Nigerian Healthcare and Its Non-existent Medical Emergency Services
Dr. John Samuel Ehiozua
No cardiac activity, Carotid pulse absent, pupils fixed and dilated, not reactive to light is all it takes for one to die in Nigeria. Most deaths in Nigeria are harrowing and lonely because the victims struggle and appeal, albeit silently, to live, but no one gives them a chance.
This piece is in memory of a dear friend, brother, and colleague whom I find challenging to refer to in past tenses: Dr. Odion Francis Ohiosimuan, aka Dr 10-Digits. We formed our friendship on a burning altar and at shallow points in our lives along with Dr.Ovie Avwenaghagha. The three of us passed through life, we saw it all; mischief, partying, studying, quarreling.
While I referred to Ovie as the soul and conscience of the group, Francis was more like the life of our team. The Ambrose Alii University medical school became a discovery ground for us, and we did have lots of fun. The trio of us remained inseparable despite getting married, having children, and living in different countries. Ohiosimuan talked a lot about his childhood and his friends, and we also got to know his very close friends and confidants like the great Alex Iwetan, Osa, and the one he loves to call 50-50. My alias Dr.12-Bills was forged and cemented in his 3-bedroom rented apartment in the heart of Ujemen town in Ekpoma, which became our meeting point for years. It is also interesting to note that we also began to bicker a lot as we grew into our late thirties, but it was all love and probably a mid-life crisis. The last time I physically saw this great man from Emai clan was the 15th of April 2019 when he traveled down to Benin in the middle of a workweek to celebrate my wife’s birthday and bid me goodbye as I was leaving the country for good; he was that selfless.
Francis was well known and loved by many, and I wasn’t surprised to see his pictures put up in my Secondary School WhatsApp group: Boys Model Secondary School Evboneka, 99 sets. We call it the compound and I was elated reading the nice words people who had encounters with him at various stages of his life had to say about him.
It was a shocker I got on January 8, 2022 at 7 am sitting in my car when I called my wife to give her my usual morning gossip. Her words were, “Honey; I have very unpleasant news for you; your friend is dead. He is sitting just at the back of a vehicle parked on the premises of a private hospital. I was stunned for God knows how long, and my first words were, “What is he doing at the back seat of the car in a hospital? Was his heart shocked? Any cardiopulmonary resuscitation? Oh, my word, I forgot I was probably daydreaming; wake up, boy, it’s Nigeria we are talking about here. I completely lost it because that would be the second time Nigeria would stab me in the back in less than five years.
First was my wife’s older sister, Dr. Cynthia Ovuede, a senior registrar in Internal Medicine at the University of Benin Teaching Hospital. She had acute complications from a cerebrovascular event and was also certified dead in the car without a chance at life. I pleaded with my wife to please do something; get him out of the vehicle, and do a cardiac massage, and coincidentally, the attending physician was also a classmate of ours. Honey, I will call you back, and so I was left in the dark and in the car at temperatures hovering at -20 degrees; It was when I started shaking I realized the car ignition was off. I quickly dialed Dr. Ovie Avwenaghagha, our mutual friend, but it was 6 am his time and so didn’t pick up; then I called Dr. Idogho Jefferey and broke the news. It will interest you to know that the first question they all asked were the same “was Cardiopulmonary Resuscitation done?. No, sir, it’s Nigeria we are talking about here; the only people who deserve a Cardiopulmonary Resuscitation are the very important persons in the society. My friend wasn’t in that class.
Now let’s talk medical science; Cardiopulmonary Resuscitation, aka CPR is simply giving the heart a kick start, and all it takes is to kneel beside a person and expend your energy by pressing on their chest. The American Heart Association lists the adult chain of survival care for an out-of-hospital cardiac arrest patient to include activation of emergency response, high-quality C.P.R., defibrillation, advanced Resuscitation, post-cardiac arrest care, and recovery. The high representation given to CPR is because quality chest compressions are all one needs to provide the heart with a fighting chance to restart and continue with its assigned duties, which is to aid blood circulation. The 2010 guideline didn’t even put it lightly “The lay rescuer should not check for a pulse and should assume that cardiac arrest is present if an adult suddenly collapses, or an unresponsive victim is not breathing normally.” It further advised the rescuer not to spend more than 10 seconds checking for a pulse but to commence chest compressions within that time frame instead. The guidelines were reviewed and updated in 2020 and now recommend laypersons to initiate Cardiopulmonary Resuscitation for presumed cardiac arrests because the risk of harm to the patient is significantly low even if the person is not in cardiac arrest.
