Investigation: Inside Kano’s coronavirus scheme
…Old order still the way of life in the ancient city
Kano State government shut down two of its three isolation centres long before mid-July. The remaining centre discharged its last Covid-19 patient on July 25. However, the Nigeria Centre for Disease Control (NCDC) has been churning out numbers of Covid-19 cases in the state since July 25, even though nobody knows where the patients are kept. Also, daily death estimates in Kano by the NCDC contradicts a statement made by Health Minister on ‘mystery deaths’ in the state. Our investigative journalist, Temitayo Ayetoto raises more puzzles on the management of infected patients in Kano after spending over a week investigating Covid-19 cases in the state.
At 10:34 am on July 27, I arrived at Yusuf Maitama Sule University Teaching Hospital (YMSUTH), welcomed by a wave of tender breeze and unfolding promise of a sunlit day.
It was the medical community hosting the Covid-19 fight in Kano. The Diagnostic Centre and the Nigeria Centre for Disease Control sat within it.
My curiosity about empty isolation wards in the middle of rising cases of infection prompted me to schedule an appointment with a man critical to the management of the pandemic in the state. I was going to hear from the horse’s mouth. For a state where late detection of the novel coronavirus led to the death of almost 1,000 people, at the rate of 43 per day, doing that was very significant. Since April, healthcare workers had been turning into patients. The dire lack of personal protective equipment (PPE) was highly pronounced. Fear was king.
A day before my arrival, July 26, Kano had ranked second after Lagos with 65 freshly confirmed cases among the raft of states rocked by the virus in Nigeria. That figure brought the total active cases to 262, according to the Nigeria Centre for Disease Control (NCDC) general fact sheet dated July 26. The NCDC is in charge of the management of the virus in Nigeria. New cases confirmed on July 25 were just three; five on July 23rd; 17 on July 22nd; 12 on 21st, and 16 on 20th. On July 27 itself, nine new cases were reported.
But the silence and scantiness that ushered me in, on that Monday morning, was oddly loud and disquieting. The gatekeepers were unbothered about me not wearing a face mask, let alone worry about temperature check or hand washing. For them, life was normal.
The further I moved the quieter it became. ‘What has happened to the pacing feet of healthcare workers?’ ‘Where are the relatives of coronavirus patients being treated waiting?’ I asked rhetorically.
I called my interpreter, but he was more than 40 minutes away. It was an opportunity to close in on offices linked to the main reception without an invitation. As I approached the main lobby, I finally met two workers, probably receptionists or secretaries. With an exchange of ‘Ina Kwana’, a pleasantry meaning ‘good morning’ in Hausa language and the excuse of waiting for our host, I was in a dark dusty room where I must not be caught.
My interpreter soon joined me. It was full of old files. My colleague, who was essentially assisting with interpretation from Hausa to English and vice-versa, manned the door, attentive to external movements. Quickly, I scanned through several files. Some of the patients’ prognoses were suggestive of Covid-19 symptoms. I was aiming for more when my interpreter whispered ‘switch off your torchlight.’ I then knew that someone was approaching. But by the time she neared us, we were out of the file room, wearing a ‘we-lost-our-way’ look.
And just when we thought we were composed enough for any shock, we bumped into her right at the door linking the reception. Her shock was apparently more, which gave us room to regain composure.
“I just came in here and there was no one here,” she said, smilingly in Hausa. We retorted with matching smiles, repressing the fear that she might suspect us. But there was no cause for alarm.
Encouraged, we began to sniff again, aiming to identify the main isolation ward where coronavirus patients were being managed. In Kano, the management of Covid-19 was assigned to three centres which were YMSUTH, Aminu Kano Teaching Hospital and Muhammadu Buhari General Hospital. We found earlier that two had been shut down. One was left and we were going to find it. Directions from two security officers and another receptionist in the estate were useful in leading us.
In no time, we were before a detached bungalow, apparently empty. The main glass doors were shut. Five middle-aged men in native tops and trousers and hand-made caps sat closely as they raised their voices from unmasked mouths in a casual gist.
Although our presence was quite interrupting, it took the effort of some rounds of greetings in Hausa to secure their attention. We intimated them of aiming to see Anifowose Abdullahi, medical director, Yusuf Maitama University Teaching Hospital Kwanar Dawaki Isolation Centre.
