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IJAW COUNCIL FOR HUMAN RIGHTS (ICHR)
DECEMBER
2003
HEALTH FOR SALE:
DEEPENING ROT AT THE
FEDERAL MEDICAL CENTRE, YENAGOA, BAYELSA STATE, NIGERIA
ICHR,
2003
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CONTENTS
1.
Introduction
2. The Historical Background
3. State of Medical Facilities
4. Cost of Health Care
5. HIV Screenings without Consent
6.
Privatization of Power
7. Recommendations
8. Appendices
Acknowledgement
This report was written by Patterson
Ogon, Founding Director, Ijaw Council for Human Rights
(ICHR).
ABOUT ICHR
The Ijaw Council for Human Rights
(ICHR) is a policy advocacy non-governmental organisation. Founded in 1998, ICHR
strives for the promotion and advancement of human rights in the Ijaw region of
the Niger Delta, Nigeria.
For over 200 years, the Ijaw have been victims
of organised assaults perpetrated by unsympathetic corporations and governments.
This remains true of the slave era and the period of palm oil trade as it is of
the present when the global economy is driven by oil and gas.
There is
now irrefutable evidence that oil which was first discovered in Nigeria at the
Ijaw community of Oloibiri has endangered the Ijaw environment. On the
political, cultural and economic fronts, the Ijaw are under threat. It would
seem as if all that the Ijaw - the largest ethnic nationality group in the Niger
Delta and the fourth in Nigeria - did all along was to accept these indignities,
without resistance and struggle. That impression is false. It is not the
evidence of our memory. The heroic resistance of the Ijaw led by Isaac Boro and
before him King William Koko and King Jaja among others easily come to mind.
ICHR is founded to build upon this rich history of commitment to social
change. By promoting human rights in the Ijaw country, we believe we are
contributing to the advancement of democracy and human rights in Nigeria, Africa
and beyond.
ICHR derives its inspiration from Ijaw history, culture and
politics. Our work is rooted in local and international human rights charters,
including the African Charter on Human and Peoples' Rights. Specifically,
Article 22 of the Charter says that:
All peoples shall have the right to
their economic, social and cultural development with due regard to their freedom
and identity and in the equal enjoyment of the common heritage of
mankind
ICHR exists to:
i) clearly and sharply articulate and
promote the rights of the Ijaw to self-determination, resource and environmental
control and sustainable development;
ii) encourage human rights education and
training in the Ijaw country.
STRATEGIES
ICHR's work is
conducted in the following ways:
i) education and training of members of
the Ijaw society, especially its women and youths for progressive social
change;
ii) action-oriented research emphasising the possibilities of
alternative political, economic and social futures;
iii) human rights
campaign and advocacy.
PROGRAMME AREAS
ICHR work is organised
around three key programmes, namely: Peace and Social Justice; Environment; and
Economic Justice.
The Peace and Social Justice Programme comprises activities
to strengthen the advocacy capacity of the Ijaw civil society; design and
implement strategies to resolve conflicts; monitor governance and promote gender
sensitivity in public policies.
The Environment Justice Programme consists of
a consolidated campaign on the negative impacts of the extractive industry in
the Ijaw country.
The Economic Justice Programme is concerned about issues of
trade and development, especially the consequences of globalisation on the Ijaw.
The programme aims to work with other civil society groups in Nigeria, Africa
and beyond to promote a people-driven alternative to the regime of the World
Trade Organisation (WTO) and other trade liberalisation
policies.
STRUCTURE
ICHR is a democratic organisation with
membership built around the programme areas. It is governed by a Board composed
of eminent academics, professionals, NGO and social movement activists.
CONTACT ADDRESS:
Ijaw Council for Human Rights
(ICHR)
#10, Ibaa Street; Off Okomoko Street;
D-Line; Port
Harcourt
Rivers State, Nigeria
Tel: 0803 705 5301
E-mail:
izonchr@yahoo.com
INTRODUCTION
…acquiescence in or even
silence before the violation of sacred professional ethics, the service by
medical men of any goal but truth for the service of humanity, can lead to
dishonour and crime in which the entire medical profession of a country must in
the last analysis be considered an accomplice.
- Andrew C. Ivy, American
Physician testifying at the Nuremberg Trials in 1949
The health sector is
one important aspect of our daily life. It does not only sustain society by
providing cure to our ailments and succour to our pains. It also stands at the
centre of all human development. The age long held cliché of a "healthy society
being a wealthy society" drives home the point.
