Our “Misdiagnosed” Healthcare System

You should have, like every other proud Nigerian, been embarrassed, maybe even sad and disappointed, when you learned that your president, Shehu Yar Adua, was hurriedly whisked to Wiesbaden, Germany, for medical care. And if you were not, it is probably because you had no idea what Wiesbaden looked like.

Wiesbaden is a “retirement city”, 20 minutes from Frankfurt and 120 minutes from Berlin, the capital of Germany. Wiesbaden is about the size of Oshogbo in Osun State, or Abeokuta in Ogun State, littered with old and medieval retirement homes. It is a relatively expensive place to live because all those who can not afford to live in Frankfurt (but work in Frankfurt) live in Wiesbaden and commute to work from there daily. Nothing, besides the Mainz River, is spectacular about Wiesbaden. I lived there from 2002 to 2007.

You should have even been doubly embarrassed if you learned that your president’s ailment had been repeatedly “misdiagnosed” in Nigeria. It took a hapless physician in Wiesbaden – Wiesbaden, for Christ’s sake – to correctly diagnose Yar Adua’s ailment. I am in shock.

There was a time in Nigerian history when the University College Hospital (UCH) in Ibadan was the authority on health problems. There was a time when the Lagos University Teaching Hospital (LUTH) in Lagos was the authority on health problems in Nigeria. There was a time when the Ahmadu Bello University Teaching Hospital (ABUTH) in Zaria served as the last word on health issues in Nigeria. If you were literally on your death knell, you went to the ABUTH, or the LUTH or the UCH. If they could not fix you up there, you died a noble death, knowing that the best brains and hands in the business tried their best. My father died in the hands of such doctors at the ABUTH in 1978 at age 42, and the entire family felt satisfied that the doctors did the best they could to save him.

Today, those three hospitals are shells of themselves – old, cruddy, empty shells. I have not been inside the LUTH or the ABUTH in a while, but I was at the UCH in 2007, visiting an ailing relative. It was the sorriest state in which a university teaching hospital could be. Should I talk about the sparse patients’ rooms or should I mention the apathetic attitude of the young doctors and nurses? Or maybe I should talk about the decrepit condition of the hospital as a whole – massive cobwebs in patients’ rooms, thick enough to trap an elephant; paint, faded and peeling off; the stench, oh, the acrid stench that permeated the air. You could get sick just by visiting that hospital. A doctor friend, who went through the UCH in our university days over 20 years ago, told me that there was less equipment in the UCH today than there was when he went through. Wow!

Technology in general, and medical technology in particular, have made many advances, nay, revolutionary strides, that it is criminal for our foremost medical establishments to remain consigned to pre-historic medical practices.

Already, Nigerians have had to live with the embarrassment of the wife of a sitting president, Stella Obasanjo, dying in a foreign hospital bed while undergoing a “tummy tuck” – a cosmetic operation that is so very routinely performed in many countries. Former Bayelsa State governor, Alamieyeseigha, walked around with a bleeding stomach from a “tummy tuck” that could have been performed in Nigeria.

What if Yar Adua had died (God forbid) in Wiesbaden? How do we explain to the world that with all the medical brains in Nigeria, the oil money and the grandiose National Hospital, in Abuja, our president sought medical care abroad (in Wiesbaden, of all places!) and died there? How do we explain that to posterity? And if Yar Adua can easily jet out to Germany for treatment, what about the rest of the 150 million (or so) Nigerians? Who do they call when they are seriously ill? Did I say “call”? Does anyone even know the Emergency telephone numbers in Nigeria? Where do Nigerians go when they are at their medical tether’s end?

In 2002, my friend’s sister and another young lady – Bukky (not her real name) – about 25 years old, visited my friend and I at the D’Rovans hotel in Ibadan. We strolled to the Suya spot right outside the hotel’s gates and purchased some Suya. All four of us ate the delicious Suya with my friend and me washing it down with some cold gulder beer. Two days later when I saw my friend’s sister, I cursorily asked about her friend. “Oh, Bukky is in the hospital, you know?” She said. She told us that Bukky had suffered from diarrhea since the day after we all ate Suya. “It is very serious o”, she said.

About two days later, my friend and I visited the so-called hospital to see Bukky. It was not a hospital. It was one of those private clinics set up in residential neighborhoods by young doctors barely two years out of medical school, whose parents are wealthy enough to fund it. They specialize more in performing abortions than treating malaria. But to many people, it is a “private hospital” and it is synonymous with private care – something long absent in government hospitals. The problem with those kinds of private clinics though is that the doctor is usually inexperienced, has limited reference materials, has no colleague on whom he could bounce ideas about treatment, cares more about paying his clinic rent and so charges exorbitantly, and comes to work only when he feels like it.

