Posted on: Tue 11-03-2025

In this concluding part, PUNCH Healthwise investigation reveals how doctors at the Federal Teaching Hospital, Lokoja in Kogi State, are overwhelmed by a lack of modern working equipment amid severe manpower shortage, leading to cases of collapse of health workers, medical errors, and avoidable deaths. SODIQ OJUROUNGBE reports

Not even the health workers of Federal Teaching Hospital, Lokoja were spared from the avoidable deaths that have plagued the facility due to a lack of medical facilities. On March 31, 2024, Salamatu Aliu, a dedicated attendant at the hospital, lost her life after completing a seven-day night shift.

Having worked tirelessly to care for others, Salamatu returned home that evening feeling unusually weak and breathless. As her condition worsened, her family rushed her back to the hospital where she had spent years working.

But instead of receiving the care she had given so selflessly to others, Salamatu was allegedly turned away from the Accident and Emergency department. Despite the desperate pleas from her family, the hospital staff refused to admit her, citing a lack of power and the inability to provide any treatment.

PUNCH Healthwise gathered that doctors and nurses on duty referred Salamatu to the Specialist Hospital in Lokoja. Unfortunately, she passed away upon arrival at the Specialist Hospital in Lokoja before receiving any medical care.

Her death, however, led to a protest in the hospital on April 4, 2024, from her colleagues, who urged the Federal Ministry of Health to investigate the hospital’s operations thoroughly.

The ward attendants during the protest reportedly expressed frustration and placed blame on the perceived indifference of the doctors and nurses at the hospital for their colleague’s untimely death.

They also claimed that negligence of duty, especially by doctors and nurses, was becoming a new norm at the A&E, where their colleague was rejected.

 

Miscarriage rampant

An investigation by PUNCH Healthwise uncovered alarming reports of several healthcare professionals suffering miscarriages due to the gruelling working conditions in the hospital.

It was gathered that beyond the outdated medical equipment used at FTH Lokoja, miscarriage among doctors and house officers has become a new normal due to extended working hours.

A document obtained by our correspondent, detailing the distribution of residents and medical officers as of February 6, 2025, reveals that the teaching hospital has only 81 residents and house officers to care for patients across its 14 departments.

Departments such as Obstetrics and Gynaecology have 12 residents and house officers, Internal Medicine has 10, Surgery has 9, Orthopedics has 8, Anaesthesia has 6, and Ophthalmology has 2.

Other departments are even more understaffed, with Radiology having only 4 house officers and no resident doctors, Family Medicine having 8 residents and house officers, Paediatrics with 6, Haematology with just 1 house officer, Dental with 4 house officers, Ear, Nose, and Throat (ENT) with 2, and Accident and Emergency with 8 house officers. Additionally, NHIA has only 1 house officer.

Findings by our correspondent revealed that at least eight house officers and doctors have tragically lost their pregnancies, with several of these incidents linked directly to the demanding and unhealthy working conditions in the FTH Lokoja.

During a conversation with some of them, it was discovered that the relentless pressure of attending to a constant flow of patients, sometimes for more than 12 hours a day, has taken a significant toll on the staff.

A senior registrar at the O&G department of the hospital shared a heartbreaking account of how the demanding hours and harsh working conditions have directly contributed to the miscarriages of three house officers within their department.

The doctor expressed frustration over the lack of support and inadequate working conditions, stating, “It is devastating to witness this, but the reality is that many of us are working hours far beyond reasonable. Some of us are forced to work shifts that stretch beyond 12 hours, sometimes with little to no break. It is physically and mentally exhausting.”

The doctor further explained that the work environment contributes to a high level of stress, with the doctors and nurses often dealing with an overwhelming influx of patients, outdated equipment, and the constant demand for quick decision-making under pressure.

“There is only so much the human body can endure. Our doctors and nurses are essentially working in a pressure cooker, and unfortunately, the consequences are now being felt personally. The constant exhaustion, stress, and poor facilities make it difficult to stay healthy, let alone carry a pregnancy to full term,” she lamented.

Also, one of the nurses who claimed to have lost her pregnancy while on duty told PUNCH Healthwise how the long shifts and the chaotic nature of the hospital environment had contributed to her physical and emotional stress.

