Tuesday, July 22, 2014

Chimamanda Adichie: The Miraculous Deliverance of Oga Jona

“From Borno we go to Yobe. I want to meet the families of the boys who were killed. I want to visit the school. Fifty-nine boys! They shot those innocent boys and burnt them to ashes! Chai! There is evil in the world o!”

As soon as he opened his eyes, he felt it. A strange peace, a calm clarity. He stretched.  Even his limbs were stronger and surer. He looked at his phone. Thirty-seven new text messages – and all while he was asleep. With one click, he deleted them. The empty screen buoyed him. Then he got up to bathe, determined to fold the day into the exact shape that he wanted.
Those Levick people had to go. No more foreign PR firms. They should have made that article in the American newspaper sound like him, they should have known better. They had to go. And he would not pay their balance; they had not fulfilled the purpose of the contract after all.
He pressed the intercom. Man Friday came in, face set in a placidly praise-singing smile.
“Good morning, Your Excellency!”
“Good morning,” Oga Jona said. “I had a revelation from God.”
Man Friday stared at him with bulging eyes.
“I said I had a revelation from God,” he repeated. “Find me new Public Relations people. Here in Nigeria. Is this country not full of mass communication departments and graduates?”
“Yes, Your Excellency.” Man Friday’s eyes narrowed; he was already thinking of whom he would bring, of how he would benefit.
 “I want a shortlist on my table on Wednesday,” Oga Jona said. “I don’t want any of the usual suspects. I want fresh blood. Like that student who asked that frank question during the economic summit.”
“Your Excellency… the procurement rules…we need somebody who is licensed by the agency licensed by the agency that licenses PR consultants…”
Oga Jona snorted. Man Friday used civil service restrictions as a weapon to fight off competition. Anybody who might push him out of his privileged position was suddenly not licensed, not approved, not registered. “I don’t want you to bring your own candidates, do you hear me? I said I want fresh blood, I’m not joking.”
“Yes, Your Excellency,” Man Friday said, voice now high-pitched with alarmed confusion.
“Put that DVD for me before you go,” Oga Jona said.
He watched the recording on the widescreen television, unhappy with his appearance in the footage. His trousers seemed too big and why had nobody adjusted his hat? Next to The Girl from Pakistan, he looked timid, scrunched into his seat. She was inspiring, that young girl, and he wished her well. But he saw now how bad this made him appear: he had ignored all the Nigerians asking him to go to Chibok, and now The Girl From Pakistan was telling the world that he promised her he would go. He promised me, she said. As if the abducted Nigerian girls did not truly matter until this girl said they did. As if what mattered to him was a photo-op with this girl made famous by surviving a gunshot wound. It made him look small. It made him look unpresidential. It made him look like a leader without a rudder.  Why had they advised him to do this? He pressed a button on his desk and waited.
Violence was unfamiliar to Oga Jona. Yet when Man Monday came in, his belly rounded and his shirt a size too tight as usual, Oga Jona fought the urge to hit and punch and slap. Instead, he settled for less: he threw a teacup at Man Monday.
“Why have you people been advising me not to go to Chibok? Why have you people been telling me that my enemies will exploit it?”
“Sah?” Man Monday had dodged the teacup and now stood flustered.
“I am going to Chibok tomorrow. I should have gone a long time ago. Now it will look as if I am going only because a foreigner, a small girl at that, told me to go. But I will still go. Nigerians have to see that this thing is troubling me too.”
“But Sah, you know…”
“Don’t ‘Sah you know’ me!” This was how his people always started. “Sah, you know…” Then they would bring up conspiracies, plots, enemies, evil spirits. No wonder giant snakes were always chasing him in his dreams: he had listened to too much of their nonsense. He remembered a quote from a teacher in his secondary school:  ‘The best answer to give your enemies is continued excellence.’ What he needed, he saw now, was an adviser like that teacher.
“Sah, the security situation…”
“Have you not seen Obama appear in Afghanistan or Iraq in the middle of the night to greet American troops? Is Chibok more dangerous than the war the Americans are always fighting up and down? Arrange it immediately. Keep it quiet. I want to meet the parents of the girls. Make gifts and provisions available to the families, as a small token of goodwill from the federal government.” He knew how much people liked such things. A tin of vegetable oil would soften some bitter hearts.
“Sah…”
“From Borno we go to Yobe. I want to meet the families of the boys who were killed. I want to visit the school. Fifty-nine boys! They shot those innocent boys and burnt them to ashes! Chai! There is evil in the world o!”
“Yes Sah.”
“These people are evil. That man Yusuf was evil. The policemen who killed him, we have to arrest them and parade them before the press. Make sure the world knows we are handling the case. But it is even more important that we tell the true story about Yusuf himself. Yes, the police should not have killed him. But does that mean his followers should now start shedding blood all over this country? Is there any Nigerian who does not have a bad story about the police? Was it not last year that my own cousin was nearly killed in police detention? Let us tell people why the Army caught him in the first place. He was evil. Remember that pastor in Maiduguri that he beheaded. Find that pastor’s wife. Let her tell her story. Let the world hear it. Show pictures of the pastor. Why have we not been telling the full story? Why didn’t we fight back when The Man From Borno was running around abroad, blaming me for everything when he too failed in his own responsibilities?” Oga Jona was getting angrier as he spoke, angry with his people, angry with himself. How could he have remained, for so long, in that darkness, that demon possession of ineptitude?
