After altering his looks and taking psychiatric lessons
every day for one week, investigative journalist ‘FISAYO SOYOMBO went
undercover for three weeks in November, including 10 straight days on ward
admission, as a patient of the Federal Neuropsychiatric Hospital, Yaba, Lagos,
one of the nation’s most historic mental rehabilitation centres. His report
unveils the decrepit state of hospital facilities, gross understaffing of
critical staff despite a bloated workforce widely believed to be populated by
ghost workers, low quality of service delivery, arbitrary charges on patients —
all stemming from personal and institutional corruption and the hospital’s
implicit stigmatizing of its very own patients.
...continued from Part I
‘THIS FOOD IS CLEARLY FOR MAD PEOPLE’
Thursday morning was pap and two pieces of bean cake. The
general complaint was that the pap lacked the sugar that the servers claimed to
have added. Afternoon was low-grade beans plus garri. Evening was lump-filled
semolina and bland ewedu stew containing a pebble-size meat. Hard as I tried to
eat, I couldn’t. That Thursday night, I lodged a verbal complaint with the male
nurse on duty. “This is not fair,” I told him in an impassioned tone,
personally pained because I was truly hungry. “It’s not like the hospital is
rendering us a favour; we paid for this service.”
Friday morning was yam and stew; it ought to contain fish or
meat but it didn’t. Afternoon was jollof rice, which, to be honest, was perhaps
the only meal that tasted good of the 28 I ate at the hospital — a success rate
of 3.6%. Dinner sucked away all the good of lunch; the eba was so lump-filled
my appetite instantly went numb; the egusi was watery as usual and therefore
tasteless. I threw it away and went to bed on empty stomach.
Saturday morning was pap and bean cakes; it was manageable.
Afternoon was stony and husky white rice with stew. Dinner was irritating; the
amala was so horrible I wondered if the lumps were deliberately introduced in
it. I couldn’t believe that someone indeed cooked that and was proud enough to
serve it to anyone.
“Look, the hospital management and the cooks in the kitchen
prepare these meals like they’re meant for mad people,” one patient told me
that night while I threw the food away for the umpteenth time. “Nobody in his
right senses would serve this kind of food to a normal human being. No hospital
will give this to regular patients. In their heads, we’ve run mad and our taste
buds can’t spot ill-prepared food.”
A ONE-MAN PROTEST
DEALT WITH ‘THE YABA LEFT WAY’
Breakfast on Sunday, November 24, was bread, tea and egg.
Lunch was jollof made from low-grade rice. The eba served for dinner was
well-done this time; however, the vegetable stew was so watery and stony it
rendered the eba inedible. I managed to eat it without complaints but one
patient who claimed to have studied Theology at a UK school couldn’t. It was
the Sunday Sheffield United’s Olivier McBurnie scored a last-gasp 3-3 equaliser
to deny Manchester United victory at Bramall Lane.
Marcus Rashford had just put United 3-2 ahead when the
theologian abruptly switched off the television in the paved courtyard to the
consternation of viewers. “This hospital is taking us for a ride and you all
are here watching football,” he barked. “This food is sh*t. They do it all the
time, and now it must stop.”
Many liked his anti-bad-food campaign but only a few
supported his methods; they wanted to continue watching their TV, but he
wouldn’t budge. A patient— let’s call him Yellow — stood up to him. There was uproar.
Had they not been separated, Yellow and the theologian might have come to
blows. During the melee, one patient kept warning the protester: “Looks like
you don’t know where you are. This is Yaba Left o. The nurses will just change
your drugs.”
“Changing of drugs,” as I was made to understand, is the
practice of adding sleeping pills to the drug list of patients deemed
troublesome by the hospital. I personally doubted the credulity of this claim,
but by Monday the theologian was sleeping like a pregnant woman. He’d borrowed
Dr. Olayinka Egbokare’s ‘Dazzling Mirage’ from me the previous day but hadn’t
read beyond the opening pages. When I saw he’d spent more than half of Tuesday
sleeping again, I approached him shortly before 5pm: “You’ve been sleeping all
day like someone bitten by tsetse fly, man. What’s wrong with you?”
 |
| The toilet used by patients of Tolani Asuni ward will make you puke! |
“Nothing, bro,” he replied. “I told the nurses the hospital
food was making me purge, so they gave me new drugs.”
