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Health Excellence : Why I relocated FamilyCare Hospital Yenagoa—-Prof Brisibe

 Prof. Seiyefa Brisibe is a Bayelsa born medical practitioner of no mean repute. Trained outside the shores of Africa, he is a Professor of Family Medicine and consultant, Family Physician, with area of interest in Geriatrics and Wellness. A native of Sabagriea in Kolokuma/Opokuma Local Government Area of the state, Brisibe has worked in various reputable national and international health organizations including UPTH, the United Nations Development Programme (UNDP), office of the MDGs in Abuja and currently lecturing at the Bayelsa state owned Niger Delta University. In this exclusive interview with Niger Delta Herald in Yenagoa, Prof. Brisibe speaks on a number of issues as they pertain to the development of the health sector in Bayelsa state. He also speaks on his passion and love for the well being of Bayelsans and how he was moved by the patriotic spirit of providing better health care for his people to relocate his health facility, the FamilyCare Hospital, from Port Harcourt to Opolo in Yenagoa, the Bayelsa state capital. Excerpts:

 

Ordinarily, some persons would expect that you establish this kind of medical facility  in cities like Abuja, Port Harcourt and Lagos where there are populations and wealthy people high purchasing power. What was on your mind when you brought the hospital home here in Yenagoa, the capital city of Bayelsa State?

Yes, as a person when I had the opportunity to study medicine, initially I wasn’t ready for medicine but somewhere along the line, my father insisted that I study medicine and then as I was in the course of reading medicine, two things came to my mind. I come from a rural area and I saw the difficulties in which people secure orthodox medical care from those rural communities and I had an incidence. In my year-five, I went to my father’s village, and then a lady was bleeding and you know we needed to take this lady for over one and a half hour boat ride to get to the next hospital. Poor me, I was seen as a doctor at that point by everybody in the community. I was called upon and  I couldn’t even set a line for this woman because her vain had collapsed and of course being a medical student and not as the expertise level like a doctor or maybe a senior doctor, I couldn’t . The only thing that came to mind was that, okay, let this woman raise her legs, she was bleeding but I was able to pad her up but she has to raise her legs. They also added a native doctor to the boat, a massager. Anytime he massaged and  toled the woman to bring her legs flat, the woman would faint. So, they realized that the legs being up was important. So, we took her to Bomadi through  Torugbene to Ekeremor and then to Bomadi. The doctor intervened and she became well. From that day I became a local hero because everybody in that boat felt it was my intervention of raising her legs that saved her. So, people started coming. That experience made me to tell myself that when I graduate I am going to open a hospital in my village; one in my father’s place and another in my mother’s place, Sabagriea. That was my intention that once I graduate, I am going to open and do what we call rural medical practice but life, as it were, I later became fisher of men. Why I say so is that instead of going to practice in the rural area I now studied, got a PhD in medicine and then became a university teacher and started training medical doctors. I don’t have the freedom to go and practice in the village any longer. With that, I always had felt that it is better to establish a practice closer home where the challenges of having medical care, accessing quality and well established medical practice is difficult. So, that has always been on my mind. So, when this opportunity came, it also came very funny because this hospital was established in 2004 in Port Harcourt when I was still in the process of studying to have my