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LUTH as ageing hospital in dire need of funding, refurbishment

By Chukwuma Muanya, Stanley Akpunonu and Adaku Onyenucheya
27 December 2018   |   4:25 am
The imposing medical facility lies between Idi-Araba, Surulere and Mushin. The Lagos University Teaching Hospital (LUTH) Idi-Araba is the foremost tertiary hospital in Lagos State.

The imposing medical facility lies between Idi-Araba, Surulere and Mushin. The Lagos University Teaching Hospital (LUTH) Idi-Araba is the foremost tertiary hospital in Lagos State. It serves as the last resort and referral for all disease conditions. It is believed that if a medical case could not be treated at LUTH then the situation is hopeless. The only other teaching hospital of repute in Lagos is the Lagos State University Teaching Hospital (LASUTH) Ikeja.

LUTH was established in 1962 to care for all-inclusive medical needs of Nigerians and has earned a reputation as the leading health care provider in the country, going by statistics of patronage.

Flooding and drainage problems
But a sore point is the perennial flooding and drainage problem at the main entrance of one of the first generation tertiary or rather teaching hospitals in the country.

The situation makes it always very difficult for motorists passing through or accessing LUTH especially during the rainy season. Little wonder the other gate that is supposed to exit motorists from the hospital is now permanently closed. Commuters are made to use only one gate for entry and exit.

There are also other two gates: one by the College of Medicine University of Lagos (CMUL); and another leads into Mushin.

LUTH, one of the most sought in the country, recently has been deserted. Many would think it is all about the unending series of industrial actions always disrupting the institution or the lack of trust in public hospitals.

When The Guardian visited the institution on Monday December 27, 2018, entering through the CMUL, the sight to behold was a dump of refuse along the street leading to the gate. One may think it is not part of the hospital but as a health institution charged to save and preserve lives, the environment should be void of factors that can predispose one to any ailment.

Entering through the College gate, a map is stationed to guide and direct visitors around the facility with the team of security under their shade always willing to be of help.

During the visit, the ever-busy LUTH was like a shadow of itself, the waiting section that houses the patients’ relatives was empty and littered, as one would think of the level of deterioration the health sector has undergone.

Strolling through the LUTH gate, you cannot help but admire the serenity and aesthetics of the environment with tall palms structurally planted to give it a breathtaking view as if one would even get better with tranquility of the place.

Going by the activities of LUTH, all clinics run on Monday, patients troop in to see consultants and experts of all sorts. But could the festive season account for the desertion of the country’s most sought hospital? Or could it be the lingering strike by the Association of Resident Doctors (ARD), LUTH chapter?

Of course, no admission is ongoing in LUTH because of the strike, though emergency cases are being taken care of and other skeletal activities are taking place.

One cannot help but admire how the environment is unlike a typical institution in the country – the cleaners always on standby, the few nurses and other health workers on ground neatly dressed and going about their duties with accustomed diligence.

Ageing infrastructure
As you enter through the gate, the outpatient department that houses the Accident and Emergency Unit greets you. The three-storey building has a fleet of stairs and a lift that rarely works. The Accident and Emergency Unit is quite distinct from the other parts of the 56-year-old edifice. The unit has been refurbished while the remaining parts of the building are begging for repairs.

Close to the refurbished Accident and Emergency Unit is a public toilet in state of disrepair. The roofing and doors are worn out. The toilets are not flushing. You have to fill a plastic bucket provided therein with water to flush. However, there is a cleaner around to help.

Shut down cancer treatment centre
Some few metres after the Accident and Emergency Unit is the decommissioned radiotherapy/cancer treatment centre. The centre has been shut since October because almost all the equipment are outdated and non- functional. However, the centre is being refurbished with a promise to provide state-of-the-art cancer treatment by the second week of January. The Guardian learnt that equipment like linear accelerator (LINAC), brachytherapy machine, Magnetic Resonance Imaging (MRI), and CT scans have been procured for the centre under a Public Private Partnership (PPP) arrangement.

It was learnt that the Nigeria Sovereign Investment Authority (NSIA) formed a partnership with LUTH to upgrade the radiotherapy unit and build an Advanced Cancer Treatment Centre. With a sum of $10 million, LUTH is being re-equipped with three new LINACs, a brachytherapy machine, treatment planning system and many other facilities.

