As I drove my car to the car wash in preparation for a programme I had the next day,I decided to board a commercial bus to buy some materials from the nearest market . While inside the bus,an argument was already ongoing and I had to listen first before making my contributions .They were discussing the recent sacking of resident doctors by our federal government through the ministry of health. It was as if everybody in the bus was against a particular man with tribal marks. The man's argument went this way,'This is exactly what is obtainable in a country where somebody that is professionally trained to handle animals,including but not limited to wild animals and fishes,or better still work with NatGeo world channel where animals are televised ,suddenly whether by divine or manmade permutations became the president of a country inhabited by human beings.' At this point I was listening with rapt attention. 'If he is wise he should have known that Abacha and other military leaders like the tyrannical General Muhammadu Buhari tried sacking striking workers but they all failed,even last year ,the same federal government tried sacking the striking ASUU lecturers but failed woefully,something that was not possible during the era of military junta,now tell me how it will be possible,the president with his minister for health should go and ask the present governor of Lagos state his experience when he sacked the 774 doctors in Lagos in 2012?,' the man continued almost fuming. Having realised that my stay in the bus was only temporary, I asked him if I could get his phone number for more talks on that subject matter ,he replied me,'young man I don't give strangers my number.' Having turned down my request and with the stigma attached to such ignominy,I decided to remain as a loner till I got to my destination,praying to God that I could get to my junction faster than it should be. Luckily,the motor boy announced,'Any market junction here' ,I shouted 'yes' from my forced withdrawn state.

As i alighted from the bus ,I did not know which of my actions to blame-was it not waiting patiently for the car washer to finish his work or was it politely requesting a phone contact from a a man I barely met? Anytime I remember that singular incident I wish I never entered that vehicle in the first place. However,I gave a second thought to the assertions made by the man. I don't think I will buy his ideas because we have had presidents from different disciplines that ruled their respective countries successfully,in fact our constitution stipulates minimum of SSCE certificate for the office of the president. I think I will blame the advisers to the president for taking such a laughable action .One thing we Nigerians don't know is that our president is a human being and according to the psychologists, every human being has maximum amount of stress he/she can bear at each point in time,above which such an individual will break down.

In Obama's first election ,immediately he defeated Hillary Clinton in the party's primaries ,Obama was pressurized to take Hillary Clinton as his vice,Obama refused arguing that his vice must be somebody that would advise him at his wit's end. This was an associate professor of law who envisaged that a time would come and he(Obama) would get to his wit's end(become confused) and at that time the government could only continue if his vice could advise him objectively at that point. Our biblical David cried unto the lord when he learnt that his sagacious (senior special) adviser,Ahitophel,had joined the camp of his own son,Absalom, who drove him out of his palace. David did not bother asking God to restore him to his palace but he prayed unto the lord as thus,'...let the advice of Ahitophel turn to the foolishness of man....' These two scenarios have shown us the indispensable roles of advisers in governance.

I will not blame the president because the disturbing issues of terrorism and Ebola epidemic are enough distraction. Uneasy,they say,lies the head that wears the crown . Regrettably,those that are supposed to advise the president appropriately are treading with caution to ensure that they retained their posts till they voluntarily withdraw to go and contest gubernatorial elections that might have been zoned to their respective senatorial zones,or better still remain politically relevant since political posts seem to be easy going concern in Nigeria.

This is a doctor in a specialised training with a view to becoming an expert called consultant in one area of medicine .It follows that after the doctor must have finished as a house officer,he/she proceeds for the one year NYSC programme,unless exempted due to age or any other reasons. Thereafter,the said doctor will apply for, and must past the 'primaries' professional examination relevant to his/her area of interest. It should be noted that no resident doctor is a PERMANENT staff of the hospital as the programme is structured in such a way that within an average period of 6-8 years the resident doctor must have either passed the two examinations(part 1 and 2) or be shown the way out. It should be noted that even if the resident doctor passes the two aforementioned professional examinations as at when due,he/she will be given a maximum grace of six months to leave the hospital if there is no space for him/her to be appointed as a consultant in the hospital .Simply put,no resident doctor is a permanent staff of the hospital in Nigeria. In contrast to this ,any member of Joint Health Sector unions(JOHESU) is a permanent staff of the hospital except those doing their one year internship programme just like their doctor counterparts called house officers.

