HealthThe Stethoscope

The mess called PUBLIC HOSPITALS

1: A patient shot by the Police was taken to the hospital and died while waiting for relatives to buy blood and provide a chest tube. Okay, in case you are new to this, this is what apparently happened.
A young woman was shot by the Police and was bleeding into her lungs. So, she required urgent blood transfusion to replace the blood being lost. She also required a tube to be placed into her chest to drain out the blood collecting there so she can continue to breathe.
Neither was possible for various reasons and this woman died.

2: Another reported story was a young man who died at a reputable tertiary hospital in Lagos after about 3 days of admission following a head injury. He had fallen off an Okada (motorcycle) and injured his head. He had bleeding on the brain (subdural hematoma) requiring immediate surgical intervention. Such intervention carried out appropriately by a trained neurosurgeon would most likely have saved his life.
The story read that there was no neurosurgeon available to perform the operation in almost 48 hours of admission. In a tertiary institution in Lagos State! Subsequently, when one was finally found, it was too late and the patient died on the operating table.

3: A few days ago, I referred a patient to one of our esteemed public hospitals in Abuja. The patient has suffered a stroke with bleeding inside her brain. The bleeding had caused blockage of the flow of brain fluid out of the brain leading to massive pressure inside the head.
She was unconscious and urgent care was required.

As a neurosurgeon, I knew she required immediate surgery which I was unable to offer at the time. Hence, the referral to a hospital where neurosurgery facility was available. She was taken to the trauma unit: a unit where immediate evaluation, resuscitation and treatment could be offered.

Alas, the patient was rejected because as the relatives were told, ‘She is not a trauma patient’. She was directed to the medical emergency unit where the again family was told, ‘We do not have a bed to admit her’.

So, this patient with a critical urgent condition that can be managed by the hospital, was not offered any credible attention. She was still in the ambulance that transferred her till I got another call asking for help.
I then directed them to a private facility in Abuja where she was immediately attended to and the pressure in her head relieved. She is alive today because of that intervention.

The point is this: we cannot currently rely on our public hospitals to deliver timely care. Referring patients to our public hospitals is a complete waste of time, money and effort as they are not equipped to deliver emergency care at the point of need.

These cases were evaluated and admitted (or not) by junior doctors and nurses. The decisions were abysmal. It is evident that the front-line junior staff in many of these hospitals are poorly trained and poorly equipped to evaluate, assess and offer emergency treatment. The line of communication and decision making by seniors is almost non-existent. Hence, these juniors make decisions far above their levels of training and competence.

The truth is that our public hospitals are a mess and are simply glorified mortuaries. They cannot keep a cockcroach alive let alone a human being! Yet, you hear of new Professors being ordained in these facilities daily. One should only image the rot many profess to. The health statistics and outcomes in most public hospitals are not worth writing about. Indeed, you would be had pressed to find any such statistics.

Many of these hospitals have accreditation to train doctors. However, many of them gain accreditation using false information and borrowed equipment. Equipment that are subsequently returned to the rightful owners. Therefore, they fail when called to deliver care. Even the President of the Federation does not trust his own personal hospital in the Presidential Villa.

Key: For now, an organized private sector working to support our public hospitals is the key to our collective survival. What we need is a compendium of suitable and qualified hospitals in the private and public sectors working hand in hand to deliver quality care regardless of the status of the patient. Public hospitals should be able to collaborate with the private sector in a meaningful symbiotic relationship that cares only about good outcomes.

Public hospitals sharing staff and equipment with private facilities with the expertise and capacity, will save lives. Referral from public hospitals to private facilities to save lives should be encouraged rather than frowned upon.

An open culture of focusing on the patient and not an elitist culture of public versus private will save lives.
In planning transportation networks and connectivity of medical facilities, the private sector is often neglected. I dare say, the patients described above would have been saved and one was saved simply by going to a private hospital.
The transport authorities should note and indeed include private hospitals near road networks and create a road map that showcases the location of all hospitals both public and private.
Saving Nigerian lives depend on it.

Dr Biodun Ogungbo, MBBS, FRCS, FRCSEd, MSc, a Contributor to Newspackng, is a neurosurgeon with Brain and Surgery Consortium at 8 Buchanan Crescent, Off Aminu Kano Street, Wuse 2, Abuja.

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