Insight

Patients, pawns on Nigeria’s COVID-19 chessboard (1)

The outbreak of the COVID-19 pandemic has created serious challenges in the public health sector. In this investigation, JULIANA FRANCIS examines the issues

Our ordeal in public hospitals – Patients
It’s been over 40 days since Tope Asoroda was buried, leaving behind his wife, Oluwakemi and four children. Oluwakemi still appears to be shell shocked over his demise. Her eyes are puffy and red from crying. The mood in the house is mournful. She ignores the pleas of surrounding sympathisers.

Tope died at the Lagos State Teaching Hospital (LASUTH) and the drama leading to his death is still fresh in the memories of his friends and family members.
Family members blamed LASUTH for his death. According to them, Tope had a stroke, but rather than commence immediate treatment to save his life, doctors tagged his file COVID-19 and went further to place him at an isolation centre at the hospital. He died the following day.

The widow refused to speak as she wept into a soaked handkerchief. She beckoned on Daniel, her 15-year-old son, to tell our reporter how his father died.
Daniel said: “My father woke up and complained that one of his eyes was hurting him. He also said he couldn’t smell. We took him to a private hospital, but after three days, the hospital referred him to LASUTH. He was not attended to until after several hours. The doctor wrote COVID-19 on his file. He died the following day.”
Tope’s friends want to know why his file was tagged COVID-19, when no test was carried out.

Some of them argued that if Tope truly died of COVID-19, the Nigeria Centre for Disease Control (NCDC) would have visited his home and neighbours to quarantine them. They also said the referring hospital would have been shut down.
Tope’s friend, Mr. Dayo, who was among those who took him to LASUTH, described his death as a waste.
He recalled the deceased’s last journey. “On 30th of April, we were in the office, when he said he was not feeling well. He called after a day or two to say that he had a stroke. I told him that was not how strokes used to attack people. But before then, he had had issues of Diabetes and High Blood Pressure (BP).”

According to Dayo, Oluwakemi later called to say Tope’s health had not improved. Friends contributed money and moved him to a private hospital.
Dayo narrated: “When I saw him at the hospital, I didn’t like his condition. One of his eyes and head were swollen, and his mouth was tilted to the other side of his face. It was obviously a stroke, though the CT scan showed nothing. The doctor referred us to LASUTH to see a neurosurgeon, saying it could be a tumour. We got there at 11a.m., but doctors didn’t attend to him until 8p.m.

They said there was no bed space. They only attended to him after a phone call from the information minister. One of the doctors said they should take him to the stroke ward, another came to take his temperature. His temperature was high and the doctor started asking questions relating to COVID-19. I told him that Tope had a stroke and urged him to look at his medical history from the referring hospital. Tope had been inside my car for hours, inside the sun, what did the doctor expect his temperature to be? After dilly-dallying, they took him to the isolation centre there. He was the only one there. The last thing I saw before I rushed to my office was someone bringing oxygen.

He had never had a breathing difficulty; I still don’t understand why he was put on oxygen. He was put at the isolation centre and abandoned. He died because he was not given medical attention on time!”
The allegation, that some public hospitals deliberately label patients’ files with a ‘COVID-19’ tag, without requisite evidence, is fast gaining ground and as such, many patients have refused to attend public health care facilities. In addition, patients also allege that since the COVID-19 outbreak, medical personnel in public hospitals prefer to focus on those infected by the pandemic, while those with terminal illnesses are said to have been forgotten and abandoned.

Our investigation revealed that since the outbreak of COVID-19, there are rising cases of preventable deaths and health complications, due to the sudden negligence of other healthcare segments. With over 90 per cent of government’s finances and human resources focused on COVID-19, less attention on other health needs seems to be triggering depreciation in Routine Health (RH) services, Reproductive, Maternal, Newborn and Child Health (RMNCH) services, Family Planning (FP) services and Routine Immunisation (RI) services. Also, progress made against Non-Communicable Diseases (NCDs) such as malaria, polio, cancers, diabetes, and hypertension has been disrupted.

Eve, who went to the Warri Central Hospital in Delta State, to complain of toothache, after her bizarre experience, she called the COVID-19 pandemic and NCDC a scam. She said: “When I got there, they asked me if I had just returned from overseas, if I had a fever, was coughing or had difficulty breathing. I told them I only had a dental problem. They gave me a form, written ‘no travel’ and ‘COVID-19 patient discharged.’ I regretted not snapping the form with my phone. When I got to the Dental Section they collected the form from me and asked me to return in a month’s time. In fact, they asked everyone who came to the hospital that day to come back in a month’s time.”

Similarly, a publisher, Mr. Dipo Kehinde, said that last week, he took his daughter to Massey Hospital on Lagos Island, after she started having issues with her voice.
He said: “We were asked to do a series of tests. We did one at Foremost Radiology Consultants Limited in Surulere for N65,000. Within two days N100,000 was gone. We were also referred to the Lagos Island General Hospital to ENT (Ear, Nose, and Throat) Section. That one was for N25,000. But when we got there, they said the machine will not work until after COVID-19. Do they know when COVID-19 will end? Now, we have all those expensive test results, but we can’t see a doctor until we do the ENT. Luckily, two days ago, my daughter got her voice back. I started thinking: What if it has been a life-threatening ailment? There is trouble out there really! This is not the time for anybody to fall sick.”

