“If you cannot change it, change your attitude” – Maya Angelou
Our life is full of uncertainty. Whatever it is that you are doing or the stage of life that you are in, change is a constant. To navigate a previously unexplored or uncharted terrain could be difficult, energy-sapping and potentially scary. The best bet is to adopt the attitude that the only thing that will never change is the certainty of changes in our environment, economy, social norms and procedures. In reality, change is life.
In the pharmaceutical sector, until 1944, there were no antimicrobials available to treat infections that were killing people in their thousands. Today, about eight decades later, there has been an explosion in the classes of antibiotics available. We now have a plethora of antimicrobials which has created a dilemma of choice for the physicians.
Even the organisms themselves have changed. The medicines that had hitherto been effective have been rendered useless through mutation, resistance development or, in some extreme cases, the medicines have been turned into substrates for micro-organism. So many other changes have been recorded, particularly with the emergence of molecular biology and the recombinant DNA technology.
The Nigerian scenario
The healthcare delivery system in Nigeria has witnessed so many changes over the years. Unfortunately, Nigeria today ranks as the 187th nation in the world in terms of the health sector. We have one of the worst health indices in the world. According to the World Health Organisation (WHO) statistics, Nigeria’s health dashboard presents a pathetic image, as follows:
Life expectancy (2016, M/F): 55/56;
Under 5 mortality (2018): 120 per 1000 live births.
15-60 years mortality (2018): 372/333 per 1000 population.
Total expenditure on health per capital (2014): $217.
It had not always been like this, however. In the past, traditional medicine and healing was the mainstay of the healthcare delivery system and this is true for all the 250 linguistic or ethnic groups in Nigeria. The herbalist or medicine man was the physician, pharmacist and nurse combined in one person and, somehow, the system was maintained in equilibrium and peace. The traditional medicine practices still remain popular in some corners of the country till date.
We moved on to the modern healthcare delivery system through the explorers and missionaries. Some of their legacies are still standing till date. It was a glorious era, even if the promoters had a mixed purpose of indoctrination and dominance.
Post-independence, we moved on to a state-controlled healthcare system and things were working, until corruption and politics defiled the system. At that time, the University College Hospital (UCH) was a centre for healthcare delivery excellence and was getting patients from other nations in Africa and the Middle East. The state Hospitals and health outposts were functioning well. Different development plans were churned out and healthcare educational institutions were set up.
Today, we have more than 30 medical schools (up from one in 1960), more than 20 pharmacy schools and numerous schools of nursing and others.
Another change, however, occurred which made “things fall apart” for the healthcare delivery system. The healthcare sector is now known more for strife, strikes and unending inter-professional rivalry. Infrastructural decay is the order of the day and a visit to any of the health institutions is a harrowing experience that may not deliver on promise.
There is obvious deficiency in training of healthcare personnel across the professions and the nation is currently witnessing acute manpower shortages. The materials needed are in short supply and affordability has become a big problem for an average due to high cost of healthcare and the out of pocket expenditure profile.
The Health Insurance Scheme that is working in other climes has failed woefully in Nigeria and the citizens are helpless. Medical tourism is the order of the day for the rich who, incidentally, are mostly government officials or those who are very close to the government circles. Others are left to their fate, to rot away and ultimately succumb to death.
For these reasons, we lack the capacity to handle challenges and breakout of epidemics and it is almost a situation of everyone to himself and no one for the nation.
Fallouts, prospects and eventualities
It is in this situation that the COVID-19 pandemic sprang on us and changed everything that we used to know. Our healthcare system cannot handle the emergency, despite the pretence to the contrary. It is known now that:
About 80 per cent of infected persons will have mild symptoms
About one in six of people with symptoms will become severely ill
Scientific modelling suggests that about one in 100 people who get COVID-19 will die.
The effect is debilitating and it is more dangerous in the elderly but anyone can get it. As at today, there is no known cure or established treatment or vaccine and management is conservative, depending on symptoms presented. The good news is that a lot of work is on-going to find a definitive therapy, vaccine and cure.
With this change, we should expect a new vista in the healthcare delivery system, with the following indicators:
Telemedicine: the focus and attention will shift rapidly to online consultation via the phone or live chat and e-prescribing
Online pharmacy with home delivery service incorporated.
Self-monitoring of vital signs, using watches, monitors, fitness trackers, etc.
Increased demand for private healthcare and home consultations to avoid crowds at public hospitals.
Increased private hospital patronage for special care.
Focus on preventive care, using immune-boosters, sanitizers and hand-washing, use of Personal Protective Equipment (PPE, masks, face shield), nutrition and exercise.
Overseas travel and medical tourism will be significantly curtailed.
During this period, we will also witness changes in social order:
Increase in rape and domestic violence, pregnancy and STDs.
Increased mental health cases, as those who cannot handle the difficulties may succumb to depression
There will be less attention to other diseases with attendant consequences.
The health systems will become strained and organizations will be stretched to the limit.
There will be increased healthcare spending by government and agencies but, as usual, we may not have much to gain as benefits.
There will longer queue time for essential services and the organisations involved will have shorter opening hours.
We may witness shortage of essential medicines because drug importation and manufacture will be curtailed, due to foreign exchange issues and lack of local inputs.
The COVID-19 pandemic has changed our our lives and nothing is going to be as it used to be again. The pandemic will not go away very soon and we have to learn how to live with it and adapt accordingly.
For individuals, we have to: i) Take charge of our business and personal live; ii) follow the rules of personal hygiene and protect ourselves with mask and social distancing; iii) Manage our income and expenditure profile.
The change is here and our best bet is to change our attitude to the change.
Written with inputs from Pharm. Olumide Obube, Pharm. Clement Hamidu and Pharm. Funmbi Okoya