President, Nigerian Medical Association, Prof. Innocent Ujah, speaks on the ongoing battle against the COVID-19 pandemic in this interview
What is your assessment of the government’s efforts at fighting COVID-19?
This is a novel disease and it is coming at a time when people are unaware and unprepared; however, it has come. Now, the government has set up the Presidential Task Force on COVID-19 that coordinates the response to the pandemic in the country and funds have been released. For the first time, we have seen the private sector contributing very generously to the response and that is a welcome addition to whatever that has been happening before. The process has started and we pray that we will continue to do our best to see that we prevail in our efforts over the disease. There is no straight answer to your question because the process is still on, but so far, the government is trying its best but we need to do more.
How can the Federal Government fill the gap?
When we are talking about government efforts, we are not just referring to the Federal Government; we are also talking about state governments because the Federal Government alone cannot do it. The local people are in their communities under the governors. So, all hands must be on the deck for us to succeed in this fight. We know that the commitments of the governors are as varied as the numbers. Many of the governors are committed, while others are not. We need to refocus on our strategies and see how we can more effectively tackle the challenge of the virus in the country.
Community transmission of the disease is on the increase. How can the curve be flattened?
I think that is one area we need to go back to the drawing board to and see what to do. The best way to do it is by evaluating what we are doing. We’re talking about three months into the pandemic in the country. These three months, how far have we gone? What is it that we could have done better than what we are currently doing? What is the new thing we can bring on board in the fight against the virus? Since the time the first case was recorded on February 27, so many things have happened and there is a need for a review to enable us enhance our strategies.
Has the government been able to convince people, particularly those at the grass roots about the existence of COVID-19?
I think we need to carry out the appropriate messages to the communities. Not just the communities alone, because even some educated people still do not believe that there is COVID-19. You know that some states, including Kogi and Cross River are still in denial despite attempts by the Nigerian Medical Association to make them see reasons that it is not something we can wish away; it is one we need to act on and respond appropriately to so that our people do not get infected heavily as a result of denial. So, the appropriate messages should be sent out.
I know that the print and electronic media are doing well in this regard, but how many people have steady power supply to be able to follow up on the PTF’s daily briefings in the electronic media and also given the fact that our reading culture is still very poor and therefore many people may not be able to follow up in the print media. So, the best way is to involve our own traditional means of communication and that requires the involvement of traditional rulers, religious leaders and leaders in the communities so that they can take it as part of their responsibilities to inform the people about the disease and its dimensions.
We have 774 local government areas in the country and what I have not seen is the active involvement of the National Orientation Agency in sensitising the people. So, many Nigerians do not believe that there is COVID-19, and I will say that it is this gap in sensitisation of the people about the disease that is responsible. I think Nigerians should listen to experts and do what they are saying. This is not politics but science. And because it is about science, we have to produce evidence but we do not have to wait until dead bodies are littering the streets before we begin to comply with safety protocols.
So, information dissemination by the National Orientation Agency is not at its best and I believe they can do more to bring this message to our people in our collective fight against the disease. Once we accept that there is COVID-19 and follow the basic protocols of regular handwashing with soap, using hand sanitizers, use of face masks and social distancing, among others, we will be able to clear the virus. But for now, the compliance level in observing these protocols is still very low.
What is even very disgusting is the level of violation of the social distancing protocol among Nigerians. I don’t think the compliance level for social distancing is up to 10 per cent and this is not good enough for our collective safety. I think the basic compliance protocol has not been successful. And again, I think this is where the PTF intervention or whoever is responsible should come in. Why will they not set up a small committee to find out why Nigerians are not complying because it is evident? You know that if you have the data and you are able to analyse, it will give you the direction on what next to do.
Do you know the reason for non-compliance with the basic protocol by Nigerians?
I don’t know because there is no evidence. One of the ways to establish that is to have data. We should get to the communities to find out why they are not using face masks, for instance, or why are they defying government directive on physical or social distancing. It is only data that will bring out this information and after collation, you will be able to say these are the reasons why people are not complying. Then, the next thing is what do we do for people to comply. That will now come out as suggestions from the findings of the research that you have carried out.
Is the NMA okay with the hazard allowance being paid to doctors?
Allowances cannot be enough, but the government is redeeming its promise. I think many people have started receiving payment alert based on the agreement reached between the health professionals and the Federal Government. The allowance we requested will come after the post COVID-19 response, but at the moment, the government is redeeming its promise based on an agreement with the health professionals.
