He introduced himself as Fred, a journalist from The Observer in London. He wanted a conversation about the recent sad demise of the toddler son of a prominent Nigerian writer in a hospital in Lagos. What were people saying in the country?
There was already a wide array of emotion-laden write-ups circulating on social media, you told him. The ever voluble ‘Duke of Shomolu’ was out with a viral piece that contained such passionate howlers as ‘there is no regulatory framework governing the health sector at any level…’, clearly unmindful of the Medical and Dental Council of Nigeria and the Lagos behemoth – HEFAMAA. The gem was ‘…50,000 people die monthly in our hospitals,’
The 50,000 a month figure could imply 50,000 people went to the hospital every month, and all died, or that 50,000 who could otherwise have lived died monthly because they went to Nigerian hospitals. It could also mean 5 million went to hospitals every month with various stages and natures of illness, and 50,000 (1%) of them died, meaning 99% ‘survived’ or ‘recovered’.
You had read about the writer’s sad loss, you informed Fred. As a psychiatrist, you could empathise with the devastation of bereavement, especially where there was a belief that the tragedy could have been avoided. The matter was already under investigation by the Lagos Health Facilities Monitoring and Accreditation Agency, and there might be some legal proceedings afoot from the family. It boiled down to a very ill Nigerian child who might or might not have been handled in compliance with the best Quality protocols and procedures, as he was being prepared for a long medical evacuation journey to the USA.
Medical incidents in hospitals, sadly, were part of every healthcare delivery system, you explained to Fred. In the USA, they were among the leading causes of mortality. This was the purpose of setting up Quality Improvement structures that focused on standardising processes and procedures through the use of protocols for every situation, and the efficient reporting and interrogation of errors.
Investigation of hospital incidents was handled by HEFAMAA, and allegations of professional misconduct by the major professional regulatory body, the Medical and Dental Council of Nigeria, equivalent to the General Medical Council in the UK. Aggrieved patients and families could also seek redress through the regular courts. There had even been a few instances similar to the Lucy Letby case in the UK where the state-led prosecution was conducted because it felt some criminal activity had been committed.
The court of public opinion, you averred, while a democratic right, was not always the fairest judge of a situation, because it was, to borrow a famous phrase from Chimamanda, ‘a one-sided narrative’.
The real challenge you went on to explain was the gap areas. MDCN, based in Abuja, lacked public visibility, and most citizens were not even aware of its duties or powers. The remit of HEFAMAA was limited to Lagos State. The rest of the country, apart from Yobe State, was basically ungoverned territory in terms of regulation and monitoring of health facilities, a sad and unacceptable situation that needed to be quickly changed. There was an urgent need for the government to push through into law a National Health Facilities Regulation Agency to provide for the whole nation the regulatory and monitoring oversight and investigative capacity that HEFAMAA was exerting itself to provide for Lagos State.
Outside of all that, you explained further, there was an ongoing effort to spread the Quality Improvement message to all levels of Healthcare – Primary, Secondary, Tertiary, including the large number of private facilities which provided most of the care in a place like Lagos. Sustained, compulsory Quality Improvement would ultimately drive medical errors and patient safety incidents down to extremely low levels, in tandem with universal best practice. A growing number of health facilities, such as the Lagoon-Iwosan Group and the Reddington Group had obtained International Quality Accreditation. The Society for Quality Health in Nigeria had received international approval to assess and Accredit hospitals based on their Quality standards. PharmAccess was working with public and private hospitals to upgrade their quality through SafeCare training and certification.
The ongoing journey needed to be spread evenly across the nation. A Nigerian or visiting foreigner should soon be able to look up the Quality certification of a hospital online before deciding to seek treatment there.
More Nigerians were staying back to undergo even the most complex medical interventions. More private investors were looking positively at ‘the Business of Healthcare’ and putting ‘patient capital’ into building and managing health facilities at all levels, including primary care, where the advent of National Health Insurance was making it possible for private entities to participate in standardised health package delivery.
A few days ago, Fred sent you a link to the article published in his newspaper.
It spoke of lack of access, skills shortages and brain drain.
‘I don’t trust doctors at all…Don’t let Nigeria happen to you…’ it quoted a respondent.
A man named ‘Edgar’ spoke about the loss of his wife in a ‘top private hospital in Lagos’ because she was admitted on a Wednesday, and the line specialist she required only worked on Tuesdays.
You had a friendly chat with Fred to explain the limits of impressionistic customer reports and ‘poor me’ narratives in making a fair judgment about a whole system. You even told him about the news out of the Minister’s office, clearly a knee-jerk reaction to public criticism, setting up a ‘Task Force’ for ‘Patient Safety’. Meanwhile, the much-needed National Health Facilities Registration Agency remained in the cooler.
As Fred explained, his newspaper had a British readership who were not interested in the ins and outs of bureaucratic health reforms in Nigeria. This was why he chose to focus on the widespread tales of woe and their human impact.
In your mind, you thanked him for his predictable focus and signed off on the conversation.
