A combination of negligence, dearth of bed spaces and acute staff shortage in the face of overwhelming patient traffic tops the list of factors militating against the efforts of Lagos State government to deliver quality health care to the citizenr
She waited seven years and nine months for the birth of her second child. Supported by her husband, Kehinde Aregbesola, 35, spared no effort to have an Easter delivery. But the tragic events of March 27, 2013 were an anticlimax of both her long wait and a five-day labour pain.
Although international health care convention says no woman should die in the process of giving birth, Kehinde lost her life at the state-owned Ifako-Ijaiye General Hospital, Lagos, with her full term foetus. Bent over with grief, Lukman Aregbesola, her widower, has only a story of pain to tell. He insists that his wife died needlessly in a cloud of official ineptitude, amidst a string of unfortunate circumstances that he has come to hang on official negligence.
Kehinde, a teacher, went through a caesarian section when she had her first child seven years ago. With the latest pregnancy, she had envisaged that the birth of her second child could likely also be through a caesarian birth. “When we got to Ifako-Ijaiye General Hospital on March 27 this year, the nurses told us to pay N64,000 for a caesarian section but before I could go and get it, they asked me to wait that it appeared she would be able to put to bed on her own,” he told the magazine.
That decision would eventually prove fatal. As things turned out, Kehinde started experiencing contractions late in the night when Aregbesola alleged that no doctor was available to attend to his wife. The bereaved man also alleged that he had to buy bread and soft drinks for the nurses in order to get them to pay his wife some attention.
As Kehinde thrashed around in labour pain, a major unforeseen complication arose. She suddenly became anaemic, her packed cell volume, PCV, plunging from 34 to 20 per cent. But Aregbesola says this development, though sudden, was still not sufficient to seal his late wife’s fate if only a doctor had been on duty. “My wife was O Negative but there was none at the Ifako-Ijaiye General Hospital. After looking for blood everywhere I finally got one pint at a nearby laboratory. But we were told to buy three pints of blood. She was transfused with that blood and seemed to get better. When I told the nurses to take a blood sample from my wife so I could go and get the remaining two pints of blood, the nurses refused, saying that only a doctor could do that.”
At that stage, unknown to Aregbesola and perhaps the nurses, time was by then more than of the essence. The nurses stood their grounds and it was rather too late before the worried man sprinted out of the premises to get the last two pints of blood. Kehinde died in the evening of April 1, Easter Sunday, after five days of admission in the hospital. “This is not the work of any witch. Negligence killed my beautiful wife at the Ifako-Ijaiye General Hospital. How I wish this did not happen to my wife. I was there when one other pregnant woman was wheeled out dead, I never knew that fate would also befall my wife,” Aregbesola lamented.
At the Ogba, Lagos home of the deceased’s parents, anger and sadness were the emotion on display. Kehinde’s colleagues who came on a commiseration visit told the magazine that the deceased was the 13th pregnant woman to die within a week at the Ifako-Ijaiye General Hospital. “We don’t know who will be next. Please help us to call the attention of the government to the attitude of the workers. People are dying,” exclaimed one of the teachers.
Just like Aregbesola, Soji Daomi, a Lagos resident, has also lost a loved one at the General Hospital, Ikorodu also in Lagos. Daomi is bitter that the attitude of medical staff robbed him of Oluwasegun Daomi, his one-year-old son. Little Segun took ill on Friday, February 22, vomiting continuously. Alarmed, Daomi took his son to a nearby private hospital where the rate at which the boy was vomiting was brought under control.
Convinced that his son needed more specialised attention, Daomi then took the boy to the paediatric and emergency department of General Hospital, Ikorodu. “We were not attended to until about 9.30pm. This was not without the intervention of one Dr Idowu, whose number was taken from one of the phone numbers pasted on the walls of the hospital. My son was given an injection and some drugs were bought for him. We were advised to come from home,” said Daomi.
On the second day, the worried father returned to the hospital when the injection could not stop his son’s persistent stooling. Daomi said his son’s temperature was also dangerously high but the two female doctors on duty at the time refused to place him on admission. Instead, they demanded a blood test for which they sent the boy’s parents to the laboratory.
Strangely, Daomi also experienced the same bureaucratic bottleneck that Aregbesola suffered. The laboratory attendant sent him back to the doctors to get a blood sample. “We went back to the doctor who sent us back to the laboratory without the blood sample. The attendant sent us back to the doctor again. They played this wicked game for a while as my son lay dying in my arms,” Daomi recalled bitterly.
