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We are the zonal centre for Sickle Cell disease — Dr. Joshua

dr. joshuaTHERE seems to be a lot of scandals emanating from your institution of recent. For instance, it is alleged that there was an employment racket and you employed close to 1,500 doctors, when there is no need for it, bringing the total sum there to over 2000. What do you have to say about this?
I think the public is being misinformed by some people who are not happy.
And I want to say here categorically and clear that there is no scandal of employment at FMC Keffi, because in the employment we did we followed due process. It was conducted by the Board  the Promotion and Discipline Committee. It was observed by the Federal Character Commission and by the Human Resources Department of the Federal Ministry of Health. So, it cannot be that all these people were there and the wrong things were done. We obtained waivers from the Federal Character Commission and they observed this exercise. The numbers are interesting, possibly to just raise the attention of the public. Yes, we have expanded rapidly in the three to four years. And we have to commensurately get the manpower to fit into all those expanded areas of service. And I see nothing wrong in employing more consultants, more nurses, more information technologists, and more administrative officers. I don't see anything wrong, especially as we obtained budgetary provisions  manpower and financial provisions. We are not complaining that we have not been able to pay salaries. So, what is the problem of somebody out there, to say that something was done wrong? He should rather thank God that there is so much rapid development within the centre and within a short period and those patients are having more confidence. Patients' turnout to the centre has more than quadrupled within the past three or four years. So, what are we asking for? Is it not development in this country? And if we are able to employ as much as there are many candidates as they are talking about, we would have succeeded in reducing unemployment in Nigeria. And even at that, when they say 1,500, it's not up to that. They inflated the figures to just may be raise some tension in the country. But if I have the money, I will employ up to that because we still need more people. We have created more departments. We have started residency in family medicine in obstetrics and gynaecology, in paediatrics etc. Because of this, we have created departments like pathology, haematology, microbiology, biochemistry, medical biochemistry. And we have out-posts with the government of the state so that we can send our staff and residents to go there and work. That's the requirements for residency.
There are three things, you have said. One you mentioned a waiver. Why do you have to obtain the federal government waiver in order to give employment to people? Is it not because you want to use that and favour some class of people?
Not at all. Waivers for some adverts does not exempt the centre from doing the proper screening. I hope you understand. Just waivers for adverts. We got that because we were running out of time. We had this team for accreditation. And because we were running out of time, we had to get a waiver, because if you don't get waivers, you have to advertise and wait for about six weeks before you now shortlist and set a date for interview. We were running out of time. So we got waivers. It is proper to get waivers if you cannot advertise and you are in a hurry to get things done quickly, especially with this kind of situation. It is not always that centres get waivers.
You said you didn't employ up that number, and you could have gladly done that, but you have not told us the number you employed. Were those you gave employment, made to pay any money to secure the employment?  
Not all. Nobody paid any kobo. And then when you talk about figures, I wish I had the figures at hand now. But for consultants, we needed consultants up to sixty. For nurses, we needed them up to about one hundred and twenty. After the exercise, some did not even come; we are still pursuing some of the consultants to report for duty. Because they have other options, they have not been able to report. So you see we are still trying to woo them to come. In fact, early in the life of the centre, people were not willing to come. But because of the rapid improvement, people are now willing to come. And so I cannot tell you the exact figures now. But definitely it's not up to a thousand, and certainly not one thousand five hundred. And the total strength now, even with corpers and the interns that just come in and pass through, is about two thousand two hundred or three hundred.
We understand the roles performed by the Federal Character Commission. But, there are allegations that you discriminated against people from certain sections of the country, when you were recruiting. What do you have to say?
There is no discrimination. In fact, we went to some of these agencies and commissions to present our documents to them. At the end of it, they even said that the people that are complaining are the ones that have been favoured.  For instance, they discovered that Nasarawa State has the highest candidates and we explained to them that we inherited some staff from the Old General Hospital, Nasarawa. There was no way we could have dumped them. Now we have been trying to employ according to the federal character norms, and employ from other places so that we can normalize the situation. For senior staff, no state is supposed to have more than 3%. For junior staff, it's more of the catchment areas, that's the state of resident of the institution and the states surrounding it. We have been making that effort to follow the norm. Anytime you open records, they will know that we have been making the efforts, and we are catching on.
You mentioned some consultants not turning-up, does it have anything to do with this insecurity problem going on in that part of the country?  
The Federal Medical Centre Keffi is secure. Even in Nasarawa State, we hardly have any insurgence around Keffi. It is rather away in Laffia, Ajiagu and so on. We have never had any insurgency around Keffi. People feel very secure. Keffi is just about fifty kilometres from the heart of Abuja, and the road is dual carriage way. And so many people feel comfortable in Keffi. I don't think that's the reason why some consultants are not coming. Rather, they may feel that the departments are not well developed. But in Keffi, as I said earlier, the rapid development has made consultants more willing to come. And so we don't have that problem. We are still waiting for more people to come.  
When you talk of rapid development, it brings me to this question. What did you meet on grand and how rapidly have you been able to expand from what was on ground when you came into office?  
