Doctors at work in Idah General Hospital, Kogi state: Misdiagnosis of ailments now a major crisis in Nigeria
By Lanre Babalola
His patient lost a kidney and died but Dr Yakubu Koji was unwilling to admit responsibility when he faced in September a tribunal set up by the Nigerian Medical and Dental Council to try a tribe of reckless and professionally negligent doctors in the country.
According to the tribunal documents, Koji of the Jimeta Clinic and Maternity, Adamawa was charged with gross professional negligence which led to the death of a patient in his care.
He was accused of incompetence in the assessment of the patient and incorrect diagnosis of his illness. To worsen matters, Koji operated on the patient because the patient insisted he should do the operation.
At the tribunal, Koji was told he was negligent in advising the patient on the risk involved in the operation, and also failing to obtain an informed consent of the patient.
At the same tribunal in September, Dr Ikeji Charles of Kefland Family Hospital, Apo Mechanic Extension, Abuja,was arraigned for causing the death of his patient, after surgery for hernia.
Charles was charged with four counts of incompetence and negligence. But like Koji, he also pleaded not guilty.
Regularly, the medical council tribunal holds sessions to hold Nigerian doctors to account and at the end, it suspends doctors found guilty of professional negligence for some months or in rare cases, ban them from practising. The session in September was the third this year.
Minister of Health Osagie Ehanire
One of the doctors recently convicted by the tribunal was Kebbi-based Jamilu Muhammad who erroneously diagnosed that a baby in the womb was dead and then carried out surgery to evacuate the supposedly dead baby. The operation however showed that the baby was alive, but the doctor had amputated the baby’s upper limb as he dissected the mother.
The medical council revealed recently it was investigating 120 doctors for various professional misconduct, while 60 others were awaiting trial at the Tribunal.
Chairman of the medical tribunal, Professor Abba Hassan, right with former health minister, Professor Adewole
Although the tribunal often sanctions the errant doctors, it is debatable if the sanctions were fitting enough for the death of their patients and the anguish this triggers for their families.
Many Nigerians have had unpalatable experiences in the hands of doctors who misdiagnosed their ailments and went on to prescribe the wrong drugs and the wrong treatment. Not many of these patients lived to tell their stories.
Across the country some Nigerians of all classes are dying of common ailments due to wrong diagnosis and drug prescriptions by supposedly trained Nigerian medical doctors.
Wrong diagnosis has become a major and lingering crisis afflicting Nigeria’s medical sector. No wonder, those who could afford it, including the nation’s president and the political leaders, whenever they fall ill, dust their passports and head to Europe, America, Middle East and Asia to seek help.
May be Nigeria would still have had human rights advocate, Chief Gani Fawehinmi alive today, if his lung cancer was detected early. But a Nigerian doctor who examined him said he was suffering from asthma and plied him with plenty asthma drugs. Fawehinmi lamented in the latter part of his life that if his ailment had been correctly diagnosed earlier, he would have taken proper care of himself. He died in 2009.
Gani Fawehinmi: lung cancer diagnosed as asthma
Afrobeat star, Femi Kuti recently tweeted about his late younger sister, Sola, who died due to wrong diagnosis by Nigerian doctors.
Wrong diagnosis has always been a problem in our country.
In 1985, Abudu Razaq, a young student of The Polytechnic, Ibadan complained of severe pains in the lower abdomen and was rushed to the State House Clinic in Marina, Lagos Island. After examining him, the doctors referred him to the then newly founded St. Nicholas Hospital, near City Hall. The team of doctors examined him and concluded that he was suffering from what they called Appendicitis and an operation to cut the appendix was recommended. They opened him up and later realised that the appendix was not ripe enough to be cut. They removed the stones in the appendix and sealed him up— a classic case of misdiagnosis by supposedly well-trained doctors. What if the patient had died in the course of the ill-advised operation based on the wrong diagnosis?
Another case of misdiagnosis by Nigerian doctors is that of Ade Bisiriyu(not real name) a patient with a sleeping disorder who walked into a clinic at Ikeja, Lagos and complained to the doctor that he couldn’t sleep at night. He told the doctor he was urinating five, six times in the night. The doctor took his body temperature, samples of his blood and urine for examinations and gave him some injections (anti-biotic) which he took for five days.