“Are you sure they didn’t ‘change your drugs’ because of
your Sunday protest?”
“No, bro. Just drugs to stop the purging.”
I could tell he was living in denial. I almost believed him,
in fact. But when I went looking for him half an hour later, he was back in
bed, sleeping and snoring away, oblivious of my presence.”
This wasn’t the effervescent man I’d come to know for almost
a week; he had become, as Darey would say, a “shadow of himself”.
FULL-BLOWN PROTEST
Monday morning was pap and bean cakes, afternoon was beans
and yam, evening was another lump-filled yam flour with okra. I went into the
nursing office not just to complain but to show the male nurse on duty. “You
know that even if we were hopelessly mentally deranged, we don’t deserve this
kind of food,” I told him. “You cannot continue doing this just because you
think nobody is watching you.”
 |
| This bathroom just as bad as the toilet. |
Breakfast on Tuesday was yam and stew, lunch mashy rice plus half-done beans, and dinner garri with stony egusi. Wednesday morning was sugarless pap with bean cakes, while lunch was mashy rice and egg with water melon. One patient who couldn’t take it anymore raised his voice against a nurse. “Please, hold your breath!” the woman exclaimed. “The people who served you the food were here minutes ago; you didn’t shout at them. Now that they’ve gone, you want to shout at me?”
The patients felt they’d directed their protest at the wrong quarters; they resolved to correct it. A protest was starting to brew. By the time the servers returned with dinner, the patients had seethed with rage for hours. Some of them had lined up with their plates but they were crowded out by the dissenting voices. Soon, they unanimously insisted they weren’t going to eat the food.
Stunned, the servers scampered to the nursing office for help. One elderly patient was impressed by the steam the nonviolent protest was gathering. I had picked out his face from the food queue the previous week when he politely asked a lady server if the yam flour to be served that day was not lump-filled. “Can you enter the kitchen?” the lady, clearly offended, had fired back.
 |
| The bathroom walls and ceiling |
“Don’t you have a father at home?” the man responded.
“Which father?” she snapped. “He’s in heaven!”
One nurse came to plead with the patients, promising that
the food would improve, but her pleas were drowned by the angry voices of the
patients. I couldn’t witness it to the end because my team had come to
discharge me against medical advice, as laid out in the plan. I’d in fact been
discharged an hour earlier but I managed to delay my exit by spending idle time
in the toilet just to witness the protest.
“We will not eat this food… we cannot take this anymore,” I
could still hear some patients shouting as I slipped through the gates of
Tolani Asuni into the general space of Yaba Left.
I may not have witnessed the outcome of the protests but I
really could tell, based on precedent. Five months back, in June, patients had
staged a stiffer protest against the servers, insisting there wouldn’t be peace
unless the CMD came forward to address them. A patient who was on admission at
the time said the group went as far as insisting they would no longer take
their drugs. “The CMD indeed came,” the patient said of the incident. “However,
to the disappointment of everyone, when she tasted the food, she claimed
nothing was wrong with it.”
‘PRINCIPALITIES AND POWERS IN THE KITCHEN’
The horrible food eaten by patients of the hospital is the
end result of a complex mix of corruption and desperate office politicking. So
said an employee of the hospital who asked not to be named for fear of
retribution.
“There are certain people who have been in charge of the
kitchen for a long time now; they are the ones who buy foodstuffs from the
market,” said the source. “When the present CMD came in, part of what she did
was to get those people out of the way. And it was quite messy — because there
were accusations that their purchases were rarely commensurate with the
released funds.”
The responsibility of buying foodstuffs and verifying the
prices was then transferred to another committee. However, in terms of the
cooking, the original set of people in charge of preparing the food remained in
charge. Repeated complaints by patients prompted a decision to employ a
dietician to oversee the kitchen.
“The dietician was frustrated out of the system by every
means possible,” the source said. “And since her exit, nobody has been brought
in for that purpose.”
The failure to replace the former dietician has meant a lack
of professional input into the goings-on in the kitchen. For instance, when
patients request special meals, the kitchen staff don’t seem to know what
should be prepared. What the patients get, instead, is the same set of food served
to all the patients.
