Healthcare in Nigeria – Experiences from the Crack of Dawn

‎For sometime now, I have been meaning to write a few articles on “WhatsApp and I”. WhatsApp takes a fair bit of my time most days. I belong to nearly seventy groups and I am an Administrator in a third of them. In some of these groups, people have come together from time to time, to light a candle in the dark.

Last Friday, I was about shutting down my laptop to go and sleep ahead of weekend work. I checked the Online calendar to know which Hub to attend, only to realise that I had no shifts booked. Surprise! Suddenly there came a dose of inspiration that lasted the night as I penned the first article, Healthcare in Nigeria – Experiences from the Crack of Dawn.

I have now downloaded the chats from our Final Year Class 1989 WhatsApp Group (FYC89), 4243 pages, 1,291,784 words since its inception on 12 March, 2016😅. We dey gist sha! Similar to other class cohort, you will find nearly fifteen characters in our WhatsApp group. There is always banter, we deal with the good, bad and ugly. We go back in time, have polite conversations on past and current affairs of the world, our fair share of discussing the state of our Nation, etc. More importantly, there is genuine social capital and chats on health. We think about our University with two Mediport Alumni as VC and DVC, how we can help our medical school. We are always there for one another. As Dionne Warwick said – That’s What Friends Are For – in good times or bad times.

I’ll be writing about the most recent class event with much verbatim transcript from the Class group:

[17/10/2023, 18:09:50] Child’s image posted.              [17/10/2023, 18:15:22] F: What? Necrotising Enterocolitis??[17/10/2023, 18:15:51] F: Poor baby!!!!                        [17/10/2023, 18:38:41] O: What do you guys think? He was delivered this morning at the TBA’s in a village.                        [17/10/2023, 18:43:51] O: I thought of this but in a day old baby born at term?                                                      [17/10/2023, 18:50:10] F: It’s possible!!! Can occur before first feeding after birth. Occurs with other anomalies like congenital heart condition, gastroschisis and low peripheral oxygen levels at birth. Let a Paediatric Surgeon see, sha!!!

[17/10/2023, 20:41:27] D: Gastroschisis

[17/10/2023, 20:50:08] O: I have not seen this baby. I asked one of nurses to send it to me. I have a branch of my hospital there. The parents are very poor. They may not be able to get themselves to PH. Do you guys know any NGO that might be interested in a case like this?                                                              [17/10/2023, 20:57:07] D: This case needs multidisciplinary care in a tertiary centre. Can’t they at least get to the Teaching Hospital? There’s a very good Paediatric surgery service there. Let them inquire about Health Insurance Scheme. They have helped a lot of people.

[17/10/2023, 21:17:19] W: Perhaps, we can help with transport money to the Hospital. Who’s the Commissioner of Health there, perhaps one of our colleagues. Let’s save a life!

[17/10/2023, 21:23:15] O: Good idea. Grabowski what’s up on your side. I can pay their transport to the Centre. Is there a paediatric surgeon?                                                                                                    [17/10/2023, 21:23:50] W: I can chip in a little for the parents too                                                           [17/10/2023, 21:25:33] O: This will really help them.                                                                           [17/10/2023, 21:27:45] D: I don’t have his number anymore. Will try and get it                                     [17/10/2023, 23:06:51] M: Yes, if it is g/chisis, bladder esxtrophy is usually involved. My experience, parents abandon such children to die. Thanks W, and others

[18/10/2023, 06:16:08] E: Many thanks for flagging up the case of this neonate. I appreciate the offer and diverse suggestions towards bringing the baby closer to the paediatric surgery team that could help. Who knows whether he is in for a time like this. Can we appeal to our colleagues to remove bottlenecks and mobilise for the rescue mission? If they save the baby it would be another celebrated case like one of us, now a Chief delivered Siamese twins at Ibadan. It is not the baby but the medical sciences that is on trial here! I am pleased that we realise history beacons on us to intervene in the hope of giving the baby a better chance of survival.

[18/10/2023, 08:59:29] S: I will also like to chip in something for this project. Pls send an account detail or K will you undertake to manage this aspect?

[18/10/2023, 12:10:24] O: I would have loved to but my practice is at the creek of the Niger Delta. It is out of where most of us are that is why you don’t see me attending functions of the class. I think anyone of us local should help out to do the coordination. I could bring them to Centre A. I could run away with your money and it will be very difficult for you to find me.

