Elizabeth Ogunbamowo
Acute shortage of doctors in public hospitals in the country is an old story. However, in the last few years, the deficit has become more pervasive and taking a toll on the Nigerian healthcare system as more outpatients are discouraged from going to public hospitals.
Contrary to the WHO standard of one doctor to 600 people, the currently obtainable ratio in Nigeria is approximately one doctor attending to over 5,000 patients which translates to unending queues, prolonged waiting period and fatigued physicians.
Statistics paints a gloomier situation––presently, only half of the nationally registered 72, 000 doctors are practising according to the Medical and Dental Council of Nigeria (MDCN) poll which also stated that the majority of the doctors are open to work opportunities overseas.
Consequently, patients who bear the brunt of the situation are alarmed.
Long queues
A few respondents who spoke with Saturday Sun vented their frustration at the ordeal they passed through each time they visit a government-owned health facility. Funmilayo Bello describes the experience as energy-sapping, time-consuming and discouraging. As a result, she has decided to always seek alternative treatment from purveyors of herbal potions first before considering going to the hospital only as a last resort.
“I’d treated fever for a long time, by buying medicines at the pharmacy on my street, but the sickness refused to abate, I decided to visit the hospital after much persuasion from my mother. On getting there, the crowd was just too much, I was instantly discouraged. I was not in for that,” she states.
Bello decided against waiting when she learnt that there was only one doctor to attend to everyone at the reception.
“I simply moved to Elewe Omo (sellers of herbal substances). After explaining how I was feeling to them, they gave me a hot potion, yellowish and very bitter. I drank it with some effort. I was asked to go home and sleep with the assurance that by the time I woke up, I’d have sweated off the sickness, and, that was exactly what happened.”
Evelyn Uche had a distasteful experience of the hospital the day she almost lost her ailing child due to inadequate medical personnel at the general hospital in her area. She recalled: “I could remember when I took my child to the General Hospital in this area, the way they attended to us was very shabby. My child developed extreme temperature in the night and we had to rush her to the hospital. The way they attended to us was so shabby, I was forced to ponder, what kind of country is this? The attitude of the nurses on duty didn’t help the matter.”
She claimed the nurses had no empathy for suffering patients, while the doctor––the only doctor around––was overworked and his attention frequently interrupted.
“The doctor was busy and occupied; a lot of people were waiting for him. Later, they called him into the theatre and he had to leave us there to attend to them at the theatre and he came back again,” Uche recalls.
She avows that the clinic at Isheri has only one doctor for all patients. “Government should help us,” she appeals.
It was the same problem––of long queues and few doctors––that discouraged Mrs Charity David from patronizing the primary health centre or the General Hospital in her area.
The mother of two says: “I have stopped going to the Primary Health Clinic at Isheri because patients are usually many. If you want to be attended to in time, you need to wake up very early, leave home around 5 am and get a good number, but the earliest you might leave there could be 2 pm, due to the crowd.”
She prefers to visit the clinic at Idimu despite the facility not having a doctor. Patients are more comfortable with the attention they get from the few nurses stationed there.
Mr Jeremiah Chinedu thinks the long queue at the hospital worsens a patient’s condition. He recounts his experience the last time he was at the hospital because of malaria fever. “I felt worse than I was before leaving home. Something needs to be done about it. How can someone go to the hospital for treatment and returned home worse?” he asked.
Unlike others, he believes the queues are long because doctors are lazy. “This is because they (doctors) sit in their offices and feel that they have attended to a certain number of people; they delay people and in the process, the queue gets longer,” he raves.
Chinedu suggests that since doctors are not often available, their duties can be delegated to the usually many nurses. “They can split the work and ensure that nurses understand the minor duties of the doctors. The hospital should be re-structured to accommodate that.”
He also suggests that the government should employ more doctors that are ready to work and are ready to fill in the gap.
Fatigued doctors
The most poignant account comes from Mrs Abigail Agbejule who opines that “the burden is too much on the doctors; we can even see it as patients.”
