Estimated Reading Time: 13
“Social distancing, please!” he warns, gesturing in a manner to remind his potential patients about one of the most iterated COVID-19 safety precautions. “I also have a family and can’t afford to contract the virus,” the anonymous doctor at the Lagos state University Teaching Hospital, LUTH, added.
This doctor, like many others in the country, is daily confronted with the quandary of attending to non-COVID-19 patients and attending to them safely. This dilemma, coupled with a shortage of staff, poor infrastructure, and insufficient medical equipment is taking a toll on Nigerians who seek medical attention.
While a few, who may be considered the lucky ones, are attended to at the hospital, many others are turned back daily partly due to fears of contracting the virus on the part of the medical staff and shortage of medical personnel and facilities.
This doctor’s next instruction confirmed the fears of the many patients waiting to be attended to at the front of the Emergency Department of LUTH on this day, June 8.
“We can’t attend to all of you. If your case is not an emergency… a very serious case, go back. For now, we’re only attending to those showing COVID-19 symptoms or emergency cases.”
Following these instructions, an aged man, whose daughter had accompanied for treatment after diagnosis for urinary tract infection, was turned back. After her failed attempts to show her father’s scan results to the doctor, the devastated lady murmurs to this reporter that: “Right now, I am only for my father and his health. I don’t care about anything else.”
The duo and many others reluctantly make way for the hospital’s exit gate. While some hope to try next time, some others may never live to see the next time.
‘Miraculously spared to live but waiting to heal’
In his late sixties, Adeyemi Jones, a stroke patient, is another person in the wait on June 8 at the A and E unit of LUTH. Despite the unpromising scenario panning out to his bare face, he remains uncompromised about his resolve at securing medical attention before dusk. He would not settle for next time.
“If he could survive the close shave with death the previous Wednesday, he is not likely to back out on seeing a doctor today,” his son, Sultan says.
Mr. Jones added in affirmation, “When I was rushed to Gbagada General Hospital in the middle of the night and didn’t meet a single doctor or nurse on duty, I thought I was going to die!”
His wife, donning a face mask branded ‘stay safe’, interjected to express that ‘only God spared his life. He got us all running helter-skelter when he had that seizure.’
Mr. Sultan said he was confused and surprised that the Gbagada hospital, known to be a host of one of the largest COVID-19 isolation centres in Lagos was empty, thereby denying people medical attention.
‘They claim to have an isolation centre in that same hospital but I am still shocked that a whole emergency unit doesn't have a single soul at that critical time my father was dying apart from the security man that spoke to us. Who knows if they have even transferred those staff to the centre?
“Let me even shock you! We were the ones that opened the hospital gate ourselves. After shouting for help at the entrance of the emergency unit, it was the security (guard) there that responded and told us there was no one on duty.”
Adeoba Adeniji-Adele, the Public Relations Officer, PRO, of the hospital told this reporter that health delivery at the hospital and the isolation centre it hosted, due to the raging virus, work separately and as different entities.
Dr. Adeleke Adesola Kaka, the hospitals Managing Director also branded Mr Jones’ allegation as untrue when provided with details.
“I can tell you that’s not true. My doctors are always on duty, even when the National Association of Resident Doctors, NARD was on strike. People just tend to assume or carry on with what someone else tells them without making confirmation.’
“Health workers in charge of treating COVID-19 patients are volunteers that were recruited and deployed to various centres and not necessarily in Gbagada hospital.
The deployment is done at the state and commission (NCDC) level,” he answered to the assumption or whether or not health workers were redeployed to the COVID-19 isolation centre.
After the futile effort to get medical attention at Gbagada General Hospital that midnight, Mr Jones was again driven to Lagos State University Teaching Hospital,
LASUTH, Ikeja, where he was eventually placed on a drip and stabilized before he was being referred to LUTH the next Thursday morning for further check-up.
At LUTH, he was advised to run some tests before returning for medical attention. Having done the tests on Monday, he is now waiting to be re-admitted.
At dusk, Mr. Jones and his family were forced to leave the hospital to seek a next time he may be lucky.
‘No bed space! No bed space… And so she died too’
Adelaja Bolanle’s mother died on June 15, 2020, but as days pass by, the rude shock of reality and memories of unpalatable events that led to her demise makes capturing the lead-up moment before she breathes her last more excruciating.
Bolanle finally finds her voice! It is with a protest. “LUTH is worse! My mother complained and got frustrated until we left.”
Her mum’s was the condition of health failure first noticed in December 2019 but worsened by poor attention on the hospital bed.
“They kept telling us no bed space, no bed space until we lobbied with nothing less than N30, 000 at the Accident and Emergency department. I saw two people die right in front of the A and E department.’
