Monday, January 26, 2015

Dr. Nick Ngwanyam Picks Holes in Cameroon’s Health Sector; Suggests Remedies

 Courtesy CRTV Morning Safari Yaounde
Dr. Nick Ngwanyam
In a bit to go through the emergency plan that the Head of State announced and instructed us to do; today, we will be looking at the health sector.
The other day I was watching the news on TV, and I heard the director of the Yaoundé Central Hospital asking us to come and carry our dead bodies that have been there for months. The hospital does not have space and I think that is one of the problems. Such an announcement communicates gaps in the health sector. The health system would be one of the issues; we would be talking about in a little while.
This morning Willy Sani greeted the patients, Olivier greeted the nurses and we will greet the doctors, in fact everybody who is working in the health sector of Cameroon. One of the problems we have in that sector is the shortage of human resources. This morning, we shall be looking at how we can improve on the health sector to meet up with the development demands that the head of state is making; because we cannot talk about development without having healthy people around. For us to have healthy people around, we need to have the infrastructure, we need to have the resources that have to take care of the part or that sector of our development. Many things have been said as far as what is to be done.  I hear there is going to be a reference hospital in every region and we are finding out whether it is an emergency to have those hospitals all around the place.
Joining us to discuss this is a medical practitioner. He is not just a medical doctor. He is a trainer of health personnel, Dr. Nick Ngwanyam.
 I said you are not just a medical doctor; first of all tell us about your days as a student. That is, how you got to be a doctor.
Thank you very much. First of all I do not know whether if we start from there we would not get lost?

No, we will not since training is part of the issue here.

Let us start by saying that I am from Donga Mantung and my village is Ntundip. I was born in Nkambe and I must say that I come from a very poor family and I was just lucky to become a medical doctor. What I have to say again is; when I look at this day; it is very difficult to see medical doctors coming from poor families. So something is wrong.

How did you do it?

Let us say that in our days, there was more social justice, than we have today. Therefore, when you came out from a poor family as a medical doctor, you had an opportunity to become a medical doctor because nature was with you. Then you never became oblivious of the fact that you have to work in that light. You have to be part of that nature to make sure that there is an opportunity for everyone not just for those who can pay for it. Therefore, when you become a medical doctor because circumstances made you to become one, then you are very conscious of the fact that you are who you are because there is a force that is with you that protects you and watches over you and you  take nothing for granted. That is the background.

You went to a school in Yaoundé?

Yes, let us start off by saying that I went to primary school in Nkambe and we used to trek through the bushes, dew, the gravel paths with no shoes and very cold and so on. It was really tough. That was in PSS Nkambe. I am talking about 1970 and from the whole primary school, we were just two of us that went to secondary school and the other guy dropped away after form five.

So you can imagine all the children from primary school, I am the only one who goes through secondary school so to speak. I ended up in CPC Bali. I start in JMBC Ndu though I ended up in CPC Bali.  What I know is that in 1975, my mother was very sick and we were living in Bali at that time and my father was in the UK. She was admitted at the Regional Hospital in Bamenda and I used to trek from Bali to Bamenda to go see her and be with her. She was sick for about four months.

I remember this German doctor, a surgeon who was very caring. I took particular interest in the nurses those days because they were very clean and neat and they knew what they were doing. There was love about everything. Even before that time, I used to see the nurses and there was something about the nurses and the doctors. I remember one doctor Ngassa in Nkambe, he used to drive in a Land Rover up and down. So there was something beautiful about this core and I was attracted to it. I was just lucky that when it came to writing the competitive exams into CUSS in those days-I am talking of 1977, I was one of the lucky few to go in. We were probably around fifty or sixty of us and I think there might have been about 2000 or more competing and we made it. That is it.

The picture you paint about the hospital then is something to envy; the environment, the personnel and so on which might not be the same thing today.

There are a lot of things that I observed and I might have been infatuated at the time and probably could not see the facts as they were.  But what I know is that the human factor was contributory and it was different, it was positive and it was worth living for.  Today, we could have the best structures but we have poor human relationships. There is something awful about us and we have to talk about it. If you want to see the difference, if you go to mission hospitals, they still have that human touch and in government hospitals, customer service is very poor. I would rate it at 15%.

