Godonu Wusu did not think anything significant would happen when he left his home in the sleepy town of Badagry sometime in August 2017. The leafy, slow-paced seaside town according to a long-running inside joke has two types of people: those who escape to explore the world in Lagos and beyond because they hate how quiet Badagry is, and those who choose to remain behind and spend their whole lives in a contented semi-holiday state.
He definitely had no idea that he would end up wrapping his car around a tree that night. He was discovered alive inside the wreckage, and rushed to Badagry General Hospital. His condition was serious, but not necessarily life-threatening if handled well. There was just one problem – Badagry General Hospital apparently had no bed space for him. Per the rules, the hospital was only allowed to refer him to another government hospital, as against a nearby private one. The nearest such hospital was in Igando, over three hours away across the dreadful Lagos – Badagry expressway.
If his condition did not kill him while waiting for a bed space, the journey to Alimosho almost certainly would. With his condition still worsening and no doctor willing to see him, Godonu’s family decided to rush him to a private clinic nearby. As it turned out, it was too late by the time they got there, and Mr Wusu died at the clinic. They had no choice but to take his corpse to the mortuary at Badagry General Hospital. The hospital, which had no bed space for Godonu while he was alive, had space for his corpse in the morgue.
Badagry’s Hospital of Horrors
When a whistleblower reached out to me a few weeks ago with an incredible story about an under-resourced, rodent-infested state general hospital with absentee doctors and a 40 percent maternal mortality rate for Caesarian Section deliveries, I should have ordinarily been skeptical. If true, the sheer scale and seriousness of managerial malfeasance and Hippocratic Oath violations outlined by the whistleblower could result in loss of medical licenses and possibly even prosecution.
However, coming from a family that seems to breed medical doctors, I am unfortunately all too aware of the sort of unbelievable stories that come out of Nigeria’s health sector. Just a few days before, the story of the unfortunate chap below from Benin had done the rounds on social media, and I myself have had one notable encounter with Nigerian public health services. I believed the whistleblower and set out to investigate the story.
Alongside my team at TheSheet TV, with support from the MacArthur Foundation, I set out on a secret mission to my hometown, armed with cameras and a microphone. On getting there, we discovered that sourcing this story would be harder than we thought. From the anticipated group of at least seven whistleblowers, we ended up speaking to only three. One by one, the others developed cold feet, even as I explained that they would not be named or identified in any way, and that I would not divulge my sources.
One of them was supposed to shoot clandestine video footage of the doctors’ room in a state of disrepair, overrun by rats, cockroaches and mosquitoes, but he stopped answering my messages and eventually I took the hint. I was left with oral testimony from two doctors and a nurse, which ordinarily should have diluted the quality of the story. Not so with Badagry General Hospital, where the level of brazen, unbelievable malfeasance is such that even its own staff reportedly die alongside patients sometimes.
According to both doctors who agreed to speak to me, an attendant who worked at the hospital recently died there after being denied treatment. This incident did not lead to any upheaval, sanctions or changes of any kind. It was just another day at a hospital that functions like a war front triage unit amidst the wealth and structure of Nigeria’s richest city. The allegations raised by all three whistleblowers included the following common complaints:
- Surgeons sometimes having to carry out operations by torchlight due to lack of electricity;
- A permanently empty pharmacy because management owes drug suppliers;
- Surgeons forced to wash hands before surgery using bucket and bailer, as against global standard of tap and running water;
- Acute under-resourcing including lack of Blood, Oxygen, electricity, running water, gloves, beds, surgery scrubs, laboratory equipment, reagents and pretty much everything else a hospital needs to function;
- Patients having to buy everything they need for treatment including gloves and soap from outside, because nothing is available in the hospital;
- A deadly staffing crisis that leads to procedures like Caesarian section being done by a single doctor who is often in a hurry;
- Sticky-fingered management who cook the books and under-report statistics to the Lagos State Health Service Commission to avoid detection;
- Total breakdown of staff discipline, with doctors missing work regularly with no consequences, and local staff pulling the indigence card to avoid all accountability;
- A ridiculously high mortality rate for all kinds of patients due to extremely avoidable causes such as lack of electricity to power incubators or lack of oxygen;
- A scandalous mortality rate of 4 in 10 for Caesarian Section patients in particular because of off-brand Oxytocin and staff shortage;
- Habitual owing of staff entitlements and stipends;
- Fraudulent accounting practices such as charging patients twice for things like anesthesia;
- Breakdown of security and flouting of rules surrounding visiting times by local residents;
- Lack of proper staff welfare, leading to staff neglect and even death;
- Lack of proper food for patients and staff, leading to avoidable health complications.
“Ko Ni Da Won L’ohun”
When we got to Badagry General Hospital, we decided to try two approaches to get a possible first hand scoop by ourselves. I instructed our in-house OAP Temitope Boma-Peterside and our cameraman Pascal Gaglo to pose as patients going in to see a doctor while we parked out of sight.
The idea was for them to capture mobile phone footage if possible, and confirm the alleged culture of malfeasance in the hospital. As it turned out, they didn’t even need to get past the gate to get a taste of what Badagry General Hospital is like. Unaware that he was being recorded, a security man responding to Temi’s request to see a doctor made reference to a certain Sunday, saying in Yoruba “Ti Sunday o ba tii ri pe eni yen fe ku, ko ni da won l’ohun” [“If Sunday doesn’t see that somebody is about to die, he won’t give them an audience”].
Getting to the reception, she was then instructed to wait, by a bored-looking nurse who stayed on the phone throughout the interaction. Presumably, she had better things to do than attend to a patient complaining of physical discomfort. Eventually, Temi was told that no doctor was around, but she could come back in the evening and hopefully, there might be a doctor available to see her then. None of this seemed to be a surprise to the people around. Just another day at Badagry General Hospital, apparently.
