Investigation: Inside Nigeria’s deadly medical quackery business

From fever to a lifetime deformity, Zulfa’a Abdullahi’s 13-year-old daughter, Aisha, is one of numerous victims of medical quackery in Nigeria. In the last 9 years, Aisha has lived with a leg deformity that has left her limping after an alleged quack doctor administered an unknown injection on her. In the densely populated urban slum […]

From fever to a lifetime deformity, Zulfa’a Abdullahi’s 13-year-old daughter, Aisha, is one of numerous victims of medical quackery in Nigeria. In the last 9 years, Aisha has lived with a leg deformity that has left her limping after an alleged quack doctor administered an unknown injection on her.

In the densely populated urban slum of Rijiyar Lemo in Kano State where Zulfa’a and her family have lived for over 10 years, she narrated how the lethal injection of a man she now describes as a “dangerous quack doctor,” endangered the life of her daughter and several others.

Sometime in 2013, Aisha, then aged three, had fever; and an injection, which Zulfa’a could not recall its name, was prescribed for her daughter at a government- owned hospital. But because of distance, Zulfa’a said she took her daughter to a nearby private clinic operated by a man she later discovered was a quack doctor.

This quack, who Zulfa’a said she could not recall his name, injected Aisha, and soon after, caused a walking abnormality for the 13-year-old. “We later noticed that her ankle was deformed and it worsened as she grew older,” Zulfa’a, a mother of eight said.

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Even as she attempted to seek legal redress, she said her husband had discouraged her and advised that they channel their energy to their daughter’s health and the fact that Aisha may need to undergo surgery in the future. “The quack doctor later died, leaving behind other children with deformity,” she said.

Like Zulfa’a’s daughter, Hajiya Bilkisu Hamza’s encounter with a medical quack left her with a condition associated with heart enlargement.

Hajiya Bilkisu, who is in her 50s, said her condition followed a surgical procedure in 2020 by an alleged quack doctor who operated a private clinic in Kano State.

Bilkisu explained that the surgery was carried out without thorough medical examination on her medical history and other underlying ailments.

“As a result, she contracted an infection that led to severe heart enlargement,” said her guardian, Malam Bashir Indabawa, who added that medical experts at the Aminu Kano Teaching Hospital (AKTH) later re-examined Bilkisu.

Explaining further, Indabawa, who was also responsible for Bilkisu’s medical bills, said the medical examination at the AKTH faulted the first surgery and Bilkisu was told that her heart had enlarged.

Both the 13-year-old Aisha and Bilkisu Hamza are part of a larger, undocumented number of Nigerians who suffer from life deformities, and in some cases, death, in the hands of medical quacks posing as certified doctors and surgeons in the country.

Findings by this newspaper revealed that there are no publicly available figures from either the Nigerian Ministry of Health or the Medical and Dental Council of Nigeria (MDCN) on the magnitude of medical quackery in the country.

Interviews with victims of quack doctors, health regulatory agencies and those posing as medical doctors showed that policy gaps on the part of the government aid the activities of medical quacks in Nigeria’s health sector.

Danger of medical quackery

In September, Daily Trust reported how one Noah Kekere, a quack doctor, was accused of illegally harvesting a patient’s kidney in Jos, Plateau State. The Nigerian Medical Association (NMA) in the state had immediately denounced his action and said Kekere was neither a medical doctor nor a member of the association.

Also, in January 2023, this newspaper reported that a joint committee of security personnel and government officials inaugurated by the chairman of Tudun Wada Local Government Council in Kano State, Alhaji Ahmad Tijjani, had discovered 130 hospitals and pharmacies allegedly operated by quack doctors. The committee alleged that some of the hospitals were manned by holders of Senior Secondary School certificates.

The chairman of the committee, Alhaji Abubakar Karafe, had said they also found an electrical engineer among the quack doctors, who was operating a private hospital and attending to patients.

“He was prescribing drugs, administering drips, blood and even attending to pregnant women. One of the quack doctors had transfused an unscreened HIV positive blood to a woman who was seeking treatment for malaria,” Daily Trust report quoted Karafe as saying.

