We Can Replace Knee Cap-Dr. Olurotimi Odunubi, CMD, Igbobi

Dr. Olurotimi Odunubi is the Chief Medical Director (CMD), National Orthopedic Hospital Igbobi, Lagos

How long have you been in the medical practice sir?

I have been in the medical practice for about 34 years now.

For exactly how long have you been the chief medical director of this hospital?

I have been in this office for a year and two months

When was this hospital formed and when did it open its doors to the public?

It started in 1945 as a rehabilitation camp for World War II injured victims. So I would say it did not start as a hospital. However, it was converted into a hospital later and then an orthopedic hospital much later in 1952.At inception it was first under Lagos State government, then it was transferred over to the Federal government. It was laterreturned to Lagos State government before it then came back again to the Federal government. So now it is under the administration of the federal government.

Apart from this hospital, do we have any other orthopedic hospital in any part of the country which is also owned by government?

There are three (3) federal government owned and controlled orthopedic hospital in Nigeria, located in Lagos, Kano, and Enugu. However, the Lagos orthopedic hospital started first. We also have orthopedic departments in all the teaching hospitals and some federal medical centres. There are also some State owned and controlled hospitals that have orthopedic department and unit, for example in Lagos state, which has orthopedic centers in three of its hospital namely Gbagada General hospital, Lagos General hospital and the Lagos State University Teaching hospital at Ikeja. Theynot just have orthopedic departments;but have orthopedic surgeons as well.

Would you say Igbobi is the Center of excellence went it come to orthopedic medicine in Nigeria?

Yes!You see when you go to most of the hospitals in the country, for example those I mentioned earlier,you will find out that most of the surgeons and technical staffthat practice there were actually trained in this hospital (Igbobi).

What is the state of facilities in Igbobi orthopedic hospital now?

Well orthopedic practice all over the world has undergone a lot of developments and changes in the last 30years. New equipmentand processes are being designed andmost of this equipment requires huge capital to acquire, so the challenge for a hospital like ours which is solely sponsored by the government would be funding. However I must say that the government is trying a lot by giving us the fundswe need to run this hospital; capital votes for development; payment of staff salary and some money for overhead. Of course we need more to keep up with recent developments in the orthopedic practice worldwide, because orthopedic practice is capital intensive. So far many of the equipment we use are not manufactured in this country, they are imported and we hope that someday we would have developed to a point where we can manufacture some of them in this country. This will indeed serve as a way of bringing down the cost of treatment for the patients.

We have often heard people say that there are some cases that could not be handled by your hospital, which leads to cases of referrals abroad. Does this imply that you don’t have specialist covering all aspect of the practice or is it a case of inadequate facilities?

To answer this question effectively, it will require identifyingthe particular patient and understanding the peculiarity of the situation, but all the same it depends on the orthopedic condition presented to the hospital. Generally for all the orthopedic cases that come to this hospital, we have therequisite skills and equipment to handle them, but sometimes you may need an equipment that is not available here to help you in the various stages of management, because management involves you making a diagnosis and it is after diagnosis that you decide what kind of treatment the patient will require and the process of rehabilitating the patient after treatment so they can be useful to themselves. At every stage of managing cases, you may need some special equipment that is not available in this hospital for instance we don’t have facilities for MRI or BT scan for now, but it is available in Lagos. So for patients that have need for diagnoses, we send them to those places where we have them and they come back with the result. That may delay the treatment, but we are hoping to have such equipment soon because we are not limited to government funding. We have gotten a go ahead from the government to source for public-private partnership and some of this diagnostic equipment can be gotten through this way. More so, the present board of the hospital has approved the setting up of a special a center for diagnosis, but there are other things too which may not be available, so patients may have to go out to get these tests done. However, for all type of orthopedic cases known to man, we have the man power and the basic equipment to treat them at this hospital.

So we can say that you have up-to-date equipment?

Like I said we have all the basic equipment needed to treat all orthopedic patients, most of this equipment is modern, and it is only some of these new once that we don’t have but we are making plans to have them soonest.

How expensive is the cost of treatment in this hospital?

