A Doctor's (Nearly) Unbiased View On JOHESU

On a normal Thursday, I would be too busy to comment on JOHESU and
its antics. Unfortunately, an NMA strike is on and I find myself with time
enough to ponder on this grave matter.
Let me tell you a story...
Once upon a time, a magistrate asked for assistants to be employed in a
bid to make his services more efficient. After some time, they got so
good in their specific tasks, they felt
indispensable and proficient enough to do all the magistrate did. They
began to agitate to bear the titles "Esquire" and "SAN". They began to
blackmail a weak government seeking re-election.
They went on strike and locked up the courts to prevent the magistrate
from working (knowing that left alone, the magistrate could still see
cases).
These assistants also went to the media and began to mislead the
public. The government
without proper consultation or consideration of "international best
practices" agreed to the
demands of these assistants due to their large number (and monetary
influence?).
So the magistrate went on strike and left them to attend to cases.
Haba, Magistrate! Why should you have gone on strike? Here's the
reason why:
An analysis of JOHESU:
Nurses: Most nurses always wanted to be nurses. They love their
profession and work closely with doctors despite the often overbearing
attitudes of
these doctors. They appear not to be too keen on this JOHESU fight as
they lack the inferiority complex displayed by other members. Within
their ranks is a battle between the traditional
Registered Nurses and the university trained B.Sc Nurses. This may
contribute to their disinterest. A lot of them are married to doctors, have
dated doctors or have doctors as children.
PS: "Doctor" refers to a medical doctor who has sworn the Hippocratic
oath or a similar oath and carries a licence to practice Medicine.
Pharmacists:
These professionals are university trained. Unfortunately, in the
government sector, their
role appears to have been largely limited to procuring, stocking and
dispensing of medications. Their occasional attempts to involve
themselves in patient care is often tainted by the mutual suspicion
between them and the clinician (doctor) directly responsible for the
patients.
The Pharm.D (Doctor of Pharmacy) programme is currently the standard
in the USA but is under some controversy in Nigeria as other university
academics (excluding medical doctors) are unhappy by what appears to
be a shortcut to a Ph.D equivalent.
Some pharmacists want(ed) to be medical doctors. In some pharmacies,
they are already masquerading as doctors.
Some are quite satisfied being what they always dreamt of.
Optometrists:
These are trained in the University to measure refractive errors and
prescribe lenses (glasses). In addition, they receive clinical training in
management of simple eye disorders.
Ophthalmologists (medical doctors specializing in eye disorders) are
inadequate in number and are
more focussed on eye diseases. Optometrists provide valuable services
as primary care providers and even ophthalmologists go to them
for glasses...but...
They are not doctors in the medical sense. Some universities run 6 year
courses and award O.D. (Doctor of Optometry).
However, when it comes to major eye disease and eye surgery, only the
ophthalmologist is licensed to treat.
Optometrists are doing well financially based on their private practices.
They are not key militants in the JOHESU saga.
Physiotherapists:
These relatively new and few entrants into Nigeria's health sector are
University-trained to carry out physical rehabilitation of patients. Some
also run private gyms.
Depending on their training institution, they receive bachelor's or
"doctorate" degrees. Most of them will confess to have chosen to read
Medicine
initially. Like the general public, most of them were not aware of their
current profession when they got university admission.
Their association is rapidly becoming one of the more militant JOHESU
affiliates.
Medical Laboratory Scientists (Technologists?)
These are the arrow-heads of JOHESU. As a group, they have the free
time, the resources and the lack of professionalism and empathy for
suffering patients needed to start this controversy.
These staff are usually not university trained as their programmes are
run by accredited teaching hospitals. They obtain memberships and
fellowships of the institutes of Laboratory Science (or Technology)
allowing them to work in Pathology laboratories.
Virtually all of these folks had the ambition of being medical doctors but
could not meet the requirements.
In better countries than Nigeria, laboratories are headed by research
scientists (in research institutes) and by consultant pathologists (in
hospitals). Research scientists are typically Ph.D holders while
consultant pathologists are medical doctors with postgraduate
specializations in Pathology.
In Nigeria, they are quick to claim they do all the work in the
laboratories of government hospitals.
In their private practices, most masquerade as doctors, prescribing
antibiotics and other drugs after spurious "Typhoid" tests.
Having grown wings, they fired the first salvo by declaring their right to
perform accreditation for all labs in Nigeria including side-labs in private
hospitals.
The next issue was preventing resident doctors in training from
accessing the labs to carry out procedures (yet they claim they do all
the work).
It got to the point, doctors were physically harassed by laboratory
scientists and hounded by the Police and SSS on the instigation of these
technologists. Luckily, most security agencies quickly washed their hands
off this matter.
Interestingly, when JOHESU members (or their family) get ill, they never
go to their fellow JOHESU members for care or advice! They always look
privately for the same doctor they insult publicly. And the doctors still
treat them specially "as colleagues".
This JOHESU problem appears to be a problem of the teaching
hospitals. State-owned hospitals and private/institutional centres would
not condone this needless rabble-rousing and jostling for primacy.
Nigerians shouldn't permit persons without direct involvement in patient-
care add to the many problems already facing our healthcare system.
Nigeria is not the only country running a teaching hospital system. Let's
look at the successful models in other countries and make things work.
That way, all these unnecessary crises in our health system will end.

