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When hospitals kill patients.

Amid COVID-19, many Nigerians are suffering in the process of accessing health care in the acclaimed best hospitals owned by government.
If not because of industrial action, it is either because of acute shortage of bed space or medical personnel. Also, the negative attitude to work by health care providers in public and private hospitals in Nigeria is particularly worrisome.
Unfortunately, the ugly events taking place in hospitals across Nigeria have further endangered the lives of patients. Investigations by Sunday Vanguard show that with COVID-19, the problems have escalated at every level of care.
Nigerians seeking health care in hospital have their fair share of the trend even in the face of life-threatening emergencies. Sunday Vanguard reports:
Crucial time
In many countries across the world, the patient is central to healthcare policy. But same may not be said about Nigeria.
It does not follow, whether a dying patient is in for emergency room treatment, routine doctor’s appointment, laboratory test or an appointment for that matter, the negative attitude and poor health services have become a way of life and doing more harm than good to the health sector.
It was like any other day in the newsroom when a colleague’s phone rang that another colleague, the late Princewill Ekwujuru, was involved in an accident; and the call threw journalists in the newsroom off balance.
Efforts were made and the patient was rushed to a private hospital in Lagos.
At that point, it was obvious that the patient had lost some crucial time before he was attended to.
This is because, unlike what is obtainable in developed countries across the world, his case was not treated as an emergency.
The hospital insisted that a deposit of N30, 000 must be made before they could commence any form of treatment.
This was a journalist who had served his country for over 20 years.
Yet he was left in pain, not because nothing could be done to save his life but his treatment was being delayed due to hurdles set by poor hospital management and lack of respect for human lives over monetary gains.
When he was finally admitted after the deposit of N30, 000 was made, the people who took him there were told his case could not be handled by the hospital and was referred to another hospital.
Meanwhile, the money paid was never refunded.
Apparently, if he was attended to on time, he may not have slipped into a coma.
That aptly describes the attitude of Nigerian hospitals in the face of emergencies.
Many Nigerians have been killed by these hospitals without knowing it as many patients may have been cured of their illnesses if help came at the right time.
Luck later smiled on Princewill as he was admitted at the Navy Reference Hospital, Ojo where successful brain surgery was carried out on him but he never came out of unconsciousness.
Today, he is no more, one death too many in the Nigerian health system. What happened to Princewill is a common occurrence in Nigeria.
Like the late Princewill, another, accident victim, Jonathan Gabriel, was taken to a public hospital in Lagos after he was involved in a motor accident along Ágege Motor Road.
On arrival at the public hospital, the patient was kept outside without treatment for hours.
According to the hospital management, there was no bed space and treatment was not administered on him until he was finally admitted about 20 minutes to 3.00 am, eight hours after the accident occurred.
Although he survived the hours of waiting, many others may not.
Investigations by Sunday Vanguard show that, earlier, the family had spent three hours trying to get Gabriel, who had severe multiple fractures, admitted into the emergency ward of some hospitals without success. The four hospitals they visited before they came to the last hospital told them there was no bed space. They were turned back.
Gabriel’s case showed that Nigeria’s healthcare system had consistently struggled with more patients than hospital beds even before the advent of the COVID-19 pandemic.
In some of the hospitals visited by Sunday Vanguard, staff who pleaded anonymity confirmed that the scenarios are common. There is limited bed space in the Accident and Emergency Wards and are usually fully occupied.
This implies that there won’t be space for other persons except there are dead or discharged patients.
Plight
The scenarios are the same and the usual plight of accident victims and emergency cases not different in most public hospitals across the country, particularly in Lagos.
The reasons are not far-fetched.
A large number of citizens explore government owned hospitals in order to get quality and affordable health care services.
Sadly, there seems to be little concern on the part of government.
The rise in the projected population of Nigeria and states like Lagos can also be pointed out as another worrisome factor militating against effective distribution of services.