“When we eventually got in, different doctors kept coming and going without any particular treatment. She (eventually) asked us to take her back home because there was no improvement in health. She passed away at home.”
When this reporter sought to know the reason behind the palpable situations at LUTH from the hospital’s Public Relations Officer, Mr. Kelechi Otuneme, he admitted the paucity of bed spaces but refuted claims of making a venture out of it.
Maintaining that patients at A and E department are usually treated, he said: “It is not true that our doctors are turning back any patients at the accident and emergency department. And, if anyone is suspected to have COVID-19 symptoms, we call the team in-charge of that to come for testing.
“It is unfortunate that not all seeking medical attention are able to be admitted at once but ordinarily LUTH, like every other teaching hospital, is established for special cases, research and training. As our PHCs are non-functional, every sick person comes to LUTH as against the capacity it can serve at a time. Even common malaria cases are now in the A &; E department,” he said.
Health workers ‘betrayed’ by the system they serve.
From February 27, 2020 when Nigeria first diagnosed an Italian of COVID-19, the figures have risen to 28,711 cases spread across the country’s capital, FCT in Abuja and 36 states as of July 6, according to the Nigeria Centre for Disease Control, NCDC.
As at July 5, the country had tested 152, 952 samples, with the confirmed cases at 28, 711, discharged patients numbering 11, 665 and rate of mortality at 645.
The same grim realities occasioned by the fear of COVID-19 were noticed at two other teaching hospitals in Osun and Ekiti states.
Around 2 p.m. on June 15, this reporter sights a nurse locking the entrance of Adult’s Accident and Emergency Unit of the Obafemi Awolowo University Teaching Hospitals Complex, OAUTHC (Wesley Guild Unit), Ilesha.
The nurse, who would not like to be identified, complained bitterly about the unsafe condition of her work and that of her colleagues occasioned by COVID-19. This condition has instilled in them fears of contracting the virus – a kind of fear that results in closure of an emergency ward during the day.
“If an accident casualty comes, we will still be expected to attend to that. We don’t have M95 (face mask), they do over there”, she said referring to the Children’s A and E unit — and immediately committed her legs to a stroll out of sight.
Although Nigerian doctors are mandated to take the Hippocratic oath – an oath of ethics that mandates them to deliver quality treatment without sentiment – at the moment of induction, the myriads of system challenges and failures have made it almost impossible to live up to the dictates of ethics. This has been worsened by covid-19
Agbaje Olaitan, a graduate of Obafemi Awolowo University and pharmacist under an internship at the teaching hospital has a sordid story to tell about the consequences of such disposition by health workers in this pandemic period.
His 56-year-old mother didn’t get a fair chance to fight for life because the doctors and nurses at Wesley, as OAUTHC unit in Ilesha is fondly called, didn’t meet up to his expectations.
“I first took her there on Friday, May 29. Without any history taken, examination, drug prescription, doctors kept telling us to go for different tests and scans. Not until around 7:30 p.m. on Saturday, June 6, when the Obstetrics and Gynaecology team confirmed my mother’s health issue,” he explains.
By the time the O and G team diagnosed her of an enlarged spleen and referred them to OAUTHC in Ife, the deteriorating health of Olaitan’s mother was almost too late to revive.
She passed on before dawn on June 7 after brief treatment in Ife.
“All these (negligence) were not happening before COVID-19 but people like to capitalize on some excuses to advance their laziness. What the hospital authorities said is that anyone with COVID-19 symptoms should not bother to come. My mother was not showing any of that, at least I can tell.
“Now, the health workers have now changed the order to mean anyone who’s not staff or doesn’t have a valid National Health Insurance Scheme (NHIS) card cannot use the hospital for now. Unfortunately, her NHIS card expired a few months ago,” he complained bitterly.
Hard as it may be to admit, John Oluwadero, another pharmacist resident in Ibadan, the capital of Oyo State, lost his mother on April 21 at the Accident and Emergency
department of Ekiti State University Teaching Hospital (EKSUTH) Ado-Ekiti.
While sharing his bitterness in an open letter to the state Governor Kayode Fayemi, he protested that his mother, a diabetes patient, was stigmatized of having COVID- 19, a reason behind nurses and their initial negligence in treating his mother on time.
In a recent interview with this reporter, he, however, stated that he would rather feel more consoled now if the state government can address the problem in the state’s health sector as outlined in his letter to the governor.
“As a family, we are not interested in driving pity over the loss our mother caused by careless handling of some health workers. I will like the state government to address the malady in the public health sector’, Oluwadero advised.
“As a public health expert, I am also ready to work with the government on the recommendations made so that we can forestall future occurrence.”
