Almost sixty years after attaining independence, Nigeria does not have a coordinated Emergency Medical Services (EMS) system. After a tour of some top public hospitals in the country, Associate Editor ADEKUNLE YUSUF reports that many Nigerians are losing their lives to injuries and illnesses that an urgent medical response would have saved
Without any inkling of what was to happen, Tuesday, November 12, sprouted into full vibrancy in Owerri, the bustling capital of Imo State. This reporter, having sneaked into the midst of forlorn figures in the waiting sections of the gigantic building housing the accident and emergency (AE) ward at the Federal Medical Centre (FMC) in the sprawling city, had kept track of activities for several hours without anyone suspecting his mission.
From burns to cuts to old people battling with breathing difficulties to patients with loss of consciousness to fits that refused to stop to life-threatening cases, the AE literally had a full plate on that sunny day – with the frenetic pace of activities almost leaving the medical team at their wit’s end. Nothing seemed to have jolted this reporter into true reality of chaotic life in the ever-busy arm of the hospital until hell was let loose. What had seemed normal all day suddenly gravitated into a scene of uproar and confusion – a bedlam of sorts.
Outside the ward, a cacophonous of voices and cries rented the air, shouting “nurse, nurse, nurse.” In their hands was Nnamdi whose body was dripping with blood. Like a scene straight from a tragic movie, it was bloody, awful, and almost hopeless. A bricklayer, the 35-year-old had accidentally slipped from the top of a multi-storey building while at work on construction site and fell on an arrow-like object that pierced through his neck – almost slithering his throat. After a closer clinical look, it was discovered that Nnamdi landed with the left lateral anterior neck on a hammer standing on the ground with its unusually long handle facing upwards. This pierced via the anterior and exited on the posterior, inflicting indescribable pain on the young man. As he was rushed into the ward, even terrified bystanders quickly broke out their hankies, wailing as they witnessed – perhaps their first jarring sight – the full depth of human pain or what could easily be written off as a gruesome death.
Not only were his chances of survival bleak; time was indeed also not his friend. But, led by the ward’s chief nursing officer, Mrs. Vivian Joe who quickly raised alarm as she spiritedly collected the restless victim, the triad team promptly rushed to the rescue. In the ensuing melee, the chief nursing officer’s neat uniform was instantly splattered with blood, but this seemed not to matter to her as the team hurriedly wheeled the dying patient into the ward. Pronto, consultants on ear, nose and throat (ENT), head and neck surgery, vascular surgeons, specialists in burns and plastics, traumatology/spine surgeons, anesthetist and theatre peri-operative experts had stormed the casualty ward.
Necessary urgent investigations were done, thanks to dutiful medical laboratory hands, who also acted promptly as the situation demanded, with 4 units of screened/cross-matched blood and results provided as fast as possible. Results revealed that the killer object passed medial to carotic vessel and internal jugular vein and lateral to the oesophagus to the trachea and vertebral column. Now in the operating suite, a mad house of sorts where the fainthearted dare not tread, more than nine top medical specialists swooped on Nnamdi as if he were the President’s son, ultimately rescuing a man who was down and, in fact, almost out. After successfully removing the wicked object that almost snuffed life out of the bricklayer, each member of the medical team that rescued him was seen beaming with triumphant smiles, saying “this man is super lucky.”
In a jiffy, he was transferred to the hospital’s intensive care unit (ICU) – like two other patients before him on that fateful day. By the time this reporter left the FMC in Owerri on November 13, the bricklayer was found to be doing very well, as doctors in the ICU said “all vitals are still stable.” That was how he cheated death, thanks to the FMC in Owerri where trauma care enjoys a pride of place in the hospital’s scheme of essential services.
But if Nnamdi, an ordinary artisan, was fortunate to enjoy the best of care when he was caught in the vortex of trauma, not many Nigerians are that lucky when the vagaries of life suddenly strike with devastating fists, pummeling them mercilessly into a situation in dire need of emergency medical services to either stay alive or give up the ghost.
Unlike the fortunate bricklayer, lack of an efficient EMS system in Ilorin, capital of Kwara State, was the big knife that tore into the fragile heart of one of Nigeria’s most illustrious journalists and playwrights (now a university lecturer in the state), cutting so deep that the wound may never heal.
Two years ago, while away in Malaysia pursuing his second doctorate degree, reports had it that his children were engrossed in the usual childish frenzy, tinkering with how to start the engine of one of the cars in the compound without the guidance of an adult.
In the ensuing state of uncontrolled excitement, what began as fun for the kids suddenly metamorphosed into a monumental tragedy that reverberated far beyond the precincts of Ilorin metropolis. Having been trapped in the car booth without anyone around to help, sustaining injuries and almost suffocated to death before help finally came, the young boy was rushed to the General Hospital in Ilorin.
Unfortunately, the emergency case could not be attended to due to lack of oxygen, which was desperately needed to revive the dying boy. He was referred to the University of Ilorin Teaching Hospital (UITH), sited many miles away.
To worsen an already bad situation, the patient was not conveyed to UITH in an ambulance that ought to be equipped with resuscitation facilities and trauma care personnel. The only boy out of the lecturer’s three children died on transit to the teaching hospital, leaving him heartbroken and traumatized.