It is the chief resident in each department that prepares the duty roaster and places every other doctor in the department into different units they will work. The function of the chief resident can be likened to the work of a permanent secretary in a ministry,who organises the day to day running of the ministry. If federal government makes good her 'threat' of sacking resident doctors,retaining the house officers and consultant,there will be confusion and chaos in the health sector as the house officers are still naive in the practical aspect of the profession. Sacking resident doctors can be likened to sacking all workers in the ministry from the permanent secretary downwards leaving only the minister/commissioner(the consultants) and the newly recruited staff (the house officers) to work in the ministry. By this singular action,it is clear that government does not care about whether there will be chaos in the health sector or not since even if they want to check their own blood pressure,they will travel abroad with tax payers' money.


Why should resident doctors be sacked in the first place why sparing the actual people(JOHESU) that foment troubles in the health sector?Since the formation of JOHESU (Joint Health Sector Unions) neither the government nor the health sector has known any peace. Has the government asked the aims and objectives of non-doctors in the health sector gathering under one umbrella(JOHESU) ?Why are doctors not part of the JOHESU?Are doctors not part of the health sector again?Why can't the individual members of this amorphous group(JOHESU) remain on their own,embarking on strike on their own?

The questions raised above are not without answers. The law establishing the medical profession empowers the doctors to be ubiquitous in the health sector. A doctor is trained to manage a patient holistically with or without the help of the paramedical professionals. These so-called paramedical professions are the creation of the doctors,introduced into the system when there were few doctors in the country .It can be likened to a scenario where a house wife employs the services of a maid possibly to help in some domestic activities,that does not mean that the house wife cannot do what the maid is employed to do. It is just part of division of labour .Now,the creation of the doctors are now killing the doctors. Can the medical laboratory scientists allow laboratory technicians/assistants to head their units in any organisation? Can the pharmacists allow the pharmacist-assistants/technicians to head any pharmacy section in any firm? Can Bsc nurses allow RN nurses or even auxiliary nurses to head the nursing units in our hospitals? In 2012 ,we all witnessed the the rivalry that erupted between the HND-holders and Bsc-holders of the Radiographers board of Nigeria. Even recently,the nation witnessed the bickering between the Pharmaceutical Council of Nigeria(PCN) and The National Association Of Pharmaceutical Technologists and Pharmacy Technicians(NAPTON) over supremacy. The former are university trained,spending at least five years while the latter are trained in either colleges of education or colleges of health technology,spending about two years. All these insurgencies can be summarized as GREED and INSUBORDINATION. It equally explains the high rates of divorce in our families today. The wife assumes the position of the head of the family because she is gainfully employed.

Can a professor of PARAlegal studies head our lowest court(magistrate court) today,no matter the many years of experience in the profession?If no,how then can a PARAmedical professional become the chief medical director of our hospitals where there are qualified medical consultants? The next phrase is 'INTERNATIONAL BEST PRACTICES'.Shall we now address our president as 'king' because the head of government in the Kingdom of Saudi Arabia answers 'king' or will I now address our president as 'prime minister' just because the head of government in the United kingdom is called a prime minister,under the so-called international best practices,without first converting to their system of government?what do this people really understand as international best practices?is it what few countries are still experimenting on, which can be jettisoned tomorrow? Should that be our international best practices?Also,even in most of those few countries where there are non-doctor consultants,these consultants don't work in the hospitals ,they work in what may be described as agencies and departments of the ministry of health. Many of the hospitals in USA where non-doctors are the heads,they are privately owned just like our missionary hospitals in Nigeria where non-doctors are the leaders. Is it not madness if medical doctors go to drugs-manufacturing firms and start struggling with pharmacists over the headship of such establishments,claiming that the post is purely administrative?Is it not absurd if medical officers start fighting to be addressed as matrons,chief medical laboratory scientists,chief pharmacists,chief security officers etc in the hospital,citing international best practices?

Aristotle said that,'Injustice is not only treating equals as as unequals,it also involves treating unequals as equals.' Robert Greene went ahead to substantiate this as thus,'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.' Following the line of thoughts of JOHESU members that,'all are equal and should be paid equally,' let us introduce it to our politics where all our leaders from the councillors to the president receive the same basic salaries and allowances. That means that anybody that fails to be enlisted in the Nigerian army,the person will simply find a shortcut in Nigerian paramilitary and then become a chief of defence or chief of army staff since all of them are security operators and the said posts are purely administrative?Another error in reasoning ,you know.

