STILL ON THE RECENT BRUTALITY AT UCH,IBADAN

You see the imbroglio between medical doctors and the paramedics is taking a new dimension where physical assaults and blockades seems to be the new order... Mazi Paul John has this to say..

How long shall we remain victims of physical assaults while performing our lawful duties? Physical assaults on medical doctors, especially the resident pathologists are becoming a regular occurrence in our tertiary hospitals. When I read the expected defence by the UCH chapter of Association of Medical Laboratory Science of Nigerian (AMLSN), exonerating one of their members, I began to wonder when this childish and barbaric behaviour would stop. Indeed, it is not yet clear to me if the law ever permits one to brutalise others or whether the law will expect that those who are constantly made victims of such brutality should live and stay with their oppressors all in the name of maintaining peace. So, I ask once again, how long the doctors shall suffer in the hands of other health workers?

It is very sad and indeed quite disheartening that the latest story concocted in defence of the Assistant Chief Medical Laboratory Scientist who physically assaulted a medical doctor in the line of her official duty sounds more like what one finds in the home videos. Otherwise, how can one explain a situation where the resident doctor was accused of fomenting trouble? According to their fictitious story, the resident doctor came into the office and went straight to the place where slides were packed, collected what she wanted and when she was told to arrange the slides, she started slapping and poking the face of the Assistant Chief Medical Laboratory Scientist. Such an accusation is not only unfounded but preposterous to say the least. Hence, anyone who believes such a crap needs to undergo immediate psychiatric evaluation just as the person who cooked up the story and the editor who allowed it to be published need to undergo the same psychiatric evaluation. Perhaps, they thought that their readers might operate at the same average level with them.

One needs not be a prophet or even forensic expert to know that the story was concocted. Yet, as if that was not enough they even went further to allege that the incident occurred before witnesses who expectedly must be JOHESU members, commissioned and tutored for the sole purpose of actualising the JOHESU mandate. Is it a crime for resident pathologists to coexist with the medical laboratory scientists in our clinical laboratories? In dealing with this matter, one must not lose sight of the remote and immediate causes of this altercation and subsequent assaults against our  resident pathologists. In law, people talk about mens rea (or the guilty mind). In other words, one of the legal maxims that might help us appreciate the issue at hand is: Actus reus non facit reum nisi mens fit rea, which may operationally be interpreted as saying that an act does not make a person culpable unless the mind is guilty. This is why a judge can deliver a judgement either in favour or against a driver who is accused of  killing somebody on the road depending on whether there is a guilty mind or not. For instance, S. 24 of the Criminal Code and  other relevant sections that are in pari materia with the provisions of the said section in other enactments clearly exculpate such a driver if no guilty mind is established because “...a person is not criminally responsible for an act or omission, which occurs independently of the exercise of his will, or for an event which occurs by accident” (S.24, CC). This provision is only subject to the proviso clearly spelt out in the self-same section regarding negligent acts or omission in which case if the collateral facts of the incident reveal a prima facie case of negligent act or omission or malice aforethought then the driver would be brought within the provisions of sections 315-319 of the Criminal Code and similar provisions in the relevant sections of the Penal Code or the Administration of Criminal Justice Law (Lagos State). I have embarked on  such a legal excursion not as a lawyer but as a sensible layman in matters of the law to show two things. First, the causal factor leading to the assault as adduced by her assailant and those who gave evidence against her cannot be the true reflection of what actually transpired. Secondly, that show of shame witnessed at UCH was nothing but a manifestation of pent-up anger and malice against medical doctors by their supposed neighbours in the health sector. This second point can easily be established given the antecedents of JOHESU members and their unbridled as well as open hatred against medical doctors.

