Emmaliver's Posts
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 NYSC › Re: B14 Kogi State Corpers Lets Meet Here by emmaliver(m): 6:25pm On Aug 01, 2014 |
Asaya boys. una welcome ooooo. kogi koppa. See u guys |
| Health › Re: Minister Of Health Warns Doctors by emmaliver(m): 7:05am On Jul 21, 2014 |
soludo93: medical doctors are generally greedy. Most Nigeria doctors with their insignificant contributions to world health, always agitate for more money. contrary, that exposes the Hippocratic oath they sworn to save life.what do u really know about that oath? you that is not greedy oya cast the first stone...... saint soludo 2 Likes |
| Health › Re: Minister Of Health Warns Doctors by emmaliver(m): 7:03am On Jul 21, 2014 |
Adikam: Doctors are trained fools.they only know abt theirselvesI can see u where born under a mango tree and that makes u more foolish than doctors. ewu....when u fall sick now u start rolling on hospital floor begging for attention..y can't u ask ur fool hardy politicians to have s re think 1 Like |
| Politics › Re: Nasarawa : Ombatse Backs Al -makura ’ S Impeachment by emmaliver(m): 9:22am On Jul 20, 2014 |
jayseehe: GEJ sponsors Boko Haramu are nobody. y will he notice u? 9 Likes |
| Christianity Etc › Re: Born-again Cchristain Singles Group... by emmaliver(m): 2:05am On Jul 20, 2014 |
cinderellla: Are you a christainv? Are you born-againv? Are you single? Let's meet here!don dey find husband abi? 1 Like |
| Health › Re: Salaries Of Doctors And Other Health Workers In Some Countries by emmaliver(m): 1:28pm On Jul 13, 2014 |
prettyprettywow: In US, all Drs specialize. Even the family physician (who are primary healthcare providers) is still an area of specialty. they still undergo residency You are not a fully qualified Dr until you are matched and done your residency which makes you a specialist!. you have just shown how ignorant you are. and please shut ur stinking mouth.... Any MBBS holder is a fully qualified doctor and is capable of practising unsupervised and carry out all treatments( including surgeries) withing the limits of his skills In this country and in any other country where he/ she has passed their board certifying exam. Going further to do residency and become a specialist. is a post graduate qualification n if the person desires to go deeper into a clinical specialty.....when next u open or gory mouth to talk. check your facts. 3 Likes |
| Health › Re: NMA Vs JOHESU Vs FG Vs Patients........ Why the hatred for doctors??? by emmaliver(m): 8:11am On Jul 11, 2014 |
PerfectFortune: The OP may claim not to be bias in his judgment but in my opinion, he is very bias.. probably because you don't understand d working conditions Doctors in the country are subjected to..... this doctors u talk about have children. parents n relatives too whom dey care for... dey also buy from d same MKT politicians buy from..... now if they are well remunerated like in other countries. n d govt provides NHIS for all of its citizens n equips d govt Hosp to be world standard. then you realize how good Nigerian doctors are in terms of skills etc.... they travel out because they don't have faith in the system here owing to the fact they crippled it by looting public funds.... have you wondered y Nigerian doctors abroad are d best among their equals? how much is radiotherapy machine for cancers n how much is a senators sitting allowance. yet we barely have only 3 non functional raditherapy machines. how many govt hospitals have functional dialysis machine? have u also y more than half of medical doctors produced here yearly travel out never to return? do you know what the world standard is. in terms of patient to doctor ratio? I will leave u to find out n tells. but bear in mind that most centers in this country lack facilities thus forcing their doctors to work with bare hands...yet they save as much lives as God encourages them to......Nigeria has enough to care for its citizens its just misplace priority. 3 Likes |
| Family › Re: Mum Suffocates 11-month-old-son Then Mourns His Death On Facebook (photo) by emmaliver(m): 7:53am On Jul 10, 2014 |
Post partum psychosis 1 Like |
| Politics › Re: APGA Offers Embattled Nyesom Wike Ticket; As Umeh Holds Crucial Talks With Him by emmaliver(m): 6:52am On Jul 10, 2014 |
Smartsyn: So APGA now wants to collect whats remaining of what this man stole from the Education Ministry..Exactly....Umeh wan collect I'm own share nah 1 Like |
| Politics › Re: Minister Can’t Call Off Strike, Doctors Insist by emmaliver(m): 8:51am On Jul 07, 2014 |
THE TITLE OF CONSULTANT AND THE QUEST FOR SPECIALIST ALLOWANCE AND TEACHING ALLOWANCE Every person and profession has the right to determine how the career progression goes. To that extent, I do not have any grouse whatsoever with people attaining Consultant status in their field. But as the saying goes, things are not always what they seem. This point will require a little of history. Before the nineties, the health system in Nigeria was a lot more organised. There were clearly defined roles for each group of health personnell, and the salary scales truly represented relativity, which is the difference in take-home pay that should exist due to differences in training, skills and input to patient care. Gradually, the unions agitated for more and more increases, more allowances, and so on. But there was a problem lurking. For while the other unions (now grouped as JOHESU) fought and battled the Military governments for pay rise after pay rise, the doctors “kept their cool” and “were more concerned with the good of the patients”. Of course in Nigeria, the loudest person gets heard first. So gradually, the gap between the salary of the doctor and the other professionals closed up. At a point, there was barely any difference. In 2008, after many years of struggle, the government approved a new salary scale for doctors which, though flawed, was meant to correct the relativity between professions. As part of that document, there was an allowance for medical and dental consultants tagged “specialist allowance”. That is the source of the problem. In a quest to get more allowances, the term “Consultant” has suddenly crept into the vocabulary of the other professions, notably Nursing and Pharmacy, of which I will make examples. They perhaps have heard that there are “Nurse Consultants” and Consultant Pharmacists” in other climes. The question is, WHAT ARE THE ROLES OF THESE CONSULTANTS IN THOSE COUNTRIES, AND WHAT ARE THE QUALIFICATIONS REQUIRED TO ATTAIN SUCH STATUS? According to the UK’s National Health Service website, a Nurse consultant “is a specialist in a particular field of healthcare... and spends at least half of her time working directly with patients, and in addition develops personal practice, is involved in research, and contributes to the education, training and development of other nurses”. To become a nurse consultant, a basic nursing degree is required, as well as a master’s degree in nursing, health services or administration, or public health, with working experience. Some even add that one requires a PhD or at least should be working towards getting one. There are other nurse consultants who may not work with patients but give advice to law firms on medical cases (e.g. malpractice cases) they have in court. The latter type of nurse consultant surely does not fit into our teaching hospitals, but the former may. Most definitions of a Consultant Pharmacist describe him/her as one involved in the care of the elderly or people in nursing homes, where he reviews their medications. Infact, the