A report made public in September 2018 by the Socio-Economic Rights and Accountability Project (SERAP) revealed the “humanitarian crisis, manifestations of corruption and mismanagement at LUTH and how unhygienic conditions, severe shortages of medicines and medical supplies in the hospital and two other federal government owned hospitals in Lagos make it extremely difficult for many Nigerians to obtain essential medical care.”

Apart from LUTH, the other two hospitals covered in the report “are the National Orthopaedic Hospital, Igbobi (NOHIL), and the Federal Medical Centre, Ebute Meta (FMC).”

The report showed “a sharp deterioration in the quality and safety of care in these hospitals. LUTH, NOHIL and FMC do not have enough cancer treatment machines. LINAC, MRI and CT scan machines are not working optimally due to erratic electricity even as the hospitals do not have back-up plans.”

According to the report, “A LINAC costs about US$5 million and the six that the federal government procured for six teaching hospitals have packed up. The dialysis machine at LUTH is outdated and its functionality at the time of study was zilch. LUTH recently lost its accreditation to teach dentistry because all its five dental chairs had packed up and there is no functional dental engine available.”

The 53 pages report is titled: “Failing Healthcare: How Federal Hospitals are letting Down the Poor and Making Healthcare a Privilege rather than a Right.”

The report, presented to the media by a professor, Dejo Olowu, Dean, School of Law, American University of Nigeria disclosed that “vital medical supplies such as oxygen, diagnostic machines, dental chairs, sterilising units, burns apparatuses, were in pronounced shortage. Overcrowded waiting rooms and wards were noticeable.”

Meanwhile, just behind the decommissioned cancer centre is the diagnostic unit/radiology department that is under reconstruction and refurbishment. Half of the building housing the diagnostic unit is shut because of ongoing work. The radiology department is also being re-equipped through a PPP initiative with Messrs JNCI to provide four new X-ray machines, fluoroscopy, mammography, MRI machine, mobile X-ray machines, ultra scan machines, picture archiving machine and many more. It was learnt that the whole facility is being upgraded to make it a one-stop imaging centre.

Functional PPP arrangements
Almost opposite the diagnostic unit is a PPP arrangement that is providing diagnostic services. The private Synlab, made possible through PPP, is an ISO-certified laboratory with an international reputation for efficient and prompt services.

Adjacent Synlab is the Advanced Fertility Centre, which charges only a modest fee for In Vitro Fertilisation (IVF) services. Prof. Oladapo Ashiru and Prof. Osato Giwa-Osagie pioneered the first-documented IVF baby at LUTH, in 1989.

Just recently, seven of nine infertile women became pregnant in one cycle of infertility treatment. It was learnt that all eight endoscopes that became dysfunctional from overuse have been fully repaired in Germany and returned to LUTH for use.

Close to the diagnostic unit is the Guinness Eye Centre. The centre looks dilapidated. But just behind the Guinness Eye Centre is a newly refurbished Crystal Optics Eyeware Laboratory that houses world-class optical lenses manufacturing facility and up-to-date eye screening gadgets.

The optical centre is now equipped to get tested and be fitted with a new pair of eye glasses under an hour.
Fewer hospital beds

Not far from the optical centre are the wards with 700-bed capacity. Each ward from A, B, C, D, E, F has 120 beds. But ward B has been shut down since October 2018 for refurbishment. This means the hospital now has a maximum bed capacity of 600. Little wonder, some patients and relative complain that they were turned back from LUTH because of no bed space.

It was learnt that the management has commenced a hospital-wide renewal of its 56-year-old ward blocks, starting with the B-Block. Sources at the hospital acknowledged that withdrawing a block of 120 beds from service will create some bed constraints, but LUTH has continued to do its best by ensuring that patients are not unduly sent away. As expedient, there is a cooperation plan with LASUTH to accommodate other patients in line with world’s standard practice.

A close inspection of the reconstruction shows it is about 80 per cent completed. But the other wards look dilapidated and in dire need of refurbishment. Another major structural problem with the wards is that there is an under ground tunnel that runs the water and electric pipes, which is almost always flooded with a stench.

However, there is a specialised ward that has all the facilities of a modern hospital. But it comes at a very huge cost. The ward was established under a PPP arrangement.

Refurbished modular theatres, HIV treatment centre
Just behind the wards are the modular theatres. The modular theatres have been refurbished and now function optimally. It was learnt that the hospital now performs at least 30 major surgical procedures daily.

Besides the modular theatre, it was learnt that in the last three and a half years, the management has successfully rehabilitated the accident and emergency department, psychiatry, dental outpatient, the 44,000 gallons/hour water treatment plant, and the industrial incinerator.

