Maintain your self esteem

Maintain your self esteem

Few facts to note!
-JOHESU is an amorphous body.
-Doctors are human beings who have family members that are also human beings.
-Yes, doctors swore the Hippocratic Oath and will aspire to defend it fully.
-Doctors work round the clock while other health professionals work shift and so has more time to spend with family and other things.
-There’s a health team in the hospital and the doctor is the head…and the doctor will always be the head with emphasis on the word, ‘always’
– Any attempt made by a doctor to press home his point can easily be mistaken for pride

I decided to play an observatory role as regards the ongoing stand off between the medical doctors and the FG(&JOHESU) hoping for a speedy resolution but as the situation has tarried, it wouldn’t be out of place to lend my voice to the fewer of the ‘warring’ groups and cry out for justice and sanity in the health sector. I will prefer that my opinion is read & commented on, if need be, by open-minded, non biased, cerebral and intuitive individuals on the social media. Patience will also be needed to read the lengthy article and also internalize it. I won’t expect anyone to exhibit an uncultured character by name calling and abuses as I’ve seen following many articles such as this. If you belong to such group of people, kindly save your data and battery life at this stage, close this and go do other stuffs on your device, say play games or scroll through your pictures. Thanks.
So let me begin by sharing my opinion about JOHESU. It’s an amalgamation of incongruent groups comprising of Nurses, Pharmacists, Physiotherapists, Medical lab scientists, Hospital technicians, Hospital orderlies, Record Officers and some other persons in the hospital excluding the doctors. It can be likened to the Nigeria Labour Congress (NLC). It is important to note that NLC, when embarking on strike press home demands that affect the groups which makes it up and occasionally defend the cause of each group of workforce within it. Unlike NLC, JOHESU sprang up with intent to use the number of many to champion the cause of a few! If only the sidelined groups to be can know this! The hypocrisy behind the formation of JOHESU will be seen in the course of this article. I tried finding out what the mission of JOHESU is on their website but my search for their website using various search engines (Google, Wikipedia) yielded no result for JOHESU as at the time of writing this. I know NANNM, an association of nurses and midwives. I know PSN for the pharmacists. I know medical lab scientists have their own association-MLSCN; but I don’t know the association of the orderlies or hospital technicians. And so, when a group of associations team up with a group of individuals, we can only pray that their intent is holy. I keep wondering if an orderly will ever become the president of JOHESU or at least the Gen Sec and thus sign releases and preside over meetings. I do hope I can get my hand on a JOHESU constitution one day, if they have. The contents must really be interesting.
Since this article is not a discourse on JOHESU, I’ll go ahead to discuss the contentious issues in the demands of NMA. The issue of relativity has not been vigorously contested by JOHESU so I’ll gloss over that. It is just reasonable that a doctor, who spent the greater number of years (&semesters) in school; who works round the clock and on whose shoulder the chunk of the responsibility of patient’s care lie be remunerated more than other health workers. As has been shown many times, Nigeria is one of the countries where the margin of relativity between the salary of doctors and some other health workers have been significantly eroded. The issue of skipping too has not been so contested as such. Again, it is only unfair to skip doctors from skipping (pardon the pun) which other health workers enjoy and has been enjoying for a long time! The issue of hazard allowance has also not been so challenged. Even JOHESU knows that if implemented, it will cut across board. Doctors, Nurses, medical lab scientist, radiology technicians and orderlies are exceptionally exposed to hospital hazards and I won’t say one group is more exposed than the other because hazard, no matter how small or infrequent can end one’s life and ambition once it occurs. The three issues that have been fiercely argued is the issue of consultancy, CMDship & post of Surgeon-General.
About consultancy, I personally would not have opposed the desire of other professionals within the health sector to become a consultant if the desire for such aspiration is the belief that being a consultant nurse or pharmacist will improve patient’s care but I do have some problems. I have a problem with JOHESU fighting for this as JOHESU where some group of members can never have a curriculum for attaining such status. If it was being fought by bodies such as NANNM, PSN or NSP etc., each body can put forward it’s blueprint, it’s purpose and what it intends to contribute to the health sector and this can be considered, discussed and individualized based on each profession’s peculiarity; Or why should a physiotherapist who is only vast in his field agitate for Nursing consultancy? Or why should an orderly fight for Consultancy status for pharmacists? Why? Has anyone thought about what the nurses or physiotherapists will do should orderlies decide to agitate for consultancy status? Will the FG be told by the populace to accede to their demand too? The other problem I have with it is that many of those agitating for consultancy status ordinarily, without even being a consultant, overstep their boundaries with impunity. Becoming a consultant will not only make them overstep their boundary, they are likely to trample upon the feet of those in the boundary they encroached upon. A nurse who is supposed to provide patient’s case note for ward round & join in the round but prefers to sit at the station will likely not come to work when she becomes a consultant. So they should put their house in order first and then other aspirations can come up. My other problem is the tendency of such status to promote quackery and deceitful therapy to patients. Some non-doctor health workers illegally prescribe medications and operate on patients who are made to believe that they’re being attended to by doctors. Imagine the extent to which such illegality will blossom should they become consultants or bear the name ‘Dr’ within the hospital setting.
About CMDship, one of the grouse of JOHESU is the phrase ‘medically qualified’ included in the requirement for being a CMD. I propose that if it’s causing confusion, it should be changed to ‘medically certified by MDCN’. That is clear enough. They ask for the reason why the post of CMD must be an exclusive preserve of the doctors. Why not?! Why should other bodies agitate for the headship of a hospital? What do they want to do differently that they can’t pass across to the CMD through their head or implement such within their own niche? Have their profession granted them an administrative edge over doctors? As far as Nigeria, at present, is concerned, the post should be reserved for medical doctors. A hospital exists, first because there’s a patient; then secondly, a doctor. Every other person are an ‘addendum’. It is hard to swallow but it is the bitter truth. A man does not leave his house, get in the cab and go to the hospital to see a nurse or a pharmacist or a medical lab scientist. He’s going to see the doctor who now decides if the patient needs nursing care or needs drug or needs to see a physiotherapist or the attention of a social worker or needs to have some tests done in the lab or needs surgery. It is interesting to note that a patient may not even need any of the above personnel or services but just reassurance. Only the doctor can determine that. Only the doctor is so trained to have a broad knowledge about other fields and a deep knowledge about his own field. If a nurse becomes the CMD and a pharmacist approaches him for a policy to be implemented in the pharmacy section of the hospital, chances are that the nurse will not understand how such policy affects the patient as she has been trained almost solely on the art of nursing. She’s likely to protect the interest of her profession. Same scenarios would play out if a pharmacist was the CMD; but a doctor in such a position has considerable knowledge about other fields and as such has significant understanding and appreciation of the workings of each sub sector of the hospital. The post of the CMD goes beyond just includes an in-depth understanding of the patient for which the hospital exists in the first place. i must add that not even all doctors can become a CMD in the teaching hospitals. Not without passing through the furnace of residency successfully and even some years after that.
Concerning the post of Surgeon-General, I don’t see Nigeria as yet ripe for such post and I’m certain it’s not a strong reason why the strike has persisted. Given the nature of the Nigerian government and system as a whole, such a post at the moment will be a duplication of role and wastage of resources and so I know if other demands are met save this, all doctors are not likely to go on strike for a long time (maybe for life).
My advice to JOHESU if they must remain amalgamated together is to quit playing the Nigerian type of politics within the health sector and do their job diligently, truthfully and be sincere in their demand and agitations. This will attract respect from the patients, the public and the doctors. We don’t need this unprecedented rife and rivalry in the health sector. It is bad for the patient. Also, they should be proud of their identity and profession and fight against some of their members who pose as doctors- operating on patient, prescribing medications- and assume the management of a patient (things they do based on the supposed experience gained having worked with doctors for a while) only to refer to a hospital when the situation is bad but when they or their relatives take ill, they quickly look for the doctors. They forget that patients are different and management must be individualized. My reason for this advice is that, if government decides to privatize the health sector either fully or partially, everyone will be negatively affected but the least hit will be the doctors. A private hospital owner can decide to employ an auxiliary nurse, private orderlies and security men and technicians. Pharmacy shops are ubiquitous. Private labs will spring up in no time. The doctor is irreplaceable and is licensed to establish his own hospital.
Having said those, I want to correct the erroneous belief that doctors are selfish and fighting for their pockets, a propaganda by JOHESU. While it is true that I’ve seen nurses who spend their resources for patients care, almost all doctors I’ve come across have at one time or the other, even as medical students, use their money to assist a patient. The desire to see a patient get well can be sometimes overwhelming for a doctor at times: doctors donate money for patients, donate blood, go out of their way to make sure blood is provided for patient, goes to the pharmacy to ensure drugs are dispensed, even runs to borrow at the pharmacy when need be, runs to the lab to get sample bottles and return samples to the lab and again return to press for speedy processing and result of the investigation. They plead (&at times quarrel) with nurses, pharmacists & orderlies medical lab scientists all in a bid to make sure patients’ care is optimal. Also, don’t see doctors as wicked when they go on strike. When doctors go on strike, they take nothing from the hospital. They only refuse to come to work. When JOHESU goes on strike, they lock up consulting rooms and keep away the stethoscopes, sphygmomanometers and other devices. The power house technicians refuse to supply electricity even when patients are on life support devices; record officers lock up the case files of patients all in a bid to frustrate the doctor’s effort. When these measures fail to ground the hospital, they coerce the orderlies (where private ones are used) into joining them. They harass doctors and even block the entrance gates of the hospital. Yet, the hospital still manages to function. During the last JOHESU strike, I took and charted patient’s vital signs, gave IV drugs, put up iv fluid, thought the relatives how to make tepid water and tepid sponge and to use the bed pan and I administered medications. Relatives got drugs outside and I managed patients within the confines of my clinical judgment. We may be on strike but many of us still consult patients around us free of charge. We’re not lazy. We only demand sanity. Blame the government. Not the doctors.
I’ll end by saying I hope that one day, the catechist, choristers, altar boys and church wardens won’t one day team up with intent to contest the headship of the parish with the priest of the catholic church .If any of those so desire to head a church, then they must go through the rigours of seminary and the cross of celibacy.

