Prof. Fola Esan is the Chief Medical Director, CMD, of ABUAD Multi-System Hospital. In this interview, he outlines the capabilities of the facility and successes achieved so far with a projection that in a few years to come, the well-equipped and specialists-staffed hospital would be not just the best in Africa but one of the best in the world.
When we read about other Teaching Hospitals, they announce some medical feats like heart transplant. Within the time the hospital started, open to the public, has there been any of such?
I must make a correction. I am not aware of any heart transplant in Nigeria yet. There have been attempts to do heart operations and they are increasing. Within the first two years of our opening, we did the first heart surgery in this hospital. As I mentioned, we have been held up by COVID now, that does not allow people to come into the hospital. We have done complex surgical operations for congenital heart diseases. We have done multiple valve replacements, and then patients who had blocked arteries to their hearts we have done interventional procedures and those who required pacemakers, we are approaching 80 procedures in total for those categories of patients. Basically, that’s for cardiac, but in the areas like neurosurgery for instance, we have done skull-based tumours; recently there was a publication about the skull-based tumour that we did, the patient was a police woman. She had been taken around for about three years. She wasn’t even aware of her environment. She couldn’t see, couldn’t walk and had a surgery here and within 48 hours, she was able to identify her relatives. And five days after surgery she was able to walk and we discharged her after a week. Those are complex surgical procedures. We have done several brain tumours, spine surgeries and so on. There is a special type of neuron surgery that we do here, it is called Awake Neurosurgery where the patient is actually awake while operating on the brain and that helps because the brain is like the control room of the body; you can ask the patient to do complex movement, test part of the brain while you operate on the brain. We have that capability, this is in terms of neurosurgery and that is why it is multi-system really; we go deep into the specialties. In general surgery, we have a European Board Certified Surgeon and minimally he does like laparoscopy endoscopy. There is a specific surgery that we do called ERCP, Endoscopic Retrograde Cholangiopancreatography; in this case, the patient will have an obstruction to the flow of bile, naturally for such cases you need to do open surgery and take out whatever is obstructing the flow of bile. But with ERCP, you can pass a tube, you don’t have to do anything surgery and take out the obstruction of bile. We do that on a regular basis here. In all the specialties, we have these surgeries, orthopaedics; we do joint replacement surgery, spine surgery and so on.
I remember the last time we were here, about two years ago, we had some Indians. Are you doing this in conjunction with some foreign specialists or all your specialists are Nigerians?
For cardiac for instance, we have a full-time cardiac surgeon, who has capabilities of heart transplant. He has done heart transplant and he is a full-time staff of the hospital and for specialty like cardiac surgery you need a lot of technical abilities in different fields, so you need a perfusionist, you need a cardiac specialist and so on. So, our cardiac team is an expatriate team, mostly Indians; they work here and they are all full-time staff. They live here and in other areas like radiology, we also have some expatriate staff and in nursing too. In the last one year, we have also established our Renal Dialysis Centre, where we have 16 dialysis machines and when we started in March 2020, we were doing an average of 10-12 cases but in August, we did 104 dialysis sessions, so, we are increasing in the area as well and in that area.
I think we have about three expatriate nurses. We started with a nurse from Dakar, we have two Indians; one in ICU, one in Dialysis Center and one in Radiology Department all on that area. But the difference is that they are all here; we don’t have to ship them in only if we have surgeries and with this we develop our own staff as we go along. For example, the Nepalese nurse that came, that helped us start our Renal Dialysis Centre spent a year. When she was going, she handed over the development to a Nigerian who is very capable. We are doing the same thing to the cardiologists; we are training our own people so that they can take over, so it is not that they come in and go out. They are full-time here and are working all the time.
I also recall the last time here that your laboratory section was in partnership with Afriglobal. Is that still on or you are fully independent now?
It is not a question of being independent or not. There is a partnership, it is quite not an outsourcing. These are new developments all over the world whereby you do some of the things and you ask people who will fully concentrate and then they do it in partnership. For example, we have an oxygen plant which we run in partnership with an outside source because some of these people are better suited to run these institutions than you doing them all the time yourself. It is a little bit out of the way; for example, Afriglobal refused to do blood transfusion, we are doing the blood transfusion all on our own with Nigerian staff. We did the equipment sourcing and all that, so, it is not for the lack of ability, it is for the greater efficiency of the system, that is why these partnerships are developed.
As much as people would want to enjoy your facilities and equipment, a lot of them will be scared whether they can afford it or not. How affordable are your services?
