Before We Crucify Late Dr Iyke Sam Enemuo!
When I got the news of Ebola in Port Harcourt,I called my colleague who works in a hospital close to that of the late doctor and the following conversation ensured,'Nna how far, are you aware of the latest news in town?,' I asked believing that he might not have heard the news revealing the cause of the death of the late doctor. 'Please don't mind that greedy and wicked colleague,' he responded.
This my friend's response is exactly what is on the lips of many of my colleagues and other residents of Rivers state. In fact if the late doctor were alive today,I would recommend that we throw all nobility to the wind and that he should be dragged outside,tied to a tree and flogged severally before the medical disciplinary committee of the Medical and Dental Council of Nigeria will irrevocably withdraw his practising licence.
Meanwhile, the Nigerian Medical Association(NMA), Plateau state chapter has started investigations to verify if the late doctor was truly a qualified doctors or one of the quack doctors that have been the bane of our medical practice in Nigeria. Although their preliminary finding showed that the late doctor actually graduated from University Of Jos ,that has not really placated the members of the association.
The communique released by the association read inter alia,'We heard that Dr Enemuo graduated from the University Of Jos and we are still investigating him to see if we can expunge his name posthumously from the records of doctors that graduated from Jos. What he did was bad because he did that at the expense of not only his life,but also the lives of others who possibly might have come into contact with Olu Ibukun all the way from Lagos to Port Harcourt.
Whatever might have been his fees is not worth the loss of his life and the risk he has put others to. So,we are investigating whether he is a true professional or a quack. He has to be sanctioned even though he is dead and those involved including the diplomat must also be sanctioned because they have messed up all the efforts the federal government has been doing to contain the spread to only Lagos and manage the situation .'
Before Plateau chapter of NMA will make good their threat,let us objectively reexamine some contents of our much respected Hippocratic (physicians') oath. One of the lines reads,' The health of my patient will be my first consideration.' Regrettably ,the late doctor is not alive today to tell us whether he chose to treat the diplomat based on monetary gain or because the health of the diplomat must take preeminence in the decision that he(the late doctor) took.
This is similar to a scenario during the trial of some suspects for the murder of Late Bola Ige, where a renowned lawyer in southwest hid a suspect in his house even when the police had declared the suspect wanted. After many days,the lawyer brought the said suspect to court for prosecution .The lawyer used that period of respite to prepare his client(the suspect) for the suspect's proper arraignment which was in line with the lawyer's expected professional conduct under such circumstance. In this case,it may be assumed that the late doctor considered the health of his patient first in line with the oath he swore.
Secondly,another line in the said oath reads,'I will respect the secrets which are confided in me,even after the patient has died.' My electronic Oxford English dictionary defines secret(as a noun) as,' something that is kept or meant to be kept unknown or unseen by others.' It follows that the late doctor might not have erred by surreptitiously keeping all that transpired between him and the diplomat right from the first time they agreed that the diplomat would fly down to Port Harcourt till the time the diplomat was finally discharged from the hotel room after recovery. It is clear that this quoted line contradicts a scenario where doctors are mandated to report any notifiable diseases to the appropriate authority.
I think our national association should actually try to amend our existing constitution to unequivocally define what constitutes a secret in the medical practice because believe you me,if the late doctor were alive today and Plateau state NMA chapter threatened him like this,he might be counselled by a lawyer to seek a redress in the law court as it concerned what should be 'a secret' in medical practice in Nigeria.
To make this point clearer,as a doctor, if your brother in-law,marrying your own biological sister, just returned from a six months vacation abroad which he had gone without the wife, and he is now rushed to the hospital and coincidentally your unit is on call that day and the laboratory tests show that he 'newly' contracted both HIV and Hepatitis B &C. If that your in-law has not yet sexually related with the wife since he returned from the travel,will that not amount to violation of the oath of secrecy if you go ahead and tell your sister,assuming that your in-law has pleaded with you not to reveal it to his wife?By respecting the secrets which your in-law has confided in you,don't you think that you are endangering the life of your sister by allowing her not to be aware of the current health status of her husband,knowing very well the health implications of these disease entities?
At the end of treating the diplomat,did the late doctor not ask the diplomat to return to the quarantine centre in Lagos for further examination? I think this should be a challenge to the NMA 's medical legislation and professional ethics committees to enact a law that will differentiate between notifiable diseases and diseases that should be kept secret even after the death of the patient.
Also, another line in the aforementioned oath reads,' I will not permit considerations of age ,disease or disability,creed,ethnic origin,gender,nationality,political,race,sexual orientation,or social standing to intervene between my duty and my patient.' A cursory look at this line may show that the late doctor might not have allowed the dreaded Ebola disease or nationality to come between him and the diplomat,who was his patient. More so,section 25 of our codes of medical ethics in Nigeria(last revised in 2008) shades more lights on the Management of HIV /AIDS and other socially dreaded infectious diseases.
It states that ,'practitioners should be aware of the prevalence of highly hazardous(contagious) ailments. While adopting the fully accepted measures to prevent themselves from becoming infected,they should in no way discriminate in handling and treating such patients,and should maintain appropriate confidentiality and adopt a multidisciplinary approach. Referral of such patients should be strictly based on professional needs.
Practitioners handling such conditions such as HIV /AIDS,Tuberculosis,Hepatitis B,Lassa fever,Ebola fever etc should be sensitive to the psychological and social factors. Practitioners should ensure that they are not used as agents by employers or others to deny affected patients their rights. Where investigations are clinically indicated ,it is ethical for the practitioner to give pre and post test counselling. Informed consent is mandatory if an investigation is needed only for research or for collecting epidemiological data,but would not directly benefit the patient.'