The importance of health in
reproducing humanity for higher responsibilities has created the need for those
who fall sick to find cure in hospitals. Similarly, the medical profession has
achieved a huge public appeal, honoured with the phrase "a noble profession".
This is evidently so because it is a trade driven more by an abiding call to
save lives than anything else. While profit does not attract prime placing,
service delivery and the will to ensure sustenance of our lives are pre-eminent.
If we take these to be true with the Federal Medical Centre (FMC)
Yenagoa, capital of Bayelsa State, Nigeria, we shall be doing grave injustice to
society. There is a deepening rot at the Medical Centre, so far the only visible
federal establishment in Bayelsa State. This 60-bed hospital which was upgraded
to a 100-bed hospital recently has some of the poorest and unimaginable
facilities in the heart of the Niger Delta and is indeed a sad advertisement of
the level of decay of social and essential services in Nigeria.
This
report, "Health for Sale: Deepening Rot at the Federal Medical Centre, Yenagoa,
Bayelsa State, Nigeria" is an exposition on the issues which have made a health
institution of referral status a glorified dispensary. The report takes a
detailed look at the establishment of the Federal Medical Centre, the
frightening state of health care delivery, the near absence of facilities as
well as the brazen sacrifice of moral and professional ethics by its management
on the altar of greed and exploitation of the sick. In 2002, our findings
revealed, the management of the hospital increased some charges by a scandalous
one thousand per cent. Medical staff, piqued at the development, have pointed
out that this is the most expensive government health institution in
Nigeria.
ICHR findings also indicate that beyond all these, are cases of
professional misconduct of screening patients and staff for HIV without consent.
Our curiosity led us to piles of yellow laboratory request forms ordering
retroviral screening between June and October 2002 with irreconcilable
handwritings. This is indicative of the fact that the examining physician in all
cases never approved the requests.
The management has also demonstrated
a dictatorial grip with a penchant for flouting statutory rules both in its
disciplinary approach, even of very senior officers.
Our investigations
revealed that retroviral screening carried out by the laboratory department was
surreptitious and indiscriminate and at the instance of the medical director,
Dr. K.K. Imananagha. He has also at different fora gleefully announced the
growing number of HIV cases in the hospital, much to the consternation of the
National Association of Resident Doctors (NARD), who for the basis of direct
contact with patients needed to be primarily aware.
The Ijaw Council for
Human Rights (ICHR) is publishing this report for the following reasons:
· To draw the attention of the federal government to the pitiable state
of health facilities at the Federal Medical Centre, Yenagoa. This should be the
only place where the poor can seek excellent health care at minimal or no
cost.
· To bring to the notice of both the Medical and Dental Council of
Nigeria and the Nigerian Medical Association unethical professional acts by some
of its members in clear violation of the principles and codes of medical
practice as declared in Geneva in 1948. It is clear to us that he pursuit and
practice of medical excellence is dependent upon sound ethical principles.
· To campaign for a drastic review of the medical charges, which has
turned the hospital, undoubtedly into the most expensive government medical
facility in Nigeria. A large segment of our population is poor and can ill
afford the expensive medical treatment offered at the hospital.
Adequate
checks should be initiated to monitor untoward and sharp practice by management
of the hospital as healthcare delivery appears anchored on profit.
The ICHR
hopes by this report to add to the corpus of viewpoints on the state of our
health institutions and help to redirect the social thinking and behavior of our
public officers.
2. HISTORICAL BACKGROUND OF THE FMC
The
Federal Medical Centre (FMC), Yenagoa was established in 1999. It had served at
various times as General Hospital and later Specialist Hospital.
At the
creation of Bayelsa on October1, 1996 the Specialist Hospital was the only
existing health facility of reckoning, at least, in name. In July 1999, the
Federal Government moved to convert it to a Federal Medical Centre. The decision
not to establish its own functional institution to cater for health needs
attracted mixed reactions from the generality of the people. Questions arose
bothering on the appropriateness of the take-over of the only existing
institution. The agenda people thought should have been to increase people's
access to more health facilities, not to deprive the already weary population
the options of comparative medical facility of choice.