Health watchers are worried that the level of unprofessionalism and poor health care services and human relations in public hospitals in Nigeria need to be checked
Although some of the alleged ills and unprofessionalism could be seen while some happen behind the scenes, complaints by patients who visit the hospitals abound. No patient who accesses care in any of the Nigerian public health facilities come out without some silent but genuine concerns. Unfortunately complaints fall on deaf ears of government and the managers of the health institutions.
Unarguably, the challenge may not totally be the fault of hospitals, health workers or management but the deplorable state of the public healthcare system in Nigeria and acute shortage of health workers.
More pathetic is the fact that Nigerians have limited choices when it comes to public healthcare services.
Right now, doctors are on strike and government that is supposed to resolve the issues has taken them to court, not minding the pains the masses who cannot afford care in private hospitals due to exorbitant charges are facing. For these Nigerians, their choice is to endure the situation and keep praying for a better care system that is not in sight.
Hospital beds
During the tenure of the immediate past Minister of Health, Prof Isaac Adewole, government began the implementation of the Basic Health Care Provision Fund, BHCPF, as part of efforts to revitalise the Primary Healthcare Centres, PHCs, in the communities.
The programme is yet to yield the desired benefits to Nigerians.
The consequences of a poor health system remain a concern and patients receive poor medical attention from unmotivated health workers, limited services and acute shortage of bed space, as well as decayed infrastructure among others.
Statistics seen by Sunday Vanguard shows that, globally, an average of 26 hospital beds are required per 10,000 people, but Nigeria is just struggling with five.
Also, a survey conducted by the Nigeria Health Watch and NOI Polls showed that Nigeria has a deficit of qualified doctors and needs at least 237,000 doctors to ensure the population’s health needs are adequately catered for but currently has only about 35,000, according to the Medical and Dental Council of Nigeria. It also found that 88 percent (9 in10) 30, 800 of the doctors are considering work opportunities abroad due to reasons such as better facilities and work environment, higher salaries, career progression and improved quality of life.“According to the findings, top on the list of countries Nigerian doctors end up are the United Kingdom and United States with 93 percent and 86 percent respectively.“Other destinations include Canada with 60 percent, Saudi Arabia 59 percent, Australia 52 percent, UAE Dubai 29 percent, The Carribean Islands 17 percent, Ireland 15 percent and South Africa 4 percent“Some doctors practicing in Nigeria and seeking opportunities outside have blamed their reasons of wanting to leave the country on high taxes and deductions from salary (98 percent), low work satisfaction (92 per cent) and poor salaries & emoluments (91 per cent).
“They accused the Nigerian government of not showing concern by mitigating the challenges facing them, calling for improvement in remuneration, upgrade of hospital facilities and equipment, increase healthcare funding and improve working conditions of health workers.“Speaking during a television programme, the Secretary General of the Nigerian Medical Association (NMA), Dr Philip Ekpe, said brain drain was not only the fact that doctors are leaving Nigeria but also that human flight has become normal as regards healthcare workers.
“The fact is that nurses and pharmacists are also leaving in droves nurses”, Ekpe said.““These countries are smart: UK, US, Australia and Saudi Arabia because every country needs doctors.““The recommendation by WHO is one doctor to 600 patients.““Now, Nigerians have trained her doctors to be very good and they are sought after.““That’s why you see that Saudi Arabia has done their investigation and background check and they realised they need to take them if their country (Nigeria) cannot offer them anything, and that’s why they are leaving for a place where they will be paid 20 times of their salaries with free accommodation.““They pay for your ticket for going there and will make you have vacations and pay for your family.
“What else do you want? They have all the equipment and facilities”.“According to him, the fact that they are leaving does not make the doctors unpatriotic.““That is why NARD is going on strike. It’s part of patriotism. You’re saying ‘wait, you’re not doing the thing you are supposed to do’”, the NMA leader said.““Nigeria should be smart to change the system to stop this brain drain. Think of the facilities, it’s not a place you can tell your friend to come and visit you.
