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Caesarean Section: The new ‘goldmine’ for Nigerian hospitals

For several days, Franka Eleki refused to be consoled. Like a woman who had just been widowed, she cried her heart out. Eyes, cheeks and skin – all testified to the grief she had been soaked in. Since a doctor delivered a most frightening news to the young mother, only few things made sense as far as she was concerned.

A bulging stomach, Eleki was due to deliver her second child in the first week of November 2015 according to results from a scan in late October. Everything was set as she eagerly anticipated the arrival of the baby which scans had revealed was a male. But as the date drew closer, anticipation and excitement soon gave way to anxiety after the baby failed to come in the first week of November as predicted. Even the extra weeks given after the due delivery date elapsed without any sign of labour or the child coming. It was a terrible period for the family.

Worried at the development, 28-year-old Eleki in company with her husband, Edward, a software engineer, visited the doctor of the hospital where she had registered and had been attending weekly ante-natal checks in the Agric area of Ikorodu, a Lagos suburb. After expressing their concern to the doctor on her situation, he directed that they go for another scan immediately and let him have the result. In less than 40 minutes, the couple returned with the result which predicted that the child would come in the second week of December 2015. The doctor checked the woman to see if the child was in the right position and ready to be born. But after his examination, he told Eleki and her husband that the head of the child was yet to enter the cervix which means that the labour process could not be triggered. He said even if they were to induce her into labour, it wasn’t going to be possible at that point since the baby’s head was yet to ‘engage’. The doctor explained to the curious and emotionally-depleted couple that the only reasons why the head of the child was yet to ‘engage’ could be perhaps because the cervix was too small for it to go in or that there was no pressure in the woman’s womb to push the baby’s head into it. He prescribed Castor Oil – a therapy used to trigger labour in pregnant women – for Eleki and advised her to check back at the hospital the following day. Throughout that night, the young mother couldn’t sleep as pains similar to labour signs engulfed her. By morning, she was back at the hospital to see the doctor on the way forward. That was where everything changed.

“After explaining my experience throughout the previous night to him, he immediately proceeded to check me to see if the baby was ready to come out,” Eleki said. “Even though I was feeling the baby’s head and force around my waist more than at previous times, the doctor simply told me that the head was yet to ‘engage’ and that the situation had become a bit critical. He said he needed to speak with my husband urgently,” the Anambra State-born lady said.

 

That afternoon, the doctor and Edward who was at work at the time, spoke. Hard and demoralising, his words destabilised the young father for the rest of the day. It was not the type of news Edward wanted to hear.

“The doctor during our conversation on the phone that afternoon told me that my wife’s situation had become very critical,” the 33-year-old software engineer told our correspondent. “He told me that from all indications, the child was too big to pass through the cervix and that if something was not done fast, it could lead to tragedy. I asked him what options were available to us and how long we had left. I was shocked with what he told me.

“With all certainty and authoritativeness, the doctor told me that the placenta of the foetus was only a few days from dying and that if that happened, it would not survive and the mother’s life would be at grave risk as well. He said the only option was for my wife to undergo surgery. The most painful part was that the doctor boasted that even if we took her to London, Germany or anywhere in the world to meet the best gynaecologists, my wife could not be delivered of the baby normally except through surgery.

“The news rattled and affected my mood at work throughout that day. The doctor sounded very convinced and emphatic about what he was saying but something within me still felt the baby could come out without operation. That was when we finally decided to contact the doctor that delivered her of our first child. The man is a gynaecologist.

“The next day, my wife had to take the pains to go look for him at his hospital in another part of Ikorodu even though the roads in that area were so terrible. She called me later that day to tell me that the doctor had checked her and said that her condition was perfect for the baby to come out normally. He told her that the child’s head had been in the cervix all along. Two days later, my wife gave birth at that hospital through normal delivery and in fact without a single tear. The same woman the first doctor said could never give birth normally even if we took her to meet the best gynaecologists in the world. It is a big shame on them because God rescued us from their evil plans,” he said.