But to our confusion, they generously told us activities were dead in the ward for over a week. Quickly, one of them offered to lead us to the office of Abdullahi who had just arrived.
In less than a minute, we were face to face with him. His speech was prepared and brief. “There is nothing I can tell you. Any information I will give to you is official information. It is correct and you will not get it from any other source.”
But we weren’t going to give up. My interpreter swung into action with some Hausa explanations while I emphasised that we came in peace. Only then did he give us some hints.
“We discharged our last patient with a severe case two weeks ago or last week,” he said. “But then, the other hospitals (Aminu Kano Teaching Hospital and Muhammadu Buhari General Hospital) had patients up till Saturday (July 25) who were not severe. Here is the only centre yet to be shut and we don’t allow asymptomatic cases here, except moderate and severe cases to avoid wasting the facilities here,” he explained.
“There is no patient in this hospital now. We used to have three Covid-19 treatment facilities, but now we are rounding off because the numbers are reducing. And most of the cases are asymptomatic. We are looking at some other ways of management. For now we are wrapping up the response and the two other facilities. So, this is the only facility that remains open.”
It was not clear where 65 persons confirmed to be infected the day before were being managed. It was not clear whether they were a mix of severe and mild or a full group of mild or a full group of severe cases. Were they all asymptomatic?
Another puzzle which no one has resolved in Kano is the number of Covid-19-related deaths. The total number of coronavirus deaths in Kano as of September 16 was 54, according to the NCDC, but a mystery death had claimed 999 in the state between April and July. The state government had earlier in April attributed it to meningitis, hypertension, diabetes, and malaria. However, Osagie Ehanire, minister of health, had responded in June that 50-60 percent of those deaths were caused by Covid-19. Fifty percent of the total deaths amounts to 500 people. The question is, why did NCDC claim that Kano had only 54 deaths as of September 16?
Asymptomatic patients do not show symptoms, but they are not immune from infecting others.
With greater caution, I asked Abdullahi if he was aware that new cases as many as 65 had been confirmed in the state the day before, but he wasn’t aware. The information was new to him and the only answer he could give for that possibility was that while some patients were managed at the dedicated centres, others simply refused to be admitted because of stigmatisation.
“So for these numbers that you are quoting, there’s a law that allows the government to prevent anyone from constituting public health threat. If they have severe cases, they bring them here,” he said.
However, an insider said that the mild cases were being sent home with the hope that they would recover later. Scientists have warned that those patients need adequate care to avoid getting worse or spreading the virus. But nobody cares in Kano.
Even though there are talks of flattening the curve in Nigeria, the country’s testing is low. Nigeria has carried out only 482, 321 tests between late March and September 16 this year, as against South Africa’s 3.92 million tests as of September 14.
In Kano, other isolation wards handling mild cases were shut. The only ward managing severe cases couldn’t account for at least one severe case in a state where 65 cases had just been confirmed. And there is no effort to supervise the management of mild cases at their homes.
This is just one of several factors prompting the public to express doubt on everyday coronavirus numbers emanating from Kano, one of Nigeria’s most populated states. The state last reported one case on September 7.
More than N500million has been contributed by individuals in a bid to fight the virus in the state. Aminu Alhassan Dantata, a billionaire, made a donation of N300million. The United Bank for Africa donated N28.5 million.
Africa’s richest man Aliko Dangote donated a 500-bed isolation centre, situated inside the playing turf of the Sani Abacha Stadium, while two Kano-based businessmen, Abba Sumaila and Abubakar Dalhatu, chairman Al-Amsad Group, donated 500 sacks of spaghetti and N5million, respectively to the state fund.
“So with no one in isolation camps in the middle of a pandemic, on what item is the money donated being spent?” an academic, who refused to give his name because of the sensitivity of the matter, said.
Efforts were made to reach Tijani Hussaini, Kano State incident manager for the virus, to explain the puzzles, but he could not be reached by phone and after visits to his office.
According to data gathered from files found in the dark room earlier, Amina Sani, 50, had a case diagnosed as chronic dry cough due to an exposure to the virus. It was similar for Ahmed Mukuthar, 43, who had a case of dry cough. He had a left soiled chest pain associated with breathlessness.