“Yes Sah!”
 “You can go.”
He picked up the iphone and spoke slowly. “I want to expand that Terror Victims Support Committee. Add one woman. Add two people personally affected by terrorism. How can you have a committee on terrorism victims with no diversity?”
On the other end of the phone, the voice was stilled by surprise. “Yes Sah!” Finally emerged, in a croak.
He put down the phone. There would be no more committees. At least until he was re-elected. And no more unending consultations. He picked up the Galaxy, scrolled through the list of contacts. He called two Big Men in the Armed Forces, the ones stealing most of the money meant for the soldiers.
“I want your resignation by Friday,” He said simply.
Their shock blistered down the phone.
“But Your Excellency…”
“Or you want me to announce that I am sacking you? At least resignation will save you embarrassment.”
If those left knew he was now serious as commander-in-chief, serious about punishing misdeed and demanding performance, they would sit up. He ate some roasted groundnuts before making the next call. To another Big Man in the Armed Forces. They had to stop arresting Northerners just like that. He remembered his former gateman in Port Harcourt. Mohammed, pleasant Mohammed with his buck teeth and his radio pressed to his ear. Mohammed would not even have the liver to support any terrorist.  He told the Big Man in the Armed Forces, “You need to carry people along. Win hearts and minds. Make Nigerians feel that you are fighting for them, not against them… And when you talk to the press and say that Nigerians should do their part to fight terrorism, stop sounding as if you are accusing them. After all, let us tell the truth, what can an ordinary person do? Nothing! Even those people who check cars, if they open a boot and see a big bomb, what will they do? Will they try to subdue an armed suicide bomber? Will they pour water on the bomb to defuse it? Will they not turn and run as fast as their legs can carry them? Let’s start a mass education campaign. Get proposals on how best to do it without scaring people. When we tell Nigerians to report suspicious behavior, let’s give them examples. Suspicious behavior does not mean anybody wearing a jellabiya. After all, was the one in Lagos not done by a woman?” He paused.
“Yes, Your Excellency!”
“As for the girls, we have to go back to negotiation. Move in immediately.”
“Yes, Your Excellency.”
“I should not have listened to what they told me in that Paris summit. Why did I even agree to follow them and go to Paris, all of us looking like colonised goats?”
From the other end, came a complete and lip-sealed silence. The Big Man in the Armed Forces dared not make a sound, lest it be mistaken as agreement on the word ‘goat.’ Besides, he had been part of the entourage for that trip and had collected even more than the normal fat juicy estacode.
“I don’t want to hear about any other mutiny,” Oga Jona continued. “You will get the funds. But I want real results! Improve the conditions of your boys. I want to see results!”
The Big Man in the Armed Forces started saying something about the Americans.
Oga Jona cut him short. “Shut up! If somebody shits inside your father’s house, is it a foreigner that will come and clean the house for you? Is Sambisa on Google Maps? How much local intelligence have you gathered? Before you ask for help, you first do your best!”
“Yes Your Excellency.”
“And why is it that nobody interviewed the girls who escaped?”
There was a pause.
“By tomorrow night I want a report on the local intelligence gathered so far!”
“Yes, Your Excellency.”
Oga Jona turned on the television and briefly watched a local channel. Who even designed those ugly studio backgrounds? There was a knock on the door. It had to be Man Thursday. Nobody else could come in anyhow.
“Good afternoon, My President,” Man Thursday said.
Short and stocky, Man Thursday was the soother who always came cradling bottles of liquid peace.
This time, Oga Jona pushed away the bottle. “Not now!’
“My President, I hope you’re feeling fine.”
“I received a revelation from God. From now on, I will stop giving interviews to foreign journalists while ignoring our own journalists.”
“But My President, you know how useless our journalists are…”
“Will Obama give an interview to AIT and ignore CBS?”
“No, Your Excellency.”
“I know some of our journalists support Bourdillon, but we also have others on our side. I will beat them at their game! I want to do interviews with two journalists that support us and one journalist that supports Bourdillon. Find one that will be easy to intimidate.”
“But…”
“I want names in the next hour.”
“Yes, Your Excellency.” Man Thursday now stood still, lips parted in the slack expression of a person no longer sure what day it was.
 “Tell the Supporters Club to change their television advertisements. They should stop mentioning ‘those who are against me.’ I will no longer give power to my enemies. They should mention only the things that I am doing. I like that one with the almajiri boy. It shows Nigerians that I have helped with education in the North. They should make more advertisements like that.”
In response, Man Thursday could only nod vigorously but mutely.
Later, after eating vegetable soup with periwinkle and a plate of sliced fruits – he was determined to keep himself from looking like Man Monday – he asked Sharp Woman to meet him in the residence. Not in the main living room, but in the smaller relaxing white parlor. Sharp Woman was the only one he fully trusted. He had sometimes allowed himself to sideline her, when he had felt blown this way and that way by the small-minded pettiness of other people. She was the only one who had not allowed him to dwell too much on his own victimhood. Once, she had told him quietly, “You have real enemies. There are people in this country who do not think you should be president simply because of where you come from. Did they not say they would make the country ungovernable for you? But not everything is the fault of your enemies. If we keep on blaming the enemies then we are making them powerful. The Bourdillon people are disorganized. They don’t have a real platform. Their platform is just anti-you. They don’t even have a credible person they can field, the only major candidate they have is the one they will not select. So stop mentioning them. Face your work.”
