The congested area of the Out-Patient Department (OPD) of the Orile-Agege General Hospital in Lagos smelt of drugs, sweat and body odour. At the concrete pavement leading into the hall, a middle-aged woman sat on the floor, head bent to the ground. Sitting opposite her was a man in African fabric, popularly called Ankara, with anger and frustration written on his face. Beside him, a frail-looking old man lied on the bench in anticipation of being called upon for medical attention. Adjacent the old man sat two young men, complaining endlessly about the frustration and delays experienced in the congested OPD.

“Just don’t listen to anybody; let us go directly into the office,” a gateman identified simply as Baba, told PREMIUM TIMES’ reporter in Yoruba as they both struggled to navigate their way through the congested space. A few of the patients mumbled some words to express their anger over the injustice of having another patient come from nowhere to jump the queue. However, Baba ignored their complaints and guided this reporter gently into one of the inner offices.

The old gateman, PREMIUM TIMES investigation revealed, works as an ‘agent’ to some staff of the general hospital. Being the first point of contact for anyone visiting the hospital, Baba helps arrange for ‘clients’ who need medical reports and certificates without going through the necessary checks and tests. In return, Baba earns between N500 and N1,000 as ‘commission’ for his service, he explained, depending on the amount involved.

The Orile-Agege General Hospital is located at Old Ota Road, off Lagos-Abeokuta expressway, in Agege area of Lagos. The hospital serves residents of areas like Agege, Ile-epo, Abule-egba, Iyana-Ipaja, and environs. Although it is not as spacious as the Lagos State University Teaching Hospital in Ikeja, patients are cured of several ailments and diseases in its vicinity.

But as the hospital serves its purpose of delivering sundry medical services to patients, PREMIUM TIMES found that a network of corrupt officials of different cadres has perfected means of issuing all sorts of reports to willing patients at negotiated prices. These officials cut across the different departments in the hospital, from the security through to the OPD.

Network of Racketeers

Immediately Baba led this reporter into one of the offices behind the OPD, a woman whom he identified casually as Aunty Juliet rose from her seat to welcome a potential ‘client’, grinning from ear to ear. Earlier, upon accosting this reporter at the gate, Baba had placed a call to her to confirm if she was in the office.

“My brother, which one do you want?” Ms Juliet said after she had extended some courtesies and directed Baba to return to the gate. But she barely waited for any response before she laid bare the various ‘medical reports’ she could help ‘procure’ with ease.

“If you are going for service (NYSC), we can help you,” she said, smiling. “Or do you need it for work? Or you want to travel out? Which one do you need exactly because the prices are different.”

Upon being told that the reporter was a prospective National Youth Service Corps (NYSC) member, which was a lie, she gave a breakdown of the prices. According to her, obtaining a medical certificate of fitness for NYSC costs N7,000; an open-ended medical report for any purpose costs N10,000; certificate of fitness for employment costs N10, 000; report certifying fitness for international travel could go as high as N20,000, among others.

When PREMIUM TIMES’ reporter sought clarification on how the certificates would be obtained and what needs to be done before they are issued, Ms Juliet allayed all fears.

“You don’t need to do anything at all” she said, brimming with smile. “Just pay the money, tell us your name and wait for some hours. You don’t need to do any test at all. No test, no medical check-up, no stress, nothing. It’s very easy. And the money is not much because we have to settle so many people whom your report will go through. We will write everything and you will like it, all within two hours. Or do you want to go and join the long queue in that OPD and wait till next week?”

After a few other back-and-forth discussions, PREMIUM TIMES’ reporter agreed to pay N5,000 for the NYSC medical certificate and a sum of N2,500 was deposited. In the absence of genuine checks and verification, a fictitious name—Badmus Olasehinde—- was given. No identity card was requested for authentification.

Upon receiving the money, Ms Juliet quickly instructed this reporter to go hide somewhere outside the hospital area and return after two hours.

