JOHESU Vs NMA fight: Johesu Agitations and Disharmony Within the Nigerian Health Sector – Facts you need to know

By. D. O. Odatuwa-Omagbemi

This piece was originally written in form of a memorandum and submitted to the Pressidential committee on Interprofessional Relationship in the Health Sector (Yayale Committee) in 2014.

Written in simple prose devoid of technicalities I feel it is still relevant today with some modifiactions to be read and publisized as a way of further enlightening the public on the current JOHESU Vs NMA Agitations and negative propaganda against the Medical Profession.
Please take time to read and share as widely as possible.

INTRODUCTION/ BACKGROUND.

The medical or health sector in any nation no doubt is a very crucial sector. The health of the nationals speaks volume on how buoyant and well managed the economy of the nation is. No responsible government can therefore afford to neglect this sector. In Nigeria, the health sector has witnessed a lot of problems and disharmonious relationship between professionals especially between medical doctors and other health sector workers or paramedical staff in recent times. The setting up of this presidential committee made of eminent Nigerians is thus, a welcome development.

 

JOHESU Vs NMA: Johesu Agitations and Disharmony Within the Nigerian Health Sector
JOHESU Vs NMA fight

Historically, the doctor or Physician, operated the hospital and took care of his patients all alone with little or no support staff as opposed to what it is today. He took history and examined his patients, made diagnosis, carried out necessary tests in the laboratory to support his diagnosis, compounded and dispensed his drugs, treated and nursed his patients. Over time he became over burdened with performing these functions all alone in addition to diagnosis and treatment of diseases. He then decided to train some persons to help out in some areas that are less demanding intellectually.

For example ; persons to help clean up patients when they soiled themselves, give them drugs when it was time, bath them, etc (duties of the present day nurse). Florence Nightingale (1820-1910) of the United kingdom helped to further popularise the nursing profession when she took advantage of the excess females in the population of UK then to train more nurses to take care of the sick, the old and injured persons.

The Physician also trained those to carry out laboratory tests, compound and dispense the drugs prescribed to patients (explains the origin of present day laboratory staff and the pharmacists respectively). The other health care staff or paramedical staff including the medical records officers, physiotherapists, health assistants, cleaners etc came into being likewise. This left the doctor with the more important and intellectually tasking job of history taking, examination, diagnoses and treatment of patient’s ailments for which he is well known today.

In the present day hospital setting, the medical doctor heads the health team all over the world. His training ensures that he has enough knowledge of what every other person in the hospital does and can correct them when they go wrong.Of course, any patients that comes to the hospital, came to see the doctor and whatever any other hospital staff does is to help the doctor succeed in his responsibility of caring for the patient and ensuring that he or she gets well. The doctor sends patients to see any other staff including: the laboratory, pharmacy and other staff as necessary and he/she patiently coordinates all their activities to ensure a favourable outcome making adjustments in treatment modalities along the line as necessary.

This is why the great overall responsibily of caring for the patient lies on the medical doctor. If anything goes wrong along the line, it is the medical doctor that is often taken to court even for mistakes of other members of the health team. If the patient reacts to blood transfusion for example as a result of improper cross-matching by the lab. Scientist, it is doctor that bears the responsibility of ensuring such a patient is given the right antedote for him not to die from such reaction even though the problem was caused by an incompetent lab. Scientist.

Same goes for a nurse who for example inadvertently administers the wrong drug or dose of drug to a patient in the ward even though the doctor prescribed the right drug and dosage. He/she does not know what to do most times and the onus eventually falls on the doctor to treat the effects of the adverse reactions from such mistakes to save the patient’s life.

Alas! if for any reason the patient dies or suffers serious disability, it is the doctor that is eventually sued to court to answer for the ‘sins’of others in the health team. It is the doctor that the patient and society knows and what every other professional in the health team does is to help the doctor succeed. Is there any querry therefore why the doctor should not be the natural head of the team?

THE SUDDEN GANG-UP AGAINST THE MEDICAL DOCTOR IN NIGERIA.

