Goodnight at Noon

GUEST COLUMNIST By Magnus Onyibe

When l attempted to provoke a debate with an article on the steady descent of Nigerian socio-economic environment into a situation that is comparable to an Intensive Care Unit (ICU) of a hospital, l had no inkling that l will sooner than later be a victim of an ICU situation.

The piece entitled “Nigeria Now Looking Like An Intensive Care Unit (ICU)” which was published on June 7 last year, evoked a lot of anxiety across a broad spectrum of Nigerian society, particularly politicians in both the ruling and opposition parties.

When l shared the view, l felt l was literally sounding a wake up call to the authorities as the ruling party; APC was marking its first year anniversary in office.

But after l wheeled my daughter Kikaose Ebiye – Onyibe, a second year law undergraduate at the university of Birmingham, U.K, into the ICU at Gold Cross Hospital on Bourdilion Road, Ikoyi Lagos, and she did not come out of the hospital alive on that fateful April 12, l realised that l had practically appropriated the sad ICU experience which was a mere essay that l had penned to prick the conscience of our leaders.

The sad incident of Kikaose being snatched away by the cold hands of death on that fateful day under strange circumstances (barely a week and a few days after the April Fools Day), when practical jokes are pulled on friends; made the tragic event worse for me, because l could hardly believe that l had watched my vivacious and multi -tasking and highly talented Kikaose, take her last breath in an ICU.

How did the forces compelling us to bid our 18 -year old daughter goodnight at noon so cleverly elude detection?
According to medical records from Bourn Brooke Varsity Medical Centre in Birmingham, England, where Kikaose received medical attention, it all started on January 7, when she thought she had mistakenly eaten an unhygienic or poorly preserved pizza.

She was examined and a minty substance was administered on her simply because the physician that examined her believed that the mint would soothe away the spasm that the young lady was experiencing and which was at that point diagnosed as Irritable Bowel Syndrome (IBS).

The second visit for same ailment, followed with a third, fourth and fifth visits to see General Practitioner (GP) at Bourn Brooke Varsity Medical Centre, where she was attended to by three different doctors in a period spanning four months, (January to April), only suggested that Kikaose had gastritis and later infection, for which the antibiotic Nitroforentoin was prescribed with only a three- day dosage.
Her mother was relieved that after about four months of what seemed like medical rigmarole in Birmingham, the seemingly elusive ailment had been identified.

With the triumphant gusto of Eureka – a sound that a scientist like Alexander Fleming might have made when he discovered penicillin, the first antibiotic medication, in 1929 – my wife invited Kikaose home to Nigeria for proper treatment with a generous dosage of antibiotics (which is not allowed in the advanced society) as it is used or abused in the developing world such as Nigeria.

But unknown to her, Kikaose had become another casualty of the failing U.K. public health system, controlled by a scheme known as National Health Service (NHS) which operates under the principle of insurance.
Incidentally, scandals emanating from NHS and medical professionals misconduct constitute salacious news in tabloids such as The Mail, The Telegraph and The Sun, among others in the U.K., which on regular basis feature articles on NHS service failures weekly.

It turned out that diagnosing or rather misdiagnosing Kikaose’s ailment first as lrritable Bowel Syndrome (lBS) and later Gastritis and finally as Urinary Tract Infection (UTI) which required treatment with antibiotics, were all false alarm.

This is so because when the GP finally tested Kikaose’s blood, it was discovered that rather than UTI, there was infection in her blood stream.
Evidently, it is a major flaw in the U.K. public health system, that without carrying out blood test or scanning her lower abdomen to properly identify the specific cause of the persistent pain in Kikaose’s stomach over a period of four months, they wrongly diagnosed UTI, prescribed and administered antibiotics in breach.
On arriving Nigeria in the early hours of Tuesday April 11, Kikaose was taken to a medical facility where the doctor recommended that she should do CT scan, which revealed that she had a ruptured appendix.
How could appendicitis elude doctors in the U.K. for nearly four months and perhaps weeks after it ruptured? You may wonder!

The answer could be traced to the NHS, which, according to sources familiar with the system, focuses more on the business aspect of Medicare as opposed to providing comprehensive health management service for the sick.
Permit me justify the foregoing conclusion. The NHS operates under the insurance principle of pooling resources from many people through affordable subscriptions with the hope that not many people would fall sick at the same time so the collective contribution of subscribers would adequately take care of the limited number of those who may be falling ill.

Owing to the excessive focus on profit, under the NHS scheme, there is cap on how much health facilities are allowed to spend on patients in order to save money. The capping of the cost per patient may also be due to excessive or bogus bills presented by some hospitals to the NHS.
In effect, the fewer the number of sick subscribers and the less funds that are expended on patients, the more profitable it is for NHS and the operators.

