Special Investigation: Crisis in the health sector (Pt.1) 

More Nigerians die from preventable conditions

Anybody outside the Nigerian health care sector would not know or understand the depth of crisis facing the country, which those involved whether as doctors, nurses, pharmacists, and other technical staff, as well as informed patients, have to confront daily to provide and access quality health care.

It is virtually almost impossible to confidently assume that a trip to the hospital would produce the expected positive curative outcome.

Since 1984, when Gen. Sani Abacha, in announcing the ouster of the civilian government of President Shehu Shagari,  described our hospitals as “mere consulting clinics” 42 years ago, Nigeria actually has continued to progress in the southern direction, which manifests in the growing brain drain of the medical professionals, widespread sale of fake and adulterated drugs, and now the prohibitive cost of health care delivery.

Although, medical facilities, both for training and practice, have increased quantitatively, the quality and efficient service delivery has in fact dropped comparatively. Only in the upscale private hospitals can one expect quality service, yet there is no guarantee, in spite of the prohibitive cost, which explains why our elite – both political and business – go abroad for even basic health need.

Doctors’ Conditions

Generally, Nigerian doctors are simply performing magic in doing their best to save lives under the most challenging circumstances. Only those familiar with the problems would appreciate the issues when doctors embark of strikes to protest existing conditions. The reality is that it takes a high level of professional commitment for any doctor to continue working in Nigeria’s public health system.

This conclusion is based on a six-month investigation of the health care system in the country, across six states in three geopolitics zones, in tertiary health institutions. Interactions with medical professionals and patients of different ages and social backgrounds, suggest sufficiently that most Nigerians – professionals and patients – would prefer outside medical practice and service if given the opportunity, respectively.

For instance, prostrate cancer has had devastating effect on male Nigerians in the past few years, that only a few of those who could travel abroad, such as Mr. Charles Oputa, alias Charly Boy, and Prof. Pat Utomi, an Ng few others, have successfully recoveed from it. Most of the people treated in the country hardly survived on a long term, because the technology and scientific knowledge is still evolving here.

From Lagos to Enugu, Anambra, Rivers, and Imo States, the story of poor medical service is the same. In fact, corruption in the system has worsened the situation in most teaching hospitals, which has bred a culture of indifference, and callous behaviors and attitude amongst healthcare professionals.

Money or Your life

Money is the only language spoken in the hospitals, as virtually every service is paid for by patients in spite of the huge subventions provided by government to the hospitals. In fact it’s as if government is not spending money at all.The fact is that government budgetary allocation to the hospitals are siphoned by the administrators in cohort with the bureaucrats and politicians, while the workers make do with whatever they can squeeze out of the system. Generally, everybody is in it.

For instance, at the University of Port Harcourt Teaching Hospital, UPTH, an Orthopedic consultant, who spoke to this reporter on confidential basis, lamented how the institution was denied basic tools of operations by the previous CMD (Chief Medical Director) for several years, until he was removed.

“It was shocking to most people how much money was coming to the hospital that was never revealed or accounted for; all through his six years, what we always heard was “no money,” to every request, which forced the hospital to increase the cost of everything.

“But within a year of the new man coming, long abandoned projects and new buildings were coming up, and equipments being installed. Nobody could believe it.

“The situation is really bad, which explains the fierce battles people fight to be appointed. It is not that government is not spending money; the problem is that the funds are simply shared or stolen, because nobody asks questions,” he said gloomily.

Most of the medical facilities provided by government in the teaching hospitals don’t last long; they are either broken down or inadequate, which compels doctors, both by necessity and pecuniary interest, to patronize private diagnostic centers, usually cited within the proximity of the institutions, and owned or associated with those working in the hospitals.

The growing lose of faith in the health care system is expressed in the large patient-population attending tertiary hospitals, which ordinarily should only handle very complex and specialist cases being referred from the secondary hospitals.

The wide gap in knowledge and, to some extent, facilities, compels most patients to the teaching hospitals, which, unfortunately, over-burden the few hands (consultants), who should attend to very serious cases.

Because of poor conditions in the secondary hospitals, which have been largely abandoned to poor people, who would be unable to afford the high cost of tertiary hospital services, most patients now flood the teaching and specialist hospitals, many for treatments that could be provided by an efficient and effective secondary hospital service.

