For 60-year-old Olanipekun Ojo, who resides at Egbeda, Lagos, going to any of the general hospitals in the state, holds the key to solving his health challenge. At least, that is the recommendation of his neighbour, Joseph.
According to Joseph, the state government has greatly improved the lot of the hospitals, especially with regard to infrastructure and personnel. Little wonder, Ojo, who before this conversation, was in a dilemma over how to tackle his hearing impairments decided to visit the General Hospital, Igando, which is not too far from his place of residence.
Excited and relieved that he was not going to pay for the hospital card, as Joseph had earlier told him that it was free for patients from 60 years and above, Ojo casually left his home the next day at 8am for the hospital. But the time he got there at about 9am, he needed nobody to tell him that his journey to receiving medical attention that day was going to be futile. Joseph, however, did not tell him about the little requirements, as it were, in the hospital.
Indeed, the reality of what happens in the hospital dawned on him when attempts to obtain a free card, which is the first requirement for seeing a physician in the hospital, proved a Herculean task. Of course, with the many patients- the elderly men and women, youths and children–hanging around the card section, he knew that his continued stay in the premises was pointless.
Having waited for over two hours, he left on the recommendation of a member of staff of the hospital, who advised him to return the following day as early as possible if he needed to receive any kind of attention. Since Igando is not too far from Egbeda, Ojo told himself that he would hit the hospital the next day before 6am if only that would enable him to see the doctor. In fact, he hinged his would-be success on the proximity factor.
Indeed, Ojo’s fruitless journey to the hospital was not peculiar to him. One of our correspondents, who visited the same general hospital had more than she bargained for. As of 6am when she arrived at the hospital, she obtained tally number 35, a pointer to the fact that she had 34 persons ahead of her. This was the first shocker. She suddenly realised that her initial thoughts of dashing in and out of the premises, would, after all, come to nought.
Listening and interacting with some other patients who had arrived in the hospital did not only send a shivers down her spine, the interaction also revealed a more interesting perspective to the dilemma that people face in the hospital.
According to one of the early birds, who later identified herself as Madam Roselyn, she had arrived at the hospital as early as 4am in order to be among the first set of persons to see a doctor.
She added, “I got here around 3.45 am. I was even thinking I was going to be the first. I was here yesterday and I saw hell. That was why I decided to come this early. I was even surprised that as early as I was, I picked tally number 15.”
Unfolding events later showed that picking the tally was one of the easiest hurdles to pass through in the process of seeing a doctor in the general hospital. Put differently, the tally panorama seems to be a microcosm of the bigger drama scene in the process of seeking to receive medical attention.
With the tally, you are directed to another office, (which our correspondent would later find out is called the Revenue Department), where you would queue outside the window. Of course, one would have thought of obtaining the card at that point. No way!
However, when it gets to your turn, you would notice a window, just slightly opened through which you squeeze your neck to see who is on the other side.
When it got to one of our correspondents’ turn to get a card, the officer rudely informed her, “I am not ready for you yet.” And when she eventually got ‘ready,’ she only asked for our correspondent’s name and passed a teller through the tiny window. Opening it and rudely again, she said, “Go to the next queue and pay.”
From the pay point, you move on to another point where you are given a folder. You might actually heave a sigh of relief thinking you have achieved it at last, at least under one hour.
But that is when the real waiting game begins. You are directed to go and wait under a canopy.
Our correspondent got under the canopy by 7.20am and was able to get her hospital card by 9.55am. Once again, she was asked to go and sit under another canopy for another waiting ‘game’ before she would see a doctor.
Fast forward to 10.20am, our correspondent, out of curiosity, decided to make more enquiries about what was causing the delay. She eventually asked a nurse whether it was possible to see an Ear, Nose and Throat doctor. That was when she was informed, after the whole process, that her efforts were all in vain.
She said, “Ah! We don’t have ENT doctor here o. You might as well go to Isolo General Hospital or LASUTH.”
