In a bit to go through the emergency
plan that the Head of State announced and instructed us to do; today, we will
be looking at the health sector.
The other day I was watching the
news on TV, and I heard the director of the Yaoundé Central Hospital asking us
to come and carry our dead bodies that have been there for months. The hospital
does not have space and I think that is one of the problems. Such an
announcement communicates gaps in the health sector. The health system would be
one of the issues; we would be talking about in a little while.
This morning Willy Sani greeted the
patients, Olivier greeted the nurses and we will greet the doctors, in fact
everybody who is working in the health sector of Cameroon. One of the problems
we have in that sector is the shortage of human resources. This morning, we
shall be looking at how we can improve on the health sector to meet up with the
development demands that the head of state is making; because we cannot talk
about development without having healthy people around. For us to have healthy
people around, we need to have the infrastructure, we need to have the
resources that have to take care of the part or that sector of our development.
Many things have been said as far as what is to be done. I hear there is
going to be a reference hospital in every region and we are finding out whether
it is an emergency to have those hospitals all around the place.
Joining us to discuss this is a
medical practitioner. He is not just a medical doctor. He is a trainer of health
personnel, Dr. Nick Ngwanyam.
I said you are not just a
medical doctor; first of all tell us about your days as a student. That is, how
you got to be a doctor.
Thank you very much. First of all I
do not know whether if we start from there we would not get lost?
No, we will not since training is
part of the issue here.
Let us start by saying that I am
from Donga Mantung and my village is Ntundip. I was born in Nkambe and I must
say that I come from a very poor family and I was just lucky to become a
medical doctor. What I have to say again is; when I look at this day; it is
very difficult to see medical doctors coming from poor families. So something
is wrong.
How did you do it?
Let us say that in our days, there
was more social justice, than we have today. Therefore, when you came out from
a poor family as a medical doctor, you had an opportunity to become a medical
doctor because nature was with you. Then you never became oblivious of the fact
that you have to work in that light. You have to be part of that nature to make
sure that there is an opportunity for everyone not just for those who can pay
for it. Therefore, when you become a medical doctor because circumstances made
you to become one, then you are very conscious of the fact that you are who you
are because there is a force that is with you that protects you and watches
over you and you take nothing for granted. That is the background.
You went to a school in Yaoundé?
Yes, let us start off by saying that
I went to primary school in Nkambe and we used to trek through the bushes, dew,
the gravel paths with no shoes and very cold and so on. It was really tough.
That was in PSS Nkambe. I am talking about 1970 and from the whole primary
school, we were just two of us that went to secondary school and the other guy
dropped away after form five.
So you can imagine all the children
from primary school, I am the only one who goes through secondary school so to
speak. I ended up in CPC Bali. I start in JMBC Ndu though I ended up in CPC Bali.
What I know is that in 1975, my mother was very sick and we were living in Bali
at that time and my father was in the UK. She was admitted at the Regional
Hospital in Bamenda and I used to trek from Bali to Bamenda to go see her and
be with her. She was sick for about four months.
I remember this German doctor, a
surgeon who was very caring. I took particular interest in the nurses those
days because they were very clean and neat and they knew what they were doing.
There was love about everything. Even before that time, I used to see the
nurses and there was something about the nurses and the doctors. I remember one
doctor Ngassa in Nkambe, he used to drive in a Land Rover up and down. So there
was something beautiful about this core and I was attracted to it. I was just
lucky that when it came to writing the competitive exams into CUSS in those
days-I am talking of 1977, I was one of the lucky few to go in. We were
probably around fifty or sixty of us and I think there might have been about
2000 or more competing and we made it. That is it.
The picture you paint about the
hospital then is something to envy; the environment, the personnel and so on
which might not be the same thing today.
There are a lot of things that I
observed and I might have been infatuated at the time and probably could not
see the facts as they were. But what I know is that the human factor was
contributory and it was different, it was positive and it was worth living
for. Today, we could have the best structures but we have poor
human relationships. There is something awful about us and we have to
talk about it. If you want to see the difference, if you go to mission
hospitals, they still have that human touch and in government hospitals,
customer service is very poor. I would rate it at 15%.
What would you say accounts for that
kind of dichotomy, civil servant mentality or training?
