THE population of Nigerians seeking medicare outside the shore of this country is increasing at an alarming rate. It is no longer an exclusive preserve of the elite, but a general practice among Nigerians, irrespective of class or status.
In the 1970s and 80s, when the practice began, the destination then were developed countries like United States of America (USA), United Kingdom, France, Canada, and Germany, among others, but at present, the hand of the pendulum has swung towards India, Malaysia, Singapore, Saudi Arabia, China and many more.
It will be an understatement to note that medical tourism, as it is called, has become a major sector boosting the economy of many of these countries, while Nigeria is draining her foreign reserve. This term has come to embrace all facets of consumers seeking treatment, improvement or change through wellness outside the coast of Nigeria.
Over 5,000 Nigerians travel to India and other countries monthly for medical treatment, according to the Nigeria Medical Association (NMA). Of the said number, nothing less than 3,000 of them travel to India.
As a result of this statistics, Nigeria is said to be losing over $500m annually (N78 billion), with $260m going to India. On the average, a traveller would spend between $20,000 and $40,000 on each medical trip.
While the Indian High Commission, disclosed that in 2012 alone, 47 per cent of Nigerians that visited India for medical purposes amounted to 18,000 people with billions of naira expended in scarce foreign exchange in the process. Another report has it that over 40,000 Nigerians obtained visas from Indian embassy that year alone.
More evidences to back this claim is the statement credited to the former
Minister of Health, Prof. Babatunde Oshotimehin and Minister of Finance in 2011 that about $200m (N30 billion), equivalent to about 20 per cent of the budgetary allocation for the health sector in 2010, could be saved annually if those traveling could be treated locally.
At present, the trend has risen steeply, with an annual figure put at N250 billion approximately, according to the Secretary, organising committee of the Nigerian Centenary Charity Ball, Dr. Kingsley Esegbue, who disclosed this during the countdown to the celebration held early this year.
If the N250 billion figure is correct, it represents about 300 per cent increase from the N78 billion ($500m) earlier put forward by the NMA in 2012. Of the N78 billion, the NMA also said that India raked in well over N40 billion, which is about 50 per cent.
Though government functionaries are largely responsible for this, especially, since the return of civil rule in 1999, but now, even the poor and the common man now seek medical treatment abroad. Their cases might be borne out of getting quality treatment for life-threatening ailments like kidney and heart transplants, cancer, hole in the heart, cardiac failings and neuro-surgical treatments, among others that Nigeria medical system is incapable of treating.
This is why the number of ordinary Nigerians besieging media and religious houses, NGOs and humanitarian organisations, seeking financial assistance to enable them travel abroad for treatment is on the increase. This is basically based on lack of confidence in the health sector.
Unfortunately, the patients on many occasions had fallen victim of sharp practices in these countries. This is different from challenges of those who died on arrival in the country or on their flights back home, due to complications arising from long hauls back home after surgery.
There was a case of a young man who travelled to Indian for treatment of an undisclosed ailment. He returned to the country after a successful surgery, but was shocked few months after to detect that one of his Kidneys had been removed.
Another, was the case of a man who went to Ghana for treatment, on his return, he detected that nails and iron were infused in his backbone. He was forced to sell his properties to seek proper medical attention in India and get those iron removed.
Stories abound of Nigerians who had ran into several fraudsters, who work in connivance with agents from these countries, to be doctors but after taking them to the hospitals, make them part with their hard-earned money and after receiving their commissions, they abandoned them to their fate.
Sadly, those victims had been crying in silence. It has been an awful experience of suffering and smiling for majority of them.
It is worrisome to note that cases of Nigerians allegedly detained in foreign country hospitals, including India, is on the increase due to their inability to settle their medical bills, yet Nigerians are still leaving the shore of the country on daily basis.
Just few weeks ago, The Guardian reported the plight of a 62-year-old Joseph Okafor, a victim of medical conspiracy in India, who raised an alarm to warn those who may want to embark on medical trip to Indian or any other country, to be wary of fake doctors and surgeons, as they are on the prowl for Nigerians.
He was not only extorted, he was also thrown out of the hospital and forced to take refuge in a hotel, where he completedhis treatment at an extra cost.
