General

Surviving the difficult times.

Press release by The Association of Private Medical Practitioners of Nigeria.

Dear Colleagues,

PREAMBLE:

Two days ago, the National Ifficers’ Committee(NOC ),met virtually to review the state of the nation as it affects the health of Nigerians and as it affects us and our practices. We were unanimous in agreeing that the Covid-19 pandemic threat was huge and still growing and we were unanimous in agreeing to adopt a protocol that will enable us support the health of Nigerians the best ways we can, under the present circumstances. We are to take appropriate measures to protect ourselves, our personnel and our facilities while sustaining our voice in demanding a fair treatment from our government.

It is worrisome and difficult to comprehend how everybody agrees that the private health sector is the predominant player and partner in our healthcare delivery system but nobody up there seems to be willing to accept their significance and relevance. We seem to have become the sacrificial lambs and prophets not known in their own land.
Because we know it is true, we shall neither relent nor slumber in our call for the integration and inclusion of private doctors into the scheme of things in developing our healthcare system as leaders and stakeholders. This advocacy will not slow or diminish until justice is done.

THE GROWING PANDEMIC AND OUR GATHERING FEARS:
The devastation of the pandemic across the world is growing in leaps and bounds. The Nigerian experience is looming large by the day. In other parts of the world, isolation centres are being built to support the existing infrastructure most of which are private hospitals. Back home, despite having the widest spread in facilities and the highest access in care, our private practitioners are being treated as though they are a mere distraction in the struggle against Covid-19. They are being told to have a high index of suspicion and refer the patients. This is happening in this era of patient centred care and patient bill of rights.

The people in authority forget that patients do not always present with classical symptoms and so may not be immediately diagnosed until their treatment is underway. And when such patients eventually turn out to be Covid-19 patient, the hospital will be deemed to have been treating a Covid-19 patient, there is a heavy threat hanging on the head of such a facility and the private doctor(s). They include the closure of the hospital and or takeover of same by the government. Such doctors are perceived as a people whose offence amounts to sacrilege for innocently doing their legitimate job but encounter a clearly natural situation. This we view as improper, unfair and unacceptable.

Doctors do not know their patient’s condition until they arrive the hospital. This is the case whether it is a private or public hospital and several hospitals have today, registered contacts and isolations. Why the mayhem on the private hospitals and not the public ones?

Most private hospitals may not have the infrastructure to manage Covid-19 patients and we are advising all members who do not have what it takes not to take in suspected or diagnosed Covid-19 patients. But in the event of the possibility of having a regular patient whose symptoms progress to culminate in Covid-19, the doctor and his facility should be treated with understanding and empathy not impunity. The process of decontamination of such a facility or section(s) of the facility should be treated with dispatch and not necessarily shut down the hospital. We cannot predict the events of diseases processes but we can afford to be efficient and effective in responding to their outcomes in the overall interest of the society. We deserve to be protected and encouraged not vilified.

We have continued to clamour for integration and empowerment to be able to play the unavoidable role that is our due in our peculiar healthcare system today but government has not come to terms with the reality of this necessity. We must therefore take appropriate measures to safely offer our best to Nigerians in the face of the threats.

NAVIGATING THE STORM:

  1. Develop your internal protocol for screening and managing patients for the ultimate safety of your personnel, or adapt the attached.
  2. The facemask and goggles are the most important PPE for Covid-19. Let us endeavour to ensure that front line workers have these at all times.
  3. Obtain and display the local NCDC telephone numbers at strategic points in the hospital.
  4. Have a high index of suspicion and apply maximum barrier management in referring suspected patients to the appropriate isolation/treatment centre.
  5. Government should carry out their regular facility audit of private facilities and accredit those that are eligible to manage Covid-19 patients. Functional state Ministries of health should readily know their hospitals and recommend them or partner with them to restructure for recommendation rather than asking them to apply.
  6. Do not treat known or highly suspected Covid-19 patients if not accredited. Refer, but in referring, be safety conscious, be protected.
  7. Where applicable, produce reusable, customized faced masks, aprons, caps for your hospital.
  8. Raise Covid-19 awareness level amongst your personnel by in-house trainings and lectures in the absence of essential government support.
  9. Set up a triage tent outside your hospital reception to aid patient sifting and sorting and reduce the chances of admitting obvious Covid-19 patients into the hospital pool.
  10. Where possible, set up another tent for observation where the patient highly suspicious of Covid-19 can be observed by appropriately protected healthcare workers awaiting transfer to appropriate isolation centre.
  11. Decontaminate accessible surfaces: Door handles, chair arms, bed railings, tables, stair case railings, etc. frequently as part of the new cleaning protocols in the hospital.
  12. Minimize hospitalization to only those that must have it.
  13. Postpone surgeries that can wait.
  14. Encourage virtual consultations especially follow up reviews.
  15. Make defensive care a tradition all through this season and always.
  16. Place a NOT A COVID-19 CENTRE signpost at your gate to alert the general public and government accordingly.
  17. Suspect every person and every patient.
  18. Prepare for the worst, expect the best.
  19. Renegotiate your tariff with the HMOs including virtual consultation fees.
  20. Communicate your experience and views to Agpmpn NOC.

CONCLUSION:
The times are truly difficult and how far away we are from the end, we will never be able to tell. We must embrace the change and adapt to the forces of change having the lives of the patients we are bound by the Hippocratic oath to care for in mind at all times but giving our own lives or the lives of our workers the attention they deserve too.

Yours in the struggle,

Amb. Dr. Ugwu Iyke Odo, MD
MB,BS, PGD-FM, MBA, MSC, DMP.
President

Dr. Ned Okoro,MD,FAGP
Secretary General

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