She narrated, “I had been on my feet for several hours, attending to multiple patients without adequate rest. I was so overwhelmed with the workload that I didn’t even realise the effect it was taking on my body until it was too late. I lost my pregnancy, and I know I am not alone in this experience.

“We are the backbone of the healthcare system, but we often do not receive the care and attention we need ourselves. The conditions are unbearable, and while we are expected to give our best to our patients, we are not allowed the time or space to take care of ourselves. This japa worsened the situation in FTH Lokoja.”

 

Struggling O&G department

Beyond the overworked staff, the infrastructural deficit and lack of essential facilities at FTH Lokoja were glaringly evident, as PUNCH Healthwise discovered during a visit. The Obstetrics and Gynaecology department faced severe shortages of both equipment and medical personnel.

Findings showed that the O&G department, essential for maternal and child health, has been forced to operate without key tools needed for proper patient care.

One of the most pressing issues at the hospital is the poor condition of the Manual Vacuum Aspiration, also known as the MVA room, which is essential for managing miscarriages and performing safe abortions.

When our correspondent was granted access to the MVA room, it was in a deplorable state. The room, which was supposed to be a sterile, safe space for critical procedures, was overcrowded with unnecessary items. Old, rusted trolleys and wheelchairs were shoved into the small space, cluttering the area and creating an unsafe environment for both patients and medical staff.

The room itself appeared neglected and dirty, with dust visible on surfaces. In one corner, a pink bed that should have been used for resuscitation was left in a disarrayed condition.

It was observed that instead of focusing on the necessary equipment for procedures, the room was overtaken by outdated and irrelevant items that made it feel more like a storage space than a functioning medical room.\

The MVA room, meant for life-saving procedures, was cramped, poorly organised, and far from the clean, well-equipped environment it should have been.

A“We don’t have the basic minimum things we need to work. For example, the MVA room is not conducive, and this impacts our ability to perform essential procedures. We are forced to rely on manual methods, which are far from ideal and can put patients at risk,” said a senior registrar at the O&G department.

 

NO ECG machine

Beyond the poor condition of the MVA room, it was gathered that there is no ECG machine in the hospital.

The ECG (electrocardiogram) machine is a fundamental piece of equipment for monitoring the heart health of patients, particularly during labour and delivery.

Without it, our correspondent gathered that the department is unable to accurately monitor and respond to potential cardiac issues, which could have dire consequences for both mothers and babies.

The senior registrar added, “There’s no ECG machine in our department. This puts both our patients and staff in danger. We are forced to monitor heart conditions through less reliable methods, which is far from ideal. It’s a risk that we shouldn’t be taking, but we have no choice.”

The lack of essential equipment in the O&G is compounded by a shortage of medical staff, which has left the remaining doctors and nurses struggling to meet the overwhelming demands.

It was learnt that the department is understaffed, with only a few senior registrars taking on the workload of multiple people.

With one registrar on outside posting and another medical officer not even being a resident doctor, the team has been forced to rely on house officers, who are often inexperienced and need constant supervision.

“We are stretched thin. It is not just about the lack of equipment; it’s also about the lack of personnel. We can’t provide the level of care we want to because we simply don’t have enough hands to do it all,” the senior registrar lamented.

 

No proper sterilisation of tools

The Central Sterile Supply Department is meant to be the backbone of any hospital, ensuring that all medical equipment and supplies are properly sterilised to prevent infections and ensure patient safety. However, at FTH Lokoja, the CSSD unit is in a state of neglect, far removed from its essential role in maintaining hygiene and patient care.

Our correspondent, who gained access to the CSSD through unofficial means, found the unit in a state of disarray. The place has been reduced to a dirty, isolated area. Medical instruments used daily in the hospital were found wrapped in soiled blue cloths, instead of being properly sterilised and stored in a clean, controlled environment.

One of the most alarming discoveries was a sterilization machine, which was found abandoned and no longer in use. Instead of relying on modern equipment to properly sterilise instruments, many of the tools are now being manually cleaned, a process that is not only time-consuming but also highly inefficient and dangerous.

The lack of functioning sterilisation equipment puts patients at an increased risk of infections, which can complicate recovery or even lead to death.

Further compounding the problem, the area used for washing critical items, including equipment for the theatre and ICU, was in deplorable condition. The room was filthy, with broken particles scattered around the washing area.

The environment was unkempt, with no clear system for ensuring the proper cleaning of essential equipment. This negligence endangers both patients and staff.

