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The ‘Angel’ Who Secretly Pays Patients’ Hospital Bills

In Nigeria, very few medical services are free of charge, and if you can’t pay your hospital bill you may not be allowed to leave. Who will help? In this deeply religious society, many stranded patients hope for divine intervention.

Zeal Akaraiwai does not have the wings of an angel – he has a sleek black Mercedes, all purring engine and deep leather seats. This 40-something financial consultant – trim and neat – steps out of his car in a potholed government hospital car park in Lagos. He is greeted warmly by a team of social workers, and gets straight to business. He asks them for “the list”.

Neatly printed on A4 paper are the names of patients who are well enough to go home. But they are not going anywhere, because they cannot pay their medical bills.

Zeal has met people who have been forced to stay on the ward for six – or even eight – weeks after they have been discharged. Some Nigerian hospitals set up instalment plans, but even the first instalment might be too onerous for those earning a pittance, or nothing at all.

Heading along crumbling walkways to the wards, Zeal listens intently to the social workers’ running commentary about those he is going to meet. In a male ward the tiles underfoot are scuffed, the paint peels, and 20 beds line the walls. Ancient fans whirr overhead, and the nurses wear epaulettes on the shoulders of starched white uniforms. An orderly is sweeping up with a dustpan and brush. Everybody is doing their best in challenging circumstances.

The social workers guide Zeal to the bedside of a patient with a heavily bandaged thigh. He bends down close, and speaks in a low voice: “What happened to you?” The young man, a barber, says he was shot by he-doesn’t-know-who.

“So how’re you going to settle your hospital bill?” asks Zeal. “I’m praying to God,” the man replies.

Zeal chats to him for a while – the man does not ask who Zeal is, and Zeal does not tell him. Then, out of earshot of the patient, Zeal checks the man’s story with the nursing staff. The bill is $250. And the barber is in luck – Zeal will pay it. Later today, the patient will go home.

Zeal does not keep in touch with any of the people he helps. He does not even want to be thanked. But there is one thing he would like in return – that one day they might tell a story about him: the story of how when they were in hospital, an angel came, paid their bill and left.

“That’s why I call this the Angel Project,” he says. “Be the angel you hope to meet.”

Paying the fees of hospital patients who are not able to settle their bills is one of the ways that Zeal realises his Christian faith. He says he wants to show people that everyone can do something to help someone else. Zeal’s friends and family also give him money for the project, and he keeps receipts in a neat black book, together with details of the patients whose bills he’s paid.

In the women’s ward, Zeal is taken to see a patient in her 60s who is unconscious and on oxygen. She has had a serious stroke. The social workers want Zeal to pay the bill she has run up so far, so she can be moved to an intensive care unit for specialist treatment. He shakes his head, and moves away from her bedside.

Outside in the corridor, the woman’s daughter joins him. She is young – and resigned. Zeal quizzes her about the health of her mother. It seems that even if the bill is paid here, it will be just the first step on a very long haul – if indeed the patient survives. Zeal speaks kindly to the young woman, and says he is sorry. She thanks him, smiles, turns, and goes back to watch over her mum.

Paying for this woman’s treatment would mean breaking Zeal’s own, self-imposed, rules – he does not generally help anyone with a serious, on-going condition. The Angel Project pays for those who are well enough to go home immediately.

“Of course, sometimes I digress,” he says.

He remembers Montserrat – a woman who bled for 11 months because she needed a hysterectomy. Zeal paid $400 for her operation. And on today’s visit to this public hospital, there is a good deal more digression.

The Angel Project picks up the tab for a patient who needs a leg ulcer operation, and Zeal wants to know about the progress of a 10-year-old who is awaiting further intestinal surgery. He has paid for her treatment so far, and will continue to do so until she returns home. The social worker says the child is doing very well.

Zeal has met this little girl, but he does not want to see her again. “She has my son’s eyes,” he remembers.

Today, Zeal visits everyone on the social workers’ list. He heads out to the cashier to settle the bills of eight patients. His hospital philanthropy always makes him feel sad, and he is angered by the failure of government.

“The mere fact an individual, like me, has to go into a hospital to pay the bills of people who are stranded speaks volumes about the injustice in the system,” he says. “There’s no reason why we cannot have proper health insurance. We have clever people who can think of schemes that can work.”

In Nigeria only 5% of the population is covered by health insurance. There is scepticism about how a universal scheme might operate, given the huge disparities of wealth, and the millions of poor people whose contributions would have to be covered by the state. But Zeal is impatient.

“Every week I see the impact of not having compulsory health insurance, and people die. So where do you want to put the price of a human life?”

 

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Sources: Linda Pressly via BBC  [1], [2]. Image sources: Grace Ekpu [1], [2].

Immigration changes in Ghana and Nigeria

GHANA | Recent Announcement Requires Medical Certificates to Be Obtained In-Country 

The Ghana Immigration Service (GIS) recently posted a brief announcement of a new policy – purportedly with an effective date of February 15 – requiring all new applicants for work and residence permits to obtain medical certificates only through the GIS medical facility at its headquarters in Ghana. Previously, medical certificates in support of a work permit applications could be issued by a local doctor in the applicant’s home country.

