₦airaland Forum

RE: False Reporting of Court Proceedings Concerning GTBank

Lagos Nigeria – June 11, 2018

The attention of Guaranty Trust Bank Plc (“the Bank”) has been drawn to false, mischievous and malicious statements circulating in the news and social media in respect of a purported directive by the Supreme Court of Nigeria to the Bank to make payments to one of its debtor Customers.

The Bank’s Customers and the General Public are hereby kindly urged to disregard these false statements as nothing could be further from the truth. There was no directive or Order issued by the Supreme Court of Nigeria to the Bank to make any payment to any of its debtor Customers.

The Bank as a highly responsible corporate citizen will in accordance with its culture and tradition refrain from making comments about on-going litigation matters and will continue to focus on using legal means to recover its bad debts. It must be emphasised that the Bank remains undeterred in its recovery drive against recalcitrant debtors.

We again reiterate that there is no iota of truth in the falsehood being peddled by desperate and mischievous elements and the General Public should disregard same in its entirety.

The Bank remains committed to providing best-in-class customer experience to all its valued Customers.

We thank you for your continued support and patronage.

Yours faithfully,

For: Guaranty Trust Bank Plc

GeeString:
7. Stop playing bet9ja: No additional write up needed here.

But bet9ja has made some people millionaires

On 25/May/2018 / In Press Publications
Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) Press Release
The attention of the Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) has been drawn to yet another rejoinder by the Nigerian Medical Association (NMA), to the current JOHESU led strike action as contained in her latest Press Release titled “RE: ONGOING STRIKE ACTION BY JOHESU AND ITS EXTENSION.” We are amazed at the despondency and sheer desperation with which the NMA has pursued this issue of adjusted salary for members of JOHESU, even when the government had earlier done same for her members.
At a time when Nigeria’s healthcare indices are at an all time low, and indeed one of the lowest in the world, at a time when the dreaded Ebola scourge is about resurfacing close to our borders, all a supposedly elitist group like the NMA has done is to bug the government of the day with unnecessary distractions, blackmails and empty threats about bringing down the government and shutting down the health sector if the government as much as adds one naira to the salaries of non medical doctors, even when the government has increased their salary twice in the not too distant past. How demeaning! How shameful! How belittling! We wish to observe that if the NMA had expended half as much energy in tacking Nigeria’s healthcare challenges, the country would have become a centre of medical tourism like the rest of the world.i. According to the NMA “In view of the above, the NMA painfully wishes to inform the Federal Government of Nigeria that any award to the non- medically qualified health professionals that violates the January and July agreements of 2014 shall result in the resumption of the suspended withdrawal of service of 2014. Please take this as a notice sir.”
ii. The NMA continued “The above reminder is predicated on the extension of the ongoing strike action embarked upon by the amorphous body called ‘JOHESU’ to states and local government areas, the basis of which is to strengthen its callous and ill motivated agitation for pay parity between her members and doctors with the resultant erosion of relativity and further hierarchical distortion in the health sector vis-à-vis her clandestine romance with some top government officials.” Oh, is the NMA afraid? What is she afraid of? Realizing that she no longer enjoys monopoly of strike action, the NMA has suddenly become jittery and desperate and like the proverbial drowning man that will clutch at anything to survive, has started casting aspersions at “some (imaginary) top government officials.”
iii. It is public knowledge that in 2009 when late President Musa Yar ‘adua was in office, NMA clamoured for salary increase for her members as usual, but met with a rebuff from the then president, who insisted that any increase in salary would cut across all professionals in the healthcare sector, and not only medical doctors. A committee was set up to work out the modalities for the increment which resulted in the Consolidated Health Salary Scale (CONHESS). This was approved by the then president and implemented in January 2010. Medical doctors and other healthcare workers were together on CONHESS then; and there was relative peace in the sector.
Iv. By 2014, when the CONHESS was due for review, the NMA as usual went behind to lobby the then president for their separate salary scale, and ended up with CONMESS which was far more robust than CONHESS. The CONMESS was quickly approved and doctors were paid their arrears promptly. Even though an adjustment in salary was calculated for non medical doctors, it was never implemented for them till date.
v. The medical doctors had their salary increased again between 2016 and 2017, under the guise of maintaining relativity. They (doctors) were initially opposed to skipping for CONHESS, for which they argued then that it was criminal to skip any level, but JOHESU went to the National Industrial Court and won the case. The doctors suddenly changed their song and started demanding for skipping for CONMESS, which was quickly approved by the Minister of Health (himself a medical doctor) and they were paid arrears pronto, whereas many health care workers on CONHESS have not been paid their skipping allowance since 2010. This is one of the reasons JOHESU is on strike today.
vi. The fact remains that medical doctors enter the CONMESS Scale at the equivalent of GL12, which is by far higher than other healthcare professionals who enter at GL 10. That in itself is relativity. At no point in time is JOHESU asking for same pay with medical doctors as the NMA and the Honourable Minister of Health would erroneously want the world to believe. All JOHESU is asking for is salary adjustment as was done for medical doctors. What erosion of relativity is NMA talking about when they are already advantaged at entry point?
i. On the issue of consultancy, hear the NMA “The demand for the appointment of other health workers as consultants (with payment of specialist allowance) is a self-centered agitation aimed at ensuring they are in charge of clinical care. This is not only an aberration (considering international best practice) that will add no value to clinical/patients care, it will certainly worsen morbidity and mortality indices in Nigeria. We therefore affirm the rejection of this demand.” Again we are tempted to ask what is the NMA afraid of? Is she acting out of ignorance of what consultants from other health professions are capable of in putting into health care or is it just a case of NMA refusing and rejecting change?
ii. Whether the NMA likes it or not, consultant pharmacists have come to stay. All over the world, including the United Kingdom, consultant pharmacists are collaborating with physicians and other professionals for optimal patient care; no wonder medical tourism is very high in those countries. That explains why even our own very President is compelled to patronize medical services in UK where the practice is close to ideal. In UK for instance, consultant renal care pharmacists work hand in hand with renal physicians and other professionals to optimize patient care, but in Nigeria, a medical officer with an MBBS or at best an internal medicine physician willclaim to know it all and prefer to consult alone so that their inadequacies will not be public knowledge. No wonder our health indices in Nigeria are competing with those of Somalia, Sudan and Togo (among the lowest in the world). We make bold to state that the NMA is not in a position to reject appointment of consultants from other health disciplines including pharmacists, because it will run counter to international best practice.
On the issue of headship of hospitals, hear the NMA “The demand for headship of Departments/Units in the hospital by members of JOHESU/AHPA will lead to unprecedented chaos in the health sector with ripple effect on the health of Nigerians. We reaffirm our rejection of this demand.” Again we state emphatically that nothing can be further from the truth. It would appear that the NMA is afraid of even its own shadow. It is common knowledge that when hospital administrators were managing hospitals before the coming of (Olikoye Ransone Kuti in 1985), there was peace, tranquility, serenity and convivial atmosphere in the hospitals. But as soon as medical doctors usurped the management of hospitals, chaos has become the order of the day. We state without equivocation that you do not need to have an MBBS or be a surgeon (FWACS) to successfully manage a hospital. You could argue about heading clinical services in a hospital, but certainly not the administration of the hospital.i. The NMA concluded by threatening the government in what has now become their hallmark “In conclusion, the Nigerian Medical Association wishes to once again remind government of the implications of acceding to any demand that violates the collective bargaining agreement of January 2014.”
ii. We wish to observe that government’s acquiescence to previous NMA demands over the years is one of the factors that emboldened the NMA to act in the way she has carried on so far. The NMA has been systematically milking Nigeria dry under the guise of collective bargaining, such that today in Nigeria, a medical house officer who just left medical school, is placed on CONMESS 1, the equivalent of CONHESS 12 (What a nurse earns after 15 years in service) while a Registrar earns same salary as an Assistant Director of Nursing Services (ADNS)!. A pharmacist who rose through the ranks to become director of pharmaceutical services, even with a Masters degree and after 35 years of service, earns about 500,000 thousand naira monthly, whereas a freshly qualified consultant (6 years post NYSC) earns over 600,000 thousand naira monthly, while older consultants earn one million naira and above monthly (there are close to ten thousand of them currently) thanks to NMA’s machinations. The irony or is it tragedy of all these is that these so called consultants see patients once a week, and a fixed number of patients at that. Other days of the week, patients are left at the mercy of house officers, medical officers and at best registrars. For how long will this treachery continue in the healthcare sector?
iii. This is the disparity that the NMA wants to maintain between their salary and those of other healthcare workers at all costs. This explains why they are so jittery and keep issuing threats to various ministers and indeed the presidency not to honour JOHESU’s demands, because of their narrow mindedness.
CONCLUSION
From the foregoing, it is very obvious that the NMA is not fighting a just cause, and as such, we demand that government should call her bluff and accede to JOHESU’s demands once and for all.NMA is threatening government with strike if government grants JOHESU’s demands; as the NMA must have observed by now; she no longer enjoys monopoly of strikes in the health sector. Any strike called by the NMA in future over salary of other health care workers will meet with further strikes by JOHESU members.We insist on our earlier call for a Unified Salary Scale for all healthcare workers, including consultants, with workers entering the scale based on their qualifications and years of service.We demand that appointment of minister of health should be rotated among the various health professionals (in line with international best practice) and should not be the exclusive preserve of medical doctors, who most of the time exhibit bias towards medical doctors at the detriment of other health care workers. This practice has unwittingly prolonged the strife in the health sector. A case in point is the World Health Organization (WHO), whose Director General is not a medical doctor, yet the world body continues to make giant strides.We insist on appointment of pharmacists and other duly qualified healthcare professionals as consultants and medical directors of federal tertiary institutions as a way out of the current quagmire.We believe it’s time to call a spade a spade. The federal government should summon the political will to call the bluff of the NMA, before she finally destroys the healthcare sector beyond repairs. As it stands now, the NMA has lost her respect and credibility among other health care professionals because of her pursuit of mediocrity and this has not augured well for service delivery in the sector.Where the government chooses to continue to treat the NMA with kid’s gloves, then Nigerians should be prepared for a long drawn out crisis in the health sector with terrible consequences for all. A stitch in time saves nine.
Please accept assurances of our esteemed regards.
Pharm. Martins Oyewole MAW Pharm. Jelili Kilani
National Chairman AHAPN National Secretary