Without a functional CSSD unit, it was learnt that the hospital is unable to provide sterile equipment and supplies, fuelling the spread of infections and compounding the neglect that pervades every level of the institution.

A public health expert, Taiwo Adenekan told PUNCH Healthwise that the lack of proper sterilisation of hospital equipment puts patients at risk of contracting hospital-acquired infections, which can be deadly.

The physician argued that the lack of a functional CSSD unit is a clear indication of the hospital’s systemic rot.

He said, “It is a failure of leadership, a failure of management, and a failure of the healthcare system as a whole. The hospital’s administration has abandoned its responsibility to provide quality healthcare, and the consequences are being borne by the patients.

“A sterile environment is not a luxury but a necessity in any healthcare setting. Without the proper sterilisation of tools, the risk of preventable infections skyrockets, making the hospital a dangerous place for patients in need of care.”

 

Filthy toilets

The state of the toilets at FTH Lokoja shows just how poor the condition of the hospital is. When our correspondent visited the A&E toilets, the strong smell of urine and faeces mixed with the damp odour of mould and mildew made it unbearable.

It was observed that the toilets were rarely flushed, and waste was left to pile up for days, making the place almost impossible to use. The walls were stained, and rust covered the metal fixtures.

At the toilet, there were no paper towels or soap, and sometimes no running water to wash hands. The bad smell filled the air, making the restroom not only uncomfortable but also a health risk.

These poor toilet conditions reflect the overall state of the hospital. Instead of providing care, the hospital exposes both patients and staff to the risk of infection.

 

Alleged victimization

Beyond the poor working conditions and lack of essential facilities, FTH Lokoja is currently embroiled in a crisis, with several doctors accusing the hospital’s Chief Medical Director, Dr. Olatunde Alabi, of victimizing them for demanding better working conditions and infrastructural upgrades.

PUNCH Healthwise gathered that the crisis reportedly began after Dr. Jimoh Umar, the embattled president of the Association of Resident Doctors, led some of his colleagues in a confrontation with the hospital management. The issues raised included a severe shortage of manpower, non-payment of arrears, inadequate call food provisions, denial of in-service training, frequent power outages, and a lack of emergency drugs and even clean water.

It was learnt that the doctors’ frustrations boiled over, and what followed was a series of allegations that the management retaliated against their efforts to address these dire concerns.

Some of the doctors who spoke with our correspondent claimed they were subjected to harassment and retaliation for simply voicing their demands for improvement.

“After we spoke out about the lack of basic amenities and the dangerous working conditions, we started facing all kinds of retaliation. Some of us have been suspended, while others were forced out of the system. We were simply asking for better working conditions so we could provide better care for our patients,” one of the affected doctors said.

The victimisation, according to the doctors, intensified when they participated in protests to demand improved welfare and better hospital facilities.

“I was summoned and questioned for misconduct, but when I asked to know what specific offence I had committed, I was given vague responses. They never provided concrete evidence or specific details. It’s clear they are punishing us for standing up for our rights,” said one of the victimised doctors, who wished to remain anonymous.

PUNCH Healthwise observed that the doctors’ grievances are not just about their immediate working conditions but also about the long-term sustainability of the healthcare system at FTH Lokoja.

Some doctors alleged that despite working long hours under difficult conditions, the management has failed to provide the necessary resources or address the systemic issues that are putting their health and patient care at risk.

“We are constantly working in an environment where we don’t even have access to the most basic tools we need. It’s incredibly frustrating. You can’t expect doctors to perform at their best when they don’t even have the most basic resources,” another doctor expressed.

According to the doctors, despite their efforts to raise awareness and seek solutions, their concerns have often been dismissed or ignored.

Some claimed that any attempt to speak out was met with hostility and unjustifiable disciplinary actions.

“We’re not asking for luxury. All we want is a safe, supportive working environment and a hospital system that is adequately equipped to serve the people. But instead, we’re being treated as though we are the problem for demanding these basic needs,” a doctor simply identified as Uthman said.

 

Temporary doctors

The issue of temporary employment in FTH Lokoja, especially for doctors, has caused a growing wave of frustration and disappointment among the workers at the hospital.

These professionals, often referred to as LOCUM medical officers, work under contracts that are regularly renewed every few months, often without the stability or benefits that come with permanent employment.