Another big issue was that of the outpatient department for persons living with Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS). Before now, the patients were attended to in tents but the hospital is now building a treatment centre for over 8,000 HIV/AIDS patients. The project is at the roofing stage now.

Independent power station, water treatment plant
A major problem that the hospital seems to have permanently solved is that of epileptic electricity supply. The hospital now has an independent power station located close to the main gate. Although most of the critical departments like the cancer centre and the modular theatres have back-up generators, the independent power station now ensures constant electricity supply at LUTH.

With the 3.48-MW PPP-financed LUTH Independent Power Project, the hospital is enjoying uninterrupted electric power supply. This informed the priority accorded each of the critical areas for uninterrupted electricity; these are the operation theatres, neonatal unit, Intensive Care Unit (ICU), and each has a backup generator. Most of these facilities also have inverter backup as a third line of defence.

Another distinct feature of LUTH is the administrative building. The now old administrative building was in very bad shape. The lift to the third floor, which houses the Chief Medical Director (CMD) rarely worked. However, the hospital has completed a new administrative building and has moved into it. The new administrative block is behind the old one, faces the car park adjacent to the Hall 36. You can oversee the morgue on the terraces of the new administrative building.

The School of Biomedical Engineering, the Advanced Fertility Centre, the Interns’ Hostel Accommodation, Olikoye Ransome Kuti Children’s Emergency Building and the Infectious Disease Isolation Unit were recently completed and put to use. Similarly, the long-abandoned Road 6 was reconstructed with gutters on both sides and has been graded and in use already while awaiting asphalting, just as the Student Nurses’ Hostels and Nurses’ Seminar rooms have all been repaired and are currently functional.

Another major problem at LUTH that seems to have been solved is the provision of clean water to all the wards and departments. Now due to the importance of water to its operations and hygiene of patients and medical and health workers, management ensures that every ward, and indeed every facility is adequately catered for with potable water. This is the result of the rehabilitation of the water treatment plant where 40,000 gallons of water is produced every hour in addition to the connection to the Lagos State Water Corporation pipeline aside from the provision of borehole in locations within the hospital.

Understandably, since 1962 when it was founded, several feats have been recorded even as it strives to meet the medical needs of an increasingly growing megacity.

LUTH, like other national institutions, always has the need to upgrade its facilities towards meeting the challenges of the time to retain confidence of its teeming patients.

It is common knowledge that population growth, pressure and time impress the burden of ‘tear and wear’ on such facilities, overstretching capacities in view of decades of usage attending to the sick who daily throng the facility, both for minor and complex medical needs.

However, in spite of these challenges, LUTH is not resting on its oars by responding to mitigate the consequences of ageing facilities with the scarce and competing resources at its disposal.

Releases and utilisation of allocation
Analysis of releases and utilisation of allocation from 2015 – 2017 indicates that in 2015, 60,999,540 was appropriated and only 30,000,000 was released to the hospital and the same amount utilised. In 2016, 130,3999,724 was appropriated while 83,9996,330 was released and 83,640,290.34 utilised. In 2017, 322,700,000 was appropriated while 161,350,000 was released and 96,782,7444.67 utilised. It was learnt that in 2016 the balance of N356,040.64 was mopped up and in 2017 the balance of N64,567,255.33 has been committed to ongoing projects.

Unfortunately, LUTH is not among the teaching hospitals that are going to benefit from the N780 million appropriated in the 2019 budget. The money is for the establishment of chemotherapy centres in University of Benin Teaching Hospital (UBTH), University of Ilorin Teaching Hospital (UITH), Ahmadu Bello University Teaching Hospital (ABUTH), University of Maiduguri Teaching Hospital (UMTH), Obafemi Awolowo University Teaching Hospital (OAUTH), University of Nigeria Teaching Hospital (UNTH), University of Port Harcourt Teaching Hospital (UPTH), Federal Medical Centre (FMC) Owerri, and FMC Abeokuta.

Further analysis showed that the N50.15 billion allocated for capital projects in the 2019 budget might have technically knocked out the plans to fully refurbish LUTH to a state-of-the-art facility and execution of other projects in the sector.
Frequent strike by resident doctors

Another major problem at LUTH is the frequency of strike by resident doctors. The doctors are currently on strike. Most activities at the hospital are grounded because of the industrial action. Although the consultants and trainee doctors are available to help the vacuum created by the laying down of tools by the resident doctors is glaring.