Since the motivating factor for health care providers under insurance scheme is profit, as opposed to the duty of care for humanity as enshrined in the Hippocratic Oath of doctors, not escalating the treatment of patients in order to avoid incurring more expenses, drives physicians and hospitals in the scheme into offering limited care of which Kikaose became a hapless victim.

For instance, if a patient had gone to same hospital (Bourne Brooke Varsity Medical Centre or Queen Elizabeth Hospital in Birmingham) as a private patient, proper diagnoses would have been undertaken from the first visit. This is because payment without recourse to NHS would have been made by the patient but attending to the complaints of a patient in any way that would result in more costs to NHS is considered wasteful and imprudent on the part of a physician and the hospital, hence patients don’t receive optimum attention.

So in a rather befuddling manner, in some western countries, especially the U.K. insurance has taken over control of healthcare service instead of medical doctors and other health care practitioners who should have been making the decisions on life and death of patients based on their Hippocratic vows.
Here lies the dilemma of parents like us who pay surcharge for healthcare to the schools in England as part of the mandatory fees and living charges with the hope that our wards or children are protected from the harm of disease or avoidable death through robust healthcare.

Hitherto, I used to take the popular saying “ignorance is bliss” to heart but l has now learnt the hard way that ignorance is not always bliss.
This is because unknown to us, NHS is a horrendously dysfunctional platform and other health insurance options like Bupa among others had filled the yawning health care gaps that NHS has wrought on the U.K. public health care system.
Upon Kikaose’s return to Nigeria, she was immediately taken to see our family doctor, who examined her and recommended a CT scan.

You can imagine how relieved we were that Kikaose was about to be relieved of the infection that had been inflicting pains on her.
But we were wrong, as things got bizarre because in the course of the CT scan procedure, it was discovered that the excruciating pain that Kikaose had been suffering was a result of a ruptured appendix.

Upon that revelation, the initial plan was to fly Kikaose back to the U.K. for the surgery to remove the ruptured appendix and the opinion of over a dozen doctors was sought and there was a consensus that Kikaose couldn’t travel back to the U.K. with a ruptured appendix without grave consequences of death possibly on the flight back.
We then settled for the surgery procedure to be performed in Gold Cross Hospital on Bourdilion Road Ikoyi, Lagos, (within the opulent vicinity of the aristocrats in Nigeria) but incredibly, the doctors whom Kikaose trusted to save her precious little life, failed her woefully.

Amongst other shortcomings, the hospital lacked simple but very critical life- saving equipment, that could have independently kept Kikaose’s heart beating and sustained her breathing when her organs, severely damaged by the toxins oozing from her appendix into her stomach cavity, collapsed.
For crying out loud, Michael Schumacher the racing car legend and crash victim is still breathing through the aid of a life support device several years after he fell into coma, how much more an 18 – year old Kikaose that survived ruptured appendix perhaps for two weeks before traveling across the Atlantic Ocean from London to Lagos bearing the pain.

Why am l lamenting so much in this piece?
The lamentation is not because l would get a kick from lampooning the U.K. medical system as symbolised by NHS or that l want to diss Gold Cross Hospital because my daughter passed away in the facility due to gross negligence on the part of the two medical institutions and systems cited.

But l am embarking on this voyage of exposition purely to share my experience from the very hard lesson learnt from the loss of a special daughter (with an uncommon passion for God) through professional negligence arising from system failure in the U.K. and lack of critical life – saving equipment in Nigerian hospitals.

My good intention is to sensitise other parents who were perhaps ignorant like me (l had no U.K. experience as l went to school in the USA) about the fact that entrusting the lives of their children into the hands of school authorities in England without a back up arrangement of registering them in private hospitals is risky and dangerous.

As such, my advice is after paying the mandatory healthcare charges embedded in the overall school fees, parents should subscribe to private sector driven health insurance service such as Bupa or get the child registered in a private medical facility to avoid becoming a victim of the most horrific tragedy of burying ones offspring in the full bloom of their lives which is tantamount to bidding them goodnight at noon.

Fortuitously, (although it may be a co-incidence) the trail blazing governor of Lagos state Akinwunmi Ambode, in the same period of Kikaose’s tragedy, was reported to have ordered the shut down of 160 medical facilities in Lagos State for lacking adequate hospitals ostensibly due to deplorable conditions in the hospitals.
That’s another feather to the governor’s cap.

By setting minimum standards for hospitals to comply with, he would be saving many lives as l am convinced that many cases like that of Kikaose abound in Nigeria but they remain undocumented.
The assertion above is derived from the belief that in more ways than one, most Nigerians who are unable to afford exorbitant health care charges are “walking corpses.” The foregoing assumption is underscored by the fact that in case of any health emergency situations, most ordinary Nigerians are as good as dead owing to the parlous state of Nigeria’s health care system.