Upon getting back to the vehicle, we tried our second idea after a quick change of clothes. We posed as a street vox-pop team asking passersby outside the hospital about their expectations for the new Lagos State governor, Babajide Sanwo-Olu. The idea was to use this as a pretext to get into the hospital premises and catch some video footage, but it quickly became clear that the security men around Badagry General Hospital decidedly do not like cameras. Our final move was to speak to our whistleblowers and get their testimonies on tape before calling it a day and heading back to Lagos, via a surprise visit to my ancestral home in Soweh-Ahovikoh.
Dead Mothers, A Mini-Fiefdom and the Cemetery Next Door
Something that struck me in the course of speaking to our sources was an overarching sense of helplessness and distance from the authorities in Alausa. Something they were all keen to stress was that Badagry General Hospital is actually not representative of how health services are administered in Lagos. The problem they said, is that because of the sheer distance and difficulty involved in getting to Badagry, it is something of a forgotten area in the minds of the Lagos State government.
The first doctor I spoke to alleged that when inspectors from Lagos State come around, management pays them bribes of up to N2 million to look the other way. Certainly, for anyone who has experienced the reality of medical care at institutions under the Lagos State Ministry of Health, stories about Badagry General and its rat-infested rooms, dying staff, lack of electricity and stratospheric maternal mortality rate sound very distant and unrelatable.
Then again, a lot of Badagry is very distant and unrelatable to the rest of Lagos. While Lagos is typically a commercial nerve centre where the street language is Yoruba and life moves at breakneck speed, Badagry is a stubbornly sleepy, somewhat insular small town, populated with trilingual people who have unfamiliar names like Tokoyon, Sedoweh and Mausedeh. It is perhaps only in Badagry that former Lagos State governor Akinwunmi Ambode could have gotten away with visiting a hastily painted and beautified uncompleted structure inside the premises of Badagry General Hospital, and using it for a somewhat misleading photo-op.
Getting to Badagry is also a very difficult undertaking, because the Lagos-Badagry expressway is currently more laterite than asphalt. The natives of Badagry are also famously reticent and perhaps a little provincial in their worldview, so the net result of all this is that Badagry has slipped through the regulatory cracks and become one of the most forgettable jurisdictions in all of Lagos. If even the road to Badagry, which is also an international road and Nigeria’s gateway to the ECOWAS region is in that state, perhaps it is not surprising that Lagos State health regulators do not pay as much attention to Badagry General Hospital as say, Alimosho General Hospital three hours down the road.
Unfortunately, this has deadly consequences for everyone from Seme down to Agbara, which is the area this hospital services. Except they can afford to go private, they are forced to make do with what passes for a government hospital in Badagry. As with Godonu Wusu mentioned at the outset, a referral from Badagry General is effectively a death sentence for patients in serious conditions – if the hospital does not kill them first. The hospital management, according to the second doctor is well aware of the regulatory distance, and exploits it to the full, running the hospital as a personal fiefdom with zero accountability.
Of the many stories my whistleblowers told, what got to me the most was the story of a pregnant mother brought in for an emergency Caesarian section. Despite having only one doctor available, the surgery was successfully carried out, only for the woman to bleed out and die in the aftermath of the operation. The cause of bleeding? A particular brand of Oxytocin administered to her, which the hospital had previously stopped using after several such cases. Due to habitually owing drug suppliers, the hospital no longer had any of the new, non-problematic Oxytocin, so it went back to using the substandard brand, resulting in a tragic and unnecessary death.
It is difficult to picture another state-owned hospital in Lagos where such an incident would not lead to an investigation from the Health Service Commission, but it is unclear whether the hospital management even kept a record of it. The first whistleblower claimed that the MD of the hospital – himself an O&G consultant – regularly alters and under-reports statistics about number of procedures performed, so the HSC is kept in the dark about just how many people are treated at Badagry General, and how many of them end up in the mortuary.
Explaining management’s interest in keeping Lagos State out of the affairs of Badagry General, he referenced the example of revenue collection. Previously, payments at the hospital were collected by civil service cashiers, and Badagry General declared about N5 million monthly revenue. Since Lagos Statre outsourced collection to an external consultant called Megalek, Badagry General now declares between N15 million and N16 million monthly revenue. Since the number of patients did not suddenly triple, that would indicate that someone’s bread was being regularly and vigorously buttered prior to automation.
According to all three whistleblowers, protecting other such avenues for pilferage is management’s only objective in running Badagry General. Premature infants may continue to die because there is no electricity to power the incubators. Expectant mothers may continue having a 4 in 10 chance of dying during childbirth. Doctors may continue performing surgeries by flashlight. Patients may continue dying on operating tables due to lack of blood and oxygen. A&E patients may keep on being sentenced to die on the expressway en-route Alimosho General, because there is no bed space or available doctor. None of this is of any concern to management, and Alausa either does not know, or chooses not to know.
All of this apparently is fine and acceptable, as long as the good times keep on rolling – for a select few in management and at Alausa. Millions of people in an entire district of Nigeria’s wealthiest city be damned.
One of my sources initially wanted to be named in this report, such was his level of exasperation with the situation. We were later advised that this was against Lagos State civil service rules. Presumably, regularly killing innocent people like Godonu Wusu is less of a concern to the civil service than the fallout of exposing high level malfeasance that is literally killing an entire town.
As we drove away, I instructed the camera operator to take a shot of the 30-second drive from Badagry General Hospital to Badagry Cemetery on the way home, so we could include it in the documentary. I must have driven along that road a few dozen times in the last two years alone, but I had never thought of how weird it was to have a huge graveyard and the only state hospital in miles located a stone’s throw from each other.
For the first time, I could see a clear link between both places.