The practical implication of the announcement and new policy is somewhat unclear, as work permit applications are typically made before the applicant travels to Ghana. If this new policy is implemented, it will have significant impact for the work permit application process. Immigration Specialists in Ghana are struggling to sort-out the new policy; however, thus far, the GIS has released no further guidance.

 

 

NIGERIA | New Executive Order Imposes Tougher Local Hiring Measures
On February 2, Nigerian President Muhammadu Buhari signed an executive order (EO5) aimed at promoting local Nigerian expertise in science, engineering, and technology. EO5 prohibits the federal Ministry of Interior (FMI) from issuing visas to foreign workers whose skills are deemed to be readily available in Nigeria. Consideration of work visas will only be given to foreign nationals where has been certified by the appropriate governmental authority that such expertise is not available in Nigeria. Under the order, Nigerian government agencies must also give hiring preference to foreign companies and firms with demonstrable and verifiable plans for indigenous development.

While further guidelines and directives on the implementation of EO5 are expected from the authorities, the executive order is expected to have significant impact on the employment-based immigration of foreign nationals, especially in fields of science, engineering, and technology. Companies hiring foreign workers should expect more rigorous scrutiny of applications for expatriate quotas and the stricter application of requirements such as the understudies requirement, registration with professional bodies, and more onsite visits and audits by Nigerian Immigration Service (NIS).

 

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Nigerian Consulate in SA: Visa Issuing Delays

Please note that the Nigerian Consulate in South Africa has run out of visa labels/stickers. Therefore, visas can only be issued earliest from next week Monday or Tuesday (23/24 October 2017).

Challenges of an African education

In addition to immigration complexities, security issues and cultural considerations, families relocating to Africa face the challenge of choosing a suitable education pathway. We look at the options.

Assignees moving to Africa often find the process uniquely challenging, owing to immigration complexities, security issues and cultural considerations. Those with school-age children face the added challenge of choosing a suitable education pathway. We look at the availability of international schooling in the region, and offer advice to help parents choose a school.With significant economic growth and one African country forming the ‘N’ in MINTs (Mexico, Indonesia, Nigeria and Turkey), the countries expected to become economic powerhouses of the future, the continent of Africa is coming into sharper focus in the world of global mobility as organisations across the world, in search of growth, look to it for new opportunities.The latest reports bear this out. EY’s 2016 Africa Attractiveness survey, Navigating Africa’s Current Uncertainties, found that, despite current uncertainties, the longer-term outlook for economic growth and investment in Africa remained positive.“The next few years will be tough – partly, even largely, as a result of a fragile global economy – but many African economies remain resilient, with two-thirds of sub-Saharan African (SSA) countries still growing at rates above the global average,” said the report.Even though growth across the region is uneven and likely to remain slower in coming years, SSA will continue for the foreseeable future to be the world’s second-fastest-growing region, after emerging Asia. Kenya, Tanzania, Mozambique and Ivory Coast are among 17 economies in the region that are forecast by the International Monetary Fund (IMF) to have grown in 2016.Larger SSA countries, such as Nigeria and Angola, have been particularly affected by lower oil prices, and growth in South Africa remains slow.Foreign direct investment (FDI) projects increased by 7 per cent year on year, from 722 in 2014 to 771 in 2015. Africa is one of only two regions in the world to have seen growth in the number of FDI projects over the past year.

School choice

Luckily, international schooling has also seen something of a boom in the region. According to the latest figures from the International School Consultancy (ISC) Group, there are currently 792 English-medium international schools throughout Africa, between them teaching more than 339,000 students. ISC Research predicts that there will be more than 1,500 such schools by 2025.

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Immigration changes in Nigeria and Egypt

NIGERIA road sign

Africa’s largest economy is slowly coming out of its worst recession in 30 years, and the Nigerian government continues to modernize its employment-based immigration system in an effort to attract international business. Earlier this year, Nigeria finally adopted the administrative regulations to implement its Immigration Act of 2015, which was the country’s first significant amendment of their immigration law in over 50 years. This year, the Immigration Regulations 2017 made broad changes to the full spectrum of business visas, visas-on-arrival, work and residence permits, entry procedures, identification and registration rules, and administrative processes.


egypt

EGYPT | Visa-Free Privileges Suspended for Qatari Citizens, and Updated List of Foreign Nationals Required to Register In-Country Within Seven-Days of Entry
Effective July 20, the Egyptian Ministry of Foreign Affairs began denying visa-free entry to Qatari citizens. This is the latest salvo in the ongoing diplomatic and trade war by 16 Middle Eastern countries against the nation of Qatar. Egyptian officials have publicly indicated that exemptions to the visa-free suspension will be considered on a case-by-case basis for Qatari nationals with Egyptian spouses or mothers; however, it is unclear thus far how applicants would exercise that option.

While Qatari nationals are still eligible to apply for visas to enter Egypt, these applications have been subject to heightened scrutiny and high rates of rejection even prior to the current escalated tensions. With the Egyptian diplomatic missions in Qatar having been withdrawn in June, applications will likely need to be lodged at the Egyptian diplomatic posts in Kuwait or Oman, which have thus far elected to remain neutral in the current dispute. Even clearing that hurdle, applications by Qatari citizens will still face greater rejection levels absent close connections to individuals or companies in Egypt.

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