IMG_1438The cost of treatment depends solely on the type of treatment required. All of these depend on the type of problem or injuries that the patient has. Because when people think of orthopedic hospital they think of fracture, but treating fractures is just one of our functions.Have it in mind also that the orthopedic sciences is all about making somebody who is crooked,look normal again, so many people think of us only in terms of fracture. More so, treatment of fracture can be cheap or expensive, there are some broken bones that you don’t have to come to the hospital for them to get healed, for example animals like cats and dogs who will leap for some weeks or days and after that you will see them moving on well. It is the same thing with human being,there are many human fractures like that too, but knowing which fracture will heal like that or not is the problem. So it will require that people come to the hospitalso that they can discover whether the bone is broken or shifted. The main purpose of treatment is to bring the bone back to its rightful position and you use POP to hold it back in its position. The POP is just the external part of the treatment what you need to hold the bone back together again is in the body, what you need then is the management of food that people will take to make the bone strong again and maybe something for pain relief like paracetamol. However, there are a group of patients who have more complicated cases, e.g. cases that require one form of surgery or the other which may be expensive. Also there are methods of treatment now that you can set and treat the bone without opening it. These are modern method of treatment and they can be expensive. We have treatment that don’t have to do with fracture, children with bow leg, k-leg deformities and all that need one form of corrections or the other, all they need is to correct them with POP, then all will be okay.Those who have problems with working maybe with their knees or one form of arthritis, we can change the knees which we call total knees replacement. So the cost of doing this is expensive, but it is still much cheaper here than travelling abroad. Take for instance the cost of doing one knee replacement here is between N750, 000 and N800,000, but if the person goes to either UK or US you will be spending around N12,000 pounds or even more. The bulk of that sum we collect here (N 800,000) cover majorly the cost of the item to be replaced. So like I said the cost of treatment will depend on the problem.

How many departments handle surgery in this hospital?
Well this is the center for bones, however we have two main departments that handle surgery and these are the orthopedic surgical unit and the plastic surgical unit. Most of the patients you see here will fall under these two groups. Also under orthopedic care,we have pediatrics units where we have consultant that manage orthopedic patients that are children, then we have what we call the spine unit and this is where we have doctors that deal with issue related to the spine i.e. spinal cord injuries. We also have the Arthroplasty unit and Arthroplasty is joints, so they handle cases that have to do with joint pains, they change joint for elderly people and all joint cases like I said. Then we also have what we call Arthroscopy unit, and they are those that deal with injuries that you treat without opening the skin and using a special instrument call Arthroscope. We also have the special trauma unit that handles difficult fractures. Theseare the five units we have under orthopedic department. Then under the plastic surgery department we have the burns unit which deal with cases of burns, they help to cover burns related injuries via plastic surgery and also help in repair of damage blood vessels, the plastic surgery unit also does any other surgery that requires plastic surgery, we all work together.

Funding has been a big problem in the management of big hospital like this, how have you been able to handle this problem?

IMG_1448Well, it has not been easy as you know the federal government is responsible for our founding and like any other government body we have to make do with whatever the government is giving. But we thank the government because they have been doing their best in terms of providing funds for us. If you look around this hospital now you will see a lot of capital projects going on. By physical development I mean construction work going on. We have the new administrative block, new theater and new emergency building. We also have a new general patient’s block under construction and some other building as well being funded by President Goodluck Jonathan’s government. These are part of the new development that the government is helping us to attain because for over 15 years, specifically since Mobolaji bank Anthony donated that two story building you see there, we have not had any new structure on ground. Having said this, we also have a building that we are using our own internally generated funds to build.  We have also been able to get some fundingthrough our public-private partnership programme so as to fill up the gap with the support of the board, but we still have needs, for example we have no residence for the resident doctor because going by their name the are supposed to live within the hospital complex, but since we don’t have one, it means they have to stay outside. We also have the federal college of orthopedic technology to train prosthetics and orthotics i.e.fabrication of artificial limbs and joints; it is the only one in West Africa which we have to provide accommodation for. So we still need a lot of financial support.

Do you carry out treatments yourself or sometimes invite or better still get some form of assistance from experts abroad?