Fellowship in 2004. It was six bed hospital in  Aboh Road, and by 2006, we moved to Port Johnson where we had an eight  bed hospital. So,  I left for abroad and somebody was managing it with my wife and when I came back I was running it from here, and then I went to Abuja for secondment. I was still shuttling that time not really because somebody was doing it but at a particular day I just felt there was need for me to bring this because  a classmate of mine, who is presently  the Chief Medical Director, Rivers State Medical Board, had this good practice, very descent in GRA. I took my daughter there, and I felt no, instead of me coming to Port Harcourt to establish this type of thing, let me go back home and establish it. That was how it started. First, l drew the plan, bringing partners to be involved and my old classmate from primary school, Dr.  Nikade was now spoken to. I told him, let us do this in partnership; get people from other specialties and let all of us be consulting partners and I become the lead consulting partner. So, it was on that basis  that, that strong desire came about, looking at Bayelsa environment. My daughter, the problem occurred in Port Harcourt but I had always had issues when my children have problems, how do I get the best? l mean somewhere I can go and sit comfortably. I saw that as an opportunity. I just said look! let me come back home and transfer the clinic all over to Bayelsa. lt is a complex scenario and with deep sense of wanting to provide the best for a challenged community that actually  brought this dream to fruition and having it in Bayelsa State. Then outside that, after doing it, it was still mix of ideas. There is no population here; how  many people will come? They don’t have money, it’s a civil servant state, the purchasing power is low, why should I even do this? But just one year, I became more inspired. The reason was that I realize  that from 2004, which was just centred around me, to 2018 that the clinic came to Bayelsa, we had  employed about 56 persons in all in Port Harcourt. Of course, the place was small, and out of this 56 only two were Bayelsans apart from myself. But I came here and then we started the first set of employment. lt was 60 persons and then  to the best of my knowledge, out of this 60  about 48 was Bayelsans. That also became very inspiring for me because I just feel that it is also an opportunity for me to put food on the table of  people that are most challenged. You could have a lot of people in Port Harcourt that are well to do, the level of well to do is stratified and even if you see a trader in Port Harcourt just by the road, and because the purchasing power is there, she is better of a trader that is selling akara or orange here here in Bayelsa. So, that again motivated the fact that yes, it is difficult, the return on investment may not be as fantastic as if it was in Port Harcourt or Abuja. At times, it still comes. Like when maybe your friend tells you look, in my place in Abuja this is what we make, you know as a human being, you will still feel it. But I just feel that it is better here. The return on investment may not be as elaborate as possible, but let it be here. Three years afterwards, we now thought about expanding.  In fact, two years afterwards and then by the third year we are able to expand. Again, patronage has been good, God has been good because from month to month we see increase in numbers; people coming and then the place was becoming a little bit too tight. You will not see that comfort when people  come. So, by the third year, we were able to complete the first phase of the annex and we have moved to that part. So that is basically some of the complex reasoning and decisions that one has to take but in all, it seems that it is something that is meant to be because that seed of wanting to practice in my area came right from medical school, not just today. So, I think that God is just directing until he says okay. This is what I feel.