Why harvests of avoidable deaths may not abate soon
In Nigeria, going by discreet observations and experiences of victims and their families in the course of extensive investigations for this story, the AE wards in many public hospitals can hardly meet public expectations in critical situations, thus reducing them to mini specialist nurseries for feeding the morgues. When dying patients are rushed to public health facilities, it is sometimes a herculean task for first-time visitors to locate the AE ward. This is so because the AE ward, which is supposed to be the ‘eyes and ears’ of the hospital, is usually buried in obscure corners in many tertiary hospitals.
After labouring to locate the AE ward, observations in many public hospitals visited showed that it is not unusual for dying patients to be left at the mercy of lackadaisical attitude of many health workers who don’t seem to understand the essence of life and how prompt care can salvage the situation in emergency situations. Sometimes, it may be the absence of basic things like oxygen and lack of bed space that lead to preventable death; while inability to pay is the barrier that stops patients in dire need of emergency care from accessing treatment.
Unlike in other facilities, there seems to be a conscious effort towards facilitating access to emergency medicine at the Usmanu Danfodiyo University Teaching Hospital (UDUTH) in Sokoto. It is perhaps the only teaching hospital that has a specially dedicated route and gate for ambulances or other vehicles conveying accident victims or people in life-threatening conditions to the facility; what this means is that ambulances do not have to compete with other users or workers while trying to gain entrance through the main gate. There is also a stand-by ambulance stationed in front of the ward, which was never used throughout the days this reporter observed activities discreetly in the unit in October.
But the ambience and size of its AE ward is obviously not befitting of a tertiary hospital of its age, size and standard. The attitude of workers in the section also has nothing to write home about. For example, when an old man was rushed to the ward in a rickety vehicle on Monday October 14, it took more than fifteen minutes before any medical personnel could come out to receive him, with the restless old man writhing in pains and sweating profusely in the car – a situation made worse by the harshness of the scorching sun. His son, Abubakar, and other relations that brought him had to resort to using hand fans to lessen the effect of the heat on the critically sick patient. And by the time a woman in hijab surfaced with a stretcher, it was a hectic time trying to evacuate him from the vehicle as all his family members had to join in lifting him. Yet, very close to the scene, a medical worker in white uniform was engrossed in telephone conversation, watching what was going on as he was busy speaking noisily in his tribal language for almost an hour. Similar cases of medical personnel looking the other way when emergency cases arrived were noticed in UDUTH.
Anomalies like this, however, seem not to be unknown to the management of the institution. When confronted with such cases of poor attitude of emergency workers in his hospital, Dr. Anas Ahmad Sabir, chief medical director, UDUTH, admitted that “it is an issue we have always tried to deal with among workers in the public sector generally, but we will continue to do our best to change it through training, retraining and reorientation.” He said the hospital never hesitates to apply the big stick whenever anyone is caught red-handed or found wanting, promising that management will continue to devise means to make people do what they are being paid for, including installation of CCTV cameras if possible.
As for the state of emergency ward, Buhari Abubakar, UDUTH head of public affairs unit, disclosed to The Nation that it is so because the hospital has since shifted its attention towards building an ultra-modern trauma ward to replace the old accident and emergency unit. This was corroborated by Dr. Sabir, who stated that it is with a view to serving the public better that the hospital has built a new trauma ward, which will soon be put into use. Inside the new place are triad section, resuscitation room, theatre, main ward, records section, and in-house pharmacy. While conducting this reporter round the new building, Dr. Bello Bashir, consultant general surgeon and head of the ward, said the new unit will raise the bar of emergency medical care in the hospital’s catchment areas.
At Sokoto Specialist Hospital, also in Sokoto town, there are standby small ambulances stationed around the trauma ward. The ward is also well located for easy accessibility, even for first-time users of the facility. Unlike other sections of the hospital, the AE as well as trauma wards are modern structures with amenities. Its emergency numbers are also boldly written everywhere, but the state of affairs inside the AE ward is so chaotic that it is hard for any meaningful emergency care to take place in it, as it is difficult to differentiate between victims and their families as well as care givers who crowd every section in the unit. All efforts to speak with the CMD of the hospital proved abortive, as he refused to grant audience to this reporter the moment he knew the mission through exchange of text messages on October 16.
For a first-time user, locating the AE ward in Ahmadu Bello University Teaching Hospital (ABUTH) in Zaria, Kaduna State, is like looking for a needle in a haystack. For users who enter either from first or second gate, accessing the AE in the sprawling complex is a huge task. During the time of Prof Lawal Khalid, the former CMD, the hospital scored poorly on all aspects of what make a tertiary hospital tick, at least judging from the state and condition of the buildings housing the various wards and offices to the general environmental sanitation in the facility. At the time, leaking sewages dotted several sections in the apex hospital, leaving users wondering then what was wrong with the hospital, especially the labour ward, hematology and medical laboratory.