On the day we went to see Bukky, she had been in the clinic for about a week. The doctor had seen her only once since the day she was brought in. Her condition was terrifying, to say the least. If I had never seen her before, I would never have known how much she had deteriorated. The gorgeous lady that we saw at D’Rovans had been reduced to a hollow, frail, wrinkled and dying body. She must have lost about 20lbs. in 4 days. Her eyes had sunk into their sockets, lips pulled apart and cheeks rarefied. The strangest thing was her abdomen. It protruded like she was 6 months pregnant! Just above her head was the Intra-Venous (IV) bag that was connected to her arm. This clinic was located in the Mokola area of Ibadan.

Her mother, who did not know who we were, told us that she had not eaten for days and the drips were all that she had received. I just KNEW that Bukky would never make it. My friend and I asked to speak with Bukky’s mother outside. We asked her if she could remove her daughter from that clinic and take her to a government hospital. She resisted at first, afraid that Bukky would be left to die at a government hospital. We pointed out to her that Bukky was dying in the private clinic anyway. The family, she said, had spent everything they had on Bukky. The clinic charged N2000 per day for the bed alone and they now owed N12,000 total. The cost of the drips and the doctor’s fees are charged separately. In fact, she said Bukky’s father had just left to borrow more money from friends. My friend and I offered to take care of the clinic’s bills if Bukky would be moved.

Bukky was moved to a government hospital in the Onireke area of Ibadan the next day. Three days after she arrived at the hospital, my friend, his sister and I visited her. The nurse at the Reception warned us about touching anything to avoid contracting diseases. In this hospital, Bukky shared a room with three other patients. As we entered the room, the thing that first caught my attention was the “bed.” Check this out: It was nothing but a tarpaulin stretcher placed on four short bamboo poles dug into the dirt floor of the hospital! A bucket was placed under the bed, right below the location of the patient’s buttocks. I looked over to a vacant “bed” and discovered that a hole, large enough, had been cut through the tarpaulin to allow patients do their toilet business. Bukky’s mother told us she was there to empty the bucket whenever Bukky used it. My mouth was agape. A plot of land in the Onireke area of Ibadan, if you found one for sale at all, would cost nothing less than N3 million.

Bukky looked at us and said softly: “thank you, sir.” Her mother, ever present at her side, also thanked us. Bukky had gotten back most of her strength and radiance in just three days! She was slightly embarrassed to be seen by strangers in her weakened condition, but we assured her that she was just like our sister. Just as we were about to leave, the doctor walked in. He must have been at least 60 years old. He was making his second and final round, checking on his patients before leaving for the day. He exuded experience and confidence. I thought I wouldn’t mind dying in the care of someone like him. I asked him what the problem was with Bukky. He told me he would let the patient tell us herself, but all he had to say was that she had been “miss-diagnosed” and therefore “miss-treated” at whatever medical facility she had been. “If she had not been brought here when she was, she would surely have died”, he concluded.

Bukky was one of the few who manage to survive common medical emergencies in Nigeria. Many have been buried prematurely because our health system is in shambles. I had not the foggiest idea what the problems were and neither did I know what solutions to proffer. But at the onset of President Yar Adua’s recent ailment, two distinguished Nigerian medical practitioners (Dr. Robert Sanda and Dr. Segun Adekale) exchanged illuminating email messages about the embarrassment. Their messages served to widen my horizon as regards our health system. What they said is enough to open your eyes. But if you can think deeper about what they did not say, you would become even a more knowledgeable person. I have asked one of them, Dr. Robert Sanda, to allow me to share with you excerpts of their messages. You will agree with me that parts of the problems with our health system are political, economical, grand official ineptitude, jealousy and institutionalized corruption, as with every thing else wrong with our country.

President Yar Adua needs to get well, wake up from the anesthetics that seem to have numbed the senses of successive administration officials and fix these issues. Sanda and Adekale are based in Saudi Arabia and Canada respectively:

“The sad reality is that our professional fore-runners have created a gulf between them and the future generations of doctors. When resident doctors started agitating for better training opportunities in the mid-1980s it was those first generation of Nigerian doctors that betrayed us and made sure that the erstwhile mandatory overseas one year training for resident doctors at the level of senior registrars was not sponsored by the government and was stopped. This second generation of doctors that trained or graduated in the 1980s and early 1990s left the country in droves. The result is that the first generation was out of touch with new medical innovations and taught the third generation outdated stuff. I recall late Professor LJ Egler lamenting around 1995 that his knowledge of HIV research was 4 years behind because the medical library had no relevant journals in the preceding 4 years.