one love,keep us together

one love,keep us together


About boloxine

I'm just me.
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  1. David says:

    No amount of blackmail will give you what you want! JOHESU is not an amorphous organization. It is a trade union. NMA is not a registered trade union; it is a professional charity and has no right to declare a strick. 2. Doctors don’t work round the clock. You have never worked round the clock. 3. Health team is not the same as administrative or management team. The title ‘Doctor’ and MBBS degree are not required for any administrative work to be done in the hospital therefore cannot entitle you to headship of a hospital. 4. The health sector has no tradition because it is a dynamic ever-changing system influenced by education, research, professional development, patients and clients needs, and technological advancements. 5. A Doctor’s salary in Nigeria is more than his contribution in relation to salaries of other health professionals (such as nurses) who contribute more to the sector (see job eveluation report 2007). 5. Are we now looking for an administrative surgeon or surgeon administrator in Nigeria? Surgeon-General is only found in the military of USA and some commonwealth countries. It has never been found in a civilian health system. And it has never been a position exculsively for surgeons or medical doctors. The current Surgeon-General of United States is a Nurse. Please stop telling lies to the public.

    • boloxine says:

      Thank you for taking time to go through the article.&I’m sure you were not referring to it when you used the word ‘blackmail’.No one does the job of blackmail than JOHESU.I’m not arguing the fact that JOHESU is a trade union but that doesn’t change the fact that it’s an amorphous is an amorphous body by dictionary definition and reality!Whether doctors have the right to go on strike is not debatable.They do.Why can’t a doctor go on strike when he’s feeling annhilated in the workplace&tending towards a dangerous point where he wouldn’t have a say on his patient?;a point where anarchy is beginning to set in.I laughed when I read the part where you said I’ve never worked round the clock.By the way,that’s my routine!I think I was explicit in my explanation of the reason why a doctor should be the head of the hospital.I gave an example of policy implementation.The interesting thing about the tradition in the health sector(yes!there’s tradition) is that there’s dynamism which should be in the ultimate interest of the patient&not some groups who wants to get to a post through the back door when the road to the post is open&accessible for all.I will really appreciate it if you can post a link to this job evaluation report so we can evaluate the source,the content&it’s recommendation.Meanwhile,if the ratio of Nigerian doctors to that of patients is very low campared to what WHO recommends and the few doctors that are in the country attend to all the Nigerian patients and they are one of the least paid in the world,I wonder what your justification is for saying doctors are bing paid more than their’s good to know your worth.Your last statement exposed one thing-you din’t finish reading the article.I shouldn’t have thanked you for your patience in the first instance.if only you read my opinion on the surgeon general issue,you wouldn’t talk about ‘spreading lies’.Thanks all the same.

    • Wazobia says: Why claim false information easily verified on the internet for the sake of argument. Who is the current surgeon general in the US? Your whole argument comes crashing down like a pack of cards

    • E! says:

      Still wondering, is it the bmls degree or the pharmacy degree that confers one administrative role? The last time I checked, there is a Director of Administration in the tertiary institutions who isn’t a Dr, and whose duty is mainly hospital administration. But coming to the overall head of the hospital, it must be a Dr cos he is the only one in the health team who has a broad knowledge about all the other departments in the hospital…. Dnt want to exchange words with u as regards ur statement that Drs dnt work round d clock cos I’m sure u knew u were not being truthful when u made that statement. Drs are the ONLY pple that can be on call for 1 straight week and still don’t have any time off. Nil body in the hospital puts in more effort in patient management than the Dr.

    • daredean says:

      But where did you get your info that the current Surgeon General of the US is a nurse?!?
      I’m appalled by this… You use a lie to tell someone to stop lying?!?
      You could simply have done a google search before making hapless claims…
      And I won’t even talk about JOHESU… That would be a needless waste of my time

    • Mark says:

      @David. You are the one telling lie to the public. The current Surgeon-General of United States is not a Nurse as you claimed. He is medical Doctor, he graduated from Feinberg School of Medicine as a medical doctor. His name is Boris Lushniak. His predecessor is also a medical Doctor. Her name is Regina Marcia Benjamin, a consultant family physician. Confirm it here:

    • Temmy says:

      Haba! David
      Why did u decide to cook up ds liessss

    • Nnabuike Ojiegbe says:

      Hahahaha…Kindly fortify your argument with the observation that the mason works harder than the architect that designed the building. I suggest we pay him more than the architect…even more than the comissioner of works & housing…hahahaha

  2. David says:

    No amount of blackmail will give you what you want! JOHESU is not an amorphous organization. It is a trade union. NMA is not a registered trade union; it is a professional charity and has no right to declare a strike. 2. Doctors don’t work round the clock. You have never worked round the clock. 3. Health team is not the same as administrative or management team. The title ‘Doctor’ and MBBS degree are not required for any administrative work to be done in the hospital therefore cannot entitle you to headship of a hospital. 4. The health sector has no tradition because it is a dynamic ever-changing system influenced by education, research, professional development, patients and clients needs, and technological advancements. 5. A Doctor’s salary in Nigeria is more than his contribution in relation to salaries of other health professionals (such as nurses) who contribute more to the sector (see job eveluation report 2007). 5. Are we now looking for an administrative surgeon or surgeon administrator in Nigeria? Surgeon-General is only found in the military of USA and some commonwealth countries. It has never been found in a civilian health system. And it has never been a position exculsively for surgeons or medical doctors. The current Surgeon-General of United States is a Nurse. Please stop telling lies to the public.

  3. Lucy says:

    Great thoughts on the issues at hand wish more people knew what was c really going on. Please visit my Web page to vote your opinions on the state of the healthcare work force in Nigeria

  4. Tayo says:

    Well my contribution is that whoever can’t read the whole story should just read the last paragraph.On the matter of JOHESU the name is even wrong so far it doesn’t include medical doctors as part of the association? Now, if an association excludes a member it must be for a reason.Its only reason for exclusion and existence is to fight the doctor and make demands that don’t include a certain member .Now I dont think the govt. should not promote fighting hence JOHESU should either cease to exist or admit doctors as members.Thank you

  5. Tayo says:

    Well my contribution is that whoever can’t read the whole story should just read the last paragraph.On the matter of JOHESU the name is even wrong so far it doesn’t include medical doctors as part of the association? Now, if an association excludes a member it must be for a reason.Its only reason for exclusion and existence is to fight the doctor and make demands that don’t include a certain member .Now I dont think the govt. should promote fighting hence JOHESU should either cease to exist or admit doctors as members.Thank you

  6. vinci says:

    Excellent piece,excellent.My fear is that a sizeable fraction of those who constitute JOHESU aren’t brainy enough to comprehend such a masterpiece of expose…..any way,posterity will judge.

  7. Wazobia says:

    Great stuff. I don’t like long story but your writeup was very interesting and the least biased I’ve read on the matter. I am happy this comes up because I believe that the state of the health sector in Nigeria needs to be addressed. Well, that’s hoping this doesn’t turn out to be a storm that gets derailed as is often the case when things are in the Nigerian context. The issue of surgeon general is null in my opinion. Doing it at this time would be analogous to conferring a medical chieftaincy title. Human organizations inherently look for what’s in their best interest and I would speculate that the SG is supposed to give NMA a little more leverage politically as the MOH most times is a stooge of the FGN. Our culture is based on hierarchy and not merit or team work and I believe this permeates all aspects of social and professional life and in this case has led to the formation of JOHESU, an ill thought out and mostly directionless organization except apparently to antagonize doctors. On the issue of the CMD, the health professional with the widest perspective (length of training and work schedule aside) is the doctor. Unless the center point of the hospital has changed from patient care then this position can only be assumed by a physician.

  8. MOG says:

    Doctors are no longer keeping the Hippocratic oat. They have abandoned the patient and pursuing politics. Sad.

    • boloxine says:

      Thanks sir/ma for your comment.Actually,it’s the other way round.Doctors are toiling to maintain the oath&prevent future boomerang which will spell doom for patients!&what more?they’re also kicking politics&bickering out of the hospital!

  9. Musa Bokani says:

    Let’s stop dis argurement and go for d best practice, I think its high time we make reference to USA, UK, and CANADA to see what is happening there. D question should be 1) Is it doctors dat head d hospitals? 2) Do we have directors in other department? 3) Do we have consultants in other departments? 4) Do we have more than one salary structure in their settings eg Con mess and conhess?.. 5) what is their Sugeon general all abt?, is it only for doctors or even for civilians? And lots more questions when answered will go along way to put an end to dis saga in the health sector.

