cramjones: Typical of the Jonathanians. You call of a strike that you did not call for in the first place? It is only under Jonathan that nurses, pharmacists, physiotherapist etc has the guts to tussle the leadership of teaching hospitals with doctors. I support and endorse the doctors strike, it is fight to finish before vagabonds take your rightful place!

#Nigeria-on-the-brink

-CramJones

egift: The major issue is that other health professionals now wants to be called "Consultants" and be given all the benefits that a trained Consultant Medical Doctor get, including appointments reserved for such title.

The question now is, How long do you serve drinks as a Flight Attendant before you start calling yourself a Pilot? Never.

If you want to be a Medical Doctor, please go and read Medicine and stop endangering our Health Sector over your failure for not reading medicine (maybe because you did not make the JAMB score).

Ufranklin92: Barbaric you know

NewsINigeria: Then who can call it off? Doctors should stop killing people.

cramjones: Typical of the Jonathanians. You call of a strike that you did not call for in the first place? It is only under Jonathan that nurses, pharmacists, physiotherapist etc has the guts to tussle the leadership of teaching hospitals with doctors. I support and endorse the doctors strike, it is fight to finish before vagabonds take your rightful place!

#Nigeria-on-the-brink

-CramJones

jmichael: U must b a product of same sex marriage!

emmaliver: RAPE OF THE BLACK GOLD – NMA Strike and
the Crisis in Nigeria’s Health Sector
INTRODUCTION
After trying hard to avoid putting pen to paper
to express the bottled up emotions inside me, a
news item on a national TV station has finally
pushed me over the edge to try to explain to
whosoever cares to listen, the reasons why the
NMA is on strike, and why there should be
public agitation in favour of it. In the said news
item, members of the public are yet to
understand the reason for the strike. For the
avoidance of doubt, I am a medical doctor and I
write from a possibly biased point of view. As
you go through this article, you may discover
areas where I agree or disagree with the issues
raised by my mother association. But while I do
that, I will try to be as reasonable and
dispassionate as possible.
I do not believe that strikes should be the
handle by which the Nigerian government turns,
such that it is impossible to press home the
demand of a labour union or group in this
country without grabbing it. The feverish efforts
used to approach an industrial action towards
its end can be applied at the moment when
there is a NOTICE of action. If this were the
habit of those in government, perhaps the
current NMA action and many others strikes by
other bodies of workers before it would have
been averted. My aversion to the use of strikes
is even more amplified when it involves the
truncation of flow of an essential service – be it
power, health, transportation, security or other.
The oath which I and my noble colleagues took
reads in part, “I will practice my profession with
conscience and dignity; the health of my patient
will be my first consideration”. In all fairness, I
want to say that inspite of the dearth of modern
day equipment, dilapidated infrastructure and
terrible working conditions, we are still
struggling to live true to our promise.
Most doctors I know today work extra hours
unpaid, donate to help patients obtain
medications or pay bills, or go out of their way
to perform “non-doctor” work just to make the
patients well. The following two examples are
true at least in the Jos University Teaching
Hospital. Doctors run around the wards to pick
up instruments and case notes (files) of
patients, when many times the nurse is idle in
the ward. Carrying files and getting all
instuments required by a doctor on ward rounds
should be a nurse’s responsibility, or at least
she should direct her orderlies and substaff on
what to do. In addition, she should make
contributions, report relevant events which
occured in the doctor’s absence, and take her
own notes during the ward round. That is what
our teachers tell us used to happen in the past.
But alas, that is not the case. She sizes up the
doctor first, to see his rank. If he or she is a
house officer (the lowest cadre), he may just as
well proceed without her. Afterall, she has a
daughter at home that is older than this “small
boy”. African megalomania at its worst. If the
doctor is a Consultant(topmost grade), she may
then gauge whether this doctor is the “friendly
type” or the “difficult type”. Because for the
difficult people, the rules have to be obeyed or
else there will be trouble. This category of
doctors is thus spared the pain of others. My
second example, though recently corrected by a
circular from management, is that doctors
sometimes become porters, carrying blood
samples and results to and from the
laboratories. In the course of seeking for results
in the laboratory, a doctor was recently slapped
in the face by a laboratory staff, leading to the
management response. While that malady
lasted, excuses for the staff who were employed
for that purpose ranged from “too few hands”
to “engaged with something else” to “its not
our job”! for want of space, I will leave other
examples alone.
I hope this leaves no one in doubt that we do
our jobs (and sometimes the jobs of others –
just to make the system work)
Now to the issues.
WHO SHOULD HEAD A HOSPITAL?
Who should head a hospital? Of course, this
kind of absurd question would not arise in a
private hospital. As we know it, the law in
Nigeria requires registration with the Medical
and Dental Council of Nigeria (MDCN) and up-
to-date payment of Annual Practicing fees for
an individual to set up a private hospital. I
carefully choose the word “hospital” because
Nigeria has an endless number of appelations
for both health facilities and slaughter houses.
And the nigerian public is so misled that there