So, what actually brought about this rapid growth and achievement in three years of coming home? What is the secret behind this?

Well, for me as a human being, I believe that hard work pays and I believe in talking to people. A lot of people will consider me to be a smart person but I know inside of me that I am not smart. What I learn is talking to people, exchanging ideas. I will prefer talking to people and then probably read and exchange ideas. So, the concept was founded in a way that looks it is not just about me. From day one, I felt that look, this should not be about me because one, I do not have the energy to practice the way I used to practice and I have moved towards being a professor, more academic and then being a manager in different spheres. I felt possibly, coming to do day-to-day practice may be difficult. So, it was built with a lot of specialists, and then everybody with different areas of interest. All of us are partners. From start, you have a radiologist, you have an anesthetics, you have people in O&G  and all that. So, the day-to-day prompting, working on the manager, supervising, restlessness, driving people, pushing people, that could also be part of it. But most importantly, the people themselves are having confidence in us. When we came in at the beginning when the Bayelsa Health Insurance Scheme had started, we felt that we were  not going to be part of BHIS because we just felt no, we just want to do it for a class. So, we don’t want people to come and get the place messed up. We don’t want the place to be rowdy, we want quiet serene; you walk into your room and in your consulting room, you will be seeing crowd. But somehow, we felt that BHIS has started, and we also came to realize that at a time if we do not key into BHIS it will be difficult for us to even pay salaries. So, we now got involved in BHIS. Last year, towards the end of the year, we now saw that BHIS gave us a statistics of all the private hospitals in the town or in the state, we were  nowhere. We started from back, but by January, we were now the most sorted private hospital. That is to say we have the highest number of people in BHIS of all the private hospitals in the state. That I can only say that it is the people accepting the brand as something that is worth putting their trust in terms of  confidentiality and all that. Of course, because in medical practice, confidentiality is very important. So, we also use that as a very strong frame work for us to grow. So, I believe that hard work, people believing in us that we are trying to create an enabling environment for people to have quality and quick service delivery are some of the reasons for our growth. We are not yet perfect even now. lt’s far away, it is a work in progress that we believe that we will perfect as we go on. I believe that all these things contributed to this growth, but most importantly, the God factor. Because as doctors, I don’t go to church that much I must tell you; it is difficult these days. I hardly go to church, but that is not to say that I do not understand the fact that in anything, for you to make progress, there is the God factor. I strongly  believe that. At times I sit up or wake up and then say wow! who else would  have done this if not for God? Because you see businesses struggle and then you just put in your hand in something, you are not the first comer and then it will be boom. So, I believe that the God factor is very important. He has been very faithful. That was why for the annex, we didn’t  do any celebration. In the dedication, all we did was not opening of the annex but dedication. We only invited my pastor. I am an Anglican, and then Dr. Nikade invited his pastor from Royal House of Grace and just those two pastors dedicated the place. They started it. When we opened the hospital first, they came to dedicate it, and then this one too. To open the place at that point, but this one is just dedication. So the God factor is very, very important but there is also no other place than working out and getting focused and setting out the institution in a way that even if you are a little bit out, the institution can run  itself. So those are some of the things that I think contributed to this growth.

We also have very special programmes in the hospital. We have a Sarah Fertility Centre, but now we are changing it to moving it to Sarah Fertility and Endoscopic Centre because we want to now begin to do surgeries without putting knives on people, not big incisions. So, through laposcopic surgery, things you can just remove an appendix and then the wound sight will be very small. So Sarah Fertility Centre is now Sarah Fertility/Endoscopic Centre, and we brought in people from South Africa at the start to establish the place; look at the theatre, do it to specification, and luckily, God also provided us with good hands, talking about the fertility specialist. God has been wonderful. Because the average is within 30%-40% or 25%- 35% nationwide but our success rate has stood outstanding from year to year between 50%-60%. There was a year that it was up to 70%. So, that flagship program is also something that I think has given us some success, and then we also have the David Wellness Clinic  in my area of interest. But now we have also changed that, not just David Wellness but David Wellness and Geriatric Clinic. At David Wellness Clinic, we get people to come and we do what is called health risk assessment through questionnaire examination, this questionnaire, we will ask you everything about your life, mother, father and then we will now select some investigation that the person is going to do and after doing that, we will be able to tell the person look with what we have seen you are likely to have this and this. These are the things, that in the next five years you are likely to have this, the next two years you are likely to have this. These are the things that you need to do to prevent you from having this and then living a healthy live. All that is also part of some of the reasons why we were able to do that and that. Although the patronage  has not been very good, not fantastic and that is mainly because of issues of finance. We want to reduce our packages so that people can ordinarily come and annually, for the past three years, we’ve also at the end of the year in a rural community, do what is called free medical outreach and the first one was in Biseni, the second one, Ayamasa and the third one was Okoloba-Sabagriea. By his grace, all things being equal, this year we will go to another community and also give back to the society, especially in rural communities where we don’t have a standard hospital, and these are some of the things that we have been doing and I think that has also contributed to the growth that people are seeing and l think it is too wonderful .But we don’t consider it to be wonderful, we just feel that we need to work a little bit harder. So that not just Bayelsans should come; let people from Ugheli, people from Warri, people from Port Harcourt, people from Abuja be able to come and say look, there is a brand.  Anything from these two flagship sectors that we have should be able to attract people from outside the Sate to come and once we do that, that is when we will now say yes we are truly successful, but for now, we are still work in progress.