Proponents of the
take-over had reasoned that it would be a quicker way of drawing federal
attention to the miserable state of health care delivery, which had been
worsened by a polluted and denuded environment arising from "the crude business
of crude oil".
The Hospital's Management Board, Ministry of Health and
the Bayelsa State Government all stood opposed to the conversion. They voted for
the establishment of a new medical institution as against the take-over. In
light of the stiff opposition from both the State government and the medical
institutions in the State, the Federal government made efforts to access the
General Hospital Okolobiri. Other options that were considered included the
General Hospitals at Ogbia and Odi. These efforts drew blank as the structures
never met the expectations of the federal team. Under these circumstances, the
then Specialist Hospital was conceded to the federal government.
There
was however a twist. The Governor, Chief D.S.P. Alamieyeseigha almost
immediately reverted the new FMC to its former status. Not resolute in this
decision, probably for good measure, the governor succumbed to intense pressure
and gave in. The State government reasoned that allowing the FMC take off will
substantially reduce its monthly wage bill as more indigenes of the State will
for the purpose of the conversion, become employees of the federal government.
Besides, the presence of the Federal Government shall be felt by way of
a tertiary health institution.
On or about September 1999, there was an
exodus of medical officers at the medical centre. This development left behind
only four highly placed medical officers and fewer junior ones. The nursing
section was not anything better.
The reasons, ICHR findings revealed,
was the fear of lack of promotion among nursing staff, a perception ascribed to
federal institutions.
The exodus was also propelled by the appointment of
Dr. Kobina Imananagha as Medical Director. Dr. Imananagha had earlier served as
Commissioner for Health during the military dispensation. Close sources say he
exhibited unsavory imperial tendencies to his professional colleagues. As the
mass movement never appeared to abate, appeals came from all corners, including
the Federal Ministry of Health that staff of Bayelsa extraction should remain.
Federal officials argued that even though it will be easy to employ people from
far and near to fill vacant positions at the hospital, it certainly will defeat
one of the very essences of creating the Federal Medical Centre, which is the
employment of its indigenes.
Undeterred, more staff moved on. Among these
were a Physician and Nephrologist who left to head the Okolobiri General
Hospital, a position he held until sometime last year. The Chairman, Medical
Advisory Committee, a Surgeon and second only to the Medical Director also
transferred his services to the State Ministry of Health. This surgeon took over
the headship of Okolobiri General Hospital from the nephrologist. The exodus
became so alarming that it prompted the State Government to put a stop to it.
Sources revealed that His Excellency gave the directive following a petition
from
Imananagha to the State Governor accusing the then Honourable
Commissioner for Health, Dr. Tarilah Tebepah, of being responsible for the mass
exodus.
Beyond all these, expectations were high and this was a source of
joy to generality of Bayelsans. Fees were moderate and affordable. Medical staff
exhibited diligence and great enthusiasm in the discharge of their duties. There
were hunches though; facilities and equipment were near absent.
The
circumstances of the take-over notwithstanding, there were a considerable
comfort that the dearth of equipment and facilities were teething problems
associated with new institutions and that it would disappear with time. How
wrong people were.
Curiously, the internally generated revenue of the
hospital rose dramatically from an all time low of about N30, 000.00 to One
Million Naira monthly at the initial take over time. It is said that the
facility generates over Three Million Naira at present.
3. STATE OF
MEDICAL FACILITIES
Public concerns about the state of health care
delivery in Nigeria are alarming. Besides limited medical facilities, there are
sharp and unethical practices by a section of medical practitioners. For a
people who have sworn to uphold ethics of the job, this is a particularly
dangerous dimension to health care principles.
The worry and
apprehension is heightening. These concerns are not misplaced. Neither are they
figments of anybody's imagination. They are simply fall-outs of the perilous
circumstances that health administrators have forced on those in search of
medical attention on a daily basis.
The apprehension simply recalls the
grim and vivid picture of Nigerian hospitals described by General Sani Abacha,
Nigeria's late maximum ruler, in a coup broadcast on December 31, 1983 in the
now famous cliché "mere consulting clinics". Tragic as the situation was,
indications were, it could worsen. And indeed it worsened
.
By official
records, there were 105 health centres in Bayelsa as at 1995. These we are made
to believe constituted of the following:
i. 9
general hospitals
ii. 34 rural health clinics
iii. 6 Leprosarium
iv.