is now no distinction between hospital,
pharmacy, clinic, dispensary, nursing home,
patent medicine seller, and a community health
officer’s spare bedroom. All manner of
attrocities are committed – there are consulting
rooms in pharmacies, theatres in nursing
homes, abortion facilities in dispensaries, and
operating rooms on people’s dining tables. The
mess is so mad that everybody who has ever
witnessed the administration of an intravenous
drug or watched an appendectomy is now fully
“medically qualified”. So the criminals who do
these things, due to the ineptitude of law
enforcement, now see themselves as equal to
all others who have licences to practice
professionally. And a handsome majority of
perpetrators of these acts are the other health
professionals and allied health professions.
The problem as I have stated, cannot arise in
Private hospitals. It is in the public institutions,
where salaries do not depend on how much
work is done, but on how much the institution
receives from the “national cake”. Not on how
much training we have received, but on how
many years we have been sleeping at the office.
Not on our individual skills and interests, but on
how many pieces of possibly fraudulent paper
are found in our credential file. For if these
attributes were to be sought by our employer,
we would never have arguments for how much
we should receive. Or who should be in charge.
Regrettably, however, our employer is an object
that neither has a head or a brain. It cannot
reason and thus cannot make any reasonable
judgment. Our employer is the black gold that
runs beneath the land and waters of the Niger
Delta and other parts of southern Nigeria. Our
employer is crude oil – our birthright and ticket
to laziness, our excuse for brazen corruption,
and our foundation for mediocrity and lack of
desire for development. And to tell the truth, I
secretly pray sometimes that the oil would just
dry up, if only to induce sanity into our country.
For if this employer were reasonable, it would
ask why there should be a difference between
the private hospital (which performs its duties
and makes a profit) and a government
institution which is just a black hole into which
money is sunk, neither getting profit nor
benefitting the masses for which it was built.
The law setting up teaching hospitals specifies
that to become the CMD, a person has to have
a basic medical degree (here meaning Bachelor
of Medicine, Bachelor of Surgery) and have
become a consultant, owning a fellowship of
one of the Postgraduate medical Colleges, as
well as a few other requirements. This is one of
the cardinal disputes of today.
Let me introduce the Joint Health Sector Unions
(JOHESU), an amalgam of Labour Unions
formed a few years ago and basically including
all other staff except Medical Doctors. Even to
a blind and deaf person, this is an association
of strange bedfellows. Pharmacists, Nurses and
laboratory Scientists alone would have made
some sense. But add Administrative staff,
accountants, medical records staff and it starts
to get confusing. When you finally integrate
cleaners, porters and other junior staff into the
mix, it tells what the only object of such a
hydra-headed conspiracy could be – the
extermination of the disciples of Hippocrates.
JOHESU seeks for appointment of CMDs to be
“made open to all competent and qualified
health professionals”. The arguments for them
are that this is done in some parts of the world,
that their members also have medical
knowledge, and that it would promote equity
and fairness. On face value, these seem to be
reasonable and genuine demands. And central
to our response has been one issue – training.
Apart from medical doctors, other health
professionals attend university courses based
on the semester system in Nigeria (let us leave
out those who have sub-degree programmes for
now – they know themselves). Apart from the
Pharmacists, who do 10 semesters, most other
professionals spend 8 semesters. Two of these
semesters however are spent doing basic
science, which is essentially same across board.
So in effect, pharmacists spend eight semesters
and other six, preparing for working life. Now
doctors also do the same basic science, with
higher credit unit loads than most others. After
the first year, however, the difference in training
time is incredible. The semester system for the
doctor is over. The remaining five years of
training are basically without holidays. When
there are breaks, they last between 2 and 3
weeks, usually after exams - and in the
University of Jos, for example, there are just
three major examinations beside continuous
assessments, which are regular. So on the
generous side, a medical student has perhaps
nine to twelve weeks of official breaks out of
five years. That is an incredible four-and-a-half
years of training. Compare that with six
semesters of four months each, totalling 24
months or 2 years. Or for the Pharmacist, eight
semesters of four months, which would be two
years and eight months. The amount of
knowledge difference is surely massive.
Asides that, the doctor is schooled in EVERY
aspect of HUMAN medicine – and in appreciable
depth. What the other professionals are
schooled in, as far as it pertains directly to
human medicine, we also learn. So what then is
the doctor’s advantage as a chief executive? A
doctor has a wider scope of training and is
equipped to understand the entire workings of a
hospital as it relates to patient care. Thus if a
lab scientist, pharmacist, nurse or other health
professional for example, speaks to a doctor
CEO about the needs of his department or
problems they are having, the doctor would fully
comprehend. If a pharmacist were giving the
same information to a lab scientist, however,
the situation would be different. This wide
scope of training and central role also has a
bearing on decision making for the best possible
allocation of resources and manpower, enabling
