By Sola Ogundipe & Gabriel Olawale
ARE public hospitals houses of health or homes of death? This is the pertinent question on the lips of patients seeking healthcare services in government health institutions in Lagos and environs in recent times. To say that government health institutions are overwhelmed and that their facilities are overstretched would be an understatement.
Expectedly, people who check into hospitals face risks. While expecting to get better, some actually end up getting worse. There are so many unfortunate horror stories about hospital risks, danger of medical complications, and perhaps worse of all, the human errors, which cannot be ruled out.
Indeed, the challenge of seeking and obtaining attention as a patient needs to be experienced to be believed as the patient spends an age battling legion of inconsistencies. It is not surprising that the typical health care provider in the public hospital has lost the confidence of patients.
At the primary level of care, nothing works. At the secondary level, activity is at best sub-optimal. There is shortage of everything from medical staff, drugs and beds, to critical equipment and funds.
Service delivery at the average public health centre is fraught with ill-motivated staff, poor time management, strikes, and decaying or decayed equipment and other inadequacies.
At these hospitals, the average patient is confronted by endless waiting, bad staff attitude, and indistinct or unmarked service points. Lately, the sick, who have been visiting General Hospitals and Health Centres in Lagos, in search of one remedy or the other, have been narrating various experiences of woe, pain and anguish.
Today’s outlook of many general hospitals is grim. They are overcrowded, short staffed, abundant with collapsed or collapsing infrastructure, meagre funds to provide for medicines and health supplies, etc. Things are so bad that common medical consumables such as syringes and cotton wool are often purchased by the patient, while in extreme cases, sensitive surgical equipment are reused on different patients without proper sterilization allowing transmission and spread of potentially deadly viral and bacterial infections among unsuspecting patients.
General Hospital, Lagos
Take for instance, the General Hospital, Lagos, the pioneer secondary health institution in Nigeria. Established in 1893 as a military hospital to care for the British Army that were sick during the colonial days, it was formerly known as African Hospital but was renamed the General Hospital to curb racial discrimination.
Since the hospital was handed over to the Federal Government during the nation’s independence on October 1, 1960, and then to the Lagos State Government on creation of the state on the May 27, 1967, it has undergone series of transformations. Sadly, not all the transformations have been positive.
When Aisha Garuba was admitted into the accident and emergency ward of the hospital, it was a demeaning experience. Aisha, who suddenly took ill in the night as a result of an undisclosed ailment, was rushed to the hospital by relatives, who constantly made overtures to the medics on duty to attend to her.
“I went in as an emergency in the night. They took me in and what I remember is that the doctors and nurses on duty were very casual in their approach. They asked for my hospital card and asked a couple of other questions that I felt were unnecessary, but even though I got attention, obviously, the response could have been better,” she told Saturday Vanguard.
Although Aisha spent just a few hours in the casualty ward, what she observed did little or nothing to improve her condition. “I did not go into the main ward but my memory of the casualty ward remains acute. It was so horrible. There was a stench coming from somewhere and it was bad.
“The environment was definitely not okay for a hospital. The place was overcrowded, it was hot because the ventilation was poor, and there were not enough beds as a result of which some patients were turned back.”
While in the casualty, Aisha saw at least six people die. “They were old people, and I did not know what their ailments were, but the fact that they died just like that was not a pleasant thought. In a way, the nurses tried, but that is not a place anyone would want to be. I had to be referred to the Teaching Hospital for follow up.”
In Aishat’s opinion, the attitude of the medical personnel was just routine. “The sense of urgency was lukewarm and not exactly what you would expect in an emergency room. The response time could have been a lot better. The facilities are old and dysfunctional. I will not recommend that place for anyone that is in need of hospital care. In short, my last word about that place is simple: Don’t go there.”
Usman Tanko’s case was no different. A Keke NAPEP operator, his brother had been referred to the hospital following injuries sustained in a road traffic accident. His argument with the security man at the entrance to the ward drew attention.
Tanko’s complaint was that the security man stopped him and his brother from entering the ward despite explanations that they were only returning to submit the result of the X-ray doctors prescribed for his brother.
“We initially did the X-ray with the hospital’s scanning machine but it was unclear. Their machine is bad so we were asked to go to a private diagnostic centre within the hospital premises.”
