Elizabeth Ogunbamowo
Anywhere you turn to, the tale seems to be the same. Of doctors and nurses demanding this and that before they can attend to you! Even if you are at the point of death!
Two months ago, in April, 2020, a Lagos-based pastor caused public stir when he accused doctors at a General Hospital in Lagos of allowing his pregnant wife to bleed to death after he allegedly refused to buy a baby delivery kit from one of the nurses. But later when confronted, the authorities admitted it was free because the government of Governor Babajide Sanwo-Olu had ordered that treatment for pregnant women be made free of charge in Lagos.
“My wife who had bled from 3am till around noon was later wheeled into the theatre after losing so much blood,” the embittered pastor lamented. “She was not comfortable after the operation and the doctor gave me a prescription to buy a drug. He asked if she had an underlying illness and I told him that she did not have. It was then it dawned on me that he was looking for a soft-landing to wriggle out of the situation. My wife died because she bled for so long without medical attention.”
Although the hospital management strongly denied asking his wife to buy baby delivery kit, the aggrieved man asked the Lagos State Government to investigate and sanction the workers for “their negligence and failure to uphold the Hippocratic Oath to save lives at all times.”
Health scare and caring in the season of COVID-19
With the coming of COVID-19 pandemic, and with everybody – doctors, nurses and ancillary health workers, seemingly, eternally engaged in a game of self-preservation and survival, families say that the age-long negligence, in times of emergency, appears to have been raised to the seventh power.
That’s what the family of Mr. Emmanuel Iwelumo, a retiree living at Ikorodu, Lagos, would tell you if you asked. They suffered their greatest shock recently when he was refused treatment on an existing ailment, on the suspicion that he was COVID-19 positive. It turned out to be so because the symptoms of the ailment, which he exhibited resemble that of the pandemic.
But two weeks after he passed on owing to the negligence based on the suspicion, his family was thrown into another round of mourning when the results of the COVID-19 test which the hospitals insisted be carried out on him came out negative.
“For a moment after I got the news everything went bleak,” Nenelyn the man’s daughter had said. “I can’t describe the calamity that befell my family. My father died out of mere suspicion from the management. The hospital could have saved his life by taking precaution while treating him since they were in doubt. Denying someone with an underlying medical condition treatment is like committing murder. So, the hospitals are complicit in the death of my father. I expected that since he was suspected to have the virus, we would have been quarantined or told to self-isolate. But no one reached out to us or bothered to know where we live. Let us assume we have the virus, we could have been spreading it.”
Although the Chief Medical Directors of the hospitals involved apologized, offered their condolences and some explanations, they were of little comfort to the bereaved family, because, to them, they came too late, for anybody to do anything worthwhile with them.
But if the Iwelumos were servile with their words, in spite of their disappointment, not so with Nwachukwu Alagbu, a 39-year-old man who narrated how he watched, helplessly, as his wife wriggled and died in agony at the University of Nigeria Teaching Hospital, Enugu, when doctors on duty at the hospital allegedly refused to attend to her over their fear that she might have COVID-19.
The pain the man felt at the loss is aptly captured by these words he posted on social media: “Those people are not doctors,” he wrote, understandably, with feelings dripping with venom. “Doctors have compassion for patients and have a passion to save lives but the ones I saw at the hospital are vampires. They watched as my wife died and the moment she died, they ran away.”
A footballer’s painful experience
Though respondents interviewed by Saturday Sun consider the word “vampire” as too strong to use to describe doctors and their nonchalant attitude, when it comes, not only to bigger issues like COVID-19, but to also lesser ones like payment of initial hospital deposit, presentation of police report, they all seem to agree with the part about “a bit of heartlessness” now fast becoming part of what it takes to be a practising medical doctor in Nigeria, in public and private hospitals. And, many of them are willing and ready to swear by the doctor’s stethoscope and Hippocratic Oath, that going by their experiences, the situation is not likely to abate any moment soon. This is in spite of the fact that the doctors, interviewed, while empathetic with some of the traumatizing and traumatic experiences, seem not to share in all the citizens’ views of them and their attitude.
Like many Nigerians, Luka tried to get busy with something during the lockdown. And when his friend, Benjamin, called him over for a football game in a nearby playfield, he went, not knowing what fate had in store for him. The game was interesting. Luka was hailed from all corners for his dexterity with the ball.
But all of a sudden, in a moment of tension, he collided with the goalkeeper, with his whole frame. As a master in the game, this was not unusual but to his surprise, he could not quickly get up as sharp pains shot through his spine. He beckoned on other players. They came to his rescue and he was rushed to a nearby clinic. There he was given first aid and he seemed to be ok.
