Dr. Caleb Ademola Gbiri is a lecturer with University of Lagos College of Medicine and also a Neuro-physiotherapist with the same institution. In this exclusive interview with Pharmanews in his office recently, he expressed his displeasure towards the unfavourable condition which he said physiotherapists are subjected to in the country.
The university don, who spoke extensively on the importance of a physiotherapist to an hospital, however, lamented that poor conditions of service and bad policies of government were part of the reasons why physiotherapists are few in the country.
Read the details below:
I am Caleb Ademola Gbiri. I am a lecturer with the University of Lagos College of Medicine and I am also a Neuro-physiotherapist.
What is physiotherapy all about?
Physiotherapy is about management of all disease conditions with minimal use of drug. It also involves preventive mechanism towards preventing disease condition and also rehabilitative and curative. Some conditions are not curable, but you can improve on the quality of life and functional performance of such an individual, while some are curable. So, physiotherapy moves from preventive to curative and to rehabilitative. Contrary to so many people’s belief that physiotherapy is all about taking care of injury. That is partially correct, in the sense that we have an aspect of physiotherapy that deals with muscular skeletal injury and sport injury. Those sets of people deal in both prevention and rehabilitation of patients after injury. What they do basically is treat injury as a result of any muscular skeletal accidents. However, instead of talking about injury, I would rather call it abnormality or pathological persons, in which physiotherapy is involved in restoring the functional performance of an individual who has a deviated functional performance from the norm.
To a lay man, who do we call a physiotherapist?
A physiotherapist is a health care practitioner who treats all disease conditions with minimal use of drug by the use of physical modalities like exercises. Physiotherapists use a lot of physical modalities and we de-emphasise, as much as possible, the use of drug. They only use drug where it is highly mandatory and they have a means in which they send the drug into the system, and not orally. Some people would say physiotherapy is all about bones, while some would say it is about muscle. It depends on whom they have had contact with, because physiotherapy is a broad spectrum of specialties, which have more sub-specialties within.
Why are physiotherapists very few in the country?
The condition of service is one of the major reasons why physiotherapists are few in this country. You see, health sector is an heterogenous sector and we have discovered that there is more favourable condition and outcome for physiotherapists outside the country than those practicing here. Nigeria actually produces sizeable numbers of physiotherapists but because of conditions of service like remuneration, work conditions, and of course, for example, we have not seen a physiotherapist becoming a Chief Medical Director of a hospital, but outside the country, those things are obtainable. Therefore, the practitioners would want to go to where the condition of service is juicier than what we have here. The importance of physiotherapists is less recognised here in Nigeria; meanwhile, they are treated as kings outside the country.
What is the importance of a physiotherapist to a hospital?
I tell you, no hospital can function adequately without a physiotherapist. I am repeating, no hospital can function adequately without a physiotherapist. Because you would discover that, in my definition, I said a physiotherapist is involved in all disease conditions, and also in the prevention modem in the health sector. Take a stroke patient, for example, it is not only giving drugs to a stroke patient that would make him or her to return to the pre-stroke activities. It involves a neuro-physiotherapist to rehabilitate the person back to normal. Meanwhile, the drug would only modulate the blood pressure and other parameters. Every patient that has undergone surgery must have a physiotherapist and therefore, any hospital that is having surgery and does not have a physiotherapist tends to have problems. We also have obstetrics and gynaecology physiotherapists (O&G), and this set of people are involved with women’s health, from peri-natal period, anti-natal period, delivery period and post-natal period, they are all involved in delivery and post delivery process. You see a lot of people play down on the significance of physiotherapists, but until a patient is exposed to all the spectrum and utilises them, then, the patient has not being adequately cared for. So, no hospital, including the primary health centres, can function adequately without a physiotherapist.
Compared to what is obtainable in advanced countries, how would you assess physiotherapy practice in Nigeria?
In terms of ability and capability of physiotherapists in Nigeria, they are at par with their counterparts elsewhere, but when it comes to exposure to facilities, remuneration and conditions of service, they are at the lowest spectrum of the ladder, and that is why we see a lot of practitioners emigrating to all those advanced countries, because there are better conditions of service in those places. So, if we can make it better here also, even if it’s not up to that of those places but a little bit comparable to it, most of these people outside would prefer to stay here, and they would contribute to our health care development. In Nigeria, our physiotherapy patient ratio is very low, when you compare it with WHO standard. In Nigeria presently, we don’t have up to one thousand physiotherapists practicing in Nigeria effectively, and we have over one hundred and sixty million population. You can imagine what would happen at the end of the day. There was a time a patient was referred to (OAUTH) Ile-Ife to see a physiotherapist but before he got there, we lost the patient. We are not having access to what we are supposed to have access to, and the few people that have access to it are not in the country. Meanwhile, recognition is also another problem, and this recognition falls in different places, on the part of government and on the part of policy makers. For example, we were talking about health policy and health bill in the National Assembly; you would discover that there has not been any input from physiotherapists into this bill. It is worrisome seeing somebody who is not a physiotherapist deciding what we should be earning, as physiotherapists; this can be very embarrassing. Also, in the National Health Insurance Scheme (NHIS), physiotherapists have not been factored into it; and among the just constituted the Board of all Teaching Hospitals and Parastatals, there is no physiotherapist in any. How would a person who does not know what is happening in a profession decide for that profession? It is impossible. So, at the end of the day, despite the fact that the health care sector is a heterogeneous sector, we are operating a monogenous focused approach. In terms of remuneration, a physiotherapist who had been practicing for more than ten years is not earning as much as another health care professional who just graduated two years ago. How would you think that such a person would be motivated? The person would rather look for a better option elsewhere by going outside the country. Again, there should be establishment of a directorate for physiotherapy in the ministry of health that would oversee into the running and policy making of physiotherapy service.
How affordable is it to consult a physiotherapist?
I would say that one of the goals of physiotherapy is to make the service affordable and accessible to everybody, irrespective of your cadre. Therefore, the only problem we are having is awareness, on the part of the populace. A lot of the time, the condition that should go for the physiotherapist would be taken to other practitioners, or even general practice, especially in the private hospitals; their referral system is nothing to write home about. They hardly refer and they like to optimise the income and so they won’t involve professionals to manage specific conditions, and at the end of the day, they complicate the problem of the patient.