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Public hospitals of anguish and sorrow

From uncaring health workers to the lack of basic amenities such as light and water, the state of public hospitals in the country is far from being conducive to patients, BUKOLA ADEBAYO reports

More than five weeks after Seyi Ogundamisi left the Surgical Emergency ward of the Lagos State University Teaching Hospital, Ikeja, Lagos, he has yet to recover from the “psychological ordeal” he experienced in the health institution.

Ogundamisi, who claimed he was in the hospital for eight days last November, noted that his admission in the nation’s foremost tertiary institution was akin to living in bondage.

Though doctors, nurses and other medics saved his life, Ogundamisi said he suffered the “trauma of his life in the cold chambers of the hospital.”

He said, “It was eight nights of torture for me and other patients. We had to endure conditions comparable to that of a prison. The only difference is that we could go and come back at will. If not, how can one explain the fact that I had to stool in a nylon bag because there was no water to flush the toilet?

“That was not all; we also did not have light for three consecutive nights. Imagine what this means for patients at the emergency unit with varying degrees of burns and wounds that needed cool air to soothe their pain and soreness.”

Ogundamisi, our correspondent gathered, sustained injuries in a gas explosion in his neighbourhood in Apapa, Lagos, which left him with burns and injuries.

In fact, when our correspondent visited Ogundamisi on his fifth day in the hospital, his wife, Tunrayo, was busy using a hand to fan his wounds.

The young woman, who was not only drenched in sweat, also looked exhausted and almost as unwell as her ailing husband.

Patients waiting for treatment at Ifako-Ijauye General Hospital, Lagos…recently.

According to Tunrayo, she had yet to catch any decent sleep in the hospital, especially as she had to stay up most of the night in order to provide the artificial air to her husband.

She added, “My sister, it has not been easy at all. We have not had light for eight hours. I have to keep fanning him, else, the heat will not let him rest. He was uncomfortable all night due to the pain and the effect of the heat on the wounds. I had to fan the wounds overnight for two days. He did not sleep for the first three days.

“I am just exhausted. I have not had my bath today because there is no water in the ward. I had to use the other one outside (pointing at the public toilet outside the ward) the first night we spent here.”

Agreed that her husband has since left the hospital, the nightmare has yet to leave the couple.

Besides the Ogundamisis, (whose real name are not used for they expressed fears of being victimised since he is still dressing his burns at LASUTH), many Nigerians, who attempt to seek assistance in many of the nation’s tertiary health facilities have sour stories of hospital life to tell.

At the Children Emergency Ward of the Lagos University Teaching Hospital, Idi-Araba, the story is not in any way different.

When our correspondent visited the Chukuemekas when their son, Ndubisi, was on admission, there was also no water flowing from the pristine white toilet in the ward.

Again, there was no light throughout the night. Children who could no more bear the discomfort of the darkness were crying, while their helpless parents tried to placate them.

Though there were air-conditioners in the ward, they were also not working that night due to the lack of electricity.

Ndubuisi’s father, Chukwuma, complained that the water and light situation had gone out of hand, and parents were making moves to contribute money to buy diesel to power the generators allocated to the ward.

He said, “There is no water since the last three days because there is also no fuel to power the generator and the Eko Electricity Distribution Company has not brought light.

“My wife has not slept or had her bath because she is the one passing the night with my son. It is when I come around that she goes to take her bath at home. From there also, she brings water that our son will use to take his own bath. The worst is that, on some occasions, the authorities even lock up bathrooms.

“The mosquitoes in LUTH have teeth. They do not allow children to sleep during the day and at night. These kids keep crying all night when the heat becomes unbearable. I do not know how sick children can sleep or get better in such an unfriendly environment. It has just been traumatic.”

However, the stories of the Chukuemekas and the Ogundamisis have thrown up some posers among stakeholders in the industry. Indeed, for many patients, the hospitals have become veritable metaphors for anguish and pain.

According to industry watchers, instead of healing homes, many of the tertiary health institutions have become torture chambers. In fact, some hold the opinion that the nation’s prisons have better conveniences and facilities than the hospitals have.

Come with torches, kerosene and candles

It is not only patients that have to endure unpalatable conditions in the hospitals. Doctors and other medics also have witnessed a fair share of this negligence and abandonment.

One of the dark lobbies in LUTH at night.

Investigations by our correspondent show that power outage has now become the norm in many public hospitals in the country.

In fact, at LUTH’s Children Ward, our correspondent saw a doctor attending to patients in the dark with torch light.

After the doctor left, the patient asked, “Why are you surprised? It is the normal thing here. They (doctors) must save lives. I have received injections with phone torchlights at night here.”