Since the outbreak of COVID-19, many top government officials can’t travel abroad for medical treatment. What has this taught the nation?
Let me say this, it is not good that we have COVID-19, and it is good that we have COVID-19. Do you know why? This is because we are saving foreign exchange. Nobody seems eager to travel abroad, because of the fear of being infected with COVID-19. That, in itself, is a lesson for us that we have to be prepared to transform or restructure our health system and build facilities that anyone can use here in the country. It is an opportunity for the high-profile people to build functional health facilities and equip the existing ones, train and retrain our health professionals and they will do the best they can.
We know that many of them, who leave the shores of Nigeria for treatment in Europe and America, turn out to see Nigerians because Nigerians are the ones treating them there. So, what is the difference? The difference is that they have the equipment that will support their diagnosis and management. And if we can have that in Nigeria, the issue of medical tourism will be reduced to the barest minimum. So, COVID-19 has brought us to know that if you cannot travel outside the country for check-up, you should be able to use what you have within.
Therefore, we should be able to improve on our facilities. The good thing is that we are saving our foreign exchange as a result of COVID-19. That is the only positive aspect of the outbreak of the disease that I know, but you can see that the people, who are infected, are still very few and that is also a positive.
During the Ebola outbreak, you were the Director-General of the Nigerian Institute of Medical Research, which was in the forefront of fighting the disease. What lessons do you think can be drawn from that experience in the fight against COVID-19?
We played our own role as a research institution during the Ebola outbreak, because we were involved intimately and we gave our advice. Most of the time, I think the government did listen to us. I don’t know whether the Nigerian Institute of Medical Research is involved in the present situation, it is only the PTF that can answer that. But during the time of Ebola outbreak, there was no doubt that a very large number of people were involved and I think that was a momentous time for us, because what we achieved at the time took the world by storm.
They didn’t believe that a country like Nigeria that’s full of negative things would quickly contain Ebola, but we did by God’s grace. One of the reasons why we were successful was the fact that the disease came through Lagos, which is the most prepared state to respond to emergencies of that nature. Secondly, there was political commitment by the then President in handling the outbreak. The present President is also committed, because funds were released. If he did not have political commitment, he wouldn’t release funds.
But what I think that needed to be rejigged is the coordination. The central coordination centre needs to work very closely with the states and give them the directives on what to do, but you find out that some states say they don’t have COVID-19, while others claim it is a mysterious disease. It shouldn’t be that way. We are saying that more people should be tested because you cannot say you don’t have COVID-19 if there is no testing going on. I believe that if people are tested, it will be good even if they turn out not to have it, then we will know they don’t have it. I think that is one area where extra coordination should be done.
What is the difference between medical research in Nigeria and other countries? Will you say Nigeria is doing enough in terms of research?
And my answer is no. There was one health policy in the Federal Ministry of Health. The research held became number eight and that is to tell you how we take research in Nigeria. And you know that research drives processes and development, but in the country, research takes the back seat. And that is why you find out that we are very chaotic in our outcomes. So, the answer is that we have not recognised research as a driver of development in the country. And that is why the fund usually allocated to it is very minimal, but you need funds and not just pittance to be able to carry out a serious research.
You cannot talk of the difference between research in Nigeria and other advanced countries without mentioning the problem of funding, because that is a major issue that has kept us where we are.
Why do medical doctors always oppose traditional medicine?
One of the problems we have in this country is that everybody is a doctor. Just look at the ongoing COVID-19; we had not seen it before but as soon as there was an outbreak, all sorts of people came out to say that they could cure the disease. Have you seen any medical doctor making such a claim? They have not done that because we have ethics and you can’t just wake up and say you can cure COVID-19.
The truth of the matter is that traditional medical practitioners are not open; we don’t know what they have. You cannot say you will agree with somebody when you don’t know what the person has. That is the problem. When we do our research, unlike our colleagues in the unorthodox medical world, the findings are all over the place. They will publish them and present them as well. Even when they thought they had done very well, there will still be criticisms and that will improve whatever we are doing.
What I am saying is that the traditional healers do not bring to the open what they are doing and nobody knows what they are doing. We should be able to discuss their activities and their findings; if it is a breakthrough, we should be able to applaud them.