How women, children suffer from poor primary health care, dilapidated facilities at Unilorin Teaching Hospital
Many Nigerians visit tertiary health institutions as a sort of fortress. They go there in anticipation of better care and treatment as compared to what obtained at primary health centres, which are nearest to them. This expectation, however, gets shattered quite often as the respite they look for at these federal government-owned health facilities, which are designed for referral cases are met with bleak results. In this report, Omolola Afolabi chronicles the struggles of poor rural people in Kwara state.
By Omolola Afolabi
Young and boisterous, Yusuf Mustapha, 25, was due to attend Nigerian Law School in 2019. With sparkling enthusiasm and high expectation of finally starting his journey to the revered bar, the young law student from the University of Ilorin, Kwara state, set out for his mother’s shop, to make plans for the much-anticipated resumption.
After concluding plans on finance and logistics, he was on his way to his hostel which is 15 km away from his mother’s shop, before he had an accident around the Government Reserved Area (GRA) opposite the police headquarters in the Ilorin metropolis.
“He had an auto accident involving the motorcycle he was riding on and another car. Bystanders at the scene reached out to us, and we tried taking him to a nearby Primary Healthcare Centre (PHC) and later decided against it because we all knew the PHC is rarely functional,” Mustapha’s 23-year-old brother, Mayowa, said.
Mustapha was later rushed to a private hospital along Oja-Iya Road, where he was examined and later confirmed to have an internal injury with his liver punctured. Mayowa said his brother had a successful operation at the hospital before things went awry.
“The doctor on duty explained that operating internal injuries was a special case, so he invited his consultant friend (a specialist on internal injuries). When they did the scans, they said that he had a 50-50 chance with the level of injury he had on his liver. They went ahead with the operation, and the doctor was happy about the success of the entire procedure.”
Mayowa noted that restlessness was observed at intermittent moments during his brother’s recuperation.
“One day, he started losing his breath and had to be connected to oxygen. Then the doctor came and told us to take him to the University of Ilorin Teaching Hospital (UITH). We know the services at UITH aren’t reliable, so we had to contact the hospital first before taking him there to ensure bed space was available for him. We informed them that the person we are bringing is connected to oxygen. They said it was fine and that we should bring him. There was no ambulance, and we had to convey him to the Intensive Care Unit (ICU) in my uncle’s Toyota Sienna.”
“At UITH, there was no light, and they told us to get an emergency kit (first aid kit) to get him stabilized before we could proceed. We didn’t have cash on us and we wanted to do a cash transfer instead, but they told us that they only accepted cash. We later got someone to give us cash to get the kits. Thereafter, we were told there was no fuel in their generator.
We had to look for that but it was very late and all the petrol stations were closed. We rushed home to get our generator. All this while, my brother was still on oxygen. Due to the way he was breathing in the car, we were told to bring him into the premises of the ICU since they were still preparing his bed.”
Mayowa explained that his brother was then disconnected from the oxygen they brought from the hospital he was referred from so that the UITH’s ICU could connect theirs, but the oxygen cylinder brought by UITH was empty.
“It was later that the nurse that brought it said she didn’t know that it was empty. He couldn’t breathe. She also said that it was the only available cylinder but at that point, he was losing his breath already. He gave up afterwards,” he recalled sorely.
More stories of grief
Ismail Olanrewaju lost his wife in 2021 at the University of Ilorin Teaching Hospital, and it still feels like a sore thumb that festers. He said the teaching hospital is long overdue for a comprehensive overhaul. Olanrewaju narrated how both primary healthcare and the University of Ilorin Teaching Hospital could not attend to his wife’s medical needs.
Olanrewaju told SOLACEBASE that his wife visited Eiyekorin Primary Health Centre when she was ill, but there were no medical officers on ground to attend to her. Olanrewaju said he was optimistic about the chances of his wife finally getting optimal treatment at a tertiary institution but was let down by the level of care she got. According to him, one would expect that a federal government health institution would deliver top-notch services that would serve the rural poor.
“They didn’t take care of her very well. After a series of tests, some of which cost as much as N100,000, they summarily packaged her and referred us to another expensive hospital. She died shortly afterwards.”
Jamiu Adeoye’s family is another victim. His sister, Hikmah was involved in an auto accident in the Fufu Area of Ilorin and her condition could have been stabilised at the nearest PHC before deteriorating, but the services are almost non-existent. Adeoye recalled how UITH officials wasted time treating his sister.
“They insisted that we should first make payments, and when we did, they commenced treatment 40 minutes later.”
Romanus Nzute also has a story to tell. He informed SOLACEBASE of how it took over three weeks before his brother could be operated on at the Intensive Care Unit.
“The operating theatre is greatly under-equipped. We were told there was no space to accommodate my brother. I am a new resident in Ilorin and while I was making enquiries about the best primary health centre to take him to, no one even recommended any to me. My neighbour particularly advised against it saying that we would not meet any health official on ground,” Nzute said.
Olatunji Akanbi, a 45-year-old resident of Ilorin took his mum from a private hospital where she was admitted to the UITH, when she went into coma. After discovering there was no space in the ICU, she was taken to the Trauma Centre on the premises of the hospital, asked to N30,000 daily for 5 days.
“Although Ilorin has a huge population of over 800,000 (According to 2006 Census figure) there is only one ICU with only three-bed spaces at the federal medical facility (UITH).
However, his mum gave ghost three days after, as expert told this newspaper that even the Trauma Centre lacked what such facility should have despite been a donated facility to the hospital.
UITH’s decaying infrastructure
The stench of the restrooms greeted this reporter at the emergency department of the UITH. This is a major deviation from the optimal levels of hygiene expected at medical centres.