Before we get lost into the roots,
may I just brush over how I see our medical services and where the weaknesses
are and how we need to strengthen that?
For those of you listening to me,
when you want to analyze anything and understand it, it does not matter the
subject. We are talking medicine now, analyze it anyway you want. Let’s use the
SWOT analyses. S.W.O.T. means you look at your Strength,
Weaknesses, Opportunities and your Threats. Try to understand that and be
open-minded when you analyze anything. Compare yourself with others around. So
if we were to compare our medical services with the American Medical Services
which we shall use as the standard.
Medicine is medicine. You will
realize that we are not up to standard. So we are called upon to standardize.
That means we have to grow up because medicine is medicine. If you have a
hernia Mr. Chifu and we have to operate you, we are not going to try to operate
you the Cameroonian way or the Ntundip way. The way you are operated in a
hospital in Ndu should be the same way you are operated in a hospital in New
York. That is the standard.
So if you look at that you would
begin to understand that we are not doing things properly. Why? Because of
infrastructure, logistics and above all because of the human factor.
So the human factor is very strong. When the president talks of
building reference hospitals in all the ten regions, even if he builds
hospitals in every village and the human factor is not corrected, he does that
in vain.
When we talk of the human factor, we
are looking at technological know-how. Do you really know what you are doing?
Do you have an analytical mind? Do you have a mind that solves problems or are
you just a copy and paste kind of person. You know the way we train children
these days, they just read the notes and then vomit them out and they pass.
That is not it. Do you have the capacity to solve problems? Do you have a human
touch? Do you have a feeling for people?
All these things you ask in the form
of rhetorical questions, are you saying these are the problems?
We have huge problems in this
country. What I want to say is that even if you build a general hospital in
every village, watch my lips, the delivery of medical services would not
increase by 10% because of the human factor. Therefore, while we are building
the hospitals, let us correct some few things. Let us sincerely and honestly
work on the human factor. If we do not do that, we would always be getting it
wrong.
Dr. from observation, you are
actually focusing on the human factor. We realize that a medical practitioner
in a government facility and still works in the private facility have different
attitudes in the two environments.
That is the problem. You cannot have
a medical doctor with two minds. That means you are a liar. You behave
differently under different circumstances. You are rude in a government
hospital and when you are in a private hospital you are nice. You cannot be
like that. You cannot be hot and cold at the same time. You just have to be
you. So we have to look for people who are just themselves and know what they
are doing.
How do we get them? How do we bring
them about? How were you brought about?
That is the problem. I am the
product of a different system. I am a product of Professor Victor Anoma Ngu,
Professor Nasah; I am a product of a different mindset altogether. Let me just
step back again in time and explain something to you. After my training in
Yaoundé as a medical doctor, I went and trained again in Nairobi as a general
surgeon on a WHO scholarship given to me by Professor Anoma Ngu. Then I
continued to London where I trained as a urologist. I came back and worked for
sometime in Bertoua then I went to BBH to work.
After spending all those years in
the university and going around the world, it is in BBH that I discovered a few
truths about medicine. One blessed day, 10 AM, I go down to the doctor’s office
for coffee and I look on the shelf, I discover this text book of medicine. I
think it was green in color, I cannot remember, Cecil’s Textbook of Medicine.
I grab it, put it on the table and open to the first page; first chapter and I
read it. That changed my life in medicine. That is what we need to do in
Cameroon.
Question number one; who is a
physician? Physician means doctor, who is a doctor? Question number
two; who is a patient? Question number three, when a patient comes to
see a doctor; what is he or she looking for? When I read those, nobody had
taught me for how many years I was in the university and nobody mentioned that
anywhere. But it opened up my eyes to understand that the patient who comes to
see you is really hurting. He is really hurting so much and we go over
it. One of the weaknesses that we have in the medical training in
Cameroon is that number one; we do not teach psychology and psychiatry.
Psychology and psychiatry is one of the areas in which we are very weak. You
cannot practice as medical doctor in the US if you do not have good
knowledge of psychiatry and psychology. You must understand the human person
and how the mind works.
