Setting up an Emergency Care Centre in Abuja, Nigeria - Essay Example

Setting up an Emergency Care Centre in Abuja,Nigeria Introduction 1 Background history What is Emergency medical care? Emergency medical carerefers to the“care delivered in the first few hours after the onset of an acute medical condition, such as a childbirth complication, heart attack, injury, or any health problem that reaches an acute stage—blood poisoning from an infection or hypoglycemia from diabetes…[and depends] on the severity of the condition and the setting in which it occurs” (Disease Control Priorities Project, 2008, 1).An emergency medical conditionmaytake placeowing to a sudden injury, obstetric complexities, severe infection, or even a chemical imbalance in the human body,often caused byalong-term neglect of the patient’s chronic medical conditions. To treat such conditions emergency medical services (EMS) are necessary, whichinclude timely intervention,quick assessment, rapidand best possible means of transportingthe patient to the closest appropriate care centreto increase the survival chances of the patient, control the morbidity rate, while also aiming to prevent disability in the affected patient (Tintinalli, 2003). Recent advancement in the field of medical technology haswidened theboundaries of what was originally seen astraditionalform of emergency services. EMSis now not only restricted to in-hospital treatment,starting from the time of the patient’s arrivalto being stabilised, but also includesappropriate transportation and pre-hospital care (fig 1)(Mahadevan and Garmel, 2005, 117). Under present services, EMSinitiates with the activities of the ‘first responders’ (people who are first toanalysethe situationand administer care during an emergency) (Jang, 2011, 3). Theinitial care starts when the situation is being stabilised, and comprise of interventions that may help to gain time and save lives, like stopping bleeding,applying mouth-to-mouth resuscitation.These can be administered while, transporting the patient in ambulances; in low-level clinics/hospitals (fig 2- base of the pyramid); or in an emergency unit of any care facility, before a patient suffering serious trauma is shifted to a specialised unit. In a specialised trauma care unit there are three more levels within EMS depending on training and some specific skill sets: EMT-Basic; EMT- Intermediate; and EMT Paramedic (ibid). Emergencies are not always preventable and associatedmedical care may be requiredunder varying circumstances,and patients may range from peasantsliving in remote rural areas, to factory workers fromcityslums, to those from the higher echelons of society. The rendition of emergency care services may extend from transportation of the patient to the care facilities by the common people and taxi drivers, to transportation bymedical professionals trained for meeting emergencies. Looking at the diverse range of requirements that may arise in emergency care services, the government must necessarily usestrategic innovation and appropriate planning of public health policies, as regards this issue. Fig 1: An overview of the EMS (Source: Kobusingye, et al., 2006, 1262). Fig 2: The Emergency Medical Care Pyramid showing various types, from non-emergency conditions at the base to the serious types, where the patient’s life is at risk (Source: Kobusingye, et al., 2006, 1262). All emergencies require medical care and attention due as first-response, but not all patients (those at the bottom of the pyramid- fig 2) must necessarily be shifted to a special hospital. While the specialized units take care of complexsituations, the facilities with a lower level set-up canhandle a large variety of medical conditions in the presence ofadequately trained technicians, and medical equipment. It is not compulsory for a physician to be presentand administer emergency care,as long as the lower level facilities can provide well-trained personnelto handle the less serious cases (Disease Control Priorities Project, 2008, 1). There are a number of wrong notionson emergency care, whichare oftenusedto justify the low importance attached to this aspect withina country’s health segment, especially in developing and poor income nations. Some of the misconceptions include ideas that equate emergency care services with simply transporting a patient in an ambulance, presuming that in-hospital emergency medical care and physiciansare the only available resources for help in such situations, while ignoring the part playedby community and facility care services.Another commonmisconceptionseen prevalent in the poor income countries is that emergency medical services are expensive,needing high-end technology and ignores the use of effective yet simple life-saving strategies. These cash strapped nations (like Nigeria, Somalia, Uganda, Sudan, and Pakistan) lack adequate public funds and tend to allocate only the minimum for developing basic health infrastructure, subsequently leading to shortage of adequately trained personnel to handle emergency situations (International Labour Organisation, 1992, 13). Sometimes health policy makersunder the presumption that emergency care relates to only ambulance services and setting up of an emergency wing within the local hospital, allocates very little public funding for emergency care. Under such conditions when actualemergencies take place; there islarge-scale mismanagement and poor handling,owing to lack of trained technicians, transporters, and physicians, giving rise to high mortality figures.Here it must be remembered that emergency care services do not always translate into large costs (McCord and Chowdhury, 2003). With appropriate planning and organization,the services can be renderedat a reasonable price, with optimal resource usage, improved care of patients, and an overall elevated health conditions of the country (White, Williams and Greenberg, 1996, 187–205). The health sector in Nigeria: Even after more than half a century of gaining independence Nigeria lacks a basic health infrastructure and the “health status indicators have remained poor despite the country’s wealth in natural and human