This article, which is the fifth in the series, continues to examine the major causes of disharmony in the health sector of Nigeria. The previous article identified and discussed a major cause; cravings for leadership.

 

Other causes include; One, lack of use of jobs description and organogram make the sector rudderless and chaotic making various segments dabbling way out of their jurisdictional competence. Nobody seems to know where his job begins and where it stops based on his intellectual and statutory ability. There is unnecessary confusion as to who heads a medical team among the key players; Nigerians with leadership craze. Doctors lead medical teams not because they have differential genetic superiority over others, but for competitive knowledge advantage. 

 

Two, inherent rivalry within the sector more especially among the top players; Doctors, pharmacists, nurses and now physiotherapists, psychologists, dietitians, radiographers, optometrists and lab scientists. Doctors are being seen as dominating the scene with born to rule and know it all mentality. That is what is being peddled on the surface. In reality this rivalry actually begins right from school where the minds of innocent students are being poisoned against a gigantic Grendel-like monster in the form of a Doctor whose influence needs a Beowulf for neutralisation. They therefore graduated with that convoluted mindset and self-imposed inferiority complex. Cultural and religious organizations even at the undergraduate level are segregated along such lines. 

 

The environment also contributed a lot where it recognizes and epitomizes only the almighty Doctor relegating others to the background. To an average man, every white-coat wearing hospital staff is a Doctor. Thus the other party reflexively adopts defensive mechanism manifesting as bizarre prefixes all over the place, curriculum redesign, academic calendar extension, demand to be consultants, relentlessly and desperately seeking for recognition. It is not uncommon to see other groups, including the lowest cadre, prescribing drugs other than over the counter ones or attempting to do surgical procedures as highlighted earlier. Communication between these groups is so poor and now is mostly through treatment sheets and consult forms, God bless you as a Doctor you donÂ’t check drug chart daily else your patient might go days without his medications. That is how bad it is. 

 

In the 2012 military Sci-Fi Battleship, Lieutenant Alex Hopper assumed command and re-enlisted retired veterans, old enough to be his grandparents who had fought battles when he was in diaper, unto the decommissioned USS Missouri to face alien invasion. They all followed his command simply because of his unique combat training without the slightest feeling of inferiority.

 

Three, there are grudges about discrepancies involving monthly wages among the various groups. All the other health workers consider it unfair the disproportionate remuneration to Doctors in the public hospitals. This also brings about the deliberate mystification between calls and shifts. Now, all hospital staffs are civil servants, however because of the nature of disease temporal unpredictability, they are required to be on ground 24/7. Since they are not cybernetics, issue of calls and shift arises which the employer compensate  to cater for their lost leisure hours. It is only Doctors that take peculiar call hours others have more humane calls or shifts. 

 

A Doctor comes to work at 8:00am and closes 4:00pm just like any other civil servants. When he is on call which in most tertiary institutions averages 4-week day call per month and one-week end call per month, however many units like Neurosurgery, Urology, Orthopaedic, Pediatric surgery, Special Care Baby Unit etc take daily call. What this means is that Resident comes to work 8:00am-4:00pm on a weekday and by that same day at 4:00pm call will start and continues up till the following morning 8:00am where he continues with work till 4:00pm when he finally closes and go home. Weekend call starts 8:00am Saturday until 8:00am Monday where again he continues until 4:00pm when he closes. This is mainly for the residents as the house officers or medical interns spend an average of 16 hours per day throughout their mandatory one-year stay. By calculation, a resident spends minimum of 112 call hours plus 160 regular hours per month and a house officer at least 480 hours during the same period. 

The House Officers although being the most junior doctor in a hospital setting, are pivotal for effective management of patients. They carry out all given instructions regarding optimal patient care. It is a pity that these senior staffs are continuously being relegated to do the work of porters for the sake of patients' care. At GL 10 they are denied teaching allowance and yet a very junior, including non-professional, hospital staff at GL 8 receives same. Doctors working in states or local governments work far more than this where you may have maximum of two Doctors per LGA or even one per 2 LGA. Down there one Doctor covers the whole 4 clinical departments. For house officers doing internship in states hospitals where you may have maximum of 4 interns per department, it is only left to be imagined. This is on the average and over simplification as Doctors donÂ’t actually have closing time until their patients are stable or lab procedures are completed. 

 

Ironically, the federal government pays for 40 units of call hours per month to all Doctors. A shift on the other hand requires 8-12 hour staff change. In the case of the nurses, they do 3 unequal shifts per day 8:00am-2:00pm, 2:00pm-9:00pm and 9:00pm-8:00am as morning, evening and night shifts on weekly rotating basis respectively. What this means is that if a nurse does morning shift this week, she receives 1-2 day work free off, then in the second week she will do evening shift where she will receive 5 days off and the third week will be her night shift routine after which she receives 9 days off. Nurses equally get a day off for any public holiday they work in. This is the same in all the level of hospitals no matter how small; they don’t get posted to any centre that can’t afford this, even if they do they only take one shift. On the average, therefore a nurse works for 168 hours per month as against a Doctor’s ≥272 hours (160 regular hours + ≥112 call hours) while the other health workers spent 170-180 hours per month. All others do calls or shifts similar to or slightly different from the nurses in addition to reduced regular work hours. 

 

I deliberately left out consultants and seniors nursing staff. Senior nursing staffs work only morning shifts. As mentioned earlier consultants direct the units during ward rounds, clinics, surgery, procedures and calls in addition to teaching and research. These are what the hospital and the university employed them to do. Consultants that are lecturers receive their basic salary and teaching allowance from the affiliated university, because they teach medical students who are under Federal Ministry of Education, while the teaching hospitals pay them clinical allowances. They are called honourary residents and consultants respectively. It is this dichotomy for ease of administrative work, some people want to exploit. They don't want research productive honourary consultants, but rather prefer academic redundant hospital consultants just like the way they currently are. Let's remind ourselves of the pillars of a tertiary hospital; they are research, advance training, clinical services and community service. 

 

Are the Doctors being favoured in wages? Let us look in to two identical salary circulars that emanated from the FG (National Salaries, Incomes and Wages commission) for CONMESS (Doctors) and CONHESS (others) dated 29th September and 8th December 2009 with reference numbers SWC/S/04/S.410/220 and SWC/S/04/S.410/Vol.II/349 respectively to base our analysis of relativity among health workers. The new salary structure eroded the relativity between Doctors, pharmacists and nurses from 4:2:1.7 to now 1:1:1 as we shall see subsequently. A fresh, i.e. entry point, BNSc Nurse and generalist/Registered nurse are permanently employed at CONHESS 07/02 (GL 08/02, the RN is initially employed at CONHESS 06/02 before promotion 6-12 months later to catch up with BNSc nurse) while Pharmacists, lab scientists and other degree holders are employed at CONHESS 08/02 (GL 09/02, but recently the first two are now employed at CONHESS 09/02 [GL 10/02]). A fresh Junior Resident (irrespective of years of working experience) or fresh Medical officer in Federal Institution is on CONMESS 02/02 (GL 12/02) while a Senior Resident is on CONMESS 03/03 (GL13/03).........

 

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