12-year-old Bilya was unable to continue with physiotherapy for a spinal injury when the lockdown was announced

Since the COVID-19 pandemic Nigerians have faced different challenges access healthcare for non-COVID-19 issues. Our reporter looks at how everyday people are navigating some of these challenges.

Adie Vanessa Offiong

Bilya, 12, and his 11-year-old brother, Iliya were involved in a road accident in August 2019 in Katsina.

Iliya had multiple injuries. He damaged that part of his penis (urethra) that conducts urine from the bladder to the outside. This injury healed with subsequent blockage of this passage now refers to as urethral stricture. He also sustained injury to his hip with the joint forcefully pulling apart (hip dislocation). The accident also left him with a ruptured bladder and now dependent on a catheter.

Bilya sustained a spinal cord injury which has left him bedridden with urinary and faecal incontinence and confined him to the use of pampers till date.  For their widowed mother, Talatu Haruna, 34, it is an indescribable pain seeing her two young sons in this state.

“Iliya and Bilya were both discharged in December from the hospital to recuperate. Iliya was at the General Amadi Rimi Specialist Hospital, Katsina, where he had three surgeries and Bilya, had two surgeries at the Orthopedic Department of the General Hospital, Katsina.

Talatu explained that, “Iliya had bladder surgery but still cannot urinate without a catheter, a tube passed to the bladder to drain urine. This catheter has to be changed fortnightly at the hospital to prevent infection. This however, has not been possible since the lockdown.

“My older son Bilya, was undergoing physiotherapy every two days following discharge but stopped abruptly, due to the COVID-19 pandemic.”

An April 8 circular with guidelines for hospital operations in Katsina

A special urological investigation (SUG/RUG scan) was prescribed for Iliya after two months of his surgery to determine the success of the surgical intervention.  The scan carried out in February revealed that, the surgery was unsuccessful. He was scheduled for another surgery in April; the fourth surgery, which was cancelled following the lockdown announcement.

In Ekiti, Anthony Falana, 90, slipped and fell in the bathroom in January. An X-Ray done at the State Teaching Hospital, Ado Ekiti, revealed that, he had broken the left neck of his femur. He was immediately hospitalised.

His son, Martin-Mary said, “In mid-February, four weeks into what should have been a 14-week admission, we were advised to take him home, because doctors were going on an industrial strike action. Soon after, COVID-19 set in and we became too scared to take him back to the hospital, because he is in the vulnerable group.”

Falana has been confined to his bed since he was discharged and is currently being treated by traditional bone setters (TBS) and a live-in nurse. The TBS massage him daily with hot water and administer medicines prescribed in the hospital.

The ability to access affordable, quality, healthcare during the COVID-19 pandemic, has become “a matter of life and death,” the International Labour Organisation, has said.

According to two policy briefs by the UN labour agency issued in May 2020, in developing countries, the pandemic has exposed lapses in social protection coverage. The ILO said these could compromise recovery plans, expose millions of people to poverty and affect global readiness to cope with similar crises.

Shahra Razavi, ILO Social Protection Department Director, said, the pandemic is a wake-up call which has shown that a lack of social protection not only affects the poor but also exposes the vulnerability of those who have been “getting by relatively well.” This is as medical charges and income loss, can easily destroy decades of family savings.

There is also the story of Osas Ajayi, 66. She was diagnosed with breast cancer in January 2020 and had a mastectomy in March in Benin City, Edo State, after which she was discharged to go home to Warri, Delta State. Her state of health took a down turn in early June, but she was unable to go back to Benin City to see her oncologist due to a ban on interstate travels.

After about two weeks of trying, her daughter Magdalene, said, “We were eventually able to take her to Benin City on June 16 after putting money together to hire a car and pay a police man to travel with us, so that we would not have too much trouble with the mobile courts on the way.”

Ajayi went into a coma shortly after, and died on June 22.

L-R A much younger Bilya and Iliya

Talatu, Iliya and Bilya’s mother who is also a primary school teacher on a ₦24, 000 ($61.94) monthly salary, it has been a struggle meeting her children’s medical bills. With the mounting medical bill and out-of pocket treatment prevalent in Nigeria, she soon ran out of money.

Fellow parishioners at the St. Martin De Porres Catholic Church, Katsina, helped raise money with which her children were treated, before churches were shut down due to COVID-19.

“I’m back to square one,” she said, “but for God’s mercy.”

Falana’s son, Martin-Mary said, his father’s medicines are quite expensive. “Before the lockdown, my elder sisters sent them from the UK, but not anymore because the borders are closed. We are now buying them for ₦120,000 and he needs two packets every month.”

Talatu said they had returned to the General Amadi Rimi Specialist Hospital, where, “we met two doctors on call and told them we needed to change Iliya’s catheter. They told us point blank that they were not working. I told them we had his surgery at their hospital and couldn’t go elsewhere for aftercare. They told us to go to another hospital because of coronavirus. In fact, they disappeared afterwards, even though we went wearing our masks, gloves and carrying sanitiser.”