The doctors downed tools because the hospital management has not paid their two months salary for September and October. No fewer than 646 doctors classified as non-regular staff are yet to receive salaries for the two months although other categories of staff have been paid. Those excluded comprise house officers, honorary consultants and resident doctors.

Sources at LUTH blamed the problem on “a shortfall in 2018 personnel budget on the GIFMIS platform” which uploaded N4.867 billion personnel budget to the hospital as against budget submission of N7,592 billion. The hospital is now in a dilemma on how to find N2,724 billion shortfall to meet its wage bill for the rest of the year.

Officials at the Budget Office in Abuja claimed: “There is no cash backing for this payment because budgetary allocation for LUTH has been exhausted.”

Impact of ongoing industrial action
LUTH, which used to be a beehive of activities looked like a cold cemetery yard.

Before now, patients used to troop in, while their relatives wait in their numbers at the waiting section created on the premises of the hospital, which was recently renovated.

Nobody was found at that waiting spot, which people take as their second home. Hardly would you see that place deserted as most people who brought in their patients would be found with mattresses, mats and pillows as well as clothes to cover their bodies due to the cold and mosquito bites.

But the spot looks deserted as if a miracle had happened, where all the sick are being cured. Only abandoned mats, clothes and luggage were found lying on the ground.

Coming from the entrance of the gate, you would experience the calm environment. What used to be as busy as a market looks like a graveyard .
All the departments and sections visited by our correspondent looked deserted. Maybe patients demanded they be discharged so they could celebrate Christmas at home or they want to spend their last moments at home with their families.

Even the pediatrics department was scanty, few patients were found in the wards unlike before now, where bed spaces were lobbied for just to put patients on emergency. Any one who falls sick now would even have the choice to choose whichever bed he/she wants to lie on.

The Guardian learnt that most of the patients had been discharged while the few still in the wards are the critical emergency cases.

None of the resident doctors who are on strike was seen around. Even those who are yet to embark on strike were not seen. Also, only few uniformed nurses were on duty, although the security men were on ground.

The HIV/AIDS section was deserted, the dental department, among others looked the same as if there was no life in there.

Sitting at a corner, one could count the number of people that entered and exited the hospital. The majority of those who were seen happened to be people who took the hospital as a short route to Mushin area, since part of the hospital faced Mushin.

Our correspondent who went around and observed the activities in the hospital for hours said there were not enough health workers on ground as the few seen went to their respective duty posts and not the scanty wards.

However, The Guardian learnt that a circular has been passed calling on the doctors to resume work because two months of the backlog salaries have been paid.

State of emergency in health sector
Another prominent feature at LUTH is long queues of patients waiting to be attended to and attitude of health workers including doctors and nurses.

Indeed, the poor state of public hospitals in Nigeria has been a challenge in recent years. This has made experts and observers, even members of the Senate to suggest that the Federal Government should declare a state of emergency in the country’s health sector.

Meanwhile, the SERAP report was part of the highlights of the public hearing held to provide forum for people to provide testimonies and submit complaints/petitions on allegations of corruption they encounter while accessing public services particularly in the health, education and water sectors. The research for the report was conducted between April and June 2018 using semi-structured in-depth interviews as the primary instrument for data collection.

The report read in part: “Our researchers observed that some wards have no mosquito nets. And there is no waiting area for mothers with sick babies. There is the Gynaecology ward, at which entrance a small bench that could seat about four persons was placed. Patients’ relatives occupied the bench, presumably. At the end of the corridor where the neonatal ward is, there is a similar four-seater bench, fully occupied. The bench, having been occupied, a group of people were standing. At the neonatal ward, it was the same case. A waiting room for mothers whose babies are on admission was not part of the hospital’s plan. The mothers have improvised.”

“A woman lay on the bare pavement under the staircase, taking a rest. Nearby was an area where waiting mothers had carved out as waiting area. A number of women, whose babies were on admission, were seen sitting or lying down on a mat or on the pavement. With the laid mats, sacks of clothes, plates, buckets etc. stacked against the wall and a woman washing clothes, it was clear that many a mother stay for days in this state.”

“Another nurse told SERAP, The infant incubator or neonatal incubator is a rigid box-like enclosure in which an infant can be kept in a controlled environment for observation and care. Some of the incubators in LUTH are not working. It is either the heater is bad, or the monitoring mechanisms are not working. The incubators available in LUTH have been in use for over 15 years.’

