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INVESTIGATION: Gravely ill patients die queuing to see Nigeria’s few specialist doctors

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In March 2013, when the pains in Ogaga Akpojaro’s breast, ankles and wrist became unbearable, she rushed to a private hospital in Ozoro, Isoko North local government area of Delta state where she lived.

A doctor, whose name she recalled only as Dr. Ben, treated her with antibiotics and a painkiller, and explained that the pains were symptoms of fatigue.

That made sense since Mrs. Akpojaro spent all her days, except Sundays, on the farm and sold garri during evenings in the local market. So she took the drugs as directed, stayed away from work for weeks, but her condition worsened. By early May, her breast had become swollen and rigid. Her ankles became taut. She rapidly lost weight and could barely walk.

“When all the pain killers Dr. Ben prescribed refused to work, he said we should take her to Ughelli General Hospital,” her only daughter, Ifoghale, recalled recently.

At the new hospital where they travelled to same night, no doctor attended to her, so they returned to Dr. Ben who referred them to Federal Medical Centre, Warri. There, a doctor explained that she needed to see an Oncologist – a cancer specialist. Delta state, one of Nigeria’s richest states, had none. So she got another referral to the Lagos University Teaching Hospital, LUTH, Idi-Araba, Lagos.

It was at LUTH, where they had borrowed money to travel to, that the family got a startling response. Without examining the gravely sick woman, a doctor minuted on the referral letter and asked her to return in two weeks.

“I was shocked and said it was not possible. I cried with no one able to console me and I created a scene,” Ifoghale, a 17-year-old student of the Delta State Polytechnic told PREMIUM TIMES.

“I had borrowed money to bring my mum to Lagos and returning in two weeks meant more expenses.”

While she waited, sobbing, the doctor emerged in the door way, and she accosted her, and pleaded that she help save her mother’s life. But the doctor calmly explained to her the hospital’s burden, and indeed Nigeria’s, one that portends great danger to public health if a response is not quick: there were just too many patients queuing for the same attention.

“He said ours was a new case and the queue is quite long and may not get to our turn even in the next two months as oncologists are so few compared with the number of cancer patients in the country. But to assist us, she phoned another oncologist in LASUTH and sent us to him,” she recalled.

With Nigeria taking the bottom lead on several global health indicators, nothing threatens to keep those woeful numbers unchanged as the dearth of qualified health personnel in key sectors of health care.

Despite the rising cases of cancer, there are only a little above 15 Oncologists in the country, experts told PREMIUM TIMES. Besides Delta state, 28 other states have no Oncologist. Only seven states in the entire country have specialist care for cancer. These include: Lagos – 7, Oyo – 7, Kaduna – 5, Edo – 1, Ondo – 1, Sokoto – 1, and Abuja – 3.

Patients like Mrs. Akpojaro travel long distances, through states, to get attention. Many don’t live to narrate their experiences. Those unable to travel for lack of money settle for non-specialists, while well-to-do families go abroad for treatment.

In Nigeria, the Lagos hospital, LUTH, is one of the most visited.

With no Paediatric Oncologist in Adamawa state and environs, Benjamin Enema, shuttles his son, Monday, who was diagnosed with leukaemia, between Adamawa and Lagos seeking the resources to keep the five-year-old alive.

“It was one of the most hectic moments of my life. Shuttling Lagos and Adamawa every now and then was not funny,” Mr. Enema said.

As the family struggled to keep up with the rigorous routine, his wife gave up her petty trading, relocated to Lagos to be with Monday while the father hunted for more cash. Their other three children lived with relatives while the ordeal lasted.

With much debt incurred, and no one willing to loan the family more money, Mr. Enema sold his inherited home and pleaded that the boy be transferred to a hospital close to Adamawa state. When that failed, he asked the doctor to discharge Monday who was still unwell. He wanted to take him to a traditional healer, where according to him, treatment would be cheaper.

“The doctors didn’t. Rather, to my surprise, some of them contributed money for my son’s hospital bills. They were even rallying to help raise the money with which to send him abroad for treatment after they learnt I had sold everything and now homeless to keep him alive. They said they would have referred him to a hospital closer home but there was no specialist to care for him in our region. Can you imagine that?” he asked.

On April 1, 2013, Monday died. “I know it’s not the doctors’ fault, they tried for my family,” the father said. “If we had the needed number of specialists in Nigeria my Monday would be alive.”

