Once again, the topic for this week has been changed due to the increasing number of harrowing experiences narrated by parents and their relatives in various Nigerian hospitals. In the past, it seemed that events like those we are about to read about could happen in certain sectors of the healthcare industry but not in others. While private establishments have traditionally battled with inadequate staffing, public hospitals were somewhat better off. The dearth of equipment in those public hospitals has more than detracted from their manpower advantage. Worse, while the teaching hospitals and federal medical centres have striven to improve their services, it remains the case that you are unlikely to obtain optimum services if you do not know a senior member of staff who works there. The primary health centres, established with a lot of background hard work, some four decades ago, have largely fallen into both disrepair and neglect. The same has been the story of nearly every general hospital in the country. To be sure, many of them did not begin to even employ consultants until a few years ago. While we have frequently discussed the problems afflicting our teaching hospitals, we have not been as affectionate towards the others on the lower rungs of the ladder.
It is largely to those ones that we dedicate our attention this week. Now, the sick person who arrives at the hospital typically endures the challenges we shall try to discuss here today. First, they are attended to according to the severity of their presenting condition. When the doctors have made a diagnosis, they proceed to write out several prescriptions, unknown in many other countries. The initial list will contain the following items: one box of latex gloves; one pack of cotton wool; one bottle of methylated spirit; one roll of plaster (4 inches or 6 inches); 10 units of syringes and needles (5 mls); the required size of cannulas (2 units at least); infusion giving set (1 unit), and one blood transfusion set if a blood transfusion is anticipated. Lastly, 10 units of 2 ml syringes and needles may be added depending on the age of the patient and what the likely medications will be. In the midst of all the confusion and anxiety in the emergency room, nothing can be done for the patient because there is no emergency stock of these materials. The nurses, therefore, wait for the prescribed materials to arrive at her station while the doctors proceed to another patient. And so, right from the emergency room, treatment tends to be very individualised with each patient in charge of their resources. Then, the patient is allocated a couch; most of these couches are trolleys actually with no form of padding.
These have no mattresses and sometimes, no linen. The patient must then also provide their wrapper, bed sheets and covering cloth. In many of these general and central or state hospitals, health workers have become accustomed to such sights. Following the issuance of the prescription sheet above, the unhappy doctor then settles down to write another one containing the patient’s more specialised needs. And so, they are given a prescription for the following items; a nasogastric tube detailing the size; a urethral catheter of the required size; two drainage bags for both of the named drains; one chest tube; one underwater sealed bottle; surgical blade(s); sterile surgical gloves in a couple of pairs for use in attaching or applying some of the materials prescribed above and finally, a third prescription sheet is written that will contain the specific medications and infusions required by the patient. The prescriptions have to be written separately because the items are too numerous to be contained in one prescription. Secondly, the prescription sheets tend to go to different pharmacies within the hospital which the patient’s relatives are often obliged to discover on their own. When they return from their different directions, they may find that the first doctor who attended to them has closed and the incoming one has opted to change some of the items already purchased. They begin to run around again to get the new materials.
Finally, the patient is settled into his or her trolley. And it is then realised that they require oxygen. In some cases, this is also prescribed and one member of the family with a vehicle dashes off into town to get a cylinder of the special gas. Another relative is nearby to take the various blood and urine samples to the laboratory. If they are fortunate and it is not 4 pm yet, the laboratory staff will be in attendance. Even so, many investigations are not possible once it is past 1pm on a normal working day. On weekends, it is an absolute disaster in many of these hospitals and in all the states of the country. During public holidays, it is just as bad with many hospitals running only with skeletal staff. Many investigations cannot be run unless the specimens are taken to private laboratories. In Africa’s largest economy, it ought to be possible to do better. The largest economy in the continent should be able to compare with the largest economy in Latin America or the Caribbean or the Middle East where the bulk of countries with underdeveloped economies are to be found. But we compare more closely with Chad and Burundi and Haiti who have the lowest income per capita in the world. The countries that have got it right with their healthcare system realise that it is a social service that has to be well funded. What we have is economic growth without development and the consequences are serious.