the hospital to run smoothly for the good of the
patients. That is why a career engineer would
most likely be the head of a construction firm
and not a welder or bricklayer, even if they all
had PhDs. A lawyer would be the head in the
courtroom, whether the clerk has a thorough
knowledge of court procedure, court rulings and
how to decide cases or not. Its simple logic.
Where people start to argue about whether
doctors are trained in management, my answer
is that other health professionals are generally
no different in that respect. Seeking for
“fairness” and “equity” and trying to avoid
things being “skewed” has absolutely no bearing
in an industry whose objective is to preserve
human life. This is not sports or entertainment
or tourism, where ignorance and mistakes can
be condoned. Any managerial mistake in a
hospital can lead to loss of life, which is
irreplaceable. And for the records, recent studies
in the UK have shown that doctors head very
few hospitals in that country, but most of the
top 100 performing hospitals are among those
headed by doctors. That kind of evidence based
argument in a sane society can have no reply.
The document regulating the tertiary hospitals
in Nigeria has said the doctor should be the
head. Since the status quo has not been
deemed a failure by the government, it should
remain. It is pertinent to add here that the
clamour for the interpretation of the phrase
“medically qualified” by JOHESU is part of the
ploy to co-opt their members into the league of
persons entitled to apply for CMD in the tertiary
institutions in the country. To be mild, this
loophole seeking is simply childish. For if
medically qualified were to be a general term for
any diploma (certificate) related to medicine,
the makers of the law would not have added a
postgraduate fellowship, which is peculiar to
doctors, to the list of requirements.
APPOINTMENT OF DIRECTORS AND THE POST
OF DEPUTY CHAIRMAN, MEDICAL ADVISORY
COMMITTEE (DCMAC)
Like I mentioned earlier, we live in a ludicrous
society. There is little respect for order, and
people appear to be more at home with
anarchy than sanity. Let’s go back to the
structure of a teaching hospital. There are three
directors in a teaching hospital – Director of
Administration (DA), Head of Clinical Services
(HOCS, also known as Chairman, Medical
Advisory Committe - CMAC), and the Chief
Medical Director, who is the Chief Executive.
The DA handles purely administrative matters,
while the CMAC handles issues related to
patient care. The CMD, of course, is their
superior and serves as the CEO. This ensures
that patient care is not sacrificed on the altar of
administrative issues and vice versa. There are
assistant directors in areas such as nursing,
finance, works, and so on. This creates a visible
chain if command within the hospital. The
yearning of JOHESU is that their members be
promoted to Director Cadre within the hospital
setting. Knowing the Nigeria we live in, no
director will be answerable to another within
the same ministry or agency. A director, as far
as I know, is only answerable to a permanent
secretary. Now unless the titles of the CMD, DA
and CMAC are changed, what will become of
the hospitals when we have, say, 100 other
“Directors” walking the corridors of the teaching
hospital? And if you make all the CMDs in
Nigeria permanent secretaries today, what will
become of the Ministry of Health? For surely,
such permanent secretaries will only report to
the Minister! And how many ministers can we
have at once?
This whole debacle is directly related to the
quest for salary increase, if u ask me. How
many other government institutions have a
hundred Directors within them as will be the
case if this request is granted? Now the irony of
it is that if this policy is approved, many
doctors would also proceed to become
directors. But our question is this – what
benefit does it add to the system? None! And
what does it take away? First, increased wage
bills for the government. Secondly, increased
anarchy in a system that is already bastardised
by unprofessionalism. Thirdly, many “directors”
will abscond from their duty posts since they
would now be too big to sit in a clinic,
laboratory, pharmacy or hospital ward. And who
would bear the brunt of it all? Our dear old
black oil. Raped, plundered and wasted, but still
faithful. Nothing can be more senseless. If
people wish to pursue an increasein pay, they
are free to do so. But for Pete’s sake, let there
be order in the hospital!
On the appointment of DCMACs, JOHESU would
simply not hear of it. Their argument is that it
is unlawful; possibly because it is not written
out in the document that created teaching/
tertiary hospitals in the country. But they forget
to add that there are circulars from the
government that support the creation of the
office. Also, the law gives the boards of the
teaching hospitals powers to take measures
that ensure the smooth running of the hospitals,
and these appointments are made by the
boards! The job of the CMAC is indeed a
tasking one and like every other Director in the
civil service, he/she should have deputies to
help with functions. I think that is simple
enough.
SKIPPING OF GRADE LEVEL 12
The Ministry of Health has issued a circular
stating that contrary to what was hitherto
obtained, where all other staff of the Ministry
skipped a grade level at some point in their
careers except doctors, we should also be
included. Though the Ministry is still in court
over the legality or otherwise of skipping, it is
only fair that all members of the family enjoy
what our father, the Federal Government, has
brought home from his hunting adventures. Abi
the oil money don finish? Na on top our head
una wan talk say the money no go reach again?
Lai lai!. I don’t believe this should be a matter
of contention. What is good for the geese is
also good for the gander.
THE TITLE OF CONSULTANT AND THE QUEST
FOR SPECIALIST ALLOWANCE AND TEACHING
ALLOWANCE