    • boloxine says:

      Thanks for suggesting a way forward

    • Wazobia says:

      I can’t answer all the questions but in relation to #1, in the US at least most hospitals are led by doctors (the title president is used most times) though there are a few hospitals led by non doctors. In any case, you will often see specific training and experience that makes this person fit for leadership of a hospital. This only means that “turn by turn” or quota system is not progressive and is a time bomb waiting to explode. My interpretation is that in the presence of qualified non-doctors, the doctor is preferred and in the absence of qualified non-doctors as is the case with Nigeria, the doctor is the only choice. Do I think other health professionals are ready for leadership in Nigeria? No but this may change over time. In summary all professionals will do much better if they focus on adding value to the system and improving themselves rather than focusing on titles.

  10. daredean says:

    Quite a long one… couldn’t bring myself to reading the whole article… Loved the conclusion… Sums it all up…
    Unfortunately, our people won’t let reason prevail!
    Such a sad situation!!!

  11. daredean says:

    Finally read through… Very well said…

  12. daredean says:

    Reblogged this on Dare's Journal and commented:
    I don’t expect y’all to agree, but I don’t think this could have been better said… This system indeed needs sanity!

  13. ola agboeze says:

    i think de root if thus problem is that most- moe than 50% of those on these other aspects of the health sector- lab scientists,pharmacists, radiographers did not want to be in these fields. majority wanted to be doctors( take a poll if they will be sincere). most nurses wanted to be same and i think dey are the least problematic. if they meant to be in those fields they would try to improve them in terms of research and dynamism of operation. there will be no time to bicker about doctors. and by de way johesu is a disaster waiting to implode!

  14. Ibrahim Abdu-Aguye says:

    I personally apreciate the truth in the write-up. The trouble with the Nigerian scene is that most things are ordered to satisfy parochial selfish interests. Where else in the world does a nurse decides what the best way to deal with an “ulcer” (benign or malignant) above the doctor’s opinion? Where else in the world does the pharmacist decide the best drug for a patient he probably has not seen or has not ordered a bacterial culture for over the attending physician? Where else does the physiotherapist takes over the job of the primary neurologist, neurosurgeon, orthopaedi surgeon or even a paediatrician. Where else does a laboratory technician or fanciful scientist without a clue about the patient’s presentation, history or clinical details decide what tissue to sample? The bitter truth is that the doctor, no matter how lowly is able to do this ALL THESE on his own and would do it more efficiently with the ASSISTANCE of the other APPENDAGES (no insult intended). Anarchy will reign unless this is appreciated and the patient will be better protected. This whole thing is sickening. Why is Nigeria so different from the rest of the world in its various organizations? By all means, correct the structural problems in the health sector but plesse don’t upset the apple cart. Create the necessary directorates, eg, Nursing, Physiotherapy etc in the Ministries snd let those professionals head them but don’t allow allow the ochestra to be directed by the man who knows the entire tunes. The doctors also need to sit up and strive to show good example and consolidate on the natural leadership conferred by their specialized training.

    • boloxine says:

      Brilliantly stated!

    • Oghor says:

      Ibrahim, many of the issues you raised already happens in many western countries, and I must admit I struggled with nurses and pharmacists challenging my opinions when I first arrived, but over time I’ve come to see that theirs is a better system.

      For starters, I must say, the major difference is the approach and manner of the person disagreeing with you. Like they say most quarrels are 5% issues and 95% attitude. When the ward pharmacist goes round and reviews the drug charts after the rounds, he leaves you a polite note to say perhaps you should consider changing Mr. A’s antibiotics to oral as he has been on IV for so long, or perhaps you hold stop or change his analgesia as the sedative effects may potentiate each other and be harmful

      Or a nurse suggesting you hold off giving more morphine as the patient is too sedated

      When you send a patient for some X-rays, you could get a call from the radiographer suggesting some other views or ultrasound that may be of less radiation and safer for the patient. Same with the lab scientist ringing to ask if a particular test can be delayed till the morning for some reason. Sometimes you agree with them other times you don’t. If you can’t resolve it peacefully then you escalate it to each other’s boss. So the radiographer could insist on not doing the X-rays you requested and you phone the radiographer to discuss with him, or you take up the nurse who refuses to give the morphine with her matron or head of nursing. These issues are resolved based on clinical evidence. Not on ‘I’m the doctor and I say so’ A lowly doctor as you put it, in Nigeria can go around giving orders and when challenged waves his doctor badge in everyone’s face, that won’t fly in a civilised society! I do t see how you claim the present system better protects the patient!

      • outlook says:

        Interprofessional relationships in the Nigerian health sector is a very complicated issue, and this is due to the infighting and animosity present between healthcare professionals. It occurs elsewhere in other countries, but not to the extent it happens in Nigeria. Like I said earlier, it’s often a reflection of the general Nigerian society, than a health sector issue alone. Many doctors will tell you about instances where pharmacists have changed their prescriptions without the courtesy of informing them, talk less of suggesting that the prescriptions could be altered based on principles. Or the instances when a laboratory scientist refuses to give you fresh whole blood because he thinks stored blood is just as good. Or instances where a nurse informs you that your instructions on daily wound dressings will not be carried out because she feels it’s unnecessary. And the whole hospital makes a scene because despite your superior argument and reasoning, they just feel you’re unjustifyably difficult.
        Relating with members of the health team takes a lot of skill and leadership qualities, but I bet you, in Nigeria, it takes much more effort. And I’m sure it’s not totally an issue of the “I-know-it-all” attitude of some doctors. And an attempt at taking these issues up with the superiors concerned will often be met with vehement territoriality issues by their bosses, or with a “let-sleeping-dogs-lie” attitude by your own boss.
        Conversely, I’ve worked with a laboratory scientist who phoned me from the lab about an abnormally high potassium, suggesting it may be a haemolysed sample, asking for another. I’ve worked with a physiotherapist who sent a patient back to me with a note suggesting I consider partial weight bearing for a patient I’d operated with a hip fracture. I’ve worked with a radiographer who advised that a mobile xray machine could be brought to the ward for xray in traction, instead of moving the patient to radiology.
        Because of this group of people, my days are brighter, I’m happier, because their insights and attitude have improved my patient outcomes and made my job easier. These species of healthcare professionals are rare in Nigeria. But they exist.
        Interprofessional harmony is a great issue in Nigeria. I hope one day, all this animosity is reduced to internationally acceptable levels. Our patients will suffer less.

      • boloxine says:

        Again,very well said.

  15. Joseph Olamide says:

    This is one piece I have read in a long time that really made sense although with a sentiment. Let introduce myself, I am a proud and well trained from one of the best universities in Nigeria as a Physiotherapist. I am always proud to be one and does not hesitate to called as so. Given that, the issues here being raised and which have been widely discussed, blogged, tweeted, and even fought over do not need to have gone this far out of control. Let me say the root cause is basically mutual suspicion. 1. Consultancy- Yes, there may be occasions where some persons overstep their boundaries but does not mean that will happen. Such have been going on but i think it is a Nigerian factor which does not augur well for all. 2. CMDship- Let each party make their presentations and let it be subject for public scrutiny and let the act of parliament be the final arbiter and then this would be put to rest. 3. The amorphousness of JOHESU, think about it, everybody knows their limit. Would you have done otherwise when you need such number on your side? JOHESU comprises of MHWUN, AHP mainly. These represent the major groups of Pharmacists, Physiotherapists, Lab Scientists, Medical Records Officers, etc
    To conclude my submission, we don’t need namecalling, mudslinging at each other because when this episode be gone, we will still come back to work together as one team. Healthcare delivery is about all working synergistically to ensure the success of our work and for the Nigerian populace. Let reason, justice, fairness be paramount in our dealings. I am calling on government to play the role of an unbiased arbiter and do what is best in overall interest of Nigeria and Nigerian people and her economy. Thanks.

  16. abeyhoney says:

    Nice one, It is always good to seek knowledge, though is not too bad to be ignorant too but the problem is when people Boldly expose their ignorance. They confedently move purulent stuff.
    Throughout the history of united state the surgeons general has always been a Doctor. The US army, Navy and Airforce also have their own surgeons General. In more than 100years history of US Military The present US army surgeon general is the first female in the army and also the first Non Doctor. The United state surgeon general is different from the 3 surgeons general in US millitary and their functions clearly Distinct. Each states In the US also have their own suirgeons general. US can’t make the mistake of Having a non Medical Doctor as surgeon General. I strongly Believe that we should go back to where we copy this Health structure and stop adulterating the system.

  17. Bidex says:

    Well articulated write -up ! However, do not forget that everyone has the right to freedom of association but it is sad that we have allowed the viraemia that has plagued the Nigerian politics to gradually set in within the highly reverred health sector. I do not have a problem with JOHESU as a group but I have issues with the rationale for their emergence. The battle for supremacy should be trivialised and let us face the real issues of sanitizing the health sector, improving on our seemingly eroding standard of medical professionalism in Nigeria. You will all cringe if you listen to the public outcry and their opinion against the Healthsector. I overheard an old man saying that he was disappointed with the way Doctors are downplaying their statutory roles and responsibilities toward their practices that he held Doctors in high esteem, placing them as god next to God. Last year November,NMA had a meeting with the Governor in portharcourt, and I was privileged to be part of the meeting. You need to see the shameful display of our Doctors fighting over ‘hampers’which the Govt has packaged well enough for everyone in attendance. Security officials, oderlies, Cleaners, etc were just in awe at our rioutous fight over something very affordable.