Contrary to what happens in other parts of the world and beyond what any reasonable person can phantom, there has been what I want to call a sudden‘gang-up’ of other hospital staff against the medical doctor (their benefactor) in Nigeria in recent times. This is for no tenable reason other than probably envy if I have to hit the nail on the head.

The question I ask is that; is it a crime for the doctor to have invited others to come and dine with him in the business of caring for patients? The hospital gate man, cleaners, the medical records officers, the laboratory staff, the nurses, the plaster technician etc, many who do not even know their right from their left in the business of patients’ care suddenly wants to take over leadership in the hospitals and direct others.

They go about wiping up sentiments. If the blind says he wants to lead the sighted and he is allowed the end will surely be disastrous especially when it has to do with human lives. All over the world people strive for excellence in all areas of human endeavour, but in Nigeria mediocrity seems to rear its ugly head everywhere including the health sector that deals with human lives. I will come to this again later in this discourse.

SOME PLAYERS IN THE HEALTH SECTOR, TRAINING, QUALIFACTIONS AND OTHER REQUIREMENTS. FUNCTIONS AND THE QUESTION OF LEADERSHIP

THE MEDICAL PRACTIONER OR DOCTOR: No doubt, the medical profession is a noble one that requires a minimum entry qualification of a university degree awarded after a rigorous training and the assimilation of a large volume of knowledge for a minimum of 6 years usually without a break (NO HOLIDAYS FROM THE SECOND YEAR TILL GRADUATION).

This leads to the award of the a Bachelors degree in Medicine and Surgery (MBBS, MD, MBChB), or Bachelor of Dental Surgery (BDS) by a recognised/approved universities. MBBS has been rated in the Guiness book of records as the toughest course in the world. It is actually a conglomeation of several degrees into one. Pass mark for all exams is 50% and above as opposed to other courses where 40% is the pass mark.

As regards rating for teaching purposes in the Universities, it is equivalent to PhD (Entry point for both is lecturer 11). Others who must have at least a 2nd class upper or first class degree before being considered for university lecturer job at all start as graduate assistants and need at least 6 years with relevant academic publications to get to that level. Please note that in places like the USA, The basic medical degree is a postgraduate one pursued only after obtaining a first degree in a science discipline.

By virtue of his training, the doctor knows basically all what other health sector workers or paramedical staff do and participates in their training. He is trained as a leader in the health sector ab initio, haven originated the other medically related professions in the first place. His/her major duty now is diagnoses and treatment of ailments.

THE NURSE: The basic requirement for a nurse that works in the hospital is the RN or registered nurse certificate which he or she acquires after about 2-3 years of training in a nursing school. Academic nurses with university degrees (BSc Nursing) who teach in the nursing schools and universities exist today, but are hardly relevant to the practical day to day patients care in hospitals (though they are now infiltrating the hospitals). The nurses as earlier mentioned help take care of patients by cleaning them up, administering drugs to them, wound dressing, taking vital signs and other such functions as directed by and under the supervision of the doctor.

For all intent and purposes the RN qualification and where necessary those with post-basic nursing qualifications eg in Paediatrics, Orthopaedics etc are those necessary and relevant to the hospital setting and patients’ care. The current clamour for BSc. and higher academic qualifications for nurses are just for pecuniary reasons and have not improved patients’ care.

My experience working with both groups showed that the RN nurses are far more knowledgeable in the practical aspect of patients’ care which is what is needed in the hospital setting. The BSc. and higher qualification holders do better as educators as most of them lack the practical knowledge of nursing.

In the past and even today in other climes the nurse was/is a close ally of the doctor as both are closely in contact with the patient and both had oaths of allegeance to the patient. To the general public the nurses and the doctors make up the hospital. In Nigeria today the nurses have gone to form an unholy alliance with impostors in the health sector who don’t care about patients’ well being and are only interested in the pecuniary gain in the system. I hope they soon retrace their steps and come back to their natural ally – the doctors.