“However, he started feeling severe pains late at night and was rushed to Gwarimpa hospital in Abuja here,” Benjamin Oguche narrated to Saturday Sun. “Even though it is a government hospital he was refused treatment because no deposit was made. Worse still, the doctors on duty refused to get close to him for fear of contracting COVID-19, even when it was obvious he was seriously in pains.”
Having been refused admission, he was moved to another hospital: Garki General Hospital, also in Abuja. But unfortunately, his case took a turn for the worse and he died upon arrival at the second hospital. Like Benjamin, many Nigerians are mourning the loss of their loved ones owing to what they see as negligence of hospital staff.
A dude’s dear dad’s death
A young Nigerian called Ifeanyi John recalled how his friend’s father died at General Hospital, Gbagada, Lagos, owing to the family’s inability to pay the initial deposit. According to him, the deceased, Edet Paul, who died last year, of high blood pressure coupled with blood shortage was rushed to the hospital for treatment. But he could not get the much-needed medical attention. Reason: his family was unable to pay a deposit of N250, 000 for treatment.
He said: “My friend really tried to go round to raise the money but he couldn’t just get it. His father was 50 to 60 years old and that was the first time he would have such health crisis. He was rushed first to a hospital located within my area. But when his condition did not improve they moved him to the General Hospital. They also demanded for money before commencing treatment even at the first hospital.”
John who narrated the incident with a whiff of regret and frustration, advocated for a health insurance scheme that could cater for every Nigerian irrespective of tongue, tribe or religion. He is also of the opinion that doctors, in obedience to their Hippocratic Oath should aim at saving lives, by treating emergency medical cases without asking for monetary deposit. “I believe that will help to save more lives.” In addition, he would want to see healthcare providers paid more and their work hours made flexible in order to allow them have time for their families. “This way, they will be more productive,” he said.
Losing a loving and loved aunt
In a chat with Saturday Sun, Olatunji Ridwan recounted the painful experience of how he lost an aunt. “Although I don’t like remembering the incident, I will share it with you all the same,” he told this reporter. “My aunt had her twin babies at a nearby clinic where she had always gone for antenatal. She was quite healthy. In fact, she phoned everyone by herself to inform us about the joyful arrival of the twins. That was the first case of twins in our family line that I know of. We were all happy.”
But their joy was cut short when the family received a call the following day saying that the woman had been referred to a specialist hospital in Ibadan owing to some birth complications. According to Olatunji, at the hospital, it took them a while to get her registered as they demanded for a registration card, which, obviously, the family didn’t have.
“No one was thinking of that,” he said. “We were all focused on stopping the convulsion and the shock she was going through. After registration, she was assigned a bed. But with time, it became obvious that she was getting weaker and weaker as her condition worsened. There was panic everywhere. But somehow she was able to make it through the night to the following morning. The hospital did the much they knew of, but she was in no way better than how she was when she was admitted.”
Faced with a difficult situation, the doctor on duty referred them to a federal hospital. But there again she was rejected and referred to another specialist hospital. “It was at that moment that I realized that our country health system has failed us,” Olatunji said. “At the last hospital, she couldn’t make it. On getting there, they insisted we must register first. We managed to do that. But while we were trying to get that done, we lost her.”
Saved from death during childbirth
A woman who would simply want to be addressed as Mrs. Felicia narrated to Saturday Sun the story of how she nearly lost her life and that of her baby at a General Hospital in Lagos on account of initial deposit of hospital bill. According to her, the baby was almost coming out when she was asked to pay up the bill required of her.
“Though we had paid part of the money we were asked to pay, they said there’s a particular fee we would need to pay before they’d admit me into the labour ward,” she recalled. “My husband ran from pillar to post in a bid to raise the money so that I could be attended to. By the time they did, I was told I needed to undergo a CS (caesarean section) to give birth to the child as the child was already finding it difficult to breathe. I was just lucky that the operation was successful. I didn’t die and my baby didn’t. My baby is almost a year now.” She advised that cases like maternity matters should be handled with utmost care as a single mistake could lead to the loss of two lives.
Losing a friend to non-presentation of police report
Oguche whose friend’s case we reported earlier also recalled how he lost another dear friend while he was in school in Lokoja about two years ago owing to inability to present a police report. He recalled how the friend, one Samuel Abuh, was butchered by another friend over a dispute.