On 25/May/2018 / In Press Publications
Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) Press Release
The attention of the Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) has been drawn to yet another rejoinder by the Nigerian Medical Association (NMA), to the current JOHESU led strike action as contained in her latest Press Release titled “RE: ONGOING STRIKE ACTION BY JOHESU AND ITS EXTENSION.” We are amazed at the despondency and sheer desperation with which the NMA has pursued this issue of adjusted salary for members of JOHESU, even when the government had earlier done same for her members.
At a time when Nigeria’s healthcare indices are at an all time low, and indeed one of the lowest in the world, at a time when the dreaded Ebola scourge is about resurfacing close to our borders, all a supposedly elitist group like the NMA has done is to bug the government of the day with unnecessary distractions, blackmails and empty threats about bringing down the government and shutting down the health sector if the government as much as adds one naira to the salaries of non medical doctors, even when the government has increased their salary twice in the not too distant past. How demeaning! How shameful! How belittling! We wish to observe that if the NMA had expended half as much energy in tacking Nigeria’s healthcare challenges, the country would have become a centre of medical tourism like the rest of the world.i. According to the NMA “In view of the above, the NMA painfully wishes to inform the Federal Government of Nigeria that any award to the non- medically qualified health professionals that violates the January and July agreements of 2014 shall result in the resumption of the suspended withdrawal of service of 2014. Please take this as a notice sir.”
ii. The NMA continued “The above reminder is predicated on the extension of the ongoing strike action embarked upon by the amorphous body called ‘JOHESU’ to states and local government areas, the basis of which is to strengthen its callous and ill motivated agitation for pay parity between her members and doctors with the resultant erosion of relativity and further hierarchical distortion in the health sector vis-à-vis her clandestine romance with some top government officials.” Oh, is the NMA afraid? What is she afraid of? Realizing that she no longer enjoys monopoly of strike action, the NMA has suddenly become jittery and desperate and like the proverbial drowning man that will clutch at anything to survive, has started casting aspersions at “some (imaginary) top government officials.”
iii. It is public knowledge that in 2009 when late President Musa Yar ‘adua was in office, NMA clamoured for salary increase for her members as usual, but met with a rebuff from the then president, who insisted that any increase in salary would cut across all professionals in the healthcare sector, and not only medical doctors. A committee was set up to work out the modalities for the increment which resulted in the Consolidated Health Salary Scale (CONHESS). This was approved by the then president and implemented in January 2010. Medical doctors and other healthcare workers were together on CONHESS then; and there was relative peace in the sector.
Iv. By 2014, when the CONHESS was due for review, the NMA as usual went behind to lobby the then president for their separate salary scale, and ended up with CONMESS which was far more robust than CONHESS. The CONMESS was quickly approved and doctors were paid their arrears promptly. Even though an adjustment in salary was calculated for non medical doctors, it was never implemented for them till date.
v. The medical doctors had their salary increased again between 2016 and 2017, under the guise of maintaining relativity. They (doctors) were initially opposed to skipping for CONHESS, for which they argued then that it was criminal to skip any level, but JOHESU went to the National Industrial Court and won the case. The doctors suddenly changed their song and started demanding for skipping for CONMESS, which was quickly approved by the Minister of Health (himself a medical doctor) and they were paid arrears pronto, whereas many health care workers on CONHESS have not been paid their skipping allowance since 2010. This is one of the reasons JOHESU is on strike today.
vi. The fact remains that medical doctors enter the CONMESS Scale at the equivalent of GL12, which is by far higher than other healthcare professionals who enter at GL 10. That in itself is relativity. At no point in time is JOHESU asking for same pay with medical doctors as the NMA and the Honourable Minister of Health would erroneously want the world to believe. All JOHESU is asking for is salary adjustment as was done for medical doctors. What erosion of relativity is NMA talking about when they are already advantaged at entry point?
i. On the issue of consultancy, hear the NMA “The demand for the appointment of other health workers as consultants (with payment of specialist allowance) is a self-centered agitation aimed at ensuring they are in charge of clinical care. This is not only an aberration (considering international best practice) that will add no value to clinical/patients care, it will certainly worsen morbidity and mortality indices in Nigeria. We therefore affirm the rejection of this demand.” Again we are tempted to ask what is the NMA afraid of? Is she acting out of ignorance of what consultants from other health professions are capable of in putting into health care or is it just a case of NMA refusing and rejecting change?
ii. Whether the NMA likes it or not, consultant pharmacists have come to stay. All over the world, including the United Kingdom, consultant pharmacists are collaborating with physicians and other professionals for optimal patient care; no wonder medical tourism is very high in those countries. That explains why even our own very President is compelled to patronize medical services in UK where the practice is close to ideal. In UK for instance, consultant renal care pharmacists work hand in hand with renal physicians and other professionals to optimize patient care, but in Nigeria, a medical officer with an MBBS or at best an internal medicine physician willclaim to know it all and prefer to consult alone so that their inadequacies will not be public knowledge. No wonder our health indices in Nigeria are competing with those of Somalia, Sudan and Togo (among the lowest in the world). We make bold to state that the NMA is not in a position to reject appointment of consultants from other health disciplines including pharmacists, because it will run counter to international best practice.
On the issue of headship of hospitals, hear the NMA “The demand for headship of Departments/Units in the hospital by members of JOHESU/AHPA will lead to unprecedented chaos in the health sector with ripple effect on the health of Nigerians. We reaffirm our rejection of this demand.” Again we state emphatically that nothing can be further from the truth. It would appear that the NMA is afraid of even its own shadow. It is common knowledge that when hospital administrators were managing hospitals before the coming of (Olikoye Ransone Kuti in 1985), there was peace, tranquility, serenity and convivial atmosphere in the hospitals. But as soon as medical doctors usurped the management of hospitals, chaos has become the order of the day. We state without equivocation that you do not need to have an MBBS or be a surgeon (FWACS) to successfully manage a hospital. You could argue about heading clinical services in a hospital, but certainly not the administration of the hospital.i. The NMA concluded by threatening the government in what has now become their hallmark “In conclusion, the Nigerian Medical Association wishes to once again remind government of the implications of acceding to any demand that violates the collective bargaining agreement of January 2014.”
ii. We wish to observe that government’s acquiescence to previous NMA demands over the years is one of the factors that emboldened the NMA to act in the way she has carried on so far. The NMA has been systematically milking Nigeria dry under the guise of collective bargaining, such that today in Nigeria, a medical house officer who just left medical school, is placed on CONMESS 1, the equivalent of CONHESS 12 (What a nurse earns after 15 years in service) while a Registrar earns same salary as an Assistant Director of Nursing Services (ADNS)!. A pharmacist who rose through the ranks to become director of pharmaceutical services, even with a Masters degree and after 35 years of service, earns about 500,000 thousand naira monthly, whereas a freshly qualified consultant (6 years post NYSC) earns over 600,000 thousand naira monthly, while older consultants earn one million naira and above monthly (there are close to ten thousand of them currently) thanks to NMA’s machinations. The irony or is it tragedy of all these is that these so called consultants see patients once a week, and a fixed number of patients at that. Other days of the week, patients are left at the mercy of house officers, medical officers and at best registrars. For how long will this treachery continue in the healthcare sector?
iii. This is the disparity that the NMA wants to maintain between their salary and those of other healthcare workers at all costs. This explains why they are so jittery and keep issuing threats to various ministers and indeed the presidency not to honour JOHESU’s demands, because of their narrow mindedness.
CONCLUSION
From the foregoing, it is very obvious that the NMA is not fighting a just cause, and as such, we demand that government should call her bluff and accede to JOHESU’s demands once and for all.NMA is threatening government with strike if government grants JOHESU’s demands; as the NMA must have observed by now; she no longer enjoys monopoly of strikes in the health sector. Any strike called by the NMA in future over salary of other health care workers will meet with further strikes by JOHESU members.We insist on our earlier call for a Unified Salary Scale for all healthcare workers, including consultants, with workers entering the scale based on their qualifications and years of service.We demand that appointment of minister of health should be rotated among the various health professionals (in line with international best practice) and should not be the exclusive preserve of medical doctors, who most of the time exhibit bias towards medical doctors at the detriment of other health care workers. This practice has unwittingly prolonged the strife in the health sector. A case in point is the World Health Organization (WHO), whose Director General is not a medical doctor, yet the world body continues to make giant strides.We insist on appointment of pharmacists and other duly qualified healthcare professionals as consultants and medical directors of federal tertiary institutions as a way out of the current quagmire.We believe it’s time to call a spade a spade. The federal government should summon the political will to call the bluff of the NMA, before she finally destroys the healthcare sector beyond repairs. As it stands now, the NMA has lost her respect and credibility among other health care professionals because of her pursuit of mediocrity and this has not augured well for service delivery in the sector.Where the government chooses to continue to treat the NMA with kid’s gloves, then Nigerians should be prepared for a long drawn out crisis in the health sector with terrible consequences for all. A stitch in time saves nine.
Please accept assurances of our esteemed regards.
Pharm. Martins Oyewole MAW Pharm. Jelili Kilani
National Chairman AHAPN National Secretary

