By Abimbola Adelakun
- Some reports emanating from Nigeria succinctly tell a story of how the multi-level dysfunction that affects the country can converge on individuals. Figures are one thing, but stories give flesh to the bare bones of statistics. According to recent reports, a pregnant woman in Rivers State had unfortunately died about a year ago while having her child. Thankfully, the pre-term child survived but had to be placed in intensive care. The extended care the newborn received amounted to around N6m, of which we were told the family could pay only a quarter. Since the balance of the payment was not forthcoming, the hospital detained the mother of the deceased (also the grandmother). At the time of the report, the grandmother and the baby had spent about a year in the hospital. The poor old woman had not only had to grieve the untimely death of her daughter but was also saddled with her grandchild’s caregiving within constricting and highly humiliating circumstances.
In that one story, you can see a compounded pile of familiar Nigerian problems: acute poverty, unaffordable medical care, resort to privatised health services, maternal mortality, and a general lack of a social safety system. There are many things one can say in this instance about the hospital that illegally detained the poor woman, but this is also a complicated story. Yes, as an enterprise in the business of restoring people to wholesomeness, they should not be subjecting them to such inhumanity. Yet, what the healthcare facility runs is a business and not a charity. If they allow everyone who uses their services but is too impoverished to pay to walk away, they will be ruined quickly. They must recoup their money somehow, and Nigeria is not exactly known for a coherent credit system that can track individuals’ creditworthiness and enforce payment plans. Most of our economic transactions are carried out in cash, paid up front. This arrangement puts a lot of stress on individuals like the grandmother in this story, whose life was put on hold for almost a year.
The whole affair is a complex story of systemic failure and lack of structural anchoring that imperils the lives of millions of Nigerians. While the hospital involved in this incident illegally detained the woman and the child, other hospitals save themselves from such hassles by demanding a significant sum upfront before attending to a patient. We had a case go viral this year when a woman in labour, Mrs Folajimi, was rejected by a private healthcare facility in Ibeju-Lekki when her family could not provide the required deposit for the clinic to proceed with her treatment. These heartbreaking stories are not new in Nigeria; they are a regular occurrence.
When the report of the detained grandmother went online, officials of the state’s Ministry of Health (who must have been disturbed by the account like the rest of us and likely also embarrassed that it occurred within their domain) came online to state that they had intervened in the matter. They did not provide details of their intervention, but given how public officials handle such issues, it is likely they negotiated to pay the bills (in whole or in part) to free the poor woman from her captivity. While we thank them for their sensitivity to the plight of the woman and her grandchild, that type of response is also why that situation has been recurrent. We are a society that lacks planning and is therefore unable to build the structures that give life and guarantee dignity for all. When we encounter systemic problems, our instinct is to treat the symptoms rather than confront the structures that have manifested in the single instance. In Rivers State, they will get that grandmother out of the hospital, but that is about where it will end. The larger structural conditions that culminated in the messy situation whereby a bereaved woman had to lose a year of her life will be glossed over by do-good politicians who will find it easier to address a single instance.
The problem of detaining people in hospitals in Nigeria has persisted for a while, and I daresay things have gotten a lot worse due to the debilitating state of the economy. Again, these issues are not new. I cannot count the number of times I have read an article in the newspaper reporting on the trend of detaining poor folks in hospitals because they cannot pay for their medical care.
In some cases, hospitals even detain corpses. The poor grieving family will be forced to search for money, their trauma compounded by the pain of losing a loved one and their remains being held to ransom by a corporate system of healthcare that can be inhumane.
In multiple academic papers, some dating back to 2013, Nigeria has been a constant case study of the global phenomenon of detaining patients in hospitals for failure of their families to pay hospital bills. In 2018, the BBC even made a documentary about that same issue. Seven years later, hardly anything has changed in the situation.
What we are looking at is a poverty problem common to countries that lack a social safety net programme. People are asked to pay for medical care in cash, and that is largely untenable anywhere. The cost of healthcare is too high for people to pay out of pocket, and that is why the Western society that gave us the modern healthcare system also created an economic plan to help alleviate much of the cost. Will Rivers State leadership think holistically about the economic situation that has led to a situation where a grandmother and a newborn will be kept in the hospital for more than a year, or will they simply rescue this single woman and move on to other things? I hope that this incident will instigate them to provide quality universal healthcare for their citizens.
Year in and year out, the Nigerian media reports on the phenomenon of detaining patients in hospitals for their debts, but that is about where it ends. This is a recurring situation in the country, but it has not inspired our leaders to take any action beyond the occasional gesture of redeeming a single person pawned by a family too impoverished to pay their bills. The other part is that a huge chunk of these stories of hospital detention usually involves a pregnant woman. To a great extent, it accounts for why Nigeria has one of the worst maternal mortality rates in the world. Over 75,000 women die in Nigeria annually just trying to give birth. These deaths are so frequent that they almost do not even register as an urgent disaster in the public consciousness. It is telling of the extent to which women are taken to be discardable if people are that injured to their dying. The case of the detained grandmother in Rivers State is another illustrative example of how poor women die giving birth and what their deaths cost the families they leave behind. It is 2025, but Nigeria has not overcome the problems of maternal mortality. That is an extremely shameful situation.
The Punch
