Dr Kayode Obembe, the National President, Nigerian Medical Association
(NMA) speaks on doctors’ grieviances against the government and why
their strike has persisted, in this interview with SADE OGUNTOLA.
It is said that there is no basis for doctors’ strike. Some people see it as
a self-serving one. What is your take?
This is because they do not have the fact. Some of the issues that
doctors are hammering on have been on the drawing board for almost 22
years. Doctors have been short-changed all along. We had tried our best
to rectify these anomalies, particularly with the various changes of salary
scales; we decided that something had to be done. We had to write off
some entitlements of doctors which runs to more than N80 billion. What
are left are allowances for just six months, because of the consideration
we had not only for the government, but the people of Nigeria. So you
can see that we are making some sacrifices.
In some of the circulars, which were issued by the government in
changing from one salary scale to the other, particularly in CONMESS and
CONHESS, doctors were short-changed and we have been talking about it
for years before we now decided we have to do something about it
But all that you have mentioned centred on money
Some of the 24 demands border on doctors’ activities. On top of the list
is the position of deputy Chairman, Medical Advisory Committee (CMAC),
which had been operating in hospitals but was tactfully abrogated.
Because of some agitations by certain groups, they cancelled it. This was
very infuriating to doctors because if you have established some
positions, all you need to do is to give the reasons for their establishment
and not to just, because some people complained, you go on to cancel it.
Second is on the position of consultants. Other health workers or
paramedics want to be bearing consultants whereas this title is only
meant for doctors in the hospital. NMA said this could produce anarchy
in the health system. Also, some paramedics also want to attain the
post of Chief Medical Director, which hitherto has been the perogative of
medical doctors.
These are some of the things that doctors feel are threatening the
structure of the hospital. And if the structure collapses, then patients’
care will suffer and it will be impossible to operate along the norms and
traditions of the profession, which is dictated by the Hippocratic Oath.
But the JOHESU’s argument is that the post of a CMD is more of
administrative than that of doctors’ duties. So they are clamouring that
they should also be given that opportunity, what do you think about
this?
The headship of the hospital has to be doctors’ because doctors own the
patients and they know how every unit of the hospital operates.
Somebody that is going to head the hospital should have the overall
knowledge of how the human human beings operate. So, that is why in
terms of functionality, the chief executive has to be a doctor. It is only
then that there will be no excuse for negligence and ignorance. We expect
that as a condition that must operate in hospitals.
We are not the only professionals that operate such a system. In the
university, the academic staff become the Vice Chancellor and there is no
way a non-academic staff can aspire to become the Vice Chancellor. We
also have this system in court. At the Federal Court of Appeal, for
example, it is not possible for you to be a judge unless you are a lawyer.
So, why should they now think that in the hospital services, the medical
profession should not be the leader? We cannot allow that to operate.
Everybody knows that the doctor is trained to know what is happening in
every department of the hospital. The paramedics are supposed to assist
doctors in the aspect of diagnosis and treatment of patients. That is why
we always believe that the headship of hospitals must be medical doctors
and this has now even been accepted.
You cannot be appointed a consultant unless your degrees are registered
with the Medical and Dental Council of Nigeria. The system has now been
clearly steamlined and it is to ensure that the system becomes more
efficient and there is more accountability. Nobody is saying that other
medical professions cannot be made heads, but they cannot be held
accountable for those areas they do not know about.
By appointing paramedics as consultants, will this be an infraction on
medical ethics and the oath you took?
The Hippocratic Oath says ‘I will maintain the structure and noble
traditions of my profession.’ We must maintain that aspect and these are
the noble traditions of the profession. It is clear in this profession that
you cannot call yourself a consultant if you are not medically qualified.
Now, the word, medically qualified, is also another amorphous statement
because many people started calling themselves medically qualified.
The medically qualified are those that had finished as a medical doctor.
Some have gone ahead to have post graduate training for another five to
10 years to become what is called specialists. They are those appointed
consultants in any hospital. After attaining this level, for somebody else to
now be bearing that title without going through those trainings is not
proper. It is an impersonation and this will not be tolerated in the health
sector.
Inclusion of funds for residency training, is one of the things NMA is
asking for, why is this so?
Some aspects of the residency training are not well-funded. Originally,
resident doctors are supposed to go for one year training abroad to
acquire overseas training. Now, this has not been well-funded, leading to
a deficiency in the training. Overseas experience is very important in the
medical profession because surgery and medicine are international
disciplines and so trainees need to know what operates in other
countries. Other areas that require funding in the residency training
programme include examinations.
That is why there must be a template for residency training programme
that is operational all over the country. With this template, when you
start the programme, from the start you know what you are entitled to
and what you are not entitled to have. This must be spelt out in black
and white. Now, everything has been put in proper perspectives and there
will be a budget for the residency training programme that involves
overseas attachment.
NMA is insisting that there must be harmonised salaries for doctors at
all levels of governance. How practicable is this?
When you negotiate with government, you had negotiated with their
employer, including the state and local governments. And they are all
expected to comply with whatever the Federal Government is approving
for their doctors. Everything boils down to the same thing for all doctors,
irrespective of where they are all seeing patients. It is when some state
executives renege in terms of making it applicable to their doctors, that
occasionally, you have pockets of strike in some of the states.
People say that NMA is an association of professionals and not a trade
union and have no basis to go on strike, how do you defend this?
NMA is purely a professional organisation guided by the rules and
regulations of the Nigerian Medical Council. NMA has followed the
regulations that are prescribed by the act during industrial action. Most
of the things being asked for in the strike are professional in nature; its
main thrust is that we want sustainable sanity in patients’ care in our
hospitals established.
Sanity in the system means the relationship between one worker and the
other is normal; that a person’s job does not infringe on the rights of
others or the working conditions of the other. A situation where a medical
laboratory scientist or medical laboratory technologist drives a doctor out
of the office and beat him up, that is chaos. We cannot allow such a
situation to continue.
That is why we are asking the government to make sure that the hospital
should be a place where you work peacefully; patients get adequate
health care and in delivering adequate healthcare, everybody is happy.
That sustainable sanity is required by us to continue to serve the society
as we should.
Mind you, doctors are not interested in strike. Strike should not occur and
if it has to occur, it must follow the guidelines by the Medical and Dental
Council of Nigeria.
How do you defend the opinion that this strike is all about doctors’ ego
and pride and that they only want to have more than their rights?
There is nobody that does not have ego. Ego is what you feel about
yourself. Everybody must be proud of it ego. The problem we are having
is that some people are no longer proud of their profession. By saying
that doctors have ego, I think it is a complementary statement.
How happy are your members seeing patients dying?
We are also not happy with the situation and that is why we are pleading
that government should look into the demands of doctors. There are
some basic minimal demands that we expect the government to meet
and already, government is looking into them. Money is the least of the
conditions; clinical governance is the main issue. Clinical governance just
means how the hospitals are governed iand we want it in a way that it
will be of most benefit to patient care.
How soon will the strike be over?
Well, that is as soon as we can convey the delegate meeting, who will
consider all the things that government had done and then we will
consider calling off the strike. I cannot say exactly when this will be, but
I believe this will be very soon.
www.tribune.com.ng/your-health/item/12147-our-strike-not-about-money-ego-obembe-nma-president