In Lagos, for instance, there are five tertiary medical institutions, namely, LUTH, LASUTH, National Orthopedic, Federal Medical Center, Yaba, and Nigeria Army Reference Hospital, and a specialized Psychiatric hospital.

Of the five general practice hospital, four of which are owned by the federal government, only Orthopedic and LASUTH – Lagos State University Teaching Hospital – can boast of basic medical facilities. In most of the others, as also obtains in different hospitals across the country, medical diagnosis is mainly commercial or private.

Where diagnostic aids are necessary or unavoidable, it has to be procured outside, where costs are exorbitant. Hence, there is usually a community of laboratories and diagnostic centers, and pharmacy stores around the hospitals.

For instance, the CT Scan machine, which is a basic facility for most common ailments, at the Nnamdi Azikiwe Teaching Hospital, Nnewi, in Anambra state, has been in disrepair for over two years, yet there is daily need for it. The result is that the private one in town, Waves laboratories, across the hospital’s old site, is kept busy by the hospital.

Concentration of Expertise

On the average, most resident doctors attending to general out-patients handle  from 20-30 patients daily, which also applies to consultants  except in few areas, such as semi urban Nnewi. The result is that doctors and consultants are extremely under work pressure to meet the days appointments.

Consequently, doctors and consultants spend very limited time with patients to adequately debrief them on the different symptoms of their cases. Most patients complained that doctors hardly listen to and question them effectively; they start writing as you start talking.

“After each consultation with a doctor, I feel something missing; as if I have not fully expressed how I feel, but the doctor has stopped talking and already prescribing medications. That was not the practice in those days when we used to spend enough time a doctor, who ask you several questions; it is really bad now,” Mr. Tunde Ajiboye, who has been attending several hospitals for what he described as a rare ailment, said.

He said that his condition was initially misdiagnosed by a young consultant, who didn’t have knowledge of it, but after three months of treatment without improvement, he had to stop and sought other opinions.

“The consultant diagnosed by just the symptoms, and even when I demand for test, and was asked to do a CT scan, there was nothing. Yet, he insisted on his position. Because my situation did not improve, I left. I don’t know the problem here…” he said.

Although, resident doctors are supposed to provide the first or initial diagnosis to facilitate the task of consultants, in most cases, and because of pressure of time, and also competency, the consultants actually conduct preliminary examinations, which defeat the purpose. The result is that getting appointments with consultants is like pressing water from stone. The average time for seeing a consultant in LUTH, LASUTH, UPTH and Orthopedic is three months, unless for those coming through medical emergency.

Effects of Japa

Consequently, for ailments beyond the knowledge of resident doctors, the patient would have to endure the intervening three months to get a specialized attention. A patient, Mr. Christian Nwokoro, who attended the Orthopedic hospital for three months, during which he had two sessions with the GOP doctors, three physiotherapy visits, and loads of drugs and x-ray, only to see the consultant, who simply referred him to a different specialist.

“It was a most frustrating experience; imagine spending three months on something irrelevant to your condition, and wasting over N100,000 for nothing, only to be asked to go elsewhere and start all over again.

“During the period, my condition actually degenerated, and even the new specialist did not have experience of the ailment, and depended on gut sense and general summation, because of lack of diagnostic facility to ascertain the actual cause.”

A resident doctor, who didn’t want his name mentioned, said that the situation is beyond them, and that doctors are doing their best in the circumstance.

“The situation is very bad, but when we go on strike to draw both government and public attention to our plight, people criticize us, meanwhile, we are trying to protect their interest, because when conditions are right, it is the patients that will benefit most. Do you know the number of doctors and nurses that have left this hospital in the past one year alone? It is almost half.

“Most of our experienced people have gone, creating a major knowledge gap in the system, where you have only consultants and low level residents, who also rely on the consultants for their training.

“So, you have consultants, who are over burdened, because they also consult outside to be able to cope with the economic conditions in the country, and take care of their family needs.

“Government is simply not serious about health care delivery in this country. If we put half of the money we spend on medical tourism in the hospitals, this Japa thing will stop and Nigerians will enjoy better service.

“The truth is that we have many avoidable mortalities because the doctors cannot performance magic; do you know how it feels to watch a patient, who could have been saved with better facilities die. It leaves a major psychological effect in you.”

Next: The scourge of fake drugs.