UNENDING CRISIS IN OUR HEALTH SECTOR; AN OPEN LETTER TO MR PRESIDENT (3)

Your Excellency ,In this series,our discourse will centre more on the solutions to the crisis and the roles of pharmacists and medical laboratory scientists in our current tertiary institutions.

While as a student,I had two pieces of experience ,which are still guiding my decision making till these days. There was a time in my university when the activities of cultists were at an alarming rate. As a new vice-chancellor came on board,he studied the possible causes of this societal problem. He discovered that my university was admitting more students for diploma programmes than bachelor and postgraduate programmes. He equally found out that greater percentage of these cultists were diploma students hence he banned diploma programmes and immediately, the rate of cultism was brought to the barest minimum ,though the diploma programmes were later reintroduced when the internally-generated revenue of the school nosedived. The question now is,what is the relationship between diploma courses in the university and cultism? The answer is simple,gaining admission into university diploma programme is easier than that of bachelor degree programme hence university diploma students are ready to forfeit their admission should they be found guilty of cultism unlike their counterparts in degree programmes.

However, It has to be clearly noted that I am not saying that all diploma students in our universities are cultists or that there are no cultists among degree students,all I am saying is that the number of degree students involved in cultism is lower than that of diploma students in the same university. Just like the vice-chancellor did,we need to go down memory lane to find out the possible cause of this crisis in our health sector. This is because Professor Chinua Achebe in one of his books,There was a country, quoted an Igbo proverb as thus, 'a man who does not know where the rain began to beat him cannot say where he dried his body.' The next question will be ,why do we have more cultists among university diploma students than their degree counterparts? The answer,as we are going to see in the later part of this discourse, is that university diploma students by virtue of their curricula are freer and more available for social activities,which cultism may erroneously form an integral part, than their degree counterparts .

Your excellency,for you to understand the importance of history in finding the root cause of any problem let me quickly digress a little ,Nelson Mandela,as we all know died of respiratory infection. His own father died of the same(similar) disease as Nelson Mandela,in his autobiography,Long Walk To Freedom, acknowledged that,' Even to my young eyes,it was clear that my father was not long for this world. He was ill with some type of lung disease,but it was not diagnosed,as my father had never visited a doctor.' The question then is why must Nelson Mandela die of the same(similar) illness that killed the father ?The answer is simple,some diseases run familial courses,affecting the members of the same family .Also,Nelson Mandela might have indulged in the same smoking habit like his father because somewhere in the book , Nelson Mandela did not hide his frustration at his father in that even at the point of death,his father was still calling for his smoking pipe which the wives initially refused to give him but when the father continued pestering them ,they gave him the pipe and he died while smoking.

Sequel to this,making an allusion to the university diploma students,it is clear that in our health sector,some people must be underemployed hence the extra time can be used for more social gatherings which as we have seen earlier can lead to cultism but in this case,an anti-doctors coalition. Underemployment is a term in Economics which is the same as underutilization, overeducation, or overqualification. It means employment of workers with high education ,skill levels or experience in jobs that do not require such abilities,take for an instance,a scenario where a medical doctor becomes a taxi driver or a carpenter. I still wonder why a pharmacist after spending five years in the university will choose to be counting drugs in the pharmacy sections of our hospitals when there are other areas to explore in the field of pharmacy. It is unarguably that more than 90% of drugs used in this country are imported .The job of drug counting can effectively and efficiently be done by SSCE holders or better still,by the pharmacy assistants who are now independent of pharmacists by virtue of the court judgement I cited in my previous article. I am writing out of experience and I still challenge the relevant authorities to visit pharmacy shops in their localities or elsewhere in the country to find out if the workers employed by pharmacists in the pharmacy shops to count drugs are not SSCE holders,auxiliary nurses and pharmacy assistants. However,the story is different in our government hospitals,drug-counting pharmacists want to be 'ordained' consultants possibly in drug counting,what a rape of our black crude?