What would you say accounts for that kind of dichotomy, civil servant mentality or training?  

Before we get lost into the roots, may I just brush over how I see our medical services and where the weaknesses are and how we need to strengthen that?
For those of you listening to me, when you want to analyze anything and understand it, it does not matter the subject. We are talking medicine now, analyze it anyway you want. Let’s use the SWOT analyses.  S.W.O.T. means you look at your Strength, Weaknesses, Opportunities and your Threats. Try to understand that and be open-minded when you analyze anything. Compare yourself with others around. So if we were to compare our medical services with the American Medical Services which we shall use as the standard.

Medicine is medicine. You will realize that we are not up to standard. So we are called upon to standardize. That means we have to grow up because medicine is medicine. If you have a hernia Mr. Chifu and we have to operate you, we are not going to try to operate you the Cameroonian way or the Ntundip way. The way you are operated in a hospital in Ndu should be the same way you are operated in a hospital in New York. That is the standard.
So if you look at that you would begin to understand that we are not doing things properly. Why? Because of infrastructure, logistics and above all because of the human factor.   So the human factor is very strong. When the president talks of building reference hospitals in all the ten regions, even if he builds hospitals in every village and the human factor is not corrected, he does that in vain.

When we talk of the human factor, we are looking at technological know-how. Do you really know what you are doing? Do you have an analytical mind? Do you have a mind that solves problems or are you just a copy and paste kind of person. You know the way we train children these days, they just read the notes and then vomit them out and they pass. That is not it. Do you have the capacity to solve problems? Do you have a human touch? Do you have a feeling for people?

All these things you ask in the form of rhetorical questions, are you saying these are the problems?

We have huge problems in this country. What I want to say is that even if you build a general hospital in every village, watch my lips, the delivery of medical services would not increase by 10% because of the human factor. Therefore, while we are building the hospitals, let us correct some few things. Let us sincerely and honestly work on the human factor. If we do not do that, we would always be getting it wrong.

Dr. from observation, you are actually focusing on the human factor. We realize that a medical practitioner in a government facility and still works in the private facility have different attitudes in the two environments.

That is the problem. You cannot have a medical doctor with two minds. That means you are a liar. You behave differently under different circumstances. You are rude in a government hospital and when you are in a private hospital you are nice. You cannot be like that. You cannot be hot and cold at the same time. You just have to be you. So we have to look for people who are just themselves and know what they are doing.

How do we get them? How do we bring them about? How were you brought about?

That is the problem. I am the product of a different system. I am a product of Professor Victor Anoma Ngu, Professor Nasah; I am a product of a different mindset altogether. Let me just step back again in time and explain something to you. After my training in Yaoundé as a medical doctor, I went and trained again in Nairobi as a general surgeon on a WHO scholarship given to me by Professor Anoma Ngu. Then I continued to London where I trained as a urologist. I came back and worked for sometime in Bertoua then I went to BBH to work.

After spending all those years in the university and going around the world, it is in BBH that I discovered a few truths about medicine. One blessed day, 10 AM, I go down to the doctor’s office for coffee and I look on the shelf, I discover this text book of medicine. I think it was green in color, I cannot remember, Cecil’s Textbook of Medicine. I grab it, put it on the table and open to the first page; first chapter and I read it. That changed my life in medicine. That is what we need to do in Cameroon.

Question number one; who is a physician?  Physician means doctor, who is a doctor? Question number two; who is a patient? Question number three, when a patient comes to see a doctor; what is he or she looking for? When I read those, nobody had taught me for how many years I was in the university and nobody mentioned that anywhere. But it opened up my eyes to understand that the patient who comes to see you is really hurting. He is really hurting so much and we go over it.  One of the weaknesses that we have in the medical training in Cameroon is that number one; we do not teach psychology and psychiatry. Psychology and psychiatry is one of the areas in which we are very weak. You cannot practice as medical doctor in the US if you do not  have good knowledge of psychiatry and psychology. You must understand the human person and how the mind works.

