Have you ever been told of a story where medical doctors managing a pregnant woman had to choose between saving her life or that of her unborn child? I have, on one occasion. It sounds like fiction, doesn't it? I can also remember clearly in one of the episodes of Grey's Anatomy where Dr Shepherd (the fictional god of neurosurgery) attempted to save mother and baby in a dicey situation, and failed woefully(as good as he was).

Last week, I was privileged to be part of a team who managed a woman with a 28 week old pregnancy who had eclampsia in one of the teaching hospitals in Nigeria. Suffice it to mention that the NIgerian health sector had been in a collapse for the past 3 months, hence this woman and her husband initially sought cafe in a private hospital. After the preliminary management, when it was time to begin the meat of the care for her condition, they ran out of money. They were to pay N300,000 (three hundred thousand naira) for continuation of care.

When they couldn't afford this money, they had to leave the private hospital and resign their fate in the hands of destiny pending when the health workers strike would be called off and government owned health institutions would be open so they can seek affordable care. A week after, their prayers were answered. The health workers strike was called off, work resumed fully in government owned health institutions and this couple were among the first set of people that hurried to seek medical care in this centre.

She was admitted immediately after her referral letter was read and the diagnosis of eclampsia confirmed from the vitals and other tests. Management began immediately. To cut the long story short, we had a pregnant eclamptic women with a 28 week old pregnancy, blood pressure of 170/110mm Hg, PCV of 24% and a financially constrained husband.

The treatment for eclampsia is termination of the pregnancy. Terminating the pregnancy means an abortion or a preterm delivery - depending on the gestational age. For a 28 week old pregnancy, the doctors decided to take the chance to save the baby and the mother - a heroic feat if you'd ask me. Saving the baby means:
1) Giving the mother corticosteroids for the foetal lung to mature amidst other preterm delivery management protocol
2) Transfusing the woman with at least 4 units of whole blood. Her PCV was 24% which is an arbitrary value considering the fact that eclampsia concentrates blood. So her true PCV is less than that.
3) Doing a clotting profile (price is N11,000). Eclampsia is a thrombogenic and fibrinolytic condition. This woman is at risk of DIC and imminent death.
4) Other Management protocol beyond the scope of this post.

The woman was started on corticosteroids for the foetal lungs to start maturation. Good step.
This woman could only afford about N11,000 which was equivalent to the amount for the clotting profile test. Unfortunately, this couldn't be done in the teaching hospital laboratory because their reagents had expired. The doctors, considering the financial constraint of the patient, did a bedside clotting test and advised the husband to use the N11, 000 to cross match blood for transfusion.

So on Wednesday last week, we went for our rounds to see this woman. Her blood pressure was still in the sky (170/100 mmHg) but the baby was still alive. The foetal heart rate was reassuring and this was indeed a good sign. We were still waiting for the husband to come with the blood for transfusion only to be told that the crossmatching could not also be done in the hospital laboratory because the reagents had expired.

Few hours after, while this woman's husband was still running around looking for where to do a crossmatch for the donors he was able to garner, we came back for a reassessment. The woman's blood pressure had dropped to 110/80mmHg. This was bad news. The only thing that was keeping the baby alive was the high blood pressure. We had to do a bedside transabdominal ultrasonography. The foetus had died.

How do we start telling this woman that her 28 week old baby who her husband was running around trying to save with her, after spending almost their entire earnings had passed on?

This is not a story to entertain you. This is to tell you that the health system in Nigeria is a big comedy. Forget all the rebuttals and counter-rebuttals you read from health workers on Nairaland, this country's health system is a joke. If this woman were to be from Cuba, or America, or Zambia, she would have been alive with the baby in Noenatal ICU trying to be alive. But not in Nigeria. The delays we have in treatment are largely due to policy and system issues. The health system is grossly underfunded, so patients have to pay so much to seek healthcare. When a teaching hospital doesn't have a single laparoscope, still has 2D ultrasound scans, give flimsy reasons as expired reagents - then you have to be very worried.

I will leave you with these few words. This woman could have been your wife, your sister, your cousin. Her unborn baby could have been your child, your nephew or your grandchild. The health sector is a comedian's enterprise. We are still in the 19th century as far as healthcare is concerned in Nigeria.

Quality healthcare should be a right - and not a privilege at a very pocket friendly cost. The government, has disappointed Nigerians - the living, the dead and even the unborn child.

Na wa o. Naija which way?

Vote Buhari....



He will equip all our primary, secondary and tertiary health institution with modern and standard facilities.