The patient came back to complain that he still couldn’t sleep. The doctor now zeroed on the patient’s age, he was 56 and declared the patient must be having prostate issues. The doctor advised him to go for a scan at a diagnostic facility on Adeniyi Jones, Ikeja. After perusing at the scan result, he concluded that the patient was suffering from prostate enlargement and recommended some drugs.
But rather than abate, the ailment became worse with the patient observing blood in his stool and pains in the anus. He went back to the doctor and the doctor analysed that it has resulted in haemorrhoids caused by acute pile. He recommended drugs again but the drugs fail to provide succour to the patient.
The pains in the anus got so severe that the patient became so confused.
He went to the doctor again and the doctor recommended that he go for another prostate scan and what he called Colonoscopy.
”After this consultation and the doctor’s reaction to my complaint, I knew he has reached a dead end. He has no solution to my problem. He was only interested in the money. I had to seek a new medical advice,” said the distraught patient.
He sought help with a doctor in Ado Odo-Ota, Ogun State. The doctor at the private medical facility listened to the patient’s complaint, asked him to go for an abdomen scan. After studying the result of the scan, the patient was placed on drips in the hospital for a 24-hour observation. Some injections were given and drugs recommended. After weeks of taking the drugs, the pain did not abate. Rather, it got worse. The patient had emaciated considerably and it was visible he was suffering internally.
Dr. T. A. Sanusi, Registrar Medical and Dental Council
The patient went to complain again to the doctor. The doctor conducted further tests and concluded it was cancer of the anus. The patient is still battling with this ailment.
Bayo Onanuga: I nearly lost my leg
In 2006, journalist Bayo Onanuga had a freak accident at home. He fell off a ladder and fractured his ankle. It was a bad fracture, what orthopaedic doctors called ‘pilon fracture’. The right ankle bone was badly shattered.
‘It happened about 5.30 am, as I jumped down from a ladder, that I felt was giving way under me, while changing the bulb In my pantry. I was helped to the General Hospital at Ikeja by a colleague, immediately after.
“At the hospital, an x-ray was done, which confirmed that the ankle was badly broken. The doctor on duty was given the x-ray and then he proceeded to cast my foot in POP.
“I immediately complained about serious discomfort after the POP cast was done: I felt some burning sensation in the sole of my foot. What I felt was beyond pain. My leg was literally on fire.
“I told the doctor, what I was feeling. He said I should bear the pain and gave me analgesic. I took the analgesic and yet the sensation did not subside.
Dr Jonathan Osamor: offers suggestions on helping doctors
“I was lucky, I was stretchered into a LASUTH VIP ward for observation after the casting. As I lay on bed, I kept complaining that my leg was ‘burning’. The nurses on duty could not understand why an adult that I was should be complaining like a baby. I persisted in ventilating my complaint.
“When it seemed they would not listen to me and they appeared not to empathise with me, I peeled off the POP. It was still wet and in minutes, I succeeded in removing it. I instantly felt relieved and I fell asleep, leg raised on a wooden plank.
Some hours after, an orthopaedic surgeon came to check on me. The first question he asked was: “Who put the POP on this man’s leg?” The nurses kept conspiratorially mute.
”And then the surgeon dropped the bomb: “If this POP had remained on this leg for five hours, the leg would have developed gangrene and we would have needed to cut it off.”
”The nurses were too ashamed to say anything. I was right and they were wrong. And the doctor who put the cast, without checking the x-ray was more criminally negligent.
“The surgeon said my ankle needed an operation and because the leg had swollen up, I would wait for one week for the operation to take place.
“I had no choice. I waited. Exactly a week after, the operation was done to deal with the pilon fracture that I had sustained.
“Though the operation was successful, with some metals put inside my leg to allow the broken bone regrow, it came with its own issues. The metals were not properly set. I ended up spending seven months at home, for an injury that should not have taken me off my routine for more than three months.
“In my case, after four months at home in Lagos, without appreciable healing, I had to travel to the UK for assistance. Three months after, I was back on my feet.
I nearly died of pneumonia
Onanuga also shared his experience with another doctor when he nearly died of pneumonia. His doctor diagnosed it as muscular pain.
“On a Saturday morning, one day in 2010, I drove myself to my doctor and told him I had pneumonia.
