[EXCLUSIVE]: At UCH’s Accident and Emergency Unit, it’s one doctor to 50 patients daily —CMD, Professor Otegbayo

The Chief Medical Director of the University College Hospital (UCH), Ibadan, Professor Jesse Otegbayo, in this interview by SADE OGUNTOLA, speaks on how the federal health institution is faring, its feats and challenges, especially in caring for accident victims and emergency patients.

A recent media report had it that a patient died at the Accident and Emergency Unit of the UCH, Ibadan, after the patient was left unattended for about 12 hours. Would you say this happened because the hospital is overwhelmed?

The report you mentioned cannot be true. UCH, Ibadan, is not a killer-institution. We have a mandate to treat and to heal. Let us look at the circumstances surrounding what was published. It said that they were told to wait. Immediately anybody arrives at UCH Accident and Emergency Unit, no matter how many people are there, there is an officer designated to look at them and see how critical their situation is. The person will report to the doctor on duty.

Regarding that particular case, in fact, at a point, they were treating them in the car but they realised that this was not ideal and was not yielding a good result. Again, we usually don’t turn patients back but with the way things are now, we may have to start doing that. Let me say that UCH, Ibadan, takes care of primary, secondary and tertiary health-care cases whereas our sole mandate is supposed to be tertiary health-care cases.

But because there is no other place to go for the kind of conditions people have, when many of them come in, we have to take all of them. The population of Ibadan is over six million, UCH is the only teaching hospital in the city and it serves the whole nation, so to say. We receive patients from Maiduguri, Kano, Sokoto and so on. The population of London is 8.9 million. They have 12 teaching hospitals, apart from the tertiary health institutions that are private. Therefore, you cannot really expect us to attend to patients the way they treat there.

I have said several times in the media that UCH is overwhelmed and oversubscribed. We have too many patients come in even beyond our carrying capacity. We have a limited number of doctors and bed spaces. Our Accident and Emergency Unit is the only functional one in the whole of Ibadan and perhaps Oyo State. I said ‘only functional’, that is, one with the capacity to really take care of emergencies, and we have just 32 beds for a population of over 6 million – if you are thinking of Ibadan alone. In that report, you read someone say he came from Delta. Others are from other places. So, we receive all these. With 32 beds, do we now start putting patients on the floor and manage them there and then another reporter will take the photograph and say ‘see how they are managing patients in UCH!’ This would not augur well. Because we are overwhelmed, we are unable to take all patients that come in at the same time. We are presently painting our wards, something which has not been done for over 14 years. They look really dirty with the paints on some wards already flaking, a depressing environment for patients.

In fact, at one point, I said if I took ill, I would not like to be admitted in some of the wards. Now, painting is ongoing, further compounding the problem that we have. That is why, in its wisdom, the Federal Government approved a building project for us, which is just beside the existing accident and emergency unit. The project is for emergency care. It has been ongoing for some three years now. When that is completed, we will have more beds and be able to take in more patients and employ more hands. But as it is today, with just 32 beds, we cannot be putting patients over one another.

This is the situation that we find ourselves in. With this kind of negative reports that patients are being delayed and given our carrying capacity and the fact that we are overwhelmed, won’t it be better for us to say go and seek help elsewhere?

What about patients that were referred to UCH from other hospitals?

Some people may decide to go to Lagos State or Ogun State if the situation is not very critical. It is unfortunate that in the case you mentioned, the patient was about to die. That must have been a very critical case.

The report claimed that the patient had a kidney problem?

When they carried out a test to determine the serum potassium, it was very high. So, that kind of person could have cardiac arrest any moment. The potassium level was very high. When potassium is high, the heart will stop beating in diastole. That is the case of that individual. Apart from that, the fact is that most of our patients do not have health insurance. Sometimes when they come in, there is no money. We cannot turn them back, yet we don’t operate free health-care system. That is why I am appealing to people to subscribe to health insurance. The national health insurance scheme has come up with some innovative ideas that even if you are not a government worker, you can still subscribe to it. Not too long ago, I put it on my status on WhatsApp for people to know that it is now available. But people don’t prepare for the rainy day; they will rather prepare for other things. Health is not taken as a priority and when problems come, they don’t come with notice all the time.

Out of every 10 patients, how many can afford to pay when they come for services at your accident and emergency unit?

Maybe about four out of 10 would be able to pay out of their pockets. But once you are insured, all you need to do is to show your card to indicate your number. So, six come in as indigents because they are basically poor; they cannot afford care. Many rich people don’t even come to our accident and emergency unit; they will rather go somewhere else. Also, some of them have been in, maybe, private hospitals and after they have spent all their money, they are asked to go to UCH. The private people, they are in business and they don’t want the patient to die there and once they cannot get money from the patient, they say go to UCH. UCH does not turn anybody back, whether you have money or not, because it is a public health institution. We don’t have the moral right to send them back. That is why we are contending with all these issues.

What is the operation like at your accident and emergency unit?

