Dr. Joseph Ugbaja is the Acting Chief Medical Director (CMD) of the Nnamdi Azikiwe Teaching Hospital, Nnewi. In this interview with ECHEZONA OKAFOR, he speaks on how Nigerians can manage the second wave of COVID-19, and his priorities as Acting CMD
As the chairman, taskforce on COVID-19 in the teaching hospital, what do you think is the best approach to tackle the second wave of the coronavirus, which they say, is deadlier
? We handled the first wave of the pandemic effectively, and we are now experiencing the second wave. During the first wave, Nigeria did very well, leading to lower rates of death and mortality. All the key institutions did their best, starting from the Ministry of Health, the PTF, NCDC, and various others. But the second wave is a lot different in terms of severity, rate of infections, and rapid of evolution of symptoms. The second wave hit very hard because, it came at a time when we in the South East were in the Christmas and New Year festivities. For the past one month, a lot of people have lost their lives.
It was not like that at the first wave. But the good thing is that the first wave allowed us the window to strengthen the system. Because, before the onset of the first wave, many institutions didn’t have isolation centres, and had no knowledge of how to manage COVID-19.
But the first wave gave Nigeria the opportunity to get prepared in many ways. So, all those structures were already on ground before the second wave. So, we now leverage on what we build at the first wave to manage the second wave.
At the teaching hospital, for instance, we have our isolation centre; where we manage patients. We have staff trained during the first wave and the management had also provided all that are needed to manage the pandemic. We have a case management team; we have the rapid response team; we have the nurses, doctors, and all the complements of staff that are needed to manage the pandemic.
Beyond this is the need for Nigerians to observe the necessary preventive measures. By preventive measures, I mean wearing of face masks, hand hygiene, maintaining social distancing, not going out when it is not necessary, and so on. So, everybody must to take responsibility by maintaining social distancing, wearing face masks, and all of that. We also have the duty to continue to educate our people on how to go about it; in order to ensure that the chain of infection and mortality are cut off.
By and large, the second wave is more serious than the first. But, as I said, the fortunate thing is that the structures are already in place to handle it.
Do you think that lockdown could be a good option in managing the second wave of COVID-19?
Lockdown has advantages and disadvantages. The virus does not move. It is the human being that moves the virus from one point to the other.
So, if you lockdown a place, and nobody moves, the virus remains in a place until it dies or it kills its victim. But if people are allowed to mix-up, the virus will spread more rapidly. On the other hand, if you look at the dynamics; considering the south east, for instance, people returned home and got mixed-up during the recent festivals of Christmas and the New Year.
Some of them have equally travelled back. So, what are we locking? It will be like locking the barn when the horse had already bolted. Lockdown also has economic and psychological effects on the people. So, government has to weigh the options. Some people also reason that lockdown does not work for us in Africa, because, many people are peasants; they survive from daily incomes. So, when there is absolute lockdown, there will be problem. A
lot of people do not believe in COVID-19. As an expert, how would you differentiate between the pandemic and ailments with similar symptoms?
COVID-19 is a flu-like ailment. Both share the same characteristics. The only thing is that the course of COVID is different, and the outcome is also different. COVID-19 is deadlier than flue. For flu, you have cough, catarrh, headache, etc. COVID-19 has almost similar features.
This is why when you have these symptoms, you should assume it is CIVID-19; then, do the needful. We have case definition for COVID. Once you have cough, catarrh, with or without fever, you should check yourself out.
What are your priorities as you mount the saddle as the Acting Chief Medical Director, CMD, Nnamdi Azikiwe University Teaching Hospital, Nnewi?
Personally, I cannot do this job alone. Health care delivery is a task for everybody. All of us must consider ourselves as critical stakeholders in taking care of the health of our people.
Everybody; men and women, old and young; we need collaboration to move the health institution forward, and place it where it should be. Be that as it may, we have mounted the saddle; we are not afraid of the task ahead; as we are already used to the system. I have been in the management of this hospital for the past seven years. So, it is a terrain we know and understand very well.
