E O EkeThursday, January 9, 2014
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here is doubt that Nigerian health care service is in very bad shape. Many hospitals are understaffed and the minimal staff that exist, do not show loyalty to the hospital because of non-regular payment of salaries and lack of equipment and resources. The pharmacies do not often have the needed drugs and the patients are left at the mercy of fake drugs. Even the laboratories do not often have the necessary reagents and culture media to conduct the needed tests and grow the suspected micro-organisms. The result is that Nigerian hospitals are shadow hospitals. The look like hospitals, smell like hospital and even act like hospital, but they are not hospitals because people often go there not to recover, but to die, which is why politician prefer to travel to India and Britain and America to treat headaches, malaria and illnesses the average Briton will go to NHS walk in centres to treat. Nigerian health care service has been in bad shape for a very long time and needs serious, bold and honest interventions

For far too long, Ambulance in Nigeria has been, not a vehicle to take critically ill patients to hospitals for life saving interventions, but a vehicle for carrying the dead, who often die after brief illnesses or blunders by health care professionals. Health care professional have practiced with criminal arrogance and audacity that show no respect for lives, views and wishes of the patient. They have rendered the services they are paid to deliver as a favour, instead of as a duty; and constant squabbling for positions between doctors and allied health care workers has been the order of the day. We know that they fight because people who occupy the positions have not been discharging the responsibilities of the positions, but enriching themselves. Other professionals rightly ask why doctors should be the only professionals who should occupy managerial posts to loot, oblivious of the fact that Nigeria operates a medical director system which gives that doctor both clinical and considerable administrative responsibilities.

Corrupt Nigerian health care professionals often use the government hospital as a place to attract patients to their private practices. They also use the time they are paid for to engage in private practices, which is criminal. This has been a long standing feature of healthcare delivery service in Nigeria. Many doctors, nurses, and laboratory scientists in Nigeria lack integrity, are very corrupt and lack the temperament and characters required for the noble professions. A great many of them are in it for the money and money alone.

I can say this because I was a doctor in Nigeria for seven years and worked in voluntary, private and public sectors. I know the various ways doctors connive with workers whose company have retainership with hospital to defraud the company and how they collude with insurance companies to alter death certificates to pay claims that should not be paid. I have watched doctors leave patients to die because they could not pay deposit and laboratory technicians send me forged result of tests I paid for but he did not perform. In Aba, a private Radiographer once sent me a result of ultrasound test saying that he saw hepatitis in the patient’s liver. The rot in the healthcare industry in Nigeria is as bad as the politics of Nigeria. Many Nigerian doctors get away with practices which would earn them prison term and serious sanctions from their professional body in developed countries.

I still remember in February, 1995, a patient who was left to die in the back ward of a mission hospital in Aba. A doctor had performed a bad caesarean operation which left her with complications. One of the surgeons who operated on those who can pay was called to help her, he took one look at her and told the family there was no hope and left the poor woman to die. I understand that he is now a professor of surgery at the state university. One of the doctors who work in the hospital came to my house and asked me to help because he know the family and they came to the hospital because of him. I followed him to see the poor girl.

What I saw that day still hunts me. It was awful. A girl of about 23 years, lying on a mattress with distended abdomen stained with greenish discharge and faeces. When I saw her, I could not hold the tears and the father said to me. ‘Please doctor, just help her, she is my daughter and her husband has left her, do your best, if she dies at least you have tried’. I could not walk away. To cut a long story short, I took the girl to theatre and operated on her for seven hours. After about seven days, they were discharged from hospital and I was not told where they were sent. The man who caused the problem was afraid that I would get very popular not knowing that working as a missionary doctor for three years had damaged me for life, and I was incapable of thinking in the way he thought I was thinking. He discharged them and would not tell me where they went.

Months later, in November 1995, while working in Abia state teaching hospital Aba, on my way to the theatre, a young girl ran towards me shouting her name. I did not recognise her and then she told me that I operated on her in a hospital many months ago, all I could say was, so you survived. I asked her, what she was doing in the hospital, she told me that a surgeon in the teaching hospital closed the colostomy I gave her and that the family owed the hospital 30,000 thousand Naira and she was working as a cleaner to pay off the debt. Tears filled my eyes and I could not hold them any longer. That day, I decided could not survive in Nigeria, and one year later, I left Nigeria. I was not paid a kobo for the surgery and did not ask for a kobo. I know that things have not changed much since I left. We need to have a different Nigeria to make progress, what I left behind and what I know still exist is horrible and need to change.

