Who Is It Who Wants to Build A House But Does Not Consider ... · After breakfast at the Thompson &...

A TGMC & UCM-Hellmann Collaboration – September 6, thru September 12, 2017 Page 1

Who Is It Who Wants to Build A House But Does Not Consider the Costs First (Lk 14:28)


SUMMARY OF PROGRAM ACTIVITIES

AT

PORT HARCOURT & AKWA IBOM

FROM SEPTEMBER 6 - 12, 2017


SITE ASSESSMENT SUMMARY

This summary captures a six-day (6) program which included a tour of the Thompson & Grace Engineering Fabrication Facility at Port

Harcourt, Thompson & Grace Medical City (TGMC) project site at Afaha Obong, and the Ibom Specialty Hospital (ISH) and courtesy visits to

His Eminence, Dr. Sunday Mbang (CON), Prelate Emeritus of the Methodist Church of Nigeria.

The site assessments delved into issues which affect the utilization of the healthcare facilities in operation in the state. A window of

opportunity opened up for possible future collaborations between existing medical facilities as supporting partners and the Thompson & Grace

Medical City (TGMC), topmost among the suggested spokes was the Ibom Specialty Hospital (ISH) which is well equipped to be a good anchor

point for improving medical tourism not only the state, but in Nigeria and West Africa as a whole.

Participants in the site assessment event included key healthcare providers in Akwa Ibom State, experts in logistics planning and hospital

management from German UKE Consult und Management GmbH- (UCM) and Hellmann Worldwide Logistics GmbH- & CO.KG. The team’s

mission was to assess the current progress at the TGMC development site in Afaha Obong, visit healthcare facilities in Akwa Ibom State and to

have an interactive session with healthcare providers, transportation experts, church/community leaders, business operators, government and

non-profit organization leaders. The assessment was designed to provide information and data on four thematic areas of situation analysis -

context, finance, concept and workforce in Medicine, Industry, Public Policy and Social welfare.

The onsite assessment began with the arrival of the representatives of UCM and Hellmann partners in Port Harcourt (PHC), Rivers State. The

representatives went on a tour of the Thompson & Grace Engineering and Fabrication Facilities, PHC. Thereafter the team travelled to Grace

Garden Apartments at Eket, where the interactive sessions took place. The program was moderated by Dr. Ikoedem Ibanga, Managing Director

of Pro-Health International who facilitated the forum starting with introduction of the visiting team and other dignitaries and attendees. An

interactive conference between the visiting German team and the attendees began with questions and investigations focused on Medicine,

Industry, Public Policy and Social welfare. The attendees provided information on the current healthcare situation in the nation, medical

tourism, hospital management, hospital logistics, land acquisition, health insurance, and assessment of hospital facilities.


SUNDAY, SEPTEMBER 10, 2017

The members of the team from UCM GmbH and Hellmann Worldwide Logistics GmbH- & CO.KG arrived at the Port Harcourt Airport and

after due clearance were received and welcomed into the country by representatives of the Thompson & Grace Group headed by Mr. Otobong

Amos and Engr. Ekemini Amos.

The team went to the Thompson & Grace Lodging Facilities in Port Harcourt where they lodged for the night.

MONDAY, SEPTEMBER 11, 2017

After breakfast at the Thompson & Grace lodging facility in Port Harcourt, the team proceeded to

view the Thompson & Grace equipment and workshops. The team found the facility properly

located close to the Seaport of Port Harcourt, adequately equipped and suited to be considered for

future TGMC logistic management center. The team left Port Harcourt for Eket where they were

received and welcomed by Thompson & Grace Group represented by Dr. Isaac Amos and other

members. The conference started at 11am with more than 20 persons in attendance at Grace

Garden Apartment, Eket Akwa Ibom State. Members of the high table and other participants were

welcomed and introduced by Dr. Isaac Amos. The list

included among others Dr. Christian Taube, Mrs

Carmen Rother, Mr. Lelio Arlt, Mr. Thomas Dierkes, Mr. Otobong Amos, Mr. Ekemini Amos, Dr.

Bassey Chukwuma, Mrs. Sediong Udo, Dr. Ime Ukpe, Prof. Saturday Job Etuk, Prof. Mrs. Imaobon S.

