“I banged on the hospital door at 1 a.m. with my daughter screaming in pain” – The difficulty of healthcare access in Nigeria

13

Editor’s Note: This week’s Thought Leadership Piece recounts the harrowing experience of Nneoma Wokemba, a mother who found herself fighting to get health care for her child in the middle of the night. Wokemba shared her experience on Facebook a few days ago. As we celebrate International Women’s Day this week, her poignant story reminds us that in Nigeria we still have a long way to go towards providing health care for the most vulnerable parts of our populations, especially women and children, the poor, the underserved, the elderly, those with special needs, and those with recurring health challenges. Her story is republished with permission and has been edited accordingly.

 

Between the hours of midnight and 4 a.m., while most people were sleeping, I was driving around town, looking for medical care for my daughter who was in the middle of a painful crisis. I’m used to this. I’ve done it for years and it has become reflex. I don’t think twice about rushing out in the middle of night. For some reason, that’s when her crises usually begins or escalates beyond what I can handle.”

Nneoma is the mother of two beautiful girls, and works as a legal officer in Enugu. Her younger daughter has sickle cell anaemia, and over the years, Nneoma has learnt to manage this health challenge and put in place checks that will facilitate access to care for her daughter whenever a crisis arises. This time around, she thought her checks were in place as usual and so when her daughter started experiencing a crisis in the middle of the night, she sprang into action. But this time around events turned out differently.

We use a hospital owned by a family friend. The staff have instructions to let us in and administer treatment no matter the time, but they recently changed staff. So this time, no one would open the door. I had her hematologist on the phone. He isn’t a staff of that hospital. However, I couldn’t reach the M.D. of the hospital to ask them to let us in. There I was, standing at the entrance at 1 a.m., alternately honking my horn and banging on the door with my daughter screaming in pain.

The ruckus attracted the local vigilante. I froze as they approached me, looking mean and bearing arms. I couldn’t tell if they were robbers or security people till the first one to get to me asked if there was a problem. The moment they saw the screaming child, they started flashing their torches at the windows of the building and they all began to shout ‘Nurse! Nurse!’ A few moments later, a nurse peeped out of a second-floor window and eventually let us in. I said a hurried thank you, carried my 56kg daughter on my back and ran into the hospital. The nurse later told me that they heard me knocking but were scared to open.”

Nneoma and her daughter. Photo courtesy: NneomaWokemba

For a parent, having a child in any kind of pain is traumatizing. Nneoma’s daughter could have had any condition, she could have had an asthma attack, or an epileptic fit, or even simply a running fever, anything that would require Nneoma to seek urgent medical attention.  Many families face this reality on an ongoing basis. It is at this juncture that the care and expertise of health personnel can function as a comfort, and this is why patient-centred care is such an important part of any health care delivery system. Were it not for her personal relationship with the hospital’s management, Nneoma would not have been granted access to the hospital so easily. This should not be the case and speaks to the arbitrary nature of healthcare access in Nigeria. She should have been able to drive to any hospital to gain treatment and get help for her daughter. Had the nurses chosen not to respond to the combined cries of a distressed mother and the vigilantes, her daughter’s life would have been held in the balance.

The hematologist came to treat my daughter. When he was setting the IV line, there was a power failure, and the security man who puts on the generator was nowhere to be found. They tried to call him on the phone but they couldn’t reach him so the IV was set using the torchlight from the phones of the doctor and nurse. Power eventually came back after a while. He then prescribed a course of treatment and left us in the care of the nurses. In a little while, the nurses informed me that they didn’t have some of the drugs in stock and I would have to get them. The time was 3.12 a.m. Yours’ truly took the prescription, kissed my daughter who was too delirious to notice and rushed out to look for a pharmacy.

I know of 24 hour pharmacies located in a not so safe area of town. Before I went there though, I had to stop at the ATM. Of course the bank was dark and empty and of course the security men were not in sight but I was on auto pilot. My only prayer was that the machine would dispense and I would not have to go to another bank. It did and I drove to the pharmacy, bought the drugs and went back to the hospital. Time was 4.02 a.m. One of the nurses looked at me as I handed over the drugs and said to me “Madam you’re strong o, driving around town at this time. It looks like your husband travelled”. “Yes” I answered, “He travelled on a very long journey”.

