Unending Crisis In Our Health Sector: An Open Letter To Mr President (2)
Your Excellency, in my last article I exposed some of the causes and the possible solutions to the lingering crisis in our health sector. As we all know,the Joint Health Sector Unions(JOHESU ) is on strike but our tertiary hospitals are still functioning because my distinguished colleagues are still working.
I suggest that a new committee be set up to look into the causes of this incessant crisis and proffer solutions to this crisis.This committee may be given about ten years or more to come out with a lasting solution to this crisis. During this ten-year-period ,there will be roundtable meetings of all the 'warring' parties in the health sector. The committee will use this period to visit the health systems of other nations of the world before coming up with the final recommendation.
This is very important because the mending-wall approach currently used by the secretary to the government of federation in resolving the crisis,is having a counterproductive effect. In the morning a circular will be issued in favour of members of Nigerian Medical Association (NMA) and in the afternoon when members of JOHESU protest ,another circular will be issued in favour of JOHESU .Then members of NMA will protest in the evening and another circular will be issued in favour of NMA .
This vicious cycle continues while our main targets,the patients,in the health sector are constantly being sent to their early graves. As the medical laboratory scientists will always quote the WHO model for healthcare practice in their network programme,The Determinant, on Radio Nigeria every Monday that , 'the patient is at the centre of a circle' ,now that JOHESU members are on strike they have forgotten in a hurry the connotative meaning of that axiomatic expression. This crisis in the health sector is assuming a cancerous dimension and believe you me,it will get to an advanced stage when no amount of solution can 'cure' it.
Your Excellency ,it may interest you to know that this very problem did not start in a day hence the solution will not just crop up in a day. Circa 2012 ,there was internal crisis among the members of the board controlling Radiography in Nigeria. Some of them that were Bsc holders wanted to lord it over the Diploma holders. There was great crisis in the board. Before then,the medical laboratory scientists had 'dislodged' all the professionals whose courses involved( and still involve) laboratory practical experiences in our hospitals .These professionals include,but not limited to, the microbiologists and the biochemists.
The microbiologists and the Biochemists were not 'smart' when the medical laboratory scientists were 'sponsoring' an Act that would dislodge the non-medical laboratory scientists from our laboratories. Having succeeded in dislodging the biochemists and the microbiologists,who could efficiently and effectively function as the laboratory scientists ,the laboratory scientists now deem it necessary to dislodge my distinguished colleagues called pathologists and laboratory resident doctors from our laboratories.
Your Excellency,it may also interest you to know that currently ,the graduate nurses have pulled out of the ongoing JOHESU strike . This scenario,when properly utilized will make the ongoing strike uneventful,in fact the striking workers will come back to beg for them to resume work . What is their reason for not joining the ongoing strike? Their welfare is not included in the JOHESU demands and they are not really comfortable with the leadership of other nurses whose certificates may be less than or equal to OND .
These graduate nurses are crying for justice in that it is culturally,socially,morally,legally and economically wrong for nurses with RN certificates to come and lord it over the graduate nurses with Bsc certificates. I humbly and respectfully support the graduate nurses in their demands because Aristotle said, 'injustice is not only treating equals as unequals,it equally involves treating unequals as equals.'
Yes,these graduate nurses pass through similar paths like us ,at least in some schools from first year till third year,all medical and Bsc nursing students stay in the same class to receive the same lectures,attending similar practical sections though the pattern of their examinations is not the same but the truth is that they pass through similar sufferings as medical students.
Having passed through similar paths as medical students in the 'first-half ' of their education,these graduate nurses are aware of the more sufferings that await the medical students when the medical students proceed to their clinical classes while the Bsc nurses return to their department to pursue their own courses. In view of the above,when graduate nurses are employed in our tertiary hospitals ,I don't really think that we will be having these skirmishes that we are currently having in our health sector.
The graduate nurses know what the medical doctors passed through while in school and how many of the medical students failed out of the college hence they will respect the doctors for who they are and not what they are,whereas the doctors will see the graduate nurses as their own next in command,exactly the same way you cordially relate with your deputy,the vice president of our dearest country. The graduate nurses are also crying foul on why their own internship scheme was not included in the JOHESU demands.
As I have written in my previous articles,under different subject matters, JOHESU is an amorphous body that believes that the activities of doctors,who are ubiquitous in our health sector, can be regulated when all non-doctors in the health sector pull their forces together in order to use their 'mass effect' to paralyse our hospitals anytime they embark on any strike.
