PROXIMITY OF RIGHT; RIGHT OF PROXIMITY:
ABUTH, Restoring Quality Care Delivered at the Doorstep of Beneficiaries
By,
U. S. Machika
The news of launching the
restoration of full operations of the Tudun Wada wing of Ahmadu Bello
University Teaching Hospital, (ABUTH) Zaria was greeted with joy across the
teaming stakeholders of the Hospital, as good tidings. No doubt, many would
benefit from this great achievement. For me, I cogitated over and over again,
to place on scale, who would benefit the most with ABUTH Tudun Wada hospital going back
into full operation.
The hospital regaining
its status is no doubt the effort of the Chief Medical Director (CMD), Prof.
Lawal Khalid. The achievement must have taken him many years of fruitful
contacts, solicitation, manoeuvres and negotiations. Without any misgiving, he
is the major catalyst behind ABUTH Tudun
Wada regaining its hospital status. Today, because of his unrelenting effort,
ABUTH Tudun Wada has taken off on a sound footing. No one can take away this achievement
from Prof. Khalid. The reality of restoring ABUTH Tudun Wada was realised under
his watch. Indeed, he would be grateful for another landmark in his CV.
Transforming his initiative into reality is a
blessing of his years of effort and hard work. Prof. Khalid’s effort sincerely
needs to be commended. Let me simply say kudos to your efforts sir. Many would
therefore be tempted to think that Prof. Khalid would benefit from the takeoff
of the hospital the most. Yes, he would be happy, but I doubt if he would be
the most happiest.
Of course, amongst other
ABUTH Tudun Wada’s beneficiaries, there are the people of Zaria and environs,
who are the primary target of the hospital. Certainly, the people of Zaria and
environs would benefit from the proximity of right, as their right of
proximity to the hospital. The people, even within the same town, had
to travel for over twenty or more kilometres to access ordinary Primary Health Care
at Shika, no matter how mild the ailment. Today, by making ABUTH Tudun Wada
fully operational, Medicare is once again brought to their walking distance.
They would definitely be most happy with the development. The takeoff of ABUTH Tudun
Wada also came with provision of employment. New and more hands must be needed
for the takeoff of the hospital. Although, the biting recession is receding,
the soaring unemployment remains. Those employed to ensure the smooth takeoff
of Tudun Wada hospital might be the most lucky and thus the most happy of all
the beneficiary of the new development in ABUTH Zaria.
No, lest I forget! Kaduna
State Government, as a strong catalyst for resuscitating and restoring the
hospital into full operation by placing its enormous weight and resources to
ensure a smooth takeoff, deserves a higher credit more than anyone else. This
is moreso taking into cognizance that ABUTH is not a state government owned
hospital. ABUTH is under the purview of the Federal Government. But the direct
populace to benefit from the medical facilities at the hospital are the people
of Kaduna State. It is thus, not a misplacement of priority for the state
government to step in, to ensure that ABUTH Tudun Wada regained its full
hospital operational status. In a political setting, with each government
seeking for means and ways of placing democratic dividends to its teaming
electorates, Mal. Nasir El-Rufai, will see the ABUTH Tudun Wada as his personal
achievement. And this may rightly be so.
The intervention of
Kaduna State Government has complemented Federal Ministry of Health’s dire need
to ensured the operational restoration of ABUTH Tudun Wada. However, this would
not take away or even minimize the joy of the Federal Ministry of Health. As
the saying goes in this part of the country – “Gyara kayan ka, bai zama sauke mu raba, ba”, which literally mean,
advising or assisting a party to take care of his properties, in no way means
being a shareholder of the property.
Whatsoever the
contribution of Kaduna State Government to have restored ABUTH Tudun Wada, the
property still belongs to the Federal Government under the Ministry of Health.
Invariably, the true beneficiary of the ABUTH Tudun Wada is the Federal
Ministry of Health. Now that life has been restored in ABUTH Tudun Wada, the
assistance and the takeoff of the hospital would only make the restructuring
and repositioning of the hospital easier for the Ministry of Health.
While I agree that each
and every one mentioned above is a great beneficiary for this laudable
achievement, it is my personal and candid believe that the greatest beneficiary
of the takeoff of ABUTH Tudun Wada is indeed, none other than Shika Hospital
Complex. This space would be too small on this piece to advance and elaborate
the reasons for choosing Shika Hospital Complex as my number one beneficiary in
restoring the full hospital operation in Tudun Wada. Justifying that will need
another separate writeup that will be done soon, when presenting the graphical
readiness of Tudun Wada hospital.
For now, let me surmise
that the takeoff of Tudun Wada is indeed a great stimulant for the Ministry of
Health to take the bull by the horn and restructure and reposition to complement
the kind gesture of Kaduna State Government. It is the Ministry’s responsibility
to uplift the hospital to the status befitting national and international Health
Facility. Yes, the people of Zaria, Kaduna state and the hospital clients
across the country and the Federal Ministry of Health would all be
beneficiaries when this status is achieved. There is no iota of doubt that proximity
to ABUTH Tudun Wada is
a privilege, but utilizing the facility is proximity of right to the
inhabitants of Zaria and Kaduna State.