This is why the pharmacists that drafted the Act establishing pharmacy sections of our hospitals made it unlawful for any private pharmacy shop to be set up within the premises of our government hospitals .Why were they afraid of private pharmacy shops coming in? They did not ( and still do not) want their own sources of national cake to be deprived of them. What concerns a doctor if another hospital is situated within or near the hospital ? The difference will be clear and patients know what they want. Is it not a waste of human resources if pharmacists end up as drug counters in our hospitals? I suggest that they be helped to set up drug-producing firms to explore other aspects of pharmacy. Today,one is ready to pay through one's nose in order to secure government work because that is the resting stage of one's career while singing the hackneyed platitude, 'international best practices' .It is now clear that if all services in any government hospital are to be privatised today and it happens that a pharmacist or a medical laboratory scientist becomes the owner of the hospital after privatisation ,will he still go on and appoint his 'kinsmen' as consultants knowing very well that all salaries and allowances will be from the internally-generated revenue? The answer is simply no because even now in their private practices they prefer the services of SSCE holders,auxiliary nurses and pharmacy/laboratory assistants/technicians to those of their 'kinsmen',what an economic sabotage?

In view of the above,we have seen that history has a way of repeating itself. The problem in our health sector today is the same problem we have as a nation which is myopic planning and improvidence .When I get stuck in traffic jam in major cities like Lagos,Kano,Abuja and Port Harcourt,the only thought that flickers through my mind is, ' our ancestors in this country never envisaged that there would be a time like this when the population would explode hence no need of planning for an efficient road network'. Today, the construction or renovation of some roads are abandoned because of the high costs of compensation that will be paid to the property owners whose buildings are going to be demolished. At times, the owners of the buildings may rush to court and get the much-respected perpetual injunction restraining the government and its agents from demolishing their buildings ,which indirectly means that the said road will never be constructed/renovated at least in this life. Today,other developed countries have efficient transport system,in fact when I visited London,I discovered that people were living in places as far as our own Borno state while working in firms located as far as our own Bayelsa state .They shuttled between between these far-distant states everyday by the help of their efficient and effective transport system,precisely the railway system.

Your excellency I am aware that you are faced with a lot of challenges,mostly manmade, and these challenges are traceable to the long rule of military rule in the country .Although I am also aware of your transformation agenda and how Nigerians want you to magically right the wrong of the many years of military rule in a second,I am totally averse to the palliative solutions that our secretary to the government of the federation has been offering to this lingering problem in our health sector. I describe it as palliative because for every three months ,there must be an industrial action in our health sector,if it is not warning strike,it will be an indefinite strike.

Even our constitutional and human rights lawyers who should study all the acts establishing medical and paramedical professions ,are busy planning to go and vie for one elective post or the other whereas those still active in the profession are busy indirectly advertising themselves. When an impeachment or any activity is going on,these supposed human rights lawyers will be busy buying newspapers preparing their legal weapons and when the action is concluded,they will grant press briefings telling one party how to reclaim their lost position. Before you know what is happening,that party has briefed the human rights lawyer and legal battle has started after all, an Igbo adage says that, 'anarchy in the society is an advantage for the members of the cabinet' ,at least the members of the cabinet will constitute the ad hoc committee that will be set up to resolve the imbroglio,with the attendant financial mobilization The casual workers that worked in Ebola treatment centres in Lagos and Rivers states didn't they complete their uncompleted buildings and smiled to the bank while the likes of my distinguished Dr Stella Adadevoh and others have transformed to another realm?

There is a clause in the ethical codes of professional bodies like the doctors and the lawyers which prohibits self-advertisement but trust Nigerians,when one door closes,the other opens. The granting of press briefing is the fastest and most cost effective means of self-advertisement that is right before man and the law. To substantiate my claims, some of our human rights lawyers are already granting press briefings supporting the honourable members of our Hallowed national Assembly that scaled through the fence, the next news will be that those lawyers that granted the press briefings are now counsel to these our honourable members. I want to state categorical clear that I am not supporting any of the warring parties in the national assembly,I just alluded to the incident to buttress the point that our human rights lawyers are more concerned with their own pockets than taking up a legal suit that will benefit the common man.

