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Still In Defence Of The Nigerian Medical Personnel By Dr. Abdullahi Dahiru My earlier rejoinder to an article called “Nigerian Medical Personnel as Merchants of Death” written by Mr. Ikechukwu Ogu has tried to correct some of his misconceptions about medical practice in Nigeria. This article will explain some of the reasons why we have many problems bedeviling the health sector in Nigeria, and suggest ways of solving some of these problems. We all know that one of the major problem is the inadequacy of health care facilities in most part of the country especially in the rural areas. The tertiary health institutions [teaching hospitals and Federal Medical Centres] and the specialist hospitals are mostly located in urban centres, whereas the primary health centres [PHC] are located in rural areas. The PHCs and the General Hospitals mostly have dilapidated structures. Most of these centres, apart from the tertiary health centres, do not have the necessary equipment and manpower to make effective diagnosis and treatment of most ailments possible. Often a patient with minor ailment like malaria, has to seek for cure in the tertiary health centre; a case that can be treated at the PHC and the General Hospitals. This has lead to congestion and overcrowding in many Specialist Hospitals and tertiary health centers. Sometimes, a patient from a government health centre has to be referred to a private clinic for investigations like ultrasound scan, laboratory tests before diagnosis is made; just because the government health facility does not have those diagnostic equipment. Most medical personnel have poor remuneration compared to other workers in other institutions. This has lead to incessant strike actions in the health sector in demand of salary increase. The attitude of our people towards the medical personnel has vitiated service delivery in most hospitals. The relationship between the medical personnel and patient or his relations is supposed to be of harmony and not confrontation. Upon slightest misunderstanding, the medical personnel are called names by the patient or their relation. Patients accuse health care workers of ‘insulting them’. On deeper scrutiny, one finds the personnel is retorting back at the patient in self defence. What do you expect a nurse to say to a patient who called her ‘prostitute’ upon minor misunderstanding? Or consider a situation in which a Doctor is called a “heartless Doctor” by a patient relation just because the Doctor has asked the relations to excuse him, and allow him finish attending to another patient before attending to their own. The situation has deteriorated to a level where patient relations have caused serious havocs and wanton destruction to hospital properties like doors and windows ,just because they can claim to have been ‘provoked’ by the medical personnel. Several times, medical personnel have been beaten by patient relations. I know a case where a nurse had her two front teeth removed by a blow from a patient relation. I am not saying that the medical personnel are totally innocent in all cases, but mostly the patient or his relation usually narrates his own side of the story so as to exonerate him from all blame, and put the blame on the medical personnel. Most of the decisions taken by the medical personnel are perceived as being based on avarice and pecuniary reasons, not on professional knowledge. When a decision is taken for a patient to undergo surgery, the Doctor has to make several lengthy discussions with the patient relations before consent is given. Even in some states in northern Nigeria where caesarean section is free, patients are reluctant to undergo the procedure when labour is complicated .The patient usually presents to the hospital very late and consent is given at a delayed time, when nothing much can be done to save the patient’s life. A bleeding patient may be accompanied to the hospital by ‘retinue’ of relations. When the relations are asked by the medical personnel to donate a single pint of blood to transfuse to the patient, many of them will disperse from the hospital. The few ones that remain will give flimsy reasons as to why they cannot donate the blood and the patient may die in the process; because most of our hospitals do not have functioning blood banks. The police should take most of the blames regarding gunshot and accident victims; because of their unnecessary harassment to the medical personnel in cases where they have attended to these patients’ without police report. Some hospitals have now started co-operating with the police to establish police outpost units attached to the emergency units of their hospitals, so that in cases of accidents, police are easily notified and attention is given to the patient urgently. The prevailing economic hardship in the country has made many patients not able to pay the hospital fees. Consider a situation where the parents of a child with severe malnutrition are asked to deposit N5000 before being admitted to peadeatric emergency unit. We all know that the parents may not be able to pay this sum of money, because ab initio poverty may have contributed to the development of the ailment. The cumulative effect of all the factors I have mentioned above has lead to frustration and lack of job satisfaction in Nigeria’s health sector. Many medical personnel are resigning from their appointment with public health institutions, and getting employment either in western countries and the Middle East, or joining international Non Governmental Organisations [NGOs]. This has set in a dangerous vicious cycle of resignation of medical personnel from government hospitals, leading to more congestion and work overload, and further resignation of more