By Chioma Obinna

When the National Hospital Abuja (NHA) was made a referral health institution in September 1999, the vision then was that Nigerians from all walks of life will not have need to travel outside the country to access health care.

The idea was to have a hospital that is well equipped, well-staffed and well maintained. Sadly, the dream has not been realised as the situation in the health facility today is far from that vision.Investigation shows a gradual decay of physical infrastructures and quality of services in the NHA while a key factor killing the hospital is corruption. Corruption is said to have eaten deep into the fabric of the society to the point that those who condemn it in daytime go to bed with it at night.

Sunday Vanguard  contacted the Minister of Health, Prof Isaac Adewole, for his comments before the first part of this investigation, penultimate Sunday. Although the Minister promised to visit the hospital for an on-the-spot assessment, he is yet to keep his promise at the time of this report.

No condition of service
One lapse in the hospital is absence of condition of service for the staff.  Sources at the health institution said that the absence of condition of service is one major reason the best hands leave after their residency.

“This is one of the reasons the staff of the hospital are also prone to industrial action to press home their grievances”, a source said
This was confirmed by a member of the sacked Board in 2014 who told Sunday Vanguard that when the Board was in place, they recommended a condition of service that has incentives slightly above what is obtained in other places so as to encourage the medical and non-medical support personnel to give in their best.

“We gave them enhanced call duty allowances and proposed other incentives on accommodation, transportation, training and research grants, welfare of family members and opportunities for exchange programmes to enable them travel out for refresher programmes or receiving Nigerian medical professionals to come home during their sabbaticals on exchange programmes”, the former Board member said.

“We even approved funds for the Chief Medical Director (CMD) to travel abroad and encourage some Nigerian doctors to return and contribute their efforts to building our health sector. All these came to naught. The hospital Management today operates without a Board to oversee its activities. Its procurements are done between the Management and the Ministry of Health.”

Health watchers believe that the scenario again brings into focus the issue of the Nigerian factor. Even when the former Board was in place, the Management was said to have tried to sideline it on the grounds that the members were not medical professionals.

Disengagement of doctors
Investigation also reveals that whereas the NHA is short-staffed, the Management keeps disengaging resident doctors.
Some doctors, who just finished their residency and were hoping to be upgraded to the rank of consultants, were said to have been asked to leave.

This development is coming at a time the ratio of doctors to patients is put at 1:50 on clinic call, an indication that the hospital is suffering severe manpower and equipment deficit.

Speaking on the situation, the Public Relations Officer of the NHA, Dr. Tayo Hastrup, who dismissed the allegation, said: “The letter of disengagement was only given to resident doctors whose period of training has expired”.

One of the doctors, whose residency expires in February 2017, however, told Sunday Vanguard: “When I finished my Youth Service and joined the NHA in 2007, I saw the hospital as an ideal place for a young brilliant doctor who wants to give his best.  But, sooner than later, the reality began to unfold. I began to discover the culture of sycophancy, mediocrity and mendacity that had permeated the fabric of the system.

“This is a place where professionals are expected to attend weddings, birthdays, house warming and other social events of their bosses to show that they are loyal. When you meet your boss coming to work, you must take his or her bag or whatever he is carrying from him.

Wherever you see him, you must walk up to greet him, leaving whatever you are doing as a sign of loyalty.
“The CMD cannot be everywhere at the same time, but, unfortunately, those who head the various departments and those that are close to him only tell him what he would like to hear. They are pre-occupied with their selfish interests while the hospital deteriorates and patients and doctors suffer.”

Sub-standard equipment
He went on: “First, we don’t have standard diagnostic equipment to work with. When we have emergency cases at night, you may find a doctor using rechargeable light or light from cell phone to find intravenous line, because the generator has packed up and there is no electricity from public supply. In a place like the National Hospital, you would expect that machines for CT scan, ECG and MRI are readily available at the emergency units. You expect that the simulator machines would be functional, but in this place, you discover that doctors use manual marking of patients with oncology cases instead of a simulator to examine the patients. First, you will not get the accurate reading that will help you determine the actual dosage to apply. We rack our brains to determine dosage to administer to the patient and determine where to direct the radiation treatment.

The MRI machine that we use in this hospital is a toy. The capacity of the Teslar is about 0.3 when what is required is a machine with a Teslar capacity of 1.5. The world standard is 3.0.We cannot rely on the readings from the MRI machine which is problem-solving equipment”
Further investigation reveals that the NHA records frequent breakdown of equipment and other facilities due to lack of repair and maintenance. The source alleged that some equipment procured in 2014 by the hospital remained in the crates and yet to be installed.

A source in the radiology department of the hospital said: “Since 1999, there has been a steady decline in our equipment and other facilities.
“As we speak now, the Linear Accelerator machine that is used for radiation in cancer treatment is broken down. It does so frequently. When it does, patients are referred to Zaria or Sokoto at extra cost.
“The new Lineal Accelerator machine procured in 2014 is still intact in the crate and we fear that it may have gone bad under the condition it is kept. We fear for the condition of the machine. Even some of the doctors who have been trained on how to use the equipment are those being forced to leave the services of the hospital.

