THE NIGERIAN HEALTH SECTOR: "SOME TRUTHS AND SHAPESHIFTERS" PART 3!


Final Part
By Dr. Jide Akeju

The introduction of an expanded program that involves greater specialization was introduced in the USA, this is generally not a worldwide practice and only one institution in the United Kingdom offers something similar to the Doctor of Physical therapy program popular in the USA. JOHESU affiliates readily point to other climes to justify their demands. It can be deduced that the agitation for a residency program by the NSP has been copied from the USA, it is not what anyone can term as best global practice and regarded as excessive in some climes where masters or PhD programs are viewed as sufficient postgraduate training. Do the NSP have the requisite facilitators and experienced trainers to oversee a qualitative residency program or are they just copying and pasting what is practiced in another place without adequately evaluating the pros and cons?

If residency program is part of the agitations of JOHESU, which of the professional bodies are going to benefit? It is clear the NSP are going to reap significantly. The terminology “Consultant” refers in our system to specialist senior doctors who are appointed to ultimately take responsibility for patient admission and management. They are also involved in clinical training and supervision of medical students and resident doctors. Some of these individuals do have dual appointments in institutions with affiliated colleges of medicine where they also teach students outside of the clinical environment; undertake research and participate in general University duties and activities. It becomes laughable when JOHESU release a statement contesting double salaries given to honorary consultants and allegations that some doctors are so highly paid even more than university professors when in fact a few of them are university professors. The term is consistent with the British system as well as some commonwealth nations.
 It should be easy to understand why some allied healthcare workers are called consultants in the USA where the equivalent of hospital medical consultants and specialists are called “Attending Physicians”. Although Prof. Alonge appeared to support the appointment of consultants from other health workers, he did point to the fact that a discrepancy exist in the interpretation of the term as it affects both groups hence a need to clarify issues. I do not think that is exactly what the deserving members of JOHESU want. They constantly point at what doctors are enjoying and I guess it is those benefits they assume doctors are enjoying that has led to the demand. 

What is the yardstick to determine who and who is deserving of consultancy positions?

 Would it not lead to further rift within the ranks of JOHESU if certain affiliates do not benefit from the consultancy largess?

What would make the non-professional groups inherent in JOHESU undeserving of being appointed as consultants? 

Are the agitators of consultancy willing and competent to shoulder the responsibilities of patient care and the demands of such appointment? 

A hospital consultant position is not a reward for longevity nor is it like the appointment of delegates to a conference. It is not the peak of a doctor’s career, a doctor does not necessarily need to be in a residency program and become a consultant before he/ she can be regarded as successful or accomplished. We should not just simply adopt terminologies that are used in other climes and take them out of context to adopt them in our own system. Nurses have also recently pointed to the appointment of a female nurse as the US Army Surgeon General as validation of their demands.

It is really easy to be awed by such information but what many fail to do is read just a little about the woman concerned Patricia Horoho. It is clear that she did not attain such lofty heights just because of being a member of a gender or profession minority; she is a first class Lieutenant General highly trained and equipped to manage such a responsibility that entails human, material and enormous financial resources. Our people in Nigeria always clamor for equation balancing at the complete expense of competence. Should the JOHESU not demand for better funding and standardized education and training instead of striving for potentially unsustainable projects that could be deflated by politics and underfunding? A fellow named Nwaneri commented on a link to a JOHESU draft on the 20th of January 2014. The man commended the JOHESU executive for their resilience but asked when and if they would also ensure residency training for medical laboratory scientists and BSc nurses. Someone should lodge a requisition for NASU residency quickly.

