Newly confirmed CMD of JUTH, Professor Edmund Bupwatda is a professor of community medicine in JUTH, North Central Nigeria. He is a former chair of the Nigerian Medical Association (NMA) Plateau state. He was the last Chairman of the Medical Advisory Committee (MAC) of (JUTH) before taking over the mantle of leadership as the Chief Medical Director (CMD).
Professor Edmund Bupwatda took over a highly polarized hospital where the union and management had always been on each other’s neck when it comes to certain industrial rights which they must always fight for before getting same. Few months to his assumption as acting CMD unionists started celebrating his ascension. With his confirmation recently there was massive jubilation in the JUTH complex which he has vowed to complete the phase 2 before leaving office. He spoke with Sam Kayode about his intentions to transform the hospital to the next level of tertiary health care in Northern Nigeria.
What really happened that your staff was accused of discrediting a particular religious group in your hospital recently?
It was a mix up between a nurse and a patient. But we asked her to explain why she said what she said. You see, a hospital staff should attend to a patient. She is a nurse that is covering there, so at the end of the day, she is supposed to give health talks to patients in the general out patient department (GOPD.) Of course she offered her own reasons when we gave her a query. You know this is civil service and you don’t just take instant judgments because it’s a process.
Please explain why you said what you said and in the first place? it’s not your duty and that does not represent the policy of a country, neither of the government and truly it does not even represent what she claims was in the system as true. When you put in a wrong input, the system shuts down, because its not true. The system we use does not have any of those stereotyped programming or profiling to say ok if you put so…so tribe it can only accept the tribe that is indigenous to a particular council area or the state, it doesn’t make sense exactly so all that she said was misinformation. At the end of the day, that misinformation is not the policy of the hospital and she was not representing the hospital. When somebody is not representing the hospital, of course its like the person is free to air his or herself whatever it is, but that is not professional. If she was the health record officer in charge like you asked then it would have been a different thing. Now we have different cadres of health officials and they are trained. We don’t just take anybody who is not trained as a health records officer and they must have of course, registration with the health record registration board. However that does not again, take away attitude to work, personal sentiments, some people bring in their own personal sentiments. So now if you are talking about on the job training, of course the department organizes that to train them because they are the first point of call in any hospital. How they treat the patient matters, the courtesy they extend to the patient gives an impression about the hospital. It does, because that is the first point of call to the new patient that is coming in, so the health record is very key and strategic.
However, the information forms have standard questions that are asked anywhere. And the essence of asking state of origin, the state of residence etc is for statistical purposes. There is nothing wrong with it. It’s being done anywhere. I mean state of residence and all of those, is in the medical parlance. It’s for research and surveillance. For instance there are certain diseases peculiar to certain regions. I will give you an example, Jos Teaching Hospital is a Federal Tertiary Hospital and it is the major referral centre not just in the North Central, we see people from Bauchi, Taraba, Nasarawa States and from FCT, sometimes from Lagos outside of our region, down to Benue. Why? Because we have a lot of specialists in some of those places. So when there is an outbreak, for instance they tell you there is an outbreak of Cholera in Taraba State, then a patient comes from that state, the essence of asking for state of origin of that patient, is that you know already there is news that there is an outbreak of Cholera in Taraba state, so you as a doctor when you see the folder of the patient, you read the bio data, you take the age, because there are certain diseases that are peculiar to certain age groups, so every information is important, when you take the sex, of course there are certain diseases that are peculiar to women or to men you know, and all of that. When you ask the tribe, there are certain cultural practices that are peculiar to certain tribes for instance genital mutilation. Some tribes, and cultures practice it. Like you know in certain tribes in the North when a woman gives birth, they give her “Kunun Kanwa” which they put a lot of potash in. This has an effect on the heart. So that is why when you know the tribe of the person, you dig deep as a doctor to know how are they practicing these things. Because we know it is already documented that this is peculiar to a particular tribe in that area. The documentation process is standard in all hospitals so you then look at it from that eye but not to discriminate on anybody. When somebody says there is an outbreak in Taraba of Cholera and then a patient comes to say I am from the state, then he is presenting with let say vomiting or frequent stooling, he has gone to the toilet maybe about 10 times in one day. Then you say where are you coming from, he says i am from Taraba, you conclude, no wonder there is an outbreak in that area. So It raises the index suspicions of a doctor to be able to work on that to say oh it is most likely coming from that region or that state, so you will be able to make a quick diagnosis to say we need to help this man and save his life.
We use it sometimes in research that is what we call retrospective, you now look at your health records its just a bunch of kits, we say ok we want to know diseases that are most prevalent that we see within lets say January to December 2021, you run the search, it gives you what you want. Lets say Kidney diseases, we can say ok can you run another test for kidney diseases. You generate evidence because of what you call hypothesis based on observations and as a researcher, as a scientist you look at things and you observe that something is happening. So it’s that data that gives you the focus yes (to create a correction) yes and the data is not giving you the number, its telling you the location, its telling you the tribes so it is purely for research. Then you dig deep, go to those communities interact with them so a steady result is got.
