What does one do when institutions entrusted with our very lives betray that trust in one's most vulnerable moment?
Few months ago in Lagos, a young lady, Ruth, was run into by a speeding car. She was rushed to the nearest hospital with hopes that she would be saved. That hospital turned her down, not because she was dead already, but because she didn't have a police report. The good Samaritans pleaded to no avail, the hospital wouldn't take her. The young lady died before she could make it to another hospital.
For many people like me, it is difficult to draw the link between police reports and accident victims. Why should a police report be needed before an accident victim would seek care? On the other hand, the requirement of police reports before gunshot victims can access healthcare is more popular, though wrongfully so. Is it ethically right to allow a man die for mere lack of a police report? Should hospitals not accept and treat every patient in need? Treat, save a life first and ask questions later? Even a criminal’s life is worth saving, if not for anything but the wealth of intelligence it holds.
In 2017, Nigeria took a bold step to introduce the National Gunshot Act which was set to turn things around. The Act stipulates compulsory treatment and care of gunshot victims, regardless of money and police report. Unfortunately, two years after many hospitals, particularly private clinics still reject such victims. In fact, the police report prerequisite seems to have extended to victims of road traffic accidents.
It is easy to surmise that clinic owners and health care workers are callous and inhumane, or why else would they turn victims away? A reactionary measure that many people have suggested is for healthcare regulatory agencies to come forth and enforce punitive measures against such hospitals that are apparently flouting a national policy. In my opinion, that would be superficial and ineffective. If the country is truly willing to solve this problem, a thorough root cause analysis is necessary to understand prevailing circumstances and proffer practical solutions.
In an emergency, the first responsibility of any healthcare worker is to save a life. Even without a national policy to #TreatFirstQuestionsLater, the natural reaction of any healthcare worker is expected to be to save the patient. And that is what many clinics do. But they have landed in trouble many times for doing so. Police officers are known to visit such clinics, harass, extort and sometimes arrest the clinic staff. Hence, clinic managers appear to have set an unwritten counter-policy against receiving such victims that may cause police hassles. Every staff on duty tries to protect her job and means of livelihood by making sure not to admit such victims.
That is not the only scenario where clinics and their staff face harassments. They face threats and violence from ruffians too. If a ruffian who suffered injury during a gang fight dies in a clinic, other members of his gang may decide to rough-handle the staff. If a popular person dies in your clinic, you may be in trouble. Some years back, when an Ibadan political celebrity died in the Accidents and Emergency room of the University College Hospital, healthcare workers had to hurriedly remove wardcoats and uniforms because his thugs became violent against anyone they recognised as such. In fact, there are several reported instances of clinics facing near demolitions and property destruction from ruffians.
Beyond police reports, the Act stipulates treating victims 'regardless of money'. Clinic owners and healthcare workers have often wondered how practicable this is especially in Nigeria where there is very little health insurance coverage. The recurrent question is: if I treat such patients, who will pay the bills? While many of them take the risk to nevertheless accept and treat such patients, others bitterly recount instances where such patients and their relatives refuse to pay (or have difficulties paying) when the patient became stable.
While all these may sound exonerative, they are in no way justifications for a victim to not be able to access care when they need it, especially in their most vulnerable period. That hospital betrayed Ruth. The healthcare system, Police Force and Nigeria betrayed Ruth. And no one is safe, until every one is safe.
Few weeks after Ruth's case in Lagos, Jemima died after being turned down for lack of police report by a hospital in Jos. Through November, a #TreatFirstQuestionsLater campaign was launched (initiated by Caleb Somtochukwu), and a petition signed by thousands of Nigerians. That petition has now been forwarded to the National Assembly.
In a few days, the world will celebrate the Universal Health Coverage Day. But only when everyone is truly able to access quality care, every time they need it, can Nigeria boast of Universal Health Coverage. It is not about what exists in policy documents, it’s about what we do every time to everyone, anyone, irrespective of how they come.
It is important that all stakeholders are made aware of on-ground realities, understand root causes, and reach practical agreement for a standard operating procedure that would truly give access to victims and patients in their moment of dire need.
To mark the upcoming Universal Health Coverage Day on December 12, a non-profit initiative, Afara 360 is holding a first-of-its kind roundtable event that will bring together high-level stakeholders and influencers from healthcare, government, Police Force, health law, and the media, as well as victims' relatives to decisively deliberate on the steps for actual implementation of the written policy document. Event details and registration: https://tinyurl.com/afara360-roundtable1
Dr Saidat Akanbi is a public health physician and global health scholar