Adanma, who uses the Air Force Base Hospital, at Ikeja, equally laments: “Every other ward, except for the General Outpatient Department (GOPD), has been shut down till after COVID-19. Before you see a doctor, you’ll do a test to confirm that your sense of taste and smell are all right. As we speak, I cannot see any consultant because of COVID-19. I have a particular health issue that I have been managing, through the help of a consultant, but now, no consultants are seeing patients. Even when you go for normal treatment, you’ll be made to go through COVID-19 screening. I had to fill a form before I could be allowed to go into the hospital. I was negative to all the questions posed. All these sections, Gynaecology, Paediatrics, MOPD, Cardiology, Orthopaedics, Eye and Dentist, have been shut down till after COVID-19.”

Mr. Sunday Ojeme’s complaint is more puzzling. He was feeling sickly, experiencing symptoms of malaria and ran to the Bola Ahmed Tinubu Health Centre at Egbeda,
for COVID-19 test.
He said: “I was asked a series of questions and my responses were written down. They also asked for my home address and phone number. They asked me to spit out and collected samples from my throat and nostrils. They promised to get back to me after a week. It’s been over six weeks now and I’ve not heard from them. I had to seek assistance from a nurse, who placed me on drip and injections. I’m fine now, but still waiting to hear from NCDC. Even if I’m negative, the right thing should have been to notify me.”

Sceptical Nigerians claim that increasing the number of supposed COVID-19 cases is a way to justify the money being pumped by the Federal Government to contain the pandemic, which they allege is being diverted.

This was corroborated by Blessing, who was present during a sensitisation exercise held for Kubwa Market women, in Abuja. Responding to the group of concerned individuals who were advising on the need to use face masks and maintain good hygiene, she said, “There is no coronavirus! Go to hospitals and tell them to stop rejecting patients. My neighbour, who suffers from asthma, almost died. He had a serious crisis and was rushed to the hospital. He was rejected and the doctors told the family to contact NCDC. If not for God, he would have died.”

Marian Imole was also rejected at the General Hospital Kubwa, as only a limited number of patients were allowed access to doctors.
She said: “I’ve been here since past 7a.m. After workers at Records Section came, they attended to a few patients and asked the rest of us to go home and come back tomorrow. Will I be here to pass through this stress if I am not sick and need to see a doctor? I was here two weeks ago because I was down with typhoid. When I came to see the doctor, he told me that the hospital management team had decided that patients would not be treated. I had no choice but to go to one of the pharmacies around town to get drugs. I came back today because I’m still not feeling well. Asking me to come back tomorrow is really annoying.”

Prompt and decisive steps saved the life of Mrs. Chris Anyanwu. “My wife was pregnant with our first child and suddenly started bleeding. She was rushed to the hospital, but nurses refused to attend to us. We also met a crowd of people shouting and crying that doctors should attend to them. We had to take her to a private clinic. She was immediately operated upon, but we lost the baby two days later. I’m glad I didn’t waste time at the General Hospital after we were rejected. It would have ended in tragedy,” her husband said.
A medical official working with the Ikorodu General Hospital admitted that COVID-19 forms were given to patients, as directed by the state government, adding that during this period of the pandemic, patients should also be treated free of medical charges. The source later revealed that although all medical case files were tagged ‘COVID-19’, to indicate that the person was treated free, it did not mean that the patient was necessarily a COVID-19 patient.

Undercover visits to some public hospitals
Our crew decided to visit some public hospitals to ascertain the truth of these allegations.
On June 15, our undercover ‘patient’ visited LASUTH, but was told it was on strike. On June 25, our patient returned to the hospital. He got there by 11a.m., but the hospital refused to give him an outpatient card. The hospital said it only attends to emergencies and he was advised to go to another General Hospital.

He said: “Many patients were at the Emergency Unit, brought by friends and family members in cars. Many of them came with referral letters but they were not allowed into the hospital building. A red tape demarcated areas where patients were allowed access. Some of the emergency patients, after waiting for hours, left in anger. The medical workers said there was no bed space and not enough doctors. Nurses came out repeatedly to warn tired patients to be extremely careful, that the rate of those being infected at LASUTH was very high. Some of the patients were seen making frantic calls to people they know, working in the hospital to come and fast-track things for them. A woman, who said that her husband needed urgent surgery, had been waiting to see a doctor at the surgery Emergency Unit since 7a.m. When she spoke with me, it was past 2p.m. There was no doctor to attend to her husband, despite his referral letter. Doctors and nurses are scared because of COVID-19 that is why they abandon emergency patients for hours, causing many deaths.”