J. Etuk, Ms. Anietie Udoh, Dr. Ikoedem Ibanga, Barr. Favour Nseobong Udomessien, Barr. Itoro

Otong. An opening prayer was delivered by the Very Rev. Fr. Christian Dominic Usungurah. Each

member of the high table appreciated the noble opportunity created by the Thompson & Grace Group

to discuss our current health care system. The conference and discussions in relation to the TGMC is summarized as follows:


ISSUES ON THE NIGERIAN HEALTHCARE SECTOR

Professor Emmanuel Ekanem was the Chairman of the conference. Professor Emmanuel

Ekanem is a Paediatrician and formerly the Chief Medical Director of the University of

Uyo Teaching Hospital (UUTH). He was supported by Professor Saturday J. Etuk, an

Obstetrician and Gynaecologist, and Prof Mrs. Imaobon S. J. Etuk, also a Paediatrician.

Dr. Isaac Amos welcomed participants to the conference and stated that the conference

is a fact finding mission to understand the position of the Akwa Ibom State government

and its people towards projects like the TGMC. Rt. Hon. Onofiok Luke, the Speaker of

Akwa Ibom State House of Assembly was specifically invited as the number three man

in government to share with the team the attitude of the Akwa Ibom Government

towards TGMC projects. This interaction forum with various stakeholders was structured into four groups, namely, medicine, politics,

industry, and welfare respectively. The outcome of the 6 days of interactive sessions will be integrated into TGMC development process

to create a suitable healthcare system to reflect political, cultural, economics and even religious and faith based practices of the Nigerian

people. We must know our environment to enable us live a productive life within the environment. The environment that makes someone

sick also has all the healing properties to heal the sick body. For instance, if someone is sick in Akwa Ibom, and he/she is taken to India

for treatment; there is the tendency of a relapse because the sick person is returning to the same environment predisposed with elements

of sickness. We must seek to understand the environment which handles diseases that comes from our lifestyle, eating behaviour,

nutritional patterns. We are seeing the emergence of non-communicable diseases like diabetes, hypertension and others resulting from the

food we eat and the habits of inactive and sedentary lifestyle. Presently, we are sick from the systems and environments we live in, but

cannot treat ourselves because we do not know our environment.

ON THE CONCEPT OF THE TGMC

The Chairman, Prof. Ekanem stated that we are evolving rapidly in the kind of diseases we are encountering. As a student he was dealing

with malnutrition and a few complex diseases; but now we are experiencing chronic inflammatory viral diseases, heart diseases and

cancer. There are also diseases that were not associated with African that are now part of our healthcare concerns and we do not have

solutions and the capacity to handle them. He explained the crucial need for medical training in his profession and his attempt to partner

with Belgore and South Africa in training young doctors to acquire new capabilities and techniques. A large number of Nigerians are


seeking medical aid outside the shores of Nigeria for even disabilities like Down’s syndrome and many others that are very expensive to

afford. This provides an opportunity to import training and equipment needed to TGMC and make it accessible to the large market and

high demand available in Nigeria.

ON THE CONTEXT OF THE TGMC

Dr. Christian Taube explained that so far, he has been able to understand the purpose of the TGMC and the need for modern medical hub.

However, TGMC on its own cannot meet all the needs of the people in this region, so we’ve got to think bigger by collaborating with

existing healthcare facilities to build capacity. Think of hubs and spokes, and to improve the design of the spokes to make healthcare

services available to everyone. With top notch expertise these hubs and spokes will affect the design of the TGMC as the main medical

hub, flanked by various spokes as the way in actualizing the TGMC vision. Under this heading a lot of factors which could affect the

TGMC were discussed and these include:

Religious/ Traditional Influences

Very Rev. Fr. Christian Dominic Usungurua explained that, most community members trust either the opinions of their pastors or

traditional leaders. Hence it is necessary to take into consideration the religious and political drive of the people when planning

healthcare. This will make them feel inclusive because they will know what they have, the purpose, and the need to prevent waste. For

that purpose, it is important that healthcare planning must be influenced by religious and traditional factors.