Another weakness in our system is, we do not know how to manipulate drugs (therapeutics). We are very weak at clinical pharmacology; we are very weak at anatomy and physiology, we are very weak in a couple of things. When you are talking to a doctor, he is prescribing when he did not understand what he is writing. You end up with a list of eight drugs and that is not it. You are besides the point. A patient is looking, number one, for a doctor who would listen to him. Just listen to the man talk and try to be with him and know how he feels. When you can do that; that is having that empathy. Listening would help him.

In that book that I read, Cecil’s Textbook of Medicine, it says that 70% of people who come to the hospital have nothing wrong with them. They have something wrong with their minds. They are just worried. They are stressed. If you could just listen to them, you would be able to understand what is wrong with them and you correct it. But if you do not, you would not and you would be beside the point. That is why patients keep moving from one doctor to another. Because our systems do not train doctors who listen and understand, patients end up with native doctors, “canda” sticks and so on. They get treated in Amour Mezam buses and so on. That is the problem we have in Cameroon.

Do you think that training or upgrading the training of the students of   the University of Yaoundé I is the main problem?  I did not hear about the other institutions.  

It is not about Yaoundé University I. It is about training as a whole in the country

In the three year emergency plan, the President emphasized on Yaoundé University I.

Probably if he talked of Yaoundé University I, then he was not broad enough. Let me step back again and explain one thing. If you take all the hospital staff in any hospital, you can divide them into three groups. You have the doctors (pharmacist, gynecologist, generalists and all other specialists) put together, and then you have the paramedical, that is the technicians which includes nurses, dental therapists and all other technicians. There are about seven groups of technicians but we know only of the nurses and laboratory technicians. Then we have the other group, what you call the support staff. We are talking of secretaries, communication staff in the hospital, the people who are responsible for hygiene. So we have these three groups.

80% of all people who work in any hospital structure are nurses. So you begin to understand that if your nurses are poorly your health service can never work. That is the first thing we ought to realize and put in what it takes to train the nurses and other technicians properly. If you have a general hospital and put a specialist doctor in every room, that hospital will not work because it is about team work. It is team work and we have to teach people what team work is all about.

 It is not about the medical doctor breathing down the necks of other people because he is a doctor. That is a wrong attitude. When you come into a civilized place, the doctor and the nurses are talking and conversing. The issue is trying to solve a problem. What do we do on this patient so that he can get up on his feet? It is not about you showing that you are the boss. We have this boss mentality. I think it is borrowed out of medicine because when you go out there, the SDO is breathing on everybody’s neck, the chief of service is breathing. You know we have   this “commandement” thinking and the doctors are now doing this “commandement” thing in hospitals.

One wrong thing that we are doing in this country is to pick people; put them in ENAM; train them for two years and put them in hospitals to boss doctors. It is a wrong thing. When you do that, you kill initiative in the hospital because the gentleman comes and begins to boss people when he does not even know how to write his name. There is a problem there and we have to be very careful. In America, my son is being trained as a medical doctor in Boston University. Schools that train medical doctors there do not do this kind of thing we are doing in Cameroon. You do not just train a medical doctor.
You go to school and become a medical doctor and in the course of learning how to become a medical doctor, you also take an MBA. That is management, so that you know how to manage personnel, finances and you know how to run a business. So every doctor has that in mind. So if you are not doing an MD associated with MBA, you are doing an MD associated with public health. It makes you a better person. Imagine all doctors working in a hospital having an MD and an MBA. They can easily manage themselves.

If we had them train like that then, for take the Cameroonian civil service, we could tell them  this is how you draft letters and so on. You could take these groups of technicians to ENAM for three months or so to show them how the Cameroonian civil service runs. I think that is the way we should go. All engineers are trained like that too. That is you do engineering and an MBA. So an MBA these days is considered more like knowing how to use a computer, knowing how to speak English and French. It is a cut- across kind of thing. You do not have to have some people who are just managers who do not understand the issues. We are functioning in boxes. We do not think out of the box and that is why nothing is working. Might be I talk too much.   

