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WHAT A HEALTH CARE SYSTEM? …NIGERIA’S MEDICINE AND STRAIN ON HUMAN CAPITAL
(Tribute To A Dear Brother, Mr. Godswill Peterside 1959-2007)

…A Country At War With Itself

ost Nigerians are currently pre-occupied with the upcoming election and sundry issues arising therefrom, including the recent medical trips by two presidential aspirants abroad. The trips by Governor Umaru Yar Adua to Germany supposedly for routine medical check and by Vice President Abubakar Atiku to London to repair a torn ligament, bring to the fore acute problems of Nigeria’s medical system.

The wealth of a nation, they say is its health, and given the current state of health care in the country, you can only conclude that Nigeria is damn poor in that regard. The system is composed of decrepit health facilities and comatose medical institutions that have suffered from prolonged neglect and under-funding, leaving everyone open to risk of unwarranted death. In such a circumstance you only pray not to fall sick in Nigeria or develop any serious ailment that requires urgent care – you are more likely to be struck by lightening than to survive an emergency medical condition in Nigeria.

Time and again we have seen where even the well-heeled in society couldn't survive, due to lack of immediate care, malpractice or focus on the wrong ailment. These are all attributes of a dysfunctional health sector that needs immediate fixing. Recently the UN rated Nigeria very high in terms of infant mortality and low chances of women surviving during child labor. Numerous statistics say a great deal about the deplorable condition, revealing that average life expectance in Nigeria has declined precipitously over decades to late 1st-century levels of Europe (40-45 years). Per capita heath care expenditure or as percentage of gross domestic product (GDP) is one of the lowest in the world. You only need to look at the chart below that compares healthcare indicators in some of the poorest countries in the world to understand the sense of urgency.

 HEALTH INDICATORS OF NIGERIA AND SELECTED COUNTRIES

#	INDICATOR	NIGERIA	AFGHANISTAN	MOZAMBIQUE	HAITI
1	Male Life expectancy at birth (in years)	45,0 (2004)	42.0 (2004)	44.0 (2004)	53.0 (2004)
2	Female Life Expectancy at birth (in years)	46,0 (2004)	42.0 (2004)	46.0 (2004)	56.0 (2004)
3	Male, Healthy life expectancy at birth (in years)	41,3 (2002)	35.3 (2002)	36.3 (2002)	43.5 (2002)
4	Female Healthy life expectancy at birth (years)	41,8 (2002)	35,8 (2002)	37.5 (2002)	44.1 (2002)
5	Probability of dying (per 1000 population) between 15 and 60 years (adult mortality rate) - Males	513 (2004)	509 (2004)	627 (2004)	417 (2004)
6	Probability of dying (per 1000 population) between 15 and 60 years (adult mortality rate) - Females	478 (2004)	448 (2004)	549 (2004)	358 (2004)
7	Probability of dying (per 1000 population) under five years of age (under-5 mortality rate)  - Males	198 (2004)	258 (2004)	154 (2004)	122 (2004)
8	Probability of dying (per 1000 population) under five years of age (under-5 mortality rate) – Females	195 (2004)	256 (2004)	150	112 (2004)
9	Total expenditure on health as percentage of gross domestic product (in %)	5.0 (2003)	6,5 (2003)	4,7 (2003)	7,5 (2003)
10	Per capita total expenditure on health at international dollar rate (in USD)	51 (2003)	26 (2003)	45 (2003)	84 (2003)

Source: World Health Organization

Nigeria’s teaching hospitals famous for training some of the best professionals in the world have all been reduced to glorified cottage clinics, as a result of which the best and brightest have left the country in search of better opportunities abroad. Estimate suggests that there are over 5000 doctors of Nigerian descent practicing in the US alone, ironically most were trained at home. Despite the tragedy of unnecessary loss of lives, from an economic standpoint funds channeled in training these professionals, or running the facilities become wasted, just as avoidable death depletes human capital of the country. Analyzing the depth despair, the sheer number of such untimely deaths from preventable diseases, accidents and incompetence paints Nigeria as a country “at war”

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Farewell to My Fallen Hero…
Godswill Peterside, was otherwise a healthy, easy-going and very talented young man. His strong believe in God and the potentials of Nigeria was unwavering despite the constant experience of uncertainties and hassle of everyday living in the country. Unlike most people in the Diaspora who fled the shores of Nigeria in search of Golden Fleece, even when he had the opportunity to leave all that trouble behind, he refused to budge – if he did, maybe he might be alive today. In the early 1980s he got admitted to study Civil Engineering in Florida A&M University in Jacksonville, Florida. But after deep soul searching and consideration he stayed back home to study the same course at the University of Science and Technology in Port Harcourt.