However, with appointment of Prof Ahmed Umdagas Hamidu as CMD in May this year, workers said things seem to be getting better in ABUTH. Its AE ward, which was originally piped directly to the hospital’s oxygen plant but had broken down for years, has now been resolved. What this means is that the ward does not have to battle with lack of oxygen as it used to do under Khalid. Many leaking sewages that used to make the hospital look like an eyesore had also been fixed. But the poor sanitation issues in and around the AE ward persist; the story is not better in other sections of the hospital. That is not. As one worker disclosed, most of the items donated to the ward to make life bearable for patients have packed up. Inside the ward, life is choking and chaotic as families of patients outnumber those receiving or giving care, making the electric fans seem to be of little value.
For two days spent incognito monitoring activities in the ward, there was not a single standby ambulance on the ground, as all the patients that accessed the facility were conveyed in commercial/private vehicles. And when victims arrived, there was no time any nurse or other medical worker was seen assisting in the evacuation of patients into the AE ward; it was the driver and patient’s families that were left to carry their cross. Even when situations demanded that patients be moved to other sections of the hospital, perhaps after achieving a safe level of stabilisation, at no time was any hospital vehicle or ambulance used to achieve the purpose. Worse still, any time a patient was moved out of AE ward, it was family members and bystanders at the entrance of the ward that were always left to do the evacuation. Sometimes, it was so bad that patients that were stretchered out of the ward would be left outside for long as family members battled with how to move their loved ones into the private vehicle.
When this reporter made known his intention to speak with the management over some of these issues, the ABUTH spokesperson, through a long telephone conversation, insisted vehemently that it was a mission impossible unless this reporter produced “an official letter, which the management may decide to approve or not.” This was on October 18. However, a text message sent to the two mobile numbers of the CMD (Prof Hamidu) was replied with a phone call. He told this reporter that he was in Abuja for the annual ritual of budget defence at the National Assembly.
Left with no option, this reporter opted to meet him in Abuja the next day. The professor of Radiology, described by many ABUTH workers as “approachable and easily accessible,” advised this reporter against traveling by road, insisting that traveling by train is safer. However, by the time this reporter was in Abuja on October 19, all efforts to reach the CMD proved abortive, as he neither answered his calls nor returned them. Frustrated, this reporter decided to send him a text message that he had arrived Abuja. A message informing asking where and time to meet Prof Hamidu was merely replied: “I am back in Zaria,” by 12.50pm. Since then, all calls, text and WhatsApp messages (the last being November 28) were neither acknowledged nor replied – despite proof that he received and read the messages.
If AE ward is truly the “eyes and ears” of any hospital, it is only in the National Hospital in Abuja, built in 1999, that this expression is given a meaning. The ward, which is sparkling clean, is what first welcomes every visitor to the hospital. Its trauma centre is also in a class of its own. But when visited on October 19 and 20, the low human traffic in and out of the hospital made the facility looked like an underutilised asset – perhaps being weekend. A reply to a prior message on October 18 to the hospital’s spokesman had forewarned that nobody would be available to speak on any issues; while the CMD never bothered to respond to text and WhatsApp messages sent to his mobile number. Another visit by The Nation on November 21 also did not yield any result. It was an unhealthy blend of emotions, as workers on duty were not friendly and forthcoming with information; while the head of the trauma center was also said to be out of town.
Like ABUTH, it is also not easy to identify the AE ward in the University of Ilorin Teaching Hospital (UITH), located in the capital of Kwara State. Right from its entrance, the road network within the hospital is in an appalling condition, with broken down drainages, dirt roads that are decked with potholes and poor landscaping. Like other buildings housing the various critical sections in the hospital, the state of its AE evidently betrays the standard and expertise of its personnel, as dilapidated ceilings and cracks are visible everywhere. Also, there was no standby ambulance around and other things befitting an emergency ward in a standard tertiary hospital, as all patients that arrived and left the ward when this reporter was in the premises were conveyed through chattered cabs. It however remains the number one choice for the teeming people of the state who throng the facility whenever in need of urgent medical or surgical intervention.
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When efforts to speak with the head of the AE ward at UITH met with brick wall, the next port of call was the Kwara State Specialist Hospital, located in Sobi area of Ilorin. Unlike UITH, the Specialist Hospital does not look like a facility that is popularly used by the people, as very few people were seen in the massive compound housing a facility that had obviously seen better days. Its AE ward is a small bungalow with few workers and a small generator to power the unit. Almost everything needed in the ward was not available as families of few patients at ward were constantly sent on errands to procure whatever was needed. What looked like an ambulance van in the hospital appeared to have fallen into disuse for a long time, with flat tyres. When this reporter confronted Dr. Salamat Isiaka-Lawal, CMD of the poorly-funded hospital, she politely declined to comment or entertain questions. After conferring with her heads of units and departments, the 45-year old consultant obstetrician and gynaecologist apologised profusely, saying civil service rules would not allow her to speak about the hospital where she is the overall boss.
