World Patient Safety Day: Nigeria battles spike in medical errors, negligence in hospitals
18 September 2024 |
4:35 am
As the world marked World Patient Safety Day 2024, yesterday, the rising cases of medical errors and wilful negligence in Nigeria came to the fore, with survivors seeking justice.
As the world marked World Patient Safety Day 2024, yesterday, the rising cases of medical errors and wilful negligence in Nigeria came to the fore, with survivors seeking justice.
They bemoaned rampant cases of compromises in patients’ safety cum avoidable errors culminating in unsafe surgical procedures, late or misdiagnosis, poor injection practices, and unsafe blood transfusion among others.
Acknowledging the menace, health practitioners also expressed concerns about overstretched facilities, shortage of workforce, lack of standard and effective regulations in public hospitals nationwide, calling for the implementation of standard healthcare protocols in hospitals to reduce the epidemic of medical errors.
Recall that in recognition of patient safety as a global health priority, 194 member-States of the World Health Organisation (WHO) at the 72nd World Health Assembly in May 2019, endorsed the establishment of World Patient Safety Day (Resolution WHA72.6), to be marked yearly on September 17.
The objectives are to increase public awareness and engagement, enhance global understanding, and spur global solidarity and action to promote patient safety.
This year’s commemoration has the theme: “Improving diagnosis for patient safety” with the slogan “Get it right, make it safe!”, highlighting the critical importance of correct and timely diagnosis in ensuring patient safety and improving health outcomes.
According to the World Health Organisation (WHO), one in every 10 patients is harmed in health care and more than three million deaths occur yearly due to unsafe care. While there is no accounting for the emotional trauma of the menace, the financial cost associated with medication errors has been estimated at $42 billion yearly.
In low-to-middle-income countries like Nigeria, as many as four in 100 people die from unsafe care. Of others, who are survivors, they live the rest of their lives with harrowing stories to tell.
For instance, Yusuph Olaniyonu, in his 50s, went from seeking an elective prostrate surgery, originally meant to last a few minutes, to end up going in and out of the surgical theatre nine times. He had six major operations and three minor procedures following a major mistake from the first surgery, which culminated in several other medical conditions and nearly paid with his life.
According to him, the surgeons during the first surgery ruptured his bladder, and in panic, “they had to abandon the prostate operation that brought him to the hospital, and hurriedly placed a catheter inside his urethra, and returned him to the hospital ward.”
“Three trips back to the theatre did not change anything. And this was enough to send everyone into panic mode. I was wheeled into the ICU, where I passed out and had to be placed on oxygen.
“At this point, it had become obvious that the medical team had reached its wit’s end. It had lost control. One of them had, in fact, quietly told my family that my chance of survival was 50-50. They were already thinking of moving to the next patient. After all, they had ‘tried their best’.”
Olaniyonu, who was eventually flown out of the country returned with a successful surgery. He said: “Perhaps I should not be alive. But I am. Despite the odds, I turned 58 today (some days ago). I am still frail and fragile. But now, I can stand on my feet again, bearing testimony to those sacred words of the Almighty Allah himself that, ‘No soul can ever die except by Allah’s leave and at a term appointed’”.
Like Olaniyonu, Serah Shimenenge Yugh, had a horror of medical experience. The 41-year-old Yugh was misdiagnosed with cancer and had one of her breasts removed. She had already undergone eight chemotherapy sessions, 25 rounds of radiotherapy, and a single mastectomy before discovering that she did not have breast cancer.
She said: “When I heard that I had no breast cancer, to be sincere, I shut down for one year. In my sleep, I could hear people speak in my head. I was traumatised and there was nobody there to comfort me.
“Every part of my life has been affected. I’m becoming a vegetable. I’m sure that I’m a vegetable. Every day, I wake up with pains, in my teeth, my eyes, and my nose. I’m no longer a woman. I don’t feel it. My bones, my backbone. I can’t sit for long. I am asking for justice. And I want them to take responsibility for their actions. This effect is lifetime,” she said.
Unlike Olaniyonu and Yugh, the 12-year-old Adebola Akin-Bright did not make it to tell the story. The teenage boy, whose small intestine reportedly went missing following surgery in a Lagos Hospital, is also a pathetic case, and one in thousands.
President of the Nigeria Medical Association (NMA), Prof. Bala Audu, told The Guardian that the greatest cause of medical error and negligence is lack of standardisation in the Nigerian system.
Audu argued that the best way to prevent medical, surgical and diagnostic errors is to have standard protocols and to make sure facilities have all that they need for doctors, nurses, and other health workers to work properly.
Narrating how medical errors occur, the NMA President said: “We have communication error which may occur when a physician writes. Maybe he wanted to write two micrograms of insulin, but the way he wrote it, it looked as if it was a milligram. So, you give a milligram instead of a microgram, which means you are giving about a hundred times the dose you want to give. So, you see, that is a human error in dosage.
