Bad

An orthopaedic doctor referred a patient to consult with us recently. The patient had significant neck pains and arm pains. He was weak and unable to hold objects, his walking was also unsteady. The MRI showed evidence of pressure on the nerves in his neck, a condition called cervical myelopathy. He needed the services of a neurosurgeon to decompress the spinal cord. So, our consultation is N30, 000. However, he refused to pay because it was a doctor who referred him!

Seriously! How does that compute? Just because you were referred does not mean we should provide a free service. I mean you can be asked to take a flight on ARIK from Lagos to Abuja, but you do not go to the airport and ask to be flown across free of charge! And of course, if you think that N30, 000 is expensive, try N100, 000 for a similar consultation on Harley Street in London. Same neurosurgeon, same Nigerian patients, every time you come to the clinic! Because, of course, someone has to pay for the electricity, the air-conditioning, the reception staff and all else in between!

So bad

A young woman with a brain tumour came for clinic consultation. She required an emergency operation to remove the tumour and protect her from injury. The operation was discussed and she went off to think about it. A month later she called from India to say that she has had three operations! She related her experiences and confirmed that the Indian doctors did exactly all we had promised to do for her here in Nigeria and more besides. Oh really!

So she now feels she could trust us and wondered if we would be so kind to see her on her return from India for follow up care; as she cannot afford to go back and forth to India! Moreover, she had spent much more than the Indian hospital said the operation would cost. Now, I don’t know about you but that left a sour taste in my mouth. Pretty disrespectful to ask a qualified and highly trained neurosurgeon to do your follow up clinic visits for an operation you did not trust him to carry out in the first instance.

The said operation is usually billed cheaply at N5, 000, 000 in Nigeria and as much as N40, 000, 000 in other countries. This is the real cost of brain and spine operations on the open market. For example, a man was billed N40, 000, 000 for a brain operation in the USA. Same operation is being done successfully here in Nigeria for N5, 000, 000.

Another, a patient of mine had successful spine surgery for N2, 500, 000 right at the same time as his brother paid N15, 000, 000 for the same surgery in Dubai. The sad fact of course is that the foreign neurosurgeon earns almost half of the money for doing the operation as we twiddle our thumbs here working for chickenfeed. So, just because we keep the costs to the barest minimum does not mean we are stupid. It does not mean we should be treated as fools.

Pretty bad

A patient with severe back pains and leg pains came to the clinic for surgical intervention. He required an operation to fix the back through removing pressure on his nerves and then insertion of pedicle screws to hold the spine together. The bill for the operation was N1, 500, 000. By the way, the same operation will likely cost N5, 000, 000 in India and up to N20, 000, 000 in America. He agreed to pay and deposited N600, 000 begging that the operation should commence as he was in severe pains.

A retired civil servant, 70 years of age with no current source of income, he said he was friendly with the Governor who had promised to help him. We agreed and operated on him successfully. In fact, he was so happy he spent an extra week in Abuja enjoying the creature comforts of the hospital, till we insisted on his discharge. It is now almost 6 months since discharge without any effort to redeem the balance of the money owed. Apparently, the Governor has not had time to listen to him!

Now, what are we to do with such people who come in distress to a private facility expecting succour and then fail to redeem their pledges once health has been restored? Many doctors continue to help and offer emergency services and in this case assistance to a crippled old man, day in day out, without any appreciation from the same patient. Perhaps we need lawyers, the courts and bailiffs to help chase these debtors all over town!

Conclusion

The private sector in Nigeria is improving at a remarkable rate to deliver quality health care hitherto unavailable in Nigeria. Many hospitals especially in Abuja and Lagos are capable of performing safe brain and spine surgery. Yet, the costs are a small fraction of the market price for the same outcomes. And YES, we are delivering better outcomes today!

The sad fact is that some patients do not value what they have. Some will complain about the environment even though it is better than home! Some will complain about the service though they have not pressurized the government to provide quality services in public hospitals. They then appear in a private facility expecting free or cheap treatment for the same quality of service they might hope to enjoy at huge costs in India or Germany. And after a good outcome and recovery, refuse to pay!

The travesty!

NB: Please feel free to discuss and share your experiences.

2 Responses

  1. MOD Abonyi

    Thanks Dr Ogungbo on this profound article. The problem with us as Nigerians is absolute lack of faith in ourselves. We don’t believe in our leaders, medicines, doctors or even our foods. We are now eating plastic Chinese foods. We need immediate liberation in the private sector or we face extinction. Patients are prepared to pay anything to anyone with white skin in India or anywhere than pay a fellow citizen. God and hardwork will get us out. Treat those that have confidence in you and leave the rest to God.

    Reply
  2. Victor Ugbelase

    Dear Dr. Ogungbo, your frustration is quite clearly expressed in this article. As briefly as you have tried to put things, I sense that you could possibly have gone on over a few more paragraphs to say so much more. I feel your pain brother!
    The middle class Nigerian patient is wary of domestic healthcare services. He seems to be more confident that he would fare better in any basic facility abroad if his health were in a critical state and requiring acute intervention.

    Given the chronicle of bizarre tales from numerous families, of deaths and permanent disabilities resulting from encounters with a good number of our healthcare providers – across all tiers, it would appear that this average Nigerian is thinking quite rationally in seeking alternative care elsewhere. He’s reasonably justified by the inherent failures of the Federal Ministry of Health.

    When patients seek your opinion and jet off abroad, well be content with the fact that you provided expert insight and medical opinions of internationally acclaimed standards, and received consultation fees. And if they feel confident that they could return to your facility for follow up care, please receive them with open arms. It’s a plus on your side. Such patients and indeed many Nigerians would need a few more years of more positive and well documented patient care narratives, emanating from a revolutionalised healthcare system such as akin to what you and your team are trying to help establish.

    Be encouraged brother Ogungbo and whilst working towards this desirable future, you could explore existing opportunities and hopefully, make some unprecedented progress. Use your vantage position in the weak, cash strapped and technologically inept health sector to improve patient education, share your success stories and some more of your challenges, explore opportunities with the NHIS to bridge finances when dealing with non-cash paying patients, seek partnerships with local and yes, foreign agencies towards improving practice standards and perhaps if there’s anything you could do towards galvanizing bailiffs into action in Nigeria, then you would have indelibly made your mark!

    Reply

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