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In Nigeria, the sick die as hospitals insist on Covid-19 test certificates before treatment

The following story is published as part of The Daily Report’s continuing coverage of Covid-19, courtesy of the Google Emergency Relief Fund

By Royal Ibeh

Yasirat Olamide (not real names) remembers the 27th June with tears, grief and sadness. It was the day she lost her husband.  Surrounded by relatives trying to console her, she recounts how her husband who had a crisis due to diabetes complication was rushed to around three high-end private hospitals in Lagos the previous evening (26th) but was rejected by all.

No Certificate, no treatment

“The nurses and doctors asked for the same thing: ‘Where is your COVID-19 certificate?’ Shocked and in tears, I begged them to admit my husband first, explaining that he wouldn’t survive the next two hours if he is not, but they all turned the other way.

“These are very expensive hospitals on the Lagos Island, some of the best in the country. We spend millions to renew our health plan with them. Yet, when we needed them the most, they closed their doors on us.

While refusing the patient, the staff on duty told Mrs Olamide what to do. She was advised to take her husband to Yaba (some 17.5km away), get him tested and return with him once the result is negative.

“Then we can commence treatment,” one of the nurses said. Mrs Olamide recognised this particular nurse; she it was who attended them the last time the couple came for their routine check-up. She begging desperately for the hospital to consider their predicament and get her husband a bed.

“It is the hospital’s policy not to treat patients without COVID-19 certificate,” the nurse said.

Mrs Olamide knew her husband didn’t have the luxury of time, because it would take hours to get to Yaba and hours to get the result.  

An avoidable death

“So we decided to call our friends in high places. One of them who works at the Infectious Disease Hospital in Yaba responded. He quickly came to collect the blood sample. That was around 11pm. Before the test result came out the following day, my husband had died. He died around 3:00 am. By the way, he tested negative.”

It can be traumatic sometimes accessing timely, life-saving healthcare in Nigeria. It’s even worse for the average family who may not have the money or know the right people. With the public healthcare system bedevilled with many challenges, many Nigerians have turned to the private hospitals for treatment.

Nigeria’s political elites and rich families fly abroad for quality medical attention. But since the airports were closed in March 2020 to prevent the spread of Covid-19, these classes of Nigerians have had to seek medical help from private hospitals. Statistics from the Healthcare Facilities Monitoring and Accreditation Agency (HEFAMAA) shows that there are 26 registered general hospitals, 256 public healthcare centres and over 2886 private facilities. 

In the past six months, many more Nigerians have had to turn to these private health facilities to access treatments; a good number have died as a result of the policy that mandates hospitals to demand COVID-19 pre-admission status.

Mrs Olamide’s husband is one of the many Nigerians, especially those with chronic illnesses that have died as a result of that policy. Mrs Olamide wonders if medical practitioners have the right to deny patients treatment.

Observation and Treatment Centre at the Nnamdi Azikiwe International Airport

Spike in maternal and child mortality

With Nigerian authorities deploying resources almost exclusively to containing COVID-19, there has been a surge in maternal, newborn, child- and pregnancy-related deaths. According to the 2020 World Population Data Sheet by the Population Reference Bureau (PRB), immunization programs and other maternal prevention activities have been ignored as healthcare workers have shifted attention to combat the pandemic.

As a consequence, Nigeria is recording about 67 infant deaths per 1,000 live births, a situation that has experts worried. They argue that while there are other socio-economic challenges facing the country, which also need attention, lack of prioritization of family planning and issues concerning population growth by government and its agencies have triggered more maternal and child mortality in the country.

The director, Department of Family Health, Federal Ministry of Health, Dr. Salma Anas-Kolo, said COVID-19 is an indirect cause of maternal, new born and child morbidity and mortality in Nigeria, which has negatively affected the implementation of Reproductive, Maternal, Newborn, Child, Adolescent Health and Nutrition (RMNCAH+N) in Nigeria.

Anas-Kolo pointed that while there was an increase in the proportion of facilities that provided family planning and Long-Acting Reversible Contraception (LARC) services during the start of year 2020, the coronavirus pandemic has caused a drop of 14 per cent.

She attributed the decrease to several factors including; patients’ reluctance to visit health facilities during the COVID-19 pandemic, the challenges with shortage of commodity supply experienced across multiple states due to the pandemic and delays in commodity replenishment at the state stores.

“Needless mortality”

Before one can practice as a doctor, he/she must swear an oath. Reminding health practitioners of the oath, the federal government has raised concern that many Nigerians have died having been denied attention in hospitals, or told there was no bed, often after they have made marathon journeys from one hospital to the other in search of help.

 The minister of Health, Dr. Osagie Ehanire, who disclosed this recently warned that the act was unacceptable as the country cannot afford to continue to lose so many of its  citizens who have in fact found their way to a hospital, only to lose their lives to health conditions, some of which could have been cured.

“Our calling as doctors and health workers is to save lives. We cannot at this time abandon a divine responsibility especially in case of emergency when our service is most needed. The situation calls for re-examining our system.

Dr Osagie Ehanire, Nigeria’s Minister of Health

“I understand that health workers are rightfully concerned about their safety in a COVID-19 pandemic. So we have provided Personal Protection Equipment (PPE), training and an infection prevention and control protocol for doctors and nurses to discharge their duties safely, without risks to themselves.

 “Efforts to control COVID-19 must not be at the expense of allowing other diseases that are equally life threatening to begin to thrive and increase mortality. It would be a serious setback if medical services, especially emergency medical service, begin to deteriorate in the wake of fighting COVID-19.

“There are places today where we suspect that needless mortality from other diseases has overtaken the threat of COVID-19. We are beginning to see that fear of, or focus on coronavirus are making some health institutions lose sight of other health hazards in our communities. 

“I therefore appeal to all medical directors that you all shall hold one another accountable for the outcomes emanating from your hospitals. No emergency should be denied attention, even if it means admitting on a stretcher or examination couch to give life-saving oxygen.”

Royal Ibeh is a freelance writer who reports on the health sector, with a special interest in maternal, newborn and children health, family planning, grassroots health and HIV. Twitter:@royal_uche

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