No Podiatrists, few Geriatricians

Nigeria has the highest number of diabetics in sub-Saharan Africa with no fewer than 1.5million Nigerians living with the condition, according to the World Health Organization.

Sufferers of diabetes are prone to injuries, especially on their feet and legs, requiring a specialist caregiver-a podiatrist. Currently, such patients would either have to go abroad or be managed by an orthopaedic surgeon as Nigeria has no podiatrist. Orthopaedic surgeons often recommend immediate amputation.

“Orthopaedic surgeons have been standing in as substitutes over the years since we do not have podiatrists nor podiatrics in Nigeria,” said Nnaemeka Nwakanma, Head of Medical Education, Nigerian Medical Dental Council of Nigeria, MDCN.

Also, while Nigeria is projected to rank 11 globally by 2015, as the country with the highest population of elderly persons–age 65 and above, the country has only one geriatric centre where the elderly receives specialist attention.

Located in the University College Hospital, Ibadan, the Chief Tony Anenih Geriatric centre was built and commissioned in November 2012.

Minister of health, Onyebuchi Chukwu, blamed what he called lack of “positive selfishness” as the major reason why Nigeria has many elderly persons but no geriatrics to care for them. He said it was the reason public office holders engage in excessive accumulation of wealth which at the end of the day becomes meaningless to them.

The chairman, Peoples Democratic Party Board of Trustees, Tony Anenih, whom the centre in UCH is named after and who himself, is over 80 years, said it was clear Nigeria has had no plans for its elderly.

“Nobody seems to be thinking about the aged in Nigeria because those who make policies, do so in their primes and are often too caught up in the present to know that sooner or later, old age with all its complications will creep in on everyone,” he said.

Few Urologists, Neurosurgeons and Cardio Therapeutic Surgeons
Statistics show that men are as likely to have fertility problems as women with rising cases of impotency, erection or ejaculation problems. A recent study at the University of Nigeria, Nsukka, as well as Ebonyi State University, Abakaliki, showed that 25.35 percent of the studied population had symptoms suggestive of Benigh Prostate Hyperplasia, BPH.

PREMIUM TIMES findings show that Nigeria has only 120 Urologists to manage millions of conditions related to male urinary tract and reproductive organs, such as BPH or enlarged prostate; cancers of the urinary tract such as kidney cancer, bladder cancer, prostate cancer, testicular cancers; infertility in men; sexual dysfunction such as erectile dysfunction; urinary tract infections.

Majority of those specialists work in government hospitals located in Lagos, Abuja and Port-Harcourt, with some of them, such as the Lagos State University Teaching Hospital, LASUTH, having just a urologist. The finding was confirmed by the Nigerian Association of Urological Surgeons.

Nigeria has few neurosurgeons and cardio-therapeutic surgeons. According to Francis Faduyile, the chairman, Lagos state chapter of the Nigerian Medical Association, they are no longer up to 10 in the country. Another source said the number of neurosurgeons may be up to 40, but not more.

“Right now, neurosurgeons and cardio therapeutic surgeons are so few in the country. The available ones are close to retirement while some governments, like the Lagos state government, have refused to employ resident doctors who can learn and take over from them,” he said.

Psychiatrists, Paediatricians, Forensic Pathologists

Mental ill health, especially depression, is a leading cause of death in Nigeria. But according to Joseph Adeyemi, a professor and Head of psychiatry department, College of Medicine, Lagos University Teaching Hospital, LUTH, Idia-Araba, psychosis is a worse phenomenon.

“People who suffer from psychosis have more inpatient care than even those receiving care for cancer,” he said.

Psychosis is characterized by derangement of personality and loss of contact with reality, while causing deterioration of normal social functioning. It is characterized by defects in judgment and other cognitive processes.

It can be caused by depression, drugs, liver or kidney failure, endocrine disorders, metabolic disorders, Alzheimer disease, epilepsy and other neurological functions. There are only about 200 practicing psychiatrists in Nigeria, our investigations show.

If all the affected mentally ill person were in hospital, one doctor would be having to attend to 167, 000 patients while psychiatry nurses will each attend to 25,000 patients.

Abolore Lawal, the Chief Medical Director, Neuro-Psychiatry Hospital, Yaba, Lagos, said the poor ratio was the result of the poor rewards for doctors in the country.

“Nigerian doctors do not want to specialize in psychiatry; rather, they prefer popular areas such as obstetrics and gynaecology, as well as surgery. The general believe is that there is more money in these specialties when compared with psychiatry. Really, it takes a calling to want to go for psychiatry,” Mr. Lawal said.

