Patients turn to beggars to escape death as economic hardship forces them out of treatment
Economic hardship amid skyrocketing prices of life-saving drugs in the country is taking its toll on patients with cancer, diabetes, hypertension, and other chronic diseases as the situation has forced many out of treatment and turned them into beggars to escape death. Janet Ogundepo reports
After spending a month on admission at the Federal Medical Centre, Lokoja, Kogi State, a driver with a diabetic foot ulcer, Mr Salifu Lawal, left the hospital without getting the recommended surgery he direly needed.
His exit was not due to the absence of health practitioners but the lack of funds to continue to pay for his treatment.
Before and during the driver’s hospital admission, he had relied on donations from family and friends coupled with this daily take home from his driving job, to buy his medications.
The rise in the prices of his medications further limited the quantity of insulin his funds could buy.
Seeing his situation, the nurses who attended to him rallied around him to beg for funds within the hospital premises, but the money was not enough.
Lawal continued, “I don’t have any hope because I have spent so much money to treat this leg. I spent N23,000 daily on it. My friends and family have supported me so much that I can’t ask for them for more.”
Without hope for future funds and with no means of livelihood, the middle-aged Kogi indigene is yet to get his insulin shot and other diabetic drugs, nor get the N700,000 needed for the surgery.
The driver said, “I was given two options; undergo surgery or amputate the leg. But I don’t have any money so I asked to be discharged with the hopes of begging for money for the surgery because I don’t want my leg to be amputated.”
But since his discharge, Lawal has returned to his village in Ankpa, where he occasionally uses his drugs when his symptoms get worse.
He has also resorted to the cheap care of herbal practitioners and local nurses to dress the diabetic foot ulcer.
“Since I got to the village, I no longer take the insulin. I can only manage to buy the tablets. I need to buy the blood sugar checker but I cannot. I have kept trying to gather the money but I cannot. I need help,” the driver said.
Affirming Lawal’s story, one of the nurses who attended to him at FMC, told PUNCH Healthwise, “Lawal is a diabetic patient with diabetic foot ulcer, Wagner’s grade five, he was on admission for about a month with daily wound dressing and was advised for amputation by the orthopaedic team. Most times he can’t even get his drugs.”
Insulin is an injection that helps the body of someone diagnosed with type 1 diabetes to turn food into energy and manage their blood sugar levels.
According to the World Health Organisation, diabetes is a chronic disease that occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin (a hormone that regulates blood glucose) it produces.
Like Lawal, many diabetics in the country can no longer afford their medications.
In February, the Diabetes Association of Nigeria decried the 200 per cent rise in insulin jabs.
They noted that the price rose from N4,000 to N12,000, making it out of reach for most diabetics.
The association demanded government subsidy and tax waiver on the importation of insulin and other diabetes medications to prevent worse outcomes for the over 12 million diabetics in the country.
Like diabetes, like hypertension
Persons battling hypertension have also complained of a rise in the drug.
Soaring cost of medications
During PUNCH Healthwise’s visit to a wholesale pharmacy store, an elderly woman, whose name could not be ascertained, bought a cocktail of several anti-hypertensive drugs.
Complaining bitterly about the prices, she said, “I bought them last for N1,700 and now it’s N2,500. What would I do? I have no choice but to buy them.”
To ensure the drugs lasted, the elderly woman told PUNCH Healthwise that she only used her drugs whenever she “feels in her body that her blood pressure was high.”
However, endocrinologists who spoke to PUNCH Healthwise stated that the irregular usage of the drugs would lead to worse health outcomes, complications and even death.
Collecting loan to pay for treatment
For over two years, a resident of Abeokuta in Ogun State, Mr Toyin Osikanmi, has spent his life savings to care for his 30-year-old son, Tobiloba, who was diagnosed with Chronic Kidney Disease.
Most of his salary as a Civil Servant with the Ogun State Primary Education Board and several contributions from family and friends was spent for Tobiloba to undergo his bi-weekly dialysis.
Toyin told PUNCH Healthwise the doctors recommended a kidney transplant and gave them an estimated bill of N10m in 2022.
However, as of Toyin’s interview with PUNCH Healthwise, not even half of the money for the transplant has been gathered.https://healthwise.punchng.com/high-cost-of-care-pushing-nigerians-deeper-into-poverty-health-minister/
Tobiloba’s father further stated that due to the inability to keep up with the N100,000 per week payment for the bi-weekly dialysis at the Federal Medical Centre, Abeokuta, he took his son to the clinic at Redemption Camp, Mowe, where he pays a little less.
Although Toyin stated that the new dialysis centre could not perform the transplant, his son now depended on dialysis.
Toyin fears that the initial N10m billed for the kidney transplant at FMC in 2022, would have doubled due to the rising cost of drugs and hospital consumables.
As it stands, Toyin’s father, whose neck is deep in debt as well as the little got from his meagre take-home after loan repayments, needs over N20m for his son’s kidney transplant.
