© 2019 - International Centre for Investigative Reporting
COVID 19: Unreported deaths, pains of patients suffering terminal illness in Lagos
AS Nigeria battles the deadly Coronavirus, disturbing indications have emerged in Lagos State, showing how, for fear of contracting Coronavirus, the staff of government hospitals abandoned non-COVID patients to die. Bankole Shakirudeen ADESHINA reports for The ICIR in Lagos.
AT about 2:00 am on Friday, June 5, 2020, Alhaja Fhadeelat Talib, a 57-year-old mother of four, died at the Medical Emergency Department of the Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos.
Twelve hours earlier, she had been rushed to the teaching hospital with the hope of getting her urgent medical attention.
But nobody attended to Fhadeelah until she breathed her last.
For about 12 hours, Fhadeelah who was said to be hypertensive, arthritic, and had manifested symptoms synonymous with food poisoning, according to her family, waited in excruciating pains for the life-saving medical intervention that never came.
The urgent appeal by Yusuf, the youngest son of the deceased, to the doctors and nurses on duty to attend to her dying mother, all fell on deaf ears.
How Fhadeelah died
A day earlier, at about 2:15 pm, Fhadeelah had been transported to the Medical Emergency Department of LASUTH, via a rented ambulance, with an oxygen mask covering her mouth and nose.
The transfer was said to have been necessitated by her deteriorated health condition at Gowon Estate Clinic, where she was initially admitted before she was referred to Crystal Hospital, a specialist hospital along -Akowonjo Road, Lagos, and later to LASUTH.
The sickness began barely 48 hours earlier, according to her family.
Rahmat, the eldest daughter of the deceased in an interview with The ICIR, accused LASUTH medical officials of ‘killing’ her mother.
Without any test whatsoever, “the doctors concluded that she was a coronavirus patient,” the 33-year-old lady said, still in shock.
She was visibly grief-stricken, gnashing her teeth and shaking her head as she spoke.
Rahmat said if her mother was COVID-19 positive as claimed by LASUTH, the two other hospitals would have so confirmed.
Rahmat also accused LASUTH officials of criminal negligence of duty, and wanted the officials to be held accountable for their wrongdoing.
“Initially, when we arrived at the Medical Emergency Department of LASUTH, we were immediately turned back,” she explained, saying it took them unending hours, begging, and calling influential individuals who interceded on their behalf before they were eventually admitted.
“Even at that, it was an Isolated Ward, said to be the hospital’s COVID 19 Center, that my mother was dumped.
“While waiting to be attended to, the oxygen my mother was placed was exhausted; we had to use the manual procedure to pump air into her lungs, with the support of a nurse that came with us from Crystal Specialist Hospital,” she told this reporter.
As she left this reporter for the waiting ambulance that was conveying the remains of her mother to the cemetery, she shook her head in grief, saying “my mother was literarily killed by the doctors and nurses at LASUTH.”
The first son of the late Fhadeelah, Papa, as he was fondly called, reiterated his sister’s accusation. He said: “There are no two ways about it: The death of my mother was caused or hastened by the medical doctors and nurses we met at LASUTH, who couldn’t attend to us till she gave up the ghost.
“For God’s sake, even if my mother was going to die eventually, shouldn’t she be attended to? Where do we turn to now in this country?” he asked, rhetorically.
He shared his grievance with this reporter, who rode with him in his car on the way to a private cemetery at Hausa Community in Agege where the deceased was later buried.
At Hausa community cemetry in Agege
At exactly 3:53 pm, the remains of Fhadeelah was lowered in the six feet grave.
The deceased’s final home was surrounded by half a dozen more open graves, to be occupied by other corpses who, according to the gravediggers, would arrive sooner or later.
The ICIR gathered that seven corpses had been buried the same day inside the facility, but the paper could not ascertain whether the deaths are COVID-19-related.
One of the gravediggers, who simply identified himself as Mallam Kabiru, said the number of people that are being buried on a daily basis at the cemetery has increased in the last two months.
“Yes, people I dey die plenty now. Before, people I dey bury five, six or seven here every day. But now, he dey pass 10, 12 and sometimes 14,” Kabir said in pidgin English.
Kabir’s position was also corroborated at the graveside by the officiating cleric, Imam Muhasheed, who disclosed that more than five relatives of his have died in the last two weeks.
