The impact of the fourth industrial action by the National Association of Resident Doctors (NARD) in the space of 15 months, the first being in June 2020, is spreading across the entire health sector, affecting not only the resident doctors, but consultants, nurses, patients and even the viability of the residency programme itself.
Many families whose loved ones were caught up in the NARD have spoken of their anger, frustration and pain at how they were neglected in their hour of need by those who swore an oath to save them when they are sick.
Findings by LEADERSHIP Weekend showed that patients, some critically ill, who were turned away from teaching hospitals, and some that didn’t get the best of attention from the government hospitals are now shunning the hospitals in preference for more stable private hospitals.
Some families turned to traditional healers to meet their health care needs.
LEADERSHIP Weekend spoke with the patients, the doctors and hospital management which at a point tried to co-opt house officers into the protest.
Even as resident doctors have suspended their two-month strike and returned to work, Nigerians are increasingly losing confidence in government-owned hospitals as strikes have become a common practice in the country’s health sector, LEADERSHIP Weekend checks revealed.
One woman, Abigail Amaechi, said she has not recovered from the shock at how her father, Mr Amaechi Mba, passed on after the authorities at University of Nigeria Teaching Hospital, Enugu, quickly discharged her father who had been on oxygen for two weeks when the strike began.
“He was in critical condition but he was stable before they summarily discharged him. We rushed him to a private hospital but his condition just got worse and worse. He was dead before daybreak. My family will never forget that terrible strike. And we are not the only ones that lost family members to the strike,” she said, adding that she will think twice before taking somebody to public hospitals in the future.
LEADERSHIP Weekend reports that mostly general and teaching hospitals offer the residency programme, which needs not only consultants and the resident doctors, but also patients whose cases are studied and diagnosed.
Resident doctors in Nigeria are medical school graduates who are training to become specialists in particular fields, under the supervision of consultants.
These doctors play a major role in hospitals as they make up almost a half of all working doctors in the country and 90 percent of the workforce in some teaching hospitals.
LEADERSHIP Weekend gathered that because of the significant role they play, whenever they go on strike, it impacts heavily on hospital operations even though consultants and house officers can attend to patients whenever the resident doctors embark on strike. House officers are newly graduated medical officers who are mandatorily attached to hospitals for a period of one year as a form of internship.
According to the founder, Alliance hospital, Dr Christopher Otabor, a resident doctor is any doctor that is less than the rank of a consultant.
“Most of them are undergoing training, specialising to become a specialist. Because of the fact that they are residents, as they are known, in the hospital, they are the ones that do most of the work. For instance, if you come to the hospital at 7pm, you will not meet any consultant, they would have gone.
“The resident doctors take instructions from the consultants and they stay to do the job but in the process they are also learning and specialising for them to write exams. They write three sets of exams before becoming specialists and can be appointed as consultants.”
He said the consultant cannot do much without the resident doctors, a reason why during the resident doctors’ strike, a lot of people took their patients out of government hospitals.
Even with the help of house officers, the hospital cannot function fully without the resident doctors, nor can there be a teaching hospital without the patients, said Otabor.
The impact from the strike was however felt across the states from, one teaching hospital to another. And although the strike by the resident doctors in Enugu has been called off, our investigations revealed that people are still afraid to take their sick ones to government-owned hospitals..
It was also gathered that patients who were relocated to private hospitals during the strike refused to go back to the government hospitals afterwards.
“I was brought to UNTH from Parklane Hospital, Enugu, but they refused to attend to me because of the strike. Even some people who paid their bills were denied treatment. So people now have confidence in private hospitals,” a patient formerly at Parklane hospital said.
A member of the management at Parklane teaching hospital, who did not want his name mentioned, said their revenue base depleted seriously due to the strike.
He told our correspondent that there are about 1000 resident doctors operating in Enugu but said migration of doctors from the state to other states might have reduced the number.
In Rivers State, resident doctors at the University of Port Harcourt Teaching Hospital (UPTH) and Rivers State University Teaching Hospital (RSUTH) joined the national strike, but those of RSUTH later withdrew from the action.
According to the chairman, Medical Advisory Committee of UPTH, Princewill Stanley, during the strike, the management of the hospital activated its strike intervention protocols.
Stanley said: “I must admit, it was not easy to run a hospital without resident doctors. The activities will slow down but the fact remains that this gridlock will now make patients stay longer than expected.
“Definitely, there were delays because resident doctors actually do the bulk of the work; because of their weight and number, they give maximum support.”
LEADERSHIP Weekend observed that resident doctors make up 60 percent of medical staff of the UPTH and RSUTH.
To Mr. Austin Job, who was on admission at UPTH, it was a very painful experience as he was attended to by skeletal staff during the resident doctors’ strike.
Job stated that his family had to move him out of the facility to RSUTH when they heard that the resident doctors at the latter were no longer part of the strike.