In those my previous articles,I warned against the repetition of what happened in the Animal Farm,written by George Orwell where comrades Napoleon and Snowball led other animals to overthrow the owner of the manor farm, Mr Jones, after which Snowball was the first victim of that coup and other animals 'judiciously' received their own dictatorial dividends of autocratic leadership of comrade Napoleon .
The graduate nurses are the first victim of my prophecy. They spend five years the same way medical laboratory scientists,pharmacists,physiotherapists, dieticians and radiographers spend in the university but the graduate nurses are the only ones in that group that are not currently enjoying the internship programme,what an injustice?
Owing to this,the graduate nurses seem to be less practically oriented at the beginning of their career when compared to their non-university counterparts with RN certificates . Your excellency, this anomaly needs to be corrected immediately unless we will carve out a line from the George Orwell's novel where Napoleon,after using 'mass effect' of other animals to overthrow the government of Mr Jones,amended one of the animal rules which initially read ,'All animals are equal' to 'Some are more equal than others.'
Why I am spending time in this discourse on graduate nurses is because of their vital roles in our health sector. If JOHESU strike is having any impact today on our tertiary hospitals ,it is because the nurses have joined. It may interest you to know that before nurses joined the current strike ,other components of JOHESU had been on strike and immediately nurses joined the strike,the health sector was shaken,though in some centres ,the management put up some measures to make the ongoing strike by non-doctors uneventful.
The vital roles of nurses in our health system cannot be overemphasized hence our government should employ more graduate nurses than those with RN/RM certificates at least in all our tertiary health facilities ,which for now are the final level of healthcare services in our country. One popular comedian said that he who took his bath in the village stream does not know how much a bucket of water costs hence the RN nurses may not know what it takes to be a university graduate whereas the graduate nurses know how difficulty it is for one to become a university graduate ,let alone being a medical doctor.
This will help to reduce the skirmishes normally encounter between junior doctors called House officers and some RN nurses in our hospitals where the RN nurses erroneously believe that they are superior to House officers by virtue of their many years of experience in the health facility. Can a permanent secretary ,irrespective of his/her many years of experience in a ministry, be greater than a newly appointed minister/commissioner in the ministry?
The vital roles of nurses and doctors can be shown by considering the number of doctors and nurses that died during the Ebola outbreak both in Nigeria and beyond. Though I stand to be corrected,I have not heard of any medical laboratory scientists,physiotherapists,radiographers,optometrists and dieticians that contracted or died of Ebola as part of their occupational hazards. This shows the real sufferers in our health sector,the doctors and the nurses ,whose pay packages should morally exceed those of other practitioners in the sector.
Your Excellency,I am in total support of an increase in the pay package for nurses though I am not in any way suggesting that doctors and nurses should be paid the same amount of money because there is no part of the world where it is done and anybody that says otherwise should come up with proofs. All I am saying is that nurses are the ones that stay with the doctors in the wards,clinics,operating theaters etc hence their pay packages should be greater than the pharmacists( whose current duties in our hospitals are counting of drugs prescribed by my most distinguished colleagues); medical laboratory scientists (whose duties have been overtaken by easy-to-operate automated laboratory machines,invention of test strips,and their other roles can efficiently and effectively be replaced by more humble biochemists and microbiologists under the professional supervision of my distinguished specialist colleagues called the pathologists); the physiotherapists (whose roles can be taken over by house officers if the salary of houses officers can be increased, better still individuals with degrees in Health and Physical Education and Sports medicine can be employed); optometrists (who are still in the sector due to benignity of my distinguished specialist colleagues called ophthalmologists); the dieticians (whose roles can be taken over by houses officers under the professional supervision of our distinguished specialist colleagues called endocrinologists);the radiographers ( whole absence cannot be felt once the pay package of specialist doctors called radiologists is increased). This list continues ad infinitum.
All I am saying is that graduate nurses need to be given their rightful place in our health sector because of their vital roles . The graduate nurses are aware of the true leaders of the health team. Now,let us critically analyse another solution. I suggest that locum paramedical professionals be employed in our hospitals so that when JOHESU expectedly embarks on any further strike,no lacuna will be created.