But for the presence of FMC in Owerri where Nnamdi was saved, events in the state suggested that its estimated 4.8 million people would have been left in the lurch; marooned completely in a situation devoid of any meaningful public resources to lean on whenever residents are in dire need of emergency medical care. As things are in a state burdened with some of the most dilapidated networks of roads, the Imo State University Teaching Hospital (IMSUTH), which was meant to complement FMC, has never lived up to public expectations – no thanks to periodic problems arising from frequent strike actions as a result of poor funding, inadequate medical equipment, paucity of medical hands, loss of accreditation and lots more.
When this reporter visited Orlu, where the facility is sited, on Wednesday November 13, IMSUTH’s premises had been overgrown with weeds; still reeling from months of indefinite work-to-rule action embarked upon by resident doctors to press home their demand for payment of arrears of 100 per cent salaries and entitlements. Despite regular spins from its management that its doctors were not on strike, every ward and unit was under lock and key – except its empty AE. Even a cursory look around the embattled facility showed that IMSUTH is a facility crying for help. Although Dr. Chukwuma Duru, CMD of IMSUTH, claimed that he was busy in an emergency meeting, he mandated a senior nurse in the ward to speak on his behalf. The ward was totally empty, leaving the two nurses on duty redundant.
But that was not all. There was also no electricity supply to the hospital or any power generating set put on when this reporter was in the premises, while the only road leading to the facility had become completely impassable for motorists. This reporter had to rely on a motorcycle to access the hailing state-owned teaching hospital. Rather than quench the feeling of despondency, visits to the Imo State Specialist Hospital, sited in Umuguma in parts of what the locals call the New Owerri, worsened it. Except in the name, there is nothing special at all in the so-called State Specialist Hospital, sited in a compound literally begging for physical infrastructural facelift. While the CMD was not around to speak with this reporter, a woman who was introduced as head of clinical services decidedly frustrated an opportunity to hear the hospital’s side of the story.
However, such anomalies are never allowed to expose the state and its people to scandals and uncertainties, as the FMC in Owerri keeps absorbing patients that would have been left stranded. Its AE ward has ten doctors who run shifts in the morning, afternoon and night, and 33 nurses with nothing less than eight nurses readily available to render services per shift. Before the ward was relocated from its previous location to a more spacious and better equipped place, it was not only limited by being short-staffed; it could only admit a maximum of 14 patients at a time (female and male) due to bed space inadequacy. Now, with the bed space constraint resolved, the AE now has separate sections for (15-bedded section) for men and (14) for women. It is supported with 50 KVA generator and solar-powered inverter to power its amenities. But Dr. Kingsley Achigbu, CMD of the hospital, said the AE is still in a temporary accommodation. By the time the new trauma centre is finally completed, he said AE will move into it because his plan is to make emergency medical care in his hospital the pride of the nation.
At Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, it is not too difficult to locate the AE, especially for users that come in through the main gate. Despite efforts to refurbish the unit, it is certainly not at the level of quality and size of a tertiary hospital expected to be the number one choice in a state inhabited by over 20 million people. On three occasions this reporter visited the ward, it was often crowded with unhappy faces of families of accident victims and those suffering from life-threatening illnesses, with many of them lacking kind words to describe the services being received in the aging hospital that is crying for refurbishment to regain its glorious past. Besides, close to 100 huge oxygen cylinders littered some corners, suggesting that the AE may not be piped directly to the hospital’s oxygen plant.
After communicating this reporter’s inability to reach the ward’s head to explain some issues during a visit, Mr. Kelechi Otuneme, Public Relations Officer (PRO) of LUTH, volunteered to help, asking that the questions be sent to him so that he would forward same to the ward’s head. That was November 26. However, despite reminders though calls and text message, there was no positive response from Otuneme. He later admitted on Monday December 2 that he had not sent the questions to the head of AE.
No doubt, it is issues such as the ones discussed above that make Nigerians to lose faith in their country’s public health facilities. Up till now, the family of Segun Ogunjobi, an electrician, has not forgiven the management of LUTH over the circumstances that surrounded the untimely death of their son in September last year. At a time he was badly in need of medical attention to stay alive, the electrician was denied admission on account of insufficient bed space in the hospital regarded as one of the country’s foremost tertiary healthcare facilities. For this, the grieving family hinged his demise not on the criminal act of the hit-and-run driver that plunged their son into coma, but on the callousness of workers at the accident and emergency ward who refused to open the gates despite ceaseless pleadings for medical help for the dying accident victim.
Segun and his friends had set out to spend the evening playing football – not knowing that fate had a wicked agenda that would send the family into mourning mood. On their way to the pitch, he was knocked down by a reckless commercial driver who sped away after hitting him. This was the beginning of his tragic end, aged 24. His friends rushed him to the Navy Town Hospital, which referred them to LUTH. However, rather than prompt medical attention, those who tried to save Segun said it was excuses galore at the AE ward in LUTH as “we were delayed because of lack of bed space.”
Tope, a brother to the late electrician, said his brother died around 10pm while receiving treatment inside the bus. “When we got to the emergency unit, we shouted for help, but nobody answered. They locked the entrance into the reception of the accident and emergency unit. We pleaded with the security guards to help us get a doctor, but they did not answer. Later, a young doctor came out to take his details and gave me a list of what to purchase, which cost N6,000. We had no money, but God favoured us with the shuttle driver, who borrowed us some money. Afterwards, I asked if we could bring him in, but the doctor said no. He said they had no bed space.