A nurse, who pleaded for anonymity, told LEADERSHIP Weekend that nurses at UPTH stopped doing shifts during the strike as a result of the workload.
In Benue State, many citizens who had patients in the hospital during the two-month strike by NARD have lamented that they went through hell during the strike period, some that are buoyant said they transferred the patients to private hospitals where they had to pay triple what they would have paid in public hospitals.
Mama Nguveren, whose husband was admitted in one of the public hospitals in Màkurdi, the state capital, said she had to take her husband back home to engage the services of a herbal doctor, hence no doctor was coming to check them again.
A nurse at Federal Medical Centre, Makurdi, who does not want her name in print said the bulk of the work was too much for them as she was working beyond the stipulated time frame.
According to her, all the extra time they put in was just a sacrifice because nobody is paying for it.
The state chairman, NARD, Dr. Ushakuma concurred that the resident doctors constituted the majority of the workforce with a rough estimate of 60 percent.
In separate telephone conversations with the chief medical director of the Benue State University Teaching Hospital (BSUTH), Prof Terrumun Swende, and Federal Medical Centre (FMC), Dr. Peteru Inunduh, all expressed joy that the strike had been called off. They agreed that the strike was not easy for them and the patients.
In Osun State, the protracted resident doctors’ strike had adverse effects on not only patients, other workforce but on the economic fortunes of the affected hospitals.
While the economic loss to the strike at Obafemi Awolowo University Teaching Hospital Ile-Ife, OAUTH, Osun State cannot be ascertained now, according to the chairman, Medical Advisory Committee (CMAC), Dr Afolabi Owojuyigbe, management appreciated the resolution of the conflict.
Dr Owojuyigbe noted that though the experience of the strike was not palatable, consultants and other health workers did their best to deliver healthcare to patients during the duration of the strike.
A nurse in the physiotherapy ward who spoke on condition of anonymity described the strike period as terrible because of the task of combining the nursing job with counseling as the case arose.
She appealed to the government to have high commitment to the health sector by at least honouring and implementing Memorandum of Understanding (MoU) reached with health workers to avoid paralysis in hospitals.
A patient at the Endoscopy Suite of the hospital simply identified as Kusamotu expressed delight at the resumption of the doctors.
He said he had been an outpatient of the hospital for a considerable period of time, adding that his case wouldn’t have deteriorated to admission level if the doctors had been at their duty posts.
According to the chief medical director, Federal Medical Centre (FMC), Umuahia, the Abia State capital, Prof Azubuike Onyebuchi, it was one of the toughest periods in recent time for the centre.
He said the centre was able to cope with the situation through effective use of the house officers and consultants who are less than 30 percent of the medical doctors and the other staff who were equally overstretched.
Onyebuchi, who said the centre suffered over 70 per cent drop in Internally Generated Revenue (IGR), added that the management was forced to be as prudent as possible in the use of the scarce resources to stay afloat.
Speaking with LEADERSHIP Weekend, president of the centre’s branch of the association, Dr. Kelechi Chikezie, said the members constitute over 70 per cent of the medical doctors.
Some of the patients and their relatives, narrating their experiences during the period, said, it is better heard than felt, adding that they are happy that it is now over.
“My hope hung in the balance then,” said a patient.
However, the nurses were divided in their experiences during the period. While some, especially the senior ones, said they were encumbered with much work, the junior ones said they had less to do.
In Niger State there are no resident doctors in the general hospitals, except at the Federal Medical Centre, Bida.
Attempts to get reaction from Dr Usman Abubakar, the new medical director of the medical centre on the impact of the strike, proved abortive as he had not taken over fully.
It was however gathered that about 30 percent of medical personnel are resident doctors and the strike reduced the capacity of the hospital to admit all the patients that required it during the strike
Instead, patients who were supposed to be on admission were made to come based on appointments to be attended to by the few doctors available.
Some of the nurses interviewed, preferring anonymity, said the strike put more pressure on them especially during emergency, while referral cases were not attended to expeditiously.
In Cross River, effort in Calabar, the state capital of Cross River, to get the input of chief medical director, CMD, of University of Calabar Teaching Hospital, UCTH, Prof. Ikpeme Ikpeme, failed woefully as the UCTH CMD declined to pick his calls or reply to text messages sent to him by our correspondent on the issues.
On difficulties faced by patients on admission as a result of the strike, one of the patients, Mrs. Sandra Ebong, who claimed to have gone through excruciating pain during the strike, said, “It was such a terrible experience for some of us who had issues to be sorted out by the hospital”.
Ebong lamented how treatment in the hospital was haphazard and shoddy due to the strike.
She stated that she was left with no other option than to seek help elsewhere at the private hospital in the city of Calabar, stressing that it’s the reason she asked UCTH authorities to discharge her to enable her to seek help at a private hospital instead of leaving her in the hands of the nurses on special duty alone.