Another weakness in our system is, we
do not know how to manipulate drugs (therapeutics). We are very weak at clinical
pharmacology; we are very weak at anatomy and physiology, we are very weak
in a couple of things. When you are talking to a doctor, he is prescribing when
he did not understand what he is writing. You end up with a list of eight drugs
and that is not it. You are besides the point. A patient is looking, number
one, for a doctor who would listen to him. Just listen to the man talk
and try to be with him and know how he feels. When you can do that; that is
having that empathy. Listening would help him.
In that book that I read, Cecil’s
Textbook of Medicine, it says that 70% of people who come to the hospital have
nothing wrong with them. They have something wrong with their minds. They are
just worried. They are stressed. If you could just listen to them, you would be
able to understand what is wrong with them and you correct it. But if you do
not, you would not and you would be beside the point. That is why patients keep
moving from one doctor to another. Because our systems do not train doctors who
listen and understand, patients end up with native doctors, “canda” sticks and
so on. They get treated in Amour Mezam buses and so on. That is the problem we
have in Cameroon.
Do you think that training or
upgrading the training of the students of the University of Yaoundé
I is the main problem? I did not hear about the other institutions.
It is not about Yaoundé University
I. It is about training as a whole in the country
In the three year emergency plan,
the President emphasized on Yaoundé University I.
Probably if he talked of Yaoundé
University I, then he was not broad enough. Let me step back again and explain
one thing. If you take all the hospital staff in any hospital, you can divide
them into three groups. You have the doctors (pharmacist, gynecologist,
generalists and all other specialists) put together, and then you have the
paramedical, that is the technicians which includes nurses, dental therapists
and all other technicians. There are about seven groups of technicians but we
know only of the nurses and laboratory technicians. Then we have the other
group, what you call the support staff. We are talking of secretaries,
communication staff in the hospital, the people who are responsible for
hygiene. So we have these three groups.
80% of all
people who work in any hospital structure are nurses. So you begin to
understand that if your nurses are poorly your health service can never work. That is the first thing we ought to realize and put in
what it takes to train the nurses and other technicians properly. If you have a
general hospital and put a specialist doctor in every room, that hospital will
not work because it is about team work. It is team work and we have to teach
people what team work is all about.
It is not about the medical
doctor breathing down the necks of other people because he is a doctor. That is
a wrong attitude. When you come into a civilized place, the doctor and the
nurses are talking and conversing. The issue is trying to solve a problem. What
do we do on this patient so that he can get up on his feet? It is not about you
showing that you are the boss. We have this boss mentality. I think it is
borrowed out of medicine because when you go out there, the SDO is breathing on
everybody’s neck, the chief of service is breathing. You know we have this
“commandement” thinking and the doctors are now doing this “commandement” thing
in hospitals.
One wrong thing that we are doing in
this country is to pick people; put them in ENAM; train them for two years and
put them in hospitals to boss doctors. It is a wrong thing. When you do that,
you kill initiative in the hospital because the gentleman comes and begins to
boss people when he does not even know how to write his name. There is a
problem there and we have to be very careful. In America, my son is being
trained as a medical doctor in Boston University. Schools that train medical
doctors there do not do this kind of thing we are doing in Cameroon. You do not
just train a medical doctor.
You go to school and become a
medical doctor and in the course of learning how to become a medical doctor,
you also take an MBA. That is management, so that you know how to manage
personnel, finances and you know how to run a business. So every doctor has
that in mind. So if you are not doing an MD associated with MBA, you are doing
an MD associated with public health. It makes you a better person. Imagine all
doctors working in a hospital having an MD and an MBA. They can easily manage
themselves.
If we had them train like that then,
for take the Cameroonian civil service, we could tell them this is how
you draft letters and so on. You could take these groups of technicians to ENAM
for three months or so to show them how the Cameroonian civil service runs. I
think that is the way we should go. All engineers are trained like that too.
That is you do engineering and an MBA. So an MBA these days is considered more
like knowing how to use a computer, knowing how to speak English and French. It
is a cut- across kind of thing. You do not have to have some people who are
just managers who do not understand the issues. We are functioning in boxes. We
do not think out of the box and that is why nothing is working. Might be I talk
too much.
It sounds very idealistic and Dr.,
one would like to know whether you do that in your school.