THE LABORATORY TECHNICIAN/TECHNOLOGIST / SCIENTIST: The basic requirement for working in a hospital laboratory ( Pathology Department) is a National Diploma (ND), in medical laboratory science or technology obtained in about two years in any government approved training institution. Higher qualifications like HND, or degrees are pursued by individuals to enhance their performance and remuneration.

They carry out tests requested by doctors on body fluid samples usually under the supervision of the Consultant Pathologist who is a specialist doctor in a tertiary hospital who also interprets the test results. It is worthy of note that the degree holders in this group (with Bachelors degree in medical lab. Science) are most vociferous group causing disarmony in the health sector today.

Against all norms and ethics of patients’ care, they have constantly mobilsed other health workers against the medical doctors for pecuniary reasons to the detriment of patients’ well being. Off course they are usually not in contact with patients and so owes them no allegiance whatsoever hence they call others out on strike for no cogent reason other than wanting to be treated like medical doctors and earn what they earn without doing what they do and taking responsibilties which the doctors take.

The Medical Lab. Technicians / Scientists are usually supervised in a hospital setting by the consultant pathologists (medical doctors) even if they have PhD. This is the practice worldwide. Their recent aggitattion not to be supervised by doctors is an aberation that can only spell doom for the health of Nigerians if accepted.

THE RADIOGRAPHER: Gets his/her training from the school of radiography where he gets a diploma after 2 or 4 years as the case may be. He operates the X-ray machines to take X-rays for patients as requested and directed by the doctor, who also interprets the results – the specialist doctor in-charge here is the radiologist. With new developments, they also operate the CT and MRI machines still also under the radiologists who also interprete the results.

THE PHARMACIST: Trains for about five years in the University to obtain a B. Pharm. They run semester systems and observe holidays like other first degree students. The degree prepares him/largely largely to work in the drug industry and his role in the hospitals entails stocking and dispensing drugs appropriately prescribed by the medical doctor.

In some climes they may do a bit more eg.giving advise on drug interactions. They call the shot in the drug / pharmaceutical industry and the doctor does not contest that with them. For all practical purposes, the Pharmacy technician can actually do all that the Pharmacists do in our hosptials today. They actually need to do more to become relevant in the hospital setting or be confined to the drug industry. The only thing they do more now is to aggitate for more pay or pay parity with doctors.

THE MEDICAL RECORDS OFFICER: Obtains a diploma after 2 or 4 years relevant training in an approved institution and helps to keep and sort out patients’ files as necessary.

THE PLASTER TECHNICIAN: Helps the doctor to apply POP and other cast materials on patients as requested by the doctor. Most times he is trained directly on the job by the Orthopaedic surgeon and at other times gets a certificate after 6 months to 1 years practical training in a hospital such as the National Orthopaedic Hospitals in Nigeria.

We can go on and on down to the cleaners and hospital gate men etc.

Today in Nigeria where things seem to work ‘up-side down’, these people want to take over as medical directors of hospitals telling doctors what to do and how to take care of their patients. They have wiped up so much sentiments and carried out so much negative propaganda and lies about the medical doctor painting him/her as very selfish and arrogant. So much so that some gullible members of the Nigerian society are already falling for their gimmicks.

Those falling for them are definitely uninformed and need to be informed appropriately. We deal with the most sacred aspect of existence (the human life) in the health sector and sentiments should not be allowed to overshadow our sense of judgement as this will only spell doom for the health sector in Nigeria.

The above exposition on the relevant players in the health sector leaves nobody in doubt that the doctor is the natural head of the health team and is internationally recognised as such. Nigeria cannot afford to be different. No doubt many of these other health care professionals especially the male nurses, pharmacists and physiotherapists, some who even still shamelessly go around deceiving the public that they are medical doctors, wanted to train initially as doctors but could not monster or withstand the rigorous intellectual and physical demands required or even get admitted into the training programme.