Prof. Saturday J. Etuk in his reaction added that a common mistake in Nigeria is that healthcare isolates these factors and if we want the

community to accept our healthcare, these religious and traditional leaders should be made part of the healthcare systems at the planning

stage of the health facilities because of the influence they have on the people. He went further to explain that provisions should be made

in healthcare facilities for chapels because Nigerians are religiously conscious people and this would boost their confidence in the

healthcare facility and system that we are offering.

Logistics, Equipment Maintenance and Handling of Medical Specimens

UKE/UCM & Hellmann have been to Port Harcourt already and have looked at the Thompson & Grace Fabrication Facilities and have

seen that they have what it takes to put the TGMC together effectively.

Mr. Lelio Arlt, Managing Director of Hellmann Worldwide Healthcare Logistics GmbH explained the need to have a definite logistic

plan when building a hospital and that is because we are in a globalised world which makes logistics and hospital building to go hand in

hand. Creating harmonized system is a necessity because it will make us avoid the general mistakes which many other hospitals make

like the issues of spare parts, maintenance, materials, electricity and so on. He further explained that the goal is not to focus only on the


end product, but the way to achieve it and keep it rolling. Hence, we have to look at the material available before making concepts, look

into the hospital’s needs and supplies to ensure we do not run into the danger of shortage which can lead to an eventual break down of the

system. We have to find answers to questions such as: “Where does it come from”?, “How do we keep it coming”?, “How do we get

goods to the hospital”?, “How do we get goods to other parts of the country”?, “Which goods can we transport with sub-contractors and

which do we need dedicated organisations to handle”?. Logistics is a chain which must never be broken.

POLITICAL FACTORS

Prof. Emmanuel Ekanem stated that it is no secret that the private sector hospitals does better than the public hospitals. TGMC must be

given full support for deploying private sector healthcare principles to make a difference in the system. The presence of TGMC will

further absorb the patients that the Government no longer can afford to send out of Nigeria on healthcare tourism.

Prof. Saturday Etuk explained that, when Ghana was faced with similar healthcare and economic challenges they sorted out these

challenges and now they have a state of the art Teaching Hospital. If Ghana with a population of about 22 Million people (about the size

of Lagos) is able to achieve a modern hospital system, then Nigeria with a larger population and market demand ought to afford one.

Thompson & Grace is thinking big for Nigeria and must be supported.

Prof. Mrs. Imaobong Saturday Etuk added that we are really in need of a healthcare revolution as public health doctors. For instance,

doctors in Calabar are currently on strike which stifles the system, when they were not on strike these doctors were unable to handle

procedures like renal transplantation and cardiac diseases.

HEALTH DELIVERY, WELFARE, PARTNERSHIP AND NURSE TRAINING

Here, Dr. Isaac Amos explained the three (3) tiers of healthcare funding operation in Nigeria: the primary healthcare system including

cottage hospitals, healthcare centers and polyclinics managed by the Local Governments; the secondary healthcare system including all

the general hospitals and clinics managed by the State Governments and; the tertiary healthcare system including University Teaching

Hospitals, Federal Medical Centers, and specialized infectious disease hospitals managed by the Federal Government. The university

teaching hospitals are supposed to be speciality or referral healthcare systems, but currently absorb everything.

He also explained that these healthcare systems have provisions for conferences where issues concerning welfare, healthcare security,

and management, funding and insurance are being discussed. The issue is not in the establishment of these mediums, but on how much

influence these mediums have on the healthcare systems.


Dr. Amos was confident that collaboration between TGMC and these sectors was the focus to organise workshops to bring health care

leaders to talk and learn about areas which they need help. He explained further that, right now, the TGMC does not have enough local

partners willing to collaborate to facilitate learning and know-how, but still waiting to hear from the College of Medical Sciences of the

University of Calabar, and University Calabar Teaching Hospital (UCTH) and The College of Health Sciences of the University of Uyo

for exchange programmes, residency and so on. He said the purpose of this collaboration is to protect hospitals and improve the delivery

of healthcare in the nation as a whole.

Dr. Christian Taube demanded to know if there was a direct contact with the professional medical societies and who they were. In his

response, Prof. Emmanuel Ekanem further explained that there are special groups like the Society of Gynaecology & Obstetrics of

Nigeria (SOGON), Paediatrics Association of Nigeria Conference (PANCOF) and Surgeons and these societies hold their separate

Annual General Conferences for all specialists and resident doctors, Nigerian Medical Association, Oncologists and so on. However, he

affirmed that there is the Medical and Dental Council of Nigeria (NMDCN) that controls licensure and regulation of quality; Nigerian

Medical Association that holds all other sub specialties together as political and pressure groups for the welfare and wellbeing of

members.

