Prof Ibrahim Abdul Wakawa, the Medical Director of the Federal Neuropsychiatric Hospital in Maiduguri. Known for his unwavering commitment to innovation and reform, Prof Wakawa has made remarkable advancements in his field. During our conversation, he shed light on the significant progress achieved under his leadership, as well as the obstacles encountered along the way.
Excerpts…
What would you like our reads to know about you?
My name is Professor Ibrahim Abdu Wakawa. I’m a professor of psychiatry with the University of Maiduguri and I’m currently the medical director of Federal Neuropsychiatric hospital here in Maiduguri. I was first appointed in 2017. And I’ve completed my first tenure, and I’m in my second and final tenure. And by God’s grace, we’ve been able to do our best to make the health system that we’ve made.
When people hear about neuropsychiatry, it sounds a bit abstract for somebody who does not know what it means. For a layman what does that really mean?
Before delving into answering that question, I think I need to first of all define what health is by the World Health Organization. They first defined health as a state of complete physical, mental and social well-being and not merely the absence of a disease. And of course, there’s a recent slogan by the WHO, that there’s no health without mental health. Neuropsychiatry is about engaging and taking care of the mental health of the populace in a recent study that was commissioned by the World Bank. It was discovered that mental health disorders contribute over a quarter of the global burden of diseases. And of course, mental health disorders have to do with how you feel, how you think, how you relate, and how you perceive the environment as a whole. So, in a situation where your feelings in those domains that I’ve mentioned are impeded, there’s definitely something wrong.
We’ve heard of the rates of suicide in other parts of the globe. Mental health conditions account for over 90% of suicide rates globally. And of course, the present day as the global drug use pandemic. We’ve heard of the Fentanyl crisis in North America and Europe. This is a problem that is looming. And of course, in Nigeria currently, particularly in the southern part of the country we’ve had ice and the Nkupurumiri crisis. All these mental health situations that need to be holistically tackled, if we also look at it nationally, the recent spate of banditry and of course particularly in the Northeast here, the Boko Haram insurgency we’ve suffered for a decade, and of course, the recent inflationary trend globally, and the economic crisis they are all potential recipes for chaos that could serve as fuel for the development of mental disorders. And that’s why giving attention to managing mental health situations or conditions is very important in the current status that we find ourselves presently in.
As Director of the Neuropsychiatry Hospital, I’m sure you met something on the ground, and you’ve been able to build on them. Would you like to share some of those innovative initiatives, programs that you’ve initiated so far?
Thank you very much. And this is a very good question. Of course, the hospital was established with the tripartite mandate of clinical service provision, training of mental health specialists and of course, research in the field of mental health. And before actually talking about what I’ve been able to achieve or the innovations have been able to bring into the system, I think I need to also give credit to my predecessors that have laid a very strong foundation for me to build upon. And I’ve looked at the developments we’ve mentioned and all the innovations we’ve been able to achieve from these three perspectives. First, in terms of clinical services provision, when we first came the hospital had a total bed capacity of about 150 but currently, we have 300 bed capacity institutions, which means the bed capacity of the institution has almost been toppled.
And apart from that, there is this negative connotation that is usually associated with mental institutions that they are usually like what you have in the pre-colonial asylum. We tried to upgrade the facilities to make them compatible with humanity and ensure that the rights of the patients are protected. We also embarked upon massive infrastructural development.
We are the first neuropsychiatric hospital currently to have a standalone compounding lab for pharmacy and are also engaged in the training of pharmacy interns. We’ve also developed a very robust radiology department which has a CT scan and has functional radiological services in X-ray and ultrasonography. We are also the first among the neuro psychiatric hospitals to develop an independent electronic medical record, which is one of the innovations that the health system is undergoing globally. We’ve also been able to upgrade the facilities in our general or outpatient department. And we’ve also been able to develop an assessment unit from scratch and in compatibility with the global standards in ensuring the rights of people who use drugs, we’ve been able to develop a Standalone rehabilitation center with all the facilities that are required for the rehabilitation, both within the hospital and in the host community. We also developed a standalone neurodiagnostic complex of which I take pride in mentioning that we have a sleep laboratory. We have two electroencephalography suits, and we’re the first public hospital in the country to purchase a state-of-the-art new technological treatment modality known as transcranial magnetic stimulation in the country or the lead we have for us to see.
We’ve also been able to greatly increase the manpower strength of the institution from I think about 300 that we made at exception, and we currently have over 600 staff in both clinical and non-clinical areas. And we’ve also been able to gain accreditation for our School of post basic psychiatric nursing, which is about the only institution that specializes in training post basic nurses for the whole Northeast region and beyond.
