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.
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.