56 health clinics
Current records lay claims to the existence of
180 comprehensive health centres. These claims are spurious and do not truly
reflect the realities in the various communities in the state. It can not be
said to be the picture desired by an already weary population in need of succor.
Communities located in isolated creeks and rivulets are even farther from health
care delivery.
At the FMC, the state of facilities is alarming. Medical
administrators have failed to improve the services and facilities in the
hospital. The situation, inside sources revealed to the ICHR, worsens every
passing year. These are few of the highlights.
(a) Water
The
FMC does not have an independent source of water supply. Whenever the public
water supply is interrupted, which are not infrequent, services at the hospital
are crippled. The situation is worsened by the lack of water storage facilities.
ICHR findings revealed that this situation has led to cancellation of
several surgical operations. Sadly, women in labour are sometimes told to bring
along with them several litres of water in cans. In other cases, patients are
moved to buy sachets of water for medical personnel for washing purposes after
attending to them. Water vending is a common sight in Yenagoa, the state
capital. Our fear is anchored on the sources of this water, as they may not be
pure for human use. The use of contaminated water for surgical purposes can
possibly complicate health matters and our medical practitioners should have
known better.
b. Equipment
Inside sources are of the view that
the Federal Medical Centre generates at present over Three Million Naira
monthly. It also receives an overhead of between Two Hundred and Fifty Thousand
Naira (N250, 000.00) and Five Hundred Thousand Naira (N500, 000.00) monthly from
the Federal Ministry Health.
Internally generated funds are meant for
the upkeep of the hospital. There is no remittance of such funds to the Federal
Ministry of Health. One would generally believe that in view of the state of
facilities, attempt would be made by the management of the hospital to equip it
with quality and up-to- date facilities in medical science. Much as the state of
facilities is shocking, it is our belief that this is the result of a
demonstrable lack of commitment by managers of the hospital. Some of the
specifics are as follows:
i. Use of unsterilized Instruments in
Casualty Ward
In the casualty ward, medical staff confirmed the use of
unsterilized instruments in suturing and dressing of wounds. They attribute this
situation to the availability of only one set of such instruments. This
development is worsened by the absence of sterilizing units and the
unwillingness of the hospital management to procure them. We fear that this is
an open license in the spread of deadly diseases including HIV to unsuspecting
patients.
ii. Labour Ward
Findings by the ICHR revealed that
only one set of delivery equipment exists in the hospital. If there are 2 or
more women in labour at a time, the instruments are simply used in turn without
sterilization. This again puts our women and babies at greater risk of
contracting deadly diseases including HIV.
There are also no functional
suction machines in the casualty, labour and theatre. Worst still, there is no
oxygen in the hospital. Any sick person needing oxygen to survive simply dies.
Several complaints by medical personnel in the hospital have been futile.
iii. Special Care Baby Unit
The Paediatrics Department of the
Federal Medical Centre runs a Special Care Baby Unit. ICHR findings revealed
that this programme is being run without a Consultant paediatrician. Headed by
the wife of the Medical Director, a Russian and medical doctor, hospital staff
maintain that in certain cases, four babies are put in the same incubator. This
act raises the risk of spreading infections. Medical practitioners are alarmed
that it is scandalous for a hospital to have a special baby care unit run by a
non-paediatrician. By medical norms, such a unit should be headed by a
neonatologist or at worst a paediatrician.
STAFF
CONCERNS
Complaints about the state of working environment at the FMC
have attracted little attention. As voices grew, especially from various
quarters including patients with whom they have direct contact, the Association
of Resident Doctors (ARD) at the hospital set up a committee.
In a memo to
the Medical Director dated October 24, 2001, they wrote:
We, the
primary stakeholders in the health care delivery system in Yenagoa and Federal
Medical Centre, Yenagoa, in particular believe that the primary aim of the
hospital is to adequately cater for the health care needs of our patients, while
maintaining and upholding the dignity of our noble profession, as our training
demands.
The memo went further thus:
Following complaints from
various quarters especially from patients with whom we always have direct
contact, about the declining state of things in the hospital, a committee was
set up by the ARD to verify such claims and where possible proffer basic
workable solutions.
The Association of Resident Doctors (ARD) in their
observation drew the attention of the hospital management to the fact that "it
is important for the medical doctor to take all necessary precautions in safe
guarding the life of patients while discharging his duty and not making the cure
of the disease more grievous than the disease itself". They regretted that "in
the absence of functional suction machine, doctors and nurses had helplessly and
painfully watched children die of what they call meconium or liquor aspiration.
