Sunday, 10 November 2013

Pay or Die ; Nigerian Hospitals



Several factors have made emergency cases in hospitals a matter of urgent concern, writes ARUKAINO UMUKORO
As far as Mr. Dayo Bamidele (not real names) was concerned, if there had been enough hospital beds, if the doctors had shown more concern, or if there were no administrative issues; maybe his three-week-old son would have survived.
“Just a few hours after my wife gave birth at the general hospital, Ifako Ijaiye, Lagos, on a Friday afternoon, she was asked to move out and wait outside the maternity ward, the nurses said someone else needed to use the bed space because of the crowd there. She was discharged the next morning on Saturday,” recalled Bamidele.
When they returned a week after the baby had been christened, they were not attended to because there were not enough hands at the hospital.
Almost three weeks later, Bamidele discovered his son was not as active as he used to be. He was also not breastfeeding properly. When his wife tried feeding him with infant milk, he vomited it, just like he had done with the breast milk earlier on.
He said, “My son was rushed to the same hospital where he was born, around 11:30pm, but the doctor on duty said we should not wait as they did not have enough bed space to accommodate the infant that night.”
At the General Hospital, he was referred to the Lagos State University Teaching Hospital, Ikeja, where they were kept waiting. After a brief observation, the doctor on duty asked the worried parents to go home, that nothing seemed wrong with the baby. Bamidele felt he carried out little examination on the boy.
“The following morning we returned the baby to LASUTH. Another doctor who attended to us that morning said something was wrong with my son, but there was no bed space. This time, we were referred to the Lagos University Teaching Hospital, Idi-Araba, but we could not bear the pain the baby was passing through. So, we quickly took him to a private hospital,” Bamidele explained.
The private hospital demanded a sum of N30,000 before the doctors agreed to begin treatment. “Luckily, I had N17,000 with me, I paid the balance afterwards,” he said.
By then, it was too late. The infant died the next morning a few hours after he was brought to the private hospital. “The doctor there told me that it was a result of an infection he had suffered during birth,” Bamidele noted.
In his view, the numerous delays in previous appointments at the hospitals worsened the situation.
Luckily for Mr. Biola Johnson (not real names), he only saw the shadow of death.
It happened on his way home to the Island after a friend had dropped him off along Airport Road, Ikeja. He made a brief stop to buy something around the bridge. Just then, in the darkness of the night, a man threatened him with a knife and asked Johnson to follow him. In a flash, Johnson suffered a deep cut on his abdomen and his face before he fled from his assailant.
It was a policeman who saw him and took him to the hospital.
When the policeman took him to the General Hospital, Ikeja, he had already lost a lot of blood, but he was conscious enough to know what was happening around him. All the medical personnel on duty were concerned with at that time was how much he would pay to open a hospital file for him to start the process of treatment. “I was conscious enough to give the policeman my phone and contacts of family and friends who came to my rescue,” Johnson recollected.  In the end, he had to pay N75,000 before he could be treated and taken in for surgery.
“I am thankful enough that the treatment was very good and sound. I’m alive today because of them (doctors). They were professionals who went beyond their call of duty. But because we live in an every-man-for-himself society, they are forced to sometimes turn away from the human side, so it has to be business first before care,” he said.
At the time of this report, SUNDAY PUNCH had not yet received approval from the Chief Medical Director to speak with the Head of Department, Medical Emergency, Lagos State University Teaching Hospital, on how the doctors handle medical emergencies, despite the challenges.
For many Nigerians, it’s a dire situation in the emergency rooms in both government and private hospitals. In some cases, patients are asked to pay as high as N100,000 or more in private hospitals as deposit before treatment could be given.
Some have blamed this situation on the high rate of poverty in the country, while others say the lack of political will to improve the country’s health sector, poor medical infrastructure, over-stretched medical personnel are also reasons why quality and affordable healthcare is still out of the reach of millions of Nigerians.
The Public Relations Officer, Nigerian Medical Association, Lagos chapter, Dr. Peter Ogunnubi, however, said things had changed in recent years, unlike in the past. “In fact, things have changed drastically under the present NMA leadership. I’m very sure such cases would be very minimal. Our doctors are very well trained now and every doctor in Nigeria knows that he cannot refuse any patient emergency care,” he said.
According to Ogunnubi, the NMA is not a law making body, but it is an association of professionals affiliated with the Medical and Dental Council of Nigeria, which has the statutory responsibility for the regulation of medical, dental and alternative medicine practice in Nigeria.
