COOUTH: A Transformation Journey Under My Watch-Akabuike

Fides Editor-in-Chief, Jude Atupulazi, recently interviewed the Chief Medical Director of Chukwuemeka Odumagwu Ojukwu University Teaching Hospital COOUTH, Dr Joseph Akabuike, on a wide range of issues under his charge, as he clocks a year and a half as the helmsman of the elite hospital.

Here are excerpts of the interview

You just marked your one year in office, and you are into your second year as the CMD of COUTH, can you give an over view of your activities in this place within the period?

My coming here is a child of circumstance as I was faced with a huge challenge of trying to restructure the place because my immediate predecessor died while in active service and I came in. So I needed to, first of all, restructure the whole place.

First of all we fenced the environment and before we came in, there was the problem of light and some areas were usually dark. So the first thing we did was trying to lighten the place. If you see the pathways, we will agree with me that the lighting there is truly functional and there will be light at night. In the hospital environment, we tried to improve the hospital environment by painting some walls and introducing rails and putting beds in some places.

One of the first things that we did that is remarkable; I couldn’t believe that this place, being a teaching hospital, had no dialysis centre because I know as a tertiary institution, other hospitals – from the primary to secondary – they refer kidney cases to this place. So the first that we did was to put up a structure for dialysis. We built the dialysis centre, imported the machine, trained our workers and now we have a functional dialysis centre and it is working.

Did you receive any aid from any international organization, federal or state government, in putting up the structure for the dialysis centre?

No. The fund came from internally generated revenue. You know that one thing about projects is that there are projections and how you go about them. If you don’t have projections, if you don’t have plans of doing anything, even if such a person has all the money in the world, the person will still not do anything. So if you have your mindset that this is what you want to achieve, you will be so shocked to the extent you go within a short period.

What have been the major challenges you have been facing?

Let me quickly touch one or two things before going into that. I have talked about the dialysis; I what to talk about the introduction of Servicom. One of this things we found out was that there was much communication gap between the patients, doctors and the workers; thus the need to introduce Servicom (service compact for all Nigerians,) and what they do is that they have phone numbers and they go about the wards and access patients’ pulses and their complains and they refer back to us. They inform us, this doctor has not come, that doctor has come; and this is now helping us and that is a way of improving the hospital environment.

The mortuary is another place we gave attention to. We have to make sure that we restored the dignity of man. We no longer keep corpses on the bare floor and scattered everywhere. We now built racks and we also have a cooling system where we keep corpses that wouldn’t go for embalmment.

Apparently, after all the strides you have made, what areas do you think need steady improvement in this hospital?

There are so many places. If you see my projection as a teaching hospital, we still need improvement in the quality of services, standard of the service, the number of specialist cases. We need more structures because if you are talking of a tertiary hospital, there is what is called specialty and you have sub-specialty and that is where the world is going.

And I know that if this place is properly positioned, particularly structure, there are so many of our people outside that are willing to come home to assist in most of these specialist surgeries. But they can’t come and start building dialysis centres. If you tell them you have a building, most of them can come on their own, even with their equipment, and that is what is happening at Adazi when the government put up the heart transplant unit.

Dr. Joseph Nwilo comes from the U.S. with some doctors and such cases are not done on a daily basis; they organize and do it. So we are aiming that this place should be a specialist centre in so many things. We are proposing a renal centre where we can do dialysis and still do kidney transplant. It is done in places in Nigeria, it is done in Umuahia and it is now done in Abuja. Incidentally when I went around, you wouldn’t believe it that the people that were doing the surgeries are from Anambra.

So if our people are doing it for other people, I believe that the only thing that is holding them is having a structure here. And once we have a structure, they will come down and help us. We need to have the special cardiac clinic where we can do open heart surgery.

Of course we have done so well in the area of diagnosis. We have the CT scan, but we also need the higher resolution machine called the MRI, so all these things are needed. Remember that when you are putting all these machines, manpower will also be needed. We are working towards having a master plan which we are forwarding to the present government.

This place should have a master plan that should be followed; step wise, by successive governments and even if this government should do the solution and do it at once, that would be great. It shouldn’t be a place where one thinks of anything and builds, because at a point you find out that we are going to have very scattered structures that wouldn’t look like a hospital.

It is very difficult for people to access health care in a tertiary health institution like yours due to communication gaps as most people do not know where to go and at times people stay up to five hours without being attended to. How do you intend to ensure that people can access health care easily?

That was why we introduced Servicom. You know our people are not fully aware of what a teaching hospital should be. A teaching hospital is a tertiary centre; not a starting point. There are entrances and you can come in as an accident emergency and we have doctors 24 hours positioned there. You can also come here as a referral and this is a referral centre.

