by Oladayo Afolabi

Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity.

- Martin Luther King, Jr.

Historically, the first documented envy-ridden feud between Nurses and Doctors was during the Crimean War (1853-1856), when Florence Nightingale was commissioned to go to Scutari barracks in order to join military doctors to combat the high mortality rate in the military hospitals. The doctors, feeling threatened, resisted the help of Nightingale and her Nurses until they became overwhelmed with casualties and succumbed to reality. This pattern of doctors being threatened by the educated and empowered Nurse has continued to plague the working relationship in the healthcare system till today.

I am therefore not surprised as the current situation is not peculiar to Nigeria. The war between Nurse Practitioners and Doctors is still on even in the country with the supposedly most advanced nursing practice in the world, USA. However, it is being done using tact, legislative lobbying and empirical evidence. In Nigeria, professional civility and self respect has been thrown to the winds as some Nigerian doctors handle this situation in an appalling manner, using a combination of verbal brawl, comical assertions and frustrated rants. This betrays their characteristic ego-servicing claims of being the most knowledgeable member of the healthcare team.

I have been silent about the ongoing row between Doctors and other health professionals since its beginning. While my colleagues and friends from other health professions have continued to spit fire and brimstone deriding the doctors, my social media walls have been squeaky clean, devoid of such tirades. This is not because of lack of professional patriotism or inability to lay the bricks of words to construct a towering harangue about the issue. But, due to many reasons – personal, interpersonal and professional, I have kept my cool and refused to give in to cheap ineffective social media rants. However, when someone like the author of this article publicly displays crass ignorance of the nursing profession through a charisma-laden, highly bombastic but grossly information-deficient and intellectually-flawed article like this; I feel forced to talk, better still, write.

READ: Ayokunle Ayk Fowosire: NMA Strike: Consultant, My Foot!

The incessant strikes in the health sector have rendered the system moribund over the years. The ongoing feud has further grounded the ailing system. This article is not meant to expatiate and justify the (absolutely justifiable!) position of nurses and other health professionals (that is reserved for another day), but to answer Mr Fowosire’s beautifully-written article, an A-rated effort in sincere ignorance and conscientious stupidity. As much as I am highly disconcerted and extremely irritated reading Mr Fowosire’s article, I will try not to walk the dishonourable path of name calling. Therefore, in order to answer his pathetic rants, I do not intend to join issues with him or stoop low to trade banters, but this article will address the misrepresentation of facts presented by the previous writer.

On this background I can begin to address Mr Fowosire’s points. Firstly, the author’s effrontery to undermine the knowledge base of graduate nurses in basic medical science courses is a display of nescience. I still remembered that when I was in second year in the university, we attended the same lectures and wrote same exams for Reproductive and Digestive physiology and Neuroanatomy courses with third year physiology and Biochemistry students. Are doctors not being taught physiology and Biochemistry by graduate physiologists and Biochemists? Maybe a graduate nurse can now boast that s/he was taught in the same class with your teacher. Also in our third year, we were taught pathology with the same note used for part four Medical student. My transcript still says I scored 77% on the same Histo and chemical pathology MCQ given to part four Medical students. How did I know this? We used part four medical students’ past MCQ questions to prepare for exams.

I will not forget to let you know that as a part 4 undergrad, I led Nursing department team to victory over senior part 6 medical students’ team in an interdepartmental debate on bothering national and international health issues; not to talk of the fact that we attended the same lectures with medical student colleagues during first year in the university and some of us clearly surpassed most of them in first year academic performance. And this is not as a result of ‘la cram la pour’ as you said, because the consistency I, specifically and many of my colleagues have shown in academic and intellectual performance over the years could not have come by that. In addition, this ironing of facts should not be misconstrued for vain ego aggrandisement but to let Mr Fowosire, many other doctors like him and the general public know that many Nurses (especially degree holders) did not do nursing because they are academically-impaired but because of their love for the profession and some because of the socio-political environment of securing admissions into University in Nigeria.

