SPECIAL REPORT: How Doctors’ Strike Subjected Abuja Patients to Avoidable Deaths, Pain and Agony

SPECIAL REPORT: How Doctors’ Strike Subjected Abuja Patients to Avoidable Deaths, Pain and Agony

By Nafisat Bello and Lawal Dahiru Mamman

On a normal day, the sun would be scorching, but this was overshadowed by drizzling rain. An accident victim was brought into the Accident and Emergency (A&E) Ward with practically no doctor in sight to immediately attend to the emergency. The victim groaned in pain in the pool of his own blood screaming for help that took so long before it came.

This was the situation that greeted PRNigeria crew on arrival at the Kuje General Hospital in the Federal Capital Territory (FCT). One could easily see that the industrial action recently embarked upon by the National Association of Resident Doctors (NARD) was biting the healthcare system very hard.

In December last year, nurses in the United Kingdom under the aegis of Royal College of Nursing (RCN) embarked on strike for the first time in 100 years and it was a big deal because it is extremely rare for such things to happen. The situation is different in Nigeria where virtually every year of every administration, doctors, nurses and other health workers embark on incessant strikes as if human life does not matter.

The issues triggering the strikes and outcries have not changed significantly over the years. The issues keep ranging from salary structures to payment of arrears, welfare packages, quality of hospital equipment, funding for training programmes among others. Reports have it that between 2000 and 2020, health workers were on nationwide strikes for at least a combined period of 264 days. This is equivalent to nine calendar months!

The aggrieved unions are usually the Nigerian Medical Association (NMA), National Association of Resident Doctors (NARD), Joint Health Sector Unions (JOHESU), Association of Medical Laboratory Scientist of Nigeria (AMLSN) and National Association of Nigerian Nurses and Midwives (NANNM).

NARD alone embarked on series of industrial actions in 2000, 2010, 2013, 2014, 2017 and 2020 over issues like better funding of residency training programme, withheld salaries, restructuring of training programme, nonchalant attitude of federal government towards the residency programme, non-payment of hazard allowance and illegal deduction of salaries.

The most recent industrial action embarked upon by NARD was after its national executive council appraised the level of implementation of the Memorandum of Understanding (MoU) signed with the government on the 19th of May 2023 following the five-day warning strike which started on the 17th of May 2023.

Some of the demands for which the association went on strike were: immediate payment of the 2023 Medical Residency Training Fund (MRTF), implementation of a minimum of 200 percent increment in Consolidated Medical Salary Structure (CONMESS) and the upward review of associated allowances, payment of outstanding arrears of consequential adjustments, hazard allowance and skipping allowance and the immediate release and implementation of the guidelines on one-for-one replacement of clinical staff that have left Nigeria in search of greener pastures in the Diaspora.

Resident doctors make up about 40 percent of Nigerian doctors, any industrial action by them will therefore take a massive toll on patients resulting in avoidable casualties.

While the reasons for incessant doctors’ strike have been enumerated above, there is an ongoing debate surrounding whether or not the resort to strike actions is not a violation of the ‘Hippocratic Oath,’ taken by doctors.

From time immemorial, the oath is taken by new physicians to uphold specific ethical standards including a pledge to dedicate their lives to saving other lives and in the service of humanity.

The oath is enshrined in the legal statutes of various jurisdictions, such that violations of the oath or pledge may carry criminal charges or other liabilities beyond the oath’s symbolic nature.

It is against this background that PRNigeria crew visited some hospitals in the Federal Capital Territory seeking to hear from patients, nurses, midwives, doctors and NARD officials about the impact of the latest industrial action.

Nurses, Midwives Overwhelmed at Kuje General Hospital

The situation our crew met at the General Hospital in Kuje was dicey. While doctors boycotted office due to the strike, nurses and other staff of the hospital were the ones running around to take care of patients.

The fact that doctors were on strike did not stop patients from flooding the general hospital as they apparently could not afford private hospitals.

The patients and family members who agreed to speak with our crew complained bitterly about the situation of the hospital without doctors. Most of them however praised the nurses who they said were the heroes and heroines who kept them alive.