    Let us all work toward redeeming our image, every other things will fall into place.

  18. olamiotan ayeni says:

    though provoking and highly insighful,i beleive the government is using the so called JOHESU to divide and rule the health sector by reducing the genuine agitations of the doctors to selfish propanganda.
    Having said that,while saving lives is key in the medical profession….a good and sane working condition is also a must for our doctors if we dnt want them to leave this country for greener pastures abroad.
    Apart from the millitaty,doctors are next in line in the order of patriotism in this country.

  19. Oghor says:

    Quite thoughtful, but some issues.

    You say doctors are the only ones who work round the clock and so have less time with their families. Who send una? If this is a problem why don’t doctors change it as has been done in UK, Ireland, Australia to name a few, rather than come here and look for sympathy.

    To those nurses etc looking for consultancy positions, some questions. What exactly will their job description be? So a matron on the Surgical ward is made consultant, will she on Monday have a theatre list, will she begin to operate patients? Will the nurse consultant endocrinologist, have her own diabetic clinic etc. I actually don’t understand this consultancy issue. In the UK you have Advance nurse practitioners who have trained similar to a masters degree level in a specialty like A and E, who have a very clearly defined role to see minor injuries, with back up by the doctors if they need help. Similarly you have Diabetic, respiratory, cardiac etc nurse specialist, who see and follow up patients in their specialty areas, including home visits sometimes, adjusting medications etc, but again after appropriate extra training and practising under the supervision of the consultants. If this is what our nurses want, fine they should agitate for that, if it is more money they want fine as well agitate for that, but I don’t understand their obsession with the title of Consultant. As for pharmacy, physiotherapy or other types of consultants I have no comment. I once met a nurse consultant in the Emergency dept in the UK, and from what I observed his role was similar to a very experienced house officer or at best a doctor just after NYSC. I.E he saw extremely straight forward patients in A and E and referred them on to the appropriate specialty. I never saw him discharge any patient. I say this, before someone begins to tell me in the UK, they have consultant nurses. I honestly would like to be educated on the job description of such a person.

    About the Issue of CMD, this is where I have the greatest issue with you.
    Doctors have a broad knowledge of other fields, true and this is a great advantage but in my opinion not a criterion for exclusion of other professions. Give the other professions some credit. if your hypothetical nurse or pharmacist above run into the problems you describe above, I expect them to educate themselves about the issues involved, ask the top specialists in that area of expertise for advise etc and then make an informed decision. The same way if an orthopaedic patient develop an arrhythmia, you call the cardiologist for advise. The same way the president will ask NOI for advise on economic issues or the Military for advise on BH.

    You’ve thrown a few barbs at nurses in your article, glass houses and stones come to mind. You say nurse consultants will not come to work, what about medical consultants that go off to run their own private practices rather than come to their government jobs? What about medical students and doctors doing Locum jobs well outside their scope of expertise? When will positions for housemanship, residency and even consultants be given purely on merit in Nigerian hospitals.
    You say a CMD nurse will protect the interest of her profession, the same way doctors are protecting the interest of theirs to the detriment of patients or other professions? What you failed to acknowledge in this CMD tussle is that the fight is more about the power and benefits that go with the position. Strip away the power, big office, cars, and other benefits and make CMD a voluntary position, where after your normal 8 – 4pm or indeed round the clock shift you stay on for a few hrs and possibly come in at weekends with no extra benefit to attend to CMD duties, let’s see how many doctors or other JOHESU members will want the job!

    As for Surgeon General, what exactly will be his job description and how would his appointment improve healthcare delivery if Nigeria. All I see is, it will be another job for the boys. Next you’ll get state surgeon generals and possible Local govt ones too, all feeding off the health budget!.

    Quite a long reply, I apologise.

    • boloxine says:

      Thanks for the lenghty reply.It’s funny to think I’m looking for sympathy on my blog.I’m sure you know that the number of doctors in Nigeria is grossly inadequate!&i’m glad you din’t deny the fact that we alone work round the clock because Doctors in the country have to go through more frequent calls to cater for the large patient load of the’s far from sourcing for’s a fact..The least I expect is show appreciation&encouragement.The countries you mentioned have more improved&more ideal health care system.

      Much of your expressed thoughts on the issue of consultancy is about your experience in the UK.I guess you’re giving information&then putting a question through to ‘JOHESUites’&my article was explicit on the hazard of granting consultancy title to other profession within the hospital setting where some non-doctors already offer false ‘doctor-therapy’ to patients.

      About CMDship.Have you asked why some group of people should wake up one day and disrupt the peace&balance in the health sector?My explanation on the reason why a hospital exists should answer your questions!Like I said in my write up,other professions are an addendum!So why should an ‘associate’ or ‘associates’ gang up to take over headship from the ‘owner’?&since the pathway to becoming a CMD is open&free,why create a turbulent passageway?you may read my last paragraph again.

      I’ve come across many medical consultants&i’m yet to see one who doesn’t come to work or except when on leave or away to a conference or so?If they don’t come,who then do the operations?who does the consultant round?who runs the clinics?it might be difficult to see them because they’ don’t usually put on a white coat&hang their ‘steth’ on their neck but they come to work&their impact on patient’s outcome is always greatly will be intersting to know the hospital where medical students&doctors doing locum OUTSIDE their scope of expertise.By ‘outside the scope of expertise’,do you mean a doctor who is a resident in O&G performing a femoral cannulation on a patient in a hospital where he’s doing locum?scope of expertise can be different from area of specialization.While I agree that there may be employment based on influence rather than’merit’, not only for doctors but for all health workers&workers in nigeria,I must add that it is not the function of the ‘CMD’ but a product of the Nigerian system!So when Nigeria is sanitized,it will cut across all sectors.&mind you,a doctor certified by MDCN must have been tested&drilled as a student before being certified save to be trusted with patient’s life.

      I don’t think any JOHESU member will even finger a CMD who protects the interest of doctors at the expense of other health workers.I’ve not seen.Sometimes,the management(including the CMD) could even be at loggerheads wt the opinion&urs on Surgeon General don’t differ much.Thanks.

  20. Oghor says:

    I should show appreciation to you, why? What have you done for me? You’re doing a job for a salary, if you think it’s not worth your while then quit. No be by force!

    UK, etc have better health system etc but that’s not the point . If Nigerian doctors feel their hrs are too long and they’re not seeing their families, they should agitate for a better system, and not whip up sentiments. You start your article by stating proudly almost like a badge of honour that doctors are the only ones who work round the clock. That’s fine, if your happy with that, then continue and don’t ask me for appreciation and encouragement, if you’re not then agitate to change it. I believe Australia stopped the system of 24hrs on call like we do In Nigeria because a few doctors fell asleep at the wheel on their way home after such shifts and died. So the system was changed for the better.

    Yes I was posing questions to JOHESUites, I gave my position on the issues you raised, some agreed with yours others didn’t.

    Again about CMDship, you seem to be saying because historically it’s always been for doctors it should remain so. I find that very strange logic. If something can be done better, are you saying we should stick with the old way because of history. Perhaps we should leave the issue of doctors skipping grades the way it is historically. Why a hospital exist is primarily for the patient, end of, though doctors are VERY IMPORTANT. When you start claiming second most important and declare others as addendums you end up with the present toxic environment. A chain is only as strong as it’s weakest link!
    Why and how would allowing other professionals CMDship be creating a turbulent pathway? I went to great length to explain why the broad knowledge of a doctor is helpful but not an exclusion criterion,and any non doctor CMD can always get the relevant advise as needed, but I see you chose not to counter that but insist on your position of a doctor being the head naturally hence you say I should re-read your last paragraph. Yes the Catholic Church apology fits your argument but sure you know if you think hard enough you’ll find many that don’t. The pilot doesn’t have to head the airline, the train driver, the railway company, the engineer, the construction or manufacturing firm etc. So let’s drop the analogies and debate the issue with relevant facts and logic. Infact I will argue that making a very experienced clinician CMD is a waste of his skills as instead of using his years of experience to treat people and teach doctors, you will keep him in a CMD office doing paper work that can be done by someone else. Like I said strip off the benefits of the CMDship let’s see how many people fight for it.

    In my department many of us, me inclusive shy away from being head or taking on administrative jobs because it’s just extra un rewarded stress, no office, no car, plenty of headaches looking for Locums or pleading with other doctors to do extra shifts when someone falls ill, attending to patients complaints, meeting with police and lawyers etc, attending disciplinary and other meetings etc. believe me in the morning most of us just want to come in see patients and go home, and leave administration for administrators! Infact many emergency departments in the UK employ business managers for their A and E depts to run the place efficienciently and the few I have met so far don’t even have a medical background, their purely business people, and don’t tell me this works because they have a more advanced health system. If we can copy Surgeon General, we can copy business managers!

