On the 17th of February, news broke that a pregnant woman died in a government hospital in Kano over the hospital’s refusal to collect old Naira notes. The husband of the deceased reported that healthcare workers refused to attend to his wife until they received evidence of money transfer. These allegations were made on a popular radio station the day after she passed away and as expected, there was public outcry over what they perceived as the wickedness of Nigeria’s healthcare system.
Firstly, I am not an investigative journalist. However, I have since perused the facts of this case since it broke, and made a few factual deductions of my own.
Shemau Sani Rabiu was a 32-year-old woman who presented to Muhammadu Abdullahi Wase Specialist Hospital (MAWSH) in labour between 4-5pm. She was un-booked (this means she was having ANC visits elsewhere) and was referred from a peripheral hospital. The deceased was said to have been bleeding for four hours prior to her coming to MAWSH. On arrival, she was examined, and a quick history was taken. The patient herself was reported to have told the staff that she had stopped feeling foetal movement. When a bedside Ultrasound Scan was done, it was determined that the baby was dead and that the patient had Placenta Abruption. In lay terms, placental abruption occurs when the placenta partly or completely separates from the inner wall of the uterus before delivery. It is a common cause of bleeding and death of babies in utero. Additionally, her blood pressure was also significantly high and this necessitated augmentation of labour so that the dead baby could be delivered quickly. Shemau delivered a fresh still birth at around 11pm.
After delivery, Shemau continued to bleed. One pint of fresh whole blood had already been given and she was on the second pint when she passed away. Her bedside clotting time was 23 minutes and so she most likely died of Disseminated Intravascular Coagulopathy (DIC) which is medical jargon for when your blood refuses to clot. Even in the best centres around the world, DIC is difficult to manage.
May her soul rest in peace, ameen.
Hospital policy demands that all patients with emergencies be treated immediately, with or without payment. What usually happens is that we have an emergency tray containing drugs and equipment necessary for resuscitation. So, when an item is used, the patient’s relatives are asked to replace it by buying it in the hospital pharmacy. Therefore, while Shemau was being attended to, some items were written for the relatives to buy.
According to Bello Ali Baffa, he brought his healthy wife to MAWSH to be managed following unsuccessful attempts at another hospital. When asked to purchase some items, he was directed to the hospital cashier who said that she did not collect old notes. He then asked to make a transfer which he did, however the credit alert was not received by the cashier. According to him, it took over three to four hours before the alert was received during which his wife was not attended to. Later, when he went back to the labour room, he was told that he had to make another payment for a C-Section. Yet again, he made another transfer which took another three to four hours before it was received. By the time he returned to his wife, she had been pronounced dead. In his mind therefore, it was this delay that caused his wife death.
Violence against health workers:
This type of case is not new to the practice of medicine. When patients or their relatives receive bad news or a pronouncement of death, it is common for them to lash out in forms of screams and sometimes resort to physical and verbal abuse of the hospital staff. Those who work in emergency medicine will tell you that their skins have grown quite thick from the insults they receive daily. However, what is not acceptable is the media reporting these incidents without verifying facts. In this age of social media and sensational reporting, media stations should be wary of one sided stories and judgement of government agencies.
The Commissioner of Health of Kano state has since released a press statement that is both factual and precise. As of the time of Shemau’s case, the Governor of Kano state had already instructed that the old naira notes still be collected as legal tender all over government hospitals. The allegations of the deceased husband were therefore refuted.
However, we have lost in the court of public opinion. People are making vicious threats and hurling insults against health workers. A nurse in the same hospital was slapped by a patient just yesterday.
Worldwide, it is alarming that workplace violence is becoming increasingly prevalent in healthcare settings. Statistics show that this violence is disproportionately higher in resource-poor countries where most cases go unreported. The perpetrators were found to be mainly patients and their relatives who were mostly male. This is not surprising because patients and their relatives place a lot of expectations on health workers and when they perceive their needs are not being met, they may resort to acts of violence. This has the potential to lead to volatile situations where the healthcare workers who are generally seen as caregivers are now the victims.
Just two months ago, Dr. Uyi Iluobe was murdered on December 29, 2022 in his hospital, at Olivet Clinic, Oghareki, Delta state. Preliminary investigation revealed that on that fateful day, a female patient whose name and address were not known came to the hospital at about 7:40pm pretending to have abdominal pain. While the doctor was attending to her, she made a phone call to the suspects whom she deceptively invited to come and pay her bill, as she was being treated by the doctor. Moments later, the hoodlums stormed the hospital in a Toyota vehicle, entered the doctor’s office, and shot him twice in the chest, leading to his death and the purported female patient fled with the suspects.
The wife of the murdered doctor reported that the doctor had quarrelled with some relative of the patient in the past due to their unwillingness to pay accrued bill from services rendered by the late doctor and even then, the said patient threatened to deal with the doctor.
In a study titled: Violence towards health workers in the workplace carried out by Usman et. al in Kaduna last year, nearly two-thirds of the participants had experienced at least one form of workplace violence in the course of their work life. The most frequent reason given by respondents as the cause of workplace violence includes long waiting time and poor attitude of health workers. This is made further aggravating in this era of poverty, unemployment and insecurity. Other factors include human factors like anger management issues and lack of patience.
The fact that the majority of the respondents have been exposed to violence at the workplace highlights the deplorable state of the health system in that area. Research shows that health workers who are exposed to violence have markedly lower productivity leading to sub-optimal patient management. It’s not rocket science. Why would I give my best if the patient is not appreciative?
The whole situation is disheartening.
The safety of all workers should be a priority for health facilities as it plays an integral role in maintaining and improving worker productivity; ultimately contributing to the strengthening of the health system. Maligning and criticizing health workers does nobody any good. Not to the patients we pledge to protect, not to the system we work in, and certainly not to our societal image. If you feel wronged, there are other civilized and more appropriate channels to follow.
Violence against healthcare workers must stop.