Doctors’ strike and the ‘flown abroad’ syndrome by Mike Ikhariale

On Monday, July 1, 2014, the Nigerian Medical Association, NMA, the umbrella organisation under which medical doctors in the country are unionised to promote the common interests of their members and the medical profession generally, embarked on a strike action that it described as both “total” and “indefinite.”

As much as I do not support the frequent disruptive outcomes of strikes in this country, given the dire straits in which the nation’s health care delivery system has found itself, I am “totally” and “indefinitely” in support of the strike. It is not normal for professionals like doctors to walk out of hospitals with patients dying unattended to but if only to limit the casualties in the long run, then, this action as unpalatable as it is, becomes inevitable.

In any case, it is almost turning a way of life in Nigeria that until a dispute, economic or political, gets to a boil at which point combatants resort to the most unorthodox and deadliest of strategies, government does not see reason to respond civilly and promptly to such demands. The result has been that key institutions of states like universities and hospitals are perpetually placed under lock and key just to make the most elementary of demands noticed and responded to accordingly.

I am particularly alarmed by the decadence that the nation’s medical institutions and facilities have fallen into. The other day, gory and shameful photos of the decadence that has befallen LUTH, a premier health institution where doctors and other professionals in the medical industry are supposed to be trained and mentored for the need of the medical needs of the country, were published to the astonishment of many. The decadence at LUTH is replicated all across the country with the situation progressively worsening as you move away from the urban centres to the rural communities.

The NMA has catalogued what it considers as wrong with our hospitals and medical professions; it listed the longstanding underfunding of health institutions and the demonstrable low attention paid to medical personnel by the government. It also drew specific attention to their professional dissatisfaction with the non-recognition of the profession in key positions in government.

I don’t see anything too impossible in what they are asking for. Even the more economic ones like their call for the increment of hazard allowance to N100, 000 monthly and the establishment of a health trust fund that will enhance the upgrading of all hospitals in the country are not too much. In view of the annoying undeserved opulence regularly displayed by our “Excellencies”, their wives and aides, the amount the doctors are asking for contextually pales into chicken feed.

There is nothing more indicative about how disdainful our leaders treat our doctors and the medical facilities in this country than the fact that it has become the fad that once a member of the nation’s elite class develops any medical condition, be it common cold or the serious ones like cancer, the only possible destination is outside Nigeria.

Whether it is the President of the Republic, his wife and family or a private individual eking out a living somewhere, all medical challenges must now be taken abroad as if there is an official conclusion that our hospitals are now no-go areas. The majority of Nigerians that fly out of the country daily are actually going for medical treatment. Whenever there is a medical problem, the first thing that comes to their minds is how to get out of the country. Yet we are supposed to have hospitals manned by men and women who are well-trained in the various fields of medical practice.

The other day I was discussing a running nose with an academic colleague and he told me that I shouldn’t just take it as a common cold as had been casually diagnosed by “our doctors” and that I should proceed immediately to South Africa. Right there inside his car he put a call across to South Africa and in a jiffy I was speaking with a medical person who clearly laid out a whole range of possibilities towards resolving my problem.

I was impressed by the professionalism exhibited and when I compared the information I got from just a telephone conversation with my earlier physical visit to an hospital in Lagos, it was already clear to me that the long-distant conversation had addressed my needs as against the dismissive “Prof, you alright and there is nothing wrong with you” that I got here even when my nose was dripping like a tap. The fellow I spoke to in Pretoria probably attended the same medical school with the one I visited in Lagos but it was obvious that while one was working with antiquated and obsolete tools the other was taking full advantage of science and technology in their latest forms.

In many respects, anyone who truly loves himself must think twice before submitting his body to medical processes in this country. If he is not scared about the likelihood of power failure at critical moments in the treatment regime, it could just be the possible absence of water or other elementary medical materials like bandages and needles at critical stages. It is really that bad. But how did we get to that abysmal level of degeneration?

The simple answer is that our leaders have failed woefully to fund our health infrastructure and diligently take care of the personnel manning them. The working environment of Nigerian doctors is at best antediluvian and, indeed, hellish. I once visited a private hospital as I have been warned to avoid government ones if I love my life. I was shocked to find the doctors there sharing one blood pressure measuring machine in turn. They were running in and out of their rooms to fetch the only functioning machine. I was heartbroken and almost walked out in disgust.

Just because Nigerian political leaders and their cronies have illegitimate access to public money with which they regularly fly abroad for medical treatment, they have decided to kill our hospitals and frustrate their workers. When it suits them, they indecently compare themselves with great leaders like Obama and Cameron; they flying around the world rubbing shoulders with them. Have they ever asked themselves if there will ever be any situation that will make leaders Obama and Putin come to Nigeria for medical checkup or treatment even for a tropical disease like malaria?

Little wonder therefore that nearly all the rich and powerful citizens of Nigeria who have died lately have all “passed away” abroad usually in India, South Africa, England and the USA. I think it is shameful that our leaders are now dying outside the shores of this country because whenever their cases go critical, the only thought worthy of consideration is to fly them out. Apart from the huge financial outlays involved (more than what the NMA is asking for), it is also an indication of a failed state when it is taken as the norm that the health facilities within cannot provide the most elementary of medical services.

Dying abroad is neither edifying nor prestigious. It is laughable to those in whose lands we now go to die. How many foreigners come to Nigeria to die? Not even from Benin Republic or Togo! To solve this problem once and for all, I expect that our doctors to remain steadfast in their demands through strikes and/or other non-strike means until our hospitals are good enough for both the rich and the poor. Docs, it’s Aluta Continua!

Pls Don't Remind us of Hippocratic oath during Doctors' Strike

...... if u see a strike, dont go reminding us of the hippocratic oath which u know nothing about. We wrote it. We swear it, we know what it means.
JOHESU on the other hand is an irrational organisation made up of other health workers, infact, basically everyone who works in a hospital. From accounts department to cleaners and the aggrieved non doctor health workers, whose sole aim is to frustrate the health sector.
In a hospital, there is the director of admin, as powerful as the CMD. An office open to every one and in most hospitals, if not all, has never been smelt by a doctor.
How can someone who is not a doctor be fighting for chief medical director. So the accounts department in a police station should start fighting for Inspector general, cos they work with the police?
How can nurses start talking about consultancy? They have matrons, CNO's and all what not. Consultancy is a position, not bestowed upon anyone. U go thru a residency program, write exams and become one under a recognised medical post graduate college.
And by becoming a consultant, u have the sole responsibility of the patient. Every other person, from the resident doctor to the nurse and orderlies are mere aides.
I don't know how to start explaining this bcos no one would understand. Its like 2moro, assuming when Nigeria was under military rule, civil defence would come out and demand to become president. But when the war starts, u send the soldiers. That u march in front of ur civil defence office DOES NOT make u a military combatant.
And if the same benefits given to these soldiers are given to the boy scouts, every one would become a boy scout.
Medical doctors were not selected. Its open to everyone. If u want to be a consultant or a CMD then u go and study medicine. U dont wake up one morning and decide to convert ur profession to what it is not.
U say Nigerians are subjecting their patients to quacks. Who are those quacks? Are they not the same people who believe by working inside a hospital they've become doctors? Thats exactly what JOHESU is doing.
The federal govt acted like they did during the fuel subsidy, kidnap, bombings and all their plain acts of ignorance. And the medical profession has just had enough of the stupidity.
The Chief medical director office is the BIRTHRIGHT of medical doctors as much as being president of Nigeria is the birthright of a nigerian citizen. U cant come from Ghana, live here for 30yrs and demand to be president.
There is a medical salary structure worked out based on relativity. No doctor has ever fought the govt based on how much they chose to pay other health workers. But relativity keeps it sane. Without the cleaners in a hospital, it wont function. So therefore, they should strike till they are paid higher than the graduate workers? Bcos they are equally important?
Keep salary structure relative, keep qualified people in their due offices and provide an enabling working environment. I dont think thats an irrational thing to fight for.
And saying NMA is envious is only laughable. Envious of who if I may ask? Of the nurse? Are u seriously for real?
JOHESU members can blog all they want and seek cheap sympathy for as long as they want. The fact still remains that the truth is the truth.
I can't chose to become a doctor and 2moro start complaining about Mikel Obi's salary. If I wanted, I could have become a footballer.
I urge Nigerians to understand that this strike, as much as it affects them, is not directed towards them.
ASUU strikes over salary, college's off education and polytechnics are on strike over money. No one has called them evil. We strike over common sense and people start ranting.
There are laws. In Nigeria, u cannot become president without at least an SSCE. If u chose not to go to secondary school, then thats ur problem. U chose ur profession, or u failed to meet the standards of the one u chose and hence went to another. Which ever way it happened, thru ur own fault or circumstances surrounding u, u dont try to turn an existing system upside down to suit ur selfish needs from wat u imagined a particular profession gains financially , at the expense of quality, efficiency and common sense.
GOODDAY

