Eyes on my phone but minding the queue, I heard a knock on the passenger side
window. I ignored it. I heard it again. Still, I ignored it, sure the hawker would go away.
Yet another knock. I turned to bid the dogged hawker go to the next car with a stern look
and encountered a smiling face showing me all the books two hands can hold. He was
saying something so I rolled the window down midway. “Customer, I have the book
now!” he said, still smiling. And now I remembered. At almost exactly the same spot,
about two or three months ago, I had bought a book from him, Femi Otedola’s Making it
Big. It had stood out from the rest of his wares which were the staple traffic trade trash.
He had sought to sell me one of those but I had found a way to end his relentless
marketing. “Do you have Chimamanda Ngozi Adichie’s Dream Count?
Just before exiting the ramp from the Katampe Bridge onto the Kubwa Expressway in Abuja, the fuel gauge flashed its yellow warning. Perfect timing, I thought, with an MRS petrol station just after the bend. I joined the long queue. I had sworn to only buy petrol, if I can help it, at a Dangote-partner station, not minding the wait to reach the pump. About twenty-five minutes but rather that than buy imported petrol, and at fully one hundred naira more per litre, for that matter! While crawling to the pumps, I would catch up on the news: the latest manifestation of Donald Trump’s autocracy at home, plutocratic pursuit of rare earth metals and other precious resources wherever they may be found outside a nuclear armed country, especially in “shithole countries”ꓼ the self-abasement of a Nobel peace prize-winner before the man who has just “colonised” her countryꓼ the unending impeachment saga in Rivers Stateꓼ the latest defection from the Peoples Democratic Party to the All Progressives Congress and the PDP’s cry of President Tinubu’s diabolic plan to turn our dear nation into a one-party dictatorship, etc. I would ignore the hawkers of hard-popped corn and groundnuts, toilet plungers and sundry plastic wares, bitter kola and Tom Tom sweets, assorted herbal cures for every ailment and men’s special needs, or whatever else hard-hustling citizens peddle in Nigeria’s road traffic trade.
Eyes on my phone but minding the queue, I heard a knock on the passenger side window. I ignored it. I heard it again. Still, I ignored it, sure the hawker would go away. Yet another knock. I turned to bid the dogged hawker go to the next car with a stern look and encountered a smiling face showing me all the books two hands can hold. He was saying something so I rolled the window down midway. “Customer, I have the book now!” he said, still smiling. And now I remembered. At almost exactly the same spot, about two or three months ago, I had bought a book from him, Femi Otedola’s Making it Big. It had stood out from the rest of his wares which were the staple traffic trade trash. He had sought to sell me one of those but I had found a way to end his relentless marketing. “Do you have Chimamanda Ngozi Adichie’s Dream Count? He didn’t and had finally moved on, half-disappointed. And now here he was happily displaying what I had requested, sure of a sale. Shrink-wrapped, the cover bearing what looks like an upside-down teardrop in shades of orange on a sky-blue background gave it a beckoning allure. He had not even waited for our haggling to be over before he dropped it on the seat to be my passenger until I got home.
Back home, I had not unwrapped my purchase before I got the shocking news, almost as if some impish spirit were intent on spoiling the thrill of opening a new book and reading the first sentence, or the first verse if it be poetry. Nkanu Nnamdi, the infant twin son of Adichie and her husband, Dr Ivara Esege, had died in a highly-recommended hospital in Lagos, following a routine stabilising procedure prior to medical evacuation the next day to the United States for treatment. What the self-vaunted specialists at Euracare Multi-Specialists Hospital needed to do — as recommended by Johns Hopkins Hospital, Baltimore, USA, to which Dr Esege is affiliated through the University of Maryland Medical Centre where he works — was merely a Magnetic Resonance Imaging of the boy’s brain, an echocardiogram, a lumbar puncture, and a peripherally inserted central catheter for the administration of intravenous medications during the evacuation flight.
In an apparent case of gross negligence, however, the specialists displayed a stunning lack of requisite professional care at almost every step. A legal notice has been issued to the hospital and in it, Adichie and Esege recount the many lapses that led to the snuffing out of the life of their baby boy: excessive dosage of propofol (the powerful anaesthetic drug the world became familiar with in 2009 as a major cause of death of pop music superstar, Michael Jackson), inadequate airway protection during sedation, failure to ensure continuous monitoring, transport without supplemental oxygen or adequate medical personnel, delayed recognition of respiratory or cardiovascular compromise, and failure to disclose risks of anaesthetic agents for informed consent. The result was that even before the tragic end, the little child had been subjected to a great deal of trauma as he endured seizures and cardiac arrest, became unresponsive and had to be resuscitated.
