The Eyes of JANUS

"I swear by Apollo, Asclepius, Hygeia, and Panacea...
and I take to witness all the gods, all the goddesses...
I will prescribe regimens for the good of my patients according to
my ability and my judgment and never do harm to anyone..."
- The Hippocratic Oath.

Hippocrates was a man given to care and seldom receiving in return. He was the greatest physician in antiquity, he is our Father, he is the reason we are. He is the reason they say we ask for too much when we ask for our rights: when we ask to be granted the same promotions and privileges as other health workers who, ironically, say we receive too much more than they do; when we ask to also skip level twelve of the civil service promotion scale like the rest do who aim to remove the "para-" from their designation; when we rise against the ridicule of a highly esteemed title. He is the reason they scorn us.

Like a true Doctor, he led by example, taught Medicine on the Island of Kos, Greece, some four and a half centuries before Christ, and healed- or, helped many to heal, as those who futilely struggle to be us would rather we say lest we be our egocentric selves again. He became the Father of modern Medicine, and our Oath is named after him. He provided humanitarian service, and that is why the power-hungry ones expect charitable servitude from us...

Some twenty-one centuries later, a girl (seventeen years of age at the time) observed so much suffering that in her was kindled an interest in nursing, and came to the rescue of the dying, by the time she was thirty. Unlike Hippocrates she did not heal, or help to heal, she helped us to help to heal, and we loved her for it. She believed in sanitation, orderliness and record-keeping, and did not strive to be recognised, to be Consultants, to stand shoulder-to-shoulder with Physicians. She wanted to be felt rather than seen, sensed rather heard, perceived rather than tasted. And when peradventure she was, she was kind, loving and sweet- rather unlike her ego-blinded descendants, soured by envy.

She was put in charge of the orderlies, a practice that yet persists, and by her humility and diligence, she turned a menial job into a (sub-)degree course that much educated folks respectED. She should have left an oath behind, restricting her descendants from envy and strife and covetousness, but she didn't; so that they now bite the very fingers that fed them. She became known as the Lady with the Lamp, the Angel of Crimea, and most importantly, the mother of modern nursing. She was Florence, she was a Nightingale, and her descendants are nothing like her.

Their origins could not have been more humble! Even Nightingale had to disobey her parents to join (and elevate) a people much looked down upon. And like every sect with humble beginnings- case in point: Boko Haram- they nursed ambitions, infiltrated our ranks and plotted against us. They married us, bore us, and were borne of us. All so they could fight us! They want us to fear them, to be in awe of them, and so they train their successors in the art of sauciness, so much that NO one likes them, not our patients, not their orderlies, not the Community Health workers, and definitely not us.

They were supposed to complement us, but over time they began to compete with us, to envy us, to abhor us. Was that how Nightingale was, so much that we allowed her to start her Nightingale School and Home for Nurses at St. Thomas's Hospital, London? Was she so competitive, so covetous, so rude? Was she conspiring with other paramedics to supplant us?- If there was anyone the Doctor should trust, it should be the nurse; alas, it WAS the nurse! And finally, they want to boss us around! On that count we say NO. Mbanu. Enough is enough. And here's why...

In Nigeria, there is one Doctor to sixty-four hundred people; yet the WHO recommends a ratio of one Doctor to six hundred. Why? In Nigeria more than anywhere else, Medicine is a rather difficult endeavour. And with our best minds in the Oil Industry serving the black gold, and the leftovers in Telecoms, literarily talking into the air to make a laudable living, we can barely recruit.

Except we dangle Consultancy, CMD-ship and appointment as Permanent Secretaries of Ministries of Health, so that those that can scale the high hurdle into Medicine will not run elsewhere, even when a six-year course takes a decade to complete, even when paramedics frustrate you because they fear you would when you became a Doctor- and they would rather they served the first hand-, and especially when your fiancée tires of your unending studentship and marries a paramedic- after all, you are both in the Health Sector: same pay grade.

And the best our dear paramedics, most of whom were not a tenth as brilliant and could not score half our cut-off marks, can do is pluck off the bait, one after the other, all in the name of fairness, equity and justice. The best they can do is frustrate us, so we can accede to their every demand. The best they can do is compete with us. After all, we are the ones on high horses- and why shouldn't we?: we are the ones with the high scores.

