Your Excellency,in my last article I  exposed some of the causes and the possible solutions to the lingering crisis in our health sector. As we all know,the Joint Health Sector Unions(JOHESU ) is on strike but our tertiary hospitals are still functioning because my distinguished colleagues are still working. I suggest that a new committee be set up to look into the causes of this incessant crisis and proffer solutions to this crisis. 

 

This committee may be given about ten years or more to come out with a lasting solution to this crisis. During this ten-year-period ,there will be roundtable meetings of all the 'warring' parties in the health sector. The committee will use this period to visit the health systems of other nations of the world before coming up with the final  recommendation.  This is very important because the mending-wall approach currently used by the secretary to  the government of federation in resolving the crisis,is having a counterproductive effect. 

 

In the morning a circular will be issued in favour of members of Nigerian Medical Association (NMA) and in the afternoon when members of JOHESU protest, another circular will be issued in favour of JOHESU .Then members of NMA will protest in the evening and another circular will be issued in favour of NMA .This vicious cycle continues while our main targets,the patients,in the health sector are constantly being sent to their early graves. As the medical laboratory scientists will always quote the WHO model for healthcare practice in their network programme,The Determinant, on Radio Nigeria every Monday that , 'the patient is at the centre of a circle' , now that JOHESU members are on strike they have forgotten in a hurry the connotative meaning of  that axiomatic expression. 

 

This crisis in the health sector is assuming a cancerous dimension and believe you me,it will get to an advanced stage when no amount of solution can 'cure' it.  Your Excellency ,it may interest you to know that this very problem did not start in a day hence the solution will not just crop up in a day. Circa 2012 ,there was internal crisis among the members of the board controlling Radiography in Nigeria. Some of them that were Bsc holders wanted to lord it over the Diploma holders. There was great crisis in the board. Before then,the medical laboratory scientists had 'dislodged' all the professionals whose courses involved( and still involve) laboratory practical experiences in our hospitals .These professionals include,but not limited to, the microbiologists and the biochemists. 

 

The microbiologists and the Biochemists were not 'smart' when the medical laboratory scientists were 'sponsoring' an Act that would dislodge the non-medical laboratory scientists from our laboratories. Having succeeded in dislodging the biochemists and the microbiologists,who could efficiently and effectively function as the laboratory scientists ,the laboratory scientists now deem it necessary to dislodge my distinguished colleagues called pathologists and laboratory resident doctors from our  laboratories.  

 

Your Excellency,it may also interest you to know that currently ,the graduate nurses have pulled out of the ongoing JOHESU strike . This scenario,when properly utilized will make the ongoing strike uneventful,in fact the striking workers will come back to beg for them to resume work . What is their reason for not joining the ongoing strike? Their welfare is not included in the JOHESU demands and they are not really comfortable with the leadership of other nurses whose certificates may be less than or equal to OND .These graduate nurses are crying for justice in that it is culturally,socially,morally,legally and economically wrong for nurses with RN certificates to come and lord it over the graduate nurses with Bsc certificates. I humbly and respectfully support the graduate nurses in their demands because Aristotle said, 'injustice is not only treating equals as unequals,it equally involves treating unequals as equals.' Yes,these graduate nurses pass through similar paths like us ,at least in some schools from first year till third year,all medical and Bsc nursing students stay in the same class to receive the same lectures,attending similar practical sections though the pattern of their examinations is not the same but the truth is that they pass through similar sufferings as medical students. Having passed through similar paths as medical students in the 'first-half ' of their education,these graduate nurses are aware of the more sufferings that await the medical students when the medical students proceed to their clinical classes while the Bsc nurses return to their department to pursue their own courses. In view of the above,when graduate nurses are employed in our tertiary hospitals ,I don't really think that we will be having these skirmishes that we are currently having in our health sector. The graduate nurses know what the medical doctors passed through while in school and how many of the medical students failed out of the college hence they will respect the doctors for who they are and not what they are,whereas the doctors will see the graduate nurses as their own next in command,exactly the same way you cordially relate with your deputy,the vice president of our dearest country. The graduate nurses are also crying foul on why their own internship scheme was not included in the JOHESU demands.  

 

As I have written in my previous articles,under different subject matters, JOHESU is an amorphous body that believes that the activities of doctors,who are ubiquitous in our health sector, can be regulated when all non-doctors in the health sector pull their forces together in order to use their 'mass effect' to paralyse our hospitals anytime they embark on any strike. In those my previous articles,I warned against the repetition of what happened in the Animal Farm,written by George Orwell where comrades Napoleon and Snowball led other animals to overthrow the owner of the manor farm,Mr Jones, after which Snowball was the first victim of that coup and other animals 'judiciously' received their own dictatorial dividends of autocratic leadership of comrade Napoleon. The graduate nurses are the first victim of my prophecy. They spend five years the same way medical laboratory scientists, pharmacists, physiotherapists,dieticians and radiographers spend in the university but the graduate nurses are the only ones in that group that are not currently enjoying the internship programme,what an injustice? Owing to this,the graduate nurses seem to be less practically oriented at the beginning of their career when compared to their non-university counterparts with RN certificates . 