“The strike is really affecting us and getting in the way of us receiving good medical care but I am most grateful that nurses were available and my wife gave birth to our baby without complications. I do hope that the government and doctors resolve the feud between them so that doctors can get back to work and perform their duties of saving lives properly,” a happy father whose wife delivered a baby after all the delay caused by the doctors’ strike, told our correspondents.

Nurses and midwives also complained bitterly while chatting with our crew about the situation as they were overwhelmed with work and had to cover for the deficit caused by the absence of resident doctors.

“As you can see we are not on strike. The government has to give these doctors what they want so that the workload can reduce because in some cases we treat patients whose problems are not within our job description so that people don’t die on us,” one of the nurses, who preferred anonymity, lamented.

Some doctors however come in occasionally to save lives if they are called upon in cases of emergency.

“As you can see, I am not all kitted as a doctor, I had to come in because of proximity, if I get called for emergency, I rush down and take care of it, those that we can’t handle as a result of inadequate equipment or medical supply, we refer to other hospitals in town like Federal Medical Centre (FMC) and the General Hospital in Garki,” a doctor, who our crew ran into and who sought anonymity, said.

On whether the strike has caused any casualties, he said: “We have not recorded any to blame the strike on and those we have were mostly brought in dead. Looking at the cases or patients, we know if we can handle them or otherwise, if we cannot, we just refer them to other hospitals as I mentioned earlier.”

Speaking on the justification of the strike action, he said: “You know some of the requests doctors are making are not outrageous. Taking hazard allowance as an example, the sum we receive currently is too meagre. During the peak of COVID-19, as a front line worker, I contracted the virus during which I had to undergo a total Tonsillectomy (surgical removal of your tonsils – round, fleshy masses in the back of your throat) which cost me about 1.5 million naira. I know what I went through to get that money.”

Deaths as Children, Women Groan in Pain at Kubwa General Hospital

If the situation at Kuje was pitiable, what our correspondents found at Kubwa General Hospital was pathetic.

It was a total shutdown as far as doctors’ presence was concerned. While the doctors were on strike and nurses had to be on their toes round the clock, patients trooped in, in large numbers.

Some patients came in dead and were taken straight to the mortuary while some died while the nurses struggled to cater for them.

There were also cases of children who our crew learnt were brought at midnight at the point of death. Some were stabilised before the nurses asked the parents to take them to private hospitals since there were no doctors to give them adequate treatment. There was however a case of a child who died as a result of the situation.

Aside from the issue of doctors’ strike, our correspondent who sneaked into the Hospital in the night also found out some absurdities that made the patients uncomfortable. Patients were seen groaning in a dark room due to bad bulbs which cannot be blamed on doctors who were on strike.

Our correspondent also witnessed a very bad situation of a patient who cried all through the night in severe pain due to lack of doctors and the fact that the nurses at a point said they would only give what had been prescribed by a doctor to the patients.

Aisha Bologi, a patient who spoke to our crew gave a detailed description of the situation in the Hospital.

She said: “I had an accident on my way home from the office.

“I was on a bike when a car came out of the park without looking and hit us and my leg was badly hurt, almost broken to pieces.

“I got to the hospital with the help of a good Samaritan that insisted the driver would have to take me to the hospital when others were watching without doing anything before his arrival.”

Describing how she got to the hospital in extreme pain only to find out that there were no doctors on duty, she said: “There were no doctors on ground, we met only the nurses, who were complaining that doctors were on strike. My husband was begging them to just do something to stop the bleeding which was too much before the nurses reluctantly asked them to bring me in.”

She said that the nurses had to go out of their way to plead with a doctor on phone to come and attend to her.

“You know they said two good heads are better than one, a doctor was invited who carried out the surgery all alone with the help of a nurse. I had to wait for long before his arrival. The surgery also took several hours because only one doctor came to my aid. I was in pain all through.

“I was earlier taken to a private hospital where I was rejected, they said that the injury was too much and we had come to the General Hospital.

“And of course the invitation (of a doctor on strike) will have to attract extra cost. Everything we used at the General Hospital we had to pay for. Everything we used was purchased down to syringes and needles.

