Dr Efunbo Dosekun, a medical doctor with specialty in paediatrics, is the brain behind Outreach Medical Services. She has been in the medical field for more than four decades. In this interview culled from Saturday Sun, she spoke on several health issues relating to women and children. Dr Dosekun stressed the need for both the states and the Federal Government to ensure good remuneration for health workers in the country so as to reduce the rate of migration of health workers (the Japa syndrome). She also advised the government on the need for partnership between federal and private hospitals for effective health care delivery system.

What motivated you to bring women together for the sake of finding a lasting solution to the healthcare issues among women and children?

As far as l am concerned, particularly to African culture, women, children and babies are vulnerable, especially babies. Again, I felt that referral system when we do have an acute problem suddenly with our health, is not good enough. There have been so many instances when we have seen children and babies brought in very late because the parents didn’t know anywhere to go. Or the parents made an attempt to go to the government hospital and had to wait for a long time, and probably not to be attended to. They may be just referred on and on from one hospital to the other till they finally go home or get frustrated. So I said Lagos is quite a developed city in infrastructure, so why don’t we have systems that match it in terms of modernity, system of communication? What I am talking about is medical response system where something has happened and you know a number to call, or you are advised to go to a particular type of hospital, health centre if it is not so bad. Or you may be advised to go to the emergency room. But there must be somebody you have to talk to when you are distressed. In England, you just ring 999 and within 10 minutes someone would attend to you. So I decided that even if it is only rudimentary, there must be a recall centre. So we did a presentation about this to a group of women called, “Women Connect” and they agreed to work with us. We spoke also to Rotary Club and they welcomed the idea. We want to change the narrative. We are mobilising women. We can’t leave everything to government. We need to come together as a movement and talk to people who are interested in social impact to help us. For instance, a community insurance or membership of a call centre for a small subscription can help. We can have access to your call centre and you give us direction 24/7, so that if anything happens at any time to somebody, the person must be able to speak to somebody and that person must be able to negotiate for the person where she would go to, or negotiate an ambulance to propel the person there, if necessary. There is so much being in the dark that I am very concerned. I have been a doctor for 43 years. I am soon going to retire.

Did you take into consideration the Nigerian factor? For instance, poor communication system, transportation, traffic, and so on?

I know there are a lot of constraints, but instead of clogging our heads with constraints, let’s concentrate more on the good things that can happen if there is some intelligence to our medical response system. You may not even get the phone number, but you know that the hospital does this good work; you could just rush off there as an emergency. The beautiful thing about it is that once it starts, we will be able to persuade our colleagues because there are a lot of things that mitigate or stop people from going to hospitals. We know that government hospitals are full. Lagos expanded over a period of 10, 12 years from 10 million to 24 million. And the growth of hospitals has not been so fast because it is not easy to set up a hospital. That is why private sector hospitals have to come in to help, because many private sector hospitals are not full. So we have to find a way which we can mobilise people who need urgent care.

There is increase in child and maternity mortality. What do you think is the cause and how can it be solved?

Everybody always say that they are ignorant, and don’t know what to do. It is a lie. The problem is lack of money. Lagos State Government has really tried in Lagos State. It is minimal. If you can get access to a bed in a Lagos State-owned hospital, it is because it has been taken care of by the Lagos State Government, but you have to pay for drugs, etc. Such is not obtainable in private hospitals. So, government needs to work with us in the private sector. They cannot fulfil the need of 24 million people in Lagos, that is the reason many go to traditional birth attendants (TBAs), and to the chemist boy. The first thing is that the government needs to collaborate with the private hospitals that are ready, because it is not all the private hospitals that are ready to start doing social impact work and changing the public health narrative.

In this situation, government should choose private hospitals to help them, particularly in the area of women, babies and children. This is necessary because the Sustainable Development Goals (SDGs) rate is almost reaching its termination. Part of the goals is to reduce the mortality rate in children, women and babies. So we need private sector. We need to unlock the potential in the private sector. There are some people who are ready to look at these social issues and are ready to develop innovative and transformative ways of dealing with large crowds. It is possible; it is even done in Indian hospitals. L have seen how they have done it. They brought down the cost, but there must be numbers. Take for instance, if the government promises to give me 50 patients daily, l will expand my premises in order to take as many people as possible. L will have a training institute where l will take young nurses and develop them to be specialised in different skills so they will be able to support the physicians in executing their clinical roles.

So, there are so many things that could be done. The government can call us in and say, for each case you see, l will pay you this amount. Or government can send the subscribers of Lagos State insurance, but of course it has to be reviewed because the premium, the billing is too low and some of these cases require acute care. Acute care is different. It is not like giving analgesics, it is very acute. You are changing the drugs, high quality drugs. They are using oxygen and high skilled people. But the government must think about it. Government cannot just think about the primary health care, because if you think about it, you will still be having lots of deaths. As primary health care does only preventative measures, they do early diagnoses, but there must be well equipped hospitals that will take care of cases that have been diagnosed by primary health care. Without that it makes everything so shallow. Women should mobilise themselves and come together. We just have to care. Wives of politicians, senior bankers, industrialists, and so on, need to leave their ivory tower of splendour and protection and come and sensitise themselves and see the suffering and come together, and demand the physicians or health planners that are interested, to come together and plan.

