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Dear Dr. Kayode Fayemi,

Exactly 12:31pm on Tuesday 21st April, my Mum went to be with the Lord at the Ekiti State University Teaching Hospital (EKSUTH) Ado-Ekiti accident and emergency department. For us as a family, we have found strength in the assurance of her eternal rest, and so we rather rejoice for a life well spent on earth, and her transition into eternal life. Even as we rejoice, I personally find the need to address issues around her passing particularly as it relates to our health system and most importantly, share some insight that will strengthen our health system in Ekiti State, particularly during public health emergencies — like the one we are currently experiencing.

I am the last child of my family, and the only health professional — a pharmacist, hence my close follow up on the well-being of my mum. My mum is both diabetic and hypertensive and she adheres strictly to her therapy. Few days before her passing, her blood glucose began to fluctuate from 33, 45 (I advised her to take glucose), and then on the following day it went on high to 254, 180, and on the morning of her passing, it was 358. That very morning as I was informed of her high blood glucose, I immediately informed one of my senior colleague who is a director in one of the state government health agencies. He helped rushed my mum to the hospital. This should be between 10:30am to 11am. I am based in Ibadan, and the lockdown made it impossible for me to travel to Ekiti even as of when she began to make her complaints.

John Oluwadero with Governor Fayemi

John Oluwadero

On getting to the hospital, my mum who at that time had stopped talking, and expressing difficulty in breathing was denied admission at the accident and emergency department, because she was not putting on nose mask. The health workers had fears that her emergency is probably COVID related. My senior colleague, however, explained to them that her case is a diabetic emergency, and he has been monitoring her treatment over the years. My mum was left in the car outside the A and E for about 50 minutes before she was finally attended to. Upon her admission, a patient who at this time was gasping for breath was only provided IV fluid, and when her breathing worsened, they brought an empty oxygen cylinder which could not last for 2 minutes. It was after this she died. 

Less than 10 minutes to her death, my eldest brother who was with her at that time recorded a video of her gasping for her breath and sent to me. At that time, it was the most annoying video I have ever seen in my life, but after her death, it became the most precious video in my life right now. I can’t understand why a patient gasping so heavily for her breath as I saw in the video will not be on oxygen. From the video, I knew she might probably not be able to make it. I look forward to showing you this video or probably send it to your mail.

Why I am addressing this letter to you?

Deborah Bolanle Oluwadero passed on at the Ekiti State University Teaching Hospital

As a Pharmacist who previously worked at EKSUTH as an Intern Pharmacist (2016), I can boldly say that the death of my mum was as a result of our weak health system in Nigeria, and negligence by health workers on duty. I am intentionally writing you not only because you are the governor of Ekiti State, where the health facility my mum died is located, but most importantly because you are the chairperson of the Nigeria Governors’ Forum. There is an urgent need for a frank conversation on our health system in Nigeria that I seriously hope you will help ignite among your colleagues in their respective states. 

Our health system is WEAK! It is a big shame that in the 21st century, a teaching hospital will not have oxygen supply readily available in less than 2 minutes of hospital admission. It is a big shame on our health system for health workers in a tertiary hospital to not be provided with personal protective equipment (PPE) amidst this coronavirus pandemic. And, most importantly, it is a big shame on those health workers on duty to assume all shortness of breath during emergencies to be COVID related.

I am also writing to you, sir, because you are not new to me and my family. You have in time past brought joy to my mum. God has used you to make her roll off the floor, appreciating God’s faithfulness on the life of her last child. In 2013, I was privileged to be sponsored by your honour to attend the First Commonwealth Conference on Education and Training of Youth Workers at the University of Pretoria South Africa. This was my first international travel and the launch of my engagement in international development. 

Following my participation at the conference as an undergraduate student at the University of Ibadan, I got appointed to serve as the pioneer Country Representative of the Commonwealth Students’ Association (CSA). After my tenure at CSA, I also got appointed to serve as the Africa Regional Representative for the Commonwealth Youth Sport for Development and Peace Working Group (CYSDP), where I recently completed my tenure as the Advocacy Focal Person for the entire 53 countries of the Commonwealth. 

Through my involvement in the Commonwealth Youth Programme, I have been inducted as an Associate Fellow of Royal Commonwealth Society, and a 2016 Finalist for the Queen of England Young Leaders Award. I have also participated in high-level meetings of the Commonwealth such as Commonwealth Youth Ministers Meeting, Commonwealth Sports Ministers Meeting, Commonwealth Education Ministers Meeting, Commonwealth Head of Government Meeting, and several others. 

