My Achievements At FMC Jalingo - MD, Dr Aisha

Dr. Aisha Shehu Adamu, is the Medical Director of the Federal Medical Centre Jalingo. Born in 1969, in Potiskum, Yobe state, Aisha attended Federal Government Girls' College Yola and University of Maiduguri where she bagged an MBBS degree with specialization in Gastroenterology. A consultant physician, Dr. Aisha Adamu in this  interview speak on her reforms at the Federal Medical Centre, Jalingo and other related issues. Excerpts:

Your tenure has been so eventful from physical Infrastructure to improved health care delivery system in the hospital. Can you take us through your journey so far?

Yes, like you said it has been very eventful, very exciting, knowledgeable and full of experiences. So when we came in 2020, we looked at the hospital and constituted an assessment team that assessed the hospital in terms of needs. We also formed a formidable management team and proceeded to start work based on the report of the assessment team.

We then came up with a new assessment of the hospital based on departments. And as you know, we are funded by the Federal Government through the yearly budget. So, we imputed our immediate needs into the budget. And we also decided to do an advocacy for more funding because we realized that the budgetary system may not take care of all our needs at the time. So, we engaged in advocacy to various organizations and philanthropists and they also assisted us in terms of infrastructure provision and also the purchase of equipment. Since that time, we have been able to put in place some infrastructure, we have also been able to buy equipment and also through the Federal Government waiver system, we were given permission to employ more staff and also put in place processes and procedures to make sure the workings of the hospital are streamlined and made easier.

We have also for the first time, strengthened the area of monitoring and evaluation.  We monitor people and we evaluate them and use whatever result we obtained to put it back into the system to make sure that we improve the system. 

What is your vision for this institution and how do you intend to sustain the gains so far recorded and improve on same?

My vision is to put in place a standard hospital that will serve the needs of the people of Taraba State and beyond in line with the Federal Government guidelines and also the mandate of the health sector, and that is what we are pursuing. Whoever comes after us, I want to believe will work to maintain the standard and even improve on what we have achieved. We also want to use all the parameters of the components of the hospital to make sure that we achieve this mission of living behind an excellent, working, effective, and affordable hospital for the people of Taraba State, and also the country and the world at large because it's not only citizens of Nigeria that patronize this hospital. So that is our main vision; to live behind a very standard, effective and affordable hospital. 

Apart from being the Medical Director, you are also a woman. How have you been able to manage the home and the office? 

It has not been easy, but God has been faithful. The good thing is that all my children are grown up and are in the universities, so they don't need micro-management. Most of the time they are in school, but of course, they have to come home on holidays. So, I make sure I keep a balance. I give them their attention when it's time to give them attention. I also give the hospital attention when it's time to be given attention. But for the family, I have a lot of support. My husband has been very supportive, I have aunties, and aids who have been helping me to also keep the hope up. So it's not a one-man show, it is a team. I have a whole team of people behind me who are very supportive, working very hard to assist me. You can see it even here. They are all part of the whole process, without them some of the functions may not have been successful and we cannot achieve them. So, it is a whole team of people working to make sure FMC succeeds from the home front to the office. 

You seems to have achieve a lot in terms of advocacy. How have you been able to achieve this?

We started by identifying people and organizations that we feel should be able to help us or have a track record of Corporate Social Responsibility, (CSR) and we visited them. We have visited a lot of people and organizations and sometimes out of 10 places visited, three would respond and then the others would promise, and we keep pushing. We don't relent, we pursue. We use networks and we make sure we persist and God has been faithful, you know. 

Despite achieving a lot in past three years, there seem to be complaints here and there from the public regarding response time especially in emergency situation and unprofessional conducts, how do you react to this and what are you doing to change this perception?

Yes, negative perceptions will come, nobody is 100 percent. Some of these things are bound to happen especially when you introduce drastic changes. Like, what is actually happening, any deviation from the norm will always bring about complaints. Some of their complaints are valid in the sense there is a new system; and people including staff are not yet used to. Let me give you an example, we introduced the electronic medical record system, and that entails a lot of learning for both the operators and the patients. People are not used to having to come get imputed, and then they have to wait for some factors maybe network issues, all those little challenges we face with electronic management system may cause some delay. If they are not properly informed, and they are not properly communicated, they may complain but their complaint may not be because of the fault of the health worker or because of negligence, it may be a systemic problem that they need to correct. 