medical personnel. Most public hospitals are now becoming more understaffed everyday. We should not forget the huge contribution of the traditional healers to mortality and morbidity in our hospitals. They use many medical jargons to cajole gullible client’s to buy their medications. Often, one hears them making advertisements on radio, television, newspapers, and in many streets of most towns in Nigeria. They can make whimsical claims of curing many ailments like diabetes, hypertension, impotence, pile etc. We know that many of these on concoctions are toxic to vital organs like the liver and kidneys. Equally harmful, is the practice of hawking orthodox drugs by illiterates in baskets under the blazing sun. It is customary for many patients to consult these people before presenting to hospital. Often the patient presents with complications and diagnosis is difficult, because the clinical features of the disease are masked by the effect of these drugs or concoctions. When the patient dies in hospital as a result of complications of ingestion of these medications, it is the medical personnel that is blamed not the herbalist or the drug hawker. Perhaps, the best solution out of our present predicament in the Nigeria’s health sector is not to put most of the blames on the medical personnel alone, but to try and address some of the problems mentioned above. Construction of more comprehensive health institutions especially in the rural areas and providing them with adequate equipment and trained personnel will reduce the congestion in General hospitals and tertiary health centres. These health centres should be able to treat minor ailments and refer complicated cases to higher centres for further management. Philanthropists, wealthy individuals, faith-based and corporate organizations can help government in this regard. Government should improve the remuneration of medical personnel in public hospitals, and provide them with other welfare packages like good accommodation. Scholarships should be given to deserving personnel for further training to improve both their knowledge and skills. This will help in reducing the brain drain from the health sector. The coverage of the National Health Insurance Scheme should be extended up to the local government level to make more people benefit from the programme; so that patients do not have to deposit money before being admitted to hospital. Even a small firm employing ten people can have a retainership account with a reputable hospital, so that their employees can always have consultation and even admissions without necessarily being asked for deposit any amount of money. Treatment for accident cases should be made free by the government. We need to always view decisions taken by the medical personnel on the patient’s problem as been based on scientifically proven evidence, and in the best interest of the patient, not on avarice or pecuniary reasons. Patients should not hesitate to seek for further clarification from the medical personnel when they are not clear with any decision. Paucity of health education has led our people to seek for remedy from traditional healers and drug hawkers. We need to enlighten our people more on the dangers of these drugs and concoctions, and people should also develop better health seeking behaviours like presenting early to hospital when they are sick, having regular medical check-ups, regular antenatal visits by pregnant women and prompt immunization of children. A regulatory body should be established to monitor the activities of traditional healers, so as to make their practice more scientific. All drug hawking should be banned. The Nigeria Police should reduce their harassment of medical personnel in cases where they have attended to accident victims without police report. We need to have legislation by the National Assembly to empower the medical personnel to attend to accident victims even without police report. However, in the interim, tertiary and specialist hospitals who receive most of these accident cases can co-operate with the police to establish police outposts attached to accident and casualty units in similar arrangement I have mentioned above. In cases of allegations of misconduct against medical personnel, it is common for people to say that “despite avalanche of complaints, nothing has been done to address our grievances”, but mostly, even where the complaints are genuine, they are not directed to the appropriate authority. As I mentioned in my previous article, complaint against any personnel regarding misconduct should be forwarded [usually in writing] to hospital where the act of misconduct is alleged to have taken place or to the relevant regulatory body like the Medical and Dental Council of Nigeria, Pharmacist Council of Nigeria or the Nursing and Midwifery Council Of Nigeria as the case may be. The hospital or the regulatory body will investigate and where the personnel are found to have committed an act of misconduct he will be punished accordingly. Medical and Dental Council, for example, can impose penalties ranging from admonishing or reprimanding a practitioner, suspending the practitioner or striking his name from the relevant register depending on the misconduct. The relationship between the patient and his relation on one hand, and the medical personnel on the other hand, should change from that of confrontation to that of harmony. Both of them must see themselves as partners trying to solve the patient’s problem. Finally, we must all know that effective health care delivery is not the responsibility of the medical personnel alone, but rather, it is the responsibility of all to make sure it is realised. DR. Abdullahi Dahiru is a medical practitioner and writes from Kano. Email: maikanodahiru@yahoo.com |