As a result of the irregular power supply, the noise from generators has become almost a permanent feature in the hospital. This has adverse implications for the patients as serenity and quiet are an important part of the convalescence process, a factor the UITH is acutely deprived of. Several of the buildings are sprawling and a cursory glance at the buildings would make one see the urgent need for an overall, confirmation of what Nigerians experience at the medical facility.
Some of these issues are evident in data obtained from the University of Ilorin Teaching Hospital’s ICU. The data showed that 26 patients out of 76 admitted died between February and July this year. The majority of those who died were low and average-income earners between the age range of 45 to 60 years old.
According to research carried out at Makerere University in Uganda, East Africa, which explores the medical mortality of Nigerians in an emergency department (ED), a total of 16587 patients were admitted during the period under review. Of these, 1262 (7.61%) died in the ED. The male-to-female ratio was 61.2% to 38.8%. Mortality was highest among the 20 to 45 years’ age range with 46.7% of deaths recorded.
Lack of drugs at the hospital
Findings also showed that the majority of the prescribed drugs were not available at the hospital’s pharmacies. Armed with a dummy prescription from a doctor in the hospital, this reporter visited pharmacies in the hospital and discovered that most prescribed drugs were not available rather patients were directed to private pharmacies opposite the entrance of the Teaching Hospital.
Experts, teaching hospital react to findings
A female doctor in the hospital who pleaded anonymity strongly recommends the banking model to ensure optimal primary and tertiary healthcare delivery.
“Banks don’t shut down because diesel is expensive, they found a way to continue running their branches bringing in the extra money to buy diesel. I don’t think anybody would complain if services are expensive because more money is needed to provide the services they seek. For some reason, they have chosen not to do this and human lives are lost without remorse.”
She argues that primary healthcare centres should be able to render basic healthcare services.
“Apart from emergency obstetric care, things like an assisted vaginal delivery, even the resuscitation of the newborn-these are things the primary healthcare centres should be able to deal with because they are basic emergency obstetric care”
“The services primary healthcare may have to refer to a higher level of care should be facilities for caesarean section or blood transfusion. This basic healthcare that I earlier mentioned, most primary healthcare centres can’t even offer it”
She explained that cities and urban centres have private hospitals and general hospitals and that most probably, it’s the capital cities that have teaching hospitals.
The doctor, an obstetric gynecologists’, pointed out that people in the cities still get higher levels of healthcare adding that locals who live in the rural areas are left with moribund healthcare institutions.
According to her, if the PHCs are well-staffed and well-equipped to perform, it will go a long way in helping these people.
“That’s probably all they’ve got, PHCs are their last hope and they are not working so they are at a serious disadvantage. When they come to a teaching hospital, most times, the story remains the same.”
The doctor who has worked for almost a decade at the hospital said the facility has no light, and there’s no water because there’s no diesel, “so how will patients even get surgery?”
“The institution itself has not made it possible to deal with emergencies because so many things that should be done have been neglected. So I would say the Nigerian healthcare system has been designed or is being run in such a way that it is a big disadvantage to people who live in rural areas and even the so-called teaching hospitals that should be the last bus stop where people should get to and get saved are not living up to expectations.”
According to a resident doctor, Dr Olushina Ajadaun, the burden on both secondary and tertiary institutions is biting because primary healthcare is almost non-existent in Nigeria and Kwara state is not an exception.
“For instance, I can tell you that now there are probably 50 to 100 cases of stroke per day in the hospital where I work and we know that from managing stroke, you need an urgent brain CT scan. A lot of federal facilities there don’t even have a CT scan, and those that have are not functioning. So patients are left with travelling to places with CT scan and some of them die on the way because these patients are practically unstable.”
Ajadaun added that the state of healthcare financing in the county also makes health insurance daunting for rural and indigent Nigerians.
“I think the various health insurance schemes including the National Health Insurance Scheme are struggling to make a necessary impact because people have to pay out of their pocket even if they are on a scheme. The scheme rarely covers basic standard drugs and supplies which are mostly unavailable at the hospitals because of poor funding. Teaching hospitals are considered unreliable because of poor financing. Do you know that some illnesses are like a death sentence in Nigeria because we don’t have the facilities? It’s not like doctors don’t know what to do, but we don’t have the facilities to work with.”
In the same vein, a former minister of health, Prof. Isaac Adewole, had posited during the launch of a checklist for assessing the quality of service at federal tertiary health institutions in the country in 2019, that tertiary health institutions were under pressure because the secondary and primary health care systems of the country are underperforming.
While the dearth of infrastructure cut across all levels of care in Nigeria, another challenge of healthcare delivery in Nigeria, is the shortage of qualified personnel. According to the Consultant Pediatric Surgeon at the Lagos University Teaching Hospital, Dr Justina Seyi-Olajide, the acute shortage of anesthetists and anesthesiologists at all levels of healthcare in Nigeria negatively impacts the quality of healthcare delivery in the country.
During a media briefing in Lagos, Dr Seyi-Olajide said the situation is so bad that patients go through surgeries in some hospitals without anesthesia.
“I know of a particular state in Nigeria that has only one anesthetist,” she said.
She attributed this shortage to the serious brain drain and mass exodus of medical professionals the country currently grapples with.
Efforts to get official reaction from UITH’s management proved abortive. At the time of filing this report, the hospital’s management is yet to respond to SOLACEBASE’s request for an interview on the findings in this report. A letter sent and delivered to the hospital management on 11 October, 2022 was greeted with silence.
This publication is produced with support from the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under the Collaborative Media Engagement for Development, Inclusion and Accountability project (CMEDIA) funded by the MacArthur Foundation.