The problem of lack of access to quality healthcare services is a major challenge in the country despite the country’s National Health Act backing access to healthcare for all Nigerians through the basic minimum package of health services. However, the problem of access to health services is a bigger challenge for persons living with disabilities with many of them facing ill-treatment, neglect, stigma, and discrimination when they go to healthcare facilities to access care. OLUWATOBILOBA JAIYEOLA, in this report, spoke with some persons living with disabilities on the range of barriers they face when accessing healthcare services, particularly in government hospitals.
When Ayomide Amuda, in her 40s, rushed into Ikorodu General Hospital, her son was gasping for air. His asthma had kicked in, beyond the control of his inhalers. But her urgency to save him was met by healthcare workers who stood aloof and seemingly less concerned about her quest for prompt attention and treatment.
When they weren’t ignoring her, the nurses were shoving her around. Her son, who also doubles as her guide because she is visually impaired, lies in a corner helplessly. Since she lost her sight, Amuda had relied on other people’s sight in hospitals, at home, in the market, and everywhere.
As soon as her son came of age, he slipped into the role of his mother’s guide. But now, the guide was ill, and no one was willing to help his mother.
She said, “Normally it is my son that assists me when I need to visit the hospital for any reason but at that time, he was sick, and he was the one that needed help and it was tough for us. It was very tough.
“We needed to be going from one place to another doing different things, making payments, doing tests, etc., and without a guide, that means it should be left in the hands of the hospital staff to do for me. Instead, they kept complaining that they don’t have my time.”
There is only so much a mum’s heart can take when her child is in danger, so Amuda cried for help, asking to be taken to the hospital’s welfare unit. The welfare staff on duty didn’t understand their duty and they turned their back on her.
Describing her experience, Amuda stated, “I asked the nurses for direction to the social welfare unit in the hospital, someone took me to the unit and by the time I got there they said they are only two on duty and none of them can leave their post to assist me.
“They blamed me for not coming to the hospital with someone that could help me and refused to leave their post to assist me. I said I thought the social welfare unit was supposed to cater to persons with disabilities and maybe the old, they replied that it wasn’t their duty to follow people like me around and that we should always come along with someone to the hospital, or not come at all if we are not with anyone to help.”
It was when her son soon fainted that the hospital workers remembered their job, she said, noting that it was then that medical personnel swarmed the boy, trying to save his life at the last minute.
They succeeded and admitted her son, but she still needed the help of an outsider.
“That day, my son fainted, that was when they deemed it fit and saw it was an emergency. So, they eventually came and rushed him, but they left me, and I didn’t follow them again. If I had brought my guide, I would have been following them every step of the way to make sure my son was okay.
“I eventually had to call one of my friends, he is also blind but he’s a partially sighted person, so he was the one that came and was assisting me all over the place and they put my son on admission, but he had to leave eventually,” she added.
After her friend left, Amuda had to ask that her six-year-old daughter be brought to her. Neglected by the health workers around her, she said she had to rely on the guidance of a child to help herself and her other child.
According to Amuda, her son could have died because she was blind and the nurses on duty didn’t care. “I felt very bad being treated this way because if my son had died that time because of the way I was treated, I don’t know what I would have done to myself.
“I started blaming myself and feeling bad that if I was not in this condition, I would have been able to be there and be present for my son in his time of need. I would have been able to assist him to do everything. Even my six-year-old daughter later got ill after her brother got discharged.
“All these made me feel very guilty because it was like I exposed her to something she was not supposed to be exposed to and I was very unhappy,” she narrated.
Madam Amuda is not alone in this type of challenge. In 2021, the Minister of Health, Osagie Ehanire, said about 0.78 per cent (1.56 million) Nigerians suffered from blindness during World Sight Day.
Many of these visually impaired persons often face serious challenges when they need medical assistance, even though this is against the ‘Discrimination against Persons with Disabilities (Prohibition) Act, 2018’.
A portion of the Act states that the “Government shall guarantee that persons with disabilities have unfettered access to adequate health care without discrimination on the basis of disability.”
But Kayode Afolabi, another person with visual impairment disagrees that there is a law that guarantees him access to healthcare services in hospitals.
