The Trouble with the Nigeria Health Sector 2 by Dr John Paul

Why is it that we Nigerians like shortcuts?

 

Somebody who could not gain admission to study medicine and surgery now wants to not only be like medical doctors but to also lead the doctors. I got admission to study one of the paramedical courses but when I saw the central role of a medical doctor in the management of patients and I was not ready to play a second fiddle to anybody,I spent good four years of my productive years in the paramedical course before changing over to medicine. There are stories here and there of how people finished their first degrees,served out their NYSC years and applied through direct entry to study medicine. In fact in my class,my best friend, who had a first degree  in medical laboratory science,painfully failed out in our second MBBS  examination. He was not deterred,he collected his transcript and moved on to another school. 

 

The paradox there was that he became a doctor before many of our classmates,those were the vagaries of life. Also,my own roommate,popularly called master,who is now a resident doctor at Federal Teaching Hospital,Abakaliki,finished his first degree,served out his NYSC years,worked for few years and later returned to school to run a master's programme. He was a demonstrator in one of our first year practical courses. While still in the programme,he applied to study medicine through direct entry and when he got the admission,he consulted many people,even his own supervisor advised him to suspend his master's programme to pursue the medicine. My roommate passed through the pains of being in the same class with 'little kids' that he taught barely one year  and who saw him as demi-god then. The funny thing there was that he was not doing better in terms of academic performance than the 'little kids' he once taught. In fact,he was not among the first hundred brilliant students in the class but he persevered and today he has fulfilled his life ambition. No wonder,one of the former ministers of education during Chief Olusegun Obasanjo regime once proposed that medicine and surgery should be studied as a second degree course in  Nigeria,though the proposal was later abandoned,just like any other Nigerian projects/policies, by the successive administration.

 

Many people are calling for peace to return to the health sector while the underlying problems are not first nipped in the bud. It is like requesting to make a peace with a man while at the same time asking the same man to prepare a timetable for how you will be sharing his wife with him. As psychologists will always say that-peace is not the absence of war but the presence of justice-there is no way you can sit on my nose and get balanced. In the actual sense of it,the doctors are the ones that have been at the receiving end. In the private hospitals,if a doctor makes a mistake and sends a patient out to a medical laboratory scientist to run a test and come back,that is a farewell to that patient as the medical laboratory scientist after the test will interpret the result and  will still go further to prescribe drugs to the patient-thanks to broad spectrum drugs.Drug interactions along with other pharmacodynamic and pharnacokinetic properties of drugs are not taken care of hence the emergence of  drug resistance and the high rate of kidney failures among patients(I do not want to talk about all these herbal mixtures with NAFDAC registration numbers-may be that should be covered in my subsequent write-ups).

 

In some areas,some pharmacy shops are in symbiotic relationship with some medical laboratory firms. When a patient comes to a pharmacy shop,whoever is there refers the patient to the laboratory firm and after the test,the patient is sent back to the pharmacist for prescription and vice versa. I don't need to call names but if at all we have functional regulatory agencies,they can verify my claims as pharmacy shops are now giving intravenous drugs and still go on to  manage diarrhoeal diseases of children with anti-motility drugs ,just to mention but a few.

 

Traditional-birth- attendants and midwives are now 'medical' directors in their 'registered' maternity homes,they only refer out their patients when the whole situation gets complicated,most of which the patients will die on the road before reaching the nearest hospital. Was it not my auntie that was advised by a consultant gynaecologist last year that her pregnancy would end with caesarean section(cs) since the first was by cs? Thereafter,my auntie was convinced by her pastor that she would deliver normally if she delivered in one of their members' maternity,who knows if the pastor gets any commission for each referral.The summary is that,that my auntie is no longer in the land of the living today courtesy of the trial of labour in a pregnant woman who became pregnant less than one year of the previous delivery by cs and who presented with the same conditions that led to the first Cs. I decided not to go into any litigation because I warned  both my auntie and the husband but they attached more importance to the prophetic declaration by  their pastor. 

