I naturally dislike arrogance. It is cancerous. Anyone who develops little pieces of arrogance in himself should be on the watch out! Otherwise those “cancerous arrogant cells” will mutate and overcome the “moral health system” of the person.

I perceived such “arrogant taste” in an article written by Dr Paul John titled “Another ultimatum from JOHESU?” I was deeply sad within me. It is really shameful that Dr Paul John, who is a medical doctor, belonged to this noble profession by descending so low to “swim in the ocean of arrogance” which negates the true principles of the medical profession.

I am an administrative officer in one of the federal medical centers in Nigeria. I never really understood this “infighting” that characterized the health sector. I have to admit this by humility. However, when I was given the privilege to become recruited into the federal civil service system few years ago, I came to witness, on a ‘first-hand’ basis what is truly happening in the Nigerian health sector, regarding the battle between NMA and JOHESU. In fact permit me to state that from what I saw and from the available literature I came across, “my eyes were opened”.

Another ultimatum from JOHESU? By Dr Paul John Part 1

Often times, we have heard the saying, “what is good for the goose should be equally good for the gander”; some have rephrased this to be “what is good for the goose and the gander is good cheese”. One of the fictional characters in George Orwell’s “Animal Farm”, held that “all animals are equal but some are more equal than the others”, after stating initially that “all animals are equal”. We also have heard that “Napoleon is always right”. This in a nutshell captures the battle of working relationship, harmony, remuneration between NMA and JOHESU. We have a situation in Nigerian health sector that “though all animals are equal”, “some animals” (the doctors) are more equal that the “other animals” (physiotherapists, nurses, pharmacists and other health workers, clinical and non-clinical). What is good for the “goose” (the doctors) is no longer good for the “gander” (non-doctors). The “goose”, having taking its own salacious full of the cheese, “with resounding cries of yummy-yummy”, have declared that the cheese is not good for the health of the “gander”!

There is an Igbo proverb, “agbara rawa nsi, efosia ya ihe ejiri mara ya. Arusi rawa nsi, agwa ya osisi ejiri pia ya”. Dr Paul made some assertions in that article of his, which at best ought to be ignored. However, I felt I had a burden to issue this reply to him and to whatever “school of thought” which he represents.

There was an interesting assertion that Dr Paul made. I would quote him thus, “If you want to become something in life, you must follow the due process. The current director general of World Health Organisation, Dr Margaret Chan, wanted to be in her current post and when she realized that the post was and is still an exclusive preserve of medical doctors, she simply applied to study medicine despite the fact that she had had a degree in Home Economics and for the fact that she was already practising as a Home Economics teacher . In my class we had many people that were studying medicine either as second or third degrees. The most annoying aspect of the whole stuff is that these medical insurgents will quote international best practices which I am sure they don't really understand the meaning”. I would like to remind Dr Paul that Jim Yong Kim the present head of the World Bank is a medical doctor, not even an economist.

When the post was vacant couple of years ago, our own Okonjo-Iweala (whose pedigree has never been questioned in the field of economics and finance management, tested and trusted as a world class economist) indicated her interest alongside Jose Antonio Ocampo (another reputable economist from Brazil). Of all the candidates, Okonjo-Iweala possessed the most formidable credential to head the World Bank. However, the medical doctor was chosen. He has been heading the World Bank and no one has ever come out to attack or criticize his administration. And he has been performing well. Someone would wonder, what is a medical doctor doing as the head of World Bank? But he has been delivering. That’s’ the truth. So Dr. Paul should not be selective in his instances that he easily brandished in his arrogant article.

Is it a criminal offence if a nurse, or a physiotherapist or a pharmacist becomes the chief medical director of a hospital? If it is a criminal offence, then the world bank executives would not have appointed a medical doctor to head that pristine financial institution, a medical doctor who is not a professional economist”! They would have put Okonjo-Iweala there. But the World Bank has not collapsed. Most of our revered Nollywood actors and actresses never read Theatre Arts. Most of our revered musicians did not study music as a profession. But they are doing very well, making Nigerian movies and music cross the shores of Nigeria and Africa.

