PONDER MY THOUGHTS BY Andrew Keili FROM HIPPOCRATIC TO HYPOCRITICAL OATH The year was 1995 and the day was Thursday, January 19. The rebels had taken over into Sierra Rutile which many thought was impenetrable. We had been promised the earth by the military top brass who said they would “send rapid deployment troops to guard this important economic centre”. Well, what we got was “rapid retreat troops” of the few military personnel that were on the ground. Everyone fled to where he or she could find refuge, including our Medical Doctor, Modupe Cole, who with other lucky staff made his way inside a dirty Rutile product barge pushed by a tug at sea to Freetown. Fast forward 2014, the good Doctor was in the forefront of a different kind of fight-the Ebola fight. This time, he succumbed to it, serving his compatriots. I met Dr Sahr Rogers on a fact finding Ebola trip to Kenema hospital a few months ago. He was held in high regard by the rest of the Medical staff and the people of Kenema. Whilst other Doctors had fled from the hospital, he told me he was the only senior Doctor left there. Sadly a few months later, he succumbed to the disease. Dr Khan, I do not know but suffice it to say he has become a national hero for his selflessness in the Ebola fight. Sadly this week, another Doctor, Olivette Buck has succumbed to the disease in the line of duty. A common thread ran through all of these good doctors. They were selfless, hard working, devoted to duty and overworked in an overburdened and under resourced health care system. They kept to their hippocratic oath, despite all these challenges ensuring their patients came first. Part of a modern version of the Hippocratic Oath, written in 1964 by Louis Lasagna, Dean of the School of Medicine at Tufts University reads: “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help”. With the numerous challenges facing our very few Doctors, we have to ask ourselves whether in fact we are not expecting them to take a “Hypocritical oath” instead. A Kenyan Doctor Muniini Mulera in an article titled “Hippocratic Oath not a doctors’ suicide pact” states that “Some have used the Hippocratic Oath to blackmail doctors into accepting abuse and the most unfair treatment by their governments. He states that “The fundamental commitments in the Classic Hippocratic Oath are respect and support for one’s teachers and colleagues; scrupulously ethical practice; and adherence to the principle of primum non nocere (first, do no harm.)” and argues that Doctors have a right to enjoy life, citing part of the oath to which the Doctor swears: “If I fulfill this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.” But what drives these people to make such selfless sacrifices even with all the discouragement and lack of incentives. A closer look at Dr Olivette Buck should enlighten us further. A teacher, Doctor and a deeply religious person, she was the embodiment of service and compassion-virtues that are in short supply in this country. Dr Buck the teacher-She started her working life as a teacher in the sciences at Annie Walsh. Radio democracy’s Asma James, one of her students aptly describes her when she says: “For some of us who attended the Annie Walsh memorial school we would never forget her. Mrs Buck as we used to call her was like a Mother to so many of us. She was so sweet and a very calm teacher. Thank you Dr Buck for contributing to my upbringing. Forever rest in Peace. I say NON SIBI SED OMNIBUS.”. Yes Asma, non sibi sed omibus, indeed! Dr Buck the Doctor-A colleague Dr Ese Thomas Macauley waxes effusively: “My colleague Dr Olivette Buck is one of the most dedicated and determined physicians I know.........a patriot and focused individual.....she was soon to be (perhaps already is) a member of the West African College of Physicians... we all need her to win this battle”. Sadly she lost the battle. Dr Buck-the God-loving Doctor-She believed in the words of the hymn writer: From thee all skill and science flow All pity care and love All calm and courage, faith and hope O pour them from above Someone who worked with her at Lumley wrote: “Through my time working at Lumley hospital she was very inspirational and a mother to some who came closer, never missing on her afternoon devotional preachings to the outpatient during lunch break and always on time to work and the last person to leave. Bishop Billy Simbo encapsulated all these virtues when he wrote: “From the time I got to know her over 40 years ago, she has been a very steady and dedicated person. Quiet and unassuming, yet very knowledgeable and steady as a rock. Many people came to know her as a devoted teacher in her early life, one who became a great example for girls to emulate. She went in to become a dedicated doctor who cared for her patients and gave her life because of that care and concern. Those of us who grew up in Scripture Union and Youth For Christ in Sierra Leone have lost a dear Sister and friend and the medical profession in Sierra Leone has lost another valuable physician............All of what I have written is in tribute to a great person who has served well, as a Christian I know we will see her again.” With the spate of problems experienced recently with health sector workers and other issues, it is obvious that the fight has been way beyond these good doctors and will be way beyond our reach unless we get massive outside support. Should the outbreak continue with recent trends, the case burden will rise exponentially. Many experts are now saying that the level of response to the Ebola outbreak is totally inadequate and that a military-style response would be required. Large field hospitals should be established, staffed by overseas medical personnel who would amongst other things implement good infection-control practices to save the lives of health-care providers. We have an acute shortage of trained health professionals to man such treatment units and have to get outside personnel. The expected announcement of the deployment of 3,000 US military troops into Liberia to direct supplies for affected countries, erect hospitals, mobilise medical personnel from across the world, train up to 500 health care workers a week and implement best practice protocols is good news. There will be an emergency meeting of the U.N. Security Council this week on the Ebola crisis. Even the AU is having volunteers - epidemiologists, clinicians, public health specialists and communications personnel deployed to Liberia initially and another batch later to Sierra Leone. The Cubans are sending some 160 medical personnel over. The contributions of other countries have been mentioned before. Meanwhile these events do not change the fact that a vast amount of our medical personnel are dying in their effort to treat people. People are understandably angry and as someone made a caustic remark in social media circles about the death of Dr Buck and others- “May her soul and that of all the dearly departed doctors and nurses, rest in the peace of their Maker. They are free from a disorderly and rudderless society that does not deserve their love and loyalty.” Bishop Billy Simbo makes a pertinent comment and proffers some suggestions: “How long is it going to take for us to train more doctors who could step into the vacuum that is being created with the death of these unique persons? It is time to do something substantial. Just like we do in honoring our war dead, we should honour them. 1. We need to have a permanent memorial for all healthcare workers who have died in this battle against Ebola. 2. We need to set up survivors’ benefits for the families of healthcare workers whose loved ones have died while serving. 3. We need to actually pay those people who are right now in the forefront of this fight against Ebola. We should not just make promises or talk about it. WE MUST PAY THEM!” Dr. Mulera observes: “The Kenyan doctors who are demanding that their government allocates at least 15 per cent of the national budget to the health sector are attempting to keep their patients from harm and from the injustice of substandard medical care. An African government which hopes to retain its medical manpower has no choice but to pay doctors salaries that take into account their many years of education; the critical nature of their work; the very long hours they must put in; the risks they face and the indispensability of their services. He makes a startling remark on government priorities: “To afford this, sub- Saharan African governments should rethink their priorities. Does country X need six air force jets worth $740 million or does it need 740 doctors? At $50,000 per doctor per year, the cost of the jets would pay 740 doctors for 20 years. Does country Y need 350 MPs and 100 presidential advisers or does it need modern equipment and other resources with which to help reduce maternal, neonatal and infant mortality? It is a matter of priorities.” Indeed. It is high time we looked at the conditions of service of our medical workers. We must examine our priorities as a country. Our Doctors must swear to a Hippocratic Oath and not a hypocritical oath! Ponder my thoughts.
Posted on: Tue, 16 Sep 2014 17:55:54 +0000
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