At the accident and emergency unit, sometimes one doctor attends to about 50 patients in a day. Usually, a doctor does a morning-to-evening shift and another one takes it over. We have a number of doctors, nurses on duty. When a new case is brought, sometimes all the doctors are on a particular patient that is either dying or is critical and that is why you send some other staff members to attend to them. You can go and verify, there is nobody that would drive into that unit and there wouldn’t be somebody to come out to see the condition the person has. Somebody will go there but it may not be a doctor in the first instance. We don’t have the luxury of putting a doctor outside to be checking cars at the accident and emergency unit but we have other staff members or officers to make an assessment and say, for instance, ‘this is so bad’ and then he rushes in to say, ‘doctor’, or ‘nurse, I have this very bad case outside’. Then they will give priority to that person. That is what is called triage. When you triage, you look for the worst-case to be attended to first. In fact, it may not be the person crying and shouting that has the worst case, because the way we react emotionally to things is different. You see somebody bleeding heavily and he just keeps quiet and somebody just has pain in the shoulder and he is crying all over the place that he is about to die. A doctor is not moved by such and that is why sometimes they think health workers are not sympathetic. But you know that the condition is not going to kill him. The case of the person that is bleeding is more critical and he is the one keeping quiet because of his nature. So, you will use your knowledge to look at the situation, even though you will still say sorry to the person. But you will attend first to the one that is more likely to die if nothing is done. That is the way health workers are trained. The average person who is not medically trained will say this man has been shouting since but nobody is attending to him. But it is because we know that the shoulder pain will not kill him.

What advice would you give patients coming into the accident and emergency unit?

The advice I would give is that you should not wait till things are too late or when things have degenerated before you come to the hospital. Often, people patronise all sorts of alternative medicine and many of them believe that alternative medicine can do a lot for them. But when things get very bad, those people will send them away or they themselves will say that they are going to UCH. So, it is like UCH is at the receiving end for the sickest of the sick and the worst of the worst conditions and that is why our mortality tends to be a bit higher. We will not say, ‘oh this patient is likely to die, let’s push him to a private hospital’. The bulk stops at our table. Even when there is only one breath left in the mouth of a patient, we will still take the patient and do our best. And believe me, our health workers are trying. The condition under which they work is harrowing. Some work 15 hours straight or more and they are human beings.

What is the state of COVID-19 management in UCH? How many patients have you managed so far?

The statistics I have last is that we have many 234 and we have a mortality of 22. I must tell you that even our staff and other people that have been infected now, the success rate for treatment is high. The bite of the infection, I don’t know. I cannot possibly explain why the infection in our population is a bit mild and many of the cases we are seeing now are very mild.

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In fact, the majority of them are asymptomatic. They do not exhibit any sign, maybe because they had contact with someone with the infection, they came to screen and they are positive. They are counselled and all that. And even the ones that take ill, most of them get healed.

They don’t exhibit complications. All the ones that died, all of them have an underlying medical condition which probably would have killed them and now the combination of the infection and the underlying disease like diabetes, hypertension, heart failure, asthma and obesity was compounded by COVID-19.

A major fallout of the COVID-19 pandemic is a large number of infected healthcare workers. How many such cases have you had at UCH?

I would not know the exact number but we likely had something in the range of 70. But they were either mild or asymptomatic cases. It cut across consultants, resident doctors, nurses and even drivers because they drive the ambulances to convey some of these patients with COVID-19. I remember that two of our drivers contracted the disease. However, we have some of our other staff members who are not even health workers, maybe administration staff. We can say that they contracted it from the hospital because they live in the community and because we are in the era of community spread of disease, some of them bring the infection from outside. Since they work in UCH, the tendency is to think that they got it from UCH.

Do you have insurance cover for your health workers?

Every Federal Government worker, by law, is supposed to register with the NHIS. So, we have health insurance, but there are a few of them that did not activate it. We have written circulars many times that everybody should go and register because it is like a contributing pension. Some amount is deducted from their salary for the insurance and the government complements it. But some still relax and will not go and activate health insurance. But for all our workers, we have health insurance. We also have indemnity insurance for doctors and nurses which we pay annually. For doctors, it is about N2 million for malpractice insurance and so on. But we are talking health now, every Federal Government employee is supposed to have health insurance.

But they claim that the insurance cover for their health is N5,000 per month?

I will not be able to answer that. Salaries and wages commission will be the ones to answer that. I don’t have any power over how much is paid and I am sure you know that payment is made right from Abuja through the IPPIS. No chief executive has any contribution to it; it is fixed from Abuja and paid from Abuja. 

If as a patient, a nurse maltreated me, my hospital card couldn’t be found, services were slow and so on, how do I deal with that? What am I supposed to do?

I am sure that you are aware of what is called service compact, the SERVICOM. Their office is just at the entrance of the hospital, very near the information centre. You can lodge your complaints there if you feel you have been defrauded, extorted or have suffered any form of injustice at all. You can register it there. It is their job; they have no other duty than to take such things up with the management or whoever is involved. Secondly, at the information centre, you can get any information: ‘something happened to me, can you give me information on how I can have this addressed?’ Thirdly, you can write a petition to the hospital management, usually addressed to the CMD or director of administration or the chairman, medical advisory committee. So, through those three avenues, you can complain. When you are not satisfied, you can escalate it to another level. Some people take legal action against the hospital and things like that. But we usually try to resolve issues amicably and not allow them to escalate to that level. 

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