“The MRI machine, which plays a key role in diagnosis in modern treatment of disease, cannot give doctors accurate reading and report became the capacity of the Teslar is too low. The modern MRI machines have moved from 1.0 to 1.5, and the latest is 3.0. “Some private individuals have 1.5but what we have here is 0.3.  If private individuals have MRI machines that can give five times the readings that we get here, then you can agree with me that what we have here is a toy”.
As of the time of filing this report, the radiation machine at the NHA had been down for six weeks.   Patients with oncology challenges are not getting treatment.

Unfortunately, harder times await cancer patients accessing care at the hospital or any other centre in the country.  Information shows that the radiation treatment machines in teaching hospitals in Enugu, Benin, Lagos, Ibadan,  Sokoto and Abuja are also down.  Sadly, these hospitals are not in a hurry to fix the machines as the various managements are complaining of money for buy forex to bring a foreign expert to fix them. Consequently, oncology patients today in the country may have to wait for a long time for their treatment to continue.

According to oncology experts, it is better for patients needing this treatment not to get radiation treatment than to get half dose or incomplete one.   “If somebody is getting radiation treatment and breaks, the cells will now build immunity and bounce back.”

Patients testimonies
Meanwhile, testimonies abound about the anomalies at NHA.Some patients and health workers, who spoke to our correspondent, poured out their frustrations. From their revelations, it was gathered that, every week, the hospital receives about 25 new cancer patients and, on any given day, it records about 45 old and new patients on schedule for radiotherapy. One of the patients said: “When the radiation machine breaks down, our treatment plan is altered. Some of the patients come from other parts of the country.  Sometimes, the patients wait for so long on the queue before they are given treatment. In some cases, interruption in power supply could keep patients for hours.”

A cancer patient, who spoke under anonymity and was first diagnosed at the hospital but had her treatment completed in India, told Sunday Vanguard that many patients have died due to the waiting period.    I would have died if I had waited.”
Another patient, currently accessing services there, confided in  Sunday Vanguard  but refused to give his name for fear of victimisation. According to him, most of the diagnostic  machines in the NHA are 35 years behind technology.

“Imagine the features, functionality and utility of the cell phones that we use today and the types that came when GSM was first introduced to the country in 2001, that is where we are today in terms of medical equipment and technology. While the world has moved to G4 and G6, we are importing equipment that have the features and functionality of first GSM generation. Their parts are no longer available and those trained in repairing them have moved up to the new technology.  When there is a breakdown, we find it difficult to get  the spare parts and engineers who can fix them”, he said.

“Patients are given under dosage which does not deal with the disease and death results from this callous action.” One of the resident doctors explained their frustrations: “We are not happy or proud of the situation but what do we do?   Doctors who are trained to save lives just sit helpless and watch patients died from preventable deaths. We cannot keep silent and allow this to continue. We are losing out to private hospitals. People are making mockery of the National Hospital Abuja, that it is a place where people who want to die go to.”

Another doctor at the foremost tertiary hospital also told our correspondent: “Some of us consult in a room with no comfortable chairs or air conditioner. We are expected to rack our brains and make diagnosis, even when we see a large number of patients within a short period of time.”
He further blamed the situation on underfunding and endemic corruption in the system. His words: “Patients are compelled to go to private hospitals for diagnosis. The problems at the health facility has brought so much pressure on consultants, resident doctors, nurses and non-medical personnel who are totally dissatisfied and sometimes disinterested in the welfare of their patients. There was an instance where a former Nigerian High Commissioner to the UK was brought to A & E and we were looking for Glucometer to check his blood/sugar level.

“The former envoy’s driver had to rush to his house in Maitama to get his own at home. How can you manage such a diabetic crisis without hourly RBS, let alone tests like SEUCR?”
At the NHA Surgical Out Patient Department, SOPD, a patient narrated his own experience. He was booked for surgery for 10am and was duly counseled not to eat or drink. He appeared for the surgery at 8.30am and was taken to the theatre around 9.00am. Thereafter, he was abandoned. He narrated his story to Sunday Vanguard: “It was when my wife became very mad with them at about 3:30pm that they told her that the doctors who were supposed to attend to me were attending a seminar”.

A patient was subjected to such long period hunger and lack of care, imagine that level of callousness by health providers. Even diagnostic tests in the NHA like FBC, PVC, Chem, MP and PCV, which cost approximately N1,500 to N2,500, have gone up by 100percent. It is challenging for patients to dole out as much as N50,000 toN80,000 for a single CT scan, MRI, Bone scan etc and the result cannot give proper diagnosis. Whereas we should be talking of a machine for PET SCAN which enables doctors to have full knowledge of the status and location of the disease in the body and determine the quantity of medication that is required for the patient.

“We operate in an environment where doctors are denied the opportunity to attend international conferences and present papers and interact with their peers from other countries. On the contrary, we spend our resources to sponsor ourselves to these events where when you present internationally accepted papers, the profile of the hospital and the country is lifted.

For instance, if we attend World Cancer Conference and present a quality and internationally accepted paper, the profile of the hospital is lifted, the image of the country is also lifted and these enable the country to get research grants”, one of the NHA resident doctors added.
Sunday Vanguard gathered from the Minister of Health that the National Hospital, Abuja is one of the referral hospitals in the country which have been earmarked by the Buhari administration for urgent refurbishment, so that it could once again become efficient in service delivery.
A healthy nation is a wealthy nation and the health of a nation is reflected in the well-being of its citizens