 

Why is it that the regulatory agency that accredits a pharmacy shop will  not approve a pharmacy shop if it is discovered that the said shop is owned by a medical doctor or that it is in the same compound with a hospital even if the shop has satisfied all the requirements including employing pharmacists?Anybody who is not happy with the central role of doctors in the health sector should simply pick up JAMB forms-either UTME or direct entry-to come and see what we saw,may be after passing through the difficulties of the course,the person will now advocate that doctors should be pushed to the corner while the JOHESU members who study their courses semester by semester with no difficulty will then become the leaders of the health sector .Nelson Mandela did a similar thing by picking a law form and studied law while in the prison in order to further his fight against the apartheid regime in his country.

    

In view of the above,I think if the government can neither disband JOHESU nor make doctors integral part of it,and cannot allow JOHESU to proceed on their proposed indefinite industrial action while salary packages and well fare of doctors are improved,then the only option left is to establish parallel JOHESU hospitals and possibly create another federal ministry just like ministry of Niger delta. The name may be federal ministry of JOHESU.I am very sure that such an establishment will not survive more than a year and it is then  that people will understand that JOHESU is an amorphous body like a keg of gunpowder waiting to explode. 

 

The the non-medical staff in JOHESU will realise that all these years,medical staff  part of JOHESU have just used them in achieving their ulterior motive which is primarily to fight doctors. The porters,the cleaners,ward-maids,mortuary-attendants etc will realise that they have been used by their more educated JOHESU members and that they have more differences than similarities for them to have existed together as a group.

 

It is akin to what happened in one of George Owen's novels,the Animal farm,where Napoleon after leading other animals to overthrow the owner of the manor farm,later turned out to be the worst ruler ever known .  If they care to learn from history,they will know what radiographers passed through in 2012 over the change of name of their regulatory body. It was then that the Bsc holders saw the HND holders as junior and inferior colleagues. 

 

A word, they say,is enough for the wise.

 

By DR PAUL JOHN

mazipauljohn@gmail.com

08083658038

We do not want to lose you our JOHESU brethren - NMA pleads

Paramedicals /Allied health care Professionals aka JOHESU,you might argue this but all that is happening now will in the long run even benefit you more and enhance ur job satisfaction. We (Doctors) re setting it straight and right in the health sector just for you.  FYI brother..We aren't fighting d masses or FG,we're in fact fighting 4 u.If we dare allow anyone else 2 take charge of ur health,we may lose you. #NMAStrike"

Why begrudge the Doctor?

For years, a healthy relationship existed between the doctor and all other health care workers. The nurse remained a nurse, the pharmacist remained a pharmacist, the laboratory scientist remained just that. It was the same for all other health care workers. There was no conflict in roles. No one crossed the other’s path. No one envied the other’s pay package. Everyone was satisfied with what they were.

In those days, there was no acrimony. There was instead harmony that allowed the hospital to work for the greater benefit of who it was really meant for: The patient. Everyone understood that health care service was a team work and everyone knew who the team leader was. Those days are gone. And gone, sadly.

All through the military regime, this breakdown in relationship did not exist. But with the levity that comes with democracy, it has come to be.

In the beginning, the doctor worked alone in his practice. You see this often when you watch foreign movies concerning doctors, who practise in a rural setting. He tends wounds, dispenses drugs, has a microscope, a few laboratory equipment and reagents. This is in fact how it was with medical practice from the beginning. The doctor was an all-rounder in the real sense of it. But with time, he began to have assistants. That was the birth of allied health workers. But as it is, those who the doctor helped exist have become Frankenstein monsters unto him.

But even in a hospital setting, while the doctor can still do the job of a pharmacist, nurse, and that of a laboratory scientist, they cannot do his job.

Perhaps, all those who used to agree that health care work is team work, but the doctor is the head of the medical team have now eaten from the “tree of life.” As we say it here, “their eyes don open.”

Now, paramedics and even ward attendants want to become Chief Medical Directors! The catechist can now become the parish priest, or even the bishop. Indeed, the dog has eaten the bone hung on its neck!

Can the court clerk or bailiff because of his years of experience become a judge? Can the Clerk of the National Assembly, who is the highest administrative officer in the National Assembly now aspire to be the President of the Senate?

