MANY indigent residents of Benue State are dying at the hands of unqualified medical personnel due to a shortage of qualified medical doctors in most rural communities in the state. Auxiliary nurses and laboratory scientists across the state posing as medical doctors often send hapless patients to their early graves. In part two of this report, Ameh EJEKWONYILO shows why the people of Benue state are helpless.

GYOH who once chaired the MDCN noted that: “There is a regulation which demands that clinic should be set up by a qualified doctor. It follows that, if there is any malpractice in that clinic, the doctor will be liable and be subjected to discipline by the Medical and Dental Council of Nigeria (DMCN). Therefore, clinics are registered by nurses and ward attendants who persuade the doctor to agree that the clinic belongs to them (the doctor) so that the clinic can be registered.”

The retired surgeon said the problem with the registration authorities is that “they don’t check the background; they don’t inspect, they don’t demand to know what is happening in that clinic.

“So, what happens is that once a doctor has put his signature and collects some money from whoever (nurse or ward attendant) registering the clinic, that is the end; he (the doctor) never remembers that a clinic was registered in his name. The practitioner who may be a nurse, a laboratory attendant or even somebody who is just blatantly fearless carries on the activity. He doesn’t receive a visit from the doctor under whose signature that clinic was opened. And the authorities don’t bother to inspect or find out what is happening in various clinics in the state.”

Gyoh also blames the regulatory authorities who are lax with registration of medical facilities in the state.

“When you register a clinic, you are supposed to inspect their equipment, building, staff, and their qualifications and experience. And it is from these that you can determine what can be done at the clinic. You can’t register a clinic that has registered as midwifery for delivering babies, and then the clinic goes on to see people with cardiac conditions and hypertension. If you inspect, you will find out that this is what they are doing! And you tell them, no, you have to do this, you have to stop this or we will withdraw your license. No, that does not happen. Once the original money is cleared from various hands, then the person who registered the clinic can do anything. So, the big fault is from the registration authorities. You must never register without specification.

He shared a personal experience to buttress his point about the complicity of regulatory authorities.

“When I retired, I came back to Gboko town in Benue State. I applied to the Benue State Ministry of Health to setup a clinic at the back of my residence. They told me, ‘Yes, setup the clinic and start operating it, and we will come and inspect it.’ But I said surely you must inspect it before you agree to what can be done there, but they (Health Ministry officials) said, ‘No, no, no. That is not how we do it. What we practice is you set up and start operating it, we will fix a date to come and inspect it.’ Sadly, they never did. That was between 2003 and 2004. I closed the clinic because in 2004, I got a job with a mission organization, a hospital at Mkar; I got appointed as the medical superintendent of that hospital. So, I closed my clinic. I operated the clinic for a few months, but when I got a job, my principle is if you have a full-time job, you have no right to open a clinic. So, I closed the clinic on my own.

“The State Ministry of Health or the Benue State Government should have a committee to register, accredit and inspect all private and even public health institutions. In fact, as far as I am concerned, all health institutions; if the government health facilities don’t meet up with the requisite standards, they should be shut down at once!”

Magnitude of the problem

While assessing the magnitude of the problem of quackery Gyoh said, “Medical quackery in Benue State is an epidemic. It’s very rampant. You as a citizen, if you go to a government health institution, you will be frustrated. If you are not frustrated, frequently, the doctor there would tell you, ‘Well, look, I can see you here but you won’t get good attention, why don’t you come to this clinic,’ and it happens to be his own private clinic. And because there is no control, it is going on; the public doesn’t have a choice but to use it. It is not only in Benue State, it is all over the federation.

“In 2018, I made a publication on the epidemic of Fecal Fistula. Fecal Fistula is when patients after an operation start discharging stool from the abdominal wound because the diagnosis is made that they (patients) have appendicitis; they (quacks) take out appendicitis and they don’t know how to do it properly due to lack of training or carelessness. After four or five days, stool begins to come out of the abdomen, and when that happens, the way of handling it is very special; you don’t just go back blindly, look at the place where the stool is coming from and you stitch it; if you do that it will worsen the matter, and that is what they (quacks) always do. They don’t understand and as a result, many patients lost their lives. Because, if you do that more stool would come out; the short-socketing of the intestine is now more severe; the infective stool excoriates the abdomen, thereby depriving the patient of nutrient; the patient loses weight and becomes anemic and if you do the third operation, the patient is dead. It is at this point that many of the quacks would refer the patient to the hospital.

As a consultant surgeon, I dealt with this problem so much. I was so fed up when I came to Benue State, that I said there is an epidemic of Fecal Fistula. It was published in the international journal of surgery. It was reported to all the authorities, but they never acted on it. So, I left it!”

