ARUKAINO UMUKORO writes on how Nigerians are groaning under the poor state of public healthcare in Nigeria, while the country’s President, Muhammadu Buhari, can afford several weeks of medical vacation abroad
When Joe Memeh was diagnosed with cancer last year, President Muhammadu Buhari was just about to travel abroad on a 10-day vacation to get medical treatment for an ear infection.
However, unlike Buhari, Memeh, a retired naval officer who was 76 at the time of the diagnosis, could not afford to travel abroad for treatment.
His family took him to a government hospital in Lagos, Nigeria’s commercial capital. First, they took him to the General Hospital, Igando, then to the Lagos State University Teaching Hospital, Ikeja; where he was referred again to the Military Hospital, Yaba; and then to the Federal Medical Centre, Ebute Meta and finally, to the Lagos University Teaching Hospital.
Memeh’s son, Buwa, told SUNDAY PUNCH it was depressing whenever he remembered his father’s travails.
He said at each hospital, health workers gave a list of reasons why he could not be treated. “The common thing with all the hospitals was that he was not allowed to come down from the car. They were prompt in bringing up their problems – It was either there was no bed space at all or they did not have available medical personnel because they were on strike. And their only remedy was a referral.
“In LUTH, the nurses were on strike. It was a doctor who came to see us and told us there was no need wasting our time. In LASUTH, they didn’t even allow him to come down from the car when they told him there was no bed space. We were asked to go even when I volunteered to bring a bed,” Buwa told SUNDAY PUNCH.
At LUTH, they were told that, since there was no bed space available, they could admit him in a private wing which the younger Memeh said would have cost the family about N2m.
Confused and frustrated, Memeh’s family rushed him from the hospital to a private clinic. However, the doctors said they could not handle the case, and referred him back to the same government hospitals where there were no bed spaces or nurses available. “They said the best place for him to be treated was the teaching hospital,” Buwa recollected, with pain in his eyes.
With no other option, Joe Memeh was taken home, and a day later, at 1pm, he died, depressed and a broken man.
“My dad was a brilliant and educated person. In my car, when we left the hospital, he shook his head and cried. He said to me, ‘I realise what Chinua Achebe meant when he said, There was a country. Indeed, my son, you can now understand what he meant; these are part of the reasons.’ I was driving, but I could feel the pain he was going through,” Buwa told SUNDAY PUNCH.
Buhari has travelled abroad for medical treatment for four times since 2015. The last trip, which ended on Friday, saw him spending 49 days in the United Kingdom.
“I have rested as much as humanly possible. I have received, I think, the best of treatment I could receive,” Buhari said on Friday to a meeting with some governors of the ruling All Progressives Congress.
But for the Memehs, a year on, there has been no cheer. They are still dealing with the pain of losing a father they believed could have been saved if the country had quality healthcare facilities.
“Our President had an ordinary ear infection and he travelled out of the country. My dad had a more severe ailment, cancer. I feel bad that my dad couldn’t get any proper healthcare. It is painful because one cannot compare ear infection and cancer. My dad needed to stabilise his health, at least he would have had more time on earth. It is only in this part of the world that leaders enjoy first class treatment but the citizens don’t, it is really frustrating. If you have not been in that situation, you would not understand how it feels. Now this is what lots of Nigerians suffer, but if I were not a victim, I wouldn’t have known. In Nigeria, one cannot rely on the government.”
Nigerians die daily from lack of health care services
A businessman, Wale Ogunjimi, in his 30s, said he had since given up hope in the country’s health system following a recent experience.
“I had a serious ear infection and because I couldn’t afford to go to a private hospital. I was directed to the General Hospital in Ikorodu, Lagos State, for treatment. I ended up waiting for about nine hours just to see the doctor because there were so many people being attended to at the time for different ailments.”
Ogunjimi said he would have died if he had been battling a more serious ailment. “Many people go through pains just to see doctors and nurses at general hospitals. I was lucky. Some people with more serious ailments had to come back the next day to see a doctor or nurse because there was none to attend to them that day.
“Two weeks ago, an 11-year-old in my area died of malaria because he could not get treatment on time at the general hospital. There are so many cases like that. If our president can travel for an ordinary ear infection, that means there is no hope for the common man like us,” Ogunjimi said.
It is commonplace to see patients and family members waiting or sleeping outside the wards in many of the country’s general hospitals due to lack of bed space, medical personnel or facilities for proper treatment. Those who cannot afford private healthcare are left to fate, and thousands have died due to lack of proper health care in Nigeria’s government hospitals. In some teaching hospitals, patients with critical illnesses have had to bear the agony of rescheduled surgeries due to lack of essential medical supplies and facilities.
This is the reason Kingsley Ezeamalu believes the country’s poor health system, and not cancer, killed his sister, 39-year-old Uju Okafor.
In 2014, Okafor had three cancerous lumps removed from her breasts. A year later, she had a mastectomy at a private clinic in Surulere, Lagos, which was followed by a six-course chemotherapy.
