SADE OGUNTOLA reports on the dire situations at the Accident and Emergency Department of the University College Hospital (UCH) Ibadan which are giving the tertiary health institutions a bad image and why the problems persist.
It emerged last week that patients at the University Teaching Hospital, Ibadan, Oyo State, lacked access to water. Toilets and other facilities that should have running water were completely in a mess and the decay didn’t just start in recent times, according to reports. The number of surgeries carried out has also reduced considerably.
Ironically, the UCH, a foremost tertiary hospital, is a medical facility that has history and reputation behind it. Stories abound of its glorious past, including the one that a Saudi king was once flown from his country to the hospital for treatment. Today, it is unlikely that would happen.
Complaints of ill-treatment of patients, including lack of bed spaces in the Accident and Emergency (A&E) Department, are now rife, with families of patients accusing the hospital of indirectly aiding the demise of their loved ones by not doing enough on time to save their lives.
In early January, Mrs Modupe Ariyo, a 61-old-old retired teacher and diabetic patient, was brought in from Abeokuta, feeling unwell. Her children decided to come to UCH in the first instance because she already had an appointment with her doctor at the hospital which was a few days from then.
However, on arrival at the hospital’s A&E Department, medical oxygen was not available and so her children had to take her to a private hospital where oxygen was available. At the private hospital, her condition did not improve. After a few days, she had to be taken back to UCH for specialist care by which time the hospital now had oxygen available. Unfortunately, she was on admission at the A&E for almost a week, leaving her relatives worried that she was not getting appropriate care since she should have been transferred to the main ward of the hospital. She eventually died.
The case of Mr Olaleye Amos Olagunju, 59 years old, who died in the early morning of January 16th was slightly different. After his death, relations accused UCH of being complicit in his death because he had earlier been rejected by the hospital. They felt he could have lived had a dose of a 100mg of Frusemide or Lasix been given to help him out of the acute pulmonary oedema case he had before death.
Olagunju, despite earlier efforts by a relation to contact his colleagues at the hospital for prompt attention, was not admitted due to COVID-19, as it was claimed that there was no space at the A&E. His wife took him to Catholic Hospital, Oluyoro, Ibadan but on getting there, no doctor was on duty. From there he was taken to Adeoyo Hospital, Yemetu, Ibadan, but died at the gate of the hospital.
However, opinions differ on the situation at the hospital’s A&E. Esther Daramola, a student, said from her experience, the idea of turning patients back without giving any form of first aid or treatment due to one reason or the other was responsible for the bad image the department currently has.
According to her, in cases of emergency, as the first responder, first aid should be give to stabilise and keep patients alive until an alternative hospital is sought.
“That is where the lapse is; that is the extra mile they should always go. It is a matter of how they respond to patients at that critical moment. For instance, if a person comes with a seriously bleeding leg, the first job is to take care of the bleeding to ensure it stops, not say ‘go away because we don’t have space,’” she explained.
“The paperwork that comes with the validity of a person on health insurance is so long; there are limited spaces and materials; limited doctors, nurses and health attendants. Those are some of the issues that UCH is facing which should be addressed,” she said.
Staff members of the hospital are not immune from this situation. Mr Femi Akintola, (not real name), a staff of the hospital, said: “I brought in a patient referred from J-Rapha Hospital, Bodija and we were in front of the A&E for three hours because there was no space. I had to break all protocols to get the patient admitted into the only space that a doctor friend I contacted earlier told me about.
Mr Akintola recounted further: “The patient I brought in had a cough; granted they will not want to rule out COVID-19, but such patients should have been taken immediately to East 2 ward, but even that took them over three hours to get done.
“So, we have patients that die there at the A&E gate because they did not receive attention. They often ask relations of some patients if they have money. Is having money to pay for services the first question to ask if a patient is to be admitted? Psychologically, you have not helped the patient because even the worry of where to get money can worsen his condition. So it is the attitude of the health workers as they attend to the patients as they come in that is the problem.”
Dr Augustine Takure, a consultant physician at the hospital, who offered explanation on why the situation persists in the hospital, said the issues at the hospital’s A&E are a reflection of the poor funding of Nigerian’s hospitals.
“It is a societal issue,” he explained, “so we need to look at it holistically. Our government must love its citizens. Secondly, they cannot equate all hospitals to all others. You cannot say, for instance, LUTH should be given the same fund as, say UCH, whose patient volume is 10 times the volume in other centres. That is where the problem is.