In fact, is it not a sign of contradiction, that these Nigerian doctors clamoring that they are the only ones worthy to head a health institution, has no form of knowledge in hospital administration. In the United States, doctors have no business in hospital administration. Of course there are professional health administrators. I know of one Institute of health administration somewhere in Cross Rivers. Why would the doctors not allow a career, professional health administrator to run the teaching hospitals, federal medical centers and other health institutions in Nigeria as Chief Medical Directors? I am saying all this so that an objective mind somewhere would see the point I am trying to make. In fact, what I suggest we should have in Nigeria is “Chief Administrative Director” (CAD), not “Chief Medical Director” (CMD) as we have it today.

That reminds me. I pray that the head of service will read this piece. From what I have read from the Public Service Rule, the entry point of staff in the civil service is Grade level 7-10. But from what we have seen today, the doctors have succeeded in making their entry point to be grade level 13! Let me explain further.

Another ultimatum from JOHESU? By Dr Paul John Part 2

The normal grade level in the civil service here in Nigeria is GL 1-6 for junior staff and GL 7- 17 for senior staff. Now in the health sector, there are two salary schemes: CONMESS and CONHESS. These two salary schemes were approved around 2009 by His Excellency Alhaji Umaru Musa Yar’Adua, former Nigerian president (may he continue to rest in peace). The Medical Doctors in the Nigerian are on CONMESS, while other medical personnel (physiotherapists, nurses, pharmacist and other clinical staff) and every other person working in the Health Sector were placed under the CONHESS structure. I would want my reader to take a look at these schemes in the chart below:

NORMAL GRADE LEVEL CONMESS (FOR DOCTORS)
Grade Level 10 CONMESS 01 (house officer/youth corps Doctor)
Grade Level 12 CONMESS 02 (Registrar/Medical Officer)
Grade Level 13 CONMESS 03 (Senior Registrar Senior Registrar II/Senior Medical Officer Grade 2)
Grade level 14 CONMESS 04 (Senior Registrar Grade 1/Senior Medical Officer Grade 1)
Grade Level 15 CONMESS 05 (Consultant/Principal Medical officer Grade 2)
Grade Level 16 CONMESS 06 (Consultant Special Grade 2/Principal Medical Officer Grade 1)
Grade Level 17 CONMESS 07 (Consultant Special Grade 1/Chief Medical Officer)

NORMAL GRADE LEVEL CONHESS (FOR OTHER CLINICAL STAFF AND HEALTH WORKERS)
Grade Level 8 CONHESS 7 -- INTERNS / NYSC
Grade Level 9 CONHESS 8 X -Officer 1
Grade Level 10 CONHESS 9 Senior X-Officer
Grade Level 12 CONHESS 11 Principal X- Officer
Grade Level 13 CONHESS 12 Assistant Chief X-Officer
Grade Level 14 CONHESS 13 Chief X-Officer
Grade Level 15 CONHESS 14 Assistant/ Deputy Director X-Officer
Grade Level 17 CONHESS 15 Director X-Officer

From the chart above, one can see that a House Officer/Corper Doctor is placed on GL 10 which is CONMESS 1, while a physiotherapist intern for example is place on GL 8 (which is CONHESS 7). Now check it, when a physiotherapist or pharmacist is fully recruited as a civil servant in the health sector, he/she is placed on GL 9 (which is CONHESS . But this is not so for the doctor, for he/she is placed on CONMESS 2 (which is GL 12)! Is this not an alarming disparity? How can a sane mind explain this inequality of monumental proportion? Can objective minded Nigerians see how the “cheese” is only good for the good and not for the gander?

In the Public Service Rule and Guideline on appointment, promotion and discipline in the Nigeria Civil service, officers on GL 7 – 14 spend minimum of 3 years before being promoted to another level, while those on GL 15-17 spend minimum of four years. You see a doctor on fresh recruitment placed on GL 12 (CONMESS 2) and a physiotherapist on fresh recruitment placed on GL 9 (CONHESS . THE physiotherapist would put in a minimum of 12 years in his civil service career before reaching GL 12, which is the commencement point of his colleague who is a medical doctor! Is this not also alarming?

