Of Government, Doctors And The Sick

By Dan Amor

Fillers emanating from the health sector point to the fact that the sector which manages the lives of the downtrodden and sick Nigerians may soon witness another major industrial action. The National As­sociation of Resident Doctors of Ni­geria (NARD) had on Monday giv­en government a 21 day ultimatum to address their nagging demands “failure which industrial harmony in our hospitals may not be guar­anteed”. Unfortunately, anticipating the outcome of its lethargic dispo­sition towards the urgent needs of the sector, the Federal Government had last week directed the immedi­ate implementation of the no-work, no-pay policy, just to intimidate the doctors into submission.

It is benumbing that health personnel entrusted with the lives of Nigeri­ans are owed salaries ranging from three to eight months by the cur­rent administration in several states of the federation. This has resulted in the collapse of the healthcare de­livery system and loss of lives in the affected states. The doctors are also peeved by the undue sack of their members from some training insti­tutions, none funding of residency training and delay in effecting pen­sion deductions of members. Ac­cording to them, hospitals at all lev­els are not adequately funded and existing facilities are not upgraded in line with international best prac­tices. In fact, our healthcare system is, lamentably, a sorry spectacle of the untold blight and decadence that have overtaken the Nigerian landscape. But another strike by doctors would spell doom for the ailing economy and its attendant hardship would be disastrous. A brief analysis of what patients suf­fered as a result of strikes in the re­cent past would here suffice.

Sometime in 2002, Mrs. Do­rathy Williams (not her real name), a pregnant teacher in Egbeda area of Lagos, fell into labour. Promptly, she gathered her ante-natal materi­als and headed for Ayinke House, the ante-natal ward of the Lagos State University Teaching Hospital built and donated by the late philan­thropist, Sir Mobolaji Bank-Antho­ny, where she had registered for the ante-natal care. But she was greeted by a rude shock: the doors were slammed on her face, as doctors and nurses had embarked on one of their countless strikes. The woman was quickly rushed to a nearby pri­vate hospital, where she laboured for another three days, without any inch near delivery. This prompted a Caesarian section which was suc­cessful. But her husband’s eyeballs nearly popped out of their sock­ets when he was slammed a bill of N45,000! The teacher-husband was able to raise N30,000, with a prom­ise to offset the balance later.

The hospital refused to budge. He had to threaten to abandon the moth­er and the child before they were discharged. Even then, vital drugs were denied them until the money was fully paid. Another woman, Mrs. Yetunde Olumide, a fashion designer, also fell into labour dur­ing the same period. Although she had a normal delivery at a private hospital near her house at Itire, she soon developed post-natal compli­cations, as she began to bleed. Plans were mooted to refer her to the La­gos University Teaching Hospital, LUTH, Idi-Araba, a stone throw to their residence, when the bleed­ing was getting out of hand. But that was not possible because of the strike. She gave up the ghost the fol­lowing day. And because there were no facilities at the maternity to pre­serve the child without the mother’s milk, it died two weeks later too.

Also, in 2002, one Charlie, a lo­cal contractor living in Iba area of Lagos, had rushed his pregnant wife to a private hospital in Ojo for delivery. It was an emergency case as it was not possible for the lady to deliver through the normal chan­nel. To be treated to a Caesarian section, the hospital management needed a cash deposit of N25,000, which Charlie could not afford. All entreaties including the pledge of Charlie’s elder sister, Lizzy’s car as collateral, were refused until the la­dy’s condition became increasingly complicated. There was no option of taking her to any General Hospi­tal due to the health workers’ strike. As she was reluctantly taken into the theatre to be operated upon, the lady died in the process.

Even then, the hospital management re­fused to release the lifeless body of the woman with that of the unborn baby insisting on having their mon­ey before the release of the corpse. It was the quick intervention of neighbours which prevented a dou­ble tragedy, as the man went wild, and like a possessed beast, started smashing everything and snarl­ing at everybody in sight. The man even threatened to sue the hospital management for negligence. He told this writer that it was his threat to abandon the lifeless body of the wife at the hospital that prompted them to release it to him even as he actually rallied round his family members in Lagos to offset the bill.

Tragic occurrences of this na­ture capture the increasing exasper­ation of most Nigerians as the level of human casualties and the social system go rapidly comatose. The turn of events is a cruel and tragic antithesis of a people’s expectation at the dawn of self rule. Over five decades into this circuitous game, in which the nation’s till had been pillaged and her vast wealth frit­tered away abroad, the rot is peak­ing; and the people are paying the imponderably colossal price. The social services sector, which more directly impugns on the people’s lives is almost at the height of a complete system collapse.

The sto­ry of virtually every social respon­sibility of the State to the people, of every area where the State remains relevant to her subjects, under the unwritten social contract principle, has been rewritten on its head: hos­pitals have graduated from mere prescription clinics into mortuar­ies; the public school system is in a shambles. Roads, including hith­erto smooth expressways, are now death traps. And more than a cen­tury after electricity supply debuted in Nigeria, her citizens still live more in darkness than in light. Hers is a complete story of retrogression and decay.

A combination of consistent un­derfunding and government’s perfidy to the welfare of health personnel, among other factors, are fast pushing the nation’s health­care into the slime. First, Govern­ment’s budgetary votes and actual spending on the health sector have consistently been grossly short of the five per cent minimum rec­ommended for all nations by the World Health Organisation, WHO. Every year, allocation to the health sector oscillates between one point five and two per cent of the entire budget for the particular year. The result has been a progressive de­terioration of infrastructure and lack of adequate drugs and vital equipment in government hos­pitals. Such has been the extent of the infrastructural rot in most of the teaching and specialist hospi­tals mischievously called “Centres of Excellence”, which are training grounds for the nation’s medical manpower pool, as common water has become gold. There is also the problem of strikes and instability in the sector which is now like a rou­tine. It is two-dimensional: a group among the health team-doctors, pharmacists, nurses, laboratory scientists, etcetera- is fighting one or another member of the team, or squaring it up to government. Usually, it is the doctors versus the rest of them. The quarrel over who among the medical team should lead has led to countless strike ac­tions as a result of claims of superi­ority or inferiority, as the case may be.

The results of these incessant strikes by health workers are mass discharge of patients resulting in massive deaths. This development, added to the scandalous fees now being charged in government hos­pitals, is luring most Nigerians into the more dangerous practice of self-medication. Many others, es­pecially pregnant women, now pa­tronize quacks and traditional birth attendants. This has led to a boom in alternative healthcare like trado-medicine. The need to regulate the boom led to the promulgation of the Alternative Medicine and Den­tal Decree N0. 23 of 1988, which gives guided recognition to trado-medicine.

But the biggest problem Nigerians are faced with these days in the healthcare sector is the esca­lating cost of healthcare delivery. More than anything else, President Buhari must do everything within his executive powers and goodwill to meet the demands of resident doctors in the country in order to halt another spectre of strike in the healthcare sector. Anything short of this, his CHANGE campaign mantra will stand out as mere self-righteous ululation and the despo­liation which our politicians have wrecked on us since 1999, will be used effectively against him in the court of history.

*Dan Amor is an Abuja-based public affairs analyst