“It was inside the bus that a nurse gave my brother two drips. I held his head, while his friends held his legs and the drip. But around 10pm, he was no longer struggling; his hands and legs became cold. I told my mum that Segun was losing his energy, but she said he was relaxing. I started shouting on everybody to call the doctor. I was crying and shouting. Suddenly, blood gushed out of his nostrils and ears. He gave up inside the shuttle. I followed them when they rushed him in; I saw when they tried to revive him, but it was too late. I shed tears when they ordered me outside. Later, a doctor came out and said she was sorry because we had lost him. They caused it all; they did not attend to us on time and I want justice,” he said.
His 59-year-old retiree mother, Elizabeth, lamented that she begged and begged the doctors and nurses on duty to no avail to take her son inside for proper treatment. “They saw my son dying and did not bother. I begged till he died inside the shuttle around 10pm. After he gave up, they came to carry him and started pumping his chest. I cried and shouted at them. I told them that they were only fooling themselves because if they had listened to me earlier, he would have probably survived,” she said.
After Segun’s death, LUTH however debunked the insinuation that it is a facility where men and women lacking empathy and human compassion work. In a message of commiseration to the family of the deceased, the hospital explained why it sometimes turns down patients who are in critical need of services of its accident and emergency ward, stressing that several factors combined to make such grim occurrences inevitable. Being the foremost public tertiary hospital in a state inhabited by over 20 million people, LUTH said it is sometimes overwhelmed with a deluge of patients, which ultimately leaves it with no other option than to ask patients to wait pending the availability of bed space or be referred to any other facility when its own ward has been stretched to its maximum capacity.
Also last year, the family of Mrs. Omolara Kalejaiye was up in arms against authorities of the Lagos State University Teaching Hospital (LASUTH) in Ikeja. Reason: lackadaisical and unethical attitude of the medical personnel at the hospital allegedly led to her death. She was rushed to LASUTH for treatment in an emergency situation on December 11, 2018, but ended up meeting her waterloo in the hospital, the family said. Unlike in other hospitals where patients are routinely declined admission on account of dearth of bed space, the late Mrs. Kalejaiye, 45, was reportedly attended to on a wheelchair due to lack of bed space.
The family claimed that she died as a result of lack of attention from the medical personnel and non-provision of an ambulance in the course of her referral. It was further alleged that the oxygen and drip the deceased was placed on were removed without the family’s consent. The deceased was said to have visited her sister in the Mile 12 area of Lagos on December 7, 2018, where she slumped and was rushed to LASUTH as an emergency case. Because there was no bed space, they took her in and attended to her on a wheelchair. After procuring all prescribed drugs, she was placed on oxygen and a drip was administered to her.
It was a moment of respite – temporary one though – when the family realised that she had been revived. Trouble was to return around 12am when her treatment was stopped, as personnel on duty informed her family to take the patient elsewhere because there was no bed space. In the process, she was already removed from the oxygen and the drip, since a decision on referral had been taken without consulting the family. The LASUTH medical personnel claimed that once a patient had been referred to another hospital, such a patient could no longer be attended to. She was told that she had been referred to the Federal Medical Centre, Ebute Meta, even without any ambulance support or prior notice to the hospital. At FMC in Ebute Meta, her family received another rude shock when they were also told that there was no bed space. Again, another referral and attendant hassles stared the family in the face. But before the family could take her to a private hospital instead, she gave up the ghost. Both LASUTH and the state government only promised to investigate the matter after the husband of the deceased petitioned the authorities, alleging that it was unethical attitude on the part of LASUTH personnel on duty that led to his wife’s death.
As a practising journalist who reports health in one of the country’s leading newspapers, Abiodun Adedapo (his real name kept on his request) is familiar with tales of lamentations and regrets pervading Nigeria’s public hospitals – whether owned by the state or federal governments – and was not ready to take any risks. That is why he simply convinced his wife to register for ante-natal care in a private hospital for their second baby. The private hospital is located around Ijaiye area of Alimosho Local Government, Lagos. But the same trouble he had tried to avoid eventually assailed him when his wife went into pre-term labor in May this year. It was past 12 midnight and she was 5 months pregnant then. Without a car of his own, it was trouble galore trying to get a cab to convey his wife to the hospital where she had registered for antenatal.
Rather than prompt service, personnel on duty started running helter-skelter; perhaps unsure of what to do to salvage the situation that demanded utmost urgency. One, the doctor was the same person that was trying to put on the generator for the hospital. And for close to one hour, he was still battling with the generator while the expectant mother wife was abandoned; writhing in pain. After he succeeded in switching on the generator, the nurses and the doctor did not know what to do; they had to call the proprietor of the hospital who is a gynaecologist. That gynaecologist didn’t arrive until about two hours later.
“It was late, so we had no option than to wait in the hospital and tolerate their lackadaisical attitude. To cut the long story short, they could not rescue the baby, even though the baby was still breathing by the time of the birth. They said they don’t have the facility to make the baby survive since the pregnancy was barely five months. If they had attended to us immediately we came, the story would probably have been different, but their lackadaisical attitude made sure we left the hospital with a preterm baby that could not survive,” he said ruefully.
