Twelve of Fourteen Have Watched Someone Borrow to Get Well.

Ask this panel what people do when the formal health system fails them and the first answer is the chemist, not the hospital. Self-medication, over-the-counter drugs bought “in bits and dosages instead of the full prescription,” and herbal concoctions, agbo in the south-west, come up again and again. The hospital is where people go when the cheaper things have stopped working, which is also why they arrive late.

Who do they turn to when things go wrong? Thirteen of fourteen say family, and most of those say a parent. One respondent’s mother is a lawyer “but she’s our family doctor too.” What would make them stop turning to family is not a better system; it is becoming a burden, or earning enough to carry it themselves.

“My monthly allowance was N33,000, barely enough to survive on, and I just kept falling ill. There was a health insurance scheme in the program, but the closest hospital to where I was posted was really far.”

Asked which of these they have seen happen to handle a serious health cost, twelve of fourteen have seen borrowing, ten have seen something sold, eight have seen a fundraiser or contributions, and four have seen someone go without treatment. Five have seen insurance cover it. The stories behind the numbers are specific: a corps member on N33,000 a month falling ill in a posting far from the nearest hospital; a mother with a chronic ulcer sent from one hospital to a dearer one, treated only because a brother in Abuja paid; a surgery that needed N35 million, raised by “begging people we know and those we don’t.”

When there is not enough money for everyone, families triage. The most critical case first, then the children, then the breadwinner, because his health is the family’s income. Parents put the children in the hospital and treat themselves with herbs. More than one respondent has watched this end in a death.

“Children are prioritised over the adults and treated first. In some cases of chronic illness I have seen the father given priority too, so he can get better and keep the family running.”

The cheaper option is a false economy the panel knows by heart. Coartem instead of a test. Half a course of drugs, better for two weeks, sick again. A woman who needed a Caesarean and had a normal delivery instead, because of the cost. “The ones that go for cheaper options sometimes make their situations harder, which always costs more.”

Insurance, where it exists, covers the small things and runs out at the serious ones; several say the process of using it was more tiring than paying. On a five-point scale of how prepared they are for a sudden, serious bill, eleven of fourteen answer one or two; the average is 1.8. Asked whether good health in Nigeria comes down mostly to money, the panel averages 3.7 of 5, and the dissenters do not argue that care is affordable, only that rest, food and a quiet village can keep a poor person well.

“A woman who needed a C-section had to settle for a normal delivery instead because of the cost. She and the baby survived, but she went through a lot in the process.”

Beyond the money, what it does to a family is the quietest answer and the most consistent one: guilt, helplessness, resentment, and a lasting fear of the next illness. “Hospital bill can reset everything.”

“I have seen people die because they tried to treat themselves in order to save cost.”

“It helped when the sickness wasn’t serious. When it was serious, there were a lot of additional things not covered that we had to pay for out of pocket.”

“Hospital bill can reset everything.”

“It breaks the family emotionally and mentally. A deep sense of guilt and helplessness for being unable to care for someone you love.”