Sadly, cases of shocking medical malpractice are so prevalent as to be more the norm than exceptions. Within recent memory, there have been reports of surgical instruments forgotten inside the bodies of patients. There was the case of Peju Ugboma who died from incorrect ventilator settings in a Lagos hospital. There was the 2025 case of Alfred Ogene who sued a hospital for negligent insertion of a catheter leading to serious internal injury and bladder damage. And there was the case of the misdiagnosis of a Lagos fashion designer with stage-three cancer, causing her to endure costly and debilitating chemotherapy treatment, only for it to be discovered later that the original biopsy was not even hers! Medical malpractice exacts unquantifiable costs in death, complication of the disease or non-treatment of the actual ailment in the case of misdiagnosisꓼ grievous bodily harmꓼ trauma and emotional distress that in extreme cases can result in permanent physical and psychological impairment and inability to function normally. And then there is the ruinous financial cost, often making destitutes of even reasonably well-off patients.
When patently avoidable error and harm occur so frequently across the board, to poor and rich alike, the damage to public health and the well-being of the nation can be virulent. It starts with extreme distrust of domestic health delivery, no matter how highly recommended a clinic or hospital might be. Those to whom money is no object would jet off to Europe and America, anywhere but our houses of horror called hospitals, to treat even cough or cold. Those who can barely do so would opt for India, South Africa, Saudi Arabia — again, anywhere but the morgues or murder clinics of Nigeria — at the price of financial ruination. As for the poorest of the poor, the vast majority of citizens, their only recourse is to herbalists and native doctors, now also known as alternative medicine practitioners, or faith healers, pastors and prophets who profess divine powers to cast out the demons, witches and wizards who cause cancer, kidney failure, liver cirrhosis, cardiovascular disease, asthma, glaucoma, pneumonia, meningitis, malaria-typhoid (the two have become one disease in Nigeria’s lengthening pathology handbook), etc. Helplessness, hopelessness and desperation make them prone to superstition. Even a headache, persistent because induced by stress, a daily fact of their existence, becomes a spiritual attack that only a powerful native doctor or spirit-filled pastor can stop. Consequently, there are far more flourishing churches together with special healing and revival camps, suitably sited along major highways on the outskirts, than there are functional hospitals in many of our cities.
Yet, the nature of faith healing is such that accountability is almost impossible. After all, if a person willingly substitutes miracles for medicine and seeks a cure at the hands of an “anointed man of God,” agent of a deity or other supernatural force, who is to blame if death or grievous harm, and not healing, is the result? How is the pastor, shaman or babalawo’s negligence and culpability to be proved and to what extent would the patient’s faith and intentions be contributory, even exculpatory, negligence? Indeed, wouldn’t the maxim of tort, volenti non fit injuria — no injury from voluntarily assumed harm — akin to a signed pre-surgery consent, vitiate his or her case? To our national shame, faith healing, whose exponential growth can be seen in large billboards along streets and highways, posters on bridge rails and pillars, and handbills and flyers everywhere, gives the damning verdict of “Miracles over Medicine” on our health delivery system for the vast majority.
It is true, of course, that even with the greatest care, costly errors can still occur and, as the great Lord Denning cautioned in The Discipline of Law, a doctor “should not be found guilty of negligence simply because something has gone wrong,” should “not be judged by the highest expert skill, but by the standard of a reasonably competent practitioner in his field.” A doctor examining a patient or a surgeon operating at a table, he said, “should not have to look over his shoulder to see if someone is coming up with the dagger of an action against him. He should be able to get on with his work.” Yet, he went on to formulate a test derived from the general principle of liability for negligence: A medical man would be found guilty of negligence if “his professional colleagues would say: ‘He really did make a mistake there. He ought not to have done that,’” and, further, “if the mistake is deserving of censure, then he is liable.” In the Supreme Court case of Ojo v. Gharoro decided in 2006, Niki Tobi, JSC, quoted Denning’s formulation approvingly. Whether or not the medical men of Euracare, holding themselves out not merely as reasonably skillful men but, rather, specialists in a state-of-the-art hospital discharged their duty of care, or that their unbiased colleagues would not say that they made a mistake, they shouldn’t have done the litany of negligent acts alleged by Nkanu’s parents, are questions of fact to be established at trial and in the investigation that the Lagos State Government has ordered. What is indubitable is that the hospital and its doctors owed Nkanu a duty of care, a duty that goes beyond professional competence to use of the right medical equipment as well as their operation only by qualified personnel in a conducive environment at every critical period.