Another victim of Nigeria’s dysfunctional health system was Dele Agekameh, one of Nigeria’s most illustrious investigative journalists, who died in October this year at 60 after battling renal disorder for seven years. Without mincing words, his first son, Fabian, a lawyer, concluded that his widely-respected father and publisher was a victim of Nigeria’s poor health system that has killed many needlessly. “He first discovered his kidney problem sometime in 2010. At the time, he was hypertensive and had a mild case of diabetes. He went to India in 2012 for a surgery to remove some kidney stones, which was successful. However, he was advised that he might need a kidney transplant as a lasting solution.
“Later in 2012, he had to begin dialysis, which he did at least two times a week and three times when he could manage it. That routine became part of his life until he passed away by 9:05 pm on Friday, 11th of October. The previous week, he went to Babcock University Teaching Hospital (BUTH) concerning complications with blood flow during his dialysis sessions, which had been an issue for some time. He had a follow-up visit at BUTH on Wednesday, two days before he passed, during which a minor procedure was performed and he was informed of the need for surgery to clear a blockage around his neck area.
“On the morning of Friday the 11th, he proceeded to Kidney Solutions, off Adeniyi Jones in Ikeja as usual, but there was difficulty hooking him up to the dialysis machines again. A surgeon from Lagos University Teaching Hospital who had seen him in the past was summoned immediately and he performed what was considered a minor procedure at the dialysis centre before he advised that dialysis must still take place. About one hour into the session, he became too weak and medication was administered, but his blood pressure remained low.
“According to his assistant who was with him, around 5 pm, the decision was taken to transfer him to a bigger hospital. Several calls were made for an ambulance to no avail until they decided to hook him up to oxygen and transport him with his personal car. After fighting traffic to get to Lagos State University Teaching Hospital, there was another issue getting him into the emergency ward, as nurses who were finishing their shift refused to attend to him, based on the account of those with him.
“They reportedly claimed that the doctor that could attend to him was busy and they should wait. He was still in his personal car, clinging to life when a doctor went out there to pronounce him dead. The doctor, one Dr Olufemi, claimed that he died on arrival. His driver and personal assistant insist he was still responsive after their arrival at LASUTH.” The famous writer and detective reporter has since been buried on November 23 at his country home in Iviukhua, Agenebode, Edo State, amidst torrents of tributes.
A haven for cheap deaths
As grim as the pictures of probably avoidable deaths chronicled above appear to be, the reality in the country is worse by far. Due to the frequency of ghastly accidents, which have sent many to their untimely graves and left many fatally wounded, Nigerian roads have been dubbed as highways of death. According to data available from the Federal Road Safety Corps (FRSC) and the National Bureau of Statistics, Nigeria loses at least two souls to road crashes every four hours. Yearly, out of estimated 11.654 million vehicles in the country, no fewer than 20,000 are involved in accidents.
From January 2013 to June 2018, records have it that the following lives were lost to road traffic accidents: 5,539 lives in 2013; 4,430 in 2014; 5,400 in 2015; 5,053 in 2016; 5,049 in 2017; 2,623 died from January to June 2018; while 126 lives were wasted on Nigerians roads between July and September 2018. In May 2017, the FRSC Corps Marshal, Boboye Oyeyemi, said during an event in Kaduna State that there were 33.7 deaths per 100,000 people in Nigeria every year. A summary of these staggering figures shows that a whopping 28,195 Nigerians were crushed in 68 months on Nigeria’s blood-sucking highways, an equivalent of 415 lives per month, 14 persons per day, and two lives every four hours – making Nigeria one of the countries with very high road fatalities in the world.
Though staggering, the above casualty figures were by no means exhaustive, as many accident cases hardly get to the notice of the FRSC, which appears to be the only federal agency that actively monitors activities on the country’s highways, performs rescue and evacuation functions and records casualty events. Although institutions such as the police and other para-military bodies also perform some semblance of services in emergency management activities in the country, experts lament there is no synergy between the agencies in a manner that can confer the requisite accuracy and integrity on the data being churned out on road accidents. While trauma care experts believe that the number of those that sustain life-threatening injuries is often far greater than those that lose their lives in road crashes, there is a conjecture that runs among medics that many among those that eventually end up in the mortuaries could probably have been saved or not died on the scene had there existed an efficient EMS system in the country.
In the second quarter of 2018, the NBS and FRSC road transport data reflected that 2,608 road crashes occurred in the country, blaming speed violation as the chief culprit (accounting for 50.65 per cent of the total road crashes in the period under review). However, while 1,331 Nigerians got killed in the road traffic crashes recorded, a total of 8,437 people sustained varying degrees of injuries. While 7,946 of the 8,437 Nigerians that got injured (representing 94 per cent of the figures) were adults, the remaining 491 (representing 6 per cent of the figure) were children. Broken down further, data showed that 6,415 male Nigerians, representing 76 per cent, got injured in road crashes in the period; while 2,022 female Nigerians, representing 24 per cent, were also injured.