Yes of course you know that I am not
boasting. You know that my school is one of the best in the country. When you
see an institution, when you see what ever, it is a reflection of it director.
When you see CRTV, it is a reflection of your director. Every institution is a
reflection of the person who runs it and has the vision. I come from very far;
you know I went to CPC Bali, what I have gathered over the years, I have been
to Nairobi, London and travelled the world over. I know how it is done and
therefore, I try to bring these things to bear on the children so that they are
different. The vision of St Louis is not just about training. It is about
training the staff of today and tomorrow. I try to put a little bit of myself
in the 1300 students we have so that as they go out into the health sector,
they will become those elements of change in our hospital system. They would be
the yeast that would raise the dough.
Amongst the problems with the health
sector, you have talked about infrastructure, the problem of training; training
not just in the numbers, but in the quality or the attitude and the course
content. You have questioned the content of our programs in the medical schools
in Cameroon which means we do not just have the problem of infrastructure to
solve. Do we have the right number of people who train and the training
facilities in Cameroon? Do you see us meeting with the quality of people we
want?
No, not at all. We are sub standard.
You know, our infrastructure as of now, if you are trying to target to
international standards, I will not put it pass 25%. Our numbers, you will not
put it pass 25%. I was surprised the other day. There was a doctor who came
from one hospital in Italy, and he is a radiologist. He was having a chat with
my wife and he mentioned that in the hospital where they are in Italy, there
are thirty of them radiologists in one hospital. That is thirty specialist
radiologists in one hospital. He goes to work at 7am and can only come back at
9pm. I am talking about one hospital in Italy and I am talking about one sub
specialty- radiology and there are thirty of them there. Use that and you begin
to understand. It is up till .., within the past two, three years that Dr. Lah
was sent to the Regional Hospital in Bamenda otherwise all this while, we never
had a radiologist in all of the North West. Dr. Ndam who is the only
radiologist working privately in his clinic in Bafoussam used to cater for
the North West and West Regions.
Let us talk about the distribution
of health facilities across the country. When you look at the health
infrastructure map in the country, do you see that the distribution is what it
should be? Are you in favor of this system of concentrating health
infrastructure in big cities?
It is not about me. It is the way
things work.
How do you appreciate that?
It is part of economics. First you
have to make sure that the whole national territory is covered with
infrastructure and this infrastructure is graded. That is why you would
have a sub divisional hospital, a divisional hospital and a regional hospital.
It does not make sense to take a general hospital and put it in Ndu. That is, a
general hospital in the real sense of it. When you talk of a general hospital,
it goes with all sort of sub specialties, machines and so on. What has been
failing is the fact that our referral system is poor.
When you just graduate as a medical
doctor; when you just finish seven or eight years as a medical doctor, you
barely have just started learning what medicine is. But you see, these young
people who have finished medicine; they will never ask you a question to try to
know more. They think they know it all and that is where they get it wrong.
When you come to a hospital; take our general hospital; it does not function
the way it was planned to function.
Might be the people who are there do
not even know it. It’s supposed to work as a team. If you go to the general
hospital, you would have the department of surgery, radiology, pediatrics,
obstetrics and all these departments. In all these departments, you would have
two, three professors at the top but with one senior professor, and all other
doctors fall under them. So it is a team, a pyramidal kind of thing and there
is a lot of respect. When you go to the hospital, you do not see epaulets as
you see in the military, but technically, everybody knows where he or she
belongs.
Here we have created a situation
where people no longer respect hierarchy and each other and we have put in
place some other mechanism which we think works but we work “a la
camerounaise.” You can be a junior and you are appointed to be the
boss. Because you are appointed to be the boss does not mean you are smart enough.
Being smart is one thing and being appointed is just another. There are
problems there and so when a patient comes from the region, and is sent into a
general hospital, the patient is supposed to be managed by that team. But the
unfortunate thing is that when a patient comes in, he is managed by an
individual. So we have a general hospital on the outside and on paper, but when
it comes to how they function, they function as small district hospitals put
together.
Dr. There is the issue of
remuneration and we see that there is a lot of brain drain. The whole health
service is not well catered for. We are told that we are going to have ten more
reference hospitals. Where would they find the people?