history of Consultant Pharmacy actually began in homes for the elderly. Other sources describe the job as having to do with “advanced roles in patient care, research and education”. Even in these countries where the title is mentioned, it appears to be a new and evolving role rather than an established position that has relevance to patient care. Requirements include a Pharm D degree, interest and experience. Some articles I came across also require a Master’s degree in pharmacy. In the absence of proper guidelines and laid down procedure for such appointments, as well as regulatory or accrediting agencies, my view is that caution be exercised in adopting this relatively new terminologies into a developing country’s health system. The issue of Consultant status is where I may differ slightly from the NMA’s position. Let anybody become a consultant of whatever profession he wants to, as long as there are stipulated procedures for doing so. The caveat is that as far as patient care is concerned, the Medical/Dental Consultant acting directly or through his lieutenant, is the only person to give directives about the patient’s care. To cut it short, being a consultant in any other field of healthcare should not give a person the right to change, obstruct or delay the implementation of a doctor’s management plan. The roles of such specialists should be merely advisory. On the part of the Government, they can go on and appoint as many consultants as they want –, Nurse Consultant, Consultant Pharmacist, Consultant Physiotherapist, Consultant Optometrist, Consultant Radiographer, Consultant Cleaner, Consultant Porter, Consultant Gateman, Consultant Accountant and Consultant Administrator. Kai, even start having Consultant visitors. Afterall, the Niger delta oil is a LovePeddler, and her patrons are endless. Just one more defilement won’t do much harm. Then the next, and the next. Let me conclude this section with a comment on the issue of teaching and specialist allowances. With the difference in knowledge between a house officer and nurse, the house officer surely does teach them a few things... if the person involved is humble enough. The point is that these guys also teach medical students, nurses and other personnell. Finally, everyone in the Health sector now wants to receive a specialist allowance and teaching allowance. Infact, some optometrists on the CONHESS salary structure now receive specialist allowances from the CONMESS salary structure. Only in Nigeria can such brazen effrontery be seen. One person, being paid on two contrasting salary scales. Well I will leave that to the public to judge, but if without additional training a lab scientist, pharmacist, optometrist or nurse wants to be called a specialist and receive allowances, the gander are also ready. The spree has only begun. RELATIVITY IN THE HEALTH SECTOR Now many that are outside the health sector may be confused about this. But to put it simply, the healthcare system revolves around a TEAM. In every team all players are important and perhaps indispensible, but there is always a captain or a leader. Usually the coach will choose a captain either based on current form, or based on age, or based on experience, or based on number of years spent in the team. In medical circles this leadership role, albeit traditional, was foisted on the doctor because of qualities including being central to patient care, perfect understanding of both normal and abnormal body function, understanding of the development of diseease and different options for curing or relieving it, and a general scope of the different areas of human medicine. As is seen in every normal salary structure, the more the training, the higher the pay. That is why a secondary school leaver and a university graduate are not put on the same grade level when they are employed. Even among graduates, those of engineering, law and pharmacy are paid higher than others. Doctors (medical and veterinary) are paid still higher. This is the concept of relativity, put simply. However in the Nigerian health sector, this rule has been and is being continually thrown to the winds. Some nurses without university degrees earn higher than pharmacists and doctors. From being started out on step 4 of the grade level as used to be the case, House officers are now started on step 2. Reasons? None! Like stated earlier, this is the result of the failure of doctors to use strikes to press home their demands, choosing negotiations instead. The only time when we got heard was during the strikes that introduced the Consolodated Medical Salary Scale (CONMESS) in 2008/2009. And in that document, there were fundamental flaws. For as you moved higher up the scale, your salary seemed to be stagnant. The creators of that document cleverly made the calculations such that a promotion added almost nothing to your total emoluments. This led to a call by the NMA for a new salary structure that makes the effect of promotion better, and government is “still looking into it”. Realising its “mistake”, government issued a circular on the 3rd of January 2014, correcting the anomalies in CONMESS. Take note that this was not NMA’s demand, but even the implementation of the government’s own response to the problem has taken six months. Not a single kobo has been released to that effect. But since we are a breed that has a genetic aberration which has foisted limitless patience on us, JOHESU will have the public believe that we are unreasonable. One funny tweet I read this morning from @bilquees_01 under the # nmastrike read, “a duke mutum a hana shi kuka”. It is in hausa and means “to beat up someone and prevent him from crying”. This perfectly describes NMA’s situation in Nigeria. We are squeezed in on every side, pressured, ambushed and bashed, but the rule is “Thou shalt not complain”. Each time there is an industrial action, you see sudden movement from the house of representatives, senate, presidency, and the so called “well meaning nigerians”. As soon as we retreat to work to observe the situation, all agreements become unbearable burdens for the government. JOHESU rushes off to introduce another variable to unbalance the equation. But thou, o physician, shalt not talk. For it is you alone that has moral obligation to the sick of the world. Arrant rubbish! HAZARD ALLOWANCE, RURAL POSTING AND OTHER ALLOWANCES Let me start with the hazard allowance. I will simply ask a question here to any member of the public. Is five thousand naira (about 28 USD or 18 GBP) enough compensation for any of the following risks to your life (and by extension, the life of your immediate family) every single day? People coughing into your face; blood splashing onto your clothes, skin, eyes and mouth; handling human faeces, urine, flesh and other fluids; working with razors, knives and needles around patients with highly infective conditions (HIV, Hepatitis B, Hepatitis C, Lassa Fever, Tuberculosis and others)? If anyone would say yes to the question, or argue that they are more exposed to these dangers than the Doctor or Nurse, let them come out. I will stop at that. When an official of the Federal Ministry of Health (FMOH) travels from Abuja to Portharcourt and spends the night, he gets paid for the inconvenience. But a doctor POSTED to a rural setting away from family and civilisation needs to go on strike to get a circular saying that he should be paid his due. For if that is not done, he may get his money, or a quarter of it. Or nothing. There is God o! CONCLUSION The current crisis in the Nigerian Health sector is