According to him, the frequent deaths are becoming worrisome to people in the community.
“In two weeks alone, I have been bereaved of seven direct relatives; two elderly men and women, two young men, and one young lady.
“The deceased we are burying here today, was with us yesterday. In fact, we were together five days ago (on Sunday), at the nikkah (marriage) of her son. I could recall that she was sitting in my car and we discussed at length about life, the deen (faith), and the thereafter (the Judgment Day). I didn’t know it was her way of saying goodbye.
“I’m not a medical doctor; or an unbeliever, but I know and believe firmly, that every single soul shall have a taste of death, but Nigeria needs to do more in terms of how to care for its citizens.
“Yes, we all are going to die by a shabbab (cause), but the healthcare professionals in our hospitals should do better and not hasten people’s deaths,” he said.
Cancer Patients at LASUTH
Unlike Fhadeelah, who could not live to tell her story, Iyanuoluwa Damilola, a chemotherapy patient at the Oncology Department of the Lagos State University Teaching Hospital, LASUTH Ikeja, Lagos, shared her painful experience at LASUTH with The ICIR.
A graduate of Economics from the University of Lagos, Damilola has been managing Colorectal Cancer for about a year.
Her struggle with the disease was characterised by a monthly chemotherapy appointment at the Oncology Department of LASUTH.
It is a painful but necessary process she must pass through if she must survive the deadly disease.
A medical surgery in an Indian hospital is already slated upon the completion of her chemo sessions. Everything must work according to plan to boost her recovery chances, doctors had told her.
This process, however, was abruptly truncated on Monday, May 18, when upon arriving at LASUTH for her chemo session, Damilola discovered that the department has been put under lock and key.
The center, according to findings, had been locked for weeks, without a plan to cater to scores of terminally ill patients who depended on its service for survival.
There was nothing they could do other than to wait, a decision that many described as costly.
“Days became weeks, as we continued to visit the hospital but to no avail,” Damilola told The ICIR in an interview, conducted over a month ago
According to her, the situation was not only life-threatening, as the disruption could relapse her progressive healing over the year, but also to other patients.
Investigation revealed that there were over three to five dozens, who visited the hospital, on appointment days –Monday, and Tuesdays; with most of them managing one terminal illness, or the others.
“I could recall a woman, who appeared to be in her early 50s. Apparently, she is a very rich woman. But she has been battling heavy bleeding for over a month and was referred to the Oncology Department of LASUTH for chemotherapy.
“She was crying profusely and begging to be attended to. At a time, she rolled herself on the floor, asking God to take her money in return for sound health. She was doing this until other patients were overwhelmed with tears. It was a very sad experience,” she told The ICIR.
Why was Oncology department of LASUTH shut?
The ICIR paid an unscheduled visit to the Oncology Department of LASUTH which looked like a ghost town on Wednesday, June 10.
Though the entrance was open, indicating activities were going on for the day, but inside of the department, nothing was visibly happening.
Throughout the 15-minute period spent by this reporter, no single official was in sight.
The front desk and the entire passageway was empty. The consultancy room and the files/registration rooms were all empty.
On other days, especially Mondays, and sometimes Tuesdays, the department is a beehive of activities, with staff attending to patients, who depend on the hospital service to rem.
Against the backdrop of Damilola’s lamentation, however, The ICIR spoke to the spokeswoman of LASUTH, Mrs. Sheyi Oniyide, who confirmed that the department was closed because of the outbreak of COVID 19 virus in the department.
Dr. Adewunmi, a senior medical officer in charge of the Welfare Department of LASUTH, who also spoke to this reporter, apologised for the development.
“I must tell you the decision was due to an outbreak of COVID 19 in the department, and it affected a number of our healthcare workers. It was in a bid to forestall this that the department was disinfected and locked down. I am very sure it would reopen next or upper Monday,” Dr. Adewumi said, believing he was speaking to the family of a patient.
When the reporter called other hospital staff to confirm the claim of COVID 19 outbreak in the Oncology Department, all the officials declined to comment.
Isolo General Hospital
March 27, an athletic young man of average height known as Joel, allegedly died at Isolo General Hospital, without been unattended to by the hospital staff.