The issues raised here are really embarrassing, am shocked Zambia is now better than us in area.am not surprised because I don't expect less in a country where mediocres are been celebrated daily. Our hospitals are very far from reality.

charleymed:
The issues raised here are really embarrassing, am shocked Zambia is now better than us in area.am not surprised because I don't expect less in a country where mediocres are been celebrated daily. Our hospitals are very far from reality.

One of my consultants who has been practicing for 23 years now as a gynecologist had part of his practice in Zambia. He's the only specialist that can do gynecologic laparoscopic surgery and procedures in our centre.

While he was on a WHO outreach in a rural health centre in Zambia, on one occasion, he wanted to examine a woman's cervix so he asked for a speculum. He did a pelvic examination manually(as it is done in Nigeria) - using his hands and eyes.

The Zambian nurse had to tell him that there is a colposcope!!!

A colposcope in a rural health centre.

Till date, he hasn't recovered from the shock. Even the Nigerian teaching hospital he trained didn't have a colposcope.

A colposcope is an instrument used to magnify visual examination of the ectocervix. It's easier, better and more efficient than a manual pelvic examination in diagnosing cervical lesions.

idu1:
Vote Buhari....



He will equip all our primary, secondary and tertiary health institution with modern and standard facilities.

He is going to find that hard going with low oil prices....

Which leads me to the conclusion that either we increase the share health has in the budget to 30% or we raise hospital fees.

And while we are at it...we diversify our economy. There is no reason why we cannot manufacture equipment for the SCBU/Neonatal intensive care unit in any hospital.

Quite sad I must say

lomaxx:


One of my consultants who has been practicing for 23 years now as a gynecologist had part of his practice in Zambia. He's the only specialist that can do gynecologic laparoscopic surgery and procedures in our centre.

While he was on a WHO outreach in a rural health centre in Zambia, on one occasion, he wanted to examine a woman's cervix so he asked for a speculum. He did a pelvic examination manually(as it is done in Nigeria) - using his hands and eyes.

The Zambian nurse had to tell him that there is a colposcope!!!

A colposcope in a rural health centre.

Till date, he hasn't recovered from the shock. Even the Nigerian teaching hospital he trained didn't have a colposcope.

A colposcope is an instrument used to magnify visual examination of the ectocervix. It's easier, better and more efficient than a manual pelvic examination in diagnosing cervical lesions.

Thank God my alma mater has a colposcope!!!

Even if its old school without a monitor....

But seriously, the Nigerian health sector is in shambles!!! And the government is not serious.....

Bros, I have seen worse scenarios than this... I have seen a woman who developed acute kidney injury after delivering twin dead babies because of poorly managed ecclampsia....

And she died too....

Nigeria is a waste wallahi!!!!

Nawo o...so sad....when naija go better self?

Nawa o...so sad....when naija go better self?

bushdoc9919:


He is going to find that hard going with low oil prices....

Which leads me to the conclusion that either we increase the share our has in the budget to 30% or we raise hospital fees.

And while we are at it...we diversify our economy. There is no reason why we cannot manufacture equipment for the SCBU/Neonatal inteinsive care unit in any hospital.

We had our best moments with the oil boom. We wasted them. It's now going to be difficult to accomplish with N10 what we could have when we had N1,000.

All governments have neglected funding the health sector - no Nigerian government has funded the health sector above 10% of the National Budget. The proposed budget for health last year was a paltry 6.7% of the total national budget - even when the World Health Organisation (WHO) recommends tat least 25%. It's a really pathetic situation.

Now raising hospital fees IS a different thing entirely. The effect on the masses would be dramatic. Quality healthcare is a right and should be accessible and affordable. As it stands now, many Nigerians cannot afford the most basic services. Nigerians should not suffer financial hardship at the instant of obtaining care.

Healthcare is an inevitable responsibility of the government. Already more than 60% of Nigerians are paying 100% for their healthcare services from start to finish. Our policy makers are either grossly inexperienced in the mechanics of health economics or the government knows what to do but are just plain insensitive.

It's a very pathetic situation.

Lagusta:


Thank God my alma mater has a colposcope!!!

Even if its old school without a monitor....

But seriously, the Nigerian health sector is in shambles!!! And the government is not serious.....

!

Haha... colposcope with no monitor.


Awolowo did not die for this.

The government has let the masses down. Few months ago, my friend went to see a physician for a problem he had. The diagnosis of nasal polyp was made. He was prepped for surgery on the same day. He did the surgery on the same day. He went back home the same day. This was free of charge from start to finish.

Actually, this is not Nigeria. This is Canada.

When I asked him how possible it was to get those things done with such austeric efficiency he said something I couldn't forget.

"We have a government that takes the health of her citizens seriously "

Sad.