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How is FMC Owerri after Dr Angela Uwakwem?

By Dr Paul John
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It is always difficult to disabuse the minds of people when the lies they were told were exactly what they were expecting. The members of the press and non-medical doctors in the health sector have portrayed medical doctors as the problems of the Nigerian health sector. While Dr Angela superintended the affairs of FMC Owerri , there was crisis and the workers presented her as the only problem of the center. Now she has finished her tenure, FMC Owerri has not shown any massive improvement as one would expect. It is still the same old story, arrears yet to be paid; not paying 100% salary et cetera. In Nigeria, it is easier to allege that a leader is corrupt, the same way an innocent girl can be labelled as a prostitute or a boy called an armed robber, cultist or internet fraudster, for no other reason that we have decided to give the dog a bad name in other to hang it. The fight against her was a national fight but people thought the fight was by workers in the center. One may ask, what was her offence?

INTRODUCTION OF PUBLIC-PRIVATE PARTNERSHIP (PPP)

Like the biblical Deborah,she had the courage to toe where other heads of government hospitals considered no-go-area. She introduced PPP in some ancillary services in the centre and that was against the inordinate principles of the cabal there , heaven,of course, was let loose. The non-medical doctors knew that once that programme was allowed to triumph in the centre, their end was near and the crisis in the health sector would be nipped in the bud. Why are they afraid of PPP? The answer is simple, they knew with PPP the end of imperiousness and unnecessary unionism in the health sector was near . This was happening despite the fact that the federal ministry of health has a department/directorate for PPP. There is one question I always ask people; the hospital that president Buhari went to in the UK, was it a government hospital or a private hospital? Although the identity of the hospital was shrouded in secrecy, I can state without mincing words that the hospital must either be privately owned or under a PPP arrangement.

This primitive type of hospital system we run in Nigeria is outdated and should be scraped,same is applicable to our university system. World class institutions like Harvard, Massachusetts Institute of Technology,Johns Hopkins; universities and their hospitals, and Apollo hospital in India, just to mention but a few, are they owned by the government? Why are non- doctors in Nigeria afraid of PPP or totally privatizing the health sector? They are aware that such programmes will automatically define each profession in the health sector. Why don’t we have JOHESU (Joint Health Sector Unions) among health workers in multinational companies, or in our private health sector? These two places are no nonsense place, how can a worker leave his place of work for the purpose of unionism and expect his payment at month end? Each person’s job is well defined in these two areas. In these two areas, no entrepreneur will employ and pay a non-doctor as a consultant but in our government hospitals ,we are ready to cut our national cake after all the proceeds of the oil in Niger Delta are everlasting. How many owners of private Pharmacy shops, medical laboratories, physiotherapy homes, Radiography scan centres, et cetera have appointed their colleagues as consultants to man or consult in their centres but I have lost count of private hospitals where medical consultants consult on daily basis? They cannot use their private centres to show us how non-medical-doctor consultants work but they want to do it in our public hospitals.

SPECIOUS ARGUMENT AGAINST PPP AND PRIVATIZATION OF THE HEALTH SECTOR

Nigeria is a place where an unconfirmed rumour is taken to be true. The specious argument those who feel threatened by the proposed introduction of PPP or fully privatizing our health sector sell to the public is that such programmes would increase the cost of medical care. From a layman’s point of view, that argument is reasonable but technically speaking, PPP or full privatization of the health sector will not only reduce the cost of medical care in Nigeria but will also raise the quality of health services rendered . Consider NITEL of those days, the corporation was the lord of our communication industry, they had the proverbial sauce and yam, and Nigerians were at their mercy. For their services to be installed in your place, you had to kowtow to them and to fix any fault thereafter you had to pay obeisance to them. It was a painful experience but when Chief Olusegun government came on board ,he said enough was enough. The doors were opened for private investors to come in ,today SIM cards of many GSM providers are free not to talk of their competitive packages. Thereafter, internet/data bundle packages were introduced; Nigerians are currently not queuing up in cyber cafes to check their e-mails, or to surf the internet as it used to be . What brought that tremendous change that nowadays even a beggar on the street has a cell-phone with a SIM card? The secret is privatization and opening of the doors to private investors in the telecommunication sector. That move automatically striped NITEL of its monopoly power. Telephone that was then an exclusive preserve of the rich and the highly-placed in the society,can now be owned and used by an average Nigerian .

Coming to our so-called federal tertiary hospitals, collection of laboratory samples end on or before 2pm on Mondays through Fridays ,and only few emergency laboratory tests can be done beyond this time and during weekends .What is the reason? Whether tests are done or not, the ministry of finance will share the national cake at month end. In other climes I have visited, all laboratory tests can be done anytime in tertiary hospitals. That means,currently in Nigeria, if a patient does not get to the laboratory section before 2pm during the week days for the collection of his blood sample,he will of course be asked to come back the next day ,without recourse to the inconvenience that will cause to the patient or the distance involved if the patient is an out-patient, the same is applicable during the weekends. If the CMD/MD of the government hospital talks ,JOHESU will shut down the centre and lock up the hospital then leave with the keys. If you want to talk, lawyers will tell you as citizens they have right to freedom of association and to embark on strike but no lawyer has ever told me that JOHESU members have right to lock up all units of the government hospitals and go with the keys when they are on strike or even beat up a CMD as it happened in UCH Ibadan during their last national strike .

