Nigerians have called for urgent reforms to the healthcare sector after the death of Chimamanda Ngozi Adichie’s 21-month-old son prompted an outpouring of grief and accounts of negligence and inadequate care.

In a leaked WhatsApp message, the bestselling author said she had been told by a doctor that the resident anaesthesiologist at the Lagos hospital treating her son Nkanu Nnamdi had administered an overdose of the sedative propofol.

Adichie and her husband, Dr Ivara Esege, have begun legal action against the hospital, accusing it of medical negligence.

For decades, the state of Nigeria’s public health sector has made national headlines with accounts of underpaid doctors carrying out surgeries by candlelight in the absence of power supply, patients paying for gloves and other missing basics, dilapidated facilities and nonexistent research departments. Those who can afford to seek care abroad typically do so.

There is also a dearth of emergency response services. When the former world heavyweight boxing champion Anthony Joshua survived a car accident in Nigeria in December, he was helped at the scene by bystanders, with no ambulance in sight.

Adichie’s sister-in-law Dr Anthea Esege Nwandu, a physician with decades of experience, has called for change.

She told Agence France-Presse: “This is a wake-up call, for we, the public, to demand accountability and transparency and consequences of negligence in our healthcare system.”

An exodus of medical personnel has exacerbated the situation, resulting in a doctor-to-patient ratio at the last count of 1:9,801. According to the health ministry, an estimated 16,000 doctors have left Nigeria in the last seven years.

‘The will of God’

As Nigerians at home and abroad mourned Adichie’s son this week and the Lagos state government ordered an inquiry, stories flooded social media about a crisis of errors by medical personnel.

In Kano state, authorities said they were investigating the case of a woman who died four months after doctors left a pair of scissors in her stomach during surgery. The woman repeatedly visited the hospital complaining of abdominal pain, but was only prescribed painkillers. Scans revealed the scissors just two days before she died.

For Ijoma Ugboma, who lost his wife in 2021, the tragedy felt painfully familiar. Peju Ugboma, a 41-year-old chef, had gone into hospital for fibroid surgery and died due to complications exacerbated by staff putting “the wrong setting of the ventilator [on] for 12 hours”, her husband said.

“Surgery on Friday, ICU on Saturday, dead on Sunday. I asked for the death certificate … but at that point I knew that I wasn’t going to let this thing go like that,” he told the Guardian.

Almost two years after Peju’s death, after a battle Ugboma said had tested him “mentally, emotionally and financially”, three of the four doctors in the operating theatre were indicted for professional misconduct.

The law firm of Olisa Agbakoba, a medical negligence lawyer with two decades’ experience, was one of two that represented the Ugboma family in court. He said in Nigeria there was no rigorous regulatory structure in place in the health sector.

“There is no requirement for routine submission of reports, no systematic inspections, and no effective enforcement of professional standards,” he said.

Agbakoba said his brother had undergone surgery by a physician who was not suitably qualified, resulting in sepsis that required a month-long treatment. “That was absolute incompetence,” he said.

Despite the abundance of medical malpractice claims, formal complaints and lawsuits remain remarkably low, partly because negligence is hard to prove. But many say there is also a cultural and spiritual dimension involved.

“People say it’s the will of God,” said Agbakoba. “They just go home and don’t talk about it … It’s underreported because many people don’t really do anything about it.”

Finding justice

Even when issues are escalated legally, medical personnel are reluctant to give professional opinions in court. Two of the three expert witnesses that testified for the Ugbomas live outside Nigeria.

“People told us they’d read through the case notes, they’d seen all the fault lines … but nobody wanted to talk and that is part of the rot in the system because there’s an unwritten oath of secrecy,” Ugboma said.

Some people are cautiously optimistic that the high-profile death of Adichie’s’s son will trigger an overhaul of the health regulatory framework.

For Ugboma, his long fight for accountability was worth it. “Right now, I can talk to my children and tell them I fought for their mother even in death,’ he said. “There’s justice out there if only one can persevere. It’s a marathon. But we can only have a better system if more people begin to challenge them.”