Written by Ekene Som Mekwunye
I didn’t how bad our public health sector is until after a very painful sojourn at 2 Government hospitals recently. It still feels like a nightmare and I wish someone would just pinch me out of this trance. I would like to share my experience of the longest 3 days of my life.
I love my dad. He’s not only been my first hero but someone that has played a significant role in my little success in life. Like most dads if not all, he’s not perfect and I have learnt from his mistakes too. My dad’s health had deteriorated in recent times. He wasn’t breathing well anymore and someone had informed my mum there was a specialist at The Lagos State Teaching Hospital (LASUTH). I rushed him over there from General Hospital, Ikorodu that had been a disaster with their services after one night there. On the way, I still remember my dad contemplating stopping by at the house first or going straight to the hospital. Little did we know.
We arrived at the ‘MEDICAL EMERGENCY’ ward of the hospital. I observed that the matrons were like gods there. They moved at their own pace and you dared not challenge them. You had to be extra nice if you wanted to be listened to. I doubt if any of them understood the meaning of the word ‘emergency’. My dad was hardly breathing at this time and I just wanted him to be attended to. He was finally given a bed after about an hour and a consultant doing a ward round came to examine him about an hour or two after. A doctor from the ear, nose and throat (ENT) department also came to examine him as his was a respiratory problem. You could see he struggled to breathe and you could hear him breathing from a distance. The doctors had agreed that they had to have a tracheotomy on my dad to ease his breathing. The consultant asked to carry out some series of tests while the ENT doctor asked for a CT Scan from a particular diagnostic lab outside the hospital at Oshodi even though there were places closer where we could have it done. He tried frantically to get us there but it was on a Sunday and they were closed till Monday. He later gave us a form designed by the lab with their letterhead and his name as referral. My dad was placed on Oxygen. He was clearly in pain.
I arrived at the hospital before 7am the next morning to see that everything was done as soon as possible so he could come out of the pain he was going through. I realized I had a couple of papers in my hands, handed to my mum by one of the doctors for the tests but was at a loss at what next to do. I kept asking questions and walking around, as that was the only way to get things done. It saddened my heart that quite a number of patients couldn’t afford to pay for these tests and you had to pay for them before it could be done for the doctors to diagnose you. None of them was free except for the HIV test. I needed to also take my dad for the CT scan, so one of the doctors wrote to book for one of the ambulances to take him there as it was a policy that no patient on admission could leave the hospital without the hospital ambulance taking the patient. We booked for it at 7am. When going for a CT scan of the Neck and chest like my dad was billed for, the patient is not supposed to eat or drink anything before it’s done.
I had seen the different state governors launching lots of ambulances so I was certain we would get one as soon as possible. The first reality hit me when I heard they didn’t have enough ambulances in the hospital and that it may take a while before the ambulance could get to our turn, as there was a list of other patients that also needed it. Only one ambulance service was available. In fact, one of the patients had booked for one since Saturday (2 days before). What made it worse was the fact that even though they didn’t have an ambulance to take a patient in pain, from the emergency ward for some very important tests that is needed for a procedure, we were also not allowed to bring in an ambulance to take him out because it was against the hospital policy. I couldn’t believe my ears as I watched my dad in pain. The doctors told me there was nothing they could do till we had done all the tests. They also could not do anything about the policy as it came from above. The diagnostic center even had ambulances and nurses but was not allowed to come pick patients. I had been on my feet all day.
I finally got one at about 3:30pm but by this time, he had eaten and the lab wouldn’t do the test. The hospital, which said that they make a nurse accompany the patient, did not get a nurse to go with us. They got someone they call a ‘Facilitator’ whose job is to help you with information concerning the hospital procedures, to go with us. She didn’t even stay with my dad but sat in front with the driver. Even the blood samples could not be taken, as I couldn’t get the doctor on duty to come extract it from him. The doctor showed up in the evening and could not collect the blood samples as it was only done earlier in the day. That was how the whole day passed by and we achieved nothing but watch my dad in pain even though I had spent the whole day on my feet trying to get the health workers to do their job. I had paid for all the tests and the procedure as well, yet could not get any service. I had to make friends with the ambulance driver and begged him to come early the next day so that we could go for the CT scan then.
