punchng/opinion/towards-ending-hostility-in-health- sector/ One night sometime ago, I had three patients who needed procedures. As I got to the second patient who needed a central line, I noticed his blood was thin as I infiltrated his skin. Despite initially transfusing him with three units of blood, his vital signs were surprisingly stable. I knew this patient was going to crash any second. For a moment, I panicked, and immediately called the blood bank, asked Mary- his nurse-for immediate blood draw for blood level. I also called the surgical team for emergent central line placement. I pondered about the source of his blood loss. His abdomen was flat but Mary felt it was scaphoid initially. Yes, she was probably right- she had seen him more. I got a bedside ultrasound- oh dear! He was bleeding in his abdomen. The hemoglobin came back as normal. I rejected this and ordered for another test, but started transfusing pending the new test results. The new result was five, a drop from a hemoglobin of 10 that morning! More in keeping the clinical picture. The bleeding was intense, so I called the blood bank again to initiate massive blood transfusion protocol. At this time, I was a little anxious and may have been yelling into the phone, but the technician understood my concern for my patient; he was going to prioritise my request. As per protocol, I was to sign some paper work before this was to be initiated. However, the protocol went on without a hitch. The charge nurse and three other nurses left their more stable patients and came to help, the EKG technician, phlebotomist were at the bedside at some point. I called the pharmacists to dispense medications as soon as possible. There were numerous blood draws with prompt lab results. Over the course of 24 hours, he received 12 units of blood along with cryoprecipitate, FFP, platelets. He had so many co-morbidities, and the surgical team was not taking him to the operating room, interventional radiologists were not impressed but were willing to assess him in the morning. Then, it was 7 am, the end of my call! Phew, the patient survived the most crucial period. Everyone was physically drained, the patient could not have made it without everyone- Teamwork – I was part of the team and was honoured to just be the coordinator and thankful we had one another. I am a third year resident in one of the internal medicine residency programmes in the United States of America, one of the many Nigerian doctors who left the country two and half years ago to pursue a fulfilling medical career. I still keep up with everything back home- medicine, strikes and others. I have read and watched a lot of articles, speeches, and interviews flying around- pride, ego, insubordination, selfishness, all kinds and manner of words being used judiciously. In the midst of this, I just wonder about the Nigerian public who should be horrified with all these drama because at some point they will be patients. Even if one goes to the only private-owned hospitals, the lack of teamwork is everywhere but may be less pronounced. The Nigerian Medical Association versus the Joint Health Sector Union- so much hostility! This silent war (not so silent anymore) has been ongoing for a long time, which needs to be addressed, and policies put in place not to satisfy either party but only with the interest of the patients at heart. The patient heads the team and all medical professionals have a very important and sensitive role to play with the well-being of the patient at heart. The attitude within the medical profession and perception of one another have overtime worsened the outcome of our patients. Medical professionalism, which is defined as changing from autonomy to accountability; from expert opinion to evidence-based medicine; from self-interest to team work and shared responsibility should be incorporated into the Nigerian medical profession. In 1965, the Nursing Practitioner was introduced in the US with a vision to help balance rising health care costs, increase the number of health care providers, and correct the inefficient distribution of health resources. Also, due to intense documentation, a doctor sees a follow- up patient in an average of 30 minutes but in Nigeria with no documentation issue, we have no such problem. The NP oftentimes will still have their notes cosigned by the physician after the plan has been discussed. Besides, the Consultant Pharmacist is the only international professional society devoted to optimal medication management and improved health outcomes for all older persons. Founded in 1969, the American Society of Consultant Pharmacists is a non-profit membership organisation currently based in Alexandria, VA. The Consultant Lab Technician is another medical professional in the system. The clinical laboratory scientist is an advocate for the patient by providing consultation to other health care professionals as well as educational support. It is impressive that members in the medical profession plan to further their careers and as such should be encouraged. However, in all these aforementioned examples, commonly highlighted in so many articles, the intention was to help the other members of the team with the ultimate interest of the patient at heart. Clearly, this is not the intention at present and Nigeria is not yet ready for this, as it will further affect our patients negatively as earlier mentioned. I find it interesting that we refuse to emulate other developmental progress in these health systems such as teamwork and patient’s advocacy. We seem to forget that without our patients, there will be no medical team. They come to us with signs and symptoms expecting us to give our best. Instead, we let our ego take control of our judgment. Yes, we need the lab scientist to work on the samples sent; however, the clinical scenario presented by the patient supersedes the results of the lab. We need the nurse to administer the treatments but the doctors have to make diagnosis first and come up with a treatment plan. The pharmacists are invaluable in the role they play, but diagnosis is still needed. Our patients do not only have malaria, typhoid that can be easily treated by everyone, in this present age due to westernised lifestyle of the public, we are now seeing a rise in non-communicable diseases like heart diseases, cancer, and also patients now having multiple illnesses together. A doctor’s passage through medical school where we have spent seven plus x years, with x equals strike should not be trivialised. After deep thinking, it can be concluded that this much hostility is due to lack of job satisfaction, resources and seemingly casualness of the government to issues as important as the health of the Nigerian public. Increment of salaries is only a temporary solution to the ongoing decay in the health system. Ibraheem M.D, wrote in from Morehouse School of Medicine, Atlanta GA, via [email protected]
Posted on: Tue, 19 Aug 2014 07:45:08 +0000
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