“Since we don’t have enough money, we have continued with the dialysis exercise since then. But, sincerely speaking, we have spent more than N20m, more into this exercise. Every week, we spend more than N200,000 and that is together with the transportation
“Since we don’t have the capacity of doing the transplant, we are using the dialysis to manage the diagnosis, just to keep on until, if God can give us a sufficient amount to carry out the transplant,” the distraught father said
No NHIS coverage
Kidney transplant, experts and medical journals say, is the preferred treatment for CKD.
Dialysis, which is a life-saving therapy for patients with CKD, is conducted twice a week. The machine performs the kidney’s work of cleansing the blood of toxins, waste and fluid by drawing out blood from the patient’s body, filtering it through an artificial kidney called a dialyzer and then returning the cleaned blood to the body.
However, dialysis and organ transplantation are not covered under the National Health Insurance Scheme.
This implies that patients needing dialysis, like Tobiloba, paid out-of-pocket.
In Federal Government Hospitals, it was gathered that a dialysis session costs around N35,000.
Findings by PUNCH Healthwise revealed that between N13 and N30m was needed for the procedure. Aside from the large sum required for the procedure, the availability of a matched donor depended on the waiting time.
Begging from church to Facebook
For a middle-aged woman, identified as Rebecca, watching her mother, Antonia Bilamin, writhe in pain and sleeplessness was always disconcerting.
In search of a solution, Rebecca told PUNCH Healthwise that she took her mother to the Lagos University Teaching Hospital, Idi-Araba.
Antonia was diagnosed with a growing cancerous lesion in her head.
“Around July last year, the doctor said there was a growth, tumour in her head and it is growing all around her head. But only the ones that could affect her sight and heart are the ones they would remove while she remains on treatment.
“So my two younger brothers and I tried to gather the money but haven’t been able to get the total amount. Aside from the surgery fees, there are drugs to buy. Our mother is over 50 years old, and the situation has made her begin to dry up with her bones and ribs jutting out. We can’t just keep looking at her dying and let the cancer kill her,” Rebecca said.
As part of measures to raise funds for the surgery, Antonia was taken to a church known for its philanthropy in Ibadan, Oyo State.
However, after spending three months in an apartment close to the church to see the philanthropist, their hopes were dashed; the verdict was that since Antonia was not looking visibly sick, she was not in dire monetary assistance.
After that, Rebecca said she began to seek assistance on social media platforms.
As it stands, Rebecca said Antonia could no longer “walk, eat and sleep properly. She cries all night. Once the headache comes, she won’t be able to sleep.”
Rescheduled for August 30
After missing the first surgery in December 2023, due to lack of funds, Antonia’s surgery was rescheduled to August 30.
Rebecca stated that the family decided to try herbal treatment since the N1.8m fee was hard to come by, coupled with the fact that only a few tumours would be removed.
“At LUTH, where we registered her last year, they gave us August 30 for the surgery and we cannot afford N1.8 million,” Rebecca said.
After several attempts at soliciting funds failed and Antonia’s condition worsened, Rebecca told PUNCH Healthwise that the family resorted to herbal care.
“The lack of funds made us switch to herbal medication,” she said.
But a solution was yet to be found at the herbal doctors’.
Rebecca still hopes for the N1.8m for the surgery at LUTH on August 30.
If the money for the surgery was not sourced, a forlorn Rebecca said, “there’s nothing we can do. But we still have to do the surgery. We need support for her to do the surgery.”
From wealth to begging
The pain rang thick in the voice of an engineer and Colorectal cancer survivor, Dozie Akwarandu as he spoke passionately on a recent Health series themed, “Cancer ‘challenge’ and health screening hesitancy among Nigerians” organised by Mbamalu X, formerly Twitter.
Although grateful for his survival, he recounts, “Someone like me too has got to a level in life where I used to give to others before I became a beggar. If you know what we pass through as colorectal cancer survivors, you won’t understand it.”
‘Stealing to buy drugs’
Professor Olufemi Fasanmade
The Unit Head of the Endocrinology, Diabetes and Metabolism division of the Department of Medicine at the College of Medicine at the University of Lagos, Idi-Araba, Professor Olufemi Fasanmade, told PUNCH Healthwise that many diabetics have resorted to reducing the drug dosage to make it last longer.
Some others, he added, skip a dose to elongate the next visit to the pharmacy store for a refill.
Sadly, the don stated, “Some have resorted to herbal medicines and miracle/spiritual homes for cure. Those in the middle class have changed from branded to Asian/generic versions or get their children sent from overseas. Many have resorted to crime including prostitution, and stealing to fund the cost of treatment.”
Speaking on the way out, Fasanmade, reiterated the need for enrollment in health insurance and preventive medicine.
“The best option is to enrol in health insurance and preventive medicine,” the endocrinologist said.
‘Govt should subsidise diabetic drugs’
Also lending his voice to the discourse, a professor of Endocrinology and Gastroenterology at the University of Uyo, Akwa-Ibom State, Uduak Okon, presented the need for government subsidy on diabetic drugs.