I throw it as a challenge to all Nigerians who have traveled outside this country for medical tourism, to come and tell me if it was a government owned hospital they went to ? In our private businesses we look for the best brains to man the business but in government owned businesses we remember federal character as contained in s.14(3) of the Constitution of the Federal Republic of Nigeria( CFRN) which is a mockery of America’s Affirmative Action. That section of our constitution currently sets aside meritocracy for mediocrity ;I leave the amendment to the National Assembly. Those arguing that privatization will increase the cost of medical care in Nigeria; I ask them whether anybody can be treated free in our government hospitals? Any day you see an accident victim with no relative, just rush the victim to the nearest government hospital and know if the victim will be treated free of charge. My personal observation has shown that the costs of many private hospitals and centres are cheaper than the costs of the so-called government owned hospitals and centres. Consider for an instance, government hospital may fix the price for a particular scan at N1500 while private centres are collecting N2000 for the same procedure. If you go to a government hospital today,they will book you to come in two weeks' time ,let us assume you use N500 as your transport fare.

By two weeks time you come back as scheduled, they will tell you that the machine is faulty and that the engineers to fix it are yet to come, you are given another two weeks or a month, depending on the mood of the person you meet. You spend another 500 for the transport fare and when you return as scheduled , JOHESU must have gone on strike to press home their demands of heading our hospitals and to be appointed as consultants ,they will shut down the system,lock up the hospital hence nobody to talk to you let alone giving you another appointment. When the patient finally do the scan, his medical condition must have deteriorated that he may no longer depend on the scan for the final diagnosis hence more advanced scans would be requested. Now compare this scenario to the patient who refuses to be baited by the N1500 fee in the government hospital but simply and wisely goes for the N2000 fee in a private centre, his result would be ready within few hours and he returns to the doctor, who makes the final diagnosis and the patient’s treatment begins same day, which pathway is cheaper and more convenient? Today, Nigerians go to India for medical tourism, what is the secret of Indian health sector? They created competitiveness in their hospital system. Consider a scenario where a hospital has five different investors independently delivering comprehensive laboratory care services, there will be competition in not only the prices of laboratory services but also in the quality of services rendered. Then nothing like not collecting patients' samples beyond 2pm, Mondays through Fridays and running few selected tests during the weekends. The workers will be paid by what they generate from the laboratories with little or no subvention from the government. in India ,the government empowers the private hospitals ,giving them soft loans and other incentives hence many of them run internship and residency programmes but in Nigeria everything is concentrated at the government hospitals.

Currently, the law setting up government pharmacy sections does not allow the establishment of private pharmacy centres within the premises of our government hospitals .What is the reason? They are aware that when private Pharmacy shops are allowed within the premises of the government hospitals ,there will be competition in the prices of drugs and the availability of drugs because when a patient goes to buy seven different drugs prescribed by the doctor and a pharmacy shop has only two out of the seven items when another pharmacy within the premises has all the seven items, the theory of consumer behaviour in economics, states that the patient will buy from the pharmacy where he can get all the items. Now that private pharmacy shops are not allowed within the premises of government hospitals, are patients not asked to go outside to buy drugs not available in our government owned pharmacy units,what then is the difference ? In Pharmacy sections of government hospitals, pharmacists count and dispense drugs prescribed by doctors but in our private pharmacy shops, owned and registered by pharmacists, the same work of counting and dispensing drugs is done by auxiliary nurses and pharmacy technicians/assistants ,what a paradox of life? No plan on local drug production but there are always plans on how to wrest power from the medical doctors. Gullible Nigerians were told that it is only private hospitals that use auxiliary nurses, I throw it as a challenge that 9 out of 10 private pharmacy shops ‘judiciously and economically’ make use of auxiliary nurses. Contact me,let us move to the field let me point them to you. By the way, why should a pharmacy shop dispense drugs without doctors prescriptions or when the patient has not been clinically reviewed by a doctor?

They made Nigerians believe that it was Dr Angela Uwakwem that was the problem of FMC Owerri ,I asked them was she or her fellow doctors the head of the account unit ,where EFCC and ICPC may need to go for an industrial training .To refund a patient who has overpaid the hospital is more grievous and stressful than the over-payment itself and at the end somebody within the account unit will divert the pay after the patient has been frustrated to abandon the refund. This is time to extend the PPP Dr Angela Uwakwem started in FMC Owerri to other government owned hospitals and where necessary to fully privatize our health sector as it is obtainable in other developed climes; and those saying such gesture will increase costs for the patients,they do not truly love the patients, they are simply using such argument to ensure the system continues in its current deplorable state.

Dr Paul John,[email protected],08083658038