Drug Stock-Outs are a problem for the Nigeria Health System. Photo Courtesy Futura-sciences.com

When healthcare advocates in Nigeria talk about drug stock-outs being a problem in the health system, it may sound like so much policy talk. It never quite hits home until it happens to you or someone you love. The thought of a young mother left looking for drugs in the middle of the night while her daughter waits in pain reveals much about the inherent harshness of the Nigerian healthcare system and erodes confidence that those in governance actually have the Nigerian people in mind. The admiration of the nurse that Nneoma, whose husband is late, is “strong” because she is doing all of this alone is heartbreaking. She should not have to do this alone… but like many women around the world, she has to be this “strong” to take care of her daughters. She is also having to fight harder because the healthcare system in Nigeria has failed her, because the governing bodies, the policy makers, have failed her. She is fighting this hard because her country continues to fail her.

Remember I have two daughters? Big sister was home alone and there was no light when we left, so in between all this I was calling to check up on her. I panicked at a point when her phone didn’t go through and I considered going home to pick her up but I eventually got her and she assured me that she was fine. Right now, baby girl is still in pain but stable. Hematologist is back and running tests and just like always we’re going to come out of this one smiling.

“Just like always…” There is a special resilience born out of what seems like continuous unrelenting adversity that makes us as Nigerians find reasons to keep smiling and keep smiling big. But the fact remains that health care access in Nigeria does not have to be this hard, for anyone, despite their challenges, despite their ability to pay, despite their location in Nigeria. It does not have to be this hard. After years of advocacy, the National Health Act is now in place as a law, yet there are challenges with implementation, especially when it comes to funding parts of the Act, such as the Basic Health Care Provision Fund. Also, many Nigerians still do not know that their rights are protected under the law. For example, during medical emergencies, it is illegal for a hospital to deny care because of payment.

Nneoma took away some important nuggets from her experience which we share here in her own words:

  1. Community support is important: “Being a single mother is hard. Being a single mom of a child with a health challenge is hard. Being a single mom of a child with a health challenge in Nigeria is hard. Please, do me a favour and hug a single mom today.”
  2. Never give up: “Dear single mom, you are stronger than you know. I’ve heard that you don’t know how strong you are till being strong is your only option. God knows exactly what He is doing. He will never leave you or forsake you. In your weakness, His strength is made perfect. He will uphold you, protect you and your children, provide for you and defend you.”
  1. There is good in the world: “There are a lot of good people out there in the world. In this journey, you will find that many people will go out of their way to show you kindness. People will be cruel but I have encountered more good than evil. Had it not been for the assistance of the vigilante, I would have ended up in an unfamiliar general hospital and it would have taken hours for her to get any attention.”

She ends with a strong message: “STAY STRONG, DON’T GIVE UP AND KNOW THAT GOD’S GOT YOU”.

For all of us fighting for a better health care system in Nigeria, Nneoma’s story is a strong reminder that there is still much work to be done. We must continue to support initiatives that make our health system better, we must never give up until stories like hers become a thing of the past, and we must always remember that there is good in the world, good that we trust will win the day.

Stay strong… Don’t give up on Nigeria’s health system.

 

Do you have a memorable healthcare experience to share? Reply in the comment section below or share on our Facebook or Twitter Page using the hashtag #HealthInNigeria