In recognition of my contribution to positive youth development, I was honoured as the 2018 Recipient of the Junior Chambers International JCI Ten Outstanding Young Person in Nigeria National Award (Children, Human Right and World Peace Category), a 2018 Fellow of Nelson Mandela School of Public Governance, University of Cape Town, 2019 Alumni, Ashoka/American Express Leadership Academy, and I currently lead a youth work organisation called Building Nations Initiative –BNI. Your support indeed launched me into international development.

As you can see, you have made a great impact on my life and made my mum smile during her lifetime. Once again, I am here to call for your support to make her smile from heaven by addressing our weak health system that brought about her unexpected transition into glory. My letter is not for political criticism. It is rather to ignite a change in our health system. You are the closet person I know within the political landscape of Nigeria that can lead nationwide advocacy on revamping our health system in Nigeria. I believe you have the power to ignite a change, and I strongly believe with my whole heart that you will definitely make my mother smile from heaven as you decide to take action. The only earthly justice that my mother deserves from the poor handling of her emergency at EKSUTH is an improved health system.

Identified challenges and possible solutions:

Below, I have categorized health systems challenges that contributed to the unexpected transitioning of my mum into glory. These challenges are not only peculiar to diabetes or other non-communicable diseases. They are key challenges that will strengthen our health systems particularly during public health emergencies like the coronavirus pandemic. 

Challenge I: Delay emergency response and patient stabilization 

At all times, whether in an epidemic emergency or not, frontline health workers at the accident and emergency department should be provided with personal protective equipment (PPE) and must be required to use them. In a 21stcentury tertiary hospital, it shouldn’t be heard that oxygen is out of stock. It should be the goal of all tertiary hospitals to ensure that oxygen is supplied to patients in less than two minutes of its need. 

There is also a great need for our health system to be fortified with excellent ambulatory and emergency services that will be within reach in less than five minutes. In EKSUTH, there are lots of ambulances parked there that probably have not been used in years. I believe they can be revived and put to good use. 

Most importantly, there is an URGENT need for the establishment of a central ambulatory and emergency agency (with toll-free call centre) that is independent of any hospital, strategically located in every community in the state. The agency should be fortified with necessary emergency facilities and provided ambulances that have oxygen in place. A patient urgently in need of oxygen should not wait till getting admitted to the hospital before accessing it, hence ambulances must ALWAYS have oxygen in place. 

If we really want to reduce death as a result of delay emergency response and patient stabilization, we must reduce the time interval between rushing a patient to a hospital and stabilizing with oxygen. This can only be achieved when we have excellent ambulatory services in place, located in every community just as we have police Hilux in their respective checkpoints in our communities. We will reduce waiting time and increase emergency response by ensuring less than ten minutes of access of patients to ambulatory services, hence saving lives. 

In Oyo State, a friend of mine recently lost his elder sister to post-partum bleeding. There was no hospital in his village. It took them more than an hour to get someone with a car that could drive the bleeding mother to the nearest hospital which is a two and half hour drive from Ofiki to Saki. If there was a well-equipped ambulance in that village, I believe her life would have been saved.

Challenge II: Shutdown of clinics in hospitals as a result of COVID related measure

Most clinics in our hospitals are currently shutdown with only maternity and accident and emergency operating. My mum’s clinic schedule is every two weeks, and if the clinics had been running, we would have properly manage the fluctuation in her blood glucose and other complaints. I am informed of someone who recently had a surgery but couldn’t go for post-surgery check-up because of the shutdown of clinics. 

Sir, I know COVID-19 is a highly infectious disease and I am proud of your prompt response by enacting strict preventive measures immediately after our index case. However, I must clearly state that the state may currently be witnessing increased mortality among non-COVID patients as a result of COVID related measures that has led to the shutdown of clinics in hospitals. After the lockdown and the resumption of clinics in respective hospitals, I sincerely expect doctors, and health information department of all hospitals to take note and follow up on their patients that are consecutively absent from clinics, and further investigate if they are alive or not. I sincerely look forward to our public health researchers investigating the contribution of COVID related measures (to include clinic shutdown) to non-COVID related deaths among out-patients in respective clinics of our hospital. 

Recommendations

There is a need for a public health emergency policy that clearly put forward a well-researched, locally adaptable preventive measures in place towards combatting epidemics in the state. One of the key focus of such policy is to put forth measures that will ensure that our already weakened health system is not worsened as a result of any public health emergency, and as such ensure all clinics are operating irrespective of the ongoing public health intervention for the epidemic. I am able to share some policy consideration that may be of relevance should the state government be interested in instituting a public health emergency policy. 