He should have listened then, despite the many choruses that drowned her voice.
It was she who, a few days later, and after the four rubbish candidates stage-managed by Man Friday, brought the new PR people, Kikelola Obi, Bola Usman and Chinwe Adeniyi – when he first saw their names, he thought: and some crazy people are saying we should divide Nigeria. They were in their early thirties, with rough faces and no make up; they looked too serious, as if they attended Deeper Life church and disapproved of laughter. They started their presentation, all three taking turns to speak. They stood straight and fearless. Their directness and confidence unnerved him.
“Sir, we voted for you the first time. We felt that you would do well if you had the mandate of the people instead of just an inherited throne. We liked you because you had no shoes. We really liked you. We had hope in you. You seemed humble and different. But with all due respect sir, we will not vote for you again unless something changes.”
He nearly jumped up from his seat. Small girls of nowadays! They had no respect! As if to make it worse, one of them added that if the election were held today, the only person she could vote for was The Man From Lagos. Oga Jona bristled. That annoying man. Even if a mosquito bit him in his state, he would find a way to blame the president for it. Still, Oga Jona could see why these foolish small girls were saying they would vote for him. The man had tried in Lagos. But their mentioning The Man From Lagos was now a challenge. He would rise to the challenge.
“Sir, the good news is that Nigerians forgive easily and Nigerians forget even more easily. You have to change strategy. Be more visible. Stop politicizing everything. Stop blaming your enemies for everything. You have to be, and seem to be, a strong, uniting leader. Make sure to keep repeating that this is not a Muslim vs. Christian thing.”
Oga Jona cut in, pleased to be able to challenge these over-sabi girls. “You think Nigerians don’t know that it is mostly Christian areas that they are targeting in Borno? And what about all those church bombings?”
The three shook their heads, uniformly, like robots. They were sipping water; they had declined everything else.
“With all due respect sir, if you look at the names of bombing victims, they are Muslims and Christians. If God forbid another terror attack occurs, you have to come out yourself and talk to Nigerians. Stop releasing wooden statements saying you condemn the attacks. We will prep you before each public appearance. You have a tendency to ramble. That’s the most important thing to watch out for. Be alert when you answer each question. Keep your answers short. You don’t have to elaborate if there is nothing to elaborate. Stick to the point. If they ask you something negative, be willing to admit past mistakes but always give the answer a positive spin. Something like ‘yes, I could have handled it better and I regret that but I am now doing better, and am determined to do even more because Nigerians want and deserve results.’ You have to start reaching out beyond your comfort zone. Nigeria has talent. Look for the best Nigerians on any subject at hand, wherever they may be, and persuade them to come and contribute on their area of expertise. Especially the ones who have no interest in government work. Even one or two who don’t completely agree with you. Think of Lincoln’s Team of Rivals.”
“What?”
“Don’t worry, sir. The important thing is to reach out beyond your circle. Oga Segi was not a calm person like you. He even used to threaten to flog people. But he had a good network. Jimmy Carter is his friend. If he needed expertise from a university in Zaria or Edinburgh or Boston, he would pick up his phone and know somebody who knew or somebody who knew somebody who knew. But with all due respect, sir, you don’t have that. Bayelsa is a small place.”
These girls really had no respect o! He glared at Sharp Woman, who shrugged and muttered, “You said you wanted people who would tell you the truth.”
But he listened.
In his first interview, the words rolled off his tongue. Those girls had made him repeat himself so many times. “I want to apologize to the Nigerian people for some actions of my government. We could have done better. No country fighting terrorism can let everything be open. But we owe our country men and women honest, clear assurance that we are taking decisive action, with enough details to be convincing. I ask for your prayers and support. I have directed the security services to set up a website that will give Nigerians accurate and up-to-date information about our war against terrorism. I have also hired specialists to manage the flow and presentation of the information.”
And the words came easily when he shook hands with the parents in Chibok, simple polite people who clutched his hand with both of theirs. He should have done this much earlier; it was so touching. “Sorry,” he said, over and over again. “Sorry. Please keep strong. We will rescue them.”
The words were more reluctant when he wore a red shirt and asked to be taken to the gathering of The People in Red at the park. But he cleared his throat and urged himself to speak, particularly because, as he emerged from within his circle of security men, the People in Red all stopped and stared. Silence reigned.
“I came to salute you,” Oga Jona started. “We are on the same side. My government has made mistakes. We are learning from them and correcting them. Please work with us. Together, we will defeat this evil.”
They were still silent and still staring; they were disarmed. He thanked them and, before they could marshal their old distrust, he turned and left. That night, as he sank to his knees in prayer, he heard the muted singing of angels.