[color=#990000][/color]On 25/May/2018 / In Press Publications
Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) Press Release
The attention of the Association of Hospital and Administrative Pharmacists of Nigeria (AHAPN) has been drawn to yet another rejoinder by the Nigerian Medical Association (NMA), to the current JOHESU led strike action as contained in her latest Press Release titled “RE: ONGOING STRIKE ACTION BY JOHESU AND ITS EXTENSION.” We are amazed at the despondency and sheer desperation with which the NMA has pursued this issue of adjusted salary for members of JOHESU, even when the government had earlier done same for her members.
At a time when Nigeria’s healthcare indices are at an all time low, and indeed one of the lowest in the world, at a time when the dreaded Ebola scourge is about resurfacing close to our borders, all a supposedly elitist group like the NMA has done is to bug the government of the day with unnecessary distractions, blackmails and empty threats about bringing down the government and shutting down the health sector if the government as much as adds one naira to the salaries of non medical doctors, even when the government has increased their salary twice in the not too distant past. How demeaning! How shameful! How belittling! We wish to observe that if the NMA had expended half as much energy in tacking Nigeria’s healthcare challenges, the country would have become a centre of medical tourism like the rest of the world.i. According to the NMA “In view of the above, the NMA painfully wishes to inform the Federal Government of Nigeria that any award to the non- medically qualified health professionals that violates the January and July agreements of 2014 shall result in the resumption of the suspended withdrawal of service of 2014. Please take this as a notice sir.”
ii. The NMA continued “The above reminder is predicated on the extension of the ongoing strike action embarked upon by the amorphous body called ‘JOHESU’ to states and local government areas, the basis of which is to strengthen its callous and ill motivated agitation for pay parity between her members and doctors with the resultant erosion of relativity and further hierarchical distortion in the health sector vis-à-vis her clandestine romance with some top government officials.” Oh, is the NMA afraid? What is she afraid of? Realizing that she no longer enjoys monopoly of strike action, the NMA has suddenly become jittery and desperate and like the proverbial drowning man that will clutch at anything to survive, has started casting aspersions at “some (imaginary) top government officials.”
iii. It is public knowledge that in 2009 when late President Musa Yar ‘adua was in office, NMA clamoured for salary increase for her members as usual, but met with a rebuff from the then president, who insisted that any increase in salary would cut across all professionals in the healthcare sector, and not only medical doctors. A committee was set up to work out the modalities for the increment which resulted in the Consolidated Health Salary Scale (CONHESS). This was approved by the then president and implemented in January 2010. Medical doctors and other healthcare workers were together on CONHESS then; and there was relative peace in the sector.
Iv. By 2014, when the CONHESS was due for review, the NMA as usual went behind to lobby the then president for their separate salary scale, and ended up with CONMESS which was far more robust than CONHESS. The CONMESS was quickly approved and doctors were paid their arrears promptly. Even though an adjustment in salary was calculated for non medical doctors, it was never implemented for them till date.
v. The medical doctors had their salary increased again between 2016 and 2017, under the guise of maintaining relativity. They (doctors) were initially opposed to skipping for CONHESS, for which they argued then that it was criminal to skip any level, but JOHESU went to the National Industrial Court and won the case. The doctors suddenly changed their song and started demanding for skipping for CONMESS, which was quickly approved by the Minister of Health (himself a medical doctor) and they were paid arrears pronto, whereas many health care workers on CONHESS have not been paid their skipping allowance since 2010. This is one of the reasons JOHESU is on strike today.
vi. The fact remains that medical doctors enter the CONMESS Scale at the equivalent of GL12, which is by far higher than other healthcare professionals who enter at GL 10. That in itself is relativity. At no point in time is JOHESU asking for same pay with medical doctors as the NMA and the Honourable Minister of Health would erroneously want the world to believe. All JOHESU is asking for is salary adjustment as was done for medical doctors. What erosion of relativity is NMA talking about when they are already advantaged at entry point?
i. On the issue of consultancy, hear the NMA “The demand for the appointment of other health workers as consultants (with payment of specialist allowance) is a self-centered agitation aimed at ensuring they are in charge of clinical care. This is not only an aberration (considering international best practice) that will add no value to clinical/patients care, it will certainly worsen morbidity and mortality indices in Nigeria. We therefore affirm the rejection of this demand.” Again we are tempted to ask what is the NMA afraid of? Is she acting out of ignorance of what consultants from other health professions are capable of in putting into health care or is it just a case of NMA refusing and rejecting change?
ii. Whether the NMA likes it or not, consultant pharmacists have come to stay. All over the world, including the United Kingdom, consultant pharmacists are collaborating with physicians and other professionals for optimal patient care; no wonder medical tourism is very high in those countries. That explains why even our own very President is compelled to patronize medical services in UK where the practice is close to ideal. In UK for instance, consultant renal care pharmacists work hand in hand with renal physicians and other professionals to optimize patient care, but in Nigeria, a medical officer with an MBBS or at best an internal medicine physician willclaim to know it all and prefer to consult alone so that their inadequacies will not be public knowledge. No wonder our health indices in Nigeria are competing with those of Somalia, Sudan and Togo (among the lowest in the world). We make bold to state that the NMA is not in a position to reject appointment of consultants from other health disciplines including pharmacists, because it will run counter to international best practice.
On the issue of headship of hospitals, hear the NMA “The demand for headship of Departments/Units in the hospital by members of JOHESU/AHPA will lead to unprecedented chaos in the health sector with ripple effect on the health of Nigerians. We reaffirm our rejection of this demand.” Again we state emphatically that nothing can be further from the truth. It would appear that the NMA is afraid of even its own shadow. It is common knowledge that when hospital administrators were managing hospitals before the coming of (Olikoye Ransone Kuti in 1985), there was peace, tranquility, serenity and convivial atmosphere in the hospitals. But as soon as medical doctors usurped the management of hospitals, chaos has become the order of the day. We state without equivocation that you do not need to have an MBBS or be a surgeon (FWACS) to successfully manage a hospital. You could argue about heading clinical services in a hospital, but certainly not the administration of the hospital.i. The NMA concluded by threatening the government in what has now become their hallmark “In conclusion, the Nigerian Medical Association wishes to once again remind government of the implications of acceding to any demand that violates the collective bargaining agreement of January 2014.”
ii. We wish to observe that government’s acquiescence to previous NMA demands over the years is one of the factors that emboldened the NMA to act in the way she has carried on so far. The NMA has been systematically milking Nigeria dry under the guise of collective bargaining, such that today in Nigeria, a medical house officer who just left medical school, is placed on CONMESS 1, the equivalent of CONHESS 12 (What a nurse earns after 15 years in service) while a Registrar earns same salary as an Assistant Director of Nursing Services (ADNS)!. A pharmacist who rose through the ranks to become director of pharmaceutical services, even with a Masters degree and after 35 years of service, earns about 500,000 thousand naira monthly, whereas a freshly qualified consultant (6 years post NYSC) earns over 600,000 thousand naira monthly, while older consultants earn one million naira and above monthly (there are close to ten thousand of them currently) thanks to NMA’s machinations. The irony or is it tragedy of all these is that these so called consultants see patients once a week, and a fixed number of patients at that. Other days of the week, patients are left at the mercy of house officers, medical officers and at best registrars. For how long will this treachery continue in the healthcare sector?
iii. This is the disparity that the NMA wants to maintain between their salary and those of other healthcare workers at all costs. This explains why they are so jittery and keep issuing threats to various ministers and indeed the presidency not to honour JOHESU’s demands, because of their narrow mindedness.
CONCLUSION
From the foregoing, it is very obvious that the NMA is not fighting a just cause, and as such, we demand that government should call her bluff and accede to JOHESU’s demands once and for all.NMA is threatening government with strike if government grants JOHESU’s demands; as the NMA must have observed by now; she no longer enjoys monopoly of strikes in the health sector. Any strike called by the NMA in future over salary of other health care workers will meet with further strikes by JOHESU members.We insist on our earlier call for a Unified Salary Scale for all healthcare workers, including consultants, with workers entering the scale based on their qualifications and years of service.We demand that appointment of minister of health should be rotated among the various health professionals (in line with international best practice) and should not be the exclusive preserve of medical doctors, who most of the time exhibit bias towards medical doctors at the detriment of other health care workers. This practice has unwittingly prolonged the strife in the health sector. A case in point is the World Health Organization (WHO), whose Director General is not a medical doctor, yet the world body continues to make giant strides.We insist on appointment of pharmacists and other duly qualified healthcare professionals as consultants and medical directors of federal tertiary institutions as a way out of the current quagmire.We believe it’s time to call a spade a spade. The federal government should summon the political will to call the bluff of the NMA, before she finally destroys the healthcare sector beyond repairs. As it stands now, the NMA has lost her respect and credibility among other health care professionals because of her pursuit of mediocrity and this has not augured well for service delivery in the sector.Where the government chooses to continue to treat the NMA with kid’s gloves, then Nigerians should be prepared for a long drawn out crisis in the health sector with terrible consequences for all. A stitch in time saves nine.
Please accept assurances of our esteemed regards.
Pharm. Martins Oyewole MAW Pharm. Jelili Kilani
National Chairman AHAPN National Secretary

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]