This for them had become a burden especially because these patients labored to
carry these pregnancies for nine months.
Parts of the observation of the
committee in their report were the unavailability of installed emergency lights
in the casualty wards. They fear that power failure may impair continuity of any
procedure in the absence of emergency lights. In view of these and many others,
the ARD urged the management to critically examine the issue they had raised
with firmness and decisiveness. ICHR feels saddened to state that the situation
has worsened tremendously.
4. COST OF MEDICAL CARE
Social
control in the area of medical charges is not novel. Given social understanding
of human differences attempts at organized social conducts has become the norm.
In many parts of the world, there is a focused attempt at improving quality of
health care delivery at reduced cost without limiting access and equity.
About 4000 years ago, the Code of Hammurabi was set out as one such
aspect of social control in charges by medical professionals. The principles,
which arose from the codes, specified eight articles upon which those in medical
practice could levy charges.
In view of our peculiarity, we wish to draw
on items 5, 6, 7 and 8 respectively of the codes on factors that should be
considered in medical charges. These include:
i. Equipment and establishment
running cost
ii. Time involved
iii. Locality where the practice is
carried out
iv. Cost of living
On April 18, 2002 the management of
the hospital in a memo, released a new set of medical fees for patients. These
charges, which internal sources say shot up by an incredulous 1000 per cent
never took into consideration, the pitiable state of equipment and facilities
and the debilitated state of healthcare delivery.
Nor was the peculiar
environment of impoverishment and dispossession of Bayelsans factored into the
exorbitant medical rates. In Bayelsa State, there is penury and starvation
occasioned by the lack of an industrial base, the civil service status of the
state and most fundamentally by the devastation of our rich agricultural base by
transnational corporations involved in the "crude business of crude oil" These
have compounded health problems and created room for the sick to look at the
direction of quacks and unorthodox medical practitioners.
Concrete
examples of the criminally high cost of health care at the FMC include the
following:
In the obstetrics and Gynecology department, patients are
charged N12, 500.00 for caesarian operations. However, an additional charge of
N2000 meant for normal delivery is still slammed on such patients. Patients are
made to pay for services not rendered.
Patients are made to pay a casualty
admission deposit of Two Thousand Naira (N 2,000.00). Out of this, Six Hundred
Naira (N600) is charged on drugs. Various sources revealed that money charged
for drugs are never used as patients are made to buy their own drugs after
prescription. In cases of surgery, patients are made to buy their consumables
even after the hospital has charged them for the items.
Other sources
say that when a patient sees a medical doctor, the person is made to pay another
N600.00, half of this money represents an "Emergency Nursing Service" and the
other half "Emergency Medical Service". Medical practitioners insist that no
such term exist in any other government owned or even private clinic in the
country. What is known as consultation fees are charged through the purchase of
a hospital card. At the Federal Medical Centre, consultation fees are charged
along side a nebulous term of "Emergency Nursing Service" and "Emergency Medical
Service".
Hospital sources reveal that most patients are only willing to
take their prescription away as drugs at the hospital pharmacy are most times
more expensive than in other pharmacies within and around Yenagoa. On this
realization, the management of the hospital instructed the attending physician
in casualty ward to hand over all prescription notes to the nurse on duty who
demands for receipt of payment of Six Hundred Naira before such prescription are
given to patients.
The reviewed charges also show that admissions into
the casualty department rose from Two Hundred Naira (N200.00) to Two Thousand
Naira (N2, 000.00) for adults and One Thousand, Two Hundred Naira (N1, 200.00)
as deposit for children. This did not qualify the patient for any sort of
medical care, except the bed space. This also excludes the card fee of Three
Hundred Naira (N300.00).
Deposits in open adult male/female ward are
Three Thousand Five Hundred Naira (N3, 500,00), while the children ward is Two
Thousand Naira (N2, 000.00). Children are charged Five Hundred Naira (N500.00)
daily, while adults pay Eight Hundred Naira (N800.00) in the wards. This does
not also include another Three Hundred Naira (N300.00) once paid for
consumables.