essentially borne out of Government’s non- affirmativeness in handling issues related to clear definition of roles, lack of a global salary structure that takes into account training, skills and competencies, and the toleration of disrespect for laws and circulars of government. This is further worsened by its lack of implementation of agreements and slow response to threats of industrial action across the country. Doctors, as part of the solutions to this quagmire, have advocated for the signing into law of the National Health Bill as passed by the Senate of the Federal Republic of Nigeria. This will resolve SOME of the problems. Secondly, a global structure for salaries and wages in the health sector, based on the points stated in paragraph 1 of this conclusion, is key to putting a stop to the impending collapse of the health sector. That action should be based on practices in advanced nations of the world who we aspire to be like. Copying some things related to relativity from the UK’s NHS would be a good start. After that, any further pay rise for staff in the health sector should be done en masse to maintain the relativity across board. This alone will bring lasting peace. A permanent resolution of these crises thus still lies at the feet of Mr President and his advisers and committees. I will bow out with a comment on the oath we took, which I quoted earlier. That oath, called the Hippocratic oath and disputably assumed to have originated from Hippocrates, never envisioned that a time would come when a physician (here referring also to a surgeon) would be an employee of the state or work in conditions so terrible that he/she would consider withdrawing services to enforce his rights and those of his patients. Hippocrates never thought that the family atmosphere that existed in all the homes he visited to see patients would condense into vampiric institutions where lieutenents would challenge his leadership and seek to take his place at the head of the team. If he had, he would perhaps have added an escape clause. For there is no longer any dignity in this practice; and our patients suffer everyday on account of all this back and forth over the same issues. Definitely, some of these problems I have dicussed are at the very heart of the matter, and others are thrown into the fray as a response to the frustration that engulfs us in the moment. But for our conscience to remain and our patients to enjoy the benefits of the doctor’s indepth knowledge and training, the atmosphere has to be right. That is what NMA is standing for today. Having gone through some of the hard facts in this article, and perhaps having been inspired by my emotive tone, I hope that more members of the public will come to agree that the current strike, apart from seeking to correct some anomalies in the health sector, will ultimately lead to greater good for the primary object of existence of the medical profession – the patient. 7 Likes |
| Politics › Re: Minister Can’t Call Off Strike, Doctors Insist by emmaliver(m): 8:48am On Jul 07, 2014 |
RAPE OF THE BLACK GOLD – NMA Strike and the Crisis in Nigeria’s Health Sector INTRODUCTION After trying hard to avoid putting pen to paper to express the bottled up emotions inside me, a news item on a national TV station has finally pushed me over the edge to try to explain to whosoever cares to listen, the reasons why the NMA is on strike, and why there should be public agitation in favour of it. In the said news item, members of the public are yet to understand the reason for the strike. For the avoidance of doubt, I am a medical doctor and I write from a possibly biased point of view. As you go through this article, you may discover areas where I agree or disagree with the issues raised by my mother association. But while I do that, I will try to be as reasonable and dispassionate as possible. I do not believe that strikes should be the handle by which the Nigerian government turns, such that it is impossible to press home the demand of a labour union or group in this country without grabbing it. The feverish efforts used to approach an industrial action towards its end can be applied at the moment when there is a NOTICE of action. If this were the habit of those in government, perhaps the current NMA action and many others strikes by other bodies of workers before it would have been averted. My aversion to the use of strikes is even more amplified when it involves the truncation of flow of an essential service – be it power, health, transportation, security or other. The oath which I and my noble colleagues took reads in part, “I will practice my profession with conscience and dignity; the health of my patient will be my first consideration”. In all fairness, I want to say that inspite of the dearth of modern day equipment, dilapidated infrastructure and terrible working conditions, we are still struggling to live true to our promise. Most doctors I know today work extra hours unpaid, donate to help patients obtain medications or pay bills, or go out of their way to perform “non-doctor” work just to make the patients well. The following two examples are true at least in the Jos University Teaching Hospital. Doctors run around the wards to pick up instruments and case notes (files) of patients, when many times the nurse is idle in the ward. Carrying files and getting all instuments required by a doctor on ward rounds should be a nurse’s responsibility, or at least she should direct her orderlies and substaff on what to do. In addition, she should make contributions, report relevant events which occured in the doctor’s absence, and take her own notes during the ward round. That is what our teachers tell us used to happen in the past. But alas, that is not the case. She sizes up the doctor first, to see his rank. If he or she is a house officer (the lowest cadre), he may just as well proceed without her. Afterall, she has a daughter at home that is older than this “small boy”. African megalomania at its worst. If the doctor is a Consultant(topmost grade), she may then gauge whether this doctor is the “friendly type” or the “difficult type”. Because for the difficult people, the rules have to be obeyed or else there will be trouble. This category of doctors is thus spared the pain of others. My second example, though recently corrected by a circular from management, is that doctors sometimes become porters, carrying blood samples and results to and from the laboratories. In the course of seeking for results in the laboratory, a doctor was recently slapped in the face by a laboratory staff, leading to the management response. While that malady lasted, excuses for the staff who were employed for that purpose ranged from “too few hands” to “engaged with something else” to “its not our job”! for want of space, I will leave other examples alone. I hope this leaves no one in doubt that we do our jobs (and sometimes the jobs of others – just to make the system work) Now to the issues. WHO SHOULD HEAD A HOSPITAL? Who should head a hospital? Of course, this kind of absurd question would not arise in a private hospital. As we know it, the law in Nigeria requires registration with the Medical and Dental Council of Nigeria (MDCN) and up- to-date payment of Annual Practicing fees for an individual to set up a private hospital. I carefully choose the word “hospital” because Nigeria has an endless number of appelations for both health facilities and slaughter houses. And the nigerian public is so misled that there is now no distinction between hospital, pharmacy, clinic, dispensary, nursing