“Honestly, I sympathise with Nigerians who attend government hospitals where they cannot be treated. It is not the fault of the hospital. I sympathise with them because they are innocent and they do not deserve such things and I feel saddened that we have people who call themselves leaders who get lost because of the wealth they are amassing,” he said.
The Head of A&E, Dr Kehinde Ojifinni, stated that the department is peculiar considering the profile of its patients and how it sorts them out for care and services.
“When a patient comes in as an emergency case, we don’t take them on the basis of first come first served. So we take them in on the basis of ‘the sickest gets treated first and which patient needs to go elsewhere.’ The one that is more critically ill is likely to die first, if he’s not attended to. And also it is not everybody’s case that is an emergency,” he said.
Dr Ojifinni, however, acknowledged that the department is faced with many constraints, including overstretched facility and a poor referral system.
“First, UCH is actually being over-stretched beyond its capacity because of the relative, if not total, breakdown of the other levels of health care in Nigeria. There are some emergencies or what we can call acute issues like someone requiring kidney dialysis or with multiple injuries from a road accident that their treatment cannot be sought at secondary health care centres. That is one major problem we have,” he said.
Dr Ojifinni explicated that a good referral system would have saved many patients from being turned back because there is practically no vacant bed space.
“Ideally in a hospital like ours, which is like a referral and tertiary hospital, there are few patients that are supposed to just come directly to us. One of the ways to make the care very quickly is that the people who are trying to access our care or the doctors who are sending a patient from the secondary health care centres should have called in ahead of time. I know it’s not possible in all cases. Such a patient is already in our minds, we are thinking there must be space and we are prepared. That is what we call preparedness,” he stated.
He however revealed that the department was working on ensuring that there is a dedicated phone number for people that are referred to UCH so they can put a call through when being referred in emergency cases. He also accused relations of patients of trying to force doctors to admit their patients at all costs only to turn round and blame the hospital if something negative happens.
Ojifinni while reacting to the case of the hypertensive patient who died at the gate of Adeoyo Hospital said, “Our capacity is 32, but that night in question we were 34. The relatives were told the hospital‘s A&E department was full, and they politely asked that he be taken to another hospital. At Oluyoro Catholic Hospital, he was also turned back and taken to Adeoyo Hospital.
“But the wrong impression I am getting from the information you have given us is that a single tablet if given would have saved the man’s life. If that is the case, then that should have been done at the private hospital if it was true.
“We also don’t have a problem with medical oxygen. We buy oxygen in bottles. But from the time COVID-19 started, oxygen has been a very big issue everywhere in the world. The Federal Ministry of Health is trying to now have oxygen plant in every state in the country which is a very good thing. However, even now if oxygen finishes, we have an oxygen concentrator that can still deliver oxygen for the patients in the resuscitation room. The oxygen concentrator is on standby by the patient’s bedside,” he disclosed.
Dr Ojifinni also admitted that the hospital is indeed overwhelmed and that the problem of no-bed space in the emergency unit will cease only when other secondary health care hospitals around it are functioning well.
“If they (secondary health centres) are paralyzed, UCH will be paralyzed in no time. UCH can only function well when those other hospitals are functioning well. That is my take; but if it is about the patient that is inside, ask how many people have complained about the services they receive inside UCH, and then we deal with that,” he said.
Chief Medical Director, UCH, Professor Abiodun Otegbayo, corroborated Dr. Ojifinni on the capacity of the A&E.
“We don’t turn any patient back unless our beds are full. We even treat some inside vehicles. If General Hospitals are functional, there will be less burden on UCH. Beside the A&E Department is a new building which is not completed yet due to inadequate funding.
“UCH is oversubscribed and overwhelmed. Most of the state governments have neglected the secondary tier of healthcare such that these hospitals have no accreditation needed to train even the lowest cadre of doctors, which are the house officers.
“Low confidence in the quality of care provided by primary and secondary healthcare facilities, have pushed patients to seek general outpatient services from tertiary hospitals. This has effectively overcrowded the hospital and overburdened our workers.
“We are calling on state governments to strengthen the general hospitals which form the larger part of the secondary tier of healthcare delivery,” he said.
So until the government turns its attention to the poor state of tertiary health facilities like the UCH, poor Nigerians who cannot afford to be treated abroad like those in the corridors of power will continue to suffer.
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