Challenge III: Weakened health system due to preventable NCD burden. 

The Department of Medicine of EKSUTH once conducted a study on “the pattern and outcome of medical admissions in Ekiti State University Teaching Hospital – A 5 Year Review”. The study which was published in the American Journal of Medicine and Medical Sciences 2015, 5 (2); 92-98, reviewed medical records of adult admissions between January 2008 and December 2012. 

According to the study, Non-communicable diseases 2315 (64.6%) constituted the majority of admitted cases during the period under review. The major non-communicable diseases (NCD) were stroke (21%), diabetes mellitus (18%), hypertension (13%), and heart failure (11%) while the main cases of communicable diseases (CD) admitted were HIV/AIDS (21%), pulmonary tuberculosis (16%) and malaria (13%). 

In 2004, I lost my Dad to diabetes, and in 2020 I lost my mother to diabetes as well. As a pharmacist, and someone made orphaned as a result of diabetes, I have come to realize that the prevention of non-communicable diseases offers better health outcomes than the management. 

NCDs are getting to become diseases burden on our health system. Five common risk factors for NCDs are obesity, physical inactivity, unhealthy diet, excess alcohol intake and tobacco. These are all preventable through early lifestyle modification.  Promoting an active lifestyle and a healthy diet are cost-effective ways to prevent NCDs. According to WHO, 25% of adults above age 18 in Nigeria are physically inactive. This is partly due to insufficient participation in physical activities during leisure time, lack of regular exercise or walking for commuting, increase in sedentary behaviour during occupational and domestic activities, lack of recreational facilities in communities, the prevalence of violence on the street, and high-density traffic. 

Physical inactivity has been identified as the fourth leading risk factor for global mortality (6% of deaths globally). Moreover, physical inactivity is estimated to be the main cause of approximately 21–25% of breast and colon cancers, 27% of diabetes and approximately 30% of ischaemic heart disease burden.

By addressing physical inactivity and unhealthy diet among young adults in Nigeria. Over 60% of our adult population would have been prevented from non-communicable diseases later on in life, hence reducing disease burden on our weak health system. 

As the advocacy focal person for the Commonwealth Youth Sport for Development and Peace working group, I implemented a nationwide advocacy, in favour of the Nigeria Sports Bill, on promoting sports and physical activity at the community level for positive health outcomes. The bill never made it to a third public hearing before the dissolution of the last national assembly. If we continue to play politics with physical activity, tobacco-free society, and healthy nutrition in Nigeria, we are only broadening diseases burden that will worsen or totally collapse our weak health system.

With the lifestyle currently lived by young people, there may be an increase in prevalence of non-communicable diseases in Nigeria. Considering our weak health system which is deteriorating by the day, if adequate preventive measures and investment are not put in place on preventing non-communicable diseases, our health system may gradually and eventually collapsed within the next ten years. 

As a family, we are currently working on establishing a memorial foundation — Joseph and Deborah Oluwadero Foundation, in honour of our parents, who lost their lives to diabetes. The foundation shall primarily be focused on the prevention of non-communicable diseases, and award of scholarship to support the education of children of indigent missionaries. As we make plans for this foundation, we look forward to Ekiti State Government paying the gratuity of our deceased mother to support the work of the foundation.

Conclusion:

This Open letter will be my second attempt of making policy recommendation to your excellency. In June 2019, I had an appreciation visit to your honour for your support to my youth work engagement. During this visit, I shared a concept note on promoting youth work in Ekiti State, and I was directed to submit it to the secretary to the state government which I did on Wednesday 3rd July 2019. After several follow up, I have since given up on the proposal. 

Sir, my desire to see the implementation of the policy recommendation aforementioned in this open letter is not what I can easily give up on like I did with the previous proposal. I believe your decision to act on the issues raised in this letter will not only make my mother smile from heaven, I strongly believe it will be her well-deserved justice that will vindicate her unexpected transition into glory as a result of poor management of her emergency owing to negligence by health workers, lack of personal protective equipment PPE and oxygen at EKSUTH accident and emergency. 

As a true lover of Ekiti people and a very compassionate leader, I believe you will read this letter and act accordingly. I am available to provide a deeper insight into issues raised in this letter. 

I look forward to hearing from you and seeing your actions.

Thank you. 

Pharm. John Oluwadero

The last child of late Deborah Bolanle Oluwadero. 

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