Kwara major health centre where nurses use lamps to deliver babies

…patients defecate in bushes, buy fuel to power facility’s generator

SODIQ OJUROUNGBE disguised as a patient to access the dilapidated 35-bedded Esie Primary Health Centre in Kwara State. Overgrown with thickets, lacking electricity supply and functional toilets, the facility, which is managed by the University of Ilorin Teaching Hospital, passes off as no decent place for a sick patient to seek treatment.

In the unhygienic, dark labour room, women birth their babies, helped by nurses clutching torch lights.

As labour pangs hit Elizabeth Alatise on a cold Saturday night in October 2021, her seemingly confused husband, Idowu, managed to clutch a bag, which had been stuffed weeks back with necessary things needed for childbirth.

Supporting his wife, who was writhing in pain, they both headed to Esie Comprehensive Hospital where they were greeted by pitch darkness.

Gently picking their way to the nurses’ section and guided by the dim light from his phone touch light, Elizabeth’s husband felt uneasy and apprehensive about the state of the hospital but was left with no choice given the urgency and his financial situation.

“There was no light and the whole place was dark. The hospital was as quiet as a graveyard when I rushed my wife there that night,” he recalled, shaking his head in a manner that indicated absolute disapproval.

Alatise said by the time he called out for help several times, a nurse emerged from one of the dark rooms, helped his wife to a bed and after accessing her, went to prepare the labour room for delivery.

However, after hours of being in labour, Elizabeth’s husband was told by one of the nurses that she would have to undergo a caesarean section due to complications that arose after failed attempts to give birth naturally.

The nurses, our correspondent was told, improvised with torch lights due to a power outage in the facility, adding that there was little they could do given the circumstance.

However, what would later jeopardise the life of Elizabeth and her unborn child was the fact that there was no doctor on the ground to carry out the procedure.

Alatise told our correspondent that accompanied by his friend that later joined him at the hospital, they travelled five kilometres on a motorcycle to the residence of the doctor attached to the facility and who was meant to carry out the CS.

On returning to the hospital, the father of two was faced with another sad reality – the hospital does not have diesel to power the Mikano generator meant to be used during such an emergency.

Alatise said already, Elizabeth was losing strength and he was left with no other choice but to go in search of fuel that night.

“When I asked the nurses why there was no light in the whole hospital, she said the small generator used to light a section of the hospital was bad, while there was no diesel available to power the big generator,” he said.

Frustrated and angry, Alatise travelled about 15 kilometres on his motorcycle to buy diesel from a black market merchant to save the life of his wife, Elizabeth.

He recounted “It was really a bad experience for me because I went to more than three filing stations before someone directed me to a house where I finally bought diesel. It was really frustrating. You won’t believe that the nurses and doctor just left my wife in pain until I returned with the diesel.”

Though Elizabeth survived the ordeal, her experience reflects the agony and anguish residents of Esie, Oro and other neighbouring communities in the Irepodun Local Government Area of Kwara State, where the hospital is located, face while trying to access basic healthcare.

Over the years, residents have decried the filthy, dilapidated state of the health centre, especially the constant darkness that the facility is thrown into at night

However, added to this unpleasant state of the facility is the shortage of medical personnel to care for patients.

Big dilapidated centre 

Esie Comprehensive Health Centre is being funded by the Federal Government and is attached to the University of Ilorin Teaching Hospital as part of its basic Health Care Services under the Fourth National Development Plan, 1981-1985.

The 35-bedded Health centre is about 55km away from Ilorin. It is a centre for active Primary Health Care services and was commissioned in 1983.

UITH on its website admitted that the health centre is among the three comprehensive health centres under its control.

The facility has a full complement of units, just like any tertiary institution, which ordinarily should enable it to effectively provide residents with high-quality healthcare.

The health facility has an operating theatre, administration block laboratory, nursing and pharmacy units, surgical and medical wards for both male and female patients, a general outpatient department, and an accident and emergency unit, among many more.