Some minutes before his death, according to Punch’s report, the deceased, who was said to have slumped during a friendly football march with his other friends, went into a coma and was wheeled into the hospital.
The nurses on duty reportedly said they were too busy to attend to him. He died while awaiting medical attention at the hospital.
“The medical system failed my friend today and I’ll get over it,” Amaka, on her Twitter account wrote, explaining that the deceased “was playing football on the field this morning and slumped and stopped breathing. He was immediately rushed to the Isolo General Hospital for urgent medical attention. But getting there, they refused to let him in because they said they don’t know if he has Coronavirus.”
According to her, “his family members kept begging and begging because time was running out and he wasn’t getting any better, he was still not breathing… The nurses did not attend to him, because according to them, they were overwhelmed with other emergency cases. They had to return him to the car and resulted in prayers.
“In tears, his elder sister still went back in and requested to see any doctor on duty, after so much argument, a doctor came out, heard the whole story from the nurses on duty and without taking a look at him (Joel) in the car or bringing him in to check him out, did certify him dead. He ordered that Joel should be transferred to the mortuary. His mother collapsed on the sport,” she narrated.
In defense of the hospital, the Chief Medical Director of the hospital, Dr. Godwin Akhaboa, who reportedly said the health institution does not usually reject patients, told The Punch that patient was brought into the hospital dead.
“There are parameters to look at before certifying a patient dead, and no doctor will say a patient is dead without checking those parameters. It’s never done; no nurse or doctor will do that. The patient had a cardiac arrest on a football field and he was brought in dead,” Akhaboa told Punch reporter.
The ICIR independent investigation revealed the CMD might not be completely truthful in his claim.
Speaking with this reporter, Dr. Lanre Soyinka, medical expert and Chief Medical Director, Oohbee Hostel, Lagos, and Dr. Favour Smart, a US-based medical doctor, disagreed with Akhaboa.
They dismissed the claim in entirety, arguing that “it would be practically and medically impossible to certify a patient dead without examining him or her!”
According to Soyinka, “certifying a patient dead without examination is like saying a soup is not sweet from its look.”
A physician and graduate of the University of Donetsk, Ukraine, Smart expressed the need for preventive measures against criminal negligence by Nigerian medical practitioners.
Smart, who completed her one-year Houseman-ship at LASUTH, said “Government hospitals in Nigeria are not well equipped to attend to many critical emergencies, but the unfortunate thing is that most of the medical personnel also complicate issues.”
Orile Agege General Hospital
A mild drama ensued at the Gynecology Department of Orile-Agege General Hospital on Thursday, June 25 concerning the COVID 19 status of a patient who died at the hospital two days earlier.
The Septuagenarian, according to her relatives, was brought from an undisclosed hospital in Ibadan, Oyo State where she was previously being attended to for an ailment.
“Monday made it two weeks we have been at this general hospital in Orile-Agege,” a niece of the deceased, who identified herself as Amaka, told this reporter, whom she presumed to be a relative to another patient in the hospital.
“My Aunt was being treated in the general ward, together with other regular patients, and she was responding to treatments up until when she passed on two days ago,“ Amaka lamented.
At exactly 3:54 pm, the remains of this patient was packaged in a body bag by officials, wearing Personal Protective Equipment, and dropped in a waiting mobile morgue belonging to the state Ministry of Health.
There was another body bag inside the van with registration number KTU 541 ER.
As the van navigated its way out of the hospital premises, relatives of the dead woman were seen chasing the vehicle, insisting their dead relative was not COVID-positive.
“We have paid all the bills; the results of the test are here, she is not a COVID 19 patient, kindly release her for us to go and bury,” a relative of the dead said.
“That was how they did at Ifako Ijaiye last week when they insisted that another patient who died of other sicknesses entirely be taken over to Yaba because of the argument that she could have died of COVID-19. The family also resisted it, explaining that she was not, but the officials didn’t listen. They forcefully took her corpse away,” a sympathizer accused the officials.
Like LUTH, the Medical Emergency Department at the general hospital was also under lock and key. It was said to be under construction, without providing an alternative for the hundreds of patients that visit this facility every day.
The maternity, children and women wards were the only places where activities were going on, apparently, but there was no doctor to respond to all of this reporter’s questions.