At Inception when we came in the accreditation, the sprint of the institution was 20 per year. But currently we’ve been able to secure 60 slots per year for our students and of course, glory be to God we’ve been having a lot of enrollments. Another area is the expansion of laboratory services. When we came in, it was a very small unit, but we’ve now expanded our laboratory services and I think probably we’ll be taking around to see to the laboratory department that is comparable to what you have in teaching hospitals with all the force subunits that are required for basic training and Laboratory Medicine. We have chemical pathology, hematology, microbiology, and of course immunology. And we’ve also been able to secure accreditation from the Medical Laboratory Science Council of Nigeria, and we currently train laboratory interns.
In terms of the Doctor strength we met, we had about eight consultants and we had less than 20 residents, of course, you know the effect of the brain drain, but currently we have over 20 consultants in the institution. And we have over 34 residents and I take pride to mention that in the recent national postgraduate medical exams and West Africa College of Physicians exam. We recorded 100% in both colleges, and we’ve also been able to set your accreditation for internship for radiographers in the institution.
I think in a nutshell, some human development and structural developments that we’ve been able to achieve. And of course, we’ve been able to develop the research and ethics department that has been able to secure the NH rate accreditation nationally. And currently if you Google, you’ll find many states of the art research that have been conducted in the institution. And I also made bold to say that when the COVID pandemic struck, we had an intervention from the federal government of which we’ve been able to develop a molecular lab and an intensive care unit and isolation centers. All these wouldn’t have been possible without the support of the federal government of Nigeria and the good staff of this institution. We thank God for the modest development we’ve been able to make.
How do you ensure that the hospital keeps up with the latest advancements and research in Neuro psychiatry? Are there any mechanisms in place to encourage further studies?
I told you the accreditation we’ve secured with all the qualities, and these are geared towards assuring training, and of course, upgrading our knowledge to meet with the current global standards. And in addition to that, we have a hospital standard assessment committee that ensures that everything that we do is in line with protocols that have been developed globally. And the other thing we do is that we have a very strong quality assurance unit that also ensures whatever we do is compatible with what is obtained globally. And I’ve also told you that we developed an ISCT center that enhances our capability in making research and updating our knowledge and conducting research that are of course, in line with hot topics in the academia as per mental health presently.
What would be your long-term vision for the Neuropsychiatric Hospital and how do you envision it’s evolving and adapting to meet the challenges?
When I came in, I tried to actually adapt a vision because the realities on ground then influenced our thought and our thinking of how to make it adapt to the Realities on ground. We met at an institution that was the only mental health facility in the epicenter of an insurgency where over 2 million people were displaced. Psychological trauma was prevalent. The reference system was completely flat as far as mental health was concerned. And we envisioned developing a center of excellence in mental health and psychological support in collaboration with partners.
And I make bold to say that we’ve established probably the first linkage system between conventional mental health institutions and non-governmental organizations in the country that make referrals of people that were psychologically traumatized as a result of the Boko Haram insurgency. We also did not restrict our services to the hospital. We extended our tentacles to the host community and IDP camps, where we provided mental health and psychosocial support services to over 13,000 Nigerians free of charge, including their medications. I want to see a system whereby mental health is extended beyond the four walls of the psychiatric institution where it is fully integrated into the primary health care system where it is fully integrated into the community. And it’s completely devoid of stigma. That’s the system I want to equip and that’s the system I want the world to adapt to.
When we were growing up, I schooled in the university of Jos, then, when you hear of professors, you want to see a very old man. Not to flatter you, your grip on the subject matter is amazing. Are we talking about putting square pegs in square holes?
Probably it’s my Pan African background. I’m from Borno state, I was born in Affikpo in current day Ebonyi state, I grew up in Jos, I did my secondary school in Taraba. My dad was a military man, he had so many postings in the southwest and northwestern part of the country. So probably I know all the six geopolitical zones of the country. I thank God Almighty that I had the privilege of going to school early, and God in His infinite mercy has done so much for me that I’ve been able to probably attain this standard. Credit to my teachers, credit to my colleagues if not it wouldn’t have been possible.
So how do you relax?
Very difficult, particularly in this position of responsibility. I hardly sleep for three hours a day. To be candid and wherever you’re, at whatever time, you’re working, so it might not be directly watching on the bench, but you keep monitoring and evaluating to track and make sure that the system works efficiently.