Is there a particular food they are eating that is causing damage to their kidneys like you said?, that is exposing many of them to come down that they don’t know themselves these are all part of the research. So in a medical institution like a University teaching hospital we conduct such researches which aids our jobs and we rely on the health records of people.
But do the heads of the medical records departments give you such research details on a yearly basis?
They do. There is a statistical unit to generate the data. They give statistics but of course there is also a daily report that comes with the beds, how many patients? On a daily basis to us the managers.
How many of these medical records people do you have in this facility?
Maybe a 100 and something, you know the facility is big but they don’t work 24 hours. But you know electronic medical records makes work easier. We have started that information that is controversial you have to fill the form before its inputted in the electronic medical records.
So even the billing system in this facility is is electronic?
Yes we have not gone fully automated on all sites but from the accounts records of the pharmacy department everything is automated. We are building it up. We want to apply it on everything, we want to scale it, that is what we are working on now.
What is the ratio of the estimate of internally generated revenue (IGR) you make now averagely?
I don’t know the figure off hand so to tell you of course I am unprepared right now because of the impromptu nature of the interview but we are doing our best.
What are some of the challenges staring you in the face in this facility?
Challenges evolve, you know if I say since I was a resident those challenges are still there. I don’t think so, That means that JUTH is not growing. But believe me we are growing and the growth in JUTH of course started when we moved from the old site to the new site. So there is progress and development. We moved here and it is a big complex which is making progress. Mark you it is not easy for government to invest into this. There were certain equipments that we didn’t have, but of course we do have them now.
How much do you charge per patient to obtain an MRI scan?
Magnetic Resonance Imaging (MRI) scan for now is expensive, I think what we charge is about N50,000, because even the CT and others are expensive too. MRI is above CT and is not a day to day investigation, so is it’s not a regular investigation it has to be highly recommended by the experts before you do MRI unlike the CT scan you frequently do.
Do you have Echocardiogram (ECO) scan which should be a step ahead of the ordinary electrocardiogram (ECG) machine?
Yes we have ECO and it’s functional.
What about endoscopy?
Yes we do.
I am asking to clear some of these areas because of the rumors making the mills that most of your equipments are broken down especially the MRI and management has not bothered to handle these problems pronto?
No..no we have. I mean the MRI was down, and I was the chair medical advisory committee (CIMAC), so I was part of the management, so you won’t say we never cared or were insensitive to it. It was down, but we needed to buy something to clear it, so it was not that my predecessor failed. Far from it. Because if he is bad, I am bad too, we were all part of the system.
But we know it is the CIMAC’s that do most of the real clinical jobs with patients and we know your records and limitations in that office. I asked for your challenges because I wanted to hear about nephology and other areas too. We hear you are backwards in terms of dialysis machinery in that department. Is it really a challenge?
Challenges are there but you said some years back that was why I am responding accordingly. We have made progress and those that came before us have done their best. You know, to bring the hospital to where we are now is not easy. And you know people have built on the past development, even the former CMD that you know, did not do badly but you the media can make or mar any one…….general laughter….. And you know this is true.
Of course there are challenges that we face, like I want more dialysis machines, newer ones, because the once we have are old, they are two they have aged and we keep having those challenges. Now the space, theatre space is a major challenge in the hospital, because we have over a 100 specialist and surgeons but we have only six suites in the entire building. So this is a major challenge which we are hoping if we have the resources, we will correct. You know, space is a constraint, I mean for some clinics. Talking about the ENT for instance, they are supposed to have a whole department but they don’t, they are managing in one corridor out there, because when we moved here this was the first phase of the building. We are trying to see how we can develop some other places and all of that. So it is a major challenge.
Do you have a trauma centre?
No, we don’t. You know those are capital intensive. So it has to be an intervention of government to be able to get you such centers and then you now talk about other things like the Dental and maxillo-facial, we are supposed to have five different departments there in the facility. We are supposed to have five different department there, but they are locked up somewhere in one place. We need to get more dental chairs which we don’t have. So those are off course constraints. Then you have the Cardio-thoracic we already trained at least two Cardio-thoracic surgeons, the third is coming on board by the grace of God, so we need an institutional complex for them, because instead of patient going to India or outside the country to access some OF these treatments, we will give them here. My deputy here a cardio-thoracic surgeon….. Pointing to his deputy in his office. He can open the heart and operate any day. They started doing some here, all they need is encouragement, so these are challenges we must overcome someday.
Have you started residency for Cardo-thoracic specialists?
No, we have not, we are building the critical number, two of them are on ground, the third person is on training very soon he will come back, so when they are three (3) It would not just be they, all the support staff around them would be coming. We need to get professional, nurses to be trained and everybody in the department will of course be lunched into that, so those are definitely things you look at. So day to day challenges are things that you know you need capital.
