The Nigerian Health Sector, for quite some time, has been polarized by lingering crisis. If it is not strike, it is Ebola and if it is not Ebola, it is the tales of agitation in different climes. The latest on the list is the suspension of the Residency program for Allopathic Physicians in Nigeria, by the incumbent President Dr Goodluck, Ebele Jonathan. The Health Sector is now like a ship on the high sea, about to be engulfed by an apoplectic torrential wave. How can we salvage this great ship from being dashed, on the hard surface of Mount Gibor? How can we get her to Mount Ararat, the symbol of peace, rest, and solitude, free from the shackles of the great deluge?

             

Before we can proffer solutions, on how to salvage the health sector, we must make sure, that we have gotten a definitive diagnosis, on what is the cause of the problem. We must not use a suppressive cum palliative therapeutic method; rather we must look at the Health Sector holistically to solving the myriads of problems.

       

At this juncture let us put the Health Sector on the Diagnostic Table and use the “Diagnoscope” to identify the problems, in order to get a Holistic Therapeutic Solution (HTS) to the lingering crisis in the Health Sector in Nigeria. 

 

THE FUNDAMENTAL PROBLEMS (1-4)

 

(1) IMPUNITY AND LAWLESS.

As a result of the over bearing attitude of some Allopathic Physicians, personified by the leadership of NMA/MDCAN that other Healthcare workers, should not reach the zenith of their professional career, there is marked resistance in the system. Members of MDCAN being the Chief Executives, of all the Government Hospitals, under the influence and control of NMA/MDCAN, undermine the scheme of service, of other Healthcare Personnel. In an act of brazen lawlessness, they jettison Government circulars as it affects the upward promotion of all healthcare workers who are not Allopathic Doctors.

 

(2) CONSPIRACY AGAINST THE STATE AND NIGERIAN CITIZENS.

First and foremost, it should be noted that the Strike action embarked, by the Nigerian Allopathic Doctors, under NMA/MDCAN, is illegal, and a conspiracy against the state. The Nigerian Labour Law is emphatic, that any non registered Trade Union cannot enjoy the rights and privileges of a Trade Union. There is a subsisting Judgment, from National Industrial Court Enugu, against NMA/MDCAN that she is not a registered Trade Union and as such, she cannot put herself forward as one. NMA/MDCAN cannot call her members out for strike, when she is not a registered Trade Union. She lacks the right of “dispute of Right” to do so.NMA/MDCAN not being a registered Trade Union, does not have Immunity of Tort. The criteria to be a Trade Union have never been met by NMA/MDCAN. Prof Akintunde Emiola, informs us in his book titled Nigerian Labour law fourth edition on page 528 that “Conspiracy, when regarded as a crime, is the agreement of two or more persons to effect unlawful purpose, whether as their ultimate aim or only as a means to it, and the crime is complete if there is such agreement, even though nothing is done in pursuance of it”. 

 

The Nigerian Penal Code in section 96 defines: “CRIMINAL CONSPIRACY” as

(1) When two or more persons agrees to do or cause to be done

(a) an illegal act; or

(b) an act which is not illegal by illegal means, such an agreement is called criminal conspiracy.

 

Section 96(2) goes further to say: Notwithstanding the provisions of subsection(1) no agreement, except an agreement to commit an offence shall amount to criminal conspiracy unless some act besides the agreement is done by one or more parties to such agreement in pursuance thereof.

 

NMA/MDCAN not only agreed to inflict untold hardship on Nigerians, but negligently abandoned their duty post, to cause injury and hurt, to the Nigerian public. This is another violation of the Public Service Rule as stated in PSR 0303301(H),PSR 030402(E),PSR 030402(O) and PSR 030402(T). Even when there was a Court Order restraining NMA/MDCAN not to have gone on strike they defiantly disobeyed, they had the audacity and temerity to be granting press conferences, that, they will not call of, the strike, even in the face of a restraining order.NMA/MDCAN brazenly violates sections 113,114,123a, 125, 129 and 130 of the penal Code. Permit me to read section 129 and 130 of the Penal code.

