I feel compelled to write on this subject because of its seriousness and the dearth of objective analyses in this forum. It is an emotive subject for both the NMA and JOHESU, and I can understand why punches fly around, but the parties must rise above petty and emotional considerations if we are to find a way forward.The NMA has a list of 24 demands but I will limit myself to the most contentious ones. At this stage, it is probably best that I introduce myself. I am medical doctor of Nigerian heritage practising in the UK. WHO SHOULD HEAD THE HOSPITALThere is no contention – the medical doctor is the head of the clinical team. He/she leads the ward rounds, clinics, surgical operations, multidisciplinary meetings etc because the ultimate responsibility for patient care rests in his/her hands.The headship of the hospital is a different matter. This is an administrative role and needs not be occupied by a medical doctor. This job is better in the hands of people who have administrative or business management skills. This is the case in countries like the UK, Canada and the US, which heavily influence our health system. Therefore, it is difficult to reason with the NMA why this job should be the exclusive right of medical doctors. NON-MEDICAL CONSULTANTSThe doctor-patient ratio in Nigeria is abysmally low and very unsafe. In my view, the role of non-medical professionals such as nurses, physiotherapists, pharmacists etc needs to expand to cope with the demands on doctors. It is important that this is done in a safe way by providing the appropriate level of training for these individuals. This is the case in countries such as the UK, Canada and the US where consultant nurses, pharmacists etc have existed for a few decades now. I do not see any problem with non-medical consultants as long as these individuals are appropriately trained and can practise competently, safely and within an agreed framework. If this arrangement enhances patient care, then where is the problem with it? Pursuing this demand is tantamount to the NMA obstructing the professional development of JOHESU members, and I don’t think this is helpful to anybody.HAZARD ALLOWANCE The types of hazard and the level to which healthcare workers are exposed vary considerably and depend on the type of job they do. Psychiatrists are hardly exposed to body fluids and their risks for contracting diseases like HIV and hepatitis are much lesser than a theatre scrub nurse. The risk of physicalassault by a patient is higher for a psychiatrist than for a surgeon. And because psychiatry nurses spend more time with the patients, their risk of assault is arguably higher than the consultant psychiatrists. The people who work in radiology departments e.g. radiologists, radiographers, nurses, porters and so on have greater exposure to radioactive materials than everyone else in the hospital.The health hazard allowance is a pittance – it needs to increase. However, I think it is important to get an independent risk assessor for impartial advice.MISCELLANEOUS I have read far too many emotional arguments on the subjectof this NMA strike and very little of an objective discourse. It is important that I draw your attention to a few of these. What has become obvious is the lack of understanding of the concept of teamwork. There is a pervasive notion among doctors that the other healthcare workers are there to serve them. JOHESU members think that doctors have become too conceited for their own good and are determined to put them in their “places”. The most important person in the hospital is the patient – not the doctor, nurse, pharmacist or laboratory scientist. Every team member is important and must be respected, including the people who do the least clinical jobs like cleaning; I don’t imagine that any hospital will remain open for long if its cleaners went on strike and dirt was allowed to accumulate to the point where it constitutes ahealth risk. I have heard so many anecdotal accounts of nurses not joining doctors on ward rounds or pharmacists altering prescriptions without first discussing these with the prescribing doctors or laboratory scientist slapping doctors; and these accounts are being given as reasons why doctors must continue to head hospitals. These are disciplinary matters, which should be managed according to existing procedures. These excuses are emotional and should not be used to block the professional development of others. Another recurrent theme in these debates is the abuse of junior doctors by both medical and non-medical staff, which appears to be endemic. There is a consistent account of junior doctors being asked to do other people’s jobs such as collecting blood from blood banks, taking samples to laboratories etc. In extreme cases, these doctors are asked to undertake non-clinical tasks by more senior doctors. This is simply unacceptable! I think it is fair to place the blame for this at the hands of consultants who are responsible to the junior doctors. But this in itself is not a good argument forblocking JOHESU members from becoming consultants in their specialties or for stopping them from heading hospitals if they have the right qualifications.I am concerned that the NMA is losing public sympathy.Increasingly, I hear people describe doctors as selfish and heartless. This is very sad and rather unfortunate. They say doctors do not have any motivation to end the strike because patients are forced to pay exorbitant fees to them in their private hospitals. Those who cannot afford these fees are left to suffer or die. If the NMA has made any efforts to carry the public along, these do not appear to have been effective (yet). CONCLUSIONTo conclude, the current strategy (i.e., recurrent strikes) is not working. Over the last decade or two, the NMA and JOHESU have taken turns to go on strikes. Perhaps, it is time to sit both parties and resolve these contentious issues once and for all. It’s pointless for the government to enter into agreements with one party knowing fully well that the other party will ask for a near-reversal of those agreements. It has become imperative to incorporate Ethics, Team work and Communications into undergraduate curricula.Disciplinary procedures are there for a reason. They must be followed when necessary.Although I practise abroad, I should point out this strike affects me too. My family and friends all live in Nigeria. And who says I am not planning to come home to practise? Lastly, let us be mindful of our own mortality – most of us will be ill some day. When this happens the only thing that will matter to us is to be looked after by caring and competent health-workers regardless of their individual specialisation. We can create that environment if we forget our individual egos and work as a team.
Dr Ijabla Raymond