[color=#990000][/color]
The Pharmaceutical Society of Nigeria (PSN) heartily appreciates the dynamic gover
nor of Lagos state, HE Akinwunmi Ambode for the creation of pharmacists’ consultancy cadre in the Scheme of Service of Lagos state, Nigeria. This is a milestone in the history of health care system in Nigeria in general and Lagos state in particular. The governor is surely in a march to advance mankind.
This circular was, however, visited with an uncivilized growing dictatorship and cruel tyranny from the NMA where they threatened and requested for the withdrawal of the circular, with even a deadline. PSN ordinarily never wanted to join issues with NMA, considering the fact that NMA is in crisis with itself in an ego cocoon, complicated by gross ignorance, incompetence and clear display of deficiency of wisdom that lengthened the strike action with JOHESU. This has turned the health sector into ridicule, a situation any serious minded body will avoid as enshrined in the Hippocratic Oath. At times like this, when inter-professional collaboration is the way forward in International best practices, NMA has chosen the path of desperate destruction.
For the sake of clarity, let me educate NMA on global best practices.
The World Health Organization (WHO), is the highest body in the world which set or make a standard for international best practice on all issues of health. Just as other systems of the world are so dynamic, so is the healthcare delivery system-dynamic in all ramifications. And any government that proclaimed good governance should always refer to WHO standard on regular bases to meet the health needs of its nation. To buttress our precarious situation, let’s look at current International best practices according to WHO ranking (April 2018) under the following headings:
The first 5 best hospital systems in the worldThe worst 5 hospital systems in the worldConsultancy/specialists status in the two systemsHealth administration in the two systems (best and worst)
The first 5 best hospital systems in the world
According to WHO ranking of 191 member countries April 2018, the following are the best 5 with effective healthcare delivery system
FranceItalySan MarinoAndorraMalta
The worst 5 hospital systems in the world
The bottoms up ward, which are considered the worst 5 among 191 member countries are:
Sierra LeoneMyanmarCentral African RepublicDemocratic Republic of the CongoNigeria
Among the 191 WHO member countries, Nigeria is sadly ranked 189 in healthcare service provision. It’s is very obvious that in Nigeria, healthcare service delivery is averse to change. We are where we are today because of the cataclysmic barrier NMA catalysed by their poor choices in the health sector. These barriers prevent the policy makers from seeing reality from the international point of view. Lagos State Government is absolutely in line with harmony and inter-professional needs to attain International best practices in the healthcare delivery system.
To understand global best practices, according to a 2017 report of the Economists Intelligence Unit, on the global access to healthcare index: UK, Canada, Australia and USA make the top 10. While Nigeria ranks among the bottom 6 overall of the 60 countries listed on the same global index. Let me take a drive with you to the practices in these countries
Health administration in the two systems
Health administration entails administrative structure in the health sector, the incumbent ministers and other heads down the structure and the bases or criteria of selection will be x-rayed to justify current positions in WHO ranking.
CountryMinister of HealthSpecialtyFranceMorisol TouraineEconomicsItalyBeatrice LorenzinJournalism and politicsSan MarinoDidier GamerdingerLawAndorraCristina Rodriguez GalanMolecular BiologyMaltaChristopher FearneMedicineUSAAlex AzarLawGermanyJens SpahnLawSaudi ArabiaTawfiq Al RavishMathematicsIsrealYaakov LitzmanTorahSpainDolors MontserratLawIndiaJagat Prakash NaddaLawCanadaGenette Petitpas TaylorSocial works
A look at the above appointments is a testimony that performance index is dependent on neutrality and administrative prowess and not on ‘medical qualification’ as commonly claimed by Nigerian medical doctors. Incidentally the Director General of World Health Organisation (WHO), Tedros Adhamon, an Ethiopian, studied Biology. If he, and all those above, were in Nigeria, NMA would have protested. This is the situation the NMA of Lagos is attempting, and writing to a Governor as knowledgeable as HE Ambode Akinwunmi- a distinguished administrator who knows his onions and is committed to advance mankind.
The criterion for selection in these great and successful countries is based on professional and administrative experience and this is the same down the administrative structure. In Nigeria (‘International best practices’ epitome!!), the criteria for selection are solely based on MBBS qualification and it is also the same down the administrative structure. Does that tell you the reason(s) for failure? Yes indeed. What a shame!!
Consultancy/Specialist status
Specialists and consultants in various fields in healthcare are a common trend. They are mandated to train and award fellowships based on their skills and competences. These healthcare team members earn specialist allowances as they render services to the patients. In this current loggerhead, NMA said the consultancy cadre is sacred to only doctors (yet, citing certain international best practices). We run Fellowship in the West African Postgraduate College of Pharmacists to improve our knowledge, attitudes, skills and competences to promote and maintain a high standard of professional pharmacy practice. We have Primary level (1 year), Part One (Two years) and Part two (Two years). Pharmacists undergo a minimum of 12 months Residency training and present dissertation that are assessed by erudite academics (Professors and all PhD holders), before the award of Fellowship in various specialties. In fact, in the USA, a Nigerian (Dr Teresa Pounds- a consultant pharmacist) heads the Residency training and runs the consultancy program in one of the biggest Universities.
I read with utmost dismay, as NMA has turned both Judge and jury in its case. Representing all parties in the health sector. Deciding the fate of everybody and declaring others as they will. This has messed up the sensibilities and sensitivities of the health sector by incessant and unrelenting relegation of others. What we have is a contradistinction to the labour law. NMA determining what others should get when NMA is not an employer of labour. This negates labour engagement and a breach of human rights. I all along thought the NMA was a serious union, until recently when the deficiency of purpose and leadership was obviously testified especially in this pharmacy consultancy cadre as embraced by a leading state in Nigeria.
A profession regulating another? This is strange. Only in an indecent and decaying system can this happen. Can a Building engineer regulate the training of a civil engineer? Can an Architect tell government not to recognize the M.Sc of a Building engineer? Nigeria is not and should not sink so abysmally. Other health professional have the right to develop themselves in line with best international practices-sincere practices please; NOT the one only NMA has access to. The interference with growth and development of healthcare in this country is becoming an embarrassment to civility.
The pharmacy consultancy cadre, as approved by Lagos State Government in the service of scheme is the best thing the health sector can achieve. PSN shall not relent in promoting the health sector in Nigeria. We commend the Lagos state Government for this bold action of International best practice.
Pharm.Ahmed I Yakasai, FPSN, FNIM, FNAPharm, FCPharm
President, Pharmaceutical Society of Nigeria (PSN)
Pharm. Emeka C. Duru
National Secretary
Pharmaceutical Society of Nigeria (PSN)

[color=#990000][/color]

The Pharmaceutical Society of Nigeria (PSN) heartily appreciates the dynamic gover
nor of Lagos state, HE Akinwunmi Ambode for the creation of pharmacists’ consultancy cadre in the Scheme of Service of Lagos state, Nigeria. This is a milestone in the history of health care system in Nigeria in general and Lagos state in particular. The governor is surely in a march to advance mankind.
This circular was, however, visited with an uncivilized growing dictatorship and cruel tyranny from the NMA where they threatened and requested for the withdrawal of the circular, with even a deadline. PSN ordinarily never wanted to join issues with NMA, considering the fact that NMA is in crisis with itself in an ego cocoon, complicated by gross ignorance, incompetence and clear display of deficiency of wisdom that lengthened the strike action with JOHESU. This has turned the health sector into ridicule, a situation any serious minded body will avoid as enshrined in the Hippocratic Oath. At times like this, when inter-professional collaboration is the way forward in International best practices, NMA has chosen the path of desperate destruction.
For the sake of clarity, let me educate NMA on global best practices.
The World Health Organization (WHO), is the highest body in the world which set or make a standard for international best practice on all issues of health. Just as other systems of the world are so dynamic, so is the healthcare delivery system-dynamic in all ramifications. And any government that proclaimed good governance should always refer to WHO standard on regular bases to meet the health needs of its nation. To buttress our precarious situation, let’s look at current International best practices according to WHO ranking (April 2018) under the following headings:
The first 5 best hospital systems in the worldThe worst 5 hospital systems in the worldConsultancy/specialists status in the two systemsHealth administration in the two systems (best and worst)
The first 5 best hospital systems in the world
According to WHO ranking of 191 member countries April 2018, the following are the best 5 with effective healthcare delivery system
FranceItalySan MarinoAndorraMalta
The worst 5 hospital systems in the world
The bottoms up ward, which are considered the worst 5 among 191 member countries are:
Sierra LeoneMyanmarCentral African RepublicDemocratic Republic of the CongoNigeria
Among the 191 WHO member countries, Nigeria is sadly ranked 189 in healthcare service provision. It’s is very obvious that in Nigeria, healthcare service delivery is averse to change. We are where we are today because of the cataclysmic barrier NMA catalysed by their poor choices in the health sector. These barriers prevent the policy makers from seeing reality from the international point of view. Lagos State Government is absolutely in line with harmony and inter-professional needs to attain International best practices in the healthcare delivery system.
To understand global best practices, according to a 2017 report of the Economists Intelligence Unit, on the global access to healthcare index: UK, Canada, Australia and USA make the top 10. While Nigeria ranks among the bottom 6 overall of the 60 countries listed on the same global index. Let me take a drive with you to the practices in these countries
Health administration in the two systems
Health administration entails administrative structure in the health sector, the incumbent ministers and other heads down the structure and the bases or criteria of selection will be x-rayed to justify current positions in WHO ranking.
CountryMinister of HealthSpecialtyFranceMorisol TouraineEconomicsItalyBeatrice LorenzinJournalism and politicsSan MarinoDidier GamerdingerLawAndorraCristina Rodriguez GalanMolecular BiologyMaltaChristopher FearneMedicineUSAAlex AzarLawGermanyJens SpahnLawSaudi ArabiaTawfiq Al RavishMathematicsIsrealYaakov LitzmanTorahSpainDolors MontserratLawIndiaJagat Prakash NaddaLawCanadaGenette Petitpas TaylorSocial works
A look at the above appointments is a testimony that performance index is dependent on neutrality and administrative prowess and not on ‘medical qualification’ as commonly claimed by Nigerian medical doctors. Incidentally the Director General of World Health Organisation (WHO), Tedros Adhamon, an Ethiopian, studied Biology. If he, and all those above, were in Nigeria, NMA would have protested. This is the situation the NMA of Lagos is attempting, and writing to a Governor as knowledgeable as HE Ambode Akinwunmi- a distinguished administrator who knows his onions and is committed to advance mankind.
The criterion for selection in these great and successful countries is based on professional and administrative experience and this is the same down the administrative structure. In Nigeria (‘International best practices’ epitome!!), the criteria for selection are solely based on MBBS qualification and it is also the same down the administrative structure. Does that tell you the reason(s) for failure? Yes indeed. What a shame!!
Consultancy/Specialist status
Specialists and consultants in various fields in healthcare are a common trend. They are mandated to train and award fellowships based on their skills and competences. These healthcare team members earn specialist allowances as they render services to the patients. In this current loggerhead, NMA said the consultancy cadre is sacred to only doctors (yet, citing certain international best practices). We run Fellowship in the West African Postgraduate College of Pharmacists to improve our knowledge, attitudes, skills and competences to promote and maintain a high standard of professional pharmacy practice. We have Primary level (1 year), Part One (Two years) and Part two (Two years). Pharmacists undergo a minimum of 12 months Residency training and present dissertation that are assessed by erudite academics (Professors and all PhD holders), before the award of Fellowship in various specialties. In fact, in the USA, a Nigerian (Dr Teresa Pounds- a consultant pharmacist) heads the Residency training and runs the consultancy program in one of the biggest Universities.
I read with utmost dismay, as NMA has turned both Judge and jury in its case. Representing all parties in the health sector. Deciding the fate of everybody and declaring others as they will. This has messed up the sensibilities and sensitivities of the health sector by incessant and unrelenting relegation of others. What we have is a contradistinction to the labour law. NMA determining what others should get when NMA is not an employer of labour. This negates labour engagement and a breach of human rights. I all along thought the NMA was a serious union, until recently when the deficiency of purpose and leadership was obviously testified especially in this pharmacy consultancy cadre as embraced by a leading state in Nigeria.
A profession regulating another? This is strange. Only in an indecent and decaying system can this happen. Can a Building engineer regulate the training of a civil engineer? Can an Architect tell government not to recognize the M.Sc of a Building engineer? Nigeria is not and should not sink so abysmally. Other health professional have the right to develop themselves in line with best international practices-sincere practices please; NOT the one only NMA has access to. The interference with growth and development of healthcare in this country is becoming an embarrassment to civility.
The pharmacy consultancy cadre, as approved by Lagos State Government in the service of scheme is the best thing the health sector can achieve. PSN shall not relent in promoting the health sector in Nigeria. We commend the Lagos state Government for this bold action of International best practice.
Pharm.Ahmed I Yakasai, FPSN, FNIM, FNAPharm, FCPharm
President, Pharmaceutical Society of Nigeria (PSN)
Pharm. Emeka C. Duru
National Secretary
Pharmaceutical Society of Nigeria (PSN)

donald197:
A better analysis and solutions to the current crisis by Dr Ibrahim Toli. Enjoy it.
Never ending health crisis

GL 1
GL 2. CONHESS 1
GL 3. CONHESS 2
GL 4. CONHESS 3
GL 5 CONHESS 4
GL 6 CONHESS 5
GL 7. CONHESS 6
GL 8 CONHESS 7
GL 9 CONHESS 8
GL10 CONHESS 9 CONMESS 1
GL12 CONHESS 10 CONMESS 2
GL13 CONHESS 11 CONMESS 3
GL14 CONHESS 12 CONMESS 4
GL15 CONHESS 13 CONMESS 5
GL16 CONHESS 14 CONMESS 6
GL17 CONHESS 15 CONMESS 7

For the benefits of those asking us what is really happening currently in the tertiary health sector. The conflict centres around MONEY and LEADERSHIP positions which in turn is link to money. Other confounders are gross indiscipline, ego, lack of job description, failure of supervision and conflict of interest. As a whole, it is a systemic failure needing urgent, radical and wholistic repair to prevent complete collapse.

