“I banged on the hospital door at 1 a.m. with my daughter screaming in pain” — The difficulty of healthcare access in Nigeria
Editor’s Note: This week’s Thought Leadership Piece recounts the harrowing experience of Nneoma Wokemba, a mother who found herself fighting to get health care for her child in the middle of the night. Wokemba shared her experience on Facebook a few days ago. As we celebrate International Women’s Day this week, her poignant story reminds us that in Nigeria we still have a long way to go towards providing health care for the most vulnerable parts of our populations, especially women and children, the poor, the underserved, the elderly, those with special needs, and those with recurring health challenges. Her story is republished with permission and has been edited accordingly.
Between the hours of midnight and 4 a.m., while most people were sleeping, I was driving around town, looking for medical care for my daughter who was in the middle of a painful crisis. I’m used to this. I’ve done it for years and it has become reflex. I don’t think twice about rushing out in the middle of night. For some reason, that’s when her crises usually begins or escalates beyond what I can handle.”
Nneoma is the mother of two beautiful girls, and works as a legal officer in Enugu. Her younger daughter has sickle cell anaemia, and over the years, Nneoma has learnt to manage this health challenge and put in place checks that will facilitate access to care for her daughter whenever a crisis arises. This time around, she thought her checks were in place as usual and so when her daughter started experiencing a crisis in the middle of the night, she sprang into action. But this time around events turned out differently.
We use a hospital owned by a family friend. The staff have instructions to let us in and administer treatment no matter the time, but they recently changed staff. So this time, no one would open the door. I had her hematologist on the phone. He isn’t a staff of that hospital. However, I couldn’t reach the M.D. of the hospital to ask them to let us in. There I was, standing at the entrance at 1 a.m., alternately honking my horn and banging on the door with my daughter screaming in pain.
The ruckus attracted the local vigilante. I froze as they approached me, looking mean and bearing arms. I couldn’t tell if they were robbers or security people till the first one to get to me asked if there was a problem. The moment they saw the screaming child, they started flashing their torches at the windows of the building and they all began to shout ‘Nurse! Nurse!’ A few moments later, a nurse peeped out of a second-floor window and eventually let us in. I said a hurried thank you, carried my 56kg daughter on my back and ran into the hospital. The nurse later told me that they heard me knocking but were scared to open.”
For a parent, having a child in any kind of pain is traumatizing. Nneoma’s daughter could have had any condition, she could have had an asthma attack, or an epileptic fit, or even simply a running fever, anything that would require Nneoma to seek urgent medical attention. Many families face this reality on an ongoing basis. It is at this juncture that the care and expertise of health personnel can function as a comfort, and this is why patient-centred care is such an important part of any health care delivery system. Were it not for her personal relationship with the hospital’s management, Nneoma would not have been granted access to the hospital so easily. This should not be the case and speaks to the arbitrary nature of healthcare access in Nigeria. She should have been able to drive to any hospital to gain treatment and get help for her daughter. Had the nurses chosen not to respond to the combined cries of a distressed mother and the vigilantes, her daughter’s life would have been held in the balance.
The hematologist came to treat my daughter. When he was setting the IV line, there was a power failure, and the security man who puts on the generator was nowhere to be found. They tried to call him on the phone but they couldn’t reach him so the IV was set using the torchlight from the phones of the doctor and nurse. Power eventually came back after a while. He then prescribed a course of treatment and left us in the care of the nurses. In a little while, the nurses informed me that they didn’t have some of the drugs in stock and I would have to get them. The time was 3.12 a.m. Yours’ truly took the prescription, kissed my daughter who was too delirious to notice and rushed out to look for a pharmacy.
I know of 24 hour pharmacies located in a not so safe area of town. Before I went there though, I had to stop at the ATM. Of course the bank was dark and empty and of course the security men were not in sight but I was on auto pilot. My only prayer was that the machine would dispense and I would not have to go to another bank. It did and I drove to the pharmacy, bought the drugs and went back to the hospital. Time was 4.02 a.m. One of the nurses looked at me as I handed over the drugs and said to me “Madam you’re strong o, driving around town at this time. It looks like your husband travelled”. “Yes” I answered, “He travelled on a very long journey”.
When healthcare advocates in Nigeria talk about drug stock-outs being a problem in the health system, it may sound like so much policy talk. It never quite hits home until it happens to you or someone you love. The thought of a young mother left looking for drugs in the middle of the night while her daughter waits in pain reveals much about the inherent harshness of the Nigerian healthcare system and erodes confidence that those in governance actually have the Nigerian people in mind. The admiration of the nurse that Nneoma, whose husband is late, is “strong” because she is doing all of this alone is heartbreaking. She should not have to do this alone… but like many women around the world, she has to be this “strong” to take care of her daughters. She is also having to fight harder because the healthcare system in Nigeria has failed her, because the governing bodies, the policy makers, have failed her. She is fighting this hard because her country continues to fail her.
Remember I have two daughters? Big sister was home alone and there was no light when we left, so in between all this I was calling to check up on her. I panicked at a point when her phone didn’t go through and I considered going home to pick her up but I eventually got her and she assured me that she was fine. Right now, baby girl is still in pain but stable. Hematologist is back and running tests and just like always we’re going to come out of this one smiling.
“Just like always…” There is a special resilience born out of what seems like continuous unrelenting adversity that makes us as Nigerians find reasons to keep smiling and keep smiling big. But the fact remains that health care access in Nigeria does not have to be this hard, for anyone, despite their challenges, despite their ability to pay, despite their location in Nigeria. It does not have to be this hard. After years of advocacy, the National Health Act is now in place as a law, yet there are challenges with implementation, especially when it comes to funding parts of the Act, such as the Basic Health Care Provision Fund. Also, many Nigerians still do not know that their rights are protected under the law. For example, during medical emergencies, it is illegal for a hospital to deny care because of payment.
Nneoma took away some important nuggets from her experience which we share here in her own words:
- Community support is important: “Being a single mother is hard. Being a single mom of a child with a health challenge is hard. Being a single mom of a child with a health challenge in Nigeria is hard. Please, do me a favour and hug a single mom today.”
- Never give up: “Dear single mom, you are stronger than you know. I’ve heard that you don’t know how strong you are till being strong is your only option. God knows exactly what He is doing. He will never leave you or forsake you. In your weakness, His strength is made perfect. He will uphold you, protect you and your children, provide for you and defend you.”
- There is good in the world: “There are a lot of good people out there in the world. In this journey, you will find that many people will go out of their way to show you kindness. People will be cruel but I have encountered more good than evil. Had it not been for the assistance of the vigilante, I would have ended up in an unfamiliar general hospital and it would have taken hours for her to get any attention.”
She ends with a strong message: “STAY STRONG, DON’T GIVE UP AND KNOW THAT GOD’S GOT YOU”.
For all of us fighting for a better health care system in Nigeria, Nneoma’s story is a strong reminder that there is still much work to be done. We must continue to support initiatives that make our health system better, we must never give up until stories like hers become a thing of the past, and we must always remember that there is good in the world, good that we trust will win the day.
Stay strong… Don’t give up on Nigeria’s health system.
Originally published at nigeriahealthwatch.com on March 8, 2017.