Critically ill patients seeking medical attention at the Lagos University Teaching Hospital, Idi-Araba and the Lagos State University Teaching Hospital, Ikeja, requiring admission and monitoring to survive are having it rough getting admitted, as the two biggest hospitals in Africa’s biggest city struggle with few bed spaces, SODIQ OJUROUNGBE reports
35-year-old Emmanuel Oyedele clutched his abdomen tightly, his face twisted in a grimace of pain and distress. His body trembled as waves of agony surged through him. For days, it was gathered that he had suffered from intense abdominal pain and vomiting, each day more debilitating than the last.
His condition had rapidly worsened, and when the private hospital he initially visited diagnosed him with a ruptured appendix, they referred him to the Lagos University Teaching Hospital for immediate medical attention. The severity of his condition left him no choice but to seek care at the popular tertiary hospital.
As he arrived at the Accident and Emergency unit of the hospital, it was immediately clear that he was entering an overwhelming sea of people, all in varying states of distress.
Our correspondent, seated under the makeshift shade just beside the entrance, observed Oyedele’s Toyota Corolla—a cream-coloured vehicle—pulled up to the gate. The man inside, clearly in excruciating pain, winced with every movement. His wife, equally exhausted, helped him out of the car, their faces etched with both fear and fatigue.
Yet despite his visibly fragile health, Oyedele was not immediately given the medical attention required due to the lack of a bed to admit him. He, like many others, had to endure the same fate of prolonged wait with their lives hanging in the balance.
Inside the A&E unit, PUNCH Healthwise gathered that the few available beds were occupied by patients who were lucky to find them empty when they got to the facility.
Our correspondent observed that irrespective of the critical state of the patient brought to the unit, admission could only be processed by the health workers if there were bed spaces.
At the entrance of the A&E, our correspondent sighted frail patients, some barely able to sit up, searching in vain for relief. Their bodies were hunched from pain or exhaustion, their eyes clouded with worry. Anxious relatives and friends flanked the entrance, pacing or sitting on the one wooden bench positioned near the gate, their legs tired from hours of waiting. Some tried to comfort their loved ones, while others simply looked around, their gazes lingering on the gate, praying to be called in next.
It was observed that the tension around the A&E entrance was palpable, as all eyes were fixed on the entrance gate, each person silently hoping for their turn to receive care.
For many hours after Oyedele arrived at LUTH, the situation was no different. He had to remain seated in the back seat of the Corolla, still clutching his abdomen in excruciating pain. Like so many others, he was forced to wait his turn, trapped in the same agonising limbo, praying for the moment when he would finally be called in for treatment.
For more than four hours, our correspondent observed how Oyedele was left unattended despite the obvious discomfort he was facing. His wife identified as Bukola told PUNCH Healthwise that when she met with the security official, she was asked to wait for their turn to be called.
“When I met with one of the security guys, he said I would need to wait till it was my turn. Even after explaining to him that my husband is currently in serious pain, he said there was not enough bed space to accommodate large patients coming for admission.
“I was told it is first come, first serve they use in attending to patients here except when it is a serious emergency. So, we were asked to wait and I am tired of waiting.
“We were referred here from a private hospital not far from this area, the hospital assured us that this is the best place to get the kind of care we want, but it is just unfortunate that we are still here stranded after several hours. Nothing has been done to even look at the situation and there are still about four people we met on the ground,” she expressed bitterly to our correspondent in Yoruba language.
Ignored for hours
19-year-old Oluwaseun was rushed to LUTH by his father. The boy who has an intravenous line (IV line) attached to his hand was seen writhing in pain while sitting in the back seat of his father’s vehicle.
His father later told PUNCH Healthwise that Oluwaseun had been experiencing severe chest pains and difficulty breathing, and was advised by a doctor at a nearby clinic to take him to LUTH for further treatment.
The father, desperate to get his son seen, approached the A&E staff. He explained his son’s worsening chest pains and difficulty breathing. The staff, though sympathetic, had no solution. They told him the hospital was full, and there were no available beds. Unless someone was discharged or an emergency occurred, his son would have to wait.
For over two hours, Oluwaseun’s father paced back and forth, unable to comprehend how his son could be in such agony while there was no one to urgently attend to him. Each time he returned to the A&E desk, the response was the same; there was no bed, and there was nothing more they could do.