I think you are absolutely correct that people are scared that we might be expensive. They look at the buildings and they talk about the equipment and the tests that we have to undergo. The fact is that it’s not true that we are expensive. We have very good buildings, very good equipment and we have very good staff but if you compare our prices with other prices, you will find that we are far more reasonable than what you can get elsewhere. Let’s take from the starting point; to register to see a doctor in this hospital is only N1,000. If you want to see a specialist or a consultant, it is N 2,000 and N1,000 for registration making a total of N3,000. But if you go to the private practitioner’s office who is in general practice, I doubt if you want to see a doctor you probably have to pay N5,000 or more and you will not have the same kind of reception that you will get here or the kind of treatment and the attention. Secondly, we do give satisfactory services. Satisfaction is our primary concern, so, it is not a question of you come in and before you finish your description or what is happening to you, there is already a prescription being handed over to you. We do practise proper medicine here. We listen to you, we examine you, and we tell you the test that you need to run to be able to make the absolute and correct diagnosis and that is the way medicine is supposed to be practised. All our people who go to India, South Africa, England or the US, they say this but a lot of them are also are used to the fact that they just come and they will be instantly attended to. I recall a situation in which a patient walked out on us because we were asking questions as to what was the matter with him. But majority of them have come to understand that this is proper medicine and that is why our numbers are increasing and if there are any complaints, our doors are never locked and we have had a few because we have to be honest. But they have been very very few and had been resolved amicably.
So, we are not cheap but we are by no means expensive as the buildings may be. The other reason people think that we will be expensive is because of the cost of running the university. We run a proper university here different from everyone else; the last time I saw this was when I was in my service when everything was provided. That’s what you get here and you cannot provide such services cheaply; you cannot run a university properly on the tuition or total fees to the students. Is it a N100,000 they pay in government institutions which buys you nothing that you want to rely on? The idea behind that was that the Federal or state governments would subsidize but these monies are not coming. That is why there are all these levies and things like that. But things are different here: you come into this university, you pay your fees, you have your health services free, you have to buy your food of course. You have clean accommodation, you have light 24 hours a day. You have water running all the time. I am not so sure that there are state universities that can provide such. That is why there is always this comparison that our school fees are higher. They are only higher as we provide far higher services that the other places can’t provide. On the other hand, if you come to the university, we provide better services at a lower cost than the average.
Some of us have visited many Teaching Hospitals and there is a trend on how they attend to you, the number of hours they will spend and others. But coming here, how many minutes or hours will it take for somebody to be attended to? I mean what is the situation here? Can I walk in and be attended to promptly? How long will it take to get services?
What I know is that you can walk in here and you will be registered within minutes. One of our advantages and one of the things people are getting used to but find difficult to start with is that we don’t give you a card, everything is electronic. So the moment you come back again, you mention your name, somebody pushes the buttons and your number comes up, they know everything, but between your coming and your being registered is a very short time, no fancies, nothing. How long it takes you to see a doctor thereafter I think is immensely short and it will depend on what brought you in. Let me give you an example: my own brother on Christmas Eve took ill in a place called Ikoro-Ekiti, some 50 kilometres away. I insisted on bringing him here, within minutes, (actually I didn’t follow, his wife brought him here). Within minutes, he was registered. He was examined and by the time I came in 20 minutes later, he already had a chest X-ray, he was admitted to hospital; he was on intravenous drip with antibiotics. He had travelled to America for a PhD studies and other things and he came and said look I have never had this kind of a treatment in my life. He is now one of our ambassadors and he is currently in New York. One of the perceptions that people have is that they will have to go through the rigours that they go through when they go to Government hospitals.
My phone number happens to be out there on the internet as a representative of the hospital so I get a lot of calls. This morning, I got two calls from Lagos and they usually end with ‘so when I get to the hospital should I call you or you meet me somewhere so that you can facilitate the thing for me.’ And, I always tell them, you don’t have to call me when you get to the hospital. Everything is electronic, once you get to the Reception and you register, then your information is accessible to all the doctors immediately. So usually within the first few minutes of getting to the hospital, the patient is before a doctor. It is true we have Specialist Clinics for each of the days but anybody who comes in sees the doctor within the shortest possible time, usually 30 minutes, and all the bottlenecks that you have queuing to open files, queuing up to see the nurse take your vital signs, hostile staff and things like that, we don’t have all of that here, everything flows quite seamlessly. You can communicate to all the departments from your office as a member of staff here and that makes it very simple to get across, so no issues at all in terms of the efficiency of staff, everything is done quite well .
When you look at your records of patients, can you say they cut across the country? Do you have patients coming from across the country or basically from Ekiti State?
In total this year, we have seen close to 17,000 patients from across the country, majority of our patients that come from outside come in for our specialty treatments like cardiac, renal and neurology, like the brain tumour I told you about came from Kwara State. These calls I said I received came from Lagos State, a lot of those cardiac surgeries are from the Northern parts of the country: Kano, Sokoto, Kebbi states among others and they keep coming for their follow-up. So we get patients from all over the country; we are hoping to progress in the area of renal transplant and I am sure with that also we will get people even from outside Nigeria because of the price that we will be putting on the procedures, so those are some of the clientele we have been getting in the hospital.