I searched for a JOHESU website but could not locate any so I turned my attention for a facebook page at least. I did find three (3) affiliated to institutions in Yobe, Gombe and the Federal Medical Center Abeokuta (FMCA). The one for the FMCA had 148 members and one administrator called Otunba Tiamiyu who is also the public relations officer of the Abeokuta chapter of JOHESU. The” admin” seems to be a young man hell bent on misinforming him many members and launching constant abuse at the management and consultants of his institution. The fellow’s command of the English language and utterances is rather appalling and one can only imagine how such a man is responsible for representing the interest of any credible association that includes pharmacists and physiotherapists. He described the resident doctors as toddlers and their protest as senseless; he was reported in the Leadership newspapers (a paper that I think is sympathetic to the mission of JOHESU) on the 26th of July 2014 to say that doctors only jump at strikes to divert patients to their private hospitals in order to charge exorbitant fees. He rejoiced that the public had arisen to curb the excesses of doctors who he accused of behaving as gods. These are the kind of people who peddle all sorts of falsehood and inconsistencies about doctors and the NMA. They regularly accuse the NMA of incessant strike actions and easily forget the many occasions the JOHESU have threatened or outrightly embarked on strike actions that effectively grounded the health sector.

A quick search through Google will produce results that clearly show that the “development” of the health sector has been greatly slowed down by frequent strike actions detonated by the camp of the JOHESU. May 7, 2012; August 21, 2013; January 15, 2014: these are all dates of outright nationwide strikes embarked upon by JOHESU. They have been calling for the sack of the current Minister of health since 2011. They made this demand on the 21st of February 2011 accusing the minister of sabotaging their interests in favor of doctors. They continued with this demand in December 2012 and January 2013. This same minister is currently being hailed for enforcing the sack of resident doctors who are not contesting CMD or director positions with the JOHESU top brass. In a letter dated January 17, 2014 and addressed to the Minister of Health, JOHESU had stated that its good faith, patience and restraint to go on strike had been taken for weakness by the government. I wonder what JOHESU needs to do for the health ministry to sack all medical laboratory scientists in order to restructure the health sector.

JOHESU has claimed that the NMA have no right to negotiate labour disputes for any reason and to embark on strikes which has been supported vehemently by a few supposedly experienced public commentators as well as some journalists who through their reportage express clear partisanship and a clearly lackadaisical approach to their work devoid of intelligent research and fairness. One reporter with the leadership newspaper put up 2 headlines online in the space of less than 30minutes that referred to the same story that aimed to vilify the NMA and doctors. The same JOHESU that claims the NMA has no bargaining right with the FG constantly make reference to a 2009 bargaining agreement that was implemented for doctors but yet to be done for them. The public commentators usually mention that doctors are part of what is regarded as “essential services” that should never go on strike. In a blog post on the 25th of October 2012 titled “The Right to Strike in Nigeria and ILO Principles on the Right to Strike”; Femi Aborishade of the Polytechnic, Ibadan and center for labour studies reviews and appraises the laws guiding strike actions in Nigeria, the principles recommended by the International Labour Organization (ILO) on strike actions and how such affects Nigeria especially the drawbacks. The Committee of Experts and the Committee on Freedom of Association of the ILO appeared to justify the scope of restriction of strike action in “essential services” which was defined in 1983 as those services “the interruption of which would endanger the life, personal safety or health of the whole or part of the population”. The Committee on Freedom of Association described that essential services in the strict sense of the term depended to a large extent on the particular circumstances prevailing in a country and that a non-essential service may however become essential if a strike lasts beyond a certain time or extends beyond a certain scope, thus endangering the life, personal safety or health of the whole or part of the population. The committee considered essential services in the strict sense may be subject to major restrictions or even prohibitions; this is inclusive of the hospital sector; electricity services; water supply services; the telephone service and air traffic control. It is instructive that the ILO’s committee mentioned “hospital sector” and not medical doctors because striking doctors renders all other health care workers redundant likewise doctors left in a health sector paralyzed by absent health workers is also a waste of time and resources. Essentially services in the UK are listed as Emergency services, Armed forces, Health and social workers, Food industry; Agriculture, veterinary and animal welfare; Essential workers at nuclear sites; Water, sewerage and drainage; Fuel and energy suppliers; Public transport,  Licensed taxis; Coastguards and lifeboat crews;  Airport and airline workers; Postal, media, telecommunications; Central and local government workers; Essential financial services staff including those involved in the delivery of cash and cheques; Prison staff; Refuse collection and industrial waste;  Funeral services; Special schools and colleges for the disabled and Essential foreign diplomatic workers. 