 

Section 129. - Whoever, being a public servant willfully omits to perform any duty pertaining to his office which he is legally bound to perform, shall, if such omission causes or tend to cause danger to human life, health or safety or causes or tends to cause a riot, be punished with imprisonment for a term which may extend to two years or with fine or both.

Section 130. - Whoever being a Public Servant wrongfully abandons his duty in a pre-arranged agreement with two or more other such Public Servants shall, if the intention or effect of such abandonment is to interfere with the performance of a public service to an extent which will cause injury or damage or grave inconvenience to the community, be punished with imprisonment for a term which may extend to two years or with fine or with both.

         

The demands and events of the day has shown that the acts of NMA/MDCAN, is prejudicial ,to the other healthcare workers, and such abandonment, is to interfere with the performance of the public service to cause injury or damage with grave inconveniencies ,to the community at large. The great Master Author, Robert T. kiyosaki says it all, that where there is an egocentric interest there is conspiracy.

 

(3) TERMINATION OF RESIDENT DOCTORS APPOINTMENT AND SUSPENSION OF RESIDENCY PROGRAM

It is highly unfortunate, that many of us have not been able to put medical humanism first. We have been playing politics, with the lives of Nigerians. We must be bold to call a spade a spade. The big question is, as at today, is the Residency training giving Nigerians the best of the aim of setting the program? Or are we training people who see themselves as Medical Emperors, who play gods with the lives of the Nigerian Citizens? A Resident Doctor is a doctor who is in training .The Nigerian Government pays for the training through the use of the tax payers money. This money for paying for the Program comes from the toil and hard work of the Nigerian populace. It is this same populace that is abandoned at the point of their medical needs, as a result of the unwarranted strike action, that is laden with prejudice. In the Common wealth, Resident Doctors who specialize are called Attending Physicians or Staff Physicians.

 

These Consultants are always there to attend to medical needs of the patients. But what do we see with our own qualified residents? Immediately you qualify to become a Consultant, you are inducted into the medical cabal of Suit Wearing Physicians. And you then become part time physician, even though they are on the pay role as fulltime physicians. Most , come to work four times in a month ,and once every month, because he/she has clinic days he/she is on duty even though, a full time staff of the hospital. It is very few, that breaks away from this routine and remain steadfast. The bulk of the works, are done by the Medical Officers. Those who remain in the service are engulfed with dual loyalty, because they shuttle between their Private Clinics and their place of primary assignment. At the end, the government work suffers. This is a violation of the Public Service Rule and the Nigerian Constitution.

 

The Resident that government pays is the one that is always used by MDCAN , to champion illegal strike actions. It is unfortunate, where, we have gotten ourselves today. There is no doubt that the RESIDENCY PROGRAM needs restructuring to meet the objective of setting the program.NMA/MDCAN has used the program to achieve their own self interest. People should be bold to say no to NMA/MDCAN for using the RESIDENCY Program to achieve sabotage and conspiracy against the state. Furthermore, all over the world it is not only allopathic doctors that have residency program, Doctors of Osteopathy, Doctors of Natural Medicine, Optometrist, Podiatrist, Pharmacist, Medical Physicist, Dentists etc all have residency programs. It is not only one professional group, that does residency, but NMA/MDCAN, reinvented the wheel in Nigeria, against International Best Practice. Residency program should not only be for Doctors of Allopathic Medicine. It should be restructured to accommodate other professionals in the Health Sector. Nigerians should stop appealing to NMA/MDCAN for breaking the laws of the land rather NMA/MDCAN should be rebuked or reprimanded, for going against the laws of the land. It is the Nigerian government, under the leadership of, President Goodluck Ebele Jonathan that we should appeal to be bold and steadfast to continue to do what is right. 