[18/10/2023, 12:15:13] W: I guess time is money. Use my account. 24 hours to remit funds. Thanks O. for helping to get them to hospital. Kindly liaise and see which Centre is easier logistic-wise (family support, expertise etc).[18/10/2023, 12:20:08] O: Hai Hai sir. Thanks for starting the ball rolling. I think Centre A is closer it will enable us start initial clinical evaluation faster. I can get them to town tomorrow morning.        [18/10/2023, 16:30:37] O: The baby is with me now. It is a degree of Gastroschisis. The defect is just above the exit of the umbilical cord. The defect is about 10cm in diameter. The protruding gut has already undergone severe ischemic changes with bleeding on contact. Child looks relatively healthy with a birth weight of 3.2kg.                                                                                                                                   

[18/10/2023, 16:39:13] O: The baby is currently on prophylactic antibiotics cover: Ceftriaxone and Genticin and 10%Dextrose infusion. Baby generally stable. By God grace, it shall be well.           

[18/10/2023, 17:03:54] D: Gangrenous bowel is a dire emergency. The child needs laparotomy with bowel resection and anastomosis. This must happen in the next 24hrs                                                              [18/10/2023, 17:08:30] C: Lord, have mercy! The absence of proper emergency services is a real shame! We can do better as a people.                                                                                                                               [18/10/2023, 20:58:34] O: AMEN and AMEN. I can’t thank you guys enough for your concern. I am proud of you. I thought we don’t have Doctors with a heart for patients like we were taught. What I see here in X State is very saddening. These guys put the dough first. A good number of them that is. They keep diverting patients from the hospital. This is a matter for another day. I will be taking the child to X first thing tomorrow morning. Thanks once again for your concern.

[18/10/2023, 22:19:02] W: We now have 300k (~£260). Please send your account, let me transfer cash in hand. On our behalf, many thanks for deciding how best to support the family. There have been historical examples where families put pressure to release all funds to them while they tried to abandon the baby. Perhaps some money for food and “general runnings” and some money set aside for hospital essentials, etc. By this time tomorrow, I will do a final transfer to you. Thanks once more to everyone who’s made God a debtor today. As the good book says, God is no man’s debtor…

[18/10/2023, 22:42:31] M: Transfer what you have now and still leave it open. Some people will do morrow
[18/10/2023, 22:42:51] O: Wow guys are wonderful. 300k just like that. It is well with you guys. GOD will continue to BLESS all of you. We can walk with our heads held high in front of GOD and in the front of man. I would suggest the money be paid into the account of the hospital and the receipt given to the family. When I get there tomorrow I will get the details and will get back to you.                          [18/10/2023, 22:50:05] W: My thinking is that one or two of us here should speak to the CMD of the hospital and get him to provide pre-op, intra- and postoperative care for this child as a service to humanity. Let the funds be used to support the feeding of the baby and mother as well as care of the child post-discharge. Is that being ambitious?

[18/10/2023, 23:28:29] J: Great idea 💡. Let them /us monitor the baby welfare at least until safe discharge. In current day 9ja ask Powerful Charles N. that 350K for our naira no go reach anywhere o by the time they buy tissue paper, needle, syringe, soap, gloves. Methylated spirit I, never mention medicine. On fluid I think? Paediatric (4.3 Dextrose/0.18 saline for IV maybe preferred); and the extruding gut covered with warm Normal saline pack- my suggestion – maybe our Paediatricians in the house can wade here. My own penny o.[19/10/2023, 00:07:23] M: Not drugs, fluids and consumables maybe consultation and hospital stay     [19/10/2023, 00:11:57] W: Indigent patients have come into hospital and at times left without paying a dime. A strong case can be made. Perhaps because of the emergency a deposit must be paid to expedite action while advocacy is done

[19/10/2023, 00:13:12] M: Even CMD buys his drugs if needs them

[19/10/2023, 00:14:40] W: We know that. Every hospital has options of wavering some or all costs depending on the situation. No free lunch. Philanthropists visit hospitals and pay indigent patients bills too.

[19/10/2023, 00:39:11] A: Hello all, Thanks for all you doing for this newborn. I agree, from the pics, it looks as if the baby has gastroschisis. I would start IVFs at 120 – 150 ml/kg to account for insensible loss from the exposed bowel. Add 2 – 4 meq/kg NaCl, 1 – 2 meq/kg KCl, 10 – 20 mg Ca and adjust accordingly to serum electrolytes. The bowel should be wrapped in sterile gauze soaked in warm saline and elevated to form a silo. This prevents kinking of the mesenteric circulation in order to preserve the remaining live bowel.

