Nigeria has an impressive emergency response for disease outbreaks but victims of road accidents and other emergencies are at the mercy of ‘Good Samaritans’ for a chance at survival.
Death tolls continue to rise in Nigeria with more than a hundred deaths reported secondary to multiple emergency-oriented incidents within a month. One of such recent outcries arose from the recent death of Patrick Fakoya, popularly known as Rico Swavey. Fakoya was a Nigerian lawyer and former housemate of 2018 edition of the popular reality television show Big Brother Naija.
Following his involvement in a ghastly accident, Fakoya was rushed to the nearest hospital, Doren Specialist Hospital, where he reportedly received emergency care. However, his critical condition warranted the need for referral to another facility for special care. This became overwhelming for the person that rushed him to the health facility hence the need for Fakoya’s friends and family to take over his care and support.
This is a familiar reality across Nigeria and while it could suggest the state of the country’s health sector, a comparison to the realities of the early days of the COVID-19 and country’s last Ebola outbreak suggested that swift emergency care — including ambulance services —can actually be swiftly implemented across the country, largely.
The COVID-19 testament of what is possible
Emergency preparedness was a major discussion during the outset of the acute phase of the COVID-19 pandemic in Nigeria even as the country continues to improve its ability to respond to communicable (infectious) diseases. This focus on infectious diseases is likely due to the rate they spread, their case fatality ratio, and significant impact on the national economy —in the short and long terms.
During the period, the Chikwe Ihekweazu-led Nigeria Centre for Disease Control (NCDC) worked with health ministries at the national and state levels to acquire, develop, hone and localise capacities for the initiation and coordination of emergency responses. This was due to the wide gap that existed in emergency response services to communicable and non-communicable diseases in the country.
During the pandemic, some state governments purchased ambulances to enhance emergency service provision in their states. In Oyo state for instance, the state governor, Seyi Makinde, announced the state spent NGN321 million to acquired ambulances to convey COVID-19 patients in the state. Similarly, Willie Obiano, governor of Anambra state, donated 63 Keke (tricycles) ambulances for the primary healthcare emergency unit in all local governments of Anambra state. Similar initiatives were announced and funded by several other state governors.
But these ambulances are probably not being fully utilised and maximised considering the daily logistical requirements including fueling, servicing, staffing, stocking, maintenance, coordination and other factors that had compelled many of these acquired ambulances to be grounded at hospital and ministry premises — benefiting no one.
Ihekweazu revealed that each local government in Nigeria now has an emergency operation centre. But while this exists, emergency care response and coordination in most places across the country is both a mirage and conflicting confusion considering coordination and effectiveness vary from one region, state, local government and street to another. But this isn’t and shouldn’t be the case as experience elsewhere suggests things can be done more differently and more effectively.
Elsewhere, residents including young children know the emergency numbers to call in distress. 911. 111. 999. And so on. But in Nigeria, despite several attempts at different levels and across government agencies, a prompt and nationally efficient, effective and proactive emergency response service for all citizens and residents remain elusive.
Nigeria’s Abuja federal capital territory and each of the country’s 36 states each has a largely struggling and sparingly uniform emergency response protocol the hallmark of which is a general lack of accountability.
In Lagos state for instance, there are various numbers published online for residents to call during an emergency. However, there have been bottlenecks around the implementation of the response. According to a study led by Chinmayee Venkatraman, out of a total of 1352 Lagos State Ambulance Service (LASAMBUS) intervention forms, the service did not address 53% of the road traffic accident (RTA) calls they received for intervention between December 2017 and May 2018. That is more than half of the total calls received.
Nigerian actor, Uti Nwachukwu recently shared his experience of hit-and-run. He said he called the emergency call number on behalf of the victim. The first call was picked and the details were recorded. But nobody showed up. He called but this time, the respondent hung up on him and refused to pick subsequent calls. He had to rescue the victim by himself.
The plight of a Samaritan in Nigeria
In present day Nigeria, the fate of many accident victims is in the hands of the willingness of the so-called Samaritans at the site of the accident. In other words, people like Nwachukwu. Some clamour for anybody with a means of transport in the neighbourhood or family members of the affected person. Meanwhile, aside from the fear of the victim dying in the care of the individual, there are greater hurdles to scale at health facilities that are expected to provide the emergency services.
In spite of directives from the government for accident victims to be given prompt care before payment, health facilities across the country still demand upfront payment (deposit) to, at least, cover the cost of materials needed to provide resuscitation and emergency care. Health finance experts often describe this unrelenting practice as a manifestation of the Nigerian population being predominantly uninsured with less than 5% of the population having some form of health insurance coverage.
And no thanks to previous experience, a hospital that provides emergency services to an accident victim without a deposit may be at loss if the patient eventually dies and/or the family and relatives refuse to pay. This is the reason why “good Samaritans” would still be compelled to pay something in order to keep the victim alive before the victim’s family and relatives take over the responsibility of footing the hospital bills.
A good Samaritan may also be compelled to wait at the hospital against his or her (or their) wish — and often more than necessary — since no one else is known to be associated with or connected to the victim. When there is no means of identifying the patient, the hospital would still need the Samaritan to standby for questioning and for history taking regarding the incident.
A good Samaritan could also be a victim of harassment, extortion and detention if responding officers are not sensitive enough about how their actions could subsequently discourage other members from stopping to help accident victims. It is therefore not surprising for individuals in need of emergency care not to receive such when no one stops to help considering the public knowledge of the potential ill-fate of the good Samaritan.
In countries where emergency services are more effective, the system is able to swiftly a victim’s next-of-kin. But in the case of Fakoya, the person that rushed him to seek emergency care was also saddled with the task of finding Fakoya’s friends and relatives. He had to record a video that was then shared on social media to call the attention of the victim’s family members.
In the Nigerian setting, this task ought not to fall on the person. It ought to be a responsibility for security operatives such as the Nigerian Police in addition to the Federal Road Safety Commission, and other constituted emergency responders.
A normal abnormality
Unlike the acute phase of the COVID-19 pandemic in Nigeria when official numbers to call when someone closeby began to show symptoms suggestive of COVID-19 were made public and there is a clear chain of responsibility among responders on what to do and where to safely take a suspected case, a typical emergency situation is often characterised with confusion. No clear protocol on what to do and who to call.
And depending on where the incident is happening, the victim could actually be another victim of theft and poor handling by individuals who are willing to help, but know little or nothing about what to do. But something has to be done considering there is no absolute guarantee that help will come when they call for one.
However, citizens over the years have come to terms with this and have developed a coping mechanism. They rescue one another when it is critical and wait when it would not worsen the condition of the victim. Even though police and road safety officers are often on the roads, especially at major points, there is no absolute guarantee that they will be close by — and there is no effective way for anyone to call for help. Everyone knows there is a problem with the current system but unlike COVID-19 and Ebola, it seems not to be a top priority, at least not yet.
What Nigeria needs to save citizens like Fakoya is a truly (effectively) working system. A well-oiled machinery that is characterised with immaculately coordinated expedited provision of logistics and assistance. This will need to be easily known to all citizens anywhere in the country as a trusted source for help in time of need.
The goal to drive this should be the realisation that irrespective of the nature of threat, every life should be considered precious and everything humanly and logistically possible should be done to give everyone a fighting chance of surviving any accident or disease outbreak.