PUNCH Healthwise gathered that this has left many doctors in the hospital in a continuous state of uncertainty about their job security, and the situation appears to be growing increasingly untenable.

Despite their critical roles in ensuring the smooth operation of healthcare facilities, LOCUM officers are subjected to what some would describe as exploitative labour practices.

These doctors, many of whom have been with the hospital for years, lamented that they face a constant threat of contract expiration, leaving them vulnerable to abrupt termination or forced unemployment.

“Every four months, I have to wait to see if they’ll renew my contract. Sometimes, it is stressful not knowing what the next step will be. You can’t plan your life or future when you’re on this kind of cycle,” said one doctor, who has worked at the same hospital for over three years.

“At first, it didn’t seem like a big deal, but over time, it wears you down. The work is just as intense as a permanent job but without the security or benefits,” he added.

The employment contracts for LOCUM medical officers, as outlined in the letters obtained by our correspondent, revealed troubling conditions.

The letter, titled ‘Engagement of Temporary Staff,’ explicitly stated that the employment will last for just four months, with the possibility of renewal at the discretion of the hospital administration.

Going through the letter, PUNCH Healthwise observed that the language of the contract also highlights the fragility of their position, as it emphasises that the decision to renew the contract can be made only two weeks before the expiration date.

Also, it was discovered that the employment letter restricts the LOCUM doctors from joining unions or participating in industrial actions.

While permanent staff are able to organise and advocate for their rights collectively, LOCUM officers are barred from this, which limits their ability to raise concerns or fight for better working conditions.

The restriction of basic workers’ rights is seen by many as an attempt to stifle any potential dissent among temporary staff, keeping them from voicing their grievances collectively.

It was gathered that the lack of permanent status means they are often excluded from crucial benefits that permanent staff enjoy, such as pension contributions, paid leave, and access to hospital-sponsored insurance plans.

This lack of entitlements often leaves them with fewer financial protections compared to their full-time counterparts, even though their work duties and hours are nearly identical.

“I’ve been here for three years now, and it feels like I am invisible. I’ve dedicated my time and effort to this hospital, and yet I am still treated like a temporary worker. It’s disheartening.

“If we had more security, if we were treated like permanent staff, we could give even more of ourselves. But right now, it feels like we’re just filling in the gaps when they are short-staffed, and no one really cares about our well-being,” said one LOCUM medical officer.

 

Private hospitals around benefiting from the loss

Investigation by PUNCH Healthwise revealed that the lack of essential facilities at FTH Lokoja has created a vacuum that private hospitals in the area have been quick to exploit.

With many patients unable to receive adequate care due to the hospital’s chronic shortages, they are left with no choice but to seek treatment at private health facilities. Hospitals located within the vicinity of FTH Lokoja, such as A4 Hospital, Shiffa Hospital, Poly Hospital, Niger Hospital, Echo Lab, and A4 Radiology Centre have benefitted from the misfortune of the public hospital.

Our correspondent also gathered that some of the largest private hospitals in Lokoja are owned by doctors who are employed by the federal government and work at FTH Lokoja.

These doctors, who are supposed to be serving the public through their government posts, are reportedly using their positions to run their own private practices, offering the very services that are lacking at the public hospital.

It was learnt that patients seeking medical attention at FTH Lokoja are often told that necessary tests and treatments, such as CT scans, blood counts, and specialised care, are unavailable due to broken equipment or insufficient supplies.

Faced with these challenges, many are left to seek these services elsewhere—often at one of the private hospitals, where they are charged substantial fees.

 

Japa, funding affecting our operation-Mgt

Reacting, the management of FTH Lokoja lamented that the hospital is contending with a high rate of resignations and retirements, which has significantly impacted service delivery.

During a detailed conversation with PUNCH Healthwise that lasted for over two hours, the Chairman of the Medical Advisory Committee of the hospital, Dr. Ebune Ojochide, attributed the escalating crisis to several factors, including a federal service-wide ban on recruitment, which has led to a reliance on temporary or “locum” staff to fill the gap.

Ojochide, responding on behalf of the Chief Medical Director, Dr. Olatunde Alabi, explained that the hospital has been unable to recruit permanent staff due to bureaucratic delays and an insufficient budget allocation to accommodate new hires.

He noted that the shortage was exacerbated by the resignation and relocation of young doctors, many of whom prefer to pursue opportunities abroad due to better pay and working conditions.