You see we agreed on one thing that
we have to come back to the human factor and so on. I am glad we all agreed on
that. The question is why are those in the health sector not delivering the
goods? Where are the weaknesses coming from? You have identified “affair
Nkap affair tres serieux.” So if you do not pay the staff and pay
them well, they will not work for you. That is the first thing.
Number two, you have to give them
respect. Sometimes it is not just the money that counts. Let’s take for
instance that in Cameroon, we are paying doctors for 150,000FCFA because there
is no money. If everybody else, like the army general are earning
150,000FCFA good and fine. But you cannot put a medical doctor on 150,000frs
and put a police commissioner, I do not know much. 400,000 or 500,000 FCFA. I
do not know how much they earn; but they do not earn the same.
The magistrate earns so much; people
who have gone to ENAM earn so much. Their salaries as they are might not be
much but they have sources where they tap on some incentives and they know how
to do it. Check on all the mansions in town and find out who is building them
and the big cars and see who is riding them. With things like these, you
begin to push your technicians to the wall. It is not even just in medicine. Up
until now technicians were not respected in Cameroon. They could be
engineers, architects or whatever. If you are in the army, you went into ENAM
and you are of the “commandement” and can dish out orders, then you are
respected. But if you know how to solve problems then you are not respected.
(A caller on the line, Good old
Patrick) Good morning Dr. Happy New Year. I understand what Dr is talking about
very well. When I was a glaucoma eye patient in London in a hospital, I knew
the entire glaucoma specialists because as he says it is a team. It goes and
goes to one another and they compare their notes. Now Dr. we are going to have
ten reference hospitals. Would you go for that or would you go for the
improvement of existing ones. That is my first question. Yesterday the
issue was on asking questions, the doctors today either they do not have the
time, over worked or are thinking something else, patients do not ask them
questions. I do not know how you do with your patients. Do you entice them to
ask you questions? Thirdly Rwanda that just recovered from war has a health
insurance that covers 90% of the population. How do you think we can do that
here?
Let’s put it this way. If we were
building our health infrastructure the way we were supposed to, we will not be
in a haste now to build ten at once. Even where we are now there is a shortage
and we are trying to catch up. As I said a general hospital is not just the
buildings. This is what we can do. We can build all the hospitals in the
divisional headquarters to have the structure and equipment of a general
hospital. That would be wonderful. That means the physical structures are
receptive and have all the equipments. That means in every divisional hospital
we can have an ultra sound machine, we can have machines to test people and
know what we are dealing with. Then if we cannot manage, then we begin sending
the patients up the ladder. The human factor is still very much a problem. I
think it is of recent that the Bamenda General hospital has two or three
gynecologists. Until now they had only one. So you can see that lack.
Are they over worked?
No it is not about being over
worked. It is poor training and I said they do not listen. The doctor patient
ratio is still very poor. When we are talking ratio, do not look at Cameroon,
do not look at Central Arica. Look at America, look at developed nations. We
have a long way to go. Remember we have eight millennium development goals and
four of them are on health. We have a huge problem in Cameroon. As I
speak to you, I Google searched health services in Cameroon and I Google
searched health services in Gabon. Gabon has a pass mark and we have a failed
mark. Check on your internet. I am not the one saying it.
So there is this problem of the
human factor and training which I will keep coming to. If we say that training
is an issue, then let us go back into the roots. How do we select our
candidates for training? When I was in Nairobi, this is what I observed. In
Kenya, there is no competitive examination into any school. After the GCE
all the students are ranked. You do not need a minister to decide, you need a
clerk who can read. He counts the first thirty and draws a line. Those first
thirty go in and train as pharmacists. He draws the line under the next one
hundred and fifty; they go in to train as doctors. Then he keeps doing
that and all the students are distributed into all the departments, faculties and
so on in the whole country. So the children of the pauper would be in there. So
it is about capacity, it is about quality. When children want to be
medical doctors, they start working for that from secondary school. The way we
are doing it now, I wish we were even doing the regional balance.
(A Caller on the line, Fosso the
Prince) I want to greet Dr. Nick Ngwanyam. I am very happy the way he speaks.
