In the last few weeks, many patients have been denied access to healthcare for fear of the unknown by the healthcare professionals in many hospitals across the country. In Lagos, there have been stories of people resorting to self-help s a result of the development.
Sunday Akelicious spoke to the National President of the Nigerian Medical Association, NMA, Dr. Francis Faduyile, on the issue. To him, there is no reason for Nigerians, regardless of status, to experience psychological trauma and ugly outcomes arising from difficulty accessing healthcare services.
Non-COVID-19 patients are said to be finding it difficult to access healthcare in private and public hospitals across the country. Doctors are trained to save lives and if at this crucial moment they are running away from patients, don’t you think they are sabotaging the physicians’ oath?
Well, I do not think it is correct that doctors or other health workers are running away from patients. In fact, medical and dental practitioners and other healthcare professionals in this country have displayed high level of commitment and professionalism during this period amidst the fragile nature of the health system.
Asking for appropriate protective equipment as prerequisite for attending to a patient, especially after an initial triage process or referral to another healthcare facility for adequate care, which might have been the narrative in some of the cases, does not constitute professional malpractice, misconduct or negligence. Don’t forget the physicians’ pledge attach immense importance to physicians’ health and well-being in the realization of optimal care.
What are the implications of this development and what is NMA doing about it?
Firstly, let’s understand the fact that there is no reason for Nigerians, regardless of status, to experience psychological trauma (which is unquantifiable most times) and ugly outcomes arising from difficulty accessing healthcare services.
Unfortunately, the precarious state of our health sector carries with it lots of impediments in accessing healthcare services even in the pre-COVID-19 era. In respect of difficulty being faced by non COVID-19 patients, it’s pathetic to say the least. But to be sincere with ourselves, it is unexpected based on the state of our health system and amidst a pandemic like COVID-19 which has caused surprise devastation to even developed nations like US, UK, etcetera.
Again, the reasons for this is multidimensional and range from lack of tools for standard infection prevention and control in our healthcare facilities to the concealment of relevant medical history by patients and their relations with healthcare workers being at the receiving end. As you are aware, we have had cases of COVID-19 without any suggestive symptoms.
The implication is unnecessary mortality from other ailments that would most likely be exponential post-COVID-19. In addition, it will worsen the health-seeking behaviour of Nigerians with loss of confidence in the health system. The NMA has continued to educate stakeholders including its membership on the need to put in place strategies that would cushion the ripple effects of COVID-19 on consumers of healthcare with other health challenges. It can only get better by the day.
What should hospitals be doing right now to ensure that Nigerians don’t lose their lives for the fear of admitting COVID-19 patients but get the healthcare they require?
The way out of this is to strengthen preparedness and readiness for which infection prevention and control is a critical element. Our hospitals and healthcare facilities must ensure the observance of standard precautionary measures and employ transmission-based precautions whenever the need arises. This calls for the availability of necessary Personal Protective Equipment (PPE) and basic amenities at all times and government at all levels must show responsibility in this regard. On the part of the health workforce, a high index of suspicion is of utmost importance.
If a non-COVID-19 patient died seeking help; don’t you think the hospital and the health workers are liable?
The issue of culpability largely depends on the event(s) that led to harm or death in the course of care-seeking. Therefore, it is a matter of diligent professional and/or legal scrutiny. On the part of health workers, it is primarily in the jurisdiction of the various professional councils like the Medical and Dental Council of Nigeria (MDCN) in the case of medical and dental practitioners. Pronouncement of liability can only be made after following due process and culpability is established.
What do you recommend that government should do with hospitals that reject patients?
My recommendation is the dictates of extant rules and laws and due process should be followed in arriving at whatever that is due to culprits. However, I must state that we must not give room for sentiments to obscure our judgment and relevant agencies must be allowed to carry out their statutory functions without incursion from other quarters.
Are you recommending that patients should now be coming with a certificate to show they are COVID-19 free?
No! There is no need for COVID-19 free certificate as a prerequisite for attending to patients and it will be unethical to ask for such during a pandemic. Currently, such is given to patients after treatment and a negative result in order to assure the community of the individual’s health status and for the purpose of reintegration.
All we hear about is that PPE is available at isolation centres; do we have enough of PPE at the Accident and Emergency Department of hospitals across the country?
The truth is that the paucity of PPE is no longer news. Though it is true that this is the case the world over as a result of the magnitude of the COVID-19 pandemic, in Nigeria, it has always been the case. Today we are lucky that we are still able to cope to a certain extent; however, doctors and other health workers have started paying the price with hospital acquired infection among healthcare professionals being on the rise and avoidable deaths too.
No doubt, the Accident and Emergency Departments in hospitals (public and private) lack an appropriate and adequate number of PPE but private hospitals are worst hit.
That is why the Nigerian Medical Association is unveiling a programme tagged ‘Save our private health practitioners initiative’ for the sole objective of raising financial and material support (donations of quality PPE and infection control consumables) to the tune of N500 million targeted at assisting private healthcare practitioners all over the nation.
The Federal Government has approved life insurance for doctors. How about doctors in state governments’ employment and the private sector? Is there no policy that is supposed to cover all doctors everywhere?
It is commendable that the Federal Government has started something, and one must also acknowledge the insurance companies which have, so far, responded to the clarion call of government in respect of this. However, the policy does not extend to healthcare professionals outside the employment of the Federal Government, and, unfortunately, no such policy that is all-inclusive. As it is, one or two state governments announced life insurance package for their health workers, and we hope this will go beyond making headlines with the commencement of implementation. We also encourage all states to ensure life insurance coverage for their health workforce. The need for the private health sector to be supported by government cannot be overemphasized.
Ghana is said to be doing group testing. Do you think Nigeria should change its testing protocol to help these patients that are being rejected by hospitals?
One key strategy in combating COVID-19 pandemic is mass testing. At the beginning of this pandemic in Nigeria, we saw few cases but with improvement in testing capacity, there has been an upsurge in numbers of positive cases. Currently, we have a situation where so many samples are awaiting testing while large numbers of suspected cases and contacts of confirmed cases are on queue for testing.
Earlier, the NMA, in anticipation of community transmission, advocated for the scaling up of testing capacity in all ramifications including decentralization and human resource for health. This is detailed in Policy Option 2 in our policy advisory tagged ‘NMA COVID-19 POLICY ADVISORY PAPER’. I wish to reiterate that if we must win this war against COVID-19 as soon as possible, we must undertake massive scale-up of testing or mass screening using RDT and further confirmation with PCR method, concentrating mainly on areas with high disease burden, strengthen sample collection, management, referral network and feedback as well as decentralize the process to facilitate effectiveness and efficiency.
This has become pertinent amidst premature ease of lockdown in Lagos and Ogun States and FCT, and the upsurge in Kano and other parts of the country.