Is the diagnostic centre is it also integrated into this packages that you are talking about?

Yes. The diagnostic centre, everything about investigations. We have a very well set up lab, x-ray, ultra sound,  all in-house. But when it comes to things like CT scan we have to do it outside. But again, the next phase that we are going in to, is to now open up our diagnostic lab, scanning, xray, pharmacy to the general public because we consider the source of our drug to be very good. The next phase of development, I think in the next two years we should have it, is that we will have our lab,  drugs, xray, gym, physiotherapy, will now be accessed by everybody in town. If you are not coming to this hospital you can go to the place to do your test, you can go to any other hospital and get treated or you can go there, buy your drugs, any hospital can give you prescription. You go to the place, buy your drugs and get treated. That is the next phase. For now everything is inside.

On the Bayelsa health summit, do you have anything to say about it,  especially on the picture they painted?

Yeah, the Bayelsa health summit, yes I was there personally. I participated all the three days. The picture is not good but it is also a work in progress. Like I told you if you ask people will say this Prof. is this that and that but I am not a smart person. lt is just talking. I believe that when people talk, the talk will  shape our thinking and it is that way that we can begin to think in a good direction. So that has been done with the Bayelsa health summit, but there are some pertinent issues that bother me as a Bayelsan, and as a critical stakeholder in the Bayelsa project. Because if at this point of my life I am not able to understand what happens in Bayelsa, not just in health, but in development generally I do not contribute, which means that I am irresponsible. I will contribute. If you don’t want to listen you don’t listen. Your ideas maybe better, I have never considered my ideas to be perfect but let it be that I am able to say something. I went there, I felt there are very critical issues in the Bayelsa health sector that we need to look at, One is the issue of training of medical students. We have three institutions struggling to train medical students. The University of Africa wants to open a college of health science that will train medical students, nurses, pharmacists. NDU already has it and then we have Bayelsa Medical University. In the real sense, I have worked in the best international organizations in this world, and I know that Bayelsa state does not have the finances to cater for three state owned medical colleges. I felt that there is need for us to sit down and talk to ourselves. Will it be better for us to de-invest in one of two of these and face one? Will it be better for us to de-invest in one and maybe merge all of them? Even in college of health science where I was Dean Faculty of Clinical Sciences for two years, the percentage is that the lecturers there, about 60% is outsiderS, people not from Bayelsa, because we don’t have the critical manpower. I don’t take apologies for that. We don’t even have a structured way of employing, if you employ and know you don’t have manpower you employ people on contract until when you have manpower. Now we need to be strategic about the way we develop manpower, when I was NMA chairman I told my people that we had a course for all the medical doctors. Alamieyeseigha sent some to Russia and all that and they came back. I sat with them and said look, in medicine this is the area of specialization, this is career pathway you chose and we direct. So those type of things I also voiced out and the need because in most cases people say they are lecturing in those places and they are living in Port Harcourt, Owerri, Imo State and when they come and in a short while, they are out. Yes, I could be here and also go to, work in another place but I am here so you can call. So I feel that was one critical issue that I talked about. I also felt that being an health economist, I felt that the issue of health care financing is a need that the state needs to be taken seriously and we need to expand our sources of financing, not just government. We need to think of how we can get very strategic partners to invest in health. These strategic partners should not be that they are investing in HIV or Malaria, they should invest in anything that will be good for human beings.  