What if NO GIRLS WERE KIDNAPPED at CHIBOK?..Francis Nmeribe

I do not expect this article to be popular with anybody.  I do not expect any accolades either.  But in security, perception is reality for the person involved.  Most Nigerians’ reality today is that 200 plus girls were kidnapped from a secondary school in Chibok, Borno State some 77 days ago while in their boarding facility while preparing to write their West African Examination Council (WAEC) Senior Secondary School Certificate Examination. As a person who lives by my analytical skill as a security practitioner, I have been following the whole saga and trying to read between the lines.  I am beginning to feel that there is strong probably no school girls were kidnapped in reality and that the whole issue has been a written piece of drama which the authors are set to keep updating to ensure there is no end as an end would expose the possibility that no one had been kidnapped.
If you have not gotten too angry to continue reading this piece, I would provide you with red flags which show that the equation does not fit together and therefore, grounds to question the story of kidnap of more than 200 girls from a school boarding facility at Chibok, Borno State.
One, so far, nobody has given an exact number of girls who were in the school that night and exactly how many were abducted and the exact number of girls who escaped before they were taken away.  Everything about the numbers have been conjectures of about 200, 274, 300 girls kidnapped or 20, 40, 60 girls had escaped.
Two, the principal of the school Mrs. Asabe Kwabura had given two different versions of how the kidnap incident happened.  In one account, “she said that she was in Maiduguri for a medical checkup and her daughter called her to tell her insurgents are attacking the school”.  In another account, Mrs. Kwabura “said that the insurgents had come to her in the guise of soldiers and told her that they need to move the girls to a safer location and she allowed them”.  Who did she call to confirm the need to move the girls?  Who did she call to tell what the “soldiers” had told her before permitting them to take the girls, should that be the true story?  If the school was not safe for the students, why and how come it was it safe for Mrs. Kwabura and her daughter that resides with her? Is it not interesting that such a begging muddle would be in place and we are ignoring it and playing into the hands of Boko Haram and all those in the same ship with them.
Three, when the first video of the “abducted girls” were shown, we were shown video of chubby happy Islamic girls who were reciting the Koran and Hadith perfectly “though they were just forcibly converted to Islam only a few weeks earlier”.  What magic did the busy Boko Haram fighters use in achieving such a feat impossible for even Albert Einstein?  If they can do that magic, we had better allow them to come and teach our children science and mathematics.
Four, on the first day when the parents of the “abducted Chibok girls” were asked to identify them from the video; the news report was that none of the girls were their daughters.  By the second day, the identification parade moved to the governor’s office and 4 girls were identified.  By the third, fourth, fifth days, we heard, 20 girls, 40 girls and 60 girls had been identified.  And that was the last we heard about identifying the girls.  What about the remaining two hundred and something if 274 or 300 girls had been abducted?
Five, a sixty year old woman was listed among those that were abducted.  Even if we assume that she is doing adult education, how come up to date, nobody has come forward to say that his or her sixty year old mother or sister or aunty was among those kidnapped if she were to be childless at that age which is possible.
Six, Mrs. Asabe Kwabura in one news report said that 43 of the girls had been accounted for and 230 are still missing.  But every day, the report in the media is that 274 girls are still missing.
Seven, some Northern leaders are already preparing us for the inevitable – the time when there would be no real girls to use in proving some girls were ever kidnapped.  Sani Shehu was quoted by the Nigerian press to say that “by the time the girls are released, they would not know themselves again and some of them may become militants”.  In the business of persuasion, that statement is tantamount to ‘preparation’ – getting us ready for the day that we could not have any girls who can vouch to being taken. Then it would be said, “They have been so confused, they cannot remember who they are anymore”. And also as soon as more female bombers join the boko haram terrorist group, it could be said that they must be the Chibok girls who have been indoctrinated.
Eight, Olusegun Obasanjo, one of the marauders of Nigeria that I distrust greatly joined forces with the North and said that “he is afraid that before long, all the Chibok girls would be impregnated by their captors”.  These are all preparations.
Nine, check it out – no single parent or parents or relations of the “Chibok girls” have come forward to discuss about their ordeal to the Nigerian press.  All that has been heard were from parents that spoke through governor Shettima of Borno State or other governor’s office officials.
My security background and instincts find it difficult to stay comfortable with these obvious conflicts and misleading statements preparing us to accept what next lie that could be sold about the Chibok school girls’ abduction.
Therefore, my imagination is running riots presently and if you have liberty to create so much embarrassment for the Nigerian nation and government, I am at liberty to imagine that the true situation is that we are being beguiled by a ruse calculated to embarrass the Nigerian government and people and also achieve sinister agenda clearly connected to the Boko Haram Agenda.  My grounds are adduced below.
One, it is not hidden anymore that the Boko Haram programme is an agenda planned and executed to bring home the threat made by no less than three eminent Northern politicians including Junaidu Mohammed, Atiku Abukakar, Muhammadu Buhari to mention but a few, that they would make Nigeria ungovernable for Jonathan if he wins the elections in 2011.  This threat has been repeated in several other ways and guises especially with the learning that President Jonathan might want to contest for a second term in 2015.
Two, when you listen to ‘Abubakar Shekau’ talk, the same statements he makes is the same that all Jonathan’s opponents are making.  After each terrorist bomb attack on the Nigerian soil and people, ‘Abubakar Shekau’ boasts how he is better than Jonathan.  He boasts that Nigerian security forces and the President are weak.  It is this same statement that the opposition and most northern elite use.  Even the failed governors’ of the North-East talk in exactly the same language and term of how Boko Haram fighters are better than the Nigerian soldiers just with the same words ‘Abukakar Shekau’ would use when boasting about his successes.
Three, since the 1950s, the United States of America have always wanted to have a military base in Nigeria.  So far, this has failed through the efforts of Nigerian students in the 1950s and 1960s and the military leaders of Nigeria and current leaders to resist the chocolate coated sword from America. An embarrassment like the kidnap of so many girls and apparent failure of Nigerian soldiers to rescue the phantom girls is enough to announce shame on a leadership and force their hands to accept help of American troops.
Four, a year or two ago, the U.S. Intelligence predicted that Nigeria would disintegrate in 2015.  Is there a chance that all that is in motion is an operation to actualize that prediction?
My counsel to the Northern peoples of Nigeria – this country is better than anything else.  If you do not live and let live, you would lose the oil money that has served you so well in the past.
To America, my counsel is that it is a wiser step to support and help Nigeria to stand in an equitable manner.  If Nigeria disintegrates, there would be no space in America regardless of you’re the efficiency of your immigration security officials and apparatus.
My one counsel for President Goodluck Jonathan, and he needs to do this before his luck runs out.  “President Jonathan should realize that we have a civil war on our hands with boko haram being the armed forces of the rebel North.  He should put on the cap of a President at war and go ahead and prosecute the war against boko haram as a war”.
Good luck to all.

Welcome to the World of NARCOLEPSY: Doctors are the best hospital managers, study reveals

Welcome to the World of NARCOLEPSY: Doctors are the best hospital managers, study reveals

Doctors are the best hospital managers, study reveals

Would hospitals have fared better over the last 30 years if doctors were in charge? New research suggests they may have done


Almost 30 years ago, what was then the biggest change to the health service since 1948 was ushered in by a report that noted: "If Florence Nightingale were carrying her lamp through the corridors of the NHS today, she would almost certainly be searching for the people in charge."

That report, by Sir Roy Griffiths, led to the introduction of general management of hospitals in place of decision-making by consensus and organisation by administrators. It was not a template for getting rid of leadership by doctors – Griffiths said they should become more involved in running budgets – but in practice few were appointed to the new general manager posts. The men (and a few women) in suits took over.

There is today little challenge to the thrust of what Griffiths recommended. But the failure to engage doctors in management is lamented widely. And a new study raises the thought that hospitals might have fared better over the past three decades if more doctors had been encouraged to seek, and been selected for, chief executive roles.

The research has been carried out by Amanda Goodall, a visiting fellow at Cass Business School in London, who has found a clear correlation between high-performing hospitals and leadership by doctors. Her study is based on US hospitals, but she sees no reason why similar results would not be found in the UK. Surprisingly, she says it is the first analysis of its kind.

Goodall took the top 100 hospitals in each of three specialties – cancer, digestive disorders and cardiac care and surgery – as ranked by the respected US News and World Report league tables for 2009. She then researched the backgrounds of their chief executives. Of the top 100 cancer hospitals, 51 had chief executives who were qualified doctors; of the top 100 units for digestive disorders, 34 had medical chief executives; of the top 100 cardiac centres, it was 37.

The remarkable thing about these figures is that, according to other research, there are some 6,500 hospitals in the US and only 235 are led by doctors. So the high-performing doctor-leaders identified by Goodall come from a very small pool indeed.

Her study, to be published in the US journal Social Science and Medicine, further established that doctor-led hospitals had quality scores some 25% higher than other units. And when she stripped out of her analysis of the three lists of top 100-performing hospitals those that featured two or three times (52 in total) she found that the correlation still held strong for the remaining 160 units that featured only once.

Goodall, whose principal post is that of senior research fellow at the IZA Institute in Bonn, Germany, says: "It seems that age-old conventions about having doctors in charge – currently an idea that is out of favour around the world – may turn out to have been right all along."

Her next step is to examine the correlation over a longer timescale.

This notion that practitioners make the best leaders is becoming familiar territory for Goodall, whose previous work suggested that many of the best universities are headed by academics. It's something that Julian Le Grand, professor of social policy at the LSE and a former senior policy adviser to Tony Blair, instinctively goes along with.

"I was always rather impressed with the quality of the doctor-managers I met in the NHS," Le Grand says. "They have that great thing that they command the respect of their colleagues, which is a fundamental problem where chief executives come in from outside."