The question of who should lead the healthcare team has also been a long-standing one. While many developed countries have undergone the health management structure-shift from vertically structured systems to a matrix structure, Mr Fowosire and many Nigerian doctors like him still live in the dark ages clamouring for ‘oga- omo ise’ relationship within the healthcare team. They want the Medical doctor to be even the director of Hospital security. This is inane absurdity. The National Health Service UK has been named as the best performing national health system in the world many times. The NHS and Hospitals in the UK are being managed by managers who are recruited through the NHS management trainee scheme. These trainees come from myriads of field, from geography to history, what matters in their recruitment is intelligence and ability to provide creative solutions to health system problems. These are recruited into the management cadre and grow through the ranks mastering the dynamics of the health system until reaching the highest managerial post of the hospitals and NHS trusts. Space will fail me to talk about the US, Canada, Sweden and so on. However, a six hours flight down south to Nigeria, we have the best medical professors and consultants wasting human resource by sitting down romanticising administration as CMDs, instead of taking care of the patients they claim to own. A predilection fuelled by the position-consciousness, power-hungry-proclivity, greed and corruption eating the fabrics of our society.

It is on ‘debatable‘ record that the best ever Minister for Health in Nigeria in performance was an economist not a Medical Doctor, Prof Eyitayo Lambo. The reason for that is not surprising, it is just common sense. A simple google-oracle consultation will show all his achievements as the longest serving Minister for Health in Nigeria. I will like to highlight that majority of my colleagues in graduating class 2012, Master in Health Planning and Management, University of Maiduguri, were seasoned consultants in different medical and surgical speciality from all over Northern Nigeria. However, I finished in top three out of the over forty six members of the class. Therefore, if the CMD position is filled based on performance and best management knowledge, skill and expertise, why should I not be lined up for consideration for such alongside my classmate medical consultants? Nevertheless, going by the meaning of CMD (Chief Medical Director), the inherent nominalistic connotation in this position is the reason why the doctors have made the position their exclusive preserve; a domain they plan to extend to commissioner for health and Minister for health positions too. As a responsible professional, in my personal opinion (which many of my colleagues may differ with) it will be clearly unreasonable to make a nurse the chief medical director. Notwithstanding, my proposition has always been, ‘why do we need a CMD if we have a CMAC?’ Therefore, I think the name CMD should be ditched and changed to favour international best practices. I think something like Chief Executive Officer or Chief Operating Officer as used in developed world should be adopted. This de-clutters the name and removes any exclusive preserve that medical doctors may lay hold on.

In trying to disparage and clarify Mr Fowosire’s embellished bombastic views of the superiority of the doctor over other health professionals, I mentioned my previous consultant classmates who I respect for their professional achievements in their field. I do not in any way use this to mean that I know what the consultants know about medicine, but I bet the consultants do not know what I know about nursing too. You do not compare grapes to mango. There is no basis for such. They are two different fruits. However, in your five-a-day dietary plan, you need to have both; one cannot replace another. On this premise, if the dictionary meaning of the term consultant, which has been selfishly usurped by doctors, is ‘a specialist’; then, why should a nurse, pharmacist or Laboratory Scientist not be called a consultant in their field if they have gathered enough knowledge, skill and competency to attain such specialised level. An expert who gives advice on business even if he has never managed one single start-up is called a business consultant. This is the case in many other professions and vocations. Why will doctors refuse to face their own effectiveness in their profession? Why are they trying so hard to bar other professions from progressing?

The ludicrous height of Mr Fowosire’s display of crassitude was the un-informed assertion that there are no male midwives in Nigeria. There is nothing like tradition in an Evidence-driven age and there is nothing like Midwifery being the exclusive domains of female nurses. I am a male midwife registered and licensed to practice by the Nursing and Midwifery Council of Nigeria. Male midwives have been produced and registered in Nigeria since 2007 and I was one of the early set of male midwives to be registered in the country in 2009. I am proud to be who I am and I am striving to be the best at what I do. I only wonder where Mr Fowosire is undergoing his medical education if he is boldly casting such un-informed aspersion about Nigerian Nursing in 2014. Your stereotyped labelling of all male nurses as wanting to become a doctor can be forgiven as another symptom of your ‘hypo-exposure-induced myopia’.