Okafor’s ordeal started in 2010, when he developed difficulty in walking and was diagnosed of Avascular Necrosis in his hips. His situation led him to seek medical assistance in India for surgery to correct the anomaly on the legs.
On May 12, 2010, he was admitted at Dr. Milind Patil’s Revival Bone & Joint Hospital, Mumbai and was discharged on June 25, 2010, after what was thought to be a successful Total Hip Replacement Cement (Exeter) on both legs. That was after he spent seven weeks.
In 2011, one of the hips relapsed, and he was forced to return to the hospital, where he was admitted on August 27, 2011. The diagnosis carried out on the affected hip reveals a loosening with LT Femoral & Acetabular. A Total Hip Replacement (hybrid cemented cup & uncemented stem) was reportedly carried out and he was discharged on October 5, 2011, after spending five weeks.
Last year, the left hip developed problem again and he was forced to visit an Orthopaedic hospital in Ikeja, Lagos, where he met one of his old school mates, Mrs. Ngozi Okanu, a retired matron at Igbobi Orthopaedic Hospital, who linked him up with one Professor Umesh Nagare, a medical doctor, who works in Oyster & Pearl Hospitals, Pume, India, but visits Nigeria often. She convinced him to try Nagare because she had worked with him for some time.
Okafor contacted the man via mail on May 26, 2014; he also forwarded previous reports and x-rays for better understanding of his situation.
In Nagare’s response, he disclosed that the man would need revision surgery for his hip, as the cup is loose and also knee replacement for right leg. He noted that the surgeries “can be sorted out in India only, as you do not have implants available in Nigeria.”For the Knee replacement, he charged $8,000 and for revision hip replacement, he charged $9,000 USD, adding that if both surgeries are carried out together, the package will be around $15,000.
“These package will include your stay for 20 days in the hospital’s private room, surgeon charges, hospital charges and others. The package will increase if you need ICU stay after surgery as stay in ICU will be added to original package amount.
“Please get back to me if you still have queries. I will be coming to Nigeria on June 18, 2014. You will require letter for visa, which I will need to arrange for you. Do not come through agents in Nigeria as they do not do anything and will charge you heavily,” the mail read.
The man’s last line raised suspicion with Okafor. What heightened his suspicion was the 20 days stay mentioned, and the huge amount of money charged for the operation, considering the fact that during his first surgery, which cost $9,000, he spent seven weeks, his second, which cost $5,000, he stayed for five weeks He wondered the type of magic that would be performed within the 20 days. But Okanu allayed his fear and he played along.
Regarding the price, they agreed to meet and negotiate when Nagare visits Nigeria. They met in a hospital in Lagos, where the three people had discussion on the issue.
“He told me that the price would not be problem and also that my stay would depend on the recovery level; that if it’s only the cup, it wouldn’t be more than $700 to $800, the hip $5,000 and the knee, $3,500. He told me that both surgeries would not be more than $9,000.
“I bought flight tickets for myself and Okanu and we travelled to India. We got there on August 3, 2014 and I was admitted at Oyster & Pearl Hospitals, Pume, a four-hour journey from the airport, unlike my previous hospital located at the point of entry.”
The final diagnosis showed failure of previous hip surgeries, revision left THR. The surgery commenced on August 7. But before then, Nagare demanded that I keep all the money I had on me with him, so that it would not be stolen, butI refused. At this point Okanu flared up at me saying that I am too suspicious. This was the person I paid N70, 000, even if she will collect commission from Nagare, she doesn’t suppose to act like that,” Okafor said.
He later demanded for a deposit of $3,500 and thereafter changed it to $4,500 before the surgery commenced and after the surgery he came back with the hospital management to demand for another $4,500.
“Instead of the $4,500 he demanded, I gave him only $2,000, with a promise that I would contact Nigeria for the balance. He then seized my passport and other travelling documents. I was surprised and asked him about the agreement we made in Nigeria. My son later sent $2,000 to him. The worst thing was that on August 18, 11 days after the surgery, when I was still recuperating, I was discharged abruptly and wheeled out of the hospital to the main road at about 9.00pm and was forced to move to a hotel. At the period, I was bleeding profusely and even collapsed in the process, the woman pretended as if she was not aware. “Before my forceful discharge, for days the blood evacuator connected to the affected leg was not working and after several complaints they never cared to replace it, which resulted in the bleeding. As at that time I was still bleeding from the stitches. Everyday I spent $120 for hotel bill, the matron upkeep and physiotherapist charges,” he stated.