Child delivery done through Caesarean Section costs between N300, 000 and N400, 000 in that hospital as the young couple would later find out. At the place where she eventually gave birth, they paid only N25, 000 – 16 times cheaper than they could have coughed out.

While the Elekis remain grateful to the heavens for rescuing them from a problem that could have drained their pockets and also put the lives of two of their own through avoidable risk, the Adekunles, another young family, have quite a different story to tell. Doctors at a private hospital in the Ogudu area of Lagos notorious for delivering babies through CS, tricked them into opting for surgery using the weapon of fear. According to Mr. Damilare Adekunle, an auto spare parts dealer, the doctors played on their naivety as potential parents to extort them.

“My wife got pregnant immediately we moved to Ogudu after our wedding in 2012,” Adekunle began his chilling narrative. “She had to quickly register for ante-natal at a nearby hospital but we never knew that the doctors there were only interested in operation and not normal delivery so that they could make more money. On one of those days when she visited for weekly checks, a nurse told her that we should be preparing N250, 000 for operation because her baby was too big and could not be delivered normally. She was only six months pregnant at the time. The nurses even told her that operation was better because there would be no labour pain and that it was safer for her and the baby.

“We were naïve and inexperienced, it did not occur to us to do extra findings or discuss with our more experienced relatives and friends, so we simply believed them. Surprisingly, one week before her due date, the hospital told her to bring her things to be delivered of the baby. Of course she was operated upon that day and everything went smoothly but it was after that period that we found out more about that hospital and how it was known to be only interested in conducting operations for pregnant women for their selfish gains.

“My wife has had two other babies after that time at a different hospital through normal delivery where we were told her pelvic was big enough to accommodate the passage of any baby. We still feel hurt and cheated by that hospital because we could have lost more than the money it deceitfully collected from us,” he said.

Though, Joy Otumagba lost about N150, 000 to a private hospital in the Apapa area of Lagos, she miraculously escaped going under the knife for a needless surgery.

As is the practice, doctors at the hospital had conquered and caged her spirit through fear about seven months into her pregnancy two years ago. On one ante-natal visit, she was told the baby she was carrying was big and could only be delivered through CS which costs around N250, 000 at the place. To make the payment flexible, Otumagba was advised to start depositing N150, 000 before her due date and pay the balance after the surgery. She had no reason to panic since the hospital was one of the best in the area. By the end of her eighth month in pregnancy, she had completed the N150, 000 initial deposit. However, the intervention of an elder relative who resides in the Ajegunle part of the metropolis swung the tide in a different direction.

“I was already looking forward to the operation when a relative who came visiting one day opened my eyes. She told me to go to another hospital and also do a pelvic scan to see if the ‘passage’ was big enough for the child to pass through or not. She said if everything supported what I was initially told by the hospital I was attending, only then should I go for the operation.

“I heeded that advice and I will forever be grateful to my uncle’s wife whom God used to pull me out of that trap. Of course the pelvic scan revealed that everything was fine, so also did the doctor at the new hospital I visited. Three weeks later, I gave birth normally without any complication. I never knew CS had become a big business for some hospitals in Nigeria,” Otumagba said.

Yusuf Abdul-amin, a young doctor learnt a bitter lesson in 2014. Newly employed at a private hospital in the Ebutte Meta area of Lagos, his dream of building a successful career in the medical profession received the perfect start any of his colleagues could have wished for.

One evening, Abdul-amin, 28 at the time, walked into the hospital to witness a pathetic scene. A pregnant woman who had been in labour for a few hours was left wriggling on a bench after the doctor on duty refused to attend to her following her husband’s protest to sign a document for a surgery to be performed on her. The doctor had insisted that operation was the only option to save the life of the baby and its mother as the ‘passage way’ was too narrow for the child to come out. It was in the middle of this precarious situation that Abdul-amin walked in. The sight of the dying woman gripped him. The newly employed doctor told his colleague of his intention to personally deliver the woman of her baby regardless of his own verdict. Less than 20 minutes after taking her into the labour room, the shrill cry of a baby livened the ward. It was a huge relief for the couple but sadly, bad news for the young doctor.