home, patent medicine seller, and a community health officer’s spare bedroom. All manner of attrocities are committed – there are consulting rooms in pharmacies, theatres in nursing homes, abortion facilities in dispensaries, and operating rooms on people’s dining tables. The mess is so mad that everybody who has ever witnessed the administration of an intravenous drug or watched an appendectomy is now fully “medically qualified”. So the criminals who do these things, due to the ineptitude of law enforcement, now see themselves as equal to all others who have licences to practice professionally. And a handsome majority of perpetrators of these acts are the other health professionals and allied health professions. The problem as I have stated, cannot arise in Private hospitals. It is in the public institutions, where salaries do not depend on how much work is done, but on how much the institution receives from the “national cake”. Not on how much training we have received, but on how many years we have been sleeping at the office. Not on our individual skills and interests, but on how many pieces of possibly fraudulent paper are found in our credential file. For if these attributes were to be sought by our employer, we would never have arguments for how much we should receive. Or who should be in charge. Regrettably, however, our employer is an object that neither has a head or a brain. It cannot reason and thus cannot make any reasonable judgment. Our employer is the black gold that runs beneath the land and waters of the Niger Delta and other parts of southern Nigeria. Our employer is crude oil – our birthright and ticket to laziness, our excuse for brazen corruption, and our foundation for mediocrity and lack of desire for development. And to tell the truth, I secretly pray sometimes that the oil would just dry up, if only to induce sanity into our country. For if this employer were reasonable, it would ask why there should be a difference between the private hospital (which performs its duties and makes a profit) and a government institution which is just a black hole into which money is sunk, neither getting profit nor benefitting the masses for which it was built. The law setting up teaching hospitals specifies that to become the CMD, a person has to have a basic medical degree (here meaning Bachelor of Medicine, Bachelor of Surgery) and have become a consultant, owning a fellowship of one of the Postgraduate medical Colleges, as well as a few other requirements. This is one of the cardinal disputes of today. Let me introduce the Joint Health Sector Unions (JOHESU), an amalgam of Labour Unions formed a few years ago and basically including all other staff except Medical Doctors. Even to a blind and deaf person, this is an association of strange bedfellows. Pharmacists, Nurses and laboratory Scientists alone would have made some sense. But add Administrative staff, accountants, medical records staff and it starts to get confusing. When you finally integrate cleaners, porters and other junior staff into the mix, it tells what the only object of such a hydra-headed conspiracy could be – the extermination of the disciples of Hippocrates. JOHESU seeks for appointment of CMDs to be “made open to all competent and qualified health professionals”. The arguments for them are that this is done in some parts of the world, that their members also have medical knowledge, and that it would promote equity and fairness. On face value, these seem to be reasonable and genuine demands. And central to our response has been one issue – training. Apart from medical doctors, other health professionals attend university courses based on the semester system in Nigeria (let us leave out those who have sub-degree programmes for now – they know themselves). Apart from the Pharmacists, who do 10 semesters, most other professionals spend 8 semesters. Two of these semesters however are spent doing basic science, which is essentially same across board. So in effect, pharmacists spend eight semesters and other six, preparing for working life. Now doctors also do the same basic science, with higher credit unit loads than most others. After the first year, however, the difference in training time is incredible. The semester system for the doctor is over. The remaining five years of training are basically without holidays. When there are breaks, they last between 2 and 3 weeks, usually after exams - and in the University of Jos, for example, there are just three major examinations beside continuous assessments, which are regular. So on the generous side, a medical student has perhaps nine to twelve weeks of official breaks out of five years. That is an incredible four-and-a-half years of training. Compare that with six semesters of four months each, totalling 24 months or 2 years. Or for the Pharmacist, eight semesters of four months, which would be two years and eight months. The amount of knowledge difference is surely massive. Asides that, the doctor is schooled in EVERY aspect of HUMAN medicine – and in appreciable depth. What the other professionals are schooled in, as far as it pertains directly to human medicine, we also learn. So what then is the doctor’s advantage as a chief executive? A doctor has a wider scope of training and is equipped to understand the entire workings of a hospital as it relates to patient care. Thus if a lab scientist, pharmacist, nurse or other health professional for example, speaks to a doctor CEO about the needs of his department or problems they are having, the doctor would fully comprehend. If a pharmacist were giving the same information to a lab scientist, however, the situation would be different. This wide scope of training and central role also has a bearing on decision making for the best possible allocation of resources and manpower, enabling the hospital to run smoothly for the good of the patients. That is why a career engineer would most likely be the head of a construction firm and not a welder or bricklayer, even if they all had PhDs. A lawyer would be the head in the courtroom, whether the clerk has a thorough knowledge of court procedure, court rulings and how to decide cases or not. Its simple logic. Where people start to argue about whether doctors are trained in management, my answer is that other health professionals are generally no different in that respect. Seeking for “fairness” and “equity” and trying to avoid things being “skewed” has absolutely no bearing in an industry whose objective is to preserve human life. This is not sports or entertainment or tourism, where ignorance and mistakes can be condoned. Any managerial mistake in a hospital can lead to loss of life, which is irreplaceable. And for the records, recent studies in the UK have shown that doctors head very few hospitals in that country, but most of the top 100 performing hospitals are among those headed by doctors. That kind of evidence based argument in a sane society can have no reply. The document regulating the tertiary hospitals in Nigeria has said the doctor should be the head. Since the status quo has not been deemed a failure by the government, it should remain. It is pertinent to add here that the clamour for the interpretation of the phrase “medically qualified” by JOHESU is part of the ploy to co-opt their members into the league of persons entitled to apply for CMD in the tertiary institutions in the country. To be mild, this loophole seeking is simply childish. For if medically qualified were to be a general term for any diploma (certificate) related to