Prof. S. Etuk on this issue also held that all these societies circulate memos which touch on some life threatening diseases in their field

and what should be done to manage such diseases; which cases are critical and which are not.

Some questions were asked under this heading and they include:

a) Whether the people here are open to professional healthcare?

This was answered in the affirmative by Prof. Saturday J. Etuk who further explained that:

The unfortunate fact about their interest in professional healthcare is that most of the population who seek such are

financially incapacitated and in the healthcare system here, the practice is payment before any form of service and that

discourages a huge number of the financially incapacitated patients.

There is also the issue of quality not quantity of the healthcare delivered to them.

b) How do we deal with the high mortality rate?

Prof. Emmanuel Ekanem explained that one of the factors which cause the high mortality rate in our healthcare system are the

activities of Traditional Birth Attendants (TBA) and that there has been and still is a battle between the healthcare providers and the

Traditional Birth Attendants to minimize this rate, but there has been no relevant improvement. The issue with the TBA is that they

have mismanaged births which increase also infant mortality. He further stated that it is difficult to stop women from procuring their


services because of the confidence they have in them. He stated that there are many instances where women register in the hospitals

for births, but do not go there to deliver and that is because the TBA’s are more friendly and receptive than the nurses who see them

as either a nuisance or another number hence tender loving care is lacking.

Prof. S. J. Etuk said that he has been advocating for more friendly nurses in his papers because this is one of the factors which

directly affect the healthcare delivery system in Nigeria especially where the issue of the Traditional Birth Attendants is in question.

c) How do we tackle the influence of Traditional Birth Attendants?

Prof. Emmanuel Ekanem said that, one way this issue can be tackled is training retired nurses and midwives so that they can go back

into their communities and run some maternity homes. They are usually accepted by the members of the community because there is

a belief that they (the retired midwives) are part of the community. They are believed to also know the pros and cons of the field and

will operate like the TBA’s but as trained professionals who will be better in that they will know the scope of their practice. We

cannot drop them out of the system in a flash but we must do so carefully. He stated that there is an undeniable fact that the

community have more confidence in the methods of the TBA’s than the hospitals not only because they are used to those methods but

also because they know and are comfortable with the persons.

Prof. Emmanuel Ekanem further advocated for the continuous training of the TBA’s but explained that though this has been done a

number of times in the past, they still resort to their former practices.

d) How can a highly qualified and skilled workforce be attracted to join the TGMC as a healthcare system?

The answer to this poser was in the introduction of good labour practices in the healthcare system and this includes; bringing in of

expatriates, encouraging proper remuneration, provisions of good healthcare facilities (because many healthcare providers get

frustrated when they know what to do but there is no facility to carry it out), good labour and job security.

e) How do we improve the welfare of citizens through our healthcare system (Insurance)?

Dr. Amos explained the concept of having an agro-based healthcare cooperative society as insurance system operating in the TGMC

especially for the indigenes of Afaha Obong community who are mostly farmers.

The National Healthcare Insurance Scheme (NHIS) took over 40 years to plan, but caters just for the healthcare of Federal Civil

Servants and does not cover up to a tenth of the Nigerian population.. So far, it is only Ondo State which has been able to develop a

healthcare insurance scheme for its civil servants. Several attempts have been made here in Akwa Ibom State and labour unions to

introduce a healthcare insurance which would cover a large percent of the population However; such has not been actualised because


the citizens have a general distrust for government innovations and activities usually laced with political factors which trammel the

functioning of public policy activities.

f) Why is the current healthcare system not working?

The answer to this question according to Prof. Emmanuel Ekanem was anchored on maintenance, over dependency on the

government and political interference. He further stated that most government healthcare workers have their private establishment

where they go to after work.

Prof. Mrs Imaobong Saturday J. Etuk also stated that most citizens prefer going to the local pharmacists, patent medicine operators

also called the “chemists” than go to the hospitals because they believe that hospitals are generally very expensive.