Without a holistic
picture, one from a distance, may not appreciate the significance of restoring
full operation at ABUTH Tudun Wada. For the records, ABUTH
came into existence some 50 years ago as a regional Teaching Hospital Complex
with several constitutes:
1.
ABUTH, Zaria & Tuberculosis (TB)
Annex
2.
ABUTH, Kaduna
3.
ABUTH, Malumfashi
4.
Orthopaedic Hospital, Dala – Kano
5.
Urban & Rural Dispensaries in Zaria
and Kaduna
6.
Medical Auxiliary Training School,
Kaduna
7.
School of Nursing, Zaria
8.
School of Midwifery, Kaduna
9.
School of Hygiene, Kano
It was administered as such until when the Northern
Regional Government was dissolved in 1968. The six northern states created out
of the old region inherited and took over the responsibility of running the
Teaching Hospital up to 1976. From that
date, the responsibility of running all Teaching Hospitals in the country was
handed over to the Federal Government. It was after that development that ABUTH
ceded some of its subdivisions to the respective states where they were
located. For instance, School of Hygiene – Kano, Nursing Home – Kaduna and Dala
Orthopaedic Hospital were all handed to their respective states.
The melting point of ABUTH’s development culminated
in merging all the constituents in one big umbrella hospital, located in a
spacious land in Shika. ABUTH is one big solid Hospital Complex. Unfortunately,
this came with its attendant challenges that almost crippled the hospital and
ruined the good name it has built over the years of professional and dedicated service
to its owners, staff and clients. Shika Hospital Complex remained a bad sore
and a bad breathe in the mouth of the hospital right from the merger. The
myriad of challenges the merger brought remained a great burden to the
management of ABUTH complex from inception to date. For the purpose of clarity
and the limited space here, I will only highlight few of these challenges; the
rest would equally wait for the piece on the benefits Shika Hospital Complex
would get from the takeoff of Tudun Wada hospital.
Let me start by reminding us that the development
that brought ABUTH into one complex resulted in completely stripping the
hospitals in Kaduna, Tudun Wada and Malunfashi of all operations. In Zaria, only
skeletal services in Tudun Wada Zaria, Sabon Gari, Yakawada and Banzazzau
comprehensive Health Centres were locally organised.
One of the most visible challenges of the
development in Shika was bed spaces. There is a visible acute shortage of bed space in ABUTH. Before the
merger all ABUTH’s constituents had one thousand two hundred and twenty
bedspaces (1220). This number was made
up of:
S/N
|
HOSPITAL
DIVISION
|
NO.
of. BED SPACE
|
1.
|
ABUTH, Kaduna
|
577
|
2.
|
ABUTH, Zaria
|
513
|
3.
|
ABUTH, Malumfashi
|
130
|
4.
|
TOTAL
|
1220
|
Amazingly, as large as
Shika is, there are very limited beds for inpatients. This could be better
understood by taking into cognizance that in the blue print of Shika, only 1000
bed spaces were proposed. At the takeoff of the hospital, to make the matter
worst, only five hundred and thirty seven (537) bed spaces with 315 beds in
phase I and 222 beds were completed in phase II respectively. Thus, Shika took
off with less than 600 bed spaces, less than half of its combine hospital
bedspaces and just slightly above one of its former hospital. Most especially, considering
the hospital’s magnificence, grandeur and amazingly impressive edifice with
national and international status attributed to the hospital standard. When in
full operation, even the 1000 beds would not be able to service the catchment
area properly. Instead of the development to bring an increase in the bed
spaces of the hospital, there was a drastic shortage. So, one can understand
the additional bed spaces with the takeoff in ABUTH Tudun Wada. Indeed this is a
lifesaver to ABUTH.
Another important challenge
the merger of the hospital brought was of human value.
The development sadly, unforgettably, dislocated the staff from their hospitals
without adequate provision in Shika. The staff of the hospital from
Kaduna, Malunfashi and Tudun Wada were hurriedly packaged to move along with
vital documents and movable facilities to Shika without adequate arrangement of
their welfare, particularly the accommodation at the new hospital complex. The
gory sight of staff sandwiched in every available corner spaces in the hospital
cannot be easily forgotten. The staff were competing with vital documents
littered all around for space. Senior officers turned their offices into
makeshift homes. The humiliating pain on the faces of staff was similar to any
of refugee rehabilitating camps. The staff were torn away from their families,
from their comfort zones and stripped of their prestige and professional mystic
authority and dignity. Many of the staff, whose resources could permit, were
plying the hospital from Kaduna, Malumfashi and Tudun Wada daily to Shika.