The CT scan is a major challenge, because what we have is 4 slide CT, when the world has moved to 128 slide, 132 and all that, so those are obsolete, even the MRI that is working is good but is 0.5 Tesla, when the world have move to 1.5 Tesla, you know so those are things that if you say you are giving me One Trillion naira, it would be durable to bring the place to a state of the art hospital where everybody can be proud of. But another major challenge of course you know is power. Yes of course because we had a power surge that affected the power plant at the moment which is going to cost over N500 million to be able to replace those things affected, so it’s a big challenge, and you know, coupled with the rise in cost of diesel once the national grid goes off you definitely have to run the hospital, this is a hospital and some people are on ventilator, some babies are on incubators. Some are doing dialysis they are dependent on that, and without power you won’t be able to get any where and that you know is a challenge. Of course other areas that we are having challenges sometimes is the human resources as we are growing as you are expanding, people are retiring. Of course the process to get them replaced is a very cumbersome one you know so those are things we need to work out as a team and sort out.
On personnel do you conserve valued senior consultants on a contract basis?
No, no! if you put them on contract, what about the younger ones coming up? What do you do with them?
I would not want to allow a consultant radiologist who is very good to go without training the younger ones.
You see it’s not as if there are others that cannot come in who have the qualification. You know government always looks for certain conditions before you give a contract staff a job. And that is when there is nobody that has that background or qualification before you do that. But in our case here, there are so many who have it and they are waiting to come. So why will you, deliberately keep them? This is because if you did not retire others won’t come in. For everybody, there is time for everything, one day all of us will retire and will leave this place. Nothing is permanent, so when you are leading, always remember that even this office is transient and temporary so you come in do your best leave a legacy. You know that is our desire as management to leave a landmark, you know that people, and posterity will always remember the impact you created on humanity before you leave.
At the end of the day, we are hoping that a Radiotherapy centre would be built. By the Grace of God the Federal Government has graciously given us that budget line, we are hoping it will go to Federal Executives Council (FEC) and it will be approved by the Fed government.
I am talking about the bunker and all that. So we are hoping to get all that by the grace of God as intervention from the Federal Government, and the Federal Government has done so much of course you don’t expect more. And you know there is scarce resources on the demand, you know the resource cannot be enough, you know as the population is growing you know the resources are becoming more scarce, and that means more demands on the Federal Government.
You don’t seem to have much done here by the private sector or don’t you have billionaires on the Plateau making contributions here?
I am not aware if we have billionaires on the Plateau, but you know, I know public spirited individuals can help anybody. It doesn’t matter whether you are from the state or not. Once there is a need, people can reach out.
I wish you can be assisted the way the managers of UMTH have been because of the choking insurgency.
We will by the grace of God. It all boils down to the resources.
What are the strongest points of this facility Prof?
We are masters of most things you can think of in the medical sector. Because if you are talking about specialists it is the number of experts we have that are well grounded and experienced that gives us the edge.
How many consultants do you have? And how result oriented is your orthopaedic dept?
Over 200. You know that is why I am telling you of experts so if you are talking about neurosurgeons operating on the head, what we have is very strong, its just that space constraint affects them we are unable to give them like I told you a befitting place to operate from.
Compared to other places like Ahmadu Bello University (ABU) or Bayero University Teaching Hospital Kano
We have Prof. Ochi, and they are doing very well, they do heap replacement here too. We do it here, it is just that we don’t blow our trumpets, we also do knee replacement in JUTH here…..his deputy cuts in……… the Kano you are talking about, go and ask any of their professors, they trained here each one of them pick any specialty, they trained here, so we still have that edge… their former CMD Aminu trained here, they all trained here, if you go to Bauchi ask they trained here, if you move to Benue they trained here, just go and enquire in Abuja, they trained here, the man that does kidney transplant in Abuja they trained here.
So you should have more than 10 nephrologists for instance?
CMD cuts in…… we have four, but you know its not that you train and keep them, of course like he said we train to give. We send them out. when you finish training and keep everybody here, then you are not impacting Nigeria, like he said, we train they go to Kano. JUTH trained a lot of the consultants in Kano, it was from internal medicine, surgery, Obstetrics and Gynaecology (O and G,) pediatrics all train here in Juth. But why JUTH has this number of experts, it is as a result of the unfortunate ethno-religious crisis of ABU Zaria that became our gain., Zaria used to be the most famous University Teaching hospital in the north. However at some point, many of them that couldn’t stand in there came to Jos and they were welcome in Jos, so that is how Jos became a very strong base for training.
How many residents do you have?
We have over 400 of them. They are all working. You see without the resident doctors it is not possible for the consultants to hold this complex full time. And that is why when the resident doctors go on strike, services goes on, but not as to the full scale as when they are helping out.
How did you settle their recent demands for school fees to be paid by the Minister?
No its not school fees, what the Federal Government is paying is resident training allowances.