states, in the Ayatollatay system how many cities do you get that kind of thing where they set up a dedicated emergency health system and they are funding it I was part of the people that crafted the second national strategic development plan for the nation I work in one whole state one whole state where we look at all these narratives it's not just there it's not just there we don't let us deceive ourselves some states codify few the rest are just like that I have access to the whole report and these are the things we look to work so first and foremost let's build our emergency health response system let's build that it is a multi-disciplinary even the training on resuscitation coronary resuscitation how many people how many of your members can actually use CPR correctly so that's where the response starts from do we have the means or the ambulance you can call and say come and take this person to General House which will take this person to teach us or whatever do you have any ambulance you can call readily because even if you have the ambulance you have the people who are there who start to trade to work so it is not just that doctors yes, they are the summation of everything but there are other inputs that we need to work on for us for this apocatic code doctors show you apocatic codes and that's what I mean by a kind of single eye narration that we are seeing in the media so for me it's going to get better if we keep discussing about it but let us take a feedback from these kind of discussions let's take a feedback and then put it into the way forward police cannot just come and tell me that reports within one hour you have 500,000 an hour to pay supposing the nature of the case will not make me report within an hour that maybe I have to stay for 5 hours that's serious supposing am I treating the person okay I have to pay security challenge who protects me take this feedback when I need to work with the police when I need to work with the general population and most of the time when this gunshot injury hits somebody is a very grave emergency I was not talking about a gunshot injury to the thigh a gunshot injury to the chest or head is a grave emergency that has less than 20 neurosurgeons who is going to open it why are you going to get them in the first instance okay you tell the general to do the whole thing they are looking for the neurosurgeon the man is somewhere in Apelkuta somewhere far what are you going to do so we have to build that basic structure basic requirement to help the doctors to vary the hypocriticals hmm interesting well we are talking today we are talking about the responsibility of the doctors to the patients that is why we are concerned about that but you know if we digress a little bit we know that the health sector has been complains upon complains some use these complains as a reason why they are leaving the country to go to other countries and then there is health tourism to other countries and none coming to Nigeria someone is coming to the Bawalawu because it is a spiritual problem but otherwise there is no tourism to Nigeria so what are these things that need to be fixed I know you have mentioned a lot of them in the course of our talking but for purpose of emphasis what are these things that need to be put in our health system the basic ones that will make our people the manpower that you have talked about that is very important for the health sector to move or to work it has to be manpower and all that so what is it that is going to maintain this manpower to stay in our country and work and secondly what is it that can be done to drive a tourism health tourism to the barest minimum to the barest minimum that is people leaving the country to go and find help somewhere else will reduce and have people coming into Nigeria to get health problems solved so tell us some of these things that need to be done by the government I know you have said it in many fora I am sure but let us have it here again we never know who is listening I don't usually like something like this but I will support Professor Campbell in Harvard University when we are doing that course you want to change the health system you follow the money why why must we follow the money because one health is capital intensive very capital intensive you have to put in your resources you have to build infrastructure you have to do research you have to develop your drugs in treatments healthcare is capital intensive what you said guys give 15% of your budget to health Nigeria is doing the best of 5% why do I call you like Malawi they are actually going beyond those things so how do you reconcile that secondly when you have a health insurance that is just doing 80% after how many years how do you get to know that because for you to build that quality also when you have the maximum production of doctors in the country yearly it's about 3,000 that's our capacity so how do you use 3,000 to deliver health 3,000 medical doctors per year to deliver health insurance when maybe 1,000 of that will also jacquard yes out of that some of that will jacquard if you can employ me in your place I will even come and work there is an external jacquard as the case may be ok people want to work because of that pull and push factors so now first and foremost to train the sufficient let them take science from secondary school let them take science when they take science improve your capacity to train more improve your capacity to train more thirdly budget for health is that if you budget for health low government can build primary health care center and run it after that government can run teaching hospital in a way and give them that power to function and then your compensation mechanism is not just about increased salary what is we looking for some of the people just want extra money to have a home in the same place give them more gauge use it to tie them down use it to tie them down give them access to do courses anywhere in the world provide that because at the end of the day there is a feedback into your system recently government said that the country live of access I think I can anybody think like that for doctors because in reality mixing is so dynamic we are talking about as you are intelligent in medicine now all those knowledge you have to pick elsewhere when you do those out of station sabbatica you need to pick those knowledge everywhere imagine about eclectic knowledge you pick from everywhere and apply it to your people so