    So you are not aware of teaching and general hospitals where consultants leave their registrars to do the work, while they come in late, leave early or not come at all while they pursue their private interests. Or consultants who are supposedly on call, collecting call duty allowance, who can’t be found when the registrar needs help? You really are serious when you say you’re not aware of this happening? During my O and G long case exam, the H.O.D had to send one of the secretaries from the clinic venue to go and physically call one of the other consultants from his office to come and conduct the exams, and to remind him that he was getting paid extra for teaching students. The particular consultant was seeing private patients in his office!

    You also have not heard of medical students in their clinical years already doing Locums before they graduate?

    You also have not heard of psychiatry or cardiology registrars going off to do weekend Locums in private hospitals where they take deliveries or even do C-Section. Surgical registrars running their own HIV specialty hospitals.

    I read somewhere that Nigeria was not a democracy but an excuse-ocracy and you have just solidified my belief of that view. So it is not the CMDS job to ensure people are employed on merit?
    Rather we should wait for Nigeria to be sanitized then it will cut across all sectors! Na wa oh. So why should a CMD fight other forms of corruption in the hospital, or try to improve the power supply in his hospital, perhaps he should wait till Nigeria is Sanitized.

    I Don’t understand the relevance of your reminding me that a doctor is certified by the MDCN. the fact that you have a medical degree is irrelevant when you’re corruptly given a residency or consultancy position you don’t deserve.

    I dont understand your last paragraph about JOHESU not fingering a CMD Who protects doctors interest above others. Are you saying JOHESU will not be bold enough to point the finger at a CMD who protects doctors interest above others, or are you saying CMDS don’t protect doctors interest to the detriment of others, I don’t get your argument there.

    • outlook says:

      A lot of issues you address here, are actually a symbol of the rot in the general Nigerian society. And specifically a problem of the Nigerian hospital system, and failure of regulatory bodies to do their jobs well.
      And it’s not limited to doctors. The same is true of all other professional in the healthcare system, and all other groups of people in the general Nigerian society. In a federal institution, nurses do shift work. You look at a roster of duties. You find that a ward has 18 nurses on the duty roll. You look inside the ward, you find only 3 nurses on duty on a Tuesday morning. Why, you ask? Every other nurse is on one off or th other, including public holiday off. everyone knows that is a collossal waste of manoower and revenue that cannot happen in the Private sector. You look at the ward. There are 40 patients, most of whom need wound dressings, medications, vital signs, feeding etc. How will these 3 nurses cope? They have only one nursing aide. The ward attendant has been sent on personal errands by the nurses. Then, you come around on the night shift. And everybody is sleeping, including the nurses who have either spread their mattresses in the nursing station or using the chairs as a couch, or asleep in the break room. You wonder why….then, you realise that these same nurses also work in private hospital locums as their day jobs during their night duty, and come to naturally sleep in the hospital at night.
      What about the theatre nurses that collect call allowances and only do shifts? Same for physiotherapists who also collect call allowances and end their call by 8pm, only to come back to work by 12pm for a half day the next working day? Don’t forget that these physiotherapists also have private clinics where they see patients in town, and also have private patients on home visits. Or the laboratory that shuts down major operations after 4pm, even though a laboratory scientist or physician is on call? Or the amount of blood laundering that goes on daily in the laboratory?
      Move outside the healthcare delivery system, and see the same analogues everywhere….the police, the army, the courts, the schools, the universities, everywhere the government has its finger, or a hold on………..
      It’s an endemic problem. In the healthcare sector, I believe the answer is universal participatory healthcare delivery system, in which government totally handoff healthcare delivery, except in a regulatory role, and healthcare funding is for direct patient care.
      In summary, remove healthcare delivery system from civil service.
      Everybody will be the better for it….

      • boloxine says:

        I must say I’m wowed by this response!the picture you painted is exactly as it is.I just find myself agreeing wt all.I could even picture it happening.There may be but I’ve not seen a nurse who stays awake all through the night shift.Many attimes I’ve gone to check on the patients in d middle of the night or that the orderlies were sent to call me&you find the nurses who have put the patient’s bed beside their station.some even turn their table to the bed&put the mattress on it&enjoy their night shift!You,sir,spoke the truth.

      • Oghor says:

        Quite refreshing to read your well thought out, well informed and measured position on these issues. You’re in the minority but hopefully sometime before the end of this century
        People like you would be in the majority. Not holding my breathe though.

      • outlook says:

        Thanks for the compliment, Oghor……
        A lot of healthcare providers have lost the vision of what healthcare delivery is all about…..compassion and care of the ill and dying. If we always focussed on this, our healthcare delivery in Nigeria would be fantastic, given our inherent culture of caring in Nigeria.
        I think a lot of healthcare professionals need to leave their comfort zones, travel to other climes and observe how things are done, for them to appreciate that the only centre of healthcare delivery has always been, and will always be the patient and his/her caregivers. Not anyone else. And we all need to work together in harmony to get the patient from where he is, to where he wants to be….any other reason is nonexistent.

    • boloxine says:

      Thanks for your thoughtful&indepth response.if you sir won’t appreciate us who work round the clock,others will. Not like it’s essential for anything though.Just human relations. My point is that there’s no way the number of doctors in Nigeria won’t still work extra time than doctors in most of those countries you mentioned,if they must totally cater for the patient load.&yes,you’re right,change can be demanded&agitated for&so,the current strike was borne out of an agitation for a better system which I believe is a process.

      I think the issue of Consultancy is resolved

      Now,back to this highly contentious aspect. No.I never at any point implied that it should be for doctors because it has always been like that. Rather it should be for doctors because that is what is best for the patient in the context of the Nigerian health sector. Saying other professionals are an addendum,which is a fact,may truly make the already toxic environment(tnx to JOHESU) more toxic,but the current situation&bizzare arguments of JOHESU called for that so that everyone knows their role&boundaries.&Yes,a chain is truly as strong as it’s weakest link,the more reason why all health workers should team up.
      Talkin about how allowing other professionals to positions create a turbulent expression there is saying there is a criteria on ground,open to the whole populace.Some pursued the criteria(knowingly or unknowingly), others don’t.some others who ran the race couldn’t meet up for one reason or the other. There was peace.How do you then reconcile making that position open to all with those who passed through the turbulence to meet the criteria wt others who don’t.Maybe if you can explain your thoughts on that.&like I said in my write up.Sincerely,do you think the intent of JOHESU to take a shot at this post is to make the system better?I’ll stop there to read your response.Yes,any non-doctor can get the relevant advise needed but then it wouldn’t matter if an orderly becomes the cmd as long as he has all stakeholders who can give the relevant advise(Remember it’s JOHESU vs NMA).
      In my catholic church apology,I mentioned a team of priest,cathechist,altar servers,choristers,church wardens who work together for smooth running of the church.the priest coordinates.u mentioned certain occupations&firms.I would like to know in what context you mentioned them.which team?working together to ensure smooth running of what?Doctors,nurses,physiotherapists,pharmacists&co should all work together to ensure the smooth running of the hospital.The doctor I think I can still stand on that analogy in my last paragraph.
      I’m not against stripping off the benefits acruing to that office but I must add that I do know some CMDs who still manage to carry out their medical duties&even teach,although not as much as they did when they were yet CMDs.But then,not all doctors are out on the field attending to patients&teaching students.The diversity of Medicine allows for various interests.Not everyone can shy away from taking on administrative jobs&i’m sure if all the benefits of that office was stripped off,some doctors would still go for it!There are many people(not just doctors alone) who are ready to make some sacrifices for humanity.
      If I may ask,do doctors head hospitals in UK?&for those headed by Administrators,is there a level of education or requirement needed?Are there nurses,physiotherpaists,pharmacists heading hospitals?Are there also exclusion criteria in the requirement to be a CMD?Business managers for A&E department sounds plausible but we’re talking about the hospital here&who do these business managers report to?The health system in UK does seem to be profit-oriented.That of Nigeria is not so.
      Saying consultants come in ‘late’ or ‘not early’,I agree but saying they don’t come at all.I already stated the reasons why they may not come but a consultant who leaves his registrar is in constant communication wt that registrar.Even in medical school,it was part of the drills.A question like ‘your consultant is not around&you’re the HO(or registrar) on call and a patient was brought to the A&E wt complaints of….&it goes on to ask what the registrar would do or how he wld relay the information to the superior.The consultant’s impact is felt greatly on patient outcome.I hope you don’t dispute that.if any registrar needs help&can’t find or contact the consultant, then I see such as a dereliction of duty on part of the consultant.There may certainly be some examples of such consultantsbut so far,I’ve seen worse among the JOHESUites,sorry to sound sentimental.
      How did the secretary who went to call the consultant know that the patients are private patients?couldn’t they be some VIP patients he had given appointment to&he thought to quickly attend to them while the students were still clerking?He won’t sit down in the ward wt you while you clerked&the chief resident may not have briefed him adequately on when he’s supposed to join his co-examiner&let’s say your assertion is true,then such a consultant has not done well.I’ve not heard of medical students doing locum before they graduate.&if a private practitioner can employ an auxiliary nurse,it sounds logical that he can ‘use’ a willing medical student to do the same thing students do in the govt hosp.Afterall,medical students assist in surgeries,set line,suture lacerations etc. in the teaching hospital&they should even do’s their training.they observe,assist&where possible be allowed to do under supervision.I would have jumped at such opportunity as a student.I don’t even have to be paid.A cardiology or psychiatry registrar doing CS makes perfect sense.What if the registrar owns his own hospital(which he’s licenced to own)&he knows how to do CS&patients that need such services come?A registrar in cardiology may even do a CS&leave the finest of scars than a registrar in O&G.if a patient wt malaria comes to you,do you say you’re not a malariologist that you’re a surgeon if indeed you know how to treat malaria?.like I said,area of specialization and scope of expertise can be different.I love your coinage of the word-excuse-ocracy.I’ll start using it too.but to say I’ve solidified your belief on that.quite is not the CMD’s job ALONE to ensure people are employed on is the job of the CMD,the DA&other stakeholders to ensure such.Or when a CMD is ratified in that position by the president of the country,&the vice president or the minister for health or even the president himself sends a candidate of his who just finished medical school for housejob&exam was conducted&the poor boy scored 52% but ahead of him is 60 candidates&the hospital neeeds 50 houseofficers.What should the cmd do?Until all stakeholders learn to respect the place of merit in the output of all sectors,the status quo is likely to remain for long.When the CMD has sole power to fight corruption within his own niche,why not?! He should improve power supply if he can but if he’s limited by funds from above,how do we make a case for him?Some forms of corruption goes beyond the office of the CMD!You need to see what the Nigeria system has become! Talking about MDCN is to say a doctor is already certified safe!So the issue of merit is that of ‘who is safer or who appears safer’&i’m not in disagreement wt you that the manner of employment can be improved upon.CMDs by virtue of their position don’t protect the interest of doctors at the expense of others.Anyone who does is not fit to head a hospital.He should be a fair umpire&act in the best interest of the patient.Thanks.

