Inside Nigeria’s teaching hospitals

Against the backdrop of incessant complaints by patients about the challenges they have to go through accessing medical care in public hospitals in Nigeria, occasioned by poor facilities and negligence by hospital staff, Chinwe Agbeze, BusinessDay’s Investigative reporter, went to two prominent teaching hospitals in the country, University College Teaching Hospital (UCH), Ibadan and Lagos University Teaching Hospital (LUTH), Lagos, to ascertain the state of the hospitals and the quality of medical care available. For seven days she disguised as an out-patient and went through the entire process, from obtaining a hospital card to consulting a doctor, down to running tests in laboratories of both teaching hospitals.

I got to University College Teaching Hospital (UCH) at Ibadan around 8.30am on Monday, October 30, 2017.  It was my first time in this hospital so I sought for directions on how to get to see a doctor.

“Go through this gate on the right,” said a man I met close to the main entrance of the hospital. “Walk straight down and take the left turn close to the car park. You will see the General Out-Patient Department (G.O.P.D) at the left just before the Accident and Emergency department. The nurses at the G.O.P.D will guide you on how to see a doctor.”

Following his direction, I was at the G.O.P.D in five minutes. Inside the G.O.P.D, I was expecting to see a crowd of patients but those I saw were not more than twenty in number. The way the patients sat caught my attention. The men had their own section, just as the women and children. The men’s section was labelled ‘MEN’ and underneath it was the inscription ‘Okunrin’, the Yoruba word for ‘men’. A similar pattern was repeated for the women and the children sections, with ‘Obinrin’ and ‘Omode’ written underneath the ‘WOMEN’ and ‘CHILDREN’ labels, respectively. Those who brought children for treatment sat in the children’s section. The helpdesk was positioned behind the women’s section but I met an empty desk.

A uniformed staff sat beside one of the consulting rooms marked ‘MEN’, which is in front of the women’s section. She was giving patient directions when I approached her. I explained to her that I was a new patient and wanted to get a card so I could see a doctor.

“You don’t need to get a card,” she said. “You need to see a doctor. Go straight down, you’ll see security there. Take number from her.”

She asked whether I was the one that wanted to see a doctor and I replied in the affirmative.

“Take female number. Then, go and pay N1,500. When you are done, come back and check your blood pressure there,” she said pointing at a nurse who sat facing the children’s section. The nurse was attending to a patient.

I did as I was directed. I saw a female security staff seated in front of a door I later learnt was an extension of the G.O.P.D. She gave me a small piece of carton paper that had ‘37’ written on it and showed me where to make the payment. I paid, gave my name as Joy Igwe and was issued two receipts – N900 for consultation and N600 for service charge. The lady who issued the receipt told me the N1,500 I paid was for consultation and I would pay that amount on every visit.

On the wall directly facing us was an inscription carved on marble. Signed by the hospital’s chief medical director, it read: “You have no right whatsoever under whatever circumstances to shout at or insult your patients. They are the reason you have a job.”

Exiting the room where I had made the payment, the security officer who gave me the female tag stopped me.

“Sister, I never eat oh,” she said in Pidgin English.

“Let me see the doctor first. I don’t know how much my treatment would cost,” I said.

She looked away. It was obvious she did not like the sound of my response.

Back at the sorting hall of the G.O.P.D, I checked my blood pressure. The result was written on a piece of paper and handed to me. I was told to sit next to the woman who had number 36. We all sat according to the number on our tags. The patients that were about twenty when I came grew to about thirty-five. I thought some people who came after the time I did were allowed to see the doctor before me but I was told they came before I did, collected tags and left.

As we waited, the consulting room marked ‘MALE’ was flung open and a young lady in white lab coats came out and shouted, “Okunrin number 21”, and a male patient went inside.

Few minutes later, a uniformed staff emerged from the consulting room beside the first and asked if everybody had registered. I said I hadn’t and was called in after which I sat for about an hour before it finally got to my turn to see the doctor.

 I entered inside the same consulting room where I got registered. This consulting room, which is occupied by a medical doctor and the staff who registers patients, admits only women.

Flanked by three medical students, Dr Makinde asked what my complaint was. I told her I had an excruciating headache, fever, cough and severe abdominal pains. She asked how long I’d been experiencing that and I told her for three days. She fished out the Out-Patient prescription form and scribbled down some drugs.

“I’ve written some drugs for you but I want you to do these investigations first,” she said, handing the papers to me. “This one is for the drugs. Ask for the pharmacy.”

The time was 11.15am.

I quickly dropped the prescription form at the pharmacy for them to cost, paid N400 for the malaria test and N3,000 for Full Blood Count (FBC) and differential count test after which I headed for the G.O.P laboratory where the malaria test was conducted. A sample of my blood was collected at 11.43am and I was told to come back for the result by 1pm. I hurried to the haematology department for the second test. I was given a bottle and sent to the Central Phlebotomy Unit.

