A Dysfunctional System Called Nigeria, by Dr. Celsus Undie

New problems arise as we face new years. The other day, NAFDAC seized forceps we use for removing kidney stones that we imported from Germany, when they arrived Lagos.

We were required to get clearance from NAFDAC to import metal surgical instruments. What has NAFDAC got to do with metal surgical instruments? The same NAFDAC says we cannot import 3-liter normal saline which we use for irrigation to flush out kidney stones when we do lithitropsy. We need it also for Holmium Laser Enucleation of the Prostate (HoLEP). It is never made in the country.

NAFDAC wrote to us to say we have to use 500 ml sachets available in the country. For some surgeries, we use over 50 liters. In fact, I have used 90 liter of irrigation on one patient one day. For 500 ml, 50 liters would mean changing 100 times in the course of one surgery. Each time you change, air goes in and you cannot see well. Also, you have to stop what you’re doing to wait for the change.

Assuming the change takes some time off the surgery, it means the surgery would last very long and patient would have to be very long under anesthesia. This isn’t safe. Frequent changes also introduce infection.Three-liter sachets are what Urologists like me who do HoLEP or laser lithotripsy use, all over the world, except in Nigeria.

Picture of a typical Nigerian hospital

In the past, we always got waivers to import 3-liter sachets. We were the only hospital in Nigeria using 3-liter sachets. At the moment, we are the only hospital in Nigeria doing HoLEP. When the 3 liters we imported finished, we applied again to NAFDAC under the new leadership and we were told we cannot import. We approached companies that make drips in the country and asked them if they could produce 3-liter sachets for us. We were prepared to buy 40,000 liters all at once. They said no. They wouldn’t produce for just one hospital.

We wrote to NAFDAC for a waiver to import enzymatic solution. We use it to wash serum proteins off endoscopic instruments after use. NAFDAC never responded. We wrote to NAFDAC for a waiver to import powders we use for sterilizing instruments after surgery. NAFDAC never responded. NAFDAC says some of these things are in the Import Prohibition List, which is under the control of Customs only.

We went to Customs. We were told to get a note from the Federal Ministry of Health. We went to the Federal Minister of Health. His Secretary did not allow us to see him. We wrote to him. We got no response. We contacted one Director in the Federal Ministry of Health via Social Media. He asked us to bring our application to him. We took it to him. He never responded till today. We heard that Customs was under the Minister of Finance. We went to the Minister of Finance and met her face to face. We submitted our applications to her. She took them by the hand. We are yet to hear from her till today.

Dr. Celsus Undie

Tell me how you would describe this situation? When we launched our new 120 Watts Laser (Moses Technology), the Minister of Health was present, represented by the Chief Medical Director of the National Hospital, Abuja. It was a laudable achievement because this was the first of this type of laser in the whole of Africa. But see the environment under which one has to practice? Isn’t this a way of saying that Nigerians should not even bother to innovate for the improvement of our system, that it is better for our citizens to travel abroad for health care?

Nigeria loses $1 billion (one billion US Dollars) to other countries on medical tourism each year. This amount is higher than the Federal budgeted allocation to Health care in the entire country.

It is very sad to call myself a Nigerian. It is a shame.

Dr Celsus Undie, is Cross River state born Consultant Urologist, based in Abuja.