#COVID19 and the condition in Akwa Ibom State;
By Dr. Johnson Imoh
DEATH OF DR DOMINIC ESSIEN- MY STORY.
This Epistle is my chronicle of the last 32 hrs of the life of the late Dr Dominic Essien who died on the 16th of April 2020. He was a Lecturer, Medical Doctor, Physiotherapist, Administrator and Entrepreneur.
As fate would have it I happened to have been played an active part of his last hours on earth and I was the last face he saw on earth.
About 9.30am 16th/04/2020 I received a call from Dr Essien to come provide Anaesthesia for a patient who was to undergo Caesarian Section in his hospital, the surgery ended about past 1pm, Dr Adeyeye of Obstetrics and Gynaecology UUTH was the surgeon. I went to his office for my payment and noticed he was looking ill. I enquired, he said he wasn’t feeling well, that he’s been coughing for about a week now. He said he had a history of chronic cough from youth which could be sometimes debilitating. I was later joined by Dr Adeneye who also for his pay. He wrote out our checks. We noticed he was in mild respiratory distress. We checked his saturation, it was 75%. We administered 2g of Rocephine, 100mg of hydrocortisone and nebulized him. At this point I had to leave as I was on call at my PPA.
Past 8pm when I had some breathing space I called him to ask how he was faring. He said he was still at his hospital. As an Anaesthetist I knew the import of his condition, my conscience couldn’t permit me to go home. I immediately went back to his hospital, met him on oxygen via nasal prongs yet his saturation was still below 80%. I told him he couldn’t stay there and needed help. He chose to go to ISH. With the need for ventilation in mind, I asked him to call and inform Dr Edubio of his condition which he did. Dr Edubio also favored ISH. He requested I drove him in my car. I gladly obliged.
We arrived ISH about 10pm, the doctors on duty were called and the drama began. They said they couldn’t attend to us because of a COVID scare that had already sent some their staff into quarantine. They said they had no idea whatsoever of the activities of the COVID team and even adviced I take him to IDH Ikot Ekpene. I told them we were going nowhere and urged them to defer to their superiors since their hands were tied. At this point they requested I called Dr Aniekeme Uwah, the State Epidemiologist for the way forward. I did, thankfully he picked up and ordered that the patient be admitted into the Holding area for suspected cases and the Management Team invited to come review him. Only then did they agree to move. We went in search of the COVID team and bumped into Dr Emmanuel John, gave him the situation report. He promptly went to work, calling the COVID doctors on duty. when they finally soughted out his accommodation, they discovered another- there was no oxygen or at least the means of delivering it. Dr John made frantic effort to get the hospital technician to sought us out to no avail. There was clearly a great divide between the COVID team and the that of the hospital. I then volunteered that we go pick up the cylinders from the patients hospital. Dr John immediately activated the Ambulance driver. By the time we got back to the Holding area we were informed they realized the pipeline oxygen was working. Dr Essien was finally placed on oxygen by past 1am. I helped connect him to the monitor and eventually left the hospital past 2am. By this time his saturation was below 70%.
First thing I did when I woke up was to update Dr Edubio of Dr Essiens condition, he promised to check on him.
I later called the doctor on duty for update. I was told his condition deteriorated but they managed to keep him alive. He also said the management team which consisted of Specialist Respiratory physicians had arrived and were attending to him, with that information I was rest assured that the needful would be done.
I am by no means related to the deceased but by the time I was leaving the hospital I was the only caregiver around, he requested I brought him his house keys from his car in the morning.
On arriving the Holding area at about 12 noon, I met fully gowned person who happened to be Dr Utuk Snr Reg O n G shouting for oxygen to delivered to him as the pipeline oxygen was exhausted. I felt I could be of help and so requested for PPE. I gowned and went in. I discovered there were 2 full oxygen cylinders but no regulators to supply. The narrative changed from bring oxygen to bring regulator. I don’t know how long the oxygen finished before I arrived but from the time I arrived to when I got the regulator was at least an hour. I connected the regulator and the patient finally got oxygen. By this time I was left alone with the patient as Dr Utuk got tired from waiting and left. Dr Atat also of OnG was giving support from outside. Dr Essien actually improved after receiving O2 for some minutes and even requested for food. I fed him with few pieces of moi moi provided by the hospital. By the time I returned him back to oxygen he never really improved beyond 40%.
I requested for assistance, for someone else to come takeover from me as I was suffocating from the heat generated by the PPE and the poor ventilatory condition of the room. I was told the protocol didn’t provide for “sit in” PPE. In other words, you come in, do your thing and go out to come back only when needed. I was forced to stay back longer, knowing fully well he needed close attention as he now very restless. He pulled off his face mask repeatedly and his canullaI dislodged. I couldn’t replace it because my goggles were fogged with perspiration and poor vision. After spending more than 2hrs with him under difficult conditions I had to move out. During this time I was giving Dr Edubio situation report every 20-30 mins with the hope that the call for ventilatory support would be activated. It never came. It wasn’t up to 20 mins after I came our attention was called that he was no longer moving, the monitors went quite, the inevitable had happened. I had asked why the call for ventilatory support was not made and was told they were waiting to rule out COVID first.
As you have noticed that Dr Edubios name has been recurring throughout this whole episode from the start. It was intentional. That’s because I know him to be the only Intensive Care physician Anaesthetist in the state, it never passed my imagination that a team could be assembled where the use of ventilators was an integral part of it’s working could be constituted and an Anaesthetist- (The only specialty with the technical know to use it) was not part of the team especially now that every case of difficulty in breathing is assumed to be a suspected case of COVID until proven otherwise. I naturally assumed he was part of the team but from all indications he was not.
No critical care nurses. The two doctors maning a critical care patient were obstetricians.
Poor coordination between the hospital staff and the COVID team.
By the way Dr Essien was not the my first victim of the day. My last action at work before going to pick our fallen colleague was to refer a 20 year old patient who was unconscious and not responding to treatment also having difficulty in breathing, they elected to go to Ibom but were rejected for the same fear of COVID reason. He died on transit to UUTH.
I think the fear of COVID has killed more people than COVID itself.
As we await the results of Dr Essiens post mortem sample. I pray that the authorities responsible would put their acts together.
May the soul of Dr Essien be a wake up call for all of us.
Dr Johnson Imoh