Prof. Afekhibe Omoti is the Chairman, Nigeria Medical Association (NMA), Edo State Branch and a Professor of Ophthalmology in the service of the University of Benin Teaching Hospital (UBTH). In this interview with MICHAEL EGBEJULE in Benin City, he bares his mind on the disparity between medical doctors and JOHESU in the on going nationwide strike embarked by the union, the crisis at the Psychiatric Hospital, Benin and other sundry issues affecting the health sector. Excerpt:

 

WHAT is the state of hospitals in Edo State particularly in UBTH in view of the ongoing nationwide strike by JOHESU?

     First and foremost, the strike that is on is by all other categories of health professionals outside the medical profession. So that means, medical doctors are working. Doctors are not on strike that must be emphasized because what we have discovered overtime is that, whenever any group of staff in the hospital goes on strike, everybody assumes that doctors are on strike. Doctors are not on strike. First and foremost, all the other groups, the pharmacists, laboratory technicians, scientists and the rest of them, the nurses, physiotherapists and all the others are on strike.

 

     What we have is that federal hospitals are the ones affected by the strike; the state hospitals are not affected, so the state hospitals are working normally. The federal hospital coming to UBTH, UBTH is functioning to a reasonable level. Because we are doctors, we cannot to do everything, which everybody does. We have the capacity to do everything but we will not do everything. We will do what is reasonable. So, we are running our clinics, we are able to carry out some operations that are important, we are carrying out some emergency services, but all our patients clinics are functioning normally, some patients are being admitted and managed in the ward, in UBTH in particular. So, in general, I think UBTH is still functioning to a reasonable level.

 

      In Uselu Psychiatric Hospital, they are also functioning normally. The only problem we have was with Irrua Specialist Teaching Hospital, where some of the doctors were not motivated to make the extra effort to work, some of them, but, a few of them are working as we speak now. We are doing our best now to ensure that the people do not just suffer basically, people who are already our clients, when they come to see us, we are able to see them and offer them medical services as they have always had, nothing reduced compare to before.

 

How are doctors coping without JOHESUs on ground in hospitals to play their role generally?

     Interestingly, particularly in UBTH, we are doing very fine. I am an Ophthalmologist, interestingly the eye specialist have the ability to do everything in the eye. So, there is nothing we cannot do alone without any category of staff. The only problem is that, the number of doctors in the hospitals is few. The people who are the main number of people are the other staff. Let me be more practical, only about five percent, less than 10 percent of all the staff in the hospital are doctors. Over 90 percent are this other category of people. 

 

     So if you come to the hospital now and you are walking in the corridor, it will look as if the place is deserted. But the truth is this, go to the clinics, go to the theatres, the wards; you find that the doctors and the patients are there. The corridors are free, because the people who roam around the corridors who are this other staff are not around.

 

      For you to understand what that means is that, there are about 2,000 of them that are on strike. Imagine putting 2,000 of them into the hospital, into this small environment, everywhere will be filled up. Its not common to see doctors walking around the corridors, they are too busy, doing one thing or the other. When you enter the hospitals and you start looking at the corridors, you don’t judge with corridors, I will need to say this, because, many press men have come to UBTH, they will not go to the clinic, they will not go to the ward or theatre, they will go to the corridor and start filming corridor and say the hospital is deserted. Are we supposed to be working in the corridor? That’s not our place of work. I have seen it regularly in all the television stations in Edo State, and I am sure that is what is going on nation wide. And it makes us begin to suspect that maybe some of these pressmen have been compromised. In truth, the hospitals are not grounded, essential services are still going on and the doctors are not crying, they are able to cope with these services, they are very able to cope with it.

 

What necessitated the JOHESU strike may not be unconnected with discrimination by doctors over other health professionals?