Inside Lagos University Teaching Hospital (LUTH)
My Aunt lives here in Ketu, but became sick middle of March, during the COVID 19 lockdown. All the initial medical interventions couldn’t normalize her. We had to rush her to LUTH.
“Unfortunately, on getting to LUTH, we were refused entry at first. After hours of waiting, we were told to take her to Yaba Hospital, where they are treating COVID patients. We were so shocked because my aunt wasn’t a carrier of the virus.
“Getting to Yaba, they referred us back to LUTH; getting back to LUTH, we were sent back to Yaba. And in the process, my aunt died a painful death,” Mrs. Dorcas Akoja, narrated a yet another painful episode to this reporter in her home in Andun Street, Ketu area of Lagos State.
As she narrated her story, she recalled other desperate patients that were brought to LUTH the same day but rejected for the fear of Coronavirus.
“There were two other patients during our time at LUTH. One of them crashed into our car, hence my vivid recollection of the event.
“They looked so worried and desperate. While we left for Yaba, they were still begging to be attended to. On our second return, we found all of them to be crying. Their sick relative appeared to have died.
“They said the deceased was diabetic or hypertensive or something, I couldn’t place it. We were so worried about our ordeal,” Mrs. Akoja narrated.
During the entire lockdown, The ICIR findings revealed that for weeks, LUTH was shut down, with the exemptions of gynecology services and all surgical emergencies. Interaction with senior officials during a visit to the apex medical institution in Lagos also corroborates this development.
But why are patients then turned back, if truly the hospital was opened for the said few services?
A visit to LUTH
As early as 8:00 am on Tuesday, June 23, activities had resumed at the Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos.
At all entry points, officials and persons suspected to be on medical appointments were seen trooping into the facility, hurrying to catch up with time.
For first time visitors, there were demarcations of carriageways for the COVID 19 patients within the hospital, with warning signs boldly written in red inks.
“COVID 19 High-Risk Area. Please Keep Off,” one of the banners read.
Opposite the hospital’s Oncology Department is the makeshift testing center for suspected coronavirus patients arriving at the center.
More than half a dozen individuals, accompanied by their relatives, were seen being attended to by healthcare officials, dressed in protective medical gear.
Those who tested positive to coronavirus are promptly transferred to the Isolation Center. Unlike this location, the Dialysis Department of LUTH, a compartment on Ward C Line was less busy. In fact, no patient was seen during this report’s visit to the place, except for two health officials, wearing laboratory aprons, gloves, booths, and facemask.
Head of the Unit, who simply identified himself as Mr. Michael declined to comment because he was busy. When The ICIR called him several times later, he didn’t answer the calls.
Speaking in defense of the hospital, its Chairman, Medical Advisory Committee, Professor Wasiu L. Adeyemo, said LUTH should instead be commended for its resilience.
Adeyemo, an oral and maxillofacial surgeon by specialisation, said LUTH doesn’t have the luxury of referring patients who are brought in for care to other hospitals, no matter how bad is the situation.
This is the reason LUTH had to engage in aggressive training of staff and the 120 healthcare volunteers enlisted for the COVID-19 period, he said.
“The training is necessary to give our best while we protect our lives in the process,” he said.
“The initial lockdown affected our operations significantly, as patients and some healthcare workers found it difficult to navigate the restrictions; but we are now stabilised.
“At some point, LUTH had to scale down some of its activities because of the movement restrictions
“It is noteworthy however to state that in the height of the lockdown, we never shut down the hospital. We were still attending to emergency surgeries and revived many other life-threatening situations.
“LUTH does not abandon, imprison patients”
Adeyemo spoke passionately in defense of his hospital, insisting that in spite of the challenges, LUTH has continued to give its best to Nigerians.
Dismissing the allegation of abdication of duty and criminal negligence during the COVID lockdown or at any other time, the medical expert submitted that the one big issue that needs to be fixed in this country is that of affordability of healthcare services.
According to him, patients or relatives of patients who could not afford the cost of treatments administered on them would continue to hold the hospital in a bad light because of their own inadequacy, unless the country provides affordable National Healthcare Insurance Policy for all.
According to him, “I am sure you must have heard about some unfounded allegations that LUTH holds patients, hostage, because of lack of payment for treatments.
