The Plight Of The Nigerian Doctor (2)

In the first part of this series ,I enumerated some of the problems limiting the functions of the medical doctors practising in Nigeria. I was supposed to suggest ways on how to reduce the plights of the Nigerian doctor but time could not permit me, due to the ongoing campaign for the change of leadership at our NMA state level nationwide .However,my regular readers have pleaded with me to complete the previous article by suggesting the ways by which the Nigerian doctors can perform optimally ,hence the need for this series.

First ,if Nigerian doctors should be compared with their counterparts in USA ,UK etc ,let the working conditions obtainable over there be brought down to Nigeria . This involves procuring state of the art medical equipment in our hospitals and making funds available for their maintenance so that it will not be like the vehicles that are constantly being donated to the Nigeria police without making any provision for their fuelling and maintenance ,hence 'roger' will fill in the gap.

This is because ,you cannot compare countries where Magnetic Resonance Imaging (MRI) ,computed Tomography(CT) scans and other modern diagnostic procedures are common and affordable ,with Nigeria where such procedures are still an exclusive preserve of the rich.

When late Nelson Mandela was sick, he was admitted and managed in a South African hospital until he gave up the ghost because they had the required medical equipment and the trained manpower but in Nigeria ,common ear infection of Mr president was a reason for international referral ,ridiculing our own Ear,Nose and Throat(ENT) surgeons.

Why should our leaders and politicians go to our hospitals when they are aware of the way they have mismanaged our hospitals through their policies and legislations?

There should be a legislation barring all government officials from seeking medical treatment abroad . We were told that president's personal physician authorised such medical tourism ,but we were not told if such authorisation was done under duress or for the physician to save his job because as Dr Osahon Enabulele,the current vice president of the Commonwealth Medical Association, described such medical tourism as a mockery of the change mantra of Buhari's administration and that of professional competence of the Nigerian doctors.

Imagine what would have happened in the secret if Mr president had directed his personal physician to give him a referral note for the medical tourism abroad and the physician refused .The next day,we might have heard that his personal physician had been fired or better still,the personal physician might be given the grace to honorably resign .All I am saying is that ,our government officials should start patronising our hospitals so that during their regular visits ,they will see for themselves how the hospitals are being managed and our challenges .

By regularly visiting our hospitals ,the government officials will witness how during our clinic days ,each doctor is meant to see at least one hundred patients in poorly ventilated and dim consulting rooms .At that point ,it will be clear that the Nigerian doctor to patient ratio is about 1: 6000. A recent study done in Gulf Medical University placed Cuba first as a country with the best doctor-patient ratio of 1:170 while ten percent of its annual budget is on health .USA and Great Britain have theirs as 1:390 and 1:440 respectively .I went to campaign to some of my colleagues in a clinic about my own candidacy ,I pitied them when I saw the number of patients out there waiting for my few colleagues to see them .One of my colleagues jeered at me as thus ,'Dr Paul John,did you see the number of people at the crusade ground out there ,so drop your flyers and leave ?' At that point ,I felt it a moral obligation to sit down and help them with pro bono medical consultation because it was clear that with the 30 to 45 minutes allocated for each patient ,those my few colleagues would definitely not see all patients that day.That is how it is all over Nigeria and Nigerians cannot ask their leaders why are there few doctors in our government hospitals .

Next time anybody wants to make comparisons ,many factors should be considered before making such comparisons as it is only in Nigeria where a doctor is meant to see an average of 100 patients in a day in poorly ventilated and dimly illuminated consulting rooms and still maintains his/her efficiency. We talk of shortage of manpower in our health sector when there are about 98% of unemployed medical doctors tramping from one private hospital to another in search of jobs. When I was in the medical school,I thought shortage of manpower meant the number of doctors available for employment were few hence we had to study our books to come and increase the number of the medical personnel ,but when I went into full practice I discovered that the shortage of manpower meant that although there were doctors looking for jobs,our government hospitals have refused to employ more medical doctors not because there were no spaces in the hospitals but because our leaders have refused to release funds for such exercise hence the few ones already in the employment were meant to do the work meant for many doctors . The picture became clearer to me when fresh medical graduates were made to stay at home for a minimum of one year before securing their internship placements. Residency placement is now an exclusive preserve of the highly connected . Nigerians should tell their leaders to first reduce our doctor-patient ratio to those of our counterparts in Cuba,USA and UK by massively employing doctors nationwide , before comparing us with those nations .

