Samuel Manuwa and the architecture of medical services in Nigeria

The problem with genuine patriots is that they always carry about a strange death wish. In fact, the most significant test for patriotism is the willingness to give up one’s life for one’s country. And it should immediately become obvious that putting this yardstick this way reduces the space of patriotism considerably. For Horace, the Roman poet, “it is a sweet and seemly thing to die for one’s country.” But patriotism goes beyond poetry; it is a real life choice that compromises every other preferences and alternatives. When Anna Akhmatova, the Russian poet, remarked in a verse, “I am not one of those who left their land/For enemies to tear apart”, she immediately clarified the agony that Horace hid beneath his celebration of the patriot.

In Nigeria, we are presented with a graphic representation of what Akhmatova meant. Nigeria is a graveyard of patriots, those who could not just be silent while watching the enemies tear apart their country. The profound irony about the Nigerian predicament is that the patriots often have to fight those who are in charge of the machineries and apparatuses of the state, and they remain ever so powerful and insensitive. Listen to Wole Soyinka delivering the funeral oration at the grave of Professor Ojetunji Aboyade: “Nigeria kills us slowly; one by one, but surely. If Oje had given less of himself to a thankless nation, he would be alive today.” But if he had been asked, Aboyade would consider any attempt at dissuading him from giving his life for Nigeria anathema. He must have known he was on a death path, and he continued all the same.

There is no patriot that does not see the objective of patriotism in its simplicity. According to Neil Coward, the British dramatist, that objective is straightforward: “That one day this country of ours, which we love so much, will find dignity and greatness and peace again.” The fulfilment of this objective now depends on the expertise and endeavor of the patriot. For the late Dr Samuel Layinka Ayodeji Manuwa, the challenge of patriotism was in putting in place the administrative components of Nigeria’s healthcare system and policies that will facilitate the smooth running of Nigeria’s medical system. And this came right at the juncture of independence when institutional dynamics and processes were coming together in an attempt to put Nigeria on a firm postcolonial footing after the horror of colonial egocentrism. This was a herculean task, the same kind that the late Professor Latunde Odeku faced on his return to the country as the first neurosurgeon not only in Nigeria but in Africa. Manuwa was the first, amongst the corps of Nigerian elite medical patriots, to return and put his medical expertise at the service of the Nigerian state.

He was not only a dedicated surgeon whose choice of tropical medicine already demonstrated his commitment to the profession of medicine in a difficult postcolonial context. In the eighteen years of service to tropical surgery and general medicine, it was essential for him to invent the excision knife for treating tropical ulcers. But like Odeku, he had to be involved in the day to day institutional working of health policy to be able to have a deeper perception of how medical services and the healthcare dynamics work. Unlike Odeku, Dr Manuwa was not contented with just being a surgeon, and struggling against the administrative dysfunctions that prevented medical care to diffuse to the Nigerian populace. There was equally a postcolonial imperative involved in Manuwa’s decision to extend the content of his patriotic service. Nigeria was at the point of achieving an administrative transfer of political power away from the colonialists to Nigerians. The objective of the Nigerianisation Policy was to ensure that the essential services and institutions become sufficiently indigenized in a manner that remove every vestige of colonialism and their ostensible policies from the Nigerian governance framework.

The immediate post-independence period in Nigeria was a herculean time in terms of administrative necessities. And it is the genius in Dr Manuwa that enabled him to immediately perceive an area of national development that was very critical if Nigerians are ever willing to make sense of their postcolonial existence. Medical services constitute an administrative framework that permits the smooth and seamless planning and coordination of medical and health services. The medical service manager therefore occupies a unique and responsible space that mediates between the healthcare system with its many and varied personnel and the citizens of a country. We immediately see the problematic of such a position in a Nigerian state that is just getting used to independence; and an independence whose institutional template the colonialists had undermined before leaving. In the first place, where was the institutional space within which medical services could be directed and managed? In the second place, where was the competence, skill set and professional acumen requires to keep medical services at the cutting edge? Thus, as the Inspector General of Medical Services in Nigeria, his first task was championing the establishment of a university teaching hospital in Nigeria. This came to fruition with the coming into existence of the University College Hospital (UCH) that was to become the receptacle for the patriotic exploits of other medical champions in Nigeria: Emmanuel Latunde Odeku, Adeoye Lambo, Umaru Shehu, Oritsejolomi Thomas, Olikoye Ransome-Kuti and many others.

