CONTINUED FROM LAST WEEK
In this concluding, JULIANA FRANCIS writes that cases of coronavirus have continued to create serious challenges in Nigeria’s public health sector
On June 24, our reporter visited the Lagos Island Maternity Hospital. He got there by 10a.m l. and by 11a.m., a doctor had attended to him, after asking him if he had a cough, fever or difficulty in breathing.
We have to protect ourselves -Health workers
Patients are not the only complainants. Medical personnel also have their challenges. They say they are understaffed and overworked. They also complain that their colleagues are being infected. A doctor working with the Lagos University Teaching Hospital (LUTH) expressed anger over patients’ accusations of non-attendance.
He said: “It’s not as if we’re not attending to patients. Normally, we see a lot of patients in a day but because of COVID-19, we’re trying to maintain social distancing. Before, we used to attend to 100 or 200 patients in a day but now, we have reduced the number to 50 patients.
If the health issue is not an emergency, please stay at home, so you don’t get infected! “Some people get exposed at hospitals. But we’re still attending to patients; our wards are full, while so many hospitals have been shut down. Hospitals are referring their patients to us. Is LUTH the only facility in Nigeria? Everyone keeps coming with referrals. We too need to rest! We have families! We are short-staffed. We attend to most of our health workers now, they have been exposed, and they have COVID-1.
They contracted the virus in the name of treating people. Patients should go to other hospitals too. Government has not paid hazard allowance. We cannot come and die because of people.” Reacting to allegations that patients’ files are tagged COVID-19 for some unfathomable reasons, the doctor said: “I wouldn’t know about other hospitals, but here in LUTH, we don’t tag patient files COVID-19. It is when they test positive, they are tagged COVID-19.” It was because of the challenges faced by the medical personnel that doctors, at state-run hospitals, on June 15, 2020, embarked on a strike.
The complaints ranged from poor welfare to inadequate personal protective equipment (PPE). Since the outbreak of the virus in Nigeria, according to the Nigeria Centre for Disease Control (NCDC), more than 800 health workers have been infected. The National Association of Resident Doctors (NARD), which constitutes more than 40 per cent of Nigeria’s doctors, complained that many health workers have died due to lack of proper equipment. Strikes by medics are common in Nigeria, where the health sector has been underfunded for years.
The country has over 200 million people and 75,000 doctors. Among those doctors, at least 33,000 have left the shores of Nigeria for greener pastures, while 42,000 are now in the country. Indeed, among the 42,000 left, many have gone into businesses and politics, leaving roughly 35,000 to handle the 200 million Nigerians. In Lagos State alone, there are over 21 million people, to be handled by 2,000 registered doctors. The NARD President, Aliyu Sokomba, disclosed that 10 medical doctors have died of coronavirus.
In Lagos State hospitals, as at June 20, over 90 nurses had been infected and one death recorded. The President, National Association of Nigerian Nurses and Midwives (NANNM), Abdulrafiu Alani Adeniji, said nurses exposed and tested for the virus are 2,130, while those that tested positive are 220. Death across states is six. It was also gathered that workers at Record Sections are majorly infected in most hospitals.
The General-Secretary, Association of Community Pharmacists of Nigeria, Lagos State branch, Mr. Jonah Okotie, disclosed that nationwide, six pharmacists have been infected, but no death recorded. A nurse at the Ikorodu General Hospital said the hospital management did not provide workers with PPE and complained of staff being under pressure. She said: “We were given nylons to cover ourselves and a pair of gloves each for all nurses to work from 8a.m. to 4p.m., risking our lives in order to take care of patients. We are overworked and under a lot of stress. During the lockdown, we looked for means to get to work.
Some weeks ago, two of our nurses were exposed to a COVID-19 patient in the hospital. The patient came in lying; when she started showing symptoms of COVID-19, she changed her story and told us she had just returned from overseas. We isolated the patient, but before then, a lot of staff had come in contact with her, without adequate protective equipment. We need help so that we as caregivers do not become COVID- 19 patients.” Reacting to some of the allegations, the NARD President, Sokomba, said he has never heard of patients’ files being tagged COVID-19.