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Sunday, July 13, 2014

My Opinion about My Colleague's Opinion on the Current Doctors' Strike: The Legalization of Quackery by JOHESU and the Federal Government

Some time ago, I came across an article on the current strike called by the Nigerian Medical Association (NMA) written by Dr Omobude and posted on Nairaland. I posted that article here and promised to write my rejoinder in due course.

In what follows, I have highlighted the writer's words in blue, italicized words, and then followed up with my own thoughts in black, regular font.


My own contribution viz; "From the comments made by contributors, it seems most people appreciate the fact that medicine is one of the most sensitive (I am trying to avoid the word "most difficult" course of study in our tertiary institution largely because it deals with human life and the uncertainties (one is not sure if he will eventually become a doctor or not), even the best students in first year could be withdrawn the following year. When I was in school, over 400 of us gained admission to study medicine but less than 120 of us who gained admission together graduated. It is also a known fact that after several attempts at entering medical school, most students eventually settle for related courses like Medical Laboratory Sciences, Nursing, Physiotherapy, pharmacy (Note that a good number of students also choose these courses as their first choice course ab initio).


Medicine is recognized globally as a noble profession; a profession that, perhaps like no other, is capable of making the difference between life and death; a profession that brings man as close to God as he can possibly come without donning sacerdotal vestments. It is for this reason that becoming a doctor is an arduous, rigorous task, achieved not necessarily by the most brilliant minds but by the most steadfast and most disciplined ones. By conferring the qualification of MBBS on an individual and calling him a doctor, you are placing your life in his hands. You are saying that you are confident that he possesses the competence to see to your health needs and those of your family, including those of your unborn children and grandchildren. It is therefore an act of faith that you are making, and such an act of faith is not made lightly. It is for this reason that although many are called to study Medicine – including those who call themselves – only few are chosen to bear the name of doctors.



Having stated the above, it is crass injustice for someone who knew from the beginning that he could not study medicine (for reasons best known to him, be it academic challenges, time spent in the training amongst others) to now realize that the name "doctor" is dignifying, and hence, desires to be called doctor (and or consultant) because he works in a tertiary institution and has garnered some years of experience. This is comparable to technologists who refer to themselves as engineers simply because they know how to assemble machines. What matters most is the qualification and not the number of years spent assisting a medical doctor. I support that health care workers can and should aspire to whatever they want and to whatever extent. They can still be called doctors. All they need do is complete a Master’s degree program and a PhD. I know some Nurses who are professors, same with pharmacists. In the USA, in the state of Arizona and some other states, it is an offense to address yourself as "doctor" if you are not a medical doctor without stating your profession immediately ( there should be no room for patients to assume you are a medical doctor when you are not).


Indeed. I support a policy that allows deserving nurses, pharmacists, radiographers, and medical laboratory scientists/technologists to attain the peaks of their respective careers, without prejudice to the primacy of the position of the doctor in the hospital, in terms of protocol, governance, and salary structure. In effect, my position is that a pharmacist who has undergone the requisite post-graduate academic training can be addressed as a lord or even as a god, provided his lordship and godhead, in the context of the hospital environment, only empower him to become a close adviser to the Managing consultant in matters concerning the Consultant’s patient. It need not be emphasized that his purely advisory role means that the managing physician is under no compulsion to act based on his pharmacist’s advice. A situation where an allied health professional (what does that really mean?) attempts to arrogate to himself the power to interfere with a patient’s treatment plan without reference to the managing physician is chaotic, irresponsible, and inconsistent with the demands of the Hippocratic Oath.



Let me emphasize that a doctor will never fight to head a pharmaceutical company. We all knew what we wanted before we wrote UME (JAMB) .... This short cut approach must be rejected. I was in Microbiology 300L when I got admission into 100L medicine, I knew what I wanted. I had classmates who were nurses, medical lab scientist, who wanted to become doctors; they took UME again.