I still wonder why unskilled and semi-skilled labourers in our health sector should be fully employed. Their services should be better rendered by private firms so that the private firms' contracts can be easily terminated whenever they come up with the widely-abused 'international best practices'. The security services in many of our hospitals are now on contract bases hence the incessant stealing of hospital equipment has been reduced to the barest minimum.Lagos state government headed by a legal luminary has shown us that it is possible to employ and retain the services of locum workers in our health sector during and after strike.
In the case of Union Bank of Nigeria vs Edet(1993) 4 NWLR pt. 287,pg 288 ,the court of appeal held that embarking on a strike action by workers is acceptable in law. What that means is that JOHESU is legally right to embark on the ongoing strike hence the government should also find a way of cushioning the effect by appointing locum workers or privatise their services because the law does not support anything that will cause avoidable death of Nigerian citizens.
Also,the Trade Disputes (Essential Services) Act Cap T9 ,laws of federation of Nigeria 2004 ,prohibits strike action by persons rendering essential services. If my suggestions are taken into consideration ,the members of JOHESU will come and beg to come back especially ,when government fully applies no-work-no-pay rule. I am still surprised why those paid journalists that were writing rubbish during the last NMA/NARD nationwide strike will not deem it necessary to take up their pen to give Nigerians the specious reasons why their paymasters are currently on strike.
Also,just like I suggested in my last article,the services of paramedical workers can be privatized. Although many people have argued that it will increase the cost of patient care which I vehemently oppose on the following grounds,how many Nigerians were able to own phone gadgets and pay for the services of communication services when our telecommunication sector was monopolistically under NITEL as compared to what we have now after privatising that sector?
The truth is that by privatising our laboratories,the cost of laboratory services will come down while the quality of services will either be improved or not compromised. When there are many laboratory firms rendering laboratory services under the strict supervision of my specialist colleagues called pathologists in a particular tertiary health facility,the cost will inadvertently be reduced while the services will be improved.
This is because When a doctor rejects the result of a laboratory investigation from a particular private laboratory firm two times, it will be clear to the private laboratory firm to sit up or be forced into extinction. On privatizing our laboratory sections and other paramedical services,the laboratory resident doctors and the pathologists will continue to regulate the activities of the private laboratory firms in the same way Nigerian Communications Commission(NCC) regulates our GSM operators.
Your Excellency, all these paramedical professionals have assistants in their various professions and it is only the medical doctors that do not train assistants because we know that all these paramedical workers are our assistants .The Bsc nurses have their assistants as the RN nurses and the auxiliary nurses, the Radiographers have Imaging scientists as their assistants, the medical laboratory scientists have the science/medical laboratory technicians as their assistants,the optometrists have the optical technologists/technicians as their own assistants,the pharmacists have the pharmacist-assistants as their second in command.
We decided not to separately train our own assistants believing that these paramedical workers would solemnly abide by the true meaning of that prefix,para, in their name but today things are falling apart,insubordination everywhere is what we teach our young ones and this 'societal norm' is breeding through.
Sometime ago,the HND holders were clamouring that the disparity between them and the university degree holders be removed but they mischievously refused to beg the government to increase their own UTME cutoff marks and O'level entry requirements along with their studying curricula as those of the university students. Once the HND holders' request is granted,the masters degree holders will raise their heads to be placed on the same salary scale as PhD holders after all,they are all postgraduate graduates. Recently,the cold war that had been existing between the Pharmaceutical Council Of Nigeria (PCN) and the National Association Of Pharmaceutical Technologists and Pharmacy Technicians (NAPTON) was brought to the fore when the chairman of Cross Rivers state Association of Community pharmacists Of Nigeria,Mr Rajah Ibiang in Calabar accused NAPTON of issuing licenses to unqualified persons to dispense drugs.
Reacting to the allegation,the Deputy national president of NAPTON,Dr Lawrence HenShaw,said the law establishing NAPTON empowered it to issue licenses to people to run drug outlets,arguing that the law establishing PCN does not give it jurisdiction over other practitioners except pharmacists .He went further to cite the Federal High Court,Ikoyi judgement ,suit number FHC/455/2007, in which NAPTON was declared the winner and an injunction was issued in favour of NAPTON restraining PCN from interfering with duties and responsibilities of NAPTON. Legally, NAPTON won the case and I am not sure if PCN appealed the judgement.