A chronicle of her experience during the last trimester of her pregnancy is instructive: “When I was pregnant, I’d go for clinic days and sometimes pregnant women were up to 200 or more. Sometimes, when the number is more than 200, the remaining ones were asked to defer their checkup till the following week. Hence, everyone strove to arrive early; those that knew that they couldn’t make it simply stayed back at home.”
Continuing, she paints a bleak picture: “They had three rooms for three doctors who attended to pregnant women. I’d once been number 80; by the time it reached my turn, the three doctors had reduced to two, the third one was called into the theatre. There were always emergencies and the doctor would have to leave. So, it was possible that someone who arrived by 6 am could leave by 4 pm or 5 pm––because as people arrived, the files were distributed to each doctor, but once one of the doctors is called to the theatre, his or her files would be shared between the other two, if your file was with him, it might end up somewhere at the bottom of the stack when moved to the next doctor, so there would be a delay. At times, the doctors might decide to take a lunch break. We’d had no choice but wait.”
The most disturbing part of the experience was the instance of a fatigued doctor.
“Sometimes, by the time we enter the doctor’s office, he or she would be so tired you can see it. It has happened to me before,” she affirms.
Agbejule gives an extract from her experience: “The female doctor that attended to me that day was tired already. She just asked me how I felt. I was about to start explaining myself (because I did a scan and the scan result showed that the placenta was already more matured than the baby) but she didn’t give me an audience. She just said that according to the PCV and blood test, my blood level was low and she wrote so many things. She didn’t even allow me to talk. What she wrote were a series of tests that cost about N12, 000, malaria test inclusive. I tried to ask her what it was she asked me to do because I had taken some tests before, she ordered me to “just go and do it,” and I had to comply. But after everything, there was nothing wrong with me. She just made me waste money. I was very angry. I was told that the matured placenta can induce labour that was what I wanted to explain to her but she just waved me off.”
Because of the overwhelming number of patients, doctors hardly have time to be thorough in their examinations, Agbejule hints further.
“Normally, when a pregnant woman enters into the doctor’s office, the doctor is supposed to listen to the heartbeat of the baby, measure the weight of the pregnancy and do other routine checks; but sometimes, when you come in, they are so tired, they’d just ask if there is a problem, once you say no, they would ask you to go home––after waiting for so long. They would not check you. This kind of attitude endangered my first pregnancy. Had the doctors been diligent, they would know that my pelvis was too narrow to deliver the baby. We got to know only while I was in labour, and after they checked me, they said, I had to be operated upon. When it was time, they told me I’d be going for C-section but I had to wait because others had already been pre-booked for CS. We got there at 1 pm and I entered the theatre at 9 pm. Even when we were through in the theatre, there was no bed.”
There are lots of nurses, but doctors are scarce, she concludes.
She offers her theory for such anomaly: “The few doctors in general hospital have their hospitals where they are called upon for emergency any time the need arise; in such a scenario, they‘ll simply abandon the government hospital to attend to their private practice.”
Hidden fees
There is a notion that basic health care is free for citizens at government hospitals. Patients’ experiences proved otherwise.
Mrs Miriam Agbosile learnt this truth recently when she went to treat herself for malaria and typhoid at a hospital she’d been told gives free health care. She arrived there empty-handed and was told she had to get a card for “just N500” and an exercise book at the clinic’s canteen. She had to return home and borrow some money.
“Asides being charged for the card, patients are asked to pay for one thing or the other, mostly unnecessary payments,” she laments.
At Idimu Health Care Center, where Mrs David takes her child to for medical checkups, mothers pay N300 to N500 for gloves, hot water, spirit and cotton wool on every clinic days. Her concern, however, was over family planning implants which used to be free but not anymore.
“Now, they ask us to pay N500,” she complains.
It gets worse with Caesarean Section says Abigail Agbejule who had passed through the experience twice; N50, 000 for vaginal delivery, N200, 000 for C-section, according to her. “Nothing is ever free in a government-owned hospital anywhere in Nigeria,” she states.
The respondents further believe doctors burden patients with hidden charges by referring them to laboratories with which they have some quid pro quo arrangement, a claim stoutly defended by from Funmi Williams. “They would ask you to do a test and recommend the laboratory where it is to be done, what you won’t know is that the doctor knows the lab technician and they get some cut from the charges,” she avows.