Furthermore, Mr Fowosire tried to lark about, tinkering with words. He used a comparison of ‘doctored’ and ‘nursed’ as a contextual basis to make an assertion that we live in a society clouded by vanity. What a comedy? What a good understanding of English language? Nevertheless, I will ask, ‘why do we nurse children and not doctor them?’ ‘Why do we nurse ambitions…?’ ‘Why do we nurse wounds and pain…?’ I guess ‘nurse’ is not a bad verb after all; but why does the verb- ‘doctor’ sound like someone falsified claims, adulterated the original and committed fraud. This is exactly what the doctors in Nigeria are currently doing raising unfounded propaganda and spreading intentional half-truths and falsified claims about the essence of the ambitions of the other health professionals, an archetype of fraud.

Mr Fowosire, your fear and concern for the society and posterity in this issue is highly unnecessary and totally misplaced. Empirical evidence has it that Nurse-Led Units are making the difference in patient’s life in the developed world. In the UK, a Nurse led unit, Barking Community Hospital (Yes a nurse-led hospital) close by my apartment has MRI machine. How many Professor of Medicine-Led teaching hospitals in Nigeria have that? That is what you should be concerned about, the fact that our hospitals are ill-equipped for 21st century medical practice. What you should be getting concerned about is the fact that Community Health Extension Workers (CHEWs) are consulting at Paediatric Out-patient departments in State Owned supposed Specialist Hospitals in Nigeria. The fact that after government spend lots of money to train a doctor (common in Northern Nigeria) till he becomes a consultant in a rare speciality then he goes to sit in the office as a CMD while all the money spent and specialist knowledge gained wastes. What you should be concerned about is the jungle medicine still being practiced in Nigerian teaching hospitals and many other cases of malpractice and negligence (documented by Olatunji Ololade in the Nation of 5th April, 2008), where doctors spent one month diagnosing a brain tumour as a sinusitis problem. And, most of all you should be very concerned about the fact that, after spending nine years for a six years course, you still have your part six MBBS exams to write. Until you become a fully certified medical doctor, your contributions in this debate are rather unwelcomed.

- Oladayo Afolabi is a trained Nurse-Midwife Researcher, Health Management Consultant and Idea Driver for MACHE initiative Nigeria. He is currently studying M.Sc. at London Metropolitan University on Dr. Muritala Muhammed Postgraduate Scholarship. Twitter handle @deeone6603

Source:http://www.thescoopng.com/oladayo-afolabi-rejoinder-nma-strike-nurses-point-view-stepped-toes/

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My bro you are good at what you do! bravo! Am so proud of you

Nurses getting their acts together......They are finally out of coma.
This is rebuttal with no temper tantrums.

@op the only thing cogent about your write-up is the grammar in which it was expressed . Apart from that it is full of known facts distorted to establish your biased stance . The gullible may read your post and fall for your subtle deception , but a discerning mind will always see the falsehood embedded in your write-up.
No where in the world is a doctor's training at par with that of a nurse. So the fact that your were breast-fed with a little pathology does not mean your understanding of the pathologic basis of diseases is as indepth as that of doctor. Though you claim you were tutored with the same notes,I can bet you that the exams were not the same. Besides the standards used to examine medical students is not the same as that used to examine a nurse. In my days one mark is subtracted for every question you fail (that's negative marking for you) .
The falsehood expressed in your post is certainly laced with the same stupidity you are complaining about. This post of yours is obviously tailored to delude the less informed masses. The error in diagnosis you mentioned above is a result of our failed healthcare system characterized by inadequate equipments and not necessarily due to a doctor's incompetence ,even in the US with all their glory and splendor in medicine patients still die due to misdiagnosis ( review Dora akunyili's case of cancer starting from the onset )
And please winning a debate and scoring higher that 'some' medical students does not make you special , the medical school as a whole regardless of your field of study (medicine , physiotherapy etc ) is a pool of brilliant minds however your training is different from that of a doctor so don't expect the same responsibilities . Besides a student's grade is influenced by many factors so those people you think your first year result surpassed theirs may be more brilliant than you many times over ( personally I always score excellent grades but I don't consider myself better than those who at one point or the other score less because the university is full of many factors that can distract a student )
Just for the records that academic achievement you think you have that makes you assume that you have arrived is no big deal , postgraduate degrees (phd ,msc etc) are very common among doctors infact most doctors go ahead to obtain international fellowships (fwas ,frcs , frcp etc) so stop getting high on your relative under-achievement