Concerning the percentage of our annual budget spent on the health,according to World Bank data( data.world bank.org ) ,the 2014 Health Expenditure Per Capita ( in current US $) for USA ,UK,Cuba and Nigeria are 9403,3935,817 and 118 respectively .'Common sense' ( though not common) teaches us that a business started with a capital of $118 can never yield same profits as those whose initial capitals were $9403,$3935 and $817 . The solution here is for Nigerians to inform their leaders to increase our health expenditure per capita as even in the transport sector ,travelling the same distance either by air or land can never consume the same time hence while other nations' health sectors are travelling by air,ours is travelling by land and mischievous elements still want us to arrive at the same destination same time as those travelling by air . Also,the remunerations of doctors should be reviewed upwards immediately while our working conditions are improved to reflect what is obtainable in those other nations. The call-food in some hospitals is not different from the meal inmates of our prisons are fed with. Housing schemes should be established for all doctors ,starting from the fresh medical school graduates upwards . Doctors' car-loan scheme should be an inalienable right of all doctors,after all ,the magistrates ,judges and justices get their free vehicles which must be replaced at most every four years .

I don't need to stress on that since the people see us as humanitarian workers hence we must live like other humanitarian workers elsewhere in the world .At banks and other public places where people are meant to queue up ,doctors then should be given a preferential treatment so that they can return to their humanitarian services to the nation .The security agencies and members of the Federal Road Safety Corps (FRSC) should not subject us to unnecessary checks once our identities are not in doubt as lives may be lost by such unnecessary checks and delays . Let our private hospitals and mission hospitals be empowered financially in order to absorb medical and health workers that our available government hospitals could not absorb .Many good hospitals and universities in USA,India etcetera are privately owned . By doing so ,we will decongest our government hospitals so that the doctor-patient ratio will improve. The three-tier system of our healthcare should be strengthened so that cases that should be handled at the levels of the primary and secondary healthcare should not have our tertiary hospitals as their first port of call. This is important because when our tertiary hospitals function as primary or secondary hospitals then there must be the need for medical tourism abroad where tertiary healthcare will be provided.

The members of the Nigerian Union of Journalists ,which I will soon be a member by virtue of my ongoing PGD programme in Journalism , should understand the harsh environment Nigerian doctors are meant to work in hence I intend having a robust relationship with them . However,they should verify all facts before publication as I will personally not tolerate any malicious reportage against my noble profession when I assume office as the next P.R.O and chairman of the Publicity Committee of my NMA state chapter . The Publicity committee under my watch will be so active and vibrant as to deal decisively with the publishers of any malicious and defamatory reportage against my profession ,not only in my state NMA chapter but also in order states of the federation . Meanwhile , when the Federal Radio Corporation of Nigeria aired one malicious commentary against the Nigerian doctors on 29/02/16 ,I wrote an open letter to the Director-General of the Radio station and forwarded a copy to the Nigerian Press Council,which is the supposed media watchdog ,but till today I have not heard any response from the Nigerian Press Council . When I will assume office as the next chairman of the publicity committee of my NMA state chapter ,I will definitely not write to the Nigerian Press Council when there is a malicious and defamatory reportage against my profession ,I will simply approach the law court .