On August 26, he discovered that the leg had swollen. He was taken back to the hospital, where the stitch was undone because of complications to be re-stitched. He spent two days there and was charged additional $800, which jerked up his balance to $1,300.
He told The Guardian that he protested the additional fee and immediately informed his children about the development. One of them called Nagare but he denied most of the things that happened, claiming that it was Okafor who demanded to be discharged and lodged in a hotel.
“The whole world is rushing to India, but there are so many criminals there. I finally paid the $9,000, and I believe that it was a gang-up with the hospital’s management to jerk up bills at the expense of their patients. They took me to a slaughter slab, what has hotel to do with a hospital?
“My previous treatment at Revival Hospital, Mumbai was under professional care and good medical and living condition, unlike what I experienced at Oyster & Pearl Hospital. The hospital was not meant for bone and nerve like Mumbai that is what those Indians do, they are criminals. They took me there to deal with me, they are acting like experts but they are criminals,” he said.
Fortunately, when The Guardian mailed Nagare, he noted that he was in Nigeria but he wasn’t in Lagos as at the time.
During the mail exchange, he did not only deny most of the allegations, he claimed that Okafor owes him operating fees, which he waved because he was not having money.
He disclosed that it was clearly mentioned to him that his previous hip replacement cup looks loose on x-rays. “If it is only cup change then the amount will be around $5,000. But if both cup and stem are loose, then cost of surgery will be around $9,000 to $10,000. After PET scan report, both components were loose. So decision was taken to change both.”
He added that he did not give Okafor any condition to either reduce or add to the cost, but that they always tell patients to carry $1,000 to $2,000 more for their logistics.
On why he mailed Okafor not to come through agents in Nigeria, he said; “As a surgeon, we get calls from Nigerian agents working for medical tourism here. They track patients and add their charges on top of it. This was just a word of caution for him. It is always the patient’s choice what they want to do.
“Nobody threw him out. He was talking to hospital management regarding his bills. An option was given to him by the management, that he could stay in the hospital and pay the bill for accommodation or move into a hotel if he wanted to reduce the cost. His discharge got delayed due to that. I don’t deal with hospital policies. You need to speak to the hospital management about this, as I told you, I consult there, I am not the owner.
Nagare denied seizing Okafor’s passports and other travelling documents; he said the passport was with the hospital management all the time, saying that he doesn’t interfere with their work.
“I think these things have to be sorted out with hospital management. My work is only related with surgery, they handle payments issues. I tried my best to answer your questions related to my work. Please talk to the hospital about management and bill related issues. I have already provided the number to you,” he stated.
When Okanu was contacted on phone, she said the problem is the issue of money. She added that because two previous surgeries had been carried out on the hips that might be the reason for the price increase but Okafor insisted that they reached an agreement that day on how much he would pay.
His case is one of the numerous episodes of fraudulent medical practices outside the shore of the country. In Nigeria today, medical NGOs now act like tour operators, who connect Nigerian clients to medical personnel abroad, they also confuse patients that their cases cannot be handled in the country, just because of commissions that would accrue to them.
It is only success stories we hear from returnees, sadly, many had died abroad which becomes double cost of bringing the corpse back home.
It is unfortunate that the rule guiding medical practice in Nigeria is not helping the matter, because we don’t have medical information on what medical advantages Nigeria has.
Lack of medical information has been the major problem, because most Nigerians are unaware that complicated issues can be handled within the country. There was a case of a 10-year-old girl, Favour, with a hole in her heart. She was brought to The Guardian in 2011 to seek financial assistance from Nigerians to take her abroad. She needed N4.5 million to cover the treatment, trip and other logistics. On reading the article, a man approached the company to assist the girl financially, shockingly he claimed that the case can be handled in Nigeria; she was treated in Lagos and within weeks the girl was on her feet.
There is another issue of follow-up, its only few of those who get treated abroad that can afford to travel back to the country where they were treated for follow-up, because it is capital intensive.