He adds: "I'm reasonably convinced by the evidence of [Goodall's] research. I think we should be moving as fast as possible to try to encourage doctor-management, as well as academic management of our universities."

Welcome to the World of NARCOLEPSY: # BringBackOurDoctors!

Welcome to the World of NARCOLEPSY: # BringBackOurDoctors!

Welcome to the World of NARCOLEPSY: THE TROUBLE WITH THE NIGERIAN HEALTH SECTOR

Welcome to the World of NARCOLEPSY: THE TROUBLE WITH THE NIGERIAN HEALTH SECTOR

Welcome to the World of NARCOLEPSY: RAPE OF THE BLACK GOLD – NMA Strike and the Crisis in Nigeria’s Health Sector

Welcome to the World of NARCOLEPSY: RAPE OF THE BLACK GOLD – NMA Strike and the Crisis in Nigeria’s Health Sector

Welcome to the World of NARCOLEPSY: A Doctor's (Nearly) Unbiased View On JOHESU

Welcome to the World of NARCOLEPSY: A Doctor's (Nearly) Unbiased View On JOHESU

Welcome to the World of NARCOLEPSY: Nigeria's Intractable Healthcare Crises; Why JOHESU is wrong.

Welcome to the World of NARCOLEPSY: Nigeria's Intractable Healthcare Crises; Why JOHESU is wrong.

Nigeria's Intractable Healthcare Crises; Why JOHESU is wrong.

Do we really need to have this conversation? Isn't it simply immodest? Is our position understood by the public? How are we perceived by the court of public opinion? Ain't we just a bunch of do no good egomaniacs with overbloated sense of entitlement?
I had tried to resist joining the fray in the conversation between Medical doctors under the aegis of the Nigeria Medical Association and the paramedical and allied professionals grouped together as JOHESU, the Joint Health staff Union. I however became constrained after asking myself the foregone questions. Indeed, opportunities to provide some perspective and insight are too golden to let slip by. Posterity, and indeed the profession would not judge us kindly if we are silent in these troubling times.
I quickly make open my affiliation to the Nigeria Medical Association as a member of about ten years standing. Equally, do I readily admit to the myriad of problems in Nigeria's healthcare generally, and specifically related to medical education, examinations, organization, practice and regulation. My opinions, thoughts and biases have been expressed variedly in publications and discourses over time.
I shall not address the 24 demands of the NMA specifically, but give an overview of why Medicine remains first among equals, primus inter pares, and preeminent in the sector and indeed in the larger society.
If Nigeria were a knowledge based society as it should be, most anomalies that are seen will not be seen; a place where princes walk, and slaves ride on horsebacks!
It is because of such anomalies that these issues arise at all, and must be discussed.
Why really are differing admission criteria set for different undergraduate university programs? Why are certain choice courses like Medicine, law, engineering, accountancy not open to all comers? Why, inspite of interests expressed is everyone not able to study medicine and are instead given programs like nursing, laboratory science etc? Why?
1. One reason is because these are professional courses that are held in very high esteem in and by all societies. An admission into any of these confers a lifetime of respect, rights, privileges and responsibilities on the individual so lucky in the eyes of society. In particular, Medicine is an occupation of benevolence, and is only second to the clergy in influence, at least historically.
Very great value is thus placed on these occupations, and such professionals occupy social class One of every society (of course,except maybe Nigeria).
It is this value that translates to premium renumeration, rewards and salaries, headship and leadership in the hospital, sector and society, and the fiduciary relationship with clients.
A natural barrier to entry is consequently placed, to limited the number and quality of persons who gain admission. The barriers to entry are reflected in the choice of subject combinations, credit requirements, JAMB cutoff points, financial requirements, demonstrated leadership potential, motivation or drive inter Alia.
Pharmacy remains the only discipline that comes close to Medicine in the healthcare industry in terms of these requirements.
2. Entry level requirements for each discipline differs equally; because of the value of each ones' contributions, roles and responsibilities. Whilst a three year associate degree is sufficient to become a registered nurse (even though bachelors programs exist), a Bsc program for Medical laboratory science, ditto for optometry and pharmacy ( 5 years) the minimum for Medicine is a professional or doctoral degree( minimum of six years). While a case may be made for a professional or doctoral degree for pharmacy(Not yet available in Nigeria) the same cannot be said for other allied medical disciplines.
It is pertinent to underscore the fact that, unlike the other programs, a semester system is not the norm in medical schools because of the sheer demands of the program, and to be able to accommodate completion in the six years duration for training. Thus, while other undergraduates relish the inter semester breaks, the average medic slaves away to survive the brutal demands of the program.
The curricula includes microbiology, chemical pathology, hematology, morbid anatomy, public health, pharmacology, surgery, Medicine, clinical clerkship etc cutting across all areas and providing a panoramic view of every area, something necessary for proper leadership.
Yours truly spent eight years, inclusive of a one year ASUU strike!
3. "Necessity" or need for on-the-job training. Please take note of the "necessity". Besides the initial doctoral or professional degree obtained, further residential training is necessary in all fields of medicine, ranging from public health, obstetrics and gynecology to Laboratory Medicine. A minimum of 4 years is required at the earliest, and up to 8 years depending on the specialty, with further differentiations and super specializations being necessary occasionally. These are the minimum mandatory requirements for practice of medicine. How then can the laboratory scientist, no matter his pedigee now lord it over the Laboratory doctor? Since when did technicians and draftsmen begin to be the boss of engineers? This is the only analogy that is apt!
Because the public sector is where anything goes literarily, members of JOHESU capitalize on this, employing the game of numbers and raw brawn to place increasingly outrageous demands on government.
A private sector driven health industry will put sanity into our heads, and water will find its level!
4. Demand, supply and rarity of skills. Because of all the aforementioned reasons, the supply of specialists, otherwise referred to as "consultants" is very limited, whilst the demand continues to be heavy. A world Health organization recommended ratio of doctor to clients is about 1: 500. But for instance, in Nigeria, the ratio of psychiatrists to the population is about 1: 1.2 million Nigerians (less than 200 psychiatrists to 167million Nigerians)
A similar abysmal picture is seen in in most specialities of Medicine in Nigeria, not least of which reason is the low renumeration compared to work load, poor work conditions etc.
5. Roles, responsibilities and demands of the job.
The physician takes full responsibility for the health of patients in his care. This includes a fiduciary relationship in which he is obliged to act in the patient's best interest at all times, and bears full responsibility for clinical and ethical judgments, and takes responsibility for litigations.
It is he who statutorily confers the sick role on an individual in any society among other things.
Without prejudice to the rights of others to self determine and aspire, "relativity" between medical doctors and the other disciplines must be preserved. A situation where brigandry becomes the deciding factor on who gets what, rather than appropriate job evaluations, enlightened assessment and international best practice is not and cannot be acceptable. The choice of doctors as head of the health team is a result of their conceptual understanding and panoramic view bestowed not by choice, but necessarily of training.
For the same reason a non accountant will never be the accountant general, and a non lawyer never the state attorney or chief justice, should a non medical doctors become the head of hospitals, particularly the tertiary hospitals.
Post script
The points above are what is used in job evaluations, not some wanton and arbitrary parameters. Not the charade which ranked "Medical doctors slightly lower than physiotherapists and laboratory scientists". Such will never fly if not with some hired pretenders. The government must look to hire world class consulting firms like KPMG, BCG, or even PWC to conduct such evaluations.
Within the hospital precinct, relatively basic functions of Nurses, laboratory technicians, physiotherapists, pharmacists are needed. A PhD in any of these has no place or use in the general hospital setting. Maybe so in the universities, not necessarily so in the hospitals.
Ultimately, some public-private partnership models will have to be introduced for some modicum of civility to return to our hospitals. The current models are unsustainable, wasteful, inefficient and ineffective. It is the reason for the whole self aggrandizement.
I do agree that doctors need to place greater emphasis on interpersonal and interdisciplinary relationships, communication, and generally view themselves as privileged custodians of a sacred duty, not as taskmasters and overlords. Our approach and manners towards others go a long way in eroding or enhancing this respect already conferred on us.
We need to reemphasize communication skills already embedded in the curriculum.
I also do agree that doctors who wish to head the hospitals must possess something other than the medical degrees. Something to help them be better managers of human, financial and material resources. Indeed I suggest that a faculty for hospital administration/management be created in the graduate medical colleges as a distinct residential track and/or postgraduate taught masters programs in Hospital management/administration be availed some universities.
Finally, the choice of career can mean so much; the difference between personal fulfilment, satisfaction or otherwise. It may mean the difference between how far one wishes to go, and how far he actually goes. Thus, the role of career counselors in secondary schools cannot be over emphasized.
He who sowed mangoes cannot now come reap plantains, or can he?

A Very Touching Story.

