Accessing Healthcare At The Price Of Pain

• A Tale Of Plenty Patients, Scarce Specialists
• ‘Pri., Sec. Healthcare Are Dead’
FACED with high level of poverty, only very few Nigerians are able to visit the expensive private hospitals for quick medical attention, preferring instead the cheaper alternative government hospitals offer. The situation, however, forces the ailing into choosing between the proverbial devil and the deep blue sea: unable to pay their way through the former, they must endure long, agonising wait, and the indignity of being reduced to just another number.

At the University of Port Harcourt Teaching Hospital (UPTH), the story of one pregnant woman captured what dozens of health seekers pass through on daily basis. Shifting her bulk, wearily, Agnes Nwapa leaves her home at 5.30am, and arrives at the hospital at 6.30am anxious to be among the first 30 on the queue. The effort notwithstanding, she sometimes waits till 3pm to see a doctor.

But putting the situation into perspective, the Chief Medical Director of the hospital, Professor Aaron Ojule, said: “The healthcare system operates in a tripod – primary, secondary and tertiary. The primary is supposed to take care of about 60 to 70 per cent of the patients; the secondary takes care of 15 to 20 per cent; the tertiary takes 10 per cent or less. We, in the tertiary stage, are supposed to be seeing people only on referrals.

“But that is a big challenge. The other two levels are almost dead; they are not working and you have services available at the tertiary level. Therefore, because we are working for Nigeria and the people coming are Nigerians, we cannot drive them away. So, when everybody comes to the tertiary centre, it becomes over crowded. We are concerned because it distracts our primary focus, which is seeing referrals, teaching and training.”

Managing healthcare centres in Rivers State became a challenge towards the end of former Governor Amaechi’s tenure. Many of the centres ran out of drugs. And primary healthcare workers stayed back at home for about seven months in protest over non-payment of their salaries and other entitlements. Though the new administration of Governor Nyesom Wike cleared the backlog, the primary healthcare system in the state is still struggling to stand on its feet.

Faced with high level of poverty, only very few Nigerians are able to visit the expensive private hospitals for quick medical attention, preferring instead the cheaper alternative government hospitals offer. The situation, however, forces the ailing into choosing between the proverbial devil and the deep blue sea: unable to pay their way through the former, they must endure long, agonising wait, and the indignity of being reduced to just another number.

At the University of Nigeria Teaching Hospital (UNTH) Enugu, The Guardian met a young lady. A worried look on her face, Ngozi, who did not disclose her complication, was the wiser to have made her second visit earlier than the first failed attempt. “I left home before 6.30am and was given the 20th slot. I learnt that the people who work here often write numbers for their friends.” But as at 12pm, she was still seen waiting for her turn to meet the doctor, who showed up at 10am!

“Sometimes, you get a directive from a doctor to go to one department and do something, only to be told there that there is nobody to attend to you. This means every other quest must wait until that is sorted out. And if you need blood for a dying relation, you have to first make a blood donation before you can be allowed to buy. I would happily patronise private hospitals had I the money. It is terrible!” cried Ikenna Chigbo, who had cared for his late father at the same hospital.

The situation is no better at the Enugu State University Teaching Hospital (ESUTH). Residents troop to the place, and are given numbers upon arrival, preparatory to frustrating hours of waiting. The situation here is particularly challenging, as there are fewer specialists compared to UNTH. There are also insufficient facilities. Sometimes, patients have to hang around wards until there is available bed space. The spaces between the beds are also small, restricting movement.

“I am waiting, so that they can bring my file,” said Mrs. Uche Ugwu. “I have been here since morning. They said they are looking for my folder because I lost the number on it. But I believe it is a ploy by these nurses to punish me, because they can easily use the computer and retrieve my folder number. It might mean I would have to come back another day, if they don’t attend to me today. There are many people here and my turn has passed. They did not forward my file when it was my turn and still they cannot find it.”

The influx of patients to ESUTH and UNTH is a result of the failure of district and general hospitals. Investigations showed that several general hospitals in the state lack qualified doctors and often, only nurses are left to care for patients.

The last administration in the state had introduced free maternal and child healthcare. The programme, meant to run throughout the state, however, flopped, as only ESUTH carried on with it. The district hospitals where services should have been provided lack facilities and trained manpower. Consequently, pressure has been on ESUTH.

To check the overflow, the state government demanded health seekers produce their tax clearance. The measure worked for a while but the quality of service fell, as the government could not keep pace with the provision of drugs and other facilities.

Suffering from a heart-related disease, Yusuf Danboyi, 41, a patient at the Plateau State Specialist Hospital, told The Guardian he had been scanned and diagnosed but has repeatedly tried to keep an appointment with a doctor that has not showed up.