medicine, the makers of the law would not have added a postgraduate fellowship, which is peculiar to doctors, to the list of requirements. APPOINTMENT OF DIRECTORS AND THE POST OF DEPUTY CHAIRMAN, MEDICAL ADVISORY COMMITTEE (DCMAC) Like I mentioned earlier, we live in a ludicrous society. There is little respect for order, and people appear to be more at home with anarchy than sanity. Let’s go back to the structure of a teaching hospital. There are three directors in a teaching hospital – Director of Administration (DA), Head of Clinical Services (HOCS, also known as Chairman, Medical Advisory Committe - CMAC), and the Chief Medical Director, who is the Chief Executive. The DA handles purely administrative matters, while the CMAC handles issues related to patient care. The CMD, of course, is their superior and serves as the CEO. This ensures that patient care is not sacrificed on the altar of administrative issues and vice versa. There are assistant directors in areas such as nursing, finance, works, and so on. This creates a visible chain if command within the hospital. The yearning of JOHESU is that their members be promoted to Director Cadre within the hospital setting. Knowing the Nigeria we live in, no director will be answerable to another within the same ministry or agency. A director, as far as I know, is only answerable to a permanent secretary. Now unless the titles of the CMD, DA and CMAC are changed, what will become of the hospitals when we have, say, 100 other “Directors” walking the corridors of the teaching hospital? And if you make all the CMDs in Nigeria permanent secretaries today, what will become of the Ministry of Health? For surely, such permanent secretaries will only report to the Minister! And how many ministers can we have at once? This whole debacle is directly related to the quest for salary increase, if u ask me. How many other government institutions have a hundred Directors within them as will be the case if this request is granted? Now the irony of it is that if this policy is approved, many doctors would also proceed to become directors. But our question is this – what benefit does it add to the system? None! And what does it take away? First, increased wage bills for the government. Secondly, increased anarchy in a system that is already bastardised by unprofessionalism. Thirdly, many “directors” will abscond from their duty posts since they would now be too big to sit in a clinic, laboratory, pharmacy or hospital ward. And who would bear the brunt of it all? Our dear old black oil. Raped, plundered and wasted, but still faithful. Nothing can be more senseless. If people wish to pursue an increasein pay, they are free to do so. But for Pete’s sake, let there be order in the hospital! On the appointment of DCMACs, JOHESU would simply not hear of it. Their argument is that it is unlawful; possibly because it is not written out in the document that created teaching/ tertiary hospitals in the country. But they forget to add that there are circulars from the government that support the creation of the office. Also, the law gives the boards of the teaching hospitals powers to take measures that ensure the smooth running of the hospitals, and these appointments are made by the boards! The job of the CMAC is indeed a tasking one and like every other Director in the civil service, he/she should have deputies to help with functions. I think that is simple enough. SKIPPING OF GRADE LEVEL 12 The Ministry of Health has issued a circular stating that contrary to what was hitherto obtained, where all other staff of the Ministry skipped a grade level at some point in their careers except doctors, we should also be included. Though the Ministry is still in court over the legality or otherwise of skipping, it is only fair that all members of the family enjoy what our father, the Federal Government, has brought home from his hunting adventures. Abi the oil money don finish? Na on top our head una wan talk say the money no go reach again? Lai lai!. I don’t believe this should be a matter of contention. What is good for the geese is also good for the gander. THE TITLE OF CONSULTANT AND THE QUEST FOR SPECIALIST ALLOWANCE AND TEACHING ALLOWANCE 4 Likes |
| Health › Re: Doctors’ Strike Cripples Hospitals Nationwide by emmaliver(m): 10:25am On Jul 02, 2014 |
THE TROUBLE WITH THE NIGERIAN HEALTH SECTOR For a longtime now I have come across so many articles and reports in the national dailies and in online social media on the rife in the health sector which centers mainly on the row between doctors and non-doctors working in the healthcare system. Most of these reports and articles, mostly lopsided, have one common denominator, presenting the Doctor as an enemy of the people and the manner of their submissions is such as to draw undue sympathy from the unsuspecting public. But for the neutral members of the society who have had cause to have sufficient contact with the hospital environment, I’m not talking of some quasi journalists, they need not be told, if there are, who the Angels and Demons are. This article is not aimed at indicting or exonerating any of the two combatant parties as both have had a fair share of the blame, and honestly, the deplorable state of our healthcare system is not as a result of the performance of the health workers, but it is a component of an overall failed system called Nigeria which the current government is still trying to salvage amongst other difficult challenges. Considering the lines along which the divide has been made, I shall delve into an inquest of some of the key issues at stake, mostly those that affect the general public, and this I will do by placing the Nigerian Doctor on one side to be reviewed alongside a few of the numerous “health professionals” working in the healthcare system with due consideration to the most important person in the system, the Patient. I shall concentrate mostly on the tertiary healthcare institutions where the bulk of the rivalry is most felt. The Patient and the Hospital: Let us begin from the beginning. A healthy person falls sick and needs to regain his health and function properly. He says to himself, “I don’t feel well enough, I need to see a Doctor. May be I should go to the hospital tomorrow”. He sets out of his house with this principal aim. On getting to the hospital, he first gets to the reception, obtains a card at the Out Patient Department and then proceeds to see a Doctor (usually a Medical Officer) if his condition is one that necessitates a Specialists attention, he is then Referred to another Doctor, the Specialist (Consultant) for further treatment. On getting to the point of referral, the Record staff assist him in opening a folder containing case notes, and in the process of this, a Doctor (Consultant) is assigned to him. The entire process of obtaining a card and folder have no direct effect on the patient’s condition but help ensure proper documentation and recording within the hospital. He is then directed to the designated Specialist or Consultant Clinic where he is received by a Nurse who does further documentation and records his vital signs which may or may not be repeated by the Doctor. Then the patient enters the clinic to see the Doctor, his primary aim for coming to the hospital ab initio. The Patient, the Doctor and Other Health Workers: The Doctor begins by taking a complete history of the patient which includes his current complaints, previous health challenges, living condition, social habits, family history, drug history, financial capacity, religious and