That's a long story that I can talk for the next one or two hours. When I came in 2010, as the Acting Medical Director, let me classify it this way: infrastructure. The infrastructure was poor. For example, for emergencies, we were managing in a single room that would only contain about seven persons. And sometimes you would see our patients on the floor, or benches outside the entrance. Now we have moved to an active emergency complex that we have up to thirty occupants working at a time. It is self-contained, with its own theatre, its own pharmacy, records and statistics and so on, and so forth. We had only eight consulting rooms. It was serving as a general out-patient department; it was serving as a medical outpatient, surgical outpatients, and paediatrics outpatients. You can imagine. A whole centre like that. But now we have moved to a bigger place. In fact, those eight rooms are being utilized now by paediatrics have moved to about 5 consulting rooms. Surgery has moved to similar number of rooms. Medical surgery has also moved to a similar number of rooms. So you see expansion has been very rapid. Then, we didn't have intensive care services. Now we have started, we have also built a people's health centre  a general health centre. We also built family planning care units, where we are doing saliva cancer screening, and so on. That's one of the requirements for residency. We have expanded our mortuary and we have expanded so many areas. In equipment, we did not have equipment like digital x-rays, city scan; we did not have many automated equipment in the laboratory; there were so many equipment we did not have in the Ostamology, ear, nose and throat department. But all these equipment are there now. In fact hardly do we refer patients to other places now, because of lack of this equipment. We have them on ground now. So that's real development.  
And then when I took over, we had only nine consultants in different areas. Now, we have over fifty consultants. That time, you found doctors just coming and going because there was no residency training on ground. Sometime they would come as few as two or three medical personnel in a department, and then patients would be waiting. Now, what we did was that we started residency, which did not exist then. We started residency, in family medicine, we have more than twenty resident doctors, going to become consultants. We started residency in obstetrics and gynaecology. We have about twenty doctors, closing to become consultants. We also have a similar number in paediatrics. Now, doctors have a reason to stay around, the quality is now there. There is no more coming and going. They are ready to stay. We are warming up to start residency even in radiology, general medicine and another thing we started that was not there is house-manship, for doctors and internship for pharmacists and medical laboratory scientists. This was happening at a rudimentary level, but when I came, it was boosted to a higher level. In fact, when I came in, one month after we started house-manship. One of the mandates of tertiary health institution is research. There was nothing going on in the area of research. When I came in, we had to set up Higher Research Ethical Committee, to give approval. I also set up a Computer Research Committee to organize research at the same time. And we are working in building a research unit building, where all these things will be housed, to prepare our research mandate. You find out that research and training have a way of boosting up quality of service. And that's why you see that people are happier with the activities in the centre.  
Having achieved all these you mentioned above, what would you say is responsible for all these attacks against your person?
That's left to them, but what has come out clearly has been the issue of indigenship. I'm from Plateau State and I'm a medical director in Nasarawa State. Some people feel that no one should come from another state and be medical director in another state. They say the post is for that state. But I think this centre, being a federal institution and I have worked here as if it is my own state, and any assignment given to me, I have done it with the whole of my heart. And when this assignment came, I did not wink. I took it, both the bull and the whole. You see the resistance is from such people that feel may be it should not be. The second reason they might be resisting is that many people think that when money is coming to a centre, it should be shared. We should rather not be using it in making developments. Some people will ask: “Is it development we are going to eat?”
And so they prefer that such money should be shared, to the stakeholders out there; the centre just acting as a conduct for siphoning government money. But a person who has conscience, will rather not do that. If there is a contract and we ensure that people around the community also benefit, we will not allow government money to be siphoned without tangible structures on ground. It does not augur well for some people.  
How long have you been in the system?  
I have been in the system since its inception. I came to the Federal Medical Centre in 2001, as one of the first six pioneer consultants in the centre. Since then, I have worked as a consultant family institutions, as a head of department, family medicine or general outpatient department and I worked as a head of crystal services, assisting the immediate past medical director in running the place. And then when he left, I became the acting medical director and today, I'm the substantive medical director, and I have just been approved to go for the second tenure. So, I will say for the past thirteen years, I have been working tirelessly in the centre, to see to its growth.  
What will it take to establish a medical tourism industry in Nigeria?
I think we are in that direction. Medical tourism means a centre that has what it takes to attract people from far and wide to come and access medical care. And it has to do with standardization. If you standardize a service, people will like to come. It also entails making information, concerning the centre in the media, in the internet.  We have a website and some individuals from outside have actually accessed our website and they were surprised that we have a functional website. They were able to get a lot of information, and when they came to Nigeria, they were amazed that we have such a good centre. Now, it also has to do with the state-of-the-art equipment, and cutting edge equipment.  And some of the equipment I have mentioned are state-of-the-act equipment, that  compared to any part of the world, you can measure up. And so, we are in that direction, I believe that when we have succeeded in polishing the centre, and computerizing the centre, you will see that people will come from other places, even from outside the country to come and access here. I believe we will be fulfilling that medical tourism you are talking about.  
Outside government subventions, do you think the medical schools you have can survive on their own, if well structured?  
Yes. I think they can survive. The government is trying and they provide these funds, and like I said, some of these funds are largely siphoned and squandered. If all the funds given to the medical centres and the teaching hospitals are judiciously utilized, we will be able to run the place. We also have to generate internally-generated revenues to support some of the things that we do. So, government alone cannot do all. And that's why recently, government has advised medical centres to go into public-private partnership in order to bridge whatever gaps that are there. We are also thinking in that direction. Any structure that we cannot quickly get the capital to construct, we are going to go into public private partnership. In fact, it's easier to run a teaching hospital than to run a university because they generate money from patients and then you plough it back to the system.
With the structures you have been able to provide on ground, would you say that the federal medical centres are being well-funded?  
They are not well-funded. I just said earlier that the funds being provided would have just done much more. But overall, we are not well-funded. For instance, we have never accessed our capital appropriation, 100 per cent. We have appropriation but at the end of it, you get twenty something percent, forty something percent.
At the end of it, you do your appropriation planning and at the end of it, you have projects not completed. So, you have to wait for another one or two years to look for funds to complete them. So, the funding is in trickles and I believe that if what was budgeted was released completely we would have made headways. I'm still appealing that subvention be increased. But government will say the funds are not available. And what they will do is give you an envelope. Whatever you see in the envelope is what you get. If the provision is not based on your needs or your potential to grow, it's just push kind of thing.

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