University of Nigeria Teaching Hospital [UNTH] Enugu

I would like everyone to read this article thoroughly and appreciate why I am so upset.

Following my nephew’s diagnosis of leukemia at UNTH, in Enugu, I requested that the hematology department send a referral note by e-mail to Saint Jude’s, a children’s cancer research hospital in Memphis, Tennessee, USA. This institution is a center of excellence for the condition my nephew had.

Why did I ask for a referral? Early red flags indicated that UNTH Enugu was not the right place for my nephew, and hindsight confirmed that it was a mistake to have sent my nephew there.

Any layperson could spot the many things wrong with the system in this department. They lacked blood and blood products. They lacked medication, and they lacked empathy. They even sent my brother to hunt for blood and medicines with which to treat my nephew.

The hematology department stalled on my request for referral. They pulled out every delaying trick in their manual. First they said they knew what they were doing. Secondly they asked that I send them a referral request letter by mail. Finally, they wanted to know my rank as a doctor, I guess for having the audacity to express my desire for a referral. I don’t know why, but each time I say or remember this part I sob and cry.

On July 6, barely twelve hours before he passed, the department hurriedly wrote a referral letter. They did not bother sending the referral by e-mail as urgency demanded. They tossed the referral note over to my brother. ‘Do whatever you want with it’ was their attitude.

Tall, light-skinned, sweet-hearted and handsome, my nephew loved to play soccer. ‘My role,’ I consistently informed the department ‘is that of a big uncle.’ They were bewildered.

Between two hematologists and a head of department, they proved themselves incapable of lowering a child’s temperature. They were unable to raise his hemoglobin or platelets above the levels he had when he arrived from another department. In the two weeks he was there, the doctors were on strike half the time.

Tell me how a kid who walked into what was supposedly a tertiary hospital ends up dying in less than two weeks for a condition as common as leukemia.

A day or so after his admission to UNTH my brother was driving when I called him to check on my nephew’s status.

‘Where are you going?’ I asked. ‘Hunting for blood donors,’ he said.

The department sent my brother to roam the rugged hills of Enugu for blood. He also had a list of medications they asked him to buy to treat his son.

When I had the opportunity, I questioned the rationale of sending a distraught father to hunt for blood.

The male hematologist had challenged my brother to go to the village, to bring everybody in to donate blood. You could tell by the tone of his voice that he despised people from the villages. The female hematologist blamed parents such as my brother for the reason why the department had not a drop of blood in the blood bank.

Faced with my nephew’s impending doom at the hands of UNTH, I reiterated my plea for an urgent referral note to Saint Jude.

‘Don’t beg me,’ fumed the female hematologist, ‘we will refer when appropriate. And, by the way,’ she added, ‘the doctors are on strike.’

Both hematologists had the firm opinion that despite the obvious shortcomings they were capable of managing my nephew at UNTH. ‘Referring a condition that we can manage would make us look foolish,’ they chorused.

‘Does the hospital have a pediatric intensive care unit?’ I asked. ‘Yes, but it is closed because the doctors are on strike,’ the female hematologist said nonchalantly. The department maintained that he was getting the best of care.

So sad: the two hematologists didn’t comprehend how rusty the unit is as a place of care, how handicapped is the tertiary center in which they operate, and how out of touch they are as doctors.

Had they referred him promptly as requested, the outcome would have been different. Instead they sat on their rumps, and pulled out all the delaying tactics in their manual.

I am not alone. Many people tell similar sad stories when relatives attend UNTH. Compared to other Nigerian hospitals in the same category, UNTH ENUGU is in the dust, stuck at the bottom of the pit.

Other teaching hospitals have functioning websites, whereas UNTH has none.

Most Nigerian teaching hospitals have contact telephone numbers and e-mail addresses, whereas UNTH has none.

Many have devoted staff, whereas UNTH has mercenary doctors who devote most of their time to their private practice and only pay lip service to UNTH.

UNTH’s pernicious culture of incompetence must stop. UNTH Enugu is not under the gun to accept patients, but once they do they are one hundred percent responsible for the care of those patients.

It is a medical malpractice to accept a patient today and allow the staff to walk out of the job the next day.

A hallmark of good medical practice is to seek immediate help for diseases in which a practitioner lacks experience or the resources to manage it. It was obvious that these doctors had no clue what they were doing. They were unaware of their incapability. They were no experts on leukemia as they claimed.

