When Sekinat, 57, wanted to have a knee replacement surgery in September at the largest tertiary hospital in Lagos, it took the intervention of her sister who is a medical staff, lobbying and a clear demonstration of the ability to foot the cost of Covid-19 test and personal protective equipment (PPE) to be used by the surgeon.
She specifically bought 12 surgical gowns costing N7,200 each, 12 pieces of N95 masks at N5,000 each, a pack of gloves at N2,500, a large bottle of antiseptic disinfectant and a pack of PPE caps.
The cost of protection was roughly N200,000, a bill that excludes the mandatory Covid-19 test of N50,000, a knee implant worth N505,000, medication of N100,000 and service fee close to N300,000.
Access to elective surgeries has been increasingly difficult as the cost of new items such as PPE and Covid-19 tests bloat the size of patients’ medical bills.
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Elective surgeries are surgeries performed on conditions that are not immediately life-threatening. Although optional and aimed at enhancing the quality of life, serious conditions like cancer count as elective, according to John Hopkins Medicine.
But in government-run hospitals where the majority of Nigerians resort to for medical remedy, patients are finding it harder to secure appointments with surgeons and face a new level of billing, even when they do.
With alarms of a second wave of the disease renting the air, hospitals have renewed enforcement of measures that limit unnecessary interaction with patients, particularly those scheduled for non-emergency purposes.
BusinessDay understands that some hospitals work with an unwritten policy of selecting patients based on the level of risk presented, since not all can afford the test or the protection.
“The reality is that the Covid-19 test is a limitation to people gaining free access to surgeries. What many have been doing is to select patients presumed safe and take universal precaution rather than waiting for a Covid-19 tests that won’t come. But it is not everyone that will take such risk,” Saliu Oseni, former chairman, Lagos chapter, of the Nigeria Medical Association (NMA).
Charge-free testing at government hospitals has not lived up to expectation as the turnaround time for results often shoots beyond surgery schedules.
In a separate interview, Rosemary Audu, head of Virology at the Nigerian Institute of Medical Research (NIMR), told BusinessDay that patients billed for surgery regrettably wait on long queues for testing with other Nigerians using the tests for purposes such as travelling abroad.
Despite coming up with a new rapid test kit that helps hospitals detect the Covid-19 status of patients within 40 minutes, adoption is yet to kick-start as production waits on investment interest from private companies.
The Lagos State University Teaching Hospital (LASUTH), for instance, has readied packs of PPE, which the cost is tacked to the bill of patients needing surgery.
This and other measures have not only increased the out-of-pocket expenditure of patients, it has placed the burden on patients to prove convincingly that they need surgery. Otherwise, they will be greeted with scorn from health workers worried about the risk of exposure to Covid-19.
Unfortunately, it is this category of patients who have suffered months of delay, and deferment of their surgery procedures due to the pandemic outbreak.
Since February, Sekinat, a trader, for instance, waited for about seven months to finally secure an appointment in September. Her plan to get operated in February was botched after hospitals stopped attending to elective surgeries during the wake of the Covid-19 outbreak.
When the hospital finally agreed to operate on her, she was bankrupt. It took borrowings, and keen rallying by relatives and friends to raise help.
But Patience Uwem was not as fortunate when she needed a surgery to amputate her right arm. She continued to lie somewhat in detention at LASUTH as she has not been able to raise the cost of her care.
As of October 27, what began as a minor herpetic whitlow attack had degenerated into a whole arm infection costing N442,880. The bill encompasses accommodation, BTS, MESD ADM, and oxygen and theatre fees.
With narrowing access to elective surgeries and a weakening ability to pay, chances of resorting to cheaper and dangerous options in traditional medicine might rise. People might equally consider living the rest of their lives in pain, just as Patrick Ukala has decided.
Ukala is a victim of the Lekki Tollgate shooting who has resolved to live with a bullet still stuck to his right arm.
Oseni, a general surgeon, suggests that the government can intervene by coming alive to the responsibility of testing and ensuring general hospitals start running the test for Covid-19 to get result released faster.