We cannot have a new Nigeria, if the way healthcare workers, especially doctor conduct themselves and practice their profession is not changed for good. This rot also exists amongst nurses, Opticians, physiotherapist, laboratory scientists etc.

When I was a little boy in 1970s, I developed a hernia and my father took me to Aba general hospital. After seeing the doctor, a nurse convinced my father to take me to a private hospital where the doctor charged 40 Naira to operate on me. Unknown to my father, the doctor had no formal training or experience in surgery, but pays nurses to send patients from general hospital to his clinic at number 5 Port Harcourt road Aba.

In his one flat clinic, he subjected me to the worst ordeal of my life. In his theatre, which was half of the sitting room divided with a large curtain, he put me on a couch and injected local anaesthesia into my groin. He kept injecting and poking me with a pin and asking me if it was painful. Then he made an incision in my groin and asked me to cough. I kept coughing until I could no longer muster enough intra-abdominal pressure to cough. All through the procedure, he kept asking nobody in particular, where is the sack, where is the sack. I cringed in pain. After what felt like eternity, he closed me up and admitted me to his clinic for seven days at additional cost. From that day I was in constant pain.

Few days after I was discharged from his hospital, the hernia reoccurred and he was told and he asked me to come back. I refused. I was a student at National high school Aba. I was in constant pain from entrapped nerve and hernia until 2002 when I had it repaired in London. I could not trust doctors in Nigeria. All the time I was helping others, I was in pain and needed help myself, but could not ask. This is what happens when professional destroys confidence in a profession. I once worked in a private hospital in Aba where an Indian doctor who claimed to have masters’ degree in surgery treated abdominal pain by inserting a tube into the abdomen. When I challenged him, he disappeared and never returned. Sadly, the poor lady died, before Dr Ojiabo, who still practices in Aba and I could help her. Nothing in these stories is made up. Nigeria’s healthcare delivery system needs urgent modernisation, change in attitude of healthcare professionals and better regulation.

While in medical school I learnt how little my doctor knew before he decided to operate on me. I learn how unprofessional his behaviour and practice were and that he did not really know what he was doing. I was shocked that a doctor, who could not identify the hernia sac by looking at the spermatic cord, could have the audacity to operate on a patient. After I studied psychiatry, I learnt that such boldness can only come from a person with personality disorder or criminal mind.

The current hostility between doctors and allied health professionals in Nigeria is unnecessary, it simply show how ignorant and unreasonable both are, about health care practice. There is no reason for such hostility as the healthcare profession is big enough to contain all. In fact, there are not enough professionals in Nigerian health care service sector. The problem is that the way the Nigerian health industry is currently structured and the endemic culture of corruption and dishonesty, makes each profession suspicious of the other’s intentions. What Nigeria needs is a person who understands and has experience of health care service delivery in Nigeria to reorganise the field and make clearer the sphere of influence of each profession.

The law is very clear, anybody who wants to practice medicine should go and train as a doctor and it should also hold doctor up to very high standard. The practice of medicine by allied health worker is unsafe and illegal and government must stop it. There is enough provision for them to practice their profession in the right and proper manner. People do not practice law because they work in Courts, or become engineers because they do very important work in a construction companies and allied medical professional who wish to practice medicine are either simply ignorant or criminally audacious and must be called to order. I know of many atrocities committed by some of them who play doctors because they work in hospitals. Medically unqualified professionals and ill trained doctors who practice beyond their training and experience put patients at risk and they are very dangerous. What the country needs to do is to better regulate doctors and other health care professionals to stop them exploiting and taking advantage of patients. Health care profession needs to be better regulated in Nigeria and this is very easy to do.

What the government needs to do is address the issue of how health care service should be paid for in a very sustainable manner that ensures every Nigeria have access to good health care when they need it. This is very easy to do, if the government is serious about the health of Nigerians and I hope that the president will address this in his transformation agenda. Nigeria is not beyond hope, but the problem does not need kid gloves.

Happy New Year!

E O Eke is qualified in medicine. At various times he has been a General medical practitioner, Medical missionary, Medical Director and senior medical officer of health in Nigeria. He specializes in child, Adolescent and adult psychiatry and lives in England with his family. His interest is in health, religion philosophy and politics. He cares for body and mind.