The Heroism Of Nigeria’s Altruistic Health Workers In The Pandemic
Countless wars have been fought between enemies with the winner perhaps brandishing the most terrible weapon on its visible enemy.
The victor annihilating and showing the vanquished his superiority.
These wars are between humans most of the time fighting for nothing or a wide range of things.
But when it comes to the war between humans and disease, or pandemic it is a story with a somewhat bleak ending if or when the soldiers are few.
The heroes in this story are the health workers who take care of everyone to the detriment of themselves when they lack weapons.
In Nigeria, our health frontline soldiers are on the battlefield without enough weapons and shields. In fact, the Nigerian health worker has everything working against him.
From the time they graduate from medical school, they must compete against the over 2300 annual graduates to be a part of the 60-130 selected for horsemanship in one of the teaching hospitals across the country. This is their first setup.
As it is with almost every sector in Nigeria, meritocracy is given little or no credence and the highest bidder wins a spot.
After their horsemanship, they must find a job to practice with earnings of a little over N100,000 and a N5000 hazard allowance. And if they cannot get a job, then as former Minister of Health, Dr Isaac Adewole has said, “Some will be specialists… some… farmers.”
Since the establishment of the first medical school at the University College Hospital in 1957 until March 2020, the medical field in Nigeria has been riddled with non-payment of salaries, allowances, and underemployment.
Currently, the country has 20.1 nurses, midwives, and doctors for every 10,000 people, the World Health Organisation (WHO) notes. With the advent of the coronavirus pandemic which has killed over 60,000 people globally, his plight is now even more compounded as he has to find ways to survive.
“Like a soldier who can get shot at the battlefront, just one mistake can end a doctor’s life,” a doctor who didn’t want his identity revealed, explained to The Guardian Life.
“One time, I got pricked by an HIV patient and the hospital couldn’t even provide post-exposure prophylaxis. Instead, I was advised to buy them myself,” the doctor said.
Another doctor at the Lagos Teaching Hospital who pleaded anonymity said “In general hospitals in Nigeria, you [patients] are sometimes expected to get cotton wool, gloves and spirits that the health workers have to use because there are times we don’t have it. Some of these families cannot afford these basics so I just use my money.”
If the situations are like this before the coronavirus pandemic, how can we have enough during a pandemic when the demand has far outstripped supplies?
Despite these circumstances, the Nigerian health workers in service have sworn allegiance to the Hippocratic code – a professional ethical commitment to saving lives.
One of the beneficiaries of this commitment is Commonwealth Young Person of the Year 2019 and onetime Guardian Life cover subject, Oluseun Ayodeji Osowobi.
Having returned to Nigeria from the UK and tested positive for the coronavirus a few days later, she writes on her social media platform that her stay at the Mainland Hospital (formerly Infectious Disease Hospital [IDH] Yaba was what saved her life.
“Some of the nurses would come in and encourage me, say a word of prayer with me.” Speaking to The Guardian Life, she quickly noted that not much is said of the low-level workers in the medical space.
In this regard, a nurse in a private hospital in Lagos told The Guardian Life that prayers are an important part because of the failings of the hospital to provide PPEs. “There are times the management will complain that you are wasting gloves and there are times, it is unavailable. So I make sure I wash my hands every time and take proactive measures. COVID-19 has only brought out the problems we are facing in our sector.”
These levels of staff are not alone in the stigmatisation. In a country where frontline workers are sometimes treated with disdain and suspicion, they often find themselves as victims of the highhandedness of senior health workers.
On April 8, Kazeem Salami, a professor and senior consultant of the University of Ilorin Teaching Hospital (UITH) on April 7 was sacked for hiding vital information about a now-deceased coronavirus subject- Muhideen Obanimomo, a 57-year-old UK returnee.
According to the management of the hospital, the need to self-isolate the deceased “was concealed from the frontline medical personnel at first contact in the A&E, an act that the hospital management considered unethical.”
Other times, it is the influence and connection privileges of the patient that reveals itself, “One morning at the consulting room, a patient told me about her symptoms and they were all linking to the coronavirus.
I was wearing a mask so I saw she was agitated and tried to make her comfortable only to be summoned by my superior who made a case because ‘my mask made her [the patient] feel like she had the virus’ ” a doctor told The Guardian Life.
Speaking on this, a senior consultant in Enugu opined, “Actually, it boils down to training. Most senior medical workers don’t present themselves for training with an emphasis on COVID.
“This is a pandemic that is evolving so when NCDC requests for participants to train, the intent of senior workers is to send the frontline for the training because they are sometimes not available. So when there is a knowledge gap, it will pose a problem in the way people perceive and manage the issue on ground.”