We are already working on this, it was worse than what is now, and it has been improving gradually. Just like a baby; you don't start walking immediately you are born. You have to learn how to sit, then start crawling, you stand you stagger, and then you straighten up. So, we are all going to the stages, and I want to assure the public that we are all working towards making sure that everything is perfect. We can't get it all at once. It's a process. So, we need to also improve our communication technique in terms of informing them, talking to them and alienating their fears. That is why we are strengthening services and strengthening a lot of other units so that they can take care of that. 

But of course, human factors will be there. We are looking at the system, anyone we identify sabotaging the system will be dealt with and disciplinary measures will be taken. So, we have been looking at these issues on their merit or on case by case basis. If there are issues, we sanction the officers concerned. If there are issues that requires us to educate the people we usually do and that is how we have been managing the system and trying to get the best out for our patients. Gradually, these issues will be sorted out and things will be fine. Let the people exercise some patience with us. Efforts are also on to educate and enlighten the public on the processes involved in the hospital.

The issue of brain drain in the system is a national issue, however some institutions have come up with home grown solutions to manage it, how you been able to tackle it here? 

I understand your point of reference. However with the brain drain, the government is trying and we are also trying locally. You know we have a window of non-regular staff we have been using. I am sure you have been hearing about Locum staff. Yeah, they are not actually permanent staff so that is what we have been using to block the gap until such a time when we get waivers for permanent employment. 

The Federal Government rules and regulations are that, as a permanent staff of the government, you have to work for the government. In case there is any reason for you to go on leave, there are conditions attached to that leave. If you go on leave without pay, you cannot go indefinitely, because you are not there and you are blocking someone's position.

There are number of years, either two years or then maybe you apply again for another two years maximum and they are criteria you have to fulfill before you leave. If you just feel that you can just one day, wake up and feel you want to go to UAE and you just move, that's a problem. Because you have not done the necessary write up, you have not been given the necessary approvals. So you have to go through the process. And if you are bonded, what we mean by bonded is, if the hospital has sponsored you, you have to spend some number of years. You were the one who signed those bonds, nobody forced you. If they say, spend 15 years, you have to spend 15 years before you go. Otherwise, you will pay them the money they spent on you, including your salary. So, that is the issue.  There is no two ways about it, the rule applies to anybody. Some people that left, they went through the whole process. It was seamless and they are still there until such a time when their time expires, then they also have to come back. We have to do something about it. You see, this is a Federal Civil Service and there are rules are regulations attached to it and we are here to make sure that these rules are regulations are abided by. 

 Medical Director Dr Aisha Shehu Adamu inspecting the ongoing new Accident and Emergency(A&E) and Intensive Care Unit( ICU) complex in 2023.

What are the challenges and how are you tackling them?

We had loads of challenges, some internal some external. And then some modifiable, others non modifiable. So, we can handle some and we cannot handle some. 

The main challenge for us like most institutions in Nigeria is funding. Funding is what cuts across everything. If you have funds you can build more offices, you can get more infrastructure, you can make sure water is flowing, you can make sure the roads are good, you can make sure that electricity is all over, but because of lack of funds we have challenges with all these things I have mentioned.  And then the processes of employment is very long and cumbersome. Someone can decide to just leave today, without processes and everything will disappear, but you cannot employ just like that. You have to go through a long process. The process of replacing exited staff is quite long and cumbersome and it leaves gaps. Gaps in the healthcare system can be very distracting because a work that is supposed to be done by four people will only overburden industry if one person leaves. People are already overburdened so there will be tendency for them to burn out easily with all associated inefficiencies and so on. 

So these are the challenges and then, of course, staff internal problems. Processes and procedures are not being followed, staff attitude may be negative, some maybe genuine because of overwork. Some people are just naturally recalcitrant. That is a very big problem, but we are working on that. We are making sure that people abide by rules and regulations and anything out of that will be dealt with. So, these are basically the challenges.