Professor Uduak Okon
He stated that patients with type one diabetes were insulin dependent, adding that patients with type two diabetes needed oral medications, whose prices have also increased.
The don noted that the lack of access to medications could lead to further diabetes complications, such as diabetic retinopathy, complications and unhealed wounds which might resort to amputation and hypertension.
“If we are looking at the affordability of the drugs now, my suggestion would be, as part of the government policies, maybe for chronic illnesses, the government can subsidise the drugs or even give them for free. They can’t survive without the drugs, especially for type 1 diabetes, which is insulin, and proper monitoring.
“Health clinics should be made available for easy access to monitoring because they need to regularly check their blood sugar. So the way out is for either the government to subsidise the drug, or make a policy that people with these conditions who cannot afford can be assessed in a specialised centre,” Okon said.
He stated that diabetics with high levels of blood sugar could go into a diabetic coma which most times leads to their death.
“Also, it is not just about people affording the insulin or drugs, there are some patients that need hospital assessment and care, because sometimes if they take the insulin improperly, maybe an overdose, it might send them into hypoglycemia, which is simply low blood sugar level and this can as well cause coma. So treatment has to be well monitored and patients must be educated on it.
“The economic situation now makes it more complicated, because if they need these drugs and tests to check for their blood sugar level and they cannot afford it, then there are certainly going to be fatalities,” the endocrinologist said.
Patients’ skip dialysis –NAN President
Professor Jacob Awobusuyi
Due to the out-of-pocket payment for dialysis and the cost of the procedure and drugs, many patients in need of the bi-weekly dialysis no longer come for them, the President of the Nigerian Association of Nephrology, Professor Jacob Awobusuyi, told PUNCH Healthwise.
“Presently, so many of them just stop coming for dialysis. Quite a number of them don’t even come, those that come, they do it once in two weeks and when they are at crisis point and this is not the best for them,” the don added.
As a result, the nephrologist asserted that such irregularity in dialysis could lead to further complications and preventable deaths within a short time.
The professor of medicine further explained, “The whole complex set of treatments that they need is such that every single aspect of that treatment is getting more and more expensive by the day and many of them are not able to afford them. Some patients who, at the expense of developing this stroke, or some other organ failure, like heart failure, have stopped taking their drugs for hypertension because it’s getting expensive.”
The researcher on Kidney Disease further noted that the rising prices of drugs have further led many patients to depend on some medications with lowered effectiveness for their conditions.
He added that this has led to inconsistent outcomes, delayed recovery time and complications from improper treatment for their disease condition.
Awobusyi commiserated with the patients and called for the onboarding of patients with chronic diseases on health insurance schemes
“In Nigeria, very few HMOs pay for dialysis. So 99 per cent of patients pay out of pocket, which is not the best for such patients,” the president stated.
Begging vs treatment
A professor of psychiatry and a Clinical Psychologist at the College of Medicine, Lagos State University, Ikeja, Ayodele Coker, stated that patients who had to beg to foot their medical bills could lose their self-respect and further suffer low self-esteem.
Professor Ayodele Coker
He further explained that the psychological aspects of begging created feelings of insecurity, worthlessness, helplessness, and the associated shame and guilt feelings.
The don, however, noted that sometimes people begging for alms to pay their medical bills could be genuine, “sometimes you have the fake beggars too.”
Coker further noted that the fake, constant and chronic beggars could be a symptom of severe mental disorders.
He noted that genuine cases of begging to pay medical bills were understandable and one people should have empathy and sympathy for.
The clinical psychologist noted, “The genuine ones, which, of course, we need to empathise, show sympathy and help them to raise funds. Of course, when they come out, they have to lower their self-esteem, self-respect and dignity. Some go to the media to beg and then people will ask for medical reports and verify from the doctors to ensure it’s a genuine cause. So for the genuine cases, it’s logical for people to ask for help, especially when you have the reasons to and when you can prove that they need help.”
‘Slow healing process’
Also speaking with PUNCH Healthwise, a Clinical Psychologist at the Department of Psychiatry, Lagos University Teaching Hospital, Dr Juliet Ottoh, said that patients, especially those with chronic medical conditions, without the means to foot their medical bills lived in anxiety.
She added that such a state of worry and uncertainty would impact the healing and recovery of such individuals, leading to complications and the co-morbidity of chronic medical health conditions.
This, the clinical psychologist said, further causes “more expense on them because they will now need some extra medications, treatment and consultation and this would hamper their progress.
“Rather than concentrating on the physical health condition alone, they now have co-morbidity; having a physical health condition and a psychological health condition.”
She urged Nigerians to promptly address health conditions before they degenerated into multiple health conditions.
The clinical psychologist advised individuals who have genuinely exhausted familial, friends and other legitimate ways of raising funds not to be ashamed to seek help.
“The right path is to ask. Take away the stigma, because all of those times you’re trying to delay, things are getting complicated and could degenerate to the point where it becomes a life-threatening illness,” Ottoh said.
