Gasping for Air: Doctor’s death exposes inherent risks of Nigerian public hospitals

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By Dr. Ifeanyi Nsofor and Patience Adejo (Lead Writers)

Editor’s Note: On the 19th of June, 2018, headlines of Nigerian newspapers carried a shocking piece about the demise of a Kogi Doctor. Realising that there must be more to this, the Nigeria Health Watch team headed out to Lokoja to find out more. While we cannot bring Dr. Rosemary Chukwudebe back to life, she must not die in vain.

The late Dr. Rosemary Chukwudebe, 42, was the Head of the Internal Medicine Department at the Kogi State Specialist Hospital (KSSH) in Lokoja. She was a graduate of the University of Benin, a caring wife and mother to three beautiful young children. Known as a dedicated doctor who worked tirelessly, she would often continue attending to her patients when doctors were on strike, saying that “Two people cannot be mad at the same time”, referring to the Kogi State government and the medical trade unions who have “normalised” strikes as the method of agreeing appropriate remuneration levels in the public health sector in Nigeria. Dr. Rosemary Chukwudebe was an exemplary doctor, the type every patient would love to meet when they are most vulnerable.

Despite her deep dedication to duty and commitment to her patients, Rosemary, unfortunately, died in the same hospital where she worked, in the same department she headed. The Kogi State Specialist Hospital, the Nigerian health system and the government failed her. Today, her family is still struggling to come to terms with her death.

Rosemary was one of a shrinking population of doctors who, despite the pressure to relocate abroad for greener pastures, stayed behind to care for Nigerians. Photo source: www.kogireports.com

According to her husband, Rosemary was not paid her salary for the third quarter of 2017. In 2018, she had only been paid salaries for January and February. She was a known asthmatic and had been managing her condition fairly well until she developed complications on Friday, June 15, 2018. She was rushed to KSSH – her place of work. Those who were present said she was breathless and fainted several times.

The hospital has a brand new Intensive Care Unit (ICU), which was commissioned by the previous administration but not equipped, so it was not functioning. As a result, oxygen could not be administered to Rosemary when she needed it the most because KSSH did not have oxygen in its ICU. Moreover, when oxygen was eventually found, there was no spanner available to open the cylinder, to release the oxygen. Sadly, the medical team on-call, despite knowing that there was no oxygen available in their facility hesitated in referring Rosemary to the Federal Medical Centre Lokoja, a tertiary health facility in the same city.

One cannot begin to imagine the harrowing experience Rosemary went through as she struggled to breathe in the hospital where she had dedicated her years of service. The hospital was without oxygen, a basic commodity a secondary health centre such as Kogi State Specialist Hospital should have had in plenty supply. And, this was only her first and immediate need. If she had survived, one can only imagine what else would be lacking; life-saving medicines, dressings, syringes, sometimes even gloves… for the doctor’s physical examination. The unavailability of these life-saving commodities in many public hospitals in Nigeria routinely leads to deaths of many patients in Nigeria, who unlike Dr. Rosemary Chukwudebe, you will never hear about. Their stories are never told.

If Rosemary who was a senior doctor and Head of the Department of Internal Medicine could die in such circumstances, how will millions of poor patients in Kogi state fare?

A health system consists of all organizations, people and actions whose primary interest is to promote, restore or maintain health. Building blocks of a health system include governance, health care financing, health workforce, medical products/technologies, information/research and service delivery.

Image source: WHO

A health system is nothing without medical products and commodities. Kogi State Specialist Hospital is a referral secondary hospital and therefore should have basic commodities such as oxygen for managing and stabilizing patients during medical emergencies. There are many other instances where patients have died because of lack of oxygen in hospitals in Nigeria. In 2017, Chris was severely ill and needed oxygen. Despite taking him to five different hospitals, he died because none of the hospitals had oxygen. Likewise, in 2014, Chizoba Ekpe, a 33-year-old mother died due to lack of oxygen at the Imo State University Teaching Hospital, Owerri. Too many Nigerians die from lack of oxygen in hospitals despite the existence of Federal Ministry of Health National Policy on Medical Oxygen.

