Nigerian Hospitals: Saving Lives or Merely keeping Alive Those Who Fail To Die?

I will not exaggerate. I will try not to be another lamenter on the bad state of things in Nigeria. Not that it is bad to lament after all it possesses the ability to bring forth redemption. Firstly, I will tell you a story, one I would have you believe is based on actual events.

Few years back, I was a medical house officer in one of the topmost tertiary hospitals in Nigeria. ‘Topmost’ here refers to one of the top two or three hospitals irrespective of the criteria used. It is arguably the most popular hospital in Nigeria among both health workers and the general populace. 

On this fateful day, I was on call at the emergency room, resumed at about 8am and immediately my attention was drawn to a young boy of about 16years. I can no longer remember his name but the whole episode lives with me till date. He was a young boy who had been operated on in a smaller town about 4-5 hours drive from my hospital about 4 days prior to this day. The surgery had not gone as planned as it was complicated by massive heamohrrage leading to hypovolemic shock causing acute kidney injury. The doctors at the referral centre had felt he would benefit from dialysis, but not having the facility to do this, they referred him to neighbouring towns having hospitals with dialysis centres. His parents had about 3 centres located in different towns to choose from but not wanting to take chances with their beloved son, they decided to come to the nation’s finest though it was the farthest of the 3 and possibly the most expensive.

I was just resuming to work. I kept wondering why the team on call earlier had not attended to him and was informed they had been busy most of the night and wanted the incoming team to see him. He had arrived at the emergency few minutes to 8am.  I took a relevant history from the parents and examined him. He was stuporous. My assessment was uremia with urgent need for dialysis. The registrar on my team also reviewed and assigned me the duty of working him up for heamodialysis and to get the dialysis team on call to review and take him for dialysis. Before he could be dialyzed, I needed to take blood samples for a number of investigations and also make the results available to the dialysis team. Running around for this, in between attending to other incoming patients to the emergency room, all was set for the dialysis team by 1pm. They promptly came to review and scheduled him for urgent dialysis. They were to ask him to be wheeled into the dialysis room ‘soon’. 

I kept on working while the boy’s mother kept beckoning on me to come attend to her child. I empathized with her and took time to explain to her all he needed now was dialysis the timing of which was in the hands of the dialysis team. At 4pm, he was still lying on the couch in the emergency room awaiting the call for dialysis. His condition was worsening. My registrar made frantic calls to the dialysis center.

At about 5pm, a member of the dialysis team came to document in his folder that they could not dialyze him as the water pump, or so, in the dialysis center was faulty. The father was confounded. He kept asking if there were other dialysis centers around he could have his boy dialyzed.

At about 6pm, the boy died. He couldn’t stay alive long enough for the water pump to be fixed. His mum looked at me as though I killed her son. I was the first to attend to him earlier that morning, I was also the one who certified him dead almost 10hours afterwards. What if they had gone to another centre instead of mine, maybe he would have made it? Why wasn’t the water pump working? Why did it take the dialysis centre hours to realize they could not have him dialyzed? That incidence caused me a lot of pain.

About 2 months after, I quit working at the center for somewhere else. The hospital had not lived up to its reputation. I promised to never return there unless I was in position to influence or change the system. I even considered leaving the medical profession if I had to practice medicine in Nigeria. I later reconsidered; the reason for this is a story for another time. When I sought placement for residency training, I never considered applying to this “Naija’s finest” tertiary hospital. You can tag it bitterness. I was disappointed.

But the story highlights a number of issues. This is not a call to have more dialysis centres set up nation-wide. It is good to note that there are more dialysis centres around today than then but the purpose of this article is not about the challenges of dialysis in Nigeria. I beg to ask, are our hospitals designed to save lives or merely there to keep alive those who are lucky not to die? Imagine a situation in which a patient has an acute illness needing a life-saving procedure; do you think our present hospitals are engaged for such?

Hey friends, here I write not of highfalutin stuffs like gene therapy of PET scans, I write of basic things like having the ability to rapidly check the blood sugar level in a patient presenting to the hospital. It would amaze you of how many emergency rooms exist without simple tools like nebulizers or ECG machines; how many labour wards lack bedside ultrasound machines; or how many emergency rooms have defibrillators – many nurses and doctors working in emergency rooms have never used one! And I fear. I will not forget to add the number of surgeries that are suspended or delayed occasionally with dire consequences due to unimaginable things like non-availability of theatre scrubs or, as well understood in the Nigeria context, due to power outage and lack of fuel in the back-up power source. And there are a lot more. At times I joke with my friends; don’t pray to be sick in Nigeria. If you must be sick, pray it is not on a weekend – it would surprise you to know many hospitals don’t have functional laboratories on weekends. And above all, pray to be lucky.

There is so much inefficiency in the system. All stakeholders must arise. Let’s start from the basics; maybe a national stipulation on minimum tools and staff training to be made available in every emergency inlets into the hospitals at secondary and tertiary levels of care or what do you think? I have intentionally avoided discussing the lack of emergency medical services in Nigeria – that also is for another day.

Whatever your take on this, I’ll leave you with a question; are hospitals in Nigeria designed to save lives?