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Nigerian Medical Personnel as Merchants Of Death: A Rejoinder to Mr. Ikechukwu A. Ogu By Dr. Abdullahi Dahiru Permit me to respond to an article with the title: “Nigerian Medical Personnel as Merchants of Death” written by a legal practitioner called Mr Ikechukwu A Ogu which appeared on gamji com. Merely browsing through the article, one will think Mr. Ogu is trying to draw the attention of the Nigerian medical personnel to some of the misdemeanours occurring in health institutions in Nigeria, but perusing through the whole article, one will realise that the writer is just trying to denigrate medical personnel and deceive the gullible into believing that medical personnel are “merchants of death”. The purpose of this essay is to correct some misconceptions about medical practice in Nigeria depicted by Mr Ogu’s article . He started by telling a story reported by one of the dailies on “how a callous attitude of a Doctor and nurses at Asokoro General Hospital caused the death of a baby but has not given us sufficient information to determine whether the baby died due to “input made by heartless and mercenary medical personnel”, or the baby died from our causes that are not the fault of the medical personnel. He continued to say that “ the need to “care” for the sick is given prominence in the training of medical personnel universally”, and added that “ unfortunately we have in Nigeria the reverse of what ought to be” and told us how his mother was treated “shabbly”in a private hospital by an “auxiliary nurse”. It is true that the care of patients is given prominence in medical practice and If Mr. Ogu will be sincere enough, he will admit that most medical practitioners adhere to that principle. Medical personnel are not infallible, and malpractice committed by a minority section of the personnel, should not lead someone to casting aspersions on the good reputation of the whole profession. I am unclear to what Mr Ogu called “maltreatment, because he has not given us enough information to substantiate his claim. Mr Ogu continues his attack on medical practitioners by saying “a doctor should attend to an emergency case in preference to other cases”, and gave a story on how “a woman with an advanced stage of pregnancy was rushed to one of the General hospitals in Abuja with excruciating pains” and told us that “alarmingly the doctors at the hospital refused to attend to her until had completed their “ward round”. The practice in most maternity units is for the pregnant woman to be attended to first by a midwife. The midwife makes an assessment of the patient. If the woman is in labour she is admitted into the labour ward and subsequently monitored by the midwife and the Doctors till delivery. Often the patient delivers in the hands of the midwife if the labour is not a complicated one. If the case is not labour, the midwife directs her to the appropriate unit in the hospital for prompt attention. It is not only when patient is “writhing in pains” that his case is considered an emergency. Often a patient may not look seriously sick but he may have life threatening condition. Ward rounds are not casual activities where a Doctor just goes round just to greet patients. It is meant to reassess patients on admission in wards and possibly review their medications. The Doctors in the wards in the case narrated above by Mr. Ogu may be attending to equally emergency cases in the wards. Whereas Mr. Ogu may not have known the rationale of doing a caesarean section, I think that is why he made this hilarious accusation: “another dangerous incidence in our public hospitals is the haste with which gynaecologist and obstetricians prescribe caesarean sections for pregnant women in labour” , and goes on to say that the “ widely held suspicion is that they are widely guided by pecuniary considerations because surgeries usually attract higher bills from patients” and suggested to Doctors to use “injections for stimulating labour”. I think a legal practitioner should not base his arguments on “widely held suspicion” but on concrete evidence and this has also demonstrated his profound ignorance on the subject. Doctors do not conduct any surgery for pecuniary reasons but rather as a life saving procedure. The joy of the medical personnel is not only to deliver the baby, but to ensure that the baby and mother are healthy. When labour is prolonged or obstructed the baby can be delivered, but with severe sequel like birth asphyxia leading to cerebral palsy[ a form of mental retardation] or rupture of the patient’s womb and subsequent death of the mother. Surgeries are only done when there is clear indication and the surgery must remain the best or the only option available. Some of the reasons why a pregnant woman will undergo caesarean section include malpresentation [the baby is presenting with buttocks, legs, hands or face], malposition, large baby that cannot be delivered vaginally, mother with narrow pelvis, placental abruption, low lying placenta, fetal distress, prolepses of the umbilical cord, pregnancy induced hypertension and eclampsia ,or a previous caesarean section with another complication. In Nigeria rate of caesarean section in most centres is less than 5 % of all deliveries compared to western countries where the rate is between15-30%.Maternal mortality is lowest in countries where caesarean section is high and vice versa. . When caesarean section is done by trained personnel, cases of “surgical instruments forgotten and stitched up inside patients’ bodies” do