It sounds very idealistic and Dr., one would like to know whether you do that in your school.

Yes of course you know that I am not boasting. You know that my school is one of the best in the country. When you see an institution, when you see what ever, it is a reflection of it director. When you see CRTV, it is a reflection of your director. Every institution is a reflection of the person who runs it and has the vision. I come from very far; you know I went to CPC Bali, what I have gathered over the years, I have been to Nairobi, London and travelled the world over. I know how it is done and therefore, I try to bring these things to bear on the children so that they are different. The vision of St Louis is not just about training. It is about training the staff of today and tomorrow. I try to put a little bit of myself in the 1300 students we have so that as they go out into the health sector, they will become those elements of change in our hospital system. They would be the yeast that would raise the dough.

Amongst the problems with the health sector, you have talked about infrastructure, the problem of training; training not just in the numbers, but in the quality or the attitude and the course content. You have questioned the content of our programs in the medical schools in Cameroon which means we do not just have the problem of infrastructure to solve.  Do we have the right number of people who train and the training facilities in Cameroon? Do you see us meeting with the quality of people we want?

No, not at all. We are sub standard. You know, our infrastructure as of now, if you are trying to target to international standards, I will not put it pass 25%. Our numbers, you will not put it pass 25%. I was surprised the other day. There was a doctor who came from one hospital in Italy, and he is a radiologist. He was having a chat with my wife and he mentioned that in the hospital where they are in Italy, there are thirty of them radiologists in one hospital. That is thirty specialist radiologists in one hospital. He goes to work at 7am and can only come back at 9pm. I am talking about one hospital in Italy and I am talking about one sub specialty- radiology and there are thirty of them there. Use that and you begin to understand. It is up till .., within the past two, three years that Dr. Lah was sent to the Regional Hospital in Bamenda otherwise all this while, we never had a radiologist in all of the North West. Dr. Ndam who is the only radiologist working  privately in his clinic in Bafoussam used to cater for the North West and West Regions.

Let us talk about the distribution of health facilities across the country. When you look at the health infrastructure map in the country, do you see that the distribution is what it should be? Are you in favor of this system of concentrating health infrastructure in big cities?

It is not about me. It is the way things work.

How do you appreciate that?

It is part of economics. First you have to make sure that the whole national territory is covered with  infrastructure and this infrastructure is graded. That is why you would have a sub divisional hospital, a divisional hospital and a regional hospital. It does not make sense to take a general hospital and put it in Ndu. That is, a general hospital in the real sense of it. When you talk of a general hospital, it goes with all sort of sub specialties, machines and so on. What has been failing is the fact that our referral system is poor.

When you just graduate as a medical doctor; when you just finish seven or eight years as a medical doctor, you barely have just started learning what medicine is. But you see, these young people who have finished medicine; they will never ask you a question to try to know more. They think they know it all and that is where they get it wrong. When you come to a hospital; take our general hospital; it does not function the way it was planned to function.

Might be the people who are there do not even know it. It’s supposed to work as a team. If you go to the general hospital, you would have the department of surgery, radiology, pediatrics, obstetrics and all these departments. In all these departments, you would have two, three professors at the top but with one senior professor, and all other doctors fall under them. So it is a team, a pyramidal kind of thing and there is a lot of respect. When you go to the hospital, you do not see epaulets as you see in the military, but technically, everybody knows where he or she belongs.

Here we have created a situation where people no longer respect hierarchy and each other and we have put in place some other mechanism which we think works but we work “a la camerounaise.” You can be a junior and you are appointed to be the boss. Because you are appointed to be the boss does not mean you are smart enough. Being smart is one thing and being appointed is just another. There are problems there and so when a patient comes from the region, and is sent into a general hospital, the patient is supposed to be managed by that team. But the unfortunate thing is that when a patient comes in, he is managed by an individual. So we have a general hospital on the outside and on paper, but when it comes to how they function, they function as small district hospitals put together.

Dr. There is the issue of remuneration and we see that there is a lot of brain drain. The whole health service is not well catered for. We are told that we are going to have ten more reference hospitals. Where would they find the people?