Betty Abah, an award-winning journalist and human rights activist noted that medical quackery had led to needless deaths and agony in Benue State.

“These deaths were as a result of the unethical practices of quacks in the state, and are largely due to the decrepit state of healthcare in Benue State. These deaths are as a result of a comatose healthcare system. A system run shamelessly by quacks at every street corner and completely unregulated. Some state-run hospitals are even worse off. The consequences are completely avoidable deaths. Every single day,” Abah said.

She added: “In most communities and towns of Benue, auxiliary nurses run private hospitals where major medical surgeries are carried out often leading to needless fatalities. These unlicensed hospitals could be described as mortuaries owing to the unwholesome practices being carried out by quacks.”

Benue State Government’s response

While speaking to our reporter in his office in Makurdi, the Benue State Commissioner for Health and Human Services,  Emmanuel Ikwulono, did not deny knowledge of the existence of quacks in the state. He even emphasised how dangerous they could be.

“Going to the field to investigate this kind of issue, you may be shocked at what you will find; because these quacks are actually very dangerous; they can physically attack you if they know that you are out to expose them. If you go to some villages, they will eat you raw. The quacks would mobilize thugs against you. They are very powerful people, who would not mind killing whoever that wants to expose their criminal activities.”

However, when pressed to comment on what the government was doing to address the problem, particularly the allegation of “abdication of responsibilities in the areas of prosecution of quacks, access to health services and the parlous condition of public hospitals in Benue,” by the NMA and other experts on the issue,  Ikwulono declined to respond.

Rather, he asked the reporter to write a formal letter to his office, requesting vital information concerning the investigative story, so as to enable him to respond appropriately. In fact, the commissioner queried the reporter for speaking to people in the state about the issue without “clearance” from his office.

“Where are the investigative proposal and ethical clearance for this story you are doing? You cannot just go into the field and begin to interact with our people without any form of clearance.

“This is so because you will need to publish data on morbidity and mortality on medical quackery in the state. This will reveal the extent of the problem being caused by quacks in Benue,” the commissioner said.

But when an application was submitted on August 25, 2020, requesting data on mortality and morbidity on victims of quackery, statistics on a number of doctors in the state’s employment as well as data on a number of registered private and public health institutions in the state,  Ikwulono did not respond. He is yet to respond as of the time of filing this report in November.

Nevertheless, findings by the reporter revealed that there are about 40 doctors in the state’s permanent employment. A source at the Benue Hospital Management Board in Makurdi confided in our reporter that “there are 120 part-time doctors, who are called Bond Doctors. They are fresh doctors from the medical school, who were given  financial aid while studying, so when they finished their studies, they are back in the state to pay back,” the source explained, adding that the “state is in dire need of medical doctors due to the shortage of trained manpower in the system.”

On its part, the Benue State House of Assembly Committee on Health and Human Services condemned the activities of quacks but pledged to look into the problem through its oversight duty on the health ministry.

“So, in our oversight, we look at the activities of government agencies, but it is the responsibility of the Ministry to regulate the activities of the private sector, especially these quacks in the medical field. Most of these people operate without a license; posing huge risks to human lives. Therefore, our responsibility as a parliament in the state is to legislate against such obnoxious practices in the state,” said Joseph Okponya, House Committee Chairman on Health.

“In our oversight, we will demand to know how far the Commissioner of Health has gone in dealing with the endemic problem of medical quackery in Benue,” he stated further.

Benue State Police Command reacts

When this reporter drew the attention of the Benue State Police Command to its “unwillingness to prosecute quacks,” in a text message, the police spokesperson, DSP Catherine Anene said she could not react to the allegation.

“(The) Commissioner of Police may have nothing to say about this (allegation) because it’s not his jurisdiction, please.”

But when the reporter pressed further to meet with the police PRO for clarification on allegations of a cover-up and general lack of will by the police authorities to prosecute quacks in the state, Anene replied with a text message, “I’m not in the office. I am part of the ongoing police recruitment (exercise).”

Health as a human right                    

However, in a telephone conversation on the claim by the police spokesperson that it was not within its purview to prosecute quacks, a human rights lawyer,  Femi Falana (SAN), countered the authorities.

“No, no, no. What the NMA should do is to petition the Inspector General of Police by virtue of Section 4 of the Police Act. All criminal offences shall be investigated and prosecuted by the police,” he said.

“People should learn to enforce the law; the NMA should also petition the Attorney General of Benue State who will then direct the State Commissioner of Police to prosecute the medical quacks in the state. The NMA themselves can also get a lawyer, get some of the investigation done, and then ask for the right of private prosecution. People are not using the law, so we are in trouble. For instance, I have told the governor of Benue State repeatedly, ‘don’t cry, and don’t say you are helpless.”