Of course a doctor has no business heading a pharmaceutical company. A doctor has almost no business in that setup, except if he also doubles as a pharmacist. A doctor is a health professional who has been trained to work with patients, to work on patients, and to work for patients. The patient is the centre of the doctor’s universe. The nurses and the pharmacists and radiographers and medical laboratory scientists in the hospital environment are satellites revolving around the doctor, waiting for him to activate any of them as needed, so that they can help out in the care of the patient by using their skills as far as the doctor requires them to use those skills and no more. What has led to this instability is that some nurses, pharmacists, and others have attempted to exit their own orbits and insert themselves into the doctor’s orbit as he revolves around the patient. Unfortunately, even if this move is well-intentioned (and in a minority of cases, I daresay it is), these allied health workers do not have the requisite training that will enable them sustain themselves in their desired orbit. As a result, this arrangement wherein a satellite becomes a planet creates a plethora of problems and solves none.

Remuneration of doctors should not be compared to any other allied health profession. Google is our friend and we can always ask. Is there anywhere in the world where pharmacists, medical lab scientists, nurses and others earn the same remuneration? If there is any, please let me know. It is quite unfortunate to see the pharmacists I once respected stoop so low, finding themselves in the nexus of abhorrent disgruntled elements of disappointed and frustrated persons fighting against not only medical doctors but themselves (because they are reducing the practice of pharmacy to drug dispensing). What happened to industrial pharmacy, what happened to drug formulation and research? I was once envious of a classmate who later became a pharmacist. While I was still doing my internship, she was done with hers (no thanks to our extended academic calendar of 6+X years as against hers of fixed 5 years), she was working in a pharmaceutical company, earning a fat salary, had an official car and a driver. Her remuneration and job description was very good and juicy, but that is her calling not for a medical doctor.


A pharmacist should earn all he is entitled to earn, and not a kobo less, as he discharges his duties in the pharmaceutical company. The pharmacist who works in the hospital however works as an aide to the doctor, and his earnings within that context should reflect the level of his relevance in that setting. Same goes for the nurses (who in my opinion should earn even more than the pharmacists and others because nurses are needed much more often and for much more diverse activities), medical laboratory technologists, radiographers, et cetera.



In every stratum of life, in every team, there is always a leader, one leader, that's why we have only one pope, only one Nigerian president, only one state governor, only one captain and indeed only one chief medical director (who must be a doctor) which must be earned and not gotten through the back door. Note that only doctors have been appointed Director General of WHO since inception, yet we have other health workers who work for WHO. The present Director General, Margaret Chan should be an inspiration to JOHESU members because she was a home economics teacher before going back to school to study medicine.


I already talked about how the patient is the centre of the doctor’s universe. The patient is like the sun. The doctor is like the earth. These “Allied Health Professionals” who comprise the Joint Health Sector Unions (JOHESU) are like the moon(s) that orbit the planet (earth) while the earth (or the doctor) orbits the sun (the patient). 



My sincere advise to JOHESU is to lead by example, they should propose an arrangement that gives health workers (apart from medical doctors) equal rights viz; the pharmacy technicians should be allowed to head the pharmacy department, auxiliary nurses and B.Sc. nurses should be paid exactly the same salary and have the same type of promotions (since they can all administer injections and dress wounds), laboratory technicians should be allowed to be the assistant head of a laboratory departments assisting a consultant pathologist. If they can successfully implement the above for 5 to 10 years, and the model works perfectly well, then maybe the federal government can look into their request. Indeed the patient care should be a team work involving the pharmacist, laboratory scientist, nurses with medical doctors at the centre. Any attempt to take the sole responsibility away from the medical doctor will lead to chaos and serious disaster.


I laughed out long, loud, and hard when I read the above paragraph. This paragraph is one of the reasons I decided to write my thoughts on the entire article. It attempts to expose the illogicality of the current position held by JOHESU and maybe the Federal Government wherein an “Allied Health Professional” (who is not a doctor, mind you) can become Chief Medical Director of a hospital. This position is not tenable, any more than it is tenable for a court clerk to be allowed to judge cases at a High Court simply because she has had an unblemished record as a Court Clerk for 20 years!





