We must fix Nigeria’s broken health system

We must fix Nigeria’s broken health system

Wednesday, March 28, 2018 6:24 am

Emevwo Biakolo

By Emevwo Biakolo

Late last week, I returned from New Delhi, India, where I had gone for a surgery. Why did I, like so many of my country men and women, go to India? Here is why. In September 2017, some six months ago, my spouse underwent surgery at a private hospital, the Lagoon Hospital (which my family has used for over 10 years) in Lagos. In accordance with proper medical practice, given the nature of the problem, a post-surgery histology and immunochemistry (lab tests to determine if the organs had cancer) was recommended.

I agreed and paid for it. It took THREE MONTHS for the reports of this test to be released by this hospital. This was after repeated inquiries by personal visits, by phone calls and text messages. The surgeon stopped picking my calls. When the report eventually came and we had a meeting on it, I asked why it took this long for the report to come.

The explanation was that this hospital, like others, sends samples abroad because there are no adequate labs in Nigeria.
Case Number 2: In spite of what happened, at this same hospital, I had a biopsy (a procedure to extract samples for lab tests) done on an inflamed prostate. A biopsy is an outpatient procedure of less than an hour.

But after the procedure, I was put in an ICU (intensive care unit) room for the requite brief recovery period. This turned out to be nightmare. I was in a pool of blood both on the bed and in the unhygienic toilet close by. There was no nurse or attendant to take care of me. In my dazed state, I stumbled out to look for toilet paper to clean myself. To cut a long story short, I eventually left the hospital for home.

But worse was to follow because not unsurprisingly, given the ICU experience, infection had occurred, an infection so massive I had to be hospitalized for 5 days. I returned home on the eve of Christmas.

Case Number 3. Given the nature of what I was experiencing as a result of my condition, I was advised to do a bone scan. I therefore travelled to Ibadan, early this year, to the University College Hospital, to do this. I duly paid N72k to the Nuclear Medicine unit. But as I write, this scan has still not been done. The reason: there are no reagents. All this was why, contrary to my usual naïve nationalism, I left Nigeria with the help of my workplace, my children and my friends to do a surgery in India.

My friends, the Nigerian health system, under General Buhari, is severely broken. We must fix this system now, or we will perish in large numbers. One thing I know for sure, this do-nothing government is not the one to fix the problem.

Professionalism and the Nigerian Health System

There many problems with the Nigerian health system, and some of them are long standing. There is a stark lack of and/or decay of equipment and facilities. There is also inadequate training and preparation of medical professionals arising from poor funding of universities, teaching hospitals and nursing schools. Neither are there sufficient drugs in the pharmacies of our hospitals, especially the public ones. Nonetheless, I believe that being a developing country also means we will not usually have the resources we require in many areas of life, and therefore we learn to cope without many of the material needs.

Professor Adewole: Nigeria’s minister of health

However, malaise in professionalism is a different matter altogether.Professionalism in the medical and health system in general, as in many other domains, comes from three principal sources, namely: law, ethics and what I may call Standard of Care. Laws regulating medical practice, and their proper enforcement, is a governmental responsibility. The Nigerian government is failing seriously there, more so now than ever.

Professional ethics is a system of self-regulation and this responsibility devolves on bodies like the Nigerian Medical Council, the Nursing Council, the Medical Association, the Nursing Association and so on. The degree to which professional ethics is being maintained in our medical and health system needs close scrutiny.
For me, though, the most glaring failure of the Nigerian health and medical system is in Standard of Care (SoC).

The principle of SoC means that the degree of competence and patient care in one hospital ought to be no significantly different from another hospital, among professionals of the same level. SoC as a principle extends beyond country borders. It means that, all other things being equal, a Nigerian doctor or nurse ought to be able to practice in Finland as in Canada, USA, Japan or Brazil, and demonstrate a comparable Standard of Care. Let me now illustrate the failure in SoC in Nigeria from my recent experience.

When my spouse went for surgery, she was duly made ready and wheeled to the operating theatre, yours sincerely in tow. But the surgery could not be done the first time. It had to be postponed for one week. Why? Because her blood pressure went up and it needed to be stabilized. Now at assessment, the hospital had her history and therefore steps ought to have been taken, including the involvement of the cardiologist in preparing her for surgery. It was only after the failure of the first attempt, that the cardiologist was brought into the picture.

Compare this with what happened at Apollo Hospitals in India. Not only did I undergo various cardiac tests and procedures, that hospital will not operate a patient without the signature and approval of the cardiologist and the physician. That is Standard of Care.

Another example: When in December I was admitted in the Lagoon Hospital for infection arising from poor management of the biopsy that was done, I noticed that whenever I made a call to the night nurse on the beeper, at 2 a.m. or 3 a.m. the quickest response time was 3 minutes. At the Apollo Hospital, the slowest response time was 30 seconds. These are the differences in standard of care between the Nigerian medical professional and the Indian one. These are differences in professionalism, not in equipment or facilities or drugs.

-Emvwo Biakolo is a Professor of Communication at School of Media and Communication, Pan-Atlantic University

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