Lagos State University Teaching Hospital, LASUTH, is a facility that records over 200 emergencies in two of its Accident & Emergency, A&E, units on a daily basis. Situated few kilometres away from the domestic terminal and Murtala Mohammed International Airport, Ikeja, LASUTH, is open to patients from all parts of the country and neighbouring African countries and is prone to unavoidable emergency cases at all times.
The 600-bed tertiary hospital, adjudged to be the busiest in Lagos, has also obtained global relevance as a place where people with various illnesses including terminal ones seek help. Unfortunately, the non functional primary healthcare system across the country has not helped the facility to function effectively as a referral and research centre. From the gate of the hospital, it was obvious that the ongoing industrial action in some Federal Government hospitals in the state was actually taking its toll on the facility with a large crowd of patients in the premises. It was exactly 12:00 noon when our correspondent arrived at the Surgical and Emergency unit of the hospital, one of its A&E.
Ambulances were strategically stationed in front of the emergency department. The running around of patients’ relations, brisk walking of medical staff within the tidy compound that exude a hospitable ambience was not absent.
Just opposite the LASEM was the ongoing construction of the Heliport as part of the new projects to improve services at the centre. The entrance into the two emergency departments, Medical Emergency and the Surgical Emergency departments were fully manned by neat security men. The triage nurse welcomes patients into the emergency and admission wards. The triage is where the process of determining the priority of patients’ treatments takes place. A first time visitor to the A&E needs no soothsayer to tell that the section defines fate of patients in emergencies. There, you find relatives of patients either hallucinating, wandering around the entrance, praying or shedding tears.
Some are found in groups discussing in low tones. Once a patient is done with the triage nurse and record officers and proper diagnoses done, treatment is initiated free of charge in the first 24- hours even when the patient is billed for referral to other hospitals. You could find some of these patients in an ambulance coach or wheel chairs because often times, the beds are full and most of the patients will require resuscitation before they are finally referred to other hospitals or moved to the wards.
One striking thing that was observed during this visit was that unlike some other hospitals, health workers including the medical doctors in the department carry out their responsibilities with special care and passion. Saturday Vanguard witnessed an instance when a young boy diagnosed with hydrocephalus which resulted to blindness urinated on the bed as a female doctor started the process of cleaning up before a nurse arrived. Another instance Saturday Vanguard witnessed was the visit of two officials from NEMA who came to make arrangement for admission of three Nigerian deportees from Libya that will require immediate treatment from the airport.
Although, there was no bed space at the time, they were encouraged to bring them straight from the airport at least for resuscitation. Our Correspondent also observed that some patients even after resuscitation are not eager to be referred to other hospitals without persuasion. Immediately a patient is brought in, a nurse and a doctor including the record officer attend to the patient. The next day after the patient must have been stabilised, the patient’s overall health is assessed. Basic tests like blood pressure, pulse, body temperature, etc., are taken. Medications are strictly dispensed and adherence to treatment closely monitored by nurses. The first 24 hours are free of charge irrespective of the kind of care given to the patient.
Patients who require urgent interventions are kept in the A&E for a maximum of 72 hours depending on the severity of their injuries. However, not all cases are admitted in the emergency wards. At the triage point, once it is discovered that a patient does not require emergency care, such patient is sent to the ward while those who come in with injuries have their bleeding controlled. Those who require oxygen are also given just as those with fractures are mobilised even if they will be referred. All these services are given free within 24 hours.
However, contrary to reports that patients sleep on the floor, the four wards and 75 beds in both the Medical and Surgical Emergency were neatly kept and patients were seen lying on a well kept bed with neat bed spread. The five beds in the Intensive Care Unit, ICU, of the department were fully occupied with patients being monitored with functional modern monitors and six nurses strategically stationed in the room. But even as strict as the management of the hospital is regarding admitting patients once the beds are full, Saturday Vanguard gathered that relations of patients even begged to be admitted on a wheelchair hoping that a patient would eventually be moved to the ward any moment.
Countless cases of patients ‘relations becoming violent have been recorded at the unit. Just last week, a father of a sick baby was arrested after he resorted to violence and damaged the hospital properties. However, a patient who has been in the department for four days and have regained consciousness confirmed to Saturday Vanguard that: “There is no need going outside the country to spend so much money when a centre like this is here.” The patient, who gave his name as Mr. Uche Daniels, said: “I have been here for about four days now. The doctors and nurses are very kind here. I am being given drugs three times a day. Unlike what we hear about government hospitals, the doctors usually come from time to time to check on us here. They are trying but we want them to do more.
Emergency services One of the medical doctors in the Surgical Emergency unit, Dr. Olufunmi Babalola hinted Saturday Vanguard that not less than 60 to 70 emergency cases are attended to in the centre on a daily basis. “This place is like a transient area. Most patients here are usually unconscious. We have monitors and machines that record their vitals. Everyone in the ICU is on oxygen and nurses are on standby to monitor them. We also have couches in the ICU and whoever requires suturing we have a room like a mini-theatre. We don’t treat patients on the floor. Once the beds are full they are full. Although, when there is no bed we stabilize all our patients, we resuscitate with fluids, pain killers, antibiotics and even if a patient requires oxygen we give but once a patient is stabilised we refer to another centre.
“One thing about this centre is that we have enough doctors, nurses and the bed space here in the surgical ward are over 30 beds including couches. About 12 to 15 doctors work in here. “We have about 40 nurses and they run shift. Rules are observed in this place. Food vendors are not allowed here. We have eateries and the hospital’s kitchen also serves foods for the patients.” At the Medical Emergency department of LASUTH, there were patients from all over the country including some from neighbouring countries like Ghana and Republic of Benin. In this unit, female and male patients are kept in separate wards. There are two resuscitation rooms with two beds, 11 beds for female wards and 12 beds for males. There also a number of couches to support the beds before patients are moved to the wards. There is also a separate room for tetanus patients. These special patients are not managed with others for medical reasons. Also, about 70 patients are seen in this unit on a daily basis out of which about 60 will be admitted.
The admission starts from the triage point, where a senior nurse identifies the nature of the illness and the record officer will be there to take information from the relatives while a doctor goes back to complete documentation and hand over to the team on call on that day. Patients who are not critically ill are taken in, all vital signs taken and they are moved to the consulting rooms where doctors are waiting to attend to them. Each morning, a nurse goes round the wards to find out how many bed spaces are available and record it on the notice board. At this point, patients brought over night who are stable will be moved out.
The Head of Department, LASUTH Medical Emergency, Dr. Adekunle Taiwo says patients sometimes are referred to other hospitals because there is no way they can admit between 50 and 60 patient on a daily basis. “In as much as we would have loved to do so, we can’t, due to lack of beds. We refer to other hospitals. But we must resuscitate before we refer to other government hospitals. “This place is usually crowded because people have refused to patronise primary Healthcare Centres and once they are here it is difficult to send them back. Many people do not know that they can access help in those health centres. We need media assistants in the area of creating awareness that PHCs also function like a hospital. This place is supposed to be a referral centre, where patients are referred from secondary care level or from another Teaching hospitals.
By Chioma Obinna