DECADES after it was established as a military rehabilitation camp for returning World War 2 prisoners of war, the National Orthopaedic Hospital, Igbobi, NOHL, has undergone a metamorphosis to become the nation’s No.1 Federal health institution for trauma management.

But it hasn’t been plain sailing, according to Dr. Olurotimi Odunubi,   the institution’s Chief Medical Director.

In this exclusive interview, he gives insight into the goings on at the famous 450-bed hospital. It’s a mixed grill of the good, the bad and the ugly. Excepts:

By Gabriel Olawale

FOr a hospital like this that focuses essentially on one specialty, it is easy to plan and develop the skills of your employees in that specialty. What we do is serve as referral centre for all the general and specialist hospitals for difficult orthopaedic cases they cannot handle.

What we have done in the last few years is to sub-specialise to improve the skills of the surgeon by focusing on specific areas of orthopaedics in which we now have five different units in the hospital. Before this, each orthopaedic consultant was treating the whole orthopaedic problem but now they have narrowed down their service to different specific areas.

Sub-order specialties: So our consultants have been trained in all this sub-order specialties, but you cannot develop doctors alone you need to develop other healthcare givers at the same time as well.

For instance, nurses, when they come to the hospital, they come with general nursing certificate but since this is an orthopaedic hospital, we have a school that runs a course for one year on post-basic nursing orthopaedic care and also another school that runs a course for one year on accident emergency nursing, to improve their skill and focus on the specialities the hospital is running.

 

Then we need other professionals like prosthetic and orthotics , these are people that fabricate artificial limbs and splat; they are very essential after treating a fracture you want to get the person back to pre-injury state as soon as possible so they are the ones that provide support for the joint, limbs and when the patient has amputation, they fabricate artificial joint so that the person can mobilised.

Unfortunately for a long time in the country there has been no school that is training them, no university or polytechnic and at a time there were only four specialties in the whole country for prosthetics. These are people who fabricate artificial legs and there was no school until we were able to establish a school here in Igbobi that is now running ND and HND programmes. This is the only school in the whole west Africa that is running programme for such specialties. Even the head of that school has retired and we have to give him a contract to make sure the school is running.

It is those people we have trained now that after their obtaining their HND, they may further their education outside the country. The service was dying already because those four specialists were trained abroad.

 

Lack of training facilities

 

The same thing happened to occupational therapists in the 1980’s. We had about three occupational therapists in this school. This speciality is trained to rehabilitate people that get disabilities from injuries, for example a driver who needs his leg after his leg had been amputated as a result of an accident. The occupational therapist has a job to ensure that he is still useful to society. They can help the patient fabricate a car that he or she can drive without a leg or train him/her on another job. These are specialities that matter because it is not just treating an injury that is priority but helping the person get back into society and be useful is what counts.

For a long time no school for such training those that have the skill had retired and we didn’t have operational therapist in this hospital until Yaba Psychiatric Hospital, started a school but it is not a degree awarding school so there is still no fulfilment, those who finished from that school, some of them that we employed have traveled abroad for further training and to get a degree so that they can have job satisfaction.

 

Professional groups

 

Let me note this, it is not only doctors that need to be develop, all the professional groups have to be developed. There is need for national policy that is focusing on developing all healthcare providers in different areas because everybody is important in ensuring total care of the patient.

On the exchanging of personnel, we do send people abroad why we invited some people as well from outside the country. Even we run courses where by specialties come from India, America. Last year we still ran a spin workshop by an America surgeon. We ran courses for paediatric- orthopaedic by an Indian specialist. Also last year we ran an hythoscope workshop. This are things we do continuously and their is a centre where we do that in this hospital.

Beyond trauma: Is just sad that when people think of Igbobi Hospital, they think we attend to only injury which is trauma. Although it forms the major part of our work really, treating patients with injury and that is why we have orthopaedic unit and plastic unit.

The Plastic Unit here tries to manage the wound well while the orthopaedic surgeon manages the tissue and bone. So apart from that, we treat other people like people with deformity especially children. Some children are born with deformities mostly of the foot which maybe curved, that is the commonest deformity all over the world. We we treat it here. There there is the issue of back pain, infection, degenerated diseases among others. All these we treat.

 

No 100% bed occupancy

 

As for whether we are underutilised or not, I can tell you that our beds are not usually 100 per cent occupied. Most times we don’t have 100 per cent bed occupancy and this can be attributed to incessant strikes in the sector. When there is a strike, the whole hospital will be empty and when work starts again patients start coming gradually and before the hospital is full another strike starts. In the last three years, we have not been able to achieve 100 per cent bed occupancy.

But for surgeries, some have to wait their turn because there are too many patients and not enough facilities to do the surgeries especially surgeries that are not emergency like total hip replacement, total knee replacement and some plastic surgeries, because we have to give priority to those who have injuries.

So whenever we have a list of those to go for surgery, we give priority to people with injury rather than people with deformity who can wait. We consider issues that are life threatening first.

In the area of total hip and knee replacement, now we are training more and more people right now. In the hospital we have at least five consultants that are doing it on a regular basis and the waiting list is getting less and less, but at the same time the awareness is increasing and more people are coming.

What we have ensured in this hospital is that there is no unit that have only one consultant because if that happens, that means if the person is on leave or not around, then that service cannot be provided on the level expected. So in all five units we have in this hospital, we have at least two consultants per unit but in a unit like trauma which is commoner, we have four. In athroplastic we have five, in spin we have two, in athroscopy and sport we have two. In plastic unit we have four consultants.

Capital  intensive

It must be stated that orthopaedic care is very capital intensive and government has been trying. In Igbobi now if you look around there are many new structures, but if we want to fast track development we cannot wait for government to do it alone, we have to be more aggressive in terms of public and private partnership.