BEFORE CREATING MORE PROBLEMS IN THE HEALTH SECTOR....by Dr Paul John

It is unarguable that the health sector is the sector with the greatest amount of disharmony and court cases. One may wonder why a sector whose members provide essential services will be so embroiled in crises. In this sector, there are two major groups : the Nigerian medical doctors and on the other side,all other members of the sector under the umbrella of Joint Health Sector Unions (JOHESU). What is the origin of the disharmony in the sector? This is important because a popular maxim says that a problem that is known is half solved. I have elucidated the origin of the disharmony  in my previous articles under different headings and they can be summarised as thus: inferiority complex and greed.

A bill is currently before the lower House of our National Assembly for the establishment of National Postgraduate Physiotherapy College of Nigeria. The name is similar to the already established National Postgraduate Medical College of Nigeria. I am aware that such similar names should not go through if they were to be registered with the Corporate Affairs Commission. When such similar names are allowed to be in a particular sector, some 'smart' individuals can claim to be fellows of the ‘National Postgraduate College' hence putting their victims into the danger of believing that the fellows are of the Medical College when the fellows are truly of the Physiotherapy College . This is already happening in the health sector where a non-medical doctor in the sector that obtains PhD will simply put Dr in his name and will never indicate that he is indeed not a medical doctor.Patients see such individual as a medical doctor and any malpractice therein will be attributed to Nigerian Medical doctors .

I read one article in March 2016 written by a non-medical doctor who has a PhD, working at Federal Medical Centre (FMC) Asaba. What attracted me to the crap was the controversial title of the article and the title of 'Dr' before the name of the writer. He was sweating to   prove to the world that even herbalists are medically qualified. He said so many craps I am not here to discuss but the essence of alluding to that matter  here is that he used the title 'Dr' because he has a PhD in another field. In some states in America, one dares not answer a doctor if one is not a medical doctor. In the United Kingdom, the phrase 'Medically qualified' was introduced to differentiate doctors that are medically qualified from doctors who are PhD holders. But today 'who is medically qualified' is subject of litigation in our courts. According to history in the UK, when the phrase 'medically qualified' was not invented, if an advert for a doctor's position was placed every doctor (medical doctors and PhD holders) would apply for the job hence the introduction of the phrase 'medically qualified ' to limit the number of applicants. Many of these non-medical doctors  PhD holders in the sector go on and manage patients and when the treatment goes awry, Nigerian medical doctors will be blamed because a greater majority of Nigerians metonymically  believe that the term 'doctor' in the health sector simply means a medical doctor .

I made a decision that I would not dignify the fellow by replying to his article against the Nigerian medical doctors but I brought up the matter here to show the world how some 'smart' people ambiguously use the term 'doctor' in Nigeria and more ambiguity will be created should the current bill scales through . I am looking forward for a bill that will ban all non-medical doctors in the health sector from parading themselves as doctors. In a developed society, a non-medical doctor in the sector with PhD will simply avoid adding 'Dr' in his/her name since the person will add PhD at the end of his/her name. That is where people are proud of their professions. That is where people don't naturally feel inferior to other professionals. That is where people are truthful to themselves.Now, See the nurses; because medical  doctors have West African College of Surgeons/Physicians then the nurses 'established' their own West African College of Nurses. I ask myself, is it only in West Africa where nursing profession is practised? Or is that all the member states are Anglophone countries? Of course, that is not the case because most of the member states are Francophone. Why must the nurses not have a wider coverage like African College of Nurses since the already established 'doctors' college  was limited to West African member states? They simply want to answer fellow of the 'West African College' so that ambiguity will be created in the mind of an outsider (who at times becomes the victim) that the fellow may be from the West African College of Surgeons/Physicians. They all want to be on par with medical doctors at all costs.