Mr. Ime Ukpe added that in some systems, there are a lot of trainings that are carried out, but after these trainings, the staff are not

interested because of the political influences in the system and also because they lack facilities.

DIAGNOSTICS AND THERAPY

Prof. S. J. Etuk stated that, it is clear that the Nigerian healthcare system can carry out certain diagnostics but does not go beyond the

basics. We need facilities. Most private sector hospitals have facilities, but do not go beyond the basics.

Dr. Amos added that it is sad that so much money is paid to foreign Embassies for medical examination of those seeking for immigrant

visas that may involve collection of medical specimens for analysis; and they collect and send specimens abroad for evaluation including

DNA. We in Thompson & Grace have done much research on this and have a clear business plan on what to do with medical diagnostics.

The Business plan on diagnostics has been submitted to UCM and Dr. Christian Taube has a copy.

a) What are the basics and what are the standards we should aim for, to go beyond the basics/ what are the portfolio people leave

Nigeria for on healthcare?

Prof. Emmanuel Ekanem answered this to include pregnancies, equipment, Chronic Heart Diseases, Congenital Heart Diseases, MRI

and CT scans, molecular diagnostics. He stated that we can handle the basics and that we have everything we need to handle all

deliveries within the country, but most women prefer to have their deliveries abroad because of citizenship and class of healthcare.

He further stated that Nigerians work in the foreign healthcare systems. The doctors are frustrated because they do not have the

facilities.


In addition, Prof. S. J. Etuk said that if we have got well planned programs and a focused workforce all will do well because we

cannot continue to depend on the government which has too much on its plate.

Dr. Amos stated that Nigerian Doctors are no doubt some of the best in their fields if given the opportunity especially abroad. He

cited the example of Dr. Oluyinka Olutoye in Cleveland, Ohio, USA where he operated a 23 week pregnant woman, brought out the

developing baby to remove tumour on the baby and implanted her back on the mother to grow till 36 weeks. We have the brains and

need to be trained for our own benefit hence if we’ve got the culture, technological support and so on we will be able to do wonderful

things for ourselves.

Prof. Mrs. Imaobong S. J. Etuk explained that the kind of healthcare services we need to focus most are those which can handle

babies less than 24 weeks old to minimize e the infant mortality rate (Neonatology), Paediatics Oncology, Paediatrics Cardiology,

breast cancer, ovarian cancer, cervical cancer, Leukaemia, haematological cases and general oncology.

b) Because diagnostics is the key to therapy, what logistics are in place to achieve this?

Dr. Amos replied that logistics within the state would not be a problem because, from the capital city of Uyo to any other part of the

state takes an hour in the most; taking into consideration all possible delays which are likely to occur on the way. But where logistics

would come into play is where those samples have to be transported from states like Rivers State, Abia, Cross River, and so on into

Akwa Ibom State will need some preservation packaging tools like the cool bag, and certain degree of temperatures to preserve the

specimen in ways they can be analysed. Here within the state, there are no high rated medical hubs where diagnostics are being

carried out and even simple diagnostics like the malaria parasite is wrongly or over diagnosed. Skill development is very critical in

the area of diagnostics: we need to identify the problems to deal with it.

Finally, in medicine it was agreed that the areas we need to focus most on are diagnostics, provision of healthcare facilities, provision

of competent healthcare staff and a continuous training programme and creation of competences to deal with illnesses that takes

Nigerians out on medical tourism.


SEPTEMBER 12 thru 14, 2017

The team proceeded to Uyo to visit His Eminence, Dr. Sunday Mbang (CON) at his home in Uyo. The

team was introduced by Mr. Otobong Amos who expressed gratitude for the opportunity to meet with him

about gaining access to Ibom Specialist Hospital (ISH). He stated the purpose of TGMC site visit and the

value that information from ISH would add to the team’s analysis. Dr. Mbang expressed his gratitude for

the visit and hope that the TGMC team would make suggestions or recommendations on how ISH could

be better managed in order to actualize its purpose of enabling a world class healthcare, medical research

and education to benefit the community and nations of Africa.