We treat our patients by ourselves but sometimes when we have seminars and conferences we do invite known experts to come and give us insights and when we do have patients with those complications we do treat them (the patients)together. Then we also have facilities for interactions with these experts via telemedicine and hold conferences with them and ask for advice, they do the same thing also for conditions that are common. Let me also add that some of the foreign experts we are talking about are Nigerians and they are all so keen to help out as much as they can sometimes, when they are free, they volunteer to come down and carry out some surgery with us.

What do you think is the reason for the low turnout of patients at Igbobi orthopedic hospital currently, being the center of excellence in orthopedic cases in the country?

Well in the 80s when I joined this hospital the beds were always full and the casualty unit was always very busy. Some of the reasons for the drop are that since we became a training center in the mid-80s, we have been able to train most of the consultants and doctors that are for example working in the orthopedic unit of Lagos state hospitals and other orthopedic hospitals nationwide. It is also worth saying here that in those days Lagos did not have an orthopedic unit in their hospital, so when a patient gets there even if it is a simple fracture they will just say this is for Igbobi. We have many centers now particularly in Lagos including private hospitals that are treating orthopedic cases. This is a good omen. Before this hospital was taken over by the federal government, Lagos state government was the one running the hospital and at that the time the believe then was that all you have to do was get yourself to the hospital and you will be treated because everything was free in Igbobi, so you have a situation where the bed was full and people were sleeping on the floor. What the hospital did was to move to a higher level. It stopped handling simple orthopediccases; rather we left them to other hospitals and moved on to handle some more complex cases. Another reason why we don’t have many patients is due to the constant strike of medical personnel. When you get a full ward today, tomorrow there is strike and the patients go home and get help elsewhere, by the time you get back to work again it will take time for you to get a full ward again and after, let say, four months we go back to another strike.All these things affect us.

Sir it is obvious that this office could be demanding, Please tell us, how do you unwind?

You have to create time to unwind and carry out someinteresting activities for yourself, especially during the weekend. My job is really a 24 hours job. My job does not just end and start here, as part of my responsibilities; sometimes I am needed in Abuja to get what is due to the hospital and talk to some people so as to get approval for the hospital programmes. So yes! I do create some time to rest especially at the weekend.

Are you into any sport sir?

Yes, I do play table tennis and some long tennis at my own level just to be fit nothing much.

What role does your family play in your professional work, giving the fact that it is somewhat difficult in nature?

I will say that there was a preparatory period or stage which they are already used to. Before this period, I was the consultant in the orthopedic and trauma department of the hospital and along with it there were a lot of official administrative duties. My children are already grown up now so the pressure is not much any longer.

What is the greatest challenge you have had since you started work as the medical director?

IMG_1449I would say funding!Now you may say it’s a general problem, but that is true.Patients too, most of who are poor, also help to add more financial burden to the hospital. This retards the development of the hospital, because you have a plan for the money only to use it on patients and it’s not coming back to you. To make the situation worse, such cases are on the rise each day. Some people say free education, free health care etc. but the truth is that nothing is free. Somebody somewhere is paying for it and if nobody pays for it then the quality of the service will go down and it may affect your plans for the hospital. So that is a major challenge. But I think part of the solution to this problem is the health insurance scheme that the federal government has put in place. If most of the patients that are coming to the hospital are covered by insurance and they know that money is not coming out of their pocket whether they have it or not, it will make people want to go to hospital for treatment and also put money in the pocket of the hospital as the insurance will pay for it. Because when somebody is down it is very difficult to run around to get money from relations, friends, and love once.

So what do you think can be done about it?

The thing is that less than ten percentage of Nigerians have any form of health insurance and most Nigerians are not prepared for any health issues when they come up, that is why when we have such cases you see us running to relatives for help. But it should not be so with the coming of the health insurance, Nigerians are very organized people and belong to clubs, associationsand what have you. I am sure if government mobilizes these groups of people and get them educated on it, they would go back to their people and also educate them on same issue.Things should have been better than this by now.

Thank you very much for your time sir

Thank you for having me

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