“The work load is so much. I’ve just told you that one doctor is doing the work of 60 doctors in this country”.“On his part, the Chairman, Medical Guild, Dr Oluwajimi Sodipo, said in Lagos alone, estimated 300 doctors have left public service since the beginning of this year.“Sodipo recommended that to stop migration of doctors, there was need to ensure favourable working conditions in hospitals in terms of facilities and call rooms amongst others““There is also the need to ensure appropriate remuneration for doctors, career progression, opportunities for skill acquisition and ensuring social facilities such as housing, security and transportation”, he stated
Acute shortage
Another major problem in the Nigerian health system is the acute shortage of medical workers.
It took the hospital a couple of days for a neuro-consultant to review the late Princewill’s case. For Gabriel, he had to wait for about 24 hours to see a consultant. This is how bad the situation is in both private and government-owned hospitals in Nigeria,
A medical doctor in public hospital attends to more than 100 patients a day and surgeries are even worse.
A case in point is a breast cancer patient, Justina, who was diagnosed with breast cancer in February 2021 and needed a quick surgery as her case is an aggressive type of breast cancer with no known type.
But despite the seriousness of her illness, the surgery is yet to be done, The hospital involved blamed the delay on the pandemic. But it is a common occurrence in government and primary healthcare centers across Nigeria.
According to a former President of the Nigerian Medical Association, which is the umbrella body for medical doctors in Nigeria, Dr. Francis Faduyile, Nigeria does not have enough doctors and the country is struggling with 35, 000 doctors taking care of over 200 million people.
Faduyile explained that Nigeria has one of the worst health indices, globally; tracing it to the fact that the ratio is one doctor to 10,000 patients.
He warned that there may not be an end to the phenomenon in the short term even if Nigeria produces 3,000 doctors annually.
The former NMA big wig, however, regretted that the brain drain was not limited to doctors as nurses, pharmacists and other health workers are leaving Nigeria.
On reasons why patients face a lot of challenges in hospitals, a health analyst and renowned medical laboratory scientist, Dr Casmier Ifeanyi, in an interview, said Nigerian hospitals are faced with a lot more than bed space shortages.
Accusing the government of paying lip services to healthcare in the country, he said: “It is pathetic and quite unfortunate that dearth of bed spaces, one of the least costly and highly re-usables of hospital items, persist.
“The despicable lack of bed spaces in our hospitals in spite of the huge resources allegedly mobilised and expended on COVID-19 response and containment is highly condemnable and unacceptable.
“Well, more to the challenge in our hospitals and a major impediment to the ongoing Covid-19 pandemic containment activities, especially against the third of the Covid-19 pandemic, is the ongoing strike by the National Association of Resident Doctors.
“This is the third week or so of the strike, yet, no end in sight.
“Nigerians are even lucky that the Hon. Minister of Labour and Employment prevailed on the Medical and Dental Consultants Association of Nigeria to halt their own strike.
“Even at that, another strike is also looming.
“The Joint Health Sector Union that accounts for well over 95 per cent of the medical and health workforce is also waiting in the wings to embark on their own strike.
“As the time ticks, so also is the third wave of the Covid-19 pandemic in Nigeria”.
According to him, one would have expected that the over $71 million reportedly raised particularly from the private sector as part of the Covid-19 funding basket would have been invested in the expansion of bed carrying capacities of Federal Medical Centers and Federal Teaching Hospitals in the country.
“The country has well over 22 Federal Medical Centers in addition to over 50 Teaching Hospitals.
“Taken together, all that needed to have been done was to increase the bed carrying capacities of these tertiary hospitals, some specialist hospitals and general hospitals at the state and local government levels.
“Regrettably, this is yet to happen hence the current ugly situation of crisis of want of bed spaces in our hospitals.
“Honestly, it’s disheartening that our government continues to pay lip service to the provision of healthcare services all over the country to citizens.
“Most of the low and middle-income countries (LMICs) of the world learnt a lot following their experiences in Covid-19 response and containment. These lessons have helped.”
He said the need to expand bed spaces was necessary now that the country was recording more cases of COVID in the third wave as reported by the National Center for Disease Control (NCDC).
Health watchers say with the pandemic exposing the lapses in the country’s health sector, there was the need to ensure good management of hospitals and not blame COVID-19 for the state of hospitals or how patients are treated.