Narrating further, Daomi said, “We came the following day, Saturday, February 21, 2013, for his injection. The doctor harshly and impatiently attended to us even when we complained of his rising temperature and continuous stooling. He was again given injection on already dehydrated body with high temperature. His condition became worse gradually every hour. He became gravely weak and pale. He was again refused admission.”
Things eventually fell apart on Monday, February 25, when the little boy’s condition took a turn for the worse. On that day, Daomi said he then finally met a friendlier doctor who patiently attended to his son. But it was too late. “She tried all her best on my son, placed him on life support machine, administered drips on him but my son died soon after that at about 5am on Monday, February 25, 2013.”
Daomi took the corpse of his little son home for burial. But he has continued to mull the entire episode and vowed to get justice for his little boy and other children who are victims of alleged complacency in public hospitals. It is the same feeling with the family of the late Aregbesola. “I will love to know why doctors that attended to him on 22, 23 and 24 of February, 2013 refused to administer drips on him knowing fully well that my late son was stooling and therefore must have lost so much fluid till he died. I will love to know whether doctors and nurses at the General Hospital, Ikorodu, paediatric and emergency department are not qualified and therefore didn’t know what best treatment my late son should have been given to avoid his death,” he said.
Frank Ogundana, a lecturer with the Lagos State Polytechnic, also lost two of his children within six months at the same hospital in Ikorodu. Attempts at getting the reaction of Mobolaji Olukoya, chief medical director, CMD, of the General Hospital, Ikorodu on the allegations proved unsuccessful as he declined to comment. “The [Lagos State] Health Service Commission is investigating the matter, so it will be subjudice to comment on the matter,” he told the magazine.
Further checks by the magazine revealed that the commission has recommended to Jide Idris, Lagos commissioner for health that the two doctors implicated in the death of little Segun Daomi be dismissed. Idris confirmed this to TELL and added that the matter has been referred to the state ministry of justice.
Indeed the case of little Segun was badly managed. Continuous vomiting in a child for more than 48 hours can be life threatening. Information sourced from the Johns Hopkins Children’s Center, Maryland, United States, US, showed that getting a diagnosis to reveal the underlying cause is important at this stage. Medical doctors who spoke with the magazine also confirmed that the normal course of treatment for a child who has been vomiting non stop would be to place him on admission, rehydrate him with drips while conducting tests to determine the underlying cause. Ayodele Falade, a paediatric surgeon with the Ladoke Akintola University Teaching Hospital, LAUTECH, Osogbo, Osun State, said dehydration is potentially dangerous for children. “More than 60 per cent of the body composition in children is water. So the first thing is to give the oral rehydration therapy at home if the dehydration is mild. But if it is severe, the child needs to be taken to the hospital for admission. If the baby is stable, you can send the baby to the laboratory but if not then it becomes a crime to send the baby to the laboratory. The baby should have been admitted and placed on drip if he or she is not stable before any other investigations,” he said.
Going by the submission of Falade, a situation where a child who has been stooling for days was refused admission and then sent to the laboratory for blood test like it happened at the General Hospital, Ikorodu is totally unexpected. However, faced with a combination of negligence on the part of medical staff, long surgery queues and unavailability of bed space, general hospitals in Lagos have lately become notorious for such incidents.
For instance, one of the places where this is most pronounced is the Neurology Department of the Lagos State University Teaching Hospital, LASUTH, Ikeja. Sometime in September 2011, Toyin Oni (not her real names, because she works in the state public service) took Michael, her husband to the Outpatient Emergency Unit of LASUTH. Hit by a partial stroke, Michael had lost the functions in the right part of his body and could barely walk. After checking his vital signs, the nurses wheeled him down a narrow corridor where he was made to take his turn in seeing a doctor. From the nurses’ station, Oni reported she could see the admission ward filled to the brim with patients spilling over onto the corridor.
The situation was so bad that Oni said she saw a female patient who was sitting on a chair while being administered a drip. A young relative stood by her side, holding up the patient and the drip bag. There was no unoccupied bed space in sight. Oni said in no time she too soon joined the little crowd of relatives standing for lack of a sitting space. She said a young man lay across the sitting space meant for relatives apparently sleeping. “Suddenly, he woke, coughing up blood. Blood spewed over his body, soaking his face and clothes. His brother who was with him frantically shouted his name while a young female doctor left one of the adjoining offices and walked past the patient and his frantic brother without even sparing them a glance. All of us standing were so shocked. I had to block my husband from seeing the patient,’’ Oni told the magazine.