      • oghor says:

        You talk of appreciating you for human relations but see nothing wrong in denigrating other healthcare professionals

        CMDship, If youre not implying it should remain with doctors for historical reasons, what then do you mean by ‘Why should associates gang up to take over headship from the ‘owner”. What makes doctors owners other than history?

        You assert ‘rather it should be for doctors because that is what is best for the patient in the context of the Nigerian Health sector’ What is the basis of this assertion? any evidence? Ive said already why your argument of a doctors broad knowledge is an advantage, but not an exclusion criterion. So have you any other logic behind your assertion

        As for the word addedndum, i wont contest it, ill only say its not a word ill use myself.

        CMDship and pathways. I wonder if anyone enters medical school with his career goal being to be CMD. My thoughts on the turbulence and race doctors face to become CMDs. Its simply not relevant.

        You should ask me that question if i was advocating for physiotherapists becoming consultants surgeons, then you can say doctors go through specific turbulent pathways and training to get there and so it should be preserved for them, they did no such things to become CMDs.

        At the risk of sounding condesceding and patronizing, i apologise, thats not the intent, but truly if you work in a developed country for 3 months you’ld drop half of these your arguments.

        Yes an orderly can become CMD if the institution has the necessary career progressive pathway.Many people start off in their teens as bellboys, shelf packers, clerks, technicians etc, in multinational organisations and 30yrs down the line they are heading these same organisations. But ofcourse in Nig, an orderly is a dead end job for an illiterate oldie or a poorly educated youth.

        You brought up the catholic analogy to butres you point, ‘if choristers and alter boys wanted to lead the church then they should go through the rigors of the seminary and the burdens of celibacy’ Again again again, this is a false analogy, that should apply to consultancy and not CMDship. So if anyone wants to be a consultant they should go through the rigors of a high Jamb score, long years of med school, residency etc I.e a consultant, like a priest, has been trained specifically for that position and someone appointed without this training would be unable to effective function in that position. This clearly is not the same for CMD. this is why i reiterate, and labour the point, your analogy should not be used here .Similarly an airline pilot should clearly fly the plane, but the CMDship of the airline should within reason be open to everyone in or outside the airline..

        Do doctors head hospitals in the UK? Im sure they do. however ive just googled several hospitals around me, and they have all sorts as chief executives, but with a bias toward accountants/financial people. some did additional hosp admin degrees others didnt.
        i dont believe there are any exclusion criteria

        Google the profiles of Simon Stevens and David Nicholson
        immediate past heads of the NHS. This position will be the equivalent of head of all govt hospitals, ie all CMDs report to him and he reports to the minister of health.

        The business manager reports to the chief executive( CMD). No. NHS hospitals are not run for profit. Most are exactly like Nigerian hospital ie, they recieve a specific yearly budget and they try to deliver good service within this budget, hence they look for efficiency

        About consultants work ethics, ofcourse if a consultant is at a conference, he has the permission of the hospital, that not what im talking about. but rather the dereliction of duty which you finally arrived at.

        You’re conflating unrelated issues. the fact that a reg/HO is trained to take decisions in the absence of his boss is irrelevant to the fact that someone ie a consultant is paid for a job and is not there to perform it.Then you say JOHESU do worse. ofcourse they do. But is that the standard? I thought doctors were superior to them, Thought they were just the addendum.

        Again if you worked in a decent country, you would not be making some of these arguments. Long case starts at 1pm, examiners should be there at 1pm, end of. it doesnt matter whether i have clerked my patient or not. Its not the chief regs job to inform him of his duties/plan his diary. He should do it himself or get a secretary. It was common knowledge he was seeing private patients. I doubt the HOD would be that angry if he were seeing VIP patients and making money for the hospital.Even he were, thats no excuse either, he should plan his day!

        Medical students do locums ask around.Dental students were doing tooth extraction in the hostels and boiling/sterilizing their instruments in the ‘kitchens’, during ASUU stikes and i attended a ‘top’ federal university.

        You would have jumped at an opportunity to do locums as a student, You would have been breaking the law and no better than the theatre or auxilary nurse masquerading as doctors. A private hospital owner is not licensed to train students, his patients are not aware they are being seen by students, and sometimes even the hospital owner is not aware. Most times they are unsupervised as they claim to be qualified doctors.

        So a cardiologist or Psychaitrist doing CS makes perfect sense. only in AN UNDEVELOPED SYSTEM LIKE OURS. So your license to open a hospital is also a license to practice in any field or scope. like someone said above, its a failure of the regulatory authorities.

        Again false analogy, malaria is usually straight forward and even patients can treat themselves. CS on the other hand is a specialized proceedure and if i meet a complicated malaria case, ill refer to the appropriate specialist.

        Another anomaly in the health system. Why should hospital opening/ownership be limited to doctors. The regulatory body should put in place the requirements for a satisfactory hospital and whoever meets this requirements should go ahead, just like for schools.
        So presently if Dangote decides to open a world class hospital, technically he cannot but a post NYSC inexperienced doctor can convert his BQ to a hospital and see patients unsupervised!

        Again, an excuse-ocracy, lack of courage and poorly defined loyalties. The precise reason the country is exactly the way it is. So because the minister/president appointed the CMD he should serve his interest to the detriment of the patient or hospital. Is it the Ministers hospital.
        What should he do? He should refuse to appoint the unqualified candidate, and fight his corner and lose his job if it comes to that.Mandela went to jail for 27yrs, Gani, Soyinka, Fela etc were in and out of jail for standing courageously because they wanted better societies, yet you think its too much to ask for a CMD to stand up to a minister who probably was his colleague a few months earlier!

        Finally, yes the country is a mess but i dont see the present attitudes/positions taken by all side as helpful.

        Also i suppose i would have written an article similar to yours if i had not left the country.
        I had the same disdain for the’ addendums’ I once said i could never marry a nurse. I found them poorly educated, quarrelsome and even beneath me. However many years abroad has changed my perspective, and i believe if you went abroad for a few years yould write differently. look at example at the brilliant conribution from ‘outlook’ above.

        Finally good luck in your struggles, I suppose at some stage my biases will get exposed so i say JOHESU know your place, Khaki no be leather!

      • boloxine says:

        Sincerely,I appreciate other health care professionals who carry out their duties diligently&are proud of their profession&i think it should be mutual.I’m sorry if it appeared I denigrated any profession.

        What makes doctors ‘owners’,by my thinking,isn’t history but exactly the same argument I’ve put forward.The doctor is central to the patient’s care!&u’ve affirmed the advantage of doctor’s knowledge over other professionals..I also explained the reasons why I feel the doctors are better equipped to manage the hospital&i kept using the phrase ‘in the Nigerian context’.what do other professionals want to do differently?is their intention to go for the post not for selfish reason&to prove their perceived equality wt doctors?I don’t know how best to say this but as for evidence,the position has only hitherto been held by doctors so it’s as good as asking for evidence to prove the post of American president is best left for an American because that is what is best for their citizens.

        My using the word addendum is just to wrap in one word,my believe that the doctor is central to the mangement of a patient.A team work brings the best out but the person who acts as the middle man&on whose shoulder the burden of treatment lies in most cases is the doctor.

        Not many people will probably get into the medical school wt career goal being to be the CMD.That was why I put in bracket-knowingly&unknowingly but for many,the thought does materialize somewhere in the medical school&for some,it would have been a drive to weather the storm.I’ll summarize my position thus: if ‘A’ is required to get ‘B’&everyone has access to ‘A’,I think it’s unfair to give B to one who doesn’t have ‘A’.That’s what I’ve been saying.

        you said ‘yes,an orderly can be CMD…&i agree wt all you said in that paragraph just because you ended by showcasing the peculiarity of this country-Nigeria.