“Or it may even be the person who wrote the wrong dosage. It could be that the drug is supposed to be given as an IM injection. For example, typically procaine penicillin is very common and is given intramuscularly, while for example, crystalline penicillin is given intravenously. But in trying to write, you now wrote procaine penicillin, and you wrote intravenous. So, you see there is an error in the route of administration. It is a very extensive field of errors.”
Audu added that the major challenge facing healthcare workers in Nigeria is the lack of infrastructure.
“The knowledge is there. In Nigeria, our doctors, nurses, and other healthcare workers don’t have problems with knowledge. We don’t have problems with skill, the problem we have is infrastructure.
“No matter how good a surgeon is, he is operating and the light goes off and the woman is bleeding. What do you do? Maybe you use the light from your phone to manage the suture. Will it be as good and as clear as if you are using the charger light? It won’t. But because you must save that life, you have to do something, in that process,” Audu said.
The NMA President, with a caveat, advised that to avoid or limit the frequency of errors, there is a need to report them when they occur. He said: “But you see, that is only possible if you make it in such a way that when you report the error, there is no punishment. If you make it punitive, people will hide the error.
“When I was a very young doctor I was a house officer. I remembered seeing with my own eyes where syrup was given as an intravenous fluid. The syrup was given by a trainee; it was injected. Of course, it refused to move because it was too thick. You can imagine if it had entered the body. So, these are among the ways errors can occur and how they can be prevented,” Audu said.
President of the Association of Medical Laboratory Scientists of Nigeria (AMLSN), Casimir Ifeanyi, told The Guardian that the issue of regulation, poor quality of reagents and consumables, and issues about human resources, all aggregate to account for the public health menace we have in Nigeria concerning misdiagnosis, malpractice, medical negligence, and quackery.
He insisted that to effectively deal with the issue of wrong diagnosis, and fake and substandard diagnostic kits, the country must ensure proper validation of medical kits that come into the country.
Ifeanyi stated that one of the challenges in the country is that over 99 per cent of the labs operating in Nigeria – private and public – do not have any form of laboratory quality management system in place. Without a quality management system in place, it is very difficult, if not impossible to track errors as they occur.
He said: “One of the issues we have is that of the human factor. In Nigeria, we have seen that medical laboratories are considered an all-comers’ affair, and that is not the practice in sane climes and globally. It is wrong for you to bring people who have studied all manner of biological science, and dump them in medical laboratories, whether government or private, to test human beings. You are experimenting with human life and the casualty levels will be quite high. Now, the problem we have is a situation where somebody studied something close to a medical laboratory.”
Ifeanyi noted that Nigeria is the second largest market in the African continent for medical diagnostics, laboratory equipment, consumables, and point-of-care testing devices.
“Nigeria is more like a dumping ground for fake, substandard, unvalidated kits and devices. We are second only to South Africa and Egypt in this regard but the difference between Nigeria and other countries is that these countries have regulations that ensure only safety reagents and testing materials are brought into their country. Whereas Nigeria is more like a dumping ground for fake, substandard, unvalidated kits and devices and so, when these things come, because our people want to cut corners and it’s difficult for you to distinguish from the fake, from the original,” he said.
Ifeanyi stressed the need for strong regulations, standardisation, and internal quality control mechanisms to be in place and derived from the law, adding that the Federal Ministry of Health is doing a whole lot with the Medical Lab Science Council of Nigeria to sanitise the medical laboratory workforce in Nigeria.
However, a Medical Law Consultant and the Founder, Lawyers Arise for People Initiative (LAP), Ebenezer Egwuatu, expressed worries about the spate of negligence in the hospitals, but “so many Nigerians do not know that they have a right to complain when they are not satisfied with the healthcare services they receive”.
He said: “Under Section 30 of the National Health Act, those who think they know do not know where to make this complaint, and those who know where to make the complaint do not know how to make this complaint.
“An acceptable complaint before the medical and dental council comes in an affidavit form. So, you go to the court, swear to an affidavit plead your facts then deposit that affidavit and file it so it is not a complaint through letter writing. There is a procedure, but a lot of people are not aware of this procedure. That is where sensitisation and awareness come into the picture.
“It is when Nigerians become aware firstly of their rights, secondly the mechanisms available to them, then they can now know how to access or seek redress,” Egwuatu said.
The WHO yesterday noted that about 16 per cent of preventable patient harm is caused by diagnostics errors, with almost all adults likely to experience it in their lifetime.
WHO Director-General, Tedros Ghebreyesus, who disclosed this noted that millions of people experience avoidable suffering every year, putting a huge burden on health systems and increasing healthcare costs.
Tedros observed that diagnostics errors can include missed, incorrect, delayed, or miscommunicated diagnoses, leading to serious harm and even death. He said: “The right diagnosis at the right time is the basis of safe and effective care. Reducing these risks takes collaboration between healthcare workers and managers, policymakers and regulators, civil society and the private sector, and importantly patients and their families. Together, let’s get it right and make it safe.”
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