When we were in medical school, we had those who could not cope with the rigours of medicine, who were withdrawn. Some of those who were withdrawn went for other disciplines not even near science. But some opted for allied courses, so that they could work in a hospital. There were also others who wanted to read medicine, but who could not meet up with the requirements, or the cut-off marks, then they opted for related courses. There are many of them. Brilliant chaps, but just that perhaps, as medicine is a calling, they were not called. But they have now come with a vengeance. They want to become doctors through the backdoor!

Care of patients is multidisciplinary, does not mean a nurse will perform a doctor’s role, or that a pharmacist should assume the role of a doctor. It does not also mean leadership role can be rotated. It only means that all the disciplines play their own unique roles to achieve a desired end.

There are many hospitals that have been set up by businessmen who are not even educated. But those hospitals are still headed by a medical director who is a medical doctor. Who heads the hospital is not in dispute. Even if a pharmacist, or a nurse, or a laboratory scientist decides to open a hospital, they will still put a doctor as the medical director. They know anything short of that will cast doubt on the integrity of the hospital. If these people will accord the doctor this respect in a private setting, why do they begrudge him a public setting? The grudge against doctors strikes at the concept called public hospital. Only in a public hospital will there be argument about who is in charge, only in a public hospital do you have conflicts of roles or who should be paid more.

Every profession is unique, but certain things make some professions premium. The Good Book called the doctor a wise man. “Honour the physician for the need thou hast of him: for the most High hath created him…he shall receive gifts of the king.

The skill of the physician shall lift up his head, and in the sight of great men he shall be praised.

Give a sweet savour, and a memorial of fine flour, and make a fat offering, and then give place to the physician.”

It cannot be controverted that the doctor plays a special role in the health care system. In complex and risky situations where there is uncertainty as the health of humans can often be, the doctor is expected to manage the complexity. This is because of his training which is rigorous and broad. We are told the syllabus for medicine is the human being.

Doctors are expected to have good judgment in every situation, even beyond the scope of guidelines and protocols. They know when to use protocols and apply them to problems and are quick to recognise changes.

In a multidisciplinary, team-based system as medical care has increasingly become, the doctor has the ultimate responsibility for a patient’s care. The team looks to the doctor for direction concerning the patient’s overall health care plan.

When something goes wrong with a patient, it is the doctor that is expected to provide answers. Leadership falls automatically on the doctor.

The special training of doctors places them in a position of authority on clinical standards and practice, especially with the intricate nature of diagnosis and treatment.

The medical degree cannot be substituted by on-the-job exposure by other health practitioners. There can never be a substitute for the extensive knowledge of clinical science and the full range of clinical skills that are the foundations of medical practice.

Doctors are now the enemies that other health care workers must join forces to defeat. But the same people who are after the doctor’s job, when they have patients who are their dear ones, they run straight to the doctor. They don’t assume to know anything anymore.

The usual excuse those who begrudge the doctor give is, “It is what happens in the US and the UK.” Just because the white man does something does it make it right? Abortion and homosexuality are the norm in many developed countries, why are we not following them? If you are doing the right thing, you can stand alone. We must stop copying the West, or making references to them. They are not smarter, or greater than us. They can learn from us.

But you might be tempted to think that those who begrudge the doctor are actually after his role, or position. But it is far from it. The truth is that money is what they seek. They think that by doing those work the doctor does, it will equate them with the doctor and a justification for greater pay package. If a nurse or a pharmacist, or a laboratory scientist or a physiotherapist earns more than a doctor, that ends the grudge against doctors. The doctor can keep his title with all his work!

Dr. Odoemena is a medical practitioner in Lagos

The Secret lives of Doctors - Starla Fitch, M.D. Author. Speaker. Coach.