resources”(Health Policy Brief for the 2010 Nigerian Elections, 2010, 1). The domestic heath indicators of Nigeria have remained stuck at the rank of 152 (out of 175) in UN’s Development Programme Human Development Index, showing the poor state of health facilities provided by the government in the country. The average life expectancy has fallen drastically from “52.6 years to 46.8 years for men and 53.8 to 48.2 for women” in Nigeria in the last decade, with worsening economic conditions (Oxford Business Group, 2010, 249).With the basic health system in the country in a deep crisis as such, it is of little wonder that Nigeria has very little (almost non-existent services) to offer in the name of emergency medical services (Solagberu, et al., 2009, 29-33). The basic provisions for health care facilities in Nigeria are a parallel responsibility of three divisions functioning within the present government, and these are the ‘primary, secondary and tertiary’ level health care divisions (Akhtar, 1991, 264). The Primary Health Care or PHCfalls within the jurisdiction of thelocal government.The primary care structures form to be thefirstplace where the patients arrive, when they fall sick. These facilities are given the responsibilty of tacklingrelatively simple healthcare problems like cold, fever, malaria, disorders from nutritional deficiencies,etc. Besides solving minor health issues, they also assist in public health education, and tacklecases of infant and maternal problems. This includesmatters related to child vaccination and family planning (Badru, 2003). The secondary health facilitiesdeal with treatment, prevention and the overall management ofmedical cases that are not too complex in nature.The more complex cases are referred to the specialist or the tertiary facilities. Secondaryhospitalscomprise of general hospitals (government funded and owned, like, OluyoroIkeja, Ijebu-Ode, IIesa, in Abeokuta- fig 3) and comprehensive health facilities(majorly owned by the private sector, as for example,Victory Hospital in Ijebu-Igbo; Gold Cross Ikoyi in Lagos, etc.). The tertiary health facilities, (specialist/teaching hospitals- fig 3), tackles serious or complex health issues.It includes some basic features of the EMS (accident and emergency unit), wards units, outpatient units, diagnostic and treatment units. Since, Nigeria has a mixed form of economy the private sector operating inthe field of health care hasan important rolewithin the delivery of health care. The Federal government limits its role to the management of the University hospitals and the tertiary health care system; the state government focuses on managing the general hospitals (within the arena of secondary health care facilities); and the local government deals with (primary health care or the dispensaries, which are monitoredthrough NPHCDA by the federal government (Erinosho, 2005). The state government spends around 4.6% of its total GDP onhealth care, while the federal government spendsaround 1.5% of the total GDP on providing health care facilities for its citizens (Vogel, R., 1993, 18). From the above figures, it is very clear that there are very little public funds made available for providing health care facilities in Nigeria, which inevitably leads to lack of infrastructure, proper training and appropriate equipment to handle emergencies. This is evident when we read in the news that the Nigerian Medical Association or NMA in a meet has demanded for improved EMS throughout the country, with proper training of the technicians and physicians, in order to bring in the right attitude while handling trauma victims (Adeleye, Nigeria: NMA advocates better Emergency Health Services, 2010). The chairperson of this meet OluwoleKukoyi opined that all the stakeholders within the health sector,which included the government,the health workers, the private sector, as well as the community,all have an equal responsibilty towards dealing with emergencies (ibid).In the same meet, the coordinator of Lagos state emergency management agency, O. O. Farotimi opined that further training of medical personnel associated with EMS is necessary. He identified the negative aspects of the Nigerian EMS, where he pointed out that “bad transportation networks, inadequate ambulances, inefficient emergency medical services, lack of good communication network and technical know-how of personnel are the major challenges of emergency health care in Nigeria” (ibid). Steps to provide quality EMS in a cost effective manner in income poor nations: While studying EMS,it must be considered as one whole system with various components that are dependent on each other, transporting the patient, pre-hospital care, and in-hospital care. Pre-hospital care comprisesof the treatment given to the patient at the site of the incident until the patient can be shifted to a morespecialised for further treatment. In the pre-hospital care, the most productive strategies that save lives, are generally fundamental and cost-effective, and can do without anyhigh-end medical equipment.Thus, if the paramedics dealing in pre-hospital care are trained well, much of the later cost, arising of specialised treatment can be avoided. Fig 3: Cost and Effectiveness of Using Trained Lay First Responders Together With Paramedics (source: Disease Control Priorities Project, 2008, 2). In cases where there is a lack of the pre-hospital care system this initial care during emergencies can be given by common people,having basic training foradministering first aid.Thus, “Recruiting and training motivated citizens, such as drivers of public transportation who often confront emergencies, to provide pre-hospital care can add to a community’s resources. A second tier of pre-hospital care is usually composed of paramedical personnel who use dedicated vehicles and equipment to take patients to hospitals rapidly. The personnel involved in pre-hospital care therefore might include a large number of lay first responders with basic training spread over a large area, and paramedical personnel at well-placed dispatch sites in urban centers. Such a tiered system can reduce delays and improve the quality of