How misdiagnosis sends Nigerians to early grave

Ibilola Essien, a lawyer and wife of ace radio broadcaster, George Essien, is lucky to be alive. In July last year, she developed a severe abdominal pain and was rushed by her husband to his HMO hospital in Ajah and one of the highly rated specialist hospitals in Lagos. There, the doctor in his diagnosis suspected urinary tract infection (UTI) and also queried acute appendicitis.

She was promptly placed on intravenous therapy popularly known as IV and was infused with 10 bags of IV fluids before the chief surgeon was called in the following day to assess her. The surgeon promptly requested for a scan, followed with blood and urine tests.

“On seeing the result of my ‘scan’ the chief surgeon was convinced that I had acute appendicitis. I did the surgery, and was on admission for five days in the hospital.I spent another five days before the pain fully subsided,” she told NHO.

She was wrong. The pain resumed in earnest two months later and she had to be rushed to another well established hospital, the Advanced Videoscopic and Laparascopic Centre, Lekki Phase 1, Lagos. Here, the Consultant Surgeon, Dr. John Ojukwu, did not talk of UTI or appendicitis. Ibilola was informed, after examination that she might have developed a liver disease or a condition known as endometriosis, a painful disorder in which the tissue that normally lines the inside of the womb (uterus) grows outside it.

Dr. Ojukwu promptly referred her to a diagnostic centre the Mecure Diagnostics and Clinic. Oshodi, Lagos, for further tests like the ultra sound, CT Scan and Liver function tests. The results revealed that Doren Specialist Hospital had cut Ibilola’s appendix for nothing. Rather, the laparoscopy showed that the surgery (appendectomy) was so poorly done and that she could have developed some complications in her intestines later.

Pa Ibezim is another lucky fellow. At 82, he was diagnosed with diabetes and suffer from hypoglycaemia low blood sugar all the time. Although he was being managed by two professors; one, a professor of medicine at the University of Nigeria Teaching Hospital (UNTH) Enugu, his condition continued to deteriorate and he was taken to Lagos two months ago very weak and incoherent.

A visit to a diabetes clinic in Lagos did not help either as he became weaker. Indeed some members of his family had thought his time was up. However, three week ago, Pa Ibezim was flown to a Maryland hospital in the United States by his son, Richard, and there was a sudden turnaround. Doctors in the US discovered that his uncontrolled low blood sugar was due to a kidney problem, which was indeed not unexpected for a diabetes patient suffering from constant bouts of hypoglycaemia. Now family members wonder why the kidney problem was not discovered by the Nigerian doctors in spite of the numerous tests and the calibre of doctors that handled his case.

But Susan Ibitayo is not so lucky. In fact, she is not alive to tell her own story. NHO investigation revealed that the 34-year-old banker was treated for stomach ulcer over three years in one of the public hospitals in Lagos and was in constant pain before doctors discovered that her problem was due to cancer of the cervix which had reached an advanced stage.

Frustrated with the misdiagnosis of the past three years coupled with the dearth of facilities in the country, Susan’s family decided to fly her abroad for treatment. Sadly, she never made it. She died before she could reach the destination – and that was after the family had sold property and borrowed money for the medical trip.

Investigation by NHO revealed a long list of Nigerians who had either died or narrowly escaped death as a result of misdiagnosis. Late human rights activist and passionate defender of the masses, Chief Gani Fawehinmi, was one of those who could not tell their own stories. He died of cancer of the lungs on September 4, 2009, after been erroneously diagnosed and treated for pneumonia for over one year by medical practitioners in Nigeria. Eventually when he was moved abroad for proper medical attention as his condition did not improve, he was discovered to be suffering from cancer of the lungs, which later resulted in his death.

An Abuja resident, Mrs. Joy Simeon, told NHO reporter how, during her pregnancy, she started experiencing pain and numbness in her hand and wrist. “I ran to my hospital (yes! one of the so called bests) but the specialist had no clue. She prescribed calcium tablets, some pain killers and sleeping pills. I took a hard look at the drugs and decided to call my friend who is a paediatrician in the US. By merely describing what was happening to my hands she simply told me I had a condition known as carpal tunnel syndrome and asked me to go read it up. That was the end of the pain.

“The truth is doctors do not know all, but Nigerian doctors will never admit to that. A general practitioner will serve as a surgeon, gynaecologist, paediatrician, physiotherapist, osteopath, dentist, optician, shrink etc God help us all.”

Prof. Oladapo Obafunwa, the Lagos State Chief Medical Examiner and Professor of Forensic Pathology at Lagos State University College of Medicine confirmed such high incidents of misdiagnosis seen during autopsies. He told NHO two of such cases: “A patient was confirmed to have died from heart attack as diagnosed by the medical personnel. After carrying out an autopsy test, we found out that the cause of death was pulmonary embolism.The patient had a blood clot in the limb, it got dislodged and travelled to the heart, eventually blocking the blood supply to the lung. They thought it was a heart attack but at the end of the day, we found it to be pulmonary embolism. If this was treated earlier he could have probably been alive by now.“We also have the case of a woman who delivered in a maternity home; after delivery she started bleeding. The medical officers did not know that she had a massive torn at the lips of her cervix. They assumed the bleeding was caused by a retained placenta or a bye product. So the tear was not repaired and she bled to death,” Obafunwa revealed.

He added, “Years ago, we were presented with a case of a person who had personality disorder, which was mistaken as psychiatric behaviour. They did the skull X-ray and the result revealed that there was a small legion in the brain. The diagnosed legion in his brain was presumed to be a cancer and also the

cause of his personality disorder.At autopsy we discovered that what was assumed to be a cancer was actually tuberculoma, a form of tuberculoses that resulted in the legion in his brain.”