Ultrasound scans and X-rays are almost impossible to get done unless you know somebody who knows who to call. If a blood transfusion is required, it will be easier to travel by road from Lagos to Ore than to get a unit of blood. It can be that bad especially if it is an uncommon blood group. Sometimes, even with all the elements cooperating with you, you may find that there is no hospital orderly to wheel the patient to the X-ray unit and back as a result of staff shortage. This then constitutes a roadblock to further progress in confirming a diagnosis. Many patients in the emergency room expire at this point. Those who progress to getting proper admission into the wards almost certainly have an iron will to live. In the final analysis, nothing is as distressing as having to prescribe a pillow for a patient admitted to a public hospital. Or getting advice to provide your standing fan because either the ceiling fan in the ward is too far from you to be effective or does not work. The supreme irony in all of this is that the most qualified healthcare staff are found in public hospitals. Their aggregate experience is second to none but they remain hampered by the lack of tools to do their job. Some of the hospitals have sought to ameliorate the condition of patients to a large extent by making up admission packs which patients can pay for at one point of service; packs which contain most of what the patient requires within the first 24 hours on admission.
However, not all hospitals have adopted this practice and the challenges therefore remain. In one bizarre scene about 10 years ago at a tertiary hospital in Lagos, an anxious husband dashed to his home to bring a generator that could be linked to the labour ward theatre so that his pregnant wife could have a caesarian section. That night, the public power supply failed and the hospital’s generator would not start. All of these events will probably sound now like some tales from a distant land but be assured that they have happened many times over. When will we get it right? Why is it so difficult to change the pattern of conducting these affairs?
Questions and answers
Dear doctor, I am sorry to disturb you but I have been confused a lot by what my doctor and my friends have told me is wrong with my right shoulder, the joint, in fact, the socket. The pain is not describable. It aches me most of the day and night and sometimes, I am not able to sleep at all. I find it difficult to wash my back with a sponge when I am bathing and I am surprised that there is no swelling. This problem has been with me for over a year and my friends have told me it is arthritis while my doctor has said it is tendonitis. I don’t know who to believe. Please I need your advice. 080556****
Thank you very much for your question. Be rest assured that you are not disturbing me. Unfortunately, you did not share your age, sex or what you do for a living with us and all these are relevant to the genesis of this complaint and its progression. However, what seems likely is a wear-and-tear disease affecting the right shoulder joint. The shoulder joint is described as a ball and socket joint with a high level of mobility, which makes it prone to peculiar types of joint diseases all of which could behave alike with minor but key differences. In this regard, osteoarthritis is a possibility but so also are at least two other types of tendon injuries. One of these is supraspinatus tendonitis and the other is restrictive capsulitis. You will have to see an orthopaedic surgeon for a proper examination and treatment plan. Your doctor can issue you with the appropriate referral.
Dear doctor, thank you very much for the work you are doing for the populace. I have a concern regarding my right leg, the part after the ankle joint. From my ankle down, there is pain although I fell about two months ago, I took some pain relief and did a lot of massaging. But the pain comes up every day especially when I undergo a little stress. What should I do? 080272****
You must be referring to your foot then. If the foot is swollen, which you did not mention, it will be good for you to have an X-ray done because there may have been a missed fracture of any of the small bones in the foot. If on the other hand there is no swelling, then you will benefit more from a combination of two pain relievers to deal with the recurrent pain. Thank you so much for your kind words but ensure you also visit a hospital and get that foot properly examined by a doctor just in case you tore a tendon or a ligament.
Dear doctor, I trust that this mail meets you in sound health and wellness. Please sir, how can we prevent maternal mortality in Nigeria, particularly among the age between 35 and 40, because in recent times, the rate of maternal deaths is alarming in the country. I can count the number of cases that occurred between March and April 2023; it calls for concern from the government and other relevant stakeholders in the health sector. It is no wonder that the affluent travel to give birth abroad. Please sir, I want to know what those things are that need to be put in place for such women before pregnancy, conception, during labour and after delivery. kadiriismail
Thank you very much for your kind words. This seems a lot like a similar question that was answered last week but there are some new criteria as well. It is not possible to rely on your figures alone in computing the number of maternal deaths that occurred during the period you mentioned. With regards to the broader question of what needs to be put in place for the proper monitoring and safe delivery of these women, that is beyond your capacity as an individual. What you must do is register any pregnant woman promptly in a proper centre established for that purpose, ensure she attends her appointments and take your doctor’s advice very seriously. In the majority of cases that reach the hospital, the outcome is positive. The majority, who have little or no access to maternity centres or hospitals, are the bigger challenge facing the government.
