Nigerian Medical Personnel as Merchants of Death

On Tuesday 15th April 2008, one of the dailies reported the heartrending story of how the callous attitude of a doctor and nurses at the Asokoro General Hospital Abuja caused the death of an unborn baby. We have been lamenting the correlation between lack of essential medical equipment and genuine drugs in our hospitals and the rising incidence of patients’ mortality in Nigeria. But few of us realize the huge input made by heartless and mercenary medical personnel to the same effect.

From what I know of their training and the Hippocratic Oath, medical doctors are expected to be caring, loving and sympathetic towards their patients. A pointer to this is the motto of the Nigerian Medical Association which declares that: “we care, God heals”. Nothing less is expected of nurses by virtue of the principles of nursing enunciated and practised by the legendary nurse, Florence Nightingale. The need to “care” for the sick is given prominence in the training of medical personnel universally. Clinical psychology teaches that there exists a vital connection between the attitude of the medical crew and a patient’s state of health. A caring and empathetic medical staff aids a patient’s sound recovery, while a contrary attitude compounds the patient’s case and endangers his life.

Unfortunately, what we have in Nigeria is mostly the ugly reverse of what ought to be. The problem pervades both the private and public health institutions. Generally, private hospitals are run as business concerns and some of the owners exercise caution not to hurt the feelings of the patients. But in their absence, the mainly auxiliary nurses (“Nurse Eliza”) treat the patients shabbily, insult and frighten them. My mother was so treated in a private hospital once and I took the matter up with the proprietor who promised to punish the erring auxiliary nurses. In our public hospitals, the same lackadaisical and indifferent attitude which has wreaked havoc on our public service is the order of the day. Often, right from the time you seek to obtain a card you see hostility staring you in the face from the nurse or administrative staff attending to you. The situation will only be different if the patient is a friend, related to them or exudes wealth.

Ordinarily, a doctor should attend to an emergency case in preference to any other case. That is hardly the case in Nigerian public hospitals. Just a few days ago, a woman with an advanced stage of pregnancy was rushed to one of the General hospitals in Abuja with excruciating stomach pains. Alarmingly, the doctors at the hospital refused to attend to her until they had completed their “Ward Round”! What justification do the doctors have for exhibiting such callousness to a pregnant woman writhing in pains? Not even a competing emergency case at the hospital by that time can offer them a defence.

Another dangerous incidence in our private and public hospitals is the haste with which gynaecologists and obstetricians prescribe Caesarian sections for pregnant women who are in labour. The widely-held suspicion is that they are guided mostly by pecuniary considerations because surgeries usually attract higher bills from patients. This writer does not condemn the resort to Caesarian section in deserving cases, especially where it is clear that a pregnant woman cannot give birth naturally and may endanger her life and that of her foetus while trying to do so. But pregnant women should not be coerced into undergoing surgery-assisted deliveries owing to the selfish motives of the doctor. In many cases, such women die of bleeding or related causes attributable to the negligence of medical personnel. What is more, cases of surgical instruments forgotten and stitched up inside patients’ bodies keep re-occurring in Nigeria. I am a layman in medicine, but I know there are injections for stimulating labour (where delayed) in pregnant women. Pray, are they no longer in use?

In emergency cases, our doctors insist that unless a patient (usually comatose or close to death) and his relations make a deposit, no medical treatment will be given him. Yet when the same patient dies owing to denial of timely medical attention, his distraught relations are asked to pay a huge amount to secure the release of the corpse. This is rampant in private hospitals, without being rare in public hospitals. Medical personnel in public hospitals who are paid from taxpayers’ monies cannot justify this callous behaviour. I do not suggest that hospitals be run as charitable organizations, but there must be better ways of getting patients or their relations to pay for medical treatment. And a patient needs to be alive to do that. Medical doctors need no prompting to place a very high premium on saving lives.

Many doctors in public hospitals engage in the unethical practice of redirecting patients to their private clinics. Patients who refuse such “advice” receive cold, perfunctory and unprofessional treatment in the hands of the doctors. The same goes for nurses who have private maternity homes or patent medicine stores. Furthermore, many accredited hospitals shortchange Nigerians in the implementation of the National Health Insurance Scheme (NHIS) and their antics frustrate the realization of government’s objective for the scheme. They misinform patients about the coverage of the NHIS and mislead them into bearing the full cost of drugs and treatment ordinarily covered by the scheme. Often, patients are told that expensive drugs covered by the NHIS are out of stock. Yet each accredited hospital receives a minimum of seventy-thousand naira (N70, 000) monthly regardless of whether it treats NHIS-covered patients or not! Unfortunately, a physical assessment of some of the accredited private hospitals makes one to query the basis of their accreditation for the NHIS.

Another sore point relates to the refusal of medical personnel to treat gunshot and accident victims until and unless they produce police reports. This has cost Nigeria several innocent human lives. The doctors claim harassment by the ever high-handed Nigerian police if they do otherwise. I am unaware of any legislation which prescribes this requirement, yet the Nigerian police brands every bloodstained person a fleeing armed robber and has coerced medical personnel to observe same as an immutable law. But reason dictates that this cannot be true in all gunshot wounds, let alone in accident injuries. Assuming every such victim is a criminal, is he not supposed to be alive to face trial? In spite of avalanche of criticisms, this ugly practice persists in our hospitals, increasing the number of dead victims. I heard the police has assured that hospitals could treat such patients first and inform the police promptly. Yet our hospitals refuse to do so. Medical personnel or hospitals stand to lose nothing if they treat such victims and report to the police promptly. And public hospitals should be in the vanguard of changing this ugly practice. Nigerians can no longer condone this medical insensitivity to human life hidden under fear of police harassment.

Probably owing to the prestige associated with the medical profession, many misfits, bereft of the necessary qualities and psychological balance, have found their way into it. Equally, a lot of heartless and unfit ladies have embraced nursing, for it offers easy local employment and opens the gate to overseas jobs. What does one say about single nurses who apparently envy pregnant women and go all out to irritate and insult them? Added to this is the alarming mercantile attitude of many Nigerian medical personnel. It is needful to carry out psychological tests on entrants into medicine and nursing, to avoid these professions being an all-comers affair. Nevertheless, there exist very good and committed Nigerian medical doctors and nurses, many of whom are known to me.

The government and the relevant professional bodies should act quickly to save the health sector from these merchants of death masquerading as medical personnel. Monitoring teams should be set up to pay routine visits to both private and public hospitals and sound out the views of patients on the attitude of medical personnel. Persons found guilty of these unsavoury behaviours should be shown the way out of the health sector. This problem demands equal (if not more) attention as that given to the monster of fake and substandard drugs. Furthermore, the government should speedily address the issue of the police-made “law” that a police report is a condition precedent for the medical treatment of gunshot and accident victims. It takes days to obtain such a report, and experience shows that the observance of this “law” has caused the death of many of such victims. Again, how can the police issue a report on what it may not have witnessed?