I arrived the hospital earlier the next morning (10th of May, 2016), not knowing it would be the longest day of my life. I begged a doctor to help take the blood samples and took them to the labs myself. I went to the ambulance office and stayed there till they got fuel for the ambulance. It was a period of fuel scarcity. I had begged my dad not to take any water or food, as we wanted to make sure nothing would impede the procedure. As a 68-year-old man, I knew it was difficult for him but we were ready. We finally made it to Oshodi for the CT scan. My dad had been on oxygen all the while as that was the only way he could breathe. I also pleaded with the workers at the blood labs to hurry so the results could be out on time. We were ready by 2pm for the operation. The HOD of the ENT department had come in to examine my dad earlier in the day, as was upset that they waited that long to perform the procedure after seeing him in so much pain. He asked why they were asking for a scan first for such an emergency when that was just the first in a series of procedures to get him healed. At this time, all I wanted was to get it done with and see my dad free. The HOD was going to take part in the operation. After waiting for a while for the theatre to be ready, he left at about 5:30pm and asked the other doctors to go on with it. The doctors had given us a long list of materials they would need for the surgery, which we bought. Nothing was left out. You would hear that health care is free for the elderly and children in Lagos State hospitals. NOT TRUE. You pay for everything to the very last pin.
The theatre didn’t send for my dad till 8pm. My dad had not eaten the whole day. I still remember him begging us to give him a little water that day. We kept pleading with him to hold on. I had stood at the entrance of the theatre from 3pm waiting for someone to come pick my dad. The doctors finally sent someone with a stretcher on wheels and to my utter dismay; he is a cleaner at the hospital. It didn’t mean much to me at this time, as all I wanted was my dad in the theatre. The cleaner was even chatting with a friend on the way. I wondered if it meant anything to him that he was going to pick a patient at the emergency ward that had been waiting the whole day. The Medical Emergency ward had two entrances and the one that had a path leading to other buildings in the hospital was locked. It took the guard a while to get it open. To make it worse, he was coming to pick someone who had been on oxygen, without an oxygen tube. He was to be accompanied by a nurse from the emergency ward, but there was none available even when he was being put on the stretcher. When we were ready to move him to the theater, the nurse was busy chatting with her colleagues. I couldn’t believe my eyes. My dad was without an oxygen mask, as we had to rush him to the theater to get him back on oxygen.
As we arrived the theatre, the cleaner dumped my dad by the side and yelled in Yoruba “I have brought the patient”. We were not allowed to go beyond a barrier but we could see further. It took the matrons about 3 minutes to come out. I pleaded with them that he had just been brought out of oxygen and needed to be back on oxygen. They laughed at me and one of them mockingly labeled me a ‘junior doctor’. The other matron then said we had to pay. I told her I had paid for it at the ENT ward but didn’t have a problem with that as I had my ATM card with me but needed my dad in. She then looked at him and said “oh! He even has beards. How do you expect us to operate on him with the beards?” (He hadn’t shaved for the few days in which his health had deteriorated.) And how were we supposed to know that? She then asked us to go look for shaving sticks at that time of the night. My brother had to dash out to search for shaving sticks to buy. At this time, my dad was just left by the side like a piece of meat. I quickly went to pay for the procedure. After my brother made it back with the shaving sticks, they started shaving him and even said the shaving sticks were not sharp. He had to go look for another set of shaving sticks while they just ignored my dad. The nurse that accompanied us from the emergency ward was just observing and couldn’t even make a case to get him on oxygen.
