Ever since the Bola Tinubu-led administration converted the Ikeja General Hospital to the Lagos State University Teaching Hospital in July 2001, the hospital has grown into one of the best Teaching Hospitals in Nigeria today. Situated on a compact campus near the domestic airport in Ikeja, LASUTH shares structures with the Lagos State University College of Medicine and houses various specialty departments and institutes; various hospital wards; pharmacies; fully equipped laboratories; administrative building; and other essential facilities.
The hospital currently has a 750-bed capacity with additional bed facilities under construction. There is also a Critical Care Unit, which provides private rooms for patients who can afford the fees. It is run by a private company but serviced by LASUTH staff. The hospital currently has just over 350 doctors in over 60 subspecialties and about 900 nurses.
LASUTH is arguably the busiest hospital in the country, with thousands of daily patient visits, at least a third being emergency cases. Although the hospital set out to provide quartenary care, the country’s healthcare culture, typified by delay in accessing care and lack of health insurance, has forced the hospital to provide all categories of care. The policy of taking on only referred cases could not be fully enforced in the face of life-threatening emergencies.
True, LASUTH’s goal is to provide world class health care and services in order to minimise medical tourism abroad, its path to world class status is hampered by several factors, including (1) cash and carry medical practice; (2) lack of full digitization of medical records; (3) personnel shortage; and (4) lack of treatment protocol, detailing the chain of activities in patient care in each department.
For over two weeks in November, 2021, I interacted with a number of LASUTH doctors, observed them at work, and shared my experiences with the Director of Clinical Services and Training, Professor Adebowale Adekoya, himself a Consultant Physician and Nephrologist, with extensive foreign experience. Undoubtedly, LASUTH doctors are caring, conscientious, collaborative, and empathetic to the concerns of their patients. However, many of them need to overcome the three assumptions underlying medical care in Nigeria: (1) that patients are ignorant; (2) that patients need not be told what exactly is wrong with them; and (3) that Nigerians can tolerate any condition and, therefore, could be treated anyhow. It is necessary to overcome these assumptions in order to respect the patients’ rights, communicate effectively with them, and observe the Hippocratic Oath of doing no harm.
In this piece, I focus on the cash-and-carry culture of medical care, which requires that patients pay instantly for medical supplies, lab tests, and medical prescriptions. Since sick patients may not be able to do this by themselves, it puts a burden on whoever accompanies the patient to the hospital, be it spouse, relative, or friend.
If you are such a person, you have to take the necessary paperwork from the doctor or nurse to the points of service-registration window, payment window, laboratory, pharmacy, and so on-spending money on the go, from a few thousands to hundreds of thousands, depending on the nature and severity of the patient’s illness and the duration of treatment. You start by paying for the registration card and a folder for storing the patient’s records. If your patient is admitted, you pay for the hospital gown he or she will wear. Once in the ward, you continue to pay as treatment progresses.
It is often a cumbersome process. For example, if your patient is in the Medical Ward in BT Hall and requires a blood test, you have to take the doctor’s request card to the lab, say BT Lab, which is about half a mile away. Your first stop at the lab is the payment window, where you get the test costed, and you pay. Then you go upstairs to the lab with the request card and payment receipt to obtain a collection bottle. You thereafter take the bottle back to the ward for the doctor to draw the blood, which you will then take back to the lab for the test. By the time you’ve done the rounds on just one blood test, you might have covered nearly two miles, not to speak of over 300 flights of stairs (i.e., steps) you would have ascended and descended in both buildings in the absence of elevators.
The wait time for a lab test may take several hours, depending on the type of test, the crowd ahead of you, lack of proper protocol, or sheer incompetence of the staff. In some cases, security guards, who are in every building in the hospital, constitute themselves into intermediaries between patients and points of service, thus causing further delay. Yet, others behave like Happy-Weekend-Sir policemen, who expect a reward for doing their job.
After submitting the sample, the lab technologist will tell you when to come for the report. You should expect delay. Since there is no system in place to alert you or the patient’s doctor, it is your responsibility to collect the report and submit it to the nurse on duty for safekeeping in the patient’s file. On one occasion, a nurse told me to keep the report until the following day, when the doctors would do the “ward round”. I insisted she must file it immediately since I already paid for the patient’s file folder for that purpose. She got the report and filed it.
To be sure, the hospital management is trying to bring points of payment closer to the wards. It also has a system in place, by which a patient employs a “Carer”, who assists in running necessary errands, including the handling of medical samples and reports. Nevertheless, it remains untidy, indeed unsafe, for others apart from medical staff and lab technologists to handle medical samples and lab reports.
If LASUTH is ever going to become a world class hospital, it must develop a more efficient way of paying for care and services. Even more importantly, it must digitize patients’ medical records so that lab reports could easily be transmitted to the patient’s digital file for any doctor in the hospital to see and share with patients. It is no longer expensive to digitize medical records, if the Nigerian factor were not introduced into the business. At the end of the day, the digitization of medical records will save cost, save time, and contribute immensely to the ease of giving care. It is now the global standard.