He said: “I’m hearing this allegation for the first time. What do hospitals do with these forms? First, you need to undergo the process that leads to diagnosing COVID-19. It involves processes, so if the doctor had reasons to suspect the patient should be tested for COVID-19 and gave out a form and later felt there was no need, and collected the form, I don’t see the cause for alarm. Ordinarily, if Nigeria was a rich country, everyone should be tested for COVID-19. You ask a physician to tell you what is wrong with you, he asked you to go through a test and you’re complaining.
I don’t understand what the big deal in testing for COVID-19 is. Why are people scared? If you go to hospital, get tested and treated, the outcome will be good. The people that have problems are those that get to hospital late. “If a patient was given the form and it was later taken, it means the doctor who saw him or her had evaluated there was no need for COVID-19 testing.” When Sokomba was told some patients had argued the forms and numbers were used as a scam to inflate the number of COVID-19 cases, which NCDC presents to the country every day, he laughed and said it was not possible.
He explained: “Let me tell you how those things work in hospitals. The doctors that see patients, do it based on experience and expertise. They then take a decision and send it forward. The next doctor that sees the patient is usually senior to the first. The senior doctor will decide whether to overrule the first doctor’s concern or confirm it, and work on it.
The first doctor is likely a general practitioner, who then sends the patient to a particular department due to his complaint. If the next doctor feels there’s no need, he attends to him, but for the COVID-19, the patient is discharged. “Let me make one correction, it is NCDC that does testing. Maybe some hospitals will want to use the form and give it to the state government. The NCDC doesn’t deal with forms, it only asks for samples. It is NCDC that gives hospitals results, but hospitals can use the form and send them to the government that they have this number of people.
“Look at it this way, if I want to fill any form and claim COVID-19, in order to use it as a scam to make money, do I need anyone to fill the forms for me? I can just fabricate names and numbers. I have the forms, they are with me. I can fill 1,000 forms myself; it is not as if patients’ passports are attached to the forms. If it was for a scam, hospitals or doctors wouldn’t need patients to do that, they can fill all the forms themselves. After all, nobody will go to hospitals to verify the names or identities of the patients.”
Further reacting to allegations that some patients, especially the terminally ill, are being neglected because of COVID19, Sokomba acknowledged it, but said things would be different soon. He said: “Weeks ago, there was a circular to all hospitals, to operate fully and take care of both COVID-19 and non- COVID-19 patients. I want to believe this allegation is an old one, when there was restriction of movement. I think with time, everything will go back to normal. I don’t think there is any health care that is under lockdown anymore.”
The Chief Medical Director of the Warri Central Hospital, Dr. Paul Okubor, insisted the COVID-19 forms have nothing to do with a patient being COVID- 19 positive. It also has nothing to with scam or escalating NCDC positive cases in order to defraud the Federal Government.
He explained: “There are no forms written COVID-19 that are given to patients. But as part of our COVID-19 preventive protocols, every patient who comes into the hospital, goes to the ‘Trial Centre.’ At that centre, the patient will be asked questions.
The questions help doctors to place patients into various COVID-19 groups. For instance, someone who is coughing, has fever and sore throat is at high risk of COVID-19. If from the checklist, the doctor thinks he or she is at high risk of COVID-19, it will be documented in the form, so that the next doctor will see that such a patient is one, he should prepare adequately to see in terms of going the extra mile to protect himself or herself.
Every doctor wears a face mask while seeing patients and maintains appropriate distancing, but if he has to see a patient that has fever and is coughing, plus other symptoms suspicious of COVID-19, then the doctor has to wear protective gear.”