Although I am not permitted to comment on the legal aspect of the judgement to avoid being charged with contempt of the court ,from moral point of view,I think the NAPTON should have lived up to their names as pharmacy technicians/assistants ? Meanwhile ,the former CBN governor having followed all this trend,started his own revolt which culminated in his disgraceful exit few months before the expiration of his tenure. My sparse knowledge of government, as an academic field of study, taught me that no appointed member of a government should accuse/fight against the government while holding the appointive position in that the honourable thing to do is for such an appointed member to resign after which the person can accuse the government.
Insubordination everywhere is what we see. The local pastor of a church near my house was transferred to another branch of the church,instead of obeying that instruction ,he resigned and opened his own church adjacent to his former branch. My recently sacked gateman enjoyed more sleep than I did and he could leave my compound at times without my consent,at the end of the month i paid him fully. He ate whatever I ate out of my benignity .The summary is that I terminated his employment when I could no longer tolerate his own 'international best practices' and till date I have refused to employ another Nigerian.
Our youths don't want to be apprentices again to learn vocational skills and when they fail in life, they will blame the government the same way a man with with less than Ten thousand naira take-home salary ,who married four wives with 30 children ,without any proper plan of training the children in school ,will blame the government when his children grow up to become prostitutes,armed or become fully involved in all social vices. Everybody erroneously believes that all Nigerians are equal before the law hence no class difference in the society . There is high rate of divorce in our society today,the reason being insubordination.
Regrettably,some unfortunate 12 Nigerian soldiers who have been following this high level of insubordination in the society repeated same in the military,unbeknown to them that the military is a profession with little or no indiscipline. The summary is that the Nigerian Army General Court martial convicted and sentenced them to death for mutiny and other related offences on September 16, 2014.My thanks goes to my distinguished legal luminary,Dr Olisa Agbakoba,SAN who has appealed the verdict on behalf of the convicted unfortunate Nigerian soldiers on the ground of lopsided composition of the court martial which to him was unconstitutional and violated the rights to fair hearing of the convicted military officers as enshrined in section 36(1) of our constitution.
While Dr Olisa Agbakoba is appealing the verdict in our law court ,I will do so in our moral court,arguing that all should be treated equally since the HND holders,NAPTON and JOHESU members are somewhat involved in the same 'mutinous' offences and they are still walking freely on our streets,granting press briefings that will make national headline news. Worst still ,members of JOHESU are still receiving their salaries while on strike for no justifiable reason,holding roundtable meetings with the government under air-conditioned conference halls ,locking up patients' case notes so that doctors will not have access to them and other related offences but these soldiers who only rebelled once and who had before then dedicated their entire lives to the integrity and unity of our dear country are currently at verge of being forcefully transformed into another realm. It is very disheartening.
My next suggestion will not go down well with the members of my noble association but it is just a suggestion which may be accepted or ignored. I suggest that medical course and all paramedical courses be brought into one course except Nursing. This is because the Radiographers,Medical laboratory scientists, the Physiotherapists etc always argue that they want to be having first contact with the patient. In our medical council ,there are two professionals who are one,the medical doctors and the dental surgeons. The medical doctors see the dental surgeons as same because both passed through same courses and similar clinical experiences with mild difference which is very infinitesimal.
Owing to this ,the medical doctor will allow the dental surgeon to have first contact with the patient because the dental surgeon knows what to do at each point in time. By having a joint medical and paramedical course,it will help remove all insurgents in the sector because many of these 'freedom fighters' causing problems in the sector were either unable to secure medicine through JAMB or failed out while already in medicine but found JOHESU courses as the closest alternative of remaining 'alive' in the health sector. By having this joint course,the cut off mark will be so high that there will be no alternative to remaining relevant in the health sector once your brain cannot carry the 'load'.How can my former colleagues who failed out and found themselves in paramedical courses now want to lord it over me and you tell me there will be peace in the sector ?
The psychologists say that , 'peace is not absence of war but presence of Justice.' All that Nigerian doctors are crying for is,let there be reward for hard work in this country . Nigerians were initially crying over the 2014 WAEC result until the recent law school result showed us the true state of affairs in this country. Can I ever encourage the young ones to study harder when mediocrity is constantly taking over meritocracy under 'international best practices.' Is there any moral justification for allowing fellow citizens pass through the 'horrors' of military training in Nigerian Defence Academy (NDA) when paramilitary officers will soon be Chief of Army staff,Chief of Defence,commanders in joint task forces etc after all when I surf the internet there must be few countries where civilians or paramilitary officers hold these posts and I will term it international best practices. Paramilitary officers will always claim to be the real military officers the same way the paramedical professionals are claiming to be the real medical officers hence we will need expatriates to come and teach us the difference between medically qualified and paramedically qualified.