What else does one expect from a country where if one is convicted of killing ONLY one person by mistake,as part of self defence or out of annoyance,the convict will be sentenced to death by hanging etc but when another is convicted of killing THOUSANDS OF INNOCENT WORSHIPPERS(WOMEN AND CHILDREN INCLUSIVE) in the name of terrorism,that convict will be sentenced to life imprisonment where the convict will be nourished permanently with tax payers' money waiting to be pardoned by the next president ? Mr John Yakubu Yusufu,one of the eight civil servants being prosecuted last year for massive embezzlements in the Nigeria Police Pension Fund, understood the principles of this inverse Nigerian law when he pleaded,'I ONLY stole N23 billion naira and the government has already seized my 32 property.' Expectedly,the judge gave him a limp tap on the wrist by asking him to pay ONLY N750,000 for him to return home and sin no more,as a waiver for the two years imprisonment earlier handed down to him.

Surprisingly,Nigerians started crying foul against that judgement,calling for the head of the judge. I maintained then,and still believe till date that the judge should not be blamed since the function of the judge is to give punishment,after convicting a suspect,according to the section of the law the suspect was charged with, by the law enforcement agents. Today,the government has decided to sack the working population of the medical profession believing that the problem has been nipped in the bud. Wole Soyinka can now be justified by his illustration of a fledgling head of state in one of his plays,The play of the Giants, who ordered the CBN governor to print more money to execute his selfish project. By sacking resident doctors,our government's action is worse than that of the head of state mentioned above,this is a time a patient can predict his or her own death while in the tertiary hospital and I think the legal unit of the hospitals need to be revamped immediately because the bereaved relatives will now start up their legal litigations over preventable deaths and medical negligence . Although,we are aware that most of our leaders are representing their pockets, their families and well-wishers,why playing politics again with the health of the patients?If our law does not operate inversely,tell me why JOHESU should be left why resident doctors were sacked?

Now,let us critically examine some of the claims of the government against doctors .The government said that they have addressed more than 90% of doctors' demands. My knowledge of mathematics( which I singlehandedly got A1) thought me that 90% of 24 will be 21.6,which is approximately 22. Now,adding the term ' MORE ', that means the government has met up with the 24 demands of doctors since the difference between 24 and 22 is just 2,which is infinitesimal. Let the government show us how they arrived at their own 90% since all these demands were published on the pages of our national newspapers.

It is quite regrettable that doctors are dealing with a government that is vacillating that cannot be trusted. Imagine a scenario where the government will issue a circular to doctors in the morning and in the afternoon the same government will issue a conflicting circular to JOHESU and when doctors protest,another circular will be issued to doctors in the evening and this cycle continues. My friend derisively suggested that,'it is like this federal government carries the circular in their cars etc and when there is any need,they will edit them and issue out.'

Remember that NMA wanted to embark on a nationwide strike early January this year but this same government pleaded that six months be given to them that they were going to address the doctors' demands but what did we see at the end? It is still the same government that came out to challenge NMA for a public debate to be presided over by our mostly uninformed Nigerian public,who are the real victims of the ongoing strike. As the lawyers will always say,'No one will be judge over his own case or a case one has interest in.' That is one of the principles of natural law,Nemo iudex in causa sua,but our honourable minister for health never considered that when he challenged doctors to a 'duel' so that the uninformed(or do I say,misinformed) victims of the strike will preside over the contest. What another error in reasoning? In view of the above,believe you me, this same government will still disappoint the lecturers in our colleges of education and polytechnics who suspended their strike in order to give the new minister for education time to study their demands. These Nigerian masses that the government and their JOHESU close friends have made to believe that Nigerian doctors are cruel,insensitive,wicked,inconsiderate etc will eventually be the final recipients of this power politics,if not now then later.