The medical laboratory science council of Nigerian Act of 2003 is subject of litigation in various courts and another bill is already being created which will exacerbate the crises in the sector. If somebody argues that the similarity of the names in one sector does not matter, why didn't INEC register Chief Chekwas Okorie's UPGA (United People's Grand Alliance) as against the already existing APGA (All Progressives Grand Alliance) in 2012 or why does Corporate Affairs Commission turn down the approval and hence the registration of a business name if there is an already existing similar name in the same or similar line of business? The basic aim of this proposed Physiotherapy College is to produce consultants who will compete 'favourably 'with the already existing medical consultants. At that point a medical consult sent from a medical unit to the physiotherapists for the management of a patient can be turned down by a physiotherapist  consultant who now sees himself as equal with the medical consultants; after all they are both fellows of 'National Postgraduate College'. At the end of the day it is the innocent Nigerian masses that will bear the brunt of it all while the lawmakers that created the bill will be flown abroad for medical treatments. Once the bill scales through ,every medical consult to the 'consultant' physiotherapist must be accompanied by a sworn affidavit.

I am happy that one of the lawmakers acknowledged that such a proposed postgraduate physiotherapy college never existed anyway in the world and that a similar one is not run as a residency programme, however suggestion was made that Nigeria could still blaze the trail, possibly to worsen the disharmony. In anywhere in the world, during ward rounds, all the professionals informed must be present so that if there is any change by the medical team, everybody can make contributions for the betterment of the patients who are our primary goal but here in Nigeria, getting the nurses (the nearest neighbours to medical doctors) to join the ward rounds will be equivalent to allowing the biblical Carmel pass through the eye of a needle. At times, the nurses on duty will either tell you they are busy to join the ward rounds by the medical team or that they are answerable to their matron. That is happening at a time when nurses have not had consultant nurses , now imagine what will happen when their West African College of Nurses starts to produce  consultant nurses! Until then only court injunctions will compel them to carry out the doctors' instructions .

A medical consult is sent from the medical team to the physiotherapists and it takes some days before responding to the consult, what will happen when consultant physiotherapists are produced if the bill before the lower House scales through? The situation in the wards then will be similar to free-for-all-fight. The medical team will be doing their  ward rounds with their consultans from the east wing of the ward, the nurses doing theirs with their  consultant nurse from the west wing, the physiotherapists with their consultants will be marching from the south wing and the dieticians or any other profession under JOHESU can now march from the north wing of the ward. I don't need to explain to my reader what will happen when these 'consultants' (who are now on par with one another) with their different teams collide at the centre of the ward. Until then, the incessant physical assaults our  resident pathologists undergo in the hand of their supposed neighbours in the laboratories will be a child's play. Immobilised patients will then be forcefully mobilised to either run for dear live or better still come and settle cases because my distinguished colleagues can never remain to be victims of physical assaults in their working place since late Nelson Mandela said in his Autobiography, The Long Walk To Freedom, that  'the oppressed is(sic) often left no recourse but to use methods that mirror those of the oppressor.'

All they want is to establish their own residency programme, to produce consultants at the end. The pilot scheme for the creation of consultancy level outside the medical profession caused more problems in the sector and here a biall is being considered . At University College Ibadan, a ' consultant' nurse  prevented a surgeon from inspecting the surgical wound he created for no other reason than the ' consultant'  nurse had inspected the wound. At Nnamdi Azikiwe Teaching Hospital, it was also reported that a 'consultant' pharmacist  changed the drugs prescribed by a medical consultant who legally owns the patient, without first informing the medical consultant as it is found in other climes. I ask again if the treatment of the patient goes awry, who is legally liable in this scenario? Having seen these overwhelming pieces of evidence, a bill  being considered to establish a postgraduate college outside the medical profession is at best an aberration. Once this Physiotherapy bill scales through ,other JOHESU members will sponsor theirs and the health sector will now be the proverbial boat that has many captains .