They now want to come through the back door to head the health team. It has never worked anywhere and Nigeria cannot be a testing ground. By the way the medical school is still open to admit any of them. They should emulate some of their colleagues who after initial training as a nurses, Physiotherapist, laboratory Scientists etc, and were not satisfied, went back to the medical school and are now doctors and even specialists and consultants in various fields of medicine. I salute their courage.

I also happen to fall into a similar group. My first degree was a Bachelor of medical sciences (B. med. SC) in Pharmacology before I proceeded to obtain an MBBS degree. Today I am a consultant Orthopaedic Surgeon having gone further to specialise in Orthopaedic surgery. I now can legally aspire to become the Chief Medical Director of any Hospital in the world without causing any stir.

I don’t think it would have been nice or acceptable if I had gotten myself a hospital job with the Bachelors degree in Pharmacology and start fighting the doctors to allow me come in through the backdoor to become the Medical director or lead the health team as others are doing now.

We know that some of the other health care professionals have even gone to the extent of extending the length of training in their fields in order to deceive the public that like the doctors they also stay long in the universities and want to be as such accorded the same level of recognition and pay as doctors in the health sector. The public should not be carried away.

As insiders we know that the course content and volume of knowledge acquiredfor the whole length of training in these programmes is by far less than that obtained by the medical students in their first 2 years of training in ; Anatomy, Physiology and Biochemistry. It will thus not make and should not make any difference even if they now make it 100 years to train as a nurse, lab. Scientist or Pharmacist.

I hear the lab, scientists with the collaboration of corrupt officials in the Nigerian Universities Commission (NUC) now want their students to spent 6 years in the Universities going through a syllabus that is largely irrelevant to what they will practice so that they can be called doctors. It is only in Nigeria that such things happen.

One wonders why the NUC did not border to look at the international practice and syllabi when such selfish requests arise before giving approval. I personally advise members of the public who want their children to be medical doctors not to be carried away by such challatans with their wicked antics. They should encourage their children to pick MBBS or BDS when filling UTME forms if they want to become medical doctors.

There are no two ways about it. If they take Medical lab. Science or Doctor of Medical Lab. Sc.(DMLS) as their UTME choice, they cannot be medical doctors except they want to become quacks. They will only be using their precious 6 years to study what they can learn in 2 – 4 years and still function fully as a professionals working in the lab.

These hippocrites now extending the number of years for medical Lab. SC. don’t even want their children to read such courses. They constantly beg and pressurise medical doctors who are lecturers to admit their children into MBBS programmes, while they encourage the public to sent their children to waste 6 years studying what they themselves studied in 2 – 4years (The international standard)

What is important is that you have not obtained the relevant qualification and training to be a medical doctors and as such cannot be one or be recognised as one. Come to think of it. Can the air hostesses/hosts suddenly wake up and say they want to take over the control of a plane and earn the same salary as the pilot? Or can a person who is not a lawyer working in the ministry of justice wake up and want to become the chief judge even if he probably has a PhD?

In a similar vein, will the Pharmacists allow a Pharmacy technician (only trained to dispense drugs) head the Pharmacy department ?, Will the nurse allow the ward orderly or health assistant to head the nursing department? Will Laboratory scientist allow the laboratory technician to lord it over him. I leave these questions for the public and those concerned to answer.

It is also necessary to point out here that having higher qualifications that bear no clinical relevance is useless and under normal circumstances should not be and are not recognised in the hospital setting. This statement has become necessary as some health workers in JOHESU have been cliaming they are masters and PhD holders and should be recognised with a higher pay or be appointed consultants as such. They should be made to know that just having a higher academic qualification does confer recognition in the hospital or clinical setting and this is not peculiar to only JOHESU members.

A doctor with with MBBS who goes further to acquire MSc and PhD in human Anatomy or human Physiology for example that bears no clinical relevance will not get additional pay or be appointed a consultant in the hospital. He will progress like any other medical officer to become a CMO. He can only get relevance and recognition in the University where he teaches medical students and progresses along the line of becoming a professor.

