Mugu-mugu Health Scheme: A failed approach
Levi’s mechanic shop sat right next to my father’s hospital at Nkwo-Orodo. Looking from afar, one could make out similarities between these two businesses that stood side by side, especially on an Nkwo market day. On days that fell on this market day, whilst motorcycles and bicycles filled the compound surrounding the hospital, cars, and motorcycles lined up and about Levi’s auto shop. Queen Juliana hospital prided itself as a front runner provider of rural healthcare and Levi auto shop held sway among his competitors along the Nkwo-orodo old road. My dad knew his patients like the back of his hands, interacted fully with the community that he catered to. Same could be said of Levi, who knew the problems of the majority of cars brought to him for repairs. I had thought at some point that he had planted some bug in my father’s Mercedes 230, straight engine, flat boot…as they described it then because its carburetor always needed some tuning each day we came down for clinics. If it was not the floating pin, then it was a gasket. When nothing was to be done, Levi instructed Okey to “just clean the carburetor”, ”O di ka carburetor suchiri asuchi”. These two businesses also shared a common neighbor, a vulcanizer by name Ata-abu, I guess a named coined from a birth anomaly that affected the size of his tongue. He always chewed on that tongue like a goat would chew cod. A mouthful at each time. He benefited from the overspill arising from both businesses. Most of the patients that came in motorcycles and bicycles, for some sheer reason always took care of their tire health before leaving the hospital. The people that had their auto health checked out by Levi, few times sent their tires off to Ata-abu. On days that Ata-abu and Levi had no customers to attend to, my dad’s Mercedes served as a stopgap in their misfortunes, with Levi tightening some engine bolt that potentially might come off and Ata-abu replacing the back tires with a spare, from an impending doom that he foresaw. It was all a win-win for those two businesses in clear difference to what went on in the hospital.
A clear difference that I saw whilst seated in the oily garage among the numerous apprentices and teeming customers. In the early days whilst going to the clinic with my dad, I had each time equated the number of bicycles and motorcycles parked at the hospital’s perimeter to money. I had always thought that a fully parked hospital meant money-lined up pockets for my dad. I had drawn my conclusions in the early days subconsciously, drawing inferences from Levi and Ata-abu’s happy faces when lined with so many potential customers. Whilst each customer that came to Ata-abu and Levi’s shop risked not getting services sought after if they did not come up with monies for parts or services, the hospital was bound by an oath to attend and render treatments regardless. It was a common sight to see cars and motorcycles in different forms of suspense. Some suspended on makeshift jacks, some in disarray from dismantled engines and motors, while others were untouched. You could hear Levi reeling out a list of needed parts once money had exchanged hands, instructing Okey, a young lad from Eziama or Emeka from Ubaha to hasten up in loosening tires for work to commence beneath the undercarriage. Once money exchanged hands, everyone could tell. Okey would be sent off to buy food from Mpa Nnamdi who lived behind the gas station adjacent to this auto shop. Emeka would be off in the same direction towards the bakery that was not far from the timber market. Ata-abu’s son would down his tools whilst eating a lot of moi-moi from the “mama put” lady that came each day.
The mechanic shop in Nigeria more or less served the same purpose that my favorite barber shop did in Los Angeles. It was a little community. It catered to people in different ways. Some came out there for solace, others came out there for companionship. A few came out there as an outlet for fresh air while others came out there to take in their daily dose of gossips. It was a beehive of a sort. A beehive that singled me out as an easy target for those that had words for my father.
Onyekachi’s father, Mr. Hyacinth from Umudinmonu in Odunmara made it a point to taunt and hound me each time he saw me in the auto shop. “Your father owes me”…he would start off, “This backache that I have today is because of your father”,” I used to carry him on my bicycle”…..He would go on and on till every other person begged him to move on. Some other man’s case was slightly different. He always reminded me of the numerous bicycle trips he made with my father, dropping him off on his way to school in Oguta. He describes the harrowing journey and made it a point to hammer in the distance that he rode “ Shite nga ruo ejemekwuru, kuwafe, gawa Oguta””Ima kwa ihe owu?…..he would say. My mental calculation put that trip to over twenty-five miles. It was quite a ride with a bicycle. He was probably related to my dad as well, so we laughed each time he told that story. The message each time was debt. My father owed a lot of people, a lot of them, who in one way contributed to his education and success. Iwualla, my grandfather, who was long dead was nowhere to refute these claims. I was hammered on both sides regardless. If it weren’t my dad, then it was those that knew my mum, those that swore that they had paid her way throughout her stay at Queen Elizabeth. My uncle “Ye-Ye” Samson, who had trained my mother would have been tossing and turning in his grave, probably laughing his head off as numerous people picked on me for “payback”.
Everyone that met me at that auto shop had one story or the other.
It was all love. This was the beauty of community healthcare. The community breathes with you. The community encompasses you. The community is family. It was quite nice to hear and appraise the heartbeat of the people while seated in that shop. It was evident in what they all wanted. A benefit from success. They wanted their right to access, they wanted a piece of theirs, from whom they considered family.
Each time, I had probably bought my dad a few more weeks of grace by buying these debtors food and drinks and any other freebies that passed by the shop, each time keeping the hope alive for a few more weeks.
Like the auto shop, a lot of horse tradings and community businesses were done in the four walls of the hospital. Community medicine is a non-conventional way of practicing medicine as it employs a different approach to treatment and betterment of its patients. A holistic approach that recognizes every facet in play is considered. Ninety percent of the people that came into the hospital in Nkwo-orodo, in addition to their ill health, came with a myriad of problems that needed attention. It was a common happening to walk into the waiting room, seeing some people complaining of some patients that had overstayed his/her welcome in my fathers’ office. He was the community counselor, he was their psychologist, he was their listening ear, a co-signatory, a next of kin,”both on paper and in person”, a loan officer, a therapist, a relationship adviser, a life coach, a nutritionist, a mediator, an arbitrator, a go-between, a historian, their succor, a shoulder to lean and most importantly a dependent hand.
