Death in Elevator, Tragedy of Lagos Maintenance Agencies

By: Yinka Shokunbi

The death of Dr. Vwaere Diaso, a house officer in the fallen elevator at the General Hospital, Odan Lagos, is a tragedy for all the Lagos State maintenance agencies.

It is a shame that such an avoidable incident happened in a government high-rise residence built for doctors and their families. If it happened to doctors worse could indeed happen to their patients.

The General Hospital Lagos, House Officers’ Apartment, or Doctors’ Quarters is a 10-storey building and one of the imposing structures on Lagos Island.

It is one of the legacies of the first administration of Lagos State, Late Brigadier General Mobolaji Johnson.

From available records, the apartment accommodates doctors who are on House jobs at the General Hospital, Lagos Island Maternity, and Massey Children and render 24/7 services to patients.

Due to years of neglect, the building suffered decay and on November 24, 2008, when there was a fire incident in which two apartments were gutted, it was just time for doctors to pack out of the apartment.

Doctors vacated the building on the instructions of Lagos State government which promised to refurbish it; causing a severe shortage of accommodation among doctors in the state.  

Mr. Babatunde Fashola then governor, only awarded the contract for refurbishing the building towards the end of his tenure in 2015.

The administration of Governor Akinwunmi Ambode completed the renovation and commissioning on June 15, 2017.

By the end of 2018, barely a few months after the apartments were allocated for use by Medical Guild to its members, there were already complaints over some of the utilities in the building.

From available records, the elevator began to malfunction as early as 2019. It was trapping residents for several minutes but many thought it had to do with the power supply to the infrastructure. A generator plant installed did little to solve the impeding danger.

On January 12, 2020, a tweet (that has now gone viral) by the medical guild read:

FACT:  The doctors’ quarters at General Hospital Lagos have 10 floors. It has a nonfunctional elevator and no running water.

Doctors who live on the 10th floor including pregnant women climb the stairs multiple times daily.

@LSMOH @ProfAkinAbayomi @JokeSanwoolu@ @nmanigeria

The Tweet only went viral three years after its first post and Dr Diaso killed in the elevator. There was no engagement with the Tweet possibly because the administrators knew little about how to use the Twitter.

Lagos Centre of Excellence

Lagos State prides itself on being a centre of excellence with good maintenance culture.

To sustain the excellence status, the government created quite a number of agencies with specific mandates to ease the workings of all its ministries and departments. The Ministry of Health has its share of agencies working for and with it.

At least three state agencies have interconnecting responsibilities and mandates that include the regulation, monitoring and maintenance of public health facilities, utilities, and infrastructure for the good of the people of Lagos.

The tragedy of these maintenance agencies is their inability to streamline functions and activities due to duplicity thereby failed to prevent the death of Dr. Diaso when it matters most.

The Lagos State Ministry of Health, for instance, has a direct regulatory agency with the mandate of monitoring and evaluating all private and public health facilities in the state.

The Health Facilities Monitoring and Accreditation Agency (HEFAMAA) established in March 2006 is responsible for monitoring both private and public health facilities within the state (to ensure their utilities and infrastructure are optimal)

In regulating and monitoring health facilities, HEFAMAA is also to ensure all registered and accredited health facilities in the state comply with and maintain set standards as approved by the State Law.

Other functions of HEFAMAA include: Setting required minimum standards for operations of health facilities both in the public and private health sectors.

The Agency also has the responsibility to advise the commissioner/ special adviser on all matters relating to the registration, inspection, and supervision of all private and public hospitals in the state and enforce compliance with the provisions of the law.

All of these functions and many more in the portfolio of HEFAMAA are meant to protect and maintain top-notch standards in both government and private health facilities in order to prevent avoidable deaths among clients due to any form of negligence.

Aside from HEFAMAA which is domiciled within the Lagos State Ministry of Health, there is also another agency, The Lagos State Infrastructure Maintenance Regulatory Agency (LASIMRA) which is an agency that domiciles with the Works Ministry.

LASIMRA is the unit of government responsible for regulating all utility infrastructure that is in public spaces within the state such as power poles, telecommunication cables, water pipes, and sewages respectively are well maintained for the safety of residents.

The mandate of LASIMRA aside from regulating all utility infrastructure in the state, is to ensure that standards and effectiveness are maintained in the infrastructural development of all utility infrastructure, especially in all public facilities.

Another Agency still with a portfolio of infrastructure maintenance in the state is Lagos State Infrastructure Asset Management Agency, LASIAMA.

LASIAMA formerly known as the Office of the Facility Management and Maintenance (OFMM) also domiciles in the Ministry of Works.

The Agency has the portfolio of ensuring proper management maintenance of all the assets and infrastructure of the state and to better manage public facilities cost effectively and energy efficiently so that public agencies can better deliver services to the people.

As an agency, its core mandate is to improve the functionality and quality of infrastructure as well as encourage more sustainable maintenance and culture in Lagos.

Unfortunately, the tragedy of these three maintenance agencies which have responsibilities of oversight functions at regular intervals on all facilities including the House Officers Apartment among other health facilities in Lagos State is that, their officials failed the state, the people, and Late Dr. Diaso!