You see we agreed on one thing that we have to come back to the human factor and so on. I am glad we all agreed on that. The question is why are those in the health sector not delivering the goods? Where are the weaknesses coming from? You have identified “affair Nkap affair tres serieux.  So if you do not pay the staff and pay them well, they will not work for you. That is the first thing.
Number two, you have to give them respect. Sometimes it is not just the money that counts. Let’s take for instance that in Cameroon, we are paying doctors for 150,000FCFA because there is no money.  If everybody else, like the army general are earning 150,000FCFA good and fine. But you cannot put a medical doctor on 150,000frs and put a police commissioner, I do not know much. 400,000 or 500,000 FCFA. I do not know how much they earn; but they do not earn the same.

The magistrate earns so much; people who have gone to ENAM earn so much. Their salaries as they are might not be much but they have sources where they tap on some incentives and they know how to do it. Check on all the mansions in town and find out who is building them and the big cars and see who is riding them.  With things like these, you begin to push your technicians to the wall. It is not even just in medicine. Up until now technicians were not respected in Cameroon. They could be engineers, architects or whatever. If you are in the army, you went into ENAM and you are of the “commandement” and can dish out orders, then you are respected. But if you know how to solve problems then you are not respected.

(A caller on the line, Good old Patrick) Good morning Dr. Happy New Year. I understand what Dr is talking about very well. When I was a glaucoma eye patient in London in a hospital, I knew the entire glaucoma specialists because as he says it is a team. It goes and goes to one another and they compare their notes. Now Dr. we are going to have ten reference hospitals. Would you go for that or would you go for the improvement of existing ones.  That is my first question. Yesterday the issue was on asking questions, the doctors today either they do not have the time, over worked or are thinking something else, patients do not ask them questions. I do not know how you do with your patients. Do you entice them to ask you questions? Thirdly Rwanda that just recovered from war has a health insurance that covers 90% of the population. How do you think we can do that here?

Let’s put it this way. If we were building our health infrastructure the way we were supposed to, we will not be in a haste now to build ten at once. Even where we are now there is a shortage and we are trying to catch up. As I said a general hospital is not just the buildings. This is what we can do. We can build all the hospitals in the divisional headquarters to have the structure and equipment of a general hospital. That would be wonderful. That means the physical structures are receptive and have all the equipments. That means in every divisional hospital we can have an ultra sound machine, we can have machines to test people and know what we are dealing with. Then if we cannot manage, then we begin sending the patients up the ladder. The human factor is still very much a problem. I think it is of recent that the Bamenda General hospital has two or three gynecologists. Until now they had only one. So you can see that lack.

Are they over worked?

No it is not about being over worked. It is poor training and I said they do not listen. The doctor patient ratio is still very poor. When we are talking ratio, do not look at Cameroon, do not look at Central Arica. Look at America, look at developed nations. We have a long way to go. Remember we have eight millennium development goals and four of them are on health. We have a huge problem in Cameroon.  As I speak to you, I Google searched health services in Cameroon and I Google searched health services in Gabon. Gabon has a pass mark and we have a failed mark. Check on your internet. I am not the one saying it.

So there is this problem of the human factor and training which I will keep coming to. If we say that training is an issue, then let us go back into the roots. How do we select our candidates for training? When I was in Nairobi, this is what I observed. In Kenya, there is no competitive examination into any school.  After the GCE all the students are ranked. You do not need a minister to decide, you need a clerk who can read. He counts the first thirty and draws a line. Those first thirty go in and train as pharmacists. He draws the line under the next one hundred and fifty; they go in to train as doctors.  Then he keeps doing that and all the students are distributed into all the departments, faculties and so on in the whole country. So the children of the pauper would be in there. So it is about capacity, it is about quality. When children want to be medical doctors, they start working for that from secondary school. The way we are doing it now, I wish we were even doing the regional balance.