Let us quickly go to my second experience as an undergraduate. My fellowship along with other fellowships were enjoying an uncompleted building on campus for our fellowship activities. The building had been abandoned and forgotten by the previous administrations . Since we were not officially assigned to the venue,the fellowships were neither paying any rent nor submitting their annual financial statement of accounts to the school authorities as enshrined in the school's constitution with respect to social and religious gatherings. One day,my fellowship decided to write officially to the school authority to connect the uncompleted building,which we were occupying ' illegally' ,to the school power supply. I advised against that but due to the fact that I was junior to all the other members of the committee,my sagacious piece of advice was taken as that of a fledgling neophyte. I used the dialectic I inherited from my father but it all failed.

A letter was forwarded to the school authority to that effect. That letter was counterproductive as it reminded the school authority that there was an abandoned project. All the fellowships and other occupants of the building were given one week to pack out of the building and work commenced immediately .During that one week of respite,all the prayer warriors from all fellowships were gathered to form what was akin to our current JTF. The aim was to call on God to touch the 'heart' of the school authority to rescind from her decision. As they were praying through the seven days days,construction materials were progressively being brought to the place and a day before the expiration of the the 7-day quit notice,it dawned on those fellowships that God is a God of justice because the prayer point of that joint prayer warriors could be interpreted as,' God do not let the school authority complete this uncompleted building .' Every fellowships returned to their tents and packed out of the property. That was what greed caused not only my fellowship but also other innocent fellowships making use of the venue.

Let us apply this experience to the incessant strike in our health sector. This is the time for our government to overhaul the health system. Why should microbiologists,biochemists and anatomists etc be dislodged from our laboratories by their smarter medical laboratory colleagues? Why should every worker(skilled,semi-skilled and unskilled) in the health sector form a coalition to gang against the doctors? What is the similarity between paramedical professionals( who spent about five years in the school) and other workers ( who got employed with SSCE ) that will make professionals be in the same group with 'casual' workers? Why should the Act establishing the pharmacy sections of our hospitals ban the setting up of private pharmacy firms within the premises of any government hospital,where expectedly the salaries of workers are from federal allocation courtesy of our black crude? Why can't pharmacy assistants and medical laboratory technicians/assistants be drafted into the internship scheme no matter how little their stipends? Why should some pharmacy shops be exceeding their boundaries by treating children with diarrhoeal diseases among other medical atrocities? Why should pharmacists sell non-over-the-counter drugs without a doctor's prescription as is obtainable elsewhere in the world ?Why is it that doctors are not part of JOHESU or is there any proof of a letter of invitation to doctors at the inception of JOHESU which doctors turned down? How can JOHESU convince us that the aim of forming the coalition was not to fight doctors? Where are those paid lopsided journalists that were writing rubbish about doctors during the last national NMA /NARD strike?Is it that they are not aware that their pay-masters are on strike for about two months now while the doctors they called medical terrorists then,are currently overworking themselves to cushion the effects of the striking paramedical workers? For the medical laboratory scientists ,their roles,if we can be truthful to ourselves,have been overtaken by modern medical practise, where almost all medical tests required are done with strips and the few ones requiring expertise are done with automated machines which are self-explanatory. In fact,my grandparents who never received any formal education know how to make use of these test strips.

Blood grouping and cross matching is what any student that attended a good secondary school should know how to do at that secondary level of education . It is a topic under Applications of Heredity and Variation in Biology . I learnt that in secondary school. I put it as a challenge to any investigative team to move round the country and investigate if almost all the Medical laboratories owned by professional medical laboratory scientists do not employ the services of SSCE holders who were given on-the-job training and that only few of them employ the services of medical laboratory assistants. I challenge them to show me how many of them that employed the services of Bsc holders in medical laboratory sciences in their private firms. China and other Asian giants are what they are today because they always tailor the wave of development to their own requirements. Time has come to grant internship programmes to biochemists and microbiologists who will work effectively under the professional supervision of my most distinguished specialist doctors called pathologists in the laboratory . Better still, the services of medical laboratory assistants/technicians will be employed .