Also, in the state-by-state casualty figures released for the second quarter of 2018 by NBS and FRSC, 64 Nigerians were injured while 12 got killed in road crashes in Abia State, posting a total casualty cases of 76; 634 injured and 66 killed in road accidents in the Federal Capital Territory (FCT); 103 injured and 13 died in Adamawa State; 31 injured and 12 killed in Akwa Ibom State; 107 injured and 17 died in Anambra State; 494 injured and 59 died in Bauchi State; 40 injured and 6 died in Bayelsa State; 186 injured and 22 died in Benue State; 72 injured and 20 killed in Borno State; 32 injured and 5 killed in Cross River State; 141 injured and 36 died in Delta State; 131 injured and 14 killed in Ebonyi State; 197 injured and 40 killed in Edo State; 44 injured and 3 killed in Ekiti State; 173 injured and 28 dead in Enugu State; 172 injured and 17 killed in Gombe State; 173 injured and 23 killed in Imo State; 145 injured and 74 dead in Jigawa State; 995 injured and 180 killed in Kaduna State.
Casualty figures from other states within the same period are: 384 injured and 47 killed in Kano State; 361 injured and 57 died in Katsina State; 82 injured and 5 died in Kebbi State; 301 injured and 51 died in Kogi State; 252 injured and 53 killed in Kwara State; 241 injured and 30 killed in Lagos State; 358 injured and 36 killed in Nasarawa State; 385 injured and 75 died in Niger State; 485 injured and 72 killed in Ogun State; 323 injured and 74 killed in Ondo State; 215 injured and 22 killed in Osun State; 308 injured and 66 killed in Oyo State; 225 injured and 6 died in Plateau State; 50 injured and 5 died in Rivers State; 153 injured and 22 died in Sokoto State; 76 injured and 9 died in Taraba State; 220 injured and 16 killed in Yobe State; while 156 were injured and 38 died in Zamfara State. Therefore, for the second quarter of 2018 alone (a period of just 3 months), there were 2,545 road traffic accidents nationwide, involving 18,320 people. Of this, 8,437 were injured and 1,331 died, leaving a casualty figure of 9,768 in just three months!
Besides the carnage on Nigerian roads, the country is witnessing a growing incidence and burden of non-communicable diseases and rising wave of gender-based violence, with the media awash with reports of gory endings of these issues. Hardly a day passes without reports of people being killed in their dozens in one part of the country or the other. In a recent report, the Nigeria Security Tracker (NST), a project of the Washington-based Council of Foreign Relations, said more than 25,794 people had encountered violent deaths in Nigeria since 2015. But many believe that mind-boggling figure is understated, as there are thousands of other Nigerians who are murdered or badly injured in remote villages, but whose accounts of misfortune do not grab the newspaper headlines.
The pervasive insecurity brought about by proliferation of illicit arms increasingly primes the country for rising violence and mass killings that now envelope the land. Last year, the Civil Society Legislative Advocacy Centre (CISLAC) said that Nigeria accounts for about 70 per cent of illegal small arms in West Africa, blaming porous borders that pave ways for free flow of arms in and out of Nigeria. Another recent research said out of 857 million small arms and light weapons in the world, 500 million are illegal with 100 million found in sub- Saharan Africa. Again, Nigeria is said to account for about 7.5 per cent of that, with experts stressing that this is what is fuelling the raging insurgency in the North-East, militancy in the Niger Delta, resurgence of the menace of herdsmen and the rising wave of violent crimes, including armed robbery, banditry, cultism and kidnappings in virtually all parts of the country that regularly throw up life-threatening injuries and illnesses that require prompt medical attention.
How to improve trauma care, emergency response services
At a recent conference in Lagos on trauma care and how Nigeria can get emergency medicine right like other countries of the world, medical experts agreed that trauma has become a global public health problem, with Nigeria recording over 4 million injuries and more than 200,000 deaths annually from road crashes – a major cause of traumatic injuries in the country. It was organised by Trauma Care International Foundation (TCIF), a non-governmental organisation (NGO) actively involved in mass health, safety education, medical advocacy campaigns, and voluntary blood donation initiatives in Nigeria. Its chairperson, Dr. Deola Philips, said there is an urgent need to begin mass health and safety education and advocacy campaigns, voluntary blood donation initiatives, hospital endowment, and MEDICAID programmes in the country. This, she explained, will increase the pool of skilled first responders in emergencies.
Trauma is said to be the leading cause of death in individuals less than 45 years of age worldwide, accounting for about 5 million deaths annually. The casualty figures and impact are lower in High- and Upper Middle-Income Countries (HUMICs) and generally much higher in Low- and Lower Middle-Income Countries (LLMICs), like Nigeria, where causative factors are many and response systems weak or non-existent. The affected age group in LLMICs is particularly significant, as victims in all the age groups are mostly aspiring and upwardly mobile family breadwinners, economically viable or still approaching the most productive years of their lives. The social impact of the loss of such figures is serious, because families, especially dependants of victims, are left more or less abruptly, without economic support.