 

(4) MEDICAL IMPERIALISM AND SABOTAGE.

As a result of the misinterpretation of the term who is medically qualified, by agents of government, members of NMA/MDCAN, who are the Chief Executives of hospitals, in connivance with NMA/MDCAN have championed acts of impunity/favoritism to the detriment of other healthcare workers. They are expected to champion collective interest and goals. Chief Executive of hospitals, have not been able to call members of NMA/MDCAN to order, when they out rightly flout government orders. Since the Court order not to embark on strike, was granted that members of NMA/MDCAN should not go on strike pending the determination of the substantive suit, before the National Industrial Court. Hospital Chief Executives were not able call NMA/MDCAN members to come back to work. They were not able to provide medical services in the hospital. In fact in many hospitals, the hospital managements, made sure that the hospital was not functional. Even when it was glaring that it was only NMA members that were on strike, they made sure that, there was no electricity in the hospitals. There was no skeletal service, rendered. It should be noted that members of Joint Health Sector Unions (JOHESU) who make up 95% of the hospital work force where around on duty but nothing was happening because the Managers of the Hospitals did not have the will to make things happen.

 

CONLUSION

The Master author Robert .T. kiyosaki, defines crisis “as the change screaming to occur” .What is happening in the Health Sector, is a harbinger that change is about to occur and it must occur for the well being of the Nigerian masses. The events of the day, have, shown that the Health Sector needs urgent restructuring. Mr, President, Dr Goodluck Ebele Jonathan, as part of the Transformation Agenda should not only look at the Residency Training of doctors, but He should look at the Nigerian Health Sector, as a whole and holistically do his best to, solve the myriads of problem.

 

(1) In order to bring sanity, harmony, and de-militarization of the Health Sector, government should ensure that the system is guided by the relevant provisions of the Constitution, the Public Service Rule, the Financial Regulations, and Circulars.

 

(2) In order to avoid professional/criminal conspiracy, no professional group should exert monopoly and be allowed to go away with acts of impunity as exemplified by NMA/MDCAN. And every Healthcare Worker should reach the zenith of their career.

 

(3) The restructuring of Residency program in Nigeria, should be made to accommodate other healthcare Professionals. Residency Program should be made contributory. The person undergoing the residency should be made to pay part of his residency fee. Any person undergoing residency training should not participate in any strike action as part of the terms of contract.

 

(4) To avoid dual loyalty/sabotage and professional monopoly, as manifested by NMA/MDCAN the hospital leadership should be handed over to Hospital administrators/Hospital Health Managers or the headship of the Hospital should be open to any Healthcare Worker/Personnel who has a bias in Health administration or Health Management.

 

(5) Currently Most Doctors who are Consultants in the hospitals do not come to work daily even though they are on the pay role as fulltime staff. The work of the Doctor who is a Consultant should be privatized. In fact the work of medical doctors, who are consultants, should be on contract basis. Contract employment for Medical Consultants is not new to International best practice.

 

(6) On no account should NMA/MDCAN be allowed to hold Nigerians to ransom, when it is not a registered Trade Union. In line with the Trade Union Act, and in line with the provisions of sections, 100,101,108, 109 of the Penal Code, she should be declared an unlawful Assembly. And she should bear the consequences of her acts of impunity.

 

(7) Government should urgently embrace medical pluralism, which is Integrative Medicine by adopting the Total Integrative Medical System Initiative (TIMS INITIATIVE) like you have in some advanced Societies. The frequent closure of hospitals, outbreak of Ebola and reemerging infections has shown that we cannot solely rely on one medical system.

 

DR BENJAMIN CHUKWUNONSO AJUFO is the SECRETARY ASSOCIATION OF MEDICAL LABORATORY SCIENTIST DELTA STATE/DOCTOR OF HOLISTIC MEDICINE wrote from Asaba Delta State.