. If the public service rule states that entry point of officers in the civil service in Nigeria is GL 7-10, why then is a medical doctor’s entry point be GL 12? Can somebody see what I am seeing? How can one explain this discrepancy that is both frightening and shocking?
. How did the Yar’Adua administration and all the permanent secretaries in the civil service commission permit this anomaly? Within 12 years, a medical doctor is hitting the peak of his career as a ‘consultant’ on GL 15(a title that Dr Paul and his arrogant colleagues, as the ‘goose’ have “incredibly defended” as their “father’s title”, thus not for the ‘gander’); but before a physiotherapist for example will hit the peak of his career, he/she is almost knocking on the door of retirement?
. Would it not have been just and fair to have a unified salary scale of all health workers (doctors, physiotherapists, nurses etc) with different entry points?

Even when the case of skipping came up, JOHESU said they are entitled to skipping. We know that there is no GL 11 in the civil service. Thus an officer on GL 10 automatically goes to 12 when he/she is due for promotion. This is what “skipping” is all about. But the NMA/MDCAN fought it stiffly. The GL 11 is CONHESS 10. Thus JOHESU stated that their members ought to skip CONHESS 9 and move to CONHESS 11. NMA even went ahead to call JOHESU thieves. But was it not most surprising that, after the NMA took JOHESU to court, and JOHESU won the case and the Industrial Court approved skipping for JOHESU, NMA then brought their own proposal of “skipping”? Who is really the thief here then?

Is not this demand of NMA marked with ridiculous greed? According to NMA, government has to skip CONMESS 2 for them, thus making their entry point to be CONMESS 3 (GL 13)! Is this not outrageous that, despite the fact that the NMA/MDCAN arm twisted the FG to make their entry point to be CONMESS 2/GL 12 , they were not satisfied and still went ahead to press that the FG skip CONMESS 2 for them? Who is fooling who? I am so angry here. Yet Dr Paul still has the temerity (in the opening paragraph of his arrogant article) to state that “is it not an act of utter folly for JOHESU (Joint Health Sector Unions) to issue another ultimatum threatening federal government to embark on another strike in the health sector?” Haiiiiiiiii!!!!!!

Articles:
. Another ultimatum from JOHESU? By Dr Paul John Part 1
. Another ultimatum from JOHESU? By Dr Paul John Part 2

Let the objective minded Nigeria see, evaluate and arrive at his/her own conclusion and check who is really fooling and insulting the collective intelligence of Nigerians on this matter. Dr Paul even stated, “I wonder how we Africans reason at times, is there anywhere in the world where doctors and non-doctors receive the same amount of salaries?” Doctors and non-doctors may not receive the same amount of salary but let the relativity be fair, just and equitable. It is even more annoying to see Dr Paul state that “how can the air hostess believe that she will receive the same amount of salary as the pilot just because both are involved in the flight? At times we Africans behave as fools, how can somebody in his right frame of mind believe that a soldier who passed through NDA (Nigerian Defence Academy) will receive the same amount of salary with a member of Nigerian security and civil defence corps just because both are involved in a peace keeping mission?” This analogy does not add up at all, it is totally off the map. It is an unsuitably silly analogy. An air hostess may not be a graduate as a pilot, but how do you treat graduate colleagues? Is the MBBS degree issued by University of Nigeria Nsukka different and more qualitative than the B.Pharm, B.Sc Nursing, issued by the same university?

It was also equally offensive for Dr Paul (as he went ahead to massage his ego) stated that JOHESU members can “pick up a JAMB UTME form, fill medicine and surgery, finish the course with MBBS certificate registrable with Medical and Dental Council of Nigeria”. This is an insult. I have also heard some medical doctors say such with “glee”. Does the fact that someone read Medicine and Surgery make him more human than I who did not study same? I so much believe in the principle of mutual respect. It is a natural law. The fact that I did not study 'medicine' does not make me a lesser human being than those who studied medicine. Some of them have embarked on ego trip. I want to remind them, if they may have forgotten, that Chinua Achebe was given admission to study medicine and surgery even on scholarship. But he went ahead to change his course to English, Theology and Literature. Had it been Achebe finished as a doctor, the world would not have known him, and as such lost such a priceless jewel of African literature; "Things Fall Apart" would have been lost forever! Chimamanda Ngozi Adichie also was to study medicine. But she went ahead and changed her course to English and Creative writing. Everyone today knows the stuff she is made of. Had it been Chimamanda ended as a doctor, the world would not have known her, and as such lost the opportunity of reading "Half of a Yellow Sun" (already translated into a movie). Dr Paul should not think that wearing the stethoscope makes him a better and more successful Nigerian than others.