From all public tertiary hospitals visited, experts disclosed that trauma accounts for a significant proportion of surgical admissions. Road traffic injury alone is currently the 9th global leading cause of death (2.2 per cent); and is expected to reach 5th position (3.6 per cent) by 2030. In Nigeria, incidence of trauma is rising at a frightening rate, with experts disclosing that it currently accounts for more than half of all surgical emergencies. Sadly, the greatest impact of injury is said to be more on the economically productive adults, especially males. On the way forward, experts say emergency medical care financing is one issue that needs to be tackled in a sustainable way. Because the National Health Insurance Scheme (NHIS) has captured less than 5 per cent in a country of about 200 million, it leaves access to healthcare to the vagaries of out-of-pocket payment for treatment of victims, leaving many a family bankrupt and hugely indebted. This fuels ‘pay before service’ policy in most public and private hospitals, even in emergency cases, since there exists no direct financing mechanism in place to ensure long-term sustainability.
On how to achieve better emergency response system in the country, UDUTH’s Dr. Bashir, who was trained in Europe, said the work in AEs will be less cumbersome and better outcomes achieved if there is an efficient national ambulance and paramedic system in place in the country. Right from accident scenes, he said paramedics who have the right training can evacuate and resuscitate victims and radio emergency wards so that “we can get prepared even before the ambulance arrives.” In the absence of EMS, he lamented that what AE specialists battle with daily are “victims that are just packed anyhow and dropped in the hospital without any prior notice.”
This, he said, often constitutes a huge problem by the time victims arrive, though his colleagues always try as much as possible to salvage the situation. “We have to establish a system of paramedics by making ambulance available at every point on our highways. We need to have ambulances that cover a specific area. I mean ambulances that are equipped; not just ambulances by name. Those who will be there will be paramedics who are trained so that they can start medication on transit and radio in through a dedicated line. Hospitals have their own lines and governments have their own, but there is no coordination. In Europe, paramedics are trained together with doctors on trauma and life-saving and if they radio in and describe a problem, you (in AE) will know what to do before they arrive,” he said.
The consensus among medical professionals is that EMS should be made to be an essential ingredient of overall healthcare system in the country because it saves lives by providing care immediately. When trauma happens, experts say EMS will guarantee and offer proper pre-hospital treatment and handling, which reduces incidence of secondary injury. For Nigeria to move its healthcare delivery to the next level, EMS services should be available and accessible in all emergencies, led by trained specialists and anchored on a sustainable template that integrates service delivery from the point of patient collection to the nearest hospital so that the ‘golden hour’ or ‘platinum ten minutes’ that define EMS all over the world can begin to have meaning in Nigeria.
According to the National President of the Nigerian Medical Association (NMA), Dr. Francis Faduyile, having an EMS that is both functional and responsive to the yearnings of Nigerians is doable, especially if those in public offices put on their thinking caps and walk their talk. “It is doable, and something that needs to be done. It will be great if we had such speed dial number,” he said. He said achieving it requires putting in place the right investment, infrastructure, human resources and technological template that accommodates all citizens and places primacy on human life.
However, he cautioned that having the software or speed dials (such as 911 in the US or 999 in the United Kingdom) or merely buying ambulances alone cannot achieve the dream. He fears that having the software (like in the more developed countries) in place is another pressure in a country that reels under a chaotic and grossly underfunded health sector, monumental infrastructural deficit and a system of government that does not seem to prioritise public welfare. The NMA boss, who hinted that emergency medical treatment is part anomalies the National Health Act seeks to address, also faulted the implementation of the law. “Unfortunately, in the operationalization, the Ministry of Health is trying to change the narrative and trying to use that fund (earmarked for emergency care such as gunshot victims that hitherto required police permit before accessing treatment) for the purchase of ambulances, which we have condemned in its entirety. However, the problem is not about policy but about implementation. The Ministry of Health needs to come back to the pragmatic way of addressing emergency medical treatment.
“The fund is primarily supposed to take care of the funds that are expended on cases of emergency that occurs in different hospitals. We expect that there should be a protocol to access the funds by those who claim they have seen emergency cases. Unfortunately, while they are supposed to streamline that process, what we learnt is that the Ministry of Health wants to use it to purchase ambulances; having ambulances does not have anything to do with emergency. Although it is an integral part of emergency treatment, it is not the ultimate. When you buy an ambulance, you think of who operates it, servicing, fueling etc. How can one place in the FCT be controlling all the states that are in the federation? Who knows how many ambulances they will provide for each of those states? So, that is not the right thing to do,” he said.
As for the way forward, Faduyile said the right thing to do is to streamline a protocol where practitioners who have treated emergency cases can access the fund for repayment for what has been expended on emergency treatment. “The Ministry of Health needs to walk the talk and not just talk without any direction. The question is: what do we need to get? Train people on EMS? The technology is not that expensive that the Nigerian government, if it is truly interested in health, should not embark on.” As many people, especially those in their economic prime, continue to die needlessly as a result of injuries and ailments that can be managed, it is obvious Nigeria is in dire need of a functional EMS to halt the daily harvests of avoidable deaths.
This investigative report is supported by Ford Foundation and the International Centre for Investigative Reporting (ICIR).