By Gideon Arinze
THE cries of children in the children’s ward repeatedly rise and fall at the Enugu State University of Science and Technology Teaching Hospital (ESUTH), Parklane, in the capital city of Enugu. Nurses garbed in white dresses walk around the ward, catering to the needs of the children. Some of the mothers in the ward hold conversations in groups of two and three. At one end of the room, housing about 15 beds, 10-month-old Chisom Nnamdi fiddles with a book. He just recovered from malaria, which began in March and wants to go home. But he can’t.
His mother, Joy Nnamdi, sits just beside him. Her face forlorn, her head resting on the bed. The hospital management had served her a bill of N92,000 after a 17-day stay at the ward.
But there was a problem.
Since she and her husband bought the drugs and everything needed to treat their son, Nnamdi thought their bill would be 40,000 to 50,000 naira.
“When they brought it, I was shocked. I thought it was for a different family”. “My husband and I had exhausted all the money we had on drugs, drips and Oxygen, which costs 8,500 each,” she said.
Afterwards, when she found time to look closely at the breakdown of the bill, she was shocked to find that N25,000 was included as money for feeding for the 17 days she and her son spent there. That is 1,500 per day and 500 per meal.
However, throughout their stay in the ward, she and her son didn’t eat any of the meals generally served by the ward orderlies because they were always terribly prepared.
Her husband had only been able to raise funds to clear half of the bill, and Nnamdi said she was prepared to stay at the hospital until her husband pays the remaining part of the bill.
“Eating hospital food should be optional,” she insisted. “You can’t force me to eat what I don’t like.”
Nnamdi’s experience is common at ESUTH, where patients and their families are forced to pay for meals that lack nutritional value. After admission, they are told to prepare to eat in the hospital as payment is compulsory.
When patients come to the hospital, some expect to learn how to balance their diet, apart from receiving treatment. But the story is different here. The hospital management prepares bad meals and ensures they pay before they leave.
Most families have had to spend more days inside the hospital, even after being discharged, because they cannot afford the exorbitant bills they are given. These families only pray and wait for Individuals and non-governmental organizations that come to the hospital to help clear patient’s bills.
Across different sections and units inside the hospital, the story is the same. But families hardly eat the food. When it is time to serve each meal, the orderlies — a group of women always garbed in brown uniforms, place the cooler on top of the table and ask individuals to “pass their plates to be served”.
Oftentimes, they carry the cooler from one ward to the other-begging people to eat because they are always rejected. The orderlies know the meals are bad. But for fear of losing their jobs, they always carry the meals around.
Usually, in the morning, watery tea and a small bread are served. It is either beans or porridge yam in the afternoon hours, and in the evening hours, it is Garri and soup. The meals are often recycled.
At the Children’s Ward, five sources interviewed said they purged endlessly after eating the meals. What some of them manage to collect is the small bread. They always go outside the hospital to get food or wait for family members to visit them.
The first time pregnant Amaka Nwobodo tasted yam and beans offered by the orderlies, she purged for three days. That was the last time she collected food. She did not want to risk her health.
Nwobodo had come to the hospital on April 9 with her son, Olisa, who had difficulty breathing. She hoped to get the best treatment and care for her son. But her hopes were dashed.
Her experience in those days when she purged was better imagined than felt. “I could not get myself. The toilet facilities were nothing to write home about. I was afraid of contracting the disease” I was afraid of remaining in the hospital after my son was discharged,” she explained.
To avoid all that, she bought everything she needed outside the hospital.
According to a study conducted by the World Health Organization, WHO, Nigeria has one of the most inefficient health systems in the world. This is partly due to poor hygiene conditions, most common in public health services often overcrowded by those who cannot afford the out-of-pocket costs for private health services.
A collaborative Survey conducted by WeBelieve Health and NOIPolls Limited revealed that most Nigerians (53%) visited public hospitals, (43%) visited Pharmacies, while only (34%) visited private hospitals.
This is even with a universal health insurance Scheme- a public health system established to provide universal coverage. The ability of the system to provide free and good quality healthcare for the entire population has been limited.
This is making life difficult for the estimated 40 per cent of Nigerians living below the poverty line of N137,430 ($381.75) a year.
Pushing for change
Leonard Onuchukwu was determined to change the narrative.
