How inadequate staff, equipment fractured Lagos orthopaedic hospital

NOH Igbobi is located along the busy Ikorodu Road in the Lagos metropolis. The institution started as a military rehabilitation camp for prisoners of war returning from the 2nd World War. After recognition by the Colonial Medical Services in 1945, it became a medical establishment known as the Igbobi Orthopaedic Hospital. In name, the hospital […]

NOH Igbobi is located along the busy Ikorodu Road in the Lagos metropolis. The institution started as a military rehabilitation camp for prisoners of war returning from the 2nd World War. After recognition by the Colonial Medical Services in 1945, it became a medical establishment known as the Igbobi Orthopaedic Hospital. In name, the hospital has undergone a metamorphosis from Igbobi Hospital to Royal Orthopaedic Hospital and now National Orthopaedic Hospital. 

 Between 1945 and 1977, the hospital was at various times under the administration of the federal government and Lagos State government. It has, however, remained a federal government health institution since 1977.

 Despite its old age, many of the structures in the hospital’s premises are new, and there are various new buildings in many strategic locations within the premises. It is safe to say Igbobi is an old institution with a new outlook. 

 The environment is clean and drainages flow easily, although there are few stagnations. The roads are well tarred and security seems to be at top gear as uniformed security men could be cited here and there. Inside the wards, however, there are still broken ceilings here and there, as our reporter observed.

The cry of a child in pain in the children’s ward could be heard from a distance. On moving closer, it was discovered that the child had nobody with her. There were no relatives with her to comfort her and no nurse to tend to her deafening cry. 

As some staff of the hospital confided in Daily Trust on Sunday, the facility suffers from shortage of medical personnel, leading many times to neglect of patients who can’t be attended to promptly. Be it children or adults, patients who enjoy the luxury of relations to stay with them during their days on admission have helping hands to tend to them when the nurses are busy. But those with no such relations are simply at the mercy of the two nurses on duty in each ward, who may choose to answer or ignore the call of a patient when beckoned. 

The agony of a patient who is neglected when he/she needs a helping hand can be so excruciating, as our reporter witnessed. Owing, of course, to its orthopaedic nature, the 450-bed hospital is populated by patients with mobility problems, many of them hung to their bed poles because of bone disabilities, or their backs glued to their beds due to spinal cord injuries. In each ward, there is a Plaster of Paris or a large swathe of bandage on someone’s hands or legs. The pain of being there is one and that of being ignored by a nurse when needed is another. 

 A nurse who spoke with Daily Trust on Sunday in confidentiality revealed that the nurses’ actions and reactions are mostly due to fatigue arising from insufficient number of nurses in the federal institution.

 The caregiver explained, “In the ward, most of the time, there is usually one staff nurse and an auxiliary. Whenever patients need to use the restroom to urinate or defecate or need to take something, they call on the only one nurse. But one nurse cannot divide herself into two. She cannot do more than her capacity. 

“Sometimes, many patients require the attention of one nurse at the same time. But a nurse cannot be dressing a patient’s wound and also be attending to another person who wants to use the toilet. She will have to finish doing one thing before jumping to another to avoid infecting a patient’s wound. So, that patients who want to defecate will have to wait; after all, it’s not an emergency.”

The ideal thing to have in any hospital, the nurse explained, is one nurse to one patient. 

 “When there is one nurse attending to 15 or 20 patients, she will be easily exhausted. Nurses are clamouring for more hands. We were all happy when an advertisement was recently placed for more nurses in Igbobi. Hopefully, things will be better when more nurses are employed,” she said.

As patients yearn for more nurses in the wards, outpatients, who only visit the hospital from their homes for one complaint or the other, are also clamouring for more doctors. Our correspondent observed last week at the outpatient clinic that many patients had not been attended to by noon, as only a few doctors attended to them. Patients were seated in the clinic according to their health challenges in fracture, trauma, spine and others. 

One of the outpatients, who identified himself simply as Muyideen, expressed his disappointment at what he called the grossly inadequate number of doctors attending to patients within the health facility. 

 According to his observation, the ratio of doctors to patients is 1:30. “At spine, they have only five doctors attending to about 150 patients every day. There are some patients for the morning and others for the evening. 

 “There are only general orthopaedic doctors in the spine department, and only one consultant. Someone can only see him when all diagnosis by the previous doctors persisted,” Muyideen said.

 In his reaction to the shortage of doctors at the NOH Igbobi, the Lagos State chairman of the Nigeria Medical Association (NMA), Dr. Olumuyiwa Odusote, told our correspondent that the issue of insufficient doctors may be due to the economic downturn in the country, which, he said, currently incapacitates the federal government and makes it impossible for it to employ new doctors.

Dr. Odusote lamented that there are, indeed, some government hospitals that have been unable to pay salaries for some months, hence the need for some doctors to travel out of the country in search of greener pastures.