cramjones: Typical of the Jonathanians. You call of a strike that you did not call for in the first place? It is only under Jonathan that nurses, pharmacists, physiotherapist etc has the guts to tussle the leadership of teaching hospitals with doctors. I support and endorse the doctors strike, it is fight to finish before vagabonds take your rightful place!

#Nigeria-on-the-brink

-CramJones

jmichael:

U must b a product of same sex marriage!

bigass: I believe Nurses (Bsc Nursing) and Pharmacist should be able to be CMDs in Tertiary hospitals as long as they meet some certain criteria Like Phd and Dip in Biz Admin.

CircleOfWilis: The president ,he was also a lecturer rite? if yes! Why has he not bn joinin ASUU/asup strike rubbish!

cramjones: Typical of the Jonathanians. You call of a strike that you did not call for in the first place? It is only under Jonathan that nurses, pharmacists, physiotherapist etc has the guts to tussle the leadership of teaching hospitals with doctors. I support and endorse the doctors strike, it is fight to finish before vagabonds take your rightful place!

#Nigeria-on-the-brink

-CramJones

emmaliver: RAPE OF THE BLACK GOLD – NMA Strike and
the Crisis in Nigeria’s Health Sector
INTRODUCTION
After trying hard to avoid putting pen to paper
to express the bottled up emotions inside me, a
news item on a national TV station has finally
pushed me over the edge to try to explain to
whosoever cares to listen, the reasons why the
NMA is on strike, and why there should be
public agitation in favour of it. In the said news
item, members of the public are yet to
understand the reason for the strike. For the
avoidance of doubt, I am a medical doctor and I
write from a possibly biased point of view. As
you go through this article, you may discover
areas where I agree or disagree with the issues
raised by my mother association. But while I do
that, I will try to be as reasonable and
dispassionate as possible.
I do not believe that strikes should be the
handle by which the Nigerian government turns,
such that it is impossible to press home the
demand of a labour union or group in this
country without grabbing it. The feverish efforts
used to approach an industrial action towards
its end can be applied at the moment when
there is a NOTICE of action. If this were the
habit of those in government, perhaps the
current NMA action and many others strikes by
other bodies of workers before it would have
been averted. My aversion to the use of strikes
is even more amplified when it involves the
truncation of flow of an essential service – be it
power, health, transportation, security or other.
The oath which I and my noble colleagues took
reads in part, “I will practice my profession with
conscience and dignity; the health of my patient
will be my first consideration”. In all fairness, I
want to say that inspite of the dearth of modern
day equipment, dilapidated infrastructure and
terrible working conditions, we are still
struggling to live true to our promise.
Most doctors I know today work extra hours
unpaid, donate to help patients obtain
medications or pay bills, or go out of their way
to perform “non-doctor” work just to make the
patients well. The following two examples are
true at least in the Jos University Teaching
Hospital. Doctors run around the wards to pick
up instruments and case notes (files) of
patients, when many times the nurse is idle in
the ward. Carrying files and getting all
instuments required by a doctor on ward rounds
should be a nurse’s responsibility, or at least
she should direct her orderlies and substaff on
what to do. In addition, she should make
contributions, report relevant events which
occured in the doctor’s absence, and take her
own notes during the ward round. That is what
our teachers tell us used to happen in the past.
But alas, that is not the case. She sizes up the
doctor first, to see his rank. If he or she is a
house officer (the lowest cadre), he may just as
well proceed without her. Afterall, she has a
daughter at home that is older than this “small
boy”. African megalomania at its worst. If the
doctor is a Consultant(topmost grade), she may
then gauge whether this doctor is the “friendly
type” or the “difficult type”. Because for the
difficult people, the rules have to be obeyed or
else there will be trouble. This category of
doctors is thus spared the pain of others. My
second example, though recently corrected by a
circular from management, is that doctors
sometimes become porters, carrying blood
samples and results to and from the
laboratories. In the course of seeking for results
in the laboratory, a doctor was recently slapped
in the face by a laboratory staff, leading to the
management response. While that malady
lasted, excuses for the staff who were employed
for that purpose ranged from “too few hands”
to “engaged with something else” to “its not
our job”! for want of space, I will leave other
examples alone.
I hope this leaves no one in doubt that we do
our jobs (and sometimes the jobs of others –
just to make the system work)
Now to the issues.
WHO SHOULD HEAD A HOSPITAL?
Who should head a hospital? Of course, this
kind of absurd question would not arise in a
private hospital. As we know it, the law in
Nigeria requires registration with the Medical
and Dental Council of Nigeria (MDCN) and up-
to-date payment of Annual Practicing fees for
an individual to set up a private hospital. I
carefully choose the word “hospital” because
Nigeria has an endless number of appelations
for both health facilities and slaughter houses.
And the nigerian public is so misled that there
is now no distinction between hospital,
pharmacy, clinic, dispensary, nursing home,
patent medicine seller, and a community health
officer’s spare bedroom. All manner of
attrocities are committed – there are consulting
rooms in pharmacies, theatres in nursing
homes, abortion facilities in dispensaries, and
operating rooms on people’s dining tables. The
mess is so mad that everybody who has ever
witnessed the administration of an intravenous
drug or watched an appendectomy is now fully
“medically qualified”. So the criminals who do
these things, due to the ineptitude of law
enforcement, now see themselves as equal to
all others who have licences to practice
professionally. And a handsome majority of
perpetrators of these acts are the other health
professionals and allied health professions.
The problem as I have stated, cannot arise in
Private hospitals. It is in the public institutions,
where salaries do not depend on how much
work is done, but on how much the institution
receives from the “national cake”. Not on how
much training we have received, but on how
many years we have been sleeping at the office.
Not on our individual skills and interests, but on
how many pieces of possibly fraudulent paper
are found in our credential file. For if these
attributes were to be sought by our employer,
we would never have arguments for how much
we should receive. Or who should be in charge.
Regrettably, however, our employer is an object
that neither has a head or a brain. It cannot
reason and thus cannot make any reasonable
judgment. Our employer is the black gold that
runs beneath the land and waters of the Niger
Delta and other parts of southern Nigeria. Our
employer is crude oil – our birthright and ticket
to laziness, our excuse for brazen corruption,
and our foundation for mediocrity and lack of
desire for development. And to tell the truth, I
secretly pray sometimes that the oil would just
dry up, if only to induce sanity into our country.
For if this employer were reasonable, it would
ask why there should be a difference between
the private hospital (which performs its duties
and makes a profit) and a government
institution which is just a black hole into which
money is sunk, neither getting profit nor
benefitting the masses for which it was built.
The law setting up teaching hospitals specifies
that to become the CMD, a person has to have
a basic medical degree (here meaning Bachelor
of Medicine, Bachelor of Surgery) and have
become a consultant, owning a fellowship of
one of the Postgraduate medical Colleges, as
well as a few other requirements. This is one of
the cardinal disputes of today.
Let me introduce the Joint Health Sector Unions
(JOHESU), an amalgam of Labour Unions
formed a few years ago and basically including
all other staff except Medical Doctors. Even to
a blind and deaf person, this is an association
of strange bedfellows. Pharmacists, Nurses and
laboratory Scientists alone would have made
some sense. But add Administrative staff,
accountants, medical records staff and it starts
to get confusing. When you finally integrate
cleaners, porters and other junior staff into the