And these constitute the twin bane of Nigeria’s healthcare system as it faced catastrophic under-funding and massive brain drain, starting with the advent in the mid-1980s of the structural adjustment programmes imposed on poor nations of the global South by the West through the World Bank and International Monetary Fund: hospitals hollowed out of well-trained and experienced doctors and an acute lack of vital equipment in a conducive environment. Which led to the phenomenon of medical tourism. Its cost to a nation whose resources are grossly underdeveloped and inadequate to the needs of its citizens, with what there is so often looted mindlessly, has been estimated by the World Health Organisation and AfrExim Bank to be between $1.5 and $2 billion annually in recent times. That is trillions of naira, at the current exchange rate of around N1,500 to a dollar, that could otherwise have built a few world-class hospitals, equipped them with state-of-the-art facilities, and attracted medical experts or specialists of unquestionable competence to them.
A glimmer of hope has recently appeared at the end of the country’s long dark healthcare tunnel. Government has marginally increased healthcare funding and more purposefully pursued private sector investments. Lagos and Abuja, in particular, have witnessed the incipient rise of hospitals that can be the equal of many in Europe and America and other medical tourism destinations. Some, happily, are the products of what may be called reverse brain drain: doctors who fled the medical maelstrom, broadened their knowledge of practice and administration abroad, and have returned to lead by example the way to safe and dependable healthcare. I can testify to the admirable standard of the medical faculty and facilities at one of such new centres of hope, First Cardiology Consultants, Lagos, to which I was referred eight years ago by arguably the best hospital in Wari. After due checks, scans and tests, I was told to my relief that I had a good heart and that the referring hospital had probably acted in excess of caution. That was before former Vice President Yemi Osinbajo sought to boost confidence in local healthcare delivery by undergoing orthopaedic surgery to treat a thigh bone fracture at Duchess International Hospital in Lagos three years ago.
So, are the little gains of the last decade now being squandered by such seemingly stark instances of medical negligence as led to the death of Nkanu Esege? Are we condemned to count the bodies of the dead and the maimed in hospitals which cannot be trusted to carry out routine procedures or adhere to the minimum standard of care? I had wondered at the beginning if an impish spirit intent on denying me the frisson of excitement in opening a new book and reading the first sentence ensured the act was preceded by the shocking news of the death of Adichie’s very young child. Not in that plain matter. The plot of Dream Count, as I gather from the vast amount written about it upon publication, is fleshed from lost or unattained loves, the body count of partners that never were, potential mates whose flaws had at first been concealed by desire. It is a narrative conceit I am eager to see how Adichie in her characteristically poised and probing prose unravels. Still, promise and disappointment. As was the case with the Nigerian traffic trade copy of her book that I bought.
When, finally, I unwrapped it and flipped randomly through the pages before reading the first sentence, I discovered that it was a pirated copy. The allure of the shrink-wrapped cover bearing what looks like an upside-down teardrop in shades of orange on a sky-blue background, shown to me through the window of my car on a lightly hazed harmattan afternoon in Abuja, had given a false picture of its physical quality. Just as the highly recommended Euracare which advertises itself as a “state-of-the-art multi-specialty hospital” failed, at least in this tragic instance, to match expectations. I stared at the book on my coffee table. In just half a decade, Adichie has lost father, mother and son. James Adichie, Nigeria’s first professor of statistics, was 88 years-old, and Grace Adichie, first female registrar of the University of Nigeria, Nsukka, was 78. Both passed the biblical three-score-and-ten and had lived well-achieved lives. Grieving for them is out of the heart’s unwillingness to let go of those we truly love, however long they may have been with us. But sooner or later, time unfastens our hands from the necks of our dearly departed parents. Nkanu’s life, on the contrary, had barely begun and so gr0ief is literally over the lifetime he was robbed of, which surpasses the parents’. Slowly, the word nightmare replaced dream. And the parallel became even more unmistakable to me: Adichie’s inconsolable sorrow is our unmitigated national horror.
Ifowodo, lawyer, poet, writer and rights and good governance advocate is principal partner at Remedium Law Partners. He may be reached at [email protected].