For the purpose of emphasis I state again “IT IS ONLY MBBS, MBChB AND BDS OR MD THAT ARE MEDICAL DEGREES FOR MEDICAL DOCTORS” – do not be deceived. They are gotten by specific and relevant training in recognised universities world wide. They are not obtained by increasing the length of training or changing the course content of other paramedical courses (eg. Lab. SC, Pharmacy, Physiotherapy etc). Even if you spend 20 years doing other paramedical courses you cannot be a medical doctor. Please let the public be informed and also inform your children and your childrens’ children.

MEDICAL SPECIALISTS, CONSULTANTS AND THE CONTROVERSY OF SPECIALIST ALLOWANCES AND OTHER REMUNERATIONS IN THE HEALTH SECTOR.

The Longman dictionary of Contemporary English defines the hospital consultant as ‘a hospital doctor of very high rank who has a lot of knowledge about a particular area of Medicine’. This presupposes that for you to be a hospital consultant, you have to first qualify as a medical doctor. The additional ‘LOT OF KNOWLEDGE’ mentioned in the definition comes from several extra years of postgraduate study (at least five years), practical experience under the tutelage of senior consultants in the area of the doctor’s interest and the passing of specific examinations as an when due. This is usually referred to as residency training at the end of which the doctor is conferred with a fellowship of the specific certified examining body in that field of medicine.

Here in Nigeria, the National Postgraduate Medical College and the West African Postgraduate Medical college are responsible for the necessary examinations and ensuring that standard is maintained. In the United Kingdom the Royal Colleges of Physicians and surgeons are responsible. The fellow or specialist then becomes eligible to be appointed a consultant which is usually not automatic and is subjection to vacancies and other considerations and institutional requirements. The post of a medical consultant comes with the highest level of responsibility in terms patients’ care and as such mere qualification does not guarantee such appointments.

Some institutions may observe a fellow by attaching them to a senior consultant in his field with strict observation for a period of 3 -5 years before appointing them consultants after being given a clean bill by the superintending senior consultant. Every patient that comes into a tertiary or secondary health institution is assigned to a consultant whose name is boldly written on the file and attendance card. From that point on, the consultant takes full responsibility for all that happens to that patient and ensures he/she gets the required treatment and get well.

One wonders then why every Dick and Harry working in the Hospital including the cleaners and those who sort out cards for patients (medical record officer), lab. Attendants etc in Nigeria today wants to be called a medical specialist and a consultant when they have not gone through the required training, to possess the required knowledge and capability. Are they asking for this because they want to earn the same salary with the specialist medical consultants or they think from the depth of their minds they can shoulder the responsibilities attached to the position? I am sure the former is true.

If so, the implications spell doom for our health sector if the government out of sentiments bow to their pressure and gimmicks. Very soon there will be no doctors in our hospitals. Why will I go through the of rigours of writing UTME and reading Medicine if I can rise to be a consultant and the medical director of a hospital by simply going to learn how to store and retrieve patients files or study nursing or midwifery for 3 years or even study less demanding courses like lab. SC or Optometry.

I will off course take the easy way out like any other person. Patients visiting the hospitals might then be content with seeing the other health workers for their treatment. I am sure that is not what we want for our health sector. Come to think of it, even the medical officer who is not a specialist working in the hospital possesses by far more knowledge and is more competent than any of the other people now clamouring to be recognised as specialists and consultants for pecuniary reasons.

If anything, the medical officer should be the first to be considered for specialist allowances and appointment as consultants. He is not clamouring for that because he knows that these differences in allowances and remunerations are what serve as incentives to motivate or spur doctors to go and specialise.The government should please be appropriately guided if they want the health sector in Nigeria to develop to world class standard to avoid these distractions from those who are more interested in their pockets rather than the health and well being of Nigerians.

I am one of those who feel that health workers should be paid well for the job of dealing with human lives. But I hate when other health workers use doctors as reference points to negotiate for increased pay, because, there is no bases for comparison in terms of job description, training and medical knowledge acquired. You cannot train as a nurse, plaster technician or laboratory scientist and want to earn the same salary as a doctor just like any other person who is not a lawyer in the ministry of justice cannot aspire to be the chief judge or earn the same salary with a judge.