A poor boy was in love with a rich man's
daughter….One day the boy proposed to her and
the girl said…”Hey! Listen, your monthly salary is
my daily hand expenses..How can I be involved
with you..?
How could you have thought of that? I can never
love you, so forget about me and get engaged to
someone else at your level”
But somehow the boy could not forget her so
easily…..Some time 10 years later they stumbled
into each other in a shopping mall.
The lady again said….,”Hey.. ! You! How are you?
Now I’m married and do you know how much my
husband’s salary is..? $15,700 per month! Can you
beat that? And he is also very smart”
The guy’s eyes got wet with tears on hearing those
words from the same lady….
A few seconds later, her husband came around but
before the lady could say a word her husband
seeing the guy, said……
“Sir you’re here and you’ve met my wife..”
Then he said to his wife, ”This is my boss, I’m also one
of
those working on his $100 million project!
And do you know a fact my dear? My boss loved a
lady but he couldn’t win her heart….That’s why he
has remained unmarried since.
How lucky would that lady have been, if she had
married this my boss now? These days, who would
love someone that much?"
He said all these to his wife.
The lady looked in total shock but couldn’t utter a
word….
————— ————— ————— ——-
MORAL: Don't underestimate anyone, don't look down
on anyone because no one knows tomorrow.
Where you have been rejected before, you will be
celebrated soon in Jesus name.
Write AMEN if U're A believer
God bless you. Feel free to SHARE for
Others to read!

RAPE OF THE BLACK GOLD – NMA Strike and the Crisis in Nigeria’s Health Sector

INTRODUCTION

After trying hard to avoid putting pen to paper to express the bottled up emotions inside me, a news item on a national TV station has finally pushed me over the edge to try to explain to whosoever cares to listen, the reasons why the NMA is on strike, and why there should be public agitation in favour of it. In the said news item, members of the public are yet to understand the reason for the strike. For the avoidance of doubt, I am a medical doctor and I write from a possibly biased point of view. As you go through this article, you may discover areas where I agree or disagree with the issues raised by my mother association. But while I do that, I will try to be as reasonable and dispassionate as possible.

I do not believe that strikes should be the handle by which the Nigerian government turns, such that it is impossible to press home the demand of a labour union or group in this country without grabbing it. The feverish efforts used to approach an industrial action towards its end can be applied at the moment when there is a NOTICE of action. If this were the habit of those in government, perhaps the current NMA action and many others strikes by other bodies of workers before it would have been averted. My aversion to the use of strikes is even more amplified when it involves the truncation of flow of an essential service – be it power, health, transportation, security or other. The oath which I and my noble colleagues took reads in part, “I will practice my profession with conscience and dignity; the health of my patient will be my first consideration”. In all fairness, I want to say that inspite of the dearth of modern day equipment, dilapidated infrastructure and terrible working conditions, we are still struggling to live true to our promise.

Most doctors I know today work extra hours unpaid, donate to help patients obtain medications or pay bills, or go out of their way to perform “non-doctor” work just to make the patients well. The following two examples are true at least in the Jos University Teaching Hospital. Doctors run around the wards to pick up instruments and case notes (files) of patients, when many times the nurse is idle in the ward. Carrying files and getting all instuments required by a doctor on ward rounds should be a nurse’s responsibility, or at least she should direct her orderlies and substaff on what to do. In addition, she should make contributions, report relevant events which occured in the doctor’s absence, and take her own notes during the ward round. That is what our teachers tell us used to happen in the past. But alas, that is not the case. She sizes up the doctor first, to see his rank. If he or she is a house officer (the lowest cadre), he may just as well proceed without her. Afterall, she has a daughter at home that is older than this “small boy”. African megalomania at its worst. If the doctor is a Consultant(topmost grade), she may then gauge whether this doctor is the “friendly type” or the “difficult type”. Because for the difficult people, the rules have to be obeyed or else there will be trouble. This category of doctors is thus spared the pain of others. My second example, though recently corrected by a circular from management, is that doctors sometimes become porters, carrying blood samples and results to and from the laboratories. In the course of seeking for results in the laboratory, a doctor was recently slapped in the face by a laboratory staff, leading to the management response. While that malady lasted, excuses for the staff who were employed for that purpose ranged from “too few hands” to “engaged with something else” to “its not our job”! for want of space, I will leave other examples alone.

I hope this leaves no one in doubt that we do our jobs (and sometimes the jobs of others – just to make the system work)
Now to the issues.

WHO SHOULD HEAD A HOSPITAL?

Who should head a hospital? Of course, this kind of absurd question would not arise in a private hospital. As we know it, the law in Nigeria requires registration with the Medical and Dental Council of Nigeria (MDCN) and up-to-date payment of Annual Practicing fees for an individual to set up a private hospital. I carefully choose the word “hospital” because Nigeria has an endless number of appelations for both health facilities and slaughter houses. And the nigerian public is so misled that there is now no distinction between hospital, pharmacy, clinic, dispensary, nursing home, patent medicine seller, and a community health officer’s spare bedroom. All manner of attrocities are committed – there are consulting rooms in pharmacies, theatres in nursing homes, abortion facilities in dispensaries, and operating rooms on people’s dining tables. The mess is so mad that everybody who has ever witnessed the administration of an intravenous drug or watched an appendectomy is now fully “medically qualified”. So the criminals who do these things, due to the ineptitude of law enforcement, now see themselves as equal to all others who have licences to practice professionally. And a handsome majority of perpetrators of these acts are the other health professionals and allied health professions.

The problem as I have stated, cannot arise in Private hospitals. It is in the public institutions, where salaries do not depend on how much work is done, but on how much the institution receives from the “national cake”. Not on how much training we have received, but on how many years we have been sleeping at the office. Not on our individual skills and interests, but on how many pieces of possibly fraudulent paper are found in our credential file. For if these attributes were to be sought by our employer, we would never have arguments for how much we should receive. Or who should be in charge. Regrettably, however, our employer is an object that neither has a head or a brain. It cannot reason and thus cannot make any reasonable judgment. Our employer is the black gold that runs beneath the land and waters of the Niger Delta and other parts of southern Nigeria. Our employer is crude oil – our birthright and ticket to laziness, our excuse for brazen corruption, and our foundation for mediocrity and lack of desire for development. And to tell the truth, I secretly pray sometimes that the oil would just dry up, if only to induce sanity into our country. For if this employer were reasonable, it would ask why there should be a difference between the private hospital (which performs its duties and makes a profit) and a government institution which is just a black hole into which money is sunk, neither getting profit nor benefitting the masses for which it was built.

The law setting up teaching hospitals specifies that to become the CMD, a person has to have a basic medical degree (here meaning Bachelor of Medicine, Bachelor of Surgery) and have become a consultant, owning a fellowship of one of the Postgraduate medical Colleges, as well as a few other requirements. This is one of the cardinal disputes of today.

Let me introduce the Joint Health Sector Unions (JOHESU), an amalgam of Labour Unions formed a few years ago and basically including all other staff except Medical Doctors. Even to a blind and deaf person, this is an association of strange bedfellows. Pharmacists, Nurses and laboratory Scientists alone would have made some sense. But add Administrative staff, accountants, medical records staff and it starts to get confusing. When you finally integrate cleaners, porters and other junior staff into the mix, it tells what the only object of such a hydra-headed conspiracy could be – the extermination of the disciples of Hippocrates.

JOHESU seeks for appointment of CMDs to be “made open to all competent and qualified health professionals”. The arguments for them are that this is done in some parts of the world, that their members also have medical knowledge, and that it would promote equity and fairness. On face value, these seem to be reasonable and genuine demands. And central to our response has been one issue – training. Apart from medical doctors, other health professionals attend university courses based on the semester system in Nigeria (let us leave out those who have sub-degree programmes for now – they know themselves). Apart from the Pharmacists, who do 10 semesters, most other professionals spend 8 semesters. Two of these semesters however are spent doing basic science, which is essentially same across board. So in effect, pharmacists spend eight semesters and other six, preparing for working life. Now doctors also do the same basic science, with higher credit unit loads than most others. After the first year, however, the difference in training time is incredible. The semester system for the doctor is over. The remaining five years of training are basically without holidays. When there are breaks, they last between 2 and 3 weeks, usually after exams - and in the University of Jos, for example, there are just three major examinations beside continuous assessments, which are regular. So on the generous side, a medical student has perhaps nine to twelve weeks of official breaks out of five years. That is an incredible four-and-a-half years of training. Compare that with six semesters of four months each, totalling 24 months or 2 years. Or for the Pharmacist, eight semesters of four months, which would be two years and eight months. The amount of knowledge difference is surely massive.

Asides that, the doctor is schooled in EVERY aspect of HUMAN medicine – and in appreciable depth. What the other professionals are schooled in, as far as it pertains directly to human medicine, we also learn. So what then is the doctor’s advantage as a chief executive? A doctor has a wider scope of training and is equipped to understand the entire workings of a hospital as it relates to patient care. Thus if a lab scientist, pharmacist, nurse or other health professional for example, speaks to a doctor CEO about the needs of his department or problems they are having, the doctor would fully comprehend. If a pharmacist were giving the same information to a lab scientist, however, the situation would be different. This wide scope of training and central role also has a bearing on decision making for the best possible allocation of resources and manpower, enabling the hospital to run smoothly for the good of the patients. That is why a career engineer would most likely be the head of a construction firm and not a welder or bricklayer, even if they all had PhDs. A lawyer would be the head in the courtroom, whether the clerk has a thorough knowledge of court procedure, court rulings and how to decide cases or not. Its simple logic.