I love this speech.

OMG! this is the most intelligent write up I have ever come across since this NMA/Johesu war started. I love the writers command of English, and the way he articulated his points without insulting any profession. This is unlike most articles i have read from doctors insulting and putting others down. You presented your case well that nobody in their right mind can fault you.You just wrote like a true professional that you are. Nursing is indeed a unique profession. Thumbs up to you.

You guys should stop using Dora's case to score cheap publicity. Which kind rubbish be this. You diagnosed her, and the cancer waited for Ten good years to come out. The cancer just respected itself for ten years? Imagine comparing yourselves to US doctors. What made you think that even after you remove the tumor that it won't come back and that she hasn't been visiting other hospitals?Mtcheeeewww

Fernandez01: @op the only thing cogent about your write-up is the grammar in which it was expressed . Apart from that it is full of known facts distorted to establish your biased stance . The gullible may read your post and fall for your subtle deception , but a discerning mind will always see the falsehood embedded in your write-up.
No where in the world is a doctor's training at par with that of a nurse. So the fact that your were breast-fed with a little pathology does not mean your understanding of the pathologic basis of diseases is as indepth as that of doctor. Though you claim you were tutored with the same notes,I can bet you that the exams were not the same. Besides the standards used to examine medical students is not the same as that used to examine a nurse. In my days one mark is subtracted for every question you fail (that's negative marking for you) .
The falsehood expressed in your post is certainly laced with the same stupidity you are complaining about. This post of yours is obviously tailored to delude the less informed masses. The error in diagnosis you mentioned above is a result of our failed healthcare system characterized by inadequate equipments and not necessarily due to a doctor's incompetence ,even in the US with all their glory and splendor in medicine patients still die due to misdiagnosis ( review Dora akunyili's case of cancer starting from the onset )
And please winning a debate and scoring higher that 'some' medical students does not make you special , the medical school as a whole regardless of your field of study (medicine , physiotherapy etc ) is a pool of brilliant minds however your training is different from that of a doctor so don't expect the same responsibilities . Besides a student's grade is influenced by many factors so those people you think your first year result surpassed theirs may be more brilliant than you many times over ( personally I always score excellent grades but I don't consider myself better than those who at one point or the other score less because the university is full of many factors that can distract a student )
Just for the records that academic achievement you think you have that makes you assume that you have arrived is no big deal , postgraduate degrees (phd ,msc etc) are very common among doctors infact most doctors go ahead to obtain international fellowships (fwas ,frcs , frcp etc) so stop getting high on your relative under achievement