Two hours after the deal was struck, this reporter returned and paid the balance of the agreed fee. He was thereafter handed a stamped and duly signed medical certificate of fitness addressed to the NYSC co-ordinator. “Keep it out of sight please,” Ms Juliet warned, before saying her goodbyes.

At the hospital gate, Baba also demanded what he described in Yoruba as “consultancy fee” and quickly accepted N500.

Issued with registration number SUB/OAGH/80/VOL.IV/560, the medical report gave the PVC of this reporter as 40 per cent, blood group as O Rh ‘D’ Positive, and genotype as AS. It also claimed to have details of stool analysis, urinalysis, mantoux and chest x-ray.

“He is hereby medically fit within the limit of investigations done,” the report, signed by one medical officer named Adeoye, said.

But like the name given by PREMIUM TIMES reporter, all of the claims contained in the report duly stamped by the hospital were fabricated and non-existent.

Many checks; sundry regulatory failures

Various institutions in Nigeria demand medical certificates for sundry reasons. Some job providers demand medical reports before employment, to ascertain the applicant’s medical records, especially in sensitive positions.

The certificates are sometimes required to obtain health benefits, to describe medical conditions, to make an insurance claim, for tax purposes, or for some legal procedures.

Medical certificates are also used to certify that someone is free of contagious diseases, drug addiction, mental illness, or other health complications. For instance, in the United States, aviation experts are required to possess a valid medical certificate that certifies sound health as part of the requirements for piloting an aeroplane or helicopter.

The NYSC also routinely re-deploys corps members to their states of choices, often when they present health concerns backed up with relevant certificates. The corps, however, says it is criminal for corps members to present fake documents.

Similarly, the Nigerian Medical Association (NMA), considered the largest medical association in the West African sub-region with over 40,000 members, has laid down ethical guidelines on how to check medical malpractices.

But while these provisions are there, the absence of effective implementation of regulations has created a booming market for corrupt officials in hospitals and laboratories across Nigeria. These officials, in collaboration with corrupt medical practitioners, issue certificates to people indiscriminately once the right amount of money exchange hands.

This practice, as PREMIUM TIMES’ reporter found out, is not peculiar to Lagos.

In Ibadan, the ‘pay’ dictates the ‘pace’

The sun shone brightly as this reporter sauntered into the premises of Ring Road State Hospital, Yemetu-Adeoyo, Ibadan, Oyo State. A man later identified as Ishola quickly approached this reporter at the gate and pledged to offer any form of help. Upon being intimated of the mission to obtain certificates without going through the “stress” of tests and check-ups, he agreed to facilitate the process.

Obtaining a medical report without the pre-requisite tests at the Adeoyo hospital is dependent on the amount paid, PREMIUM TIMES’ learnt. “The amount you pay will determine how many people will be drafted in and how fast the report will come out,” Mr Ishola explained. He later gave a breakdown of the prices: medical fitness certificate for NYSC costs between N3,000 and N5,000; medical report for employment purposes costs up to N10,000; while what he called “To Whom” medical report costs between N7,000 to N10, 000.

Upon agreeing to help procure the one for employment application at N5,000, Mr Ishola demanded details like name, blood group, and genotype. But because of the ‘meagre’ sum involved, he said, it will take longer than usual to process it.

“Text me your details and come back on Friday afternoon,” he explained, adding that he would send the details to other compliant officers.

On the agreed day, PREMIUM TIMES’ reporter returned to the hospital and was asked to wait for another two hours at the test centre after payments were made. Together with another official, Mr Ishola moved into some of the major offices and after some hours of delay, a medical report finally surfaced.

“This is to certify that the above named has been examined and found physically and mentally fit for your purpose,” the report, which had fictitious details of the patient’s medical records, claimed. Although it contained written results of tests like RVS, chest X-ray, glucose, visual acuity, Malaria Parasite, Sputum test, Hepatitis B & C and others, they were all fabricated as the reporter never went through any such test.

The report, with reference number RRSH/949, was signed by one V. Oyedokun, a doctor.

