Gasping for Air: Doctor’s death exposes inherent risks of Nigerian public hospitals

By Dr. Ifeanyi Nsofor and Patience Adejo (Lead Writers)

Editor’s Note: On the 19th of June, 2018, headlines of Nigerian newspapers carried a shocking piece about the demise of a Kogi Doctor. Realising that there must be more to this, the Nigeria Health Watch team headed out to Lokoja to find out more. While we cannot bring Dr. Rosemary Chukwudebe back to life, she must not die in vain.

The late Dr. Rosemary Chukwudebe, 42, was the Head of the Internal Medicine Department at the Kogi State Specialist Hospital (KSSH) in Lokoja. She was a graduate of the University of Benin, a caring wife and mother to three beautiful young children. Known as a dedicated doctor who worked tirelessly, she would often continue attending to her patients when doctors were on strike, saying that “Two people cannot be mad at the same time”, referring to the Kogi State government and the medical trade unions who have “normalised” strikes as the method of agreeing appropriate remuneration levels in the public health sector in Nigeria. Dr. Rosemary Chukwudebe was an exemplary doctor, the type every patient would love to meet when they are most vulnerable.

Despite her deep dedication to duty and commitment to her patients, Rosemary, unfortunately, died in the same hospital where she worked, in the same department she headed. The Kogi State Specialist Hospital, the Nigerian health system and the government failed her. Today, her family is still struggling to come to terms with her death.

Rosemary was one of a shrinking population of doctors who, despite the pressure to relocate abroad for greener pastures, stayed behind to care for Nigerians. Photo source: www.kogireports.com

According to her husband, Rosemary was not paid her salary for the third quarter of 2017. In 2018, she had only been paid salaries for January and February. She was a known asthmatic and had been managing her condition fairly well until she developed complications on Friday, June 15, 2018. She was rushed to KSSH – her place of work. Those who were present said she was breathless and fainted several times.

The hospital has a brand new Intensive Care Unit (ICU), which was commissioned by the previous administration but not equipped, so it was not functioning. As a result, oxygen could not be administered to Rosemary when she needed it the most because KSSH did not have oxygen in its ICU. Moreover, when oxygen was eventually found, there was no spanner available to open the cylinder, to release the oxygen. Sadly, the medical team on-call, despite knowing that there was no oxygen available in their facility hesitated in referring Rosemary to the Federal Medical Centre Lokoja, a tertiary health facility in the same city.

One cannot begin to imagine the harrowing experience Rosemary went through as she struggled to breathe in the hospital where she had dedicated her years of service. The hospital was without oxygen, a basic commodity a secondary health centre such as Kogi State Specialist Hospital should have had in plenty supply. And, this was only her first and immediate need. If she had survived, one can only imagine what else would be lacking; life-saving medicines, dressings, syringes, sometimes even gloves… for the doctor’s physical examination. The unavailability of these life-saving commodities in many public hospitals in Nigeria routinely leads to deaths of many patients in Nigeria, who unlike Dr. Rosemary Chukwudebe, you will never hear about. Their stories are never told.

If Rosemary who was a senior doctor and Head of the Department of Internal Medicine could die in such circumstances, how will millions of poor patients in Kogi state fare?

A health system consists of all organizations, people and actions whose primary interest is to promote, restore or maintain health. Building blocks of a health system include governance, health care financing, health workforce, medical products/technologies, information/research and service delivery.

Image source: WHO

A health system is nothing without medical products and commodities. Kogi State Specialist Hospital is a referral secondary hospital and therefore should have basic commodities such as oxygen for managing and stabilizing patients during medical emergencies. There are many other instances where patients have died because of lack of oxygen in hospitals in Nigeria. In 2017, Chris was severely ill and needed oxygen. Despite taking him to five different hospitals, he died because none of the hospitals had oxygen. Likewise, in 2014, Chizoba Ekpe, a 33-year-old mother died due to lack of oxygen at the Imo State University Teaching Hospital, Owerri. Too many Nigerians die from lack of oxygen in hospitals despite the existence of Federal Ministry of Health National Policy on Medical Oxygen.

The National Policy on Medical Oxygen stipulates that, “the administration of supplemental oxygen is an essential element of appropriate management for a wide range of clinical conditions. However, oxygen is a drug and therefore requires prescribing in all situations. Failure to administer oxygen appropriately can result in serious harm to the patient”. Hospitals in Kogi and other states in Nigeria must prioritise the provision of standard oxygen plants that are piped directly to wards.

Image credit: Nigeria Health Watch

Rosemary was one of a shrinking population of doctors who, despite the pressure to relocate abroad for greener pastures, stayed behind to care for Nigerians. Despite this, she was owed salaries for several months by the Kogi state government. Her husband and colleagues feel this may have contributed to complications that led to her death. Poor working conditions, poor remuneration and search for better facilities and a work environment, were some reasons given for leaving by respondents in a survey conducted by Nigeria Health Watch and NOI Polls, on emigration of Nigerian medical doctors. It is unconscionable that Rosemary was not paid for many months by the Kogi state government. We suspect that she is not alone. How does a doctor work for months, without a salary? Yet this is what Rosemary did, and she must have wondered, what else could she do?

Two years ago, the National Council on Health approved for states in Nigeria to begin to sign health insurance laws. Kogi state is one of the states that have not signed a health insurance scheme into law, though they recently approved the creation of the agency to handle the health insurance scheme. While we cannot conclude that this would have saved Dr. Rosemary Chukwudebe, the evidence we have clearly shows that if implemented, universal health coverage will guarantee improved quality, accessibility and affordability of care. There are global, continental and national advocacy efforts for universal health coverage.

To be sure, Rosemary is not better than others who have died because of poor healthcare in Kogi state and across Nigeria. No one should die like this. How can the Kogi state government ensure that her death counts, and more people do not die in such circumstances?

Kogi State Specialist Hospital is a referral secondary hospital and therefore should have basic commodities such as oxygen for managing and stabilizing patients during medical emergencies. Image source: www.newshawktime.com

The six building blocks of a health system is a good blueprint to work with. None of these building blocks are possible without good governance provided by strong leadership of the health sector. It is time that Governor Yahaya Bello of Kogi state and governors of other states prioritise the health sector in their states. The Kogi state government could start by making the development of and signing a health insurance law top priority, to ensure the proper framework is available to pave the road to universal health coverage for the people of Kogi state, including the needed funding for the health sector. Funding will not solve all the problems but with better financing of healthcare, basic medical commodities such as oxygen would be available in health facilities, saving lives.

Rosemary was buried on Friday, July 6, 2018 in Onitsha, Anambra State. We mourn with her husband and children. She worked hard to save lives in Kogi state but was failed by the state’s health system. Nigerians must rise to the occasion and hold the government accountable for quality healthcare.

If we do not raise our voices, no one else will. If you think this is not your problem, think of Rosemary… and think again. Nigerians deserve better. The Kogi state government must ensure that Rosemary’s death is not in vain.