What do our Doctors want?

Symbolism with Simbo Olorunfemi

Email: simboor@yahoo.com Twitter: @simboolorunfemi

Simbo QEDSome of the most wonderful people in my life (a few of them, cherished friends) are doctors. Medical doctors, that is. Even though our society is too eager to permanently hang the stethoscope around their necks, etching the professional calling on their foreheads, many of them shrug off the stereotype of a doctor quarantined from the society they live in.  Their well-rounded humanity comes forth, as they bring down the wall their peculiar call and long years of training erect around them. What can we do without the doctors in our lives? We love our doctors. They deserve the very best.

But the way the body of doctors is going about it leaves much to be desired. Yesterday, it was the Association of Resident Doctors. The other time, it was the Medical Guild. Today, it is the Nigerian Medical Association (NMA). You can be forgiven if you think NMA has become a trade union – an affiliate of the Nigerian Labour Congress (NLC). But it is not. It might be spending as much time threatening to go on strike, like NUPENG, but it is a professional body, nevertheless. It is not that bad, that we should now confuse NMA with that other union ever ready to proceed on strike over everything, over nothing. Trucks towed by LASTMA for turning the bridge to a parking lot? NUPENG goes on strike. IPMAN leadership tussle? NUPENG threatens to go on strike.

Indeed, there is little debate that Nigeria has become one huge cadaver, with everyone showing up with knives as teeth, biting at will. The Political class, civil servants, contractors, foreigners, footballers, are milking the cow to death, with little care for its health. It has become a free-for-all, with the collective argument about the bloated recurrent expenditure of government is lost in the process. It counts for nothing, once it has to do with their pay-checks. We all desire federalism – but not when it has to do with the wage structure in the country. The man in Dutse desires to be paid same wage with the one in Lagos, irrespective of the disparity in cost of living. Who cares – there is no connection made between frivolous spending of government money and the low quality of life in the country. Who even remembers these days that those in the public sector constitute a tiny minority – with majority of Nigerians operating in the informal sector without any form of social safety net, health scheme, financial support or pension scheme? Yet, some state governments have nothing left in their pots once they pay salaries of workers.  Nothing to take care of the pot once provision is made for the infrastructure of the stomach.

Our public sector is over-staffed, over-pampered and disrespectful. They are so powerful and have little or no regard for the public they are supposed to serve. We have teachers who cannot pass examinations they set for their own students. Yet they will rather vote out the governor rather than let the system be reformed. Absenteeism, indolence, inefficiency and corruption cut across the system. We all know the truth, but who dares take on them? One governor who dared to look in the direction of teachers is now out of job.

Any time we hear of a rumbling from the public service, it is always something to do with the condition of service. Even when they sugar-coat the demands, with the nice-sounding items placed on the top for us to see, dig slightly you will find that the real issue has more to do with the size of the cake on their plate than anything else. ASUU was on strike for months. ASUP has been on strike for almost a year now. We might as well just pack it up, and file for bankruptcy.

Our doctors are on an indefinite strike of their own at the moment.  The other time it was about CONMESS, this time it is more of the perennial turf battle. What is it with health workers simply not being able to get along as a team? The NMA has 24 items in its shopping basket. But for items 6 and 22 that have to do with National Health Bill, Universal Health Insurance and Health Trust Fund smartly tucked in, the other 22 items read like something drawn up by a newly-wedded wife in a polygamous home, to lay claim to the turf. The doctors want appointed four deputy chairmen, medical advisory committee for each teaching hospital; the appointment of a surgeon-general for the federation with immediate effect; that Grade level 12 CONMESS must be skipped for doctors; an exclusive use of the title – “Consultant”.  They do not want non-doctors to use the title – ‘Consultant’.  Doctors maintain there should be what is called salary relativity in comparison to other workers; the payment of a monthly hazard allowance of N100, 000; a withdrawal of the CBN circular authorizing the Medical Laboratory Science Council of Nigeria to approve licenses for the importation of in-vitro diagnostics. They are also displeased with payment of call duty allowance to other practitioners in the sector; and they do not want the appointment of directors in the hospitals.

The debate over the ethical correctness of doctors going on strike has never really been settled, with the following considerations often coming up – “It  could result in avoidable suffering and death; It would be a breach of the implicit contract doctors have entered into with their patients; It would be against the code of ethics doctors may have sworn to; It would amount to ‘holding to ransom’ a weak and vulnerable segment of the population for material gain; It would shatter the image of doctors as selfless healers; and Doctors are already overpaid – strike action is greed”.

Perhaps, if the benefits to the society far outweigh the loss suffered on account of doctors embarking on strike, a painful nod of support might be permitted, but to have our kind-hearted friends down tools for the sake of these listed items is, to say the least, disappointing. There can be no justification for this needless ego-tripping by our doctors. Why does it come across as if the role of other practitioners in the sector is only grudgingly acknowledged by doctors? Someone needs to tell the NMA to play it smart, before it finally loses face.

Other practitioners in the sector remind us that the days the doctor ‘owned’ the patient is gone. The prevailing trend, we are told, is a multi-disciplinary approach to care. So, what is all that stuff about doctors wanting exclusivity to some administrative titles and positions? Is there anything in training or calling that confers a special administrative acumen on doctors? One would think we would all be looking at the global practice where administration is separated from patient care.

By the way, there is the small matter of the Health Insurance, which we all need to join hands to drive an expansion of its coverage. Some say, a number of doctors are not quite keen on that. But that is where the future of the sector lies – not this battle over a little turf.  In the words of Governor Babatunde Fashola, “we must look at the larger picture, which indeed is about baking the larger cake. We are always trying to get the biggest share of a small cake. If the cake is bigger, we will get bigger cuts, but if we focus on trying to get the biggest share of a small cake, it would be very difficult.”