Our reporter travelled to Kano State to get additional details of the situation and the woman who was transfused with an unscreened blood but gathered from Malam Shaaban Idris, a member of the joint-committee, that she later died. Efforts to reach the relatives of the victim were unsuccessful as the family contact became uncooperative.

However, speaking further, the chairman of the committee told our reporter that the alleged quack doctors apprehended during the raid had been released after they were made to sign letters of undertaking to desist from the practice.

Medical experts, however, faulted method of quackery checks and said releasing medical quacks with a warning could pose potential danger to others in the future.

Explaining further, the chairman of the NMA in Kano State, Abdullahi Sulaiman said, “These people (quack doctors) continue to cause harm by making wrong diagnoses and giving concoctions, wrong drugs, overdosing or under-dosing of drugs, performing surgeries with complications, which are life-threatening or even leading to death of patients.

“Many people masquerade as doctors and offer treatment to the unsuspecting public. Even here in Kano, one guy was arrested more than twice as a quack (or fake) doctor but was released after he was taken to court.”

He said Nigeria lacked the necessary laws to adequately prosecute offenders; and where they are present, the laws are obsolete and carry light sentences or provide fine options that do not adequately serve as deterrent to others.

“The practice is also fuelled by low regulations, ignorance and poverty on the part of patients,” he said.

The NMA chairman said their various branches were making efforts by advocating review of state anti-quackery laws to reflect the gravity of the offence. “Some state branches have even submitted drafts of anti-quackery laws to their Houses of Assembly,” he added.

We were trained by other fake doctors – Quacks

For over three years, Sani Musa worked as a record keeper in a public hospital in Kano State. While off duty, he also worked as one of Nigeria’s self-proclaimed doctors. Musa said he carried out at least 15 abortions in two years.

Musa, who claimed to have repented, said, “I found my way into the practice through a friend I stayed with. I closely watched how he conducted abortions in his pharmacy. With that experience, I started my own back-alley abortion practice.”

The 27-year-old, however, said that in 2022 he had a wake-up call after one of the procedures became complicated and the patient almost died.

Abortion in Nigeria is illegal and carries a heavy jail sentence of up to 14 years, unless it is performed to save the life of a pregnant woman. While young pregnant women desperate to conceal their pregnancies find themselves patronising these quacks, the resultant implication has in some instances led to the death of many.

A consultant family physician and lifestyle and sexual health specialist at the Aminu Kano Teaching Hospital (AKTH), Dr Fatima Damagun, explained that the Society of Gynecologists and Obstetricians of Nigeria estimated that about 20,000 Nigerian women died from unsafe abortions each year.

“Based on a study carried out in South West, Nigeria, the commonest complication was sepsis (infection involving two or more biological systems). Sepsis can lead to chronic pelvic infections that can subsequently lead to infertility. Sepsis can also cause bleeding and death.

“Another complication is bleeding directly from the surgical evacuation of the fetus that can also lead to death,” she said.

Like Sani Musa, who was mentored by a quack, Lawan Garba, who was among the Kano quack doctors apprehended and paraded in January by a joint anti-quackery investigation committee, was equally mentored by a quack doctor who owned a private hospital.

While being questioned in January, Garba confessed to the joint anti-quackery investigation committee that he had been in the illegal business for about five years, even though he had no qualification in any health-related field.

In a video made available to Daily Trust Saturday by the committee, Garba could be heard saying he ran a patent medicine store at Korau community of Tudun Wada in Kano State, where he stored injections and treated patients.

 

 

How Nigeria’s weak regulations aid quackery

Nigeria’s laws frown at medical quackery and prescribe punishment for anyone posing as a medical doctor to endanger the lives of citizens. Section 17 (1a and b) and (5a &b) of the Medical and Dental Practitioners Act, Cap. M8 LFN 2004, prescribes punishments in fines between N5,000 and N10,000 or imprisonment not exceeding five years against the practice of quackery and other related offences, including using the title of physician, surgeon or doctor.

But there are concerns over the low penalty for an offence as grievous as medical quackery, which endangers human lives.

A former member of the House of Representatives for Njikoka/Anaocha/Dunukofia constituency of Anambra State, Dozie Nwankwo, had in 2017 sponsored a bill to amend the act by increasing the punishment for the practice of quackery as provided for under section 17(5a) and (b) of the MDP Act.