There are currently two salary structures in the public tertiary hospitals in Nigeria. They are called CONMESS for medical doctors and CONHESS for all other hospital workers including those in the administration and accounts. CONMESS was born on 29/09/2009 via the circular SWC/S/04/S.410/220 while the CONHESS was born on 08/12/2009 through the circular SWC/S/04/S.410/Vol.II/349 of National Salary Income and Wages Commission (NSIWC) respectively. Both the two salary structures are consolidated and derived from the traditional grade level (GL) system as shown above. Note that there is no GL 11 in the traditional grading system for all civil servants which is taken care of in both CONMESS and CONHESS, hence the APPARENT lack of level skipping in them.

The States and local government councils are still using the traditional grading system and pay less than the FG. To my knowledge only Yobe State has just started paying health workers exactly as the FG!

I will be using the traditional grade level system for ease of understanding. Very very few people including those in the Accountant General of the Federation's office easily comprehend the interrelationship of the 3 salary scales.

Between 1998-2013, doctors and any other hospital worker of equivalent level had identical basic salary while between 2009-2013 they had identical basic salary, hazard and teaching allowances. The differences were in call allowances where doctors earned higher and specialist allowance to medical consultants or specialists on GL 15-17 only. Note that doctors on GL 15-17 that are not specialists are not PAYED specialist allowance. In 2014 relativity was restored where the basic salary of doctors became 20-50% higher than equivalent levels of other hospital workers from GL 13-17 only. There had always been differential pay relativity between doctors and other health workers from 1960 to 1998 at various ratios. In the years 1998-2013 that was when relativity was lost. When it was restored in 2014, the conflict resolution compromise was to forgo 25 years of arrears.

After graduation from medical school, a doctor practices for 12 consecutive months under supervision of a specialist or a very senior doctor of no less than GL 15 before given licence to practice independently. These group of doctors are called house officers. Pharmacists, degree nurses and medical lab scientist have similar program and they are called interns. They are employed at GL 10 for doctors and GL 9 for the other 3 until around 2013-2014 except for degree nurses that started internship around 2016-2017. Both earn salary for one year only because of the services they offered, but they are not regular staff and hence not the entry points in to civil service.

The entry points (post NYSC) for doctors in to civil service were GL 12, pharmacists GL 10, medical laboratory scientists GL 10, degree nurses GL 9 and non degree nurses GL 8 in the tertiary public hospitals. In contrast entry point for degree holders in other ministries is GL 8. In 2013 the National Industrial Court of Nigeria (NICN) passed a judgement for skipping of GL 12 for health workers on CONHESS ie any other hospital worker except doctors. So the entry point of pharmacists, medical lab scientists (and degree nurses around 2017-2018) still remains GL 10 with skipping of GL 12 around 2013-2014. In view of this, the entry point of doctors now shifted to GL 13 between 2016-2017. Other health workers are variously employed at GL 8-9.

Medical doctors can pursue their post graduate studies through Residency Training Program (RTP) or traditional postgraduate degrees of MSc and PhD otherwise they join the public service like any other degree holder. Doctors that join the RTP in tertiary and teaching hospitals are called Resident doctors. They gain entry only after passing an exam with a pass rate of 35-45% and average waiting time of 2-4 years. They are doctors under training to become specialists. They are temporary staffs throughout the training and get promoted only after passing exams, 2-4 years after starting the program in the first stage and 3-5 years in the second stage. This is a privilege enjoyed by 15-25% per exam. The specialist exams are conducted twice a year in Ibadan and Lagos. Other health workers including specialist medical doctors are permanently employed in the hospital. The latter are also University lecturers for teaching, research and supervision of undergraduate and postgraduate students including non doctors.

Medical doctors with first degree in the University are employed as Lecturer II similar to PhD holders while every other degree holders are employed as Graduate Assistants, in the military doctors occupy the rank of equivalent of army Lieutenant and 2nd lieutenant in others, DSP and ASP in police, in Custom and Immigration same, SIO1 and SIO2 in DSS respectively.

The other aspect is that of leadership.

a) At present both the substantive and State ministers are medical doctors (prerogative of Mr President).

b) The following are departments in the Federal Ministry of Health (FMOH), ii, iii and iv are headed by medical doctors http://www.health.gov.ng/index.php/department/84-departments.

i) Department of Procurement with two divisions; capital and recurrent.

ii) Department of Family Health with five divisions; Child Health, Gender adolescent school and elderly care, Health promotion, Nutrition and Reproductive Health.

iii) Department of Health Planning Research and Statistics.

iv) Department of Public Health with eight divisions; Non-communicable diseases, Neglected Tropical diseases, Occupational health and safety, Port health services, National Tuberclosis and Leprosy Control Programme, National Malaria elimination programme, HIV AIDS and Epidemiology services.

v) Department of Finance and Accounts.

vi) Department of Human resources.

vii) Department of Food and drug services.

c) The following are agencies under FMOH http://www.health.gov.ng/index.php/department/79-the-ministry. Agencies i, iii and iv are headed by medical doctors.

i) National Primary Health Care Development Agency (NPHCDA).

ii) National Agency for Food & Drugs Administration and Control (NAFDAC).

iii) National Health Insurance Scheme (NHIS).

iv) National Institute of Medical Research (NIMR).

d) All the chief executives of tertiary hospitals are specialist medical doctors (Act of the National Assembly). There are 13 Federal Specialty Hospitals, 21 Federal Medical Centres and 22 Federal Teaching Hospitals http://www.health.gov.ng/index.php/department/83-parastatals.

e) The following are directorates in the tertiary hospitals

i) Director of Clinical Services and Training/Chairman Medical Advisory Committee headed by specialist medical doctor. There are divisions like 2 deputies headed by specialist medical doctors, (deputy) director nursing headed by a nurse, (deputy) director pharmacy headed by a pharmacist.

ii) Director of Administration headed by an administrator with divisions that include establishments, account and supply, audit, expenditure, works, nutrition, kitchen, laundry, security, etc.

f) Headship of clinical departments, clinical and training laboratories in the tertiary hospitals for teaching, training and research of undergraduate and postgraduate students. They are all headed by specialist medical doctors/unversity lecturers and in the laboratories they are also called Pathologists with units headed by optometrists, radiographers, medical scientists, technicians etc.

In my opinion the solutions to the unending crisis in the health sector are mainly,

1. Implementation of the Presidential Committee of Experts on Inter-Professional Relationship in the Public Health Sector report by Yayale Ahmed committee submitted to FG on 19/12/2014.

2. Invitation of "foreign" experts like PricewaterhouseCoopers and Agenda for Change for proper job evaluation and placement.

3. Consideration for law amendments and the movement of all tertiary hospitals under affiliated universities. They also have their issues, but they seem to be relatively more stable. There is high academic loss in the current setting.

4. Strengthen and make wholistic coverage the National Health Insurance Scheme (NHIS), and then privatise all tertiary hospitals. Both LGA, States and FG shall concentrate in primary and secondary health care services especially the former. In my limited opinion, this is the best long term solution to our low quality health care services in Nigeria. There shall also be active support for purely private investments in health. The investors will decide who heads or leads who, what, which and how.

5. Positions of leadership in the FMOH, parastatals and its agencies can be tackle by the FG as it deems fit.

You can correct me where I erred. May God forgive my mistakes.

Aknowledgement: Dr N.L. Orhue, my friends in other climes.

ibrahim Toli
doctoli@gmail.com

Some of these things you wrote na lie. Government must stop sponsoring the resident programs of doctor. Doctors should sponsor their education and leave government alone. These doctors have been deceivin Nigerians.

