The Medical Director, National Orthopaedic Hospital, Igbobi, Dr.Olurotimi Odunubi, in an interview with Ademola Olonilua clears the air on claims made by some of his patients
Some of the patients have complained that they are at the mercy of the nurses whenever they want to defecate once it is past the general time. Most of them said they hold it or defecate on themselves because the nurses ignore them, are you aware of this development?
We have not received such a report but it is possible; we cannot rule out things like that. It may be a one off thing but there are various avenues for patients to complain. If a member of staff, either a nurse or any healthcare worker, is not up to the task he is given and the patient is suffering for it, the patient should make his complaint as promptly as possible either to the most senior nurse, if it is a junior nurse that has done what is not acceptable to the patient. He can also report to the Servicom unit of the hospital. He can report to the team managing him, that is the group of doctors treating him and even in the worst scenario come directly to us or send their relatives to the medical director’s office. We listen to them if they have any complaint but as for this particular complaint, I have not received it in recent times that nurses do not attend to patients. Of course, there might be shortage of nurses, there might be a delay in attending to a patient especially during afternoon or night duties when maybe one or two nurses are available for 34 patients. The same nurse gives drugs so there may be some delay but if it is something that is recurring often, then the patient should complain. There is no way a patient would make such complaint that it would not be looked into but I have not received such recently.
The patients say that they are mandated to pay N1,000 daily for feeding but the food is like prisoners’ food. They complain that the food is stale and half cooked, have such complaints been passed on to your desk?
There is a company that is given the task of preparing food for patients and that is Tetrazini. They are not left on their own; there is a monitoring and quality control committee that tastes the food before they are served to patients. That committee can condemn the food and refuse it being served to patients. That is the first stage of control. When they serve it to patients in the ward, the patients can complain. Once or twice in between, maybe one week or two weeks we have complaints like there is too much salt in the food but not major complaint. This is the first time I am hearing something like the food being referred to as prisoners’ food. I have not heard something like that, but they have talked about maybe too much salt, or that it is at times watery and when such complaints are made, they are corrected. It is brought to the notice of the company and it is corrected. Recently, there have been less complaints about food. The N1,000 is for three meals per day; that is; breakfast, lunch and dinner.
Some of them say that since they do not like the hospital food they would prefer their families to bring food for them from home…
That is not advisable because once a patient is on admission, whatever happens to him on admission is the hospital’s responsibility. If somebody eats food brought from outside and he has diarrhoea, he would say he developed it during the time he was under our care. He would not say that it was the food that was brought from outside that caused the diarrhea. As much as possible, the hospital should be in control of what is happening to the patient while he is on admission. There should be quality control in terms of the food that is served because the food is also important in the recovery of the patient.
Why is it mandatory for patients to buy the meal ticket because they said if they do not buy the ticket, it would be added to their bill?
It does not happen that way. Patients buy the meal ticket and they submit it to the hospital when they want to eat. If somebody buys N14,000 worth of meal tickets for two weeks, if he chooses not to eat tomorrow, then he would not submit his meal ticket; that is the way he shows he does not want to eat tomorrow. If he submits his meal ticket, then it means that he wants to eat tomorrow. If a patient has paid for the meal ticket, then it is with the patient when he wants to eat and the day before, he submits his ticket and he would be served food. We want to serve all patients and if we have 190 patients in the ward only about 120 are eating the hospital food, some are not. Whether they have the ticket and they are not presenting it or they finished the one they bought and they are not buying more ticket. It is not everybody that is in the hospital that is eating the hospital food and they are not fasting. The record shows that they are not eating.
So if they do not buy the ticket, it would not reflect in their bill?
No. Once they pay for food, they are given tickets commensurate with what they paid. Nobody would give them a bill for what they did not eat because they will not be served food if they do not present the ticket. If it is this morning that they are collecting ticket for the day and you don’t present your ticket for food, you will not be served food. That means you have made alternative arrangement for feeding which is part of what we are trying to discourage because we don’t believe those patients are not eating. They are getting food from outside or buying food from whatever source and smuggling it inside despite all the notices that nobody should bring food from outside. The number of people eating does not tally with the number of people on admission. It shows that some patients are not eating the hospital food.
We learnt that the toilet bulb of a particular ward was burnt for over three weeks…
I am not aware of such laxity because there is an electrical unit and bulbs like that are bought in bulk and they are replaced as they are burnt; so it would be unusual for a bulb to be burnt for three weeks and it is not changed unless the nurses there did not report to the electrical unit. They are bought in bulk and are replaced as required by the electrical unit.