(A Caller on the line, Fosso the Prince) I want to greet Dr. Nick Ngwanyam. I am very happy the way he speaks. If we have people like him, two or three in Cameroon the situation especially in the health field would change. Tabe you know I am a trainer at the training school for midwives in Bamenda. I happened to have taken part time also with St Louis. Dr. I have this worry and also a question.  Why is it that we know that standards are falling, nurses are poorly dressed not neat yet today there are schools just everywhere and you move around town seeing people flying out white shirts in the name of training as nurses or medical doctors. The Ministry of Higher Education creates training schools and the ministry of Public Health creates others. At the end you do not know what. You come to a school you see a poorly dressed child in the name of a student and you do not know the prescribed uniform. Is it not supposed to be according to the training?

Yesterday before I came down to Yaoundé, just as I was about entering St Louis, I saw one student who was wearing a white jacket and he was looking like a butcher. I thought this was one of my students who has gone wild. I stopped the car and I called him and asked, who are you? Of course he did not have our insignia on him, but he told me that he was a student training as a medical doctor from the University of Bamenda. So I drove off.
You are insinuating that students who are trained in schools authorized by the Ministry of Public Health are properly dressed, that is false. There is a problem between the ministry of Higher Education and the Ministry of Public Health as we speak in relation to training. It is an ego problem. The people of the Ministry of Public Health think that they have the upper hand when it comes to training staff but the Ministry of Higher Education think they have a right to do it too. This comes from the job description of the two Ministries.

Do not forget, the Ministry of Professional Education is also training nurses. What is lacking is a sense of understanding between all these ministries and what should be done. The issue is not who is doing what. There should be standardization. There should be a standard exam to be written when you have finished your course so that when you pass your exam fine, if you don’t then bad. It does not matter where you trained. There should be standard programs for training, who should come in for training and who should train. We reject some student from our school. Even if you have ‘A’ Levels and you do not meet a certain mark, we do not take you.  Sometimes people just train anybody, and when you train just anybody, you can never get it right. When we say training, some people just go there stand, loiter and wear a white uniform. When you wear a white uniform it does not make you a nurse at the end of the day.

What is the relationship between politics and health? This is because as I understand, you wanted to run for the senatorial. Is it because you wanted to improve on the bills on health?

That is correct. I became interested in politics not because I really wanted to. His Eminence Christian Cardinal Tumi is the person who taught me the relationship between politics and whatever happens. I learnt that lesson in 2008 about 6th or 8th of December when I asked a question about President Obama and his winning to become the president of America.  Here I am looking at somebody who is younger than I, who is also a black and is the president of the world so to speak.  How did he make it? I was intrigued.  He taught be some few things about platforms and principles. You know things work on principles.

In Cameroon, we think that things work on feelings. That is where we make the greatest mistake. Things do not work on feelings. Chifu, you might be my brother because I know you. I should not deal with you because I know you. If I am dealing with you because I know you, I should be working but on your strength.  Let me cut a long story short, so I asked how did this happen? But he taught me that nothing works until the policies are right. Things in a country work on standard operating procedures. That is policies. What is the policy for this and this? Policy would be the business plan for anything. So you follow that business plan. You come, sit together and you say what the problem is and you define that problem. If it is not working you revise it and do the SMART. That is how things work.

So the cardinal told me, for Cameroon to be right, we have to pay attention to our policies. Number two, we have to make sure that those policies are implemented to the letter not half measures. When you have the right policies that are implemented to the letter then things would work. If you do not do this and you think you would stay around, even if it takes fifty years, nature would wait and nothing would change. That is the problem. That is why I became interested in politics. Politics to make sure that, number one, the right policies are put in place and two, are implemented. You cannot make that happen if there is no truth. Our problem is not parliament or the senate. Our problem is the truth.

Do you think health insurance policy is going to make healthcare accessible?

While we were waiting on the corridors, some people called and said we should talk about health insurance and Chrise Mbunwe said we should talk about the medical forum. Another person asked what is my relationship with the medical council? So we would try to look at those points very quickly.
Health insurance is a very good thing. But we should say one thing. There is nothing like something for nothing. Somebody must pay for something. What would be the use of a health insurance? We want to be able to create a system where whether you have money or not, you have good health care. That is the bottom line. But who should pay for it? What should be the source of income to pay for that? We can have a health insurance in a health system that works. If you try to have a health insurance in a health system that does not work, it will still not work.

