Insight

COVID-19: Still a big challenge to Nigeria’s healthcare system

The outbreak of the coronavirus pandemic has impacted public health negatively, leaving mortality and morbidity in its wake, writes APPOLONIA ADEYEMI

Mr. Tijani Yusuf (not real name), an official of a hospitality business outfit located in Abuja, received the shock of his life during the coronavirus lockdown in Abuja. Spirited efforts he and some of his colleagues made to make a client who took ill suddenly to access health care failed. However, the failure was not because the lady who was ill didn’t get people to rush her, under emergency, to the hospital, rather, it bordered on the fear of not contracting the dreaded COVID-19. Although the sick lady was taken to five different health facilities, none of the doctors, nurses and other care workers met on duty had the empathy to care for her.

Yusuf related his ordeal in a viral video. He said: “This is Gwarinpa General Hospital; I am here with two of my staff since morning. We had a female guest, because we run a hospitality business. The lady got sick.

So, we had to take her to the hospital. “First of all, we usually report the presence of our entire guests to the divisional police headquarters, but the business lady came in and got really ill that she couldn’t stand or sit and couldn’t do anything.

“This is the fifth hospital we are coming to today. We had earlier gone to the General Hospital that is close to where our facility is. “If you look right here, she is in lying right behind me in the ambulance.

“We have to pay for every trip to the National Hospital, Abuja, Gwarinpa General Hospital and to all the hospitals we have been to today. “It was at the National Hospital that I lost my cool because in each of the hospitals we were told that there was no bed space, and even though, they could see that this lady who is in her early 60s couldn’t sit or stand; so, she is on a stretcher. “This is about 8.30 in the evening.

We’ve been up since 7 o’clock in the morning to do all that is required to be done and in each case, they would tell us: ‘there’s no bed space’. They will check her vitals and they will see that she didn’t have a high temperature.

So, it’s assumed that it was not COVID-19, but we were told to go home. “After I had finished raking and shouting, I calmed down again because we are not medical people and we can’t take care of sick people. “The sick lady obviously can’t go back to the hotel because we can’t take care of her, but here we are; we have been turned back including from the National Hospital Abuja.” Yusuf advised Nigerians to do everything possible not to fall sick.

“Don’t get sick because it’s a very crazy time to be sick in Nigeria. If you do get sick in this lockdown, you are on your own. “This is Gwarinpa General Hospital. This is where we are and that’s the lady lying there in the ambulance and this is every day in Nigeria.” Although the monologue of Yusuf sounded unreal and relates more like the scene in a movie or a drama of sort, this was a true account of a true life incident which occurred during the lockdown in the Federal Capital Territory (FCT), Abuja. Yusuf added that as he and two others who took the lady waited at the Gwarinpa General Hospital, a supposedly COVID-19 patient, who was also rushed to the hospital but denied treatment, died in the ambulance which brought him. Yet, the doctors and other healthcare staff were not moved.

It was very traumatic for the relatives of the dead. Rejection of patients based on the fear of contracting COVID-19 was not limited to Abuja; it was a national problem. Relating her experience during the lockdown back in Lagos, Adaeze, a final year undergraduate whose health has deteriorated severely in the last two years due to kidney failure, said she was rushed, on emergency, to the Federal Medical Centre (FMC), Ebute-Metta in Lagos. Prior to her arrival at the facility, she had vomited persistently for three days. By the third day, when her vomit changed from watery fluid to blood, her relations, out of fear, rushed her to the FMC.

She said: “We got to FMC, Ebute-Metta; it was on a Sunday. The officials we met at the facility said there was nothing they could do as their Radiology Unit did not open on Sundays; the only thing they would do was keep me there without giving me any treatment till the next day. We had to leave. “Thereafter, we went to Avon Medical Centre at Surulere but the facility was not open for service.

So, from there, we went to the Infectious Disease Hospital (IDH), Yaba, but the staff on ground said they did not have testing kits to check if I had COVID-19. “Consequently, they told my relations that brought me to take me to the Onikan Isolation Centre and when we got there, officials there said they don’t test people for coronavirus there; they only admit people who have been confirmed to have COVID-19. At that stage, the staff at the Onikan Isolation Centre said we should go back to IDH.

“When it became clear to my relations that we were just being tossed up and down with several excuses for not taking me in, my relations took me back home. The option that was open to us thereafter was going to pharmacies from where we got some medications.” Another traumatic experience of doctors failing to treat a sick patient was that of a petty trader whose eight-year-old daughter required orthopaedic care for pain in the femur. That event, which occurred at the National Orthopaedic Hospital, Igbobi, Lagos (NOHIL), revealed that doctors were scared of coming close to patients for fear of contracting COVID-19. According to the mother of Iyanu, who found that her daughter could not use that hand to lift a little bucket of water or to execute little domestic chores without complaining of pain, decided to take her to NOHIL. On arrival at that facility, which was in June after the first eased lockdown, she said four doctors who saw all the new cases did not use their regular consulting rooms. They had actually moved consultations with patients to in an open space within the hospital.