“I was sacked by the owner of the hospital that day, less than two weeks after I was employed because I allowed the woman to give birth through normal delivery,” Abdul-amin told our correspondent on the phone from his base in the United States where he has since relocated and has been practising. “The owner of the hospital, who is a woman, asked me how I expected them to pay salaries and meet up with other obligations if staff prevented people from paying for operations even if they were unnecessary. The other doctors at the hospital have become part of the system and that was why they felt I was crazy when I insisted that the woman could be delivered of her baby normally.

“Even though I was shocked at that experience, I don’t regret losing that job for saving the life of an innocent woman and her baby. The hospital could have charged them at least N230, 000 instead of the N35, 000 they eventually paid. Only God knows how many families that hospital would have ruined through this criminal and unethical method. It is a nasty experience I find very hard to forget,” he said.

According to the United Nations Children Education Fund, about 5.9 million babies are born in Nigeria every year with around one million from that number dying before the age of five. While many of these babies arrive through normal deliveries, caesarean births – the chunk of it needless – have contributed to an increasing part of that figure. Latest reports say women in developing countries like Nigeria are 300 times more likely to die during childbirth as a result of pregnancy-related complications than their peers in the developed world.

Though, Caesarean Section, which is birth through an incision in the abdominal wall and uterus rather than through the vagina, has saved dozens of lives across the country, new findings by Saturday PUNCH reveal that most hospitals in urban centres are now using it to milk many families, especially young couples who are desperate to welcome their first babies.

A lot of these couples in a bid to satisfy the hospitals’ ‘greed’, sell entire possessions just to raise funds for needless surgeries that risks the lives of their loved ones.

The World Health Organisation says that CS should be done only as a life-saving measure when there is a risk of foetal or maternal death. The global organisation believes, “There should be no justification for any region in the world to have CS rates higher than 10 to 15 per cent.” In Nigeria, some states like Kebbi have a CS rate of 20.3 per cent.

A professor and former WHO consultant, Dr. Sundari Raveendran, said subjecting women to CS when not medically necessary is a violation of women’s rights.

“There are good reasons to be concerned about the spate of unnecessary C-sections carried out in a casual manner. Consent has been taken from women, and doctors are not giving full and complete information about the possible side effects of abdominal surgery,” she said.

A surgeon with the Lagos State University Teaching Hospital, Dr. Olugbenga Saliu Oseni, explained that CS, as an interventional delivery process, should only be explored when it is the only option left to save the lives of mother and baby.

“The best thing to happen to a woman is to have a normal delivery but when this is not available, the preferred option should be CS.

“There are many reasons why a doctor may prescribe CS and some occur in critical situations. But it will be crazy for any doctor to elect to do CS because he wants to make more money; that means that person is not an expert,” he said.

While before now CS in most public hospitals across the country was between N60, 000 and N75, 000, the fee has since been jacked up to around 150,000 and N200, 000 in many of the places today. In private hospitals, it hovers between N300, 000 and N1m.

A gynaecologist, Dr. Samuel Adebayo, fingers the high cost of medical equipment and other necessary infrastructure like regular electricity supply as part of the reasons why some hospitals charge exorbitant fees for CS. He said about 90 per cent of the medical supplies needed for the procedure is imported.

“Most of the supplies we use are not produced in Nigeria; not even the surgical blade that is used to severe the umbilical from the mother. The anaesthetic pack alone goes for N35, 000 in some areas, though it used to be N15, 000. Even ordinary Paracetamol injection is imported. That is why you see that even teaching hospitals have to increase their price.

“Again, absence of regular electricity supply is another challenge because we must sterilise all the surgical instruments we use and we must also ensure that we are on generator when doing the operation because you cannot afford to experience power failure during a Caesarian delivery. It is a multi-sector problem which government must address,” he said.