For Oni and her husband, the real shock awaited them in the neurology section of the Medical Outpatient Department where hospital staff handed Michael a January 2012 appointment. “I could not believe it. We were told that we had to come back four months later to see a neurosurgeon. All my appeals that my husband was very sick fell on deaf ears. I later called one of my friends who made a few calls and the same neurosurgeon we were told was so busy and couldn’t see my husband until four months time, actually attended to my husband in the evening of the same day at a private hospital in Ogba. It was a horrible ordeal,” she said.
As shocking as they sound, the experiences of Aregbesola, Daomi and Oni appear to be the routine experience of many who daily throng general hospitals in the state in search of medical attention. Pressured by an increasing population of patients and few medical personnel, health care management in Lagos government hospitals is often delayed, perfunctory and non satisfactory. Still, these hospitals are the choice of thousands who cannot afford the cost of private hospitals.
The challenge came with the upgrade of several general hospitals in Lagos State. The upgrade of facilities in those hospitals attracted more patients from both within and outside Lagos. Doctors and nurses who spoke to the magazine on the condition of anonymity confirmed the overwhelming population from Lagos and border towns in Ogun State that daily throng general hospitals in Lagos seeking treatment. “We are up to our neck with patients. If you come here on some days, you will see mothers lying down with their children on the floor. This is because there are no bed spaces for them and we cannot turn them back,” a doctor said.
While admitting that there is pressure on facilities in Lagos, Idris insisted that such pressure can never be taken as excuse for negligence or a wrong attitude to work by doctors. “There is no doubt there is a lot of pressure on our facilities but again, I will not use that as an excuse for some of these lapses. Basically, we are trying to make sure that quality care is given. One thing we do know is that anybody found wanting in terms of denigration of duty or inappropriate behaviour will be sanctioned,” the health commissioner said.
While agreeing with Idris that doctors have a duty to rise above challenges and discharge their duties effectively, Olumuyiwa Odusote, chairman, Lagos State Medical Guild, however wants the state government to also spare a thought for the welfare of the medical workers. “We have 26 general hospitals and how many hospitals have they been able to upgrade? Less than 10. If you see the consulting room in some of the hospitals, you wouldn’t want to believe a doctor is sitting there. Many of the doctors do not have offices in these hospitals, once you finish seeing the patients, you just roam about until closing time, these are the things that have been problems for quite a long time and are not addressed,” he said.
As far as Odusote is concerned, even where the state government has improved health facilities at the general hospitals, there is still the need to improve the welfare of the medical health workers. “Even if you spend $100 billion to equip an hospital and you neglect those who will work with those equipment, they are not going to work, because somebody who is disgruntled will not be able to pay attention to details and the equipment are sensitive, they need somebody who is concentrated and more focused to manage them,” he said.
But the welfare Odusote is talking about comes at a cost that the state government appears to have found nearly impossible to handle. To handle the traffic, the government had earlier employed contract doctors to augment the work of the regular doctors in its employ. Indeed, Lagos State has the highest number of doctors in the country.
But that effort is yet to tame the number of patients who seek treatment from inside and outside the state. Doctors at the secondary health levels are also said to take calls moving from one hospital to another. It appears this has created a situation where doctors soak up so much stress running from one hospital to another and negotiating head splitting traffic snarls to keep appointments with patients. A typical doctor in Lagos is said to run shift shuttling between at least three government hospitals in a day.
Odusote says, “There is a gross shortage of doctors in Lagos State. We were battling with shortage of doctors in the hospital and it’s now more severe. You see 60 to 70 patients of a general hospital and may be there are two doctors to attend to them, how do they cope with that?” he queried.
Idris however told the magazine that there is no shortage of doctors in the state. “We don’t have locum doctors in Lagos State. Between LASUTH and HSC, (Hospital Service Commission), we have about 1,500 doctors but they come and go. It is a flux and that is excluding doctors at the primary health care level,” he said.
In spite of the commissioners’ explanation, shortage of specialists and rising number of patients at all state owned medical facilities have continued to ensure that even patients who need life-saving surgeries are condemned to a roster which sometimes see them getting appointments that could be as far away as six months or a year.
That was the case of Abdul Bassit Ibrahim, a 10-year-old hernia patient awaiting surgery at LASUTH. In 2012, media reports indicated that Ibrahim had been on the waiting list since 2009. After a series of postponements, Ibrahim’s surgery has been fixed for November 2013. “When Ibrahim first visited the hospital, he was five years old and now he is nine. We see other patients lamenting that they have been coming even before 2009. My fear is that they may also postpone the surgery from 2013 to 2014,’’ Tawakalit, his mother told the magazine.
