Editor’s Note: A few weeks ago, we were delighted to hear about a donation of an electroencephalography machine (EEG) to the Neurology Unit at the University of Nigeria Teaching Hospital (UNTH) by members of the graduating class of 1994 based in North America. We have often written about the scale of the challenges facing the Nigerian health sector, and are conscious that it will take more than philanthropy to solve some of the biggest challenges. We are however, also aware that given the scale of the challenges, every little bit counts. We reached out to Dr Obi Umeh, a representative of the donor group, and Professor Ikenna Onwuekwe, of the Neurology unit at UNTH, to learn more about the project and share any lessons from the experience. We have collated their responses below. (Please note that our co-founder Dr Ike Anya is a member of the 1994 class but was not involved in this project)
The Genesis: A desire to provide a solution
We caught up with Dr Obi Umeh, who represented the alumni class of 1994, to find out exactly how this idea emerged. He pointed out that the project arose from “a desire to go from just TALKING about ‘giving back’ to our alma mater… to being part of the solution”.
In countries like the US and the UK, the alumni of a university usually remains actively connected to the university, and most institutions even have an alumni officer, special newsletters and events that serve to not only inform and engage alumni, but also to give them specific and curated opportunities to give back to the place that has trained them so well. This essentially breeds an ecosystem of connection and belonging long after students have graduated. In Nigeria, the reverse seems to be the case, where alumni are the ones who decide independently to reach out to their institutions of learning. One interesting aside would be whether universities could do more to create platforms or avenues for alumni to give back on a regular basis.
The group recognized that for the intervention they wanted to make to have the desired impact, it had to address an unmet need locally, so they engaged with consultant colleagues at UNTH to send proposals for urgent, impactful, and rapidly executable projects within a predefined budget for which someone at UNTH was ready to be the champion.
The Opportunity: A chronic need for equipment
Back at the UNTH campus, Prof Onwuekwe has been a Senior Lecturer, Consultant Physician and Neurologist at UNTH since 2005. A seasoned lecturer, his passion to teach his students neurology as well as take care of patients had persisted despite the less than ideal conditions at the University. Upon hearing about the alumni’s call for project ideas, Prof. Onwuekwe imagined how much more his unit would be able to do if it had the necessary equipment in place. When we spoke to him, he highlighted that fact that UNTH, like most Federal Teaching Hospitals and centres of medical excellence in Nigeria, had suffered greatly from lack of specialised diagnostic equipment and basic facilities. This has been worsened by the recent economic downturn in the country.
“In Neurology, we had struggled in the last decade or so to build up a small but resilient unit to demystify this ‘perceived to be difficult’ medical specialty, and assist our many patients with neurological disorders, who suffer misdiagnosis and mismanagement at the hands of charlatans and quacks,” he said, adding that, “Epilepsy is a major neurological and social disease and its impact is worsened by the paucity of neurologists and the dearth of EEG services across the country.”
Onwuekwe told Nigeria Health Watch that before this alumni project came into play, no federal tertiary hospital in the South East had an EEG machine. “The last one in UNTH broke down in 2014 and so the hospital had 3 young EEG technicians without any work to do,” he said. He pointed out that the few private facilities in Enugu charged high fees, which discouraged many patients who needed an EEG. As a result of this lack of equipment, medical students and postgraduate resident doctors training in Internal Medicine, Neurology, Paediatrics, Neurosurgery and Psychiatry had no practical experience with the EEG. He also noted that several efforts to get the hospital management to understand the acute need for the service to be restored came to nought.
“When a group of classmates from the 1994 class approached us to identify a project, with the cooperation of Dr Obinna Onodugo, the hospital CMAC, we threw the debate open to consultants in UNTH. Specialties and departments made passionate and persuasive appeals for apheresis machines for Haematology, kits and equipment for Surgery, endoscopes for Gastroenterology, Wi-Fi services for doctors and even public toilets for patients and hospital workers! In Neurology, we badly needed an EEG machine for accreditation of our postgraduate residency programme. Our patients needed it. Our students needed it and the hospital needed the revenue it could bring. ~ Prof. Onwuekwe
With the intense competition of proposals from different, departments, Onwuekwe said that for them one major concern was sustainability – previous machines yielded revenue but in spite of the huge revenues yielded, they broke down due to inability of the hospital to make funds available for routine repairs and maintenance.