Perhaps a little anecdote will clarify matters. My experience while in a paramedical course in the university opened my eyes to present plights of medical doctors. In those days I was made to see every student in Medicine and Surgery as my enemy. If the person greeted me on the road, I would tell myself that the fellow wanted to announce his or her presence whereas, if the medical student in another occasion decided not to greet me, I would say to myself that the fellow was arrogant. Fortunately, I got some friends who were passing through what I was passing through; anytime we came together we would discuss the arrogance of medical students. We declared a cold war against a set of people who might not even know we existed. While we were doing that we were still writing JAMB and borrowing courses that would allow us change over to Medicine and Surgery. Was that not a self-deceit? We hated the people in a course but we could do anything humanly possible to secure admission into the course . We naturally felt inferior to the medical students. At the department level, some of our senior colleagues would always come to talk to us, assuring us  that the paramedical course we were studying was better than Medicine  & Surgery but upon further investigations we later found out that those seniors colleagues  tried all they could to change over to medicine after their first year but it was either they could not score the minimum CGPA (Cumulative Grade Point Average) required or that the department refused to release their files.

The inferiority complex I suffered was unimaginable. In fact, I used to claim that I was a medical student at home and outside the school premises in those days such that some members of my family and friends even went ahead to address me as a 'doctor'  when I was a mere paramedical student. However, barely one month we started our studies in the university, an incident happened that initially embarrassed me but later became the driving force that made me what I am today. We were introducing ourselves in a function at Onitsha when I introduced myself as a first year student of Medicine and Surgery, UNN unknown to me there was a first year UNN medical student in the gathering. When he finally introduced himself I felt uneasy, though I intermittently assured myself that there was no way that young man could have known all his classmates within one month we all started studies at Nsukka; besides almost all the courses were general courses hence it would be difficult for him to have known all his classmates in such a short time frame. Despite my assurances, I still felt inferior and uncomfortable as a barefaced liar while the function lasted.

The young man approached me after the programme for a discussion and I flowed with him because we were then doing all courses together except just few ones and we knew all the lecturers but after that day I avoided that fellow like Lassa fever  until I did the needful by changing over to medicine. In view of this, when I read the expected communiqué released by UCH chapter of AMLSN  exonerating one of their own, I sincerely told myself that if I had not changed over to medicine, I might have been the one issuing that communiqué. Why did I hate medical students when I was studying a paramedical course even when none of the medical students had ever insulted me? Why did I naturally feel inferior to them  then? Well, the answer to this recent brutality in UCH is simple: when inferiority complex is longstanding without any hope of immediate relief, it turns into depression. Medically, a depressed patient  can do anything including but not limited to suicide. Thus, the type of aggression or even brutality we regularly see against our resident pathologists while performing their statutory duties is not unconnected to a similar experience as the one I passed through.

The first question begging for an answer is: who was responsible in making the slides available to the resident doctor in question? Was it not a dereliction of duty for the JOHESU member who should man the duty post where the slides were kept not to be around when a slide was needed by the victim? This is important because they boasted they had witnesses. Yet none of the witnesses could help the resident pathologist to retrieve the slides or at least attend to her when she got to the place. Most annoying of it all is the lame explanation that when the resident doctor was gently approached to rearrange the slides, she started poking and slapping the Assistant Chief Medical Laboratory Scientist. I am aware that medical laboratory science is a paramedical course but the practitioners should not 'para-reason', even our paramilitary officers often reason properly. By applying 'Average-Man Theory' in Psychology or the reasonable man test to this case, the worst that the resident doctor would do, if at all she felt that a junior worker was dishing out instructions to her would be to hiss and leave the room without rearranging the the slides; that is if the slides were ever scattered in the first place while the Assistant Chief Medical Laboratory Scientist might decide to ignore her or to report her to the authorities. It cannot, therefore, accord with good reason that a mere act of asking a medical doctor to rearrange slides would sufficiently provoke her as to make her slap the Assistant Chief Medical Laboratory Scientist much less doing so repeatedly and poking his face as alleged.

Consequently, it is unimaginable that  neither the aggressor nor his arranged witnesses were available  to release the slide to the resident pathologist but the aggressor later resurfaced  as the Commander in Chief of Laboratory services  to transmit orders for the permutation of the slides. In many centres when doctors go to duty posts manned by JOHESU members, the doctor would be made to queue up with patients and patients' relatives without recourse to the fact that when a doctor decides to personally come to perform what a patient or the relatives should do, there must be an immediate need for that. Where is the camaraderie when a doctor comes to retrieve the results of the laboratory investigation of a patient from a post manned by a JOHESU member,the doctor is made to queue up with the patients and their relatives but when the 'consultant' JOHESU members 'Nicodemusly' and  surreptitiously creep into clinics and places manned by medical doctors the doctors will give them preferential treatments so that they can return to their duty posts on time. Must a  doctor kowtow before  a nurse in the ward for her to go into their store to replace exhausted medical consumables in the ward?

