DOCTORS WITHOUT BOTHERS My History teacher in history, Mrs Vero Okpomo firmly believes my choice of Architecture as a course of study and profession is a monumental loss to Medicine. That was her opinion a little over 30 years ago; a sentiment she re-affirmed in December 2008. A teacher’s opinion shouldn’t be trifled with so I must confess that I’ve had cause over the years to consider whether I’m not some kind of prodigal in Architecture. To Mrs Okpomo’s eternal credit, she noticed my keen interest in matters of health, and this dates back to long before I had any inkling of my professional and career preferences. So despite having been in practice for a better part of two decades, my interest subsists – that is, in Medicine. Strange as it sounds, I have more pals in the medical professions than in my own all-comers turf: the nebulous and ubiquitous building and construction industry. At the risk of being denounced as a saboteur, I want to state that health is much more important than shelter. If you’ve ever been truly sick, you’ll appreciate why they say ‘health is wealth.’ And why not? Good health has no attractive alternatives. Ill health and death are not particularly desirable. But shelter, whether the acceptable or marginal types, do have alternatives. Homelessness isn’t exactly life-threatening, and mankind has co-habited with this aberration for ages. So if I assert that healthcare givers are more important than shelter providers, you should appreciate my straightforward logic. Yar’adua’s 7-point agenda, the 8-points’ MDGs and the much touted Vision 20-2020 all have health as critical pillars. To underscore its primacy, 3 points of the MDGs deal exclusively with health issues. And it couldn’t have been otherwise especially for a developing economy like ours. It is my considered opinion that the success of any developmental blueprint is hinged on the twin issues of health and education. Of the duo, health is the more critical. In the October 28, 2009 edition of Sunday Triumph, the Chief Medical Director of the Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun was quoted as saying that Nigeria’s healthcare delivery had vastly improved. His assertion was based on the fact that the doctor-patient ratio is now 1:4000, and that from a mere 6 teaching hospitals in 1960, the number had swelled to 30! But not every doctor shares this optimistic outlook. During the recently held annual general meeting of the Abuja branch of the Nigerian Medical Association (NMA), Dr Jerry Oguzie (NMA’s National President) revealed that only one doctor attends to 100,000 patients! I’m not about to take sides with either of these eminent medical personalities but the mere fact of the wide disparity in the statistics speaks volumes about what is not right in Nigeria’s longsuffering house of health. I’ve elected to present facts concerning doctors not because the other medical professions are less critical. Far from it. Medicine is the discipline I’m most conversant with and as I earlier stated, I probably know more doctors than architects. The same distressing statistics will also prove true for pharmacists, nurses, midwives, physiotherapists, medical lab scientists and even mortuary attendants. Facts emanating from these other allied fields are even more alarming and depressing. I don’t suppose it will come as a surprise if an emergency is declared in our healthcare sector. Dr Alexander Bekweri Akani heads the Family Medicine Department of the University of Port Harcourt Teaching Hospital. I’ve known him since his medical school days as light-hearted and easy-going. Very few things bother him and he is blessed with a stable and loving family. In our undergraduate days in the 80s, we played lots of music and mischief – of the harmless sort – that is! It came therefore as an absolute shock when I learnt of his hospitalization a few weeks back. Alex expectedly tried to make light of the situation but his doting wife of nearly 2 decades, Nedie, was more forthcoming. It turned out he had a mild stroke and had to be kept on the bed for a week: a most difficult task to pull off with a doctor. Then I began to wonder how a young, lively and almost care-free man could wind up in such a dire condition. I arrived at the sobering conclusion that Alex had been taking on much more than he could safely bear. Unfortunately, he himself did not realize just how close he had come to the breaking point. Sadly, Alex’s experience paints a sorry picture of what health professionals are up against. It is especially so in the public sector where there is always so much to accomplish but so few and so little to work with. Most public health institutions are grossly under-staffed and under-equipped. When you factor in our precarious power scenario and the unending antics of venal politicians, you have a situation that is capable of torpedoing our loftiest developmental aspirations. There have been efforts, though mostly forced, to improve the working conditions of doctors in recent times. These must be acknowledged and commended. But let it be made especially clear that the average remuneration of doctors in the public sector is far from commensurate with the critical services they offer and the risks they are constantly exposed to. It is patently unfair to expect peak performance from doctors when they have a hundred and one issues to worry about and impossible odds to surmount. If we want them at their best – and I think we’re all agreed on that – let’s give them less to be bothered about. Let their headache result only from how to keep the rest of us alive and well. Wuse General Hospital is probably one of Abuja’s busiest. Dr Okoli was until a few months ago, one of the over-worked staff there. While at Wuse, he saw an average of 100 patients during a 6-hour consulting period; averaging 3.6 minutes per patient, including turnover time. WHO says 20 minutes/patient is the acceptable minimum. So due to no fault of the doctor, he is compelled to diagnose and prescribe within 3 minutes; and he is subjected to this harrowing ordeal 5 days a week. And this is in addition to other equally critical clinical and administrative responsibilities. It shouldn’t come as a surprise when the services they render sometimes fall below expectation. That’s what chronic fatigue does to us, something