The common question been raised by medical experts is; should Nigeria change its rules to avoid this?
The rot in Nigeria healthcare sector has been linked to this problem. Gone are the days that Nigeria was a medical destination for foreigners, where medical personnel, especially Indians are on the pay slip of many hospitals. The exploits of the University College Hospital (UCH), Ibadan, Oyo State, and many more across the country in the past are indelible. But now, the rot in the system is irritating. Public healthcare is almost down and it is so bad.
When the National President of the NMA, Kayode Obembe was contacted on phone, he told The Guardian that part of NMA’s move to curb the menace is the clamour for the office of Surgeon-General.
He noted that the post of Surgeon General would actually ensure an interface between internal and external intervention in healthcare delivery services so that if anybody is going abroad, it is the office that would be in-charge to ensure proper treatment and the follow-up management of the patient, “but when this office is not in existence, there is no coordination at all.
“Another system that has been in existence is the National Health Insurance Scheme (NHIS). Under this scheme if a Doctor is attending to a patient in Nigeria, he would have done all the necessary preliminary investigations, package it and then write the report, and direct the patient to where he/she would get the appropriate treatment abroad.
“These information are very vital towards continuation management in other countries. But in Nigeria, we are not making use of this Insurance Scheme, whereby your provider in Nigeria can write a report and can send you to where proper management can be made. So, situations where people just get on the aeroplane and go abroad without any medical report is the reason why many of them run into problems when overseas.
He advised every Nigerian to register with a Primary Health Provider and get report from them before going abroad, adding that Teaching Hospitals can also write the report, which would be issued to the doctor overseas.
Said he, “This is an issue of international concern so that they would communicate directly with each other. These are things the NMA has been trying to do in terms of publishing that all over the country. We try to make contacts with Nigerian doctors, who are overseas on how they can help to make sure that Nigerian citizens are not subjected to any fraudulent practices when they go abroad for treatment. All these are the efforts we are making. We are also engaging in enlightenment, advocacy and trying to guide prospective patients in terms of getting experts from Nigeria hospitals before going abroad.”
On how to stop fraudulent doctors from coming to the country, Obembe noted that NMA has no power to arrest anybody. He stated that the immigration, the police and officials of foreign affairs department will have to do their job to stop these act, saying the police would need to also be involved to track their agents.
Dr. Obadare of the Liberty Specialist Hospital, Ilupeju, who also commented on the issue, condemned the practice of going outside the country for medical treatment, adding that there are medical experts in the country, who can treat patients’ successfully. “I am against medical tourism, yet I hate racism,” he stated.
To Dr. Sodipo Oluwajimi,
Senior registrar, Family Medicine, Lagos State University Teaching Hospital (LASUTH), Ikeja, Nigerians are lured to medical tourism, due to the aggressive advertisement by foreign medical groups, some of whom offer false hope to patients, failure of the government to fund and equip tertiary health institutions, making patients to lose confidence in the health system, failure of government to create an enabling environment for private medical practitioners to get the latest medical equipment, incessant strikes in the health sector, which has made patients lose confidence in the health sector
and poor remuneration of health professionals which prevents them from updating themselves on the latest developments in medicine.
To him, government has to ensure that only genuine cases travel abroad for treatment especially those being sponsored with government funds. “The NMA has to ensure that there is a standardised referral system and that any doctor who refer patients for monetary gain are sanctioned. There should be increased funding by government to ensure the citizenry have access to the latest medical, they should set up exchange programmes for medical doctors and other practitioners to have an orientation of best practices, government has to empower the private medical sector by giving interest free loans and setting up of an intervention fund to enable doctors buy the latest equipment.”
He noted that there is need for re-orientation of the public that travelling abroad is not a cure to any disease and that government should put in place policies to encourage Nigerian medical professionals in diaspora to come back home and contribute to growing the Nigerian medical sector.
“All in all, the government should empower the Nigerian medical sector to become a hub for medical tourism in Africa, as India is to other parts of the world. Medical tourism can be a great foreign exchange earner for the Nigerian government and the medical doctors with an added advantage of best medical practices for Nigerian patients if we develop the Nigerian health sector,” Oluwajimi said.
Nigerian Guardian News