Where people start to argue about whether doctors are trained in management, my answer is that other health professionals are generally no different in that respect. Seeking for “fairness” and “equity” and trying to avoid things being “skewed” has absolutely no bearing in an industry whose objective is to preserve human life. This is not sports or entertainment or tourism, where ignorance and mistakes can be condoned. Any managerial mistake in a hospital can lead to loss of life, which is irreplaceable. And for the records, recent studies in the UK have shown that doctors head very few hospitals in that country, but most of the top 100 performing hospitals are among those headed by doctors. That kind of evidence based argument in a sane society can have no reply. The document regulating the tertiary hospitals in Nigeria has said the doctor should be the head. Since the status quo has not been deemed a failure by the government, it should remain. It is pertinent to add here that the clamour for the interpretation of the phrase “medically qualified” by JOHESU is part of the ploy to co-opt their members into the league of persons entitled to apply for CMD in the tertiary institutions in the country. To be mild, this loophole seeking is simply childish. For if medically qualified were to be a general term for any diploma (certificate) related to medicine, the makers of the law would not have added a postgraduate fellowship, which is peculiar to doctors, to the list of requirements.

APPOINTMENT OF DIRECTORS AND THE POST OF DEPUTY CHAIRMAN, MEDICAL ADVISORY COMMITTEE (DCMAC)

Like I mentioned earlier, we live in a ludicrous society. There is little respect for order, and people appear to be more at home with anarchy than sanity. Let’s go back to the structure of a teaching hospital. There are three directors in a teaching hospital – Director of Administration (DA), Head of Clinical Services (HOCS, also known as Chairman, Medical Advisory Committe - CMAC), and the Chief Medical Director, who is the Chief Executive. The DA handles purely administrative matters, while the CMAC handles issues related to patient care. The CMD, of course, is their superior and serves as the CEO. This ensures that patient care is not sacrificed on the altar of administrative issues and vice versa. There are assistant directors in areas such as nursing, finance, works, and so on. This creates a visible chain if command within the hospital. The yearning of JOHESU is that their members be promoted to Director Cadre within the hospital setting. Knowing the Nigeria we live in, no director will be answerable to another within the same ministry or agency. A director, as far as I know, is only answerable to a permanent secretary. Now unless the titles of the CMD, DA and CMAC are changed, what will become of the hospitals when we have, say, 100 other “Directors” walking the corridors of the teaching hospital? And if you make all the CMDs in Nigeria permanent secretaries today, what will become of the Ministry of Health? For surely, such permanent secretaries will only report to the Minister! And how many ministers can we have at once?

This whole debacle is directly related to the quest for salary increase, if u ask me. How many other government institutions have a hundred Directors within them as will be the case if this request is granted? Now the irony of it is that if this policy is approved, many doctors would also proceed to become directors. But our question is this – what benefit does it add to the system? None! And what does it take away? First, increased wage bills for the government. Secondly, increased anarchy in a system that is already bastardised by unprofessionalism. Thirdly, many “directors” will abscond from their duty posts since they would now be too big to sit in a clinic, laboratory, pharmacy or hospital ward. And who would bear the brunt of it all? Our dear old black oil. Raped, plundered and wasted, but still faithful. Nothing can be more senseless. If people wish to pursue an increasein pay, they are free to do so. But for Pete’s sake, let there be order in the hospital!

On the appointment of DCMACs, JOHESU would simply not hear of it. Their argument is that it is unlawful; possibly because it is not written out in the document that created teaching/tertiary hospitals in the country. But they forget to add that there are circulars from the government that support the creation of the office. Also, the law gives the boards of the teaching hospitals powers to take measures that ensure the smooth running of the hospitals, and these appointments are made by the boards! The job of the CMAC is indeed a tasking one and like every other Director in the civil service, he/she should have deputies to help with functions. I think that is simple enough.

SKIPPING OF GRADE LEVEL 12

The Ministry of Health has issued a circular stating that contrary to what was hitherto obtained, where all other staff of the Ministry skipped a grade level at some point in their careers except doctors, we should also be included. Though the Ministry is still in court over the legality or otherwise of skipping, it is only fair that all members of the family enjoy what our father, the Federal Government, has brought home from his hunting adventures. Abi the oil money don finish? Na on top our head una wan talk say the money no go reach again? Lai lai!. I don’t believe this should be a matter of contention. What is good for the geese is also good for the gander.

THE TITLE OF CONSULTANT AND THE QUEST FOR SPECIALIST ALLOWANCE AND TEACHING ALLOWANCE

Every person and profession has the right to determine how the career progression goes. To that extent, I do not have any grouse whatsoever with people attaining Consultant status in their field. But as the saying goes, things are not always what they seem. This point will require a little of history. Before the nineties, the health system in Nigeria was a lot more organised. There were clearly defined roles for each group of health personnell, and the salary scales truly represented relativity, which is the difference in take-home pay that should exist due to differences in training, skills and input to patient care. Gradually, the unions agitated for more and more increases, more allowances, and so on. But there was a problem lurking. For while the other unions (now grouped as JOHESU) fought and battled the Military governments for pay rise after pay rise, the doctors “kept their cool” and “were more concerned with the good of the patients”. Of course in Nigeria, the loudest person gets heard first. So gradually, the gap between the salary of the doctor and the other professionals closed up. At a point, there was barely any difference. In 2008, after many years of struggle, the government approved a new salary scale for doctors which, though flawed, was meant to correct the relativity between professions. As part of that document, there was an allowance for medical and dental consultants tagged “specialist allowance”. That is the source of the problem. In a quest to get more allowances, the term “Consultant” has suddenly crept into the vocabulary of the other professions, notably Nursing and Pharmacy, of which I will make examples. They perhaps have heard that there are “Nurse Consultants” and Consultant Pharmacists” in other climes. The question is, WHAT ARE THE ROLES OF THESE CONSULTANTS IN THOSE COUNTRIES, AND WHAT ARE THE QUALIFICATIONS REQUIRED TO ATTAIN SUCH STATUS?

According to the UK’s National Health Service website, a Nurse consultant “is a specialist in a particular field of healthcare... and spends at least half of her time working directly with patients, and in addition develops personal practice, is involved in research, and contributes to the education, training and development of other nurses”. To become a nurse consultant, a basic nursing degree is required, as well as a master’s degree in nursing, health services or administration, or public health, with working experience. Some even add that one requires a PhD or at least should be working towards getting one. There are other nurse consultants who may not work with patients but give advice to law firms on medical cases (e.g. malpractice cases) they have in court. The latter type of nurse consultant surely does not fit into our teaching hospitals, but the former may.

Most definitions of a Consultant Pharmacist describe him/her as one involved in the care of the elderly or people in nursing homes, where he reviews their medications. Infact, the history of Consultant Pharmacy actually began in homes for the elderly. Other sources describe the job as having to do with “advanced roles in patient care, research and education”. Even in these countries where the title is mentioned, it appears to be a new and evolving role rather than an established position that has relevance to patient care. Requirements include a Pharm D degree, interest and experience. Some articles I came across also require a Master’s degree in pharmacy. In the absence of proper guidelines and laid down procedure for such appointments, as well as regulatory or accrediting agencies, my view is that caution be exercised in adopting this relatively new terminologies into a developing country’s health system.

The issue of Consultant status is where I may differ slightly from the NMA’s position. Let anybody become a consultant of whatever profession he wants to, as long as there are stipulated procedures for doing so. The caveat is that as far as patient care is concerned, the Medical/Dental Consultant acting directly or through his lieutenant, is the only person to give directives about the patient’s care. To cut it short, being a consultant in any other field of healthcare should not give a person the right to change, obstruct or delay the implementation of a doctor’s management plan. The roles of such specialists should be merely advisory.

On the part of the Government, they can go on and appoint as many consultants as they want –, Nurse Consultant, Consultant Pharmacist, Consultant Physiotherapist, Consultant Optometrist, Consultant Radiographer, Consultant Cleaner, Consultant Porter, Consultant Gateman, Consultant Accountant and Consultant Administrator. Kai, even start having Consultant visitors. Afterall, the Niger delta oil is a whore, and her patrons are endless. Just one more defilement won’t do much harm. Then the next, and the next.

Let me conclude this section with a comment on the issue of teaching and specialist allowances. With the difference in knowledge between a house officer and nurse, the house officer surely does teach them a few things... if the person involved is humble enough. The point is that these guys also teach medical students, nurses and other personnell. Finally, everyone in the Health sector now wants to receive a specialist allowance and teaching allowance. Infact, some optometrists on the CONHESS salary structure now receive specialist allowances from the CONMESS salary structure. Only in Nigeria can such brazen effrontery be seen. One person, being paid on two contrasting salary scales. Well I will leave that to the public to judge, but if without additional training a lab scientist, pharmacist, optometrist or nurse wants to be called a specialist and receive allowances, the gander are also ready. The spree has only begun.

RELATIVITY IN THE HEALTH SECTOR

Now many that are outside the health sector may be confused about this. But to put it simply, the healthcare system revolves around a TEAM. In every team all players are important and perhaps indispensible, but there is always a captain or a leader. Usually the coach will choose a captain either based on current form, or based on age, or based on experience, or based on number of years spent in the team. In medical circles this leadership role, albeit traditional, was foisted on the doctor because of qualities including being central to patient care, perfect understanding of both normal and abnormal body function, understanding of the development of diseease and different options for curing or relieving it, and a general scope of the different areas of human medicine. As is seen in every normal salary structure, the more the training, the higher the pay. That is why a secondary school leaver and a university graduate are not put on the same grade level when they are employed. Even among graduates, those of engineering, law and pharmacy are paid higher than others. Doctors (medical and veterinary) are paid still higher. This is the concept of relativity, put simply.

