THESE AVOIDABLE AND UNWARRANTED DEATHS MUST STOP

I watched the video of Mrs Loveth Nwogu, the mother of the three year old David that died while receiving treatment at one of the health facilities in Lagos State and my heart bleeds. It is painful that a young , vibrant, promising and cheerful David who the parents took to the health facility for treatment of catarh and cough died in a very controversial situation. I feel the pains of the parents, the trauma and agony they will live with as there are puzzles they may never be able to solve. The father did everything a diligent and lovely father would do yet the catastrophe surfaced with its hydra-head dropping sorrow and agony into their family. May the Lord Almighty console the family. They did not use self medication or go to a local chemist to buy drugs to administer on him. They relied on the system but the system failed them. So sad!

Both father and mother of David alleged that the child died as a result of negligence and misconduct in service delivery. It is more baffling that the father of the child made frantic efforts which would have prevented the ugly experience but his opinion did not count which is one of the characteristics of personnel in most heath facilities in Nigeria.

According to the Lagos State Commissioner for Health, Prof. Akin Abayomi, a full investigation into the allegation shall be carried out .

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The investigation will according to him include an autopsy, a review of medical records of the patient and additional documents, enquiries from medical staff who attended to the deceased, and the parents of the child.

It is sad that this could happen in Lagos State or any State in Nigeria for that matter. If this could happen in Lagos, only God knows what happens in other places. Only God knows the number of David that have fallen to avoidable deaths. For how long shall people continue to die avoidable deaths? Why would our dear Nigeria system kill the dream of Davids that would have ensured the emancipation of the country.

While not attempting to be judgemental, I would like to state that the Nigeria system failed David.

I could internalise the explanations of the young couple based on some personal experiences. I recall losing a friend and colleague in the early 90s. He was a young, agile footballer whose strength and dexterity in the defense earned him the nickname “Iron”. He had gone to the hospital for the operation of appendicitis and on application of anaesthesia, he coughed heavily and died.

That the father of David expressed reservations about the effects of the first injection should have prompted those treating David to think twice but I am aware that in almost all situations, the patient and the family are almost not relevant in the delivery of care. The health care providers wear the toga of “Mr Know all”. Unfortunately, the errors of misjudgement of the care providers could lead to death.

I remember the case of Mrs W who had an operation in one of the foremost government health facilities in Abeokuta, Ogun State. She was expected to be fine days after the operation but unfortunately she could not even sit on her hospital bed due to excessive dizziness. It got so bad that the doctors felt we should not allow people to visit her again apparently insinuating that the situation was spiritual. We became worried. The situation was horrific and the comments from the doctors was terrifying! We sought the opinion of a family friend and Medical Director of a Tertiary Institution in the State who without stress affirmed that the woman was reacting to one of the drugs. He directed us to check for a sign on her body when we go visiting the second day and lo and behold we saw it. We tactically stopped the drugs and within two days the woman was good to go home. What could have happened if we did not get the other opinion? I later sought an audience with the doctor to explain what happened to him. According to him, once patients do the operation, the drugs are given to them and they get better. He was having that experience for the first time. I explained to him the principle of variation from the perspective of trees which is my area of specialization. He thanked me, we exchanged phone numbers and we left the hospital. Mrs W was lucky but not many people have been that lucky.

I have seen people who were admitted into health facility because of high blood pressure only for the management of the high blood pressure to lead to low blood pressure and eventual death of the patient. Unfortunately, our system takes it as an act of God “Amuwa Olorun” whereas most of them are avoidable if we adopt due diligence.

How will the parents of David fathom their boy shouting after taking an injection and then died.

I equally remember the case of a female student in one of the tertiary institutions in Ogun State who visited a health facility outside her campus. The nurse had given an injection to lessen her menstrual pain and the lady allegedly complained of difficulty in breathing almost immediately after taking the injection. Rather than start bothering on what could have caused the difficulty in breathing, the nurse went ahead to give another dose and before long the lady was dead. That an injection works for Mr A does not necessarily mean it would work for Mr B but unfortunately, some of our people commit error of generalisation. Understandably, the nurse was trying to solve a problem but ended up creating an unsolvable problem as death closes all.

One other thing I have also observed is that majority of the health personnel lack listening ear. They can easily compete with God once you are at their mercy. To those category, you do not know anything and must just take orders. Imagine what would have happened if the people at the facility had listened to the alleged observations of the father of the child. It is possible David would be jumping around today.

A few years back, I had travelled to Ibadan to see Mrs P who was admitted in one of the best hospitals in the town. Mrs P had been on oxygen for days with no appreciable improvement and it was almost certain that we were losing her. I had to appeal to my wife to forget her identity as a Chief Nursing Officer as the Nurse on duty swore that they were not going to use the oxygen kit we sourced when it was discovered that their oxygen source had issues. She felt using the kit a good Samaritan gave us would embarrass their establishment and she was ready to sacrifice a whole human being to oil their ego. We literally begged and gave assurances for them to use what they needed but did not have.

Our health personnel need to be probing! If she had developed interest in why the injection mesmerised the child, perhaps she would not have given the next injection. In the case of the 69 year old Mrs P, the breathing normalises with oxygen but on disconnection from oxygen, her breathing and pains were unimaginable. This continued for days until another doctor just summarily affirmed that there was a blockage somewhere making the air impassable. The blockage was flushed and Mrs P is eating amala today years after. Only God knows the number of people who had died in such circumstances. Unfortunately, our system would always find reason to accommodate the negligence and lack of due diligence.

We take cars to mechanics, they make errors and we bear the brunt. We excuse them for lack of education. However, the errors of health personnel lead to irreplaceable loss. Many have lost closed family members due to poor judgement most especially on issues relating to drug administration. The case of David should help to save the future of other children. The commitment of the Hon. Commissioner of Health Lagos State is weighty and hopefully the issue will be followed to a logical conclusion.

According to Dr. Abiodun Amusan, the Director of Health Services, Federal University of Agriculture, Abeokuta, deaths in whatever form and circumstances attract emotions negatively from close relations even when they happen outside healthcare facilities. No two deaths are exactly the same no matter how similar their circumstances seem.

Dr. Amusan emphasized that the objectives of every healthcare professionals are to improve health and promote treatment outcomes and that the objectives of every healthcare facility is to provide best treatment outcomes in every encounter with patients. He identified certain factors are not under the control of the professionals which include time factors which is the interval between onset of illness and report for treatment at the RIGHT facilities. According to him, In many African settings proceeding to accredited facilities at the early onset of illness is very RARE. Other factors which affect efficient health care delivery identified by him are failure of patients and relations to reveal ALL medications tried at home or elsewhere before reporting at the accredited facilities to the attending physicians noting that drug interactions are a very important cause of avoidable deaths in hospital. Also Clinical laboratories labelling errors leading to giving patient A the laboratory result meant for patient B which could lead to wrong prescription even from the most competent physicians.

One can begin to hope that the thorough and comprehensive investigation promised Nigerians by the Lagos State Commissioner of Health would beyond unraveling the circumstances that led to the death of David give birth to health care services that can be accessed without fear while commiserating with the family of late David and others who have lost their loved ones in similar circumstances. These avoidable and unwarranted deaths can and must stop.

Dr Kayode Ogunjobi