- How misdiagnosis, medical error imperil lives in the country
Bola Otun loves children but she would never feel one pulse in her womb. She said: “Children are God’s greatest gifts to us. A child is a miracle, an aspect of a woman’s second nature.” Even so, Otun would never feel a child or “second nature” prowl in her scraped uterus.
“No child will grow in me. I can never conceive. Not in this lifetime,” she said, in the tenor of a woman who had made peace with her life’s brutal truth.
Six years ago, Otun, consulted an older relative for her first and only pregnancy. Then 34, she felt at peace entrusting her life and that of her unborn child in care of her uncle, an obstetrician. Earlier, she consulted her private doctor but at her parents’ advice, she consulted her uncle who worked with a public hospital. Things were smooth until delivery hour; a complication arose and the doctor opted to perform a Caeserian Section (CS) on her. Eventually, she lost the baby.
After trying to conceive repeatedly without success, she sought help outside the country and it was discovered that Otun would never conceive another child in her life.
“Findings revealed severe adhesions, scar tissue formation, and uterine blockage. When I returned to the country, I confronted him; initially, he refused to own up to his fault but two years later, he came to beg me, prostrating on the floor. He said he was too scared and broken to tell me that he had bungled the CS and destroyed my womb. I threatened to sue him but my parents urged me to leave him God’s judgement,” said Otun.
Despite her predicament, Otun is upbeat. Save occasional spells of desolation due to her predicament, she spots a permanent sparkle in her eyes. Unlike Cordelia Obong.
Obong’s eyes darken like burnt clay from afar. Closer, you would find that she can only see with one eye. The 13-year-old is totally blind in her left eye and it’s a great task getting to see with her right.
Her predicament started six years ago, when she was diagnosed with an eye defect. Her mother, Patricia, had taken her for treatment at a government hospital in Calabar, Cross River State.
There, a resident doctor recommended that she commenced eye treatment; he referred her to an optician, who prescribed medicated glasses to correct what was perceived as Cordelia’s short-sightedness.
“Two years after she started using glasses,” said Patricia, “her condition worsened. She could not see the blackboard even though her teacher had helped to change her seat to the front row. We returned to the eye doctor and he prescribed stronger lens and a daily dose of Prednisolene, claiming it would correct her sight.”
But it never corrected her sight. Soon, Cordelia’s sight deteriorated and it became impossible for her to read her textbooks and use her computer laptop device. Eventually, mother and child, at the advice of a family friend, consulted a scout for a hospital based in New Delhi, India. Two months later, they travelled to India where Cordelia was diagnosed with brain tumor.
The tumor was extracted in a surgery that cost Cordelia her left eye. It also cost her mother three plots of inherited land and her Hyundai Saloon automobile which she had to pawn to raise fund for her daughter’s medical bills. The Obongs spent N3.3 million to restore Cordelia’s sight. But it mightn’t have cost her so much had her ailment being properly diagnosed.
According to Professor Sam Ohaegbulaem, Chief Neurosurgeon, Memphis Hospital, Enugu, many poor and unassuming Nigerians are daily forced to embark on expensive medical trips abroad to treat ailments that could be treated in the country.
“The problem is misdiagnosis. Many have lost their sight because their doctors had erroneously diagnosed them with eye ailments and recommended glasses to them whereas proper diagnoses would probably reveal that such patients suffered from some benign brain tumour.”
Recently, Professor Ohaegbulaem and his Memphis team treated a patient to successful recovery of her limbs after the latter suffered seemingly irreparable paralysis in the wake of an agonising bout with brain tumour.
“The young woman came with paralysis affecting her arms and legs. They had moved her from place to place including prayer houses in search of cure but when she got here, a Magnetic Resonance Imagery (MRI) was done and we discovered that the problem was high up in the neck, at the junction of her brain and spinal cord.
There was a big tumour there and it was pressing on her spine and that happened to be the cause of her paralysis. We performed the surgery which lasted seven hours and at the end, her paralysis was cured. The lady in question has begun to walk and make use of her arms again. She didn’t have to travel to India to get cured,” said Ohaegbulem.
Different strokes for different folks
Different strokes it is for different folks; no matter what anyone says, Biodun Alogba reposes no faith in Nigerian doctors. “I have had terrible encounters with doctors of local teaching hospitals.
For four years, I was persistently diagnosed with typhoid fever and pneumonia by our local doctors. It wasn’t until I travelled to the United Kingdom that doctors there revealed to me that I was suffering from a tumour in my right lung. Luckily for me, it was operable. I would have died receiving the wrong treatment had I not sought better opinion outside the country,” he said.