Expressing his concern during a conversation with our correspondent, Oluwaseun’s father lamented that his son’s condition continued to deteriorate without anybody to urgently attend to their need.
“I don’t understand. My son is suffering, and we’ve been waiting here for hours. Why can’t they find a bed for him? Why can’t the hospital make more space for patients like my son?” he asked, his voice breaking with frustration.
Waiting in vain
It has become a daily struggle for patients with conditions requiring admission at LUTH and LASUTH.
An investigation by PUNCH Healthwise revealed that the stories of Oyedele and Oluwaseun, who endured hours of agony before being admitted to LUTH, were just a glimpse into a much larger crisis that happened in the two teaching hospitals in Lagos State.
Our correspondent gathered that despite LUTH’s bed capacity of 1,050, the hospital consistently faces a severe shortage of beds due to the volume of patients referred to the hospitals from private health facilities.
This shortage has grown into a major problem that has led to avoidable deaths besides aggravating the condition of patients turned down.
It has also placed pain on patients’ relatives as well as immense strain on the entire healthcare system.
Experts say the hospital bed capacity is insufficient given the large population of over 20 million Lagos residents.
The President of the Medical and Dental Consultants Association of Nigeria, Professor Aminu Mohammad argued that considering this vast population, Lagos State needs more than three healthcare facilities, each with a capacity of over 1,000 beds, to adequately meet the demand for medical services.
Still at LUTH, PUNCH Healthwise further observed more patients and their relatives anxiously waiting for their turn to be attended to in the A&E unit. Many of the patients were seen writhing in pain, but the sight seemed routine for the triage team of young doctors, who would casually step out every 30 minutes to an hour to assess new cases before returning inside the hospital.
Speaking with some of them, they shared how they spent hours at the gate, waiting for their loved ones to receive treatment.
It was observed that none of the patients had waited less than three to four hours for care. While a very serious case involving a family of four from a gas explosion was ‘promptly’ attended to after about 30 minutes at the entrance of the A&E, PUNCH Healthwise observed that others weren’t attended to until four to six hours later, depending on the bed space availability and the severity of the cases.
A similar situation in LASUTH
The situation at LASUTH, another big tertiary facility in the city, mirrors the challenges faced at LUTH.
Despite being one of the busiest hospitals in the state with about 800-bed capacity, PUNCH Healthwise discovered that LASUTH is equally burdened by overcrowding and limited bed space, leading to long waiting times for critical patients.
Patients and their families were anxiously waiting outside the Medical Emergency unit, expecting the hospital to discharge patients on admission who were fairly okay for beds to be available for them during a visit to the hospital by our correspondent.
Many patients, PUNCH Healthwise observed, were in severe pain and were seen sitting in private vehicles, writhing in pain while waiting for their turn to be called in.
Relatives, some of whom had travelled from distant parts of Lagos, expressed frustration over the lack of beds and the time it took to receive any form of care.
A health worker at LASUTH who did not mention his name because he was not authorised to speak, revealed that the hospital had been operating at full capacity for months, with the surge in patients worsening the already strained resources.
Our correspondent gathered that at LASUTH, the situation has become a routine battle, with medical staff scrambling to accommodate as many patients as possible, often leaving some critically ill individuals waiting for extended periods.
As with LUTH, patients’ families at LASUTH often hang on to the hope that a patient will be discharged or transferred to another ward, clearing up a space for their loved ones.
Some families spoke of their difficult decisions whether to wait, hoping for a bed to open up, or to seek out private care, which many simply couldn’t afford.
The battle to get bed space
Conversation with some of the patients’ relatives showed that the battle to secure a bed in Lagos’ busiest hospitals is nothing short of gruelling, with each patient and their family having to navigate a maze of bureaucracy, overcrowding, and unrelenting desperation.
For many, the journey is marked by hours of waiting, agonising uncertainty, and the heartbreaking realisation that their loved ones’ survival depends not only on medical care but also on the availability of scarce hospital beds.
One of the relatives identified as Olumide narrated how his 76-year-old father had collapsed at home from what appeared to be a severe stroke.
Olumide said by the time they arrived at LASUTH, his father was barely conscious, but still, the battle for a bed was only just beginning.
“I thought that when I got to the hospital, they would immediately help him. But no, we were told to wait. My father could hardly speak. I kept begging them, telling them that he was in critical condition, but they told us there were no beds available.