Narrating his experience, he said, “Going to the hospital with my condition is often tough. If I don’t go with anyone, no one would assist me. The time I went alone, I found it very difficult to get help from staff and even patients.
“When nurses notice my condition, some of them act well, some will harshly tell me to go and sit down there ‘we are coming we are coming’. Some have feelings for others though and try to help.
“I was once at LASUTH, though, at the initial stage of my impairment. When I got there, some nurses weren’t helpful and neither were the patients but they also have their own problems that they are dealing with. After then, I stopped going to general hospitals.”
He added, “We face a lot of discrimination in the hospital and even everywhere but we still have few good Nigerians who really understand our plight.”
The visually impaired persons are not alone in facing discrimination from hospitals; it is a common sad tale amongst persons living with disabilities.
People with hearing impairment often complain about their inability to communicate with medical personnel while people in wheelchairs struggle with access to medical facilities because of a lack of ramps and other physical facilities.
Since she was wrongfully injected as a child, Ekiti State indigene, Oluwatobi Olagunju, has had to depend on crushes and a caliper shoe for mobility.
Moving around is a struggle for her, and visiting hospitals only aggravates it, although she said, she occasionally meets angels in human forms. She said it isn’t only hospital staff that reminds her of her condition.
“One time, the woman selling snacks at the General hospital Ikorodu was also looking down on me. The lady was very rude.
“I was the first person to call her and when I did, she ignored me but when other people called, she answered. When she eventually answered she flung the snacks and was like leave me alone and I was confused. I was wondering what I did to her. She started eyeing me up to down like who is she and what is she saying.
“I felt very bad and started crying like what is all this? The matron stood up for me and started talking to her. The matron asked her ‘what has this lady done to you that you are abusing her’. The woman corrected her. She told her that what she did was very wrong because she saw how I felt and saw I was crying,” she narrated.
Olagunju added, “We are not equal and the way I have programmed my memory is to forget all those issues and bad experiences that make me sad because when I remember, it makes me feel very bad and I could start crying again. So I learned to forget them and not to put them in my mind much.”
While Article 25 of the UN Convention on the Rights of Persons with Disabilities guarantees the right of persons with disabilities to attain the highest standard of health, without discrimination, the World Health Organisation notes that the reality is different across countries, as only a few provide adequate quality services for people with disabilities.
According to a WHO report, “People with disability encounter a range of barriers when they attempt to access health care. People with disability commonly report experiences of prejudice, stigma, and discrimination by health service providers and other staff at health facilities.
“Many service providers have limited knowledge and understanding of the rights of people with disability and their health needs and have inadequate training and professional development about disability.
“Many health services do not have policies in place to accommodate the needs of people with disability. Such policies could include allowing longer and flexible appointment times, providing outreach services, and reducing costs for people with disability.”
According to the National President, Nigeria Association of the Blind, Mr. Ishiyaku Adamu, the office received lots of complaints from persons with disabilities regarding stigmatisation.
He stated that before the disability commission was founded, they partnered with human rights lawyers, human rights commission offices across the country, and the media to expose the issue.
Speaking on how the cloud of discrimination can be cleared, Adamu said, “One of the things that the hearing impaired are advocating for is for the government to employ sign interpreters in various hospitals so that it will ease communication between the medical personnel and the patient when they visit the hospital.
“It is only in National Hospital Abuja I was told that they employed one deaf to take care of that. When it comes to the blind, they would also love to have accessibility whereby they can travel independently in the hospital and there would be an opportunity for them to work independently.
“As regards drug prescriptions, maybe the Federal Ministry of Health can make it mandatory for those producing drugs to start using braille and other things so it will make things easier for a visually impaired individual to understand their prescriptions.”
He further added, “The most important issue that is concerning for persons with disability is the access to health insurance. It is a key issue, there is no social protection. Yes, we have social protection, like the one of 2016 and the current one they are reforming which talks about providing health facilities, talking about social protection for persons with disability but they are not being implemented.
