What do these doctors want?
As I type this the world cup has ended and Germany
crowned the world champions after their victory over the Argentines in a
scintillating finals and it is about 2 weeks since the doctors in Nigeria embarked
on an indefinite strike. This worries me because the poor masses are left at
the mercy of the private practitioners, quacks and their fees.
Then I ask myself what do these doctors actually want? Did
they get it wrong, what happened to their Hippocratic oath , are they being
selfish? What do we stand to gain from it as a people and what does the
government stand to gain out of all this?
The Nigerian doctor has been described as a god who wants to be worshipped, some
have also described him as a terrorist
equating him to the dreaded boko haram sect. He has received all manner of name
calling and insults because he decided to go on a total strike for the first
time in a long time. This makes me to wonder does the doctor actually deserve
all these. The man/woman whom you will give your life to handle when ill at the
point of death, does he really deserve this?
For the first time in a long time, the Nigeria medical association (NMA)
ordered a total strike involving all the doctors working in the public
hospitals in Nigeria. For the first time they are all singing in one voice
because the soul of the profession is being threatened. The consultants are not
saying one thing and the resident doctors saying another thing. Everybody is
saying let the proper thing be done. This action is most regrettable but that
is the language our government and society hears.
Is the doctor being over pampered by the society, is his
knowledge superior to that of others because he spent 6 years in school? Why is
he even on strike in the first instance? Is it because of administrative issues,
is NMA a union that they should go on strike in the first instance? What happened
to saving lives? These are just some of the concerns expressed by the Nigerian public.
The issues involved in this strike is as complex as the
entity called Nigeria. Like the process of granting the southeast an additional
state in the south east metamorphosing into creating 18 additional states for Nigeria
in the on going national conference. That is how complex the issues in the
health sector is. And to an outsider it may even be a bit confusing and some
doctors are even confused as to why the strike in the first place. The more one
tries to make sense of it the more complex it seems. Nigerians are complex by
nature and often times their problems require a complex approach to make it
satisfactory to all parties. However in this case the onus lies with the
federal government to do what is right.
So what
do these doctors want?
I Am going to try
to say what they want and proffer some explanations and what needs to be done
for the doctors to return to their duty posts.
a. They want only doctors to be addressed
and described as consultants in the hospital setting. Does
this make them egoistic? Anybody can be a consultant but in the hospital only
the doctor can be a consultant. Same as only one pilot can be a pilot in a plane
others can be co-pilots. Only one captain can steer a ship even if there are
others of same rank on board. The term consultant in the hospital setting
describes the relationship the specialist doctor has with his patient who has
come to consult him concerning a specific ailment. And for him to be appointed
a consultant by a hospital, he must have obtained the necessary training and qualifications. Because in the tertiary
health institutions, only the consultant owns a patient and directs on how the
patient management should proceed. Therefore if you want to be addressed as a
consultant in the hospital setting go get the necessary qualifications and
training and be ready to take responsibility of the patient. It is a
misconception to think that doctors don’t want others to be called a
consultant. No what we say is that in the hospital we want only a person with
the requisite training and qualification be appointed as a consultant. Even doctors
who are academic professors and not clinical consultants cannot own patients in
the tertiary health institutions.
b. They want the National Health Bill (NHB)
passed. We are happy that the house of representatives have
passed this bill and we are waiting for the senate to follow suit. This is a
bill that will address universal health insurance for Nigerians and make
healthcare accessible to majority of Nigerians. This is a bill that will help
sanitize the healthcare sector of these perennial problems that make everybody
go on strike always.
c. Hazard allowance of at least N100 000. This
point is one that vexes my being. The current hazard allowance of N5000 is
totally not acceptable. You can only imagine the level of risks and hazards the
doctor and other healthcare worker exposes himself to. Exposure and treatment to
tuberculosis, hepatitis b, AIDS and lassa fever just to mention a few, cannot
be treated with N5000 that is the
gospel truth. Talk more the psychological trauma associated and when you factor
in the burden to the family following the demise of a doctor who in most cases
is the breadwinner to any of the aforementioned, it is catastrophic. Please as
a matter of urgency this should be addressed speedily. If a classroom lecturer
who is exposed to “chalk” and occasional student unrest can get as much as N30000 as hazard allowance, the government
can do better for the doctors.
d. They want the harassment, intimidation
and physical assault of pathologist by lab scientists being tolerated by the
federal ministry of health (FMOH) to stop. In what sane clime
is this obtainable, that one professional will attack another to the point of
physical assault over work related issues.? What sort of society do we live in?