Over the years he thrived professionally both in the public and private sectors. After a successful stint with the government as a resident engineer, with the attendant un-ending bureaucracy and politics, he opted to venture into private business, operating an engineering consulting and construction company. Prior to his death he was quite busy in several projects in Niger Delta area. Not notwithstanding the constant restiveness and threat to personal safety in the area, he stuck to his guns and was optimistic to the end, believing that the country was opening a new vista with the reforms occurring in the political landscape and economic arena – if people like him didn't stay around and help out, how then can we blame the deplorable condition on inept politicians? he often questioned.

Growing up, I always admired his courage and tenacity, so it was only natural that I became influenced by those positive traits in an older brother. His demise was a classic example of rampant negligence by some inexperienced medical professionals in Nigeria and underscores the total failure or inability of the system to mitigate situations in a timely fashion. He died supposedly out of complications arising from a gall stone surgery. From my interaction with medical doctors here in the US, that is usually not a complex procedure, more often than not you don't even require a surgery to remedy gallstone problem. Apparently a referral from another “experienced” doctor led him to a surgeon who interpreted the result of a scan as gallstone that needed to be removed. After our conversation to explore alternative options, he was confident that nothing will go wrong and that in no time he will be up and running again – that was never to be.

For some reason, no such gall bladder stone was discovered or removed during the surgery, however his liver became affected resulting in his death. In midst of this predicament he still remained quite convinced that his condition was only temporary and will improve in no time. Was his death the result of perennial optimism by someone who felt nothing could go wrong and believed in Nigeria to the end, or failure of a broken medical infrastructure in a country that seem to be at war with itself? That is left for posterity to judge. He will truly be missed – may his gentle soul rest in perfect peace.

…Socio-Economic Ramifications
Just as he would have wished, rather than brood over his departure I wanted to illustrate how the focus in Nigeria is often misguided, while the country continues to slide, families’ surfer unnecessary loss of loved ones and critical productive workforce is steadily depleting. As much as some people are stuck with this naive mentality that death is pre-ordained, I'd argue that advancement in science/technology and experience of developed countries or even a third-world country like Cuba has proven that life-span is a function of how well the healthcare system functions, consequently people are able to live longer and defy death not because it was divinely pre-determined but because the medical support system is efficient. If that weren't the case, we would have life expectancy of stone-age men, who lived far less than we are living today.

There is never a good time to die, and the emotional trauma cuts real deep across board, however Nigeria’s scenario is made more painful when people depart at their prime; at an age when they are most productive and most useful to society. That happens so frequently that it begs the question of whether policy-makers realize the importance of human capital in their planning process? It makes you feel very dispensable simply because you are a Nigeria living at home. The message this sends also is that if you chose to stay back home, then your life will be worth little or nothing. Ultimately no one is immortal, the powers-that-be in Nigeria are acting really stupid by undermining that vital sector – ones in a while, despite your position in society everyone will succumb to this nuisance called death, in Nigeria not even the air-ambulance can be a life-saver.

How do you for instance achieve Millennium Development Goals (MDG) or become a top-twenty economy if you lack basic medical care that can cater to the most essential element of the productivity value chain – human being. The emotional trauma of death can never be quantified in dollars and cents, but the socio-economic damage suffered by the country at large when an able-bodied and experienced person is lost through an untimely death is simply irreplaceable. This really poses a dangerous threat to economic revival in African communities and indeed a state of emergency confronting Nigeria that calls for immediate action.

Chamberlain is the Founder & President of New Era Capital Corp. and MyCompleteFinance.com, a New York based financial services group. He was previously a Financial Advisor in the Global Private Client Group, of Merrill Lynch.