There is currently a bill that has been on the table of the Nigerian National assembly and being sponsored by Hon Patrick Asadu, titled, 'A Bill  for  an  Act  to  Establish  the  National  Council  of  Radiology  and  Radiation  Medicine  to  Provide for  the  Control  and  Practice  of  the  Profession  of  Radiology,  Radiation  Medicine,  Nuclear  Medicine, Radiotherapy,  Radiography,  Medical  Physics  and  Technology  and  for  Other  Related  Matters.' My discussion about this 'unfortunate' bill stems from the position that I am a duly qualified and registered practitioner of one of the concerned professions, Radiography.

 

Before I go on to explain the contents of this bill and the unfortunate chaos and confusion it will plunge the Nigerian health system into, permit me to make some very important clarifications about some of the professions mentioned in the bill. This explanation is important in order to put the general public in proper perspective of what is at stake here. First and foremost, the only groups in the list which can hold onto the title as distinct professions are Radiography and Medical Physics. Radiography as a profession uses highly specialized and technical equipment utilizing energies from radiation, magnetic fields, ultrasonic waves e.t.c for either diagnosis or therapy. When the use of these mediums is for the purpose of producing images of the body systems for medical diagnosis, it is referred to as diagnostic radiography. However, their use (especially high energy x-rays and gamma rays) for the treatment of cancer is referred to as therapeutic radiography or radiotherapy. So, you can refer to radiotherapy as a branch of radiography.

 

Medical physics is another profession on its own that play very important roles including both the commissioning of machines that emit radiation as well as ensuring their safe use. They are also indispensable in the planning of radiation doses delivered to patients undergoing radiotherapy treatments and are equally involved in quality assurance procedures of the radiation equipment.

 

Radiology and Nuclear medicine are however not distinct professions. Whereas radiography and Medical physics are studied in universities and the graduates registered and licensed by appropriate bodies to become professionals, the same cannot be said about radiology and Nuclear medicine. These two are actually specializations within the medical profession. This implies that a doctor first graduates from a university with an MBBS and undergoes further specialization training in the clinical setting in a chosen specialty (in this case residency program in Radiology) and after a stipulated period becomes a specialist/consultant in that field. This is the same as is obtainable in pediatrics, oncology, gynaecology e.t.c. Therefore, the primary profession is Medicine and this is why you do not have separate licencing and regulatory bodies for them as they are all under the oversight of Medical and Dental Council of Nigeria (MDCN). By the way, radiology is primarily involved in the interpretation of diagnostic images of the human body (produced in most cases by radiographers) as well as some therapeutic aspects referred to as interventional radiology.

 

Having gone through this explanation, it should be noted that the professions concerned in this bill already have regulatory bodies that are established by different acts of the Federal Republic of Nigeria. That for radiographers is Radiographers Registration Board of Nigeria (RRBN) and it is charged with the responsibility of determining  the standards of  knowledge and  skill to be attained  by  registrants of the Radiography profession;  securing the establishment  and maintenance of a register of  persons registered as members of  the profession; conducting examinations in  the profession  and  awarding  certificates or  diplomas to successful candidates as appropriate; as well as other responsibilities obtainable from the provisions of its establishing act. As earlier mentioned, the regulatory and oversight duty for the practice of medicine (including radiology specialization) falls within the purview of MDCN. 

 

It is therefore outrageous for one to conceive establishing a council that will lump up different autonomous professions under one regulatory body, especially when the constituent membership of the said council will be skewed in favour of one group, a specialization of a profession for that matter. An approximate figure of membership of the council as proposed by the bill will see doctors (predominantly radiologists) occupying 70% of positions while the remaining will be spread among others. Equally note that the registrar of this proposed council will be appointed by the council (wait for it...) in 'consultation with the Association of Radiologist of Nigeria'.  Is this not an unprecedented legislative anomaly that is being promoted by Hon Patrick Asadu, who is unsurprisingly a medical doctor? I make bold to say (and any objective individual can attest to it) that this is an attempt to subdue and subjugate the Radiography (and other) profession(s) and the reasons for this will not be far fetched. I am yet to see any developed country in the world where this is done as I will show you in a moment.

 

The United States of America has the regulatory body for radiographers (Radiologic Technologists as they call them) as 'American Registry of Radiologic Technologists (ARRT)'. In Australia, the body is referred to as 'Medical Radiation Practice Board of Australia', while in Canada it is called 'Canadian Association of Medical Radiation Technologists (CAMRT)'. All these are constituted by Radiographers and their responsibility is towards the profession of Radiography. For the United Kingdom and Ireland, there exists a regulatory body that oversees allied health professions (including Radiographers, Dieticians, Physiotherapists, Labouratory Scientists, occupational therapists, social workers e.t.c) as a group and these are the HCPC and CORU respectively. Again, the medical doctors are excluded from these 'Councils', as they have their separate regulatory bodies, the General Medical Council UK and the Medical Council Ireland. Now again I ask, of what preceding evidence does Hon Patrick Asadu and  his medical colleagues have to sponsor this obnoxious bill? This is a plot for modern day slavery of radiographers by radiologists and it should be regarded as an affront to the autonomy of the radiography profession. 