When the native of Amechi Awkunanaw in Enugu South Local government first heard that families of patients were being asked to pay for the food they don’t eat, he thought it was all a joke. He ignored it.
He and his wife, Uchechi, had brought their daughter, 1-year and three months old Daniella, to the hospital on 10 April after she started stooling and vomiting. They had returned from Abuja for the burial of his father-in-law.
Onuchukwu became interested when one of the orderlies serving the meals walked into the children’s ward, begging families to collect food.
“What she was serving was jollof rice she had brought from another ward where it was rejected. But she continued, and when she got to one of the women inside the ward with the food, the woman asked why she (the ward orderly) was forcing people to eat,” he said.
The orderly said the food was meant for some families in another ward who said they were not interested. When she was asked to eat the food, she refused and said it was not good enough.
Onuchukwu was disappointed when he took a closer look and saw what the woman was serving. He said he only saw grains of rice that looked like they were only coloured, without necessary ingredients. “I could not believe my eyes,” he said.
Irked by what he had seen, Leonard told the orderly that he would not pay and that he had been buying meals outside the hospital all this while. But she insisted that he would pay since everybody was paying.
When she left, women inside the ward began to complain about how bad the meals were and how they had a running stomach when they tried to eat.
Onuchukwu quickly picked up his phone and called the hospital’s hotline to complain about what was happening. But he was told by the worker that picked the call that it was an established policy of the hospital.
“She said I was the only one who has complained about the practice and that I was only wasting my time by calling to complain, “he said.
As soon as he said he would not pay for the food and was ready to take up the hospital management on the matter, the worker hung up the call.
“Even if it meant going to the police, I was ready because I can’t pay for service they did not render. It is unheard of. Eating hospital food should be optional,” he said.
Because he was a civil servant and only recently came back from Abuja, Leonard quickly asked his wife to request the transfer of their baby to a hospital in Abuja. Tension was beginning to brew at this point.
“We decided that we would take her to the University of Abuja Teaching Hospital and told one of the doctors, and he prepared a reference letter for us. They prepared the bill,” he continued.
When he received it, the amount was N29,500 for the four days he had spent with his wife and daughter.
Out of that amount, he was charged N6,000 for food. He was also charged 10,000 for utility — electricity and water, which is N2,500 daily. There were 2,000 for children’s consumables, 7,500 for daily stay, 2,000 for out-patient-department cards and 2,000 for admission fees.
Immediately, he went to the Cash Office and questioned why he was being asked to pay for the food he did not eat. He was told by the workers that there was nothing they could do as the management had taken the decision.
He asked to pay other bills. But they refused and insisted he must pay the whole amount. Unwilling to pay the money, he came back to the children’s ward and asked his wife to prepare so they could leave the hospital.
Immediately they got out of the ward; they were stopped by security men who said they would not leave the hospital unless they cleared their bill. Soon, Onuchukwu began an anti-food protest, raising his voice for everyone to hear.
I could not imagine myself paying for the food. It was a clear case of extortion, “he said.
Other women in the ward soon joined, too. That attracted the attention of visitors at the hospital and patients in other wards who questioned the decision by the management to enforce their food on patients.
Soon, police officers arrived and took Leonard and his wife to the Abakaliki Road police station. The Divisional Police Officer, DPO, asked them to return to the hospital and settle their differences.
The hospital management had invited the police to quell the situation.
Back at the hospital, the chief security officer, CSO Fidelis Onuduagu, met with the Chief Medical Director, CMD Hycienth Onah, who ordered that the bill for daily feeding be waived for Onuchukwu. He finally paid N21,500. He had paid N2,000 earlier.
Onuduagu said it had been a rule in the hospital that whether patients admitted to eating the meals offered to them or not, they must pay.
“The food given to patients is not healthy enough. Many people have been complaining, “But there is nothing we can do. We have to obey the hospital management,” he said.
Part of what families are asked to pay for is the utility bill- light and water. But hanging on top of the wall, inside the ward, is a television set that did not work while this reporter was at the hospital. Sources interviewed also said it had not worked since they were admitted.
Not all families are as bold and fortunate as Leonard. It is a different story for such families who can’t speak up as the hospital management is determined to keep extorting money from patients.