All we need is support from all the critical stakeholders to move the hospital forward. Our vision is to make the Nnamdi Azikiwe University Teaching Hospital rank among top five best teaching hospitals in Nigeria. We want to achieve this through three critical pathways: The first is massive infrastructural development at the permanent site of the teaching hospital. We cannot rank among the best with the present state of things at the temporary site of the hospital; so, we must move to the permanent site. Infrastructural development is key towards achieving our vision.
The second pathway is human capital development. If we built the infrastructure and put them in place without training staff, which have requisite knowledge to man such infrastructure, we have not done much. The human capital development is in three forms. First one is for the staff to acquire the needed skill and knowledge to treat the patients. Secondly is to train them in attitudinal change; because, healthcare industry is a service industry. So, even if we have all the skills in this world, and we cannot relate very well with our patients, we have not achieved anything as a hospital.
We have a vision, and the vision has to be shared by the staff. Any vision that is not shared is a dead vision. As acting CMD, I cannot execute my vision alone; people have to share the vision from the highest cadre to the lowest; so that they can understand the vision and strategic plans towards achieving the vision.
We’re going to train our staff in three arms; skills acquisition, knowledge and content management. We want to be one of the best; so, we must step out to get the knowledge. In the coming weeks and months, we shall be sending our staff out; both for local and international trainings.
Attitudinal change knowledge is central to achieving our vision. All of us are aware that the image of our teaching hospital is not at its best. This is as a result of the fact that some of our staff does not treat patients the way they should be treated. These are attitudinal issues. So, we are going to organise serious sensitization and attitudinal change campaigns and workshops, in order to re-orientate ourselves in terms of behaving the proper way. Our patients must be treated with the honour and dignity they deserve. In addition to the training, we are going to intensify monitoring.
We are going to monitor our staff. It is either you buckle up or you leave the system. That is the way it is going to be; because, we want to be the best. Any patient that steps into NAUTH must leave the hospital happy or happier than he came. This is not negotiable! Our staff must sit up. I trust my people; once they are given the requisite training, they will wake up.
In addition to training them in attitudinal change, we are going to monitor them through SERVICOM. We are going to improve the capacity of the SERVICOM to be able to discover our staff members whose attitudes are not consistent with the vision of the hospital; so that we can give them the required training. Any staffer whose attitude does not fall in line with the requirement of the hospital is a misfit. If that happens, we can ask you to leave the system.
There are no two ways about it. We are going to provide a whole lot of feedback mechanism for the patients through which they can reach the management. We are going to paste numbers at strategic places in the hospital; so that any patient who is not happy with our services will call. Of course, we are also going to give our staff name tags. That means that any staffer without the name tag is not part of us. So, as a staff, a patient does not need to argue with you or ask about your identity.
So, when the patient calls the SERVICOM or whoever that is heading a department, he will be able to make proper reference to staff in question.
We are also going to strengthen our disciplinary measures; but in doing that our intention is not to punish our staff, but to encourage them to do better. If after training a staff he fails to fall in line, we will re-train him, until such a time when it becomes obvious that he cannot fit in.
We are also going to do a lot of staff motivation. We will provide packages to encourage staff members that excel in their jobs and some of them who are helping us to achieve our vision. The third arm that is as important as other arms is acquisition of the state of the art equipment for the hospital.
We cannot be talking about becoming the best with an analogue system. Lucky enough, the public/private partnership model is being espoused by the health ministry. In Nnewi and around Anambra, we also have individuals who are willing to partner with the hospital to acquire these equipment, because, we cannot do it alone.
Getting the state-of-the-art equipment is part of what we want to achieve. We are going to do direct investment, as much as we can, with our IGR and what we get from the federal government; but largely, we are going to explore the public/private partnership model to be able to drive this forward. Some of the pillars that will help us to achieve this are to work as a team.
As I said earlier, a vision that is not shared is a dead vision. We have the central team, which are the board and the management of the hospital. I am going to rally everybody together, both the board and the management. It won’t be a big task for me to mobilise them. They already know this vision I have. That makes it easy