The bill had suggested increasing the fines and terms of imprisonment to at least N1million and five-year imprisonment against the practice of quackery, and N5million and 10-year imprisonment as punishment for other related offences, depending on their severity, as provided for under section 17 of the act.

Nwankwo committed to several appointments with our reporter to speak on the bill but never honored any. However, the chairman, House Committee on Rules and Business, Francis Waive, said the bill was introduced to the 8th Assembly in July 2017 and referred to the Committee on Health Institutions in October, 2017.

In a WhatsApp chat with our reporter, Waive said the committee did not report back on the bill till the end of the 8th Assembly. He also said there was no re-presentation of the bill in the 9th Assembly.

He, however, recommended that Nwankwo needed to send a draft and his thoughts on the bill to the present House for re-introduction.

“The rules indicate that a bill not passed by an Assembly dies at the end of that tenure except reintroduced by a serving member. Nwankwo’s bill didn’t cross the committee stage,” Waive added.

This reporter made further attempts to get the reaction of Nwankwo on the recommendations of Francis Waive but the former legislator did not respond.

To tackle the challenge in legislation, the MDCN, a regulatory body for the professions of medicine, dentistry and alternative medicine, urged all state governments to emulate Lagos State by making anti-quackery legislations that would keep medical quacks behind bars.

“If they catch and sentence you to 34 or 36 months in prison, by the time you come out you would become an ex-convict, and you would have been wounded and permanently dented in terms of image. And you cannot go back to that environment; you will run away,” the registrar of the MDCN, Dr Tajuddin Sanusi said.

Sanusi, in an interview with Daily Trust Saturday, said the Council was limited by its laws and can only hand over quack doctors to law enforcement agencies.

“At best, we are prosecution witnesses when they are being tried. But how many of the cases have they (law enforcement agency) actually tried in the many we have reported?”

How MDCN’s verification policy aids medical quackery

Data obtained from public records and reported stories showed that as at October 2022, Nigeria had about 24,000 licensed medical doctors. However, on the portal of the MDCN, there is no published list of licensed doctors in the country. Instead, the Council expects citizens to submit a complaint against any medical practitioner, quack personnel, school or hospital through the service portal, which shall in turn be forwarded to its Department of Professional Discipline for investigation.

As at September 2023, the disciplinary unit, on the MDCN portal had two names on its sanction lists since November 2020, while there was no published name on the quack register under its inspectorate activities unit.

Our reporter reached out to the registrar of the MDCN, Dr Sanusi, who said they had over 150 cases pending for investigation. He said the Council had completed investigation on over 70 cases related to quackery but was awaiting trial.

Daily Trust Saturday also made attempts to verify the licence status of certain medical doctors on the MDCN portal, but our reporter was moved to a remitter page, where he was asked to pay N20,000 to verify the status of a doctor.

This is contrary to what is obtainable in Kenya, where it is free to verify the licence of anyone posing as a medical practitioner. As part of its policy to check quackery in its health sector, the Kenya Medical Practitioners and Dentist Council (KMPDC) publishes list of all registered medical, dental practitioners and health facilities licensed to operate in the country on its official website.

Investigation by Daily Trust Saturday revealed that the KMPDC also has an SMS short code for instant verification of the licence status of health facilities and medical, dental practitioners, as well as community oral health officers in order to check medical quackery.

However, in Nigeria, the MDCN states that it demands a fee of N20,000, an amount that is two-third of the minimum wage for workers in the country, to verify the status of a medical doctor because the Nigerian government no longer funds the council.

The registrar said, “It is at a cost because the new thinking of the government is that they are no longer funding us, partially or fully. Even before now, they were not funding us fully. This time around, there’s nothing from the government, such as personnel cost, capital expenditure, overhead.”

Our investigation revealed that this is despite the over N240m in revenue annually generated by the MDCN for the renewal of doctors’ licences from the approximately 240,000 medical doctors in the country. Each doctor is expected to pay a minimum fee of N10,000 annually for renewal of his/her licence; and medical consultants pay higher.

This story was sponsored by Daily Trust Foundation with support from MacArthur Foundation