Even the so called “big men” are not exactly safe if they are not where they can safely be airlifted to Europe, lndia or Israel for proper medical care because most of our so – called top class, high fees charging hospitals lack critical life saving infrastructure.
That’s obviously a sordid reflection of the state of our health care system which has been on a downward slippery slope as evident in the number of Nigerian presidents or heads of state that have sought medical care abroad in the past four decades.

For instance, President Muhammadu Buhari who has recently been facing health challenges. Despite his patently strong passion to make Nigeria greater through revolutionary changes which he promised the electorate, his failing health has prevented him from vigorously pursuing his vision.
After spending 49 days in the U.K. receiving medical care earlier this year, he has now returned to the U.K. for more care to enable him recover faster.

Little surprise, politics has beclouded the judgement of some Nigerians who have been mischievously speculating that the President’s health had deteriorated so badly that he was unable to perform his duties despite his recent appearance at his desk to put a lie to the rumours before his latest trip.
Whereas Nigerians should have been sympathising with Buhari and wishing him speedy recovery like the British do whenever Queen Elizabeth of England and her husband were hospitalised, it would appear that some are making political capital out of the President’s illness.

What has happened to the milk of human kindness and the spirit of brotherly care of which Nigerians are legendary?
Incidentally, l had expressed same indignation when the late president Yar’Adua failing health was politicised and did same when the ailing former First Lady Patience Jonathan became a hotly debated issue in the polity.

In any case, in the current instance, and in previous cases, the presidency is not exactly blameless for the public opprobrium generated by our president’s health challenge. What l’m saying is that the wall of secrecy that Aso Rock builds around the health status of our political leaders drives a bridge between them and the masses. I’m convinced that it is the veil of secrecy and mysticism around Aso Rock dwellers that create the impression that presidents are super humans and thus invincible that sets the populace against their leaders. Trust me, if Nigerians know how the first family feeds, what aches them and how they dwell in villa like normal humans, they will earn their sympathy and cry when they cry.

Before now, former First Lady Patience, wife of immediate past President Goodluck Jonathan, had also fallen terribly ill compelling her to embark on medical tourism abroad that kept her away for a lengthy period of time resulting in wild speculations about her health status.
It may also be recalled that in 2010, former President Umaru Yar’Adua of blessed memory passed away after going on medical tourism to Saudi Arabia too.

Similarly, former military President lbrahim Badamasi Babangida, lBB, famously went to Germany to seek medical attention for his foot disease referred to as “radiculopathy.”
How long would Nigerians and their leaders keep going on medical tourism instead of getting medical care at home? If as a nation we have been able to build a world rated financial services system, why can’t we develop a world-class medical system. I’m not talking about the likes of National Hospital, Abuja that was built under General Sani Abacha’s regime but run down shortly after due to civil bureaucracy. I’m thinking about superb private sector driven health care services.

Is it not preposterous that despite the huge budgetary provisions for health care in Nigeria (in excess of N55b in 2017) we seem not to have been able to take health care beyond the very rudimentary stage where the colonialists left it before independence nearly sixty (60) years ago? For the purpose of clarity, a sound health system is not an indicator of how wealthy the people are or how economically buoyant a country is. If that were the measure, Cuba would not have one of the best medical services in the world.

According to data from the National Bureau of Statistics, Nigerians spend an estimated $2 billion annually on medical tourism to mainly India and Israel especially for organ transplant.

In the light of the foregoing narrative, is it not time that hospitals in Nigeria, (public or private) based on the capacity, quality of facilities and ability of the medical personnel managing them, are upgraded and categorised as the Central Bank of Nigeria (CBN) does with banks which are divided into micro finance, regional and national banks depending on the size of their balance sheet and branch network?

Lagos State Governor Ambode should pioneer the initiative of setting minimum standards for various categories of health care facilities and establish monitoring teams that would visit the hospitals to ensure compliance with the set standards.

Hospitals should also be compelled to put in conspicuous locations the services that they have capacity to render, with the types and number of medical gadgets available for patients to see and enable them make the life and death decisions on whether to patronise the hospitals or otherwise. It is fraudulent for hospitals to tout or create wrong impression about their capacity and ability.

If any one thinks my suggestions are weird or obnoxious, they remember that tobacco producers were compelled by law to emblazon on their products the message: “Cigarette Smoking is Dangerous to Health.”
No precautionary measures to save life should be too much.
Is it not for similar reasons that Federal Road Safety Corp, FRSC is advocating that car owners be compelled to fix speed limiting gadgets in their vehicles?

Recently, activists in many countries including the USA stepped up agitation for fizzy drinks to be more heavily taxed; have labels on the product packaging boldly warning about the sugar content, and also clearly remind consumers that excess sugar can kill.
Certainly, my recommendations are practicable measures to prevent Nigerians, especially our children who are the future, from dying unnecessarily.

• Mr. Onyibe, a former Delta State Commissioner for Information and a development strategist, sent in this piece from Canada.