Discussion13 Comments

  1. Thank you very much for your piece on the ever present reality of the Nigerian Health System.
    I commend Nneoma for her relentless struggle and know that God who has kept her will continue to do so.
    Important though is the lesson from her victorious travail. What is our take home from her experience as citizens of this country?
    I would like to suggest the following based on some of the information highlighted by you:
    1. Health Care access and financing: Even though the government has not been able to make good on loads of promises, they have been able to deliver to an extent on the Social health insurance scheme which is available at a minimal fee to government workers and now to the general population at an annual fee which is quite modest. This scheme grants you access to a hospital where basic health care needs and occasionally secondary care may be provided. The enrollee gets a choice of hospitals close to their residence or work place. In so doing the need to travel long distances to access care may be avoided and out of pocket payments for care reduced to a minimum.
    This formal registration at a hospital also makes you and your family known to a group of health care providers who are then familiar with the family history and provide continous, comprehensive and coordinated care.
    2. Community support: No man is an island. it is important to interact with neighbours to a reasonable extent. A similar experience once happened to my neighbour whose husband had an accident and had to be rushed from the site of an injury to the hospital, even though I was not in the know initially, I went over to the house and moved the children to mine and sorted them out for the next few days till their mother could get a relative to take over care.
    3. Finally: it is imperative that awareness about sickle cell disease and the means of prevention be continually sang out loud such that an easily preventable condition will not continue to cause morbidity and mortality while we pray and hope that our leaders get it right in our country.
    Thank you.

  2. Securing healthcare in Nigeria might be hard due to several factors, some of which are not related with the usual excuse, “lack of funds”. but due to ignorance or outright wickedness on the part of those who suppose to make things happen but do not care because, they can always find their ways, hook or crook, when the need arises.

    The story by Nneoma, the mother of two beautiful girls as she has narrated above is not only appalling but combines with sympathy. Leave the non-availability of medical facilities in the country. Don’t our govt and policy makers know that many pharmacists and the related establishments should be located near medical facilities and encourage entrepreneurs to cite such places near hospitals and medical care institutions? Don’t the same authorities know that the activities of pharmacists or chemists should regulated and made to function to serve the needs of those affected?

    In organized societies, pharmacies are opened and run by pharmacists, assisted by trained assistants in case the expert is not available to sell the drugs to customers, but in Nigeria, anyone with how much he can afford, can open a shop and stock God knows what kind of drugs and start selling to the uninformed and desperate public. Also, in a normal functioning system, in districts that make a town or city, there are, from day to day, “pharmacies on duties” that are wide announced or published in different media daily for the public to know where they can procure drugs at any time 24 hours on that day. This duty rotates among the pharmacies on daily, weekly or monthly basis. This serves patients and their attendants the problems of having to run halter skelter looking for drugs even in the middle of the night.

    Based on the above, I am hereby, calling on our policy makers and those in the healthcare sector, to learn from others if they cannot develop their own, and do the right things to save our people from petty problems that do not require even a kobo to solve.

    Wishing the little girl a quick recovery!

  3. Re-Nneoma.The National Health Act.-Right to emergency treatment. Good. The doctor is denied sleep, uses his family income, runs the generator, pay the staffs,wait for government beaurocracy to pay.Those in change are never affected. There should be a simple system on ground to enable any facility get paid in 48 hours maximum. Otherwise—drugs stock out,no light, will be the order of the day may God help Nigeria amen.

  4. Thank you for posting this. As incredulous and sickening as it is, it a true reflection of what the health services are today in our country and it puts everyone to shame. Correcting it is a task for all of us; not just those in the healthcare profession. For it is not only the provision of healthcare that is comatose, most other things too do not work – recall the single mother’s experience with electricity, security and the banks. We must collectively demand and work for a better country where our individual and collective needs are met to a large extent by a better structured and functional society. Resting it all on God, as we often do, does not seem to be the answer. He has been very kind to us as a people and besides, He has sufficiently empowered us – look at our land; look at our people. We must take our destiny in our own hands especially now that people are closing boarders against us and compelling us to address our own problems instead of running away from them to other lands to receive insults and derision. This story should be made into a movie; the profoundness of its lessons so demands.

  5. Wow tnk u so much for the story. IT is jst a clinch of wat we as mothers go thru in d health system it is really HORRIFYING kudos to nneoma for ever being the resilient fighter may God bless all mothers

  6. A horrible and touchy story from a strong, loving and dedicated mother. An acid test for the resilience of our health system. Time to start thinking of the POLYCLINICS that serve communities, the Cuban way. NPHCDA and NHIS can partner with private sector to start experimenting.
    For saving the life of her beautiful daughter despite all odds, I recommend her for a National honour.
    Long live the Federal Republic of Nigeria.