So, I also mentioned those things. I also talked about certain laws, because as we speak, in the Ministry of Health, if you are not a doctor that has PhD equivalent degree which is the fellowship, you cannot be a Chief Medical Director of the hospital management board, and I felt that no, that is wrong. I am qualified. If I was thinking about myself I will not be thinking that way but I feel a doctor that has been in Ministry of Health working as a civil servant, even if you do not have an extra specialist qualification you should be able to head that because that is all about administration, and the hands that you need are those that have been working in rural areas because most of the hospitals are in rural areas. So, understand the concept of rural medical practice. A  doctor that does not have that additional PhD equivalent degree should also be given the opportunity, and those are legislative things that need to be changed which I also made mention of strongly. I also felt that the CMD tenure of places like Niger Delta University should be changed. It should be eight years, two tenure. Go to the university style, five years you leave, another person comes. These are societal changes that we need to do, because it is only when places are constrictive that you do not enhance ownership and people do not give in their best. I also mentioned that the issue of domesticating the national health bill is very  important and genuine, and a lot of speakers also mentioned that. I felt that that is important. Once that is done, though finances is a difficult problem, I know the next five to ten years finances in this country is going to be very difficult. Anybody that wants to deceive you, leave it, it’s going to be very difficult. So, state governors, at times I can’t even imagine how they will be executing projects because the money that comes  will just go into recurrent expenditures. So, if we have that type of platform that says okay, every year 1% of our GDP or our revenue is  into health, if we have that probably, this bad picture that was painted would not be there because Prof. Ogoina gave a very good situational analysis of what is happening that can only be changed  when you have good financial background. I also made mention of it because luckily, I was one of the few Bayelsans that were requested on personal ground to submit a memorandum. So, I also talked about the emergency medical services. This state does not have emergency medical services. If a woman is bleeding in Korokorosei there is no boat medical ambulance that can bring that woman to Yenagoa in the next one or two hours, and we must have a strong emergency medical services delivery platform. So that if a woman is bleeding in Koluama, the doctor or the midwife or even the traditional ruler there can call the ambulance services and say look, my subject is bleeding, come, and that should be dispatched. It may not be in Yenagoa, it may be in Peremabiri, because in medical emergencies the thing that makes the difference is the time. So, I also presented that. This is because my area of interest is geriatrics which is medicine of care for the elderly. People are becoming older and older and in most cases we forget them. They are a little bit of forgotten group and in my memorandum I stated that look, there is need for us to now think a little bit about that. Anybody above 60 is elderly, and for you to enjoy old age is not just being sick but you should be able to assist yourself, do things yourself. You want to wear your clothes you wear it yourself. You know, a lot of elderly people you see them work, but in terms of being themselves, they can’t, poor frailty has come into the issues. But if we give it a special look, this issue of frailty will begin to reduce. You will see that the number of people that will develop being frail by 70 will be reducing. If we give it more look, more people will get to 80 with strong health. So, I also mentioned that. These were contribution to that effect, and I believed that whoever that is looking at it should be able to look at it passionately and dispassionately so that the little funds we have we can channel them appropriately. Because running three medical universities, three medical schools in a state like Bayelsa is inimical to development generally. So, those were the issues that were discussed. I even painted the context because the set of medical students spent about 14 years in medical school. Because the process of getting a medical school accredited is very rigorous, we cannot let our children to pass through that same process all over again, so those were some of the issues I discussed and I think that the summit gave everybody opportunity to express its or her own view. I also talked about private medical practice, that there is need for government to come into private medical practice, multiple tasking and all that is there, and then the  guideline.  Government should be able to have a department or a unit in ministry of health with primary responsibility to see how private medical practice in the state grows. Because there is no society that achieves a reasonable level of health without the private sector because government hospitals will  not be in every nook and cranny. So, those are some of the things and I am happy that I participated and I am able to put in my voice in these areas.

In your perspective, you just mentioned these three institutions that we have. If we say let us harmonize, which of the institutions will you want the government to really focus on.