Fernandez01: @op the only thing cogent about your write-up is the grammar in which it was expressed . Apart from that it is full of known facts distorted to establish your biased stance . The gullible may read your post and fall for your subtle deception , but a discerning mind will always see the falsehood embedded in your write-up.
No where in the world is a doctor's training at par with that of a nurse. So the fact that your were breast-fed with a little pathology does not mean your understanding of the pathologic basis of diseases is as indepth as that of doctor. Though you claim you were tutored with the same notes,I can bet you that the exams were not the same. Besides the standards used to examine medical students is not the same as that used to examine a nurse. In my days one mark is subtracted for every question you fail (that's negative marking for you) .
The falsehood expressed in your post is certainly laced with the same stupidity you are complaining about. This post of yours is obviously tailored to delude the less informed masses. The error in diagnosis you mentioned above is a result of our failed healthcare system characterized by inadequate equipments and not necessarily due to a doctor's incompetence ,even in the US with all their glory and splendor in medicine patients still die due to misdiagnosis ( review Dora akunyili's case of cancer starting from the onset )
And please winning a debate and scoring higher that 'some' medical students does not make you special , the medical school as a whole regardless of your field of study (medicine , physiotherapy etc ) is a pool of brilliant minds however your training is different from that of a doctor so don't expect the same responsibilities . Besides a student's grade is influenced by many factors so those people you think your first year result surpassed theirs may be more brilliant than you many times over ( personally I always score excellent grades but I don't consider myself better than those who at one point or the other score less because the university is full of many factors that can distract a student )
Just for the records that academic achievement you think you have that makes you assume that you have arrived is no big deal , postgraduate degrees (phd ,msc etc) are very common among doctors infact most doctors go ahead to obtain international fellowships (fwas ,frcs , frcp etc) so stop getting high on your relative under achievement

Thanks chief.

@op is a sinister "maradona" who has used his mastery of the queen's language to beguile the uninformed and distort historical truisms.

He/she has loquaciously dug into an arsenal of blind-lies in order to buttress his arguments. Where in the world do medical curriculum run at par with that of nursing but in the writer's hallucinations.

In making a simple point in this discourse, he has gone adrift into murky waters and ensnared himself with lies from which deliverance only meant more lies to be doled out. we have business people setting up hospitals in Nigeria but don't run the clinical aspects of it and neither do they create an amorphous order in the head-ship of the health team, so why must that of the public sector be different.

In my little period of working in a federal run medical institution, I have discovered that the higher cadre of nurses are so academically poor and inefficient. They barely can survive a wardround without a gasp. They are so pompous and arrogant that even patient's relations literally fear them. These are the lot that want to foist themselves on us as consultant without recourse to any vetting from an academic body.

I thank you my chief for dispelling this surplanter who has not even tried to hide the fact that he enjoys the benefits of a doctor by way of scholarship in his present undertaking.

Fernandez01: @op the only thing cogent about your write-up is the grammar in which it was expressed . Apart from that it is full of known facts distorted to establish your biased stance . The gullible may read your post and fall for your subtle deception , but a discerning mind will always see the falsehood embedded in your write-up.
No where in the world is a doctor's training at par with that of a nurse. So the fact that your were breast-fed with a little pathology does not mean your understanding of the pathologic basis of diseases is as indepth as that of doctor. Though you claim you were tutored with the same notes,I can bet you that the exams were not the same. Besides the standards used to examine medical students is not the same as that used to examine a nurse. In my days one mark is subtracted for every question you fail (that's negative marking for you) .
The falsehood expressed in your post is certainly laced with the same stupidity you are complaining about. This post of yours is obviously tailored to delude the less informed masses. The error in diagnosis you mentioned above is a result of our failed healthcare system characterized by inadequate equipments and not necessarily due to a doctor's incompetence ,even in the US with all their glory and splendor in medicine patients still die due to misdiagnosis ( review Dora akunyili's case of cancer starting from the onset )
And please winning a debate and scoring higher that 'some' medical students does not make you special , the medical school as a whole regardless of your field of study (medicine , physiotherapy etc ) is a pool of brilliant minds however your training is different from that of a doctor so don't expect the same responsibilities . Besides a student's grade is influenced by many factors so those people you think your first year result surpassed theirs may be more brilliant than you many times over ( personally I always score excellent grades but I don't consider myself better than those who at one point or the other score less because the university is full of many factors that can distract a student )
Just for the records that academic achievement you think you have that makes you assume that you have arrived is no big deal , postgraduate degrees (phd ,msc etc) are very common among doctors infact most doctors go ahead to obtain international fellowships (fwas ,frcs , frcp etc) so stop getting high on your relative under achievement

The usual ego-driven rants.
Tired of reading the same rants over and over again because they always contain same thing:
we are smarter than you
have more knowledge and degree than you
know about medicine than you.
Just watch out for nurses like this guy that are made of hot tar and bitumen.
Refute his claims but not resorting to calling the post spreading of falsehoods as usual without any meaningful facts laden rebuttals.