However, building a college hospital did not define the full extent of Manuwa’s challenge in the consolidation of medical services in Nigeria. There was an urgent need to integrate his duties as the director of medical services with the administrative processes of the Nigerian public service. In fact, we can say that the birth of the UCH was the graphic demonstration of the public service challenges that the medical services would face. In other words, with the establishment of the UCH, the challenges of healthcare delivery became a stark one. It became obvious that the medical system that the colonialists put in place was not meant to facilitate the health of the colonized. While the late Professor Latunde Odeku was putting in place the training of neurosurgical staff at the UCH, his effort could only be considered a relative success because of the pioneering original efforts of Dr Manuwa and others like him who had to rethink the colonial system and its medical delivery dynamics.

For identifying the administrative core of the challenge of healthcare delivery in Nigeria, it became inevitable that Dr Manuwa’s superhuman energies would not only make him the Chief Medical Adviser to the Nigerian Government, but that he would become the first Nigerian Commissioner of the Federal Public Service Commission. It is unfortunate that Manuwa’s place in the series of administrative attempts at reforming the public service system in Nigeria has hardly been recognized. This position enabled him to inject his first class reform ideas on how the medical services could be made to perform efficiently in a postcolonial and post-independence context at a time when Nigerians carried the palpable hope of enjoying the fruits of independence. And what better, and indeed first, place to enjoy this than in the effective treatments of colonial psychosis? Fundamentally, Manuwa saw the urgency of injecting professionalism and public service values into the template of the medical services in a manner that will make the University College Hospital an efficient healthcare machinery.

The medical services in Nigeria, and most especially at the time Dr Manuwa was laying its foundation at the UCH, required a crop of managers and personnel that had the competence and capacities to facilitate the running of a postcolonial university college hospital. Thus, Manuwa saw, with administrative clarity, what has been missing since the Fulton Report of 1968 and the Udoji Report of 1974 recommended a performance management system that has the advantages of introducing a managerial revolution the public service need to transform its performance and productivity framework. However, what the UCH has become today is a direct reflection of the state of the public service generally in Nigeria. Healthcare delivery system constitutes one of the damning aspects of Nigeria’s infrastructural deficit. And the Manuwa legacy of medical service tells us that this deficit has always been there. The entry of the military into Nigeria’s political history became one of the singular dynamics that undermined the works of patriots like Manuwa.

When the Udoji Report was submitted, the military and its collaborators deliberately neglected the performance management and managerial reforms dimensions of the report and focused, myopically, on the wage component. This became a brutal inversion of the axiomatic truth that the health of a people is the wealth of the nation. The Federal military government, in other words, infused an obscene amount of money into the system at the expense of a more fundamental reform that would have facilitated the higher performance of administrative systems like the UCH, and capacitated the productivity of its medical services. With the trajectory of the administrative and medical services of Dr Samuel Manuwa, we are inevitably opening up more lamentable part of Nigeria’s administrative history. But on the other hand, we are also demonstrating the innovative paths which these pioneers opened up for the redemption of Nigeria. In this sense, Manuwa stands tall in the same hall of fame where we have Chief Simeon Adebo and Jerome Udoji as well as the medical hall of heroes where Odeku and Lambo are.

However, like all these unsung heroes, Dr Manuwa also had a taste of the shock treatment that the Nigerian government applies to her heroes. In spite of his meritorious contribution to the foundation of a professionalized medical services in Nigeria, Manuwa was a prime example of the ill-effect of the civil service purge in the mid-70s. It is to this massive, military-led public service retrenchment that we owe the planting of the seed of bureaucratic corruption which led civil servants to prefer immediate gratification to the noble ethos of service. Manuwa was a bad example of how not to treat eminent and public servants. When he died in 1976, it must have been of a broken heart. As it were, Nigeria killed him, as usual. And his death left in its wake a compromised civil service rather than one sold on the true meaning of serving Nigeria.

The starting point of a true reform trajectory is to listen to those who are toiling or who have toiled relentlessly in the field that requires reforming. Dr Samuel Manuwa, from a very humble Ilaje-Ese Odo beginning in Ondo state, passed through the administrative and academic rank and file to get to the very top where the view about reform becomes even clearer. It has now become a consistent point of indictment to keep neglecting the voices of these patriots which keep calling to us as Nigerians from beyond the grave. They are really not asking for celebration. On the contrary, remembering them is to continue extending the trajectory of patriotic service in the course of which they gave their lives.

“He who will, intelligently, lay down his life for his country,” says Frederick Douglass, the American abolitionist, “is a man whom it is not in human nature to despise.” When Nigeria stops despising these patriots, dead and alive, and transform its negative policy towards them, that is when we can be said to have genuinely commenced the project of nation building.