However in the Nigerian health sector, this rule has been and is being continually thrown to the winds. Some nurses without university degrees earn higher than pharmacists and doctors. From being started out on step 4 of the grade level as used to be the case, House officers are now started on step 2. Reasons? None! Like stated earlier, this is the result of the failure of doctors to use strikes to press home their demands, choosing negotiations instead. The only time when we got heard was during the strikes that introduced the Consolodated Medical Salary Scale (CONMESS) in 2008/2009. And in that document, there were fundamental flaws. For as you moved higher up the scale, your salary seemed to be stagnant. The creators of that document cleverly made the calculations such that a promotion added almost nothing to your total emoluments. This led to a call by the NMA for a new salary structure that makes the effect of promotion better, and government is “still looking into it”. Realising its “mistake”, government issued a circular on the 3rd of January 2014, correcting the anomalies in CONMESS. Take note that this was not NMA’s demand, but even the implementation of the government’s own response to the problem has taken six months. Not a single kobo has been released to that effect. But since we are a breed that has a genetic aberration which has foisted limitless patience on us, JOHESU will have the public believe that we are unreasonable.

One funny tweet I read this morning from @bilquees_01 under the #nmastrike read, “a duke mutum a hana shi kuka”. It is in hausa and means “to beat up someone and prevent him from crying”. This perfectly describes NMA’s situation in Nigeria. We are squeezed in on every side, pressured, ambushed and bashed, but the rule is “Thou shalt not complain”. Each time there is an industrial action, you see sudden movement from the house of representatives, senate, presidency, and the so called “well meaning nigerians”. As soon as we retreat to work to observe the situation, all agreements become unbearable burdens for the government. JOHESU rushes off to introduce another variable to unbalance the equation. But thou, o physician, shalt not talk. For it is you alone that has moral obligation to the sick of the world. Arrant rubbish!

HAZARD ALLOWANCE, RURAL POSTING AND OTHER ALLOWANCES

Let me start with the hazard allowance. I will simply ask a question here to any member of the public. Is five thousand naira (about 28 USD or 18 GBP) enough compensation for any of the following risks to your life (and by extension, the life of your immediate family) every single day? People coughing into your face; blood splashing onto your clothes, skin, eyes and mouth; handling human faeces, urine, flesh and other fluids; working with razors, knives and needles around patients with highly infective conditions (HIV, Hepatitis B, Hepatitis C, Lassa Fever, Tuberculosis and others)?

If anyone would say yes to the question, or argue that they are more exposed to these dangers than the Doctor or Nurse, let them come out. I will stop at that.

When an official of the Federal Ministry of Health (FMOH) travels from Abuja to Portharcourt and spends the night, he gets paid for the inconvenience. But a doctor POSTED to a rural setting away from family and civilisation needs to go on strike to get a circular saying that he should be paid his due. For if that is not done, he may get his money, or a quarter of it. Or nothing.

There is God o!

CONCLUSION

The current crisis in the Nigerian Health sector is essentially borne out of Government’s non-affirmativeness in handling issues related to clear definition of roles, lack of a global salary structure that takes into account training, skills and competencies, and the toleration of disrespect for laws and circulars of government. This is further worsened by its lack of implementation of agreements and slow response to threats of industrial action across the country.

Doctors, as part of the solutions to this quagmire, have advocated for the signing into law of the National Health Bill as passed by the Senate of the Federal Republic of Nigeria. This will resolve SOME of the problems.

Secondly, a global structure for salaries and wages in the health sector, based on the points stated in paragraph 1 of this conclusion, is key to putting a stop to the impending collapse of the health sector. That action should be based on practices in advanced nations of the world who we aspire to be like. Copying some things related to relativity from the UK’s NHS would be a good start. After that, any further pay rise for staff in the health sector should be done en masse to maintain the relativity across board. This alone will bring lasting peace.

A permanent resolution of these crises thus still lies at the feet of Mr President and his advisers and committees.

I will bow out with a comment on the oath we took, which I quoted earlier. That oath, called the Hippocratic oath and disputably assumed to have originated from Hippocrates, never envisioned that a time would come when a physician (here referring also to a surgeon) would be an employee of the state or work in conditions so terrible that he/she would consider withdrawing services to enforce his rights and those of his patients. Hippocrates never thought that the family atmosphere that existed in all the homes he visited to see patients would condense into vampiric institutions where lieutenents would challenge his leadership and seek to take his place at the head of the team. If he had, he would perhaps have added an escape clause.

For there is no longer any dignity in this practice; and our patients suffer everyday on account of all this back and forth over the same issues. Definitely, some of these problems I have dicussed are at the very heart of the matter, and others are thrown into the fray as a response to the frustration that engulfs us in the moment. But for our conscience to remain and our patients to enjoy the benefits of the doctor’s indepth knowledge and training, the atmosphere has to be right. That is what NMA is standing for today.

Having gone through some of the hard facts in this article, and perhaps having been inspired by my emotive tone, I hope that more members of the public will come to agree that the current strike, apart from seeking to correct some anomalies in the health sector, will ultimately lead to greater good for the primary object of existence of the medical profession – the patient.