We are not meant to be treating malaria and other minor sicknesses. This is a teaching hospital, the highest level of hospital all over the world. So we are supposed to treat cases that are difficult for other doctors. So one can be referred to a special unit because we have about 63 consultants and there is no hospital that has more than three and those with more than three are coming to borrow from us.

Patients can also come as through general out-patient department. They will see you and after that, they will know if it is a minor case. If so they will treat the person and allow such a person to go and if it is the one that required a specialist, they will refer such a person to the specialist. But people don’t know about this structure and they often come in and start walking around.

And how about Security in this place?

This place is fully secured as we have been engaged with a security outfit. Every ward has a security person and we have in both gates and it has not been easy tackling with security. In our private ward, you can’t enter without putting down your name and phone number with the security man. And you have to call the person you came to see and the person will approve of your coming. This is because we have people of higher class in that ward. I think we are doing the best within our limits in terms of security. This group that we have now, they are about 53 people manning various wards.

You have a well instituted mother and child referral centre, how was it like before the structure was put up? Can you talk about the oxygen gas plant here in the hospital?

The mother and child referral centre is a blessing to Anambra State. It came up through me after my attention was drawn through Prof. Solo Chukwulobelu, the Secretary to the State Government, and we applied and they gave us. It was built and equipped by Chevron. At a point, the process was not moving very well for one reason or the other and it was at a standstill until I came in in 2021 and I had to revitalize the process and within three months of assuming office, it became functional. It is one of the best places you can deliver in terms of standard.

We have two theaters with a special baby care unit where premature babies and babies that have jaundice can be taken care of. It cares for all deliveries and that is why it is called mother and child. Delivery and immediate delivery, that’s what we have there.

And about the oxygen gas plant, it is supposed to be one of the best in the country but it has lots of maintenance challenges and it is meant to produce 210 cylinders within 24 hours. This present government has taken it up and we have even invited the company that built the oxygen gas plant to overhaul it and ensure that it is working. Actually, it is a very good project.

There is this issue of patients who stay here receiving food from a certain restaurant domiciled here. The food, according to sources, is assumed as a free gift from the hospital but at the end of their stay in the hospital, the patients are charged for the food.

Well, thank God you said they assumed. That assumption was the problem. There is no free meal anywhere in Nigeria now. Most of the patients were given explanations. The hospital felt like harmonizing what our patients eat in terms of quality, sanitation of food preparation and in terms of making the hospital to look neat. So that project was even there before I came in.

The problem came up when things started getting so expensive and that made us to review the bill. And before then, people were complaining that there was no meat in the food and when we did it, it raised a lot of dust and by now we have reverted to them feeding themselves and we are still working on it so that they can get their food anywhere they want.

What are the immediate projections that you have for the hospital?

If all things are equal, we are projecting that in the next 4 years, we would have realized most of these specialist areas, with them being functional. And we would have a lot of supporting structures in this place and also most of these specialist areas would have opened up.

We are also making effort to ensure that our workers do the needful. I have noticed that even some people who work here don’t even know what work ethics entails. Working here and working in the main market are not the same thing because buying and selling doesn’t involve life; but if you are dealing with human beings, there is a level of things you must know and most of them don’t know.

So we have engaged a human resource group that will be coming to educate our people on the special nature of their work as healthcare workers. People that are coming to the hospital don’t come to smile as one comes, either to receive pain, pay money or receive a dead body.

Thus healthcare workers must relieve these people of the anxiety of coming to hospital. And surprisingly, some of us here have our own individual problems and it ends up being problems facing problems. And we are looking at addressing the problem.

Is there any mechanism in place to checkmate nurses who are rude to patients?

Actually what happens in out setting is that we have laws that we don’t implement. If you come to the hospital, you have cadres of workers. If you have the matron, you have the senior nursing officer and others that are under direct control of most of these people, but most often, even people who are at the head don’t know how to utilize their powers. When you begin to see a senior nurse exchanging words with a cleaner, then there is a problem because what the senior nurse is expected to do is to issue a query and that person will not do such again.

But all in all, we have this Servicom through which we are looking into doctor-patient relationship. But I found out that it will not solve the problem because, mostly, they are ignorant. Someone does something that is severe and the person will start begging because she or he is not aware.

So we still feel that this idea of getting people to talk to them, have some level of training for them on work ethics, which will be done department by department, will generally help to shape them before you begin to handle them individually.

Finally, the roads are becoming dilapidated. What plans do you have to make sure that the roads are put back in shape?

Actually, the roads need maintenance. I think they were built about 10-15 years ago and we have presented it to the government and to the Works Department. When they came, they had to open up the space wider to measure  (the road) and that is what worsened it. So we are still hoping that soonest that  road will be fixed.