They stood at a safe distance from the patients from where they shouted to patients to relate the health challenges that brought them. Iyanu’s mother told the New Telegraph that after narrating the pain her daughter experienced in her femur, the doctor advised her to take the girl home and bring her to the hospital after the coronavirus pandemic was over.

She said: “The doctor said; ‘there is nothing we can do now as most out-patient activities have been temporarily suspended because of COVID-19 lockdown’. “I haven’t bothered to go back to NOHIL again for that purpose till date.” While the majority of Nigerians, particularly those who could not afford accessing care from private health facilities, criticised healthcare workers for neglecting their responsibilities based on their fear of contracting COVID-19, the doctors, on their part, have lamented that their fear of COVID-19 was real. Not too long afterwards, there were reports of many emergency patients who came into facilities and deliberately withheld information about their travel history.

After providing them the needed care, many doctors, nurses and other healthcare workers became infected with coronavirus. At the onset of the outbreak of coronavirus in the country, doctors, through the Nigeria Medical Association (NMA) under the leadership of the immediate past President, Dr. Francis Faduyile, had urged the Federal and state governments to equip frontline health workers with sufficient personal protective equipment (PPE), without which care workers would be exposed to coronavirus infection.

With the inadequate provision of PPE for health care workers, the NMA advised its members to view every medical case in the hospitals as potential COVID-19 case. Investigations revealed that the NMA position was actually the basis for rejecting patients in various facilities. Patients were advised to stay at home to prevent contracting coronavirus from hospital settings. The Chairman of Medical Guild, Dr. Oluwajimi Sodipo, blamed the government for the situation. Medical Guild is an association of doctors employed by the Lagos State government. “If we do not get the issue of testing right, we would keep on having these challenges.

“Our own position is that if somebody presents in the hospital, the coronavirus test is conducted and if it’s a COVID-19 positive, case action is taken. If it’s not a COVID-19 positive case, we treat that person.

“What is happening now is that sometimes samples are taken for weeks, the patients are in the wards and after the long wait the results are returned positive, with dire consequences for all the health workers that have been in contact with such patients.

There is also the danger of other patients that happen to be round getting infected with COVID-19. “That is why we say that the people that should come to hospitals are emergency and serious cases only,” Sodipo said. This, according to him, is to ensure tha people who come for care for minor illness do not end up getting infected with COVID-19.

On May 1, the Minister of Health, Dr. Osagie Ehanire, dropped the bombshell when he announced at the Presidential Task Force (PTF) media briefing that the total number of health workers infected with the novel coronavirus in the country had reached 113. He said: “Around six per cent of the COVID-19 cases in the country comprise healthcare professionals, with some of them working in private hospitals.” Speaking in a similar vein, the Director- General (DG) of the Nigeria Centre for Disease Control (NCDC), Dr. Chikew Ihekweazu, said the healthcare workers infected, they were not just numbers, according to him, 29 of them work for NCDC.

“They are people I know; they have families, wives and children,” he said. During all that period, the NMA, the National Association of Resident Doctors (NARD), the Medical Guild, the doctors employed by the Lagos State government, the National Association Nigerian Nurses and Midwives (NANNM), the Joint Health Sector Unions (JOHESU), among others, kept calling on both the Federal and state governments to provide adequate PPEs not only for frontline workers but for all the healthcare workers facing the risk of contracting the coronavirus.

Even the NARD commenced an indefinite nationwide strike on June 15, over failed negotiations with the Federal Government on the welfare and inadequate provisions of PPEs, among other factors.

Although, the strike was called off after the first week, after the intervention of the Governors’ Forum, there hasn’t been any significant change about the negative attitude of health workers towards the plight of patients, a factor which has led to so many preventable deaths. Sadly, emergency patients are often ignored and unattended to for several hours which most times run into days; eventually some of the patients die.

What happens is that the medical doctors, nurses, physiotherapists, among others, don’t demonstrate commitment to care for patients. Rather, most of them choose to negate their responsibilities on the usual excuse of ‘no bed space’ while many patients suffer because of the neglect.

Based on this situation, concerned individuals, the public and international organisations are now asking for how long patients would continue to languish in pain without an end to the obnoxious practice. With the recent World Health Organisation (WHO) announcement that the coronavirus pandemic would be on for the next two years, many Nigerians are now worried about this disturbing trend and now seeking measures to mitigate its impact.