“Walk straight, turn to your left and enter the second door on your left. They will collect your blood there. When they are done, bring the sample here,” a pregnant female staff who attended to me instructed.

I did as instructed and was back with the blood sample. I was told to check back by 3.30pm. I looked at the time, it was 11.57am.

I picked up the prescription form from the pharmacy and went back to the G.O.P lab for my test results and was told to check back at 2pm.

“There was no light. They just put on the generator now,” an attendant at the lab said.

I sat at the lab’s reception and watched television with other patients who were probably waiting for their test results. The result was ready by 2pm. After an hour and a half, I picked up my second test.

Back at the G.O.P.D, I was shocked to see the place empty. It was 3.45pm and I was referred to the G.O.P.D extension. A doctor in one of the consulting rooms interpreted the results of the tests.

“The results are fine,” she said. “Have you bought the drugs?”

“No, I haven’t,” I said.

She asked me to go ahead and buy them. When I asked why I should take the drugs when my result showed I was fine, she said, “It does not matter. Just go ahead and buy them.”

She brought out a prescription form and scribbled down more drugs for me to buy.

The following day, I got to the hospital around 7am and got the female tag number 14. I was told no doctor was around. An hour later, a female uniformed staff addressed us in Yoruba, translating some in English. She told us the category of patients they see in UCH and different places we can do our tests in the hospital.

“Consultation fee for those 15 years and above is N1,500. For those below 15 years, it’s N600. The fee is not for case folder. The doctor will determine if you need to open one,” she said.

“This is the sorting hall. This is where you’ll be sorted out. We still have other sub-G.O.P.D. We call everywhere G.O.P.D,” she said and took her leave.

I checked my blood pressure and sat waiting for doctors to resume for the day. Few minutes later, I stood up to use the restroom. On opening the ladies’ room, I saw a pool of water on the floor. Close to the door by the left were two filthy sinks and a medium-sized drum containing water. The floor was covered with water. The water closet was not only ancient but it was an eyesore. If this type of toilet exists in a hospital as reputable as UCH, I wondered what those in other teaching hospitals would look like.

Back in the sorting hall, I met a patient few numbers behind me whining. She said all the money she had on her was N2,000. According to her, she thought treatments in teaching hospitals were cheaper.

“This is too expensive. If I pay N1,500 just to see the doctor, I’ll be left with N500. How about the tests and drugs?” she complained to the patient who sat beside her.

“That’s UCH for you,” responded the patient she complained to.

I did not pay for consultation on the second day because it was a follow-up. I went in to see the doctor at 10.13am. She asked what I complained of and I told her. She asked if the headache was still as bad as I complained earlier. I told her it was worse. She asked if I slept well and I said I didn’t because the headache was disturbing.

“Is there anything bothering your mind or did you relocate? Are you in a new environment? Do you have many churches around you that will be binding and casting every night?” she asked and I answered in the negative.

She looked at the lab results I handed her earlier and asked if I had bought the drugs. I told her I was waiting to know the result of the test.

“Your results are fine. No malaria, no infection was shown here and your PCV is also fine but you can take the drugs,” she said.

When I asked her why I should take them when my results were fine, she said, “Ideally you are supposed to do the test three times, eight-hourly, and if you pick malaria in any one, you go ahead.”

She tore the initial prescription form and wrote another for me. As I stood up to leave, she asked for my name and I gave her.

Accident and Emergency

Leaving the sorting hall of the G.O.P.D, I saw a crowd of people close to the entrance of the Accident and Emergency department. Some prayed while others were either lost in deep thought or chatting. I saw five security men at the entrance. I wanted to have a peep inside the wards but was told its past their visiting hours. The hours, I learnt, are 11am-12pm and 5pm-6pm.

I saw two young men pacing up and down. One of them had his wife in the emergency ward and was furious the way her case was handled. He was too disturbed to speak but his friend told me that the man’s wife was diagnosed with hypertension induced by pregnancy. According to him, the doctors said the baby was not growing because blood and fluid was not flowing to the child. The wife’s blood pressure was going up and a test had to be conducted to determine what was wrong but they were told the test was conducted only on Wednesdays.

“The life of a mother and child is involved and they want us to wait for five days? In an emergency situation, are they not supposed to run the test? The doctors are just working on assumptions to manage the situation. What if something happens to the mother or child?” the disturbed friend queried.

“This same woman lost her child few months ago in this same hospital. The child was in coma and when the child came out of it, the nurses were not close. So, the child went into coma again and that was the end. When you come here and you are able to go out safe and sound, it’s just God,” he said.

When I asked why they decided to use the hospital after the sad incident, he said, “Naturally, many of us believe in teaching hospitals. If we go to private hospitals and there are complications, they will still refer us here.”