Alogba was lucky. Unlike Gani Fawehinmi. The late human rights activist died of cancer in 2009 after being continually misdiagnosed of typhoid fever by Nigerian medical personnel. A proper diagnosis of his ailment was done abroad but it was too late; he died after battling the disease for over one year.
And few people would forget in a hurry, the sad case of Rukayya Adamu. The four-year-old old girl from Zaria, Kaduna State, fell sick and was taken to Salama Hospital in Zaria. After running some tests, her parents were told that their daughter suffered from sickle cell anaemia and that she had malaria; and she was treated accordingly.
When Rukayya’s condition didn’t improve, her parents took her back to the hospital where she was admitted immediately and was told she needed blood transfusion. The transfusion was done through one of the veins in her leg because they could not find any in her hands.
Unfortunately, after the transfusion, the leg became swollen and Rukkaya had to be taken back to the hospital. Rukkaya’s parents were told to take her back home, elevate her legs and administer ice therapy. When that didn’t work she was taken back to the hospital where the parents met the hostility of the staff but when they examined the leg again, they discovered that they could not handle the case anymore so they referred the child to the Ahmadu Bello University Teaching Hospital (ABUTH) in Shika.
At ABUTH, Rukayya’s parents were told that her leg needed to be amputated immediately due to the infection that was spreading in it. After the amputation was done, further tests were carried out at ABUTH, and the doctors told Rukayya’s parents that she was not a sickler and Salama Hospital misdiagnosed her from the start, according to Hafsat Mohammed Baba of the Global Initiative for Women and Children (GIWAC)
Epilepsy drug for earache
Unlike, Rukayya, Bosede Ibikunle escaped a raw deal via medical misdiagnosis. In May 2013, Ibikunle complained of excruciating pain in her left ear. She was initially treated by a resident doctor at the Orile Agege General Hospital on June 11, 2013, but she experienced no relief. She returned to the hospital on June 28, 2013 and was treated by the same doctor who treated her earlier; this time around, he prescribed three drugs-Stemetil 5mg; Carbamazepine 200mg and Neurotin.
It turned out that Carbamazepine and Neurotin are anti-epileptic drugs. This was revealed by different pharmacists at various drug stores she visited as well as private medical doctors whom she consulted to confirm the veracity of the revelation about the two drugs.
Ibikunle’s family physician equally noted that she would have developed serious complications if she had used the drugs since she wasn’t suffering from epilepsy.
Meanwhile, she went back to the hospital to confront the doctor over his wrong prescription during which the doctor and his colleagues apologised and pleaded with her for forgiveness. She was urged not to further her protest in order to save the resident doctor’s job.
The Obongs, Rukayya and Ibikunles’ experiences no doubt constitute a minute fraction of the hassles many Nigerians suffer in search of quality medical care. Every year, many lives are lost in the country to misdiagnosis and medical error in the treatment of communicable diseases, particularly cancer, malaria, pneumonia, and diarrhoea, according to medical experts.
This has led to massive exodus of Nigerians who could afford it outside the country in search of quality
medical care. The situation becomes worrisome when elected public officers continually jet out at the slightest opportunity in pursuit of quality medical care spanning routine medical check-ups to grievous health problems.
Exodus to India
Recent estimates reveal that Nigeria loses about $1.35 billion (N359.2 billion) to medical tourism annually, which is in the region of the country’s annual budget for the health sector. It is also estimated that an average of 9,000 medical tours occur monthly from Nigeria to other countries, with India being the major beneficiary of 500 visits monthly.
The amount includes the sums spent on medical treatment, expenditure on patients’ relatives, earnings of Nigerian medical doctors seeking greener pastures abroad and other expenses on travel documents.
Further breakdown of the expenditure by Dr Ufuoma Okotete, an expert on medical tourism and Director, Diamond Helix Medical Assistance, an international medical referral organisation, revealed that an average air ticket to India costs about N250, 000. And according to her, the Indian High Commission in Lagos issues about 40 medical visas per day.
She noted that medium surgery patients spend as much as $8, 000 for treatment while a spinal surgery patient spends about $15,000. Renal transplant surgeries cost about $20,000 without after-surgery maintenance.
An average cardiac surgery costs about $8, 000 for children and about $15, 000 for adults. A cancer patient spends more than $20,000 for the total cost of treatment. An air ambulance to Germany costs N20 million, while an average ambulance charter to India costs N30 million.
It is, however, sad to note that despite the lure and touted magic of medical tourism, seeking medical treatment abroad is hardly always as magical as it’s cracked out to be. The case of Patience Uvaise is instructive.
