That Illegal Closure Of Hospitals!

The anti-medical-doctors’ fight has taken another dimension, it is no longer limited to our government-owned hospitals, it has escalated to the private health sector. Late last year it was reported that a private hospital in Abuja was allegedly shut down by some radiographers without minding there were specialist doctors called radiologists? I think that matter is still in the law court. Since those that struck the Abuja hospital went home unhurt, recently our ears were inundated with sad news of the closure of another hospital by National Association of Nigerian Nurses and Midwives (NANNM) in Ogun state. Their reason was that the hospital was training quack nurses. What is the definition of a quack nurse? Are auxiliary nurses that are internationally recognised also among the quack nurses? Is NANNM statutorily empowered to regulate the practice of auxiliary nurses? The Act establishing Nursing and Midwifery Council of Nigeria is meant for the regulation of nurses and midwives in Nigeria and not meant to regulate the activities of auxiliary nurses. The Act states that “nurse” or “midwife” means a person who is registered to practise the profession in accordance with the provisions of this Act (Nursing and Midwifery Registration Act). The Act never bothered to define auxiliary nursing, the way it did not define other health professions like medicine, pharmacy, radiography et cetera hence it has no jurisdictional power over them. In view of this, will it be wrong if I state that auxiliary nurses, nursing mothers, nursemaids, nursery nurses et cetera are not to be regulated by the current Act establishing the Nursing/Midwifery profession the same way the Act establishing the Medical and Dental Council of Nigeria does not allow her to regulate other doctors (like holders of PHD, honorary causa et cetera) that are not medical doctors. s20 (1-2) of the Nursing and Midwifery ACT states that (1) Any person not being a person duly registered under this Act who- (a) for or in expectation of reward practises or holds himself out to practise as such; or (b) without reasonable excuse takes or uses any name, title, addition or description implying that he is authorised by law to practise as a nurse or midwife, is guilty of an offence under this section. (2) Any person who employs any unregistered person as a nurse or midwife is guilty of an offence under this section and liable on conviction to be punished as provided in this section. It is clear that this offence is for people who impersonate registered nurses/midwives but not those who practise or parade themselves as auxiliary nurses, nursing mothers, nursemaids et cetera.

We saw the legal battle that took place over the years before the Pharmacy Council of Nigeria took over the regulation of pharmacy technicians. Let me digress a little in order for me to use the case of pharmacy technicians to buttress my points on auxiliary nurses. The world number one encyclopaedia (Wikipedia) has this to say about the rivalry between Nigeria’s Pharmacy Council of Nigeria and the body regulating pharmacy technicians:

Pharmacy technicians in Nigeria make up 75% of pharmaceutical work force and are looking for their council (pharmacy technician and technologist council of Nigeria) reason being the pharmacist council of Nigeria (PCN) refuses to allocate responsibilities that will give them right to practice at community level interdependently. The case was in court and the court ruled against PCN on 12/3/2008.

Nigerian pharmacy technicians in collaboration with the National Board of Technical Education (NBTE) are currently saving Nigerian economy and Nigerians from the professional monopoly played by pharmacist Council of Nigeria (PCN) which led to abundant fake drugs due lack of manpower. This exposed Nigerian to a lot of problems which equally led to reduction in productivity leading to sustainable poverty. Nigerian pharmacy technicians in collaboration with NBTE are able to achieve these by introducing ND/HND in pharmaceutical technology. PCN is doing everything possible to stop this training in order to sustain its monopoly, demanding Federal Ministry of Education to direct NBTE to stop accrediting the polytechnics while these courses are offered in Ghana, Sudan and other countries. The meeting was called at the instance of NBTE on 25th May 2016 where the PCN representative of the Honourable Minister of Health, Federal Ministry of Education, Pharmaceutical Society of Nigeria (PSN) and National Association of Pharmaceutical Technologists and Pharmacy Technicians of Nigeria were in attendance. Certain issues bothering on the nomenclature pharmaceutical technologists, the curriculum and the accrediting body for polytechnic graduates of pharmaceutical technology were raised. There it was made clear that the nomenclature (Pharmaceutical Technologist) is not new in Nigeria as the training of people bearing the name dates back to the former School of Pharmaceutical Technologists between 1981 and 1985. The premises of the school are being used as the liaison office of PCN today. It was also established that NBTE is saddled with the accreditation of courses offered by Polytechnics and monotechnics in the Federal Republic of Nigeria. As for the curriculum findings, it was revealed that NBTE is in line with the legal instrument that established the Board. Meanwhile, it was unanimously agreed that all relevant bodies should come together to review the complaints of PCN by NBTE.

