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Our rickety hospitals and a health system in shambles

By Ugoji Egbujo

When you hear some of the cases of medical malpractice that have become all too rampant now you can’t but conclude that some medical doctors have become petty fraudsters. It’s one thing to commit a mistake that falls below the standard expected of doctors or even one that borders on ‘criminal’ negligence , it is however egregious evil to engage in activities aimed primarily at defrauding patients. And tragically, in many of these cases, hapless victims must “leave it to God”

“Doctors are no angels. But medicine should have no room for scoundrels. The doctor- patient relationship is that of trust and confidence. The society , every society , expects doctors to possess angelic attributes and makes certain special demands on them as fiduciaries. The physicians’ oath commits them to exemplary professional conduct and dedication to their patients and humanity in general. Their trainings are rigorous but the job often calls on humaneness not necessarily acquired through formal education. In many societies, dignity belongs to them.

“Doctors in Nigeria were once revered. And bright kids were told from cradle that medical career would confirm their giftedness. But not any longer. The majority of our doctors are still men and women of exceptional character and intellectual endowment. Much of the blame for the deterioration in medical care must rest on the society. Rotten apples abound but it would appear that a more systemic affliction has gripped the national health care system. Assuming what we have can be called a system. The general rot has seeped into and is consuming the medical community. The calamity that our degenerating health sector has become is an inevitable consequence of chronic poor planning, poor funding and poor regulation.

HospitalDoctors are being bashed right , left and centre . Once, they were celebrated nobles. Are they now villains? Tales of medical horrors and inexcusably poor medical care are rife. The virulent cancer it appears is metastasizing rapidly . Are doctors mere scapegoats? Scapegoatism as remedy for a multi-faceted social issue is perhaps short sighted, emotional nonsense. Because citizens , patients, must be offered adequate protection, tangible solutions. And comprehensive restoration of the health care sector will need more than the telling tales of woes about hospitals and the lampooning of doctors.

Medical doctors are some of Nigeria’s brightest hands . And they are arguably Nigeria’s best trained professionals. And if Nigeria has suffered brain drain, the bulk of lost grey matter is her doctors. Doctors possess internationally marketable skills , so those who stay behind despite the greenness of foreign pastures should be appreciated . But a careless doctor is a grave danger to the society. She is as dangerous as a violent criminal on the loose. So those who have chosen to stay are only useful if they are committed to the promotion of the health of the community. Fortunately , medical practice is one of the few professions where there still exists a semblance of internal regulation and where trainings still aspire to some level of international acceptance.

Generally , work ethic in Nigeria is poor and the public, regrettably, has become inured to pervasive mediocrity. So why is the public so dissatisfied with our doctors and why are reported cases of medical malpractice and outright medical fraud now rampant? Perhaps only banks and telecom companies and their likes can be sharks whose clumsiness must be accepted and paid for by consumers. I agree hospitals should be held to much higher standards.

But our expectations are often naïve. We are an overly optimistic people. We neglect things that should matter the most and yet expect a medical service delivery system that is not decrepit. When priorities border on vanity and superficiality , necessity and substance are neglected. So when we manage to build and install, we leave to disintegrate. Most public hospitals are poorly maintained and private hospitals cannot attract funding needed to be real hospitals.

The health sector despite our inordinate fantastical wishes cannot be isolated from and rendered immune to the decay that has beset the collective.

What you sow , you shall reap. Doctors struggle to keep our teaching and reference hospitals open , but they unfortunately remain what someone recently referred to as ‘white washed sepulchers’. The rich and powerful know the state of our hospitals, and they rarely go to them. So you have a mighty Lagos with a mighty population and a mighty but functionally moribund Lagos University Teaching Hospital (LUTH). A LUTH with rickety beds. And senior government officials live with and are comforted by the delusion that they can always get to their preferred hospitals abroad. Many times however, life and death will unfortunately depend not on the availability of an air ambulance but on how many minutes it takes to get to the nearest proper clinic. The rich , even the rich must be worried. “What happens if I slip off the stair case and sustain a serious head injury? What if I develop a sudden cardiac arrest?”