Okubor said that the only way for a doctor to know high risk patients, is for those at the Trial Centre to write something on the form, which will be taken to a particular department for the next doctor. He added: “This doesn’t mean the patient, who was given a form, has COVID- 19. COVID-19 diagnoses are made only after testing.” Okubor added that asking questions to know their high risk group is a global standard protocol.
Terminally ill patients in shadow of COVID-19
The Chairman of Sickle Cell Aid Foundation, Shira Local Government Area, Bauchi State, Muhammad Kafi Liman, lamented that the shortage of blood bags, high cost of drugs, and other sundry issues are affecting sickle cell patients as a result of inter-state border closures then. According to him, the lockdown, precipitated by the COVID-19 outbreak worsened the condition of sickle cell patients. He said: “The lockdown has affected us by putting our lives at risk and making us live in constant fear over the nonavailability or shortage of palliative drugs for sickle cell anaemia.
It has also led to a shortage of nutritious food necessary for the production of red blood cells. The government and other stakeholders are taking drastic measures to contain the spread of COVID-19 without taking us, sickle cell anaemia patients, into consideration.”
Liman argued that the government has failed to ensure the protection of sickle cell patients because of COVID-19 and also failed to create awareness and educate sickle cell patients on the effect of the COVID-19 pandemic. According to him, sickle patients, especially the less privileged, are suffering because of shortage of drugs, as the lockdown made most vital drugs become exorbitant. He said: “We used to buy a blood bag at the rate of N2,000, but with the government-imposed extended restrictions on movement, its price increased. This high cost of essential products has destabilised our lives.
The government should be sensitive to the needs of sickle cell patients. We are unable to cope.” When our reporter paid a visit to public and private hospitals and some chemists in Bauchi State some days after the enforcement of the lockdown, he noticed that the price of a blood bag had risen from N2,000 to N3,000 and N4,000 in public and private hospitals. The price of anti-malaria medicines almost doubled going by what it was before the lockdown. The President of Doctors Save A Life Foundation, Richard Okoye, said he was not happy with the healthcare delivery because of COVID-19.
He said too many sick people have been neglected, died and are dying because the health sector is no longer giving them attention. Okoye opined that the NCDC, public and private hospitals should synergise to save lives. He said: “Most deaths these days are not COVID-19 related.
Our professionals know the life+threatening symptoms of COVID-19 are respiratory distress. The person will be gasping for air. Before the onset of COVID-19, people had been having breathlessness. Breathlessness is secondary to congenital heart failure from asthmatic attack, and a number of chronic illnesses can block people from breathing properly. But today, we conclude that all people in such situations all have COVID-19. I want to call upon the honourable Minister of Health, NCDC and governors, to look into this subject. Most of our patients can no longer go to hospitals; most hospitals cannot admit them. Ever since St Nicholas Hospital was shut down on the basis of COVID-19, most private hospitals have refused to admit patients.
They tell patients to go and get papers from NCDC before they’ll be treated. Today, a prominent man died, who everyone knew to be hypertensive. The experience came, and all hospitals rejected him. He was taken back home and died in the house. It is time we changed this narrative.
It is time we looked at how these things could be reviewed.” Okoye also recounted that there was a pregnant woman in Owerri, known to be an asthmatic patient. The woman had a crisis, went to several hospitals, but none of the hospitals accepted her.
“There are a lot of sick Nigerians, right there in their homes, all afraid of coming out, fearful of being identified as being COVID-19 patients. Today, most hypertensive people can’t come out and if the heart is not pumping blood, they might have difficulty in breathing. If such patients go to hospital, they will not be assisted because hospitals will be afraid of receiving them. Hospitals have to wait to get the diagnosis from NCDC before they give attention to such patients,” said Okoye.
He maintained that shutting down private hospitals is not helping matters, because they are the bedrock of the Nigerian healthcare. “How do we save our kidney, asthmatic and patients of different chronicity that are afraid to come out today because hospitals will assume they have COVID-19? “Let the NCDC, the Ministry of Health, the governors have a meeting with the leadership of the Association of General and Private Medical Practitioners of Nigeria (AGPMP), discuss and collaborate with NCDC whereby every hospital can be instructed.