“We waited for more than three hours. I kept asking when my father would be seen, and they just told me to wait. I was crying and begging them. It wasn’t until another patient was discharged that a bed finally opened up for my father. He was admitted around 7 PM, six hours after we first arrived.”
For Blessing, a single mother of two, the anguish of waiting for a bed was only compounded by the fact that her 20-year-old daughter, Amara, was in critical condition after a severe allergic reaction to some food she had eaten.
Blessing told our correspondent that Amara’s throat was swollen, and she was struggling to breathe.
“We arrived at LASUTH around PM. I was so scared. Amara couldn’t speak, she could barely breathe. I thought they would rush her in immediately, but the nurses just asked us to wait. I kept telling them that she might die if she wasn’t seen right away, but they said we had to wait our turn,” Blessing recalled.
After more than three hours of waiting, Blessing said her persistence finally paid off when another patient was discharged.
She added, “They called us at around 5:30 PM. It felt like a lifetime. When we were admitted, I thought I had just been given a second chance to save my daughter.
“They quickly administered treatment, and thankfully, she started to recover. But I’ll never forget the hours I spent just watching her struggle to breathe and not being able to do anything.
“It’s a pain I carry with me. Every time I think about it, my heart breaks again. I don’t know what I would have done if we hadn’t been admitted when we were.”
In-patient deaths
Different research revealed that patients admitted to the hospital during high emergency department overcrowding times had a five per cent greater risk of in-patient death than similar patients admitted to the same hospital when there was less overcrowding.
A study titled; ‘Overcrowding in an Emergency Department of a Referral Centre in Nigeria’, noted that overcrowding in emergency centres is a worldwide concern which triggers crises that may affect access to health care and the quality of services
According to the study, 56 per cent of deaths occurred in Africa due to ED overcrowding with almost 60 per cent of increased mortality occurring in children and elderly emergencies in Nigeria.
The study also identified limited space in the ED, keeping patients longer than expected in the ED, delays in support services like laboratory investigations and supply of emergency drugs as major triggers to ED overcrowding.
The researchers, however, noted that these conditions result in the presence of more cases than the unit can accommodate and cope with.
“The consequences of poor referral systems as observed in Nigeria and other African countries is that national hospitals are flooded with patients that should have been treated in primary and secondary level hospitals. Findings from this study revealed that poor referral systems, on orthopaedic or trauma like medical cases (66.7%) accessed the ED triggering overcrowding in the ED,” the study read partly.
Uncontrolled population, overwhelmed tertiary hospitals
Stakeholders in the health sector argued that uncontrolled population growth and an increasing number of patients visiting tertiary hospitals for basic healthcare are major factors contributing to the shortage of bed spaces at big hospitals.
The experts lamented that many individuals continue to flock to these advanced medical facilities for basic healthcare needs, bypassing primary and secondary care centres.
According to them, tertiary hospitals become overwhelmed with routine cases, and they face severe shortages of beds, leading to delays in treatment and overcrowding.
The President of the Medical and Dental Consultants Association of Nigeria, Prof. Aminu Mohammad, attributed the shortage of bed spaces to a combination of factors, including the lack of functional primary healthcare centres, inadequate human resources, and inadequate facilities.
The MDCAN president identified the lack of clear stratification of healthcare services as a major contributor to the shortage of bed spaces in Nigerian hospitals.
According to the surgeon, the ideal healthcare system should have a clear stratification of services, with primary healthcare centres handling basic cases, secondary hospitals handling more complex cases, and tertiary hospitals handling specialised cases.
The professor noted that in Nigeria, everybody tends to flock to tertiary hospitals, regardless of the nature of their illness.
This, he said, puts a lot of pressure on the tertiary hospitals, leading to a shortage of bed spaces.
He noted that many primary healthcare centres in Nigeria lack the necessary facilities and human resources to handle even basic cases. As a result, patients are forced to seek care at tertiary hospitals, which are already overwhelmed.
Speaking further, the don also identified the brain drain of healthcare workers as a major contributor to the shortage of bed spaces.
He noted that many healthcare workers were leaving Nigeria in search of better opportunities abroad, leading to a shortage of skilled personnel in the country.
He stated that the welfare of healthcare workers in Nigeria is very poor, lamenting that healthcare workers are not well paid and that their working conditions are often very poor.