“I know the ex-President you were referring to…” (This was another previous Nigerian president that was misdiagnosed of his ailment until the diagnosis proffered by Dr. Adekale, which was ridiculed and rejected by his superiors in Nigeria at the time, was upheld in France and in Germany and the then ex-President was correctly treated in France!). “… And I know your eminent senior Professors at the time. These are the same grandiose men and women who would never admit to having gone wrong let alone admit that a junior colleague could be right. I recall the former chaplain of ABU protestant chapel, Cyril Okorocha ThD, lamenting the fact that Nigerian leaders would climb a height and then remove the ladder to make sure that nobody else caught up with them. This is the legacy of our medical forebears in Nigeria and though I know many people would feel offended by this statement from me, in my perception it is the reality on the ground. How else can you explain this scenario: a candidate for the primaries of the national postgraduate exams was told by his examiner that he would not be allowed to pass at his first attempt because the examiner passed at his fifth attempt? Or better still, a candidate was asked how many times he had read the book REVIEW OF MEDICAL PHYSIOLOGY by Ganong and when he replied that he read it twice from cover to cover, the examiner told him to come back after reading it five times from cover to cover. In other places, the examiners would let the candidate know his areas of weakness and advise him to focus on them and wish him good luck at his next exam. No, not in Nigeria! The more failures the merrier!

“Just recently a colleague from medical school had to bring his sister-in-law here in Saudi Arabia to remove an intra-maxillary sinus polyp because the consultant ENT (Ears, Nose and Throat) surgeon at the National Hospital, Abuja said he had no facilities for endoscopic nasal surgery. Right here, Hail General Hospital boasts of endoscopic nasal surgery sets, and endoscopic surgeries are an everyday thing. Yet the National Hospital in Abuja has to turn patients away. What a mess our health system is in. In a way this episode is a blessing in disguise as it should make the president aware of the staggering backwardness of the health system in Nigeria and look around for exceptional Nigerians to revive the health sector or we are all doomed. The N300 million shared shamelessly and sacrilegiously as Christmas bonus by the staff of the Ministry of Health last year by the holy name of Jesus Christ would have done the country a degree of good if, for example, half of it was spent buying endoscopic ENT equipments and sharing the same to all hospitals in Nigeria that have ENT doctors. The other half could have been spent in sending at least 30 to 40 Nigerian ENT surgeons for short courses of between 6 to 12 months, and fewer ENT patients would have to leave the country for treatment in places like Saudi Arabia.”

Since the ABUTH, UCH and LUTH have been relegated to the status of glorified clinics, I visited the website of the so-called doyen of Nigeria’s hospitals – the National Hospital, Abuja. It was founded in 1999.

Here is their “Mission Statement”: We are the flagship of the medical institutions in Nigeria and endowed with sophistication in men and materials. Our corporate objective is to provide a friendly atmosphere for the care of all discerning patients without discrimination. We serve with empathy for the sick and devotion to duty. Our services are prompt, courteous, comprehensive, efficient and effective.

The “flagship of medical institutions in Nigeria”? The…The… Flagship? If they are the most important and the most prestigious (for that is the meaning of “flagship”) then we are in deep trouble. “…Sophistication in men and materials”? Yet we are unable to properly diagnose the ailment of our No1 citizen? “…Comprehensive, efficient and effective”? Haba! Give me a break.

The problem is not that our doctors are intellectually deficient. Lack of resources in our medical establishments, to include even the lack of modern equipment in our teaching hospitals, seems to me to be a major contributing factor to this malaise. I know too many Nigerian doctors, young and old, who come to the United States after being denied employment, pay raise or even promotion, take the requisite certifying Board examinations and pass in flying colors on their first attempt, and go on to become indispensable in their fields. Dr. Sanda reminded me of Dr. Janeth Chiaka Ejike, based in California, USA, who received a prestigious award at the third congress of the World Society for the Abdominal Compartment Syndrome (WSACS) held in Belgium in 2007. Dr. Sanda and Dr. Chiaka are the only Nigerians on this international body. Chiaka would never have been so recognized if she had remained in Nigeria. In fact, she might have spent half of her life hopping from one jail to another if she agitated for her rights like many of our bright minds have had to do.