At the age of 50, Uvaise left Nigeria for India in search of quality medical care. She was seeking treatment for cervical spondylosis, a disorder that causes abnormal wear on the cartilage and bones of the neck (cervical vertebrae). It is a common cause of chronic neck pain. Uvaise sought cure at the
privately-run Hiranandani Hospital in Navi Mumbai, where she ended up paralysed after three surgeries. Uvaise, lamenting her misfortune, stated that when she arrived in India, she could walk but due to negligence on the part of the doctors at the private hospital that treated her, she was rendered quadriplegic (paralysed from the waist down).
She sued the Indian hospital at a Bombay Court but the hospital maintained that it was not negligent.
Besides Uvaise, many other Nigerians have suffered the rough end of ill-advised medical tourism abroad. For instance, Dr. Biodun Ogungbo, Consultant Neurological Surgeon, Brain and Spine Surgery Consortium, Abuja, narrated his sad experiences with a patient who tried out medical tourism after being subjected to a costly cocktail of misdiagnosis and wrong prescriptions.
“She was complaining of headache and had been vomiting for days. She had been treated for malaria, resistant malaria, poorly treated malaria, chronic malaria and typhoid fever for weeks. It wasn’t until she had a seizure that a scan of the brain was ordered. This showed a large tumour occupying the whole of her left brain. The tumour looked aggressive and it was difficult to find anywhere in Nigeria where she could have further treatment. She, therefore, went to Egypt.
“The Egyptians were very nice and supportive to the family. But they failed in one massive respect. They did not tell the family the whole truth; that radiotherapy was not enough to stop the tumour from growing. The poor girl was discharged after completing the ‘treatment’ with reassurances that all was well. So when she returned to my care with more symptoms of headache and vomiting, I ordered a new brain scan. Alas, the tumour had continued to grow, relentlessly. She died, sadly,” lamented Dr. Ogungbo.
The threat of quackery
Speaking recently at the 50th anniversary celebration of MLSCN, former military Head of State, Gen Yakubu Gowon, identified quackery as a major threat to credibility of medical laboratory science practice in the country.
He said: “It’s disturbing that with degree programmes in laboratory science in 25 universities, over 30, 000 medical lab scientists, 23, 000 lab technicians and over 15,000 assistants, there are still growing incidences of quackery in the profession.”
Also, the Medical Laboratory Science Council of Nigeria, MLSCN, recently disclosed, that, about 95 per cent of the medical laboratories in some hospitals in Nigeria, as well as private medical laboratories that are scattered throughout Nigeria are manned by quacks and unqualified medical laboratory scientists.
This was disclosed by the Acting Registrar and Chief Executive Officer (CEO) of Medical Laboratory Science Council of Nigeria, Tosan Erhabor, at the 18th Annual Conference and Annual General Meeting (AGM), of the Guild of Medical Laboratory Directors of Nigeria, (GMLDN), held at Emmaus House, Awka, Anambra State.
MDCN to the rescue?
As part of its efforts to sanitise the health sector, the Medical and Dental Council of Nigeria (MDCN) recently set up a tribunal in Abuja, to try about 100 medical doctors from across the country over various professional misconduct.
In a recent trial, Dr. Jamilu Muhammad of Martha Bamaiyi General Hospital, Zuru, Kebbi State, was suspended for six months for mismanaging a pregnant woman’s case and severing the lower limb of a baby while carrying out a surgery that was deemed unnecessary.
Muhammad was accused of erroneously diagnosing the baby to have died in its mother’s womb and decided to carry out a surgery in order to evacuate it from the mother. However, after severing the lower limb of the baby, it was discovered that the baby was alive.
The challenge of inadequate funding
A major challenge of healthcare financing in the country is the miserly budgetary allocation to the health sector. Bodunde Aketi, a social health worker stated that: “Poor health financing aggravates the shortcomings of the sector; where government fails to fund the acquisition of essential palliative and diagnostic equipment, the citizens bear the brunt. They suffer misdiagnosis and die untimely death on the watch of poorly trained health personnel.”
There is no gainsaying government allocation to the health sector has been fraught with controversy. Stakeholders in the health sector condemn the figures as inadequate and ill-suited to contemporary health challenges.
President Muhammadu Buhari has proposed a recurrent expenditure of N315.62 billion for the ministry of health in the 2019 appropriation bill summited to the National Assembly. The health allocation in the 2018 appropriation bill was N340.456 billion, out of the total budget of N8.612 trillion, which represents 3.95 per cent of the total budget.