“The complaints about the quality of food persist but the
reasons are not clear,” the source concluded. “It is hard to say whether some
of the foodstuffs are being kept back or not, but the final food output that we
see is not palatable at all. And this has been going on for years.”
THE PATIENTS’ BATHROOM IS AN EYESORE
The first time I entered the toilet serving Tolani Asuni
Ward, the scenery was so nauseating I wanted to puke. I ran straight back out!
The tiles were either irredeemably stained or unrestrainedly peeling off the
walls. Parts of the floor were somewhat waterlogged, helped by burst pipes that
shelled out water in place of regular taps. The water closets had all lost
their lids and, just like the pint-sized bathrooms, had become permanently
discoloured by filth. Professor Asuni would be turning in his grave at the
sight of the bathroom in the ward named after him!
One consequence of the shabby state of the Asuni toilet is
the pressure it puts on Adeoye Lambo’s, still relatively new. A philanthropist
— not the hospital management — renovated the Adeoye Lambo bathroom recently.
This was a bathroom built for a small group, the 30 patients of Lambo, but it
now serves no less than 20 more patients from Asuni. I was a late bloomer in
this regard — until my sixth day at the ward, when, seeing that I was holding
myself back from using the toilet, a patient asked me to “try Lambo like almost
everyone else”.
‘CORRUPTION AND ALL THAT STUFF’
 |
| Patients watching TV shortly before the clash of interests |
Someday during my first week of admission, there was almost
an outbreak of fisticuffs between the theologian and another patient who is the
son of a pastor, over the rights to the television remote in the lobby. Each
wanted to see something on TV that the other didn’t want to. In truth, the
pastor’s son was part of a small clique that controlled the TV remote; the
theologian was indeed right to protest. As resentment welled up in both
parties, the pastor’s son, clearly ego-battered at being knock off his perch,
barked out to the theologian: “Look, I paid the same amount as you did to be in
this ward, therefore I have the same rights as you do to watch whatever I
want.”
Irritated by the raised voices, the nurse on duty
intervened. “Please, you people should stop all this noise about how much you
paid,” she cut in. “You think it is your money that was used to fund this DStv
subscription? Look, most the of things you see around here are not from the
management; you know this is Nigeria and there is corruption and all that
stuff. Most of the social services you enjoy here were put in place by public-spirited
individuals.”
She hadn’t lied. I would later discover that the monthly
DStv subscription was paid for by a doctor. The bathroom at Adeoye Lambo was
renovated by an Egba chief. The hospital had sold him the idea of renovating
Tolani Asuni as well, but he didn’t buy it, insisting he would only renovate
Lambo because the late psychiatrist hailed from his town. The painting of the
exterior of Tolani Asuni Ward, plus an inscription that reads ‘Turn off drugs,
turn on the music’, was the idea of an arts-endowed ex-drug patient. Even the
materials used for the painting were donated; they weren’t from the hospital.
‘WHO SHOULD MISBEHAVE IF NOT A MAD MAN?’
 |
| Mali Kush will push you right to the edge of the cliff. Flee from it! |
Not long after I got to the ward, I started to notice a
thin, dark boy at Adeoye Lambo. He was restless and desperate to get out of the
hospital. He must have been aged somewhere between 17 and 20; he had a few open
sores as well. The first time I saw him, it was so early in the morning yet he
was shedding tears profusely. Two problems. He wanted to leave the ward; and if
he couldn’t, he wanted access to Mali Kush and Colorado, two of the many drugs
he abused. In his first few days, he was pretty unstable, crying, howling,
scratching his body, sometimes screaming incoherently and acting irrationally.
For these, he often earned himself cheap slaps and whips from the nurses, much
to the chagrin of one of the two elderly patients in the ward — a dark-skinned sexagenarian
who always spotted a black pair of spotty boxer shorts. While he sometimes
changed his vests, his black briefs were ever-present, leaving me wondering if
he had so many pairs or he wore just one over and over again.
“You’ve started beating him again!” the man screamed one
day. “Why?”
We were soon told he took some keys that weren’t his. I’m
not sure if the keys belonged to a fellow patient or a nurse, but I remember
the nurses were clearly displeased, and they beat him for it.