People from Ila in Osun State, students of Federal Polytechnic, Offa, and residents of Eruku and Ijarasin, are among those that seek medical care at the hospital.

However, an investigation by PUNCH Healthwise revealed that the health centre barely provides the minimum care sought by patients.

During a visit to the centre, it was observed that the main entrance and the entire compound were overgrown with weeds and looked unkempt. The buildings appeared weak and showed signs of distress.

Nets on windows of the male and female wards were partially torn and provided easy passage to mosquitoes and dangerous reptiles that could be lurking around.

Overall, the hospital looked abandoned with broken windows and doors hanging on their hinges.

At the reception, the benches provided for patients and visitors alike were infested with termites, while the roof had partially caved in.

Pitch darkness in a health facility

Our correspondent learnt that any time the giant generator is powered on, electricity is rationed within the various units and wards.

To confirm this, days after the first visit, at about 7 pm, after a heavy downpour, our correspondent alongside a resident trekked for about 1.4 kilometres from Esie town, to the outskirts, where the health centre is located.

They had to carefully make their way through the dark, rough bushy path leading to the health centre, guided by torch lights on their phones.

At the facility, the darkness was overwhelming and for a newcomer, it would have been a difficult venture trying to locate the place as it was bordered by trees and tall grasses.
Before our correspondent and his guide could make it to one of the hospital’s buildings, they were approached by a security guard that wanted to know their mission.

When told that our correspondent was having excruciating abdominal pain, he said the centre does not attend to patients at night but that he would allow them to see the nurse on duty.

They were directed to an office powered by the mini rechargeable lamp, where a nurse on duty was waiting.

For the two hours that our correspondent spent at the facility, he observed that the nurse navigated the dark hospital premises using the lamp Meanwhile, sitting on her table, were two other lamps.

At the time of the visit, five students from Imam Hamzat College of Health Sciences and Technology, Ilorin, were also there for treatment and the nurse was the only one on the ground to attend to them.

At some point, the visibly overwhelmed nurse asked two of the students to help check on some patients on admission in a ward that was some meters away.

Feigning curiosity, our correspondent asked the nurse why the hospital had no electricity.  The woman, who later identified herself as Temitope, revealed that the facility would be in total darkness until the next month when there is an allocation from the government.

She explained that the hospital had exhausted its monthly budget for fuel and diesel.

The nurse revealed that eight patients were presently on admission and they have no choice but to stay without electricity.

Temitope said, “Their relatives came with lamps, which is what all other patients do. I charged all these lamps before resuming duty today because they are what I will use throughout the night.  It is only on rare occasions that there will be light at night.

“There is something wrong with our electricity and we have complained to the distribution company and they promised to come and find out what happened. Except there is electricity, many nights are always like this and we are used to it. That is why we don’t really admit people at night, except it is a serious case and we are left with no choice.”

Nurses use lamps to deliver babies 

Speaking further, the nurse said there were times they had to improvise with rechargeable lamps and touches on their mobile phones to deliver babies at the hospital.

Temitope also revealed that the same method is deployed when there is a need to administer drips to patients on admission.

“If there is an emergency, these are the torchlights we will use to attend to the patient. I brought the lamp from my house and I will use the flashlight on my phone when they run down.

“There have been instances when we had to put our phone touch lights on and mount it on our head with rubber bands to deliver babies. God has been with us all the while.

“This is my job and will I say because there is no light and refuse to report for duty? It is not like we don’t have generators, the only challenge is lack of fuel and diesel.

“Recently, solar was mounted to power the labour room and some wards, but it went bad. This hospital will remain in darkness like this till morning. There is nothing I can do about it.”

Relatives contribute to buy fuel

A resident, Tajudeen Awoyale claimed that he brought his father to the hospital and he was admitted for one week without electricity.

He, however, said when the heat became unbearable one of the nights, relatives of patients came together and contributed to buy diesel used to power the big generator.

