Death and Dying in Nigeria–A Social Commentary

The Bible says “there is a time to be born and a time to die”. This saying reminds everyone of our mortality and the debt. A discourse about dying and death in most human society including Nigeria is a taboo.

In ancient days and during war in Yoruba land, the emissary that is not wise enough and come home to announce the demise of a War General equally request his own personal death warrant. Any discussion around dying and death in most of the African culture is tantamount to an invite of death spirit – a bad omen and wishing somebody dead.

The modern society dramatizes death a lot on televisions and films. This is the reason why young kids only experience death as violence but never in real life. To the extent that children are not usually encouraged to attend funerals in order to protect their emotions and underrating their understanding of death issues.

Do Nigerians experience good death?

Good death could be regarded as a peaceful, painless, smooth transition and dying with dignity. The question is how many Nigerians enjoy such natural phenomenon?

Poverty, lack of basic medications including strong analgesics (Opioids) to relief pains and the rapidly collapsing family support for patients on death bed are some of the factors making good death a challenge. For patients and families suffering from life – threatening or life-limiting illnesses, the health care professionals advise them to take the patient home for “there is nothing we can do again”. So how do the dying patients experience good death at home in a society where we have institutionalized death in the hospitals and developed pathological fear to witnessing death of loved ones at home.

The rich ones are the worst affected as we usually read some egocentric advertised obituaries ‘ died in UK or USA hospital’. Lest we forget that our forefathers enjoyed dying in their homes surrounded by their children and families. I could still remember when the whole world stood still and many faithfuls including the CNN were keeping vigils near Late Pope John II home when with dignity he refused to be admitted into the hospital. Nigerians need to go back to the era of providing good death at home just like some countries in developed world.

Hospice and palliative care services in UK and US contribute significantly to ease the pain and burdens of dying and death and also facilitate deaths at home with the families. Palliative care was introduced to Nigeria since 1993 but has been facing a lot of challenges in making it accessible to million of Nigerians in need. Some of which include lack of recognition and its inclusion in the national health policy by the government.

Nevertheless, there are about eight health facilities in the country offering the service but they are plagued with serious dearth of manpower, funding and experts with skills and knowledge of palliative care.

Palliative care is regarded as an approach to improve the quality of life of patients and families suffering from life-threatening conditions by providing pain and symptom control beside addressing their social-economic, emotional, cultural and spiritual issues. It is an arm of medical field that provides holistic approach to the needs of both the patients and families taking into cognizance the body, mind and spirit. It is not really an End – of – Life care alone as it is recommended at the point of diagnosis of a disease condition as a continuum of care.

It is applicable in disease conditions like cancer, stroke, end-stage renal, liver, diabetes and HIV/AIDS. Patients generally may suffer physical pains, social, emotional and spiritual distress that often result to “total pains” but most times the care often focuses mainly on the physical aspect of the disease.

The contemporary medical practice including the World Health Organization emphasize holistic care model which primarily involves treating both the disease and the patient. A dying patient and family experiencing social, emotional and spiritual distress and pains require assistance from multidisciplinary team of health care professionals to handle these three domains. What are the roles of patients, families, community, religious organizations, health care providers, carer, hospitals and most importantly the government in the provision of good death to dying Nigerians.

To me personally, I find it difficult to rationalize lack of or inadequate preparation for deaths as it is often the case in our society. You inform a patient of an impending death and he looks at you as an insane person wishing him dead. His natural response would be ‘I reject it in Jesus name’ and next time you come to see, he would pretend he is deep asleep and does not want to be disturbed. Per adventure the family got to know first they would inform the health care professionals not to let the patient know that death is already knocking on the door – ‘conspiracy of silence‘. All in attempt to protect the patient fearing the bad news might even kill the patient faster rather than empowering the patient to prepare for the journey ahead.