Meanwhile at the Murtala Mohamed Specialist Hospital where isolation ward was now extinct, the scene was a dangerous one where possibly infected persons mixed freely with uninfected persons.
Interactions between health care workers and patients were as though the coronavirus had ceased to exist in that clime.
Worse were droves of friends and relatives, mostly women, who swarmed the waiting arena of the hospital in a feast-like fashion. They sat in clusters on brightly patterned mats, chattering, eating with their bare hands from same plates as they breastfed crying infants in some instances.
The solidarity wait in a hospital premises during a pandemic signalled much of the held belief that the virus is a concocted concept.
While they worried about the medical condition of their loved ones lying in wards, they left not even a pinch of consideration for their personal protection against the rampaging disease that had sent more than 1,000 people in Nigeria to their early graves.
Abdullahi, quoted earlier, was sure that the ‘old normal’ of people sitting in clusters or eating together in close distance couldn’t continue.
“It is not advisable at all to remove protective protocols. People still have to maintain social distancing and use face masks and wash hands regularly. We have to see how we can adjust our day-to-day lives to maintain those protocols because we don’t yet know the nature of the disease. We are still trying to understand whether people can be re-infected,” he explained.
With pandemics, mutations occur in the form of change in appearance of genetic determinants. An individual infected with a type in stage A, for instance, can be re-infected in stage B.
Reports of re-infection have already emerged in Hong Kong, Europe and the United States.
A 33-year-old man suffered a second bout of infection more than four months after his first attack, researchers in Hong Kong found.
His first encounter didn’t provide him enough immunity to wade off a second attack, strongly backing the possibility of a second wave.
Another patient, 25, was confirmed with the first coronavirus reinfection involving severe symptoms.
People who do not have symptoms may still spread the virus to others.
Regrettably, the healthcare workers at Muhammadu Buhari General Hospital were spending their own money buying PPE essential to the discharge of their duties because the government did not think PPE was important, according to one health worker who pleaded anonymity.
In several instances, patients simply had to shoulder the cost of PPE before any procedure could be performed on them, it was learnt.
Abubakar Sanni was combing the hospital for the drugs with his bleeding wife when I found him grousing bitterly about what he termed ‘a ridiculous list of medicines’ given to him, and the overwhelming flow of patients seeking care from hospital rooms with fewer doctors and nurses. He spoke in Hausa.
My interpreter made the engagement easier by interacting with him in Hausa. A raft of issues was infuriating him. Cases coming from the outskirts of Kano complicated the congestion. In terms of cost, alternatives such as Muhammadu Buhari Giginyu Hospital and Isyaka Rabiu Hospital were now off limits for the poor and lower middle-class, including a local government civil servant like himself.
Top of his worry however, was that with coronavirus in the picture, his out-of-pocket burden had soared.
His wife, Maryam, 36, had suddenly begun to bleed three months into pregnancy, a situation that pushed her into clinical emergency. But rather than being placed on a bed rest immediately, she had to scamper round the hospital alongside her husband in a bid to gain a doctor’s attention.
The list Sanni complained about required his wife to get an ultra sound scanning and be placed under progressive care unit (PCU). She was to buy three sets of succinylcholine chloride (SCC) syringes, three sets of surgical gloves, two sets of Canular pink and some injections.
“There are enough primary healthcare centres, but Kano needs more general hospitals. Government should employ qualified doctors that will look after the health situation of patients,” Sanni said in frustration.
“There are myriad of challenges bedevilling the healthcare system of Kano. Nepotism is also part of what is causing backwardness, pushing patients who do not know a doctor personally into frustration,” he further said.
“Most doctors in government hospitals delay in checking patients and, to some extent, harass us. It’s worse when a patient needs surgery. Most of these doctors have agents that direct patients to their private hospitals. It is so hard to find a doctor in the hospital but very easy to find the same doctors in the private hospitals they refer patients to.”
At the Amino Kano Hospital, strict measures were in place to curb the spread of the virus but it didn’t translate into relief for Hadiza, a young mother who rushed her infant from the outskirts of Kano to the teaching hospital.
