The rising cases of poorly managed surgical procedures — sometimes driven by a hidden intention to steal vital organs — have exposed the cracks in Nigeria’s healthcare system.
The crack has fuelled distrust in the quality of local healthcare over the past years, contributing to an estimated $1 billion to $10 billion that Nigerians spend on outbound medical tourism yearly.
Following the kidney harvest of middle-aged Kehinde Kamal at a private clinic in Nasarawa and the removal of a portion of the intestine of 12-year-old patient Adebola Akin-Bright at a private hospital in Lagos, questions have arisen about why poor practices thrive within the health system.
The lack of trust is leading to a growing push for increased patient protection such that a patient can get a clear receipt of their vital organs through tests before and after a surgical procedure.
Akin Osibogun, a professor of Public Health at the College of Medicine, University of Lagos, told BusinessDay that by standard practice, patients have the right to consent to a surgery and can request for a post-surgical scan overviewing their system to be doubly sure of what has happened to them.
“But of course, it costs money. That is the only challenge in this environment because even to go for the surgery, many people are struggling to find the money for the surgery. Then to find more money to do a scan before and after can be tasking,” he said.
Regarding Akin-Bright, whose circumstance is still being investigated, both the private and public hospitals that managed him have been wrestling over who should take the blame for a procedure done wrong.
At Obitoks Hospital, a private health practice in the Alimosho Local Government Area of Lagos State, Abayomi Baiyewu, a medical doctor who is not a certified surgeon, performed two surgeries on Akin-Bright.
The patient was referred to the Lagos State University Teaching Hospital (LASUTH) eight days post-operation at the request of the parents.
There, another corrective surgery was initiated at the point of obstruction of his intestine, a procedure that had 4 inches out of about 24 feet of the normal small intestine removed.
The patient was operated on July 14 in an admission period that lasted for 28 days in LASUTH, during which his mother cried out that the intestine had “disappeared”.
However, a panel set up by the Health Facility Monitoring and Accreditation Agency (HEFAMAA) confirmed that the X-ray tests done while the patient was on admission at LASUTH also showed the presence of the intestine.
According to the Association of Nigerian Private Medical Practitioners, its findings indicate that a large mass of black tissue was removed at LASUTH and handed to the patient’s mother to take to the histopathology laboratory.
Due to the technical nature of some of the processes, the fault-finding mission has not been a walk in the park and more is expected in the coming days.
But more people are fearful and more circumspect of the quality of care available in the country.
Medical regulatory bodies are less trusted and known to respond more swiftly to misconduct often after fatal failures might have been recorded at quack centres that open their doors to unsuspecting public members.
According to health professionals, the ethics of the profession do not permit any doctor or any professional to remove any body organ for a non-professional reason, even though these misconducts still happen under the radar.
If a patient has to be sent for pathology for a histology report, it should be communicated to the patients or their relatives before the surgery, Osibogun explained.
By standard procedure, the professor noted that if there was intestinal obstruction and a portion of the intestine died, it would have to be removed and that must be communicated to the relatives.
“You let them know what happened during surgery and that when you opened up, you found that there is a certain segment with no life again. So you have to remove it and then let the family know. If they want, you can actually give them,” he said. “Perhaps if they failed to communicate, you can’t also blame the relatives for assuming or suspecting any kind of thing.”
On regulation, Osibogun said the agencies often lack the capacity to monitor all events in health practice partly due to manpower shortage.
Instead, people should raise an alarm and notify agencies such as HEFAMAA when they notice signs of quackery.
Olufemi Fasanmade, a professor of Medicine at the College of Medicine, Lagos University Teaching Hospital, noted that not all doctors can perform a surgery.
But this has been inadequately regulated in Nigeria’s health space, he said.
“If a professor of nursing goes and starts operating, he can be arrested because it’s not his field. It’s not his area, especially if the patient dies. So those are the things that regulate our practice,” he said.
He also called for bodies such as the Medical and Dental Council of Nigeria, Pharmaceutical Council of Nigeria, Nursing and Midwifery Council of Nigeria, and the Federal Ministry of Health to do more to sanitise the healthcare practice in the country.