economists aptly dub, diminishing returns. Dr Okoli was recently redeployed to the General Hospital in Nyanya but even there, it’s the same story. During a recent night call duty, he and another colleague had to perform 4 Caesarean sections! Talk of magicians. And do you know how much they receive as hazard allowance? I better not say that here. Erstwhile aide to former Vice President Atiku Abubakar, Dr Onukaba Adinoyi-Ojo wrote an emotive account of how his dear wife, Rachel died. And this occurred in the National Hospital Abuja – of all places – and under circumstances that could have been mitigated. The piece left no doubt that Dr Ojo and his late missus were the greatest of pals, so I could identify with the pain and anguish of losing her. Trust me, a big chunk of the gifted, young man lies interred with that sweet lady. My prayer is that he employs what he has left to engender positive change especially in the near-comatose health sector. Dr Ojo’s story highlighted issues with the personnel and hospital infrastructure that border on incompetence, lack or inadequacy, and the near absence of inter-unit synergy. It is hard enough to witness the slow demise of a loved one, but one is quickly brought to the border of sanity when those who are sworn to make a difference show scant concern. It is a good thing people don’t usually come to the hospital armed. There would have been many gory incidents, and a further-depleted medical workforce. For its age and size, the National Hospital Abuja is certainly one of Nigeria’s best staffed and more-equipped tertiary health institutions. Whether that standard meets the global minimum is a matter I’d rather leave for the gurus and wonks. Since the hospital was inaugurated in the 90s, I’ve had cause to patronize its services, and I have friends and acquaintances across the medical professions and cadres. I can therefore say, without equivocation that under the circumstances, the NHA has discharged its onerous mandate creditably. Every profession, every institution harbours its fair share of misfits and hirelings. And there’s a sprinkling of this lot even at the highest levels of this pivotal sector. These are people for whom dereliction of duty is a badge of honour; men and women who have become captive to the irresistible lure of filthy lucre. For them, people’s illnesses and misfortunes are merely convenient stepping stones to vast pecuniary reward. And on a bad day when you encounter them, you’ll come away with a sour experience like Dr Ojo’s. The truth is that the vast majority of doctors and other health professionals are competent and committed. There are many in isolated and far-flung places who’re doggedly labouring with courage and worn-out tools to actualize the vaunted agendas of successive administrations. When epidemics break, while we rush out, they rush in. Those we stigmatize and cast out are the very ones they embrace and nurture. We trust them to remove all evidences of our lasciviousness and debauchery, and like we also demand of our pastors and bankers, they must put a lid on our dirty, little secrets. For the most part, they’ve remained true to the Hippocratic Oath and to our oft confusing and dubious demands. They labour tirelessly, day and night to remove the very reason for which they exist. If that isn’t the epitome of humanitarianism, then nothing else is. Scores of doctors lose their lives trying to salvage that of others. It is either in the process of combatting deadly diseases or in the frontlines of needless wars. I don’t understand what propels an unarmed person towards the battlefront while fully aware that every step takes him/her closer to certain death. What motivates people to put their lives on the line for the sake of others? Is it foolishness or madness? Now I wish I had actualized Mrs Okpomo’s wish; maybe I would have understood. Médecin Sans Frontières: you know them? That’s French for Doctors Without Borders; and that explains what they are about. Now you also know where a part of the inspiration for this piece comes from. This is a group of doctors and other healthcare professionals who choose the conflict zones of this world to do what they know best: saving lives. Take a hike to Darfur or Somalia and you’ll find them fully entrenched. If those are a bit far-flung, try our own Niger Delta and the poisoned mining pits of Zamfara. There you’ll find brilliant and focused young people who’ve given up promising careers to pursue deep-seated ambitions that even the most altruistic among us will strain to appreciate. They ignore political, geographical, religious and linguistic borders and barriers to bring succour to the ailing and dying. And all these at grave, monumental risks. Are they propelled by money or fame? I wish I knew. But there’s something I’m almost certain of. It can’t be because of how much they are paid. Don’t be fazed by the fancy ties and white overalls doctors don. The job they do is anything but pretty. Cutting up body parts and poking into all manner of orifices is not exactly the stuff of fun. The first time I saw plenty of blood, I barely managed to keep from throwing up. This people are our true heroes and we’re obligated to treat them as such. How? We must respect and appreciate them: doctors and the rest of them. Relevant authorities must be compelled to ensure all the right tools are provided for them to mind their jobs with fewer distractions and less bothers. Most importantly, they should be adequately rewarded and well remunerated. The legion of our health professionals who now ply their trade abroad did not leave the shores of Nigeria because they loved her any less than those who seem stranded here. They were frustrated out by the very same reasons our healthcare delivery system is still presently endangered. And we must take care not to drive many more to that painful but inevitable decision. If I had my way, doctors and other health professionals will be the highest paid in the land. They deserve to earn higher than politicians and bankers; and certainly much higher than architects! The only people who should earn higher than them are those who sweat and toil to make them: teachers. Now, that’s a bigger matter for a better day!
Posted on: Thu, 31 Jul 2014 17:52:15 +0000
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