My own approach to court will not be the usual civil litigations as I will introduce the criminal aspect of the litigation .Sections 373 through 381 of our Criminal code ,Laws of Federal Republic of Nigeria, clearly define what defamation is and the punishments to be meted out to offenders . Section 373 of our criminal code defines defamatory matter as a matter likely to injure reputation of any person ( association ) by exposing him(her) to hatred ,contempt ,or ridicule ,or likely to damage any person in his(her) profession or trade by an injury to his(her) reputation .I hope that publishers or editors of defamatory publications will not claim ignorance of those sections of our criminal code when I assume office because section 22 of the same code,while shedding more lights on the ignorance of the law,states inter alia,that Ignorance of the law does not afford any excuse for any act or omission which would otherwise constitute an offence. Also section 375 of the same code goes on to state that any person who publishes any defamatory matter is guilty of a misdemeanor ,and is liable to imprisonment for one year; and any person who publishes any defamatory matter knowing it to be false is liable to imprisonment for two years. Under my tenure,publishing any defamatory reportage against my profession ,is a way of begging the prison officials to open their gates for you.

I am aware of the Press freedom and the Freedom of Information Act ,but none of them empowers the members of the press to defame a noble profession like mine,such that an average Nigerian out there sees us as professionals that are over-demanding,insensitive to the plights of their patients,wicked,inhuman,greedy,wicked etcetera. Whenever we record a feat in medical practice ,a doctor is kidnapped or NMA /its affiliates issue ultimatums to the government ,there will be marginal press coverage but when a doctor is allegedly involved in a case of malpractice or when doctors embark on strike ( as last resort) due to the fact that the government has arrogantly reneged on earlier signed agreements with doctors,the press will give it wider coverage . The publicity committee under my watch will not only be disabusing the minds of Nigerians concerning any malicious reportage against my noble profession,but will also ensure that the culprits of such defamatory publications are brought to book because Ola Rotimi in his book,The gods are not to blame ,said that ,when the frog in the front falls into a pit ,others will take caution . They cannot intend selling their newspapers or increasing traffic to their online media houses by defaming my profession or members of my profession .

Finally ,the rivalry in the health sector should be nipped in the bud immediately by the introduction of Public Private partnership in some hospital ancillary services such as the laboratories,pharmacy sections ,cleaning services,security etcetera . Many hospitals are now making use of private security companies as against the primitive ways of employing workers as hospital security men .With such arrangement ,whenever the security company violates the contractual agreement with the management of the hospital ,the management terminates their services and another security company is appointed .With this arrangement ,the security men working in the hospitals under the auspices of the private security companies ,are not part of the amorphous union called JOHESU and workers presented by the private security companies will not embark on strike calling for the establishment of National Postgraduate Security College because they want to be like doctors who have National postgraduate Medical College or start greedily demanding specialist allowance so that we can have 'consultant' security men. They will also not drag the leadership of either our clinical laboratories or the hospitals in general .

Such an arrangement should be extended to the our laboratories,dietary units ,pharmacy sections etc .I am aware no good entrepreneur who wants to make reasonable profit and at the same time maintains the quality of his services ,will ever employ a non-pathologist to head any of our four pathology units as JOHESU is demanding .Under such arrangement ,the security men working in our hospitals from the private security companies don't go on strike when JOHESU goes on strike hence our hospital properties are safe at all times. Such an arrangement comes with competition such that the owner of the security company knows that once the efficiency of their services are compromised ,the hospital management will terminate the appointment .We want to see such arrangement in other ancillary services hence no entrepreneur will ever employ and regularly pay a pharmacist to be counting drugs in our pharmacy units when there are pharmacy technicians .My Indian colleague reliably informed me that why they can never have the type of rivalry we have in our health sector is that the doctors head their hospitals and sizeable number of their hospitals are either privately owned or being run under public private partnership. Is it after a doctor allocates a small space to a paramedical worker to operate under the supervision of the doctor that the paramedical worker will come and start dragging the headship of the hospital with the doctor ?

Dr Paul John
Port Harcourt,Rivers state
mazipauljohn@gmail.com ,08083658038