If you have an index or suspicion, you can have an isolation hall, NCDC could also get involved, go round the different hospitals, checkout a place they can recommend for isolation. Let them work in partnership, with the isolation ward available in the hospitals. “We will save the lives of most of the people that already have chronic illnesses and need some level of emergency attention,” Okoye added.
Government and public health sector
The National Coordinator of the PTF, Dr. Sani Aliyu, who lamented a drop in the quality and access to health services in the country, said health services are no longer concentrating on other health conditions. He said: “We have seen reduced access to health care, medical diagnosis for other conditions especially for the most vulnerable population like children, the elderly and those with underlying illnesses such as diabetes.
People need to be able to access care. We have been observing a steady rise in maternal and child mortality as a result of disruption of essential services. We’ve also seen mother and child health services, routine vaccinations, access to care for chronic conditions such as HIV and other treatment not being delivered in our hospitals.
We’re seeing diversions of certain drugs like second line treatment for HIV currently being used for COVID-19.” Aliyu appealed to health facilities to explore extensive precautionary measures to ensure no one is denied access to healthcare.
He said: “We’re asking health institutions to make sure they have proper access processes for people presenting with COVID-19 symptoms, they must have holding areas and screening areas so that the staff can protect themselves and at the same time be able to deliver care.
The PTF will continue to protect the lives and safety of health workers in the public and private sector. We’re appealing to the private sector facilities to make sure they have adequate PPE to protect their staff and get in touch with us if they have difficulties obtaining PPE.
We can point them in the right direction. “Hospitals are there to look after patients, hospitals are not there to turn back patients. People should not be allowed to suffer or die because of COVID-19 infection. We must not allow preventable deaths to occur in our communities simply because of COVID-19 or because we are afraid of it.” The Minister of Health, Dr. Osagie Ehanire, while speaking on NARD and its challenges, said PPE had been made available to many hospitals.
He added: “There are countries in the world where there are shortages. In fact, there was global shortage. Sometimes, it may be that the warehouse of the facilities may not give it out, I don’t know, but we are on the central side doing everything to facilitate distribution of PPE.
“We also explained that this COVID- 19 period is not a good time to withdraw services because people’s lives can be at risk. COVID-19 does not discriminate.” Ehanire also expressed disappointment over the continual rejection of patients by some hospitals.
He said: “With the question of the rejection of patients at treatment centres, that is something we have been preaching against. We have always said that the least you can do is do a trial, examine a patient and give him or her advice because if you give someone advice about what to do or where to go, it is also a medical help. That is what we expect every practitioner to do. We want the services to go on. “It is true that there has been a decline in the routine n services being offered at our hospitals, both public and private.
We want those figures to get better, in the entire mission we have entered, we have always sent people from family health and people from primary health care, to ensure that they restore and revive the problem of lack of reducing services to routine cases.”
The minister said retired health workers should come out of their retirement to volunteer. He added: “We require more efforts because doctors are working excessive hours. Some of them are doing double shifts and there are instances when patients with very serious medical challenges require many hours of a doctor’s attention. We need volunteer doctors, nurses, laboratory scientists and so on.” Due to the COVID-19 and its attendant challenges on the health sector, patients and doctors, President Muhammadu Buhari’s administration has rolled out efforts to cushion the effects of the pandemic.
The Vice President, Prof. Yemi Osinbanjo, disclosed that N126 billion of the N500 billion initial stimulus fund factored into the current budget is going into healthcare. He added: “We’ve all noted how states have risen to the challenge of the COVID- 19 pandemic and how healthcare facilities are being resuscitated, with new isolation centres and new ICUs coming up. The number of testing centres have also increased. We are hopeful that we’ll be able to sustain that momentum.”
•This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check project