Your Excellency, sometime in 2013,Nigeria decided to withdraw her troops from United Nations ,UN,peace-keeping force in Mali despite the fact that Nigeria was the fourth largest troop contributory country under the United Nations Peacekeeping operations. My further investigations showed that the withdrawal of the troops was in protest to UN security council 's appointment of a 50- year old Rwandan army general,Jean-Bosco Kazura, the force commander instead of a Nigerian officer,Major General Shehu Abdulkadir,who was the force commander of Africa-led International Support Mission in Mali(AFISMA) from inception in January 2013.Major General Shehu Abdulkadir was said to have come out tops in the interview for the appointment of the force commander but was sidelined. Further analysis showed that what Nigeria contributed in that mission was far above what Rwanda contributed,worst still the Nigerian officer was one of the best,if not the best,in the interview but was finally sidelined.
Your Excellency,if Nigeria could ignore her international relations and decided to withdraw her forces from a UN mission despite being the fourth largest troop contributory country under the United Nations Peacekeeping Operations just because unequaled countries were treated as equals,Nigeria being the victim of that international politics, what will happen when there are medical consultants, who have added average of eight years of intensive studies after passing out of medical school with MBBS ,then a JOHESU member with first degree or RN certificate is made the CMD or the head of a department? I don't want to remind you of the razzmatazz that took place when you appointed the former Inspector-general of police,Abubarkar Rimgim, from the lower rank of Assistant-Inspector-general of police (A.I.G) when there were superior officers at higher ranks of Deputy Inspector-general of police (D.I.G).I know that the JOHESU members clamouring for the posts of consultants,heads of clinical departments and chief medical directors have mischievously ignored to tell you that there are doctors called medical officers with MBBS certificates,at times with postgraduate certificates, who can never be called consultants or become heads of a clinical department/CMD in our tertiary hospitals despite their many years in our tertiary hospitals ?
Everything in Nigeria seems to be going the opposite side. These JOHESU members clamouring to be crowned consultants quoting their hackneyed platitude, 'international best practices' ,making references to American health system,are they aware that Nigerian and American health systems are not the same. Majority of the health institutions on American soil are privately owned,doctors are called MD and in a state like Arizona, it is a crime to add the title 'Dr' when you are not a medical doctor but in Nigeria, anybody with PhD is a doctor hence in the eyes of the Nigerian public such person is a medical doctor.
Are they aware that a consultant medical doctor is called 'Attending' in America hence the term consultant can be given out to other non-doctors in the health institution .Nigerian health system was carved out of British system,how many non-doctor consultants work in the hospital premises in UK ? One thing with Nigerians is that we are fast but impatient learners.
In view of the above,somebody that attended a food seminar for one day becomes a dietician/food specialist the next day,treating people in his/her own locality .That was why the former CBN governor wanted to print five thousand naira notes in 2012 under international best practices without considering the inflationary effects of such exercise in our own economy but I thank God that some Nigerians took it personal and the protest was so alarming that your Federal Executive Council rejected the proposal. I agreed with the former CBN governor that there were and are still countries where five thousand denominations are found in their currencies but our economy and theirs are not the same. See our entertainment industry,a film can be produced in less than a week.
I mean the film will be written, acted,edited and will hit the market in less than a week because we are fast but impatient learners whereas Hollywood films may take years to hit the market and at the end it will teach professionals in their own fields. Imagine a medical doctor watching a film from Hollywood in which none of the characters is a medical doctor or a paramedical worker but the characters will teach the healthcare professionals in their own field. Each line is poetic and one can learn English language as well from Hollywood films.
What is the difference between our films and that of Hollywood films?Time is the difference which will give room for professional analyses of the films. Here when an internet sufferer finds out a new system which the country is still experimenting on,it becomes our international best practices. Yes,in some states in America,the physiotherapists are allowed to have first contact with the patients,the next question is, on what premise? Do you compare their curriculum with ours?