A new twist
Five days after Onuchukwu and his family left, nurses came to the children’s ward to inform parents that the hospital management has asked anyone who is not interested in receiving their meals to fill a form, detailing why they don’t want to eat and wait for an appointment with the chief medical director.
Sources interviewed, however, said they filled the forms, but nothing changed.
“Some of us went, but the Chief Medical Director said our reasons were not genuine enough and that we just have to pay,” Chioma Ozioko, who left the hospital one week after she was discharged, said.
Ozioko had spent 15 days in the hospital with her five-month-old son, Kachisicho Ozioko, who was admitted with Sepsis which caused him to stool and vomit. When her bill came out, it was N83,100, out of which she was billed N22,500 for feeding per day.
She had other bills to clear, such as utility, children’s consumables, daily stay, emergency cases card and admission card. But what was most worrying for her was the bill for food which she said she did not eat all through her stay.
“I am breastfeeding. I could not have eaten that poison and fed my son so he would become sick again. I had spent everything I had on medication. On Oxygen alone, I spent N34,000,” she explained.
Ozioko also spoke of how one of the workers at the hospital, who would not want to be mentioned for fear of victimization, alleged that CMD Onah had a target given to him by the Enugu State government.
“He does not want to stop extorting patients because he is supposed to make returns to the state and also have his share out of it,” Ozioko, who only left the hospital one week after they were discharged, said.
Mba left three weeks after he was discharged.
When Gabriel Mba got a bill of 128,000 from the hospital, he was troubled with the thought of how to clear the money. What was most worrying for him was that he would have to pay N42,000 just for food.
He and his wife, Ijeoma, had spent four weeks at the hospital after their child, Dominion, was admitted with a seizure. Like every other family, Mba did not eat the meals served. He always went outside the hospital to buy everything they needed.
“I came to the hospital with N50,000. But I had already spent everything on food, drugs and oxygen used in treating my son. And now, I have this bill to clear”. I don’t know what to do,” an enraged Mba said.
After they were discharged, Mba said they spent three weeks inside the hospital because he could not afford the bill. “It was one day when we were inside the ward that a certain man came and helped us clear the bill, “he said.
He said he would have remained in the hospital.
Culture of negligence
Apart from the fact that patients are made to pay for the food they don’t eat, there is a deep-seated culture of negligence at the hospital.
Onuchukwu recalled how he and his wife were badly treated when they first got to the hospital at 6:45 pm that Saturday with their daughter.
Staff told the couple that the man assigned to give the hospital card was not around. Leonard and his wife had to move around in search of him. He was eventually found discussing with fellow workers. He had left his duty post.
“He asked us to pay 2,500 for the card. We paid and got the card,” Onuchukwu said.
But when they got to the emergency ward and called the attention of doctors and nurses around, no one responded. They only got attention at 9:30 pm when one of the doctors came and wrote a list of drugs for Onuchukwu to buy. Uchechi became a bit okay after she took some of the drugs that night.
But she started stooling and vomiting the next morning again. This time, her condition had gone worse. Leonard had left the previous night and asked his sister to come and stay with his wife at the hospital.
When he came back the following morning, his wife was crying. His daughter was left unattended.
“She was dying before my eyes. She was losing strength. As my wife cried, I begged the doctors and nurses. But they couldn’t respond till it was 2 pm,” he recalled.
Angered by the negligence, he asked that his daughter be discharged so he could take her elsewhere. “They gathered and started begging me to calm down so they could give me attention. They gave me attention immediately, and my baby began to recover,” he said.
He also spoke of how a certain family rushed to the emergency ward that same day, carrying their baby and shouting that she had bullet wounds. Armed robbers had attacked them.
The parents had wounds too. But that of the baby was more critical and needed urgent attention. When they came in, shouting that they had been attacked, the doctor said there was no space.
“When he said there was no space, I became weak and imagined my child in that condition. It could be anybody’s child. That was when I realized that negligence was a character in that hospital. How can a doctor that swore to save lives tell a baby in an emergency that there was no space”?
Chief Medical Director declines comment
When contacted for his reaction to the allegations, CMD Onah said he doesn’t speak to journalists.
“No comments. I don’t talk to Journalists,” he said.
Nnamdi finally left the hospital two weeks after she was discharged. But that was after some group of individuals helped clear her bills.