cultural beliefs, and then proceeds to do a complete physical examination of his entire body system, at the end of which the Doctor would have verified the patients complaints and identified any other problems unknown to the patient, before arriving at a Provisional Diagnosis. He then counsels the patient, draws up a treatment plan, which is to be strictly adhered to provided the patient is within the hospital environment, and automatically takes full responsibility for any problems encountered along the line. He finally schedules him for a follow-up visit to ascertain his response to treatment. This process of history taking creates a personal relationship between the Patient and the Doctor and this is where the confidence of a patient on the Healthcare system of a Nation is built; the Doctor-Patient Relationship. The treatment plan of the Patient, drawn by the Doctor, may or may not include; the investigations (or tests) both laboratory or radiological to be carried out, the drugs to be dispensed and the appropriate prescription, the additional care to be rendered outside the basic nursing care and the treatment orders to be followed, some of which he does himself (or via his subordinate Doctors) and others by the Nurses. There is no stereotyped outline of what must be done for every patient; investigations to be carried out, treatment to be administered or drugs to be prescribed lies solely at the discretion of the Patient and his Doctor. Apart from the Nurses, all other “Health Professionals” come into patient care when the Doctor’s plan involves them. Clearly, a patient has no business with the Radiographer if the Doctor’s plan does not involve radiography, neither does he have any business with the Pharmacist if the patient does not require any drugs, of course, not every patients require drugs. Therefore, it is safe to assert that if Patient Care is the sole interest of everybody in the Health sector, then the Doctor takes the Central stage in this service to Patients and must carry the Nurses along at every point in time, and together they look out for any other “Health Professional” that should be roped into patient care. Why then should the Doctor take the Central stage? Very simple. He has been trained thoroughly to do so. Invariably, the Doctor is naturally the undisputed leader of the Health team and only two classes of people can challenge this standing; the criminal minded ones pursing their selfish interests and the dim- wits incapable of any logical reasoning. On the Headship of the Hospital: Over time, the functional head of the tertiary hospital setting has been the office of the Chief Medical Director, CMD, and part of the Act establishing the hospitals specified that this position be held by a Medical Doctor. However, there has recently been a loud cry from other “Health Professionals” under the auspices of the Joint Health Workers Union (JOHESU) for the chance to also partake in the “enjoyment” of this office, as if to say it is a political office, a “National Cake” which should be shared equally to everyone in the scene, whereas, it is the most sensitive of all positions in the hospital setting, one with huge implications on the health of patients. The Medical Doctors on the other hand, insist that the office of the Chief Medical Director and the headship in general, of the Hospitals is their exclusive reserve. How true is this claim by the Doctors? Again, it is very simple. Healthcare is all about patient care, and in rendering care to the patient who is the main focus of everyone, the Doctor is the arrow head. He brings together the activities of all in the health care delivery system to bear fruit on the health of the patient. He has a broad-based and yet in-depth medical knowledge that enables him to function as a leader in patient management and take responsibility for the outcome. It is then indeed a funny ideology to expect the Doctor to maintain leadership of Patient Management and then cede the leadership of the Hospital Management to a Non-Doctor. Right thinking people would agree that whoever takes the blame should take the lead. Leadership is about responsibility, and Doctors embrace such responsibility mainly as it involves lives which they have sworn an oath to protect. Furthermore, JOHESU, a body comprising of other “health professionals”, support staffs and in fact all in the Hospital setting except Doctors, claim to be equal and allied to Medicine. But my question is, how is the clerical staff allied to Medicine? How can a support staff head the core members of the organization? Also, why should a “profession” that is “allied” to Medicine surmount Medicine? Can a Non-Lawyer become the Attorney General of the Federation? Why isn’t the office of the Vice-Chancellor made open to every staff in the University system since ASUU and NASUU both consist of “professionals”? How would ceding hospital leadership to JOHESU improve the health indices of our country? These are people that do not deal directly with patients, people that do not really understand the agony of patients which Doctors do. The saddest part is the extent they can go to press home their irrational demands. We have a documented occurrence of how they turned off power supply to the Intensive Care Unit during a JOHESU orchestrated strike action in a southeastern Teaching Hospital leading to death of patients on life support. This was an attempt to frustrate the Doctors’ effort to keep hospital services running while they were “striking”. How can people who have displayed this level of irresponsibility be allowed to head the Health sector? Again, God forbid! It is a common saying that Doctors are “proud”, and I insist, they have very just reasons to be, and when it comes to arrogance, the patients can tell who amongst Doctors and Nurses are more approachable. Doctors are a select class of elite and comprise the best brains of the society. Yes, the entry requirements into the profession and the medical training ensure that only the best emerge as Doctors. As such, the government has to understand that any arrangement that sees a Non-Doctor in a sensitive position to head Doctors in any Health related issue would be met with fierce resistance and the never ending tussle it will ensue will have detrimental effects on our nation’s healthcare delivery. In the interest of peace and decorum, the Federal Government has to dig in and ensure that the status quo is been maintained. The ear that will hear needs not be the size of a raffia palm. On conferment of Consultancy on other “Health Professionals”: A Consultant (Medical) is the title for a senior hospital-based physician or surgeon who has completed all of his/her specialist (Residency) training and has been placed on the specialist register (Fellow) in their chosen specialty. This level of Doctor joins the Civil service as a Consultant and automatically leads a team of Doctors comprising Residents, Medical Officers and House Officers who train under him. Currently, there has been an outcry by JOHESU to also be awarded Honorary Consultancy based on the fact that Doctors are been appointed as Consultants, why not they too. The concession of the government to this particular demand has led to the entire hospital going berserk in some centers. This was done against the warning of the Nigerian Medical Association that the introduction of such “alien” practices would be detrimental to the lives of patients and the results are showing. At the Nnamdi Azikiwe University Teaching Hospitals, it is been said that a “Consultant Pharmacist” invaded