The crisis in Nigeria’s heath sector -By Paul John

Your Excellency, our discourse will centre more on the solutions to the crisis and the roles of pharmacists and medical laboratory scientists in our current tertiary institutions.

I still wonder why a pharmacist after spending five years in the university will choose to be counting drugs in the pharmacy sections of our hospitals when there are other areas to explore in the field of pharmacy. It is unarguably that more than 90% of drugs used in this country are imported. The job of drug counting can effectively and efficiently be done by SSCE holders or better still, by the pharmacy assistants who are now independent of pharmacists by virtue of the recent court judgement. I am writing out of experience and I still challenge the relevant authorities to visit pharmacy shops in their localities or elsewhere in the country to find out if the workers employed by pharmacists in the pharmacy shops to count drugs are not SSCE holders, auxiliary nurses and pharmacy assistants. However, the story is different in our government hospitals, drug-counting pharmacists want to be ‘ordained’ consultants possibly in drug counting, what a rape of our black crude?

This is why the pharmacists that drafted the Act establishing pharmacy sections of our hospitals made it unlawful for any private pharmacy shop to be set up within the premises of our government hospitals .Why were they afraid of private pharmacy shops coming in? They did not (and still do not) want their own sources of national cake to be deprived of them. What concerns a doctor, if another hospital is situated within or near the hospital? The difference will be clear and patients know what they want. Is it not a waste of human resources, if pharmacists end up as drug counters in our hospitals? I suggest that they be helped to set up drug-producing firms to explore other aspects of pharmacy.

We have seen that history has a way of repeating itself. The problem in our health sector today is the same problem we have as a nation, which is myopic planning and improvidence. Your Excellency, I am aware that you are faced with a lot of challenges, mostly manmade, and these challenges are traceable to the long military rule in the country. Although I am also aware of your transformation agenda and how Nigerians want you to magically right the wrong of the many years of military rule in a second, I am totally averse to the palliative solutions that our secretary to the government of the federation has been offering to this lingering problem in our health sector. I describe it as palliative because for every three months, there must be an industrial action in our health sector, if it is not warning strike, it will be an indefinite strike.

Even our constitutional and human rights lawyers, who should study all the acts establishing medical and paramedical professions, are busy planning to go and vie for one elective post or the other, whereas those still active in the profession are busy indirectly advertising themselves. When an impeachment or any activity is going on, these supposed human rights lawyers will be busy buying newspapers preparing their legal weapons and when the action is concluded, they will grant press briefings telling one party how to reclaim their lost position. Before you know what is happening, that party has briefed the human rights lawyer and legal battle has started after all, an Igbo adage says that, ‘anarchy in the society is an advantage for the members of the cabinet’, at least the members of the cabinet will constitute the ad hoc committee that will be set up to resolve the imbroglio, with the attendant financial mobilization.

There is a clause in the ethical codes of professional bodies like the doctors and the lawyers which prohibits self-advertisement but trust Nigerians, when one door closes, the other opens. The granting of press briefing is the fastest and most cost effective means of self-advertisement that is right before man and the law.

This is the time for our government to overhaul the health system. Why should microbiologists, biochemists and anatomists etc be dislodged from our laboratories by their smarter medical laboratory colleagues? Why should every worker (skilled, semi-skilled and unskilled) in the health sector form a coalition to gang up against the doctors? What is the similarity between paramedical professionals (who spent about five years in the school) and other workers (who got employed with SSCE) that will make professionals be in the same group with ‘casual’ workers? Why should the Act establishing the pharmacy sections of our hospitals ban the setting up of private pharmacy firms within the premises of any government hospital, where expectedly the salaries of workers are from federal allocation courtesy of our black crude? Why can’t pharmacy assistants and medical laboratory technicians/assistants be drafted into the internship scheme no matter how little their stipends? Why should some pharmacy shops be exceeding their boundaries by treating children with diarrhoeal diseases among other medical atrocities? Why should pharmacists sell non-over-the-counter drugs without a doctor’s prescription, as is obtainable elsewhere in the world? Why is it that doctors are not part of JOHESU or is there any proof of a letter of invitation to doctors at the inception of JOHESU which doctors turned down? How can JOHESU convince us that the aim of forming the coalition was not to fight doctors? Where are those paid lopsided journalists that were writing rubbish about doctors during the last national NMA /NARD strike? Is it that they are not aware that their paymasters are on strike for about two months now while the doctors they called medical terrorists then, are currently overworking themselves to cushion the effects of the striking paramedical workers? For the medical laboratory scientists, their roles, if we can be truthful to ourselves, have been overtaken by modern medical practise, where almost all medical tests required are done with strips and the few ones requiring expertise are done with automated machines which are self-explanatory. In fact, my grandparents who never received any formal education know how to make use of these test strips.