The National Policy on Medical Oxygen stipulates that, “the administration of supplemental oxygen is an essential element of appropriate management for a wide range of clinical conditions. However, oxygen is a drug and therefore requires prescribing in all situations. Failure to administer oxygen appropriately can result in serious harm to the patient”. Hospitals in Kogi and other states in Nigeria must prioritise the provision of standard oxygen plants that are piped directly to wards.

Image credit: Nigeria Health Watch

Rosemary was one of a shrinking population of doctors who, despite the pressure to relocate abroad for greener pastures, stayed behind to care for Nigerians. Despite this, she was owed salaries for several months by the Kogi state government. Her husband and colleagues feel this may have contributed to complications that led to her death. Poor working conditions, poor remuneration and search for better facilities and a work environment, were some reasons given for leaving by respondents in a survey conducted by Nigeria Health Watch and NOI Polls, on emigration of Nigerian medical doctors. It is unconscionable that Rosemary was not paid for many months by the Kogi state government. We suspect that she is not alone. How does a doctor work for months, without a salary? Yet this is what Rosemary did, and she must have wondered, what else could she do?

Two years ago, the National Council on Health approved for states in Nigeria to begin to sign health insurance laws. Kogi state is one of the states that have not signed a health insurance scheme into law, though they recently approved the creation of the agency to handle the health insurance scheme. While we cannot conclude that this would have saved Dr. Rosemary Chukwudebe, the evidence we have clearly shows that if implemented, universal health coverage will guarantee improved quality, accessibility and affordability of care. There are global, continental and national advocacy efforts for universal health coverage.

To be sure, Rosemary is not better than others who have died because of poor healthcare in Kogi state and across Nigeria. No one should die like this. How can the Kogi state government ensure that her death counts, and more people do not die in such circumstances?

Kogi State Specialist Hospital is a referral secondary hospital and therefore should have basic commodities such as oxygen for managing and stabilizing patients during medical emergencies. Image source: www.newshawktime.com

The six building blocks of a health system is a good blueprint to work with. None of these building blocks are possible without good governance provided by strong leadership of the health sector. It is time that Governor Yahaya Bello of Kogi state and governors of other states prioritise the health sector in their states. The Kogi state government could start by making the development of and signing a health insurance law top priority, to ensure the proper framework is available to pave the road to universal health coverage for the people of Kogi state, including the needed funding for the health sector. Funding will not solve all the problems but with better financing of healthcare, basic medical commodities such as oxygen would be available in health facilities, saving lives.

Rosemary was buried on Friday, July 6, 2018 in Onitsha, Anambra State. We mourn with her husband and children. She worked hard to save lives in Kogi state but was failed by the state’s health system. Nigerians must rise to the occasion and hold the government accountable for quality healthcare.

If we do not raise our voices, no one else will. If you think this is not your problem, think of Rosemary… and think again. Nigerians deserve better. The Kogi state government must ensure that Rosemary’s death is not in vain.

Discussion24 Comments

  1. This is really sad, she had such a bright future and cared about her work. I hope that things can get better in this country.

  2. Akinwumi Fajola

    Really sad. Very preventable loss if the simple things had been done. Cost was not the issue here…

  3. Very sad indeed! Can GMD and AGPMPN, as groups of private practitioners come to provide relief? The groups can incorporate schemes in their schedules that can provide alternative services to bridge deficencies of government agencies. Sucn services, if provided, should be adequately publicized, as alternative option for the benefit of the public. Dr. Rosemary may have survived if she was rushed to a centre with guaranteed oxygen supply! May her soul rest in peace. I.D. ONYIAH, MB, BS. FRCS. EGMD. Enugu, Nigeria.

  4. This is indeed a sad end to the life of a life saver. Thought shortage of oxygen was only a Ghanaian problem. God save West Africa.

  5. Yet the Senator in that constituency is paid N13.5 million every month for constituency projects..

    Rest in peace Dr Rosemary Chukwudebe..

    Mat those who directly or indirectly contributed to the situations that lead to your death never know peace..

  6. OGONDA A BENNETT

    Wow! People dying from something as basic as oxygen while our politicians are squandering away our money. Na wa o! We really need change!