Even the Pharmacist will not agree to earn the same salary with a plaster or Pharmacy technician. Even those with same qualifications but different job descriptions should earn differently. In the University today for example a person who MSc. Degree in public admistration and works as lecturer earns more than a non-teaching staff with exactly the same qualification. That is what job description is all about.

THE POST OF A MEDICAL DIRECTOR OR CHIEF MEDICAL DIRECTOR OF SPECIALIST AND TEACHING HOSPITALS.

I need to make some specific comments here to set records straight. These two group of hospitals are the highest level of health care delivery in any part of the world also referred to as level 1 hospitals. Hither to, this post has always been held by medical consultants in a tenured manner by appointment and laws establishing the institutions are quite clear about it. Not more than one medical director exists in the hospital at a time. Many consultants never get appointed to that post before they retire from the system and once a person’s tenure expires he no longer bears that appelation – ‘Director’ as he becomes an ordinary consultant like others.

Nobody takes the post and stays there for ever. Recently after obtaining some questionable court judgements, members of the amorphous JOHESU have also been aggitating to be appointed directors and medical directors within the hospital setting. There is no position they don’t want to get to through the back door.

Even though the law is quite clear that a medical qualification is basic to aspire for the post and the doctor is the only one with medical qualification in the hospital, the physiotherapist, medical records officer, plaster technician etc are also claiming their certificates should be accepted as medical qualifications and consequently be allowed to contest for the post medical director. Wonders shall never end. It is obvious that these persons are just out to destroy the health system of this country if allowed.

This committee (Yayale Committee) has the opportunity to stop them by giving the right advice to the president today. Medical directorship is not a child’s play or an all comers affair. It is a highly professional post requiring high level of medical knowledge in addition to administrative competence. Sentiments, mediocrity and blackmail cannot be allowed to rear its head in our health system. The human life is sacrosanct.

The idea of having multiple directors of the various professionals within the hospital setting as also suggested by the same blanket notorious industrial court judgement is quite alien to hospital administration and should be jettisoned. It will only bring confusion, chaos and anarchy within the hospital. It will rather generate more rancour as the multiple directors will start to claim superiority over each other giving orders and counter orders. It will be tantamount to creating storm within a tea cup.

The status quo should be maintained if we don’t want the health system to collapse. I advise that other health workers with degrees should arrange their carreer progression like the medical doctors (MBBS holders) in the hospital who progress to become chief medical officers CMOs (level 17-peak) to also move along the same line to their peak as eg. Chief Lab.

Scientist, chief Pharmacist etc at level 17. This they should do instead of asking to be named consultants, the responsibities they cannot shoulder since they are not trained to do so. Those in the minstry can become directors as applicable but not within the hospital setting. – nomenclature varies with setting. In the universities as we know only lecturers can become professors, non-academic staff cannot aspire to become a professor just like the university registar will not aspire to be called a director or permanent secretary. In other words, every setting has its relevant nomenclature.

THE RECENT JUDGMENT BY THE INDUSTRIAL COURT

The industrial court has recently been giving questionable blanket judgments granting the requests of the joint health workers unions (JOHESU) one of them being that lab. Scientists should no longer be supervised by pathologists.

This is one of the saddest things that has happened to our health care system. It is unfortunate that while the judiciary is trying to redeem its image some unscrupulous judges are busy dragging it down.

Any judge that knows the import of the judgement would not grant it no matter the pressure and inducement offered. Some of us are however not too surprised. We have been witnesses to judges giving ridiculous judgements at odd hours and even on Sundays and public holidays in this country that nearly threw this country into chaos and disintegration in the past. I advise the National Judicial council to remove and discipline such judges for gross incompetence and abuse of office while government takes appropriate steps to appeal the judgement. It was meant to cause chaos in the health sector.