     We should look at the main issues not the strike: number one, one of the request of JOHESU is that doctors who are called honorary consultants should not be if possible in any hospital, they should minimize that honorary consultants, the government should emphasize hospital consultant. In truth, this shows the highest level of ignorance, they have always accused us that we are the ones that dictate what happens in their professions. What is happening is that, they are the ones telling us (doctors) how we should function. Why do they think hospitals like University of Benin Teaching Hospital is called that name? It is called a teaching hospital, because, it is originally part of a university. The real people, who should handle this institution, are from the university. It is only because of convenience, putting the hospital under Ministry of Health, and Ministry of Education that this separation has come into play.

 

      An honorary consultant does every duty that a hospital consultant does. But he gets half the pay of a hospital consultant; because the university takes the other half. So, it is even far more beneficial for the hospital to have honorary consultants. And let us be clear, without the honorary consultants, these hospitals become general hospitals. There will not even be tertiary hospitals; it is the honorary consultants that make them ‘teaching hospitals’. The status of this hospital is dependent on the honorary consultants. It is the honorary consultants who are professors, that frequently you see heading the hospitals, and they are the ones that give the hospitals a status, because honorary consultants, being university lecturers also, need a continued undergoing training programmes to improve their skills, and then, they train resident doctors. Honorary consultants are more than essential, even more needed than they themselves in the JOHESU by far, that is number one.

 

     Number two, they say they do not want doctors to head the hospital anymore, they should also be allowed to head the hospital, I think that is very far from the truth. If a medical doctor is the leader of a health team; so why can’t he be the head of the hospital? Should the person who is under me in the health team now be over me? It does not make sense. And let us even look at it in another way: there are pharmaceutical companies, which were headed by pharmacists, doctors do not work in a pharmaceutical company, they are headed by pharmacists but most of them (pharmaceutical companies) have collapsed now because of mismanagement. Nobody has talked about that, pharmacists are trained to be able to formulate and make drugs, do research and find new drugs, but that is not what is happening in Nigeria, all they are doing is counting drugs in the hospitals. 

 

 

     We really do not need them, we need a few of them to supervise and maybe formulate a few things. But the people we need are technicians, because, if you count drugs, you don’t have to go to the university for six years to get a doctor – just to count drugs. Then, because you now find that, there is nothing you are doing, you now say okay, no, I want to head the hospital, simply because you have no job satisfaction in what you are doing. If pharmacists spend their training, the training government is giving them to formulate drugs, to manufacture drugs, by now; this country will be a better place. Because only the money we are spending, wasting on foreign exchange to import drugs into this country, we would not need to do that.     

 

      Look at the pharmaceutical companies, most of them have collapsed, do they (pharmacists) now want to come to the hospital so the hospital will collapse too? I can bet you, despite the underfunding in the hospitals, no hospital has collapsed. So, anybody who says NMA cannot manage the hospitals is not telling the truth because, under very difficult circumstances, doctors have managed all hospitals, and no hospital collapsed. Doctors do what they are trained to do, not something else. In Nigeria now, if you go to pharmacists, many of them are pretending to be doctors. And that bring me to the third point.

 

     The third point is that, they (pharmacists) say they want to become consultants. In Nigeria, we operate a British system and in a British system, everybody thus, are trained into his profession, but in America, everybody is trained and become a doctor, doctor this, doctor that. An American cannot mistake a medical doctor from a doctor of pharmacy or say, a doctor of laboratory, laboratory technician and all that. He (an American) would not make a mistake, the reason is that, a medical doctor has the title ‘MD’ after his name, and when a patient goes to the hospital in the United States, he says, ‘are you an ‘MD’? He (an American) asks specifically, and in addition, there is what they call litigation, the level of litigation is very high in America, and so, you dare not do what you are not supposed to do.

 

     In Nigeria at the moment, in almost every pharmacy, there are pharmacists pretending to be medical doctors and telling people they are doctors and treating them. There are people who are plaster technicians, they call themselves ‘orthopedic surgeons’, there are many male nurses, in fact, and most male nurses pretend and deceive the public that they are doctors. So if you now want to use legislation to make them consultants, what are you doing? You have simply assisted them to deceive the public even more and the people will not even know what they are looking for in the hospital.

 

You cannot distinguish one profession from the other, so quackery is what will be encouraged if we allow this to happen. 