His account: “He was immediately rushed to the Federal Medical Centre at about 2 am. But we were told to bring a police report otherwise he would not be attended to. After we successfully argued that one, noting that there was no need for that as it was not gunshot wounds he was being treated for, after much delay, they requested for a deposit. And, as we were about to pay, they claimed there was no bed space for him. All this while, he continued to lose blood from his wounds. He was later denied treatment. We immediately moved him to the state specialist hospital. There again, they insisted on police report, in spite of our argument. But by the time it arrived, he was pronounced dead. It was unfortunate.”
Losing a dad over police report
Another young man who identified himself as John also told the story of how he lost his dad, on April 1, 2014, because of police report. According to him, while he was at work, that day, he received a call from his elder brother informing him about his father’s involvement in a motor accident. He told him that he had been rushed to Abubakar Tafawa Balewa Teaching Hospital (ATBUTH), Bauchi. Having been so informed, he went from his office, to look for his dad in the hospital’s male ward. But when his search yielded no result, they referred him to the Trauma Centre. There he found his dad hanging between life and death.
“After identifying him, we were told to go bring police report before they would proceed with treatment,” he said. “I begged them to commence because of his state promising to get the report as soon as possible. But they did not budge. I saw that as a sign of insensitivity and therefore created a scene insisting that they must attend to my father with or without the police report. A male nurse who felt threatened by what he saw as my unruly behaviour sent for the hospital security guards to come and take me away from the place. My brother asked me to take things cool, adding that he knows a pastor who works as a senior nurse at the hospital. Armed with that information I rode my bike to the church where the man was pastoring, found him and told him of the trouble we were having getting the hospital authorities to commence treatment of my father while we work to get the needed police report. He left what he was doing immediately and followed me with a few other pastors from the church. But by the time we got back my father had passed on. I got back only to meet his corpse. I was completely devastated.”
A medical doctor’s view
While the medical doctors interviewed by Saturday Sun are very sympathetic with patients and families, on some of the mentioned experiences, they would, however, want them to know that they are not like the devils they are trying to make them look like in the eyes of well-meaning public.
A medical doctor who pleaded for anonymity urged everyone to work hard enough to cater for the health needs of their loved ones including themselves. “It’s not easy but that’s the way out,” he said. “In advanced countries, we have insurance companies that are responsible for this and those who don’t have insurance cover get to pay so much for it and, at times experience the same fate as that experienced by few Nigerians. We keep trying to blackmail the hospitals and forget that it takes so much to cater for the health needs of people even in an emergency”.
On the vexed issue of initial deposit demand by hospitals, armed with allusion, he asked: “Is it possible for Nigerians to rush to the pharmacy stores to beg for drugs and other resources on credit or before payment? No. But they expect hospitals to do that. Yes, hospital should save lives first.”
Then he offered a solution: “The solution is simple: everyone should key into the National Health Insurance Scheme or get registered under different Health Management Organizations. With this, they can access care at the hospital they registered as their hospital of choice and avoid unnecessary problems.”
Asked to defend the allegation about doctors prioritizing money over lives, unmindful of their Hippocratic Oath, the doctor said: “We have lost too many good doctors because of this Hippocratic crap and hence it needs to be modified. Many health facilities have been ridiculed and called names on social media for holding people against their will just because the patients could not pay their bills. A stitch in time, they say, saves nine. Everyone should work towards having a health insurance policy of some form.”
Initial deposit and emergency cases
Reacting to the issue of initial deposit, Dr. Olawunmi Anu-Adenuga, a medical doctor at Ekiti State University Teaching Hospital, Ado-Ekiti, stated that the federal government has already put in place a law which states that all patients who come to the hospital due to traumatic wounds either from accident, gunshots or from assault of any other kind, should be attended to without demanding for a deposit sum.
She admits that while this law may require obedience from healthcare givers in public hospitals she is not too sure of how it is going to be received in private hospitals. “One cannot speak for private hospitals,” she said. “The onus is on the Director and staff of such hospitals because running a hospital is capital-intensive and most patients either resort to violence or emotional abuse or even run away after being treated. It is therefore expected that such facility may request for deposit to avoid unfortunate circumstances.”
In the alternative, she advised people to use government hospitals when it comes to emergency cases. Or, find specialist private hospitals and stay committed to the facility. Peradventure an emergency occurs, such patients are already familiar with such a hospital and thus without payment, can be attended to.
Addressing the issue of doctors not remembering their Hippocratic Oath, in most cases, she said: “It depends on how we look at it. The Hippocratic Oath does not say that patients should be treated free-of-charge. Money was used to buy the equipment and drugs that the patients will use. The rich can rise up to help the poor, by pumping money into the heath sector. For example, Bill Gates is subsidising the anti-malarial drugs for African countries. The rich people in Africa and Nigeria should be encouraged to do the same thing here.”