OSAK UWUBANMWEN WROTE

ONE FINAL SOLUTION TO THE INCESSANT MEDICAL HEALTH WORKERS STRIKE IN NIGERIA (LONG POST).
Today I have decided to write on a topic I have avoided for a very long time, the incessant medical health workers strike in Nigeria, and I do this with no apology to anyone but rightfully so. First, as a concerned Nigerian and a trained pharmacist living in Canada, My elder brother is a physician with two fellowships in the United Kingdom. Our last born in my family is an optometrist with a Doctor of Optometry degree (OD) in U.K too, and my spouse is a trained Canadian Nurse with specialty and additional certification in Dialysis. The reason I make this declaration is I come from a medical family with all intent and purpose. We, (my brothers) and I got our medical or healthcare degrees from the University of Benin, and we all went to school almost at the same time close to one another. I can say medicine, pharmacy or optometry are hard degrees to earn, they all are and have their peculiarities and challenges. All medical degrees are hard and this is true. One is not talking about a diploma equivalent, I mean an MBBS,
a B. Pharm, a BSc Nursing and an OD. It will also include a degree in medical laboratory or physiology. In all these courses statistically less than half of the class would graduate and earn the degree. In pharmacy school, about one hundred and forty of us started, and just forty-two of us graduated. Some of my classmates were even asked to withdraw after the fourth year when they would at least be getting a degree in many other faculties. It is wrong for anyone to claim that one medical degree is harder than the other. The city I live, Calgary and a neighboring city Edmonton medicine is a three-year degree course, and you only qualify like pharmacy and dentistry after the first degree, and you can have your first degree in any subject area. I am spending the time to disprove some myths so that people can see where I am coming from. When I took the joint admission and matriculation examinations my first choice was pharmacy, my second choice was pharmacy, and my third choice was pharmacy, but the only difference was I also chose Obafemi Awolowo University Ife and the University of Ibadan as new universities of choice if the University of Benin did not admit me. The head of all medical or clinical works should be a doctor (physician) as the doctor owns the patients this is a universal practice and same in Nigeria and Canada, he takes the final decision with the consent of the patients too. But I have unlimited access to these patients as part of inter-collaborative care and network. The patients also give me consent to have assess to medical information relating their diagnosis, medical history including all medications, test, no matter what was done and requested by the physician be it Laboratory work, MRI, X-ray, Ultrasound I can assess and they know this is in the best interest of the patients. I work with the doctors, nurses, laboratory scientist, chiropractor, physiotherapist, the dieticians, etc. to care for these patients. The doctor cannot question my right to assess these patients, and he cannot prevent it, this is how we work and whatever intervention I need to carry out in the best interest of the patient I must inform the owner of the patient the doctor (physician). There is also an advisory intervention(s) that one can only make through the doctors (physician), These I communicate in clear terms to the lead physician and giving clinical reasons why I think this will be in the best interest of the patient. These are all documented the patients would be informed and the physician consequently written to that effect this is often medication and disease based. The physicians love these collaborations and would have it no other way. They see me as a trusted partner, and the healthcare laws recognize these functions and duties protecting everyone. As an Alberta pharmacist, I can write prescriptions sometimes for minor ailments and sometimes for more complex cases like adding a prescription for a lipid-lowering agent to a patient at risk of cardiovascular complications if diabetes or high-risk cardiovascular patient. I have a LAB ID and can request some laboratory test directly. Some of the minor prescriptions I may write are common antibiotics and sometimes medications for cold sore or eye infections. In Canada like America pharmacy has a residency program to specialize in any area of pharmacy of interest like psychiatry, oncology, cardiovascular, nephrology, radio-nuclear pharmacy, transplant pharmacy or others and after the four to six years they become a consultant pharmacist. Many pharmacists run clinics with their physicians who are very busy, most of the prescriptions I see from the anticoagulation clinics are from pharmacists written on behalf of the lead physician who is the head of the team. Pharmacists or nurse clinicians are running many diabetes clinics on behalf of the lead physician who now has time to attend to more complex clinical and complicated medical problems. All these are within the Canadian healthcare setting in my province Alberta. All residents in training in any institution or hospital settings are trained by clinical staff be they physicians, pharmacist or nurses. A sad event I was informed recently was the physicians in a university teaching hospital in Nigeria refused the Doctor of Pharmacy students assess to their patients and thus the ward, sad can only happen in Nigeria. A hospital headed by a physician released a circular to this effect to truncate the Doctor of Pharmacy degree program rotation, sad again. Remember that a poorly trained member of the healthcare team under any specialization becomes a clinical burden to you as head and lead clinician and your citizens. The physician is the head and the others are the neck and body just like any good marriage neither can function well without the other. In the University of Benin pharmacology department is under the school of pharmacy and rightfully so and some of the lecturers are not even pharmacists but pharmacology experts. How would you feel if the pharmacology department under the pharmacy school refused to train the MBBS students or would be graduates in pharmacology a precondition required for an MBBS graduation? The problem of health aggregation and turbulence was created by Professor Ransom Kuti of blessed memory under Babangida regime based on the brain drain of Nigerian trained physicians to Saudi Arabia, United Kingdom, and United States of America etc. but the truth is all healthcare professions in Nigeria is adversely affected by this syndrome. In my class of forty-two graduates over twenty of us are overseas, there are over ten thousand Nigerian pharmacist graduates of Nigeria practicing outside Nigeria, know that there used to be only six pharmacy schools in Nigeria. The nurses are worse off there are more than fifty thousand Nigerian nurses outside Nigeria. In fact, many nurses in psychiatry in Nigeria just use the institutions as a training ground before they move to Australia and United States of America. So, what is the solution let these specializations, all healthcare workers come together and fight the common enemy the government in their divide and rule game? If they come together government would be forced to run health as it is supposed to as done in many countries like even Rwanda. Let each and everyone go negotiate what they think they deserve and none should interfere with another. If you are talking of no parity is that before 1984 of Ransom Kuti or after, please go back and see what was before Ransom Kuti. Since Ransom Kuti left there has not be any peace in our healthcare system. In football a striker can earn more than the team coach based on perceived productivity, wages or salaries should be individualized a transplant or neurosurgeon is the highest earning medical professional I know and not the medical director or clinical director. Today it is ARD, next it is NMA and then JOHESU all strike, strike and, strike. The Nigerian government hospitals operate only six months a year and that has been the case in the last ten years or more. The question is a doctor that graduated ten years ago should earn more than a pharmacist or nurse agreed but should a doctor that graduated ten years ago earn more than a pharmacist or nurse of twenty-five years in the hospital one a consultant and the other a director of nursing or pharmacy services. The position of medical director and head of clinical services should be occupied by doctors yes. However, the head of the hospital should be called Head Hospital Administrator that everyone including the chief medical director will report and answer to too. The Head Hospital administrator different from the head of administration as it is now should be one that specialized in hospital administration with a Ph.D. He or She will work to create a conducive environment for all to function and thrive optimally. At the start of the year, he would ask all that they need, the medical director, the head of the pharmacy, head of nursing, the head of the laboratory, the head of the laundry the head of catering, and others what would they need, and the Head Hospital administrator would put a budget for everything and everyone including quality food served to all worker on call be they physician, pharmacist nurse or laboratory scientist. The opinion that the medical director should be a doctor yes but be dealing with medical and clinical issues only, not funds, money or budget execution. The focus should be on quality delivery like we want a new theatre for renal and liver transplant and the Head Hospital administrator will go raise the fund from government and private sector to provide one. We need that number of a new oncologist or transplant surgeon and the Head Hospital administration go around through a medical recruitment agency to get them the best, only the best. We need support for residency for resident doctors and pharmacists in training and the head hospital administrator gets the budget form them and link with people all over the world to provide quality resources persons. Finally, the minister of health can be anyone that understands how health care works not necessary a physician as this is more a political position and for party members look at the developed countries and tell us how many physicians there are as minister of health? Very few if any, we need their clinical skills in the hospitals and research and not being a political minister. I have seen many good hospitals rise to the occasion headed by a physician and have also seen many hospitals ruined by a physician as head too, so, the fact that a physician is the head of the hospital in real Nigerian terms means nothing and can only be one way to self-preserve and cause accretion in these facilities. Last year Nigerians spent about one billion dollars on medical tourism and going by these facts as soon as Togo, Benin, Niger, and Ghana get their acts together there may be no need for medical or healthcare workers in Nigeria, this may be exaggerated but a set reality. Today it is India, and as soon as it is near home, people will go across for a holiday and get the world-class treatment they may need and can afford. Wake up Nigeria, and Shalom.