 His solution to the issue of insufficient doctors at Igbobi and other hospitals is that the government should increase the budgetary allocation to health, as well as further guarantee job security.

 The medical director of the orthopaedic hospital, Dr Olurotimi Odunuga, disclosed that for each unit, there are three consultants, as well as three senior doctors and three resident doctors, bringing the total number of doctors serving each unit to nine.

 It was understood that there is a machine for spine surgery that has been unavailable for some months. In his observation, Muyideen, a spine patient said: “The machine for spine surgery has not been functioning for over six months. It has been damaged. They kept promising they will fix it, yet nothing has been done about it. When I was there in November, there were over 20 people lined up to use the machine for their operation.

 “Each spine operation that will be done by a patient costs N500,000. There are some special cases that will gulp up to N1.2 million. If they collect as much as that for an operation from one patient, why can’t they afford to buy another one? What happens to the money they have been making from the machine all this while?”

 He narrated the story of a patient on a nearby bed who was in so much pain with a spine problem and was ready to buy the spine surgery machine but could not afford it when told the price. 

 “To relieve the pain for spine injury patients, the spine specialists carry out minor surgery on patients and collect nothing less than N300,000 for surgery that will give only temporary relief for only two to three months. And the person will have to do it again for another few months relief,” Muyideen said.

Odunuga has another perspective to it. While he agreed there is a machine that is faulty, he insisted all that Muyideen and other patients said may not be entirely true.

 The medical director disclosed that the machine, called the image intensifier, is an x-ray machine used in the theatre to view the inner part of the body without necessarily opening the skin and is used by all medical units in the hospital. The image intensifier, according to him, guides treatment and makes the job easier. There are two of such machines in the premises.

Explaining the cause of the complaint, the MD said the less than seven-year-old machines both got damaged within two weeks of each other more than six months ago. 

 “The hospital was in a dilemma because the machine couldn’t be repaired locally. The supplier had to get a technician from India who arrived after eight weeks due to visa problems and other issues. One of the machines was fixed and the other one was leaking oil even after fixing it. The oil leakage led to its abandonment because it was not safe for use as the oil can go into the operation room. A special gum for the leakage was sent but when applied by our trained technician, the leakage persisted. So, when the Indian technician visits next, it will be done by him. The repair cost us N2m each,” he said. 

Odunuga added that the other machine is being used by all other units, but the spine unit could not use it as the pictures it produces are not as clear as they used to be due to the deep nature of the spine in the human body. 

While some surgeries, especially some that needed the use of the image intensifier were suspended, all other ones are still being done. 

Enumerating the challenges and possibilities involved in having another machine, the medical director admitted that procuring another machine was not in this year’s budget. He said: “There are procedures in procuring anything in government-owned hospitals. We were looking at the possibility of renting from a radio diagnostic centre, but it was not available. We even looked at the possibility of buying a second-hand one, which was close to N5m. After inspecting, it was discovered that it was not good enough.

“We were disappointing the patients. So, we started the process of buying a new image intensifier machine eight weeks ago. Adverts were placed in Daily Trust and The Guardian newspapers. The prices submitted by nine companies after the publications ranged from N15m to N135m. A committee has been created to work on it.”

Our correspondent learnt that the image intensifier machine ought to last for a minimum of 10 years. 

Regarding the exorbitant price charged for surgery, Odunuga stressed that the hospital merely charges between N20,000 and N25,000 for the use of the image intensifier, while it is the additional cost of anaesthesia, surgery and consumables that shoot the entire treatment charge up. 

 The medical director argued he found out during his last visit to South Africa that the price charged for the use of the same machine in a government-owned hospital was between N120,000 and N150,000. He said that the meagre amount charged in Nigerian federal health institutions, and subsidized by the government, makes it difficult for managements to easily replace or repair the machines. 

 He said: “If we charge higher, many people will not be able to afford it. Quality service is expensive. And many of the equipment items being used are not produced in Nigeria. Cost of surgery varies and it all depends on the type of surgery, consumables, anaesthesia and other factors. It can be as high as over N1m. Same surgery in a private hospital in this country will cost between N3m and N4m. It is not the same price for everyone as all patients’ health challenges are not the same.”

 After observing activities at the hospital for two nights, Daily Trust on Sunday saw that the NOH Igbobi is not unaffected by the poor power supply problem that afflicts the country. There were nights nurses used rechargeable lamps to attend to patients. 

The MD disclosed that management spends over N8m monthly to buy diesel to fuel the generating set, while the Ikeja Distribution Company also collects a minimum of N6m monthly, totalling a monthly expense of about N14m on energy, “yet power supply can’t be guaranteed for 24 hours,” adding that the hospital is compelled to spread the cost on power supply, otherwise it would be unable to provide any service.