If we have people like him, two or three in Cameroon the situation especially
in the health field would change. Tabe you know I am a trainer at the training
school for midwives in Bamenda. I happened to have taken part time also with St
Louis. Dr. I have this worry and also a question. Why is it that we know
that standards are falling, nurses are poorly dressed not neat yet today there
are schools just everywhere and you move around town seeing people flying out
white shirts in the name of training as nurses or medical doctors. The Ministry
of Higher Education creates training schools and the ministry of Public Health
creates others. At the end you do not know what. You come to a school you see a
poorly dressed child in the name of a student and you do not know the
prescribed uniform. Is it not supposed to be according to the training?
Yesterday before I came down to
Yaoundé, just as I was about entering St Louis, I saw one student who was
wearing a white jacket and he was looking like a butcher. I thought this was
one of my students who has gone wild. I stopped the car and I called him and
asked, who are you? Of course he did not have our insignia on him, but he told
me that he was a student training as a medical doctor from the University of
Bamenda. So I drove off.
You are insinuating that students
who are trained in schools authorized by the Ministry of Public Health are
properly dressed, that is false. There is a problem between the ministry of
Higher Education and the Ministry of Public Health as we speak in relation to
training. It is an ego problem. The people of the Ministry of Public Health
think that they have the upper hand when it comes to training staff but the
Ministry of Higher Education think they have a right to do it too. This comes
from the job description of the two Ministries.
Do not forget, the Ministry of
Professional Education is also training nurses. What is lacking is a sense of
understanding between all these ministries and what should be done. The issue
is not who is doing what. There should be standardization. There
should be a standard exam to be written when you have finished your course so
that when you pass your exam fine, if you don’t then bad. It does not matter
where you trained. There should be standard programs for training, who should
come in for training and who should train. We reject some student from our
school. Even if you have ‘A’ Levels and you do not meet a certain mark, we do
not take you. Sometimes people just train anybody, and when you train
just anybody, you can never get it right. When we say training, some people
just go there stand, loiter and wear a white uniform. When you wear a white
uniform it does not make you a nurse at the end of the day.
What is the relationship between
politics and health? This is because as I understand, you wanted to run for the
senatorial. Is it because you wanted to improve on the bills on health?
That is correct. I became interested
in politics not because I really wanted to. His Eminence Christian Cardinal
Tumi is the person who taught me the relationship between politics and whatever
happens. I learnt that lesson in 2008 about 6th or 8th of December when I asked
a question about President Obama and his winning to become the president of
America. Here I am looking at somebody who is younger than I, who is also
a black and is the president of the world so to speak. How did he make
it? I was intrigued. He taught be some few things about platforms and
principles. You know things work on principles.
In
Cameroon, we think that things work on feelings. That is where we make the greatest mistake. Things do not
work on feelings. Chifu, you might be my brother because I know you. I should
not deal with you because I know you. If I am dealing with you because I know
you, I should be working but on your strength. Let me cut a long story
short, so I asked how did this happen? But he taught me that nothing
works until the policies are right. Things in a country work on
standard operating procedures. That is policies. What is the policy for this
and this? Policy would be the business plan for anything. So you follow that
business plan. You come, sit together and you say what the problem is and you
define that problem. If it is not working you revise it and do the SMART.
That is how things work.
So the cardinal told me, for
Cameroon to be right, we have to pay attention to our policies. Number two, we
have to make sure that those policies are implemented to the letter not half
measures. When you have the right policies that are implemented to the
letter then things would work. If you do not do this and you think you
would stay around, even if it takes fifty years, nature would wait and nothing
would change. That is the problem. That is why I became interested in politics.
Politics to make sure that, number one, the right policies are put in place and
two, are implemented. You cannot make that happen if there is no truth.
Our problem is not parliament or the senate. Our problem is the truth.
Do you think health insurance policy
is going to make healthcare accessible?
While we were waiting on the
corridors, some people called and said we should talk about health insurance
and Chrise Mbunwe said we should talk about the medical forum. Another person
asked what is my relationship with the medical council? So we would try to look
at those points very quickly.
Health insurance is a very good thing.
But we should say one thing. There is nothing like something for nothing. Somebody
must pay for something. What would be the use of a health insurance? We
want to be able to create a system where whether you have money or not, you
have good health care. That is the bottom line. But who should pay for it? What
should be the source of income to pay for that? We can have a health insurance
in a health system that works. If you try to have a health insurance in a
health system that does not work, it will still not work.