Recently, the registrar of PCN, Pharm Elijah Mohammed during a review of the accreditation process and guidelines for Colleges/Schools of Health Technologies in the country last year, said that the PCN approved private colleges/ and schools of Health Technology because the training of pharmacy technicians is essential to the nation’s health care delivery. After fighting against pharmacy technicians, PCN now remembers that pharmacy technicians are essential to the nation’s health care system, corroborating what Wikipedia earlier said that pharmacy technicians make up 75% of pharmaceutical work force in Nigeria. Pharm Elijah went further to state that collaboration was ongoing with the National Primary Healthcare Development Agency (NPHCDA) for proper placement of pharmacy technicians within the framework of primary health care services such that they head the drug stores at the local government headquarters and, handling of dispensing of drugs at the facility levels. Whether we accept it or not, just like the Pharmacy technicians, the auxiliary nurses play a vital role and occupy a significant percentage in our private health sector, the earlier the Nursing and Midwifery Council of Nigeria amends her Act in order to regulate the training and practice of auxiliary nursing in Nigeria the better.

Let us come back to our matter at hand, s.39 (1-3) of the Codes of Medical Ethics in Nigeria, the association of a medical practitioner with unqualified and unregistered persons practising medicine, dentistry, or midwifery, was properly treated. I want to dwell more on subsection 3b of this section which states as follows:

Shortage of medical and dental practitioners leads to the training and employment of nurses, midwives, physiotherapists, dispensers, and other persons to perform specialised functions relevant to medicine, surgery and midwifery that are supposed to be exclusively done by the registered fully qualified professionals. This arrangement can be legitimate only if the non-medically qualified clinicians follow protocols provided by the supervising doctor and if the latter continues to exercise effective supervision over the persons so employed and retains personal responsibility for the overall management of the patients. Any assistant or paramedical professional so employed should be the one registered by his or her appropriate regulatory body.

This subsection is very important to our discourse because it empowers the qualified medical practitioner to train OTHER PERSONS to perform specialised functions. The only clause in the foregoing subsection which may require interpretation of the court is “Any assistant or paramedical professional so employed should be the one registered by his or her appropriate regulatory body.” This is because many people working in the hospitals are yet to get regulatory bodies. The last I checked, the anatomists were still working on or amending their bill in the National Assembly. I don’t know if generator operators, mortuary attendants, porters, auxiliary nurses, accountants, ,security men et cetera working in our hospitals ( both private and government-owned) have their own regulatory bodies or are registered with their regulatory bodies, and if a doctor relates with such persons yet to have regulatory bodies, does it mean that such a medical practitioner has contravened this subsection? Can a doctor be guilty if he employs an accountant who is not an ICAN member? What of the messengers with First school Leaving Certificates working in our hospitals that have no regulatory bodies?

Auxiliary nursing as a practice falls into what is internationally recognised as Unlicensed Assistive Personnel (UAP). Wikipedia defines UAP as a class of paraprofessionals who assist individuals with physical disabilities , mental impairments, and other health care needs with their activities of daily living (ADLs) and provide bedside care—including basic nursing procedures—all under the supervision of a registered nurse , licensed practical nurse or other health care professional . UAPs must demonstrate their abilities and competencies before gaining any expanded responsibilities within the clinical setting.

They provide care for patients in hospitals , residents of nursing facilities , clients in private homes, and others in need of their services due to effects of old age or disability . UAPs, by definition, do not hold a license or other mandatory professional requirements for practice, though many hold various certifications. They are collectively categorized under the group “Personal care workers in health services” in the International Standard Classification of Occupations , 2008 revision. The nursing assistant, nursing auxiliary, auxiliary nurse , patient care technician, home health aide/assistant, geriatric aide/assistant, psychiatric aide, nurse aide, or nurse tech are all common titles that are considered to be UAPs in many countries.