In the 2017 budget, N304 billion was budgeted for the health sector, out of which a whopping 83 per cent, about N252 billion, was for recurrent expenditure and a mere 17 per cent, about N51.6 billion was for capital expenditure. The health budget was just 4.17 per cent of the entire 2017 budget.
While that was seen as inadequate for a sector that needed critical intervention, the 2016 budget was even lower, at N282.1bn, out of which N221.7 billion was for recurrent expenditure, while a paltry N35.6 billion was for capital expenditure.
Also, in 2015, the total sum allocated to the health sector was N280.5 billion, out of which N237 billion was budgeted for recurrent expenditure and N22.6 billion was for capital expenditure.
This is a far cry from the April 2001 Abuja Declaration on health which mandates African Union Countries to commit at least 15 per cent of their national budget to healthcare.
Doctors’ grief
While victims and relatives of victims of shoddy medicine heap the blame on medical practitioners, the latter contend that they are hardly to blame. Issues bordering on very poor remuneration, frequent power failure, inadequate manpower, loss of man hours and delay caused by the huge population that besiege the hospitals daily, absence of comfortable waiting lounge for patients and their relatives, long queues to pay for services, poor water supply and sanitation, among other challenges, account for a reduction in morale and most medical accidents in the country, alleged Fadekemi Badmos, a medical doctor.
Successive governments, according to her, have neglected primary, secondary and tertiary health services for decades to the point that very few public facilities are functional.
An outdated medical curriculum
Professor Ohaegbulaem recommended periodic 10-year recertification exercise for physicians in the country. According to him, if Nigerian doctors are required to retake the medical exam every 10 years, it will keep them abreast of recent advancements in the medical field.
“Doctors have to engage in continuing education to improve their knowledge. In some countries, physicians belonging to certain specialist fields have to take the postgraduate recertification examination every 10 years.
As a neurosurgeon for instance, your certification is only valid for 10 years. Every 10 years, you have to sit for the board exam. This is in addition to other continuing education programmes. The idea is to keep you fresh in knowledge and competent. It is a way to keep bad medicine from happening to good people,” he said.
Dr. Benedict Nwomeh, Associate Professor of Surgery at the Ohio State University College of Medicine and attending pediatric surgeon at Nationwide Children’s Hospital, Columbus, equally emphasised to the Nigerian Health Watch, the importance of periodic reform of the nation’s medical curriculum to improve medical education and produce physicians optimally aligned to attend to recurring health problems in the country.
According to Nwomeh, “if we are to respond to the health needs of our people, the new curriculum will require fundamental changes to the relationship between the lecturers and their students. The old top-down, paternalistic, even oppressive attitude of the teachers will have to give way to a system that focuses primarily on the needs of the students. In the new curriculum, students will have the opportunity to assess the lecturers. Those teachers who are consistently rated as lacking in requisite knowledge, ineffective, unhelpful, or lacking mentoring skills will have difficulty maintaining their teaching appointment.”
The senate intervenes
The Senate recently summoned the Minister of Health, Prof Isaac Adewole, over the poor state of teaching hospitals in the country, demanding accountability on the funds allocated to the health sector by the Federal Government over the years.
The lawmakers mandated the Committee on Health to “conduct an emergency investigative hearing on the state of health care services in our teaching hospitals and report back to the Senate within one week.”
The Senate also urged the Federal Government to adopt a medical bill subsidy policy for patients with terminal ailments and “immediately adopt short and long-term measures that will holistically address the challenges confronting our teaching hospitals.”
Can your hospital save you?
At the backdrop of interventions in the health sector, Dr. Ogungbo asks pertinent questions. He laments that, “The number of people we are losing daily in sometimes preventable circumstances is high. We do not have widespread credible emergency response teams. Many of our public hospitals are ill-equipped and poorly staffed. There are hospitals in Nigeria where it is on record that certain equipment have been provided: for huge sums of money. But, either the equipment are not bought and the funds totally diverted or an obsolete used version is bought, or a new state of the art model is bought and then diverted to the personal clinic in the home town of the Chief Medical Director, Commissioner or some Minister.”
So what happens when you need help? In a significant riposte to medical directors and doctors nationwide, Ogungbo asked: “If you were seriously ill and were rushed to the hospital where you work, do you have the staff, with requisite training, equipment and accessible consumables to save lives, in your own hospital?”
These, too, are pertinent questions for the Nigerian leadership to answer: “Can Nigerian hospitals save lives? Which hospital has been equipped to international standards to save the life of the average Nigerian tax payer?”
Leave a Reply