He was later wheeled in for the operation. We really felt relieved. “Finally” we all said to ourselves. After a few minutes, one of the doctors rushed to us and said they would not be able to go ahead with the operation anymore. We were all in shock and wondered what had happened. He said that his oxygen level had gone very low and that he was too weak to have the operation. At this point, we just couldn’t believe our ears. My brother and I rushed into the theatre. They wheeled him out and again, without oxygen. One of the doctors then asked the matron in charge of the theatre for a mobile oxygen cylinder for him to use on his way back to the emergency ward. Her response was “which one did you bring when you were coming? Please excuse me”. They asked the cleaner to take my dad back to the emergency ward. One of the assistants almost broke my dad’s hand as he wheeled him out whilst talking and not concentrating, my dad’s hand had stuck to the door and he didn’t realize it. I wished someone would wake me up from this nightmare but it was my reality like that of a lot of Nigerians.
By the time we got back to the emergency ward, the door was locked and we got upset as we were rushing to get him back on oxygen. We asked the gateman to please hurry up and he even started ranting before he went to get the key. By the time we got in to where his bed was he had run out of oxygen and passed on. That was when the nurses and doctors started rushing to try to resuscitate him. They brought an oxygen mask and started administering CPR but it was too late. My mum had suddenly become a widow and my siblings and I; fatherless. We just lost our esteemed father who died like he was nothing when he meant the whole world to us and other people.
It’s painful losing a husband and father, but what hurts more is the way we lost him. The hospital treated him like a piece of rubbish. My experience at LASUTH is one I would never forget. I saw more people at the wards die in my 3 days than I had seen in my whole 38 years on earth. People died like it was in fashion. I would never forget a little boy who was constantly in pain as his parents watched helplessly. I would go to meet the nurses to please come attend to him and they would say I shouldn’t mind him. I arrived that Tuesday morning to hear he had passed on. I later heard all he needed was a blood transfusion and his parents couldn’t afford it but our politicians are carting away billions. The nurses and matrons are constantly rude to patients and would even yell at them sometimes. I can’t remember the number of times I went to remind them that the drip of a patient was finished and needs to be changed. They were mainly good at chatting with themselves at a corner were they sat all the time. For crying out loud, this is an emergency ward with the bold inscription at the entrance ‘MEDICAL EMERGENCY’ but they hardly treated anything as such. This is a profession where 5 seconds could be a lot of time. If some people had 5 seconds they could have been alive today. But they have no idea how important time is in saving lives. A lot of those deaths only happened because those people lived in Nigeria. Yea! That was their only crime. This is the reason the government officials in Nigeria send their kids to school abroad and travel outside the country to treat a headache. We need a real CHANGE.
During the 3 days I spent there, I observed a lot of things. I could understand that some of their departments are understaffed and they didn’t have some of the funding they require. I can completely understand that. But what does it take to show care? Just to care like they are supposed to. When you care for people, it shows in your actions. These people took an oath to save lives in their profession but are doing the opposite. That is not to say I did not see or notice one or two nurses and doctors who gave their all and were very professional and polite as they did their job but it’s difficult to see their good efforts in a sea of wickedness. And with time, some of them are either frustrated out or forced to join in the neglect of care. The hospital has a team known as the monitoring team who as supposed to monitor all these things but they are just as bad. All they do is simply join the matrons and nurses and gist away. They should all be fired in my opinion as they barely do anything.
My father’s name was Peter Ezekolie Mekwunye. But this article is not just about my dad. I already lost him and sadly cannot bring him back. But thousands of other dads and other people would be visiting these hospitals. Are we going to allow the same thing to happen to them? It’s also not just about me fighting LASUTH as you can see from my heading that it happens in all government hospitals. As a matter of fact, LASUTH has one of the ‘best’ services for a government hospital and because the family did all we could, my dad got a lot more service than the average patient gets. So if this could still be happening, you can begin to imagine the decadence in our health sector and what it’s like in many government hospitals
I observed a few issues and bottlenecks in the operations of the hospital and based on my professional and personal experience, I would like to give some recommendations that could help reduce the number of casualties in our government hospitals.