However, Obafunwa said misdiagnosis is not limited to Nigeria alone as other countries also record misdiagnoses, “What is peculiar to Nigerians is that a lot of quacks are acting as doctors.There are people who claim to be doctors when in fact they are not doctors. There is what we describe as affordable medicine, people go to a certain individual and let them prescribe drug for them. People most times go to other paramedics, pharmacists, nurses and even quacks when they are sick.”

Obafunwa who is also the Vice Chancellor of the Lagos State University (LASU) however, admitted that aside from quacks and paramedics, doctors also misdiagnose, He explained that the level of doctor’s expertise will determine how appropriate he or she will diagnose.

“There is a difference between a house officer who is just coming out of school and a medical doctor with some years of experience or a doctor with specialty in a particular area. So the standard you apply as a house officer will be different from the standard you apply as a senior medical officer or from a consultant in that particular area.”

One young man, Obum Okoye, told NHO how he had severe abdominal pain years back and was diagnosed and treated for food poisoning at an Enugu based hospital, Enugu. A year later, he went back to the same hospital and saw another doctor who suspected appendicitis and sent him for ultrasound diagnoses. The diagnostic report he got from Handsar Diagnostic Clinic, Enugu revealed perforated intestine with ruptured appendicitis, but did not show the actual site.He had to go back for another test in another diagnostic centre which now revealed the actual location.

According to Prof. Obafunwa, the young man, Obum Okoye, was lucky to be alive. “Someone with appendicitis not properly diagnosed, either by the nonphysician or even an inexperienced physician could lead to rupture of the appendix resulting in generalised infection of the abdominal cavity which could result in death.

“Again, you might think someone has appendicitis when in fact what the person is suffering from is acute pancreatitis which is inflammation of the pancreas, and that could create a lot of problem. You might also think that what an individual has is a duodenal ulcer when in fact what you are dealing with is a minor heart attack or even a serious one as the case may be,” he explained.

In his view, misdiagnosis poses great danger to a patient. It could lead to complications which could in turn lead to death. Missing a diagnosis of a cancerous growth is even more fatal, he added, saying, “when the diagnosis of a cancerous growth is missed, the cancer continues to grow, by the time it is detected, there has been a spread to other organs such that treatment at that point becomes difficult.”

For instance, according to him, it could be worrisome when a breast lump is increasing in size thus, it is important that a general surgeon be contacted to examine the patient, or to ask the radiologist to do an X-ray or mammogram to examine the lump. Based on the findings, the doctor can then decide whether it is a cancerous growth or not.

“A biopsy of the lump is taken or a fine needle aspirator, and processed by the pathologist under the microscope in order to assert whether it’s cancerous or not. There are some conditions that might look benign, but it probably have some features that might make the pathologist suspicious.”

In the case of a benign but suspicious growth or when the pathologist has some doubts regarding the growth, he advised that the pathologist should seek the opinion of other pathologists.

“If reports from another pathologist still confirm it benign but with suspicious areas, he can decide to report back to the surgeon with the findings and the advice that the patient be closely monitored.The surgeon might go ahead and remove the lump just to be on the safe side, while still closely monitoring the patient.”

However, he noted that during the monitoring period, it is not uncommon for the patient to slip through and get lost in the system; either moving to another location or just to stop going for check up entirely.

NHO investigation however revealed that inaccurate laboratory results also contribute to the spate of misdiagnosis being recorded in the country. Many laboratories are also being run by quacks while some still rely on inferior test kits and reagents. But a laboratory scientist who pleaded anonymous blamed doctors for such false reports from the laboratories. According to her, a lab will only carry out tests based on doctor’s request.

“If a doctor requests for a malaria parasite test or a widal test for typhoid fever, for instance, the laboratory will not go out to conduct a test for heart disease. So if it turns out that the patient is being treated for typhoid when he has a heart disease, then the doctor has to take the full blame,” she said. The lab scientist however confirmed NHO’s investigation about the high number of unregistered laboratories in most Nigerian cities.

“They are the ones that will use inferior test kits or reagents as you have said. No laboratory duly registered by the appropriate agency would do that because there are standards expected of such labs.”

Prof. Obafunwa however, believe that a majority of cases of wrong diagnoses could be avoided if the doctor has accurate knowledge of the medical history of the patient

“A doctor is trained to review the history that the patient is presented with, tie it to the clinical examination of the patient and come to a conclusion. In some cases he might send the patient for additional test, whether it’s radiological test, X-ray or pathological test to confirm the diagnosis.

“However, there are not so many pathologists in Nigeria so, having more pathologists will most likely improve the quality of diagnoses in Nigeria,” he further said.

But victims of misdiagnosis could seek legal redress. According to a legal practitioner, Barr. Steve Adaramoye, misdiagnoses are seen as a criminal offence and the offence is regarded as criminal negligence.

“In the case where such medical misdiagnosis is committed, the patient has the right to sue the hospital for failing its responsibility. In the case where the offence is committed by a staff of the hospital, he can also sue the medical personnel for damage and demand to be compensated, he told NHO.

“In the situation where the victim dies, the family of the deceased has the right to sue the hospital or staff of the hospital involved depending on who is responsible, he added.”

But this legal right is not enjoyed by many Nigerians due to ignorance and poverty he said, adding that, “People will prefer not to get involved in law cases because of the finance, time and corruption surrounding the system. But my advice is that such person should be brave enough to sue.”

Perhaps, Nigerians will need to take Adaramoye’s advice to reduce the rate of misdiagnosis cases in the country.