  7. Not even the health workers are immuned from the poor health care delivery system of this country. Every health worker should take care of him/herself because no one cares about us.

  8. This is really sad. It shows the poor managerial level of medical Doctors themselves who are ruling the hospital to their selfish financial gain. The Commissioner for health of the state is a Medical Doctor, The Permanent secretary of the Hospital management board is a Medical Doctor , The CMD of the hospital is a Medical Doctor, The HOD Medicine, is a Medical Doctor, The HOD medical department (internal medicine) is a Medical Doctor,. Yet they can’t afford to approve simple Oxygen in the wards. Even when the nurses make requisition for all of all these important life saving materials for usage, when the request gets to their table, they will put pending, claiming no money, meanwhile all they do is to share the internal generated fund of the hospital. This can never happen in advance country like USA and UK where a qualified person among the health team, be it pharmacist, lab scientist, Nurse, Physiotherapist, can be made to head the hospital. Until we change from Medical Doctors dominance in healthcare system in Nigeria, this will continue to happen. Its unfortunate this woman died cheaply from the poor administrative power and selfishness of her professional, (doctors) colleagues.

    • Hmm, kindly clarify how a pharmacist would have made oxygen available if they were the CEO of the hospital?
      You statements make me cringe, you are driving your own agenda on the back of an unfortunate incident and your points have no relevance.
      The system in Nigeria is corrupt period!
      Whoever is in charge would have done the same, siphon funds

    • I acknowledge that life is prize less, but taking action against the government is the civil thing to do. The family must sue the federal government, specifically, the minister for health.

  9. Pingback: How A Senior Medical Doctor Died In Kogi Hospital For Lack Of Oxygen Tanks | 247ureports.com

  10. It’s sad hearing the news. I remember vividly when I was serving in kogi 2012. U took good care of me like your siblings. I will always remember you in my memory.

  11. I acknowledge that life is prize less, but taking action against the government is the civil thing to do. The family must sue the federal government, specifically, the minister for health.

  12. Nwukor Samuel r

    Shame to Kogi state, CMD and Internal medicine department for killing such a rare Gem. Posterity will remember you one day.

  13. Preston Ukoli, MD

    I send my condolences to the family, colleagues and friends of Dr Rosemary Chukwudebe. May God give you the strength to bear this great loss.

    I am sure many are aware that myriads of Nigerians are passing on under similar circumstances. The problem is not just a scarcity of oxygen, parenteral corticosteroids, health insurance schemes or paucity of assistance for medical practitioners by medical associations. The truth is that Nigeria has gone far below that point. Infrastructure is effectively non-existent for the average Nigerian, and from what I hear, this now includes physicians in the country. Apparently, these days, one’s survival is at jeopardy if one cannot provide one’s own drinking water, food, electric power and other needs. Apparently, a significant percentage of employees are not getting any pay-checks for several months at a time. We will have to find a way to bridge these basic gaps before we can hope to see any significant improvement in healthcare in our beloved country.

  14. Pius Ogbu Sunday

    This is truly sad and painful! It’s not just in Kogi State, but a reflection of the sad state of our health institutions from primary to tertiary. My diagnosis => SYSTEMIC FAILURE midwifed by years of vision-less, wicked and corrupt leaders.

  15. Tokunbo Olayide

    This is so sad. I cannot believe this is happening in Nigeria. You have our leaders jetting off to UK or US for treatment because they can afford it. Here is someone trying so hard to save lives and what does she have to show for it. Nothing absolutely nothing. The people who will suffer the most from this lost is her family. I am deeply sorry for their lost.

  16. We as doctors have to do more. Most of our health managers are just not doing it right. We prioritize poorly. The allied health workers are not helping matters either. If only we can speak with one voice, the politicians will surely listen, but most of us choose to become praise singers to politicians while others are more interested in grabbing positions or struggling to keep ungodly positions. Nepotism in every sector! We will prefer to employ wheel loggers than those that can offer services in many sectors. Just a trip to most of our government health institutions will clear anyone’s doubt. So many people without job description while the needed professionals are lacking.
    May her soul rest in peace.

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