[19/10/2023, 00:47:10] A: https://youtu.be/Zo3cZH_7BRs?si=hyk4oIUViKcy2Zw-                                        [19/10/2023, 00:54:08] A If baby has dead bowel, it should be resected and depending on how much is removed, immediate anastomosis may not be possible. Antibiotics should cover gram positives, negatives and anaerobes

[19/10/2023, 01:01:03] J: Dà álu Paediatrician.                                                                                            [19/10/2023, 09:05:40] W: 1. KG – 50k 2. TO – 50k 3. OJ – 50k 4. MO- 20k 5. AD – 15k 6. SFO – 20k 7. KW – 20k 8. KWS – 30k 9. AHG – 45k 10. IA – 50k 11 MCDI – 20k

[19/10/2023, 13:56:34] O: Good afternoon house. I am at SCBU X                                                          [19/10/2023, 16:41:21] O: Good evening house. I know you guys are having a Great day. I am presently at X with the baby at the SCBU. The baby has been admitted and preliminary investigations have commenced treatment has also started. Blood is being organized for transfusion the paediatric surgeon will see him today. He is in the theatre right now. His name is Dr. O. This is the latest.                                     

[19/10/2023, 16:42:48] C: A million thanks for your laudable efforts. God bless you.                                [19/10/2023, 16:50:06] O: On getting to X, I saw the wisdom in paying the money into my account that is why I am sending it. Sorry for the inconveniences.                                                                              [19/10/2023, 16:54:35] W: ‎Sent                                                                                                                 [19/10/2023, 16:56:35] O: That was quick. Received with thanks on behalf of the class. Ps. 41:13 will keep speaking for us in the NAME of JESUS. AMEN.                                                                                        [19/10/2023, 16:59:34] O: He has been seen by the surgeon. He said the surgery will be done tonight or first thing tomorrow morning.                                                                                                                        [19/10/2023, 17:01:04] F: Your efforts towards the well-being of this baby is recorded as a pillar in the House of the Lord. I say, THANK YOU my brother                                                                                                    [19/10/2023, 17:01:27] O: You guys are wonderful. GOD never forgets people like you. Prepare for strange Blessings before the end of this month.                                                                                                [19/10/2023, 17:02:05] F: The Lord does much more for us                                                                      [19/10/2023, 17:02:24] O: AMEN AND AMEN. YOU GUYS MADE IT POSSIBLE.                                            [19/10/2023, 17:03:23] W: You have sacrificed time and money. God sees all…                                         [19/10/2023, 17:04:55] O: You guys triggered the drive.                                                                       [19/10/2023, 18:27:17] OO: I had seen this briefly yesterday among my saved documents but didn’t know where it came from. Have just seen it here. It’s sobering. I like to send in a little change if I can get the accounts. Thanks to you guys for showing interest and paying immediate attention to this.

[19/10/2023, 21:40:26] O: Update: I got the 370k sent. I met Dr. O. He said:

1. There is atresia in the proximal end of the ileum.
2. Evisceration of the caecum and extending to the first part of the transverse column.
3. Extensive gangrene effecting the gut.
4. He would have taken off a large portion of the gut, that the portion to anastomose will be short.
5. He will go ahead and do surgery that anything can happen. That barring any logistical challenges he will do the surgery next tomorrow.
6. He said there was no urgency now.
7. The prognosis is not very good but he will go ahead and do the surgery. In medicine anything can happen and you never say never.
8. Child was on blood transfusion amongst other medications before I left the hospital at 7:30pm.

Expenditure:

• Child Emergency card: 1600                                 
• Medical consumable 1: from CHILDRENS’ PHARMACY: 10,680.
• Medical consumables 2: from E. Pharmacy: 15,100
• S/E/U/Cr+ Ca.  CHEM. PATH. LAB: 11,050.
• FBC, Differentials, grouping and cross matching, X HAEM. LAB. 3150.
• BLOOD 25,000
• Other consumables, Pampers, bucket etc. Baby dress wipes: 12,400.
• Total Expenditure 79,980.

 [19/10/2023, 21:43:10] D: Like he said…. prognosis poor. Likely other anomalies including VACTERL.         [19/10/2023, 21:55:16] O: You never know. Anything can happen.                                                             [20/10/2023, 20:17:20] O: Good evening class. Update on the baby:

1. Relatively stable.
2. Blood taken for serum bilirubin.
3. Had blood transfusion again today.
4. Case taken over by the paediatric surgical team.
5. I had to leave for my hospital today.
6. 100k transferred to the grandfather to buy whatever is required. Told to ask whenever he needs more.