Agwaza Maxwell Dagba writes from Jos, Nigeria

THE TROUBLE WITH THE NIGERIAN HEALTH SECTOR

For a longtime now I have come across so many articles and reports in the national dailies and in online social media on the rife in the health sector which centers mainly on the row between doctors and non-doctors working in the healthcare system. Most of these reports and articles, mostly lopsided, have one common denominator, presenting the Doctor as an enemy of the people and the manner of their submissions is such as to draw undue sympathy from the unsuspecting public. But for the neutral members of the society who have had cause to have sufficient contact with the hospital environment, I’m not talking of some quasi journalists, they need not be told, if there are, who the Angels and Demons are.
This article is not aimed at indicting or exonerating any of the two combatant parties as both have had a fair share of the blame, and honestly, the deplorable state of our healthcare system is not as a result of the performance of the health workers, but it is a component of an overall failed system called Nigeria which the current government is still trying to salvage amongst other difficult challenges. Considering the lines along which the divide has been made, I shall delve into an inquest of some of the key issues at stake, mostly those that affect the general public, and this I will do by placing the Nigerian Doctor on one side to be reviewed alongside a few of the numerous “health professionals” working in the healthcare system with due consideration to the most important person in the system, the Patient. I shall concentrate mostly on the tertiary healthcare institutions where the bulk of the rivalry is most felt.
The Patient and the Hospital:
Let us begin from the beginning. A healthy person falls sick and needs to regain his health and function properly. He says to himself, “I don’t feel well enough, I need to see a Doctor. May be I should go to the hospital tomorrow”. He sets out of his house with this principal aim. On getting to the hospital, he first gets to the reception, obtains a card at the Out Patient Department and then proceeds to see a Doctor (usually a Medical Officer) if his condition is one that necessitates a Specialists attention, he is then Referred to another Doctor, the Specialist (Consultant) for further treatment. On getting to the point of referral, the Record staffs assist him in opening a folder containing case notes, and in the process of this, a Doctor (Consultant) is assigned to him. The entire processes of obtaining a card and folder have no direct effect on the patient’s condition but helps ensure proper documentation and recording within the hospital. He is then directed to the designated Specialist or Consultant Clinic where he is received by a Nurse who does further documentation and records his vital signs which may or may not be repeated by the Doctor. Then the patient enters the clinic to see the Doctor, his primary aim for coming to the hospital ab initio.
The Patient, the Doctor and Other Health Workers:
The Doctor begins by taking a complete history of the patient which includes his current complaints, previous health challenges, living condition, social habits, family history, drug history, financial capacity, religious and cultural beliefs, and then proceeds to do a complete physical examination of his entire body system, at the end of which the Doctor would have verified the patients complaints and identify any other problems unknown to the patient, before arriving at a Provisional Diagnosis. He then counsels the patient, draws up a treatment plan, which is to be strictly adhered to provided the patient is within the hospital environment, and automatically takes full responsibility for any problems encountered along the line. He finally schedules him for a follow-up visit to ascertain his response to treatment. This process of history taking creates a personal relationship between the Patient and the Doctor and this is where the confidence of a patient on the Healthcare system of a Nation is built; the Doctor-Patient Relationship.
The treatment plan of the Patient, drawn by the Doctor, may or may not include; the investigations (or tests) both laboratory or radiological to be carried out, the drugs to be dispensed and the appropriate prescription, the additional care to be rendered outside the basic nursing care and the treatment orders to be followed, some of which he does himself (or via his subordinate Doctors) and others by the Nurses. There is no stereotyped outline of what must be done for every patient; investigations to be carried out, treatment to be administered or drugs to be prescribed lies solely at the discretion of the Patient and his Doctor.
Apart from the Nurses, all other “Health Professionals” come into patient care when the Doctor’s plan involves them. Clearly, a patient has no business with the Radiographer if the Doctor’s plan does not involve radiography, neither does he have any business with the Pharmacist if the patient does not require any drugs, of course, not every patients require drugs. Therefore, it is safe to assert that if Patient Care is the sole interest of everybody in the Health sector, then the Doctor takes the Central stage in this service to Patients and must carry the Nurses along at every point in time, and together they look out for any other “Health Professional” that should be roped into patient care. Why then should the Doctor take the Central stage? Very simple. He has been trained thoroughly to do so. Invariably, the Doctor is naturally the undisputed leader of the Health team and only two classes of people can challenge this standing; the criminal minded ones pursing their selfish interests and the dim-wits incapable of any logical reasoning.
On the Headship of the Hospital:
Over time, the functional head of the tertiary hospital setting has been the office of the Chief Medical Director, CMD, and part of the Act establishing the hospitals specified that this position be held by a Medical Doctor. However, there has recently been a loud cry from other “Health Professionals” under the auspices of the Joint Health Workers Union (JOHESU) for the chance to also partake in the “enjoyment” of this office, as if to say it is a political office, a “National Cake” which should be shared equally to everyone in the scene, whereas, it is the most sensitive of all positions in the hospital setting, one with huge implications on the health of patients. The Medical Doctors on the other hand, insist that the office of the Chief Medical Director and the headship in general, of the Hospitals is their exclusive reserve.
How true is this claim by the Doctors? Again, it is very simple. Healthcare is all about patient care, and in rendering care to the patient who is the main focus of everyone, the Doctor is the arrow head. He brings together the activities of all in the health care delivery system to bear fruit in the health of the patient. He has a broad-based and yet in-depth medical knowledge that enables him to function as a leader in patient management and take responsibility for the outcome. It is then indeed a funny ideology to expect the Doctor to maintain leadership of Patient Management and then cede the leadership of the Hospital Management to a Non-Doctor. Right thinking people would agree that whoever takes the blame should take the lead. Leadership is about responsibility, and Doctors embrace such responsibility mainly as it involves lives which they have sworn an oath to protect.
Furthermore, JOHESU, a body comprising of other “health professionals”, support staffs and in fact all in the Hospital setting except Doctors, claim to be equal and allied to Medicine. But my question is, how is the clerical staff allied to Medicine? How can a support staff head the core members of the organization? Also, why should a “profession” that is “allied” to Medicine surmount Medicine? Can a Non-Lawyer become the Attorney General of the Federation? Why isn’t the office of the Vice-Chancellor made open to every staff in the University system since ASUU and NASUU both consist of “professionals”? How would ceding hospital leadership to JOHESU improve the health indices of our country? These are people that do not deal directly with patients, people that do not really understand the agony of patients which Doctors do. The saddest part is the extent they can go to press home their irrational demands. We have a documented occurrence of how they turned off power supply to the Intensive Care Unit during a JOHESU orchestrated strike action in a southeastern Teaching Hospital leading to death of patients on life support. This was an attempt to frustrate the Doctors’ effort to keep hospital services running while they were “striking”. How can people who have displayed this level of irresponsibility be allowed to head the Health sector? Again, God forbid!
It is a common saying that Doctors are “proud”, and I insist, they have very just reasons to be, and when it comes to arrogance, the patients can tell who amongst Doctors and Nurses are more approachable. Doctors are a selected class of elites and comprise the best brains of the society. Yes, the entry requirements into the profession and the medical training ensure that only the bests emerge as Doctors. As such, the government has to understand that any arrangement that sees a Non-Doctor in a sensitive position to head Doctors in any Health related issue would be met with fierce resistance and the never ending tussle it will ensue will have detrimental effects on our nation’s healthcare delivery. In the interest of peace and decorum, the Federal Government have to dig in and ensure that the status quo is been maintained. The ear that will hear needs not be the size of a raffia palm.
On conferment of Consultancy on other “Health Professionals”:
A Consultant (Medical) is the title for a senior hospital-based physician or surgeon who has completed all of his/her specialist (Residency) training and has been placed on the specialist register (Fellow) in their chosen specialty. This level of Doctor joins the Civil service as a Consultant and automatically leads a team of Doctors comprising Residents, Medical Officers and House Officers who train under him.
Currently, there has been an outcry by JOHESU to also be awarded Honorary Consultancy based on the fact that Doctors are been appointed as Consultants, why not they too. The concession of the government to this particular demand has led to the entire hospital going berserk in some centers. This was done against the warning of the Nigerian Medical Association that the introduction of such “alien” practices would be detrimental to the lives of patients and the results are showing.
At the Nnamdi Azikiwe University Teaching Hospitals, it is been said that a “Consultant Pharmacist” invaded the wards with his team, cancelling patients prescriptions and also demanded that a Consultant Cardiologist remove a key drug in an inpatient prescription, on grounds that the drug has some known adverse effects. Another report have it that in Abuja University Teaching Hospital, the Ante-Natal Clinic was invaded by Nurses who decided to consult patients and make prescriptions, of which the Doctors left the clinic and the Patients were confused. Patients who sought to see their Doctors were told that there was a “Consultant Nurse” who does whatever a Consultant does. Also, in University College Hospital, Ibadan, stories had it that a Consultant Plastic Surgeon was barred from reviewing the surgical wound he created post-operatively because a “Consultant Nurse” had reviewed the wound earlier and was satisfied with her findings.
Let us address one of these occurrences. It is grave ignorance for a Pharmacist to tamper with a drug prescription simply because he has looked through his drug formulary and have identified a known adverse effect of the drug when he/she has no knowledge of the processes involved in the making of diagnosis and prescriptions. Patient management is highly individualized. To make a prescription, the Doctors put many things into consideration viz; patient’s history and examination, financial cost of the drug, benefits against the risk of using the drug, other drugs to be administered etc. Sometimes the side effect of a drug is the desired effect needed in one patient but would remain a serious adverse effect in another patient. But no, the Pharmacist didn’t think in that line before cancelling prescriptions. I am not saying every doctor’s prescription is infallible. No. But if a pharmacist wishes to express concern over a patient’s prescription, he should discuss with the Doctor to sort out their concerns.
This whole consultancy for non-doctors arose as a result of their quest to have better remuneration. I am not opposed to better remuneration for other health workers, but looking for cheap means to it at the expense of the lives of patients is grossly unacceptable. Why would you want to be a Specialist (Consultant) when you have no specialty, or you have a specialty in an area whose service is not needed? Even if a non-doctor must be a consultant that does not automatically make him/her a Doctor. We all know how to become a Doctor and age is no barrier.
If non-doctors must immutably be made consultants, their duties and jurisdictions must be clearly spelt out and understood by all involved. A Consultant Nurse should be confined to Nursing Practice and she will be expected to enhance it, not to invade Medical Practice. She must ensure that the management plan of a Doctor is properly carried out, even if he is a House Officer. Unfortunately, the idea of non-doctor consultant emanates from the desire of these other “health Professionals” for position and better pay than the desire to meet any specific needs. For instance, a ward Nurse that does her duties properly becomes a Consultant, what extra services and improvement does that bring to nursing care? The fact that there exist non-doctor consultants in a few foreign countries does not explain why the government should channel huge sums of money into the payment of honorarium to consultants that add nothing to the existing system but chaos. The NMA have identified these unhealthy health policies and should do all it can to prevent it from killing Nigerians.
On relativity of Wages:
Another very important object of discord is the demand by JOHESU for a unified salary scheme for everyone in the health sector and that will see a close approximation of the eventual earnings of all in the sector. What else can be sillier? Need I remind us that in every organization there is usually an established strata. Even in heaven, there are Angels and Arch angels, and the angels are content with their positions and would not want to usurp the duties of the Arch angels either. People cannot obtain different qualifications, different expertise, subserve different needs and end up earning similar pay. No. That cannot happen. Why would a non-specialist insist on being paid specialists allowance? Why would a Non-doctor terrorize the government because he wants to be paid like Doctors? Where in the world is that obtainable? Relativity is sacrosanct and must be reflected both on the basic salaries and all allowances.
Granted. Doctors are few. Very very few. The World Health Organisiation recommends that a Doctor should consult not more than seven patients in a clinic session and should pay maximum attention to their needs, but our environment see us in a situation where a Doctor consults over 40 patients in one clinic session, yet, he is underpaid compared to his colleagues even in nearby Ghana. There are less than 30,000 Doctors currently practicing in Nigeria subserving over 170 million Nigerians, and there is a dire need for more, but that will not push the Medical schools to take in everybody and churn out unqualified people as Doctors, neither will the Nigerian Doctor allow a Non-Doctor to tamper with the lives of patients. Doctors swore an oath to preserve lives and the NMA must see to it that the lives of Nigerians are safeguarded. If the Hippocratic Oath is to be taken serious, then the NMA must win this battle.
More often than not, we are clear on the knowledge that it is injustice to treat equal people unequally, but it fails to come to our minds that, it is graver injustice to treat unequal people equally. This is not pride, it is a statement of fact. Doctors and Non-doctors in the Health sector are not equal and they cannot be treated as equal. There is a reason why some students work harder than others to become Doctors. Some sat for JAMB several times to achieve that, although many fail to do so and even some do fail out of medical school and end up as “other Health Professionals”. To eventually anticipate to be rewarded equally with those who triumphed where you failed is simply madness. The government must see to it that relativity is maintained. For if a Nurse or Pharmacist consults patient, not regarding quality of the consult, earns equally with a Doctor and even get a chance to head the Doctor, why then would one need to work harder to become a Doctor when he can easily become a Pharmacist? Tampering with relativity is a conscious attempt at breeding mediocrity, again at the expense of lives. If the Nurses and Pharmacists accept to be paid equally with the Lab “Scientist” and Janitors, it’s their own cup of tea, but paying Doctors and Non-doctors equally? God forbid!
On the Physiotherapists’ demand to make first contact with Patients:
According to Prof. K. E. Obidike, there are three reasons why patients go to see Doctors. Firstly, is to ascertain the causes of their complaints and resolve them. Secondly, is to identify any other health problems unknown to the patient, and again, resolve them timely, and finally, to have a baseline documentation of the patient as a reference for subsequent health issues. The second reason especially, answers the question as to why a Physiotherapist cannot make first contact with patients. Medicine is holistic, and the initial assessment of a patient takes the entire body system into account not just the presenting complaints. Therefore, Physiotherapists should remain Physiotherapists and should come into action when consulted. Simple.
On adoption of Foreign Healthcare Structure:
The fundamental idea behind the establishment of Tertiary Healthcare centers (Teaching Hospitals) in Nigeria was primarily for training of Medical Practitioners, Research, and provision of specialized healthcare at very affordable rate. It is not a business venture, and if this aims and objectives are to be met, then the hospital must be made to operate under the very Act that established it. Comparing our Healthcare practices with that of foreign nations without a review of the aim and objectives viz-a-viz that of our country is practically insane. Granted, a few hospitals in Canada are headed by Non-Doctors, and there are few Non-Doctor Consultants with well-defined jurisdictions in a few foreign countries, but that does not in any way directly improve their health indices. After all, high quality health care is still not affordable for a large proportion of Americans despite their very potent health insurance system.
Our very first interest should be to assist the government, which some members of the health sector have chosen to distract, to ensure there is affordable healthcare services to all its citizenry, seek ways of improving the training of the medical personnel and carry out Research programs that will elevate the quality of healthcare delivery in our own nation. Yes. We can go abroad and observe what obtains from there, but instead of disrupting order in the already existing system, by trying to blindly implement it over here, we can see how best to fit a few of them into our system and get the best out of it. The Government should concentrate on policies that will better the lives of the larger population of Nigerians, not those that pacify some disgruntled group of individuals fighting for position and their own other personal interests.
There are many other issues that do not only need Government attention, but also its speedy response. Some of these areas include: the appointment of Directors in the hospitals which distorts the chain of command in the hospitals, induces anarchy and expose patients to conflicting treatment and management directives; the passage of the National Health Bill, and extension of Universal Health Coverage to cover 100% Nigerians and not 30% as currently prescribed by the National Health Insurance Scheme; the appointment of the office of the Surgeon General of the Federation alongside many other pressing needs. These are health issues of paramount importance and the Government cannot afford to be lackadaisical about them. No. Not this time.
My Recommendations:
First of all, JOHESU is an amorphous body comprising of different entities with varying agitations, concerns, qualifications, expertise, and eligibility status and should not be confronted in that front by the government. Our government has to recognize the various constituents independently and verify their individual complaints as some parts of it have no moral standee to withdraw its services because of the unmet demands of another. For instance, The Medical and Health Workers Union (MHWU) comprising of Clerks, Messengers, Record Officers, Admin staffs, Janitors, Engineers, Security etc., an association of different people with absolutely no training in any Health related courses should not dare to aspire for headship positions in the hospital let alone been prevented from doing so. We do not have to give reasons why they should not. Therefore, the five different associations and unions under JOHESU should be made to make their specific submissions independent of one another for clarity.
Secondly, the Nigerian Labour Congress and Trade Union Congress should look beyond Unionism and focus on the ultimate goal of everybody in the health sector which is adequate Health care for the Nation. They should relinquish their parochial stand in the dispute between JOHESU and NMA, and as well desist from all forms of hooliganism and attempt to bully the Government and NMA on this matter.
Finally, the Government should resist all attempts to coerce it into yielding to the demands of one party in the dispute when the matter is still in court. There should be absolute regard for the Rule of Law. And all previous “concessions” should be stalled, and pending till a decisive ruling by the court.
We can go on and on to address so many other issues in the health sector that require attention but I have decided to throw light at just some parts of it before the Doctors under the auspices of the Nigerian Medical Association, an association of all certified Medical Doctors practicing in Nigeria down their tools as proposed come July 1st, 2014. Before the health of the nation would be thrown into the hands of Non-Doctors in the Health sector that usually prefer the exclusive services of Doctors when they and their loved ones take ill. Before the general public begin to lash out on Doctors and blame them for lives lost as a result of the forthcoming massive industrial action. The onus lie on the general public to call out on the Government to resolve these life threatening issues before the Doctors take to this hurtful last resort of theirs.
God bless Nigeria.
By,
Basil, C. B. – M.B.B.S (Nigeria),
Department of Clinical Chemistry and Metabolic Medicine,
Benue State University Teaching Hospital.