For paediatricians, the World Health Organization says no fewer than 11 percent of children who die yearly are from Nigeria. About 13 children under the age of five die every minute in the country due to lack of immediate care and basic medical interventions.

Acute shortage of trained paediatricians, is found as a major contributing factor to Nigeria’s high numbers. Our findings reveal that Nigeria has only 600 consultant paediatricians to manage and care for the nation’s 70 million children, out of which over 40 million are under the age of five. Majority of paediatricians are in Lagos and Abuja.

The situation is quite different in other climes. For instance, the UK has 3,084 trained consultant paediatricians and 1,184 associate paediatric specialists for her 20million children. This does not include the 3,174 paediatricians currently undergoing training.

For Forensic Pathologists who investigate causes of death, there are only four in the entire country. Albert Anjorin, an eminent professor of pathology with the University of Ilorin confirmed our findings, and attributed Nigeria’s failure in resolving crime to factors such as the dearth of forensic pathologists.

“A forensic investigation would help classify such deaths into either natural, suicidal, homicidal, accidental, misadventure or be consigned as ‘open verdict’” he said.

William Odesanmi, a foremost professor of Forensic Pathology of the department of Morbid Anatomy and Forensic Medicine, Obafemi Awolowo University, Ile-Ife, said he would have loved to boast of at least 20 forensic pathologists in the country, but the present situation is a far cry.

As cases of cancer increases, help fades away

Annual estimates of the incidence of this killer disease which often gives no symptoms at its early stage is put at no fewer than 7,000 in Nigeria. But experts refute this figure describing it as a gross underestimation.

Moji Animashaun, Administrative Director at the Lagos State University Teaching Hospital LASUTH, said cancer treatment accessibility in Nigeria is virtually non-existent. She noted that the dearth in the availability of oncology specialists ranging from MDs to medical physicists to radiologists and even to oncology nurses makes the situation really discouraging.

The situation is worsened by the fact that the actual number of oncologist specialists available in the country remains unknown. For instance, during the West African Health summit, which held in September 2011, Nigeria was said to have just 15 Oncologists.

But Clement Adebamowo, a renowned Nigerian Oncologist with the UCH, Ibadan and who is the initiator of the Society of Oncology and Cancer Research of Nigeria, SOCRON, told PREMIUM TIMES there was no established figure.

On that morning in May, Mrs Akpojaro and her daughter, Ifoghalo, saw the Oncologist they were referred to in LASUTH and the doctor offered to help despite his own volume of patients, because his professional friend at LUTH had made the referral.

The doctor ordered a test that amounted to N55,000 while Ifoghalo had only N6, 500. “There was nothing more the doctor could do for us. He had many indigent patients like us and had exhausted all the money he earmarks to assist patients who can’t afford certain bills so could not assist us financially,” she said.

The Oncologist wanted to refer them to Benin but was told the only Oncologist in the state was out of the country at that time. The two women traveled back to Delta state to borrow more money for the test.

“It took me a week to raise N80, 000 and it wouldn’t have been enough. There was no place in Delta state where we could even do the test worse still, at a cheaper rate, so we had to go back to Lagos,” she said.

But as they arrived Lagos, Mrs. Akpojaro, now under unbearable pains as her condition worsened, died while she was already at Ikeja close to the hospital, her daughter told PREMIUM TIMES.

Now, with no support, Ifoghale spends more time out of school after her mother’s death. She continues to tend her mother’s farm, venturing out early morning, and returning early to sell her wares at the market.

“My education is suffering, my grades in school are dropping. My mother was poor while alive but she was even better than my uncles and aunts. They (her uncles and aunts) are very poor; they barely eat three square meals so can’t help me with at least my education.”

Members of the Enema family are now scattered with no place to call home. Mr. Enema squats with a friend in Ojodu Berger, an outskirt of Lagos, where he keeps three menial jobs in order to raise money to pay back all his creditors. His wife is back to her parent’s family in Zabin Zaria, Kaduna state, where she helps other women sell their farm produce, baby sits and does laundry.

She is assisting her husband raise funds in paying back the loans owed. The couple presently cannot fend for their three kids, hence, two now live with two different relations in Taraba and Adamawa states respectively while the eldest who is 11 years old is now a househelp to a French man in Jos, Plateau state.

“When we finish paying the debt and can afford to pay for a room, we will come together as a family again. For now, we have to remain like this,” Mrs Enema told PREMIUM TIMES.

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