        Before I rest my case on the catholic church analogy,I’ll just say if it’s relevant to being a consultant&being a consultant(or fellow) is relevant to being a CMD(by my earlier assertions),then it still stands.But taken,I’ll no longer use the analogy on this thread.

        Just to be informed,do doctors report to these accounts/financial people&are they empowered to hire&fire any of the hospital staff?

        thanks for that referral.Both simon stevens and David Nicholson were chief executive of NHS England.They’re also astute politicians.But I don’t get when you said they are equivalent to head of govt. hospitals ie CMDs report to them.What post in Nigeria would that be equivalent to,I mean what do you mean by head of govt. Hospitals?(NHS England oversees the budget, planning, delivery and day-to-day operation of the commissioning side of the NHS in England as set out in the Health and Social Care Act 2012.It holds the contracts for GPs and NHS dentists.)It does seem NHS England is a recent development.
        Are most hospitals in UK NHS hospitals?(Just for information).

        If a consultant’s absence causes a negative effect on a patient then such consultant has failed in his duties&i think until every1 starts treating each patient like their close relatives,we may not get it perfectly right.I only sited the fact that JOHESU do worse&you’re’s not&will never be the standard.

        I totally agree that working in a more decent country would have broadend my horizon,changed some of my perspectives&probably some of these assertions I presently have,which is partly borne of&for the system I’ve been in.

        Where I trained,the chief resident co-ordinates(on instruction&guidance from the HOD) long case exams.we don’t even have a specific time cos we do it in batches&time patient is allocated differs.Seem you trained in a place where all students writing O&G end of posting in a particular day get patients to go round at once.We wouldn’t have known if your consultant was seeing private patients anyway.

        Dental students doing tooth extraction in the hostel?I’m sure that is not what you referred to as locum.There’s that tendency to want to try out practical knowledge on unsuspecting ‘patients’.they probably don’t have a good grasp of how grave the consequence of their ‘quack’ unsupervised actions could be&such should be discouraged in whatever medical school it exists.

        Sir.I never said I’ll jump at an opportunity to do locum(I don’t really get your definition of locum sir).I would have jumped at an opportunity to learn under my consultants whether in the teaching hospital or their private hospital&i’ll be glad to assist within the capacity expected of a medical there evidence to support the fact that Consultants can’t teach a medical student within the confines of a private hospital?Searching online,I came across some private hospitals where medical students are being taught.

        If I may ask,are you saying it’s wrong for a registrar in psychiatry to perform a CS on a woman assessed to have low risk for complications?

        Ok.malaria is a false analogy.What of the hypothetical psychiatry registrar in his privately owned clinic treating a patient wt hypovolemic shock if he knows how to treat such.Would that be beyond his scope?I understnd that a specialist should stick to his area of specialization for the best outcome but are there regulations banning a particular consultant from carrying out procedures that doesn’t belong to his area of specialization even if he has the requisite knowledge&skill for that procedure&a patient who needs such services?I’ve known cases one cannot handle,one refers.

        I agree that provision of efficient hospitals to any willing&able individual is great.

        It is never too much to ask that a CMD stands on his feet for merit&against his employer if need be.&that was why I wrote this in my earlier reply-Until all stakeholders learn to respect the place of merit in the output of all sectors,the status quo is likely to remain for long.The issue of sentimental appointment,though cut across many countries&even the developed ones,it is worse in Nigeria&i hope one day,it will change.So I don’t think my thoughts on that fits into excuse-ocracy.*laughs*.

        &like I agreed earlier,yes,my article could have been written differently&with different perspective&ideas if I’d been in other climes.

        Thanks a lot for your patience&sparkling contribution.

  21. outlook says:

    This is a nice article.
    I will just give a general comment: it was well written, with a little bias, though.
    I am an orthopaedic surgeon. My responses may be a little biased, because, like all humans, I can only see tthrough my eyes, not someone else’s.
    I have been a doctor for quite some time. I have practised in both public and private institutions. I have practised at all levels of healthcare delivery, primary, secondary and tertiary.
    I’ve been to quite a few countries in the name of fellowships, both in the west and in the Middle east.
    And my summation is that the way forward in the healthcare sector in Nigeria is for the government to hands-off healthcare delivery. The government is to only continue in it’s regulatory role in healthcare, and not direct the affairs of the healthcare system.
    In line with the provisions of the Nigerian constitution, where it is stated that the welfare of the citizenry is the primary role of the government, the government still continues to partly fund healthcare through a National Health Service, or a trust, which may or may not be insurance based. In the present system of things, the government pays staff salaries, and funds hospital budgets. In my own particular model, the government pays for direct patient care, instead.
    The hospitals are run as Trusts that source their own funding. Funding primarily comes from patient care, but also from internally generated revenues e.g. courses, shops, consultancy services, research grants, etc. From this funding, hospital staff are paid and the hospital is run.
    This is a very very very difficult process to achieve in Nigeria, but it will likely end the disease called healthcare delivery in Nigeria.
    In this system, your remuneration depends solely on your contribution to the system. The issue of relativity will be automatically addressed. Even within professions, people won’t earn the same. For example, an orthopaedic surgeon who does hip replacements, and makes a lot of revenue for the hospital by partnering with an implant company, thereby bringing in more revenue to the system will definitely earn more than another orthopaedic surgeon who doesn’t. Also, a neurologist that attracts research grants from a pharmaceutical company or NGO, will earn more money than one who doesn’t. This system will reward excellence, and have no place for mediocrity. Indices like patient satisfaction, infection rates, complication rates now become very important for everyone.
    In that system, you don’t just relax on your oars, you improve yourself continually, whether you’re a doctor, nurse, pharmacist or physiotherapist. You make sure that you improve your contribution to the system, or the system drops you.
    Government regulates the hospitals and declares minimum standards of operations. The professional licensing bodies regulate the professions. Professional associations also maintain active involvement in policing the hospitals as pressure groups, but the hospitals decide how best to run themselves.
    Public health campaigns become the second rigorous duty of government. The role of government here is the reduction of disease burden by preventive measures in all areas, including trauma, improving the environment, smoking etc. This leads to less spending on disease cures, thereby reducing health spending.
    On the overall, all Nigerians will be better for it, JOHESU inclusive.
    One last thing, blurring of the roles of people in the health team as obtained in the hospitAls, Is one of the main issues at hand……but this shouldn’t be an issue. All the professional licensing bodies already have that sorted out. We don’t need to redefine those.
    I hope one day, this dream of mine (it most likely won’t ever happen) may come to reality. There are many hurdles to cross. From middlemen with inflated contracts, to fake medicines and substandard equipment, from unqualified personnel parading themselves as doctors to misrepresentation by traditional healers…….

    • boloxine says:

      Lovely opinion sir/ma.I do hope Nigeria grows to such a state where the solution you proferred can be implemented.thnks for your thoughts.

      • outlook says:

        I do hope soon, too…… incidentally, there was a mention of Privatizing the hospitals at the last meeting with the house of reps committee, but DG budgets was said to have advised against it. The reason he gave was unfounded, though, based on the model I proposed above, government will still be involved. I believe it may happen sooner than later, when government realises that the health sector in its present form, is a bottomless pit where money is sunk literally and inefficiency reigns supreme. And it may happen next year, after current election and BH activities that cloud the judgement of government has been cleared.

      • boloxine says:

        It sounds like a public-private partnership thing. The disadvantage of that is the fact that a lot of people will lose their job!A lot!But the system will be sanitized.We may get to such stage if the health sector continue to have repeated crisis.

      • outlook says:

        Well, boloxine, sir…….that a lot of people will lose their jobs is absolutely inevitable…….for one, undoubtedly, the administrative department and accounts department of major hospitals that have overbloated staff volumes, will be cut down to 3 or 4 people and a set of computers. Records department will largely suffer the same fate. Laboratories will automate, and cut down on the number of scientists, pathologists will assume more clinical roles in the laboratories.
        A lot of the present roles of doctors on the wards will be relegated to nurses, some routine procedures like setting iv lines, iv drugs, routine preoperative surgical procedures amongst others. Thus, the need for nurses will increase, this might mean increasing number of shifts and ward presence, or increased number of persons. Number of doctors may therefore reduce.
        All areas of the healthcare delivery center will definitely be affected to root out redundancy and mediocrity, and bring in greater efficiency, eliminate waste and multiplicity of functions.
        The best thing about all this, is that each healthcare professional aspires to greater heights, so as to remain relevant to the system. I see a lot of doctors do this, and it makes me happy that there are still people in Nigeria that are hellbent on quality in all they do. They do not rely on their head knowledge from medical school or residency. They continue their education with international conferences and courses that they sponsor from their own pockets, striving to improve practise.
        This new system will definitely seek out these professionals, and the system will be better for it.
        The present system only breeds mediocrity. That’s what the Nigerian civil service does. It is in civil service that your remuneration and worth is based in your years of service, not the quality you bring into the sector. It is in civil service that the ICU nurse with special skills in managing unconscious patients with surgical airways and the OPD nurse who takes vital signs and arranges patients to see doctors earn the same amount. Just because they are both PNOs.
        I’m just looking forward to when we willachieve such a state of affairs.

      • boloxine says:

        *pensive*.Sir,I may be more disposed to believing that the outcome of such a policy might be grossly unpredictable.I still believe that Doctors will be the least affected&that less nurses will be needed in the hospital.