mix, it tells what the only object of such a
hydra-headed conspiracy could be – the
extermination of the disciples of Hippocrates.
JOHESU seeks for appointment of CMDs to be
“made open to all competent and qualified
health professionals”. The arguments for them
are that this is done in some parts of the world,
that their members also have medical
knowledge, and that it would promote equity
and fairness. On face value, these seem to be
reasonable and genuine demands. And central
to our response has been one issue – training.
Apart from medical doctors, other health
professionals attend university courses based
on the semester system in Nigeria (let us leave
out those who have sub-degree programmes for
now – they know themselves). Apart from the
Pharmacists, who do 10 semesters, most other
professionals spend 8 semesters. Two of these
semesters however are spent doing basic
science, which is essentially same across board.
So in effect, pharmacists spend eight semesters
and other six, preparing for working life. Now
doctors also do the same basic science, with
higher credit unit loads than most others. After
the first year, however, the difference in training
time is incredible. The semester system for the
doctor is over. The remaining five years of
training are basically without holidays. When
there are breaks, they last between 2 and 3
weeks, usually after exams - and in the
University of Jos, for example, there are just
three major examinations beside continuous
assessments, which are regular. So on the
generous side, a medical student has perhaps
nine to twelve weeks of official breaks out of
five years. That is an incredible four-and-a-half
years of training. Compare that with six
semesters of four months each, totalling 24
months or 2 years. Or for the Pharmacist, eight
semesters of four months, which would be two
years and eight months. The amount of
knowledge difference is surely massive.
Asides that, the doctor is schooled in EVERY
aspect of HUMAN medicine – and in appreciable
depth. What the other professionals are
schooled in, as far as it pertains directly to
human medicine, we also learn. So what then is
the doctor’s advantage as a chief executive? A
doctor has a wider scope of training and is
equipped to understand the entire workings of a
hospital as it relates to patient care. Thus if a
lab scientist, pharmacist, nurse or other health
professional for example, speaks to a doctor
CEO about the needs of his department or
problems they are having, the doctor would fully
comprehend. If a pharmacist were giving the
same information to a lab scientist, however,
the situation would be different. This wide
scope of training and central role also has a
bearing on decision making for the best possible
allocation of resources and manpower, enabling
the hospital to run smoothly for the good of the
patients. That is why a career engineer would
most likely be the head of a construction firm
and not a welder or bricklayer, even if they all
had PhDs. A lawyer would be the head in the
courtroom, whether the clerk has a thorough
knowledge of court procedure, court rulings and
how to decide cases or not. Its simple logic.
Where people start to argue about whether
doctors are trained in management, my answer
is that other health professionals are generally
no different in that respect. Seeking for
“fairness” and “equity” and trying to avoid
things being “skewed” has absolutely no bearing
in an industry whose objective is to preserve
human life. This is not sports or entertainment
or tourism, where ignorance and mistakes can
be condoned. Any managerial mistake in a
hospital can lead to loss of life, which is
irreplaceable. And for the records, recent studies
in the UK have shown that doctors head very
few hospitals in that country, but most of the
top 100 performing hospitals are among those
headed by doctors. That kind of evidence based
argument in a sane society can have no reply.
The document regulating the tertiary hospitals
in Nigeria has said the doctor should be the
head. Since the status quo has not been
deemed a failure by the government, it should
remain. It is pertinent to add here that the
clamour for the interpretation of the phrase
“medically qualified” by JOHESU is part of the
ploy to co-opt their members into the league of
persons entitled to apply for CMD in the tertiary
institutions in the country. To be mild, this
loophole seeking is simply childish. For if
medically qualified were to be a general term for
any diploma (certificate) related to medicine,
the makers of the law would not have added a
postgraduate fellowship, which is peculiar to
doctors, to the list of requirements.
APPOINTMENT OF DIRECTORS AND THE POST
OF DEPUTY CHAIRMAN, MEDICAL ADVISORY
COMMITTEE (DCMAC)
Like I mentioned earlier, we live in a ludicrous
society. There is little respect for order, and
people appear to be more at home with
anarchy than sanity. Let’s go back to the
structure of a teaching hospital. There are three
directors in a teaching hospital – Director of
Administration (DA), Head of Clinical Services
(HOCS, also known as Chairman, Medical
Advisory Committe - CMAC), and the Chief
Medical Director, who is the Chief Executive.
The DA handles purely administrative matters,
while the CMAC handles issues related to
patient care. The CMD, of course, is their
superior and serves as the CEO. This ensures
that patient care is not sacrificed on the altar of
administrative issues and vice versa. There are
assistant directors in areas such as nursing,
finance, works, and so on. This creates a visible
chain if command within the hospital. The
yearning of JOHESU is that their members be
promoted to Director Cadre within the hospital
setting. Knowing the Nigeria we live in, no
director will be answerable to another within
the same ministry or agency. A director, as far
as I know, is only answerable to a permanent
secretary. Now unless the titles of the CMD, DA
and CMAC are changed, what will become of
the hospitals when we have, say, 100 other
“Directors” walking the corridors of the teaching
hospital? And if you make all the CMDs in
Nigeria permanent secretaries today, what will
become of the Ministry of Health? For surely,
such permanent secretaries will only report to
the Minister! And how many ministers can we
have at once?
This whole debacle is directly related to the
quest for salary increase, if u ask me. How
many other government institutions have a
hundred Directors within them as will be the
case if this request is granted? Now the irony of
it is that if this policy is approved, many
doctors would also proceed to become
directors. But our question is this – what
benefit does it add to the system? None! And
what does it take away? First, increased wage
bills for the government. Secondly, increased
anarchy in a system that is already bastardised
by unprofessionalism. Thirdly, many “directors”
will abscond from their duty posts since they
would now be too big to sit in a clinic,
laboratory, pharmacy or hospital ward. And who
would bear the brunt of it all? Our dear old
black oil. Raped, plundered and wasted, but still
faithful. Nothing can be more senseless. If
people wish to pursue an increasein pay, they
are free to do so. But for Pete’s sake, let there
be order in the hospital!
On the appointment of DCMACs, JOHESU would
simply not hear of it. Their argument is that it
is unlawful; possibly because it is not written
out in the document that created teaching/
tertiary hospitals in the country. But they forget
to add that there are circulars from the
government that support the creation of the
office. Also, the law gives the boards of the
teaching hospitals powers to take measures
that ensure the smooth running of the hospitals,
and these appointments are made by the
boards! The job of the CMAC is indeed a
tasking one and like every other Director in the
civil service, he/she should have deputies to
help with functions. I think that is simple
enough.
SKIPPING OF GRADE LEVEL 12
The Ministry of Health has issued a circular
stating that contrary to what was hitherto
obtained, where all other staff of the Ministry
skipped a grade level at some point in their
careers except doctors, we should also be
included. Though the Ministry is still in court
over the legality or otherwise of skipping, it is
only fair that all members of the family enjoy
what our father, the Federal Government, has
brought home from his hunting adventures. Abi
the oil money don finish? Na on top our head
una wan talk say the money no go reach again?
Lai lai!. I don’t believe this should be a matter
of contention. What is good for the geese is
also good for the gander.
THE TITLE OF CONSULTANT AND THE QUEST
FOR SPECIALIST ALLOWANCE AND TEACHING
ALLOWANCE