On June 16, we visited the Igando General Hospital and collected an outpatient card for N500. Toll numbers were given on a first come basis. Our reporter’s number was Batch 3, number 7. Nurses and doctors were heard complaining that their colleagues were being infected by the virus. The hospital started attending to patients by 9:30a.m. A nurse first came out to address the patients, asking them to observe social distance and fill a form. She also told them that if their ailments were not severe, they should state their health issue and the doctor would tell them what to do.
On June 20, our reporter went incognito to Warri Central Hospital, Delta State, to complain of severe chest pain. He paid N500 for his outpatient card.
He was referred to an office, where he was asked to wait for the doctor.

He said: “When I was called, the doctor started asking me questions related to COVID-19. He asked if I had a cough or respiratory challenges. As he was talking, he wanted to start filling a form, but I told him that I didn’t come to the hospital because I had COVID-19. I told him that in spite of my chest pain, I could still fill a form. The doctor said that I should respond to his questions, so that he would know how to handle my case. I repeated that I had chest pain. He refused to give me the form to fill and called a nurse to walk me out.”
Our reporter went round the hospital to investigate further and learnt that most patients have allegedly stopped going to the hospital because of the COVID-19 forms.
He added: “I also learnt that before, they used to give the forms to patients, but when it started generating problems, doctors started to fill them on behalf of the patients. I also learnt that if you have symptoms of COVID-19, they take the person to the isolation centre.”

On June 22, we went to Apapa General Hospital. It was raining. Things were different because of COVID-19. Before, patients were allowed into the hospital building to be attended to by nurses and doctors. But on that particular day, patients were kept outside, under a canopy, inside the rain. The hospital, which used to be full of patients, had fewer patients. Before attending to our reporter, he was asked questions relating to COVID-19 symptoms.
On June 23, our reporter went to Lagos State University Teaching Hospital (LUTH), Idi-Araba, Mushin and Isolo General Hospital, and discovered that due to COVID-19, there was a 100 per cent increase in service fees, drugs and lab tests. These are hospitals primarily established to attend to the healthcare of the poor masses.
Also on June 23, another reporter went to the Diette Koki Memorial Hospital, Yenagoa, Bayelsa State, posing as a patient. It was discovered that the virus has also affected the number of patients doctors see on a daily basis.
An official told the ‘supposed patient’ that the hospital has a certain number of patients it attends to everyday and that the reporter came late. This was even though she got there by 8a.m. The nurse snapped: “You want to see a doctor at this time, come back tomorrow! We have exceeded our number for today. You can come back tomorrow. If you are not able to be among the 50 people for the day, the doctor will not see you. Before 7:30a.m. every day, the 50 patients are complete. If you come here by 8a.m., you won’t be seen by any doctor. If you are here for an emergency, you go to the Emergency Unit. We are doing this because of coronavirus.”

At the Isolo General Hospital, Lagos, the outpatient appointment card which used to be N500, is now N1,000. However, patients were attended to.
At LUTH, patients were told to wait outside for a doctor to ascertain the nature of the health complaint, before entry is allowed into the hospital. The hospital said it wouldn’t attend to any case, unless it was an emergency. Our reporter was also attended to outside, with a doctor asking a series of questions. Satisfied our reporter didn’t have COVID-19 symptoms, he was asked to go to the Records Section, which was on the third floor. However, the Record Section, where outpatient cards are usually given, was locked. A nurse said the hospital only attended to sick staff members. The nurse added: “We’re not attending to patients. You can come back in the first week of July. We’re following management’s directives. We can’t attend to anyone until further notice.”
A frustrated patient, Mr. Nelson, who our reporter met at the hospital, fumed: “I was referred to LUTH because of my heart problem. Must I have symptoms of COVID-19 before doctors will attend to me? It’s unfortunate that nothing ever works in this country.”
Another patient, Mr. Kenneth Dike, at Isolo General Hospital, who thought he was speaking with a fellow patient, lamented: “I’ve spent more than I expected because I believed it would be cheaper in a government hospital compared to a private one. We now pay through our noses in government hospitals.”
Mr. Akpan, a patient with liver problems, said he had been coming to the Isolo General Hospital for over three weeks.

He said: “I’m tired! Every doctor I’m assigned to, tells me to go for a test. I have been pushed from one doctor to another, with each recommending tests. I have spent over N100,000 on laboratory tests and drugs within three weeks in the hospital and yet my health is not improving.”
On June 24, our reporter was at the Gbagada General Hospital. He was refused an outpatient card because he got there by noon. The following day, he returned to the hospital. He got there by 9a.m., but again, workers at the Record Section refused to give him a card.

He was told that to see a doctor, he should be at the hospital between 5a.m. and 7a.m.
He was also told the hospital has a certain number of patients it attends to every day. Our reporter and other patients were asked to go to any nearby health centre.
A source at the hospital said: “Patients rushed to the Emergency Unit here are dying on a daily basis because they are not allowed into the hospital. They leave them outside after checking their vital signs. When they are rushed into the premises, they stop them right there and subject them to a series of questions. They leave them there for hours. Many of them are referral cases. They die outside there, waiting for doctors to attend to them.”
On that particular day, a lady, who was rushed to the Emergency Unit the previous evening, died outside. But pregnant women and children were being attended to.

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