If the physiotherapy students stay with medical students the same way dentistry students stay with medical students in their course of study,why won't us allow the physiotherapists to have first contacts with the patient? Many of these medical 'insurgents' were either unable to score high to gain admission into medicine or failed out while in the college,now they want to measure up with their colleagues at all costs. I don't need to remind you that those who were not favoured by your presentbgovernment in terms of appointive positions are currently your political enemies who will never see anything good in your administration.
Many of them have tried to hoodwink us that the reason for forming JOHESU was to prevent several trade unions in the health sector ,believing that we are still in the kindergarten. When everybody in a firm gathers against the director,will you tell me it is to prevent more trade unions in the firm? They tell us that the WHO model for healthcare practice is that the patient is at the center of a circle without sitting down to know the connotative meaning of that model .To them,it meant everybody in the health sector is equal hence all individual contributions to the patient will be unsupervised and uncoordinated by a team leader. From this premise,they will argue that they will not take instructions from the doctors even when the real interpretation of that model is that the patients' care is the primary role of all medical and paramedical workers in the sector .It means that medical and paramedical workers are in the hospitals because the patients are there.
The lexicographers may call it, patient-centric model. Hence,if I bring that model to Nigeria,the Nigerian citizens will be at the centre of a circle surrounded by the Executive,Judiciary and Legislative arms of our local,state and federal governments .Does that model now remove you as the number one citizen of the country,or the governors as the number one citizens of their states,same with the local government chairmen? Nigerians are really fast learners but very impatient to acquire the required skills.
Owing to this impatience ,a medical laboratory scientists or technicians will not relax to acquire the required practical skills ,the next moment he has opened a laboratory where intending couples will be issued AA genotype result during their premarital medical tests, and at the end of the day the couple will come down with children who are sickle cell patients,if it were in a developed clime,the litigation that would follow from such impatient practice would be enough to withdraw the practitioner's license but in this part of the world we believe that majority of things happening to us are spiritual hence no need for further investigations or litigations .Through out my stay in UK ,I learnt a lot from their medical system. If two couples who were certified AA genotype before marriage,later gave birth to a child suffering from sickle cell disease,it means that either the woman was involved in extramarital affairs hence the child was not fathered by her husband or that the hospital that did the delivery exchanged the child with that of another,all this problem is created out of impatience and insubordination.
Finally,anytime I am held up in the traffic jam of our major cities like Lagos,Kano and Port Harcourt,what flickers through my mind is that if our forefathers were provident,they would think of constructing good road networks in these major cities so that they could handle societal problems of population explosion in the future. It is now clear that our forefathers kept on with palliative construction of our roads at least today your administration is still talking about road constructions and maintenance when other nations have moved to another level of development hence let us find a detailed lasting solution ,that will stand the test of time, to this lingering problem in our health sector.
If by commission or Omission , injustice is meted out to Nigerian doctors by granting the demands of JOHESU ,doctors may seek justice elsewhere because there are three ways justice can be gotten in nature,from the law,the people or God. Consider,for an instance,when the result of laboratory investigation signed by a non-doctor consultant is rejected two times by the clinician who is the doctor that requested the investigations,nobody will tell the non-doctor consultants to go into extinction.
Also,when the attending doctor specifically warn the patient not to buy any of the prescribed drugs from the hospital's pharmacy,it is a matter of time,the drugs in the pharmacy will expire and when there is no money in the hospitals' Drugs Revolving accounts ,nobody will tell the 'consultant' pharmacists,it is time they left the hospital to the real owners.
My prayers is that this crisis does not get to that level hence I am calling on the government to either set up a committee that will take a minimum of ten years to resolve this crisis in the sector. The services of expatriates may be hired to act as unbiased umpire .The curricula used in training doctors and other paramedical workers will be taken into consideration to determine the remunerations and other packages because as Robert Greene said in his book,The 48 Laws of power, that, 'Treating everyone equally means ignoring their differences ,elevating the less skilful and suppressing those who excel...if you attempt to treat everyone equally and fairly ,you will confront the problem that some people do certain things better than others.'
Meanwhile,we should not be like bats,that are neither terrestrial nor arboreal animals. We must choose which system of health we want to run,if British,let it be purely British ,same if American system.At the interim we should employ the services of locum paramedical workers or better still privatise our laboratories bringing many competitors where pathologies and resident doctors in pathology units will have oversight function on those private firms.
My next article on this subject matter will expose more rot in the system.
Dr Paul John