I must confess, the turn of events in recent years is not encouraging, it has a most negative effect on the already brain drain that has plagued the Nigerian health sector, what they should be fighting for(collectively, doctors inclusive) should be how to increase the slots for residency training, better remuneration and welfare package across board,how to promote research and get scholarships to further enhance skills and build career, cooperate with doctors to ease the admission of their children into medical school so that their desire can come into fruition. I believed in our generation, we must fight together, my friends who are pharmacist, physiotherapist and nurses know we are not the same, their "ogas" should stop the Tom and Jerry display of ignorance and comic. Yes, I respect them, I respect every other health worker, they have their role which must be respected and indeed the best patient outcome is in team work. The reasoning that doctors go on strike in order to increase private patronage is not only myopic but a serious neurological deficit on the part of those who have such reasoning. What will you say when pharmacist and lab scientists go on strike, where do patients buy drugs from( they don't only go on strike, but they frustrate the effort of anyone who choose to deliver care by switching off power generators, hiding surgical instruments, locking up stores amongst others). Yes, most doctors have private hospitals in order to meet the increasing demands in the health sector but pharmacist and others also own pharmacy shops and laboratories, committing the most heinous crimes of consulting, examining and treating patients in their shops which is not designated for such, oh what a lawless nation. Most patients have worsened their clinical condition and indeed died from such crimes. Permit me to call their act genocide of the highest order towards Nigerians.





It is worthy of note that the JOHESU folks, who masterminded this current imbroglio, have consistently turned a blind eye to the real problems bedeviling patients and Nigerian citizens in Nigeria – the hundreds of young women and girls who die every day at the hands of “chemists” and “nurses” and “pharmacists” while trying to take care of a certain OBGYN-related issue, the millions of people who are misdiagnosed as having “severe typhoid” and then saddled with prescriptions featuring the simultaneous administration of amoxicillin and ampicillin, the others who simply complain of pains and are then given 4 different types of NSAIDs at full doses, resulting in an upsurge in the number of bleeding PUD patients that present to us in the Emergency room, the native doctors whose signposts litter our streets and who have a potion that cures all diseases under the sun and even those ones afflicting the sun (of course, the potion cures all diseases by inducing renal failure - dead men do not fall ill). No. JOHESU sees nothing to fight in this. The Federal Government does not see the people who die from all these. 

Yet, these Nigerians are victims of a new kind of terror; the kind of terror that has been happening on the streets; the kind of terror that JOHESU is trying to get the Federal Government to unleash on our public hospitals – the terror that I can label the Legalization of Quackery; the establishment of a system wherein a Consultant nurse or Consultant pharmacist can arbitrarily interfere with a doctor's treatment plan, without the doctor's approval - a treatment plan that was arrived at after obtaining a thorough medical history and conducting a comprehensive physical examination (both of which a doctor and no one else is trained to do); the adoption of a policy that converts medical care from a focused enterprise undertaken by a team with a leader to a dangerously haphazard competition among very differently equipped individuals, at the expense of the patient.

This is the kind of injustice that patients and the entire Nigerian citizenry should reject with one voice. This is the kind of terror that should receive condemnation as loud and universal as that given to Boko Haram. It is the responsibility of every doctor to take whatever steps are necessary to defend and protect the lives of his patients. A very necessary first step would be the immediate Delegalization of Quackery in Nigerian Hospitals.



On the Doctors' Strike: When the Tail Wags the Dog

There has emerged in Nigeria a new kind of terrorism - the kind that dresses its mischief up as Freedom of Expression. This is the brand of terrorism that I see unleashed on Facebook and in some sections of the media. The terrorists are the ill-informed, the misinformed, the dis-informed, and those responsible for all the misinformation and disinformation. The victims of this terror attack are the patients whose unfortunate plight the terrorists are now using to prosecute their campaign of calumny against Nigerian doctors. 

Doctors working in Nigerian government hospitals recently proceeded on a strike action to press home their demands for a better (and fairer) working environment, one that recognizes the relative contributions of the doctor to the system vis-à-vis the so-called "allied health professionals"; one that recognizes the years of arduous training that goes into the production of a single medical doctor worth the name; one that recognizes the level of risk to which every doctor exposes himself in order to discharge the responsibilities imposed on him by society and by his Oath. But this strike was not the first step, as some would like the public to believe. The Federal Government had been approached and several meetings had been held; several promises were made and broken. But doctors knew the costs of a strike, any strike, to their image and their integrity. So the broken promises were forgiven; new MOUs were signed and again reneged upon.

The journalists who cry foul now were all quiet. Every one of them. They instead wrote beautiful stories about a certain First Lady whose use and abuse of a certain global language reminds one of the bushisms of President George Bush II. They did not see it fit to call on the government to renounce its culture of making promises and then unashamedly breaking them. They unleashed uncommon adjectives in describing the thievery of our politicians who smiled home as their bank accounts swelled. They toured hospitals in India and wrote about them in our dailies. But the agitations of the doctors were not newsworthy. They made no tail-lines, never mind headlines. At that time, the doctors were not small gods. No. They were just wallpaper whose complaints could easily be ignored.

