News The African Way

Investigation: Shortage Of Medical Workers, Equipment Killing Accident Victims And Pregnant Women In Kaduna Public Hospitals

By Iliya Kure
Kaduna (Nigeria) — No doubt accident remains one of the leading causes of deaths in Nigeria. A recent report by National Bureau of Statistics (NBS) on accidents in the country, covering the last 3 years gave the breakdown of those killed in 2013 as 5, 539; the figure for 2014 as 4,430; while that of 2015 as 5,042.

The report shows that 12, 372 persons were injured in road accidents in 2013; 12, 227 in 2014 and 10, 257 in 2015.

It also put the total number of reported road accidents during the period at 24, 954 in the 36 states of the federation and the FCT.

When six Medical Doctors from Ekiti State died in Kaduna, in April, enroute Sokoto for Nigerian Medical Association Meeting, little did citizens know about the condition of General Hospital Doka in Kaduna State – a hospital meant to provide emergency services to victims of accidents on Kaduna – Abuja road.

The Hospital is strategically located, almost halfway through the journey, but grossly under staffed and ill-equipped to provide any emergency service.

One of the surviving Ekiti Doctors narrated how they were taken to Doka hospital after the accident, but there was only one nurse on duty and there were no adequate emergency equipment to cater for the needs of the accident victims.

AFRICAPRIMENEWS reported thus:

Chairman, Nigerian Medical Association (NMA), Ekiti State branch, Dr. John Akinbote who spoke on his hospital bed said lack of immediate medical attention was responsible for his colleagues death.

“Those that died would have survived if we got good medical attention from the point of the accident to the Doka General Hospital in Kaduna.

“It became even worst, when we got to Doka Hospital, there was no single Doctor to attend to us and the only nurse on duty had no first aid facilities to administer treatment.

“I am sure, if personnel of Federal Road Safety, FRSC that took us to Doka Hospital and the nurse on duty had medical facilities to give first aid treatment, our doctors and driver wouldn’t have died,” he said.

A surviving medical doctor was said to have got up and rendered support to the only nurse on duty in attending to his colleagues, before they were finally moved to Saint Gerard’s Catholic Hospital in Kaduna City.

This is the same hospital where wife of late Minister of State for Labour and Productivity, James Ocholi, was taken to, before she too passed on.

The hospital has also not been able to save scores of accident victims on Kaduna – Abuja road through first aid and emergency services, before referral to any hospital of higher status.

The situation is the same with all public hospitals in Kaduna State. No wonder, the decision by Federal Road Safety Corps rescue team to move all accident victims in Kaduna vicinity to St. Gerard’s Catholic Hospital instead of any public hospital in Kaduna metropolis.

An investigation into operations and capability of the hospital reveals that the hospital is a mere shadow of what it represents.

Our investigations confirm that General/Rural hospital Doka is grossly under staffed; with only a medical director, a corper doctor and few nurses. In some cases the medical director is in Kaduna for official functions, leaving the corper doctor and a nurse to handle emergency cases and attend to other patients, including those on admission.

The emergency unit is nothing to write home about. It is a dilapidated building with outdated equipment begging for replacement.

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Other Hospitals

A visit to General Hospital Kawo at night, brought to light the agony patients and their relatives go through when they seek medical assistance at that hour; It is a case of taking their issue to Mr. Nobody.

Most patients expressed dissatisfaction as a result of absence of doctors to attend to them. Our team visited the hospital as patients at about 10 pm, but were told the doctor had gone on break. The team waited till midnight, but the doctor did not return.

Earlier in a conversation, a medical worker, who said the doctor had gone on break had discouraged our team from waiting for the doctor, but stood firm that the doctor would return “soon”.

Those on admission had also complained on attitudes of the medical workers of not coming to check on patients in the night, adding that “hardly do we see doctors on call in the night,” said a patient relative.
One of the patients (name withheld) said “I have been here since last week to look after my sick mother,”

The source added “we only see doctors in the day, once it is night, only nurses come to instruct our patients to take their drugs and even check the sick ones. I have seen many people take their sick ones back home when they come in the night, this is because there are no doctors on calls in the night.