What would you say is the motivation for people to leave and travel hundreds of miles from the North?
Well, when we started generally in terms of the whole hospital, we were seeing very few patients because of the perception of the likelihood of being very expensive. We did a lot of drives to get patients, we did a lot of publicity. But I can tell you that majority of the patients that we got and we are still getting are by direct referrals from those patients that have been treated here. So once a patient comes here and is successfully operated for a cardiac surgery at an affordable price, he goes back and tells those who have been suffering for years, like patients who have been having dialysis in other centres when they do their tests and the parameters are still bad and they have a lot of complications, and when they come here and do their dialysis and within a few weeks they make good recoveries. They call others to come; so it’s like a network. People who had conditions and were treated successfully go out and publicise the hospital and that brings us patients, so that is how our patients base has risen to close to 17,000 patients in nine months, mostly referrals from those that have been treated here directly.
What has been your experience with people in government, especially political office holders and other VIPs?
I believe we have a reasonable number and we wish to add more. We had two or three ex-governors here, one of whom ultimately died in fairness and was 80-something years. One was treated and became very well. He just came for a check and was full of praises. We had a few high-ranking Chiefs and Obas and in fact we still have one right now. One of them had some brain problems and he was treated so we are getting a big spectrum of people. We could do with more no doubt about that and we have recently set up a marketing unit to try and popularize us by going from hospital to hospital to tell them what we can do instead of people going elsewhere. We are far cheaper than taking anybody to England or to India where probably it is the cheapest but when you compute into it transportation cost, what most people usually think is how much it will cost to see the doctor, they forget the transportation cost, cost of living and so on. It is so much easier to come here virtually for everything and ultimately it will be for everything and we are making rapid progress.
You have spent a year as the CMD, where do you see this hospital in another five years, God sparing your life?
I certainly will no longer be CMD at that time but I can see this hospital being perhaps the very best in Africa and one of the very best in the whole world. I will say one of the very best in the whole world because we have a long way. As they say, Rome was not built a day, it takes time to consolidate and develop a reputation but among our peers we will certainly be number one. I hope the government will be helpful in improving the transportation problems around here and making the conditions of living generally in Nigeria a little more comfortable so that everybody will be able to pay for the services that we are able to render because it will not be cheap and the reason we are having problems with health is that we think that health is cheap. As a matter of fact, less than one percent of our GDP is spent on health in this country. I learnt that recently I think the actual figure is .75 percent. There was a conference on health financing organised by Nigeria Academy of Science in partnership with the UK Academy of Medicine where these figures were shown but I haven’t confirmed if they are right. If we can have a form of universal health coverage for the population, it is going to make things a lot better. I think we have a very bright future and I hope and pray that the Founder will be around to see the fruition of these expensive projects and one that he has committed all his resources and all his energy.
You said it took a lot of persuasion for you to come to take up this job at 81. What was the motivation for you?
First, it was the Founder, I was lucky to have been invited at the very beginning when he wanted to set up this university, I was one of the so-called eggheads that were gathered in Ibadan to give the Founder ideas as to how and if a university can be founded at all and to be honest with you, there were about 15 or so of us and mainly from University of Ibadan. The Chairman was the late Prof. Tekana Tamuno and he said the Founder said he wanted to start a university. I think this was in April, he said he wanted to start and admit people by September of the following year and we said no, it is not possible and I remember him clearly saying: ‘I didn’t ask you whether it was possible or not. Tell me what I need to do to make it possible’, then, we said everything, the rest is history and I think in October of that year, they started building here and by November of the following year students were here with everything that they needed.
At the beginning, we said they were going to have phases, Phase1, Phase 2, Phase 3 but the Founder said we needed to collapse these phases because it was going to take too long. So, two years after they started, I was asked again to come and sign papers again because they wanted to start a Medical School. Now I didn’t say it was impossible. I was handicapped. What I am trying to say is that I had been with the development of the place, I know the Founder when I was very much younger but the honest truth is that my bones were beginning to crick and I keep telling him I wasn’t made the same day he was made. We were actually made by the same God but we don’t have the same genes. The reason I finally succumbed was that I wanted to continue to buy into his vision and to do the little I can, understanding my own system, and trying to let him know that I am not the same person as I was 30 years ago, so that my frailties will be understood. That is why I keep telling people it is the truth but if you work with a man like this you can’t afford to be slack; you cannot afford to be lazy because he will call you, the message he sent to me came at 9:30 pm yesterday night. Sometimes you get an email from him that this is what is going to happen tomorrow so you need to be on your toes. Those were the things I had to consider before I said ok, I will take the job but only on protest and that I will give my very best to the best of my ability and I must say I have a fantastic person as my Deputy, Dr. Akinola Akinmade.