It was January 21 on the 6th floor at a hospital in Etobicoke, Canada. I was on tour with some persons when we were suddenly interrupted by flashing blue lights at almost all points my eyes could focus on, and then the announcer calmly called out the words code blue 6th floor and gave a room number. Within 5 minutes, the floor was filled with more than 30 persons; you couldn’t even tell who a doctor or nurse or an allied health practitioner was because they all wore scrubs with one mission in mind to save a life. The only person you could decipher easily was the security guard, who stood calmly at the door, watching the procedure and taking his notes. There was an immediate coldness in the air, and then we were interrupted by the nurse taking us around, a PHD Candidate and scholar, in her rights, asked us to please clear the hallway as they will need to take the patient to the intensive care unit when spontaneous circulation returns. Such arrogance, or was it overconfidence, and when I glanced at the wall to my right and saw the words Be a Hero/ Help a Hero, I understood where the confidence was coming from. I fought back the tears and didn’t know when I spoke with pulsed lips the words “Ahhh !!! Francis, if only you managed to escape like some of us did, you possibly would still be alive today.
The Nigeria health care system is in shambles, with the handlers clueless on how to run a hospital. The medical and dental council cannot effectively regulate the practice of medicine in a country where the number of strikes for better working equipment and training is like the air we breath. It will be absurd to argue that the hospitals have ambulance vehicles in their parking lots when it is actually a piece of equipment in the larger picture of Emergency Medical Service that is meant to provide urgent pre-hospital treatment and stabilisation for serious illnesses and injuries. The Federal Ministry of Health policy document on Emergency Medical Service dated March 2016 sums up the lack of seriousness and will to effect change amongst the handlers of the health sector. Why waste taxpayers’ money on a committee when you know their recommendations won’t be implemented; by the way it was a beautiful thirty paged document which should be covered with dust under the minister of heaths desk.
In more serious countries, the essential requirement to go on a posting in a hospital is a yearly Basic Life Support course with certification. How many Nigerian clinical staff can boast of training in Basic Life Support, not to mention advanced cardiovascular life support or an advanced trauma life support certification. Can Nigeria ever get it right ? not in my lifetime; the reason I didn’t look back when I had the privilege to swap my citizenship. There are distinguished medical practitioners in Nigeria who continue to give their all despite the chaotic health system. I pray their country and profession will not fail them when needed. Francis had some medical challenges while writing an examination and from eyewitnesses, he didn’t get the deserved attention. Interestingly, the Examination body had not deemed it necessary to offer a detailed explanation of events at the scene to his family. The exam venue was a four-star hotel with no medical emergency preparedness, hydration stations, or ambulance services. The hospital refused to allow him in because they didn’t want to have to explain to the family or the security agents who will possibly want to harass them; we don’t want any issues, so please remain in the car while we do the needful. Dear colleagues, no pulse doesn’t mean they are dead, let’s not abuse the term Brought in Dead/Dead on Arrival. Please give them a fighting chance.
How many more will have to go before Nigeria learns her lesson. With heaviness in my heart and tears in my eyes, I say goodbye to my friend Dr. Francis Ohiosimuan Odion, and may the good Lord grant you eternal rest. My only regret is that I didn’t have the privilege to speak to him in 2022 before he passed.
Dr. Ohiosimuan was laid to rest February 4, 2022 at his home in Benin City, Nigeria. He was 40 years old. His online memorial: https://www.forevermissed.com/francis-ohiosimuan-odion
John Samuel Ehiozua writes from Ontario, Canada.
