Is PPE scarcity in Nigerian hospitals causing death of non-coronavirus patients?

It was around 11 am on Tuesday, April 21 when Mrs. Deborah Oluwadero was rushed to the Ekiti State University Teaching Hospital in Nigeria’s southwest region. Diabetic and hypertensive, she sometimes suffered from fluctuating blood glucose.

According to her son, John, who himself is a pharmacist, on few days before his mother’s passing, her blood glucose, began to fluctuate. It rose to 33, 45, 254, 180, and by April 21. It had risen to as high as 358.

ESUTH is the largest public hospital in the town of Ado-Ekiti where she resided. So, it was the obvious choice for treatment when her children realized they could no longer manage the case at home.

“On getting to the hospital, my mum who at that time had stopped talking, and expressing difficulty in breathing was denied admission at the accident and emergency department, because she was not putting on nose mask. The health workers had fears that her emergency is probably COVID related.”

In Nigeria, scarcity of PPEs in public hospitals is putting the lives of health workers at risk with at least 113 healthcare workers confirmed to have been infected with COVID-19 as of April 30, according to Nigeria’s health minister, Dr. Osagie Ehanire.

Unfortunately, in Nigeria hospitals where the shortage of staff is already putting pressure on healthcare workers, a paranoia is building. Doctors would rather stay off patients when they do not have the proper protective equipment.

That paranoia, John believes, led to the death of his mother. In a case that has generated controversy in the country and has elicited a response and investigation by the governor of the state, John said his mother was left unattended for at least 73 minutes.

John said when the staff of the hospital later summoned the courage to attend to his mother, other factors like scarcity of supply – another problem bedeviling the Nigerian health sector – came into play. By then it was too late.

“Upon her admission, a patient who at this time was gasping for breath was only provided IV fluid, and when her breathing worsened, they brought an empty oxygen cylinder which could not last for 2 minutes. It was after this she died,” he said.

In response to this case, Ekiti State Governor Dr. Kayode Fayemi said he had ordered an investigation into the case. He added that preliminary reports from the hospital management suggested that there was no shortage of oxygen or PPEs in the hospital. This is a response many have criticized for not reflecting the reality in the hospital.

The governor said, “I am convinced that contrary to the report you got, there were no deliberate acts of negligence in the management process. From her case file, she was attended to by 11:05 am. That was within 35 minutes of her leaving home to present at the Emergency Room, including travel time, going by your timeline.

“My findings also showed that all patients coming to EKSUTH and other hospitals in the state, whether at the outpatient clinics or any of the admission points, are all checked for any symptoms to indicate their current status before admission. This standard, non-invasive procedure is not an indication that the patient is considered a COVID-19 case but rather to determine the level of self-protection the team should adopt.”

However, one thing is certain, no accusation or counter-accusation can help bring the deceased back to life.

There have been similar reports in different parts of the country since Nigeria recorded its coronavirus index case on February 27.

An example is this case reported in this tweet:

It has been impossible to confirm the details of this accusation as the family declined to speak with the press when they were contacted.

But in another case, a 40-year-old man, Nwachukwu Alagbu, accused doctors of the University of Nigeria Teaching Hospital in Enugu State of neglecting his wife for fear of the coronavirus.

The victim, 35-year-old Nkiru reportedly developed a cardiovascular disorder shortly after her last child less than two years ago.

Nwachukwu said after many months of relief from her ailment, his wife had been having challenges such as fever, breathlessness, chest pain, morbid weakness and loss of appetite since January 2020 but had been to a few hospitals until she was referred to a diagnostic clinic on April 14, 2020.

Unfortunately, all the symptoms exhibited by Nkiru are similar to those experienced by COVID-19 patients. But at the diagnostic clinic, Nwachukwu said it did not take long for a consultant to refer her to a cardiologist as all tests pointed to a cardiovascular disease.

Alagbu said “My wife and I had not traveled outside Enugu and Anambra states in the last five years. We had never come in contact with anyone diagnosed or suspected of having COVID-19.

“I took her to the UNTH, that was where the worst happened. A doctor came and from a prescribed social distance asked a few questions. Quickly, he concluded that it was a case of COVID-19.

“Within a short while, after the doctor made that COVID-19 proclamation, all the medical personnel disappeared. No one bothered to come close to her while she was lying in the car helpless.

“I have never felt so incapacitated like this since I was born some 40 years ago. I saw my wife die like a foul in a hospital, and the doctors turned their backs on her and walked away without pity or compassion. it took the Chief Medical Director of the hospital to attend to her personally and certify her dead after the sick had been in the hospital for hours without the desired attention.”

Nwachukwu said the earlier health workers who had earlier attended to his wife had not PPEs.

 The management of UNTH declined to comment on this case.

Commenting on this trend, President of the Nigerian Medical Association, Dr. Francis Faduyile, said it is reasonable for any healthcare worker who does have the needed protective equipment to work with to stay away from the patient at a time like this because “every patient is a potential COVID-19 case.”

Faduyile said the fact that doctors are at their duty post is enough to show that they are ready to work but that it is the duty of the state governments to provide protective equipment to enable doctors and other health workers to do their jobs.

He said, “Health workers also have families. If you bring a patient in who is bleeding, do you expect doctors to treat such patients when I do not even have gloves?

“We have seen the results of many doctors not having PPEs to work within the number of them who have contracted COVID-19 in Nigeria. Staying away from the threat posed by potential COVID-19 cases is not paranoia, it is simply what happens when the government has refused to do the needful of providing PPEs.”

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