Dr Paul went on arrogantly, “A time will come when we will be importing the services of foreign doctors because nobody will ever go and study medicine in this country since the remunerations for both medical and paramedical professionals are the same. This is because nobody likes taking a difficult path (like medicine) even our lord Jesus never wanted to pass through the sufferings on the cross hence his prayers in the garden of Gethsemane, 'father if it is possible , let this cup pass over me ....' A nurse with RN certificate which is less than or equal to OND or NCE wants to come and head medical consultants who are fellows of different postgraduate medical colleges, is that not madness? is it not time for us to invite the services of the psychiatrists?” O my Goodness! Did someone hear that? I am getting angrier. So those who studied medicine are the most intelligent and those who could not are dunces? Can we see that ego trip? So Chinua Achebe was a dunce by changing his course from Medicine to English, Theology and Literature, thereby choosing “an easy path” to a “more difficult path”? Yet even in his “dunce capacity” he shook the literary world with his works, a feat that Dr Paul may never match in his entire lifetime?

As a medical doctor, what research or medical theory has Dr Paul ever propounded, formulated or actualized to make the study of medicine better? When ebola hit the Nigerian space, what was his contribution? Has he developed a specimen to cure ebola? Instead, Dr Paul would wait for American Zmapp (produced by a pharmaceutical company in the US). What research breakthrough has Nigerian doctors in Nigeria made in medicine? Yet the FG would be pumping billions of Naira into their residency programme, after which some of them either open their private clinics or “jet out finally” from the country.

I thank God so much for one thing: GOD IS GOD, AND HE IS STILL GOD. Had it been the medical doctors in Nigeria were God, I bet with 101% certainty, they would have eternally shut the door of heaven on some because they are not doctors!

Is it not amazing that some Nigerian doctors “do not know how to peel and slice their onions well”, yet these claim to be professionals “who own the patient”. I am so sorry to state this here. Some the deaths recorded here in Nigerian hospitals are a result of “professional negligence, ignorance and incompetence” from these “arrogant doctors”. I have witnessed a case where a “medical doctor”, “certified in character, learning and practice” prescribed heavy antibiotics for a pregnant woman. The woman suffered miscarriage later. I have seen couple of cases where the pharmacist had to return a doctor’s prescription. Of course the doctor “knows all”. I have seen a case where a medical doctor increased the dosage of a particular drug for my friend’s dad (who suffered partial stroke). The man’s BP went low; he could not talk neither could he recognize anyone. When the prescription was shown to another doctor, he shouted, saying that on no account should the prescription be increased! But it was his colleague, a “professional” that increased the prescription. Which one shall we talk and ignore the other? And from my impression, the NMA is so ready and vigilant to turn a blind eye to this ineptitude and defend her colleagues in “brotherhood”. But when it comes to the issue of salary, remuneration and other forms of welfare enhancement, they cry out at their loudest voice, ever ready to deploy and redeploy their rank and file for a showdown, a strike. I am happy that at last Jonathan has shown them that inevitable red card. For NMA/MDCAN to think of embarking on any strike anymore in Nigeria, they will have a rethink.

Let me make myself clear. The medical profession is a noble profession. I can and will never dispute that in my lifetime. It is a thing of joy to see that God almighty the Creator or man and woman, who desires us to be in good health, made it possible that man has access to a form of knowledge concerning human health, which has helped to extend the lifespan of men on earth. This is what doctors do. Many of us would have died through one illness or the other, had it been there were no doctors. Can any sane mind imagine how the world would look like had it been there were no medical doctors? Thus their presence in the society is a gift from God to men. But they should not be arrogant, especially here in Nigeria. This privilege (and I still call it a privilege) to learn about human health ought to make doctors more humble in rendering health care giving services.

Dr Paul John should kindly take note of this truth if he truly has ears to listen!

BY IBE, V.C.N
misereremeidomine@outlook.com

I agree this is quite long, but not too long for someone interested in following happenings in our crisis-infested health sector.

JOHESU vs NMA again?

Excellent write up.