Hospitals in Nigeria have become war zones
IN Nigeria, health professionals work under fear of attack. We are saving lives amid fear for own lives.
“He screamed that it was an emergency and I explained to him that no time was being wasted as I will be completing the cross- match test while he made the payment. Next thing I knew, I was hanging mid- air with the man’s hands around my throat. I remember screaming, “Jesus help me!”. Excerpt from true story.
In 2021, after witnessing a few violent attacks against my colleagues at the tertiary hospital where I worked, I shifted the focus of the human stories segment of The White Coat to covering stories of violence against health care workers. This was part of our effort to amplify the emerging trend.
During this time, I heard heartbreaking stories of violence against health professionals by patients and patients’ relatives.
“As he raised the baton to strike me, the only fear I had was for my unborn child. I summoned all the strength I had in me and held off his hand while praying fervently for help”. Excerpt from true story. No health worker was immune to this violence, from Medical Laboratory Scientists, Pharmacists, to Nurses and Medical Doctors. Cadre didn’t matter either, as was seen in the case of a female consultant in a government hospital in Abuja, who was beaten up by male relatives of a patient due to accusations of delayed examination of their relative. In her defense, she was attending to a more urgent case but they did not care.
From stories I covered on and off records, female health workers were more prone to this attack, obviously due to our perceived lesser physical strength.
“Sir, we’re having a conversation, just you and I. I’m not shouting, I’m not raising my…” I was mid- sentence when I felt the spittle hit my face. The man literally spat on me. I couldn’t believe what had just happened. I ran to the tap to wash my face. All this while, he kept shouting insults at me. I heard one of the patients say to him, “she has a right to ask you to wait” but the man was still adamant”. Excerpt from true story.
Cases of such violence are usually reported to the local police by the hospital but in the long run, it usually falls on the health professional involved to decide on the direction of the case i. e. to sue or to withdraw the case, usually after an agreement has been reached by both parties. This agreement is usually in the form of a verbal apology. There’s yet to be an official report of monetary or any type of tangible settlement. Surprisingly, hospital managements and professional associations are yet to make a scape goat of attackers to serve as a deterrent to such attacks. Victims themselves are sometimes reluctant to come forward. There were lots of gruesome cases we couldn’t cover due to the victims’ reluctance to come forward for reasons best known to them. Unsurprisingly, the populace is silent on the issue. No outrage, no condemnation, nothing. It is almost as if there’s an unspoken approval that health workers deserve what they are getting. Are there cases of genuine medical negligence? yes, of course. But the question is, what constitutes negligence and who has the authority to ascertain negligence? patients/ patient’s relative? Moreover, medical negligence should not be the alter on which we literally sacrifice our health professionals. There are legal means to obtain justice.
“He came back enraged, screaming insults at me. He accused me of deliberately making him walk up and down the hospital. I didn’t respond. Next thing I knew, he started to throw punches at me. I resisted the urge to hit back because I was supposed to be the professional, instead I tried to dodge as much as I could while pushing him away from me”. Excerpt from true story
Fast forward to January 23, 2024, precisely. I was scrolling down my X timeline when I happened upon a video. All the stories of violence I had covered did not prepare me for what I watched nor could they absorb my shock. I never thought or imagined that things could degenerate to this level.
In what can only be described as a scene in a typical Hollywood movie about a civil war somewhere in Africa, sounds of gunshots filled the air, mixed with the screams of onlookers and staff of the hospital. Except, this wasn’t a movie. It was a live video taken by a doctor on duty. And it wasn’t a civil war in a country somewhere in Africa but a Federal Medical Centre in a North Central State in Nigeria! The attackers were not the Boko haram terrorists or the unknown gun men that have been terrorising the country but aggrieved ‘ powerful’ individuals that were said to have lost a relative.
It was even more shocking when it dawned on me that even war- torn countries are not allowed to attack medical personnel. It is a war crime. The rules of war dictate so.
Nigeria’s healthcare challenges are world famous and too numerous to mention. Top of the list is the medical brain drain that has depleted the country’s human resources for health. Nigeria has a doctor to patient ratio of 1 doctor to 8000 patients. The WHO recommends 1 doctor to 600 patients.
Additionally, Nigeria has an inefficient health insurance scheme that has left over 80 per cent of her citizens paying out - of - pocket for health expenditures. Almost 20 years after its launch, the National Health Insurance scheme ( NHIS) now National Health Insurance Act ( NHIA) has managed a feeble five per cent enrollment of over 200 million people.
Combine this out- of- pocket payment with the fact that over 63 per cent of Nigerians are multidimensionally poor and what you get is a highly volatile population, prone to aggression out of frustration. Naturally, this aggression is the catalyst necessary for change if channeled towards holding the people responsible accountable. However, socio- politically, Nigeria defies the natural order of human behavior. Political philosopher Jean- Jacques Rousseau said the poor will eat the rich because he must not have known about Nigeria.
In Nigeria, the poor eats the poor and the powerless oppresses his fellow compatriot at the slightest opportunity. Nigerians are quick to put a tire around the neck of a thief who stole garri and set him ablaze but will bow down and kiss the feet of a politician who stole billions of naira. Sum up this socio- political behavior and our economic realities.
The answer you get is the reason health professionals have become the easy target of frustrated Nigerians. Instead of holding the government accountable for the state of Nigeria’s healthcare system, Nigerians will rather blame and attack health professionals who are themselves victims of the same failed system.
Reports say 4000 doctors and other health professionals left Nigeria in 2023. You would think that Nigerians will appreciate the efforts of the few still on ground but no, they don’t. Instead, in an unnatural behavior, they will roll out the red carpet for the corrupt politicians who are responsible for their plight - all for some bread crumbs - and then beat up health professionals. Once upon a time, doctors in Nigeria were on top of the food chain and revered by the public. In fact, it used to be the goal and pride of every family to have a medical doctor. This is no longer the case.
Nigeria has been overridden by corruption and our society is so morally bankrupt that people only respect wealth, no matter how ill gotten. Criminals are in charge of our national cake and they decide who gets a slice or a chunk of it. In the words of the urban philosophy trio, The Lox, “First you get the money, then you get the power, after you get the power, people will respect you”.
Unfortunately for the average Nigerian doctor and of course all health professionals in Nigeria, our poor remuneration cannot buy us the power we need to command the respect and reverence of the Nigerian public. This means that violence against health professionals is here to stay except concerned authorities consider our plight worthy of their attention.
Ironically, for a country not at war, Nigeria needs its own ‘ Geneva Convention’. All the medical regulatory bodies and professional associations must work together towards enacting effective laws and enforcing swift punishment for perpetrators of violence against health professionals. It should no longer be the prerogative of the victim to fight for justice alone. Injury to one should be injury to all.
Sadly, I do not have much hope of this happening. Nigerian systems are notoriously reactionary by default. It may take the death, God forbid ( forgive me, I am a Nigerian) of one or more health professionals at the hands of a patient or patient’s relative( s) for concerned parties to wake up.