So sorry about how the health system of Nigeria is right now.

Yes you do need a specialist but I think while at it, you should try to optimize your PCV. I am sure with your knowledge, I am sure you know about your steady state. If its below your steady state, I think you should be transfused and I am sure you are compliant with your routine drugs.

Going outside the country to seek health care is way too expensive as you do not have insurance.

The best is to find a way to see a hematologist and a cardiologist. I could organise for you to see these specialists