She thought the son would be rescued but hopes got slimmer when she realised that she had to raise N45, 000, on one hand, for a surgery to solve the obstruction of her baby’s abdomen and about N15, 000 for PPE needed during the surgery.
She made a living from selling ‘Kulikuli’, a local snack, while her husband was a casual worker.
At the point we met, she had spent N10, 000 at the hospital but was also going through pregnancy pains.
She, her mum and in-laws were heading back home with two options: seek traditional medicine intervention or watch the baby’s condition worsen.
On my third day, I gained access to the adult female ward under the guise of working for an international organisation that donates PPEs to hospitals. I engaged a store keeper who happened to be excited at my mere mention of PPEs.
“For about three weeks, we have been experiencing shortage of PPE. Patients are being directed to buy PPE for themselves. It is now a law (unwritten) in our hospital that if a patient needs operation, facemasks and hand gloves must be provided by the patients for doctors before commencement of any operation,” she confirmed to my colleague interpreter in Hausa.
The hospital basically relies on grants and donations which come in insufficient amount occasionally, and sometimes with fanfare when it is some government parastatal donating.
Although the curve appears to be flattening across the country and new researches are beginning to indicate that human immune system cells are learning coronavirus so they can fight it off again, continued community spread has shown that the old order cannot be resumed. But in Kano, old order is still the way of life.
Rosemary Audu, head of virology, Nigeria Institute of Medical Research (NIMR), told BDSUNDAY that poor compliance with hygiene precautions has continued to drive community transmission.
The pandemic has the ability to produce fatalities, especially for individuals with underlying health problems. Meanwhile, 46 percent of 54, 587 confirmed cases are youths between 21 and 40. So far, Nigeria has only been able to test the 417, 398 samples as of 3rd September. And Kano has 1,727 of total cases confirmed.
Analysts think it will require a holistic approach for the government to get it right with the health system and raise the quality to such that all can access. The government, they say, must increase health funding and ensure budgetary allocations translate into better health infrastructures.
The recent strike by the Nigerian Association of Resident Doctors (NARD) has, again, proved that Nigeria may be far from a future where neglect of the healthcare sector needs would be over.
It is the second time during the coronavirus pandemic that doctors have picketed government offices for failure to honour demands including the implementation of residency funding, Covid-19 allowance, payment of hazard allowance and the outstanding salary shortfalls of 2014, 2015, and 2016.
It is equally the second glaring opportunity that the Federal Government has squandered to demonstrate an unreserved commitment to prioritise its healthcare sector by boosting the morale of its fighters in a fight against a pandemic.
Worldwide, health systems where essential workers are owed salaries, allowances and lack the improved equipment to deliver quality results in their jobs naturally lose talents to climes where these demands are aggressively protected.
Saudi Arabia is luring Nigerian doctors with $4,500 (over N2m) per month as salary compared with N100, 000 to N200,000 received by most doctors in the country.
At least, 7,875 Nigerian doctors are practising in the United Kingdom currently, according to the UK’s General Medical Council while 4,000 ply their trade in the United States of America.
More than 20,000 Nigerian doctors currently work outside the country just as 80 percent of those working in the country are aggressively chasing exit options, a recent NOI Polls survey revealed.
Estimates show that it has one doctor to 6,000 people, as against WHO’s recommendation of one to 600 people.
Another poll citing the Medical and Dental Council of Nigeria (MDCN) reports that there are about 72,000 nationally-registered Nigerian doctors, with only 35,000 practising in-country. Estimates say there is a deficit of over 260,000 doctors in Nigeria and a minimum of 10,605 new doctors need to be recruited annually to meet global targets.
Abasi Ene-Obong, chief executive of 54GENE, a health technology company focused on genomics, said Nigeria needs to demonstrate healthcare as a priority.
“We keep looking at foreign investments as the saviour for healthcare, but good policy can also increase healthcare financing. It doesn’t have to be only investments, it could be the fact that more people can pay for or that health insurance is rejuvenated in the country and made in a way that people have access to it,” Ene-Obong told BDSUNDAY.
“When there is financing in the healthcare space, it will fund the healthcare improvement organically. We need to be looking at ways of increasing financing from within as well as ways to attract investment from outside,” Ene-Obong said.