These observations, many industry watchers say, not far from the truth. Doctors in training and others attached to some hospitals attest to the fact that they carry out many surgical procedures with torch light and the one from their mobile phones in cases of emergency due to epileptic nature of power supply in the hospitals.

A doctor working at the Gbagada General Hospital, Lagos, who spoke on condition of anonymity for the fear of victimisation, said he had embarked on several procedures on patients using illumination from his mobile phone at the hospital.

He said, “What do you do when a woman in labour comes in and there is no light and the generator has no fuel? You must save that life even if it requires making use of the torch light. Imagine searching for a patient’s vein with torchlight in the dark, no matter how good you are as a doctor, you will not be 100 per cent composed.

“Yet, it is this war-like situation that we face each day. It is destabilising and demoralising when a doctor cannot do his best for the patients because their circumstances make us helpless too.”

Another doctor confirmed the development, saying he on many occasions had attended to pregnant women and accident victims in the dark due to consistent power outage at the hospital.

He added, “An accident victim was rushed here just last week. He was bleeding because of the serious injury he sustained on his knee and there was no electricity. We all quickly brought out our torches and attended to him. If, for instance, we had waited for electricity that night, we would have waited for another six hours. If we had not attended to him, the young man would have bled to death.”

Even patients are not ignorant of this development. For pregnant women to register for antenatal care at the Akowonjo Health Centre in the Alimosho Local Government Area, and the Ilasamaja Health Centre, Oshodi/Isolo Local Government Area, there is an unwritten requirement that they must produce two litres of kerosene, new torch lights and batteries as well as candles in case electricity suddenly goes off.

Strike is frustrating our service – Acting LUTH CMD

Perennial strikes by workers in health institutions in Nigeria are frustrating the delivery of medical and non-medical services, according to LUTH’s Acting Chief Medical Director, Prof. Chris Bode.

Bode also spoke on the epileptic nature of electricity supply and the complaints about poor water supply in the hospital. He said the ongoing strike by health workers was crippling medical services and dwindling resources available to maintain the tertiary hospital.

“The ongoing nationwide strike by the Joint Health Sector Unions in all public hospitals has gone on for too long. We are just doing all we can to put the place going. The idea is that we do not want to shut down totally the facility. It is not only patients that suffer during strikes, the hospital suffers too because we are not generating any internal revenue to run the facility to its full capacity.

“For one, health workers who should be seeing to the maintenance of facilities, such as water pumps, repairing nets and other services in the hospital have been on a nationwide strike for the past two months.

“When a 700-bed hospital is not functioning at full capacity, you cannot generate funds to run it when you have just 100 patients. We are only doing our best to deliver medical services so that the hospital does not shut down. If we put on a 500 KVA generator meant to carry 200-bed spaces for 20 people because workers are on strike and there are a few patients, we are running at a huge loss.

“We will look into it and put patients together in the few wards so that we can concentrate power supply in those wards,”

Besides Bode’s comments, other stakeholders say that the task of running a public health institution in the country is enormous. According to them, chief medical directors of hospitals only receive meagre subventions from the authorities, yet they are to provide the best of services to the masses.

Not only do they have to manage beggarly resources from the federal and state governments, they also have to contend with frequent industrial action from dissatisfied workers and doctors who shut down hospitals at the slightest excuse.

For instance, between July and August, doctors under the aegis of the Nigerian Medical Association were on strike over issues bordering on welfare. Shortly after the doctors came back from their two-month strike, nurses, pharmacists, radiologists, physiotherapists and non-medical personnel in public service embarked on another industrial action in November.

Two months after, workers who form the majority of the workforce in these hospitals have yet to return to work.

But reacting to the Ogundamisi’s allegation that regular water supply is a luxury at the Surgical Emergency Unit of LASUTH, the Head of the Unit, Dr. Ibrahim Mustapha, said he was not aware of the claim.

Mustapha noted that the hospital provided basic necessities, such as light and water regularly at the emergency ward except when there was a break down or a prolonged industrial action by workers in charge of maintaining the utilities.

According to Mustapha, the hospital has connected to the Lagos State Public and Private Power Project to address power outage from the defunct Power Holding Company of Nigeria.

He said, “If that happened, it must have been that there was a breakdown which would not take us more than a day to fix it. Though power supply is not regular in the country, we tackled this a year ago when we connected with the Lagos PPP project that serves Ikeja, Alausa Area and GRA. ”

Tortuous long queues

Bribing health workers so that one’s medical records can be brought to the doctor’s attention is another unwritten practice in many public health institutions.

Why is it so? The queues to see a doctor in public hospitals are not only long but also tortuous, such that patients, especially for those that reside far have to camp overnight at the hospitals in order to secure an appointment to see a doctor. For those that reside adjacent to such facilities, they start converging on the premises as early as 5am.