While in many parts of Europe and the United States of America the cost of CS is largely covered under the national health insurance, in Nigeria, women on the verge of delivery and their families are made to cough out huge sums from their pockets without largely any form of support from government. As a result of this, many nursing mothers are held back in the hospital for several days after delivering and sometimes weeks until their husbands or relations can clear the bogus bills.

President, Nigeria Medical Association, Dr. Kayode Obembe, said there must be certain indicators in place for a CS to take place. He said carrying out such surgeries when these indicators are absent is not only unethical but also a violation of the rights of a patient.

“Caesarean Section in the real sense of it is a life saving measure but there must be some clear cut indicators for performing such. If there is any situation now where anybody performs Caesarean Section and there are no indications for it, the patients or their relations are quite free to report to the Medical and Dental Council of Nigeria and professionals in that field would be asked to go and reappraise the procedure. Nobody should be tricked into delivering at any hospital against their wish,” he said.

Public Relations Officer of the Medical and Dental Council of Nigeria, Mr. Henry Okwuokenye, toldSaturday PUNCH that there is a tribunal and investigating panel in place that looks into any such matter and hands down appropriate sanction if complaints get to them.

He said the MDCN cannot do much on the matter except victims of such fraudulent practice take the courage to report their experiences to the organisation as they cannot be everywhere at the same time.

“The MDCN is not in hospitals everywhere, so we may not know some of these things except people give us information and make reports. We have an investigating panel and tribunal that look into matters like this and try erring doctors. As soon as we get such reports, erring doctors would be tried and dealt with.

“We need people to come out and make reports for us to set examples of these doctors. If we get only one of these fraudulent doctors and make him or her scapegoat, the others will behave properly,” he said.

Constitutional lawyer, Mr. Jiti Ogunye, posits that if truly some doctors now deliberately lure pregnant women into electing for needless CS just for pecuniary motives, they have both violated the patients’ rights and breached a fundamental part of the law.

“Subjecting a pregnant and expectant mother on the verge of delivery to a fraudulent and needless caesarian operation, based on misleading and fraudulent representation that she could not self-deliver her baby unless subjected to an assisted delivery procedure, in order to compel the woman and her husband to pay huge sums of money to a medical practitioner, maternity home, clinic or hospital, is not only cruel in the extreme but also unlawful and illegal. It is a gross act of professional misconduct, a civil wrong and a criminal act.

“It is against the physician oath because it is a surgical operation which ought to be embarked upon only to save the lives of the mother and child. It is not a cosmetic surgery. Thus, under Section 16 of the Medical and Dental Practitioners Act, Cap M8, Vol 8, Laws of the Federation, 2004, such a medical practitioner, clinic or hospital is liable to be sanctioned for infamous conduct or professional misconduct.

“Such act also constitutes a civil wrong. It is tantamount to a violation of the integrity of the body of the woman. It is a tort, an act of battery that is actionable under the law of negligence, the categories of which, in law, are never closed,” he said.

A sociologist, Lanre Adewuyi, told Saturday PUNCH that this sad trend of needless extortion and unethical practice will continue to soar in Nigeria because of the seeming goldmine doctors and private hospitals appear to have found in CS.

According to him, the poor regulation of the industry and the weak laws guiding the practice in Nigeria is another dimension to the problem.

“Many of these beautiful hospitals and smartly-dressed gynaecologists are more interested in financial gains than saving lives. A caesarean delivery costs an average of N200, 000 in many of these private hospitals. By the time they add other related charges, you could be paying as much as N350, 000. This is a lot of money for the hospitals and that is why they would continue to trick pregnant women into opting for CS.

In a country plagued by scores of social problems top among them infrastructural shortfalls, many hospitals across Nigeria – government and private – have had to provide basic needs like clean portable water, security and even motorable roads on their own. This is aside spending huge amounts providing their own electricity supply and equipping the facilities to acceptable standards.

Adewuyi explains that until government lives up to its side of the social contract by providing basic infrastructure in the country, those who do so on their own would continue to dictate the tune to the larger majority – in this case helpless pregnant women like Mrs. Adekunle and Otumagba whose hard-earned money is daily slithered away from their grip.

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