Already we are talking of a health system that does not work. First you must have a health system that works, then now a health insurance would be tagged on that and it would become smooth. Even without a health insurance, there are ways and means for us to make healthcare accessible, affordable and available to patients. As of now, we are doing things that do not make those health services available.

If we had the right staff distributed all over the national territory; that would already be solving lots of problems. Remember when we stated, I said most of our doctors are not very sharp in clinical psychology and therapeutics. So we are at times treating and wasting money on things that do not need any treatment. Just by simply listening to a patient, 50% of the patient’s problems would be solved. If you as a doctor, you are looking at the patient’s pocket instead of looking at the patient, there is a problem and you would not get it right.

May I mention something here and let the citizens be aware of it. We are making a lot of wrong diagnosis of typhoid in this country. We see typhoid and malaria in everything. It is all wrong. There is this thing called the Widal test. I am sure every Cameroonian is aware of the Widal test. It is the most common test in Cameroon. Widal test is not the right test for diagnosing typhoid. The right test to diagnose typhoid is the culture of the blood or culture of the urine.

So you can imagine the amount of money we have been wasting over the years ever since I was a medical student. Over the years, we have been treating something that does not exist. If you go on to teach doctors, laboratory technicians and nurses on how to diagnose typhoid, a lot of patients would keep their money in their pockets. This is because we have been throwing this money away treating something that is wrong.  I am not saying that typhoid fever does not exist.

Imagine you take your car to the technician, mechanic or whatever and there is a problem in the engine. Let’s suppose the car is not functioning well and the technician tells you that they are the plugs. Then you buy the plugs and put them in the car and it still does not function well because the problem was with the fuel filter. You see you waste money and that happens a lot. It also happens a lot in medicine when the right diagnoses are not made.

There was this story. I read it somewhere. In a production chain or in a factory setting; most Cameroonians would not know because they do not know what a factory looks like. We do not have factories. In a factory setting where things are laid down in a conveyor belt and the whole thing is going round, the whole factory came to a stop and the manager called a technician to come and repair. The technician went around and with a hammer, he came to one point and taped it and the whole factory started running.  His bill was about three hundred pounds or so. Then the manager said, how can you bill me three hundred pounds for just tapping? So the man changed the bill and said, “Ok, this is the bill, for tapping one pound; knowing where to tap 299 pounds.”
That is the value of knowledge. That is the value of knowing what to do.

Let talk about the health forum.

The problem with the health forum is that, you come to a forum where everything is already laid out. This minister or so will come and talk and they do not know what they are talking about. There might be somebody in the hall who would try to say, “hey we have been doing it wrongly,” they would rather say “toi c’est qui?”  We do not listen.

Someone wanted to find out your relationship with the medical council.

Before we get lost into that, we were trying to see how we could make health services better and at least affordable to the people. This insurance thing; we will have to mature into it because somebody has to pay for it. The question is, who pays for it? Do not forget, there are some services that the population needs which nobody can pay for. It is the government that pays for. We are looking at things like roads, electricity, water and health is one of those things. It does not matter how much we talk, the government is responsible for giving us health.
Then, the population now sees in what way they can contribute to make that health affordable and better. It is still the responsibility of the government to wake up so that we have our health. It has to do more with policy and good governance. As I was telling you, Gabon this small country of about 1.5million people; they have a factory (listen to me and listen well) that produces drugs.  

If you look at what you spent in the hospital here in Cameroon, you would realize that most of your expenditure goes paying for drugs.  What I am saying therefore is, we could also have our factory in Cameroon producing our own drugs and you would be reducing the cost of medical care by so much. The question we are going to ask is, how come we have about three hundred to five hundred pharmacists and none of them can produce a tablet? The problem seems to be more with policy, taxation and so on. I know there is a Bamilike man in Douala who has been trying to put a factory to produce drugs, but his problem has not much been with technology but with policy and taxation.

When News Breaks Out, We Break In. (The 2014 Bloggies Finalist)

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