On the issue of non-justiciability of health matters in Chapter 2 of the Nigerian Constitution, where citizens find it difficult to demand their rights to quality healthcare from the court, Falana said, “The right to health is enforceable in Nigeria by virtue of Article 16 of the African Charter on Human and Peoples Rights Act. Every Nigerian by the provisions of the Act is entitled to healthcare. It is a human right that is beyond Chapter 2 of the 1999 Constitution of the Federal Republic of Nigeria.”

“The courts have held that the provisions of the African Charter are applicable in Nigeria. There are judgments of the court where the African Charter had been applied on right to health. For instance, the case of Odafe V Attorney General of the Federation, where some prisoners required special treatment and they were imprisoned in Port-Harcourt, Rivers State, and the court ordered that they should be removed from the prison, put in a specialist hospital at the expense of the government.”

Another lawyer who specialises in the prosecution of quacks and erring medical doctors before the Medical and Dental Council of Nigeria, MDCN,  Ahmed Adetola-Kazeem, said the extant laws against medical quackery in Nigeria are the Criminal Code Act, Penal Code Act, the Criminal  Law and Penal  Law of various states.

He lamented that corruption has remained the bane of an effective legal battle against medical quackery in Nigeria.

“The level of prosecution (of quacks) is low because of the lackadaisical attitude of the police and their failure to work hand in hand with the complainant(s) which is often times the Medical and Dental Council of Nigeria in ensuring that cases are followed to a logical conclusion.”

“It is the responsibility of the State and Federal Ministry of Justice as well as the Police to prosecute quacks, provided that the Police Prosecutor is a lawyer in view of section 66(1) of the Nigeria Police Act 2020,” Adetola – Kazeem explained.

Way forward

In charting the way forward in combating the nefarious activities of quacks in the state,  Otene was of the view that the state government has to take a systematic approach.

“There are no problems without solutions, but the solutions have to be systemic. It has to be a systematic solution covering everything. For instance, the health system has to be strengthened; especially the primary healthcare system in Nigeria has to be strengthened because that is the health sector that is supposed to take healthcare to the grassroots. It is not properly funded; it is well-organized on paper but in actual sense, it is not organised as it should be, because people do not have these primary healthcare centres; functional, comprehensive PHCs within reach in their communities and villages, they are forced to patronize alternatives that might end up either maiming them or taking their lives.

“If we strengthen our primary healthcare system and our universal health coverage, we strengthen our national health insurance scheme or community-based insurance scheme; because with the national health insurance scheme or community health-based insurance scheme, what we are actually doing is to get a better financing option for healthcare for our population, so that people that get sick do not nurse that fear that, ‘Oh my God, if I go to the hospital I have no money on me to pay.’ So, when all these are in place, they would know that when they go to the hospital, they can access healthcare from an insurance scheme that is on the ground.

So, Nigeria has to, apart from strengthening its primary healthcare scheme, we have to strengthen our health insurance scheme; make healthcare more accessible and affordable to the average Nigerian.

“When Nigerians can differentiate a qualified medical doctor from a quack and can reach a doctor as fast and easily as a quack and will pay with little difference to the quack as I pay the qualified medical doctor. Nigerians are not fools; most people will prefer to be seen by those they know are better trained to see them. But when you take options off the hands of a human being, then you leave them with whatever is left at their disposal.

“It is a complex problem and the solution has to be multi-pronged. Eventually, there has to be better financing of healthcare. We always say we are committed to budget 15 percent of our national budget annually to healthcare, but I doubt if we have ever crossed 5 percent of that. Sometimes, the budget is 3.9percent or 3.7percent, 4 percent. We hardly cross 5% and we are supposed to commit 15% minimum of our annual budget to health and health-related issues.

Clearly, just like every other sector in the country, health is not as funded as it should be.”

In proffering solutions to the problem,  Mohammed said, “So, there should be regular, periodic inspection of healthcare centres to ensure there is compliance with laid down rules and procedures of service delivery in the medical profession. They are not doing this, and I guess it is because of logistically challenges or so.”

On his part, Adetola-Kazeem explained that the problem can be dealt with in a decisive manner: “The (Benue) State (government) should work more with the Medical and Dental Council of Nigeria which are necessary witness as the Institution that licenses Medical and Dental Practitioners and have the absolute authority to determine who is a real or fake doctor.

The state should also properly monitor and ensure that Police Officers are properly trained to be able to effectively investigate and gather evidence that will lead to the eventual conviction of quack doctors. The state should also ensure that the police are properly monitored to ensure there is no compromise and to make sure those who compromise are brought to book. The prosecutors should also be properly trained to ensure a positive result at the trial.”

This report was supported by the Institute of War and Peace Reporting (IWPR) and the International Centre for Investigative Reporting (ICIR).