“He asked me about the symptoms I had. I said I felt breathless when I climbed the stairs. I could no longer exercise because of this. I said I felt some pain in my rib cage on the right and I was not feeling very well.
“He didn’t agree with me that my symptoms spelled pneumonia. Instead, he said what was ailing me was ‘muscular ache’.
“To resolve all arguments, he asked me to go for a scan. I did. The result however did not confirm my own diagnosis. The area of my body scanned showed nothing.
“My doctor said: “I told you so, you do not have pneumonia. You have muscular ache. So he gave me some analgesics.I took the medicine home and used as prescribed.
“By the evening of same day my diagnosis was confirmed by what I began to notice. In the night, I went downstairs in my house to pick something in the backyard and suddenly I was gripped by excruciating pain in my stomach. I crouched and had to maintain the position to crawl back into the house. I was the only one at home. My wife had travelled.
“The following day, I became more alarmed. When I sneezed, the mucus that came out was laced with blood. When I coughed, I also saw blood in my phlegm. These are signs of pneumonia that a senior colleague of mine had experienced. I decided to help myself and Googled the best medicine for pneumonia.
“I wrote it down and went to one of the best pharmacies in Ikeja to buy the drug. I started to use it instantly. Two days after, I decided to seek help, again in the UK.
“I was diagnosed with pneumonia. The scan done by a female Nigerian trained radiologist, now working in the UK, picked up some blood clots in my rib cage area. The doctor said the pneumonia would have killed me and even wondered how I had survived. I didn’t tell him I was on my own self-prescribed medication.
“He gave me the same drug that I bought in Lagos, with an additional one. And he asked me to start using them immediately. About five days after, the pneumonia was clear and I was fit enough to return to my country.
Another case of misdiagnosis by Nigerian doctors was narrated by a female journalist who blamed wrong diagnosis by doctors for her brother’s death.
”I lost my immediate elder brother to the cold hands of death on Saturday, February 25, 2017, due to what I call inconclusive diagnosis. Prior to his death, he was a known Sickle Cell Disease (SCD) patient, and he was well managed by my parents and other members of the family.
“He came over to my parents’ complaining of fever and leg pain, and on Thursday night, he became unconscious and was rushed to the hospital, unfortunately, he didn’t survive the experience. His blood sample was collected and a series of tests conducted on him.
“Initially, he was said to have suffered from stress, which was as a result of insomnia he experienced some weeks before he took ill.Then another result came in on Friday evening that he had a Stroke, and it had affected his brain.
“I didn’t understand what that meant, especially since he could move his limbs, but his eyes were open with him rolling his eyeballs involuntarily; he was neither here, nor there.
“Once the result about the brain stroke was handed to my mum, we were advised to take him for a Magnetic Resonance Imaging (MRI) – a brain scan, to ascertain the depth of the damage caused by the stroke to his brain. This was only done in 2 hospitals in Lagos.
“When his condition became really unstable Friday night and this caused my mum to shout and panic as she sought help for her son, one of the doctors carelessly said that she should not disturb them with her noise as he was going to die eventually.
“After a series of attacks and instability on Friday night with doctors battling to keep him alive, they managed to resuscitate him with oxygen, unfortunately, he passed on Saturday morning.
“He died before midday. Doctors claimed he died from jaundice complications and that confused me the more”, she said.
Fictional Aneurysm
Sumbo Adeyemi, a Nigerian lady in her twenties complained of severe headache all the time. She first went to St Nicholas Hospital in central Lagos, where the doctor she met, after a scan, diagnosed that she had Intracranial aneurysm and recommended a brain surgery for the supposed ailment.
Alarmed, her relations asked her to seek another diagnosis, from another doctor. The new doctor recommended an MRI scan at a Mecure centre in Lekki. The scan showed not aneurysm but another ailment in the brain.
Confused because of two conflicting diagnosis, Sumbo’s family suggested a third diagnosis outside the country.
In the UK, about 12 doctors, who attended to her rejected outright the two conflicting scans done in Lagos and said they could not have been for the lady.
They then told her that her problem was migraine and that it was caused by insufficient sleep and stress. They advised her to stop watching football, among other stressful things. She was then given some analgesics to use.
The lady is married now and has children and the “migraine” had disappeared. What if she had agreed that doctors open up her brain, in search of a non-existent aneuryism?