“I was however lucky as the doctor who helped me and the nurses really tried for me. Right there in my presence, serious emergency cases were brought in but they were rejected because there were no doctors on ground, they were told to take them to private hospitals. I don’t know if these people survived.

“The doctor was good, at least he tried his best to calm the situation at the moment. He keeps coming to check up on me. The nurses have been good and hard working too.

“The worst set of people to go on strike are doctors. Their primary duty is to save lives and the primary duty of the government is to save its citizens. Doctors are leaving Nigeria because Nigerian health authorities are not concerned about the exodus of health staff to overseas. Better pay and medical facilities have been cited as the main reasons for the flight of Nigerian doctors, nurses, and paramedical staff. Government should give them whatever they want. This pain is too much. It hurts to see patients in severe pain and serious emergency cases being turned down because of lack of doctors on ground,” she added.

More Deaths as Patients’ Influx Overwhelms Garki General Hospital

Though this facility was not affected by the industrial action embarked upon by NARD, they felt the impact massively as patients were being referred to them from other parts of the FCT and beyond. The pressure was intense, bed spaces were occupied, patients were waiting longer than necessary and some were receiving treatment outside on wheelchairs.

A lady who simply identified herself as Christina shared her experience, saying: “I have been here since 7:00am. I came early so that my brother who has a kidney problem can have the dialysis he was scheduled for today. But unfortunately, the doctors said they are busy and the dialysis machines are not enough, I have to wait till 1:00pm. We don’t have money, if not we would have gone for the procedure in a private hospital.”

Nurse Garba who works in the Hospital also told our correspondents that the situation was becoming unbearable.

“The whole hospital is overwhelmed. You can see patients receiving treatment outside on wheelchairs and benches which is not appropriate.

“Although we receive a lot referrals on a good day, the strike by resident doctors in other healthcare facilities has exacerbated the condition, therefore, authorities responsible should do the needful,” the nurse said.

“Of course doctors are on strike, this is obvious in any department or ward you visit, I believe you saw for yourselves upon entering the building. Our workers are stretched beyond capacity. No bed space to accommodate patients, patients receiving treatment on wheel chair, benches etc” an administrative officer, in the Hospital, who pleaded anonymity, added.

One of the doctors who wished to remain anonymous also spoke to the team about how patients were not getting the necessary attention because of lack of enough doctors and nurses to cope with the influx of patients from other hospitals.

“We are overwhelmed with the number of patients that are brought in or are being transferred from other hospitals. As you can see, we don’t have enough space to accommodate patients, patients are busy receiving treatments while seated when they are supposed to be on the bed resting.

“Some of the patients were turned back because there was no space, neither are there necessary facilities and doctors around to attend to the patients,” he said.

The doctor also mentioned the high rate of casualties that was recorded in the Hospital due to lack of proper attention and distance from other states.

“Since the beginning of this strike, we have recorded more casualties due to lack of proper attention because of shortage of doctors. Doctors are not enough, while the ones available are attending to other patients in critical conditions.

“Some of the patients are brought in dead due to the distance they cover to bring them to the Hospital from other states, while some made it to the Hospital but still couldn’t survive because of the delay in attending to them.

“So, its very important that the government does something about this strike, give in to the demands, improve the doctors’ welfare and remuneration, so that all these can stop,” he added.

Reasonable Normalcy at University of Abuja Teaching Hospital, Gwagwalada

The atmosphere was fairly different as observed by our correspondents at the University of Abuja Teaching Hospital (UATH) Gwagwalada. The Hospital operated like every other day, patients were receiving necessary attention and the difference here was attributed to the fact that the facility was a Teaching Hospital.

“As I speak to you, I have been attended to today, all that is keeping me here is to be called upon by the lab technician for test results and going to the pharmacy to get drugs that will be prescribed by the doctor,” Mallam Sani, a hypertensive patient responded when quizzed about getting attention from doctors during the peak of NARD strike.

Mr. Sani Sulaiman, Public Relations Officer (PRO), UATH had this to say: “You know this is a Teaching Hospital with over 100 consultants. Consequently, the absence of resident doctors is not felt here like other facilities. On the other hand, interns, doctors on housemanship, and those under the aegis of NMA and JOHESU have also helped in steadying the situation.”