“A nurse, who has worked for four years in LUTH spoke to our researchers: ‘Some beds in different wards are too old to still be in use, but LUTH knows how to manage. Some of the available beds have become dilapidated. Some beds can cause accidents. They have beds from which patients can fall. It has really happened, and I’ve seen it happen. But they keep managing.’”

“Another medical personnel said, ‘Even bed sheets are in short supply. Patients use their wrapper for bed sheets sometimes. And when they use LUTH bed sheets, they are usually old and torn most of the time. Toilets in LUTH are centres of disease distribution. You can be sure to get urinary tract infections and the like. I am referring to the toilets in different wards.’”

“According to a senior doctor who spoke to SERAP, ‘There is poor water supply in LUTH and water is supposed to be an essential commodity, especially in a hospital. It’s deplorable to the extent that water does not run in the taps. You are seeing LUTH’s flowers and wall paints, but it is rotten inside. I will be right to say things are not working optimally in LUTH.’”

“At all the three study sites, derelict and obsolete equipment were commonplace. Most wheelchairs in LUTH are stiff and old. They are not in optimal condition. There is a poor maintenance culture. Not even the lifts are working well. One can easily get stuck in an elevator; so it is better to use the staircases. The lift in E Block is bad to the extent that they got a man to manually operate the lift when people enter and are in transit. It doesn’t even have doors anymore.”

“LUTH has its own laboratories but the doctors there prefer to refer patients to the private laboratory because private labs are considered to be more efficient and delivered results quicker.”

“16-year-old Ngozi Eze (not the real name), who was diagnosed with stomach obstruction and was referred to LUTH for an urgent surgery to avoid complications, shared his experience with us: ‘when we got to LUTH, we were told there was no bed in the general ward. We were referred to the VIP section and they said I would have to wait for about three weeks before the surgery could be done, because such surgeries are pre-booked; this was despite that my condition was critical. At the end of the day, we had no choice but to return to a private hospital where the surgery was eventually done.’”

“Another nurse at LUTH said, ‘the facilities are overstretched. To see a specialist on clinic days you have to leave your home by 4am or 5am to be at LUTH by 6.30am to join the queue early. Even at that, there are no guarantees you will be attended to.’”

“Nurses are forced to pick and choose patients to attend to. The ideal World Health Organisation (WHO) standard is five nurses to one patient. In LUTH it’s two nurses to 30 patients. In each ward, there are about 30 patients, and there are only about four nurses for each shift. In the afternoon, there’ll be two nurses, and in the night, there’ll be two nurses.”

“People are dying in service, they are not being replaced; people are resigning, they are not being replaced; people are retiring, they are not being replaced; people are leaving for greener pasture outside Nigeria, they are not being replaced. So, it has cut down the number of professionals that ought to be rendering health care service. And this has also made the management of this hospital (LUTH) to be employing professionals on a casual basis, which is actually against the provisions of the law.”

“Another senior medical officer at LUTH said, ‘LUTH is like a dumping ground for health care in Lagos. It’s usually the extreme cases that are brought to LUTH after treatment elsewhere has failed. Even if you’re rushed in as an emergency case, it’s not guaranteed that you’ll be attended to. Sometimes they’ll tell you there are no available beds unless you can afford the VIP section. LUTH is supposed to be the last hope of the common man in terms of health care. Once you come here, you’re expected to get answers. Sometimes you get answers. But there are a whole lot of challenges. Government is not paying attention to the health sector.’”

“Another nurse said, ‘There are patients that need to be bathed in the morning with hot water because they cannot help themselves. But there will be no hot water; so, we use cold water to bath them. Is it not when there is electricity that the heater will work? That is if there is heat. And you have to bathe the patient because you’re closing for the day. So, what do you do? The generators are not working.’ Sometimes, in the night, there is no light in the wards. Nurses sometimes use torchlight to attend to patients. LUTH electricity just recently improved, still electricity supply is epileptic. It’s still bad but it was worse. Before, there was no electricity at all day and night.’”

Other testimonies gathered for the report read in part: “This is a machine designed to move breathable air into and out of the lungs, to provide breathing for a patient who is physically unable to breathe or breathing insufficiently. When a patient cannot breathe anymore because the lungs are not functioning, the ventilator is used to aid artificial breathing. It’s only available in a few hospitals. As big as LUTH is, there is none. The state of health care in LUTH is deplorable.”

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