My dear Hippocratic colleagues in diaspora,
I read about the meeting some of your delegates had with the senate committee chairman on health and the request for you to relocate to Nigeria . It will be a dereliction of duty on my own part to allow my professional colleagues make the worst decisions they will perpetually regret . Having being away for some time ,there is every tendency that you may not have known the happenings in our health sector and in the country at large . I have decided to write this piece because a line in our physicians’ oath declaration states that : My colleagues will be my brothers and sisters . Is it not ironical that why we in this part of the world are looking for an ‘escape velocity ‘ to disappear from this space (where we suffer grief and pain ),you are being given a ‘relocating velocity’ for you to fall from your excited state back to your primordial ground state?
I hope you are aware that in this part of the world ,the patients-doctors ratio is 6000:1 . It may sound hyperbolic but that is the situation here and the patients you are going to consecrate your lives for their services ,will be the first to verbally attack you when you withdraw your services after working for three months without any salary from the government .Medical doctors under the employment of Imo state government will tell you how they are currently surviving without three months salaries . The story is not different in some other states. Now,let me clearly list the challenges you are going to face when You finally relocate. This will help you balance the risks you are about taking and the benefits (if any) and I am sure the risks must outweigh the benefits by one million fold .
SECURITY OF LIFE AND PROPERTY
Medical doctors in this part of the world are hunted and kidnapped by some of the people they have laid their lives to save . The latest of such kidnapping spree took place on March 23,2016 in Kogi state where kidnappers disguised as patient and patient relatives, abducted Dr U.O . Chukwu from his private hospital at 10 am in Okpo ,Kogi state .It may interest you to know that on January 25,2016 medical doctors in Rivers state under the umbrella of Nigeria Medical Association (NMA) carried out a peaceful protest where we marched around the major streets of Port Harcourt to register our displeasure over the incessant kidnappings of our members .The peaceful protest was triggered by the fact that within sixteen days ,four medical doctors were victims of kidnapping ,two were successfully kidnapped and ransom ‘judiciously’ paid,the remaining two doctors had their different stories , one was shot in the abdomen when he resisted abduction and exploratory laparotomy later done for him and the other one successfully escaped .
We met with both the Rivers state commissioner of Police and his DSS counterpart during the protest . They all assured us of our safety in the state and their assurances can be summarised as ‘the security agents are on top of the situation ‘. I don’t need to tell you the implied meaning of that clause. However ,despite the assurances many of us are still alert and once there is any strange movement around us ,we will take off . I don’t want to delve into how many medical doctors that were kidnapped last year alone or the nine doctors that were kidnapped in 2014 in Rivers state but I will not forget in a hurry an elderly colleague,Dr Samuel Okpara, who was kidnapped in Port Harcourt last year but when the family could not pay the ransom before the deadline ,he was sent to his early grave by his abductors and his decomposing corps was later found at the back of Government Comprehensive Secondary school,Borokiri Port Harcourt . The patients ,the journalists and the Nigerian masses will not see how we are being hunted but once doctors go on strike over insecurity ,they will cast aspersions on us . I don’t need to waste my time in telling you how our government has abandoned the family of Dr Stella Ameyo Shade Adadevoh ,the consultant endocrinologist at first consultants hospital in Lagos who sacrificed her life to save Nigeria from Ebola.
RIVALRY IN THE HEALTH SECTOR
Nigeria is the only country where our international best practices are derived from few countries that are still experimenting a particular system. Don’t be surprised that as our country practises a presidential system of government,one group of people may come out one day to clamour for parliamentary system of government ,citing other countries that practise parliamentary system of government as their international best practices .In our health sector,there is an amorphous union called JOHESU ,this group contains everybody working in the hospital except the medical doctors and I heard a rumour recently that they want to further increase their numerical strength my incorporating patients’ relatives and the taxi drivers that ply within and outside the premises of the hospital into their union .The basic aim of this amorphous union,comprising cleaners,Radiographers ,technicians, Physiotherapists,mortuary attendants ,generator operators,clerical staff,medical laboratory scientists,medical record officers ,pharmacists,security men etc, is to use their numerical strength to fight medical doctors to a stand still in the sector . Their fight is both physical,spiritual and legal. In the physical aspect,medical doctors ,especially our resident pathologists ,are being assaulted physically ,the most recent being the one that just occurred in UCH Ibadan and the association the oppressor belongs to has come out to issue a communique exonerating ‘one of their own’,claiming there are witnesses ,who expectedly must be their members .
In the spiritual aspect,In late 2014 their leaders enjoined all their members nationwide to fast and pray at the beginning of one of their incessant industrial actions hence prayers were said for them in churches,mosques ,shrines and other religious houses in order to take over the headship of the health sector . For the legal aspect,there are so many pending court cases where purely medical matters are brought before conventional courts to be presided by non-medical judges . At times in the law courts,English dictionary (not medical dictionary) is used to define who a pathologist is . Meanwhile, the Acts establishing each profession in the health sector having envisaged the grave danger of presenting a purely health matter before a conventional court manned by judges not learned in health matters , created tribunals/panels for each of the professions and the tribunals/panels are equal in status to High Courts such that their judgements can only be appealed in the appellant courts .