“If you look at the current reform on the National Health Insurance Scheme, little has been said for persons with disability and you know the majority of persons with disability are poor, they don’t have access to finance especially to take care of their health cost and a lot of them are already dealing with pre-existing health conditions.
“There is no measure put in place by the government to say maybe a certain category of persons with disability will be having free health care services.
“Even the National Disability Act did not talk about free healthcare except for those with intellectual disability but what about someone with a spinal cord injury that requires constant medication and is living on drugs throughout his life and requires medical attention? Also, other persons with disability have families who require this kind of support. The law does not cover them,” Adamu said.
What Lagos Office for Disability Affairs is doing
In Lagos, persons with disability are registered under the Lagos State Office for Disability Affairs.
LASODA says it tries to help uphold the rights of all persons living with any form of disability in Lagos State by safeguarding them against all forms of discrimination and giving them equal rights and opportunities.
Findings from PUNCH Healthwise revealed that all persons interviewed are registered under LASODA yet, yet they still face challenges accessing healthcare services.
Efforts to speak with the General Manager of LASODA, Mr. Oluwadamilare Ogundairo, however, were unsuccessful He did not answer calls made to his line and also did note respond to text messages sent to him.
Stigma could cause psychological issues in persons living with disabilities -Expert
Speaking with PUNCH HealthWise, a clinical psychologist at the Department of Psychiatry, Dr. Juliet Ottoh, said when persons with disabilities are treated poorly; it reminds them of their current state, eventually resulting in them experiencing emotional and psychological pain.
She said, “Some of them are full of pain; it forms psychological effects. They experience emotional pain and most of them even have self-pity.
They would question themselves that why am I like this, why is my own life like this, why am I different from other people and they forget that in any situation and anywhere you find yourself, you are unique in your own way.
“Anyone can have a disability and some persons were not born with it. Accidents, traumatic experiences, and many other things could cause a disability. It doesn’t mean their life is truncated.”
She added, “In this society we are, people with disabilities tend to be seen differently. People stigmatise them.
“People need to realise that their fault and that they are going through a lot. So sensitisation and awareness of the populace are important. People need to be aware that to suffer disability is not a curse.”
Ottoh who works at the Lagos University Teaching Hospital urged health workers to empathise with persons with disabilities whenever they visit the hospital to make them feel comfortable and safe.
She said, “For medical practitioners, the first thing is empathy. Once anyone with a disability comes into your facility, you must first and foremost empathise with them, and let the person know you are there to support them because a nonchalant attitude can make them uncomfortable. They will not even want to speak to you or even get treated and may not want to come back to that facility.
“Once you show them empathy, they will feel like they’ve had a warm reception from this person and can speak freely about how they feel, hoping to feel better.”
Need for disability-friendly facilities
Founder of the Advocacy for women with disabilities initiative, Patience Ogolo-Dickson stressed the need for disability-friendly structures to be put in place in hospitals to enable persons with disabilities to have quality access to healthcare.
“If structures are not in place, if systems are not accessible, if special needs they need to function effectively and differently are not there, it will be very difficult for them to achieve success, especially in healthcare settings.
“If a structure does not account for sign language interpreters or the structures are not accessible to wheelchairs or they are not accessible to people using crutches, it will also affect their healthcare because they will not be able to go into those facilities to access health services.
“Healthcare is an essential component of human life so whether you have a disability or not it is very important, but unfortunately we are living in a society that doesn’t prioritise issues of persons with disabilities around health,” she said.
Ogolo-Dickson urged the government to ensure already set policies aimed at addressing these challenges are implemented, adding that the government should integrate persons with disability and their issues around healthcare into the health curriculums in institutions in the state.
“We can review already existing policies and make them more inclusive but most importantly what we need is the implementation of the policy, so if there is no implementation then why are we having policies? It is only when you implement that you can make things accessible and make things work according to what the citizens want.”
In addition, “I always advocate that it is good for health workers to have it in their health curriculum as they go through their college of medicine or wherever they go to do their health study.
“Health workers need to be more knowledgeable for them to be able to take care of persons with disability better.
“They should include persons with disability and their issues around health into the curriculums, that way they will know how to handle persons with disability and it will also increase their knowledge around them,” she said.
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