OSAK UWUBANMWEN WROTE

ONE FINAL SOLUTION TO THE INCESSANT MEDICAL HEALTH WORKERS STRIKE IN NIGERIA (LONG POST).
Today I have decided to write on a topic I have avoided for a very long time, the incessant medical health workers strike in Nigeria, and I do this with no apology to anyone but rightfully so. First, as a concerned Nigerian and a trained pharmacist living in Canada, My elder brother is a physician with two fellowships in the United Kingdom. Our last born in my family is an optometrist with a Doctor of Optometry degree (OD) in U.K too, and my spouse is a trained Canadian Nurse with specialty and additional certification in Dialysis. The reason I make this declaration is I come from a medical family with all intent and purpose. We, (my brothers) and I got our medical or healthcare degrees from the University of Benin, and we all went to school almost at the same time close to one another. I can say medicine, pharmacy or optometry are hard degrees to earn, they all are and have their peculiarities and challenges. All medical degrees are hard and this is true. One is not talking about a diploma equivalent, I mean an MBBS,
a B. Pharm, a BSc Nursing and an OD. It will also include a degree in medical laboratory or physiology. In all these courses statistically less than half of the class would graduate and earn the degree. In pharmacy school, about one hundred and forty of us started, and just forty-two of us graduated. Some of my classmates were even asked to withdraw after the fourth year when they would at least be getting a degree in many other faculties. It is wrong for anyone to claim that one medical degree is harder than the other. The city I live, Calgary and a neighboring city Edmonton medicine is a three-year degree course, and you only qualify like pharmacy and dentistry after the first degree, and you can have your first degree in any subject area. I am spending the time to disprove some myths so that people can see where I am coming from. When I took the joint admission and matriculation examinations my first choice was pharmacy, my second choice was pharmacy, and my third choice was pharmacy, but the only difference was I also chose Obafemi Awolowo University Ife and the University of Ibadan as new universities of choice if the University of Benin did not admit me. The head of all medical or clinical works should be a doctor (physician) as the doctor owns the patients this is a universal practice and same in Nigeria and Canada, he takes the final decision with the consent of the patients too. But I have unlimited access to these patients as part of inter-collaborative care and network. The patients also give me consent to have assess to medical information relating their diagnosis, medical history including all medications, test, no matter what was done and requested by the physician be it Laboratory work, MRI, X-ray, Ultrasound I can assess and they know this is in the best interest of the patients. I work with the doctors, nurses, laboratory scientist, chiropractor, physiotherapist, the dieticians, etc. to care for these patients. The doctor cannot question my right to assess these patients, and he cannot prevent it, this is how we work and whatever intervention I need to carry out in the best interest of the patient I must inform the owner of the patient the doctor (physician). There is also an advisory intervention(s) that one can only make through the doctors (physician), These I communicate in clear terms to the lead physician and giving clinical reasons why I think this will be in the best interest of the patient. These are all documented the patients would be informed and the physician consequently written to that effect this is often medication and disease based. The physicians love these collaborations and would have it no other way. They see me as a trusted partner, and the healthcare laws recognize these functions and duties protecting everyone. As an Alberta pharmacist, I can write prescriptions sometimes for minor ailments and sometimes for more complex cases like adding a prescription for a lipid-lowering agent to a patient at risk of cardiovascular complications if diabetes or high-risk cardiovascular patient. I have a LAB ID and can request some laboratory test directly. Some of the minor prescriptions I may write are common antibiotics and sometimes medications for cold sore or eye infections. In Canada like America pharmacy has a residency program to specialize in any area of pharmacy of interest like psychiatry, oncology, cardiovascular, nephrology, radio-nuclear pharmacy, transplant pharmacy or others and after the four to six years they become a consultant pharmacist. Many pharmacists run clinics with their physicians who are very busy, most of the prescriptions I see from the anticoagulation clinics are from pharmacists written on behalf of the lead physician who is the head of the team. Pharmacists or nurse clinicians are running many diabetes clinics on behalf of the lead physician who now has time to attend to more complex clinical and complicated medical problems. All these are within the Canadian healthcare setting in my province Alberta. All residents in training in any institution or hospital settings are trained by clinical staff be they physicians, pharmacist or nurses. A sad event I was informed recently was the physicians in a university teaching hospital in Nigeria refused the Doctor of Pharmacy students assess to their patients and thus the ward, sad can only happen in Nigeria. A hospital headed by a physician released a circular to this effect to truncate the Doctor of Pharmacy degree program rotation, sad again. Remember that a poorly trained member of the healthcare team under any specialization becomes a clinical burden to you as head and lead clinician and your citizens. The physician is the head and the others are the neck and body just like any good marriage neither can function well without the other. In the University of Benin pharmacology department is under the school of pharmacy and rightfully so and some of the lecturers are not even pharmacists but pharmacology experts. How would you feel if the pharmacology department under the pharmacy school refused to train the MBBS students or would be graduates in pharmacology a precondition required for an MBBS graduation? The problem of health aggregation and turbulence was created by Professor Ransom Kuti of blessed memory under Babangida regime based on the brain drain of Nigerian trained physicians to Saudi Arabia, United Kingdom, and United States of America etc. but the truth is all healthcare professions in Nigeria is adversely affected by this syndrome. In my class of forty-two graduates over twenty of us are overseas, there are over ten thousand Nigerian pharmacist graduates of Nigeria practicing outside Nigeria, know that there used to be only six pharmacy schools in Nigeria. The nurses are worse off there are more than fifty thousand Nigerian nurses outside Nigeria. In fact, many nurses in psychiatry in Nigeria just use the institutions as a training ground before they move to Australia and United States of America. So, what is the solution let these specializations, all healthcare workers come together and fight the common enemy the government in their divide and rule game? If they come together government would be forced to run health as it is supposed to as done in many countries like even Rwanda. Let each and everyone go negotiate what they think they deserve and none should interfere with another. If you are talking of no parity is that before 1984 of Ransom Kuti or after, please go back and see what was before Ransom Kuti. Since Ransom Kuti left there has not be any peace in our healthcare system. In football a striker can earn more than the team coach based on perceived productivity, wages or salaries should be individualized a transplant or neurosurgeon is the highest earning medical professional I know and not the medical director or clinical director. Today it is ARD, next it is NMA and then JOHESU all strike, strike and, strike. The Nigerian government hospitals operate only six months a year and that has been the case in the last ten years or more. The question is a doctor that graduated ten years ago should earn more than a pharmacist or nurse agreed but should a doctor that graduated ten years ago earn more than a pharmacist or nurse of twenty-five years in the hospital one a consultant and the other a director of nursing or pharmacy services. The position of medical director and head of clinical services should be occupied by doctors yes. However, the head of the hospital should be called Head Hospital Administrator that everyone including the chief medical director will report and answer to too. The Head Hospital administrator different from the head of administration as it is now should be one that specialized in hospital administration with a Ph.D. He or She will work to create a conducive environment for all to function and thrive optimally. At the start of the year, he would ask all that they need, the medical director, the head of the pharmacy, head of nursing, the head of the laboratory, the head of the laundry the head of catering, and others what would they need, and the Head Hospital administrator would put a budget for everything and everyone including quality food served to all worker on call be they physician, pharmacist nurse or laboratory scientist. The opinion that the medical director should be a doctor yes but be dealing with medical and clinical issues only, not funds, money or budget execution. The focus should be on quality delivery like we want a new theatre for renal and liver transplant and the Head Hospital administrator will go raise the fund from government and private sector to provide one. We need that number of a new oncologist or transplant surgeon and the Head Hospital administration go around through a medical recruitment agency to get them the best, only the best. We need support for residency for resident doctors and pharmacists in training and the head hospital administrator gets the budget form them and link with people all over the world to provide quality resources persons. Finally, the minister of health can be anyone that understands how health care works not necessary a physician as this is more a political position and for party members look at the developed countries and tell us how many physicians there are as minister of health? Very few if any, we need their clinical skills in the hospitals and research and not being a political minister. I have seen many good hospitals rise to the occasion headed by a physician and have also seen many hospitals ruined by a physician as head too, so, the fact that a physician is the head of the hospital in real Nigerian terms means nothing and can only be one way to self-preserve and cause accretion in these facilities. Last year Nigerians spent about one billion dollars on medical tourism and going by these facts as soon as Togo, Benin, Niger, and Ghana get their acts together there may be no need for medical or healthcare workers in Nigeria, this may be exaggerated but a set reality. Today it is India, and as soon as it is near home, people will go across for a holiday and get the world-class treatment they may need and can afford. Wake up Nigeria, and Shalom.

Hmmm!! These same set of nairaland doctors again with these their lies?

Una no dey tire?

Thank God Nigerians and the general public are now asking questions and beginning to know what is happening. Only time will tell.

I tire for una.

Hmmm! These same set of doctors again with their lies just to score cheap points?

I tire for una!

DABMarkNig2019:
This war of words should end. whether we like it or not, we're team mates caring for our patients from different points of care and perspective. Drs are leaders of the health team and i have great respect for them. I have many of them as friends from school and have met with so many others now in practice. They're wonderful sets of professionals.
As we seek to understand ourselves, we should never give room to hate. We shouldn't be enemies with one another.
#There should be no profiling
#Let love lead...love knows no enemy
#AVARANCHI
#AVARANCHI

My brother I like your comment, just that we should place some of these quacks where they should be so they will stop misinforming the unsuspecting public. I too have plenty doctor friends, great and enlightened ones that will even seek the opinion of Pharmacists other health professionals when they are confused. I respect such doctors that know what they are doing and not these nairaland warriors. Pharmacy and Medicine are noble professions and nobody will want to take shit from each other.
Thank you my brother and thank you to all the medical radiographers, doctors, physiotherapist, nurses, lab scientist and Pharmacist in the house.
I rest my case.

DABMarkNig2019:
I said that because I'm contented being a pxcist.
I'm proud of who i am and I don't go about raising shoulder.

My brother raise shoulder jare if it requires you to raise shoulder. E no easy to pass through a Pharmacy school. If they say e easy, make them come study pharmacy. That's why the doctors keep asking you the requirement to open a community pharmacy that they want to open one and I keep telling them the requirement is B.Pharm. It always pains them when I tell them the simple truth and answer.

danilmo:
wait o, my problem is , was it not the pharmacology u guys studied from year 345 and 6(pharmD) that a doctor studied within a Year coupled with pathology self all within a year, and boldly that doctor challenged u and proved he knows more than u , even death with ur guys self in d so call pharmacology.. hiaa, nawa o..

am sure u won't want him to take u round the clock of MBBS
in the like of
Radiology, neuroscience, psychiatric, paediatric ,surgery , pathology, O&G ,medicine and the rest as far as petient management is concern..

Doctor still know these and still know if not more than u the pharmacology u spent 4years to know.

its a pity, who curse pharmacy student self...very low IQ set of people who wail but was given hope set on a deformed pedals.
that if they can struggle for survival..alas

FYI, maybe that's y MBBS board set high admission cut off before admission so only people with high brain capacity will fit and come in,

hmm, trust me u will never see a doctor stoop so low to study pharmacy after his MBBS degree but plenty pjarm are here in my college begging to survive the heat in MBBS..

Mumu you and your team of quack doctors can not still tell me how hepatotoxicity in paracetamol poisoning occurs. Doctor! Doctor!! Almost 48hours and you and you team of 6 quack doctors couldn't come up with an answer. Shame on you and that you useless mbbs that has no other value outside the 4walls of your consulting cubicle. You mentioned Radiology, neuroscience, psychiatric, paediatric ,surgery , pathology, O&G which are areas in your field, what if I take you round in Pharmaceutics, Pharmaceutical Technology, Pharmaceutical microbiology, Pharmacognosy, Nanomedicine and Technology, Pharmaceutical chemistry, Drug design. If you are not a Pharmacist, you can never be a Pharmacist.

Waillers!!
Doctors are already stooping low according to you with their mbbs to come and study Pharmacy.
Jealousy and envy will continue to kill you.

If you are not a Pharmacist hide your face or go pick the next jamb form or DE form and apply with ur mbbs and start 2nd year.

TempoJames:
So with all this knowledge You guys couldn't attend to your fellow johesu members that had accident but leave them to the mercy of quacks?
I know many pharmacists that prosper only by selling codeine and tramadol.
If you guys are that knowledgeable why do pharmacists go back to study mbbs?
Your knowledge can not match that of a medical doctor. You just know drugs but u have very shallow knowledge on its clinical applications.
You will be surprised how shallow ur knowledge is in the presence of a medical doctor.
You think a doctor's knowledge of pharmacology only ends with p/kinetic,p/dynamic,moa n sideeffects?
let me give u 3 take home clinical problem to ponder on

1) why wouldn't you like to give hematinics to a child with mild to moderate anemia with an acute febrile illness?

2) why wouldn't you like to start a px with previous thrombotic event on warfarin alone?

3)why wouldn't you like to give paracetamol to a child with fever untill u rule out a viral infection?

Let's see how you can use ur knowledge in real clinical setting.....

1. Why wouldn't you give hematinics to a child with acute febrile illness that is placed on artemisua anua derivative?

2. Why wouldn't you like to start a patient with previous thrombotic event on low dose acetylsalycilic acid or clopidogrel alone?

