Notorious for apathy

Complaints about the poor reception patients get at government hospitals are getting louder, OBODO EJIRO writes.

“That was the fourth government-owned hospital we had taken our ailing mother to on that hot afternoon. We were however told the same thing that we had been told in the three before and as my sister heard those words again, she broke down and began to sub loudly,” Nonso Obiukwu says.

“We were told in all four hospitals that there was no bed to admit our mother,” Chinyere Obiukwu, Nonso’s elder sister, says.

“But by the time I started rolling on the floor and wailing, ‘please don’t let my mother die,’ the attendants took us inside the ward. To our surprise, there were two empty beds,” Chinyere, who spoke from a rented apartment in a downscale part of Lagos, says.

“Before then, the attendants said all they can offer us was a chair from which our mother could receive treatment,” Chinyere says, as she tries hard to fight back the tears.

Their mother, 71, eventually passed on a day after being admitted. According to Chinyere, the doctor announced the passage with the words: “She has packed up.”

Nigeria’s state-owned hospitals are increasingly becoming known as institutions that show high degree of apathy to patients.

This does not apply to a section of the population, as the elderly, pregnant women and even children have faced the fury of often-irate nurses, matrons and sometimes doctors, as they try to access care.

A 2015 survey conducted by BusinessDay’s Research and Intelligence Unit (BRIU), as part of its health sector report, drew attention to this anomaly.

The report particularly showed that nurses and low cadre employees at government-owned hospitals were inclined to being rude and sometimes inconsiderate to the plight of patients.

The survey, which was conducted as part of the report, showed that the hostile behaviour of some medical practitioners at government hospitals constitutes a major worry for patients, as they try to access care.

“When I took my sick child to a federal hospital in Lagos,” Ekaette Moses says, “the matron did not empathise with me and help, she threatened to throw us out if I do not follow her strict instructions.”

Another patient, who was delivered of a baby at a state hospital, points to the amount of bullying she received in the process of delivery. “Why are those in the private hospitals more polite,” she asks. “But some of those who are employed in the public system also work part-time in private hospitals, so why is their attitude different when they return to the public hospitals,” she asks in retrospect.

The BRIU survey identified three factors that might be responsible for the current state of affairs.

First, public hospitals are always more crowded than their private counterparts. Secondly, the medical personnel-to-patient ratio in public hospitals is lower than in the private hospital system.

And, that is because of a national draught of health care providers. For instance, with a population estimate of 170 million, Nigeria needs 237,000 medical doctors as against the 36,000 the country currently has. Some rough estimates put the number of registered nurses at 150,000. This has bred an average Doctor-Patient ratio of 1:53,333, while registered Nurse-Patient ratio stands at 1:1,066.

The result has been that medical practitioners, especially in the public health system, are under immense pressure. A doctor in the public health system who spoke on condition of anonymity says that doctors in the system who are supposed to see between 25-30 patients sometimes have to see more than 70 patients on a daily basis. In some cases, a doctor is on call for more than two days at a stretch.

(In fairness, Nigeria is not alone in terms of this statistic. Only five of the 49 countries categorised as low-income economies by the World Health Organisation (WHO) meet the minimum threshold of 23 doctors, nurses and midwives per 10,000 population that was established by the WHO as necessary to deliver essential maternal and child health services. But given the human and natural resources at the country’s disposal, it has no excuse.)

Thirdly, the pressure on facilities and space is higher in government hospitals. Taken together, these factors put a lot of direct and indirect pressure on employees of public hospitals.

Nigeria’s health care system has suffered several downturns over the years. Despite the country’s position as the biggest economy in Africa, it is greatly underserved in the health care sphere.

While various reforms have been put forward by government to address the wide-ranging issues in the health care system, they are yet to be implemented at the state and local government levels.

A 2009 communiqué released by the Nigerian National Health Conference stated that Nigeria’s “health care system remains weak as evidenced by lack of coordination, fragmentation of services, dearth of resources, including drug and supplies, inadequate and decaying infrastructure, inequity in resource distribution, and access to care and very deplorable quality of care.”

The communiqué outlined lack of clarity of roles and responsibilities among the different levels of government to have compounded the problem.

Poor budgetary allocation to the health sector has also been a problem. For instance, over the last five years, the Federal Budget on health has stood at an average of 5% of total budgeted sum, which is a far cry from the 15% recommended during a meeting of African Heads of States and Government which Nigeria hosted in Abuja in 2001.

“Government is not properly funding even the education of medical practitioners,” Friday Okonofua, a professor of gynaecology at the University of Benin, says in a telephone conversation with BusinessDay.

“If you compare what medical students have at their disposal these days with what we had at our disposal in our time, you will notice a wide gap, Okonofu, also a fellow of the New York Academy of Science, says.

Because of the complexity of the medical environment, Okonofua says most Nigerian medical practitioners prefer to go to more developed climes to practice as soon as the opportunity presents itself.

But notwithstanding, it is only human to “empatise with people when they are in disturbing circumstances,” says a Lagos based psychologist, who chose not to have his name mentioned. It’s true the conditions of service are often far from ideal but there are still some in the system who still show compassion to the sick and ailing, he says.