emmaliver: THE TITLE OF CONSULTANT AND THE QUEST
FOR SPECIALIST ALLOWANCE AND TEACHING
ALLOWANCE
Every person and profession has the right to
determine how the career progression goes. To
that extent, I do not have any grouse
whatsoever with people attaining Consultant
status in their field. But as the saying goes,
things are not always what they seem. This
point will require a little of history. Before the
nineties, the health system in Nigeria was a lot
more organised. There were clearly defined
roles for each group of health personnell, and
the salary scales truly represented relativity,
which is the difference in take-home pay that
should exist due to differences in training, skills
and input to patient care. Gradually, the unions
agitated for more and more increases, more
allowances, and so on. But there was a problem
lurking. For while the other unions (now
grouped as JOHESU) fought and battled the
Military governments for pay rise after pay rise,
the doctors “kept their cool” and “were more
concerned with the good of the patients”. Of
course in Nigeria, the loudest person gets heard
first. So gradually, the gap between the salary
of the doctor and the other professionals closed
up. At a point, there was barely any difference.
In 2008, after many years of struggle, the
government approved a new salary scale for
doctors which, though flawed, was meant to
correct the relativity between professions. As
part of that document, there was an allowance
for medical and dental consultants tagged
“specialist allowance”. That is the source of the
problem. In a quest to get more allowances, the
term “Consultant” has suddenly crept into the
vocabulary of the other professions, notably
Nursing and Pharmacy, of which I will make
examples. They perhaps have heard that there
are “Nurse Consultants” and Consultant
Pharmacists” in other climes. The question is,
WHAT ARE THE ROLES OF THESE
CONSULTANTS IN THOSE COUNTRIES, AND
WHAT ARE THE QUALIFICATIONS REQUIRED TO
ATTAIN SUCH STATUS?
According to the UK’s National Health Service
website, a Nurse consultant “is a specialist in a
particular field of healthcare... and spends at
least half of her time working directly with
patients, and in addition develops personal
practice, is involved in research, and contributes
to the education, training and development of
other nurses”. To become a nurse consultant, a
basic nursing degree is required, as well as a
master’s degree in nursing, health services or
administration, or public health, with working
experience. Some even add that one requires a
PhD or at least should be working towards
getting one. There are other nurse consultants
who may not work with patients but give advice
to law firms on medical cases (e.g. malpractice
cases) they have in court. The latter type of
nurse consultant surely does not fit into our
teaching hospitals, but the former may.
Most definitions of a Consultant Pharmacist
describe him/her as one involved in the care of
the elderly or people in nursing homes, where
he reviews their medications. Infact, the history
of Consultant Pharmacy actually began in
homes for the elderly. Other sources describe
the job as having to do with “advanced roles in
patient care, research and education”. Even in
these countries where the title is mentioned, it
appears to be a new and evolving role rather
than an established position that has relevance
to patient care. Requirements include a Pharm
D degree, interest and experience. Some articles
I came across also require a Master’s degree in
pharmacy. In the absence of proper guidelines
and laid down procedure for such appointments,
as well as regulatory or accrediting agencies,
my view is that caution be exercised in adopting
this relatively new terminologies into a
developing country’s health system.
The issue of Consultant status is where I may
differ slightly from the NMA’s position. Let
anybody become a consultant of whatever
profession he wants to, as long as there are
stipulated procedures for doing so. The caveat
is that as far as patient care is concerned, the
Medical/Dental Consultant acting directly or
through his lieutenant, is the only person to
give directives about the patient’s care. To cut
it short, being a consultant in any other field of
healthcare should not give a person the right to
change, obstruct or delay the implementation of
a doctor’s management plan. The roles of such
specialists should be merely advisory.
On the part of the Government, they can go on
and appoint as many consultants as they want
–, Nurse Consultant, Consultant Pharmacist,
Consultant Physiotherapist, Consultant
Optometrist, Consultant Radiographer,
Consultant Cleaner, Consultant Porter,
Consultant Gateman, Consultant Accountant
and Consultant Administrator. Kai, even start
having Consultant visitors. Afterall, the Niger
delta oil is a LovePeddler, and her patrons are
endless. Just one more defilement won’t do
much harm. Then the next, and the next.
Let me conclude this section with a comment
on the issue of teaching and specialist
allowances. With the difference in knowledge
between a house officer and nurse, the house
officer surely does teach them a few things... if
the person involved is humble enough. The
point is that these guys also teach medical
students, nurses and other personnell. Finally,
everyone in the Health sector now wants to
receive a specialist allowance and teaching
allowance. Infact, some optometrists on the
CONHESS salary structure now receive
specialist allowances from the CONMESS salary
structure. Only in Nigeria can such brazen
effrontery be seen. One person, being paid on
two contrasting salary scales. Well I will leave
that to the public to judge, but if without
additional training a lab scientist, pharmacist,
optometrist or nurse wants to be called a
specialist and receive allowances, the gander
are also ready. The spree has only begun.
RELATIVITY IN THE HEALTH SECTOR
Now many that are outside the health sector
may be confused about this. But to put it
simply, the healthcare system revolves around a
TEAM. In every team all players are important
and perhaps indispensible, but there is always a
captain or a leader. Usually the coach will
choose a captain either based on current form,
or based on age, or based on experience, or
based on number of years spent in the team. In
medical circles this leadership role, albeit
traditional, was foisted on the doctor because of
qualities including being central to patient care,
perfect understanding of both normal and
abnormal body function, understanding of the
development of diseease and different options
for curing or relieving it, and a general scope of
the different areas of human medicine. As is
seen in every normal salary structure, the more
the training, the higher the pay. That is why a