Blood grouping and cross matching is what any student that attended a good secondary school should know how to do at that secondary level of education. It is a topic under Applications of Heredity and Variation in Biology. I learnt that in secondary school. I put it as a challenge to any investigative team to move round the country and investigate if almost all the Medical laboratories owned by professional medical laboratory scientists do not employ the services of SSCE holders who were given on-the-job training and that only few of them employ the services of medical laboratory assistants. I challenge them to show me how many of them that employed the services of Bsc holders in medical laboratory sciences in their private firms. China and other Asian giants are what they are today because they always tailor the wave of development to their own requirements. Time has come to grant internship programmes to biochemists and microbiologists who will work effectively under the professional supervision of my most distinguished specialist doctors called pathologists in the laboratory. Better still, the services of medical laboratory assistants/technicians will be employed.

Today,we are waiting for the court to interpret the meaning of medically qualified as it concerns the eligibility for the appointment of a chief medical director. One annoying thing is that we are asking why our children are not doing well in external examinations evidenced by the poor performances in 2014 WAEC and law school results,when we are also guilty of the same offence. It is a matter of time, people will soon approach the law- court for the interpretation of simple sentences such as, Obi is a boy.

What if the court interprets that phrase as being anybody in the medical and paramedical professions, that means that a nurse with PhD certificate will now become a medical doctor,’ doctor’ coming from the PhD whereas ‘medical’ coming from the interpretation of medically qualified. If the rumour being circulated in the social media, concerning a leaked portion of Yayale Ahmed recommendation recently submitted to the president, is true, that means more crises are imminent in our health sector.

In that unconfirmed report circulating in our social media, nurses and Pharmacists are regarded as medical professionals along with doctors. If members of Nigerian Customs, Nigeria Security and Civil Defence Corps, Nigeria Immigration Services etc will claim to be in the military, will soldiers now become paramilitary?

My prayer is, let the rumour not be true because as I warned in my previous article, there are three sources of justice; the law, God and the people. Imagine a scenario, where an investigation result is rejected by the clinician, who is the doctor managing the patient, the reason being that a non-doctor ‘consultant’ signed the result. At that point the ball will be on the court of the patients to beshouting,’please I want a specialist medical doctor consultant to sign my investigation result else, let me go outside and run the test because I don’t want to do it two times etc.’ At this point there will be more anarchy in the system as ‘consultant’ pharmacists will soon disappear because no money in the hospitals’ drug revolving fund to buy more drugs and the drugs already bought have expired as the ‘real’ owners of the hospitals after attending to the patients have instructed them to buy all drugs outside the hospital.

Your Excellency, you must have heard where they argued that, ‘the posts of chief medical director and minister of health are purely administrative.’ Also you must have heard where they claimed that, the Nigerian Medical Association (NMA),is not a labour union hence your government should not negotiate with them.’ This will tell you how far they have gone in non-health matters because my mother always tells me that,’ any plot that led to murder was not planned in a day.’

Your Excellency, they tell us about international best practices, making references to American health system. Many of the famous hospitals in America are privately owned and a medical consultant is called ‘Attending’ hence they can relinquish the term, consultant, to any non-medical doctor the same way our legal practitioners relinquished the term, Esquire to members of the public since they cannot share the term Barrister with anybody. They have equally failed to inform us that the societies of pathologists in Canada, USA, United kingdom, Australia etc are responsible for the accreditation of clinical laboratories and the certification of medical laboratory scientists, who are also known as medical technologists, in fact the document guiding the establishment of clinical laboratories in UK explicitly states that the director/head of the laboratory must be a medical consultant whose qualification is that of a member of the Royal College of Pathologists or its equivalent, where this is not possible, a high ranking medical laboratory staff may manage the laboratory but must be overseen at least weekly by a pathologist.

Also, the biochemists, anatomists are part of the allied health staff of the clinical laboratories. In view of the above, If we are going to correct the health system of Nigeria, we should start with international health best practices by empowering pathologists to take up their job descriptions fully and the microbiologists, biochemists and anatomists to return to our laboratories.