[20/10/2023, 20:20:50] MO: Well done. God bless you for your labour of love.                                             [20/10/2023, 20:22:35] O: AMEN AND AMEN!!!! You made it possible. If not for you, it would have been a wish. I thank you all once again for your concern.                                                                                   [20/10/2023, 20:25:45] F: Thank you for taking the lead in the preservation of the baby’s life. I say again, may the Lord prosper the works of your hands, O.                                                                                                 [20/10/2023, 20:27:56] O: AMEN AND AMEN MY BROTHER. NA UNA MAKE AM HAPPEN.              [21/10/2023, 11:04:34] O: I just been informed that the baby has been taken to the theatre.

[21/10/2023, 14:09:03] S: There are silent facilitators and givers. Today, the University of Port Harcourt Teaching Hospital has a new MRI and has been in use; courtesy of a facilitator here in our class. I have just received two VG70 AEOMED Ventilators on behalf of UPTH, (market value ₦15,000,000 each). This donation was also facilitated by the same person. Dear Colleagues, I cannot hide this Goodwill towards mankind/humanity. Please join me to appreciate DR. LINUS NNAKENYI for making these donations possible. May the good Lord bless you, my brother.

[21/10/2023, 14:48:54] W: Thanks very kindly! OO – 15k EN – 50k CN – 20k CO – 20k [21/10/2023, 16:23:17] L: Thanks Prof. Ogan for providing the much needed steer to ensure the actualization of these donations. Remain blessed

[21/10/2023, 16:52:29] F: Nna anyi uku, meka we-eee. Obula nyemati at all at all. Nye imelum ta did not sacrifice me. Vurum again tuo neli                        [22/10/2023, 20:15:35] O: Good evening class. I trust you all had Great day. Surgery was successfully done yesterday. Baby is relatively good health. Vital signs are stable. Satisfaction first day post op.                                                     

[22/10/2023, 20:25:26] F: Praise God-oooo It will ultimately end in Praise and Glory  to God                  [22/10/2023, 20:52:08] O: AMEN AND AMEN!!!! WE GIVE GOD THE GLORY.

24/10/2023, 20:12:32] O: Good evening class. Apparently because of network challenges because I was very mobile yesterday I couldn’t reach the grandfather of the baby. He finally got to me this morning with the sad news that the baby passed at about 4pm yesterday. He said the baby’s condition suddenly took a down turn at about 12noon yesterday and he passed at about 4pm. That he was already back home and had buried the baby. I want to thank you all for your efforts. The baby’s grandfather said he doesn’t know how to express his gratitude. That he has never experienced this kind of thing before. Where total strangers will take it upon themselves to help someone. That he is short of words but he still went to say words of blessings. I would like to thank us again. WE WILL KEEP LAUGHING IN THE NAME OF JESUS. AMEN. There is a balance 105,100. Before leaving the hospital yesterday, he said he paid 150k. Apparently he added some money to the 100k I gave to him yesterday morning. I waited to break the news this evening because I knew we will all be busy during the day.

[25/10/2023, 01:24:15] W: Very sad news despite the best efforts of the class led by K. Perhaps in a different clime surgery would have been done much earlier and the endpoint may have been different… That said, we must do the usual – give God thanks. I’m in agreement that we refund the rest of the family’s hospital expenses and give the grandfather the balance of funds raised with K. which would probably cover the cost of transport back home, funeral, etc. The last bit is that there is additional #105,000 with me. In all of this, there has been no mention of the deceased child’s mother. I wish we could use this money to support her with an interest-free microfinance program (6-12 months) with a view to giving her the capital if she manages to repay it. I’m not suggesting that K has to oversee it but just dropping the idea here.

[25/10/2023, 06:59:03] ID: K. well done for all your sacrifices. Time is of essence to us as medical professionals yet you it up to ensure that the best was done for the child. For those that donated, may the Lord bless you all.[25/10/2023, 08:00:20] O: I like this idea of yours. Giving her the money as a loan I think will ginger her. If the money is given to her without this rider she may misuse it. She will need this kind of money to speed up her healing process                                                                                                                           

[25/10/2023, 08:02:48] MO: Please let it be a grant rather than a loan.                                                    [25/10/2023, 08:25:03] O: We will give her the money as a loan but she may not pay back. It is called a loan so that she won’t squander the money. Ideally, our work as health care providers is to give parents (in case of a minor) or the client/patient all the information necessary to make an informed choice. The choice can then be a consent or decline, both of which should be respected. Unfortunately, some of us have become marketers who not only push medical products but coerce and threaten people into taking them!