secondary school leaver and a university
graduate are not put on the same grade level
when they are employed. Even among
graduates, those of engineering, law and
pharmacy are paid higher than others. Doctors
(medical and veterinary) are paid still higher.
This is the concept of relativity, put simply.
However in the Nigerian health sector, this rule
has been and is being continually thrown to the
winds. Some nurses without university degrees
earn higher than pharmacists and doctors. From
being started out on step 4 of the grade level as
used to be the case, House officers are now
started on step 2. Reasons? None! Like stated
earlier, this is the result of the failure of doctors
to use strikes to press home their demands,
choosing negotiations instead. The only time
when we got heard was during the strikes that
introduced the Consolodated Medical Salary
Scale (CONMESS) in 2008/2009. And in that
document, there were fundamental flaws. For
as you moved higher up the scale, your salary
seemed to be stagnant. The creators of that
document cleverly made the calculations such
that a promotion added almost nothing to your
total emoluments. This led to a call by the NMA
for a new salary structure that makes the effect
of promotion better, and government is “still
looking into it”. Realising its “mistake”,
government issued a circular on the 3rd of
January 2014, correcting the anomalies in
CONMESS. Take note that this was not NMA’s
demand, but even the implementation of the
government’s own response to the problem has
taken six months. Not a single kobo has been
released to that effect. But since we are a breed
that has a genetic aberration which has foisted
limitless patience on us, JOHESU will have the
public believe that we are unreasonable.
One funny tweet I read this morning from
@bilquees_01 under the # nmastrike read, “a
duke mutum a hana shi kuka”. It is in hausa
and means “to beat up someone and prevent
him from crying”. This perfectly describes
NMA’s situation in Nigeria. We are squeezed in
on every side, pressured, ambushed and bashed,
but the rule is “Thou shalt not complain”. Each
time there is an industrial action, you see
sudden movement from the house of
representatives, senate, presidency, and the so
called “well meaning nigerians”. As soon as we
retreat to work to observe the situation, all
agreements become unbearable burdens for the
government. JOHESU rushes off to introduce
another variable to unbalance the equation. But
thou, o physician, shalt not talk. For it is you
alone that has moral obligation to the sick of
the world. Arrant rubbish!
HAZARD ALLOWANCE, RURAL POSTING AND
OTHER ALLOWANCES
Let me start with the hazard allowance. I will
simply ask a question here to any member of
the public. Is five thousand naira (about 28 USD
or 18 GBP) enough compensation for any of the
following risks to your life (and by extension,
the life of your immediate family) every single
day? People coughing into your face; blood
splashing onto your clothes, skin, eyes and
mouth; handling human faeces, urine, flesh and
other fluids; working with razors, knives and
needles around patients with highly infective
conditions (HIV, Hepatitis B, Hepatitis C, Lassa
Fever, Tuberculosis and others)?
If anyone would say yes to the question, or
argue that they are more exposed to these
dangers than the Doctor or Nurse, let them
come out. I will stop at that.
When an official of the Federal Ministry of
Health (FMOH) travels from Abuja to
Portharcourt and spends the night, he gets paid
for the inconvenience. But a doctor POSTED to
a rural setting away from family and civilisation
needs to go on strike to get a circular saying
that he should be paid his due. For if that is
not done, he may get his money, or a quarter of
it. Or nothing.
There is God o!
CONCLUSION
The current crisis in the Nigerian Health sector
is essentially borne out of Government’s non-
affirmativeness in handling issues related to
clear definition of roles, lack of a global salary
structure that takes into account training, skills
and competencies, and the toleration of
disrespect for laws and circulars of government.
This is further worsened by its lack of
implementation of agreements and slow
response to threats of industrial action across
the country.
Doctors, as part of the solutions to this
quagmire, have advocated for the signing into
law of the National Health Bill as passed by the
Senate of the Federal Republic of Nigeria. This
will resolve SOME of the problems.
Secondly, a global structure for salaries and
wages in the health sector, based on the points
stated in paragraph 1 of this conclusion, is key
to putting a stop to the impending collapse of
the health sector. That action should be based
on practices in advanced nations of the world
who we aspire to be like. Copying some things
related to relativity from the UK’s NHS would
be a good start. After that, any further pay rise
for staff in the health sector should be done en
masse to maintain the relativity across board.
This alone will bring lasting peace.
A permanent resolution of these crises thus still
lies at the feet of Mr President and his advisers
and committees.
I will bow out with a comment on the oath we
took, which I quoted earlier. That oath, called
the Hippocratic oath and disputably assumed to
have originated from Hippocrates, never
envisioned that a time would come when a
physician (here referring also to a surgeon)
would be an employee of the state or work in
conditions so terrible that he/she would
consider withdrawing services to enforce his
rights and those of his patients. Hippocrates
never thought that the family atmosphere that
existed in all the homes he visited to see
patients would condense into vampiric
institutions where lieutenents would challenge
his leadership and seek to take his place at the
head of the team. If he had, he would perhaps
have added an escape clause.
For there is no longer any dignity in this
practice; and our patients suffer everyday on
account of all this back and forth over the same
issues. Definitely, some of these problems I
have dicussed are at the very heart of the
matter, and others are thrown into the fray as a
response to the frustration that engulfs us in
the moment. But for our conscience to remain
and our patients to enjoy the benefits of the
doctor’s indepth knowledge and training, the
atmosphere has to be right. That is what NMA
is standing for today.
Having gone through some of the hard facts in
this article, and perhaps having been inspired
by my emotive tone, I hope that more members
of the public will come to agree that the current
strike, apart from seeking to correct some
anomalies in the health sector, will ultimately
lead to greater good for the primary object of
existence of the medical profession – the
patient.