Recently, when my parents came for a visit, our conversations led me to realize something important: I have been a doctor for more than 20 years, and yet my parents have no idea what my daily life is like. It then occurred to me that if they have no idea, then surely my patients have no idea either.
So, if you're a patient who's ever wondered what medicine looks like from where doctors stand, here goes...
Doctors cancel root canals and oil changes and skip their children's soccer games when they know their patients need them.
Doctors change their vacation schedules when patients schedule elective procedures several weeks down the road, so as not to inconvenience the patients, even though the patients are retired and have a bit more flexible schedule.
Doctors motor through clinic, surgery, and hospital rounds with a full bladder, an empty tummy, and a dry mouth because we consume no fluids for hours. Because we can. Because we feel guilty sometimes when we take a moment to ourselves. Because people are waiting.
Doctors are just as mortified as you are miffed when our schedules blow up in our faces and we keep you waiting for more than 10 minutes, let alone for more than 20 minutes, even if the reason is because we were in the emergency room or operating room or procedure room doing something to help a patient who was in much worse shape than you.
Doctors worry about you -- a lot. Not in a cowering, you-might-be-a-lawsuit-waiting-to-happen way, but more like in a, "Please, Lord, let them heal well despite the fact that they are diabetic and still smoking a pack a day, and though I know it must be hard for them to quit, I've asked them to stop so many times" way, or a "That specimen looks worrisome. I hope it will be fine and that they won't need more surgery. I wonder how long it will take the pathologist to let me know?" way.
Doctors are never talking to their broker, their tailor, their jeweler, or their Porsche dealer when they are late. They may be talking to the doctor taking care of their grandmother in a hospital in another state, or their uncle trying to explain their aunt's bad prognosis that they've just heard, or their spouse explaining why they can't be at the recital / ballgame / Scout meeting tonight.
Doctors are just as grateful as you are -- sometimes more so -- when your medical news is good. Whether it's a pathology report that's benign, your lab results that are now within normal limits, or an X-ray that shows improvement, we are rooting for you like the best cheerleader ever from the moment we order the test to the moment we get the report. We don't act like it because we don't want you to be freaked out by our level of concern. We are taught by our superiors and encouraged by our colleagues to act tough and we think that's what you want, too. But now you know: Deep inside, we're marshmallows.
When the phone or beeper goes off in the middle of the night, we are grateful if our family members are not calling and the emergency room is not calling. We can go back to sleep -- sometimes -- if all that's needed is the answer to an easy question from a patient. We hope we were awake enough to fully explain why everything is fine before our heads fall back onto our pillows.
We are grateful as we end our day that our patients did well, that our family is safe and healthy, and that we have completed another day of doing our best and "first, doing no harm." We marvel at the human body every day. We long to tell you, dear patient, how much we care. We hope you know.
Follow Starla Fitch, M.D. on Twitter: www.twitter.com/StarlaFitchMD

The doctors in this country are not given the necessary respect that they need - Lab scientist

Gloria Iheanacho writes. And i found it interesting.
I am a Medical lab scientist in one of the state hospitals. I have this strange feeling for doctors, hatred is the extreme form of what i feel about them. Its nothing personal. My family are JOHESU-mother is a nurse practising in the US for more than 16yrs, father is a pharmacist. 2 of my siblings are pharmacist and one a nurse. My mother watched the sunrise daily yesterday and kept on screaming. Theres no place in the US in which the other health workers heads. They are usually headed by doctors. Not all nurses are made consultants. You talk about consultant nurse when you talk about the legal aspect and they dont work in hospitals. Relativity is maintained everywhere in the health sector. Whats the debate about?
As hard as it is for me to write this, i want to be on the side of truth. The doctors in this country are not given the necessary respect that they need. Personally, i have read the 24 point demands and i think theres so much sense in it. The FG needs to do something about this. Lets join our hands and build our health sector. Health they say is wealth.