Reacting to such situations, David Oke, CMD, LASUTH lamented the burgeoning number of patients the teaching hospital has to take on. “We can only accommodate what we can. When our beds are full, they are full. The work before LASUTH is enormous, we have patients on referrals not just from hospitals within Lagos, patients also come from Osun, Oyo, Kaduna states, Abuja and as far as Benin Republic,” he said.
Now, as far as Idris is concerned, this is not supposed to be. He blamed the pressure on general hospitals and tertiary health institutions on the non-utilisation of primary health care centres, PHCs. “You can imagine a cardiologist in LASUTH who should deal with the heart in a much higher level attending to malaria and pneumonia cases. You are wasting his time and talents and at the end of the day we are not getting value for money,” Idris said.
It is ironic that while the state government has initiated a high profile initiative to integrate maternal, newborn and child health by constructing eight maternal and childcare centres at its facilities across the state, casualty cases are still on the rise at these hospitals. The state government also recently vowed to save the lives of six million children and 200,000 mothers through its Integrated Maternal New-Born and Child Health Strategy.
Perhaps, the biggest leap in the reduction of the high maternal and infant mortality in Lagos has been the relatively new primary health care reform. Idris said the Lagos State government has initiated flagship PHCs, which would run a 24-hour service in all the local governments in the state. Although there are 277 PHCs in the state, there are plans to build 57 flagship PHCs, which would run a 24-hour service. In the estimation of the government, each local government will have at least one flagship PHC providing standard care.
Yewande Adeshina, special adviser to the governor on public health, said the flagship centres have moved beyond routine immunisations. “We have moved away from traditional PHC system which focuses mostly on immunisation and antenatal care and preventive screening. To help the secondary facilities we have added non-communicable diseases including cancers such as breasts, cervical, prostate and colon cancer,” she said.
With all these efforts, why are the secondary health centres still congested? Adeshina has an answer, “If they [primary health centres] are all not functioning properly, people will tend to migrate to general hospitals and put pressure on the facilities there and that is why there is a conscious effort from the government to reverse that. Let’s deal with the primary care level, get all the facilities functional or be more functional.”
However, investigations show that even with the revitalisation of PHCs, the state still has a long way to go in the provision of equipments necessary to considerably reduce the high maternal and infant mortality rate and stem the traffic to general hospitals. This was manifested during a recent orientation programme for new doctors employed to man PHCs in the state where the doctors lamented the state of affairs in their respective centres.
For instance, a medical doctor from Imota PHC spoke of how a convulsing child was brought to her and there was “not a single needle and syringe to take care of the baby. So I want to know who actually funds the PHCs?” she said. Another doctor with the Ikotun Local Council Development Authority, LCDA, gave a scenario where a pregnant woman was about to put to bed. “The baby was in distress and we sent the mother to Alimosho General Hospital and they charged her N70,000 for not being registered there.” In the same vein another doctor from Isheri PHC complained that there are no prescription sheets or office files to document cases and doctors have resorted to tearing sheets of paper to write prescriptions.
A 2013 assessment of flagship PHCs in Lagos State is also damning. The study, undertaken by InnovationMatters and the Lagos State Civil Society Partnership, found that many of the flagship PHCs have inadequate equipment to tackle post-partum haemorrhage, a condition where a woman loses excessive blood after childbirth. Misoprostol and Oxytocin, a drug and injection have been found to stop post-partum bleeding which is a leading cause of death for new mothers.
Dede Kadiri, executive director, InnovationMatters said, “in the event of power outage, patients are made to contribute the cost of fuelling generator in eight out of 20 PHCs assessed. The assessment found that only six out of 20 PHCs have fully functional power supply backup. For eight of the PHCs assessed, generators are not fully functional as a result of lack of imprest to purchase fuel to operate them. In some others, generators are not even available.”
The special adviser promised that the challenges would be addressed and the flagship PHCs would eventually go round the state. “General hospitals are not built for immunisation and other minor cases. It is when PHCs cannot handle a case that they refer the patient to secondary hospital such as general hospital. We had to come up with a revitalisation process for the primary health care system, which led to the development of a template that is now being used as a yardstick in our PHCs. The revitalisation programme is essentially to create a 24-hour power supply for health care service within the 57 local governments and council development areas. We will eventually have 57 comprehensive, 24-hour running PHCs. We name them the flagship centres because of the excellence and improvement expected of them,” she said. The earlier the authorities did this the better. This will go a long way to stem the rate at which people die at health facilities in the state.