3. Why wouldn't you like to give antibiotics to a child with flu.

Good luck.

theuniqueone:
Abegi pity the doctor wannabe. Thanks for putting the academic dwarf in his right place. You just confirmed to me the awesomeness of mbbs program. I am humbled to be a doctor. I wish we are in ward round so that stuff will just flow unhindered. Thanks once again

Wailer!
I pity you and also pity those that come to see you. Let God save them from your hands. Shame on you. You are hiding under the shadow of your colleague that can't even aswer simple question. That's why you keep doing copy and paste in the clinic and keep killin innocent patients with your illiteracy. You wouldn't want pharmacist to take up ward round because you are scared. We will keep exposing you quacks till you humble youself and learn. Pharmacists will keep exposing you. Simple paracetamol question you cannot answer and you call youself a doctor. Which school did you graduate from?

jefdr001:
Nice one mr. But how does this help a patient. Btw we know more than this. my pharmacology lecturers admitted medical students perform better than pharmacy students in pharmacology.

When I see an undergraduate I know. What level are you in bro?

WesleyPepper:
Lol..This is ridiculous !! Acetylcysteine is cysteine analogue with a longer half life.Your methionine is just another AA that can be used for the management of paracetamol toxicity.

What is the commonest route of administration of the N-acetylcysteine in clinical settings?

And after how many seconds, minutes or hours would your antidote be useless If you fail to act ?

What zone of hepatic lobule is the commonest site of liver damage due to acetaminophen toxicity ? And why is it the commonest site ?

What type of necrosis does it cause ?

Gimme the prognostic signs of the toxicity ?

And can you tell me about the symptoms, signs and management of fulminant hepatic failure ?

The above questions are definitely beyond the scope of your curriculum.
My questions covered pharmacology, pathology and GI medicine ..

Keep calm and dispense my prescriptions quietly

Olodo answer my question and tell us how the hepatotoxicity occurs and stop peeing on your pant when a pharmacist is talkin. I already mentioned some of the answers to your fellow quack. It took you up to 24hours with the help of Google and your dumb colleagues to respond to a simple question on a simple and so common drug as paracetamol. Doctor! Doctor!! Relax and learn from a pharmacist, you errand boy and apprentice. Keep doing copy and paste of you consultant work from page to page and from folder to folder.

If you are not a pharmacist, hide your face.

DABMarkNig2019:
ideally i shouldn't have given a response to this but just to put everything in the right perspective i it's needful to give you an answer although I'm surprised that you're being taught this at postgraduate level in medical sciences since you're a resident dr.
I will answer your questions one after the other.
1. The commonest route of administration of NAC is the intravenous route because onset of action is fastest through this route. IV route is also preferred because patients with PCM toxicity are always unconscious. If there is some levels of consciousness activated charcoal should be administered too.
2. The usual time to act after pcm toxicity is between 8 to 10 hrs but even at that anytime such a patient present to the hospital he should still be given NAC so late presentation should never preclude it's administration.
3. The site of the liver mostly damaged is the centre lobular because its a highly perfused part. The metabolic enzymes for pcm metabolism are are also found in high concentration there too so the most affected part.
4. Type of necrosis is fulminating hepatic necrosis.
5. signs of toxicity usually occur in four phases. If you are a good you should know.
6. Those signs are majorly encephalopathy, cerebral edema, raised intracranial pressure and of course jaundice.
I can't answer all your questions now...i just got back from work. I'm hungry but shocked that this what you're being taught in your so called post graduate studies...If you meet with a postgraduate clinical pharmacist you'll be ashamed of yourself.
Next time ask questions that are evidence base not this academic one.
No matter how you try to present yourself from research to health care the pxcist is your Lord

Those doctors are always scare of pharmacist that's why they tremble and poo on their pants whenever they hear pharmacists are comin for ward round and run to report to their CMAC.
See the kind of question a resident doctor is askin that a 3rd year student in pharmacy school will comfortably answer. Remind those errand boys and apprentice too that there will be high levels of aminotranserase, hypoprothrombinemia and renal failure can also occur.
Those quacks should relax and learn from pharmacists once it comes to drugs and medications.
It took the combine efforts of more than 5 so called doctors and up to 24hours to respond to 2nd year basic pharmacology question I asked which they cannot answer, rather they twist the question and asked what a 3rd year pharmacy student will answer. Shame on these doctors. If you want to avoid these quacks killing you with drugs, always ask your pharmacist.
Doctors always envying pharmacist.
If you are not a pharmacist, hide your face.

FuckFuckBoy:
Mourinho deserves to lose.Why would he start Jones ahead of Bailey? Bailey is our best defender but he stubbornly insisted on playing that overrated English duo

I wonder what Jones is still doing in United. He is the worst player in the team. I heard he even made ENGLAND 23 man list for the world cup. England will just comot for group stage with people like jones.

WesleyPepper:
That dude is what you wish you were..
Bloody diapenser :-

Bloody errand boy and apprentice! Always envying Pharmacist. That's why you keep giving patients wrong doses of drugs.

theuniqueone:
I found it rather unfortunate that you pharmacists believe that drs know nothing about drug metabolism. Sad. Paracetamol is primarily metabolized in the liver by the microsomal cytochrome p450 enzyme system via glucronic acid conjugation into other derivatives which I don't want to go into in details and subsequently eliminated in bile. Please can you Doctor wannabes give me a step by step management of paracetamol poisoning and its prognostic indicators. That was how my pharmacist made a diagnosis of UTI in a child with every facie of sickle cell disease. If you are not a doctor, you can never be a doctor

Google always giving you half information. Thanks to Google but listen let me teach you for free. Paracetamol underGoes gluroronidation and sulfation to its conjugates (which I won't tell you) and these make up 95% of the excreted metabolites.
However there is an alternative pathway which makes up the remaining 5%. It is the cytochrome p450 dependent glutathion conjugation pathway. I won't tell you the name of the metabolite so you can ask Google again and learn. So what you typed up there is trash.

Have you heard of Acetylcysteine and Methionine? Mr. Doctor!!

Freddonance:
Finally, it is the wish of every pharmacists to answer doctor both home & abroad. a tittle some people are tired of bearing

Answer the question I asked you Mr man. Because you saw the word chemistry, your empty brain told you it is a pharmaceutical chemistry question, or are you and your fellow 'I know all' doctors still asking and waiting on Google?
No Nigerian Pharmacist will want to answer a doctor, even those with Pharm D that are qualified to take the title Drs will still tell you they are Pharmacists.
They are proudly Pharmacist.
Don't compare your one semester pharmacology with 4 years pharmacology (B. Pharm) or 5years pharmacology (Pharm. D) of a pharmacist.

Freddonance:
People are very funny. for ur mind that's pharmacology question? now I understand how much u know pharmacology

Asking question on pharmaceutical chemistry when pharmacology was intended shows u do not know pharmacology is a branch of basic medical sciences.

Answer it 'PROFESSOR KNOW ALL'. Quack doctor. It's still basic pharmacology question of common paracetamol you prescribe everyday. Which medical school did you finish from please? I pity patients that come to see you. Which hospital do you even work in?

Freddonance:
The last time I checked, your BSc nursing is a requirement for admission into 200level medicine in Nigerian universities & outside the shore of Nigeria, RN still is a requirements for MBBS program.

Pls do not show hatred for others. Do what u love wholeheartedly & avoid all these unnecessary argument. I want to believe u are a responsible lady who has self respect. pls do maintain ur integrity as a nurse cos no amount hate speeches will bring down any profession, not even medicine.

A doctor after studying medicine and surgery still came to study pharmacy. He started from 2nd year and his requirement to study pharmacy is your almighty mbbs same with someone with b.sc nursing or b.sc parasitology.
Grow up and learn.

Freddonance:
That is your own opinion but I challenge you to dare any doctor here in pharmacology. That's when your nerves will be calmed(repolarized)

Olodo! U think drugs are all about pharmacology which you don't even know. Oya over sabi doctor, tell me the chemistry in the elimination processes of the paracetamol you prescribe everyday : 1g tds x 3\7.
Answer fast!

FreeConCiencE:
If you do that, you are putting your life in jeopardy. Your life is at risk. You may be lucky not to have wrong diagnosis and treatment plans by the pharmacist now but you may not always be lucky. By that time, your life or those of your relatives may be the price you will pay for that wrong step. In saner climes, pharmacist will not dispense drugs for patients without doctor's prescriptions. Forget about all these envy and jealousy. Doctors are trained clinically with living human beings to take thorough history, provisional diagnosis, requesting for right investigations and then definitive diagnosis and proper treatment plans and with high knowledge of pathology which is the basis of diseases. Pharmacist or any other health professionals are not trained in this regard and this is what distinguishes doctors. This is not to say that other health professionals are not important. In fact, most of what they can do for patients on behalf of doctors were learnt from the doctors after many years of working with doctors. That is piece of advice I can offer you now. Cheers!

You have not heard of Pharmacist prescribers, that Pharmacists also prescribe drugs or your lecturers in school refuse to teach you that one and don't want you to know it? You always tremble when you hear a pharmacist is around, why?

Freddonance:
You keep blabbing only surgeon are the real doctors.
Have u ever asked ur self if that is true why aren't everyone going into surgery?
Even surgeons respect Physicians especially when it has to do with intelligence(real medicine) but u are here spewing hatred. Physician are so good that they can tell you over 200 side effects of paracetamol, Yes, they are that good(only doctors know this) & to think u can practice medicine by virtue of being in the ward with a doctor is the higher level of show of shame & ignorance.
Again, every MBBS holder can delve into surgery any day, any time. Yea, that's the power of MBBS. whoever wishes to perform any surgical procedure can do it so long as it is within his limit. The issue of litigation comes into play only when complications of the said procedure ensue.

Is it the physician that don't know that panadol and paracetamol are the same drug, that will tell us the side effects of paracetamol? Does the physician even know how paracetamol works and how it is metabolized and eliminated not to talk of its side effects? What most doctors know is that paracetamol is used to treat headache and fever which even someone in primary school knows.
No wonder someone called doctors malaria and typhoid doctors which some doctors no even sabi treat.

ifyalways:
Is this article REALLY 'bout pure water/cholera or about pharmacists,their pains and tales

Once there's an epidemic,everybody becomes an authority and analyst. Did they just notice that Nigerians drink pure water ?

FOOL!

FreeConCiencE:

My brother the thing tire me oo