“The condition of the hospital, especially at night is worrisome. You can imagine what the place which is surrounded by bushes will look like at night. It is not like my dad was okay when we left the place, but we could not cope without a toilet and electricity,’ Awoyale lamented.

Corroborating his claim that patients’ relatives contribute money to buy diesel to power the hospital’s generating set, Alatise said he once participated in the contribution.

He said, “After my wife’s CS, she spent more than two weeks at the hospital and during that period, I contributed or brought petrol to have the small generating set powered.

“I would have moved my wife to another hospital but this is the best around here. The major challenges are the non-availability of power supply and toilets.

“The hospital doesn’t have enough staff. It is too far from the town. If I don’t come with my motorcycle, I would have to trek for several kilometres, especially on nights when there is a need to get drugs or something urgent.”

Patients defecate in bush

Further findings by our correspondent revealed that the hospital has no functional toilet since the only one serving the facility, which is quite a distance away, became unusable. The only available option, it was gathered, is for patients to defecate inside polythene bags and toss them into the bush.

Relatives on their part, go into the bush to answer the call of nature.

About five patients, who claimed to have spent at least three days in the hospital said their relatives brought containers with which they defecate when the need arise.

Sunday Oladipupo, who was at the hospital on two different occasions as a caregiver and also as a patient. told PUNCH Healthwise that during his stay, he would defecate into a nylon bag and throw it into the bush behind his ward.

he recounted, “I bought a potty for my brother that was on admission at one point, and every morning, I will always take his faeces to dispose of in the bush. As a caregiver, I always go to defecate inside the bush. They did not provide a toilet for us.

“When I had an accident about three weeks ago and I was rushed here, the nurse wanted to have me admitted, but because of my past experiences, I refused and opted to be coming from home for further treatment.”

Similarly, 82-year-old Maria Afolayan recalled how she was throwing excreta and urine into the bush when her brother-in-law was admitted to the facility in October 2022.

Afolayan said, “Throwing faeces and urine in the bush is a common practice at the hospital. I have seen a lot of people doing that.

“You know that the hospital is a very big one and it is surrounded by bushes. So, it is easier for anyone to just go to any part of the compound and throw their faeces away.”

A worker at the hospital who spoke on the condition of anonymity said the hospital has a toilet, but that lack of water supply made patients and their relatives stay clear of the place.

The source accused patients and their relatives of blocking the toilet pipes with polythene bags.

“There was a time the toilet was really bad and it was renovated. But because we don’t have enough water supply, some relatives were asked to throw urine and faeces into the bush, far away from the hospital environment. They are the ones destroying the toilet and when we repair it, they will send up spoiling it again,” she said.

The Need for Toilets

The Centres for Diseases Control and Prevention in a report, stressed that the absence of basic sanitation facilities can result in an unhealthy environment contaminated by human waste.

The health organisation noted that without proper sanitation facilities, waste from infected individuals can contaminate a community’s land and water, increasing the risk of infection to others.

Proper waste disposal, the CDC stated, can slow the infection cycle of many disease-causing agents.

According to the health body, the absence of basic sanitation facilities contributes to the spread of many diseases/conditions that can cause widespread illness and death.

The CDC noted that without proper sanitation facilities, people often have no choice but to live in and drink water from an environment contaminated with waste from infected individuals, thereby putting themselves at risk for future infection.

“Inadequate waste disposal drives the infection cycle of many bacteria and other germs that can be spread through contaminated soil, food, water, and insects such as flies,” it added.

In March 2015, the World Health Organization and the United Nations Children’s Fund released a report on the status of water and sanitation in healthcare facilities from 54 low- and middle-income countries.

Data representing 66 000 health facilities showed that water was not readily available in about 40%.

Over a third of the facilities lacked soap for hand washing and a fifth lacked toilets.

In many countries and in facilities where water was available, there was no guarantee that it was safe for consumption.

According to the report, Health facilities serve as hotbeds for infection and patients seeking treatment fall ill and may die due to a lack of the most basic requirements for good hygiene – safe, reliable water supplies and adequate sanitation.