However, the end unravelled for Okafor when it was time for her post-mastectomy radiotherapy. There was no radiotherapy machine at the Nnamdi Azikiwe Teaching Hospital, Nnewi, in Anambra State, where she worked. At the neighbouring Enugu State Teaching Hospital, the only machine they had, had broken down.
She was faced with the same stark reality at the teaching hospitals in Benin, Edo State, and the National Hospital, Abuja, the Federal Capital Territory.
“For eight months, she travelled around the country in search of equipment for her chemotherapy. She travelled to Lagos in May last year when she was told that the once faulty radiotherapy equipment in LUTH had become operational again. But the equipment broke down some days later before it got to her turn,” Kingsley said.
Sadly, it was too late for Okafor when she was eventually taken to a private hospital in the state where they had the machine. She died a few weeks later in May. She left behind a distraught husband and a son.
“Maybe she would have survived if there were radiotherapy machines in these teaching hospitals,” Ezeamalu said.
There are only seven radiotherapy machines for a country with over 170 million people. Only two of them are functional.
It is the same for many other ailments, with little or no facilities readily available to treat them in the country’s public hospitals.
The Nnamdi Azikiwe University Teaching Hospital, Nnewi, with a yearly budget of N167m or about four per cent of the N3.87bn capital allocation for State House Medical Centre, Aso Villa, Abuja, the official home of the Presidency, is one of the country’s tertiary hospitals in need of urgent funding.
“My cousin who had a car accident last year was taken to the teaching hospital for treatment, but because they place was overcrowded, they couldn’t attend to him on time, we had to wait for several hours. He died as a result of lack of healthcare,” said Francis Amadi, who noted that many in the hospital were abandoned by the hospital staff when their cases could not be handled.
The immediate past president, Nigerian Association of Resident Doctors, Dr. Mohammed Askira, told SUNDAY PUNCH that the country’s dysfunctional public healthcare system had caused preventable deaths.
“I have several instances of deaths from poor or unavailable healthcare. I am going to give you one prominent one. A former minister of state for labour and employment and his family could not be saved after their car had an accident on one of the busiest highways in Nigeria. He was travelling between Abuja and Kaduna expressway.
“Unfortunately, this man and some of his family members could have been saved if between Abuja, from Zuba to Kaduna, there were one or two functional healthcare facilities that attend to accident and other medical emergencies. But we lack manpower and facilities to attend to emergencies. The truth is, the healthcare system in Nigeria is pathetic and we are running a grossly dysfunctional system.”
A medical doctor, Kingsley Ekwuazi, noted that poverty, lack of facilities in public hospitals and well-trained medical personnel in the public health system were major clogs in the country’s health sector.
“Ordinary Nigerians die every day because they cannot afford or access quality healthcare services. I know of a woman who gave birth and was referred to a general hospital. She had renal failure and died later because she could not afford dialysis. Most government hospitals now charge for health services, unlike before, where most of these services used to be free,” he said.
Statistics that shame a nation
In October last year, the Minister of State for Health, Dr.Osagie Ehanire, said Nigeria was spending over $1bn annually on medical treatment, noting that the Federal Government was committed to improving health facilities nationwide to stem the tide.
But that tide may take a while to abate as millions of Nigerians groan under the burden of a lack of or poor health care system.
Nigerians reportedly spend at least $3bn (over N1trn) annually on medical tourism annually. An Indian doctor, who did not want to be named for fear of victimisation by his employers in his home country and in Nigeria, told SUNDAY PUNCH that the Indian government makes about $100m from Nigeria alone as a result of medical tourism.
“Half of that sum is spent on treating top Nigerian public officials in India, from top civil servants to your lawmakers. Some of them just come to Indian hospitals for simple medical check-up that can be easily done in Nigerian hospitals. If the right structures are put in place in Nigerian hospitals, from facilities to skilled/trained personnel, at least half of the medical tourism money will stay in Nigeria,” the Indian doctor added.
The US, Germany, Dubai in the United Arab Emirates and India are the top four destinations for medical tourism by Nigerians, the doctor said.
Also, statistics from the World Health Organisation show that about 2,400 children under the age of five and almost 200 women of childbearing age die daily due to ineffective health services.
“Every year, 100,000s of children below the age of five die because of malaria and complications of malaria, while 824 women die per every 100,000 live births in Nigeria. It is terrible,” said Askira.
Nigeria has the highest rates of maternal and child deaths after India, and accounts for about 10 per cent of under-five deaths globally.
Just recently, the Federal Government allocated N3.87bn to the State House Medical Centre, Aso Villa, Abuja, a sum that is more than the total capital budget of the country’s 16 Federal Government teaching hospital, which are usually under-staffed, overcrowded and lacking in major facilities for routine healthcare services and medical emergencies.
Experts have said the Aso Villa medical centre’s budget of N3.87bn would have built at least 76 PHCs in many rural communities in Nigeria.
For a country of over 170 million people, there are not enough Primary Health Care centres in 36 states across the country. In addition, most of them are in various state of disrepair or abandonment.