 

It is already disheartening that of all the allied health professions in Nigeria, it is only Radiography that is being denied its autonomy in government hospitals and establishments. It has always been a frustration when as a radiographer, one is left at the mercy of a radiologist to decide your case in management meetings of the hospital, because they have been imposed as ones Head of Department. So a graduate of an autonomous department in the university, with a license by an autonomous regulatory body (established by an Act of the Federal Republic of Nigeria) ends up subservient to a specialization of medicine. Yet in the midst of the injustices meted out against them by the system over the years, Radiographers have always been peaceful and cannot be attributed with any trait of causing unrest in the health sector. This is one of the reason they seemingly appear less visible among the allied health professionals. In spite of all these, the doctors are scheming through the legislative process to render them as perpetual slaves in their own profession.

 

This bill seeking to establish an act for 'National  Council  of  Radiology  and  Radiation  Medicine' intends not only to undermine the authority of the Radiographers Registration Board of Nigeria (RRBN), but also that of the Medical and Dental Council of Nigeria(MDCN). Should it see the light of day, the establishment of the so called council will plunge the health sector into unfathomable confusion. First of all, what happens to the oversight of MDCN over the radiologists if the latter succeeds in having their own separate regulatory council? If this precedence is set, do we expect to see more councils for oncology, paediatrics, obstetrics and gynaecology, pathology and numerous other specialties of medicine? How can we guarantee the needed trust among health workers which is necessary for teamwork, if doctors are given authority to regulate other allied health professions? For registration of professionals, the proposed council as noted in the bill will collaborate with the National Postgraduate college of medicine, Radiographers Registration Board of Nigeria and the Medical Physics Board for a supply of their respective registrants. Also, for CME purposes, the council again intend to consider the MDCN and RRBN acts. One would ask, what then is the essence of the council if it intends to carry out responsibilities that have already been assigned to other regulatory bodies and their acts? 

 

Does the council  intend to become a regulator of regulators? They seek to be given the power to 'discipline any Radiologist, Radiotherapist, Nuclear Medicine, Radiographer and Medical Physicist IN CONJUNCTION with their respective boards or councils'. Furthermore, the council also intends to 'licence and monitor facilities to ensure that they meet minimum required standards IN COLLABORATION with the NNRA (Nigerian Nuclear Regulatory Agency). Why then would we need the services of NNRA, RRBN, MDCN, MPB e.t.c if the proposed council intends to carry out these duties? Is this not an usurpation of responsibilities of these government established bodies? Of what benefit will these duplication be to the society, especially the patients that use the services of these professionals in the hospital? What could make a medical doctor turn politician conceive this dangerous bill if not to assuage the unwholesome appetite of his colleagues?

 

I perceive this development as a sinister move by radiologists to empower poorly trained technicians into arm twisting radiographers from their professional responsibilities. This can be alluded from the bill as 'Technicians' were included as part of the registrants to be considered into the 'profession'. There have been several evidence of radiologists teaching technicians to carry out x-ray procedures in private diagnostic facilities, without a second thought about the attendant radiation hazards that could follow. Radiation in the hands of a poorly trained personnel is a risk to not just the patients, but to generations yet unborn. The RRBN has been in the fore front of this battle against quackery and a lot of Medical doctors have been indicted as accomplices to these quacks, who they employ because of the cheap labour they (quacks) provide. Could it be that this bill is sponsored in order to deprive RRBN of such powers? I leave this for them to answer.

 

Just to conclude, I would like to remind Hon Patrick Asadu and his medical colleagues that the health institution is all about team work. It involves the contributions of numerous professionals who deploy their various competencies for the well being of the patient. Therefore, anything that will jeopardize this teamwork and cause disharmony among the professionals, will not augur well for the entire health system. Dr Felicitas Idigo (PhD), the immediate past HOD of Department of Radiography and Radiological sciences (UNN), on reacting to the bill asserted, "This bill will be counterproductive in health care delivery as it will erode inter- professional collaboration required for provision of high quality and efficient patient care. Health care delivery involves team work and each professional entity should be accorded required recognition for mutual trust and peaceful coexistence."

 

This bill is self serving and will do no good to the patient, the health/medical professionals and the Nigerian society. I will advice that instead of seeking ways to subjugate other health professionals, medical doctors should focus on developing themselves and improving on their practice. The brain drain that is characteristic of Nigeria due to the exodus of health professionals to developed countries needs to be addressed. The decadence that has befallen our government hospitals leading to the waste of tax payers money by our politicians for medical tourism in other countries needs to be addressed. Efforts should be made to improve the infrastructures in our hospitals and investments made in the training of health professionals for efficient service delivery to our patients. I call on the Presidency,  Minister of Health, House of Assembly members and all relevant stakeholders to ensure that this bill does not see the light of the day. This is to avoid the instability it will cause in our already fragile health sector.

 

By Iweka Edozie

Medical Radiographer