RECOMMENDATIONS AND THE WAY FORWARD

Haven taken some time to explain the origin of the seemingly dis-harmonious relationship between the doctor and other health workers, it is only natural to make some suggestions on how to improve on this inter-professional relationship within the hospital:
As already explained, the medical doctor or Physician remains the founder and father of the health profession. His or her headship or leadership in the health team is incontrovertible as everybody knows.

The health team is like a family whose head remains the father and this is not arguable. Other members of the family need to understand or be made to understand this for peace to reign. The hatred and continuous bickering in our hospital will become a thing of the past if this is recognised by others. It is not a matter of ego but sincerely accepting what is right and obvious. It is a question of whom the cap fits. Anybody that wants to aspire to the position of headship must therefore first go through the medical school and become a medical doctor. The life of the patient should be what is of paramount interest to all persons working in the health sector.

There is thus,need to enlighten others in the team that every member of the team is important but there has to be a captain for the team to succeed. This enlightenment or education should from now on start at the point of entry into the training programmes of the various professions in form of career guidance so that people can change their minds from the onset if they are not comfortable with their career lines.

An aspiring nurse, Pharmacist or Lab. Scientist for example should be made to understand from the time of filling the UTME form that he cannot become the CMD or MD of a tertiary hospital in future even he spents 20 years reading his course of choice. He should then be advised to change to medicine (MBBS os BDS) if he desires to be a CMD or Hospital consultant in future so that he does not get frustrated and start making trouble in future.

There is need to make and amend appropriate laws in the health sector to reflect the specific functions and career lines of professionals. This will also reduce the disharmonious relationship between the professional groups. From experience, it is obvious that many persons in the health sector do not know their line of duty as they dabble into performing or usurping the function of others. For example, a laboratory scientist writes out test result for a patient and goes on to interpret such result and even recommend drugs rightly or wrongly when he has not gotten requisite the training to do that. A pharmacist seeking to obtain prescription rights in Nigeria when he has not gotten the required training, theoretical knowledge and competence.

He knows that is not what is obtained internationally but still wants to force illegality down the throat of Nigerians. These are exclusive prerogatives or functions of the Physician or doctor. When the doctor protests or points these out to them they develop hatred and mobilise other health workers to gang-up against him. Much education and well spelt out laws and penalties for those that break the laws are thus required. There is peace in the system in other countries because everybody knows what to do and does it to the best of his/her knowledge or ability.

Those caring for our health should be well and appropriately remunerated. Human lives are dear and those caring for them should be made happy all the time in order to get the best out of them. Everybody from the security man at the gate to the medical director should be well paid. The concept of relativity based on competence and level of expertise and training should however be borne in mind while doing this. This will motivate staff and encourage the quest for knowledge and professionalism. There is no where in the world where everybody gets paid the same salaries and allowances.

Salaries are based on level of training, competence, performance, the demands of your job and above all relevant contribution to patients care. Even among the specialist doctors in advanced countries there are differences in pay. The neurosurgeon for example whose work is more tasking and demanding earns more pay than the general surgeon. That is the direction we should be moving to now. Salaries are not paid based on sentiments or the amount of noise or trouble made by a particular group.

The post of’ SURGEON GENERAL’ should be established as currently canvassed by the Nigerian Medical Association. This will enhance performance and professionalism in the health sector and restore the lost glory of the medical profession in Nigeria.

The industrial court judgement is definitely not implementable if peace is to reign in the health sector. Government should take steps to appeal the case and punish the erring judge to deter others from allowing themselves to be used to perpetrate illegality, confusion and chaos.

In conclusion, it is clear that the work of this committee is a daunting one. However given the calibre of the members and their antecedents, I am certain that reason and not sentiments will prevail in your final decision and recommendations to MR. PRESIDENT.

How long will this JOHESU Vs NMA fight last? JOHESU and NMA

Thank you and God bless.

DAVID O. ODATUWA-OMAGBEMI
(Bmed Sc. (hons). MBBS, FMCS,FICS)
Consultant Orthopaedic and Trauma Surgeon.
(Current chairman, MDCAN DELSUTH)
Oghara. Delta state.

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