“He took keys belonging to a nurse and he wasn’t supposed
to, and so?” the man queried no one in particular. “We say someone is mad, you
say he is misbehaving? Who should misbehave if not a mad man?”
 |
Come to this lawn anytime from 8pm and watch well-fed rats criss-cross it in their numbers.
|
The elderly patient motioned the boy to come over, and to the surprise of everyone, he hearkened. The boy sat beside him, calm and attentive. I witnessed this two more times, that there was uproar and this man was the only one who could still the boy. How come the boy listened to him without a beating? The man blew his own trumpet on the third occasion.
“Without beating him, he listens to me when I talk to him,”
he boasted. “No nurse should beat him. He may be mad but all he needs is love.
He’ll do whatever you ask him to if you ask nicely.”
When asked to comment, a psychiatric doctor, who didn’t want
to be named for fear of being seen as helping to plan the undercover work,
condemned the act.
“It is a matter on two levels,” he says.
“I do not support beating a patient under any guise. But if
a patient is violent — kicks at a doctor/nurse, bites someone and so on — maybe
I can understand the beating, even though it still doesn’t make it right.
“However, if a patient exhibits stubbornness prompted by
mental illness, such as the boy taking possession of keys that aren’t his, it’s
not right to beat him. He wasn’t violent, why should he be rewarded with
violence?”
Had the boy been beaten up at a hospital in the UK, the
nurses in question would have been investigated and dismissed if found guilty.
So said a Nigerian psychiatric nurse based in Camden, a district of northwest
London, England.
|
| Wall design by an ex-inmate |
“Even if a patient is violent, a nurse has no right to
respond with physical assault,” she said.
“By policy here in the UK, if the patient hits you, you are
not allowed to hit back. Mentally-ill patients are vulnerable people; they are
vulnerable, that’s why they are in the hospital. If you hit back and there is a
complaint, you will be investigated; if found guilty, you will be suspended or
sacked, depending on the weight of your guilt. There are cameras everywhere so
there’s always evidence.
“What that nurse can do is to restrain the patient. And it
may interest you to know that the nurse cannot do it solitarily. You alone
cannot; you have to involve a minimum of two staff. And then the extent of
strength you invest into restraining the patient has to be commensurate with
the scale of violence perpetrated by the patient. By the way, restraining has
to be the last resort. The first step is to call for help by pressing the alarm
button attached to your body.”
10 DAYS, NO TREATMENT — 10 DAYS OF NOTHING
On the day I arrived Tolani Asuni, before I slipped into the
hospital-approved pyjamas and I was stripped of all my personal possessions, I
asked the nurse on duty exactly what kind of treatment to expect since the
doctors had exempted me from drugs and injections. “Therapy,” she answered me.
“Group Therapy (GT) and Cognitive Behavioural Therapy (CBT).”
Held every working day of the week, the GT allowed all drug
inpatients to come together to learn from one another’s mistakes. It was led by
a firm but likeable bald-headed male doctor, who is an alumnus of the
University of Ibadan, plus a fair-complexioned female psychologist who spoke
with a thick Igbo accent and was generally considered by patients as brilliant
but puffy. The GT came with the total N120,000 admission package.
But I would need to pay an extra N10,000, the nurse told me.
This was separate from the admission fee, and this was regardless of the
initial charge of N20,000 for drugs that the hospital knew I wouldn’t need but
made me pay for. If I paid the N10,000 early enough, the nurse explained, I
would get an early CBT date. So I paid in cash right there — before I stepped
into the room allocated to me in the ward.
I would soon find out my CBT had been scheduled for December
31 — six full weeks after the commencement of admission. Effectively, this
meant that the hospital was offering me no single condition-specific treatment
or therapy. I spent the last five days of my stay pestering the nurses, doctors
and psychologist for a readjustment of my CBT date. “My brother, it’s not our
fault,” the Igbo-accented psychologist told me one day. “Tell Buhari to employ
more people.”
Until my discharge on the 10th day, I hadn’t experienced one
single session of CBT. Just before signing the papers for my release as pressed
for by my team, Dr. Ojo, the consultant in charge of my case, said: “Let me
emphasisie that we have not released him so that you can take him away
permanently. He should be coming from home — because we know that we haven’t
done anything on him. Up till now, he hasn’t even been attended to at this ward
yet.”