Suturing of the smallest laceration in the Casualty Ward
attracts a fee of Two Thousand Naira (N2, 000.00). The amount here excludes cost
of purchase of drugs, gloves and injectables. It is not uncommon therefore to
find patients who having struggled to pay deposits especially in the casualty,
end up signing against medical advice due to financial constraints.
The
FMC Yenagoa, once a beehive of clinical activities has become a ghost of its
former self. The casualty ward that used to be filled to capacity resulting in
rejection of patients for lack of bed space now boasts of empty beds in a great
number of days in the week. Only seriously ill children on blood transfusion and
terminally ill patients are seen. ICHR sources reveal that the Medical Director
has at different times ordered staff to pray against the devil at the FMC gate
preventing patients from coming to the hospital.
Findings also revealed
that while patients pay N300.00 for in-patients folder, receipts reflect N150.00
for emergency card. Most people are never admitted and therefore do not need an
in-patient folder. In spite of this, the extra charge of N150.00 for un-admitted
emergency patients is never refunded.
The ICHR is aware that our lives
still run on 24 hours daily. However, at the accident and emergency unit of the
hospital, we were pained to find out that charges are in most instances not
based on the first 24 hours of admission. Against the norm, if a patient is
admitted in the hospital at 10.00 pm for instance, his bill should cover him
till 10.00 pm the following day. Quite on the contrary, patients are charged for
two (2) days instead of the initial deposit. Our understanding of this kind of
charge is anchored on the reasoning that because a new dawn breaks from 12
midnight, the patient is presumed admitted for two days anytime beyond 12
midnight
The Federal Medical Centre, Yenagoa charges N800 daily per bed
space. From our investigations, the following charges are obtainable in other
Teaching Hospitals.
a. University of Benin Teaching Hospital N420/night
b. UPTH - N3000.00, first 14 days
c. UCH - N300.00/night
d. UMTH -
N150.00./night
We wish to stress that the charges are criminal, inhuman
and only reflect the hospital as a commercial enterprise. The FMC Yenagoa,
appears undoubtedly the most expensive government medical institution in
Nigeria.
We regret that this hospital at the heart of an impoverished
population is an institution of plunder and rape on sick and poor people.
5. HIV SCREENING WITHOUT CONSENT
"The rights to information,
informed consent and respect for a patient's anatomy are well accepted". Recent
epidemiological surveys show that the south- south has reached an explosive
level in the prevalence of HIV/AIDS. Part of the dilemma associated with this
dreaded disease, first discovered in 1986 in Nigeria, is the level of
stigmatization that goes with it.
Modern medical practice is founded
upon the Hippocratic Oath known in current terms as the Geneva Declaration
adopted at the 2nd World Medical General Assembly in September 1948.
The
Hippocratic oath (Geneva Declaration) states inter alia that "I WILL NOT PERMIT
considerations of age, disease, or disability, creed, ethnic origin, gender,
nationality, political, race, sexual orientation or social standing to intervene
between my duty and my patient". Elsewhere it further states "I WILL respect the
secrets which are confided in me, even after the patient has died".
A
great part of the medical community here and else where has handled the HIV/AIDS
pandemic with levity. It only reveals how un-informed some medical professionals
are about the AIDS scourge vis-à-vis the ethics of their profession. There have
been reports of HIV patients being refused medical attention, even in government
hospitals. Surgeons even deny them surgical intervention in life-threatening
situations. This situation has encouraged Voluntary Confidential Counseling and
Testing (VCCT) even in ante-natal clinics. The availability of anti retroviral
drugs in cases of pregnancy has helped reduction in Mother-To-Child-Transmission
(MTCT).
It is the view of experts that VCCT will greatly reduce the
prevalence of HIV/AIDS as proper counseling is the key to realistic living, even
in the most hopeless of situations. A properly counseled person will therefore
not help in propagating the disease. He /She may rather help in propagating the
message.
On the other hand, accidental information on a person's HIV
status could be damaging to the individual. It could also portend great danger
to society generally. In extreme cases, such a person may either commit suicide
or go on a "distribution mission". It was therefore a shock when staff of the
hospital discovered that for over a year, staff and patients were being secretly
screened for retro-viral status without their consent. There were no pre-test
and post test counseling. Well over a year, a patient lay ill at the hospital.
