How to improve emergency medicine in Nigeria
Recently, the Nigerian Minister for Health, Osagie Enahire, introduced the National Emergency Medical Service and Ambulance System as a new system within Nigerian health care, set to promote emergency medicine. He said the “National Emergency Medical Service and Ambulance System is meant to combat harmful traditional practices and strengthen the decision-making power to seek appropriate health care. This will help reduce the number of deaths caused by the delay in access to healthcare services”. Before now, ambulance services were executed by individual hospitals (public and private) as well as independent organizations and agencies.
Emergency medicine is a branch of medicine that focuses on the diagnosis and treatment of illnesses and injuries that occur unexpectedly. Without emergency medicine, trauma patients would have no means to urgent care. Emergency medicine ensures life-threatening illnesses and injuries are detected much earlier and managed efficiently.
According to Dr. Ehanire, the elimination of delays in access to healthcare will reduce Nigeria’s high mortality rates. Many preventable deaths and lifelong injuries occur randomly every day, particularly among pregnant women, due to lack of an efficient emergency care system. For example, a baseline survey done by Nigeria Health Watch in 2020 in Ebonyi state revealed that 1 in 7 women said that the long distance to health facilities posed great challenges in accessing care, particularly due to underdeveloped road networks in rural communities.
Life is precious and measures to preserve it should be taken seriously. In the last 3 months of 2018, NBS and FRSC reported that 2,608 road crashes occurred in Nigeria, resulting in 1,331 fatalities and 8,437 injuries of varying degrees. The report also declared that a lot of these deaths and serious injuries could have been preventable if there was a good accident and emergency medical system in place.
There are many functional private ambulance services like DASH, Emergency Response Africa, Ambulance Nigeria, and others. The media should promote these services and make good use of various means, like movies, to create awareness about the importance of rescue teams and ambulances in case of an accident.
In order to create an efficient system that suits citizens, their views must be listened to, while misinformation about emergency medicine should be addressed. CPR and first aid courses and training should also be mandated for selected members of organisations in case of an emergency. Every citizen should be educated on the importance of having First Aid at home.
Nigeria is yet to standardize emergency training; re-organization of curricula is needed to train more competent professionals that can deliver efficiently. In 2009, a structured residency program was pioneered in Ghana to meet the country’s emergency medical needs. It is saddening to realize that only this small West African country has been able to achieve this level of training within the West African Sub-region.
Other challenges that need to be addressed in order to improve emergency medicine include a lack of expert paramedics; inadequate skills acquisition and training; a high patient-to-provider ratio; and insufficient administrative support.
Ultimately, the government needs to construct roads to reduce delays in getting to the scene of accidents and health emergencies. The government should also establish more emergency centres to increase coverage and reduce the distance required.
Policies, strategies, and regulations should be put in place so that resources and financial support will be available, including robust monitoring systems to ensure that funds meant for accident and emergency medicine are properly stewarded. Some countries, like the USA, have rules and regulations in place that emergency care should be administered irrespective of patients’ inability to pay. The Nigerian government should also make first aid provisions at the point of care available at no immediate user cost. A review of how countries have built efficient emergency care systems should be done and adapted for the Nigerian context.
Improving emergency medicine will contribute greatly to achieving Universal Health Coverage. A good road network and emergency call centres connected to ambulance services and hospitals will increase access to emergency medicine. If Nigerians can make medical distress calls to call centres and if victims of accidents can be transferred to facilities as fast as possible, a lot of lives would be saved.
1. Ifeanyi Nsofor: Without Health, we have nothing (TedxOguiRoad, 2018). Available at: https://www.youtube.com/watch?v=u4r_0TLTBQw