Already we are talking of a health
system that does not work. First you must have a health system that works, then
now a health insurance would be tagged on that and it would become smooth. Even
without a health insurance, there are ways and means for us to make healthcare
accessible, affordable and available to patients. As of now, we are doing
things that do not make those health services available.
If we had the right staff
distributed all over the national territory; that would already be solving lots
of problems. Remember when we stated, I said most of our doctors are not very
sharp in clinical psychology and therapeutics. So we are at times treating and
wasting money on things that do not need any treatment. Just by simply
listening to a patient, 50% of the patient’s problems would be solved. If you
as a doctor, you are looking at the patient’s pocket instead of looking at the
patient, there is a problem and you would not get it right.
May I mention something here and let
the citizens be aware of it. We are making a lot of wrong diagnosis of typhoid
in this country. We see typhoid and malaria in everything. It is all wrong.
There is this thing called the Widal test. I am sure every Cameroonian is aware
of the Widal test. It is the most common test in Cameroon. Widal test is not
the right test for diagnosing typhoid. The right test to diagnose typhoid is
the culture of the blood or culture of the urine.
So you can imagine the amount of
money we have been wasting over the years ever since I was a medical student.
Over the years, we have been treating something that does not exist. If you go
on to teach doctors, laboratory technicians and nurses on how to diagnose
typhoid, a lot of patients would keep their money in their pockets. This is
because we have been throwing this money away treating something that is wrong.
I am not saying that typhoid fever does not exist.
Imagine you take your car to the
technician, mechanic or whatever and there is a problem in the engine. Let’s
suppose the car is not functioning well and the technician tells you that they
are the plugs. Then you buy the plugs and put them in the car and it still does
not function well because the problem was with the fuel filter. You see you
waste money and that happens a lot. It also happens a lot in medicine when the
right diagnoses are not made.
There was this story. I read it
somewhere. In a production chain or in a factory setting; most Cameroonians
would not know because they do not know what a factory looks like. We do not
have factories. In a factory setting where things are laid down in a conveyor
belt and the whole thing is going round, the whole factory came to a stop and
the manager called a technician to come and repair. The technician went around
and with a hammer, he came to one point and taped it and the whole factory
started running. His bill was about three hundred pounds or so. Then the
manager said, how can you bill me three hundred pounds for just tapping? So the
man changed the bill and said, “Ok, this is the bill, for tapping one pound;
knowing where to tap 299 pounds.”
That is the value of knowledge. That
is the value of knowing what to do.
Let talk about the health forum.
The problem with the health forum is
that, you come to a forum where everything is already laid out. This minister
or so will come and talk and they do not know what they are talking about.
There might be somebody in the hall who would try to say, “hey we have
been doing it wrongly,” they would rather say “toi c’est qui?”
We do not listen.
Someone wanted to find out your
relationship with the medical council.
Before we get lost into that, we
were trying to see how we could make health services better and at least
affordable to the people. This insurance thing; we will have to mature into it
because somebody has to pay for it. The question is, who pays for it? Do not
forget, there are some services that the population needs which nobody can pay
for. It is the government that pays for. We are looking at things like roads,
electricity, water and health is one of those things. It does not matter how
much we talk, the government is responsible for giving us health.
Then, the population now sees in
what way they can contribute to make that health affordable and better. It is
still the responsibility of the government to wake up so that we have our
health. It has to do more with policy and good governance. As I was telling
you, Gabon this small country of about 1.5million people; they have a factory
(listen to me and listen well) that produces drugs.
If you look at what you spent in the
hospital here in Cameroon, you would realize that most of your expenditure goes
paying for drugs. What I am saying therefore is, we could also have our
factory in Cameroon producing our own drugs and you would be reducing the cost
of medical care by so much. The question we are going to ask is, how come we
have about three hundred to five hundred pharmacists and none of them can
produce a tablet? The problem seems to be more with policy, taxation and so on.
I know there is a Bamilike man in Douala who has been trying to put a factory
to produce drugs, but his problem has not much been with technology but with
policy and taxation.
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