The reason is obvious. It is half-knowledge. And it is all they possess. It is half, not because it did not spend so long in school, which it didn't; or because it did not have a curriculum half as comprehensive, which, again, it didn't. It is half because it cannot cure the patient; because it needs the Doctor (for it) to function optimally; because it is unrestrained, unbounded, uncouth. Half-knowledge at its depth; won't you agree?

And as the Yoruba observe,
Wúrúkú làá yírìnká
Gbọ̀ọ̀rọ̀-gbọọrọ làá dọ̀bálẹ̀
Kúná-kúná làá fọ́'jú
Kùùnà-kuuna làá d'étẹ̀
Ojú àfọ́-ìfọ́tán
Ìjà níí dááálẹ

I read my life out and spend donkey years to get into Med School and the Medical profession, to someday become a Consultant and CMD and PS, and then someone who could barely pass U(T)ME and had to combine separate WASSCE results to enter School of something is offered the same emoluments in the name of fairness and equity? Where the hell is the goddamn justice? Ó da, is it my fault that they couldn't score enough to get into Medicine? Is it my fault that I am from Hippocrates and they are not? Is it my fault that Medicine is a profession much too noble for their scores?

They want to be Consultants, àbí. Ok, how, since they understand fairness so well, is it fair for a Doctor to spend five, six, eight years in (postgraduate) residency training and exams- not work experience o- to be a Consultant, while someone else does next to nothing to be a consultant in the same Health Sector? Scratch that; ...while someone else becomes a consultant just by virtue of the donkey years she has spent in the wards or office accumulating morbid fat from doing so much sitting around and getting paid for sidon look? Yes, I just said that; how many Doctors, female for female, are as obese as our dear No-be-only-Doctors-waka-come?

Since they so want to be fair, ALL courses represented in Joint Health Sector Unions should have the same admission requirements as Medicine. After all, we will be getting the same pay as they demand, the same titles and positions, as they desire, and the same workload, as they deserve. And it is just not fair for some to take shortcuts undisclosed in their sanctimonious we-are-the-victims charade. Now let's see which one of them will have one-tenth as many students as in Medicine. But, no, that would be much too fair; it would be much too fair for Schools of something, of Health and of Nursing to be deserted, empty for want of successful candidates...

They have said the only thing Doctors do is examine the patient; that the lab scientists diagnose, the nurses take care of the patient and the pharmacists dispense drugs; all so we can all be Consultants! Apparently, the C. lab scientist takes the patients' samples- or even knows which to take-; again, scratch that: ...the C. nurses being very handy take all possible samples; at least they know what "pan-culture" is, even if they misplace the indications. Their C. orderlies take them to the C. lab techs who sniff all the samples to find the diagnosis... No wonder we have to force results out of those labs: samples too plenty!

Meanwhile, the C. pharmacists, likewise able to make diagnoses (thanks to PCL la cram, la pour) dispense all the drugs that fit the bill pending the C. lab techs' verdict(s)- they are not always sure now that Doctors are no longer in charge- and defend their stance with the term "empirical management"... Little wonder they have full shops but when you ask for that prime brand, it is a crime for them to have it.

Apparently, the fools that propounded that hypothesis never heard of the terms "clinical diagnosis", "differential diagnoses", or "provisional diagnosis"; and I'll leave that at that because the more you teach these people the more they feel they are better than you. Lab scientists make (all) the diagnoses o, and when they take forever, patients die. No wonder. So all of you blaming Doctors for your relatives lost, you now know whom to accost.

Fast forward...

The patient is rushed in. He wants to see the Consultant. Since there are just so many consultants, and since he cannot enunciate the capital C in the Consultant he wants to see, some consultant sees him... He is a Doctor, thank God. But since he'd actually have been a Registrar back when the Health Sector was sane, before "consultant" became a dime a dozen, the much-older and much-"experienced" C. nurse (actually an SNO) hinders his much looked-down-upon "examination", the only reason he is still allowed in the para equity-ruled hospital...

The smart Doctor, having learned from the numerous negligence suits lost and pending, documents that the C. nurse prevented him from doing his job in an Observations Notebook he now keeps since the case note is again the jurisdiction of the nurses who have apparently colluded with the HIM (medical records) to keep it from him. He manages to get a few witness-signatures from on looking patients bold enough to defy the C. nurse's threats and acrimony, and from fellow Doctors. The C. social worker can't be bothered, there are too many deaths unexplained, and debts unpaid-...