That reminds me of my experience while in the university. When our fellowship was to organise a programme, we in the organising unit would be mandated to inform the relevant authorities. I discovered that we spent more time with the school security than any other offices, be it that of the Vice-Chancellor. On entering the office of a security officer (who might have secured that employment with or without first school leaving certificate), he would like to show us that he was the lord of the office and at the end wasting our precious time but going to the offices manned by academics, they would just sign our forms for us to return to our academic activities. Time has come for the installaction of  closed circuit television (CCTV) cameras in all our clinical laboratories and all meeting points common to both our resident pathologists and their aggressors. This is very necessary because with the spate of assaults on our colleagues, one day we may see the decomposing corps of a resident doctor dumped in an office as these aggressors have ready-made “witnesses” to testify to their innocence.   Who knows if these ever-ready and professionally-primed, trained or tutored witnesses will then testify that they saw the deceased commit suicide?

Also, I enjoin my colleagues in the field of psychiatry to offer help to our neighbours because as I earlier stated, if depression can lead to suicidal attempts then  assault on a fellow worker might be one of the aftermaths of depression. More so, when a person in an argument resorts to the use of brute force against his opponent, it shows that the aggressor has lost the argument. This is what is known in logic as argumentum ad baculum which means appeal to force. Counsel them to be proud of their professions and never to claim being medical doctors outside the hospital premises or declaring cold war where war shouldn't have existed in the first place . Remind them of a Latin maxim which states that : Abussus non tollit usum ,which can be interpreted as the abuse of a thing (  medical doctors) does not abolish its usefulness.Remind them that from time immemorial ,there were originally three primary learned professionals ( the priest,the scribe-the lawyer- and the physician ) and till date the medical profession remains the foremost globally .Counsel them to pick up JAMB forms( UTME or Direct Entry) in case the inferiority complex and depression remain refractory to medical treatments.  When they opposed both the appointment of Dr Paul Orhii as the DG of NAFDAC and the clarion call by NMA that public officers be barred from medical tourism abroad, I told myself that our friends needed some psychiatric help. Depression and frustration must never be handled with kids gloves. Their specious argument against the proposed public-private partnership in our hospitals serves as a comic relief to me anytime I feel like laughing. They are deceiving the masses that the programme will increase medical cost for the patient when truly they are aware that all their demands will die a natural death and their roles properly defined on introduction of the programme because no wise entrepreneur will ever make a medical laboratory scientist the head of a clinical laboratory in the presence of pathologists or 'ordain' a JOHESU member as a consultant and pay him or her like one. They are now claiming to protect the patients from increased medical cost without recourse to the fact that their unwarranted incessant industrial actions have sent many patients to their early graves .

Finally, I will like to appeal to my medical elders to amend S.66 of our Codes of Medical Ethics which abhors us from the use of physical, biological/chemical and psychological torture on any citizen. This is because S.33 (2) (a) of the Constitution of the Federal Republic of Nigeria, CFRN, 1999 (as amended) while shedding more lights on Right to Life empowers Nigerian citizens to defend themselves from unlawful violence. This is because the people that drafted that section of our Codes of Medical Ethics never envisaged that there would be a time our fellow workers would become our oppressors as Late Nelson Mandela, in his autobiography, The Long Walk to Freedom, rightly stated: “the oppressed is (sic) often left no recourse but to use methods that mirror those of the oppressor”. While we are waiting for the installation of CCTV cameras, I advise all resident pathologists to move in pairs with their camera phones for recordings when approaching areas designated as JOHESU hotbeds . In this era of technology, they can as well buy and always wear spy cameras and eye glasses as that will preclude JOHESU tutored 'witnesses' from mendaciously  coming to  testify against any  of their victims in the nearest future.

Dr Paul John

Port Harcourt,Rivers state

mazipauljohn@gmail.com,08083658038