He claimed that this japa trend led to the closure of critical units such as the Neurology, Pulmonology, and Haematology departments of FTH Lokoja.

The medical advisory head explained how the locum system was adopted to address the manpower shortage in hospitals.

According to him, the locum system was introduced as a temporary measure to fill the gap created by the exit of doctors from the hospital.

He explained that the hospital was unable to recruit new doctors due to a service-wide ban on recruitment in the public service, which led to the introduction of the locum system.

“Locum is a standard practice worldwide. It allows hospitals to maintain critical services when they cannot recruit full-time staff due to financial and bureaucratic limitations.”

Ojochide also noted that while the locum system has been in place for some time, it has come under fire from critics who view it as a form of ‘casualisation’ of the workforce, particularly because some doctors have been on temporary contracts for extended periods, sometimes up to three years.

Despite the criticism, he argued that the hospital’s reliance on locum doctors is driven by necessity rather than a desire to exploit the workforce.

“We have to balance the need for services with the available manpower,” he said, adding that the hospital has always given preference to existing locum staff when recruitment opportunities arise.

“We are hopeful that the approval for more permanent staff will come soon, and when it does, those who have been working with us on locum appointments will be given priority in the recruitment process,” Ojochide added.

The medical advisory chairman acknowledged that despite efforts to address the staffing issue, many departments are now functioning with minimal staff and, in some cases, without specialised consultants.

“Our consultants are resigning, and the units that once catered to specialized care are now closed,” he said.

He noted that despite efforts to find locum doctors to temporarily fill these vacancies, the number of available medical professionals is limited, further straining the system.

The medical advisory head lamented that the resignation crisis forced many healthcare workers to take on multiple roles, adding that he, as a plastic surgeon, sometimes works for over 12 hours a day to keep up with the surge in emergencies.

“I am the only plastic surgeon in the entire state. While I am in the theatre operating, even if you bring 10 more patients that need me, I cannot be in two places at the same time. So, there are a lot of times that I work from 10 to around 10 in the night,” he explained.

“Many doctors are considering leaving the country for better financial prospects, particularly in nations like Saudi Arabia and Australia, where they can earn significantly higher salaries. Some of my colleagues are leaving for Saudi Arabia. The salary there is about 15 times higher than what we earn here,” he lamented.

Addressing claims that some workers had lost pregnancies due to overwork, Ojochide acknowledged that the excessive workload has become a significant issue for the hospital staff.

He confirmed that the increasing number of resignations among doctors and other healthcare professionals has left the hospital struggling to manage patient care, particularly in specialised departments.

“The workload is much. The reality is that the staff are overworked, and it’s not just the young doctors but even consultants. The resignation rate is high, and it’s impacting everyone,” he admitted.

Ojochide shared a personal experience where he collapsed during duty due to the workload.

“There was a day when I collapsed after a long shift. Maybe if I was not in the hospital environment, where I received immediate care from my colleagues, I would have died by now,” he stated.

 

Funding gap

One key issue raised by Ojochide was the chronic underfunding faced by hospitals nationwide, particularly in the face of Nigeria’s current economic climate.

He lamented that health funding has consistently been one of the most challenging aspects of public health policy in Nigeria.

“We must be realistic. The funding challenge is the biggest issue for every government hospital in Nigeria. It’s not just us; it’s everywhere. Health is expensive, and while the government is trying, it can’t be enough given the economic realities we face

“Our capital project for the past year hasn’t been fully funded. Many of our projects, like expanding the A&E, still require funding. But even the 35 per cent that we do get is not enough to complete the projects we’ve already started,” he explained.

Ojochide emphasised that the current leadership focused on completing abandoned projects rather than starting new ones.

This approach, he said, has allowed the hospital to make incremental improvements over time.

He pointed out that the hospital is still the most resourced healthcare facility in Kogi State, with highly trained consultants, nurses, and medical personnel doing their best to deliver quality care under very difficult circumstances.

“We are doing the best we can with what we have. There is no other hospital in this state that can offer the level of care we provide, and we remain committed to saving lives and improving our services every day. However, we need to understand the public and the media. This is not a matter of negligence or poor management; this is the reality of working with inherited structures, limited funds, and overwhelming demand,” he concluded.

By  

Sodiq Ojuroungbe

Punch News

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