Yeah, as a person, initially, my personal opinion was that, we should de-invest with the proposed medical school in University of Africa, and then the Bayelsa State  Medical University and develop college of health sciences in NDU. That was my first thinking. I also access the sensibility of some of these issues. Presently, my position is this; the Bayelsa State Medical University should stand, we will remove and take college of health science in NDU and make it to be part of the Bayelsa State Medical University. Like l told you, 60% is outsiders for Bayelsa State Medical University. I don’t know the number of percentage that will be outsiders. Not only that, honestly, not only that but the fact is that you will be making everybody to work in three places and then nobody will even give in their best in one place. Because many of the consultants that are in FMC are the people that are adjunct lecturers in NDU. So I feel that at this point, let the Bayelsa medical university stand , let the college of health sciences be fused into that. People will argue that it is difficult, that the Medical and Dental Council will not agree, NUC will not agree, but for the purposes of finances of the state, and also for the purposes of strategic  development of medical services and medical health system in the state, we need to give a political will and talk, engage Medical and Dental Council, engage National University Commission which is doable. I know that it’s very doable, so that they will bring Niger delta university college of health sciences, pharmacy, medicine, medical lab, nursing to Bayelsa medical university. In that way, the problems, the suffering that our children suffered during the process of establishing the college of health science in NDU will not happen. If we do not do that, bet me, these students that have been taken in BMU will spend 12- 14 years, so if you do that then it will also have opportunity since NDU was established, I mean the college of health science, which is about 14 years now. We have not been given a quota to graduate more than 50 medical doctors, because the investment into it has been when we have opportunity, we are thinking of University of Africa; when we have opportunity we are thinking of Bayelsa Medical University. If we invest you will be able to have quota, and the investment that is in Bayelsa Medical University, if you bring that, we already have 50, we can expand it to 70  or 120. So, for me, the government should take this very serious. As far as I am concerned, they are the major stakeholders. I am only probably saying this because of my expertise level, and at this my age and God given opportunity, if  I don’t open my mouth and say what I think will help us in the future, that means I am irresponsible . Again, the Bayelsa Medical University, that hospital was built as the Niger Delta University Teaching Hospital. So, the university must be out of that place, even if it is not out of that place the teaching hospital of the university will be headed by a CMD outside the VC or Provost. We must get back to that place and use it as the teaching hospital. The bed occupancy of Niger Delta University as we speak in a year is about 29%. Meanwhile, bed occupancy in FMC is over 100%. This is because distance and transportation is one of the strongest obstacles to access of health. So, it is important that we do it in a way that our teaching hospital is located in a place where somebody from Brass will say, i am coming to Yenagoa, and he has landed, will sake I am coming to Yenagoa, you have landed, somebody from Nembe, I am coming to Yenagoa, you have landed, or  somebody from Koluama, I am coming to yenagoa, you have landed. Not somebody from Koluama coming, I will come to Yenagoa first, and then I will now look for another transport or something  to get to Okolobiri, that is a very serious problem. Yes I am not against it being in Okolobiri but if we must do that , we must strategically think of clear established means of one time transport from most parts connecting to Okolobiri. That hospital you see built by Alamieseigha is rotting away, and it is disservice to the state, it is disservice to our people.

So, its conversion to a university doesn’t make any difference?

No, it should not be converted to a university, it is built as a hospital. It should be a hospital. The university can be beside but that place must be the teaching hospital of the Bayelsa Medical University. If argument comes and says look, it is college of health science, that place should be the university teaching hospital of the college of health sciences. Those are my very strong opinions. They may change tomorrow. But I strongly believe that looking at the financial context and then the strategic health manpower development of the state, that route is the best route. Why? I said we should de-invest that. Another reason is that the Bayelsa Medical University gives  us an opportunity to expand the manpower that we are going to train. Things like autoplast technicians, people that do things when people have fracture, create those mouldings that will keep the leg fit, radiographers, those are opportunities that possibly may come a little bit faster with the university than college of health science. But all that is strong will, if we have invested by now we would be graduating more than 50.

Any other thing to add to what you have just said about the FamilyCare

I am okay, we are just thanking God for his grace and faithfulness.

 

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