Your excellency, this anomaly needs to be corrected immediately unless we will carve out a line from the George Orwell's novel where Napoleon,after using 'mass effect' of other animals to overthrow the government of Mr Jones,amended one of the animal rules which initially read ,'All animals are equal' to 'Some are more equal than others.' Why I am spending time in this discourse on graduate nurses is because of their vital roles in our health sector. If JOHESU strike is having any impact today on our tertiary hospitals ,it is because the nurses have joined. It may interest you to know that before nurses joined the current strike ,other components of JOHESU had been on strike and immediately nurses joined the strike,the health sector was shaken,though in some centres ,the management put up some measures to make the ongoing strike by non-doctors uneventful. The vital roles of nurses in our health system cannot be overemphasized hence our government should employ more graduate nurses than those with RN/RM certificates at least in all our tertiary health facilities ,which for now are the final level of healthcare services in our country. One popular comedian said that he who took his bath in the village stream does not know how much a bucket of water costs hence the RN nurses may not know what it takes to be a university graduate whereas the graduate nurses know how difficulty it is for one to become a university graduate ,let alone being a medical doctor. 

 

This will help to reduce the skirmishes normally encounter between junior doctors called House officers and some RN nurses in our hospitals where the RN nurses erroneously believe that they are superior to House officers by virtue of their many years of experience in the health facility. Can a permanent secretary ,irrespective of his/her many years of experience in a ministry, be greater than a newly appointed minister/commissioner in the ministry? The vital roles of nurses and doctors can be shown by considering the number of doctors and nurses that died during the Ebola outbreak both in Nigeria and beyond. Though I stand to be corrected,I have not heard of any medical laboratory scientists,physiotherapists,radiographers,optometrists and dieticians that contracted or died of Ebola as part of their occupational hazards . This shows the real sufferers in our health sector,the doctors and the nurses ,whose pay packages should morally exceed those of other practitioners in the sector. Your Excellency,I am in total support of an increase in the pay package for nurses though I am not in any way suggesting that doctors and nurses should be paid the same amount of money because there is no part of the world where it is done and anybody that says otherwise should come up with proofs. 

 

All I am saying is that nurses are the ones that stay with the doctors in the wards,clinics,operating theaters etc hence their pay packages should be greater than the pharmacists( whose current duties in our hospitals are counting of drugs prescribed by my most distinguished colleagues);medical laboratory scientists ( whose duties have been overtaken by easy-to-operate automated laboratory machines,invention of test strips,and their other roles can efficiently and effectively be replaced by more humble biochemists and microbiologists under the professional supervision of my distinguished specialist colleagues called the pathologists); the physiotherapists (whose roles can be taken over by house officers if the salary of houses officers can be increased,better still individuals with degrees in Health and Physical Education and Sports medicine can be employed); optometrists( who are still in the sector due to benignity of my distinguished specialist colleagues called ophthalmologists); the dieticians (whose roles can be taken over by houses officers under the professional supervision of our distinguished specialist colleagues called endocrinologists);the radiographers ( whole absence cannot be felt once the pay package of specialist doctors called radiologists is increased). 

 

This list continues ad infinitum. All I am saying is that graduate nurses need to be given their rightful place in our health sector because of their vital roles . The graduate nurses are aware of the true leaders of the health team. Now,let us critically analyse another solution. I suggest that locum paramedical professionals be employed in our hospitals so that when JOHESU expectedly embarks on any further strike,no lacuna will be created .I still wonder why unskilled and semi-skilled labourers in our health sector should be fully employed. Their services should be better rendered by private firms so that the private firms' contracts can be easily terminated whenever they come up with the widely-abused 'international best practices'. The security services in many of our hospitals are now on contract bases hence the incessant stealing of hospital equipment has been reduced to the barest minimum.Lagos state government headed by a legal luminary has shown us that it is possible to employ and retain the services of locum workers in our health sector during and after strike .

 

In the case of Union Bank of Nigeria vs Edet(1993) 4 NWLR pt. 287,pg 288 ,the court of appeal held that embarking on a strike action by workers is acceptable in law. What that means is that JOHESU is legally right to embark on the ongoing strike hence the government should also find a way of cushioning the effect by appointing locum workers or privatise their services because the law does not support anything that will cause avoidable death of Nigerian citizens. Also,the Trade Disputes (Essential Services) Act Cap T9 ,laws of federation of Nigeria 2004 ,prohibits strike action by persons rendering essential services. If my suggestions are taken into consideration ,the members of JOHESU will come and beg to come back especially ,when government fully applies no-work-no-pay rule.

 

I am still surprised why those paid journalists that were writing rubbish during the last NMA/NARD nationwide strike will not deem it necessary to take up their pen to give Nigerians the specious reasons why their paymasters are currently on strike. 

 

TO READ THE FULL ARTICLE CLICK HERE 

 

By  Dr Paul John 

Port Harcourt, Rivers state 

[email protected] 08083658038