Health Malpractice And Re-conceptualising Public Health -By Ismail Misbahu

It’s terrifying seeing our medical practitioners repeating past historical mistakes, indeed even worse. Even more terrible, is the way they so often usher or made to germinate the rot and accommodate the blunders as a source of pride and authority(?).  It tells a lot about the corrosive State regimes under whose guidance the practice of medical professions could only be biblicised.

Reading from our history shelves, we noticed the much-rated suspicion in the colonial manner of public health campaigns⸺the most notorious of which, according to Murray Last (2019), was the sleeping sickness service. Everyone was gathered to be checked by colonial health inspectors who, it turned out, were not only concerned with providing care to affected persons but more intently taking away beautiful women and girls to far away camps for ‘long term treatment’! Similarly, doctors given the task of doing post-mortems had to have special protection round the clock as cases of corpses taken from mortuaries revealed how chest cavities were found stuffed with paper and various parts missing as well. In the name of ‘scientific testing’ these dead bodies⸺which in most cases were used to improve the health of colonial officers, Army and Police⸺were never returned to their original shape! This practice persisted even after independence until the 1970s when drastic reforms began to appear. It was this scary development that explained the beginning of rural skepticism about public health-care system.

While these developments were accorded with fairly good reforms in the 1970s, they’re gradually taking new dimensions at present, especially in terms of the attitudes and of course, the manner by which medical doctors (emerging young practitioners especially) are approaching their clients/patients in public hospitals. Many could observe, the standards, decorum and methods guiding the conduct of medical practitioners particularly their mode of engagement with ordinary/poor clients/patients in especially public health-care centers has been so erratic, very detrimental indeed. In most of the rural North-west, the relationship between some staff in health-care clinics and their clients/patients is becoming more hurtful and distressful (maybe because they feel they worth the value of their profession more than that of the ordinary person needing their services). Patients in public hospitals (especially poor people who could not attend private clinics) are suffering from all forms of disdain and condescension from their physicians. Maybe because the latter lack proper orientation about what the concept of treatment entails in the culture of medical professionalism. Treatment of a patient does not only mean medicating his wound or relieving his pain or fever, but more importantly how his psychological pain is attended to, as well as his reaction and appearance is handled and treated in this regard.

It baffles me whenever I compare the mode of engagement of physicians with their patients in public hospitals in the rural South-west for example, and the rural North. Attention has so been paid across the rural South-west about the health of the public per se, which has been aided by regular orientation campaigns and organized rallies on safety measures, oratories on health tips and suggestions on improving health-care system, as well as provision of first aid kits including hydrogen peroxides and other anti-germs, detergents and mosquito nets etc. This has not been so because they earn higher salaries or their living environment is far better off. It might be because their population is relatively lower compared to the North, but more importantly it is because they care enough and dare to sacrifice more of their time, energy and sometimes even their resources to deliver the necessary health-care services needed of them from their communities.

My little experience while living with a friend who’s admitted in a remote rural hospital, in Kwara State, during my compulsory NYSC, was a reflection of all these. They cared enough and though there’s dearth in the availability of modern health-care facilities, cleanliness and consistency of staff in discharging their duties is indeed admirable. In such a friendly environment, one needs less from a relative in keeping his surroundings neat and clean. The exhibiting readiness of the attending workers to do all these is endorsing. This is indeed a part of the whole treatment patients need to be given.

How do we become void of all these when in reality these are not out of our ability but keep making us detest patronizing public hospitals any further; sometimes even health-care centers and private clinics have not been so patronized by rural and semi-urban dwellers. It is excruciating to approach patients with disdain or even back-eye their presence and abuse them with an undeserving gesture of hopelessness. It’s traumatic when at this time, artificial death is haunting all and sundry, to see patients (especially women), coming as early as faster than sun-rise, queuing up before a physician in ICUs and other outpatient units, waiting for hours but without anybody attending to them. The fact that patient/doctor ratio is higher in public health-care centers does not however, delete the fact that medical practitioners tend to be busy attending to their ‘best clients’ outside public hospitals⸺clients with financial capacity to double-pay patronage and attend their private wards and clinics while the poor, women and children especially, are left unbearably vulnerable to fatal mortalities⸺which is, of course, not about death only but also about regularly occurring illnesses with high tendency of mortal deaths.

The view that people in rural areas do not always want to patronize health-care centers couldn’t be untrue, however not at all times this has been so the case. They’re forced to take this choice only when they find themselves in total disregard to public health-care provision⸺bar possibly minor cases⸺where individuals afford them services on eye-care and meningitis for example. The most convincing fact indeed, is that, the daily unbearable increase in the number of in-patients from rural areas to semi-urban centers tends to always keep medical doctors busy away from attending their work, perhaps thinking the services they offer do not match their pay, and so the deliberate avoidance of such a large number of patients.

Notwithstanding, the story may be reversed if dedication and sacrifice that have been the principles of the health profession, are adhered to. A medical/dental practitioner whose exceptional professionality thousands of lives benefit from, should not give damn to such declarative rules and regulations enshrined in the Medical and Dental Council of Nigeria. There’s the more important need for both registered and ‘unregistered’ practitioners to maintain decent and decorous relationships with their clients and patients in the course of professional transactions and treatment. It’s alarming that the underdeveloped capitalist reality of our time today, is making this culture disappear with unbearable consequences. There shouldn’t be fraudulent or dirty deals in any form, not least the question of fake professional bills, illegal abortion, collusion, fees sharing, false certification and whole lots. These are more-or-less a resemblance of past historical mistakes outlined above.

How much do we then know about the health of the public⸺persons who have been forced to abominate public health services as a result of these attitudes and made to keep exploiting their wits and traditionally cure their illnesses? This is far from the conception of public health, for there are possible differences between the latter and health of the public. Today health advocates tent to talk much about public health⸺ways of government and policies on health⸺as well as the manner by which global changes in health affect public health policy direction. What of the health of the public⸺ordinary people⸺women especially, who handle variety of illness at home range from the use of bitter fruit (Hausa: gauta) to cure stomach-tight, tamarind and (or) natron (Hausa: Tsamiya, da kanwa) to cure stomach rumbling, salt or palm oil (Hausa: gishiri ko manja) in stopping bleeding, cutting on women’s anterior part to cure gishiri⸺an illness that prolongs child delivery, etcetera?

The concern here is to draw the attention of public health policy makers to consider accommodating some of the above home-care practices⸺largely under-recorded, not even appeared in questionnaires, or so academically documented, including men circumcision (Hausa: kaho) usually being done by barber-surgeons for blood-letting among many others. For these home-care practices are more than just ‘old habits’, they are indeed increasingly becoming integral elements in most of the rural families’ own system of ‘public health-care’. It should be noted that since the 1970s, people in rural communities in the North-west, as in other places, have been the ones doing the best of their effort to subsistently keep themselves healthy and alive. They couldn’t have remained consistent on these practices had they not been so effective to their health.

Contemporary public health in Northern Nigeria is gradually perpetuating the much earlier colonial policy of ‘subsistence health-care’. Government lets the public get on with managing their own health and ensuring their well-being with herbal medicines and healers alongside markets as well as petty traders⸺vendors and street hawkers.

*This observation is drawn from my field experience on data collection across various rural communities of Katsina, Zamfara and Sokoto States.