Monday, 23 January 2012

Which Hospital Should I Attend?

Joachim Ibeziako Ezeji.

Stories emanating from our many hospitals these days leave much to be desired. This is most especially the case in public health institutions. I am tempted to conclude that it is part of the burgeoning rot in the Nigerian system, but must it continue?

I have had cause in the recent past to attend the Federal Medical Centre in Owerri. My experience at this hospital is most nauseating. I had arrived as early as 9am in the morning of that fateful day, and after due protocols, joined the queue of outpatients waiting to see the doctor. Due to the huge number of outpatients on the queue, it was yet to be my turn even at 1pm.It was most saddening to realize that only one doctor was attending to this huge number of patients. I was disappointed when I discovered this.

Can you imagine, just one doctor for such a crowd in a hospital in a state capital and moreover a federal medical centre for that matter. I was sad but was still patient. At about 1.30pm news came that the doctor was going for break and that we should either wait till he returns or come the next day. Despite this news, I still opted to wait. My patience however ran out when even at 3pm the doctor was yet to be back from his break. An hour later, which was at about 4pm, one of the nurses on duty lousily came to announce that the doctor won’t be returning anymore and that we should come back the next day. I felt like crying, what a shame!

It was very painful to recall that on the queue with me on that day were very poor patients who were really sick and had traveled from remote locations to see the doctor and possibly seek solutions to their ailments. I pitied them and wondered what callous system we have in place in this country. I had little option than to leave but with a promise never to seek medical attention in that hospital anymore. In addition to the time lost being on that queue was also the money paid for card.

When I later shared my experience with a friend who works in the laboratory section of the hospital, he called me ‘anya ura’ (a fool) and said that I should have tipped (bribed) one of the nurses who would have facilitated my seeing the doctor without any delay.

Yet, even while at the laboratory section I had noticed how employed officials were hawking their trade. Both the student attach├ęs and full time staff of the centre were all over the place prowling on visitors for patronage. They simply wanted anybody to patronize them and have they run your tests for you. Of course they never cared if you were for that or something else.

Since after that discouraging experience, I have alternatively resorted to private clinics. There is no doubt that the level of service on offer in private clinics is better than those in public hospitals but the snag here is the cost. Prohibitive cost in these clinics makes even primary health care unaffordable for many, especially the poor, this thus constitutes my primary reservation.

Most of these private clinics are harboring ‘no nothings’ as both nurses and medical doctors or officers. Added to this is that tendency for shylock profiteering. By this I mean that the level of service often given is inversely proportional to the fees charged. There are no doubts few exceptions. In Owerri we know clinics that see their work as a service to humanity. We know them but they a very few.

Is it therefore surprising, that chemists and pharmacy shops are thriving even on fake drugs? This should not surprise you any longer because many people now find it affordable and convenient to simply walk up to the next shop to buy anti-malaria drugs like ‘fansidar’ or request for a mixture that will ease their weakness and make them available for productive chores even with the high risk of buying fake or killer brands.

