– North’s biggest hospital now a shadow of its old glory
– We’re struggling to survive – Hospital’s management
Sola Ojo, Kaduna
During its glorious era, Ahmadu Bello University Teaching Hospital (ABUTH), located at Shika road, Zaria, Kaduna State, was the pride of Northern Nigeria. The region’s first and leading federal Teaching Hospital was for many years training ground for young medical doctors and other specialists.
However, in recent time, the situation at the medical facility is a far cry from the ideal. The Teaching Hospital, suffering from inadequate medical facilities, is gradually falling into decay, becoming, according to many observers, a mere consulting outfit.
Established as Institute of Health in 1968, and transformed into Ahmadu Bello University Teaching Hospital in accordance with statute 15 of the University Law (Amendment Act Schedule 16) by the former northern Nigeria government, ABUTH’s primary objective is the provision of facilities for training of doctors, nursing and other medical personnel. Half a century later, the once prestigious hospital has become a shadow of its former self. Many even opined that it has become an institution living on its past glory.
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Some of those who patronized the hospital in recent months have been critical of the quality of services rendered there. One of such critics is Dr Yakubu Ja’e, Director, Khulataur Rashiduun Foundation and Secretary, Daawah Committee, Shika District.
He expresses his concern over the poor state of facilities at the hospital to Saturday Sun. “The environment is dirty, not befitting of a hospital of this status… an unhygienic environment where people urinate and defecate indiscriminately especially on weekends because virtually all the essential services operate at zero level. Everywhere is terribly smelly.”
He supports his comments with a personal experience. “I took my father to a therapist in the hospital. Unfortunately, about five minutes into the work, there was power failure and that was it.”
He expresses dismay over the non-availability of basic equipment one would expect in a hospital of such a status. “Ordinary scanners that are available in private hospitals are not available. You have to be referred to private hospitals or 44 Army Reference Hospital in Kaduna.”
He also complained about cleaners using ordinary water to clean up the wards. “For about a week we spent there, we had to pay out of our pocket for the disinfectant used to clean the area we were. For five days, there was no water to use either in the toilet or in the mosque,” he says. Dr Ja’e calls on all concerned stakeholders, especially the federal government, to save the institution from total collapse.
A view from the inside
Professor Lawal Khalid, the Chief Medical Director (CMD) of the institution was not around when Saturday Sun visited at the hospital on a fact-finding mission. However, when contacted over the phone, he directed Professor Adamu Ahmed, Chairman, Medical Advisory Committee (CMAC), to speak on behalf of the institution.
According to the CMAC chairman, the Teaching Hospital’s struggle to survive is due to dwindling fund from the federal government in recent times. The ‘fund drought’ has made it difficult for the hospital to meet up with the ever-increasing demand for medical services by its multi-dimensional patients.
Ahmed gives an insight to the hospital’s humongous patrons and the medical corps that serves them. “This Teaching Hospital is the primary health and referral centre in Northern Nigeria. We receive patients from neighbouring states and countries. We receive patients frequently from Niger Republic. So we have a very high density of patients. In terms of staffing, such as doctors, nurses, laboratory scientists, we have highly technically-trained staff. Their level of ability, competence, is very good. Our doctors and consultants are highly specialized and well trained. We have a large number of residents who are undergoing training in special specialties.”
Staff deficit and dearth of equipment
He continued by spotlighting the problem areas. “Unfortunately, we are seriously short-staffed. In the past three to four years, we have not had any opportunity for a major recruitment of staff. Those staff that left the system, those that retired, those that died, we are yet to have the opportunity to replace them. Year after year, the number of staff drops lower. This is putting serious pressure on the staff currently around. The same thing is happening in administration, accounting and other units.” He hints of ongoing “arrangements with relevant ministries so we can do some recruitment.”
A second problem is the availability of medical equipment, and the situation is equally grim. Using the institution cancer treatment department as an example, the picture Ahmed paints is one of systematic neglect that in the end usually leads to institutional collapse.
