Almost sixty years after attaining independence, Nigeria does not have a coordinated emergency medical services (EMS) system. After a tour of some top public hospitals in the country, Associate Editor ADEKUNLE YUSUF reports that many Nigerians are losing their lives to injuries and illnesses that an urgent medical response would have saved

WITHOUT any inkling of what was to happen, Tuesday, November 12, sprouted into full vibrancy in Owerri, the bustling capital of Imo State. This reporter, having sneaked into the midst of forlorn figures in the waiting sections of the gigantic building housing the accident and emergency (AE) ward at the Federal Medical Centre (FMC) in the sprawling city, had kept track of activities for several hours without anyone suspecting his mission.

From burns to cuts to old people battling with breathing difficulties to patients with loss of consciousness to fits that refused to stop to life-threatening cases, the AE literally had a full plate on that sunny day – with the frenetic pace of activities almost leaving the medical team at their wit’s end. Nothing seemed to have jolted this reporter into true reality of chaotic life in the ever-busy arm of the hospital until hell was let loose. What had seemed normal all day suddenly gravitated into a scene of uproar and confusion – a bedlam of sorts.

Outside the ward, a cacophonous of voices and cries rented the air, shouting “nurse, nurse, nurse.” In their hands was Nnamdi whose body was dripping with blood. Like a scene straight from a tragic movie, it was bloody, awful, and almost hopeless. A bricklayer, the 35-year-old had accidentally slipped from the top of a multi-storey building while at work on construction site and fell on an arrow-like object that pierced through his neck – almost slithering his throat. After a closer clinical look, it was discovered that Nnamdi landed with the left lateral anterior neck on a hammer standing on the ground with its unusually long handle facing upwards. This pierced via the anterior and exited on the posterior, inflicting indescribable pain on the young man. As he was rushed into the ward, even terrified bystanders quickly broke out their hankies, wailing as they witnessed – perhaps their first jarring sight – the full depth of human pain or what could easily be written off as a gruesome death.

Not only were his chances of survival bleak; time was indeed also not his friend. But, led by the ward’s chief nursing officer, Mrs. Vivian Joe who quickly raised alarm as she spiritedly collected the restless victim, the triad team promptly rushed to the rescue. In the ensuing melee, the chief nursing officer’s neat uniform was instantly splattered with blood, but this seemed not to matter to her as the team hurriedly wheeled the dying patient into the ward. Pronto, consultants on ear, nose and throat (ENT), head and neck surgery, vascular surgeons, specialists in burns and plastics, traumatology/spine surgeons, anesthetist, and theatre peri-operative experts had stormed the casualty ward.

Necessary urgent investigations were done, thanks to dutiful medical laboratory hands, who also acted promptly as the situation demanded, with 4 units of screened/cross-matched blood and results provided as fast as possible. Results revealed that the killer object passed medial to the carotic vessel and internal jugular vein and lateral to the oesophagus to the trachea and vertebral column. Now in the operating suite, a madhouse of sorts where the fainthearted dare not tread, more than nine top medical specialists swooped on Nnamdi as if he were the President’s son, ultimately rescuing a man who was down and, in fact, almost out. After successfully removing the wicked object that almost snuffed life out of the bricklayer, each member of the medical team that rescued him was seen beaming with triumphant smiles, saying “this man is super lucky.”

In a jiffy, he was transferred to the hospital’s intensive care unit (ICU) – like two other patients before him on that fateful day. By the time this reporter left the FMC in Owerri on November 13, the bricklayer was found to be doing very well, as doctors in the ICU said: “all vitals are still stable.” That was how he cheated death, thanks to the FMC in Owerri where trauma care enjoys a pride of place in the hospital’s scheme of essential services.

But if Nnamdi, an ordinary artisan, was fortunate to enjoy the best of care when he was caught in the vortex of trauma, not many Nigerians are that lucky when the vagaries of life suddenly strike with devastating fists, pummeling them mercilessly into a situation in dire need of emergency medical services to either stay alive or give up the ghost. Unlike the fortunate bricklayer, lack of an efficient EMS system in Ilorin, capital of Kwara State, was the big knife that tore into the fragile heart of one Nigeria’s most illustrious journalists and playwrights (now a university lecturer in the state), cutting so deep that the wound may never heal.

