‘Why death of accident victim isn’t our hospital’s fault’

The Lagos University Teaching Hospital (LUTH) at Idi Araba, Lagos, was established in 1962 to offer tertiary health services and engage in teaching and research. Presently, it attends to 2, 000 outpatient cases and 120 new emergencies on a daily basis, even as 50 new patients are admitted every day. The Chief Medical Director (CMD), […]

The Lagos University Teaching Hospital (LUTH) at Idi Araba, Lagos, was established in 1962 to offer tertiary health services and engage in teaching and research. Presently, it attends to 2, 000 outpatient cases and 120 new emergencies on a daily basis, even as 50 new patients are admitted every day. The Chief Medical Director (CMD), Prof. Chris Bode, in this interview speaks on how LUTH is overstretched and sundry other issues. Excerpts:

 

Daily Trust: On Monday, a victim of hit-and-run reportedly died at the gate of your hospital. What actually happened?

Prof. Chris Bode: Any death is an unfortunate situation. Mr. Segun Ogunjobi who was 24 years old did not die at our gate and he was not left unattended in LUTH. The true story was that he was seen registered and promptly treated. Our record shows that he was brought into LUTH at 6:43pm on Sunday, 2nd September, in a public vehicle upon referral from Navy Hospital, Ojo. Information at our disposal indicated that he was hit by a commercial vehicle. He was brought to LUTH from LASUTH where he was initially referred from Navy Hospital, Ojo. Our findings at LUTH indicated that the victim did not receive initial resuscitation at the hospital of first call after the accident. Other medical findings were that he had high level of unconsciousness following the accident which raised his heart rate. He also had bruises on his face.

An assessment of moderate traumatic brain injury was made by the attending doctor who saw him within five minutes of arrival. Staff on duty said resuscitation was immediately commenced even while he was in the vehicle with intravenous fluids administered through two venous accesses sited on arrival in LUTH. The Emergency Unit of LUTH, in line with our protocol for such cases, provided all initial materials for resuscitation. His relatives were informed that the materials would be replaced later by them. It is true that the victim could not be provided a bed immediately as the emergency center was at full bed capacity. This was explained in detail to the relatives. Also, the neurosurgical team was informed about his case and a Computerized Axial Tomography (CAT-scan) was requested to determine the extent of brain injury following review by the consultant in the Triage Unit. His family however could not provide funds for the CT-scan. Meanwhile, the A&E Unit continued to make arrangements to provide a bed space in the Center while resuscitative effort was on-going.

Reports indicate that the family continued to delay in ensuring a CT scan. Our team continued to monitor his level of consciousness. Eventually, a bed was provided following the transfer of another patient to the theatre for emergency surgery. Some 90 minutes after arrival, his level of consciousness depreciated and attempts at cardiopulmonary resuscitation was not successful. Let me emphasize that unlike the other centers where he had been taken to following the accident, LUTH did all that was possible within the constraints of our environment. This particular case was a bad one before he got to our center for intervention. His care which should have commenced several hours since injury was delayed till he got to LUTH.

DT: With just 500 beds in a city with an estimated eight million people, majority depending on government healthcare services, how do you cope with the pressure?

Bode: No doubt, it has been a herculean experience for us.  In spite of this, we try to mitigate the consequences of huge hospital attendance and we will keep improving as our funding improves. For instance, the institution has commenced a hospital-wide renewal of its 56-years-old ward blocks, starting with the B-Block. Expectedly, withdrawing a block of 120 beds from service has created some bed constraints, but we have continued to do our best in the circumstance by ensuring that nobody is sent away, and on rare occasions we arrange with the Lagos State University Teaching Hospital to accommodate such patients in line with world’s best standard practice.

DT: Will you ascribe the situation to inadequate funding by government or manpower shortage, or both?

Bode: Truly, the government cannot solely be responsible for funding the health sector, even when huge resources are being massively invested in the sector. This informed the ingenuity of the management at LUTH to embrace the Public Private Partnership arrangement. For instance, out of the N60.9 million appropriated for LUTH in 2015, only N30 million was released for the year. In 2016, we got N83.9 million out of the N130.3 million budgeted and in 2017, the total release was N161.3 million of the N322.7 million appropriated. So, it is understandable why alternative sources must be explored to keep providing services.

DT: What strategies have you put in place in the last three years to cope with the rising demand for services?

Bode: A lot has been done within our resources and abilities to scale up our services. Remember we are talking of human life and wellbeing of the Nigerian people here, so we cannot but adopt whatever measures are desirable to add value to how patients are given attention, within reasonable time and of course, with charges too.

Part of what we have done is the addition of the new Blood Bank, a new Accidents and Emergency Laboratory, Optical Workshop and Laboratory, Acute Stroke Care Centre, Endo-laser Surgical Suite which was built from scratch. Each of these was the first of its kind in Nigeria and these projects have attracted favorable comments from clients, other Federal institutions, government and staff.

In the last three and a half years, we have successfully rehabilitated the Modular Theatre, Accident and Emergency Department, Psychiatry and the Dental Outpatient departments. Water is very important to hygiene and our operations, therefore our 44,000 gallons per hour Water Treatment Plant is very functional now alongside the Industrial Incinerator and the Administrative Block which were previously in disrepair. All have been rehabilitated and are now fully in use. All eight endoscopes that became dysfunctional from overuse have been fully repaired in Germany and returned to LUTH for use.

Presently, we stock more than 80 per cent of prescribed drugs and we have enough stock of medical consumables at all times. Those we could not stock are the rarely prescribed items, implants and other expensive individualized needs.

DT: Are you optimistic that these measures can stand the test of time amidst the increasing population of Lagos?

Bode: Despite the pressure, we must continue to do our best for the welfare and wellbeing of our citizens. There is no other option. As we are all aware, government resources are also not limitless in the face of competing demands. As you know, citizens are also yearning for quality education, good roads and potable water in all our towns and villages. All these are competing for scarce resources. It is therefore critical that the health care sector is managed by competent, committed and selfless managers and policy makers who can think out of the box and make the greatest impact with limited available resources and manpower.

At LUTH efforts are ongoing to further improve efficiency of service delivery in the hospital. You can see the renovated Triage Area of our Accidents and Emergency Department. New wards for services are now in high demand and we need a Stroke Rehabilitation Unit, Burns Ward and a Ward for Child Psychiatry. We have plans to build and equip more Operation Theatre Suites, modernize the Anatomy and Molecular Pathology section, get new equipment and facilities, including new dental chairs, new CSSD equipment and new elevators. All these plans are subject to availability of funds.