A few days ago a letter was written by the Nigerian Medical Association (NMA) and addressed to the Honorable Minister of Labor and Employment. The letter, which was cast as the NMA’s position regarding the demands of the Joint Health Sector Unions/Assembly of HealthCare Professional Associations (JOHESU/AHPA) from the Federal Government has drawn expected concerns, questions and condemnation from well meaning and discerning Nigerians. Sadly, this is how the Nigerian health sector has been reduced to – an arena for power play, egotism and suppression; unjustifiably meted out from one group of professionals to another.

 

Nigerians from all walks of life are understandably appalled that legitimate demands from a lawful association in exercise of their rights to seek better conditions of service could without pretense be so brazenly contested by their coordinate colleagues from the same sector. But this has become the lot of all other healthcare professionals in the hands of Nigerian medical doctors, represented by the NMA, especially in, but not limited to the public healthcare sector, who routinely suffer untold magnitude of disdain, disrespect and degradation, through the perpetuation of a tacit agenda to suppress and neutralize the relevance and professional aspirations of any other field of learning in the healthcare industry other than them. Nigerian medical doctors have continued to advocate an atmosphere of destructive dominance, engendering an unhealthy culture of class and elitism to the detriment and disservice of all other healthcare professionals. This letter is further proof of it.

 

A general overview of the NMA letter reveals an unmistakable and disturbing intent to meddle, interfere and obstruct. Do not give them this, and don’t give them that, don’t grant them this request, or that request, they don’t deserve anything, if you must review their pay, then you must increase ours as well, and yes we do also want our retirement age to be extended. In all, while the NMA not only failed, as they have always done, to justifiably prove why they don’t want professional and career advancements for their coordinate colleagues as is their right, and in line with International standards they would rather do anything to remain sole ‘beneficiaries’ of the professional gains of practicing in the Nigerian Health industry, as currently is the case, and as well, threaten resistance and chaos if their demands are not met. In other words, other professionals dare not make any demands, and if and when they do, the NMA must consider it tolerable with them before Government can grant any such demand. This medical imperialism by our self acclaimed professional over lords, against best practices, moral and professional decency in a nutshell is the main reason why the Nigerian Healthcare system is stagnated and in limbo. The reason why we are yet to lay a claim at the world stage even though we have the potentials.

For the benefit of members of the public, and avoidance of further misinformation and miseducation of the Nigerian masses, it is essential to state as follows:

 

That the group Joint Health Sector Unions/Assembly of HealthCare Professional Associations (JOHESU/AHPA) with its constituent and amalgamated associations as a lawful body of Nigerian healthcare professionals reserves the constitutional rights of any labor/trade union to enter into any form of negotiation or bargains with its employers, in this case the Federal Government, on behalf of its members. It is therefore unsportsmanlike and shady for any group to call this right to question or infringe upon the existence, manner, process, procedure and contents of their negotiation, more so when this interference is not only aimed at selfish gains and intents, but to undermine the professional standing of others.

 

AHAPN Rejoinder To NMA Call To Federal Government To Reject Salary Adjustment For JOHESU Members 

 

It is out of place for the NMA to assume and conclude that members of another professional body do not have any justification to ask for salary scale adjustment, and even more atrocious and extreme to actively work against it. It is meddlesome for the NMA to agitate against a review of the Consolidated Health Salary Structure (CONHESS), and threaten the Federal Government as a result. This is the extent of obstruction; interference and hindrances we suffer. We wish the people’s court to adjudicate this, and make their informed conclusion.

 

Clinical/Patient Care in societies with advanced healthcare system is broadly structured into Medicine and Medical Applied sciences often times referred to as Allied Health. This is the branch of healthcare whose members includes critical disciplines such as the following in no particular order: Nurses, Pharmacists, Medical lab scientists/technicians, Optometrists, Physiotherapists, etcetera just to mention a few, and in Nigeria are represented by amalgamated associations under JOHESU/AHPA. These fields of healthcare and disciplines of learning are so broad in their rights that they are made up of different and varied specialties and sub-specialties. The field of Optometry for instance has specialties such as: Public Health Optometry, Cornea and Contact Lens Practice, Rehabilitative Optometry and Low Vision Care, Orthoptics, etcetera. 