egift:

I wanted to return fire, but I am the sane one. So what is wrong in my post?

hydeka: Vagabonds? Jones you're still the programmed robot you've always been. These same vagabonds are the people who would clip the wings of these dictators in the healthcare system who think they can hold everybody to ransome because of their selfish demands which they want us to believe is in everyone's best interest. In the hospital they act as the lords even in cases outside their jurisdiction. They want to head every department in the hospital because they claim to know everything about patients, drugs, physiotherapy, nursing care and they go about dictating to everyone. They believe their opinion should be final. And now that the other members of the healthcare team are standing up to put an end to this anomaly, they resort to blackmailing the government and the people. That is professional tyranny at it's peak. All health practitioners are stakeholders in patient care so there is no reason why a particular group should resort to an autocratic approach in the administration of such a team. If they are all needed to ensure proper healthcare delivery, then they all should have equal say in matters affecting the team.

IdomaLikita:

To all who requoted the Long Article just to makes us Scroll unnecessarily! may Amadioha and Sango do a Combo on you! Bastards!

cramjones: Typical of the Jonathanians. You call of a strike that you did not call for in the first place? It is only under Jonathan that nurses, pharmacists, physiotherapist etc has the guts to tussle the leadership of teaching hospitals with doctors. I support and endorse the doctors strike, it is fight to finish before vagabonds take your rightful place!

#Nigeria-on-the-brink

-CramJones

egift: The major issue is that other health professionals now wants to be called "Consultants" and be given all the benefits that a trained Consultant Medical Doctor get, including appointments reserved for such title.

The question now is, How long do you serve drinks as a Flight Attendant before you start calling yourself a Pilot? Never.

If you want to be a Medical Doctor, please go and read Medicine and stop endangering our Health Sector over your failure for not reading medicine (maybe because you did not make the JAMB score).

jfem: DETAILED SOURCE: http://nationalmirroronline.net/new/minister-cant-call-off-strike-doctors-insist/

The Nigeria Medical Association, NMA, has reacted to the speculation at the weekend by the Federal Ministry of Health that the ongoing strike will end today.

It said that only the association could determine if the strike would end or not.

The Secretary of the Lagos State chapter of the association, Dr. Bami Boye, told our correspondent that the association would determine whether to abort the strike or not pending the resolution of the emergency delegates meeting currently ongoing in Abuja.

He said: “The Minister of Health goofed. He has no right to say whether we are ending the strike or not. He was not the one that told us to start and he will not decide if we are ending it or not. This will be decided by the delegates at the meeting today.”

As the strike continues, patients in government hospitals are hopeful that doctors will consider their plight and bring an end to the strike action.

DETAILED SOURCE: http://nationalmirroronline.net/new/minister-cant-call-off-strike-doctors-insist/

NewsINigeria: Then who can call it off? Doctors should stop killing people.








people should stop killing Doctors pls



Graphic pics: Police van chase okada rider & his passengers to their deaths
>>> http://www./nigerian-politics-news/police-van-chase-okada-rider/