“I am not the only person who is receiving this kind of attention. The doctor attends to two or three patients and then sneaks away. We don’t know where he goes. We would be asked to wait for him. We continue to do so until we become exhausted, hungry and have to disperse. I believe there are not enough hands to manage the patients. The solution to this unfriendly treatment is for the government to ban doctors from operating parallel and personal hospitals, so that they can concentrate. There should be a monitoring team to check the excesses and routine absence of these doctors,” said Danboyi.

Another, Patience Jolomn, 32, who did not disclose her ailment, said she has been coming to the hospital and now feels greatly discouraged because she returns every time to find the co-patients she saw the previous day still waiting to be attended.

“There are no drugs in the hospital. What the doctor does is refer you to a certain pharmacy or to his private clinic, where you would be required to pay exorbitant rates. Doctors are never blamed for this action. If they are sanctioned, they will stop the practice,” she said.

Diagnosed with cataract, Mr. Joshua Ishaku, 58, voiced his disappointment: “I went to the State Specialist Hospital as a public servant registered with the National Health Insurance Scheme (NHIS). The treatment was only fair. I had to pay for some of the services. The doctors kept saying, ‘come today, come tomorrow.’ After the surgery on my eyes, I abandoned visitation; I was tired of hearing, ‘come today, come tomorrow.’ I took the prescription to the pharmacy. They said the drugs were not available. I had to buy them elsewhere at a huge cost.”

Efforts to see the Chief Medical Director of the hospital proved abortive; he was not in the office and none of the staff wanted to speak on his behalf.

Many doctors are consultants in private hospitals that pay them well and regularly. So, they take the jobs there more seriously than they do that of the government, which sometimes may even owe the doctors several months’ salaries. The government offers free healthcare and hospital become flooded but it does not pay good salaries. There is also a shortage of manpower and funds for equipment. At the end, people blame the doctors, which is not fair.”

According to Dr. Chukwuemeka Azubuike, lecturer at the Department of Pharmaceutics and Pharm. Tech. in the Faculty of Pharmacy, Lagos State University Hospital (LUTH): “The challenges of accessing medical attention in many hospitals are the result of a number of reasons. Doctor to patient ratio is very high. There is poor management and administration, with civil service syndrome and bureaucracy. Some doctors and other health personnel also pay more attention to their private businesses.

“I think the way forward is for government to employ more doctors and other health workers. The management of hospitals should also employ effective mechanisms for monitoring and evaluation. Besides, the welfare of the health workers should be improved upon.”

By 8am, the general hospital in Ajeromi Local Government Area, Lagos State was already a sea of heads. But the long queues is a normal phenomenon, according to Olu, who seemed to have the last word on who gets a card or walks in to see a doctor.
“The queue is a normal thing, here. Being a general hospital where things are cheaper and some treatments free, you should expect to find people queuing up all day, sometimes as early as 6am.” He, however, added: “Not all wards are hit by the long queue. Optometry and dentistry have fewer people. But wards for the pregnant are always packed full because the service is free.”

A medical personnel there who chose to remain anonymous, said: “It is not that the hospital is understaffed; specialists are not being employed according to need. For example, in a hospital where antenatal care is free and eye care is not, you still find the same amount of doctors being employed. The government should get more specialists in wards with large number of patients.
“Again, many doctors are consultants in private hospitals that pay them well and regularly. So, they take the jobs there more seriously than they do that of the government, which sometimes may even owe the doctors several months’ salaries. The government offers free healthcare and hospitals become flooded but it does not pay good salaries. There is also a shortage of manpower and funds for equipment. At the end, people blame the doctors, which is not fair.”

Besides availability of drugs or medical personnel, the attitude of health workers can also be distressing. “If I could, I would never set foot here. I would rather go to a private hospital and be treated respectfully,” said Halima Bala, a pregnant woman in Kano State. Her grouse: the way nurses insult expectant women. Another patient, Audu Dan Asabe, shared her grief: “The fact that medical services are free in the state does not mean the workers should treat us anyhow.”

At the Aminu Kano Teaching Hospital (AKTH), a source close to the management said the hospital is in critical need of hands, saying many staff left the hospital at the peak of attacks by insurgents in the state, adding: “The hospital is now seriously understaffed. For example, in the Special Baby Care Unit (SBCU) where you sometimes have more than 200 babies, the ward can only boast of two nurses. This is very pathetic and difficult to comprehend.”

The World Health Organisation’s doctor/population ratio is 1:600. That is one doctor to every 600 persons. Renown for its national healthcare policy, Cuba, with a population of 11,000,000, has 90,000 doctors. That is eight to every 1000. But with a population of over 170,000,000, Nigeria, according to the CIA’s World Fact Book (2009), has 0.41 physician caring for 1000 people or one doctor managing a crowd of over 2000 patients!