By now, it is clear that the first world countries are trying to get a grip of the virus. So far, 18 doctors have died in Italy after being infected with the virus. Spain reported that over 3,900 health care workers have become infected. Yet these are countries that have taken steps to recall retired doctors, solicit for volunteering health workers of different nationalities and pay frontline workers additional cost.
In Nigeria where there is a deficit, the government has again turned a blind eye to the problems of the healthcare sector.
Indeed, it is pertinent to note that the Health Care Fund continues to drop under the current administration. The 2020 Appropriation Bill puts the Consolidated Revenue Fund (CRF) at N10.33trillion, a shortfall of the National Health Act (2014) recommendation where “at least 1 per cent of the Consolidated Revenue Fund (CRF) shall be allocated to Basic Health Care Fund (BHCF)”. Calculations by the PremiumTimes reveals that the BHCF should be N103.3 billion and not N44.50 billion.
In a country where full-body protective gear and PPEs (Personal Protective Equipment) is largely unavailable for workers and there are unemployed health workers, it is imperative to question the intentions of the government.
In a letter dated April 5 to the Federal Government under the leadership Dr Francis Adedayo Faduyile, the president of Nigerian Medical Association (NMA), the letter which sought to dissuade the Federal government from bringing in the Chinese medical team had as its third (3) and nine (9) reasons,
“The lack of PPE (Personal Protective Equipment), grossly inadequate test kits, and test centres across the country, and the absolute lack of any form of insurance for the workforce are primordial issues begging for attention at this time.”
“In rejecting the invitation of the Chinese doctors, the NMA would instead urge the Federal Government to review and approve better welfare incentives to the frontline medical personnel. The provision of adequate personal protective equipment, opening and properly equipping more isolation centres and health facilities across the country is an excellent first step. Deploying more resources to facilitate testing as we are beginning to witness community transmission of COVID-19 is equally a better application of scarce resources. ”
Buttressing this statement, the consultant said, “I don’t think that we need the experience of the Chinese. They had a high death toll within a short space of time. Now, for the past month since we had our first gate of COVID until now we have not hit the 300-mark [at the time of writing]. It means that we have a completely different epidemiology in Nigeria compared to the Chinese. If they were coming from an environment like Nigeria, then we’d know that we have the same kind of disease process and progression so what are they coming to teach us? We are not going to learn from them.”
In defence of this action, the Director-General of the NCDC (Nigeria Centre for Disease Control), Dr Chikwe Ihekweazu told The Guardian Life, “If there is anything we have learnt from this pandemic, it is that all countries must see each other as partners. There is a lot for us to learn from the Government of China’s response to the COVID-19 outbreak. We will focus on their best practice in outbreak response activities and identify ways in which we can strengthen our current response strategy.”
Yet, our attention must be drawn to the limited number of ventilators to enable them to carry out their duties. According to Daily Trust, Nigeria, a state of about 200 million, has at least 169 ventilators. Fortunately, some concerned citizens are joining in the fight. William Gyang and Nura Jubri, are citizens who are fixing over 40 defective machines including ventilators at the University of Jos teaching hospital.
Coupled with these problems is Dr Osagie Ehanire, Nigeria’s health minister’s complete ignorance of the existence of a hazard allowance for health workers in this pandemic.
The consultant adds, “There are some states that have been struggling to pay salaries and now you are expecting the state to have isolation and treatment centres when you know that they were struggling before this pandemic. There should be a bailout fund for COVID and strict supervision to check if each state has a work plan so all states can be on the same plane implementation wise.”
However, we must commend the efforts of the NCDC in training over 3,500 healthcare workers on COVID-19 prevention and control in the last three months. Indeed, in a country where her people are not a disclosing community, the NCDC has made commendable inclusive efforts.
“A significant proportion of these are healthcare workers from private health facilities. We are working closely with the Federal Ministry of Health to set up a protocol and guidance for private health facilities to manage COVID-19 patients. While we aim to expand the case management capacity in Nigeria, we must ensure a harmonised and well-coordinated approach by the Federal Ministry of Health, for public and private health facilities,” Dr Ihekweazu said.
Service from all and by all
There is an urgent need to protect health workers in Nigeria. And the message of health workers is simple: Save us and the health sector. With the number of confirmed cases on the rise, there is a need to avoid making patients out of health workers and as Nigerians, now is the time to take our personal Hippocratic oath- to swear to protect the lives of our health workers.
However, we must ask: When this pandemic is over, will the health sector’s problems end?
**Timileyin Omilana contributed to this article.