Then, the so-called "Allied Health Professionals" deceived the government into agreeing to an arrangement that effectively allows virtually anyone in the hospital to tamper with patients' prescriptions without the prior knowledge of the doctor, while at the same time holding the doctor liable for anything that happens to the patient as a result of that tampering. In other words, some nurses, pharmacists, laboratory technicians, and medical records staff secured for themselves the fiat of the government to alter the treatment plans of patients without the notice of the doctor; at the same time, the doctor's responsibility for any untoward event that happens to the patient is upheld. Aside from the obvious illogicality of the move, could anyone have come up with any better prescription for chaos and terror than the "Allied Health Professionals" have done?

The Nigerian Medical Association and all Nigerian doctors nationwide are in solidarity with their patients and with all and sundry. This strike has been called to defend the patient from the mediocrity that JOHESU seeks to impose on the Health Sector. This strike has been called because to do otherwise is tantamount to a repudiation of our Oath.

The patient comes to the hospital and entrusts his life to the hands of the doctor. The doctor treats that life with all the dignity it deserves - that is what he spent six years plus in a Nigerian university getting trained to do. In the course of protecting that life, he uses the tools at his disposal, and these tools include nurses, pharmacists, laboratory technologists, radiographers, etc. It is not compulsory that he uses each and every one of those tools in attending to each patient. He uses the tools available to him on a need-to-use basis. His training includes sharpening his discretion to know when to use what. A situation where the tools decide that they are as good as their operator is analogous to a situation wherein the tail wags the dog.



Therefore, in order to ensure that JOHESU does not turn our hospitals into abattoirs, Nigerians worldwide should task the Nigerian government to do the needful. The patient needs the doctor. The doctor needs the nurse. The doctor may sometimes need the others. That is how it is. Simple. Very, very simple.

Saturday, July 12, 2014

The Current NMA Strike: A Colleague's Opinion

On July 1, 2014, the Nigerian Medical Association once again rose in defence of the practice of Medicine in Nigeria, and took a step designed at preserving our hallowed practice from the jaws of mediocrity, which seem to have taken all else in this nation. The NMA is leading a struggle to attempt to prevent the Joint Health Sector Unions (JOHESU) from infecting our practice with that bug that we call the Nigerian factor. 


I found the following article on Nairaland and thought I should share it on my own space. It was written by a well-respected colleague, Dr E. Omobude. While I do not agree with all the contents (and will therefore issue a clarification of my own position in future), I think it is important that we understand that the responsibility for the current strike lies with the Federal Government and with the JOHESU folks who fired the first salvo. Happy reading. 


THE JOHESU BROUHAHA ....... MY PERSONAL OPINION

Commenting on a topic, "most preferred course of choice in Nigerian Universities". According to the write up, medicine came first as the most preferred choice even though it is only offered by about 34 of the about 124 universities in Nigeria. Most contributors gave different reasons why it is most preferred, ranging from remuneration and prestige to excellence.  My own contribution viz; "From the comments made by contributors, it seems most people appreciate the fact that medicine is one of the most sensitive (I am trying to avoid the word "most difficult"wink course of study in our tertiary institution largely because it deals with human life and the uncertainties (one is not sure if he will eventually become a doctor or not), even the best students in first year could be withdrawn the following year. When I was in school, over 400 of us gained admission to study medicine but less than 120 of us who gained admission together graduated. It is also a known fact that after several attempts at entering medical school, most students eventually settle for related courses like Medical Laboratory Sciences, Nursing, Physiotherapy, pharmacy (Note that a good number of students also choose these courses as their first choice course ab initio). 

Having stated the above, it is crass injustice for someone who knew from the beginning that he could not study medicine (for reasons best known to him, be it academic challenges, time spent in the training amongst others) to now realize that the name "doctor" is dignifying, and hence, desires to be called doctor(and or consultant) because he works in a tertiary institution and has garnered some years of experience. This is comparable to technologists who refer to themselves as engineers simply because they know how to assemble machines. What matters most is the qualification and not the number of years spent assisting a medical doctor.

I support that health care workers can and should aspire to whatever they want and to whatever extent. They can still be called doctors. All they need do is complete a masters degree program and a PhD. I know some Nurses who are professors, same with pharmacists. In the USA states of Arizona, and some other states, it is an offense to address yourself as "doctor" if you are not a medical doctor without stating your profession immediately( there should be no room for patients to assume you are a medical doctor when you are not). Let me emphasize that a doctor will never fight to head a pharmaceutical company. We all knew what we wanted before we wrote UME (JAMB) .... This short cut approach must be rejected. I was in Microbiology 300L when I got admission into 100L medicine, I knew what I wanted. I had classmates who were nurses, medical lab scientist, who wanted to become doctors; they took UME again. 

Remuneration of doctors should not be compared to any other allied health profession. Google is our friend and we can always ask. Is there anywhere in the world where pharmacists, medical lab scientists, nurses and others earn the same remuneration? If there is any, please let me know.

