Some of us have seen and experienced the truth... We need to rise above petty tirades to save our ailing health sector
Revisiting The NMA Strike -*
The Candid Opinion Of A UK-Based Doctor
By *Dr. Ijabla Raymond*
Although I practise abroad, I should point out
that this strike affects me too. My family and
friends all live in Nigeria.
I feel compelled to write on this subject
because of its seriousness and the dearth of
objective analyses on our social media. It is
an emotive subject for both *NMA* and
*JOHESU* members, and I can understand
why punches fly around, but both parties must
rise above petty and emotional considerations
if we are to find a way forward.
For clarification purposes, the *NMA*
represents medical doctors whilst *JOHESU*
is a union of all health workers who are not
doctors.
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 HOSPITAL*
There is no contention – the medical doctor is
the head of the *clinical team.* He/she leads
the ward rounds, clinics, surgical operations,
multidisciplinary meetings and so on because
the ultimate and final responsibility for patient
care rests in his/her hands.
The headship of the hospital is a different
matter. This is an *administrative* office,
which 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 CONSULTANTS*
The doctor-patient ratio in Nigeria is
_dangerously low._ In my view, the roles of
non-medical professionals such as nurses,
physiotherapists, pharmacists etc need 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 both competently and
safely within an *agreed framework* . These
professionals have separate (but
complimentary) job descriptions and their
roles are not designed to replace or dispense
with the services of the doctor. If this
arrangement enhances patient care, then
where is the problem with it? The NMA needs
to demonstrate to the public and to the
government how the creation of these non-
medical consultant positions will adversely
affect patient care, otherwise, its demands will
be perceived as 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. For instance, psychiatrists are hardly
exposed to body fluids and their risks for
contracting diseases like HIV and hepatitis are
much less than for a theatre scrub nurse. The
risk of physical assault by a patient is higher
for a psychiatrist than for a surgeon. And
because psychiatric nurses spend more time
with patients, their risks of assault are
arguably higher than those of consultant
psychiatrists.
The people who work in radiology
departments such as radiologists,
radiographers, nurses, porters and so on have
greater exposure to radioactive materials than
everyone else in the hospital.
The current health hazard allowance of
N5,000 is unconscionable – it needs to
increase. However, I think it is imperative to
get an independent risk assessor for impartial
advice.
*MISCELLANEOUS*
I have read far too many emotional arguments
on these issues 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* – it is *not* the
_doctor_ , _nurse_ , _pharmacist_ or
_laboratory scientist_ or anyone else. 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
longer than a week if its cleaners went on
strike and dirt was allowed to accumulate to
the point where it constitutes a health 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.
The other reason I have heard doctors give for
not wanting our non-medical colleagues to
bear the "consultant" title is the fear that
patients will confuse them or anybody else in
a white-coat for a doctor and give such people
an excuse for autonomous practice.
This reason is *not good enough* because
this problem can be solved by wearing names
badges and/or colour coded uniforms. Also
health professionals should introduce
themselves to patients at the start of
consultations. But more significantly, this can
be an issue of regulation - any one found to
be (criminally) practising over and beyond
their job description, competence level or
professional registration becomes liable to
disciplinary procedures.
Our health system suffers from poor
regulation. This is why anyone can open a
chemist and dole out antibiotics
indiscriminately. It is the reason doctors are
scared that consultant pharmacists, nurses
and physiotherapists will steal their patients.
But it is also the reason why doctors may
recommend an operation to a patient where
none is necessary just so they can charge
more. This is a problem that is in urgent need
of attention.
I hope that this something both NMA &
JOHESU will flag up in the near future.
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 narrative 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 supposed to be
responsible for junior doctors. But this in
itself is not a good argument for blocking
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
patients who cannot afford these fees are left
to suffer or die. If the NMA has made any
efforts to change this public perception, then
these do not appear to have been effective.
*CONCLUSION*
The current strategy (i.e., recurrent strikes) is
not working. Over the last decade or two, the
NMA and non-medical health workers (more
recently represented by JOHESU) have taken
turns to go on strikes. Perhaps, it is time for
both parties to sit together, talk to each other
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 reversal of those agreements._
I think the time has come to incorporate
Ethics, Teamwork and Communications into
undergraduate curricula. The various online
comments I have read from medical and non-
medical colleagues show that whilst many
easily mouth off "team work", a practical
understanding of what this means is lacking.
Disciplinary procedures are there for a reason.
They must be followed when necessary.
Although I practise abroad, I should point out
that 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, we must all be mindful of our own
mortality. Most of us will be ill someday.
And 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.
*Ijabla Raymond,* a medical doctor of
Nigerian heritage writes from the UK. Contact:
_ijabla.raymond@facebook.com._[/color][color=#990000]