Dr Paul John , Port Harcourt, Rivers state ,firstname.lastname@example.org, 08083658038
I was enraged when I read about the demise of an inmate two days after she was delivered of a set of twins through caesarean section in Calabar. I got angrier when I read the press release by the prisons authorities in Cross River state .This is because of my experience in medical practice and prison evangelism in Nigeria. Prisons Officers working at the Public Relations Office must do the job they were employed to do which is to create a good image of the Nigeria Prisons service (NPS) to the public but for ASP Effanga Etim, who is the Public Relations officer of NPS Cross River command, to state that: “We assure the public that the health and welfare of prisoners remain our top priority,” that is what I call overzealousness of one’s job or simply one’s job taken too far.
While in the medical school in those days at the University of Nigeria, Ituku Ozalla ,there was this prison inmate that was being managed for hypertensive heart diseases and I was lucky to be doing my clinical posting in that medical unit when she was irregularly being brought to the unit for her clinical appointments by the prison officers . Our consultant was worried that despite all the drugs previously prescribed to the inmate, her medical condition was deteriorating. Meanwhile, the prisons authorities would bring her to the hospital the days they liked or as the accompanying prisons officer told us ,’’We will bring her the day our oga provides transport for us .’’
Governor Ayade of Cross River state
Normally, when the inmate (a female) entered the consulting room for her medical consultation, the prisons officer (a male) would follow her ,such action cannot be seen in saner climes because ,though she was an inmate she had not been convicted hence S36(5) of the Nigerian constitution which stipulates the innocence of an accused until convicted by a competent law-court still applies in her case and the inmate still has the right to privacy with her doctors as contained in S.37 of the Nigerian constitution as amended.
Our consultant was worried because he had changed many drugs for this prisoner but her condition was getting worse. To be frank, our consultant seemed to be at his wits end, as to me he did not know what else to do or another drugs to prescribe. However, he had to prove that it was through academic and clinical training that he earned the title of a medical consultant hence he asked the prisons officer if they had been buying all the medications previously prescribed for the inmate, the officer was very smart in answering the question, he simply said that his own unit was to accompany inmates if they were going outside the prison hence he did not know about how drugs were given to inmates.
At this point, our consultant asked the prisons officer to go outside the consulting room so that we could talk with the inmate privately. The prison officer refused initially but when he was reminded that he did not have any legal right to enter the consulting room with the inmate in the first place and that he should not abuse such privilege, then he reluctantly left the consulting room for us to have a one-on-one discussion with our patient.
The event that followed after the prisons officer left the consulting room still hurts me till this day. The inmate without mincing words told us that none of the previously prescribed medications had been given to her by the prisons authorities and that one of the instructions given to her on their way to the hospital any day the prison officers would deem it necessary to bring her to the hospital was that she would answer in the affirmative if she was asked if she took her previous medications. At this time everybody in the consulting room was filled with rage, some girls started shedding tears, and if not our medical training and other Nigerian laws that forbade violence against a peace officer , I and my colleagues felt like pouncing on the prisons officer when he returned to the consulting room to pick up his ‘’victim’’ ,after the consultation , at least for us to use him as a point of contact to register our ‘’joint’’ anger against the prisons authorities .
They are aware that not taking a sick inmate to the hospital may be used against them in the law-court but they were also aware that in Nigeria there was no way one could prove in the law-court that the inmate was not given the previously prescribed medications. Who would be the witness during such trail, another prisoner or the patient who might be dead or in a vegetative state when the matter would come up in the law-court? To me, this was the height of man’s inhumanity to a fellow man. In developed countries, prisoners when freed become good citizens but in Nigeria when prisoners are freed they become hardened criminals or worse than they were before being remanded in prison custody because of the conditions they were exposed to while in custody and most of them would proceed to the hospital for medical attention because of the health challenges they were freed with.
Read Chief Olusegun Obasanjo’s ‘’ MY WATCH volume 1’’ about his prison experience when he was jailed by the Sani Abacha regime as a VIP (former military head of state then), thereafter tell me the situations of common Nigerians who are not VIPs in our prisons. In my village there is a wise saying that ‘’ One should not lose weight or look unhealthy as an inmate in Nigerian prison.’’ My friend who was once remanded in Nigerian prison always jokingly describes somebody who does not know how to cook good/palatable food as a good candidate whose services will be needed by Nigerian prisons service.
Can you see why I believe in reincarnation? With atrocities I have seen or witnessed in Nigeria, there is no other explanation for such happenings except the belief that reincarnation is real? I believe that we that found ourselves in this part of the globe might have sinned in our previous world hence we reincarnated to this part of the globe to suffer for our past deeds . Think of how politicians make use of the same youths they have rendered useless and worthless to rig elections and still jettison them thereafter. At least our security agents in Abuja and Calabar are busy arresting sex workers at night clubs while Abuja-Kaduna highway and Emuoha- Rumuji-axis of East-West Road in Rivers state have been taken over by hoodlums. It is only reincarnation that explains the observation where Niger Delta militants are under military siege while IPOB was declared as a terrorist Organization whereas there is ongoing controversy about Myetti Allah and proposed N100 billion grants.
The inmate with hypertensive heart diseases was progressively deteriorating because she had not taken her previous medications but the officer and his likes would be in the Church on Sundays or Mosques on Fridays to worship the God/Allah they had never seen? Was that not madness? At this point, we tasked ourselves and contributed money to make sure the drugs prescribed for the inmate were bought by us before she left that very day. Luckily, our consultant was ‘’highly connected’’ hence he made it clear to the prisons officer that he, the consultant, would call prisons authorities in Abuja if the state command would not be providing the inmate’s medications or foot the bill of her medical investigations . The consultant told us that his friend was a very top officer with the Nigeria Prisons service and that the budget for an average prisoner in Nigeria then was about N18,000 but go to prison and see the type of food the inmates eat .At least those that have visited police stations might have overheard Police officers threatening a suspect whether he wanted to go to prison and eat half-cooked beans?