JOHESU’S CLAIMS AGAINST DOCTORS IN NIGERIA; A CASE OF HISTORIC AMNESIA by Korie Amarchi

 When Pharm. Olumide Akintayo, the president of Pharmaceutical Society of Nigeria a renowned JOHESU Warlord recently alleged that Nigerian Doctors are trying to force the Hippocratic order of Medicine on other paramedical professionals in Nigeria when they insist that Doctors must continue to lead the medical team. First, as an activist, it made some sense to me, but on second thought, my mind went to World Health Organization (WHO) the United Nations Human Right Arm of Health.
This took me to the year precisely April, 1948 when the man George Brock Chisholm from Canada became the first Director General (DG) of WHO winning with a vote of 46-2. This great man was initially a soldier with Canadian Expeditionary Force, who out of his passion for medicine and because medicine is not hereditary, struggled to earn for himself Doctor of Medicine (MD) from the University of Toronto, he was a renowned Medical Doctor with psychiatry bias. He led WHO till 1953.
To fill the vacancy created by Brock Chisholm’s exit, another man Marcolino Gomes Candau a Brazilian, was elected to head WHO for the next twenty years. He was a medical doctor that graduated from the state of Rio de Janeiro, University of Brazil and Johns Hopkins University.
When Gomes Candau left in 1973, another man a Danish Medical Doctor Halfan Mahler was made the DG of WHO. He was to give us the historic Alma-Ata Declaration, and led the organization for the next fifteen years.
After the exit of Mahler in 1988, there came another medical doctor from Japan by name Hiroshi Nakajima who graduated from medicine at the Tokyo Medical University . it is of importance to note that when Hiroshi was employed in 1994 at WHO, he was the scientist in charge of Drug Evaluation and monitoring which led to his being made in 1976, the Head of WHO Drug Policies and Management where he pioneered the concept of today’s essential drugs.
In Nigeria today, if a doctor who by training been endowed to be versatile in drugs and therapeutics is made the head of such parastatal, JOHESU will call for earthquake, it has become a crime in Nigeria for a doctor to oversee the council that formulates the training of nurses or even hospital cleaners. So sad!!
After Hiroshi’s exit in 1998 came another Medical Colossus, the Norwegian Iron lady Gro Harlem Brundtland who headed WHO from 1998 to 2003. Brundtland’s first choice of carrier was neither to be an Environmentalist or Politician, but to be a doctor like her father. She was a Specialist in Rehabilitation Medicine and is good to note that this lady served three terms as Norways Prime Minister.
In 2003, another new head was appointed to lead WHO, the great Dr Lee Gong-Wook. Lee was the first Korean to lead an international agency. A medical doctor who also obtained a medical degree at Seoul National University. Lee tenure was rudely cut short by his untimely death in 2006.
Following the sudden death of Dr Lee, another acting head was appointed to lead WHO from May 2006 to January 2007 by name Anders Nordstrom. Also Anders was a medical graduate of karolinska Institut Sweden, who prior his DG appointment was WHO’s Assistant DG and has a background that combines development experience in the field, National and International Health Policy and Planning, and Strategic leadership.
After this short interregnum of Lee’s death , a substantive DG, Dr Margaret Chan was appointed and she resumed duties in January, 2007. Dr Chan who is the current WHO, was previously trained as a Home Economist, but for her love and passion for medicine, had to go to the University of Western Ontario for her medical circumcision where she qualified as a medical doctor in 1977 after which she joined the Hong Kong government in 1978 as a Medical Officer.
So why the noise about the imperialistic nature of Nigerian Medical Association? Why is it that the black Africans only way of reaching the outer space is by witchcraft? What is wrong in our continent in doing the needful in encouraging our scientist to first gain the expertise that will aid us build a spacecraft? How can our noble brothers and amiable sisters who are Pharmacists and Nurses choose to form gangsterish association with hospital cleaners, laborers, porters and security men whose sole aim is to find a way of bringing down the laboring Hippocratic order of medicine in this amorphous assembly of JOHESU (Joint Health Sector Union) or simply put “Joe Hates U”?
While one cannot be blind to the corruption being seen among the various heads of our health institutions where some Medical Directors have become even more administratively horrible and financially corrupt like the mere rogues that abound in our political landscape, that will never be allowed for the excuse to water down the hierarchical order of the noble medical profession.
Like in any other profession of the world, there are men who have administrative and academic excellence as their watch word, such doctors should be given leadership positions instead of the government trying to turn the revered medical profession into a banana republic where porters want to be called medical consultants in “medical porterring” thereby confusing our already disoriented patients.
Let’s be proud of who we are in this nation as professionals and strive to be who we we want to be through the legally available means.
If WHO can as a standard United Nations Health Organization have a respected order of who becomes who, why is our health ministry getting confused on how to maintain order in the health sector.
Even if wishes were horses,

Catholic Catechists can never be called Archbishops!! Ka Chineke Mezie Okwu!!!!