It was further noted that Pregnant mothers rely on a birthing environment that places them or their babies at risk.

“Infections cause nearly half of the late neonatal deaths, many of which are attributable to inadequate hygiene. The same conditions contribute to major disease outbreaks, such as cholera, as well as the spread of antimicrobial resistance – another major public health threat.

“Safe water and adequate sanitation are fundamental to a healthy and dignified life. The benefits of water and sanitation include the prevention of diarrhoeal diseases, other infections are prevented, better nutrition, financial and economic savings, and improved education, especially for girls.

“The challenges for installing or improving necessary, basic WASH infrastructure in low- and middle-income healthcare facilities are much more complex and will require low-cost, innovative solutions,” it stated.

At the Water and Health Conference, a variety of international organisations, like the WHO/UNICEF and the national and subnational governments made presentations on how they are working to address these gaps.

Approaches adopted ranged from high-level political advocacy, and capacity-building programmes, to facility and healthcare staff-based service delivery improvements.

Patients at risk of snake, scorpion bite

PUNCH Healthwise gathered that on several occasions, security guards at the centre have killed snakes, scorpions and other dangerous reptiles within the premises.

A worker at the hospital, who also spoke under the condition of anonymity, said most of the reptiles were killed in patients’ wards, adding that the abandoned structure inside the facility acts as their abode.

“Rainy season is usually the worse time here because we see scorpions every time. It is a normal thing. Some weeks ago, we killed two snakes in the male ward. This is a very big place and because we don’t have a perimeter fence, it is difficult to keep those dangerous animals away.

“You will discover that the hospital is located in the middle of a jungle and there are animals that live around us. We have been facing this particular dangerous challenge for years and nothing has been done about it,” the source said.

Hospital surrounding breeding ground for mosquitoes

A public health expert at the Federal Medical Centre, Idi-Aba, Abeokuta in Ogun State, Dr. Seun Ademoye said the location of the hospital may predispose patients to infections.

He also noted that they may also come down with malaria as the surrounding bush will be a breeding ground for mosquitoes.

“It is really dangerous for the patients. The place needs to be cleared to protect patients from getting infections.

“While nature is important, having a bush as you described is different from having a garden in a hospital environment. So, they need to do something or they will just discover that patients on admission will suffer more severe illness.”

Shortage of staff 

Findings by PUNCH Healthwise revealed that the facility is understaffed.

It was gathered that most of the health workers live outside the Esie community, which is quite some distance from the health centre.

It was learnt that while some do not report to work for weeks, others resume late.

Findings by our correspondent showed that out of eight workers attached to the administrative department, only four come to work regularly.

Our correspondent gathered that three staff work in the records department, while only four out of the eight security guards employed to work in the hospital usually report for duty. The hospital, it was discovered, has seven attendants and seven nurses.

While the facility is expected to have three doctors, findings by PUNCH Healthwise showed that only two usually come to work.

While one of the doctors that head the hospital lives in Esie, the two others, it was learnt, come all the way from Offa and Ilorin respectively.

Using Google Earth, it was discovered that Ilorin is approximately 59.7 kilometres from Esie, while Offa is 28.9 kilometres from the location of the hospital.

Patients stranded

79-year-old, Sunday Oyeniyi, appeared tired after returning from the Esie comprehensive hospital on this very afternoon as our correspondent waited outside his house to speak with him.

In palpable anger, Oyeniyi narrated how he waited for one of the male doctors at the health centre for several hours, but he never show up.

The septuagenarian said he left the facility hungry and out of frustration having not had anything to eat all day.

He lamented that for several days, he had made efforts to secure an appointment with the said doctor but it had been difficult due to his non-availability.

Oyeniyi alleged that the said doctor has a private hospital in the community and channels all his time and energy into its daily operation.

The elderly man claimed that he is being compelled by his health challenges to see the doctor and was unhappy that on this particular day, despite getting to the health centre around 9 am, he still could not see him.