 

So also are all the other medical field or body of discipline categorized under Allied Health. Being concerned with, and based on actual observation, prevention and treatment of diseases and deformities in patients rather than mere experimentation or theory they are therefore essentially and wholly Clinical in nature, and certainly hospital based. Unfortunately, it is only in our clime that Medical doctors/Physicians claim expertise and mastery in all of these fields, adopt to serve as over lords and dictators to trained experts, and then allege same to be International best practices. International best practices approve and allots that these different fields be autonomous and administered under different departments. 

 

Hence there is an autonomous Department of Optometry and not one under the Department of Ophthalmology. This is so irrespective of where and when it appears their different functions align. Nevertheless, every department, independent or autonomous, in a healthcare setting, hospitals and institutions work together for the good of the patient. The quest for autonomy is not a fight for space or territory. It is not a struggle for power and positions. This is how Nigeria gets to be at par with healthcare delivery in advanced societies. This is application of International best practice, to achieve best results with the right structure, for the good of the patient.

 

It is incumbent on the practitioners to aim for, and attain the highest heights possible in their pursuit of knowledge in their various advanced, robust, dynamic and elaborate fields. Becoming a specialist or a consultant therefore, having passed through all the necessary requirements and qualifications is only modest and needful, not just for the individual practitioner and the patients that may come under his immediate and remote care, but for the entire Nigerian Healthcare system. 

 

Why any group of professionals, the NMA in this instance, who claim the interest of the Nigerian patient should oppose this is beyond logic. 

 

A common dictionary definition of a Consultant is ‘a person who gives professional or expert advice.’ This level of expertise however requires an above basic qualification; feat different fields in healthcare outside of Medicine have evolutionally labored to put in place to be at par with standard International practices. 

 

A case in point is the Nigerian Postgraduate College of Optometrists. All over the world, there are Consultant Physicians, Nurses, Optometrists, Physiotherapists, Pharmacists etcetera. This can be achieved after completing the requisite postgraduate and fellowship trainings in a subspecialty, and fulfilling all professional requirements necessary for this stratum classification. These are not just mere titles. It is simply a level of expertise acquired through years of training and experience. And they all work in hospitals, which is their natural habitat, and not just in private practice. 

 

Open Letter On JOHESU/AHPA Response To NMA Call To Federal Government Not To Appoint Consultants From Other Health Professions

 

It would have been laughable, but it is sad how the NMA would rather that only Consultant Physicians work in hospital settings while other Consultants should NOT work in the same setting. Such hypocrisy and ignorance they argue is because ‘physicians may not need their services.’ It is however very pertinent to point out and clarify that these Consultants are essentially to meet the need of the Patients, not the Physicians. And to this extent we agree that the physicians may not need their services, but the Patients certainly do need these services!

 

In the UK National Health Services (NHS), our often used destination for advanced medical care, the most senior Allied Health Practitioners are referred to as Consultants in their disciplines. These people, a study of ‘Allied Health Professional as Consultants: An Exploratory Study in an Australian Context’ posits, are lead clinicians providing advice regarding diagnosis, prognosis, and treatment as well as carrying out specialist programs of care. From this same study, according to the NHS Job Evaluation Handbook the purpose of the naming convention was to consolidate and validate career progression reflecting the significance of the Consultant role. The aim of recognizing the Allied Health Professionals Consultants within the NHS include the strengthening of clinical leadership, provision of career opportunity, and retention of clinical expertise; to further drive creativity and innovation. 

 

Allied Health Practitioners Consultants have the extra responsibilities of education, leadership and research. This is what the NMA’s much-quoted International Best Practices look like. Allied Health Practitioners, as typical Nigerian Doctors would want the world to believe are not inferior human beings. They are not technical or support staff. They are much more than that. They form part of a team with the task to save and to preserve lives. Whereas other climes take pride in establishing the crucial importance of all members of this team, our Nigerian Doctors, fight, deprive, reduce and rubbish them.