He complained about the hospital not having a movable scanning machine.

“Patients are moved to where the scanning machine is. If someone is on life support, he is on his own because he cannot be moved,” he said.

At the reception, I could see beds lined up with patients on them. I told the lady that attended to me that I wanted to see a friend who was admitted that morning and gave the name of the friend as Ayo. She asked for his surname and I told her I could not remember.

“If you don’t know the surname, how will I know?’’ she asked, irritated. “The only thing I can help you do is check the patients that were brought in this morning.”

After five minutes, she said, “We have one Ayoola Olaoye here.”

“That’s him,” I said.

“Go to Ward South East 3,” she said.

I climbed up to see a security man seated in front of the ward and walked in. I gave the nurse that attended to me the name of the patient I wanted to see but I was told he was just wheeled out for CT-scan. I said I saw the patient but he wasn’t the one I had come to see. I asked to be allowed to look around for the patient and my request was granted.

The ward was painted green with dangling brown curtains demarcating each bed. I counted 12 beds where I stood, two were unoccupied. Four nurses had their chairs and desk positioned in the middle of the room, two sat at the entrance of the room while a nurse was attending to a patient. The television was on but no one was watching. However, the fans were off. One couldn’t tell if they were functional but some patients had standing fans by their beds which could mean that the ceiling fans weren’t working. All the rooms I visited had that in common. The patients said some nights they had to sleep without light.

One machine for so many

I met a crowd of patients waiting to be attended to at the Department of Radiation and Oncology. I learnt the functional radiotherapy machine was the attraction. A young lady who had accompanied an elderly woman to the hospital was furious they had to do the tests all over again after spending so much already in another hospital.

“We came here and they asked her to do the tests again. Even the ones we brought, they didn’t even touch them. We did new sets of tests in their lab apart from the ultrasound and x-ray we had to do outside because their machine is not working,” she told me when I told her I planned bringing a cousin who was down with cancer for treatment in UCH.

A middle-aged woman who said she had been battling with cancer for two years now said the past few years had been horrible for her and her family.

“We have been moving from one hospital to another, one state to another. I came all the way from Port Harcourt because of the machines. I don’t have a family here which means we had to get accommodation for the number of days we will spend here, and that’s additional cost,” the woman said.

A staff in the department told me all the machines were working perfectly well. The clinic days are Mondays, Tuesdays and Thursdays and they start attending to patients by 8am.

At the Akinkugue Kidney Centre of the hospital, I was told the dialysis machine had stopped working.

“We operate this clinic only on Fridays but our machine is faulty. Our patients do the tests outside and bring the results back to us,” he said. 

Clinic for the aged

Located a street after the Out-Patient department is the Geriatric Centre of the hospital where those who are 60 years and above receive treatment. I saw the aged get treatment effortlessly. The staff I met on duty told me this hospital opens its doors from Mondays to Fridays. She told me that new patients were given a form to fill after which they pay N2,000 – N1,000 for the case file, N500 for consultation, and N500 for service charge. Thereafter, the patient is required to pay N1,000 for consultation on every visit.

“If the patient can afford NHIS, he can pay N18,000. This covers admission, tests and drugs for one year. The patient bears only 10 percent of the cost of drugs,” the staff told me.

Lagos University Teaching Hospital

Done with UCH, I decided to visit Lagos University Teaching Hospital (LUTH) located at Idi-Araba. I got to the hospital by 8am on Wednesday, November 15, 2017, and was directed to the Out-Patient department but on getting there, I was told to come the following day.

“We don’t attend to new patients on Wednesdays. We can only see you today if you have a card here or if your situation is critical but I can see it’s not. You came here by yourself, you were not carried down here,” a doctor in Out-Patient department told me.

I made further enquires and was told that the consultation fee is N1,000 after which the patient pays N600 upon every visit. I was also advised to come early the following day (Thursday) as registration takes a lot of time.

The following day, I got to the hospital at 8.09am. I was given a form at the G.O.P.D which I filled, paid N1,000 and submitted the form with the receipt of payment. It was 9.01am when I finished. I checked my height, weight and blood pressure. My appointment card was ready at 10.53am. My appointment days, which were weekdays with the exception of Wednesdays, were written at the back of the card. I was told that the hospital only attends to staff and those under NHIS on Wednesdays.

The fans were faulty, the blade guards were missing and I could see the metal blades. The televisions too were faulty. So, there was nothing to keep the patients relaxed and entertained. The seats were not enough and a fight almost ensued between two patients. One had got up to use the restroom and was immediately replaced only to come back and demand for her seat. A middle-aged woman was pained to see those who came after the time she did being called in to see the doctor. She complained to one of the nurses but was told the hospital gives preferential treatment to their students, staff and patients under NHIS.