There is one problem with the justice system that the British brought to us. Somebody will know the obvious truth but will not say it,rather he will be looking for a lacuna to evade that truth. Chinua Achebe,in 'There Was A Country', summarized everything about Europeans as thus, 'But I have also learned a little more skepticism about them than my father had any need for. Does it matter,I ask myself,the centuries before European Christians sailed down to us in ships to deliver the Gospel and save us from darkness,the other European Christians ,also sailing in ships,delivered us to the transatlantic slave trade and unleashed darkness in our world.' This is why somebody can be lying and mischievously be quoting international best practices. If all services in our hospitals were privatised and it happened that a JOHESU member was now the owner of the hospital ,would that person go on and appoint his fellow JOHESU members as consultants with the attendant payment of specialist allowances ? The answer is no because many of them that own pharmacy shops and laboratories currently are more comfortable with the services of SSCE holders and technicians than their own professional colleagues because they are aware that their current job requires little or no formal education.

Today,we are waiting for the court to interpret the meaning of medically qualified as it concerns the eligibility for the appointment of a chief medical director. One annoying thing is that we are asking why our children are not doing well in external examinations evidenced by the poor performances in 2014 WAEC and law school results,when we are also guilty of the same offence. It is a matter of time, people will soon approach the law- court for the interpretation of simple sentences such as, Obi is a boy. My electronic Oxford dictionary of English,version 4.3 106 defines the term paramedical as, 'relating to services and professions which supplement and support medical work but do not require a fully qualified doctor(such as nursing,radiography,emergency first aid,physiotherapy and dietetics).' Now,a country is waiting for the interpretation of medically qualified and not paramedically qualified , what a waste of time and show of shame? This is why some universities insist on applicants passing English language as a requisite for admission . What if the court interprets that phrase as being anybody in the medical and paramedical professions,that means that a nurse with PhD certificate will now become a medical doctor,'doctor' coming from the PhD whereas 'medical' coming from the interpretation of medically qualified. If the rumour being circulated in the social media,concerning a leaked portion of Yayale Ahmed recommendation recently submitted to the president, is true,that means more crises are imminent in our health sector.

In that unconfirmed report circulating in our social media,nurses and pharmacists are regarded as medical professionals along with doctors. If members of Nigerian customs ,Nigeria Security and Civil Defence Corps,Nigeria Immigration Services etc will claim to be the military ,will soldiers now become paramilitary? I have cited the definition of the term 'paramedical' from internationally-recognised Oxford lexicographers .In that definition,they went ahead to include the paramedical professionals in the bracket for clarity . My prayer is, let the rumour not be true because as I warned in my previous article,there are three sources of justice;the law,God and the people. Imagine a scenario ,where an investigation result is rejected by the clinician ,who is the doctor managing the patient,the reason being that a non-doctor 'consultant' signed the result. At that point the ball will be on the court of the patients to be shouting ,'please I want a specialist medical doctor consultant to sign my investigation result or else let me go outside and run the test because I don't want to do it two times etc.' At this point there will be more anarchy in the system as 'consultant' pharmacists will soon disappear because no money in the hospitals' drug revolving fund to buy more drugs and the drugs already bought have expired as the 'real' owners of the hospitals after attending to the patients have instructed them to buy all drugs outside the hospital.

Meanwhile,in our health sector today, the life of a doctor is regimented and he is so busy that at times he forgets to attend social events of friends or family members. In the tertiary hospital ,for an instance, If today is not consultant's ward round,it will be senior registrar's or registrar's ward round in addition to running of clinics and taking the patients to the operating theatre( if in surgery or surgery-related specialty). That is not all,the doctor may be on call where he is obligated to be awake for 24 hours and if anything happens the doctor will pay dearly for it. Also,he is mandated to present some seminar topics,mortality reviews and other clinical presentations in either his unit or at the departmental clinical conferences. These academic events are not without intensive studies and preparations as other colleagues are always there to fastidiously pick out the flaws in the presentation and to intellectually embarrass the presenter . While the doctor is busy studying and exchanging ideas with colleagues for the betterment of the patient who is in the ward,clinic or who will soon undergo surgery, a group of people who should be working as a team with us,are busy planning how to dislodge us out of the system,the same way a group of people were busy gathering legal weapons that ousted NFA and installed NFF and after that ,the problems in our football sector are still on the increase.