A medical doctor’s differing view
But Dr. Segun Bankole, a family physician in Lagos who spoke with Saturday Sun, on the emergency cases and the need for doctors to obey their Hippocratic Oath, seems to differ in his opinion with others on this score. He agreed though with them on some other points. He stated that once an emergency comes in, a doctor has to take care of it first, with or without a deposit. “Emergency means that the patient will die any minute if the doctor does not intervene and if the patient dies, who would you be asking for money?,” he queried. “This is not about Nigeria health system. That is the code everywhere: save the life first before any other thing.”
He however explained that immediate commencement of treatment depends on different kinds of emergencies. “There are some emergencies that you don’t even bother asking what the name of the patient is,” he said. “You have to do something immediately before you start asking what happened. Those are critical emergencies: you save life first; it would be immoral to be asking for money before you save life. This also applies to the case of ectopic pregnancy; the young lady might die immediately if you don’t intervene.”
He noted that there are some emergencies that are not immediately life-threatening. But because it is an emergency, there has to be some form of intervention, though there’s still room for some sort of interactions that give the medical personnel an insight into the medical history of the patient.
Reason for the buck-passing
He blames the buck-passing between the doctor and patients on the medical environment. His position: “I believe that the problem is our environment. Quote me on this. Any health system anywhere in the world, no matter how well-intentioned or how well-planned, where a person would have to dip their hands into their pocket and pay for healthcare at the time of accessing that health system is going to fail. That is why health insurance is the key. If health insurance works, there won’t be the need for this debate. Sometimes you have to look at things from the side of the hospital. And we all experience this. An emergency comes. You use all your consumables. Another comes, the same thing. And nobody is paying. You need to ask the hospitals too: they would tell you their stories. I too have a long list of debtors, some of them would even bring their television sets to come and deposit begging us to discharge their relatives but you’d never see them again. Most hospitals are running into debts. Despite the fact that it is humanitarian thing, it is also a business. If you don’t run it as a business, it would fail. This applies to both private and government hospitals. Even in government hospitals, you pay your money.”
He said private hospitals may be worse-hit in terms of expenses and mounting debts. “Private hospitals have to pay their staff. The hospital has to run their generator. They pay to get gloves and drugs. They run a lot of courses and the only way to survive is to generate revenue one way or the other. A lot of hospitals have learnt their lesson the bitter way. They’ve issued free health care services for emergencies and people are either not willing to pay or not able to pay.”
A Chief Medical Director’s comment
For Dr. Ismail Busari, Chief Medical Officer, Infectious Diseases Centre, Akure, the reason for attending to emergency cases with or without an initial deposit varies from hospital to hospital. “We cannot generalize,” he said. “What applies in a particular hospital might not apply in another one even though they are both government-owned. If the government asks hospital staff in a government hospital to treat patients free but unfortunately the patient comes and there is nothing the doctor can work with, definitely the patient would be asked to get some things.”
He, however said that it all depends on the situation of the patient as at the time he was brought in and on what exactly the patient needs. “If it is within the capacity of the health worker and it’s not available in the hospital, such a patient can be assisted,” he said. “But if it’s not something the doctor can cope with as an individual, I don’t think the doctor should overstretch himself. Rather he’d ask the patient to go get what is needed or the relatives that brought him in. The patient will not see it that way because the government has already stated that everything is free. But when they get there, they realize that this thing is not free. It shouldn’t be this way. Ordinarily, once a patient comes, he ought to get treated before any payment is requested.” As an ultimate solution, he too recommends a health insurance package that would cater for people’s healthcare when the need arises.
Police clarifies position
On the issue of police report, in an interview with Saturday Sun, the Police Public Relations Officer, in Lagos state, Bala Elkana said that police report is not a prerequisite for treatment of any gunshot or accident victims in both private and government hospitals. He added that the force had tried as much as possible to intimate doctors and other health workers with this fact.
“We’ve held many meetings with the Nigerian Medical Association here in Lagos and we’re regularly in touch,” he explained. “We held a lot of enlightenment programmes with doctors in several locations so that we can work together to put an end to this because the laws are very clear. The law does not require police report before saving lives. The number one priority of every doctor is to save lives. Among the five policing priorities also, the number one thing is to defend lives. So you see, we are all working towards the same thing, saving lives before any other thing.”
He, however, added that the law requires that a hospital, which admits a gunshot or accident victim notify the police of such case within two hours of the commencement of the treatment. This, according to him, helps the police in their investigations as to whether the patient is an armed robber or victim of an armed robbery.
“And there are punishments for hospitals which refuse to accept or treat such an emergency. If the person dies because a hospital rejected him, there is provision for compensation for the family.”