Don’t bother asking any nurse why you weren’t informed, you would get a rude answer, “so what do you want us to do, manufacture an ENT doctor? If you don’t want to see a general practitioner, then go nah. Wetin concern us?”
The situation is worse at the Lagos State University Teaching Hospital, Ikeja where some patients sleep in the hospital while some others arrive at the hospital as early as 4.30am to have a realistic chance of getting to see a doctor.
Due to the large number of patients that throng the hospital daily, the practice at its Medical Outpatients Clinic is for patients to pick numbers as they arrive. A sheet of paper with numbers 1- 150 is always left on a window sill overnight and held in position by a stone.
Each patient is expected to tear off the next number from the sheet on arrival at the clinic.
Investigation by Saturday PUNCH shows that patients who sleep over at the hospital are mainly those who have to travel far distances. Such patients are from places like Ikorodu, Epe, Badagry in Lagos and even neighbouring Oyo and Ogun states.
For instance, a 64-year-old patient, Michael Ogundeji, from Ikorodu, told Saturday PUNCHthat he always slept in the hospital each time he had to keep an appointment with a doctor because of the large number of patients he had to compete with.
“I come from Ikorodu and there is always traffic on the Lagos-Ikorodu Expressway every morning. So it is risky to leave Ikorodu in the morning and expect to be here early enough because of the large number of patients that come here. The best bet for me is to sleep here so I can pick a good number,” he said.
Another patient who refused to mention his name because he was afraid that the report might be used against him said, “ I tried in time past to come early but never got to see a doctor, so I decided to always sleep overnight each time I want to see the doctor. At least, with that I’m sure I will get a good number.
“I would have loved to visit a general hospital near my area in Badagry, but there are no specialists there, I know many people come here, but then I’m the one looking for solution to my health challenge, I’m prepared to do what it takes to get well.”
Asked why she couldn’t go to hospitals in Ogun State, another patient, Mrs . Taibat Ayida, said she lived in a suburb close to Lagos but classified under Ogun State. She said she chose to sleep in the hospital so that she could get to see a doctor on time.
Sadly, some of the patients learnt the lesson the hard way.
For instance, Ogundeji’s first visit to the hospital was in December 2013. He had arrived around 8am, thinking he had arrived early enough.
But by that time, the queue of patients waiting to see doctors was already long. At the end of the day, Ogundeji left without seeing a doctor.
“That was when I learnt my lesson. I got here by 8am on that day but the moment I saw the long queue, I knew I was very late. I knew that I was going to sleep here to meet up with my next appointment,” he added.
Further investigation shows that getting to the hospital very early sometimes does not guarantee that a patient will even see a doctor in good time. It also does not mean that the patient will pick a good number.
A patient, Abeke Bello, 83, arrived at the hospital at 5.30am one cold morning to find that her number was 62.
Having met less than 10 other patients who were physically present, Bello said she was surprised that many people had picked numbers before her.
She said, “I took a taxi from Ogudu where I live to get here on time but I was shocked that I was number 62. I had expected to pick a number that was not up to 10. There were less than 10 people here, so where were all the people that picked the numbers?
“I tried to get here earlier but it was not possible. The last time I came by 5am for my last appointment in January, I left around 2.30pm. So I wonder when I would leave the hospital now that I came at 5.30am and picked number 62.”
Saturday PUNCH learnt that some officials of the hospital’s Records Department take advantage of the situation of the system to profit through racketeering.
Some of the officials collect money from patients to keep numbers for them or arrange for them to see doctors on time. The money paid to the officials usually varies between N200 and N500.
A doctor in the hospital who did not want to be named, said health workers “are neck-deep in the racketeering.”
The doctor said, “But what they collect depends on the patients’ ability to negotiate. A patient can pay as low as N200 to see a doctor on time. There is also a lot of lopsidedness in the transfer system- that is when a patient is referred from one department to another. For instance, if the patient is being referred to the appropriate department like the ENT or Surgery, the department may have been booked for the entire year because there are too many people. But it is an opportunity for some people in the Records Department to make quick money again. They arrange early dates for patients. The price also depends on the negotiating power of the patients.