It is quite unfortunate to see the pharmacists I once respected stoop so low, finding themselves in the nexus of abhorrent disgruntled elements of disappointed and frustrated persons fighting against not only medical doctors but themselves (because they are reducing the practice of pharmacy to drug dispensing). What happened to industrial pharmacy, what happened to drug formulation and research? I was once envious of a classmate who later became a pharmacist. While I was still doing my internship, she was done with hers (no thanks to our extended academic calendar of 6+X years as against hers of fixed 5 years), she was working in a pharmaceutical company, earning a fat salary, had an official car and a driver. Her remuneration and job description was very good and juicy, but that is her calling not for a medical doctor.

In every stratum of life, in every team, there is always a leader, one leader, that's why we have only one pope, only one Nigerian president, only one state governor, only one captain and indeed only one chief medical director (who must be a doctor) which must be earned and not gotten through the back door. Note that only doctors have been appointed Director General of WHO since inception, yet we have other health workers who work for WHO. The present Director General, Margaret Chan should be an inspiration to JOHESU members because she was a home economics teacher before going back to school to study medicine.

My sincere advise to JOHESU is to lead by example, they should propose an arrangement that gives health workers (apart from medical doctors) equal rights viz; the pharmacy technicians should be allowed to head the pharmacy department, auxiliary nurses and B.Sc. nurses should be paid exactly the same salary and have the same type of promotions (since they can all administer injections and dress wounds), laboratory technicians should be allowed to be the assistant head of a laboratory departments assisting a consultant pathologist. If they can successfully implement the above for 5 to 10 years, and the model works perfectly well, then maybe the federal government can look into their request.

Indeed the patient care should be a team work involving the pharmacist, laboratory scientist, nurses with medical doctors at the centre. Any attempt to take the sole responsibility away from the medical doctor will lead to chaos and serious disaster.

I must confess, the turn of events in recent years is not encouraging, it has a most negative effect on the already brain drain that has plagued the Nigerian health sector, what they should be fighting for(collectively, doctors inclusive) should be how to increase the slots for residency training, better remuneration and welfare package across board,how to promote research and get scholarships to further enhance skills and build career, cooperate with doctors to ease the admission of their children into medical school so that their desire can come into fruition. I believed in our generation, we must fight together, my friends who are pharmacist, physiotherapist and nurses know we are not the same, their "ogas" should stop the Tom and Jerry display of ignorance and comic. Yes, I respect them, I respect every other health worker, they have their role which must be respected and indeed the best patient outcome is in team work.

The reasoning that doctors go on strike in order to increase private patronage is not only myopic but a serious neurological deficit on the part of those who have such reasoning. What will you say when pharmacist and lab scientists go on strike, where do patients buy drugs from( they don't only go on strike, but they frustrate the effort of anyone who choose to deliver care by switching of power generators, hiding surgical instruments, locking up stores amongst others). Yes, most doctors have private hospitals in order to meet the increasing demands in the health sector but pharmacist and others also own pharmacy shops and laboratories, committing the most heinous crimes of consulting, examining and treating patients in their shops which is not designated for such, oh what a lawless nation. Most patients have worsened their clinical condition and indeed died from such crimes. Permit me to call their act genocide of the highest order towards Nigerians.

On this note, I appeal to the federal government to call a spade a spade, to consider the sufferings of the poor patients and do the needful. Medical doctors and indeed the patients deserve more than this ill treatment. 

Long live NARD
Long live NMA.
Long live the Federal republic of Nigeria.


Dr Eilojie Omobude
MBChB.
Immediate Past ASG ARD, UBTH.
Former NiMSA president


References: 1. http://www.nytimes.com/2011/10/02/health/policy/02docs.html?pagewanted=all&_r=0
2. http://en.m.wikipedia.org/wiki/World_Health_Organization#Governance_and_support
3. http://en.m.wikipedia.org/wiki/Brock_Chisholm
4. http://en.m.wikipedia.org/wiki/Hiroshi_Nakajima
5. http://en.m.wikipedia.org/wiki/Gro_Harlem_Brundtland Former prime minister of Norway 
6. http://en.m.wikipedia.org/wiki/Lee_Jong-wook
7. http://en.m.wikipedia.org/wiki/Anders_Nordstr√∂m
8. http://en.m.wikipedia.org/wiki/Margaret_Chan
9. http://www.forbes.com/pictures/efkk45hlhe/no-1-best-paying-job-anesthesiologists/
10. http://www.telegraph.co.uk/finance/personalfinance/9834351/Best-paid-jobs-in-the-UK.html?frame=2465310
11. http://en.m.wikipedia.org/wiki/Johns_Hopkins_Hospital#Dean.2F_CEO_of_Johns_Hopkins_Medicine
12. http://en.m.wikipedia.org/wiki/Harsh_Vardhan_(Delhi_politician)
13. http://www.nairaland.com/1800627/most-preferred-courses-nigerian-universities
http://en.m.wikipedia.org/wiki/Margaret_Chan