The team visited ISH and toured all floors and facilities to assess the state and conditions of the building

and equipment. Dr. Christian, Dr. Amos, Mrs Rother and Barr. Otong met with the administrative staff to

discuss operational and management gaps that affect healthcare services delivery to the community. In

the final analysis, TGMC team envisioned the value ISH could serve as a General hospital in

collaboration with Thompson & Grace Specialty Hospital. This is because the purpose of a specialty

hospital is to cater for the complex healthcare needs of a community. TGMC and ISH teams entertained

the thought that shared services between the two entities would enhance access to quality and affordable

healthcare services. In light of that discussion, both teams agree to engage to further discussions on how

to build, operate and manage a world class healthcare, medical research and education facility in Akwa Ibom State.

The team proceeded to the project site at Afaha Obong where they were welcomed by the friendly

members of the community made up of village youths, Rev. Fr. Usungurah and others. Though no

buildings have been erected at the site yet, there were buildings materials already on ground, and a

warehouse which stored some more building materials. The team interacted with the villagers who were

friendly and optimistic about the project coming to their community.

The team was served with some local delicacies of vegetarian snacks (nya), groundnuts and drinks

served by the Very Rv. Fr. Christian Usungurah and his group. Gratitude was expressed by the priest on

behalf of his community for the innovation which would bring enlightenment to improve the standards of living of his people.


FRIDAY, SEPTEMBER 15, 2017

After breakfast, the team had a brief conference where we viewed the general hospital at St. Gallen which

had provision for the adults and children’s wing separated by reasonable distance but sharing some

equipment and logistics. Dr. Christian Taube explained that though they are independent of each other in

distance and function, they do not work together in spite of the use of some crucial facilities by both

hospitals.

So far, valuable steps have been taken not only to tour the possible sites of the TGMC and the sites of her

anticipated collaborators, but most importantly, steps have been taken in all spheres possible to ensure

such collaborations work for the good of the TGMC and the general public as a whole.

EVENING MEETING

This meeting brought to an end the on-site analyses and tour of the TGMC site and assessment of other healthcare facilities which could

collaborate with the TGMC in provision of world class healthcare in Africa. Many gaps in the current healthcare system were identified with

innovations to be made by the TGMC to fill the gaps examined and such innovations include;

The sensitization of the people through their churches and welfare centers.

Welfare of children through the establishment of a separate general hospital for adults and children.

Waste management and fire management resources.

Logistics and hospital management.

Dr. Amos expressed his gratitude to the team for their diligence and support and assured the team members of the imminent success in the site

visits and outcome.

SATURDAY, SEPTEMBER 16, 2017

The team had a breakfast and after the good byes, departed to Port Harcourt airport and Uyo airport heading to their respective destinations.


CONCLUSION

The team was introduced to Madam Grace Thompson Amos, the matriarch of the family. She

welcomed everyone and expressed her gratitude in their interest in TGMC and the

accomplishments made so far.

The site assessment of TGMC by UCM/Hellmann involved site analyses and strategic

adaption of the current situation of healthcare and logistics in Akwa Ibom State marked the

third phase of data collection towards the actualization of the TGMC project. The visit

brought many stakeholders in the field of medicine, education and transportation

management together to participate in formulating a world class healthcare construct in

Nigeria. Site assessment revealed hidden values in existing infrastructure such as Ibom

Specialty Hospital (ISH). These values further defined leverageable opportunities to collaborate in order to provide a manged ecosystem

capable of providing a true world class healthcare services that can be accessible and affordable by the community, and other people the

nations of Africa.

The most attractive point of this tour is not just placing plans for the TGMC but the involvement and optimism shown by some stakeholders

and all the TGMC partners in the project. We are optimistic that when the team meets again, the path on how to actualize the vision of Live,

Work, Learn, Play and Heal would be further elaborated.


For additional information on the Thompson & Grace Medical City Project, go to www.tgmedicalcity.com

This summary was prepared by the TGMC Project Management Office team and published by Dr. Emmanuel Umoh.

(It is, in part, based on notes recorded by Barr. Itoro Otong, excerpts from recorded videos and photo images captured by a hired photographer

for the conference).

Event Sponsors:

Thompson & Grace Group

Thompson & Grace Investments Ltd

Thompson & Grace Pharmaceuticals Ltd

Thompson & Grace Foundation

Thompson & Grace Garden Apartments & Resorts

STRATEGIC PARTNERS:

http://www.tgmedicalcity.com/

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