The PRO admitted that operations were not optimal but contingency plans were put in place before the resident doctors began the industrial action.

“Before the doctors finally embarked on the strike, we held what we termed pre-strike training and lecture for doctors, nurses and midwives to cushion the effect. We discussed Attitudinal Changes in the Work Place, Effective Leadership and Negligence in Nursing Practice among others.

“We stated categorically that our cardinal principle is that our doors remain open and patients must be attended to, the only thing is that patients must be patient before they receive treatment since we receive referrals from other states like Plateau, Kaduna, Kogi, Benue among others.

“In all of this, I must admit that our services are not optimal,” he concluded.

Doctors’ Hippocratic Oath at a Glance

Before they start practice, qualified doctors are required to take an oath and pledge to save lives by whatever means.

The complete Hippocratic Oath goes thus:

“AS A MEMBER OF THE MEDICAL PROFESSION:

“I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

“THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

“I WILL RESPECT the autonomy and dignity of my patient;

“I WILL MAINTAIN the utmost respect for human life;

“I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;

“I WILL RESPECT the secrets that are confided in me, even after the patient has died;

“I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

“I WILL FOSTER the honour and noble traditions of the medical profession;

“I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

“I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

“I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

“I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

“I MAKE THESE PROMISES solemnly, freely, and upon my honour.”

Our Doctors are not to Blame – NARD

Quizzed on why doctors embark on strike at the slightest provocation in violation of the above Hippocratic Oath, the President of NARD, University of Abuja Teaching Hospital Chapter, Dr Ochi Christabel, justified the constant industrial actions, calling on government to do the needful.

“The medical profession has evolved from the time the oath was first written, that was why the World Medical Association added the clause: ‘I will attend to my own health, wellbeing, and abilities in order to provide care of the highest standard.’ You need to be fit before you can administer care to others, doctors are not superhuman, we are like every other person with needs,” the doctor argued.

The NARD president noted that series of strikes by doctors resulted in some of the developments witnessed in the medical profession but more still has to be done because the demands did not come out of the blues.

“Let us take the one-for-one replacement policy which is one of our demands as a case study. The policy is meant to recruit health workers to cover the gap created by those that have gone out in search of greener pastures. If this is not done, a job meant for ten persons will now be for two or even one person. This is not healthy for doctors. This results in depression and other mental health challenges, you can see reports of doctors dying everyday.

“We have barely 200 resident doctors here and this is because of the pressure mounted by the management of the Hospital. If we followed the normal employment process, we wouldn’t have been up to 20.

“From this figure, in July, 13 female and 12 male doctors left the country to other parts of the world. In Benue State, a chapter of NARD with 20 doctors now has five as we speak.

“A survey we carried out pointed out that poor remuneration is the major factor chasing health workers out of the country.

“The health sector needs healing and this is the time to do it.

“The health sector is really in shambles and health workers are essential in any country hence we should be treated as such. Government must be truthful and respect agreements,” Dr Ochi said.

Proposed 10% Budgetary Allocation to Health: A Beacon of Hope?

President Bola Ahmed Tinubu through his Special Adviser on Health, Salma Ibrahim-Anas, recently announced the intention to increase the annual budgetary allocation to the health sector to 10 percent with the possibility of further increment in the future if the allocation is managed judiciously.

Describing the current budgetary allocation to the sector as abysmally poor at less than five percent, the presidential aide assured Nigerians that the President was committed to adequately financing the health sector.

Since the strike was merely suspended to see if government would do the needful, it remains to be seen if all outstanding agreements will be fulfilled and if the new 10 percent budgetary allocation would bring about a breath of fresh air in the health sector.

Obviously, Nigerians deserve better. Doctors and other health workers are human too and they deserve better from Nigeria. The former cannot give back the care it has not gotten from the latter. It has to be symbiotic.

Indeed, both patients and doctors deserve better from the Nigerian government.

This report is produced with support from the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under the Collaborative Media Engagement for Development Inclusivity and Accountability project (CMEDIA) funded by the MacArthur Foundation