Dear doctor, my son is a year and seven months old. He developed a high-grade fever three nights ago and I started to give him Ibuprofen syrup. The following day, he developed catarrh and by yesterday afternoon he was coughing too. His body is really hot in the evenings and night. He had these same symptoms last month and we took him to a hospital where they ran tests for him and said he had an infection. That was just over three weeks ago now; so can he have that infection again? I am confused and stressed. I don’t sleep and he is not comfortable. What do we do please? 080713****
I sympathise with you. It is possible for a child to have another infection not necessarily the same as the previous one but similar in its presentation. Another infection is possible, yes. However, you described a pattern of fever that is worse in the evenings and of a high grade. That is often seen more usually with malaria. In his case, of course, this outlook is complicated by an upper respiratory tract infection. It is important to have him examined by a paediatrician, who will request that he does the relevant tests and be more comfortable to treat him based on the laboratory evidence. Once this is adhered to, your son will be fine. However, do not rely on antipyretics alone to control the fever; you can administer frequent baths with water at room temperature to avoid a convulsion.
Dear doctor, my son is one year and two months. He woke up two days ago and just began to cry in a way he had never cried before. I checked everywhere I could think of like his butt, ears and mouth, but I couldn’t find anything wrong with him. But when he passed stool, it was just blood and mucus. All through yesterday he did this four times and developed a mild fever so we went to a hospital in our area where they checked his tummy and took some of the stool for tests but we were not admitted after I confirmed that he was not vomiting. Today, the amount of blood in the stool is really scary but he isn’t crying anymore. The doctors are confused and are not telling us anything other than we should wait for the results. What should we do, sir? +447432****
Interesting story there. If not that you said he was no longer crying I would have asked you to get ready for an emergency operation. However, without vomiting, he most likely has bacteria-induced dysentery and should do well with simple antibiotics. Amoeba, Shigella and Campylobacter can cause similar kinds of illness. Unfortunately, from what I can see, you are not in the country and it will be nearly impossible for you to obtain any antibiotics for his use. In that case, you should wait for the results to be available and then he can get the treatment he needs.
Dear doctor, if a man is aged 40 years and no longer has erections, what options does he have for treatment? I am not married yet and this is giving my parents a lot of concern, but they are not even aware that I have this problem which has been like this for nearly two years now. Please tell me the way forward. 08120****
At 40 years, you are too young to have this kind of experience. Perhaps, there is a hidden medical problem that has made it impossible for you to gain erections. But your decision to wait for two years before seeking advice is a bit unsettling. At any rate, you should see a urologist at the nearest public hospital to your residence. If you are unable to locate one by yourself, your regular doctor should be able to refer you appropriately. Good luck.
Dear doctor, I have an ulcer and it is killing me. I have been having a tough time with a stomach ulcer. The doctor I am using now is suggesting that I see a gastroenterologist for an endoscopy test so that I will know how to get myself treated, but that is too expensive for me at this time and I am just wondering what else can be done in the interim. They tested my stool and said I was bleeding internally. What should I do? Now, I have been given Omeprazole and I have started using it. There is some relief but I want to be cured, not relieved only. 080330****
If blood was detected in your stool, it is imperative for you to undergo this investigation so that your oesophagus, stomach and duodenum can be looked at with high-resolution mirrors. If there is any area of bleeding, it can be burnt off and stopped, and if there is a growth a biopsy of it can be obtained for further analysis in a proper laboratory. However, in the absence of the requisite funds to conduct this investigation, you should be availed of the opportunity to have a urease test done and H.pylori looked for in your stool. These are useful investigations for the detection of peptic ulcer disease.