this happens and the parent ministry does little to nothing? If the federal
ministry of health wishes to proscribe the position of pathologists in the
health care sector let them say so. Pathology is the bedrock of clinical
medicine and a very vital component of patient management. The mistake people
make is to assume that it revolves only around carrying out investigations and reporting
results. I implore the FMOH to properly delineate job descriptions and roles to
forestall further shenanigans in the hospitals. A good and conducive working
environment breeds excellence.
e. They want a Health Trust Fund for
upgrading of the hospitals. Why do we have to go on strike before
the government does the needful? The situation where a patient with a head
injury travels over 3 hours to have an MRI scan done should be frowned upon. This
is a good idea that should be supported by all. Facilities in the hospitals
should be brought up to world standard and a trust fund will go a long way in
making this a reality. And all the medical tourism abroad will be brought to a
minimum with its associated loss of income and revenue to the government. Because
if I can get a kidney transplant done successfully in Ibadan at N2milloin why
would I go to India to do it for N6million. And still pay airfare and book
hotel rooms etc. these logistics can be minimized if we have same services here
in Nigeria.
f. They want only doctors to be Chief
Medical Directors. This is also the root of the unrest in the
health sector. This issue has been discussed for a very long time. The Igbo
will say “anyi aga hapu omenala mewe
omenelu?”(are we going to sacrifice our culture/tradition for the unknown?).
God forbid. From the days of Hippocrates till date It is the custom of the
medical profession for the doctors to lead while the others assist him. Why then
should we then discard this tradition because somebody has acquired an MSc or
PhD. The doctor has the holistic knowledge of the patient and the appropriate management
of the patient. The training of a doctor gives him/her the knowledge of how to
run basic investigations and dispense the necessary drugs for his patient,
however due to the cumbersome nature of the duties, this made him to teach
others how to assist him to make the work less tedious for him which gave birth
to these other disciplines. It is like an airhostess who has been trained to
handle the passengers to now say that because she has spent 100years in the
cockpit she is now qualified to fly the plane. We must be careful of the
precedents we are setting in this country. If nurses, pharmacists, lab scientist
who decide to set up private hospitals in the country still look for an MBBS
doctor despite having administrative managers to be their medical directors.
why would they now want the opposite in the public hospitals? If the judiciary
says a court clerk by virtue of having worked in the court for 50years can now
be a chief judge or the university council saying that a non-academic staff can
now aspire to be a vice-chancellor, then anybody can be a Chief Medical Director.
But until then let us allow the status quo.
g. Finally they want relativity and
skipping.. these are administrative terms which are sacrosanct all
over the world in the healthcare sector and should be dealt with accordingly by
the FMOH.
Having x-rayed some of the things the doctors want out
of the 24 demands, does it now mean the doctor is selfish or not satisfied with
his job? The mistake one will make is to think that this strike is all about
salaries and wages. What they want is that sanity should reign and global best
practices be instituted in our healthcare system. We don’t want our brothers
and children after spending long years and consuming a lot of expenses in the
course of their studies to leave Nigeria for the shores of the west or middle
east because the working conditions are not favorable. The doctors are fighting
for the soul of their profession and want the sacredness of the profession
maintained. Medicine will not be bastardized because we are Nigerians.
Nigerian doctors are also part of the masses or common
man, because some say they don’t have sympathy for the masses or common man. The
strike is also affecting them and their loved ones, as they also have to take
their people to private hospitals during this period. Not all doctors have a
private clinic as being insinuated in some quarters. Nigerian doctors don’t have
the luxury of going abroad for treatment as our politicians because most of
them cannot afford it. That is why we want the system to be better and we can
give our people the best services available.
The Nigerian doctor wants to work in an environment
where there is mutual respect and clear cut delineation of roles and duties. He
doesn’t want to work in an environment where he will be looking over his
shoulder wondering if the lab scientist is about to hack him to death, he doesn’t
want a situation where a patient has to go to a place about 3 hours away to
have basic investigations done. He doesn’t want to leave Nigeria after
studying. He wants a situation where he won’t be cancelling surgeries because
there is no light, he wants to be at par with his colleagues elsewhere
rendering services to the best of his capacity. He wants an efficient system. This
is what the Nigerian doctor wants.
How will he be satisfied to go back to work? The government
must show sincerity in its negotiations. We have lost confidence and trust in
our leaders. It is not just enough to sign memorandum of understanding (MOU)
and realizing circulars, government must be seen to be sincere by implementing all
agreements.
It is regrettable that we
have to resort to strikes and industrial actions to get the attention of the
government and the society. All well meaning Nigerians must speak up to solve
this imbroglio and get the doctors back to the hospitals.
Dr Nnanna Agwu (mbbs)
Development
Consultant/ Resident Doctor.
twitter handle @drscopey
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