Certainly, something is wrong with Nigerian doctors such that they keep missing the goal post in diagnosing their patients’ ailments.
Dr Jonathan Osamor of the Oyo State General Hospital, Moniya, Ibadan gave some explanations: .
“For wrong diagnosis to be made, there are so many components. The first important component is clerking, taking down the history from the patient. If your patient cannot explain very well, you may not be able to extract relevant information from him or her. There could be communication barrier, which may occur as a result of the patient speaking one language and the doctor speak another. Your interpretation of the complaint goes a long way. You may misinterpret the complaint. Another component is you physically examining the patient, whether you can elicit any kind of sign from the patient. That is where your own clinical skill comes in. If you are not versed clinically, you may not be able to identify which of the system of the body is faulty.
“The body is divided into systems – cardiovascular for the circulation, chest for respiratory, abdomen and so on. So, if you examine the system and you are not able to elicit information on some signs that will point to where that pathology is, then you fall back on investigations. Investigation also depends on if the patient has the money and if the laboratory facility is adequate. In other words, there are so many components that could go wrong.
“But you see, it supposed to be a team work. The first point of contact is the junior doctor who has to review with his senior. That is the check, the control. But if you have a facility such as a primary healthcare centre or a local government hospital whereby the doctor is all in all, then there is bound to be a problem.
So, it is the fault of the system we are running. There is no funding, there is no policy from the policy makers as to the milestones you can achieve. The point is that when you have a system that is not organised, it becomes chaotic and things like wrong diagnosis and prescription can occur”, Osamor said.
“Take for instance, general hospitals where the staff are not enough. They may not be able to interpret the complaint of the patient accurately. That can lead to wrong diagnosis and of course, that will be predisposed to wrong prescription. So, it is a lot of components that are involved: Patient communication, presentation, the language barrier, your own understanding or level of your experience, how you were exposed and then laboratory interpretation. If the lab is not functioning, you may just prescribe without waiting for laboratory confirmation of the particular complaint the patient has.
“So, it is the fault of the system we are running. There is no funding, there is no policy from the policy makers as to the milestones you can achieve. The point is that when you have a system that is not organised, it becomes chaotic and things like wrong diagnosis and prescription can occur”, Osamor said.
Dr Sulaiman Abiodun, Obstetrician and Gynaecologist at University College Hospital, also in Ibadan largely agreed with Osamor. Abiodun also blamed poor training of medical doctors, work load and poor rewards as the reasons for rampant misdiagnosis.
“When doctors are overworked, there may be a problem. Everybody has a limit. The moment one has gotten to his or her limit, you cannot expect him or her to perform optimally compared to when he or she has not been over stretched. When you are over stretched, stress will surely set in. The system cannot have the best of you again. Also, many doctors do not have adequate sleep due to the enormous and overwhelming work they do. All these factors will affect the efficiency of the doctors or the quality of the services they will render.
Abiodun also identified poor and non-functioning equipment for diagnosis as part of the crisis of medicare in Nigeria.
How can we stem the crisis of misdiagnosis? Osamor again volunteered some suggestions:
“First for all, the policy makers must have a vision that will guarantee a standard practice in the medical industry. The policy making bodies like hospital management board and ministry of health must be determined to do things rightly. There must be political will to make things work.
“Funding is another issue. The government must fund healthcare system properly. A lot of hospitals don’t have adequate consulting rooms. The roof of a hospital is leaking. There is a structural decay. Also, staffing is very important. You must be able to staff and encourage your staff to the level that they are retained.
“So, there is need for manpower, human capacity building, in-service training, seminars, conferences that they should go so that they can be exposed. And of course, remuneration. Remuneration is very important. If the doctors are well remunerated, they will stay in Nigeria and give their best and there will not be issue of brain drain. So, we have a problem of systemic failure. Policy makers should be able to make a lot of difference when it comes to that”, Osamor said.
Like Osamor, Abiodun also stressed the need for training and retraining doctors. Training, he said, is very important to any profession. “To enable doctors receive good training in medical schools, government needs to properly fund medical institutions and adequately provide necessary equipment to train them with. After medical schools, training and retraining is important so that the doctors will not be outdated”.
*With reports by Gbenro Adesina/Ibadan; Olufumilola Olukomaiya & Jennifer Okundia.