THE ROAD TO BECOMING A CONSULTANT

Cut this from the wall of Essien Attah:

As the clamour by nurses, pharmacists
and lab scientists to be named consultants
in Government hospitals reaches feverish
pitch the Nigerian public is caught up in a
needless war that is born out of recurring
strikes in the health sector as the two
titans clash.
Many ask why are doctors so opposed to
the assumed right of Nurses, Lab
scientists and pharmacists to wear the
label Consultant. Here is the reason why?
These paramedics are deluding
themselves into adducing that years of
service equate to attaining a consultancy.
This is miles from the truth.
A Consultant is a post attained by
appointment upon a medical doctor
completing a specialist training course
and passing the prerequisite exams in a
bid to acquire a fellowship.
This fellowship is the equivalent to a PhD
as ratified by the National Universities
Commission.
While striving to attain this Fellowship the
doctor is listed as a temporary staff of the
institution where he trains and his
appointment is subject to termination
without gratuity or benefits if he fails to
complete his training in a stipulated
period.
Hence not all Doctors can be consultants.
Some are medical officers of great
standing but alas being a medical officer
for 30years doesn't make one a
consultant. Neither does dispensing drugs
as a patent medicine dealer make one a
Pharmacist. Nor taking deliveries in the
village for 40years make a Traditional
birth attendant a Double qualified midwife.
Hence it is a misnomer for a being to
wake up and abrogate Consultant Nurse to
oneself without any certification to back it
up. And to be a consultant one must have
a specialty. So what specialties in Nursing
and Lab science have been created up to
PhD level recognised by NUC? Absolutely
none.
Alas only the Pharmacist deserve the
appellation Consultant. For there are a
gamut of specialties in pharmacy ranging
from pharmaceutics to pharmacognosy
hence they are indeed worthy of
recognition if they further their learning up
to the PhD level.
But alas all this talk of Consultant Nurse,
Consultant Lab Scientist, Consultant Ward
Orderly and Consultant Cleaners is just a
ploy to abrogate undeserved fame to
one's self and to hoodwink the
Government into paying Specialist
allowance to non specialists.
A Specialist differs from others. Others
can do what a specialist does is true. But
a Specialist not only does, he knows why
and how to do what he does and most
importantly he can handle complicated
cases and teach others to do what he
does.
For example any medical officer can do a
Caesarean Section but many can't explain
the pathology behind the events leading
up to the need for the operation.
Recently a Doctor from my unit went to
the lab "Asking for the Hematologist"
A lab person stepped forward usurping the
Doctor specialising in Hematology.
" Yes am the Hematologist" he boldly said
"Good I have a patient who has just had
Abruptio placentae and Disseminated
Intravascular Coagulopathy in need of
urgent review"
"Bros I beg no vex. Na lab scientist I be.
This one pass my power. I beg see the
Real Hematologist sitting there. I beg go
meet am" was the perplexed reply.
Hence sitting in a lab for 20years doing
PCV and Full blood count and testing for
malaria and typhoid can never equate to
being a consultant.
A consultant is an elite breed. The last
resort. He is next to God. For if he fails
then only a miracle from God can save
that person. So one wonders how one can
apply being a Consultant in Bed making to
critical patient care.
Even the Consultant Nurse in wound
dressing cannot divulge the
pathophysiology of wound healing hence
of what point is the adjudge title.
Alas experience is vital in Medicine. I
listen to my nurses for they have seen
more cases than I have thus I weigh their
opinions against my own clinical
judgement. Their input in patient care
should never be overlooked.
But alas every final decision on patient
care rests with the consultant. He makes
the hard choices. Like terminating a
pregnancy in a woman who has searched
for a baby for 10 years because she has
severe pre eclampsia at 5 months and her
kidneys are failing.
These dilemmas are what makes a
consultant. A consultant does what is best
for the patient at all times. Each patient
listed under a consultant is legally bound
to receive the best care possible under
the prevailing circumstance. Now with
multiple paramedical consultants running
amock on whom will the patient's care
rest upon?
Hence any paramedic that wishes to
become a consultant should be ready to
pass through the grueling training and
stop dreaming of an overnight
consultancy.
 That is folly to say the least.