He needed a pint of blood, which was never forth coming. Eventually he
approached a staff for donation. As expected, the staff was scared because he
was not sure of his/her HIV status. When he expressed his fears, the laboratory
scientist assured him that he was negative. It turned out that the said staff
had gone to the laboratory department a day earlier for malaria parasite test
and had been tested for HIV as well!
The above example is only one of
the several cases of involuntary screening and a clear demonstration of
professional misconduct. We wish to state that it amounted to unethical
professional conduct on the part of the medical director to order for mandatory
HIV screening as part of pre-employment medical examination of staff, even for
those who had been in the employ of the hospital for between 6 months to 3
years. ICHR findings revealed that an order was given to the coordinator of the
laboratory services of the hospital by the Medical Director to have blood
samples of staff collected for pre- employment medical test to be screened for
HIV without their consent and without the examining physician's directive. The
Medical Director was to be informed of the result and a copy kept in the file of
the member of staff in the administrative department. Also, the results
submitted to the attending Physician who also expressed shock at results he did
not order for. For some strange reasons, ICHR was told these results are not in
the medical files of staff, which is meant to contain all such records. ICHR
could not confirm if the Chief Medical Officer in charge of staff medical care
made any formal protest relating to this matter, as is expected of him.
In Bayelsa State, recent epidemiological surveys keep the prevalence
rate of HIV/AIDS at 7.2 per cent. This means that for every 14 persons, at least
1 person has the virus. It is therefore not a surprise that 11 persons have
tested positive in the hospital. As the rumour of infected staff took over the
premises of the hospital, others hurriedly stopped their medical examination.
Besides, they were being made to pay for it with their monies ranging from N2,
500.00 - N4, 000.00 deducted at source. We wish to add that this is in clear
violation of the Federal Civil Service Rules, Chapter 9 Section 1, Paragraph 3
which states inter alia: "every person selected for appointment either temporary
or in a permanent capacity shall be required to present himself for examination
by a Government Medical Practitioner (or one so approved by Government) with a
view to it being ascertained whether he is physically fit for service. Unless
otherwise provided in the offer of appointment, the fee for such an examination
shall be paid by the Federal Government".
Following the non response of staff
to do the medical test, internal memos addressed to individual staff were issued
by the administration department, requesting such staff to go for their medical
and that such staff were to compulsorily do a HIV screening amongst other
things. (see attached document).
It is on record that the Medical and
Health Workers Union of Nigeria (MHWUN) as well as the Association of Resident
Doctors (ARD) acted promptly by asking the management to desist form such
malpractice. They went further to boycott the 3rd anniversary of the Federal
Medical Centre.
ICHR feels concerned that on the basis of this, some
staff were unofficially threatened to leave the employ of the hospital because
they were HIV positive. Besides, the level of ethical decadence and professional
misconduct is alarming, especially in the laboratory unit of the hospital.
Officials of the Administrative Department know the medical history of any staff
that uses the medical outpatient department.
From the position of the
International Labour Organization (ILO) Code of Practice on HIV/AIDS and the
world of work, there should not be discrimination against workers on the basis
of real or perceived HIV status. This is in order to create room for decent work
spirit and respect for human rights, and also for the dignity of persons
infected or affected by HIV/AIDS. Essentially this is because discrimination and
stigmatization of People Living with HIV/AIDS (PLWHA) are the bane to promoting
its prevention.
According to the ILO, HIV screening for purposes of
exclusion from employment or work processes should not be required of job
applicants or persons in employment. This is not the case at the Federal Medical
Centre, Yenagoa.
6. PRIVATIZATION OF POWER
The Federal Medical
Centre, Yenagoa is a public enterprise. It should be run in accordance with the
rules and procedure of the public service. However, power at the health
institution has been privatised to the advantage of the medical
director.
6.1 Internet facility/Mobile phones
Sources reveal
that on or about July 2003 the director acquired an Internet facility for the
medical centre but sited it in his official residence. As at the time of going
to press with this report, no office in the hospital has been connected to the
facility. Only recently, he spent over One Million Naira (N1, 000,000.00) in the
purchase of mobile phones for some heads of departments and selected nurses.
This is a clear case of misplaced priority for a hospital that can ill afford a
water storage tank.
6.2 Paediatrics Department
Indications are
to the effect that he has made his Russian wife the Head of Paediatrics
Department even though she is not specialist in the field. The wife is also
overseer in all of the Casualty Department, store and kitchen. She is also
chairman of the entire hospital revolving fund.