the wards with his team, cancelling patients prescriptions and also demanded that a Consultant Cardiologist remove a key drug in an inpatient prescription, on grounds that the drug has some known adverse effects. Another report has it that in Abuja University Teaching Hospital, the Ante- Natal Clinic was invaded by Nurses who decided to consult patients and make prescriptions, of which the Doctors left the clinic and the Patients were confused. Patients who sought to see their Doctors were told that there was a “Consultant Nurse” who does whatever a Consultant does. Also, in University College Hospital, Ibadan, stories had it that a Consultant Plastic Surgeon was barred from reviewing the surgical wound he created post- operatively because a “Consultant Nurse” had reviewed the wound earlier and was satisfied with her findings. Let us address one of these occurrences. It is grave ignorance for a Pharmacist to tamper with a drug prescription simply because he has looked through his drug formulary and has identified a known adverse effect of the drug when he/she has no knowledge of the processes involved in the making of diagnosis and prescriptions. Patient management is highly individualized. To make a prescription, the Doctors put many things into consideration viz; patient’s history and examination, financial cost of the drug, benefits against the risk of using the drug, other drugs to be administered etc. Sometimes the side effect of a drug is the desired effect needed in one patient but would remain a serious adverse effect in another patient. But no, the Pharmacist didn’t think in that line before cancelling prescriptions. I am not saying every doctor’s prescription is infallible. No. But if a pharmacist wishes to express concern over a patient’s prescription, he should discuss with the Doctor to sort out their concerns. This whole consultancy for non-doctors arose as a result of their quest to have better remuneration. I am not opposed to better remuneration for other health workers, but looking for cheap means to it at the expense of the lives of patients is grossly unacceptable. Why would you want to be a Specialist (Consultant) when you have no specialty, or you have a specialty in an area whose service is not needed? Even if a non-doctor must be a consultant that does not automatically make him/her a Doctor. We all know how to become a Doctor and age is no barrier. If non-doctors must immutably be made consultants, their duties and jurisdictions must be clearly spelt out and understood by all involved. A Consultant Nurse should be confined to Nursing Practice and she will be expected to enhance it, not to invade Medical Practice. She must ensure that the management plan of a Doctor is properly carried out, even if he is a House Officer. Unfortunately, the idea of non- doctor consultant emanates from the desire of these other “health Professionals” for position and better pay than the desire to meet any specific needs. For instance, a ward Nurse that does her duties properly becomes a Consultant, what extra services and improvement does that bring to nursing care? The fact that there exist non-doctor consultants in a few foreign countries does not explain why the government should channel huge sums of money into the payment of honorarium to consultants that add nothing to the existing system but chaos. The NMA have identified these unhealthy health policies and should do all it can to prevent it from killing Nigerians. On relativity of Wages: Another very important object of discord is the demand by JOHESU for a unified salary scheme for everyone in the health sector and that will see a close approximation of the eventual earnings of all in the sector. What else can be sillier? Need I remind us that in every organization there is usually an established strata. Even in heaven, there are Angels and Arch angels, and the angels are content with their positions and would not want to usurp the duties of the Arch angels either. People cannot obtain different qualifications, different expertise, subserve different needs and end up earning similar pay. No. That cannot happen. Why would a non-specialist insist on being paid specialists allowance? Why would a Non-doctor terrorize the government because he wants to be paid like Doctors? Where in the world is that obtainable? Relativity is sacrosanct and must be reflected both on the basic salaries and all allowances. Granted. Doctors are few. Very very few. The World Health Organisiation recommends that a Doctor should consult not more than seven patients in a clinic session and should pay maximum attention to their needs, but our environment see us in a situation where a Doctor consults over 40 patients in one clinic session, yet, he is underpaid compared to his colleagues even in nearby Ghana. There are less than 30,000 Doctors currently practicing in Nigeria subserving over 170 million Nigerians, and there is a dire need for more, but that will not push the Medical schools to take in everybody and churn out unqualified people as Doctors, neither will the Nigerian Doctor allow a Non-Doctor to tamper with the lives of patients. Doctors swore an oath to preserve lives and the NMA must see to it that the lives of Nigerians are safeguarded. If the Hippocratic Oath is to be taken serious, then the NMA must win this battle. More often than not, we are clear on the knowledge that it is injustice to treat equal people unequally, but it fails to come to our minds that, it is graver injustice to treat unequal people equally. This is not pride, it is a statement of fact. Doctors and Non-doctors in the Health sector are not equal and they cannot be treated as equal. There is a reason why some students work harder than others to become Doctors. Some sat for JAMB several times to achieve that, although many fail to do so and even some do fail out of medical school and end up as “other Health Professionals”. To eventually anticipate to be rewarded equally with those who triumphed where you failed is simply madness. The government must see to it that relativity is maintained. For if a Nurse or Pharmacist consults patient, not regarding quality of the consult, earns equally with a Doctor and even get a chance to head the Doctor, why then would one need to work harder to become a Doctor when he can easily become a Pharmacist? Tampering with relativity is a conscious attempt at breeding mediocrity, again at the expense of lives. If the Nurses and Pharmacists accept to be paid equally with the Lab “Scientist” and Janitors, it’s their own cup of tea, but paying Doctors and Non-doctors equally? God forbid! On the Physiotherapists’ demand to make first contact with Patients: According to Prof. K. E. Obidike, there are three reasons why patients go to see Doctors. Firstly, is to ascertain the causes of their complaints and resolve them. Secondly, is to identify any other health problems unknown to the patient, and again, resolve them timely, and finally, to have a baseline documentation of the patient as a reference for subsequent health issues. The second reason especially, answers the question as to why a Physiotherapist cannot make first contact with patients. Medicine is holistic, and the initial assessment of a patient takes the entire body system into account not just the presenting complaints. Therefore, Physiotherapists should remain Physiotherapist s and should come into action when consulted. Simp |
| Health › Re: Doctors’ Strike Cripples Hospitals Nationwide by emmaliver(m): 9:37am On Jul 02, 2014 |