Having been in the medical field for more than four decades in the healthcare system particularly taking care of children, what do you consider major health challenges facing babies, and how can they be prevented?

Pre-maturity in babies or babies appearing smaller than they should, that is sepsis, mothers having problem during the birthing process, can kill babies. Other killer diseases among babies include; a baby coming out not breathing well, and jaundice. Research has shown that the mother has to be in a good state before and after child birth to avoid malnutrition in babies. To avoid these diseases also, pregnant women should not just sit down at home, they must ensure they attend antenatal care.

I think Nigeria has done well in terms of providing primary health care that are facing antenatal care. There is such a wide choice on where pregnant women could go for antenatal care in Nigeria.

Also, pregnant women need to get in constant touch with doctors, senior nurses. There must be partnership. If there is proper antenatal care with expectant mothers taking their routine drugs, some of the pickup problems such as Caesarean Section (CS) should be detected on time and followed up appropriately.

There is what is called entrapatom period, that is 48 hours before and 48 hours after birth, just a period around delivery. That is when all sorts of things happen. It is a period the mother or the baby can die. A baby may come out not breathing well, but with skilled health practitioners around, some of these problems can be adequately taken care of. Having a baby at home or with traditional birth attendants, we want to see how we can reduce it. Those in rural and semi urban areas, I agree we have to train them, especially when there is no medical centre close by. When they are well trained, they will be able to identify dangers on time and follow up immediately. If those periods can be tidy, we will see fewer problems when the baby comes out.

In this country, we are seeing jaundice which is simple to treat in babies. It is just to put the baby under specialised light, and yet we are having jaundice. High jaundice destroys the baby.

In many West African countries they do not see it anymore, because they have a follow-up system called Health Surveillance System where they check the babies when they are three days, to make sure that they have not become very jaundiced. Our system is not strong enough. To treat jaundice is not rocket science. We need just strategies and then technical team, the doctors, to come up with a real robust programme that is around that time, 24 hours before and 24 hours after, to make sure that everything is standardized whenever the person is going to have the baby. Even the mothers can be trained in these early warning signs.

So when we finish having these things, we now must have a good emergency response system so that when things go wrong, you must be able to call a number. Those workers there must also have a conversation with the hospitals, find out who has a bed, so that we don’t do the crazy thing we are doing where we are sending people from one hospital to the other with a child that is gasping. Can you imagine the pain that parents are going to go through, and this in a private transport Keke Marwa in a country with bridges and skyscrapers? It is not right. Women have to stand up because the political system is still so immature. They are not being called to deliver their mandates. We all just sit down and wait for another election.

Some mothers do not like breastfeeding their babies, rather they prefer artificial milk. What is your take on this?

It Is so important that women should breastfeed their babies very well because, breastfeeding does not only give the baby the right nutrient – babies who are well breast fed have a better attachment to their mothers. It is called bonding. It is an emotional bridge between a child and the parents. Research has found that those children who have solid attachment with their parents have less mental health problems. They are able to cope better when they had challenges along the line, even up to old age. Children who are well breastfed have less tantrums, less addiction, and better school performance. This can be referred to as emotional. Also talking about physical health, if you read about the component of breast milk, it did not only contain carbohydrate, protein, fats, vitamins, there is also additional factor there that is going to allow the immune system of the baby to grow, because we know that the immune system grows across time. They challenge the body nerve, which is weak in the first one year. God has given us special fluid to help the baby’s immune system grow properly. Inside the breast milk, there are already resolved factors. There are factors there that stimulate the immune system. There are bacteria there that are called friendly bacteria that stimulate the immune system, particularly in that breast milk in the first few days of life. It is yellow and it is called cholesterol.

How about adults? Some have said breast milk is also good for adults.

That’s right. Even now, adults take it because it has such a useful element in it. It makes a healthy adult. So we must not miss that opportunity. This is the time that the old and the new can combine. In our native culture there’re different ways we can do to promote lactation, and also in modern science, there are equipments that they give. There are also herbal drugs that can help in lactation.

Report has shown that there is increased rate of medical flight in the country. What is the way out?

Medical flight is natural phenomena. The fact is that things are getting tougher in the country and people are looking for a way out. If the private and government hospitals can pay their health workers well, l think it will go a long way in reducing the rate in which health workers leave the country in search of better remuneration.

What is your advice to women?

There is need for women, particularly in Lagos, to form a women group that will enable them establish community insurance. Let us have a community insurance, no matter the small amount. Let us do less fashion, and decide the amount that each will put down every month and, we have volume and we can now plan. With such plan in place, women will know hospitals to partner with, so that when they or their children are sick, they will know which hospital to visit, and such hospital will not charge them much because it is a group thing.

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