At times I wonder what constitutes JOHESU’s definition of international best practices. Internationally, nursing assistants or auxiliary nurses are recognised and that of course can never be part of their international best practices but when it comes to fighting to wrest power from medical doctors in our government hospitals, they will remember the so-called international best practices. I read in the news the other day where one clown was threatening to sue the publishers of one of our national newspapers for their “indiscriminate use of the word-nurse”. It is clear that the clown could not differentiate between a registered/staff nurse and other meanings of nurse/nursing. That means that the clown does not know the meaning of: a nursing mother; wet nurse; to nurse an idea; nursemaid; nursery nurse et cetera. I think I may advise NANNM to toe the path of PCN that sought an alternative resolution with pharmacy technicians and incorporated them under PCN regulation. I am still wondering the legal power NANNM has to close down a hospital. This madness, of course, is taking another dimension. Medical doctors all these years have allowed others to carry war into their territories, I heard there is massive grouping of all the auxiliary nurses across the country to challenge intruders into their profession, I am yet to see where the ACT establishing the Nursing and Midwifery profession empowers it to regulate the activities of auxiliary nurses. I don’t see any moral justification where government trains and certifies Traditional Birth Attendants after few months of training whereas auxiliary nurses that train for not less than three years are not recognised.

Now, let us assume that our supreme court finally holds that auxiliary nursing profession is illegal against international best practices (as International Standard classification of Occupations recognised auxiliary nursing as a profession) ;and if our National Assembly fails to pass a bill establishing the auxiliary nursing as a profession, then all the pharmacy shops across the country will be the first to lay off all auxiliary nurses in their employments. Thereafter, all the maternities owned by nurses (without a supervising doctor) will be closed down. If the nurses hate auxiliary nurses why do maternities owned by nurses only make use of auxiliary nurses? I have my facts, I can pick them up when empowered or asked to do so. I wonder why our leaders will sit down in a time like this while our supposed neighbours in the health sector portray us to the members of the Nigerian public as those destroying the health sector. This is the time to be offensive as our defensive tactics is no longer working. All those working in medical laboratories that go on to prescribe drugs to patients after test results are out, should be behind bars, the pharmacists that dispense drugs without doctors’ prescriptions should be confined within the walls of Kirikiri maximum prison. Those pharmaceutical shops in Port Harcourt and all over the country that treat diarrhoea in children or that have small “hospital” beds in their shops where parenteral drugs and infusions are administered to patients should be tried and jailed. Any radiological investigations from private firms without the signature of a radiologist will be rejected by the consulting clinician. The nurses/midwives, who own hospitals and interview doctors before employing them against the MDCN rule, that only a doctor can interview another doctor, should be sanctioned and their hospitals shut down and they should be made to eat “half-cooked” beans in our prisons. Those paramedical professionals who answer medical doctors should be arrested and prosecuted for impersonation. I volunteer myself for this struggle to save our noble profession. There are secret cameras and other gadgets we can use to document evidence against them such that anybody arraigned will simply plead guilty to the charge to avoid wasting the time of the court because the evidence will be overwhelming. Arresting them is simple, simulate patients wearing the secret cameras to visit them in their private facilities where the non-medical doctors pose as medical doctors thereafter they will be arrested and prosecuted. When empowered, there is no way we cannot be arresting at least 100 people per day. I may not state our modus operandi until we hit the field. This madness should be nipped in the bud now because the way these guys are moving in the profession they may soon box all medical doctors to a corner after which they will declare their JOHESU “caliphate” in the health sector.

Also, the hospitals owned and registered by doctors who are now late should be revisited because the relatives normally keep on renewing the practising licences of the demised doctors. Every renewal of licences must be done through the state NMA chapters who in turn must use the affiliate bodies in the state, to identify every member. Getting CME points these days is very easy, just register for the CME and at the end, it will be issued to you. One person can even obtain for more than 10 people. This anomaly must be corrected. There are hospitals where non-doctor relatives of demised doctors go on to run the hospitals registered by the doctors before they died, hence non-doctors can interview, hire and fire doctors. This nonsense must immediately be addressed. A nurse who owns a hospital was even bragging to a doctor while interviewing him for an employment, that she, the nurse, would teach the doctor how to perform surgeries only if the doctor being interviewed would be humble and diligent. That is the type of nonsense we condone in Nigeria and they still have the effrontery to shut down a hospital because the doctor complied with s39 (3b) of the Act guiding his profession. Okay, let us eliminate or exterminate all auxiliary nurses as against international best practices and see how many pharmacy shops and maternities owned by nurses that will survive. This is the time to rid this profession of impersonators. Any doctor found to have used his licence to cover a hospital not owned by a doctor or a maternity should be properly investigated because many of the doctors use their licences to cover hospitals/maternities miles away from their towns of residence. I once again volunteer myself to carry this battle to other professions’ strongholds because I cannot imagine people with logs of wood in their eyes getting ready and willing to remove a suspected speck of sawdust in other people’s eyes ( which may end up being a Pteridium or Pingueculm)

Dr Paul John -Port Harcourt, 08083658038,[email protected]