NOTICE OF NATIONWIDE STRIKE by NARD Courtesy of Alfa Jamiyu Rising from their respective emergency delegates meeting, the National Association of Resident Doctors (NARD) and the Nigerian Medical Association (NMA), have called for an indefinite strike from 00.00hrs July 1st, 2014. Notice is hereby given to the general public to visit the hospitals and get healthcare from the consultant pharmacists, lab technologists, nurses, optometrists, physiotherapists and radiographers. These other healthcare providers will clerk you, examine you, interprete your lab results, interprete your radiographs/CT's, carry out your surgeries, give you appropriate drugs and nurse you back to health; (as has been legislated by the government of GEJ as represented by the SGF, in their recent Circulars). So, in effect, you will get your standard world- class care without the medical doctors, as recently declared by the FGN. Dont be afraid! In JOHESU we trust!!!!!! N/B: The general public is also by this notice informed that they must resist any attempt to discharge their relatives from hospitals, they should insist on getting healthcare from the other staff, since they even do more work than these "arrogant" doctors; as espoused in the Circular on job evaluation and description done in the health sector 4years ago. |
| Health › Re: Doctors’ Strike Cripples Hospitals Nationwide by emmaliver(m): 9:27am On Jul 02, 2014 |
publicenemy: these doctors are always taking advantage of their position in the society,peaple will lose their lives as a result of this but the doctors dont care....all they care about is their selfish interests....cowards.. your name has said who u are. public enemy 2 Likes |
| Car Talk › Re: Tips on How To Protect Your Car From Being Stolen This Christmas Period by emmaliver(m): 1:30pm On Dec 23, 2013 |
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| Business › Re: Profitable Small Business Ideas For Nigerians by emmaliver(m): 9:48pm On Dec 14, 2013 |
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| Phones › Re: Simple Guide For Airtel BlackBerry Plans On Non-bb Devices by emmaliver(m): 8:41pm On Dec 09, 2013 |
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| Politics › Re: G7 Govs, nPDP Are Comfortable With APC by emmaliver(m): 2:33pm On Nov 04, 2013 |
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| Romance › Re: 25 Warning Signs Of A Possible Breakup In Your Relationship by emmaliver(m): 7:10pm On Nov 02, 2013 |
[quote author=D-Explorer]Every relationship has its high and low moments. Even at times, not foreseen, things could suddenly change to a point of disbelief. Ugly surprises do occur in relationships but the fact remains that they do give us warning signs. Nobody wants a split in their relationship, hence, we ignore these signs especially when we either feel safe in it or we don’t want to let go. The important side to this is that, making a relationship work isn't a lone decision. It takes you-two to get at it – making efforts and showing commitment. No matter how unexpected a break-up seem to have happened, it always come along with alerts – various warning signs, and they could be silent or just too obvious even when you ignore them. In one of my most-read article – how to save a dying relationship , I highlighted proven and practical ways to revive a seemingly dead relationship and before making this content, I understood that every stage of a relationship comes with uncertainties and the possibility of surviving at such moments would depend on the strength of the both parties. It would be a matter of concern if you or your partner chooses to deal with it alone. Break-up do happen, even to promising relationships, it’s mostly prompted by contrary influence, incompatibility or inability to compromise some standards. Whichever way it comes, there are signs foretelling the possibility of a split in your relationship and from my experience as a relationship counselor, I've gathered 25 signs for both genders that should get your attention. * When his excuse is always the same or contradictory. * When he stops doing what he did to get you. * When you’re often compared to his ex. * When he loves his privacy. * When she starts keeping sensitive secrets. * When she makes important decisions without your consent. * When she gets mad at minor issues. * When you’re alone and nothing seems missing – You ran a whole day without his thought going through your mind? * When he introduces you as his friend and not his girl/woman. * When he no longer cares about important matters that concerns you. * When he always find a fault about you to defend/justify his action(s). * When you take your friends as more priority than him. * When he replaces regular calling with text messages. * When she’s not always happy around you. * When it’s only sex that keeps your relationship alive. * When he gives you no attention because of his friends or job. * When he’s not in any way jealous about your males or concerned about the calls you receive – This isn't insecurity, it only shows he's keenly interest and the fact that he can’t afford to lose you. * When he no longer seek your opinion or careless about them. * When she communicates less with you but complains more. * When she’s being controlled by her mother. * When he doubts every excuse/reason you give. * When she settles for you alone and avoids your family/friends. * No discussion about the future or he plans his future without you in the picture. * When she ask for a break regularly. * When both of you finds it difficult to make collective decision(s) or remain on the same page on important matters. These warning signs are for our caution. If you don’t give them good attention, it could result in a sudden break-up of your relationship. If you ever experience any of these disturbing signs, have a good discussion with your partner and try never to ignore it. In a relationship, you’re truly happy when your partner is happy. A one-sided affair will always find its way to hit the rock. The good side to this is that these signs can be swiftly identified; it’s either what he/she stops doing or what he/she starts doing. Whichever way, don’t let the negative signs be, don’t manage any, don’t prevent or ignore, cure them! Heal your relationship of little faults because it could form a breaking point for more trouble. SOURCE: http://www.coachdexplorer.com/2013/11/25-warning-signs-of-possible-breakup-in.html[/quote] |
| Jobs/Vacancies › Re: Federal Government Agency Recruiting 2013 by emmaliver(m): 12:10am On Oct 24, 2013 |
u3fine: Client : Federal Government Agency/Parastatal with emphasis on youth mobilisation requires the sservices of performance focused individuals to occupy the following positions. |
| Autos › Re: Free Vin Checks And Reports by emmaliver(m): 3:48pm On Oct 16, 2013 |
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| Autos › Re: Free Vin Checks And Reports by emmaliver(m): 3:10pm On Oct 16, 2013 |
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| Health › Re: Nation Wide Strike By Resident Doctors From 1st October by emmaliver(m): 6:27pm On Sep 30, 2013 |
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| Autos › Re: Free Vin Checks And Reports by emmaliver(m): 1:20pm On Sep 18, 2013 |
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| Autos › Re: Nearly Used Camry 03 Mod 4sale In Ph @920k Xle by emmaliver(m): 9:16pm On Sep 16, 2013 |
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| Autos › Re: Nearly Used Camry 03 Mod 4sale In Ph @920k Xle by emmaliver(m): 7:33am On Sep 16, 2013 |
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