Parishioners have once again come to Talatu’s aid. One of them, a medical doctor now goes to change Iliya’s catheter at home.

Kawu advises that Falana be taken back to hospital for expert care

Public Health specialist, Dr Akin Osibogun shared his thoughts on the challenges that Nigerians are having to deal with because of the pandemic, and the need for health workers to be cautious.

He explained that, with this kind of pandemic there will be panic on all sides, with everyone including medical personnel fearing for their safety. This is especially as, “we have a pathogen of high consequence that is highly infective.”

“This will have implications for patient care because non-COVID-19 patients will have challenges accessing health services.”

Osibogun, advised that, from local to state and federal government, more awareness should be created amongst health professionals.

He said, “If there is not enough sufficient knowledge on how to protect themselves, health workers are at risk. And once they feel they are at risk, they would rather not want to touch patients.”

The ILO advises policymakers against a tunnel vision approach on COVID-19 which could reduce the ability of health systems to respond to other conditions that kill people daily.

The UN agency calls for urgent, short-term measures to close the coverage gaps – which, would result in public health support, poverty prevention and the promotion of rights to health and social security.

Dr Philip Ekpe, Secretary General of Nigerian Medical Association said that while there are various complications and complexities, that are leading to the difficulty in the management of patients during the pandemic, he may not entirely agree that hospitals are turning patients away, especially as this is not happening in the Federal Capital Territory where he works.

Ekpe said, “I go round and I have not seen where patients are being turned back. I go round and I have not seen where patients are being turned back. The only thing is, most hospitals are insisting you wear your facemask before you come in. Even if you come in a coma or other conditions, the doctor is already wearing a facemask or PPE and will attend to the patient. Sometimes, the relatives of the patients need to be further investigated to know the exact situation.”

He explained that, “The only thing is, most hospitals are insisting you wear your facemask before you come in. Even if you come in a coma or other conditions, the doctor is already wearing a facemask or PPE and will attend to the patient. Sometimes, the relatives of the patients need to be further investigated to know the exact situation.”

Dr AdulJalil Umar Abdullahi, General Manager of the Katsina State Hospital Services Management Board signed a circular dated April 8 and titled, “General Guidelines on decongestion of hospital to control spread of COVID-19.” The circular with reference number KHSMB/GM/XXXVOL.I, was addressed to “All Medical Directors/Medical Officer i/c” stating eight guideline they were to follow. The sixth guideline said, “Postpone all elective surgeries.”

The Katsina State chairperson of the Nigerian Medical Association (NMA) Dr Nafiu Mohammed explained that surgeries like those of Bilya and Iliya fall under this category because they are not emergency cases.

Talatu’s brother-in-law, a priest in Sokoto, bought a physiotherapy machine which he had been unable to send to her due to the lockdown. When Bilya developed an infection a doctor family friend, had to smuggle his sample to the lab to ascertain what kind of infection it was.

With the ease of the lockdown, the Orthopaedic Department of the General Hospital Katsina has not admitted Bilya because of manpower shortage, to continue his care.

Since December when Iliya had surgery, he has been using catheter. His brother Bilya is not walking and has developed bed sores. He has also been using pampers since the accident, because he can’t control his urine and faeces.

“Their situations are worsening daily,” Talatu said.

High Chief Anthony Falana

Orthopaedic Spinal surgeon, Dr Ahidjo Kawu explained what the delay in Bilya’s and Falana’s treatments could mean for them.

Kawu said, “Bilya’s case is that of a complete spinal cord injury following road traffic injury. The critical time for help is within the first 24 hours of injuries. It is this time that decompressive surgery with or without stabilization of the spine would have helped.”

He said, “Falana’s injury dramatically increases his risk of death due to his age.  Older adults have a five-to eight times higher risk of dying within the first three months of a hip fracture. It is even worse that he will not be on his feet and the risk of pulmonary embolization leading to death is also a contributory factor to death. Now that you have added treatment by a traditional bone setter, it is riskier.”

Kawu advises that Falana be taken back to hospital, “because the longer he stays in bed, the worse his leg will become. He needs to get expert care as quickly as possible.

“Iliya can have urethral reconstruction which is readily available with many experts who can attend to him.”

Speaking on Bilya’s case, he said, “Few centres in northern Nigeria can boast of a spinal team on call who will do such lifesaving surgery within such period.  Now that he has passed the emergency phase, he will require an institutional rehabilitation which is not available in our country.”

As a way of remedying the challenges the like of Talatu, currently face, the ILO proposes that policymakers extend sickness benefit coverage to everyone, According to the agency, this should also include increasing benefit levels to ensure they provide income security, speeding benefit delivery and expanding the scope of benefits to include prevention, diagnosis and treatment.

This report was facilitated by the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under its COVID-19 Reality Check project.