‘Higher amount’ at LASUTH

To get a medical certificate at the Lagos State University Teaching Hospital (LASUTH), Ikeja, one has to part with a ‘higher’ amount, declared a security official at the hospital, whom PREMIUM TIMES identified simply as Oga Sam. He had approached this reporter to offer direction within the hospital complex but, upon being told of the mission, he ended up linking PREMIUM TIMES with medical officials who issue the certificate without appropriate tests.

“But these ones here are ‘high class’ people o, you have to pay higher amount,” he quipped, when this reporter narrated his plan to offer N4,000 for NYSC certificate of fitness. Together with Mr Sam, PREMIUM TIMES’ reporter went into the offices of two of the medical consultants at the Department of Pathology and Forensic Medicine. The official who agreed to issue the report, however, declined to entertain further questions because of the low amount involved. He would soon request that both this reporter and Mr Sam vacate the office.

After a few minutes of haggling with Mr Sam outside of the offices, he agreed to help beg the medical officer to accept N5,000. About ten minutes afterwards, he came out smiling and announced that the official had agreed with the N5,000 fee. “But you won’t be able to go in again, just give me your details,” he said. A modified version of the fictitious name – Badmus Olumuyiwa – was quickly supplied with no evidence of authentication. Payment was made.

About two hours afterwards, Mr Sam surfaced with the medical report.

“The above named patient was seen at the medical out-patient unit on 2nd February, 2019 with history of easy fatigueability and bilateral pedal swelling,” the report said. It also claimed that the consultant examined the patient’s pulse, blood pressure, abdomen and other sensitive parts of the body, adding that the fictitious patient had been on medication.

The report, with reference number SUB/LASUTH/302, was signed by A. O Oshineye, a consultant cardiologist. It also contains the NMA’s doctor’s stamp.

Like in all previous hospitals, the details were all fabricated as this reporter never went through any medical check.

Officials Keep Mum

When this reporter challenged the various health institutions with results of his investigations, he never got any response. At both the Agege and Ikeja general hospitals, our reporter was directed to the ministry of health at the Lagos State Secretariat. At the secretariat, officials declined to comment.

In Adeoyo, Ibadan, officials who declined to have their name in print said they were not authorised to speak, yet failed to give an appropriate directive.

The NMA Code of Medical Ethics frowns at illegal issuance of certificates to patients. “Therefore, any practitioner who signs or issues in his professional capacity any certificate, report or other documents of kindred character, containing statements which he knows or ought to know to be untrue, misleading or otherwise improper, is liable to disciplinary proceedings,” the code explicitly reads.

A medical health practitioner, Tavershima Adongo, told PREMIUM TIMES that a medical report is a document not just tenable at workplaces but in a court of law, and the words are to be taken just as they are written.

“If such a document is written without the necessary knowledge to the one who signs it, knowingly or not, it is a medical malpractice and an offence not pardonable in a court of law,” he said.

“Individuals can be susceptible to health conditions that are sometimes not overt and may be elicited with some diagnostic tests. If such is not done, in the end, the one who writes a report lies.”

Several NMA officials refused to speak on this prevalent fraud in the hospitals. But Roland Aigbovo, the chairman of the Association of Resident Doctors in Abuja, told PREMIUM TIMES that the medical association will do all it can to deter quackery and fraud in the medical profession. He added that the NMA created a means to check the fraud.

“There has been indiscriminate issuance of medical reports from hospitals in recent times due to what I will term poverty,” he said.

“A careful look at this led to the launching of doctors’ stamp by the leadership of our association to check this ugly tide.”

However, as seen in the fraudulent certificate obtained in LASUTH, which had a doctor’s stamp, the introduction of the doctor’s stamp has done little to address the concern.

“Ultimately this cycle can take away trust, for individual professionals and in the larger system too.

“Today, for instance, Nigerians write all sorts of tests like English language tests to live or work in the UK for instance even though we are supposedly taught in English in our schools. We might perhaps have to get medical reports from their countries if our system loses credence here too,” Mr Adongo, the doctor, said.