About an hour later, a female staff called my name and those of some patients. She had our case files in her hand and asked us to follow her. We walked behind her, like a herd of sheep follow the lead of a shepherd, from one consulting room to another. When we got to the door of a consulting room, she would call some names and tell the patients to wait there to see the doctor in that consulting room. When we got to the last consulting room, she started the process all over again all the way from the first consulting room. My case file finally landed in Consulting Room 1.

On the door of the consulting room were the names of consultants and senior registrars. Beside this consulting room is another written ‘Geriatric clinic’. The few seats were occupied and I stood like others. The files kept increasing and the place became crowded. An elderly woman sitting close to where I stood was worried that she had to wait for hours to see a doctor.

“This is my fourth time here for the same complaint. I came last week and was told to come back on Monday this week because doctors were writing exams. On Monday, I was told to check back on Tuesday. I did tests on Tuesday and came today (Thursday) before 8am. It’s almost 12pm and I see more young ladies going inside the consulting room for the elderly,” she said.

I went in to see the doctor at 12.49pm. Dr Akodu attended to me but her name wasn’t on the door. The roof of most of the rooms I entered had giant holes in them and this consulting room was no exception. I complained of a nagging headache and fever. The doctor asked some questions after which she wrote down some drugs and said I should conduct some tests.

As directed, I went to the ground floor to pay for the tests but was shocked when I was told that malaria test was N1,500. When I complained that it was almost four times the cost of malaria test at UCH, I was told that LUTH’s was the real test.

I paid N1,500 for malaria test and N1,800 for full blood count test. I was given two bottles, a pair of hand gloves, and a syringe to get samples of my blood upstairs. I was told to hurry as they close by 2pm. I got to the first floor to meet a large crowd. I joined the queue.

I had my blood samples by 1.53pm and was directed to the main lab, a 10 minutes’ walk. At the main lab, I submitted the blood samples. I was told to check back by 5pm for the FBC test result and 6pm for the malaria parasite test result. The time was 2.14pm.

An elderly woman who submitted her blood samples before I did was told that the blood had clotted. So, she has to do it again but because they could not take her blood since it was past 2pm, she was told to return the following day.

My FBC test result was ready at 5pm but the malaria test was not ready at 6pm and I was asked to come back by 8pm.

“Your result should have been ready in three hours but there is no light,” the lab attendant explained.

When I asked if there was no generating set, he said, “The hospital did not give us generator. So, anytime they take the light we have to wait and continue when there is light. Please don’t say I told you.”

The test was not ready by 8pm and I was advised to check back the following day, but when I returned the next day, the story was the same. I had to wait till 10am to collect my test result.

Immediately I collected the result, I hurried back to the G.O.P.D but was told to come back on Monday.

“You are supposed to be here between 8am and 10am. It’s almost 10.30am,” the health record officer said.

I tried so hard to explain to her that the delay wasn’t my fault but she said there was nothing she could do.

“Will I pay for consultation when I come around on Monday? This is a follow-up. I just want the doctor to interpret my test results,” I said.

“Even if you want to say ‘ good morning, doctor’, you’ll pay N600,” she said.

One restroom for all

While waiting for my test results, I decided to have a look at the restrooms. I visited three of them and there was no difference. In all three cases, the ceilings had caved in. The floor was covered with a pool of water mixed with urine.

I saw men and women queue up to use the same toilet. An elderly man who could no longer suppress his urine was advised to urinate where he stood and he did.

“How do they expect men and women to share the same toilet?” a nun who was waiting to use the toilet said aloud.

“Women are supposed to have pride abi?” a man on the queue asked in response to what the nun had said. “But na una dey cause am. Women behaviour these days no be am. Na why LUTH decided not to respect una.’’

When I went in, I saw the water closet but the tank was missing. There were buckets in front of the toilet but no water. So, everyone used the toilet without flushing and that contributed to the offensive smell emanating from the restrooms.

Only radiotherapy machine broke down 4 months ago

The oncology department of the hospital was deserted except for few staff who sat chatting. I was told that day wasn’t their clinic day.

One of the doctors told me that the radiotherapy machine broke down four months ago and the hospital does not have a bone marrow machine. He told me the clinic days were Mondays, Tuesdays and Thursdays.

“If the machine starts working today, you’ll meet over a thousand people here tomorrow morning and before you know it, the machine will break down again. The machine is overworked,” he said.

“Obasanjo donated the radiotherapy machine to LUTH in 2007 and that’s the only machine we have been using to treat patients since then. When a patient comes to us now, we refer them to any teaching hospital in the country where the machine is functional. We have lost some many cancer patients because of this.  The hospital has never had a bone marrow machine so we refer our patients to the two hospitals in the country that have this machine, which is either UCH Ibadan or Abuja,” the doctor said.