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Nigeria: As General Hospitals Become 'Killing Grounds'

Hussain J. Ibrahim and Amina Alhassan

3 January 2009

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Mr Mike Okon was an expectant father as he sat on the bench outside the labour room of the maternity ward of the Wuse General Hospital, anxiously awaiting the news of his wife's delivery.

She had just been taken into the labour room and laid on the delivery bed by the nurses who attended to her. But barely ten minutes later, noisy arguments from the labour room jarred on his nerves and he went in to take a look when he saw his wife cursing and dragging along her heavy frame towards the exit door. On enquiry, he was simply told by the nurses that since his wife's baby "is not ready to come out, she should please stand up and give other women the bed.

" The nurses hurriedly rushed in another woman who was in the throes of labour pains and laid her on the bed. A clearly aghast Okon told Weekly Trust: "The funniest thing is that it was an attendant, not even a nurse or a doctor who ordered my wife to get up, even though what she was experiencing was a very painful and slow labour. I mean, how can you tell a woman in labour such and expect her to be in a stable state? These people need to be reoriented on how to treat patients!"

It is easy to blame the doctors and nurses and dismiss them as callous and uncaring but they too are victims of a healthcare delivery system that is in a crisis state. The experience of Okon's wife highlights some of the challenges: inadequate facilities to take care of ever-increasing number of patients who are urgently in need of care and poorly trained and inadequate staff who deliver healthcare in the absence of skilled professionals.

Nigeria continues to rank low in virtually all the health, life expectancy, mortality rate and well-being indexes set up by the World Health Organisation (WHO) and other development partners to monitor and measure the condition of living in countries of the world. Government officials often cite inadequate finance to properly tackle healthcare challenges as a reason for the poor state of healthcare. But then a measure of how flimsy an excuse it is could be attested to by the fact that almost every year the Federal Ministry of Health and state Ministries of Health declares sums running into several billions of naira as unspent money from the health budget. This, in a health system where hospitals lack beds, drugs, equipment and professional health workers.

"We cannot have people that are poor, sick and dying yet we are returning money," the chairperson of the House Committee on MDGs, Hon. Saudatu, was quoted as retorting not so long ago while lamenting that ministries and parastatals had returned about N36 billion to government coffers at the end of 2007 as unspent money from the MDGs, three of which seven goals are health related (reduction in child mortality rates, improving maternal health and combating the spread of HIV/AIDS and other killer disease like tuberculosis and malaria).

While it has done nothing to put some shine on the healthcare system, the unspent budget of the Federal Ministry of Health had in 2008 spawned a saga of alleged corruption.

Simply put, the collapse of the healthcare system in Nigeria is mainly as a result of the failure of the primary healthcare system, which ideally should accommodate majority of the health problems of the citizenry, freeing the secondary healthcare systems (general hospitals) and the tertiary healthcare systems (teaching hospitals) to accommodate patients with acute ailments and concentrate on research.

"70 percent of all ailments could be treated at the primary care levels and just 20 percent of ailments need to get to the secondary level and 5 percent to the tertiary level," says Okafor Mike, an official of the Federal Ministry of Health. "But as at now general hospitals are treating primary cases while teaching hospitals are treating malaria and diarrhoea. There is so much pressure on the secondary healthcare that it has been far overstretched beyond its limit."

The failure of primary healthcare could be linked to the failure of local government administrations and the massive corruption that makes it such an easy conduit by governments at the grassroots and the state level to siphon money provided by the federal government and donor agencies like the World Bank and WHO. One major casualty of this is the general hospitals who now are forced to take up the functions of the primary health centres in addition to theirs. "When the general hospitals were built they were meant to cater for just a little population in the capital city but now the situation is different as the hospitals can barely cater for one third of the population it receives," Mike says.

Nigeria is a microcosm of that world where prophets, witchdoctors and trado-medical charlatans with wild claims of cure for ailments ranging from HIV/AIDS, breast cancer and polio have taken over the health landscape. More worrying still is the fact that they keep claiming new converts by the day. It is now common to be accosted while walking in the street by hand-bill sharing followers announcing the latest miracle crusade where a 'man of God' is going to demonstrate his powers to cure cancer and make HIV/AIDS disappear. In more local settings, self-styled 'traditional doctors' brandish liquid concoctions or powdery substances in public places like markets and motor parks with a guarantee to treat malaria, typhoid fever, rheumatism, chest pain, ulcer, pile and a host of other ailments all in one single concoction.

Abdu, who plies his trade as a traditional doctor at Dei-Dei, a village at the outskirts of Abuja says with pride that for the intervention of doctors like him many Nigerians would be left without hope at all. "We are not charlatans," he says. "People who patronise us know we can provide them with the kind of cure the hospitals cannot provide and have made expensive."

Going to the general hospital to dieMaimuna, after complications she developed when a C-section was carried out on her at a hospital in Kogi State. Even though he has resigned to fate and takes solace that it is God who gives and takes life, he seethes with anger when he reflects that her dead was avoidable. When Maimuna developed labour problems, she was rushed to the theatre and a C-section carried out on her. The operation was successful. But she later began to rave to herself. The nurses concluded she had high fever. "It was not based on a diagnosis since all this while no single test had been carried out on her, before or after the operation," says Salihu. So, relying on their hunch, they began to inject her with chloroquine. Her condition only got worse. Later, in desperation, the nurses surmised she needed more blood. She was still receiving the blood when she gave up the ghost. "All this, while the doctor could not be found," says Salihu bitterly.

Then hospitals have been accused by patients of sometimes introducing questionable procedures to get them to pay more for medical services. Mr Chinedu, a patient's husband who brought his wife for delivery in a general hospital says when he brought his wife she pleaded not to be attended by a particular doctor that patients have nicknamed 'Doctor Knife'. He says Doctor Knife made his reputation because after some hours and a woman does not put to bed he just goes ahead with a C-section. "While one is not saying they cannot resort to a C-section but at least the woman should be given a chance. Just take a census and you will be surprised at the rate at which C-sections are being carried out in hospitals."

A way out of the disarray witnessed in the Nigeria health system was the National Health Bill introduced by the last Minister of Health, Prof. Grange to the National Assembly for passage. She told the Senate "there is no health legislation describing the national health system and defining the roles and responsibilities of the three tiers of government and other stakeholders in the system. This has led to confusion, duplication of functions and sometimes lapses in the performance of essential public health functions."

Simply put, the former health minister is saying all the three tiers of government just do what they feel like without planning or coordination. While the Senate has passed the bill it is awaiting the scrutiny of the House of Representatives before it could be sent to the president. But experts more pragmatic about the ways of the Nigerian government with its penchant to make all the politically right statements say it is foolish to leave the health system in the hands of the government alone, as time runs out.

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