Why COVID-19 has worsened access to healthcare
By May 2020, at least 90,000 health-care workers have been infected with COVID-19 globally, according to the International Council of Nurses (ICN), although the figures are believed to be underestimated across different countries.
The president of the National Association of Nigerian Nurses and Midwives (NANNM), Mr. AbdulRafiu Adeniji stated that the rates of COVID-19 spread and fatality are ‘enough to trigger anybody, thereby leading to the seemingly shift in attention away from non-communicable and communicable diseases.’
He said further, “Although, it's not ideal for medical professionals to ignore any patient but the reality in Nigeria is a true reflection of not only lack of PPEs for healthcare workers treating COVID-19 patients but also that of the shortage of manpower, infrastructures and lack of motivation for the healthcare professionals.
“Besides, our primary healthcare centres are almost not functional. Unfortunately, when all these happen, something will suffer.”
He noted that Nigeria has less than 200,000 nurses to a population of 800,000 people against the advice of the World Health Organisation.
“WHO recommended that PHC should be made to attend to 70% of frequently- occurring illnesses, secondary healthcare centres to handle 15% to 20% while teaching hospitals to handle 5 to 10 percent of people with chronic illnesses alongside research and training but the reverse is the case in Nigeria.
“Our PHCs are suffering because public health nurses, midwives, and other related- health workers are not allowed to do what they are basically trained to do which includes providing healthcare to most of these patients at that local level and referral to see specialist doctors for critical cases.
Mr. Adeniji’s concern on the PHC brings to spotlight the current administration’s low commitment to the healthcare of its citizens is the proposed allocation for the
Basic Health Care Fund (BHCF) in the 2020 budget. A check on the budget item for BHCF in the health budget indicates N25.560 billion is allocated. This does not reflect the expected 1 per cent allocation as stipulated in the National Health Act (2014).
The same reality holds for general spending on health in the country. The World Health Organization in the Abuja Declaration of April 2001 recommended that for Nigeria to be considered to be prioritising healthcare, the government must commit at least 15% of its annual budget to the healthcare sector.
Nigeria still lags behind some African countries like Rwanda and South Africa in this recommendation. In 2015, 5.78% was appropriated for the health sector. 4.13 % in 2016, 5.17 % in 2017, 4.49 % in 2018, 4.7% in 2019 while 4.16% is budgeted for 2020.
This reality also conforms with the findings of Udeme, an accountability platform that monitors procurement in Nigeria. Udeme’s findings revealed that many health projects nominated by lawmakers were either unexecuted or missing. For example, between 2015 and 2019, the federal government allocated over N5 billion for the construction and equipment of PHCs under the yearly Zonal Intervention Projects (ZIPs).
Data from the National Primary Health Care Development Agency, NPHCDA shows that between 2001 and 2014, N32.7 billion was spent on construction of 687 PHCs in Nigeria. This expenditure, however, has not translated into functional PHCs. UDEME lead, Ijeoma Okereke stated that the damning reality is responsible for the overpopulation of sick Nigerians at secondary and tertiary health facilities.
“Ideally, PHCs should be their first point of call during emergencies, but that isn’t so because they are grossly underfunded and lacking in quality management.”
Ms. Ijeoma suggested that “revitalization of PHCs should be saddled on both local and state governments and not with the NPHCDA, as it had been in the past”.
“Over the years, UDEME project ascertained that communities with functional PHCs took up the responsibility of maintaining the facility even when the government fail to. Because they are the ones funding the PHC, they guard it with their lives. As such, it is very important that the government leverage on this community interest for a better future for the young and vulnerable in Nigeria.”
“One of the lessons COVID-19 has taught us is the dire need for tele-medicine and tele-nursing”, Mr. Adeniji said.
Wikipedia defines tele-nursing refers to the use of information technology in the provision of nursing services whenever physical distance exists between patient and nurse, or between any number of nurses. As a field, it is part of telemedicine and has many points of contact with other medical and non-medical applications, such as tele-diagnosis, tele-consultation, and tele-monitoring.
Reeling out the plans of the association, the NANNM President said, “We are now training a crop of people who would be in charge of health call centres to give over- the-counter remedies. This will reduce the impacts of the burden of diseases and save lives.
“By the virtue of our network, we can easily identify the nurses, doctors, laboratory attendants at each senatorial district that would work hand-in-hand for coordination when there is a need to redirect people to nearby hospitals.
“There may be challenges along the way but this is an initiative that has been in practice in advanced countries and we hope to succeed with it too in order to give qualitative, safe, timely, very accessible counselling and care.”
Support for this report was provided by Premium Times Centre for Investigative Journalism with funding support from Free Press Unlimited