Your excellency,you must have heard where they argued that , 'the posts of chief medical directors and minister of health are purely administrative.' Also you must have heard where they claimed that,'my noble association ,the Nigerian Medical association(NMA),is not a labour union hence your government should not negotiate with them.' This will tell you how far they have gone in non-health matters because my mother always tells me that ,'any plot that led to murder was not planned in a day.' As earlier noted,while doctors are busy sacrificing their comfort and that of their immediate family members for the good of the patients,these our supposed team members are busy planning how to end what they call 'arrogance' of Nigerian medical doctors. I have narrated incessantly my experience while as a paramedical student before finally doing the needful which was crossing over to medicine where I thought and still believe that I belong to. In those days as a paramedical student ,if a medical student greeted me,I would say he just wanted to announce his presence and when a medical student passed by without greeting me,I would regard such fellow as being saucy. Today, if my respected most distinguished NMA national president talks,they will say he is arrogant . Remember that was exactly what they said about his predecessor ,Dr Osahon Enabulele.

Our people axiomatically say that, 'an idle man is devil's workshop .' Who and who are really idle in our health sector ? Majority of these paramedical professionals run a three-shift roaster per day. That means we have those that work in the morning,afternoon and evening/night. It follows that if one paramedical worker is in afternoon shift,he is free both in the morning and evening/night. Let me quickly say that these free hours are enough to gather any material needed for any anti-doctors activities. Meanwhile ,the little time that the doctor has will be used for reading in order to remain current in the modern medical practice .Your excellency,it may interest you to know that another trap has been set for the medical doctors. That is in the form of a course called Health Management which is currently being run in some universities. The aim of that course is that if JOHESU fails to overrun the posts of CMD and minister for health with their current weapons ,then the Health managers will be statutorily mandated to declare these two important posts as part of their 'caliphate'.

Meanwhile,I want to specially thank our federal government for the proposed no-work-no-pay for the striking workers. I am pleading for it to be implemented immediately,starting from the payment of December salary. Forget the threats from their 'ogas at the top',NLC and TUC, two governors who are renowned legal luminaries have shown us the antidote to striking workers,employment of locum workers as in Lagos state and the use of legal instrument to 'cut the spine' of of striking workers as in Enugu state. All that the managements of our hospitals need to do is to go ahead and privatise all paramedical courses or better give land spaces within the hospital for private firms to come and invest in areas of laboratories,radiography,pharmacy,dietetics and cleaning services .If we can tell ourselves the truth, doctors can efficiently work with the medical laboratory assistants, pharmacist assistants, and all other technicians and these assistants will be more humble than their 'international best practices' counterparts. Our government can as well empower private hospitals through granting of loans and subsidization of fees so that these private hospitals can run secondary and tertiary services( as is obtainable in United states of America),let me see if there will be JOHESU in private hospitals. We will now see those that will appoint non doctors as consultants and pay them specialist allowances from the internally generated revenue of their hospitals. Is it not madness if a doctor decides to answer a matron/chief nursing officer;chief pharmacist/medical laboratory scientist/physiotherapist or if a doctor goes to a drug-manufacturing firm to drag the headship with a pharmacist,then while should others want to answer doctors,consultants,chief medical directors etc ?

Your Excellency,they tell us about international best practices,making references to American health system. Many of the famous hospitals in America are privately owned and a medical consultant is called 'Attending' hence they can relinquish the term,consultant, to any non-medical doctor the same way our legal practitioners relinquished the term esquire to members of the public since they cannot share the term barrister with anybody. They have equally failed to inform us that the societies of pathologists in Canada, USA, United kingdom, Australia etc are responsible for the accreditation of clinical laboratories and the certification of medical laboratory scientists,who are also known as medical technologists,in fact the document guiding the establishment of clinical laboratories in UK explicitly states that the director/head of the laboratory must be a medical consultant whose qualification is that of a member of the Royal college of pathologists or its equivalent,where this is not possible,a high ranking medical laboratory staff may manage the laboratory but must be overseen at least weekly by a pathologist. Also,the biochemists, anatomists are part of the allied health staff of the clinical laboratories. In view of the above,If we are going to correct the health system of Nigeria, we should start with international health best practices by empowering pathologists to take up their job descriptions fully and the microbiologists,biochemists and anatomists to return to our laboratories.

More facts will be revealed in my subsequent articles under this subject-matter.

Dr Paul John
Port Harcourt,
Rivers state.
08083658038
[email protected]