EPILOGUE:

FYC89 is the fourth set of graduates of the College of Health Sciences, University of Port Harcourt, Nigeria. We have few claims to history. We were the first to produce First Class Honours (in Physiology and Pharmacology) in the former four-year Bachelor of Medical Sciences programme, before proceeding to 36-month Clinical training. We were also the first class to produce a Year Book in University of Port Harcourt, etc. We are now global like those before us – in Nigeria, South Africa, Australia, UK, USA, etc. Each one of us has been a doctor for 34 years. In our midst, we have several Family Doctors (private and public), Anaesthetists, Pain Physician, Paediatrician, General Surgeon, Urologist, Cardiologist, Neurosurgeon, Psychiatrists, Public Health Physicians, Professors of Microbiology, Anaesthesia, Gastroenterology and Endocrinology, physicians who have reached the pinnacle of the Oil & Gas, pharmaceutical industries and so on; not forgetting one or two who have combined medical practice with Politics. Some of us have retired. Imagine this number of experts from one class in one medical school and multiply it by the number of medical schools and Alumni sets in Nigeria.

Sadly, we were unable to save the life of our “class baby” despite our best efforts. You know why? It is simply because the boy was born to poor parents in a country run largely by kleptocrats whose sole purpose is to loot the country. Thank God for the likes of another Uniport Alumnus, Governor Alex Otti of Abia State – a breath of fresh air and a beacon of hope.

Now, imagine if our deceased child was born in the UK or other countries where institutions have been built. The diagram below explains how he could have been managed.

1. The congenital abnormality would probably have been picked up during Antenatal care because pregnant women are offered a dating (12-week) Ultrasound scan and a detailed, ~20-week (mid-pregnancy or Anomaly scan). The latter scan checks the physical development of the baby, although it cannot pick up every condition. The 20-week screening scan looks in detail at the baby’s bones, heart, brain, spinal cord, face, kidneys and abdomen. It allows the sonographer to look for 11 rare conditions (one of which is gastroschisis which our baby had).
2. If the diagnosis is made during the antenatal period, the mother-to-be is counselled and delivery planned for a Surgical centre. Arrangements would have been made in advance for resuscitation, wrapping of the exposed part of the body, the baby transferred to Neonatal Intensive Care Unit (NICU), protective antibiotics commenced and the Specialist Surgical Registrar-on-Call informed to come and access the baby once stable.
3. If the diagnosis is made after delivery, arrangements are immediately made to transfer the baby after necessary resuscitation and stabilisation to a NICU for further care.

Did you notice that after forty-eight hours of whipping round, we managed to raise a total of 475,000 naira about £410, which is only a fraction of the cost of one bottle of the exotic drinks some of our politicians drink regularly? One of us left his medical practice, travelled to a rural community to bring the child to a tertiary hospital. He gave up an entire day’s work in his private Medical Practice to try and save the life of a child, born to parents who have very little in a nation, where politicians and other people in authority steal pass armed robbery. Primary Health Care or functional medical referral systems simply do not exist in such remote communities and even in most major cities.

The #1 cause of ill-health is poverty. The broad determinants of health – education, primary health care, homes, skills for jobs, water, electricity, transport and security are veritable areas for investments. These bring results that will always outlive the politics of positions and political structures. Continuing the legacy of borrowing to buy exotic cars or presidential yacht no epp anybody. On the contrary, such moves only widen the social gap causing more deaths of mothers and babies, sudden demise of people in their most productive years.

I would like to cover this nakedness of healthcare with a positive message but I feel very angry in my spirit. I know so many of my colleagues (exemplified by Dr Oweifie Keme above) go way beyond the call of duty to save lives. Despite being very senior doctors they are struggling to make ends meet. In the ever worsening hardship, a cabal of politicians are living larger than life itself and do so with uncharitable arrogance. Why are we so quiet? You can see from the chats above that there are very religious people in our class. This is expected as Nigerians are the second most religious and praying people in the world. People prayed for the child’s healing but did not stop there. They took action to safe his life. What action are you taking to save Nigeria from serial thieves? The foundation of health is GOOD GOVERNANCE that is ACCOUNTABLE to the PEOPLE.

P L O Lumumba once said many of us have ideas but no power and those who have power do not have ideas. All said and done we have no other country but the land of our birth. Well-meaning Nigerians must try and make it work by standing shoulder to shoulder. Talk is cheap, we know. Prayer is good but beyond the talking and praying, we must take action, first in our little spaces by doing the right thing, more importantly coming together to speak truth to power, the recent events in Rivers State being a mind-boggling case in point!

Abiye Hector-Goma is an Administrator of the WhatsApp group of FYC89. He is also a UK-based General Practitioner who believes Nigeria will be a great Nation in his lifetime but is acutely aware this can only happen when kleptocracy is chased out of the country. Who will bell the cat?