When it became obvious that they did not know what they were doing their egos did not allow them to seek a second opinion or be open to a prompt referral as requested. Looking foolish is what they feared, and foolish is what they became.

I am not sure who among them insisted that my rank as a doctor must be a prerequisite for granting a referral request.

Since when did a doctor’s rank become one of the criteria for granting a referral request? Everybody interested in a patient’s wellbeing – mother, father, and relatives – must be accorded the respect of a timely referral when they ask; more so when the hospital lacks experience and resources, and the doctors are on strike.

How can a parent deal simultaneously with the impending disaster of losing a child and run a blood errand for a teaching hospital? The department ought to be ashamed. They need to be shut down.

Instead of consulting experts in the field they ignored a child with a fever, low platelets, and low hemoglobin. Despite having two hematologists who claim to be experts, they were unable to improve any of those parameters above the treatment carried out by a private doctor.

Seriously, is this really an institution of higher learning where doctors train?

At the same time as claiming that their department was fully equipped to take care of a 17-year-old male with leukemia, they admitted that their doctors were on strike and that their pediatric intensive care unit was closed.

It was easy to tell that they were living on another planet. Where else on earth but UNTH would the distraught parent of a very sick child be sent to roam the hills of Enugu in the hunt for blood and medicine?

They should have consulted other experts in the field, but they did not; they should have reached out to the outside world, but they did not; above all, they should have left their egos at home but they did not. What a shame.

They never gave my nephew a second chance. They watched him as he died but he was not on any continuous monitoring for vital signs required of a child this sick. They diagnosed him with leukemia but never gave him a single dose of chemotherapy.

Despite the seriousness of his condition, they only obtained a blood count once every three days. His laboratory values were repeated only when I asked. The woman hematologist did not have his laboratory result at her fingertips; she needed time to look up the result of an acutely sick child.

Given the circumstances of his death, the head of the department should have reached out to my family to explain what happened, and what they did trying to treat him. Instead they have refused to discuss with me my nephew’s final days. Of the two e-mails I sent, one was returned as undeliverable. I am still waiting for a reply to the other.

If their e-mail address and telephone numbers are no good, how can their skills and knowledge be at the cutting edge of medical care?

No other family or child should go through this kind of agony. There was no basis for such a degree of malicious obstruction when family members asked for a referral to a better equipped and managed institution.

The hematology unit at UNTH Enugu woefully failed to meet the minimum standard of care expected of a tertiary teaching hospital. Until it is deemed fit for patient care, the department must be shut down.

2 Comments

  1. Anazoeze Madu

    My dear friend and colleague, I am Dr Madu, a consultant Haematologist with the department of haematology of UNTH. Let me start by expressing my condolences on the loss of your nephew. However, I do not think your assertions are correct. I have worked with that department both as a resident doctor and consultant for the past 15 years and I am certain the unit has handled a minimum of 2000 children diagnosed with acute leukaemia in that time period and therefore cannot be said tobe Iinexinexperienced in that regard.
    The unit has 3 professors of haematology including an expert in marrow transplant and the head of department who had worked in St Thomases hospital UK for more than 10 years before his return. If these men an women are inexperienced then I wonder who is.
    The peculiar situation in the country and it’s blood transfusion system has been a source of worry to all health practitioners and haematologists in particular. We operate a system of related blood donor replacement. You will be surprised to note that we (the insensitive and incompetent lot) not only donate blood for our patients but also go begging medical students as well as university students to donate blood for patients. You can ask anyone in UNEC if you doubt this. So asking the patients parents to join in the search is nothing out of the ordinary, hoping your nephew does not belong to a rare blood group.
    I wasn’t around during this incident but I can vouch for all our doctors with regards to patient care. Acute leukaemia in children is always a nightmare especially once sepsis steps in because our hands are tied and as a colleague you should know that no one gives chemotherapy to a septic cancer patient. The main aim of management is support and treatment of sepsis,whether your nephew was stable enough to be transported can only be assessed by the doctors on ground and even from your account that patient was obviously not fit enough to be moved. Accept my condolences once again and good day.
    Dr Madu

    Reply
  2. luke

    Dear Dr. Madu , I would like you to, please, explain to us laymen whether a patient or his family can request for refferal and be granted that request or refferal can only be done at the discretion of the immediate doctor of a patient. This is because the anger of the uncle to the deceased lies in the refusal of the UNTH doctors to grant the referral request on time. Rest in peace to the dead! Onwu ajoka!

    Reply

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