Recently, the Minister of Health, Prof. Isaac Adewole, said the Federal Government hopes to achieve a target of 10,000 revitalised PHCs nationwide.
A litany of foreign medical trips: Buhari, Yar’Adua, Jonathan, others
In April 2016, the Federal Government said that it would not provide funds for any government official to travel abroad for medical treatment unless the case could not be handled in Nigeria.
However, economic analysts say the Federal Government has reportedly spent billions of naira of taxpayers’ money on these medical trips abroad.
In November 2009, the late President Umaru Yar ’Adua was hospitalised for about five months in Saudi Arabia for an undisclosed ailment. Nigerians were, however, kept in the dark until Yar ‘Adua died in May, 2010 and it was revealed that he had been battling a heart condition.
His then Vice President, Goodluck Jonathan, who took over the reins of power following Yar ‘Adua’s death, was then elected in 2011 as President. In 2014, Nigeria’s then First Lady, Patience Jonathan, was reportedly flown to Germany from Abuja for surgery for an undisclosed ailment. On her return, after several subtle denials from the presidency, Dame Patience, speaking during the farewell service in honour of the Jonathans’ at Aso Villa chapel on May 17, 2016, said she had gone for major operations during the re-election campaign of her husband, Goodluck Jonathan. “I almost died,” she reportedly said.
The wife of former President Olusegun Obasanjo, Stella, died in a Spanish hospital, following a liposuction procedure that went awry.
Similarly, several of Nigeria’s former presidents and top politicians have gone abroad for medical treatments.
Aside from the presidents and their spouses, key government officials, including some state governors, have also embraced foreign hospitals for routine check-ups and medical treatments.
In September 2015, former Akwa Ibom State Governor and now Senate Minority Leader, Godswill Akpabio, travelled to the UK after sustaining injuries in a car crash in Abuja, the Federal Capital Territory.
This was despite the construction of standard specialist hospital in Uyo, Akwa Ibom State capital by the former governor, in his time.
The former governor, during the opening of the hospital, had said the health facility, which reportedly cost about N30bn of taxpayers money to build, would dissuade Nigerians from travelling abroad for medical treatment because the expertise is now available in the state.
A faulty health system, national budget
The Nigerian health system operates along a three-tier system – primary health care at the local government level, secondary health care at state level and tertiary health care at federal level. However, primary health care, which was designed as the cornerstone of Nigeria’s health policy and is the first point of contact for most Nigerians within the healthcare system, has been neglected for decades.
Teaching hospitals in Nigeria are overcrowded because the other levels of healthcare in the country – primary and secondary healthcare – are not functional or available, said Prof. Kayode Osagbemi, of the University of Ilorin Teaching Hospital, Kwara State.
“If the PHCs are not well grounded, funded and well supervised, people would naturally boycott them and go to the teaching hospitals. But these teaching hospitals cannot concentrate on complications, research and training because of these drawbacks; we don’t have enough consultant specialists, and the ones that are available do not have a functional system to work with. So, these teaching hospitals handle other cases that should have been taken care of by the PHCs and secondary health centres because their levels are not near optimum.”
Osagbemi noted that the major causes of death in Nigeria are malaria, measles, malnutrition and other infections, and pregnancy-related or childbirth-related cases.
The exodus of Nigerian doctors to other climes for greener pastures is also a major headache for the public health system in Nigeria. According to the Vice President, Commonwealth Medical Association, Dr. Osahon Enabulele, who is also a former President of the Nigerian Medical Association, there are about 3,000 Nigerian-trained doctors in the UK and about 5,000 in the United States.
Nigeria’s annual health budget, compared to other African countries, is abysmally poor, Askira added.
Osagbemi also noted that Nigeria’s annual health budget is usually below the 15 per cent recommended by the World Health Organisation.
The country’s health budget has been on the decrease since 2011. In 2013, only 5.6 per cent was allocated for the health sector.
Askira said this was a major factor contributing to the poor state of healthcare in the country.
He said, “If you compare with most other countries in Africa, Nigeria is the one with the poorest budgetary allocation for the health sector. In 2017, about 4.1 per cent of the national budget was budgeted for the health sector, which is in contravention of the Abuja Declaration of 2001 that says 15 per cent of the country’s annual budgetary allocation should go to the health sector. If the health sector is not adequately funded, there would be problems. For any country to have sustainable development, it must critically fund three sectors: health, education and security. In Nigeria it is very poor.”
Nigeria’s 2017 budget is N7.298tn, with N304bn provided for the health sector. The per capita value of the 2017 health budget is about N1,700, an amount not enough for the effective treatment of malaria. Less than five per cent of the country’s combined (federal and state governments) budget of about N13.5tn is to be spent on public health in 2017.
Askira said thousands of Nigerians die daily because the Federal Government had failed to provide the citizens with quality and affordable healthcare.
“Effective, affordable healthcare is not available to Nigerians because the primary healthcare is neglected, secondary health care is in tatters, and the tertiary tier has no adequate facilities or motivated manpower because salaries are not well paid and on time,” he said.
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