The resultant transfer of
aggression was all hipped on the innocent hospital clients and patients, a
major disservice to professionalism and dedication. The staff’s human relation,
their courteous and profession etiquette in handling patients and patient’s relatives
was thrown to the dogs. The humiliation they suffered for the shoddy
arrangement of transfer brought about by the merger of the ABUTH hospital
complex to Shika continued to this day. To augment finances, Public Service
Rules were flagrantly abused, as some staff resorted into hawking and running small
business, corner-shops and malls within the professional service area took
place. Those with capital were urged to “assist” the staff by selling clothes,
food items, furniture, home appliances and fittings, perfumes, jewelleries and
ornaments, specialised and branded products on higher purchase and these ‘merchants’ were known to every staff
within the hospital complex.
The merger also polarised
the Doctor/Nurse superiority in Shika. Many known duties and responsibilities
of Nurses at the national and international hospitals settings were stripped
from Nurses in Shika and given to Doctors. While Doctors in Shika continue to
bask in superiority, Nurses are made to feel as nothing but appendages in
Shika. This equally had eroded a healthy and professional relationship between
the two separate autonomous, but symbiotic team cadres in a proper care giving
institution. The effect of this again falls on the innocent patient and his
relatives.
To this day, the staff of
Shika did not recover from that sad episode of dislodgement and dislocation. And
their human relation on how to treat the hospital clients has never regained it
professionalism even years after most of the actual staff who suffered that
humiliation had long retired. What happened was, they simply transferred their
humiliation as a relay baton to their younger colleagues. This
is the primary cause for many middle and elite classes running away from Shika.
Clients’ see most hospital staff in
Shika as cold, unresponsive and hostile. The hospital cannot be said to
effectively provide health care delivery if it continues to focus only
on diseases rather than patients.
The practices in Shika continue to deteriorate
because of this. Managerial efforts right from the days of Prof. Rafindadi and
now Prof. Khalid tried to solve this problem, but definitely could not eliminate
what seems to have been an imprinted psyche. I am emphasising this to ensure
that this does not manifest in ABUTH Tudun Wada. The area to start with in
ABUTH Tudun Wada is to tackle the vital issue of ‘Human Relations!’ The staff-client relationship really
needs complete appraisal. Positive human relations, such as friendship,
affection, attention, respect, patience and solidarity should be reemphasised
in the day-to-day dealings in the hospital.
This is of paramount importance in restoring ABUTH
Tudun Wada. Because of the small number of staff running the skeletal services
in ABUTH Tudun Wada, professional etiquette and human relations was of high
standard. The Doctors and Nurses in Tudun Wada relate as close knitted family
and team-players. The Doctor/Nurse superiority in Shika is completely absent in
Tudun Wada. The spirit of team work permeates the atmosphere in Tudun Wada.
This is where the management need to start in their
effort of restoring ABUTH’s glory and pre-eminence of quality service delivery to
humanity. This is particularly, the greatest litmus test to the new D.A.
Sallau. The redeployment of staff to Tudun Wada must be done meticulously. That
is where administrative sagacity challenges meritocracy. Merit must be of two
faces – Competence and Conduct, NOT a mere CV. The discipline of ABUTH Tudun
Wada must start with the choice of the Hospital Matron. Proper orientation must
also be given to the new staff before they are corrupted by ill practices of
ABUTH Shika. All hands need to be on deck to ensure that ABUTH Tudun Wada sets
a new lease and standard in Health Care Delivery. It should set a stage as a
true pedestal in providing quality care to its teaming clients. In the long run
it is the attitude of these important professionals that determines both the
quality of Health Care Delivery and patronage in ABUTH Tudun Wada.
The leadership in ABUTH Tudun Wada should also frequently
put in place processes of evaluation by setting high performance as the main yardstick of
quality day-in-day-out. It would no longer be a case of once in a while or
Nigeria’s normal window dressing or worst of all – eye service performance
(only when one is certain to be noticed). High performance will gradually
become an organizational habit, for high performance must not be an ACT but truly a HABIT. It is one thing
to set high performance targets and another to enforce it.
It is thus very crucial for Tudun Wada to instill or
re-instill in her clients that there are many highly skilled, dedicated people
working at all levels ready at all times to serve them efficiently and
effectively. It is the responsibility of the hospital to help shatter the walls
of doubt about how ‘we are treated’ not medically but in terms of human
relations. Since what is driving people away from Shika is definitely not the
technical aspect of Medicare but the manner they are handled by the staff,
particularly the unorganized, unsystematic procedural waiting. It is very
important for ABUTH Tudun Wada to reduce procedural waiting to the minimal. ABUTH
Tudun Wada should strive to ensure that it:
i.
develops better accessibility to their
health care services
ii.
Facilitates better communication between
their staff and patients
iii.
decreases patients’ waiting time
iv.
improves their appointment system,
v.
facilitates the needed information
access to patients and patient’s relatives
vi.
motivates their personnel to devote more
time to patients
It is only then that the quality of care delivered
to beneficiaries in ABUTH Tudun Wada would truly achieve the purpose of
restoring its full hospital operation. Shika, can then focus on research,
teaching, graduate and post graduate transition and the handling of major
secondary and tertiary referral cases.