It is the view of the ICHR
that no person is so endowed as to perform all the above-specified tasks in a
federal institution in an era where qualified manpower parades the street in
search of employment.
It was also revealed to the ICHR that during his
tenure as Commissioner for Health, he prevented the Head of the Health Systems
Fund from travelling oversees. This was a trip sponsored by the World Health
Organization. He was accused of sitting on the file until he left with the exit
of the military because his agenda of sending his secretary along failed.
6.3 Discipline of Staff
We wish to note that under public
service rules, a disciplinary committee should handle matters relating to staff
misconduct. However, the situation is such that the power to discipline and even
interdict has been privatized. For reporting late to work, a medical doctor was
punished with half salary for two consecutive months. This punishment was meted
out without following the due process. Consequently the whims and caprices of
the Medical Director have thus become the service rule in the hospital.
We hasten to add that under the Federal Government Public Service Rule
04103 (as revised on January 1, 2000), the Federal Civil Service Commission has
delegated full disciplinary powers to Permanent Secretaries and Heads of
Extra-Ministerial Departments in respect of officers on salary Grade Levels 01 -
13 with the exception of the power of dismissal which falls between Grade Levels
01 - 06.
Sometime in 2002 the Medical Director ordered for an internal
audit of staff, unauthorized by the Federal Ministry of Health, in which he
demoted a great number of staff, especially those who were in his bad books.
This exercise led to many a staff losing one grade level or several steps in the
same grade level. At the time this resulted in wide protest amongst staff.
Close sources say the Medical Director told affected officers not to
protest. However, they could appeal. Should they protest, he said their case
would be like the resource control suit, which the Supreme Court ruled in favour
of the Federal Government. Undoubtedly, Management was likened to the Federal
Government and the staff the State.
We wish to stress that a "government
hospital should render social and essential services meant to assist the
people". To turn a government hospital into a profit making institution without
the benefit of quality services is morally and ethically wrong.
The
Federal Medical Centre, Yenagoa, is a boiling pot with a sealed lid. We hope we
can pull it steps away from the precipice.
RECOMMENDATIONS:
In view of the above, the Ijaw
Council for Human Rights (ICHR) demands as follows:
1. Government should
make it a matter of urgent attention to equip the hospital both in terms of
personnel and facilities, considering the harsh terrain and attendant deplorable
health care services in Bayelsa State.
2. The Federal Ministry of Health
and the Medical and Dental Council of Nigeria (MDCN) should properly investigate
and prosecute the Medical Director of all allegations of professional misconduct
leveled against him with the overall motive of safeguarding our health
institutions from further abuse. ICHR is aware the Association of Resident
Doctors petitioned the MDCN on account of this gross professional misconduct,
which was later withdrawn because of mediations and pressures from certain
quarters. We believe this withdrawal was ill motivated and improper. We
therefore restate that the MDCN should as a matter of honour and urgency reopen
this matter.
3. The Board of the hospital should be dissolved having
shown gross incompetence in serving as a check on management.
4. The
immediate removals of the Medical Director on grounds of gross incompetence,
professional misconduct and abuse of public office.
5. The hospital
should ensure relief for those who have suffered hardship with in respect of the
surreptitious HIV screening every effort to commence anti-retroviral treatment
if necessary at the expense of the hospital.
6. Employment of people
with professional management experience in the management of the hospital. The
present administrative machinery has shown incompetence in guarding the excesses
of the Medical Director, particularly on matters of staff discipline in
accordance with public service rules.
APPENDICES
1.
Medical certificate of fitness. Internal memo to staff of the FMC.
2.
Sample copies of HIV test illegally obtained without consent of patients.
3. So called "Approved" charges for 2002 IN-PATIENTS".
4. Letter
from the Medical and Health Workers Union of Nigeria to the Medical Director,
Federal Medical Centre, Yenagoa.
5. Letter from Association of Resident
Doctors to the Medical Director, Federal Medical Centre,
Yenagoa
Outside Back page
"We, the primary
stakeholders in the health care delivery system in Yenagoa and Federal Medical
Centre, Yenagoa, in particular believe that the primary aim of the hospital is
to adequately cater for the health care needs of our patients, while maintaining
and upholding the dignity of our noble profession, as our training
demands."
-Association of Resident Doctors (ARD)
Federal Medical
Centre, Yenagoa
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