“The consultants would visit the hospital to meet with patients whenever they felt like it. The normal routine check-up of patients wasn’t there. I had no option than to ask to be discharged and seek help elsewhere in a private health facility.”
Ebong stated that no patient would be satisfied if he goes to hospital and be left in the hands of nurses alone without having access to doctors.
“I didn’t like what I experienced during the strike,” the patient maintained.
According to one of the nurses, Ekanem Bernard, who refused to give details about the unit that she works at the University of Calabar Teaching Hospital UCTH, “There was nothing like work overload because we had only few patients to be taken care of.
“Before the resident doctors’ strike began, I think management of the hospital got patients with critical cases discharged. Of course patients that were allowed to stay at the hospital with us were the ones with manageable cases. Besides, the hospital was no longer admitting people with critical cases. So nothing like work overload,” Bernard stated.
The NARD strike crippled activities in Delta State University Teaching Hospital, DELSUTH, Oghara and Federal Medical Centre, FMC, Asaba.
At the FMC, Asaba, and DELSUTH, Oghara, the resident doctors abandoned the hospitals while in- and out-patients left the hospitals frustrated.
Some patients, who spoke to newsmen at the FMC, Asaba, pleaded with the doctors not to embark on strike again, while calling on government to meet the demands of the doctors.
Both nurses and patients at the two hospitals, while expressing happiness over the resumption of the doctors, said they actually missed some of the patients, the striking doctors and other activities in the hospital during the strike.
According to one of the nurses at FMC who spoke under anonymity, he said they were underutilized likewise most of their equipments which must have deprived the hospital of income and need to spend money to service the unused hospital tools.
The doctors at DELSUTH, according to the the President Dr. Odukuye Rukevwe and the General Secretary Dr. Adja Harrison called for immediate payment of the 2021 Medical Residency Training Fund to them to continue the training of specialist doctors in Delta State, payment of a reasonable percentage of the backlog of bench fees and to maintain same with a monthly payment of one million naira for the purpose.
Particularly, Dr Osifo Nwabunor, State Chairman, Resident Doctors pressed for facilities to be adequately equipped in preparation for training,
Dr Victor Osiatuma, Chief Medical Director, Federal Medical Center, (FMC), Asaba agreed that there were shorfalls in what the hospital was expected to realise, stating that management is collating its records now that the doctors are back to work.
He regretted that activities at the hospital during the strike was low, which he agreed resulted to low patronage because there was the impression that nobody would attend to them if patients had come to the hospital for treatment or any other medical advise.
Osiatuma, though said cost on services reduced, he however disclosed that what the hospital realised during the strike was a far cry compared to when there was no strike and the hospital fully functional.
Delta State Commissioner for Health, Dr Mordi Ononye, when asked about the effect of the strike on DELSUTH, said the state government has recently released N68 million to the Teaching Hospital to address some of the issues demanding urgent attention.
Patients, however called on the government to reconcile with the striking doctors to find a permanent solution to the incessant strikes by medical doctors..
The public relations officer of the Federal Medical Centre (FMC) ,Owerri , Dr. Mrs Jacy Achonu revealed that the calling off of the strike by resident doctors portends great relief to the FMC, Owerri, as the strike impacted negatively on the hospital.
According to her ,the hospital personnel, consultants and nurses had to work extra hours so as to meet up with the demands of the patients.
Dr. Achonu said some relatives of patients, who decided to evacuate their wards, however reduced the expected income of the hospital as they witnessed a slight drop in revenue
The PRO stressed that the ratio of resident doctors in FMC could be put to about 20 percent as the consultants account for 80 percent of doctors at the facility.
In her contribution, one of the nurses, who spoke on condition of anonymity, said it was not easy operating during the strike and expressed optimism that with the calling off of the strike, the workload on each staff will be reduced significantly.
In Kwara State, the strike led to the restriction on admission of new patients at the University of Ilorin Teaching Hospital (UITH).
Most patients on admission prior to the commencement of the doctors’ strike also relocated to private hospitals for adequate medical attention.
A senior management staff of UITH who pleaded anonymity told LEADERSHIP Weekend that “the doctors strike resulted in admissions of only critical cases and more volume of work for consultants.
“Basically, the internally generated revenue of the hospital dropped but there are other sources of revenue through laboratories, mortuary and consultancy firms,” he added.
The husband of a patient on admission at the hospital, Alhaji AbdulWahab Olajide lamented that he had to take his wife to a private hospital in Ogbomosho, Oyo State for medical attention.
LEADERSHIP Weekend also gathered that the resident doctors account for about 25 percent of the UITH workforce .
“But they (resident doctors) are the most active in that sector. They work at night and on shifts,” a source disclosed.