      • outlook says:

        Hhhhhmmmmmmm….definitely unpredictable. And the system will keep evolving with time. Actually the need for more nurses and more nursing time will stem from increasing responsibility of nurses on the wards. But this might be checked by automation. I was recently at a trauma centre where automated machines with monitors allowed a nurse in a centralized work station record vital sign progression on 15 patients at a glance. It was an HDU. A lot of systems are now available that significantly reduce manual labour in the wards, and thus, need for many hands. Continuous passive motion devices are increasingly being used for joint physiotherapy, rotating air and water beds have replaced manual 4 hourly turning of bedridden patients that previously required 4 people per patient etc. But these are evolved systems. It still remains a speculation, as I said before.

      • boloxine says:

        Very well said sir!

  22. joe says:

    @David : ur a big fool. Whenever u or ur relatives are ill, send them to see a johesu member. Pls don’t see a doctor. Idiot.

    • boloxine says:

      Thanks chief joe but I would rather we refrain from getting abusive.We can make our opinion known in love&try to make corrections in a conducive social environment.One day,the health sector shall be great again.

      • outlook says:

        I also want to register my disapproval of Mr Joe’s choice of words and name calling. I am particularly appalled that an intellectual will use such outdoor language on a public forum such as this.
        I want to assume Mr Joe is a doctor. Pls, kindly be a good example of decorum to the society that our profession requires. Such language is not fit to address even a servant with, talk less of other healthcare professionals. Our differences of opinion as per how healthcare delivery should happen in Nigeria should not make us descend to name calling and insults. Words such as ‘fool’ and ‘idiot’ belong to the streets, not among intellectuals.
        We can all make our points known without resorting to them.

      • boloxine says:

        Well stated sir.I really appreciate your awesome contributions&m honoured to have you read my write up.Thanks

      • Niyi says:

        By far the best article I’ve read on this imbroglio for a long time!
        Being a doctor I’m obviously biased towards the doctors’ plight but I don’t argue blindly.
        I‘m married to a pharmacist, like most doctors have ‘JOHESU’ spouses or relatives. I assume most families don’t display JOHESU vs NMA in their family lives.
        If we can marry them then we can work together as professionals with evryone appreciating their scope of work and demonstrating mutual respect and utmost profesionalism. Every health professional should be proud of their discipline without striving to be doctors through the back door.
        The door to the MED schools are still quite open and with some hardwork even the hospital clerks can still become doctors.
        I started undergraduate training in biochemistry but in order not to feel inferior to anyone, I invested more energy and resources. Today I am a consultant obstetrician. Many should draw inspiration from my case and channel their energy towards constructive paths instaed of the unnecessary ‘negativism’ of the anti-doctors crusade. It will be a mockery of the rigoh.rous process of producing medical consultants to allow the use of the word consultant for any other professional in the hospital setting without following the necessary path.
        This crisis is unnecessary. It has been borne out of the selfish interest of a minority who feel unsatisfied with their status. Despite knowing the truth, they have decided to brain-wash the majority ‘who will not bother to verify obvious truth in public domain’ with half – truth and they have unfortunately jumped on the ignorant band- wagon. T hank you for the brilliant piece.

        For the sake of balance there are a few professionals in the health sector who are proud of their calling and will not for a second wish to be a doctor. I commend them for being proud of their identity.

  23. Oghor says:

    I’ll have to give up now, trying to get you to see that there is a difference between something ( a medical degree) being ADVANTAGEOUS to have and something being NECESSARY to have to perform in a particular position(CMD)!

    Who says A is ‘required’ for B? Apart from history, but then you say you’re not basing your argument on history when that’s exactly what you’re doing

    All I see from your arguments is JOHESITES should not get anywhere near CMDship because you don’t trust their motives, and intentions, and you fear it is another attempt at power grab that will put them closer to parity with doctors. All of these are valid reasons and I would not contest them if you stated these as your primary reason for not giving them CMDship. My beef is when you try to cloak your position with the issue of. Medical degree being NECESSARY rather than ADVANTAGEOUS to CMDship. That was why I brought in David Nicholson whose degree was in history and politics, and Simon Stevens whose degree is in Politics yet they headed the NHS.

    I’m no expert on the NHS but from what I understand about it.
    Founded 1948, most if not all government owned hospitals in the UK are under the umbrella of the NHS.. In Nigeria it Will be the equivalent of, all local government, state government and federal government owned hospital being managed under one organisation, and the head of this organisation being run by someone with a degree in history and politics!

    Again your analogy with the US president is not logical but I won’t digress by trying to explain why.

    Each hospital is run by a chief executive and like I said many have a background of accountancy/finance, and yes doctors and everyone else report to them, and can be hired and fired by them, because THEY ARE THE HEAD OF THE ORGANISATIONS.

    About psychiatrist doing CS etc. I’ll try to explain our different opinions and why I say that only makes sense in an undeveloped system like ours in Nigeria.

    In most developed countries after your first degree and house job you can still only work in a clinical setting under supervision. So you can go back and do a residency in o and g, Medicine, surgery etc like we do in Nigeria, you can also go and do a residency in general practise aka family medicine etc minimum 3 years before you can open your own GP practice, and you generally practice within your specialty. If you choose to do Locums outside your area of specialisation then it’s usually under the supervision of the other specialist and not on your own. So if a psychiatrist who was training for several years in O and G before he changed to psychiatry decides to do O and G Locums at the weekend, he does it under the supervision of the O and G consultant. He cannot open an O and G practise on his own because he doesn’t have the qualification. If for whatever reason he does CS without O and G consultant back up, When something goes wrong with his patient and he ends up in court, the first thing her lawyer will ask to see is his qualification that allowed him do CS, and once he can’t produce it, his problems starts. And in fairly certain it’s a criminal offence, not just an issue with the medical council and civil claims for damages from his patient. Just like in Nigeria if you’re thrown out of university the night before graduation you cannot practise as a doctor. But in Nigeria any post NYSC doctor can convert his BQ into a neurosurgery theatre.

    I’m not aware consultants are allowed to teach doctors in their private practise. I thought you only thought in approved hospitals. Before I left nigeria only 4 hospitals had approval to teach ie take house officers – Eko, st Nicholas, Duro soleye and first consultant all in Lagos. However with the advent of private hospitals this may have changed.

    • boloxine says:

      *smile*At this juncture,I guess there’s been an extensive dilation on our areas of ‘disagreement’&factually.You,sir,expressed some superior arguments based largely on the environment&experience you’ve been exposed to as I look forward to being a part of other climes too&so I ‘concede’ on this thread.Thanks for the great deal of information&enlightment sir.It’s indeed a privilege&an eye opener to dialogue wt you on the blog.

  24. Oghor says:

    With the advent of private universities I mean

  25. Hiswill says:

    Wonderful articles and comments so far, but picture this;
    Healthcare is likened to a family that existed and still is by reason of reproduction. Every family must have a head and its subordinate, with each have a specific undesputable functions which help the affairs of the family thrive. The healthcare is one with a polygamous face. These issues listed did not just start with us, our fathers(professional) ate the grape and our teeth is set on edge. We have refused to take off the problems by the root, i

  26. nwanji ify says:

    I feel the key thing is this cmdship fin. the idea is to equate any postgraduate academic exercise with degree to mean consultancy. that consultancy becomes equal to that of the physician or surgeon colleges. then since everyone is a consultant and the law seems to say only consultant s be cmds, then anyone can be a cmd. well its all well and good. I feel the issue is with our system. the need for a man at the top to make a final say. that man shd easily be a doctor but then doctors many times havent justified their positions. maybe this tussle is a good thing as it should task our doctor cmds and remind them everyone is watching. as regards privatisation I must say its in the offing. in my fb post on this matter, I wrote on how this could statistically pan out. I want to share it here for criticism.
    The issues with this country stem partly from inability to see the future. If not Johesu would have seen that its latest moves signal the
    beginning of its end. The immediate results has been this paralysing strike. Lets assume that somehow nma is persuaded to allow for
    doctors to report to nurses, scientists and pharmacists. They also get almost equal renumeration especially with promotion. Yes similar
    salary scale. What are the facts? Medicine is the most stressful course (guiness book of records). The idiots who study it do so
    for money of for prestige. Both resons have now been taken away legally. So naturally admissions into medicine declines and that into
    paramedics swells. Those who still choose to study medicine do so only because its cheaper here and are just basically raping the
    to flee asap. Same with those who do their residency. Smart ones these! Those who can move into the private sector where no nurse
    say “I want to be cmd of your hospital”. For now at least only doctors are permitted to open hospitals (this may change in the future).
    Others are finally able to decide to leave the country. Others stay as they are confined by age, family commitments or not just being
    enough to leave. Recall that doctors make up only 5% of the health sector. What happens when you compress that to say 3%? At a
    ratio of
    1% doctors to 19% johesu, close to 40% johesu become under employed. Note that the effects of the strike has been produced by just
    5% of
    the workforce. Due to chronic underemployment, government likely places embago on hiring johesu. Might even relieve a good number.
    this point, the 3% of doctors who now have better bargaining power can ask for basically anything. Govt looses as facilities are
    underutilized, the health sector is becoming like nepa. Govt decides to privatize the health sector. What was the first thing that occurred
    when Nepa was privatized?
    In a briefer thread, govt tired of the bickering btw nma and johesu privatizes the health sector under the guise of a public private

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