Segun Adetoye, an outpatient, who attends the blood pressure clinic in LASUTH, said any day he had an appointment in the hospital he would to leave his house as early as 4am in order to meet his 5am target.

According to him, any day he failed to do so, there was no likelihood that he would see the physician.

He added, “There was a day that I got to LASUTH by 6am and the hall was filled with patients. There was no seat at all because we were many. I was on my feet from 8am to 2pm. When I saw that my feet were swollen, I had to tip the record officer with N500. In fact, I initially gave her N200, which she refused. But by the time I added the N300, my elusive folder surfaced almost immediately.

“The doctor just looked at my swollen feet, checked my vital signs and said because my leg was swollen and I had high blood pressure, there was the likelihood that I had kidney disease. He then asked me to go for some tests.

“It was after I got the result that we found out that I was misdiagnosed. I did not have kidney disease. He did not even apologise for the error.”

The cold hands of nurses

In the thinking of many stakeholders, a hospital is a place where patients should meet with professionals who have empathy and sympathy. This fellow-feeling spirit, they, however, say is lacking in many Nigerian hospitals.

A nursing mother, who had her baby last February, likened what she went through in the hands of the midwives at the Ifako-Ijaiye General Hospital, to sheer “humiliation”.

She had nothing positive to say for the obstetric care she got on her day of delivery.

She said, “I got to the hospital around 7pm. I was taken upstairs and told to wait while I was in labour. I was there for an hour, crying and shivering because of the pain. The midwife that was supposed to attend to me abandoned me and was engaged in endless conversation with another nurse.

“I overheard her telling the other nurse in Yoruba, ‘See her shaking, she is catching cold. She barked at me again, ‘you had better not push until you have contractions. Otherwise, you will just injure yourself.’

“Even when I felt the baby coming, she still did not show much concern. It was the other nurse in an Islamic garb that told her that the baby was showing before she came to meet me. She kept lamenting that she had never had a delivery this messy. She said, ‘Both mother and baby are just a mess.’

“While I was praying aloud, saying, ‘God, don’t let me die here, she shouted back, ‘Eh! Look at this woman saying she is going to die. Whatever you say will happen. If you knew you could not handle labour pains, why didn’t you do a Caesarean Section?”

However, she applauded the health workers in charge of antenatal services at the hospital, even while vowing never to undergo delivery at the hospital again.

She said, “Apart from the usual bribe given to some nurses to get you to see a doctor earlier than others, the ante-natal was quite smooth because I didn’t expect much. They had a few doctors and nurses who are overworked and often exhausted.

“We had to wait for several hours just to see the doctor or have the nurses checked our vital signs. God knows I will never go there to deliver again!”

Another nursing mother told our correspondent that she still had scars to show for the bitter experience she had during her baby’s delivery at the maternal and child centre of the hospital.

She said that on getting to the hospital on the day of delivery, it took the health records’ personnel more than an hour to find her records.

“It was not until my husband bribed them that they brought out my records. It took another two hours before I saw a doctor. They said they were busy with other women in the theatre. I was just lying there in pain.

“All the while, the midwives were shouting on me to keep quiet. While she was stitching me up after the delivery, she was in a hurry. Even the doctor complained that she did a shoddy job some days later when I was still seeing blood. I had to be re-stitched. It was a very painful experience for me.”

Overhaul the training of nurses

While patients receive treatment as kings in civilised climes, many of their counterparts in Nigeria are paupers begging for medical attention.

The negative attitude of nurses who are to show compassion and care to patients is a problem that can no longer be ignored.

Observers have expressed worries that the actions and inactions of health workers, especially nurses in some public hospitals, have endangered patients’ lives.

They noted that nursing care in the country was deteriorating, warning that if there was no stop to this, more people would be dying daily.

According to consultant neurologist, Dr. Biodun Ogungbo, the attitude of nurses, who are usually the first set of professionals that patients meet, could either make or mar the hospital.

He said, “The Nursing and Midwifery Council of Nigeria has a huge task in hand to restore dignity to the nursing profession. They have to overhaul the training of nurses and make it a serious business.

“The schools of nursing need to be upgraded and restructured to deliver quality training. Some doctors should be involved in the training of nurses, both in the practical and theoretical aspects, for relevance in the work place.

“Nurses seem to have lost pride and passion for the job. The council should take a clue from other professional bodies and give the profession a facelift. Career upgrade should be encouraged among nurses, even to the PhD level (postgraduate nursing school with varying specialisation); for there is something that continuing education does to an individual. It refines you and brings about a positive change in perception and behaviour. Nurses need to be proactive and confident in their ability.”