If this nation realizes the importance of these diverse industries to the welfare of their people, why do our leaders assume they as politicians are more important that everyone else? 

They utilize divisive tactics to set sectors that ought to be in perfect harmony and operate in unison at each other’s femoral arteries while they simply embark on state funded trips to nations where doctors and health workers are well catered for to even think of strikes for checkup and definitive treatment. Workers who ought to know their services are equally as essential as what doctors provide sit perched on their moral high grounds to condemn doctors for demanding better conditions for the collective health sector while they move around without condemnation when they go on their own frequent strikes that shuts down record offices, morgues, theatres, pharmacies, stores, oxygen supply and wards amongst others. These frequent strikes are generally assumed to be doctors’ strike by the average visitor to the hospital. The mischievous members of JOHESU leverage on this misconception to divert the responsibility from themselves towards doctors instead.

Nigerians have to arise and make concrete demands from their government to improve their welfare. They should not just wallow in the mud and take just whatever crumbs the FG throws at them. The funds meant for developing the health sector to international standards are constantly being squandered and those who ought to know better have chosen not to be enlightened enough to ask the relevant questions and have offered themselves with the associations they represent willingly or otherwise to be tools in the hands of politicians to perpetually impoverish Nigerians

The story in the book of 1kings chapter 3 tells the story of 2 characters; prostitutes who had babies. One woman canvassed for the living baby to be split down the middle while the other only wanted the integrity of the baby. The king in his wisdom judged rightly and awarded the baby to the true mother. The NMA is asking for the status quo to be maintained while JOHESU wants what they deem are their rights and privileges. This is not to say doctors are immune to blame in all that has transpired but the truth is that the things demanded for by the JOHESU if granted would largely plunge the health sector into further crises that may not even involve the NMA. The Nurses, pharmacists and physiotherapists would become consultants; directors would emerge and then a number of the “patch patch” members would be left stranded or with crumbs. The pharmacists and physiotherapists know that they cannot embark on any effective strike to get their desired consultancy status and residency programs without the foot soldiers that would lock the doors and grind federal institutions to a halt. These unfortunate ones will realize albeit too late that they were only used and deceived with promises of better welfare packages and wage grade level increases. Some of them may never get to those grade levels by virtue of their limited educational qualifications and poverty of additional training irrespective of the years of service they offer.

The FG approved huge benefits and amnesty for reportedly surrendered militants from the Niger-Delta region. Some of these individuals have been widely reported in the local media to be on training or academic programs overseas. This is not entirely true as many Nigerians from a certain geopolitical region of Nigeria favored by the incumbent have flooded choice institutions across the world for undergraduate degrees in the stead of these militants and to the detriment of the nation’s tertiary educational sector. It is shocking that Nigerians are unmoved by the nonchalance of the FG to ensuring equity and providing even good facilities within the country. It is not surprising that government runs like normal despite the onslaught of misguided insurgents in the northeast and the over 130days of secondary school girls stranded in captivity. It is baffling that some Nigerians find it convenient to tolerate the idea of the President Jonathan's reluctance or refusal to visit his troops in the north east of Nigeria despite having the resources to do so in a flash. 

Why do some Nigerians who are supposedly educated find it very appropriate to berate doctors who insist on certain minimum standards before the strike is called off or before moving all out against the Ebola scourge? For them and some health workers, it is all about a Hippocratic Oath they seem to know nothing about. Nurses also have their oath but conveniently forget it when it comes to vilifying doctors. Is it only doctors that take oaths before embarking on their assignments? Did President Jonathan recite a poem at his inauguration?

Dr. Jide Akeju 
Senior Resident
Jideakej@gmail.com

Medic-ALL.Inc 2014

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