One other discovery at the Kawo hospital is the absence of a generator to power the hospital facility at night. Patients and their relatives heavily relied on their mobile phone torchlights to brighten their surroundings.

The situation is not different at Yusuf Dantsoho Specialist Hospital Tudun Wada Kaduna, where our team discovered no single doctor on call at about 9 pm. Only a nurse was seen on duty at the Out Patient Department; other nurses were also seen checking on patients in their wards.

The team met Malam Salisu whose father was admitted by the OPD doctor on a Monday date. Salisu said a day later, they couldn’t see the next doctor to prescribe drugs for his sick father.

“When we came in the morning, it was the OPD doctor that saw my dad, admitted him and put him on drugs. But as I speak to you now, we are still waiting to see the next doctor to check on him. We were told that he was a consultant and so he will not be in the hospital until Wednesday.

“We have conducted six tests as prescribed by the OPD doctor. They are all in his folder, but there’s no doctor to make comment on them because the consultant doctor has not come.”

This is the same story at other department like Paediatric, Where the team heard patients and their relative complaining about their consultant too. “You can only see doctors in the afternoon not in the night.” One of them said

On inquiry, another said, “If there is any emergency by 12 midnight only nurses check on patients, because the doctor on duty will not be around. This is unfortunate,” he said.

A patient, Nasidi who was admitted at Yusuf Dantsoho Hospital since two months ago, narrated his experience to the team while saying;

“You hardly see doctors in the night, in fact, throughout my stay I can’t remember seeing any of the doctors visiting us in the night, mostly, the doctor would come on visitation by 9 pm after which you will not see them until the following day.

“The doctor sometimes do come around when there is an emergency case, if not, only nurses will check on patients. The sad thing is when it’s Friday the moment they leave no one will be around, till Monday,” he said.

There were reports that most of the doctors abandoned their duties for their privately owned hospitals.

“People say the doctors abandon their night duties to be able to work in their private hospitals, or in other private hospitals where they work,” source who worked with a private pharmaceutical company in the state said.

“I know this because I market drugs in hospitals, I do come in the night to see their pharmacists and I know the kind of things I do see here.

“This is not happening only in Yusuf Dantsoho hospital, it’s the same story in other hospitals within the metropolis where I go to market my products. So, it has become normal for doctors to abandon their patients in the night,” he said.

 

Free Maternal And Child Health Services

Kaduna State government has been announcing that it is providing free drugs and medical services to its citizens, but report of surveys are showing otherwise.

An investigation by our team found flaws, revealing that the policy only exist on paper. Most Primary Healthcare Centres (PHCs) and hospitals across the state do not have such drugs in their facilities. Patients meant to be covered by the programme were constantly subjected to paying for drugs.

A recent survey by a Coalition of NGOs, Maternal and Child Health – Civil Society Partnership (MCH-CS Partnership) shows a similar result to findings by our team.

Key findings from their survey shows;
* Stock out syndrome still exists in the health facilities visited
* Irregular supply of drugs
* Drugs supply/distribution mostly not based on requisition
* Inadequate equipment for the provision of basic EOC especially at the PHC
* Supply of drugs that are about to expire
* Poor awareness of the FMCH program components by the public
* Lack of FMCH guide lines at health centers
* Government not specifying those services that is free to the public
* Weak referral system
* Delay in referral especially from the peripheral hospitals (PHCs)
* Lack of ambulances at the PHCs to assist in emergencies and referrals
* Fees were charged for some FMCH services (such as drugs, cards, antiseptics, sanitary pads, olive oil, laboratory investigations etc.
* Poor facility structures especially at Rural Hospital Doka
* Inadequate clean water supply and waste disposal system in health facilities.