 

Our Advice

In a seemingly enduringly culture of authoritatively misinforming and misleading the Nigerian public in their unhealthy posture of the ‘be all’ and ‘know all’ of the Health sector in Nigeria, a lot of misleading information has unabatedly been peddled in the public domain by the NMA and it is becoming embarrassing to all of us. 

 

Healthcare service is a teamwork with the aggregate efforts, abilities, expertise and know-how of all healthcare practitioner even down to the hospital cleaner brought to bare in order to save lives, there is no one face of the healthcare system. The team is the face of it. The tradition of excessively over reckoning the importance of one aspect of Medical personnel while underrating, undermining and undervaluing others is very dangerous and it is opposed to International best practices. When we cite International best practices, there is the utmost need to be factual in so doing, and not customize it to suit our group desires and aspirations.

 

Each and every healthcare personnel should be treated with regard dignity and value and not with contempt as inferior underlings with insufficient education or worthy aspirations. The integrity and strategic importance of our professions must be respected and allowed their right of place, growth and advancement without any meddlesomeness and characteristic obstructions of any kind. The value of our services should be appreciated and not undermined. It is not enough to say Live and let Live. Healthcare is teamwork.

 

Nigerian Doctors under the aegis of their parent body should desist from their proprietary practice of arm-twisting the Federal Government with threats and even more threats. Doing so with the intent to undercut and sabotage the demands of another professional body is rather treacherous.

 

It is so troubling when the NMA describes increment of salary of professionals working in the healthcare industry as ‘Unfortunate’. How much bitterness can a body have against another? Their politics of supremacy, their predatory antics and proclivity to ‘pull them down’ must be rejected and condemned by all. This has become absolutely crucial if we really yearn for the growth of the health sector.

 

To the General public, the demands of JOHESU/AHPA are not about mundane gains. It is about establishing right structures in the 21st century Nigerian health system, setting in place correct precedencies, and allowing for individual and institutional growths that would make for better healthcare delivery. It is neither the intention of the Union nor its constituent associations to fight for positions and territory, but to stay focused in building the healthcare industry that we would all be proud of, through every available constructive means. 

 

Sadly, the NMA has at various times called and employed several means including threats to ensure that the Federal Government does not obey these court rulings, which includes among other things the abolition of the notorious and unlawful position of the Deputy Chairman Medical Advisory Committee (DMAC), a tool frequently used in the suppression, silencing and marginalization of other healthcare professionals that are not Medical Doctors, unlawfully created by the Governing Boards of Hospitals through deliberate misapplication of Section 18(1) of the University Teaching Hospital (Reconstruction of boards etc.) Act CAP U 15, VOL 15. LFN 2004, without the requisite due regard given to any personnel establishment or statutory approval for the office as deemed necessary by the provisions of the Act. 

 

This recalcitrance among other destructive tendencies makes it urgent that we all call for a complete overhaul, and a thorough revamping of a system that has been rendered so demeaning, discriminatory and demoralizing that many hardworking healthcare professionals can not afford the least bit of job satisfaction in their chosen career.

 

The Nigerian Optometric Association (NOA), and all other relevant sub associations/groups under our umbrella are in full support of the yearnings and aspirations of JOHESU/AHPA. We shall not let our calling and training be trifled with. This calling is, and must be about the people and only about the people. We hereby urge our colleagues to set aside their annihilatory tendencies towards other healthcare professionals, and show much needed maturity in their immediate, and hereafter relationships and dealings, to advance the Nigerian healthcare system, and the general health needs of the Nigerian masses.

 

We will continue our best in ensuring that the Nigeria Healthcare sector does not become a laughing stock, and the butt of shameful jokes by other professional.

 

Dr. Emmanuel Richard Onuoha

[email protected]

Dr. Emmanuel Onuoha is an Optomerist and writes from Riyadh, Kingdom of Saudi Arabia.