Another patient, Idowu Emmanuel, was among the scores of those waiting for attention at the surgical outpatient department. He told Saturday Vanguard how he had arrived as early as 7am accompanied by his wife, but his expectations of keeping his appointment with the doctor were thwarted when the records officer could not locate his case file. Looking dejected, Idowu said it took the best part of four hours before an emergency file could be opened for him. Worse still, he was given a new appointment on another date.
Deborah Yinusa’s own experience involved her daughter who was on admission and required certain medication to be purchased. “I was instructed to get the prescribed drugs outside the hospital because the hospital’s own pharmacy did not stock the prescribed drugs. In fact the pharmacy was not well equipped and I was disappointed at the standard which is not befitting for such a big hospital. I was later directed to one particular pharmacy on the Island.”
A middle-aged man, who identified himself as Seyi, said he had been attending the hospital for treatment in the past three months and had witnessed the death of several patients. Speaking to Saturday Vanguard in confidence, he said some of the deaths could have been prevented in his own estimation.
When accosted, Taiwo Akinbami was carrying a urine bag and wearing a sober look. Initially, he declined to comment, but later opened up. “The way and manner I was addressed by one of the nurses made me sad,” he remarked.
“I was seated when I observed that the names of patients were being called, so I approached the nurses to say that I had not heard my name. But the nurse’s reply shocked me. She was extremely rude and insensitive. First she asked whether I had my ears inside my pockets when patients’ names were being called. Then she said I shouldn’t bother her because she wasn’t the one that caused my present predicament. I felt so bad by her conduct. It is a shame that someone of such terrible disposition and attitude works as a health worker in a big hospital like this.”
Funmilola Olabuyide who was there to change the dressing on a wound told Saturday Vanguard her first experience at the hospital was nothing good to remember, but quickly added that now she had many friends among the doctors and nurses that help fast-track attention whenever she visited.
“When my husband was first rushed to this hospital two years ago, he was rejected and referred to another hospital due to lack of space. But this year when I was involved in fire incident, they admitted me and gave me good treatment. I have noticed that they are under staffed and overwhelmed by the large number of patients. This alone is a major challenge. Many of the workers have the mentality of civil servants. They arrive late to work most times and leave early when there are still patients waiting to be attended to.”
The bottom line is that today, at the General Hospital, Lagos, patients complain that the attitude of some of the doctors and health workers is not encouraging. To the average patient, a public hospital is a place where patients and their relatives are treated with disdain, and their feelings or opinions mean nothing to the health workers.
Aside from being overcrowded, some crucial facilities that can aid quick recovery are lacking. Patients are stylishly diverted to the pharmacist even as a number of essential drugs are not available in the hospital pharmacy. Diagnostic equipment like X–ray machine, are either broken down or unavailable.
While a couple of ambulances from the fleet recently procured by the Lagos State Government are on ground, a couple of decrepit ambulances are still being put to use. At the emergency department, relatives are left to sit on bare floor or stand for hours on end. The front of emergency and casualty department is noisy and disorderly.
The toilet attached to the hospital was under lock and key when Saturday Vanguard visited, and the relatives of patients and other visitors were being compelled to pay to make use of a privately managed public toilet facility within the premises.
Investigations by Saturday Vanguard revealed that some of the reasons for the problems faced by patients in public hospitals are poor staffing, inadequate remuneration, lack of training opportunities, poor facilities and security for doctors.
The working definition of a hospital as recommended by the World Health Organisation, WHO is: “A residential establishment which provides short-term and long-term medical care consisting of observational, diagnostic, therapeutic and rehabilitative services for persons suffering or suspected to be suffering from a disease or injury. It may or may not also provide services for ambulatory patients on an out-patient basis.”
For decades, there has been a growing dissatisfaction with the existing health services in public hospitals and a silent revolution for better health care services has commenced. Currently, it is recognized that the standard of health services the public expect is not being provided.
A very high proportion of the population particularly in the semi-urban and rural areas, does not have any access to health services, which can be used by only the privileged few and urban dwellers.
A way out is for public-spirited individuals and corporations to step in and help out. Arguably, government cannot do it alone.