For a drug patient that hadn’t entered psychosis, that had
never experienced it, that wasn’t placed on drugs or injection, this is
inexplicable, actually. Ten full days of “doing nothing” on a patient who
already made full payment!
STAFF SHORTAGE, GHOST WORKERS, LOPSIDED RECRUITMENT
In truth, the hospital was experiencing an acute shortage of
nurses, doctors and psychologists. Only two psychologists served a patient
population that often hovered around 535 inpatients and approximately 800
outpatients. Working in shifts, the nurses number just under 200, but they were
evidently overworked. Ideally, two of them ought to be on duty in the morning,
and another two at night. This seldom happened. Oftentimes, two worked in the
morning and one in the evening, or one in the morning and two in the evening.
In addition to the general shortage of nurses, there is also
a shortfall between the number of nurses on the hospital’s books and those
actually operating the shifts. For a number of reasons.
“People retire every year, people get transferred, people
die, people travel. If today there’s an opportunity for 50 nurses to travel, they
won’t even wait till tomorrow,” a nurse said on phone when asked to explain the
inadequacy of nurses.
“All these deplete the workforce. Even I myself, if I get an
opportunity to travel for a course for two or three years, I will go. But my
name will remain in the employ of the hospital. There are people benefitting
from such arrangements, which, of course is their absolute right. It’s
in-practice training, and they return to the hospital better equipped for the
job.”
 |
| One of the many overworked nurses at Yaba Left |
Sometimes, nurses are seconded to other institutions to
offer stability for a period of time, and they’re not replaced during their
absence. One or two staff may even be hospitalised long term, yet no one is
employed to fill in for them. Instead, their work is spread among the remaining
staff.
“At every point in time, there is avenue for many people not
to be on ground,” he added. “And the expectation of the government and the
hospital management is on the nominal role. However, statutorily, everyone on
the nominal role cannot be on the ground.”
According to the nurse, these challenges are nothing new,
not peculiar to the neuropsychiatric hospital, and easily solvable with
constant reemployment and futuristic planning.
“Since October this year, a serious administration would
have sat down to say, how many people are retiring next year: how many nurses,
pharmacists, doctor, cleaners, and so on? How many staff relocated abroad or
travelled for trainings?” said the nurse.
“Then you can factor all these information into your
recruitment plan for the next year — even if not to expand, at least to
maintain the current staff strength. The solution is to employ more and plan
ahead.”
The problem, though, is anything but that simple. Even if
nobody wants to talk about it, the scourge of ghost working is an open secret
at the hospital. The nurse quoted above admitted that he was “aware that there
were ghost workers” at the hospital, but he said would rather not talk about it
as he was, by official duty, not in a position to obtain formal evidence.
He was the second Yaba Left nurse contacted during the
search for evidence. But unlike the first, who downright turned down a request
to speak, he sent us the contact details of a nurse who “certainly can give you
evidence”. “I don’t know if she will want to speak with you,” he warned. “But
if you’re able to, trust me you’ll get a clear picture of the number of ghost
workers in the system.”
At exactly 11:02am on December 23, I called the nurse, a
female. She asked that I call back at 4pm. When I did at exactly 4pm, her
initially encouraging countenance had become unfriendly “Please I’m still very
very busy [sic]; I’m not yet at home.”
Asked what time I could call back or if she didn’t want me
to at all, she replied: “You may not bother at all. I’m extremely busy
presently.”
A mini-breakthrough came through a fourth nurse based in the
South-South, who promised to speak with a colleague of his at Yaba Left. The
answer, when it came via Whatsapp chat, read: “The trusted colleague I spoke
with confirmed to me that there are ghost workers. But he said what he will not
do is give me names.”
Beyond ghost-working, there is a litany of admin issues to
be resolved at Yaba Left. The hospital’s consultant-resident doctor ratio is
thought to be approximately 2:1; meanwhile, standard practice is 1:4! This
anomaly, I understand, has festered this badly because lots of consultants who
should have exited the system are being retained on curious grounds. Aside the
belief in some quarters that probably as many as 500 nurses are in the
hospital’s records while roughly half do the work in practice, it is
interesting to note that there are approximately 1,000 admin staff on paper —
more than the number of nurses and doctors combined! There are two
psychologists on drug ward but about 12 in the entire hospital, which is still
grossly inadequate. There are only four occupational therapists even though the
hospital runs a school of occupational therapy.