New Telegraph asked the new President of the NMA, Prof. Innocent Ujah, whether doctors were right to be rejecting patients needed treatment. He said it was difficult to say that doctors were rejecting patients.

According to him, such rejection could arise from either the patients coming late to hospitals or because some of the investigations the patients request had been seen before. He added: “There is no reason at all for any doctor to reject any patient who comes to the hospital because that is not our ethics. “We are to see every patient that is there in the hospital. Unfortunately, the doctors are overwhelmed by a large number of patients with limited number of doctors. That weighs them down.

The burn-out sessions are becoming increasingly severe, but doctors have no reason at all to reject any patient treatment.” When pressed further to address this as many patients now detest seeking care in health facilities based on the ordeal they face in health facilities, Ujah said, “patients should not experience this; it is a zero option. If for any reason a patient is not seen, I wouldn’t say rejected, there are avenues in the hospital to report.

“If a patient is not seen in the hospital and there are no good reasons, such a patient should report to the management of the hospital.” Incidentally, the position of the NMA president was in line with that of the Minister of Health, Ehanire, who said it was unethical and unacceptable for medical doctors to deliberately reject and turn back patients from their hospitals without attending to them or offering necessary advice on what to do.

The minister not only threatened to withdraw the licences of medical doctors found doing that, he advised anyone who is rejected at any hospital or medical facility to write and complain to the board of such hospital, the Federal Ministry of Health (FMOH), or the state Ministry of Health in case of state hospitals. “It is unethical to reject patients who come to the hospital for treatment.

I have said here repeatedly that every person who comes to the hospital must be seen and attended to and at least, be given advice on what to do. “If you can’t do it, advise him on where to go. But to just say go, we don’t handle that, is not ethical, and it is not acceptable. “So, if that happens anywhere, you have the authority to write to the board of that hospital and lay complaints. “This is very important.

So, we do receive cases or complaints like that and we have always followed them up and in cases where it is proven that there is an infringement on the right of the patient, it is referred to the Medical and Dental Council of Nigeria (MDCN) and it is well known that they have gone as far as withdrawing licences of doctors for cases of very serious medical misbehaviour,” Ehanire said. Reacting similarly to whether patient care should be abandoned because of COVID-19, a Public Health Physician, Dr. Samuel Okerinde, said even during the COVID-19 pandemic, health workers have been patriotic and wouldn’t abandon patient care even though they are constantly being faced with myriads of challenges.

Okerinde, however, admitted that there have been a few cases where some people, including COVID-19 patients, could not access care due to lack of PPE and facilities to manage them. “In situations like these, the patients are usually referred to facilities where they could be properly managed,” he said. On whether it was possible to turn around the situation of rejecting patients care for whatever reason, Okerinde said, “changing the narrative is a possibility that would indeed require the collective responsibility of the government, the health team and the citizens; they all have a role play in changing the narrative.

“The government needs to provide responsible stewardship and leadership particularly in the area of policy implementation and healthcare funding. The government should, as a matter of urgency, declare a state of emergency in the health sector as it is currently in a state of crisis.

“They need to provide adequate funding by budgeting more to the healthcare sector.” According to the public health physician, the Abuja Declaration, which recommends that heads of African states budget at least 15 per cent of their annual budgets to health, should be implemented while the funds allocated should also be effectively and efficiently utilised and appropriately accounted for. He added that they should also ensure that all forms of leakages and corruption are blocked. Okerinde said important also is the issue of the social welfare and benefits for the health workforce.

He said: “The government should ensure that the welfare of health workers is adequately catered for. There should be prompt payment of wages, allowances and salaries of all health workers. “The government should ensure that there is provision of adequate PPEs, equipment and improve the infrastructure required by the health team to work effectively in delivering care to the patients.” On the role of health staff, Okerinde said their lives matter at this time and everything should be done to keep them safe.

He added: “The health workers should ensure they protect themselves by observing the universal safety precautions and practice infection prevention control (IPC) protocol while dealing with all patients whether COVID-19 related or not.

“They should also ensure that they remain patriotic while they continue to battle the COVID-19 pandemic. The interest of the patients must also be protected at all times while they also ensure they keep safe.”

With regard to individuals, the public health physician said, “every individual needs to take personal responsibility for their health by ensuring that they observe all rules and regulations set out by the authorities such as physical distancing, hand washing, wearing face mask, avoiding crowded places, etc. “Also, if any individual notices any symptoms suggestive of COVID-19, he should ensure that he presents at the health facility closest to him and not selfmedicate.”

However, on the definitive way forward in addressing COVID-19 and its fallout, Okerinde said discovering a potent vaccine, which will be able to prevent further spread of the virus, will help. He added: “Until this is achieved, we can only continue to live and adjust our lives to the current realities. That is, the new normal.”

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