He was everything for his people.
Unlike the auto shop that downed its tools at slightest signs of dusk, my dad toiled till the gas lamps went no more. Unlike the auto shop that announced its closure once traffic was less, my dad went on full steam, chipping down at patients problems till the very last.
I had always wondered where he got the strength to push through each day with these people despite the low financial rewards. “My reward is in heaven “ he would say…”There is joy giving back to these people that pray day in, day out for me”,” their health is my wealth”…he would finish up, each time with a renewed spirit that masked streaks of tiredness from the days’ tussle.
Today, healthcare delivery in my community is a shadow of itself. It is a long cry from what it should have been. I would say the same for most other communities. The Ubaha community hospital had struggled for so many years to live up to desired expectations. It had, with a lot of difficulties provided the indigents of Ubaha and its environs with a skeletal bouquet of services that hardly reflected positively on the general well being of the populace. Successive administrative governments had further fueled the decline of this communal privilege by squandering priorities that were native to community medicine. These priorities were a panacea to success for effective delivery of health in any society.
Health is wealth. Two ingredients that support an effective campaign for this core statement were passion and commitment. These two spices had clearly evaded my community for a very long time. A trial of medical administrators over the years to salvage institution had not worked for the mere reason of lack in these ingredients. Some that came along had commitment but no passion, some had passion but no commitment. The foundation of engagement, therefore, was faulty from the onset. An establishment that had been set up to gun for profits, set up to line the pockets of the community and communal heads, one set up with little attention to the very reason it was built in the first place, one that paid no attention to the indices that improved health among its indigents
The Ubaha community hospital had been treated as a goose that laid golden eggs. Since it was a collective communal hospital, successive governments have tried to milk its financial capacity as to suit the coffers of the communal purse rather than improve on its capacity to attend to the health of its immediate community, paying more attention to those facets of the hospital that brought in more money. They had placed wealth over health……maintaining a mortuary section that had constant and ever-increasing customers rather than improving on the totality in the delivery of healthcare to its dwindling indigents.
This is what we see in many local governments of today, this is what successive governments offer….. a system ran by those that do not have the required ingredients needed to maximize potentials in sectors like this. What we are now laden with were bogus promises that tickled the ears, elephant aspersions that cast bright futures, fabu-fabu mandates and manifestos that promised “state of the art this and that”, “fully equipped this and that”, “wonder on earth this and that”. A lot of whitewash health schemes, promoted by incompetent people, handed down to unsuspecting indigents were now the order of the day. All for nothing.
All they simply lacked were right people that had the peoples interest at heart. They needed people who could feel the heartbeat of the people. They needed people who were ready to listen to the cries of the populace. They needed doctors who had viable oaths hanging around their neck, who were bound by unforeseen gag to have the best interest of the patient at heart. They needed men and women who were compassionate. They needed people that were well and all rounded, people who would become almost everything for their people,
But yet they had settled for sweet talkers, they had gone for politicians in the community, they had gone for financial administrators and community hedge fund managers who shamelessly had owl eyes on the money, they had elevated con-men to standards not seen before. Local chiefs were now healthcare professionals, pouring libation on waiting rooms, now converted to venues for town hall meetings. The community and it’s communal strength decimated to an all-time low where crumbs in services where appreciated by indigents who thereafter had no choice.
We now had leaders that looked down on the rest of us as “Mugus”
Healthcare delivery in the community is not a talk -talk, it is a do-do. Round pegs are needed in round holes to ensure that this mandate enshrouded in the provision for establishing a community hospital were met.
Anything short of this as far as the trained eye could reach is “Mugu-mugu” health care….scam in the highest order.
At It matters period, we are saying no to these approaches. We are formulating ways that will put the health of our indigents at the forefront. We are raising discusses that help indigents know what is due to them. We have an idea. It might be a long shot but we will not stop till an iota of hope is raised.
Preventive Medicine is the way to go. We would encourage pockets of societies to embrace those measures that slow the progression of diseases. Lifestyle modifications and proper follow-up of our key focus areas would be our trump card.
Our HOD( Hypertension, Osteoarthritis, and Diabetes) focus module will be promoted among the indigents of Ubaha and other environs. Our campaign would be centered around robust follow-ups and management of HOD. Our resolve would be solely to discredit the firebrand and “mugu” approaches as exhibited by our today leaders and persons of interest. We would educate our indigents to shun those interventions that line them up in fields and open classrooms, shun those medical missions and outreaches that do not solve the underlying problems but rather serve as ego boosters for conveners, who leave right back to their bases, leaving the indigents high and dry. We want to revive a sense of commitment among the people.
We would start in small pockets. We would select sample patients from different villages that have these diseases mentioned and religiously follow them over time. We would collate relevant data to track our progress over time. We would train medication reminders that would follow our patients over time, we would encourage volunteers that will become crusaders for healthy living. We would assign nutritionist and nursing aides to track blood pressure and blood glucose levels. A community-based approach for exercise for a certain age bracket would be instituted. Lifestyle modification parameters would be followed to the maximum. Care coordination for our indigents would be tailored on person to person basis.
An approach like ours reeks of passion and commitment.
This is only an idea that we know would have the desired impact on the general health status of the community when tracked over time. We would thrive to see it to fruition and get back the depleted health status of communities robust again.
Uchenna Iwualla M.D
It Matters Period.