not happen as Mr Ogu want his readers to fatuously believe. Induction or augmentation of labour can only be done when there no contraindication to vaginal delivery. Even then, the Doctor must make sure that the theatre is ready so that when the procedure fails, caesarean section is done immediately. Patients are not coerced to undergo any procedure in hospitals. The patient is usually counselled and the Doctor will get a written consent from the patient. Doctors in public hospitals do not receive any gratuity for doing any surgery, nor is any Doctor given an award for doing more surgeries than his colleagues. The fees paid by the patient does not go into the doctor’s account but goes to a revolving fund with which the hospital procures materials needed for the surgery like anaesthetic materials, sutures etc. He also accused Doctors of insisting that “unless a patient [usually comatose or close to death] to make deposit before any medical treatment will be given to them” .In this case it is not the fault of the Doctors. Public hospitals in Nigeria are owned by governments and medical care is also not free. The only solution I think is for governments to make all emergency services free. Mr. Ogu further accused Doctors of redirecting patients to their private clinics. The congestion in government hospitals make patients seek for care in private clinics. When a medical practitioners direct the patient to his clinic, the patient can complain to the hospital authorities where an appropriate action will be taken on the practitioner. He attacked the National Health Insurance Scheme [NHIS] saying that “patients are being misinformed about the coverage and are being misled into bearing the full cost of drugs and treatment ordinarily covered by the scheme. Often, patients are told that expensive drugs covered by NHIS are out of stock”. We should realize that the NHIS is a new program and like most programs in Nigeria is bound to have some problems especially at the initial stage. The program has started with federal government employees and gradually extending it to state and local government employees then to all Nigerians in general. At present only federal government employees are beneficiaries of the program. There may be some shortcomings in the implementation of the program. We should not look at the short comings and forget the merits. NHIS has ensured that beneficiaries have access to free consultation, essential drugs [not necessarily expensive ones] and free deliveries. It is with appropriate feedback from the beneficiaries to NHIS that the program will improve. Now, let us come to his accusation that medical personnel are refusing to treat victims of gunshot and accident victims until and unless they produce police report. I think this is not a problem caused by medical personnel, as even himself has admitted that “the Nigerian police brands every blood stained person a fleeing armed robber and has coerced medical personnel to observe same as an immutable law”. How can you blame some body for an offence you think he has committed under coercion of the police? I know an instance where healthcare personnel are put in police cells for two days just because they have attended to armed robbers without police report! Mr. Ogu continues with this vituperative remark: “probably owing to the prestige associated with the medical profession many misfits, bereft of the necessary qualities and psychological balance, have found their way into it” and suggested a psychological test to be carried out on entrants into medicine and nursing. He should know that psychological test will not determine who has the psychological balance to enter into any profession. Nobody carry any test for entrants into law and other professions. Even when a Supreme Court judge is to be appointed, nobody carry out any psychological test to determine if he is suitable or not. Why then should Mr. Ogu demand for psychological test to be done to entrants into medicine and nursing?. Medical schools train their students both in learning and character. Students are constantly monitored through out the training. Even after graduation a Doctor is given a temporary license and has to work for I year under supervision of 4 different specialists. The assessment during the one year training is mostly in character. A doctor that fails that assessment will not be fully registered as a medical practitioner in Nigeria. We need to direct complaints regarding professional negligence and malpractice by Doctors to the appropriate authority, either the hospital concerned or the Medical and Dental council of Nigeria [MDCN]which s the regulatory body empowered by law to regulate Medical and Dental practice in Nigeria. It has the Medical and Dental Practitioners investigating Panel and the Medical and Dental Practitioners Disciplinary Tribunal that adjudicate on cases of negligence or malpractice against any Doctor. The council may impose penalties for Doctors found guilty of misconduct ranging from admonishing or reprimanding a practitioner, suspending the practitioner or striking the practitioner’s name from the relevant register either permanently or for a determined period. In conclusion, while Medical practitioners are ready to always welcome genuine complaints regarding misdemeanors done in carrying out their duties, false accusations based on conjectures and ignorance should be thrown in to the dustbin where they rightly belong. I rest my case. DR Abdullahi Dahiru is a medical practitioner.
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