How about the traditional and herbal practitioners? Their trade booms because they are cashing in on the existing lacuna in the formal health sector. Moreover the average Nigerian is a traditionalist.
As I talk about our hospitals, I also remember tragic events that make urgent revolution in the health sector most urgent. Last year my friend Amadi lost his wife in a hospital. It was a case of maternal mortality. The woman was pregnant, and died just few minutes after delivery. She had for 9 months attended the same hospital for ante natal clinic. The essence of the ante natal was to safe guard safe delivery. But this was not to be as she was at the point of delivery diagnosed to have acute malaria. The outcome was death for the innocent woman. Then tell me the essence of all than routine checks during the ante natal because when it mattered most that was defeated.
Three weeks ago, Kalu who is another friend of mine took his sick mother to another clinic in Owerri when the woman showed signs of debilitating physical fitness. She was having high blood pressure with series of persisting weakness and fatigue. At the hospital the poor woman was virtually abandoned by those supposedly paid to administer her at the center. She died three days after.
This then brings to the fore the recent case of negligence recorded at the Federal Medical Centre, Asaba Delta State. The consequence of that negligence was maternal deaths for four pregnant women.
The outcry from that dastardly event forced the Federal Government of Nigeria to terminate the appointment of the Medical Director, Dr. G.O. Ebo and other varying sanctions to others found culpable in the scandal. The Minister of Health, Professor, Eyitayo Lambo while briefing the press on the Government recommendations of a white paper said the Centre recorded 4 maternal deaths within a space of thirty days (one month).Prof. Lambo lamented that he came to know of the unfortunate incidents only from the Newspapers report of July 14, 2006, after he directed that, any such occurrences in any tertiary Health Institutions must be brought to his office within 48 hours.
The punishment according to Lambo was part of the effort to stem the unsatisfactory trend in tertiary Health Institutions and in the public interest. He further stated that the administration’s determination to deliver qualitative service to Nigerians, in the spirit of Health Sector Reform Programme, was unwavering and must be steadfast about it.
It is also within current memory that the former Medical Director of Lagos University Teaching Hospital was retired from service on similar negligence in the case of Baby Eniola who contacted HIV/AIDS through blood transfusion in the hospital.
It is not my intention to go on chronicling these failures or to dwell on the poor state of most of these hospitals, their names not withstanding. Dr. Azubike Nwaeje, the Nigerian Medical Association (NMA) chairman, Anambra State Chapter said so much on this recently. He revealed to a national newspaper that the General Hospital Onitsha where he is the Chief Medical Officer is rotting away because of lack of care and attention by successive administrations.
Built in 1965 by the then Dr. Micheal Okpara’s administration of the Eastern region. Dr. Nwaeje said nothing functions in the hospital.
In his words “The plant house is not functional and most times we conduct our operations in the theatre with lanterns. The hospital was once accredited, but it has now lost its accreditation because there are no facilities. The former Governor of the state, Ngige did his house-manship in this hospital in 1975, and when he came we thought he would do some thing to uplift the hospital and earn it accreditation but to no avail. As I am talking to you now, there is no borehole anywhere here and the stores are empty”, he said.
Without any fear of contradiction I make bold to generalize this situation in many hospitals in Nigeria be they state or federal owned, primary, secondary or tertiary classified. Many people who run these hospitals are afraid to speak out like Dr.Nwaeje. Yet millions of naira is budgeted yearly for health to no avail.
This now brings me closer home. Amidst all these unsettling issues are claims that Imo State has an effective health care delivery system comprising hospitals and paramedical centers. These medical establishments which are located in different local government areas of the state are categorized into five main groups: Government owned Specialist Hospitals, General Hospitals; Voluntary Agency Hospitals (Missionary Hospitals); Community Owned Hospitals; and, privately owned hospitals.
Also, there are claims that the Imo State Health Care Delivery Scheme has adopted a grassroots approach through the establishment of rural basic healthcare centers and village primary healthcare centers in all the Local council areas. The efficiency of these centers if at all in existence is no doubt in doubt when viewed against a number of factors. Top of them is corruption; then, the lopsided nature of state government attention on development which ‘favors’ Orlu zone over Okigwe and Owerri zones; the inertia of doctors to ply their trade in rural areas and the comatose state of infrastructure existing in most of these communities. In most cases there are no access roads to these communities. This is worsened by sheer scarcity of clean drinking water etc.
In discussing these issues I make bold to suggest that the incoming administration in Imo State should consider free medical services to persons aged below 16 years and those of 70 years and above as a priority.
They could set up a state health insurance scheme where indigenes will contribute as little as N100.00 monthly and receive Free State medical services surpassing private medical services from public clinics and hospitals.
It is lamentable that despite our wealth and huge incomes as either a state in Nigeria or a country, especially from petroleum resources our people especially the poor suffer in silence over ailments that are curable and those, which are manageable. The result in most cases is declination of human productivity, poverty and deaths.

Free medical services for those aged below 16 and those above 60 is workable and should be explored in Nigeria. Imo State can herald it and serve as a model for others to emulate. Also, all those aged above 18 years but who remain in full time education, could also enjoy free health services but for those who are out of education but gainfully employed, the medical insurance will be their avenue to receiving state funded medical attention.

I don’t see anything utopian in this suggestion after all a whopping sum of more than $380bn has either been stolen or wasted by Nigerian governments since independence in 1960.The EFFCC boss Mallam Ribadu said this much to BBC recently. This was also corroborated by the World Bank President Mr.Paul Wolfowitz in an international conference recently. I am currently researching to know the percentage of this amount that came from Imo Sate.

My nostalgia with public and private hospitals may not go away quickly until something tangible is put on the table. I have a somewhat feeling that this may not be early in coming even as a new government sets to take the centre stage soon. This is so because no concrete or convincing talk has been made in this direction up till now by any of our legion of aspirants to political offices. I am listening attentively and would be appreciative to hear something good in this direction. Please let that politician who has something to offer say so now, else my and of course that of a million others, prevarication on which hospital to attend continues.

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