care” (ibid, 2-3). Another major step in making EMS cost effective in income poor nations like Nigeria is,cutting down on the pre-hospital time,by immediately notifyingthe EMS; a quick response from the vehicular services; judicious time usage at the site of the incident,and fast transfer to any specialised unit. Ghana is a case study in this regards, where we find that “the majority of injured people are transported to a hospital by some type of commercial vehicle, such as a taxi or bus. A pilot program trained 335 commercial drivers using a six-hour, basic first aid course. The training course used volunteer labor and paid for drivers’ transportation to the training, amounting to US$3 per participant. Researchers assessed the effectiveness of the training by comparing the process of trauma care provided before and after the training” (ibid, 3). Another important aspect is the proper training of the medical personnel working in EMS.India is a case study in this regards, and have successfully trained many of its personnel in trauma management.However, a majority of thepoor income nations like Nigeria avoid such trainingowing to high costs prohibitive costs. In India, the National Trauma ManagementCourse has worked out a method to bypass the exorbitant costs of training the medical personnel. Here “an indigenous two-day course developed in India by the Academy of Traumatology (India) with the help of international peers. The curriculum takes into account local conditions and capabilities. The cost is US$50 per trainee, and the course is taught by local trainers to a group of 100 trainees at a time. Animal specimens are used to teach life-saving procedures instead of expensive commercially produced manikins. More than 2,000 health professionals have been trained in less than three years. The course has now become a national training standard for immediate trauma care in India” (Kobusingye, O., et al., 2006, 1273). Thus, we find that there are many ways to create an effective EMS within a country (even within a poor-income nation like Nigeria), using different cost effective measures. 1.2 Aims and objectives The chief objective of the paper is to examine from a close setting, present situation of the health sector in Nigeria, while comparingit some of the health indicators with other countries. From this close study of the Nigerian health sector, a rationale for the project will be drawn,and the objectives derived, while taking into consideration actions to be taken, the cost of project, expectations from the Nigerian government and the expectations from our group in setting up an Emergency Care Centre (A and E) in Abuja, Nigeria. It will also justify as why our group(including nurses and doctors with several years of experience in the NHS) should be allowed to handle the project. 1.3 Nature of the study In this study, the researcher will focus on three main questions to have a better comprehension of the important aspects of EMS, defects in the present Nigerian heath sector and the almost non-existent EMS as observed within the country, and to formulate ways to elevate the almost abysmal condition EMS in Nigeria, in a most cost-effective way. What is the significance of EMS within the heath sector of an income poor country like Nigeria? How to bring create an effective EMS using cost effective means? What is the necessity of training and re-training of the technicians and other medical personnel associated with EMS, and what is the role of the government, the health workers, and the community within the scope of EMS? 1.4 Purpose and significance of the study As we have already seen that Nigeria lacks a basic health infrastructure, with very little funds allocated for its public health system. Care facilities 1989 1990 1991 General hospital 987 897 897 maternity 3172 3331 3349 Paediatric - - 1 Orthopaedic specialist 3 3 3 Medical healthcentres 985 Dispensaries 8405 Teaching hospital/ specialist 14 14 14 Others 9471 9716 9962 total 13647 13961 23616 Fig 4:number of health establishments in Nigeria (1989 - 1991) (Source: Adebanjo and Oladeji, 2006, 381-398). From the table given above we find a serious lack of any specialised unit (almost non-existent) especially to treat emergency cases. However here one must remember that owing to a lack of modern and organised record keeping system in Nigeria, under the new transitional government, it is almost impossible to derive any reliable data as regards the recent heath sector status in this country (International Labour Organisation, 1992, 13). Further according to a 2006 report prepared by Erinoshoin collaboration with Federal Ministry of Health, we find that,in 1992,there were only around 18000 doctors available to take care of thepatients and hospitals (including EMS), thus showing the negligent state of health affairs in the country. In a more recent report conducted by WHO in 2006 that the surveyed the Nigerian health scenario in more recent terms, found that there were still very few medical personnel in the country, to deal with the treatment and prevention of simple diseases like malaria or fever, leave aside dealing with complex issues like EMS. Medical personnel Numbers Percentage Doctors 34923 9.4 Nurses 210306 56.6 Community Health workers 115761 31.14 Fig 5: The main health personnel in Nigeria 2003-2004, (Source: WHO, Heath profile of Nigeria- 2006 [Country Health System Fact Sheet 2006 Nigeria], 2006). From the table given above it is clear that there are very few doctors (only 9.4%) to deal with any kind of medical emergencies in Nigeria. Thus, with a serious lack of adequately trained personnel in this field in Nigeria, it justifies as why our group(including nurses and doctors with several years of experience in the NHS) should be allowed to handle the project, which involves setting up an Emergency Care Centre (A and E) in Abuja, Nigeria. From this project, both the government and our members would expect to elevate the present abysmal standards of EMS in Nigeria, and work towards creating a more effective system, and bring down the mortality rates caused from trauma. 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