Another resident, Olusola Ojomu, said he visited the health centre on three different occasions before he could secure an appointment with one of the doctors.

While noting that the service of the hospital is good, he maintained that the constant absence of health workers hampers the smooth running of the place as others are always overburdened.

he said, “Before you can secure an appointment with a doctor here, you will go there several times.

“We heard they were three. One is expected to work from Monday to Wednesday, the second person will work between Thursday and Friday, and the last is expected to work on weekends.

“Despite this arrangement, it is only the doctor living in Esie that we see regularly. There are times they will tell us that the two living far away from Esie, are unavailable. And even on the days they are meant to come, they will resume late or not come at all.”

Pharmacy without drugs

PUNCH Healthwise discovered that the pharmacy inside the hospital functions below capacity and that drugs above N1,000 cannot be bought there.

Aside from the unavailability of essential drugs, the pharmacy does not operate on weekends, despite having two staff running morning and afternoon shifts respectively.

Speaking on this, Oladipupo, who had been involved in an accident revealed that the plaster used to dress his wound and drugs prescribed by the doctor were bought from Oro, a community that is about 10 kilometres from the hospital.

“Not even ordinary cotton wool is available there. We had to buy everything used to stitch my head from Oro,” he said with a smack on his face.

Alatise, on his part, revealed that most of the drugs administered to his wife during her two weeks stay at the hospital were brought from Oro.

He said, “Any drug that the price is beyond N1,000, can’t be seen inside the pharmacy. You will need to go to Oro. On several occasions, I went to the town in the middle of the night especially when the drugs are needed urgently. The pharmacy is more or less not functioning.”

Our story–Hospital reacts

The medical officer in charge of Esie comprehensive health centre, Dr. Abdulrahmam Olakintan in a chat with PUNCH Healthwise said the condition of the hospital had improved since he took over.

He claimed to have solved the problem of electricity, water and security challenges facing the hospital, noting that the health centre staff had to contribute money to ensure constant electricity supply.

On why the hospital was in darkness, especially during our correspondent’s visit, Olakintan explained that in order to ensure judicial use of allocation earmarked for the smooth running of the facility, the giant generator is made to operate only when there is an emergency.

He said, “Concerning the issue of electricity, we are managing the little money we get as allocation. We can’t put on the generator at night unless there is a need for it, like during an emergency.

“In this hospital, you’re seeing now, no surgery, blood transfusion or medical procedure was being carried out here until I came. Thank God it has been revived up to this level.”

When asked why the facility does not a functional toilet, the doctor said, “The toilet you are talking about, the one at the gate, they said they want durability, and the toilet that we have doesn’t really fit into that.

“We have to appreciate the effort of some people that came from Ilorin, to renovate the toilet, but it was clogged by the activities of some patients and their relatives.

“So, can you blame the CMD for that? You cannot blame him because it is the patients that keep on blocking the place, We are making an effort to ensure the place is usable soon.”

On the allegation that patients usually contribute money to purchase fuel for the generator, he, “The person that said he went to buy fuel brought a patient at night, and we explained to him that we were yet to be reimbursed, The money comes every quarter.

“So, what we do is ensure that apart from the money we get, we buy diesel and have it stored. What happened is that we have exhausted our supply.

“That man volunteered and we contributed 10,000, which was given to him. He also said he would personally add N5, 000, It was voluntary and nobody forced him.”

He, however, directed our correspondent to the management of the UITH for further inquiries.

“Please, kindly contact the CMD of the teaching hospital because we are under them. I am not actually permitted to speak, I am just saying some of these for clarification purposes,” the doctor said with finality.

When contacted, the Head, Corporate Affairs Unit, UITH, Mrs Elizabeth Ajiboye, said she will reach out to the CMD and get back to our correspondent.

Several attempts to reach out to her later were not successful.

As of the time of filing this report, she had yet to respond to calls made to her mobile.

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