The International Best Practices We Need
International best practices, is the hackneyed phrase introduced into our health sector by JOHESU in their inordinate quest to take over the leadership of the health sector. The phrase is selective as it is not extended to their own wrong practices. They call for international best practices in matters that will favour their inordinate demands but ignore the same international best practices when it comes to their own wrongdoings .Let us critically analyse the areas of their practices that truly require these international best practices .
The pharmacists and their practices. It is only in Nigeria where ignorant patients walk into pharmacy shops to buy drugs without doctors' prescription(s). Some of those with doctors' prescriptions do so with the previous prescriptions which clinically may need to be modified by the doctor(s) who made the previous prescriptions. Many Nigerian patients ,use their previous prescriptions anytime they have similar illness without knowing that prescriptions are made based on many factors hence a prescription made for a patient today may change tomorrow.
Those in the pharmacy shop are more interested in their sales hence nobody bothers to ask the naive patients why they are presenting their old prescriptions. Also,many pharmacists have consultation rooms in their shops ,usurping the functions of medical doctors,without the requisite clinical exposure .The daredevil ones have 'upgraded' to the level of siting intravenous lines and treating naive patients in their makeshift Accident and Emergency wards .To them ,international best practices are not require in those areas as correcting the anomaly will affect their means of livelihood .
It is only in Nigeria where the chain of drug distribution is in the hands of non-pharmacists .Go to our open drug markets and see the few number of pharmacists there .To them,international best practices are not required in that area. What a self deceit ? If pharmacists are busy usurping the roles of the medical doctors,what conscience will they have to ask the patent medicine dealers ,the herbalist or the pharmacy technicians to do the right thing ? It is said that he who wants equity must come with clean hands .Tell them let international best practices guide their practices ,they will say no but the only place they want international best practices to be entrenched is taking over leadership of our health sector. A man who could not manage his family ,can he now manage a community of different families?
The most annoying aspect of it all is that greater than 90% of drugs used in this country are imported even the few ones that are into manufacturing have expatriates at their helm of affairs while all that their leaders want is to be in our hospitals to either drag leadership positions with the doctors or to sit down to be doing what my role model,Dr Osahon Enabulele called 'drug counting'. They complain of unemployment while neglecting the drug manufacturing aspect of their profession .They want to become 'consultants' just like doctors ,I ask consultants in what? Is it consultants in drug counting or consultants in doing the job of Pharmacy assistants/technicians ?
The medical laboratory scientists as part of JOHESU equally want the entrenchment of international best practices in our health system .The same people that when you send your patient to them for laboratory investigations , in the private practice ,that patient will never come back until complications develop. Somebody will ask me ,how? These guys have their stereotyped prescriptions for all ailments known to man .Once they find anything positive in their laboratory investigations ,they will prescribe all the drugs in their lists to the patients,throwing to the wind the drug-drug interactions among other pharmacokinetic and pharmacodynamic properties of drugs .The clinical states of the patients ,to them ,are not relevant in the choice of drugs for such patients .It is still the same group of people that have the effrontery to shout 'international best practices ' . To them ,the incessant physical assaults by them against my respected distinguished colleagues in pathology units of our laboratories do not require international best practices?
Whenever a resident pathologist is physically assaulted ,they will come out with an official statement to exonerate one of their own ,boasting that they have well-primed and professionally trained eye- witnesses who are also JOHESU members but those witnesses could neither prevent the physical assault nor call in the authorities before the oppressor descended on my distinguished colleagues in their places of work. International best practices do not cover where they run pre-marriage laboratory tests and tell intending couples that one is of AA Genotype while the other partner is of As Genotype and at the end of the day, the couple will give birth to sicklers .To them international best practices do not need to be implemented in that area. Today university graduates want to sit down and be running tests that make use of self-explanatory diagnostic strips . Did i hear Somebody ask, why there are crises in the health sector,the answer is simple ,a group called JOHESU is free in the sector hence they are free to form more alliances against the doctors who combine their practices with regular studies .Tell me the moral justification for a university graduate to sit down and be running laboratory tests with self-explanatory strips which my illiterate grandmother never encountered any difficulty in making use of ?
The nurses are also part of the alliance called JOHESU .The RN and RM nurses are sitting on the Bsc holders in their profession and they are still shouting international best practices .No wonder UGONSA which is an association of BSc nurses always dissociate itself from any strike embarked upon by the nurses in general .I am still waiting for the nurses to show me where in the world or part of their international best practices where house officers are meant to kowtow to them before they will go into their stores to bring out medical consumables that are meant to be in the wards,Accident and Emergency units and in our clinics .They are still yet to convince me why nurses in some units will be sitting down and be chatting with one another while doctors are doing ward round in the units .They should be told that international best practices must begin with them.
I may not say more about the physiotherapists since the legislators are already preparing their bill so that their residency programme will start. I only want to plead with the legislators in our National Assembly to equally add in the proposed bill the establishment of Judiciary High Courts within the premises of our health institutions. This is because there is no way a medical consultant will send a medical consult to another 'consultant' physiotherapist who then sees himself as an equal to the medical consultant.
The essence of the High court is that any consult from the medical consultants must be backed up with a sworn affidavit and motion exparte ,the court can then issue a court order compelling the consultant physiotherapist to honour the medical consult .We can easily envisage what will happen then ,if by now we don't have consultant physiotherapists that it takes them days or weeks to honour simple medical consults for the continued management of the patients ,who are our main concern in the health sector.
At times a lot of reminders will have to be sent before they honour the simple consult .I am aware that the consultant physiotherapists will never want to be under the CMAC and then they will be the lords of the hospital,you come to them with trepidations .More bills may still be passed to create more problems in the health sector,does it concern them when they fly out of the country with tax payers money to check their blood sugar and blood pressure .After all,the fire ignited in the Medical Laboratory Science Council Act of 2003 (which is at variance with some sections of the Act establishing the Medical and Dental Council) is still subjects of litigations in various courts. I heard that cleaners,security men ,mortuary attendants etc are also preparing their bills to start their own residency programmes .I think that will be a good idea since in the public hearing for the establishment of the proposed National postgraduate physiotherapy college ,it was revealed that nowhere in the world where a residency programme like that existed since many universities were already running their proposed programmes ,but some lawmakers were still hellbent on passing the bill.
Finally ,I may not write on all the professions under JOHESU but my only advice to them is that international best practices should start by their being proud of their professions .There is no need of answering a doctor ( at least in the health sector ) if you are not a medical doctor .Even those with PhD should apply the principles of international best practices by writing 'PhD' after their names ,without having to add 'Dr' in front of their names.
I want stickers on cars and name tags that will state depict clauses like 'I am proud to be a nurse,medical laboratory scientists,physiotherapist,mortuary attendants etc' and even if some of our fledgling patients erroneously address them as doctors,let them correct the patients immediately .No international best practices will be better than one being proud of one's profession .Nigerian doctors are blamed for the quackery by these guys impersonating the real medical doctors.
Dr Paul John
Port Harcourt,Rivers state
08083658038, mazipauljohn @gmail.com