If Gift Julius and her husband had been able to pay the N250,000 demanded by officials at the Intensive Care Unit (ICU) of the Lagos University Teaching Hospital (LUTH), perhaps three of their children would still be alive.

In the evening of July 16, 2018, while Mrs Julius, who lived in Ilaje, a ghetto in the largely affluent neighbourhood of Lekki, was in nearby Sangotedo where she worked as a maid, tragedy struck her family.

Her husband, John, locked their four children in their one-room apartment in the often-crowded tenement building common in Nigeria’s ghettos called ‘face-me-I-face-you’ while he went to buy something at a bus-stop close to their home. Before he returned, the children who were between five and one-year-old, inadvertently set fire on the family mattress. The fire soon spread to the entire room.

By the time neighbours broke into the room to rescue the children, they were badly burned. Before they arrived at a nearby hospital, one of the children was already dead. The three surviving children, who suffered burns of between 60 per cent to 73 per cent of their bodies were later referred to LUTH.

At LUTH the distraught parents were asked to deposit N250,000 before the children could be treated at the hospital’s ICU. They could not raise the money. Soon two of the surviving three children died.

The surviving five-year-old, who was the least injured because he had hidden inside a fridge, as the fire burned, was hanging on to life by a fragile thread. In fact, he would have died like his siblings had the family not received help from the Health Emergency Initiative (HEI), a not-for-profit organisation that provides medical assistance for people who are financially distressed.

In Ajegunle, another impoverished neighbourhood of Lagos, Modinat Ogunmade, a widow and mother of five thought her 12-year-old son, Ezekiel, had malaria. But after days of treating him with herbs, his condition got worse. Soon Ezekiel started experiencing intestinal obstruction and in no time, his abdomen became swollen and doctors told Ms Ogunmade they would require surgery.

Modinat Ogunmade and her son, Segun Ezekiel. [Photo credit: Ifeoluwa Adediran]

Ms Ogunmade entered into panic mode. She ekes out a living selling sachet alcoholic beverages at motor parks. There was no way she could afford to pay for surgery. Luckily for her, the cost of the surgery was waived by the hospital but she still needed to raise N25,000.00 to buy drugs and to cover other post-surgery needs of her son.

She said one morning as she was at home preparing a meal for her recuperating son at the hospital, she received a call from the hospital that what was left of her son’s bill had been paid.

“I don’t know them, they said they came through the social worker,” she said.

Those she was referring to were officials of HEI who had visited the hospital in her absence and had cleared her outstanding bill.

Succour to indigent patients

A 2018 survey by The World Poverty Clock, an organisation that tracks world poverty, declared that Nigeria is the poverty capital of the world. According to the report, 87 million Nigerians, about half of the country’s population, lives in extreme poverty. The survey defined extreme poverty as a situation when someone’s daily income is below $2 a day.

Nigeria is one of the least countries with access to quality healthcare. In 2018, the medical journal, The Lancet, in its survey which reviewed access and quality of healthcare in 195 countries from 1990 to 2015, ranked Nigeria at 140th position.

A 2018 Health Maintenance Organisations (HMOs) industry report by audit firm Agusto & Co., stated that only 5 per cent of Nigerians have health insurance, which means most Nigerian pay for medical care out of pocket.

Therefore, a combination of widespread poverty, poor access to healthcare and low insurance penetration is a recipe for disaster. Just outside the Lagos State University Teaching Hospital (LASUTH) at Ikeja, indigents patients regularly beg for alms from passers-by and motorists to conduct medical tests or to pay for mounting bill. The situation is no different from other major hospitals across the country.

Paschal Achunine, the executive director of HEI, told PREMIUM TIMES that the organisation was established in 2015 to provide succour for indigent Nigerians, especially victims of health emergencies who cannot afford to foot their medical bills.

The focus of the Health Emergency Initiative is to create succour to indigents patients, those who typically die because of ₦5,000.00, ₦10,000.00, ₦20,000.00 and below,” he said.

Mr Achunine explained that patients typically die or are held hostage in hospitals because they could not afford hospital bills as little as N10,000.00 or less due to the extreme poverty in the country.

Medical Detention

Mr Achunine also explained that the inability of indigent patients to pay their medical bills after treatment has led to a growing case of what is now referred to as medical detention.

Medical detention is a situation where patients who are unable to pay their medical bills are held hostage by private and public hospitals until they pay. A 2017 Chatham House report stated the victims of medical detentions, which is most prevalent in sub-Saharan Africa and parts of Asia, are mostly “women requiring life-saving emergency caesarean sections, and their babies.”

The report stated that the people who are most vulnerable to medical detention are the poorest of the poor requiring emergency treatments. Apart from being subjected to physical and verbal abuses by medical officials, detaining indigent people for unpaid treatments further pushes them into poverty, the report stated.

“The practice of detaining people in hospitals for non-payment of medical bills deters healthcare use, increases medical impoverishment, and is a denial of international human rights standards, including the right not to be imprisoned as a debtor, and the right to access to medical care,” the report stated.

How HEI helps patients

Rowland Ugiangbe, the hospital liaison officer for HEI, told PREMIUM TIMES the focus of his organisation is to reduce medical detention in the country. He explained that HEI works with social workers stationed in public hospitals in Lagos, Nigeria’s largest city, to identify the most vulnerable patients.

“The doctors send details of patients who cannot afford medical bills to social workers, the social workers then call on the Health Emergency Initiative for intervention,” he said.

Mr Achunine explained that HEI does not give cash to patients or their family members. He said this approach was adopted to prevent patients or their family member from diverting the money to meet other needs rather than to cover their medical bills.

He said HEI pays directly to hospitals or pharmacies account. He explained that for the money, the organisation only covers bills not exceeding N20,000.00.

Mr Achunine said the organisation primarily focuses on paying for the treatment ailments such as malaria, typhoid fever, malnutrition, diarrhoea, pneumonia and others which cost N20,000.00 or less to treat.

For victims of health emergencies such as road accidents, HEI ensures that treatment is not delayed or denied due to unavailability of funds. In Nigeria where hospitals usually demand victims of emergencies to make down payment before they are treated, HEI, without a doubt, is helping to save lives.

For instance, HEI’s accident emergency project, #ThatNoneShouldDie Initiative, a collaboration with the Federal Road Safety Commission, ensures that accident victims are treated even when they do not have money. To do this, HEI signed an MOU with selected hospitals in Lagos where accident victims receive life-saving emergency treatments at no cost.

Last August, HEI paid the hospital bills of five critically injured victims of the accident between a truck belonging to Dangote Industry and the Bus Rapid Transit (BRT) bus in Lagos.

Similarly, through its “First Responders’ Scheme” HEI is training people on how to handle health emergencies and administer first aid before they are taken to hospitals. The organisation hopes that this project will help eradicate the culture of people taking pictures and videos of victims during road accidents and other emergencies instead of providing life-saving assistance.

A call for more assistance

Though HEI has received financial support from individuals and corporate donors such as PricewaterhouseCoopers (PwC), United Parcel Service (UPS, USA), Woodhall Capital Foundation, MRS Oil Plc, Business Network International, Mr Achunine said the organisation will help more indigent patients if it gets more financial support.

“What we are doing is a pan-Nigeria programme that is aimed at bringing succour to vulnerable people. You are aware that not less than 96 million Nigerians live in extreme poverty, so what HEI is doing requires the support of corporates, individuals so that we can reach more. It’s sad and painful that people die because of N10,000 in a country like Nigeria,” he said.