In view of the above,many questions are begging for answers. Did the late doctor adopt the fully accepted measures to prevent himself from becoming infected?This is because it is now clear that the late doctor was aware of the diagnosis before embarking on the treatment hence he decided to restrict the diplomat to the hotel room to avoid infecting other patients in his own hospital .Unfortunately,he is not alive today to tell us if he adopted fully accepted measures,I am aware that many people will differ with me at this point but we have to ask ourselves these questions, those two American missionary doctors that were infected in Liberia,where they not wearing the personal protective equipment while treating their patients?Also,can any doctor make use of syringes without wearing latex gloves ?
This is because my first instruction then as a house officer was that,'don't ever handle any patient without latex gloves even if the patient is your relative.' This brings us to another question,can this Ebola virus disease be contracted through air?The American center for disease control and prevention states,'although in the laboratory the Ebola viruses display some capability of infection through small-particle aerosols,airborne spread among humans has not been clearly demonstrated.' As research is still ongoing to establish any airborne spread,our clinical experience is pointing towards that route of spread.
Another question begging for an answer is ,did the late doctor actually inform the management of the hotel before and during the treatment of the diplomat about the inherent dangers of lodging the diplomat in the hotel since it was reported that that the late doctor personally poured Jik in a bid to sanitize the hotel room when the diplomat left? Although by informing the management of the hotel the late doctor might have violated the oath of secrecy ,I think that would help the management of the hotel in containing the spread of the virus among the staff and other users of the hotel.
Also, our above quoted ethical code mandates the practitioner to be sensitive to the social and psychological factors hence by telling the management of the hospital,he might have violated this code hence giving room for social stigmatization against the diplomat which would have great psychological effects on the patient. I think this is a challenge to our medical legislation committee to remove all ambiguities in our constitution and the code of medical ethics as the ethical code while shading more lights on the management of highly infectious diseases by practitioners states that,'practitioners should ensure that they are not used as agents by employers or others to deny affected patients their rights.
Did the diplomat actually have any right in this case?If yes,what is the limitation of such right?Also,the late doctor having seen that he could manage the diplomat(evidenced by the later recovery of the diplomat) alone without referral,did the late doctor have any right in this case to respect the secrets the diplomat(then his patient) confided in him?
I am not aware if there is any law in Nigeria that prevents the diplomat from travelling from lagos to Port Harcourt to seek medical attention and those calling for manslaughter charge against the diplomat should know that any foreigner once cleared my our immigration service to enter the country has rights to freedom of movement till the expiration of the time given to him by our immigration service. Instead of vilifying the late doctor and the diplomat,this is time for our NMA's medical legislation committees both at the federal and state levels review our existing laws to accommodate the duties of a doctor during notifiable diseases like this Ebola virus disease. Also,our legislative arm of the government both at the state and federal levels should enact laws to accommodate national health emergencies like this.
This is because my expatriate friend always tells me that,'it easier to make money and enjoy it in lawless nations.' There is no gainsaying the fact that many African nations are lawless in some human endeavours. The man that brought the index case of Ebola virus disease decided to come to Nigeria to seek medical attention even when he had American visa and the wife leaving in USA.
Is American health system not better than Nigerian health system and was it not more convenient for Patrick Sawyer to travel to where the wife was to seek medical attention ?Why did the wife of Patrick Sawyer not come down to Nigeria to stay with the husband as the patient relative at First consultant hospital ?Patrick Sawyer and the wife were aware of the lapses in our law hence they decided to toy with us.
Our leaders in our noble profession should know that as the practice of medicine changes with time ,that is exactly how the law governing the profession should change with time hence our constitutions,bye-laws,and the code of medical ethics in Nigeria must be yearly reviewed to accommodate the new trends in the profession . Also,our legislative arm of the government especially those at the National Assembly will use this as a course of study to enact more laws to fill up the lacunae in our health system.
In the UK ,it is a crime for a HIV positive man to sleep with a HIV negative lady without first declaring his true health status to the lady and if the lady finally consents,the man must use a condom correctly .If the man fails to obey this simply rule he will face legal consequences which at the end will render him bankrupt hence that will serve as a deterrent to others but in Nigeria,opposite is the case,in fact a HIV positive man can even decide to be infecting at least three ladies per day. The man may even go ahead to marry without first telling the lady his health status without considering the fate of the unborn children. Many of the ladies discover their HIV status when they come for antenatal clinics in our government hospitals where all serological tests are compulsory for all pregnant women. This ugly scenario is not only restricted to Nigeria.
A popular Ghanaian actress,Joyce Dzidzor Nartey, recently narrated how a member of her church infected her with the dreaded HIV. How will our law makers enact law that will help the common man,when they are enmeshed in one corruption or the other? While we preach against stigmatization of people living with HIV,is there any law in Nigeria prohibiting them from infecting more people in the society?Believe you me,Patrick Sawyer knew that he could easily come to Nigeria to introduce the infection without any legal consequences, no wonder he had the effrontery to be urinating on and be struggling with the staff of the First Consultants Hospital when the diagnosis of Ebola Virus disease was finally made.
If he had travelled to USA where there are strict laws virtually covering all human endeavours ,would he have behaved the way he behaved while at the hospital in Nigeria and would not the government have convicted him posthumously and the family heavily fined? Also,the remorseless Liberian official that cleared Patrick Sawyer to travel down to Nigeria even when Sawyer was to be quarantined in Liberia,what has our Nigerian government done to the official through the Liberian government to serve as a deterrent to others?
DR PAUL JOHN
Port Harcourt,Rivers state