If this government is really serious,which I vehemently doubt, in revolving this impasse in the health sector,the following must be immediately implemented:

(1)JOHESU should be disbanded forthwith since their real name should have been anti-doctors union in the health sector. This is because there is no way a group of workers will gang up against the manager and you expect peace in that organisation. An Igbo adage says,if you want to separate fight,u must stop quarrel .Let each individual professional bodies/associations stand on their own and when they deem it necessary to go on strike,they should go alone while the hospital is allowed to function in their absence. I am cocksure that JOHESU will never allow this for a simple reason. When nurses go on strike,doctors called house officers and medical officers along with patients' relatives will bridge the gap. When Radiographers go on strike alone,doctors called radiologists will make their strike uneventful,when medical laboratory scientists say it is their time to embark on strike,doctors called pathologists(medical microbiologists,haematologists,chemical pathologists,histopathologists) will take over while all the side labs manned by doctors become functional. Even the pharmacists know that their functions in the hospitals are now that of the sale's girls/boys,since dispensing of drugs based on doctors' prescriptions is what anybody that understands some dispensing terms can easily do . I challenge my readers today to make their enquiries round town to find out that many of the attendants that work in pharmacists-owned pharmacy shops ,selling drugs to the public are SSCE-holders. The maximum educational qualifications of such attendants there are the certificates held by members of NAPTON and auxiliary nurses .Auxiliary nurses' certificates, to the best of my knowledge, are not backed by any law .Now,coming to government- owned establishments,these pharmacists will sit down dispensing drugs waiting for their monthly salaries,what an economical sabotage and waste of human resources of people that spent at least five years to get their certificates? This is exactly the way it has been among the component members of JOHESU ,for an instance,the medical laboratory scientists will be using easy-to-be-read strips in the laboratories,which only require unskilled labour,to do their tests and at the end they clamour to be 'crowned' consultants at least if not for their self-recognition at least for their many years of 'sitting' down to be doing tests that anybody can buy the strips and do at home. No wonder, I am also appealing to NFF to leave Keshi alone and appoint me as the super eagle coach since I have virtually watched all super eagle matches. What another error in reasoning?

(2)All allied medical areas must be privatised immediately so that favourable competition can come into our health sector and the management of the hospitals should contract firms to supply these allied medical services such that any firm that violates the terms of the contract will be shown the way out,the contract terminated and another firm contracted.

(3)Medical Laboratory scientists and Pharmacists should be jettisoned under the umbrella of privatization. This will not only sanitize the hospitals but will also go a long way in improving the efficiency as well as creating jobs for thousands of unemployed graduates out there who will work with all diligence knowing that the doctors are the team leaders . Microbiologists, Biochemists and laboratory technicians should be immediately captured into the one-year internship programmes because they can as well do what these medical laboratory scientists can do under the supervision of well trained pathologists.

(4) Our hospitals should be properly networked through which patients' information should be swimming. This will decongest our record rooms as well as the medical record JOHESU staff.

(5) For the nurses,they should be mandated,possibly through swearing of affidavits, to hold on to their oath , in which they swore to be at service of the physicians. This will stop the scenarios where nurses refuse to accept instructions from house officers and junior resident doctors in our tertiary hospitals

(6)All public office holders,whether
elected or appointed, should be barred from travelling abroad to seek medical attention unless when doctors in our tertiary hospitals advise otherwise based on the clinical state of such an individual. Nelson Mandela was hospitalized and treated in South Africa,he was never flown abroad. As we have been adjudged the biggest economy in Africa,do we still allow our political office holders travel abroad to go and check their blood sugar with our tax payers' money?If they receive all their treatments here,our hospitals will be properly equipped because they know that once there is any mistake,they will find themselves in the morgue leaving behind their public embezzled funds to unknown beneficiaries. That will help to bring to an end the scenarios where a complicated surgery will be stated with light powered by the hospital's generated but ended up with lights from cellphones ,torchlights etc among other inefficiencies in the health sector. Each tertiary hospitals will have at least three CT(computed tomography) and three MRI(magnetic resonance imaging) machines operating on three shifts model with employment of more health workers.

(7)Pharmacy interns should be doing their one year internship programmes in drug manufacturing firms and medical laboratory science as a course should be proscribed as many of the tests now are automated and are more straightforward, performing most of the tests with strips which anybody can learn in a day.

There are more to be done in the health sector but let us take them one after the other. The members of NMA should not worry about the sack of the resident doctors as it is part of political gimmicks which cannot be feasible even under draconian law. The leadership of NMA should not be deterred by this temporary setback and they should continue with the ongoing strike until the government shows serious commitment to permanently and genuinely address the injustices in the health sector since Aristotle said,'We make war that we may live in peace.'

Dr Paul John
[email protected]
(A port-based medical practitioner )

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Articles by Paul John