Please let me start with a warning; this article is lengthy (close to 2000 words) but it may address most if not all issues concerning the subject above. I pray it’s worth your time. Let’s go!
On Friday 17th April 2020, I made two posts on twitter that have gone viral and generated much conversation online. The first read thus, “A friend took his wife to General Hospital Ikorodu, Lagos for child birth. He was given a prescription to buy 2 sets of Personal Protective Equipment (PPEs) for health workers, he spent 6k. Why should patients bear this burden? What happens to those who can’t afford 6k?” Attached to the tweet was a prescription paper with the name of the patient concealed and the receipt of purchase of PPE from a pharmaceutical store. At the time of writing this piece, it has gotten 1280 Retweets, 1,356 Likes and 321 direct comments.
The second tweet reads thus, “I’m 100% in favour of personal protective equipment for health workers. But shifting the cost to pregnant women and other patients this hard time is counterproductive. Lagos can do better than this. Pls do something fast, Gov. @jidesanwoolu & @profAkinAbayomi”. The photo of the hospital and receipt of payment for PPE were attached. This one has less engagement, 66 retweets, 137 likes and 32 direct comments.
Expectedly, the tweets provoked some questions, outbursts, arguments, accusations and demands for accountability. I also got some feedback on the ripples it created on some WhatsApp groups. I was able to read over 90% of the comments on twitter and replied directly to four. I am writing this article because I have respect for those who have expressed opinions on the matter and I may not be able to respond to each of them individually. I will analyse the comments, provide my perspective to the issues raised so far and make some recommendations. But let me provide some background information before the analysis.
Why did I make such post in the first place? One may wonder. Actually, Thursday, 16th April 2020 was quite a busy day for me. I was in an online (Zoom) meeting for over 4 hours with fellow Executive Board members of the West African Network of Emerging Leaders in Health Policy and Systems (WANEL). We were brainstorming on how to reposition our organization to make more impact in improving quality of health care in the sub-region now and after Covid-19 period. I used the night to return many of the missed calls I had. One of them was that of a friend of about 20 years. His pregnant wife was due for child birth this week. She was restless and I could hear her voice on the background. I encouraged them to go to Ikorodu General Hospital that night, which was where she had antenatal care. They were reluctant, they preferred going to a private hospital they had visited earlier but it was a bit far from their location.
Why were they reluctant? They alleged that they waited for over 5 hours during their previous visit a week earlier but were not seen by any doctor. I persuaded them to go back there for two reasons, one was the proximity – it is can be problematic for them accessing health facility at the Mainland with the multiple road blocks mounted by lockdown enforcers. The second reason was that it’s better for her to deliver at a hospital where she had antenatal care as her past medical history could easily be accessed. They obeyed and went to GH Ikorodu in the morning. My guy was loaded, all he cared about was safe delivery for his wife who had a beleaguered obstetric history. When I called to check on how they fared, he picked and told me he was on a queue at a private pharmacy store where he and other patients’ relatives went to buy PPEs prescribed for them. It got me thinking. Why should patients bear the cost burden for PPEs when the state governor had recently announced free maternal health services? What would be the fate of patients who cannot afford the N6,000 cost of PPEs? Anyone who has good understanding of maternal health will agree with me that it is a potential barrier to access and can lead to higher maternal mortality. The fact that the doctors and other health workers deserve and must use PPEs at this time is not questionable and I fully understand that. I believed asking those questions will get the attention of the state government and make them do the needful. And that I did. Has this purpose been achieved? I will be back with a response, let me analyse the reactions my tweet received.
For the purpose of clarity, permit me to categorize the responders into three groups. Group One understood the message and its intent. They were holding the Lagos State government and health workers at GH Ikorodu accountable for the provision of affordable health care to the people especially this period of economic hardship caused by Covid-19 pandemic. They agreed that health workers deserve to have PPEs but the billions of naira donated to Lagos State government should be used to make them available. Group Two were former users of GH Ikorodu who had unpleasant experiences. They put blames on the doctors and health workers, accused them of negligence, corruption and treating patients with disrespect. Some of them suggested that PPEs may have been supplied by government but possibly diverted by the doctors for personal gains. Group Three of the responders are predominantly health workers who found the tweet offensive and an attempt to indict the doctor on duty. Many of them made emotional arguments; they queried why the name of the doctor who made the prescription was not concealed. More so, some of them considered patients who can’t pay 6k after 9 months of pregnancy as being irresponsible, one even recommended home delivery for such people. Some in this group feared that Dr Aderinwale and his colleagues may be dragged online or victimized by government. A few of them even heaped personal attacks and described me in very derogatory terms. That’s not unexpected in a public space like twitter where responders’ IQs or capacity to comprehend and behave responsibly vary.