He added, “The issue of bed space is a serious issue in the sense that if you look at the total bed space that we have in Nigeria may not be adequate to cater for the population of Nigeria. So, if there is no bed, a healthcare worker is constrained because you cannot remove another patient from the bed to put another one just because somebody came as an emergency or someone came with a condition that warrants admission. But if there is no bed space, the healthcare workers are handcuffed in the sense that it is also unethical for somebody you are already caring for who happens to be on the bed and you now say you will remove him and put another patient.
“Each hospital ideally should be assessed and people should know its capacity. For example, you may see 500 or 700-bed capacity hospitals that have 100% bed occupancy and then other patients will come with critical conditions that can only be managed in those hospitals. So what do you do? You can’t send them elsewhere because that is the best hospital for them to be cared for and therefore you find a way of managing until that bed becomes available.”
Also speaking, the Chairman Board of Trustees of the Public Health Sustainable Advocacy Initiative, Ayo Adebusoye identified the shortage of bed spaces in major hospitals in Lagos as a long-standing issue that has been worsened by the state’s uncontrolled population growth.
According to him, the main cause of the shortage of bed spaces is the uncontrolled population growth in Lagos, which has been further complicated by internal migration into the state.
Adebusoye, who is also a public health reform advocate, noted that while birth control measures have been implemented in most southern states, the influx of people into Lagos has put a strain on the state’s healthcare infrastructure.
He stressed that addressing the shortage of bed spaces requires a multi-faceted approach.
“This shortage of bed spaces in big Hospitals like LUTH, LASUTH and General Hospital Lagos has been going on for years. The uncontrolled Population growth is the main cause. Even with birth control in most Southern states, the internal migration into Lagos is uncontrollable – that is the remote cause and that is difficult to control,” he maintained.
Suggesting way forward
The MDCAN president, however, called on the government to take urgent steps to address the shortage of bed spaces in Nigerian hospitals.
He urged the government to urgently increase the number of hospital beds in the country.
Mohammad recommended that the government should increase the number of primary healthcare centres and equip them with the necessary facilities and human resources.
The don also called on the government to improve the welfare of healthcare workers, including their pay and working conditions.
This, he said, would help to reduce the brain drain of healthcare workers and ensure that Nigeria has enough skilled personnel to man its hospitals.
Corroborating him, Adebusoye advocated for an increase in the number of general hospitals or, at the very least, an expansion of the capacity of existing hospitals.
He stressed the need for an increase in the number of health centres, which would help reduce the number of people seeking specialist attention.
The health advocate highlighted the critical need for an increase in the number of healthcare workers, including doctors and nurses.
Adebusoye emphasised the importance of addressing the welfare of healthcare workers, including their pay and conditions of service.
He noted that the ‘Japa phenomenon’, where healthcare workers leave the country in search of better opportunities, can be mitigated by offering incentives such as allowances, rural posting allowances, and study leave.
How we manage bed space crisis — LASUTH
The Chief Medical Director of LASUTH, Prof. Adetokunbo Fabanwo, stated that while there may be delays in finding a bed for patients brought to the hospital’s emergency unit, there is never a delay in providing them with the immediate medical attention they require.
According to Fabanwo, LASUTH’s emergency response system is designed to provide immediate attention to patients, regardless of the availability of bed space.
Fabanwo noted that patients in emergencies are given immediate attention, including first aid and stabilisation, while efforts are made to find bed space for them.
He revealed that patients in ambulances and private cars outside the emergency unit often have drips running through them and oxygen fixed on them, even before they are admitted.
“As an emergency, there is no delay in getting care. There may be a delay in getting a bed for them, but there is no delay in accessing them. And the continuation of their care depends on when they have a bed, but they will get immediate first aid, and immediate attention,” he explained.
The LASUTH CMD acknowledged that the hospital’s bed space capacity was sometimes overstretched, leading to delays in admitting patients.
He, however, explained that the hospital has a policy of transferring patients who are not yet fully recovered to the ward to make room for more critical cases at the medical emergency unit.
“Sometimes in getting a bed, we may have to transfer a patient that is not ready to go to the ward, but because we have another emergency, we would rather move that patient to the ward so that this emergency can occupy the bed in the emergency room. That process takes time. It may take two hours to three hours.