I don’t want to talk about my other experiences in Prison evangelism because that will make my write-up verbose and boring. What are the nutritional and health statuses of our Nigerian prison inmates who are not pregnant not to talk of having pregnant inmates in Nigerian prisons. Is it not shameful for us as a nation that our prisons are still modeled on punitive measures when other saner nations see their prisons as reformation, corrective and rehabilitation centers?
I call for more investigations on the death of this Calabar inmate. Were the prisons officers in Calabar taking the pregnant inmate to the said General hospital regularly on her antenatal clinic days or the day their ogas at the top provided transport to them? What food were they serving her in the prison? Was insecticide treated net provided for her to be used while in the custody? They should let us know the birth complications that could take her life two days after delivery through‘’common’’ caesarean section? Why was the managing unit during her antenatal days not classified her pregnancy as ‘’High risk pregnancy’’ and referred her to the tertiary health institution for expert management? Why should the Cross River state commissioner of Health be involved before the prisons service could take an adequate care of an inmate under their custody? What happened to the money in the budget appropriated for the health and welfare of prisoners?
We are all aware of the bureaucracy in getting across to Nigerian leaders not to talk of the position of a honourable commissioner of health in a big state like Cross River. What is the cost of caesarean section in a public hospital that Cross River state command of Nigeria Prisons service must involve the commissioner of health in the state before the inmate can benefit from such procedure? This is happening after in 2018 budget defence , we were told that that the federal government spends N17 billion annually on feeding of convicts and awaiting trial inmates in 244 prisons nationwide. I think EFCC and ICPC have a great work to do here if they are really anti-graft agencies and not agencies used to fight political opponents .
What is the value of life in Nigeria? I put it to all Nigerians, that there are many of such ‘’Calabar’’ stories going on among inmates in our prisons nationwide. Why didn’t those that managed the woman envisage the likely complications and refer the poor pregnant inmate to UCTH where there are more facilities to handle possible complications from such procedure? Were units of blood provided before the said caesarean section was performed? Were the baseline investigations carried out before taking the poor inmate to the operating theatre? What were the measures put in place to manage post operative complications by the managing team? When did the prisons officers rush the lady to the General hospital, was it when they liked irrespective of the stage of labour the inmate was ,after all ,to them an inmate was less a human ? If the pregnancy was classified as a high risk pregnancy by the managing team at the General hospital, why was she not booked for an elective caesarean section at 37 weeks under the care of an obstetrician?
With my previous experience, I am very sure that this inmate in question was not brought to the said General hospital regularly during her antenatal clinic days. I throw it as a challenge to the prisons authorities to prove me wrong on any of my assertions above with facts. How many hours did the woman pass through labour before they rushed her to the General hospital?
If innocent protesters could be shot with live ammunition in this country and those who survived death by the whiskers were charged with compromising national security, terrorism and treasonable felony, now tell me what inmates would be passing through in our prisons. It is not necessary for the prisons authorities to reply me rather I want them to confute my assertions by allowing independent bodies to ascertain the health and nutritional statuses of all inmates in their custody.
I am aware that my colleagues at both the General Hospital and UCTH will not refuse to make public the circumstances surrounding the death of this Calabar inmate and also tell us the specific complication that occurred ,though as medical doctors we are expected not to divulge the secrets of our patients even after their deaths ,however article 44(f) of the Codes of Medical Ethics(COME) in Nigeria empowers medical practitioners to divulge some patients’ secrets in what the code calls ‘’discretionary breach of confidentiality to protect the patient or the community from imminent danger’’. In this case, we need to protect the lives of our inmates in Nigerian prisons. This country will remain stagnant until people start to pay for their actions and inactions.
A patient does not just die like that after surgery, there must be warning signs before complications set in, even the deadly post operative Pulmonary embolism has warning signs and it can be prevented in good hands and where the facilities are available . If low-incoming earning artisans can have their wives deliver their babies through caesarean sections in private hospitals (where the cost is higher) how come Nigeria Prisons service ,Cross River command ,must involve the Cross River state Commissioner of health to defray the cost of caesarean section in a public hospital ( where the cost is lower)? What happened to the funds released to them by their authorities in Abuja?
We wait for both hospitals to tell us the complications that developed two days after the surgery then I will publish another article to show how the complications would have been prevented if people who claimed that the health of their inmates was their top priority had done the needful .
Currently from the statistics released last year, Nigeria is one of the most dangerous places in the world to give birth and 4th country with the worst maternal mortality rate ahead of Sierra Leone, Central African Republic and Chad.
According to the World Bank estimates, Nigeria’s Maternal Mortality Rate, MMR is still as high as 821 per 100,000 live births. Worst still, of the 303,000 women that died globally due to complications of pregnancy and child births in 2015, 58,000 women died in Nigeria.
I believe that this piece will help our judges in deciding whether to remand a suspect with any health challenge or not. I also encourage our judges to visit our prisons and have first-hand information of what we have in there. That will inform their decisions on remanding a suspect in prison custody or giving the suspect the least possible bail condition so that any suspects with health challenges can take care of themselves at home while facing any bailable criminal trial.
I wait for more responses before I will release the remaining part of this write-up.