    • Prof, You are in the position to facilitate your suggestion… It is just unfortunate the that the overall governing body FMoH does not care. Big shame! God will continue to protect us mothers and our children.

  7. The lengths a mother would go to for her child is amazing. I am a mother and know firsthand what it feels like watching your child suffer in pain.

  8. Nneoma….I only have one thing to tell you “JISIKE” Weldone. This word strengthens me a lot when told and I will beat my chest never to give up on myself and my 2 beautiful sons (5 & 3) at no matter any point even in my lowest mood(depressed). Being a single mom too no be cake but God has being awesome allllll the way. I had a similar case sometime in 2015 at Enugu when I just moved back with my sons to my parents home. My lil one developed high fever very wee hr of the night..my mum and I droved around looking for a hospital for help with empty pockect(no job for over 30months) which was dreadful and no solution came…I had one great choice left; giving my son communion (water and biscuit), praying with every stregthen in me that hour just to get him stabilized till morning before an angel in form of friend sent me tripple the money I needed for his complete treatment even their school fees inculded.
    Am so happy and blessed reading this message from you Nne because we all single mums are amazing positive warriors and warriors always will come out tops. Hang in there sis, you aint alone. He above shall never forsake you one bit.
    I know a lot has being shakened in our country for long…healthcare and other basic ammenities that should be accessed easily and swifly but hasnt being of great news. We collectively beg in our tiny voices today that the authorities in charge to please help to see these areas could be boosted…often times its the children and mothers this affects more in the society. Our country Nigeria is blessed and every life counts! 

  9. Oluwatobi Kehinde Lala

    Wow! The travails of motherhood! I salute women everywhere. This story highlights not only the challenges of health but also of a number of other things including security, power, infrastructure development, sense of communal good, health financing, absentee fathers etc.

    I recently read the president’s comment about having received multiple transfusions and honestly, I chuckled a bit. His single ordeal was my quarterly reality: multiple blood transfusions was my nightmare as a child owing to sickle cell anaemia. With critical pcv of 9% on occasion.

    I made up my mind to be a part of the solution. I became a biomedical scientist with specialty in haematology. I started a campaign for voluntary blood donation called Blood Drive Initiative.

    I urge all with touched by this post and all with similar experiences to take it as a call to action and do something to be a part of the solution.

    Nneoma, let me hook you up with my (now 62year old) mother who single handedly raised 5children, 3 of whom were afflicted with the sickle cell disease. I lost my twin sister at age 7/8, my brother and I (38, 36 respectively) still fighting and winning the battle against sickle disease. I wish you and your daughters well.

  10. I commend your resilience Nneoma, but I’ll like to add this, please if you live in Nigeria, and you don’t have access to quality healthcare, research about and look for Aloe Vera which is a popular medicinal plant. I use this for my daughter mixed with honey daily, she’s 7 years old and never had a crisis not until Nov last year when we probably forgot she had sickle cell and mistakenly exposed her to the cold weather. She’s doing fine now and we make sure she’s well hydrated, takes her folic acid and her multivitamin daily. Please also, children with sickle cell shouldn’t be sent to a boarding school in my opinion, it’s a chronic illness and these children should be closely monitored. Always encourage them to drink plenty of water, and if you have access to the aloe Vera leave, you only need the gel, and mix it with honey, and have them drink it daily. I hope this helps someone.

  11. I commend your resilience Nneoma, but I’ll like to add this, please if you live in Nigeria, and you don’t have access to quality healthcare, research about and look for Aloe Vera which is a popular medicinal plant. I use this for my daughter mixed with honey daily, she’s 7 years old and never had a crisis not until Nov last year when we probably forgot she had sickle cell and mistakenly exposed her to the cold weather. She’s doing fine now and we make sure she’s well hydrated, takes her folic acid and her multivitamin daily. Please also, children with sickle cell shouldn’t be sent to a boarding school in my opinion, it’s a chronic illness and these children should be closely monitored. Always encourage them to drink plenty of water, and if you have access to the aloe Vera leave, you only need the gel, and mix it with honey, and have them drink it daily. I hope this helps someone.

Leave A Reply