“One of the laws is that whenever a patient has an emergency situation, you must do everything possible as a doctor to first of all stabilise that patient without demanding for anything. That is the code of the MDCN. No doctor should refuse to treat a patient that is involved in an emergency situation. They must first of all stabilise that patient,” Ogunnubi explained.
“Nobody should be denied treatment in severe and emergency cases. Doctors must ensure that the patient is first of all stabilised by carrying out the necessary resuscitative measures before demanding for money for the definitive treatment,” added Dr. Segun Akinniranye, a medical doctor with 14 years experience in the UK as a consultant in intensive care medicine and anaesthesia.
David Abia-Okon, a medical doctor at a private hospital in Lagos, also echoed the same views. He agreed that the initial stabilisation of the patient was vital. However, he highlighted the challenges most doctors, especially those at private hospitals faced in treating emergency cases and the reasons why many demand for a deposit sum before commencing treatment of patients.
According to Abia-Okon, what doctors charge most of the time is less than the actual cost of treating a patient. He based his conclusion by calculating the cost of the hospital facilities, medical equipment, labour, water consumption and electricity bills, cost of fuel or diesel for generators, among other running costs.
“Also, the government collects tax and all kinds of levies from us who run private hospitals. So, government hospitals can afford to subsidise their fees, they pay their staff and their medications are more affordable (because of subsidies). But you shouldn’t expect the same in a private hospital business. So, imagine somebody now coming to ask for further rebate on the medications or services, it won’t work,” he said.
With these factors, free health care, even in emergency cases, is almost impossible, Abia-Okon said.
He also said the high fees charged by private hospitals for medical treatment when compared to government hospitals are also due to these factors.
“Where I practise is a very volatile area, so there is hardly any week that  you will not have an accident case or these area boys fighting and injuring one another. And quite often, just to save life, you help them out for free. I’ve been in the profession for 37 years; I will not allow somebody to die because of N10,000. That is principle-wise. But business-wise, it appears not to make sense; it is like telling someone to go to any restaurant to eat without paying simply because he is hungry,” he said.
According to Part B of the MDCN Code of Medical  Ethics in Nigeria, guiding professional conduct, the following among others constitute professional negligence: Failure to attend promptly to a patient requiring urgent attention when the practitioner was in a position to do so; manifestation of incompetence in the assessment of a patient; making a mistake in treatment, for example, amputation of the wrong limb, inadvertent termination of a pregnancy, prescribing the wrong drug in error for a correctly diagnosed ailment, and so on; failure to refer or transfer a patient in good time when such a referral or transfer was necessary; failure to do anything that ought reasonably to have been done under any circumstance for the good of the patient.
All the same, providing medical services simply on humanitarian ground almost all of the time is a difficult thing to do, noted Abia-Okon. “Also, it is not easy to finance private hospitals like the government hospitals,” he said.
Despite the obvious limitations in the provision of quality and affordable health care in the country, Ogunnubi also agreed that the ‘business of medicine was expensive’. “Don’t forget that these doctors are also employees. Patients should not come to the hospital with the aim of not paying. If you don’t pay, you will be referred to where they can accommodate you,” he said
The country also needs more hospitals, equipment and facilities to be able to cope with the growing demands for medical services in state, teaching and private hospitals across the country, Akinniranye noted. “It’s unfortunate that there is a lot of demand for bed space at the general hospitals because the number is very few when compared to the population.  We have very good doctors, but the hospital beds are not just enough to serve the population of Nigeria.”
Lagos State, with only a handful of teaching hospitals, has an estimated population of over 21 million, according to www.lagosstate.gov.ng.
No wonder Abia-Okon pointed out that the best solution was for the country to have a functioning national health insurance scheme, which will provide easy access to quality healthcare for all Nigerians at an affordable cost through various prepayment systems.
Not only that, there needs to be adequate manpower to be able to take care of medical emergencies. Also, considering the country’s growing population, the government also needs to invest more in the health sector, Akinniranye said. “There should be more investment in terms of manpower training — doctors, nurses, paramedics, even the ambulance drivers, equipment, upgrade of facilities, provision of drugs and access to it. Everything needs to come together to move the health sector forward,” he added.
Although Nigeria has a National Health Insurance Scheme, established under Act 35 of 1999 by the Federal Government, analysts say only five percent or less of the country’s over 160 million population are enlisted on the scheme. Some are not aware it even exists. A December 2015 deadline has been reportedly set by the NHIS to get all Nigerians into the scheme. With the many problems bedevilling the country’s health sector, that remains to be seen.
BY ARUKAINO UMUKORO for punch newspapers
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