“Sometimes, they write a false time on a patient’s card to make it appear that the patient had arrived earlier. Most doctors don’t bother about all these things, they just get on with attending to whoever is ushered into their offices.”
Saturday PUNCH observed that the only department that seemed to be devoid of such racketeering was the Emergency Department, where the severity of the patients’ health condition was generally considered.
A doctor at the hospital also confirmed this, saying, “That is because once it’s emergency, it’s emergency. The doctor will look at the case that requires the most urgent attention.”
So except for the Emergency Department, patients generally have to queue and lobby for appointments, which include getting to see doctors and doing medical tests or surgeries.
But generally, the system is such that patients who sleep in the hospital still have to wait for a long time before being attended to in spite of being early arrivals. This is because officials of the Records Department do not get to the office until around 8am while other hospital support staff like cleaners, lab attendants and others are not ready till around 10am.
Therefore, clinics do not start before 10am. So those who arrive early often idle away, sometimes in awkward conditions till they are attended to.
Also at Ifako-Ijaiye General Hospital, Lagos, our correspondent noticed that there were four sheets of paper placed on window sills and tables for patients’ use on arrival. The sheets were for patients coming for antenatal care, laboratory tests, medical appointments and for new patients.
Pasted on a wall beside the list for new patients was a notice that said, “Coming for the first time? Pick a number, sit under the canopy and listen for your number to be called for registration.” The information was repeated in Yoruba.
A new patient, Oloyede Emmanuel, who arrived at the hospital at 6.20am, picked number 8. The patient who picked number one was said to have arrived at the hospital before 6am.
One of the old patients who had arrived early, Elizabeth, also said coming as early as 6am did not mean that patients would be able to leave the hospital early.
“We may be here till 12pm and the new patients may even be here for a longer time since they won’t start attending to patients till around 10am,” she said.
It was learnt that patients who did not lobby or pay to get early appointments in some of the busy government hospitals, especially LASUTH, sometimes paid with their lives.
For instance, doctors at LASUTH said some patients had died or had their conditions worsened while they were waiting to see doctors. Such situations often occur in cases where patients are being transferred from one department to another.
According to a doctor, “There are too many patients coming in; so some departments are booked for the entire year. Sometimes, when the patient even gets to see a doctor and he is asked to go and do a test like the ECG (Electrocardiogram) that tells the activity of the heart, the proper thing is to do the test and get the result right there and then.
“But this is never the case. The patient has to queue every step of the way. At the hospital, the patient will have to get a date to get the test done and will still have to wait for an appointment to get the test result. So, the result may not come back till about one week later and the patient could have a massive heart attack within the period he’s lobbying to do the test or get the result. Some people have died in that process.”
Meanwhile, our correspondents’ interactions with patients and workers at LASUTH revealed the probable factors responsible for the endless number of patients that throng the facility on a daily basis, clogging up the system.
One of the attractions is the state government’s free-health campaign for old and paediatric patients. Also until recently, registration was free for patients.
“Before, we only needed to pay for tests and drugs. If you’re old or very young, you could also get some drugs free of charge. Such patients could be asked to go and buy the ones that were not available in the pharmacy,” said a patient, Taiwo Ganiyu.
But according to doctors, Lagos hospitals lack the capacity to take care of the influx of patients occasioned by the government’s policy.
A doctor said, “The state’s free-health campaign deceived many people. Everybody pays for (registration) card now unlike before when patients didn’t need to pay. Even with the free health for patients below 12 years old and above 65 years old, support services like the laboratories and pharmacies have been privatised. This rendered the ones initially run by the hospitals moribund because they were starved of funds.
“Therefore, patients are forced to patronise the private laboratories and pharmacies, putting a lot of pressure on them.”
The doctor said that some government policies were not in tandem with the situation at most government hospitals.