Major Challenges discovered by their survey;

* Inadequate and delay in release of budgetary provisions for running health facilities across the state
* Inadequate clean water supply and waste disposal system in health facilities
* Weak monitoring and evaluation system
* Shortage of skilled personnel especially Doctors, nurses and midwifes in the various PHC centres.

When flagging the FMCH programme in 2007, Kaduna State Government had set a target in its Strategic Plan with clear goals.

Below are extracts from the plan;

Strategic Objectives of the FMCH Policy
By 2009
• Maternal Health: Ensure that a package of free basic and effective maternal health services including drugs is available to at least 80% all pregnant women.
• Child Health: Ensure that a package of free basic and effective child health services including drugs is available to at least 80% of all children under five years
• Human Resource Development: Increase the production, retraining, and retention of MCH personnel and ensure equitable distribution.
• Enhance Mothers function as frontline carers
• Infrastructure development. Ensure rational development, use and maintenance of physical infra-structure for service provision
• Legislation. Enact and implement laws to govern the provision and performance of services and protect the rights of clients.
• Create an enabling environment and systems: Develop and strengthen key management and support systems required for the timely and efficient delivery and utilisation of priority services.
Infrastructure Development
• Develop and implement facility rationalisation plan in which health facilities will be grouped into functional clusters, each consisting of a well- equipped hospital and a number of PHC facilities
o Hospital to serve as referral centre for the PHC facilities
o Private hospitals will be considered for accreditation as referral centres
• Rehabilitate and equip 510 PHC facilities and 25 hospitals.
HR Development and Management
• Increase numbers of health workers in the facilities with emphasis on MCH/PHC speciality (350 engaged nurses for 2007)
• Retain available staff by providing incentive packages e.g. training and comfortable working environment etc
• Improve quality and performance by up-grading skills
• Re-distribute for greater equity using strategies of selective incentive and by enforcement
• Develop special packages to improve knowledge and skills of mothers and carers
Referral, Transport, Communication and Logistics
• Design and implement a referral system based on clustering and linkage with radio, phone and ambulance. Develop referral forms and tools
• Develop and train staff in the use of referral forms and tools
• Provide One (1) ambulance per cluster
• Provide radio communication between referral centre and at least 80% of its satellites

Services Under FMCH:

Package of Care for the Under 5 Children include:
• Malaria
• Acute respiratory infections
• Diarrhoea diseases
• Measles
• Worm infections
• Meningitis
• HIV (mainly transmitted from infected mother)

Package of Care for Pregnant women include:
• ANC
• Treatment of severe anaemia, including malaria
• Normal Delivery
• Treatment Complications during pregnancy, delivery and 6 weeks after delivery e.g APH, PPH, Eclampsia, Sepsis etc including C/S operation

The details of the care expected from health workers in the facilities are arranged as preventive, promotive and curative at each level of care. (PHC & SHC).

True Position Of Things

The investigation by our team found out that the workforce in Kaduna State public health sector has continued to shrink, owing to poor salaries and incentive to retain workers. As a result, tertiary health institutions like Ahmadu Bello University Teaching Hospital, the National Eye Centre, and neighbouring state governments have absorbed a good number of the experienced workers.

More than 40% of the medical workers are due for retirement in about three years time.

A good number of those approaching retirement are eager to leave before the end of 2016. This is because of a new pension scheme that seems unfavourable to retirees.

The team also discovered that the promised free drugs for pregnant women and children below the age of five years is not accessible in hospitals in Kaduna, as patients pay for their drugs. Not even a ‘patient’s card’ has been printed by government to support the programme.

The free drugs programme has only succeeded in creating friction between patients and medical workers, where patients accuse hospital staff of diverting free drugs that are not available in the first place. The irony is where the state government has stationed consultants to collect money in the hospitals for each service rendered, including payment for drugs. This is greatly discouraging pregnant women from seeking medical services at hospitals; and when complications arise during home deliveries, they end up dying, or remain with a lifetime injury.

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