Morotov1: The usual ego-driven rants.
Tired of reading the same rants over and over again because they always contain same thing:
we are smarter than you
have more knowledge and degree than you
know about medicine than you.
Just watch out for nurses like this guy that are made of hot tar and bitumen.
Refute his claims but not resorting to calling the post spreading of falsehoods as usual without any meaningful facts laden rebuttals.

If from the bottom of your heart you believe that you have more knowledge of medicine and degrees than a doctor then I recommend a thorough brain evaluation for you . If you had even the most rudimentary knowledge of healthcare delivery and at least an almost average IQ you'll see through the deceit in the post . If the paramedics are as knowledgeable as they claim , then why is it that the so called 'knowledgeable support staff of yours ' can't fill in the shoes of the striking doctors. capisce

prettyprettywow: You guys should stop using Dora's case to score cheap publicity. Which kind rubbish be this. You diagnosed her, and the cancer waited for Ten good years to come out. The cancer just respected itself for ten years? Imagine comparing yourselves to US doctors. What made you think that even after you remove the tumor that it won't come back and that she hasn't been visiting other hospitals?Mtcheeeewww

My dear, if you knew the pathogenesis of cancer you'll reconsider your stance

Egotism at its peak . Imagine butterflies pretending to be birds. Well am not surprised even lucifer after getting full of himself sought to be like God , hence the rebellion

Fernandez01:

If from the bottom of your heart you believe that you have more knowledge of medicine and degrees than a doctor then I recommend a thorough brain evaluation for you . If you had even the most rudimentary knowledge of healthcare delivery and at least an almost average IQ you'll see through the deceit in the post . If the paramedics are as knowledgeable as they claim , then why is it that the so called 'knowledgeable support staff of yours ' can't fill in the shoes of the striking doctors. capisce

Same temper tantrum of who is who. Name calling, usual rants..........blabla. In the court of public opinion Nigerian doctors will lose big time because they have poor debating skill devoid of fact but sentiment which when constantly repeated loose its substance and taste. The only reason they didn't encroach is because they obey the law and acknowledge boundaries.

[quote author=firedup]
Mr Fowosire, your fear and concern for the society and posterity in this issue is highly unnecessary and totally misplaced. Empirical evidence has it that Nurse-Led Units are making the difference in patient’s life in the developed world. In the UK, a Nurse led unit, Barking Community Hospital (Yes a nurse-led hospital) close by my apartment has MRI machine. How many Professor of Medicine-Led teaching hospitals in Nigeria have that?
Thank God for google. The hospital you mentioned is led by a team of 8 clinical directors including a chair that is a clinical director, and 7 others including a nurse director. Stop lying to the public just because you want to make a point. Here's the link. www.barkingdagenhamccg.nhs.uk/About-us/governing-body-members.htm
And for the public, don't believe everything you read. Google is your friend.

NMA should stop using her death to score cheap publicity. After all, she is not here to state her own side of the story.

Fernandez01:

My dear, if you knew the pathogenesis of cancer you'll reconsider your stance

[quote author=chioma134][/quote] In a haste to discredit what the article you quoted contains you failed to research appropriately on the Barking community hospital. Using Google as a guide, there appeared to be a lot of Barking-named hospital of which the one you uploaded their website is one of them. Seems the one mentioned in the article in particular is yet to have a website, but it shows that there are really a nurse-led clinics operating in advanced countries.