And a disenchanted society is left to throw tantrums at doctors and nurses for whom contempt rather than admiration is now reserved. Same society so steeped in anomie that nobility and public sacrifice count for shiftlessness . A “cash and carry “society where means and morality mean nothing and the only meaningful end is tons of money. A society in a perpetual haste to no where, and where people trample on rules effortlessly and on flowers planted with public funds with contempt. A society in need of taming.

Once , a patient brought severely critically ill died in the emergency room of the Lagos University Teaching Hospital (LUTH). Moments after , ‘ area boys’ arrived in droves, unhindered , to visit mayhem on the medical staff in the emergency ward in Idi Araba. For the invading group of urchins, doctors and nurses were responsible for the death of the patient. Such orgies of violence are not confined to LUTH. They have been reported in many other hospitals across the country. In a place like Lagos where civility makes one vulnerable , doctors, who must be nearly always be seen as gentle , are soft targets of such savagery. Most deaths taking place in Nigerian hospitals are not caused by doctors. Doctors are not infallible and do make mistakes . But the pain of morbidity and of bereavement must make room for that understanding, the understanding that doctors are, in the main, rescuers.

But even relatives who won’t pay , who dump the sick on doctors and abscond , often still find moral justification to vilify conscientious health workers . If every patient presenting in emergency rooms in the country must be treated then someone has to pay for it and it can’t be the doctors. People expect mandatory treatment for all presenting in emergency and they think somehow the physician’s oath entitles them to that. Even if that oath were that of servitude, doctors cannot meet the health challenges that only good governance and effective people oriented legislation and health insurance programmes can ameliorate. Americans have a legislation which makes that possible (EMTALA), which ensures anyone presenting in the emergency is treated . Their doctors do not pick up such bills. Without tools, without rewards, without respect, somehow doctors are yet expected to be living sacrifices? Many point to private hospitals and wonder if patients owe anything more than the fees they are charged. Hospitals are not outfits for unbridled profit making. The truth is that competition and lack of regulation mean that many hardworking private medical proprietors scratch to survive because sharks and quacks rule the trade. Doctors, even those in private hospitals, are compassionate. They ask for and receive much less than their due.

“Yet some hold the contrary view that doctors have become too commercial. Some say that doctors should be “called” and that many are not “called”. Perhaps not exactly the epiphanic prompting many pastors claim but “calling” , in the sense of having an innate compelling passion to care for the sick. Others expect more, expect doctors to possess a meekness , a tendency towards abstinence , contentment and charity . But doctors are ambitious people and hospitals pay bills. Many say a doctor should not insist on his payment before treatment? And should be gentle about his demands of it afterwards? Doctors are not monks and nuns and are not sworn to poverty.

Long ago, doctors were respected here. The police would nod in respect and wave them on and perhaps kidnappers would have spared them. Not anymore, nearly every one is now wild and nothing is sacred. Doctors are harrassed by the police for stabilizing gun shot victims and molested by relatives when they insist on police report before continuing treatment. Doctors are even derided in churches. People walk up to the altar to give testimonies of the Lord’s mercies and they are often not done until they have eviscerated doctors. Doctors are often cast as agents of doom who peddle convoluted , jaw breaking, names of illnesses that ‘saints’ must learn not to pronounce. And some of these testimonies end with a relish in the perceived profoundness of the ignorance of doctors. “I travelled from hospital to hospital………” you know that narrative.

The tension between doctors and their patients in a community where many live below poverty line, where no effective national health insurance policy exists must be expectedly high. Poverty means people can’t think about health until perhaps when they are manifestly ill. And because they live on the edge, they cannot get adequate medical care when stricken by infirmity until complications have set in. But there is more, doctors will tell you that those who have means would look after their cars more than they would care for their health. They pay the bills of auto mechanics promptly but will regularly owe hospitals as they jump from one to another strangulating clinics with chords of debts. And private hospital owners pine and writhe in frustration. And public hospitals get practically nothing from national and state budgets. They didn’t learn from the Ebola outbreak that good health is first line of national defence and that an epidemic could be more deadly than Boko haram . Wise people know however that good health is best economic asset.

I must confess that the general decay that has worn thin societal moral fabric is ravaging the health sector. A penchant for shoddiness fueled by the ‘get rich quick’ craze has also gripped some doctors. It is true that doctors must aspire to be different and the oath foists that on them. But how can anyone in this society which has made money its god resist the pull of mammonism?

 

To be continued next week

 

 


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