The Nigerian emergency department

In the Nigerian emergency department, the expectations of the patients and their relatives are the same as anywhere else. What differs is the manner and extent to which this is met. The facilities and personnel available to handle emergency situations in several emergency rooms vary, depending on the hospital.

The new single storey adult accident and emergency building of the Obafemi Awolowo University Teaching Hospital, Ife, one of the oldest and largest hospitals in Nigeria, has about 20 couches, a number which is well below capacity. Often trolleys and stretchers in cubicles, on the corridor, and sometimes even, the floor supplement the beds. Such is the scene in a typical tertiary care hospital in Nigeria.

Patients present to emergency departments after trying to have the problem solved elsewhere--churches, prayer houses, with traditional healers, with patent medicine dealers, and even with self acclaimed pseudo-orthodox medical practitioners. Kenneth Ochulor, medical registrar at the University College Hospital, Ibadan, said, "Here, the sick usually wait and waste away at home, only coming to hospital at the very last moment, at night and often accompanied by a riot of people, usually in a shabby bus, most of who would begin to sneak away, beginning with the eldest--once you start to talk about money. In Nigeria, the chief complaint and possibly the greatest aggravating factor for the progression of illness is poverty," said a medical student at the University of Calabar Teaching Hospital who wants to remain unnamed.

Like most public facilities in Nigeria, the emergency departments of most public hospitals have had their own share of neglect recently. Patients may die because of inadequate oxygen or lack of power to operate a defibrillator. In the face of all these constraints, the emergency departments in most Nigerian hospitals are still able to meet public health demands. Many doctors in Nigeria say, to be able to practice efficiently in Nigeria, you must be prepared to sacrifice and improvise.

Your clinical skills and judgment have to be in top form. A great deal depends on what you have been able to observe, palpate, percuss, and auscultate. Your decision afterwards may make the difference between life and death. In some cases for which tests are available, the patient may not be able to pay for them and so in effect they are non-existent.

One patient said, "It is not as if we like suffering or that we don't know help is available, but we come to the hospital as a last resort because we know we may not be able to buy the drugs that will be prescribed. At least I can always find and prepare the herbs the traditional healer will ask me to take."

In Nigerian emergency departments is a lavish display of the variety and folly of humankind and its exposure of the limitations of "medicine," which sees doctors practising with old technology and clinical skill.

In retrospect, if patients present on time, and the authorities upgrade the facilities and embark upon proper maintenance measures for the currently available ones, then the emergency departments will be able to meet the people's expectations on more occasions and greater positive impacts will be made on their lives.

Chibuzo Odigwe fourth year medical student, University of Calabar Teaching Hospital, Nigeria
Email: chibuzo2k2@yahoo.com

Seye Abimbola fifth year medical student, Obafemi Awolowo University Teaching Hospital, Nigeria
Email: vosofa@yahoo.com

studentBMJ 2004;12:393-436 November ISSN 0966-6494