Ekiti state Governor, Kayode Fayemi responded to an open letter addressed to him by the son of a resident of the state, Mrs Oluwadero Deborah Bolanle, who died at the Ekiti State University Teaching Hospital in Ado-Ekiti the state capital.
Dear Dr. Kayode Fayemi,
Exactly 12:31pm on Tuesday 21st April, my Mum went to be with the Lord at the Ekiti State University Teaching Hospital (EKSUTH) Ado-Ekiti, accident and emergency department.
For us as a family, we have found strength in the assurance of her eternal rest, and so we rather rejoice for a life well spent on earth, and her transition into eternal life.
Even as we rejoice, I personally find the need to address issues around her passing particularly as it relates to our health system and most importantly, share some insight that will strengthen our health system in Ekiti State, particularly during public health emergencies — like the one we are currently experiencing.
I am the last child of my family, and the only health professional — a pharmacist, hence my close follow up on the well-being of my mum. My mum is both diabetic and hypertensive and she adheres strictly to her therapy.
Few days before her passing, her blood glucose began to fluctuate from 33, 45 (I advised her to take glucose), and then on the following day it went on high to 254, 180, and on the morning of her passing, it was 358. That very morning as I was informed of her high blood glucose, I immediately informed one of my senior colleague who is a director in one of the state government health agencies. He helped rush my mum to the hospital.
This should be between 10:30am to 11am. I am based in Ibadan, and the lockdown made it impossible for me to travel to Ekiti even as of when she began to make her complaints.
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. My senior colleague, however, explained to them that her case is a diabetic emergency, and he has been monitoring her treatment over the years.
My mum was left in the car outside the A and E for about 50 minutes before she was finally attended to.
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.
Less than 10 minutes to her death, my eldest brother who was with her at that time recorded a video of her gasping for her breath and sent to me. At that time, it was the most annoying video I have ever seen in my life, but after her death, it became the most precious video in my life right now.
I can’t understand why a patient gasping so heavily for her breath as I saw in the video will not be on oxygen. From the video, I knew she might probably not be able to make it. I look forward to showing you this video or probably send it to your mail.
WHY I AM ADDRESSING THIS LETTER TO YOU?
Deborah Bolanle Oluwadero passed on at the Ekiti State University Teaching Hospital.
As a Pharmacist who previously worked at EKSUTH as an Intern Pharmacist (2016), I can boldly say that the death of my mum was as a result of our weak health system in Nigeria, and negligence by health workers on duty.
I am intentionally writing you not only because you are the Governor of Ekiti State, where the health facility my mum died is located, but most importantly because you are the chairperson of the Nigeria Governors’ Forum. There is an urgent need for a frank conversation on our health system in Nigeria that I seriously hope you will help ignite among your colleagues in their respective states.
Our health system is WEAK!
It is a big shame that in the 21st century, a teaching hospital will not have oxygen supply readily available in less than 2 minutes of hospital admission.
It is a big shame on our health system for health workers in a tertiary hospital to not be provided with personal protective equipment (PPE) amidst this coronavirus pandemic.
And, most importantly, it is a big shame on those health workers on duty to assume all shortness of breath during emergencies to be COVID related.
The Governor's response:👇
Your open letter on the above stated was brought to my attention.
First, I commiserate with the entire Oluwadero family on the demise of your mum, Mrs Oluwadero Deborah Bolanle at the Ekiti State University Teaching Hospital. Ado-Ekiti recently.
Irrespective of the circumstances, the death of a parent is a difficult life event for most people and I pray for strength and fortitude for you all at this trying period of mama’s transition.
It is however a testimonial to your good upbringing that in spite of your personal pain, you are concerned about the systemic issues in Nigeria’s health sector as detailed in your open treatise.
Before I try to address those concerns, let me let you know that I ordered an immediate investigation into the circumstances surrounding your mother’s death at the Ekiti State Teaching Hospital EKSUTH and 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 11:05am. 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.
I can also confirm that there was no shortage of oxygen or PPEs before, during or after the sad incident at the ER and there was proof that all clinics were operational, even during the lockdown, as our health workers were exempted from the restrictions as essential workers.
From the case evaluation, the continued and unmonitored glucose administration before her hospitalization appeared to have complicated the management. May her soul rest in perfect peace.
As a health worker yourself, I believe you have first hand experience of the personal risk your colleagues face daily in a pandemic situation hence the need to be extra cautious when admitting a new patient with symptoms similar to COVID-19.
This may account for the perceived delays though still within standard stipulated response timing in an ER.
One cannot however fail to agree with your observations on the weakness of our healthcare sector as a nation in general and as a sub-national in particular.
While the issues you identified are valid, the systemic re-engineering needed to change this narrative require enormous resources.
For instance, the cost of maintaining an independent ambulatory service you recommended is too prohibitive for the average Nigerian. One ambulance visit in a developed country like the United States could cost as much as $3,000; that is over N1million naira at today’s exchange rate! How many Ekiti Citizens can afford to pay N1million for an ambulance in an emergency?
That is why many state governments have tried to procure ambulances for their healthcare centers.
In Ekiti State, all our Secondary and Tertiary Healthcare centers have at least one functional ambulance for patient emergencies. While this may be inadequate, until we are able to adequately fund healthcare, probably through a health insurance scheme, such interventions would remain our only way to mitigate the circumstances.
As a nation, we have to master a difficult balancing act between dwindling resources and an increasing population, against a background of decades of low investment in infrastructure.
Private sector investment may therefore be our most sustainable option to fund an efficient healthcare system and we are already exploring this at the level of the Nigeria Governors’ Forum, which I currently chair.
On our part in Ekiti State, in spite of our excruciating financial challenges, my administration has always prioritized the safety, protection and well being of our citizens.
EKSUTH alone has a recurrent grant of N2.6bn in the 2020 budget and that is separate from the Healthcare capital budget of almost N3bn. Health and Human Services sector is 12% of this year’s budget while we are targeting an increase to at least 18 percent of the total budget in subsequent years.
Since the beginning of the current COVID-19 pandemic, we have procured large quantities of PPEs, surgical masks, clinical gloves, Infrared thermometers, automatic dispensers of hand sanitizer, and Veronica buckets for hand washing, all of which are readily available at the various service points despite the very high cost of procuring these items.
Government will continue to ensure that the hospitals and all our health care centres work towards an improved and responsive health system, which will be of great benefit to the generality of the people.
I particularly find your observation on the need to increase our efforts on prevention of non-communicable diseases as a policy shift worth considering and the State Government would be glad to work with your proposed family foundation and other non-governmental organizations in this area as it should reduce the pressure on our healthcare system.
Let me assure you that all the points raised in the letter are well noted as it is within your inalienable right as a citizen to point out certain developments you consider unsavoury, with a view to ensuring the situation is redressed.
In closing, it gladdened my heart to read of your footprints in the global developmental economy from the humble beginnings of our sponsorship to attend the first event in South Africa less than a decade ago. Yours is a justification of my confidence in the ability of the Ekiti Youth which we are working very hard to unlock through our investment in the Knowledge Economy.
Thank you for making a difference in your generation and making Ekiti State proud. Indeed, with young people like you, we are truly the Land of Honor.
Again, please accept my condolences and my best regards to your family.
Dr. Kayode Fayemi