By Francis Ewherido
The story of Mrs. Ngozi Udebu, a teacher and housewife, who died recently at the Lagos University Teaching Hospital, Idi Araba, Lagos, occupied a bit of space in Vanguard during the week. I do not have all the details, but available information points to the misnomers that characterize health care delivery in Nigeria.
Saving lives is the prime duty of health care professionals, but this is not the situation in Nigeria. Saving lives is secondary or further down the priority list of many health care professionals. In organised societies, if a case is emergency, money, procedures and protocols take the back seat. Saving the life of the victim takes precedence. But here, getting a card, paying a deposit and other unnecessary protocols come first before the patient gets treatment. The deceased’s grieving husband, Ausbet Udebu, said this much in the Vanguard interview.
The attitude of some Nigerian health care professionals to saving lives is very poor, but it is a reflection of our societal attitude to life generally, not just human life. Boko Haram kills fellow human beings without qualms; Fulani herdsmen wipe out entire villages, and slaughter fellow human beings the way they cannot slaughter their (ordinary) cows. We destroy our forests and green vegetations as if the world is going to end with this generation. When government plants grass along our roads we walk on the grass, instead of the concrete sidewalks, until they wither and die. Bad portions of our roads go unrepaired for months and years, causing accidents and claiming lives. Our value orientation is warped and morbid. Why health care is different is because it has to do with saving lives. That makes any anomaly unacceptable. The standard of care of health and care professionals must be premium, especially in emergency cases.
In 2005, I had an abscess in my palate. Diagnosing it took a while, then the ENT doctor cut it open to off load all the pus and liquid trapped in there. Since he could not stitch it, he gave me antibiotics to prevent infection until it healed. His prescription turned out to be ineffective. On the fourth day, I started vomiting blood. I was rushed to a popular hospital. Even though my white singlet was red with blood, they insisted on admission formalities of card, N100,000 deposit among others. By the time we finished meeting all their conditions, there was no ENT doctor to attend to me. My family piled pressure on them before an ENT doctor finally showed up four hours later. Anything could have happened before then and many Nigerian families have lost loved ones because of such formalities and delays.
Our health care problem is hydra-headed. There is, for example, poor funding of government-owned health care institutions, poor conditions of service, unfriendly working environment, obsolete equipment, among others; but my concerns today are the contributions of health care professionals to the sad situation. The attitude of Nigerian health care professionals to life should be a lot better than what obtains in the larger society. Their primary job is to save life and they should strive to save every life that comes their way as if their own life depends on it.
For instance, many innocent Nigerians have died from gunshot wounds because doctors would not treat them without a police report, even when the police said treat first and then report such cases. Even if the police did not say so, a doctor who treasures life should treat a gunshot victim and contact the police thereafter. What are they afraid of, detention? What is the big deal if they save lives and get detained in the process? Didn’t Jesus die to save them? (I am talking to the Christians among them.)
Many health care professionals seem to have lost their value for life because they see death so often. But no matter how many deaths they see, every life must still be precious. Medical professionals should stop behaving as if they are made of steel. They are regular people like the rest of us and the death of their loved ones also destabilizes them. They should therefore not treat other people’s loved ones with levity. Moreover they should live their Hippocratic Oath.
Indebtedness is one of the killers of businesses, so health care professionals have a responsibility to ensure patients pay for services. But they must strike a balance between business and saving lives. In cases of emergencies, they should save lives first and demand payment later. Unfortunately, many patients and their families have been most unfaithful, but that does not diminish the necessity to save lives. This brings to fore the need to make health insurance more effective and widespread. Much of the distrust between patients and health care professionals would be eliminated if health insurance was widespread.
Health insurance, like other insurances, is bedeviled by illiteracy, low awareness, poverty and affordability. There is need for more awareness and the National Health Insurance Scheme and other such providers need to come up with convenient and affordable schemes. They should put in place and perfect systems and processes to enable subscribers pay little sums daily or weekly. For example, telling a family struggling to provide basic necessities to pay a lump sum of N100,000 for health insurance is a tall order. But if you break it down, they might just be able to key in. A couple of such schemes are already running, but more awareness and accessibility need to be created.
I noticed that doctors who work in government health care facilities abroad also engage in practice outside their institutions, but I suspect the arrangement is well structured and formalized. In our own case, some health care professionals kill or make public health care institutions inefficient so that their private practices can flourish. The problem is not necessarily the PP (private practice), but robbing Peter to pay Paul.
Health care professional must put in their best so that when people lose their loved ones, they will be assured that the health care professionals did not cause or speed up the death. Our health care institutions must not be converted to killing fields.