 

      Every country must design its health programme, as it is peculiar to the people that they have. Nigerians are not as highly educated and litigation conscious as Americans. Even in Europe where they are highly educated, other categories of staff are not called doctors or consultants in the hospitals.

 

There are few that they may be but all these consultants that we are talking about are consultants – like contractor consultants from anywhere and they are not functioning normally in the hospital, and they know the limit to their responsibility. In Nigeria, give somebody one millimeter, he takes twenty-five miles, if you make these people consultants, they will claim that they are the medical consultants, which is not true and that is the reason why in a University set up now, all of them are trying to extend their four year programme which can actually be squashed to two year programme to six years so that they can say they are now doctors and they can resemble medical doctors.

 

What they do not realize is that, if we make the medical programme to be like the laboratory scientist or technician programme is, it will take like twenty years to finish that programme because, a doctor has to learn everything: he has to learn some pharmacy, some nursing, everything – there is no part of a medical care that a doctor is not trained in and that is the reason why, when a doctor heads an institution, he knows what is happening everywhere, put a pharmacist as the head of a hospital, he does not know what is going on in the theatre, he does not know what is happening in CSSD where instruments are sterilized, he is not involved in that, but a doctor is trained in all that. What is happening in the plaster room, he (pharmacist) does not know what is going on. He only knows what is happening in the dispensing of drugs, but a doctor knows everything everywhere.

 

That is the reason why, for a profession that handles life, this is not a mechanic workshop, where if you spoil the car, you can always repair it or go and buy another engine, there is no life to replace on a dead person, there is no duplicate for life. You cannot take chances and handover the health of Nigerians to people who do not know what they do and that is what we (medical doctors) are saying.

 

Many people are fighting for the benefit of few. Motivated simply, by envy of the medical profession that is all. That is the problem.

 

What is the position of NMA on this issue as it affects the health sector?

The position is clear; NMA expects that the government should do the right thing. NMA insists that everybody should stick to his own profession and be law abiding, that is what NMA has asked for, nothing else, if everybody should stick to his training, if you are a pharmacist, do what a pharmacist is expected to do, and not saying no, I want to be a doctor, if you are a nurse, do what a nurse is expected to do, not ‘I want to become a doctor’, if you are a laboratory technologist, please, stay in your laboratory and do your laboratory investigations, that is what you are trained and made to do, do not say no you want to start consulting and you want to become a consultant

 

The unending crisis at the Federal Psychiatric Hospital, Uselu Benin City is tearing the hospital apart, how has NMA been able to intervene to resolve the crisis?

    It is because of the problem we have in Nigeria. In Nigeria, everything has become cash and carry; even a cleaner can say he wants to be a permanent secretary. What has happened here in Nigeria is that, some people have gone to court, I cannot tell you under what circumstances, but they went to court and got judgments that go against the norms of the Nigerian society. So, people can go and get judgment or they go lobby the national assembly to get laws passed in their favour or they lobby government officials to achieve what they want but even they themselves know the truth, even now that JOHESU is on strike, the majority of people who come for treatment are JOHESU members and their families, why don’t they go and meet themselves to treat themselves since they feel that the doctors are not important?

 

      In fact, one of the greatest fallacies we have heard is that they can treat; the doctors only need to operate. I have never heard where a pharmacist is the one to make a diagnosis and treat people; he does not because he is not trained to do so. He is trained to know about drugs and what they (pharmacist) are doing is guess work, it is outright quackery, that is what they are doing, nothing else. 

 

   What is happening in the psychiatric hospital is very unfortunate. At the moment, its unfortunate that there is so much crisis in an institution between some doctors and their medical director, not really some doctors, actually, some staff because, there are doctors, pharmacists and other groups involved, on one against the management of the hospital, in truth, the Nigeria Medical Association is looking into the matter, a committee has already been set up and we are already taking evidence from both groups, and I also know that some of them have gone to court, so it will be prohibitive for me to comment on that matter.

 by MICHAEL EGBEJULE