1. Re-orientation in the health sector
One of the first things I realized was that death didn’t mean a thing to the doctors and nurses there anymore. This includes the gatemen, cleaners and all the workers. Their hearts have become hardened as they see these things happen on a regular basis. They need a re-orientation. I cannot understand how for the love of God, people in the business of savings lives can be this callous and unmoved.
2. Creation of a Quality Assurance Unit
There should be a unit that would be known to all patients as they come in where they can provide feedback on the quality of professionalism received nurses, matrons or any health worker. The health workers have their nametags on their uniforms and can easily be identified. The body that would handle the disciplinary actions should the health personnel be found wanting, should not be purely staff of the hospitals or else they would not be fair. If employees know they would be punished or sacked for such actions, they would change their attitude. This would be backed up, by proper training for them on how to relate with patients. They really need it and those that refuse to learn would have to leave the system.
3. Investigations on death cases in the hospital
Every death should be thoroughly investigated. If the nurses and doctors know that they can get fired or even go to prison for death of any patient caused by negligence on their part, they would change their ways. None of all those deaths I saw was investigated. They just move on like nothing happened. This has to stop and proper experts in the field should be able to ascertain the causes. I know it’s a law to investigate deaths but it never happens. We have to take this serious.
4. Review of policies to ensure operational efficiency
The hospital has to realize that time is of essence when it comes to emergencies and if they can’t provide enough ambulances, should allow other ambulances render services to this patients to help save their lives. The diagnostic center even had ambulances but was not allowed to pick patients up from the hospital.
5. Effective Monitoring
There has to be a proper monitoring team at every level. At the wards and theaters to see that procedures are properly done and everyone is doing their job, as they should.
6. Inter-departmental Collaboration
There was no synergy between the different departments. E.g. the Medical emergency ward, the ENT department and the theatre. Each one played God when it came to their departments without realizing that if one failed, it would affect the others. Lives are constantly being played with every day and they have to learn to value lives. I also strongly recommend they hire an operations management expert to help with the system flow, as synergy is very important.
7. Effective Leadership
Most, if not all the Chief Medical Directors are appointment based on their academic qualification and papers written. It takes much more than that to run an organization. They have to be chosen based on their leadership and organizational skills because at that level is about how you work with people. If our government hospitals were made to work with only funds they generate, they would realize that these patients are customers and they would treat them better.
8. Failure in oversight functions
The Senators, House of Rep members, State House of Assemblies, Minister of Health and all the commissioners of health must also share in this blame. They have oversight functions and their lapses are partly responsible for these deaths. Everyone has to wake up to his or her responsibilities.
I miss my dad a lot. He was a fun loving person. He was fearless and always stood for the truth. He always wanted to help and had a heart of Gold. He was a footballer as a youth and loved to watch football till he lost his sight about 5 years ago. But he still loved to discuss it. We argued a lot about football. He was a Chelsea FC fan. These past few days have been my worst. I smile at times but there are buckets of tears behind that smile. I can’t imagine what every 23rd of December would be like for my siblings and me as we have spent every one of them celebrating his birthday. I can’t fight for him anymore but I can, for many others. We can’t continue losing people because a few others refused to do the job they are paid to do.
We call on the senate committee on health to please address these issues urgently and the Minister of health and all the commissioners of health in all the states to rise to this challenge. This is the kind of change we need.
We would like others who have suffered similar fatality or support the cause to join in the conversation till something is done about it across the nation. Please use the hash tag #valuenigerians to start a discussion and share your own story on our social media handles on Facebook (Value Nigerian), twitter (@valuenigerians) and Instagram (Valuenigerians) so that we can drive the numbers to cause a change.
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Written by Ekene Som Mekwunye.
Ekene is an award winning filmmaker and an Executive MBA student at the Lagos Business School, PAU. He is based in Lagos, Nigeria and can be reached via [email protected] or @ekenem on Twitter.