Another challenge is payment of outsourced staff. You know we outsource companies for the cleaners, security, and laundry and so on.  Sometimes we have delay in their pay and you know when you don't pay them on time, it translates to lack of efficiency in what they do. They are not motivated and so many things can happen if you imagine your security not being paid. So it's a very big issue, delay in releases of funds for all those things. And so many others challenges that we are trying to make sure that we overcome.

With these challenges, what can you outline as your prospects and how are you making use of technology to address some of these challenges?

We want to leverage on technology to make sure that we increase efficiency. Like I told you the electronic medical record is one of them and we are bringing on board the file management system where everything will be done electronically. And also, we also want to use technology to improve healthcare provision. In terms of diagnosis and treatment, and also even surveillance. So there are so many ways we can use technology. Even though this may translate to needing less humans, but of course, it will increase efficiency and patient satisfaction. For now, we are interested in bringing in technology and human experts at the same time. What it also means is that role will now change. So they have to be trained now on their new rules. So, the prospects are there for expansion of medical care, strengthening medical care and also the prospects of human development capacity development to handle the new era of doing business. So, there are so many prospects. Yes, the fear is there, that technology may take over the workforce, but no, we can actually divert attention and train them to work together by repositioning technology. 

There are a few women in such managerial roles in the country, what will be your advocacy for having women like you in such sensitive offices?

To women out there, they should just prepare, train themselves, and do what needs to be done. Just make sure that when the opportunity comes, you are ready. I don't think there is much difference between the boy child and the girl child in terms of early education and so on. The difficulty comes with managerial positions like this. I have to tell you that it is not easy for women, but you have to forge ahead, do the work, get prepared like I said, so that immediately the opportunity comes you also compete and I am sure our male folks will give us the room for the affirmative action, the federal character principle and we will also give us an opportunity to serve because women all over are doing very well.

There are complaints from National Health Insurance Scheme subscribers about receiving less value for their money in FMC. How do you react to this?

Yes, I am aware of the complaint. If the National Health Insurance Scheme says we should buy a drug worth N500 naira and give their subscribers that is what we will do. You know there is something about generic and branded drugs. NHIS use scientific names, they don't use brands. Maybe if a generic drug is N500, branded is N2000. It is economic sense, they will not pay that N2000 but N500. So, you have to give the drug that is commercially equal with the money paid. So it's not peculiar to FMC Jalingo, it is a NHIS principle. If you want that N2000 drug, you just have to simply fill up the N1, 500. So this question should be directed at NHIS, not FMC.

What is your appeal to the government regarding the challenges you highlighted?

What I want to say is just an appeal to government to increase funding, and supportive care. To the federal government, the state government, please give us more support, we are working in Jalingo and we are willing to collaborate and work with you in terms of the general health care system of the state and we expect more support from the state government. We also want to work with Local Government and the community. We are here for them primarily. That is why we are here. They should try as much as possible to understand our processes.  Ignorance, they say is not an excuse. We try to educate and create awareness for them on how we operate our services and how they can benefit from our services. 

I also will also want to appeal to well-meaning Nigerians that have the means, they can come and collaborate with us so that we can help our patients.  We cannot do it alone. The Federal Government cannot do it alone. All of us have to put our hands together so that we can work together and come up with a standard healthcare system for our people, our state, so that we don't need to travel long distances to assess care. If someone has to go to Gombe, imagine the number of people that need to travel with the person and some of them will go there and stay in conditions that are not actually favorable and end up with so many disadvantages. So, all of us are in this business of prospering FMC together, let us put our hands together and make sure we do. 

To the staff, you have sworn an oath to work for humanity. You have sworn allegiance to confidentiality. So please, I want to urge you to abide by those. There is no two ways about it, you are here to help the patient and the patient comes first, every other thing is secondary and we as a management team here, we are willing to take the drivers' seat and move this hospital to the next level. 

You talked about areas of intervention, what are those low hanging fruits that you will want intervention immediately?

You know we have a budgetary system. We have a strategic plan. The immediate needs we want to include in the budget going forward is the cancer center, the geriatric center and the psychiatric complex. These are areas that we are lacking currently here and we need quick intervention like you said these are our "low-hanging fruits." We want to make sure it these projects are in the budget for next year. On the whole, there are so many things which I cannot mention one by one, but like I said we need intervention.