“The truth remains that we do not have detention here in LUTH. On the contrary, however, what usually happens is that patients come into the facility near dead. We attend to them; resuscitate them. They needed surgery; we did for them. They needed treatment; we administered. We do all of these even if you have not paid a single dime to us because the government policy does not allow us to refuse them the essential service, payment or not. But when it is time to pay, the issue would start,” he explained.
“Meanwhile, to ensure uninterrupted service, we have created what I can call a social welfare/health basket where we pull out funds from where we administer all these treatments. And when patients are well, they are expected to pay so as to replenish the pool,” he explained.
The surgeon said the issue of affordability of healthcare is the most pressing problem in Nigeria.
“Because we witness this situation often, it has become obvious that many Nigerians can’t afford even the most basic and inevitable life-saving healthcare services. The solution is simply the Healthcare Insurance Policy for all Nigerians.
“I am aware there is a Bill yet to be assented to by President Muhammadu Buhari on this; perhaps in the next few weeks, he is going to append his signature. The bill, when signed into law, would make it compulsory for everybody to access affordable healthcare service,” he concluded.
Lagos State government reacts
Professor Akin Abayomi, Commissioner for Health, vehemently defended the State Government, saying the Babajide Sanwo-Olu-led administration is “evidently” the most responsive and efficient in the management of all health-related crises in the country, especially during the COVID 19 pandemic.
Abayomi said pursuant to this commitment, 26 of the 27 general hospitals in the state were dedicated to non-COVID treatments.
According to him, “there is only one General Hospital that is managing COVID; and that is the Infectious Diseases Hospital, Yaba. The remaining 26 hospitals are continuing to provide, non-COVID 19 treatment to all Lagosians,”
Corroborating the commissioner’s submission, Dr. Muyiwa Eniayenwun, State Permanent Secretary, Health Service Commission, added that “we are quite aware of the fact that taking care of the patients with COVID 19 infection and the others with pre-existing conditions is our responsibility as a government. And that is exactly what we are doing.
Eniayenwun acknowledged that “I know that there were issues of healthcare workers not responding to patients before but that has been overcome by training and I can assure you that our facilities now respond appropriately.
“You may say that when they are doing that, the processes may slow things down a little bit, but that does not mean that the hospitals don’t take care of their normal patients,” he said.
The Permanent Secretary however pleaded with this reporter to furnish him with the details of the persons affected, with a promise that he would prompt LASUTH management to commence an immediate investigation into it.
He said he did not have such a report of the allegation and promised to investigate and make the finding public.
What the law says about criminal negligence by healthcare workers
Ifeoma P. Enemo, a Professor of Law from the University of Nigeria, in her book: “Medical Negligence: Liability Of Health Care Providers And Hospitals”, defined Medical Negligence as a breach of a duty of care by a person in the medical profession, to a patient, which results in damage to the patient
Enemo submits that criminal or civil proceedings may be instituted against health care providers for negligence in the performance of their duties because the practitioners could be said to be those who are qualified and appropriately registered (where necessary) to practice any of the health-related professions within the medical field.
Healthcare workers include doctors, nurses, ophthalmologists, physiologists, physiotherapists, dentists, pharmacists, laboratory scientists and others.
“If a health care provider does not use reasonable care, or his conduct falls below the standard of care required by law, he is said to be negligent,” she said.
The book’s abstract notes that:
“The healthcare system in Nigeria has recorded unimaginable and unsatisfactory performance in quality delivery for a very long time.
“Medical services are still not accessible to many people, especially the poor. When accessed, patients receive sub-standard care in many cases due to the negligence on the part of one health care provider or another.
‘When services are unaffordable, the patients go to quacks who may provide cheaper services, while causing greater harm or damage to the injured patients and their families.
“The truth is that many people in Nigeria do not know their rights, and many have limited knowledge. Certainly, if those patients become better informed of their rights and the reality of their taking out successful lawsuits against negligent health care providers, the quality of health care may improve in Nigeria.”
But the professor did not add that seeking justice in Nigeria is a also frustrating experience, even for the privileged. Therefore, for those who lose family members due to hospital negligence, they just want to bury their dead and leave justice to God, rather than spending more money to squeeze out equity from the failed Nigerian justice system.
Report edited by Ajibola Amzat