Two years ago, while away in Malaysia pursuing his second doctorate degree, reports had it that his children were engrossed in the usual childish frenzy, tinkering with how to start the engine of one of the cars in the compound without the guidance of an adult. In the ensuing state of uncontrolled excitement, what began as fun for the kids suddenly metamorphosed into a monumental tragedy that reverberated far beyond the precincts of Ilorin metropolis. Having been trapped in the car booth without anyone around to help, sustaining injuries and almost suffocated to death before help finally came, the young boy was rushed to the General Hospital in Ilorin. Unfortunately, the emergency case could not be attended to due to lack of oxygen, which was desperately needed to revive the dying boy. He was referred to the University of Ilorin Teaching Hospital (UITH), sited many miles away. To worsen an already bad situation, the patient was not conveyed to UITH in an ambulance that ought to be equipped with resuscitation facilities and trauma care personnel. The only boy out of the lecturer’s three children died on transit to the teaching hospital, leaving him heartbroken and traumatized.'

Why harvests of avoidable deaths may not abate soon

In Nigeria, going by discreet observations and experiences of victims and their families in the course of extensive investigations for this story, the AE wards in many public hospitals can hardly meet public expectations in critical situations, thus reducing them to mini specialist nurseries for feeding the morgues. When dying patients are rushed to public health facilities, it is sometimes a herculean task for first-time visitors to locate the AE ward. This is so because the AE ward, which is supposed to be the ‘eyes and ears’ of the hospital, is usually buried in obscure corners in many tertiary hospitals.

After labouring to locate the AE ward, observations in many public hospitals visited showed that it is not unusual for dying patients to be left at the mercy of lackadaisical attitude of many health workers who don’t seem to understand the essence of life and how prompt care can salvage the situation in emergency situations. Sometimes, it may be the absence of basic things like oxygen and lack of bed space that lead to preventable death; while inability to pay is the barrier that stops patients in dire need of emergency care from accessing treatment.

Unlike in other facilities, there seems to be a conscious effort towards facilitating access to emergency medicine at the Usmanu Danfodiyo University Teaching Hospital (UDUTH) in Sokoto. It is perhaps the only teaching hospital that has a specially dedicated route and gate for ambulances or other vehicles conveying accident victims or people in life-threatening conditions to the facility; what this means is that ambulances do not have to compete with other users or workers while trying to gain entrance through the main gate. There is also a stand-by ambulance stationed in front of the ward, which was never used throughout the days this reporter observed activities discreetly in the unit in October.

But the ambience and size of its AE ward is obviously not befitting of a tertiary hospital of its age, size and standard. The attitude of workers in the section also has nothing to write home about. For example, when an old man was rushed to the ward in a rickety vehicle on Monday, October 14, it took more than fifteen minutes before any medical personnel could come out to receive him, with the restless old man writhing in pains and sweating profusely in the car – a situation made worse by the harshness of the scorching sun. His son, Abubakar, and other relations that brought him had to resort to using hand fans to lessen the effect of the heat on the critically sick patient. And by the time a woman in hijab surfaced with a stretcher, it was a hectic time trying to evacuate him from the vehicle as all his family members had to join in lifting him. Yet, very close to the scene, a medical worker in white uniform was engrossed in a telephone conversation, watching what was going on as he was busy speaking noisily in his tribal language for almost an hour. Similar cases of medical personnel looking the other way when emergency cases arrived were noticed in UDUTH.

Anomalies like this, however, seem not to be unknown to the management of the institution. When confronted with such cases of poor attitude of emergency workers in his hospital, Dr. Anas Ahmad Sabir, chief medical director, UDUTH, admitted that “it is an issue we have always tried to deal with among workers in the public sector generally, but we will continue to do our best to change it through training, retraining and reorientation.” He said the hospital never hesitates to apply the big stick whenever anyone is caught red-handed or found wanting, promising that management will continue to devise means to make people do what they are being paid for, including installation of CCTV cameras if possible.

READ MORE: https://www.icirnigeria.org/horror-of-nigerias-dysfunctional-emergency-medical-services-part-1/