Table of content
1. INTRODUCTION
2. ACE as a model
3. Challenges
4. To the government
5. ConclusionAwojobi Clinic Eruwa; running a successful rural hospital in Nigeria.
INTRODUCTION
As a student who wants to see medical practice to advance in Nigeria, visiting Awojobi Clinic Eruwa (ACE) was one of the best things the Ibarapa offered me. The zeal to stay back home and practice a kind of medicine that is driven by indigenous technology and available manpower was born through that visit. This is particularly important in an era like ours when there is mass exodus of doctors to greener pastures across the globe, especially to the United states, United kingdom and United Arab Emirates. This encounter with the clinic was in April of 2019, during my community medicine posting ( the Ibarapa posting). Before then, I believed that Nigerians were only good at theorizing and very poor at applying sciences taught in schools. This may qualify as a fallacy of generalization. But, I have seen so many chemists, engineers, physicists etc. who practice no science. Visiting Awojobi clinic dealt with this fallacy. I saw for the very first time, a place where indigenous technology reigned and I was impressed.
Because the visit was very short, about an hour, I decided to come back another time for adequate exposure to the wonderful innovations at ACE and to also understudy the systems that run such a place. In this paper, I will be highlighting some of the observations I made at ACE, hoping that other ACE’s will be born through some of my findings. Before I delve into the story proper, permit me to introduce Dr. Awojobi, the man after whom the clinic was named.Late Dr. Oluyombo Adetilewa Awojobi was born to the family of late Omooba Daniel Adekoya Awojobi of Itun Elepe, Ikorodu, Lagos state and late madam Comfort Bamidele Awojobi. He was 8th of 9 of the family. His early childhood and education were in Lagos before he move to Ibadan for hos tertiary education in the university of Ibadan where he studied medicine. He graduated in 1975 with a distinction in surgery.
After National youth service in Benue state, he went back to UCH and commenced postgraduate training in surgery in 1977. His connection to Eruwa happened in April 1980, when he was posted to the Ibarapa District Hospital for a one-month internship after graduating from medical school. The Ibarapa program was designed by the University of Ibadan to help rural areas by providing them with basic health care services using recently qualified medical doctors.After graduating from medical school, he returned to Eruwa to work as a surgeon in the government hospital. He was a consultant surgeon at the District hospital Eruwa for 3 years. Due to bureaucracy, in 1986,he left the hospital to establish his own private practice. He set up the hospital with his savings and an interest-free loan from Pa. Obisesan. The rest is history.In 2000, the late prof. Olikoye Ransome Kuti, the then minister of health of the Federal republic of Nigeria paid a visit to Awojobi Clinic Eruwa. He had this to say “ highly privileged to visit this hospital, an example of commitment, concern for fellow beings, innovation and imagination…… I like the way he fabricates everything and saves everything. I have visited an exemplary phenomenon and honored to be here. Can this be replicated? It must take a particular kind of person!!”
Dr. Awojobi derives his inspiration from the writing of Niccolo Machiavelli an Italian philosopher which he quoted “ There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things.”ACE as a modelIt is very important for doctors, especially to rural doctors, to understand that for one to run an efficient yet affordable hospital innovation and invention can not be neglected. Late Dr. Awojobi understood this hence his numerous inventions. This is time for doctors, Nigerian doctors, to look inward and ask “what do we have?” and “what can we do with what we have?”. The situation of power supply in Nigeria does not look like one that will improve soon, that means that a rural doctor must always look for alternatives. Awojobi realized this very early in his practice and sought for ways to reduce his dependence on the national grid. He,in fact, went ahead to develop non electronic versions of equipment he needed for the smooth running of his clinic.