“But once we know that there is no hope, we quickly write a referral letter to them to try other hospitals, first and foremost, within the Lagos state public health sector, and then secondly, the federal hospitals, like FMC, Ebute-Metta, or LUTH,” he said
Why we have a high burden — LUTH
Reacting, the Chief Medical Director of LUTH, Prof Wasiu Adeyemo attributed the high burden of bed shortages in the hospital to a combination of key factors, including an inadequate referral system, shortage of medical personnel, and the lack of functional primary healthcare centres across the country.
Speaking on the reason patients had to wait for hours before getting bed space, the professor lamented that the hospital’s Accident and Emergency (A&E) unit is often overcrowded, with patients arriving without prior preparation or referral.
According to him, private hospitals and other healthcare facilities often fail to adequately prepare and communicate with tertiary hospitals like LUTH before sending critically ill patients.
The LUTH CMD insisted that this lack of communication and proper referral notes complicates the situation, as medical teams are not given enough information to prepare for the incoming patient’s needs.
He explained, “For example, if a patient is critically ill and needs intensive care or critical care admission, you need to prepare the receiving hospital. But we don’t see that in almost 100 per cent of cases, particularly with cases coming from private hospitals.
“Once they (other hospitals) know they cannot cope or manage a case, they just give the patient a referral letter, for those who can even give. Some of them won’t even give a referral; they’ll just say, ‘Okay, go to LUTH, go to UHC,’ among other tertiary hospitals. You can’t take an emergency like that because you need to make some preparations.
“A patient who needs critical care can’t just be moved to a teaching hospital. We need to prepare, and we need to know what the problem is. There are many times people call me and say that a patient needs care and they’re on their way. How can you say they’re on their way? You are supposed to send me the referral notes so that I have an idea. Is this something that has to do with the heart? Is this something that has to do with the kidney? Is this something that has to do with the brain? Is this something that has to do with the liver? So, we need to know; those are some of the issues that we need to tackle.”
Speaking on efforts to improve the referral system, the professor added, “I think the federal government is doing something about that, through national emergency services. And I hope that it’s going to be effective and that in the next few months, we will be able to sort that out.
“Our referral system needs to be top-notch. Presently, the referral system is nothing to write home about, and that is one of the problems.”
Shortage of staff
The LUTH CMD also lamented the shortage of medical personnel, particularly in the Intensive Care Unit, contributed to the hospital’s inability to admit all patients requiring ICU care.
He explained that this shortage of health workers led to LUTH being overwhelmed with patients, especially those in need of emergency care.
While revealing that the hospital expanded its ICU capacity from six to 38 beds, Adeyemo pointed out that LUTH still faces significant challenges in accommodating all patients who require critical care due to the limited number of available staff to properly manage the beds.
“Even with the new 30-bed ICU, we often do not reach full capacity because we lack the staff to manage all the patients. The reality is that when a new patient needs ICU care, there are times when we simply do not have the space or the necessary staff to accommodate them,” he noted.
The CMD explained that while the hospital’s total capacity exceeds 1,000 beds, about 12 of its wards are currently undergoing renovation.
According to him, as a result of the renovation, those wards are not operational, and patients are being merged into the available spaces.
“Our total capacity is over a thousand, but about 12 of our wards are undergoing renovation. These wards are not operating, so we have to merge patients into the available ones.
“The over 1,000-bed capacity is sufficient for us, but we are landlocked here; we cannot expand further,” Adeyemo stated.
Way forward
The LUTH CMD, however, underscored the importance of addressing the broader health system issues contributing to the pressure on tertiary hospitals.
He noted that many primary healthcare centres and general hospitals across the country are either non-functional or underfunded, which forces a greater number of patients to seek care at tertiary hospitals like LUTH.
“The primary healthcare centres and general hospitals should be the first point of contact for most patients. Unfortunately, these facilities are not functioning at optimal levels in many parts of the country, and this results in a higher influx of patients to tertiary hospitals,” he said.
Adeyemo also highlighted the need for better health insurance coverage, which he believes would alleviate some of the burden on tertiary hospitals by enabling more patients to afford care at lower-level facilities.
He stressed that universal health coverage is critical to reducing the pressure on hospitals like LUTH and LASUTH and improving healthcare accessibility for all Nigerians.
He stated, “We need a system where everyone is contributing to a health insurance pool. This would mean that when people need care, they can access it without the financial burden of having to pay out-of-pocket.
“Universal health coverage, with proper functioning of primary healthcare centres, would relieve tertiary hospitals of a significant portion of the burden they are currently facing.”