We overheard nurses complain that they are understaffed and overwhelmed with work but that the hospital is not recruiting. Why?
This is a Federal Government hospital and there is a procedure for employment. You will have to present your case to the supervising ministry which then passes it to the head of service. You cannot employ until you are given permission to employ. We have made request for employment and we are waiting for approval.
Patients believe that the hospital services are too expensive for a Federal Government establishment. Some believe that if you do not have enough money, you can die in this hospital. Why are the hospital services not subsidised?
Compared to a private hospital, things are heavily subsidised here. Some surgeries that are done here would be done two or three times the cost in a private hospital. The government is subsidising but we have to keep the hospital running and a lot of poor people come to this hospital. We do not turn back emergency cases and we use the resources we have to treat them. Somebody has to replenish those resources or else when patients come next time, they would not be available to them then you will have a hospital where patients would get to the casualty ward and there would be no drip, injection or syringe if we just treat patients and not collect money. Despite all that, the hospital and government policy is that any emergency or lifesaving procedure should be carried out first with what is available, then you can present a bill to the patient after.
We learnt that patients pay about N1,000 to nurses that clean their wounds…
They do not pay to nurses. What the patient is talking about is the dressing pack. When a patient’s wound is to be dressed, there is a package that contains instruments used for the dressing. It comes packaged already from the central sterilising unit. It is that pack they pay for, not to the nurses. The amount you pay depends on how big your wound is; you can pay as little as N500 or as much as N1000 depending on how big your wound is. It is the pack that the patient pays for and he would be given a hospital receipt. It is not a personal payment.
Is it true that doctors hardly make ward rounds during public holidays and weekends and they only come around about twice a week?
That is strange and I am also hearing that for the first time because there are various categories of doctors. If people insist on seeing the most senior doctors every day, that may not happen but there are resident doctors who are supposed to go to the ward every day to see the patients. The hospital is open 24 hours and there are always doctors in the casualty and accident ward to attend to patients.
Is it true that the hospital hardly gives refunds?
There is a procedure for those who have refunds because the money has already gone into the government’s account and to take it out, the person that paid it has to apply. Some people think they can come to the medical director’s office and say, ‘give me a refund’. The money is not in the medical director’s office, it is in the government’s account and a procedure has to be gone through to verify that you paid the money and how much the refund is. Once that is done, they would get their money.
Now that you are aware that the patients are at the mercy of nurses to pass faeces, what are you going to do about the situation?
We would discuss it with the head of nurses; As I said, I have not heard such a report specifically. Since it has been brought to my notice now, I will discuss it with them. The times that I think such may happen could be in the afternoon or night when the nurses are few on the ground but it should not be something that should be delayed for so long lest the patient messes himself up in the ward, I have not heard of such a report.
What are some of the challenges the hospital faces?
They are many and you have identified some of them like shortage of staff and overworked staff, inability to recover bills from patients. Government’s resources are diminishing, so we understand the plight of the government. The overhead they give to government establishments keeps reducing.
For instance in this hospital about four years ago, government was giving about N7m per month to boost the internally generated revenue but as I am talking to you, for this year’s budget, it is less than N3m and things have become more expensive over the years. Power bill alone is over N5.8m per month for this hospital. We spend almost N9m to buy diesel every month to keep the generators running. If government is giving us less than N3m and for power supply alone, we are already spending N15m, you can understand the challenge. We still have other bills like water rate, refuse disposal, buying drugs, etc. but if government subvention is inadequate, the only people we can turn to pay adequately is the patient that seeks the service unless the service quality will continue to go down every day. Beyond that, we are also partnering with the private sector; a lot of philanthropists are helping the hospital. Some people just come and ask for patients that are poor, they give them the names, they look at the bill and pay. It happens once in a while but we need more support from the private sector. Most of the big hospitals you see abroad are surviving on foundations and donations from people that have dedicated their resources to help such institutions, not essentially from the government. We need to do more of that. The only major project that has been sustained over the years was donated by Sir Mobolaji Bank-Anthony since 1985, it is a two storey building. If we have had more donations like that about 30 years after, things would be better. I know that for sister hospitals like the one in Kano, some of the Dantatas and the Dangotes have put up buildings there and they are doing a lot. We are trying to reach out; we need to partner with the private sector to improve the quality of the hospital because the government cannot do it alone.
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