now you are counseling that are you going to be using Babalawaw prophet to heal your people so I don't just understand some of this decision we take instead of us to be able to compete from just one single drug called ozampic they made the country made a lot of money we cannot even develop anything in this place so you know the quality of your university and education is important the quality of your budgeting is important the kind of training you give to your people and the update training to your doctors is also important people want to stay here they love to stay in Nigeria but they also want to have that kind of environment to practice the medicine the way they want to practice it so they know I'm sure the government knows but why we are not seeing them implementing this why we are not seeing them is another big issue you can know you may want to implement but if we focus on health I was listening to a Q and A you brought to the fore you feed your nation you provide health system you provide education for them so these are priorities when you say manifesto having 100, 200 pages it's manifesto of deceit and lies just from 5 things it's sufficient to make a lot of change in your nation so people know I'm not the one to even just say this but I want to just be through the contribution to what is known already we'll get there we'll get there you said something about developing something in our country we can't even develop and all that I'd like your opinion or what your feeling is about not just orthodox medicine but traditional medicine what's the place of traditional medicine in modern day health modern day health let's say so what do you feel as doctors about traditional medicine and its development what we need is standardization of traditional medicine when anybody has any pastata in Nigeria it's actually they're looking for pepper, they're looking for money lots to do the work I can tell you authoritatively even in the care of cancer worldwide they put traditional medicine incorporate traditional medicine into a lot of those anti-cancer drugs recently in charge of breathing had came down with process cancer they said look guys I'm not going to use any medicine, I'm going to use herbs now you know the herb is going to be used probably going to go to India you know because just what they standardize they're evening medicine to a point where it's having incorporated into the orthodox drugs medicine that handshake is very essential but for the handshake to happen we need to develop that standardize our traditional medicine appropriately, we need to we can't just be looking at it as an assumption we need to, so for me where we're missing it exactly is that we have not done enough to standardize our traditional medicine and curiously I remember one of the research done in the past but one traditional medicine that has this erection it was found that it was even Viagra that was incorporated into the orthodox medicine the orthodox medicine is actually you know horrendous you cannot just imagine what it means so that standardization and checking NAPDAC is not empowered because I remember in the past years ago we were still having challenges in trying to check to analyze the content of a lot of traditional products so together once you do standardize anybody who sell anything for you in the bus on the street even in the church or mosque they will sell it as traditional medicine ok so in the world nowadays we are seeing that you know synchronicity kind of you know handshake across orthodox medicine traditional medicine or what I would call a mystical or esoteric medicine where people use meditation relaxation you know to actually calm mind and you know further make other medicine work the discussion is ongoing and they are working on it even the role of prayer in human health people are looking at everything but for our own we are still at a level of magical thinking we want it to just happen magically you decree and it happens decree and it happens and not just in our medicine it has eroded the politics and the way the way we look for money let it just happen magically so magical thinking will not solve anything it is critical thinking that will actually solve anything we should be able to do our thing and test if we are seeing that this medicine, this traditional medicine this leaf can cure this thing apply it now let's say the result is something like that we are not in contentions we are in cooperation we should cooperate and we will not attend to ourselves this is a good way to drop it we would like to thank you doctor for coming on the program and enlightening us we do hope that the government sits up not just to make policies and laws but also to look at all the corners that will make those policies and laws to succeed especially engaging the critical stakeholders in whatever they want to say in whatever pronouncements they want to make it's not just in health we have seen them make pronouncements in so many other things that we are just looking at them like did they think it through or did they just wake up one morning and say okay let me make the people clap for us we would like to thank you so much for coming on the show this morning oh thank you for having me thank you talking with doctor Tui public health physician and publisher CEO health Nica and the argument today was that hospitals have shown apocratic oath and law in treatment of gunshot victims he was giving us the reasons why these things happen and what needs to be done for this law or policy to come to fruition and people do the needful thing and very important thing was security and then a second thing was who foots the bill and so many other things so we do hope that whoever is watching right now whoever is listening will do the needful let's start from the basic ones and then we move up and this is where eventually we are going to draw the curtain on today's breakfast and remember our quote for today was that health is a relationship with your body be sure that you have that positive relationship so that your body will stay healthy and if it stays healthy that is the greatest wealth that you can have you have woken up today and it's a very important day we do hope that we will all make the best of today for our own benefit and to the greater glory of our country Nigeria and not forgetting glorifying the Lord who made this happen thank you so much for being a part of our show this morning let's do it again tomorrow my name is Nyam Gul Akaji