Lagos Public Health Facilities and Maintenance Culture

Public health facilities in Lagos State have undoubtedly enjoyed the massive attention of the government since 2004 and till date.

The landscape of health infrastructure continues to improve with the provision of modern facilities and equipment in a patient-friendly environment.

Lagos State government scores highly in health infrastructure, provision of good and reliable care and services for all ages and the state has become the Mecca of healthcare delivery in Nigeria.

During the administration of Governor Fashola, the practice was, having the contractors of facilities build, operate, and manage all the facilities for a period of time during when state personnel are trained to take over before transfer. Then, there was a noticeably great maintenance culture of all the health facilities in the state.

Soon after the termination of the engagement period of the operators in 2015 by the Akinwunmi Ambode administration, the maintenance culture waned.

Investigation by Healthstyleplus shows, most of the public health facilities with elevators, ramps, ambulances, water system and telecommunication pipes, theatre equipment, ICU equipment, laboratories, diagnostic centres, and many more facilities which are to be at the utmost top-notch at all times soon began to run down.

Patients have to go out of hospital premises to do simple medical tests and examinations at referrals; and take results back to doctors before treatment. Emergency situations have become dire.

This practice prevails across all public health facilities in the state including the primary healthcare centres and the Lagos State University Teaching Hospital (LASUTH).

According to the Chairman of the Medical Guild Dr. Saheed Ahmad “Since rehabilitation of the House Officers quarters in 2015 -16, myriads of problems trailed the structure; Power supply, water supply, non-functional lift, rodent infestation among others”.

He said residents of the quarters continue to lay series of complaints over time especially with the installation of the elevator which was imbued with intractable functional failures but nothing tangible was achieved.

According to Saheed, “In 2015, contracts were awarded for the installation of ‘new’ lifts in the building as part of general rehabilitation of the facility. The installation was done by one HORIVAC Engineering, a sub to the main contractor carrying out the rehabilitation of the HOs quarters.

“Since 2015/2016 when the elevator was installed, it was never attended to by this subcontractor thereafter, said Saheed.

By 2019, the Medical Guild he said, wrote to LASIAMA and had several other engagements with various government agencies variously claiming to be responsible for the facility in question, with little improvement.

This is a further proof of the tragedy of the maintenance agencies of the state with multiplicity of overlapping tasks yet none taking direct responsibility for action.

The Medical Guild listed several failures in the building maintenance on the sides of all the supervising agencies, the facility manager, the Health Services Commission, the employer of the doctors, and the supervisory ministry of health.

Indeed the death of Dr. Vwaere Diaso was needless and avoidable and Governor Babajide Sanwoolu’s investigating panel would have to go beyond looking for what went wrong at the Doctors’ apartment.

If possible, heads must roll. There is a need to look into the supervisory roles and overlapping functions of all the maintenance agencies and streamline who does what!

There seem to be too many agencies doing similar things hence buck-passing. Supervisory Health Service Commission and the Ministry of Health equally need some introspection. Leadership quality may indeed be on trial.

From the submissions of the Medical Guild, the system represented by all the public -funded agencies failed the stakeholders and there lies the real tragedy.

• The process of contracting and project execution were fraught with multiple areas of obscurity.
• Contractors, and sub-contractors no evidence of certification in lift installation or management, little knowledge of safety standards requirements, and no evidence of safety certification.
• The chain of supervisory and maintenance cascade among several entities is cumbersome and impractical. These agencies of government or entities carried about with no direct responsibility to or respect for end users or management of host health institutions.
• There is the failure of official transmission of complaints about the lift from the management of General Hospital Lagos to its supervisory agency (HSC), upon witnessing the lift malfunction even on the day of commissioning.
• Total failure of supervision and maintenance of the quarters by LASIAMA or its contracted Facility Manager, and failure of same to report observed problems with the elevator to their Principal, LASIAMA, despite being aware and involved in these problems.
• As part of safety protocols, the lift had no stationed operator, no warning signs, and no contact numbers in case of problems.

The General Hospital Lagos was built in 1893 as a British Military Hospital and on October 1, 1960, at the independence was handed over to the Federal Government. On May 7, 1967, at the creation of Lagos State the hospital was handed over to the state government under the Administration of Brigadier General Mobolaji Johnson. (1967-1975).

The hospital serves as a training centre for doctors, pharmacists, nurses, radiographers, and medical technologists across the country and has a capacity for 250 beds. 

But for the size of the hospital and its location on the ever-busy and choked Island, the hospital could have enjoyed the status of being a tertiary facility for the Lagos State University. It however serves as an annex to some sub-specialties of the Lagos State University Teaching Hospital (LASUTH)

Some of the services at the secondary care facility include General Medicine, Surgery, Ophthalmology, Orthopedics, Physiotherapy, Maternity, Obstetrics and Gynaecology, Paediatrics, Emergency Services, Nursing Care, Pharmacy, Pathology, Radiology, chest clinic, Dental care, physical medicine, medical rehabilitation centre, and Hematology.