The worrying aspect of the whole scenario is that the programmes to be run by the college if the bill scales through ,are already being run by different universities as postgraduate courses, what then is the need to waste our meagre resources to duplicate programmes that are already run by the universities? As I stated earlier, greed and inferiority complex must be dealt with if we intend to nip the problem of the health sector in the bud. Let every other professional in the sector  be proud and contented with his/her profession. If medical consultants in Nigeria decide today to answer 'Attending' as their USA counterparts, it is a matter of time, all the other professionals will jettison the idea of having their own consultants and start clamouring for their own 'Attending'. If medical doctors today come out to amend  the law that created their own  National Postgraduate Medical  College of Nigerian so that the college answers 'Medical College', the physiotherapists will immediately change theirs which is still pending before the lower House to Pphysiotherapy  College. The same if we change West African College of Surgeons/Physicians to African College of Surgeons/Physicians,the nurses will upgrade .

Why all these imitations if others were satisfied with and proud of their professions? Has there been any medical doctor who aspired to retire as Chief Nursing Officer/Matron? Why create a fight where fight naturally should not exist? The medical laboratory science council Act of 2003 never considered there are laboratory doctors who major in different fields of pathology. The more worrisome are  some arguments portraying  pathologists as people that do autopsy without recourse to the fact that apart from Morbid Anatomy/Histopathology, there are three more branches of pathology (Medical microbiology, Haematology/Immunology and Chemical Pathology). No one has come out to sponsor a bill that will make many of our drugs to be manufactured here in order to create more employment for our citizens, greater majority of drugs used in Nigeria are imported, I don't need to tell the economists what that will do to our Balance of Trade and Balance of Payment in a fiscal year. I want to see a bill that will make pharmacists take over our open drug markets. Go to Onitsha bridgehead market, Ariaria Drug market, just to mention a few, most of the traders there are SSCE holders, anybody can buy any drug he wants in Nigeria so long as he or she has the money. This should have not been the case if the pharmacists had taken over our drug markets and dispense only drugs prescribed by medical doctors .

I was in a place where they were discussing somebody that died. What killed him? He took 1000mg of Tramadol and he died. They never knew I was a doctor. I kept mute, finished my meal and left. Who dispensed the drugs to the deceased? The pharmacists will say it is the patent medicine dealer etc and the patent medicine dealer will say it is the pharmacists. The blaming game continues and people die in their thousands in my country. I want a bill that will place the patent medicine dealers, pharmacy assistants and other drug dealers in the country under the pharmacists so that our drug distribution will be unidirectional. I want a bill that will make it compulsory that no pharmacy dispenses a drug without a doctor's prescription. When I travelled to Israel, I wanted to buy 'common' Paracetamol what we classify here as OTC (Over The Counter) drug, the pharmacist refused and demanded a doctor's prescription, I thought the pharmacist was joking after I revealed my identity to him until it dawned on me that I had overstayed my welcome then I had to call a friend practising there to come and prescribe for me. If that could happen to a medical doctor what will happen to an ordinary citizen in Israel. No pharmacist or any other JOHESU member will support such a bill because they know what that will do to their daily sales. We need a bill that will prevent all these herbalists who go about dishing out false health  information to the Nigerian masses that all ailments are caused by Staphylococcus aureus .

In Nigeria, the attendants in a pharmacy shop will convince you to buy more drugs because the more the sales, the more the profit and the more their promotion. We need a bill to correct all these anomalies. The case of late Cynthia Osokogu where one of the suspects openly confessed that he bought the drug from a pharmacist, is still fresh in our memory. That is the bill Nigerians need now to prevent selling drugs (especially the sedative-hypnotics) to people without a doctor's prescription and identification. We want a bill that will either eliminate the traditional bone setters or their practice to be regulated by the physiotherapists. The health sector is in a dire need of so many 'corrective bills' not the ones that will further polarise the warring members just like the current bill before the lower House, which expectedly will create more problems in the health sector and depreciate the deteriorating coffers of the government especially as the programmes are already run by most universities in the country as postgraduate courses .

Dr Paul John

Port Harcourt,Rivers state

08083658038,mazipauljohn@gmail.com