According to Prof Ahmed: “ABUTH is a centre of excellence for the treatment of cancer in the whole country. By implication, this institution is supposed to be the most important centre for treating cancer in the country––that is in theory. As we speak, the reality is that basic facilities for the treatment of cancer are not available here.”
He describes how such a deficit impact on the hospital. “Let us begin with the diagnosis. To do that, you need highly skilled technical staff. The staff that will do the work are available, but equipment as simple as CT scan is not available in our institution. The one we have been using was provided sometimes around 2005. We have been repairing it over and over again. Now, it is not economically wise to repair it again. It has permanently shut down. So, we don’t have CT scan as we speak now. That means any patient that requires a CT scan has to be sent to another place and the nearest place is Kaduna.
“The other equipment, Magnetic Rational Imaging (MRI), frequently breaks down. We would repair it but after a while, it will break down. These highly technical equipment require regular servicing. We have been using our own for a long time and they have already outlived their usefulness.
“For treatment of cancer, you either do radiotherapy or you do surgery. People that will do surgery are available, but at a stage you cannot do surgery for patients. The only option is radiotherapy. This radiotherapy equipment has been breaking down––and it is the only functional equipment in the whole country––because it’s overworked Unfortunately, it has [now] broken down.”Ahmed however expresses hope that “we will get a radiotherapy machine soon.”
Unpaid workers and colossal electricity expenditure
Prof. Ahmed also clarifies the issue of poor hygiene frequently raised by patients and their relatives.
The news is equally disheartening.
“For the past five years, the federal government has proscribed employment of security men, gardeners and cleaners in the hospital. The services are contracted to private companies. We call them outsourced services. Their salaries usually come from the Federal Ministry of Health. Unfortunately, for the past 18 months, the ministry has not released any money for these people.
So, we owe them indirectly, though, in reality, it is the ministry that owes them. For this reason, their morale is low and some of them do not even come to work. At the end of the day, we have to find a way out on our own with the little money we have and that is why we can still have some of them around.”
Electricity is one of the biggest hurdles before the hospital. “Now, that is one important problem,” says Amed.
He explains concisely: “We have 12 big generating sets, each capable of 200 KVA and usually, about eight of them are working at any point in time. We rely on Kaduna Electricity Distribution Company for energy but when that fails, we complement with our generators.
“However, there are some departments we cannot link directly to the public power supply due to its epileptic nature. Those departments, are permanently on generators because they have sensitive equipment. For example, in the radiology department, we start the generator from Monday morning till Friday afternoon because of the equipment there.”
While the public electricity supplier charges the hospital an average of N10 million or N11 million per month, Ahmed avows that: “In addition, we buy between five and six million naira fuel to power those generators every month.”
The figure contrasts sharply with the hospital’s monthly revenue. “But the total overhead for the hospital in one month is five million naira––sometimes we stay two to three months without getting it. You can see that we are really struggling to survive,” says the CMAC chair.
High volume patients vs high mortality record
On the complaints of the hospital’s high mortality rate, Prof Ahmed waves it aside as untenable and instead offers an insight.
“We receive a lot of patients and one of the reasons for that is because we have the expertise. The second reason is because we are the cheapest teaching hospital in the country. A patient card is obtained at N200, and we don’t charge children for card. Our consultation is free of charge. Caesarian Section in our hospital, as at today, is N40, 000. There is nowhere you will get it less than N150, 000 in Zaria. In Kaduna, people pay between N200, 000 to N500, 000 for CS. Unfortunately, the public erroneously believe ABUTH service is expensive and consequently, patients will not come to the hospital until they have tried different hospitals. Before such patients finally reached our hospital, they have exhausted themselves, spent huge money. And they often arrive here in a terribly state; a medical condition that could have been easily treated here in the first place, would have been complicated elsewhere before coming here––and when the patient’s condition is complicated, other hospitals try to get rid of him. So, in reality, the patients that died here were usually directed to the hospital at the last moment because the people that initiated their treatment knew they were going to die. And, of course, our institution is the last hope; we cannot reject them, no matter how bad their condition is, even if they do not have money. That is what gives the wrong impression that people come here to die. That impression is absolutely not true.”