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Consultants opt out of NMA strike, resume work....HOW TRUE?

Relying on the judgment of the National Industrial Court which stopped the Federal Government from implementing the agreement it had earlier reached with the Joint Health Sector Union and their planned strike,
The Medical and Dental Consultants Association of Nigeria has assured all patients and Nigerians of its commitment to uninterrupted and high quality health care services in all hospitals across the country.
The association urged its members nationwide to ignore the ongoing strike called by the Nigerian Medical Association, saying they should continue to provide services to patients.
The NMA President, Dr. Kayode Obeme, had said that last week’s interim injunction by the NIC has no link with the doctors strike as it was merely an issue between MDCAN and government.
“Every doctor is a member of NMA, other affiliates are allowed to operate also. We sought legal advice on the court injunction; our legal opinion is that the court order did not mention any reference to NMA and since it did not mention NMA, we don’t want to dwell on it,” he stated.
But the MDCAN said reports from hospitals nationwide and data collected from members after its meeting on Saturday in Ilorin, showed that members of the association -orthopedic surgeons, obstetricians, gynaecologists, infectious diseases specialists, physicians and several other specialists- had been attending to patients in various hospitals across the country.

In a statement on Sunday by its National President, Dr. Steven Oluwole, the consultants said they had been doing this “within the limits that are practicable in the current prevailing situation and circumstances.”
The meeting was to review the state of healthcare delivery in the country.
Oluwole said, “We note, without reservations, the unnecessary rivalry that has thrown the health sector into endless cycles of strikes and threat of strikes.
“The MDCAN complies fully with the restraining order on all parties, which is contained in the ruling, delivered by Hon. Justice M.N. Esowe on June 27, 2014, on the Motion Ex-Parte for an Order of Interim Injunction in Suit No. NICN/ABJ/177/2014 [Incorporated Trustees of MDCAN v. Federal Ministry of Health, Federal Ministry of Labour and Productivity & Attorney-General of the Federation, ( pending before the National Industrial Court, Abuja, Federal Capital Territory.
“In the same vein, MDCAN expects the other parties to the above suit to comply fully with the terms of the said restraining order. Branches of the MDCAN and individual consultants should continue to provide services to patients, but should exercise their professional judgement as to the best care feasible and practicable in the current situation.
“All patients and Nigerians are assured of our commitment to uninterrupted and high quality healthcare services. MDCAN pleads with the Federal Government of Nigeria to do all that is necessary to bring a quick end to the current impasse..

# BringBackOurDoctors!

**Stolen (And I don't think its funny either)

This outrageous act of arrogance on the part of Nigerian doctors has become nothing short of discriminatory against other medical workers and downright sickening.
We must not allow such nonsense to continue, so to that effect we the Action for Fellowship for Orderlies, Accountants and nurses union. (AFO ANU) and Other Koncerned Paramedics Organisation (OKPO), have come up with the following demands in the following sectors....
A) All cabin crew should be allowed to fly the aircrafts in Nigeria
B) Henceforth, gatemen are eligible to be appointed as chief of defence staff
C) That the midwives should be allowed to perform C/S on any relative of the federal executive council that might require this surgery
D) That henceforth, that any super eagles' supporter who has watched up to 5 games live should become the chief coach and be entitled to all allowances.
E) That the patent medicine dealer should be eligible to be appointed chief pharmacist.
F) That any orderly who has spent at least one year equivalent of post basic nursing training in a specialized ward be referred to as specialist and be paid specialist allowance. Afterall, the auxilliary nurses have being enjoying all the entitlements of the B.Sc nurses since the Gowon's regime.
G) That driving license shall be granted those who have ever played Need for speed past the first stage.
H) That the appointment to the office of the chief judge of the federation and minister of justice shall not be limited to LLB holder, but open to all staff in the ministry of justice. Afterall, all of us don judge case at one point or the other in our lifetime.
I) Morticians and people who wash corpses are Pathologists too. They spend more time with the dead bodies.
J) Henceforth, all staff of the national assemblies shall be referred to as senator and shall be paid as stipulated in the document that guides the remuneration of the elected senators.
k) Henceforth, a credit in pigeon English can be accepted in place of English language in Nigerian universities.
Native doctors, herbalists and traditional bone setters must hence forth be allowed to occupy the position of minster for health.
Position of Chief of army staff should be occupied by vigilante group members.
Hence forth, civil defence, road safety and man 'o' war should be entitled to the position of chief of defence staff.
Mechanics n electricians henceforth would be bona fide members n excos of Nigerian society of engineers.