Thank you for reading up to this point. Permit me to share a brief information about my professional background to enable any reader put issues in a proper perspective, my qualification was queried by some respondents. I am medical doctor, trained at the University of Ibadan College of Medicine (West Africa’s best medical school – make I brag small…lol). I had my postgraduate trainings in public health policy and management at the United States. Most of my work experience is in Nigeria, I only worked for a couple of years in the US and Togo. My experience cuts across different thematic areas in public health including maternal and child health and has taken me to 32 states across the country. I have a deep understanding of our health system, the challenges of government, health workers and patients as well.
For me, the issue at stake here is life; the lives of health workers as well as lives of patients who utilize the services of General Hospital Ikorodu. I feel ashamed that Nigeria accounts for the second highest number of women who die from pregnancy-related health conditions in the world. The number one cause is excessive bleeding during pregnancy or after child birth. And over 90% of pregnant women who die from bleeding are not attended to by midwives, doctors or nurses. Most of them deliver at home, church or with traditional birth attendants. The barrier for them is majorly lack of money or rude attitude of some health care providers. Both government and health care workers are needed to remove this barrier. Anyone conversant with maternal health will agree with me that payment of N6,000 for PPE will deny many women access to skilled birth attendants at the Ikorodu General Hospital. My friend could afford it, he paid for his wife and even provided financial support to many others whose money were not enough. I was told some patients were even begging the health workers to wave the PPE requirement because they had no money for it. The health workers cannot also attend to patients without protecting themselves, we have few around and cannot afford to lose them to Covid-19.
The question becomes, who should provide the PPEs? I strongly think it is the responsibility of the Lagos State government for obvious reasons, one is to ensure access to maternal health care for all in accordance with its own promise to the people and second is to serve as palliative to Lagosians and enable them survive the hardship caused by the economic lockdown. Has government provided sufficient PPEs to Ikorodu General Hospital? If no, why the delay? When do they intend to provide enough supplies? If yes, why are patients required to buy a pair? There are a number of possibilities here. It is possible government is yet to make any or adequate supply of PPEs to the hospital. It is also possible adequate number has been pushed from the government but diverted before it got to the hospital or by the management of the hospital for personal gains.
Wao…this piece is becoming too lengthy and I have to end it, but not without telling you about some things that have been happening on the background and why I did not conceal Dr Aderinwale’s name on the prescription paper. Let me begin from the later. As a physician, I can defend any prescription I make and I won’t give a hoot if anyone posts it on social media or even on TV. If I can’t be bold enough to do so, then my professional competence should be questioned. If there is no PPE in the hospital, the choice before the doctor is either to prescribe for the patient (like in this case) or ask the patient to leave. If I’m in Dr Aderinwale’s shoes and faced with those two choices, I will do exactly what he did and can defend it anywhere. So I don’t have any ill-intention towards him or his hospital, but someone must be held accountable. My assumption is that Governor Sanwaoolu’s administration is responsible and will not victimize a doctor who simply wants to protect himself during a global deadly pandemic. Interestingly, those who complain about this are same people who may question the authenticity of the prescription if all names were concealed. However, if any doctor diverted PPEs to a nearby private health facility and prescribes same for patients to buy, then such a doctor deserves to get appropriate punishment.
Finally, I was reliably informed that the Lagos State Government has contacted the Medical Director of the hospital and a panel may be constituted to ascertain the true position of things. My hope is that their intervention is not just to look for a scapegoat but to make sure all health workers in GH Ikorodu and across the state have all equipment and devices they need to work while protecting themselves. Government should also ensure that no patient is denied health care this period because of their inability to pay for PPE. If in this process anyone is found to have erred, appropriate punishment would not be out of place. Health is a serious business and everyone involved must demonstrate highest level of professionalism, empathy and integrity. I join many Nigerians to commend the Lagos State Government on how it has been managing the Covid-19 pandemic and pray that the management of other health conditions receive adequate attention.
If you read to this point, na you try pass (thumb up!). Consider this quote by Mahatma Gandhi, “The true measure of any society can be found in how it treats its most vulnerable members.” My last word is this: We are as strong as the weakest and most vulnerable among us. Let us #MakeOurHospitalWork for all and leave no one behind. God bless Nigeria!
Dr. Eze is a public health specialist, sustainable development consultant and publisher of talkhealth9ja.com. He tweets @donlaz4u and can be reached via lazudeze@gmail.com.