The C. lab techs are too busy being consultants to attend to samples that the patient's relatives brought themselves since the C. orderlies are busy plotting how to displace the CMD, a C. nurse, and install one of their own, or at worst, a C. office messenger who can feel their pains and their need to be heard in this time of equity-derived nepotism by C. nurses who, now that they have all they have wanted, have disbanded JOHESU, and turned their backs... Na today? And so they have on their side the C.s from Engineering, the kitchen, laundry, and gardening; and pharm techs, the latter because the C. pharmacists do not allow them to have C.s. The case is yet in court...

The C. pharmacist, now regretting his role in the anarchy helps himself to some of his antidepressants. His PCL has failed him. He was never trained to examine a patient the clinical way, and, as it turns out, the undeniable difference between a Doctor and a secretary is clinical examination: they both take histories in shorthand. And if he bombarded the patient anymore with his directionless chemicals, they would die- the one of renal and/or hepatic failure, whichever does him in first; the other of guilt. He was a "man of honour", only he joined the wrong hands...

The patient dies, all the same. He is related by his father's side to the C. admin officer, who is sad, and by his mother's side to the C. accountant, who is distraught. The C. HIM notes how nearly every patient dies, and the rest are handicapped, he swears to never be part of rebellion in his next life; but we only live once. The C. social worker finally jolted to action by the rants of her ex-comrades decides to appease them, to no avail. "The gods are indeed angry," she consoles herself...

The C. gateman calls the family aside at the gate and advises them to get a lawyer. Yes, he knows just the one. He nearly tells them of how he is the lawyers' agent, eyes and ears; of how big his commission is; of how the C. mortuary attendant is in on the deal, bringing autopsy findings to the table, after he has taken the corpse to the Pathologist's; but he doesn't tell. They promise to give him something for his effort in obtaining justice for their brother. The C. PRO is swamped by negative publicity; there is only so much she can do...

The C. radiographer actually does X-ray an infant's testicles yielding to pressure from the most influential of the C. orderlies. It was only the week before that the C. cleaners likewise forced him to X-ray the foetus of one of their numerous private patients. "If only my Consultant Radiologist had not travelled abroad to that sane health system that we advocated for, and never got. Now I am stranded here," he mourns...

The lawyer is happy: The dead patient's family sues. Their lawyer is happy. The Doctor presents his Notebook. His lawyer is happy. The Minister of Health is joined in the suit, as should be: it was a government-owned facility, after all, before it was closed when there were more suits than sanity. And after what turns out to be a waste of time defending negligence, the Judge rules, to the chagrin of everyone else, save the plaintiff.

"This ruling is becoming a routine, it should be recorded and played, case-in, case-out," wonders the court clerk, who, the Judge eyes as he thinks, "you too had better not aspired to replace me." "Well, we are learned in this Sector sha, only not learned in time to realise what really was happening to the Health Sector. Now I have to fly my children out of the country each time they are sick, even from malaria..."

And the verdict is:
"Let's say for the sake of argument that the only things Doctors do is examine. Do they help the patients?"
"Yes!"
"Why can't the rest of you examine?"
- No answer. -
"If examination is not so important, why don't you run the hospitals during NMA strikes?"
- No answer. -
"Did you want to be Consultants- or was it forced upon you?"
"Yes."
"Then do the work of a Consultant: own a patient, stand on your own, take risks..."
- No answer! -
...
By now, I believe, you know how it ends. I will be a good boy and save you the bad news...

Lóbátán! Ẹ kàn nbá Ọyá jà ni, Ṣàngó ló ni ṣẹ́ẹ́rẹ́...

Ayokunle Ayk Fowosire.
Sagamu.

The deeds that men do will outlive them to live on long after they are no more. You never change a winning team, even if the nurses don't want the captain to be Doctors. Most importantly, you never put nurses in charge...

Yes, I know what they did, and do, to CHEWs. A man is appraised, not by the foul he cries, not by the fowls he keeps, but by the way he treats those (he perceives to be) beneath him...

I see the past (and the present) and the future. I am Janus. And you have just seen through my eyes...