The Process: Cinching the deal
Still, to his delight, the alumni class of 1994 selected the Neurolgy Unit’s project. To address the issue of maintenance, the group wrote the Chief Medical Director of UNTH informing him of the intent to donate the machine. “The donors and the recipients had to devise an innovative way to ensure that the EEG service worked devoid of hospital red tape and bureaucracy, which had crippled previous machines,” Prof. Onwuekwe said, adding that, “We succeeded in working out an MOU that provided for 35% of the revenue to be retained in a separate dedicated account managed by the Neurology Unit and independent of the hospital.”
As can be imagined, convincing the hospital management took time as both parties sorted out legal issues in connection to the agreement. In the end, Prof. Onwuekwe said “Dr Onodugo was able to convince the Chief Medical Director and the Hospital Legal Adviser to buy into the idea and the terms – a freewill donation but with an MOU to govern its use which would protect 35% of revenue accruing in a separate account over which the donors would have oversight, and maintained by the HOD neurology for maintenance of equipment and future expansion of services.”
Eventually in February 2017, the MOU was signed and the selected supplier was asked to supply and install the modern 57-channel Natus-Grass model digital EEG machine. This was finally completed on May 8, 2017.
The Nuggets: Challenges faced, lessons learned
- Initially planned as a project of the global alumni class of 1994 but focused on North America Alumni, and within that, a “coalition of the willing” because it was easier to manage with more philosophical alignment and less “analysis paralysis”.
- Establishing parameters for decision making and leadership facilitation – the donors chose a leadership facilitator and agreed to decision by majority vote (used doodle buddy)
For fundraising/budgeting – the donors adopted a pledge model with an annual contribution by each willing member with a suggested minimum but no maximum based on an agreed minimum budget required to execute impactful projects.
- Donors also agreed to commit to projects where execution was relatively rapid once funds and champion(s) were available and nominated a member to coordinate fund collection and deployment.
- To source the equipment, the donors asked for quotes from multiple dealers and selected the best supplier with whom they signed an agreements for installation and after sales service with partial payment to start and final payments upon confirmation of satisfactory installation.
The follow-up: Advice for others who might want to follow suit
- Organize yourselves in whatever unit sizes make sense. Focus on the willing and do not be detracted by the naysayers.
- Identify a leader/champion who is committed to do the work that’s required. Everyone has great ideas and suggestions, but few are committed to see it through to success.
- Don’t bite off more than you can chew! Focus on projects you can actually complete, and which your group can afford, in a short enough duration. No one needs yet another uncompleted project. Go from your realistic budget to the project not the other way round.
- Don’t be a messiah! Ask people at home what they NEED within your budget not what you THINK they should need.
- Find a local champion! Someone local has to be your passionate partner. Focus on critical things relevant to patient care not optional stuff for care providers.
- Protect your investment! Trust but verify. Get different quotes! Talk to recommended suppliers before selection. Get a signed contract for everything. Never pay more than half upfront. Full payment only on confirmation of satisfactory work.
- Decide on your business model with the recipient organization. Either give and walk away or give with rules of engagement (MoU) or build, operate and transfer (after 99 years). Whatever you do, get a legal agreement signed by all parties.
- Finally, recognize you can’t save the world. Don’t let the enormity of the entire problem prevent you from doing that which you can.
The Neurology Unit was excited to have this service restored with the latest EEG technology in the country available in UNTH Enugu at a more affordable price for patients, boosting the morale of the doctors and technicians.
This project followed others by alumni-the 1995 class in 2016 sponsored the upgrade and installation of facilities in the Faculty lecture hall and the final year medical students’ hostel in UNTH. In 2015, the 1989 class set also embarked on projects in the College and Faculty.
Are there other alumni projects going on in hospitals in Nigeria? We would love to hear about them and share the experiences. We hope stories like these will inspire others to give back to the institutions where they trained.