For instance, LASUTH’s electronic record keeping and a directive by the state government that no patient should be turned back contributed to the congestion at the hospital.
“Because of state government’s directive that all patients must be seen, we admit patients on the floor at the emergency because we don’t want to turn them back. Patients also know that LASUTH can’t turn them back. So the whole system is just overstretched,” the doctor added.
Also, investigation shows that the hospital’s attempts at keeping patients’ records electronically have not been affecting health service delivery positively.
Health workers at the hospital said the process involves scanning patients’ records. But while a patient’s record is being scanned which is a rather long process, he or she cannot access the records for the time being.
“So if such a patient needs to see a doctor or have something to do in the hospital, he or she will have to be issued another registration card,” said a non-medical staff who did not want to be named.
Some patients and doctors at the hospital also blamed the state of some primary health centres and general hospitals for the overcrowded wards in LASUTH. They said many of them were ill-equipped and had shortage of manpower.
For instance, Bello said she left Gbagada General Hospital, Lagos for LASUTH because she was dissatisfied with the service she received there.
“It was from Gbagada General Hospital that I came here because I didn’t like the service I was getting there. This is better because it’s a teaching hospital,” she said, explaining why she was travelling the long distance to LASUTH.
Confirming the situation, a doctor at LASUTH said, “Some patients come to LASUTH because they are not satisfied with the services they are getting at general hospitals close to them. The primary health care centres that should take care of minor ailments are even worse. Many of the other hospitals are only structurally fine; they lack the needed manpower and equipment. So the doctors, nurses and other workers in LASUTH are overworked.”
The President of the Nigerian Medical Association, Dr. Osahon Enabulele, also lamented the number of hours patients wait to see doctors. He blamed part of the problem on the shortage of doctors in the country, saying that Nigeria needs to improve on its doctor-patient ratio.
Enabulele said there were about 27,000 doctors in Nigeria serving about 170 million people.
He said, “Ideally, one would like to have one doctor to one citizen, but since that is not likely, we say a minimum of one doctor to 600 people. That is the real world expectation. But in Nigeria, it’s one to over 6000 people. We revolve around 27,000 doctors practising in Nigeria. Doctors working here are working extremely tired because the challenge is enormous.
“Ideally, the maximum a doctor should see in a day is 30 patients, but in Nigeria, we have doctors seeing close to 100 patients a day. It doesn’t make sense. We have very chronic shortage of medical manpower in Nigeria. So you do not expect doctors to satisfactorily deliver. We need close to 100 years to meet up with the global standard, if other countries are not developing. Most doctors are leaving the country because of the increasing problems here.
“That is why we have long waiting times in hospitals. There are endless queues and when doctors are over-stressed, their attitude becomes a problem. The issues are many which unfortunately are not being addressed, especially at the state and local government levels because most of them don’t employ. In one state for instance with over three million people, there are only 115 doctors.”
Enabulele said the health care system is made strong by “a good aggregate performance of the primary, secondary and the tertiary sectors, which is lacking in Nigeria”. He, however, called for increase in budgetary allocation to the health sector by all governments in the country.
The Lagos State Commissioner for Information, Lateef Ibirogba, described the situation as a reflection of the state government’s investment in the health sector.
He said, “It shows that the public has much confidence in the facilities of the state government. It shows that they see that our public hospitals are reliable. This is not saying that we can’t improve on what we have.
“So many people patronise us because they know that we have put things in place to make sure that our hospitals are in shape. Our personnel are being trained and the right equipment are being put in place. There are many ways you can look at the issue. Rather than see the situation as encouraging racketeering, which I don’t know how you came by it, I see it as a sign that people have more faith in public hospitals than private hospitals. This is also because we employ the best brains.”
When our correspondent pointed out that investigation showed that the congestion in LASUTH and some General hospitals was a failure of the PHCs, Ibirogba said, “We wanted our PHCs to run for 24 hours which is now the case. Still, we want to have more flagship PHCs in Lagos so that every neighbourhood and local government will have.”