Yes, I agree with section 6 of our 1999 constitution ( as amended) which vests judicial powers in our courts but my argument is that since our lawmakers never envisaged the current crisis in the health sector when drafting the laws that set up different courts,I suggest that a special court( health court ) that will be manned by health judicial officers be established to take care of this crisis in the health sector . For my critics,I am not alone in this clarion call as the former national president of Nigerian Bar Association (NBA) ,Bar Olisa Agbakoba(SAN ) in July 2013 made a similar clarion call . As a legal Juggernaut he threatened to sue both the National Assembly and Attorney General of the Federation for the absence of Christian/Ecclesiastical court in our 1999 constitution .He observed that no provision was made for Christians to have their religious and spiritual affairs adjudicated by persons adequately learned in Ecclesiastical laws and biblical jurisprudence,whereas sections 260,265,275,280 recognised the establishment of customary and Islamic courts . In the same vein ,I call for the establishment of health courts where health workers will have their health,medical and paramedical affairs adjudicated by persons adequately learned in health,medical and paramedical laws and jurisprudence .
In view of this ,we are not surprised when pathologists are seen only as those that perform autopsy without knowing that the field of pathology has others subspecialties like Haematology/Immunology,Chemical Pathology ,Medical microbiology apart from Histopathology/Morbid Anatomy people already know . These JOHESU members want to take over the headship of the sector even in the clinical matters ,the same way the air hostesses and other members of the flight crew will one day in this country want to take over the management of the cockpits from the pilots, after all,as JOHESU members always believe and argue ,the work of pilots as well as those of the CMD and minister of health are purely administrative .They may surf the internet and see few countries where air hostesses can convert to pilots after about five years of active service and that will definitely serve as their international best practices.
THE ABUSE OF THE TITLE ‘DR’
In this part of the world , almost everybody answers a doctor. Nobody goes on to investigate what type of certificate the supposed doctor holds . In view of this , smart herbalists produce their herbal concoctions and brand their products such as ‘Dr XYZ Goko cleanser ‘ etc .The XYZ represents their individual names .The ‘Dr’ is mischievously used to hoodwink the unsuspecting members of the public ,who believe that anybody answering a doctor within the health sector must be a qualified medical doctor .The impunity goes on and in the long run ,our people come down with kidney and liver failures due to excessive consumption of these concoctions that are believed to ‘cure’ all ailments .All their diagnoses revolve around Staphylococcus aureus . Chimamanda Adichie in her book,Half Of A Yellow Sun, while satirising such high level of illiteracy and deceit in this part of the world showed where a PhD holder in non-medical related field was invited by the neighbours to resuscitate a child having acute exacerbation of bronchial asthma. Meanwhile, The pharmacognosy unit of pharmaceutical sciences that is supposed to regulate the herbal practice in the country ,is very busy with JOHESU mandate in ‘exorcising ‘ medical doctors out of the health sector,leaving their primary responsibilities unattended to.
My dear distinguished colleagues,this part of the world is not like where you are currently practising where PhD holders that are non-medical doctors will honourably write their names as Mr XYZ, PHD ,in this part of the world they will like to be addressed and their names written as Dr XYZ in order to hoodwink the members of the public . Most of the JOHESU members ,including the cleaners ,technicians etc make use of ward/lab coats and stethoscope in their cars and the implied meaning to an average Nigerian is that they are qualified medical doctors hence they go on to be addressed as such by their neighbours ,relatives,church members etc. They go on to treat their victims and when the treatments fail,the Nigerian medical doctors will be blamed . I had a friend,a medical laboratory scientist,who tried all he could to change over to medicine while we were in the university but the vicissitudes of his academic performances prevented him .
He graduated as a medical laboratory scientist but all his neighbours,relatives and church members address him as a medical doctor and they bring all sorts of medical cases to him. I separated from him after two incidents. First,when he wanted to marry ,he presented himself as a medical doctor to his fiancee and his potential in-laws. I warned him that I would not be his ‘best man ‘ in a wedding built on falsehood .Secondly ,there was a day we were together , one of his potential in-laws called him complaining of chronic cough,he went ahead to tell the person to mix lime juice with ‘kai kai’ ( locally brewed alcohol) then take it for three weeks. I got annoyed with him because the right thing was to refer the person to a medical doctor in a hospital .I went ahead to enlighten him that when relatives call me for a particular medical case,I will always advise them to visit a hospital nearest to them thereafter I can speak with the doctor because before any treatment should be initiated,there must be a good history taking,physical examinations and investigations .
This fellow in question and his likes in the sector will be somewhere practising as medical doctors,and their malpractices will be attributed to the failure of Nigerian medical doctors .Also our system supports such ugly occurrence ,where will I report him? If I report him to NMA ,medical doctors do not have jurisdiction over non medical doctors,if I report him to his professional association,I don’t need a prophet to tell me that they will never punish one of their own over a matter brought by one of their sworn enemies(the medical doctors).The case in UCH Ibadan cited above will be vitally important in substantiating my point . If I go to the state ministry of health to report such fellow ,I will end up wasting my time and energy .Reporting him to the police will lead to a nuclear fission-like reaction.( To be continued)
Dr Paul John
Port Harcourt,Rivers state