Have you heard of the manual suction machine or the manual haematocrit centrifuge? These are some of the technologies he embraced at ACE. Instances where manual equipment were seemingly impossible to invent, he went for alternative sources of power. For example, his distillation machine was powered by a native fire house fueled by corn cob. He fabricated his own ambulances by a union between a motorcycle and a chart. When water was as scarce as gold, he resorted to self made dams for water supply. ACE is a vivid example of “using what is available to one’s advantage “.ACE runs a research base clinic. Late Dr. Awojobi was a renowned scholar with a keen eyes for details. He was given to research even as he toke the path of private practice. He numerous publications bears record to this. He was not satisfied with the level of information at his disposal. He was a voracious reader. If we must move our healthcare system to the next level, research must be at the front burner of such a system. The doctor must keep himself updated with the latest information on treatment and management of diseases.
The onus lies on him to also find ways of domesticating new ideas in the world of medicine. These is little a doctor can achieve if he refuses to grow in knowledge. ACE is well known for its advances in areas such as in the management of chronic ulcers. Most of the chronic ulcers cases management at ACE, come for far and near after such case has been labeled hopeless. Herniorrhapy and snake bites are other areas this clinic has show great dexterity in. These did not just happen, a man decide to learn, unlearn, and sometimes relearn new areas of managing conditions that are common among his patients. ACE does not play with patients’ records. They understand that a faintest pen is still be that the sharpest memory. Patients records are file systematically to allow for easy access. From the wealth of information in these files, and ACE has been able to fine tune management of common diseases.
These managements approaches are often compared and scrutinized with findings else and are almost always made available in publications.Unlike many other private hospitals, ACE incorporated an informal residency program for doctors who desire to pursue careers in surgery, Obstetrics and gynecology and those who wish to setup their own private practices. What other better can ACE be replicated if not through training such as this? The idea was to train residents that will go on to reproduce what they have learnt across the country. It runs for 12 months, within which the doctor is expected to have seen and managed a certain number of surgical cases. Late Dr. Awojobi in emphasizing the importance of training said “ the logjam of retaining medical officers in rural Nigeria could be solved formally using established governmental institutions and informally through private sector initiatives. First, rural health institutions should be made functional using the appropriate technology (as we have developed ourselves in our clinic)…. Rotations through rural health institutions should be made compulsory during postgraduate training as it is with undergraduate training but the trainers should also be resident in the institution. “ He was really decades ahead of his generation.
Training junior staff is another way ACE has contributed to the labour market. A junior staff is employed on a contract of 3 years. The staff is training to function in a particular unit of the hospital. Some even go as far as becoming retained as nurses after their have exhausted their 3 year contract. It is assumed that during this training, the staff, who are mostly young adults, especially secondary school leavers, would have decided on the path he/she wants to take in life. This invariably keeps these young people busy so that devil does not make workshops of them. I learnt this program is very flexible that it allows participants enough time to pursue other ventures. I remember a young man that I met during my elective. He had just written the university of Ibadan post UTME before I resumed. In one of our numerous chat, I got to know that he run q shift at ACE. He was permanently on night shift with two weeks on and the alternate off. He resumes at 6pm and closes at 8 am. Right from inception, ACE made patient care its priority.
This made ACE to move from a profit driven venture to a service driven one. This does not mean that ACE is a nonprofit organization. Rather, ACE through its innovative approach to healthcare services, has been able to lean backward a bit in other to accommodate the less privileged in society. They understand that patients fail to present to the hospital as a result of high cost of these services. It is a fact that health care is very expensive especially when the caregivers refuse to look inward for alternative technologies. The care patients receive at ACE is very impressive. The hospital is arranged in such a way that the bureaucracy patients meet in big hospitals are eliminated. From the consulting room, a patient moves to the dispensary then to the laboratory or and the radiology department. This free flowing sequence has really helped in reducing unnecessary time wasting. Patient care was taken to another level when the management decided to allow patients’ relations come into the theater to both provide the needed emotional support and observe what was being done for their wards. Late prof. Olikoye Ransome kuti was impressed by this practice that he said” I like the way he admits relations to the theater to watch operations on their sick relatives.” On referral