There have also been complaints of deducted but unremitted
tax from staff income, plus hushed talks about the nature of ongoing projects,
the identity of the contractor and the financial value of the contracts.
‘I DON’T TALK ON PHONE’ — YABA LEFT CMD
On Friday
January 17, 2020, I contacted Dr. Oluyemisi Ogun, the Chief Medical Director of
the hospital, for her response to my findings. I had only mentioned “the
quality of food that patients eat and understaffing, inadequate number of
nurses possibly due to…” when she interjected: “Who gave you the statistics?
Who is complaining to you? If you have anything, come and see us, please.
“When I see
you face-to-face… I don’t talk on phone. If you have any problem, then come and
then we see, and then you can see the facts yourself on ground. Thank you.”
MAKING YABA LEFT RIGHT
As with all
other government-run hospitals, funding is one of the major impediments to the
smooth operations of Yaba Left. Despite joining 20 other member nations of the
African Union to sign the 2001 Abuja Declaration agreeing on the allocation of
15 percent of federal budgets to healthcare, Nigeria has never met the target,
and has in fact always fallen short of even the halfway mark. Only 3.95 per
cent of the 2018 budget was reserved for the Ministry of Health; it was less
than 2 per cent in 2019 and 4.14 per cent in 2020. The highest percentage since
the declaration was the 5.95 per cent of 2012. Meanwhile, seven countries —
Rwanda, Botswana, Niger, Zambia, Malawi, Burkina Faso and Togo — have all met
the Abuja target.
The
neuropsychiatric hospital at Yaba — and indeed other government-managed
hospitals — can’t offer quality healthcare to the people with continued
underfunding, especially with an ever-increasing patient population that rose
by 51 per cent from 40,502 outpatients and inpatients in 2018 to 61,154 in
2019. However, the finance-induced problems of tertiary hospitals nationwide
are always complicated by “corruption and all that stuff”.
In the 2017
budget, for example, N9 billion was specifically allotted to the purchase of
radiotherapy machines for some teaching hospitals (and another N117 million was
also budgeted for cancer-related issues). At that time, the most expensive
linac radiotherapy machines cost between of $750,000 and $1.5million (between
N228 million and N456million, at the then CBN rate), excluding associated costs
such as the vault that will house the system, treatment planning and oncology
information system software, lasers, and other accessories. Still, the
government bought only one RT machine — for the National Hospital! And this is
despite knowing there were only four functioning radiotherapy machines all over
the country at the time to serve an estimated 200million Nigerians, The
question, then, is: where is the rest of the N8bn?
One big
strength of the Federal Neuropsychiatric Hospital Yaba is the sheer passion of
majority of its workforce. There are many Dr. Ogunlowos and Dr. Akingbolas at
the hospital — medical staff who are incredibly committed to the profession but
are becoming increasingly pessimistic about the Nigeria project.
“Many of us
love this job to bits but our frustrations with the system pushed us out of the
country,” said a former staff of the hospital who now practices in the Canada.
“I hope the government addresses Yaba Left’s problems because the more the
doctors get frustrated by the system, the more they leave and the more the
number of untreated or shabbily-treated mentally-ill patients walking the
streets. That can’t be good for Nigeria.”
Those
sentiments were shared by the UK-based Nigerian nurse. “I probably would have
beaten that boy myself if I was still in Nigeria,” she said.
“Over there
in Nigeria, it isn’t that professionals are inherently civil. But here in the
UK, we have a system in place that punishes unprofessional behaviour. That way,
civility is inculcated by sheer force of discipline. Look at the idea of CCTV
camera, for instance! We can do it in Nigeria, too, if we really want to.”
This is the second and final of a two-part
series. You may read Part I here.
This investigation was published with
collaborative support from Cable Newspaper Journalism Foundation and Business
Day.
Advertise on NigerianEye.com to reach thousands of our daily users
No comments
Post a Comment
Kindly drop a comment below.
(Comments are moderated. Clean comments will be approved immediately)
Advert Enquires - Reach out to us at NigerianEye@gmail.com