Wednesday, August 28, 2013

The Doctor Amongst Other Health Workers

 There is an ibo saying meant to emphasize the power in numbers. It advances the philosophy that if you decide to cook for the entire community they will gladly gather and enjoy the feast. But if the entire community decides to cook for you, you will choke.

This article is inspired by an incident which took place yesterday evening.

I work in a mission hospital run by a partnership between Nigerians and Americans. During some introductions one of the Americans said to a Nigerian 'Good evening, I hear you're a pharmacist. I'm Pharmacist Green'. The Nigerian replies the American thus: 'No, I'm a Doctor of Pharmacy, I'm Dr. Igbinovia'. I slumped in my chair in utter shock.

In reality, Health-care delivery isn't a question of nomenclature it is about service. As a rule, I never write a title before my name. I'm simply Obasi Ndubisi. But that's exactly where the prevailing mentality in Nigeria gives a visitor to this country a rude culture shock. Nigerian's are so title conscious!!! We can go on strike because of a title. Nay, I dare say a Nigerian can kill and be killed for a title! That's not even where it ends. In an ideal setting, Healthcare delivery isn't about numbers, it is a question of people. But in Nigeria I'm yet to find a single situation that's ideal or even approximates being an ideal situation. Ideal situations don't exist anywhere in Nigeria. In reality this is exactly where the other health workers have juggled the system against the doctor. They've tried successfully to make the health sector to be about numbers. You should be at their meetings. I have friends who are leaders at there. Their refrain is that there is power in numbers. While the doctor's remains patients care first, theirs is solidarity forever. While the doctor insists his association is a professional body, his support staffs pretense to forming professional bodies is akin to putting a wrong label on a wrong bottle. For their unions are actually trade unions concerned ONLY about the welfare of their profession. To their credit however, they tend to be acutely concerned with forming alliances that will boost their number. That is where the Nigerian Doctor has failed. He hasn't formed any vital connection with other professional bodies in the health sector. He cannot say the pharmacist is his ally. He cannot say the nurse will rally round him when push comes to shove. He cannot call on the Laboratory Scientist for a just cause. He can only himself with a certain supercillousness which by the way, the public has observed. This has made it utterly impossible for the Nigerian Doctor to be seen as a community leader. The Nigerian Doctor is so far away from the community, always holed up in some consulting room or in some library reading for his numerous professional exams. The doctor wouldn't attend the wedding of a nurse, He wouldn't even attend the wedding ceremony of a fellow Doctor. He's too busy to be seen at social functions, nay, he thinks they are beneath him. My wedding is soon and I'm not expecting to see Doctors there. Thankfully from my early days I noticed this deficiency in the genetic make up of the Nigerian Doctor and I made more friends outside the Medical Profession than within - those ones are more community oriented. The Nigerian Doctor is quick to talk about the Lawyer but what they fail to realize is that Lawyers are immersed in society. They derive their sense of worth in their community organization and social commentaries. They are prominent public affairs analysts. They even take up pro bono cases representing the poor for free or for a token fee. Little wonder they have amassed tremendous public support. And that is a Lawyers wealth. Today the public will be more willing to save a Lawyer from the guillotine than to save a Doctor. So Lawyers get all they want. Not just because they are an arm of government but because of their romance with the public. For in modern society, communities don't sympathize with those who they feel deem themselves superior.

Having worked in villages, on Christian missions out reaches, delivering free medical care to the poorest of the poor, I can say first hand that the public will only sympathize with the Nigerian Doctor the day he eats their food, wears their clothes, speaks their language and becomes a vital part of their community. For as long as the nurse is seen as being more accessible in the community so long will the nurse have the public sympathy. For as long as the community pharmacist is seen as being more patient and willing to listen to a clients ramblings so long so long will the pharmacy be the first and often times last resort of most clients. This is undeniably so because the pulse of culture today shows that the community is where the action is. Barrack Obama, a Lawyer by training was a community mobilizer first, long before becoming a Senatorial candidate. The health sector being a vital part of a society's cultural identity, is naturally moving towards a community centred approach - which I have tagged communi-centrism. For a long time now I have canvassed at the top of my lungs that we adopt as a long term strategy, a Community Driven Development (CDD) model. It seems other health workers are cashing in on this trend while the Nigerian Doctor is fighting for turf in his traditional ground - the hospital. Truth is that Community Pharmacists are becoming more relevant to society than the Nigerian doctor, stuck in his consulting room. The reality is that a certain physiotherapist who I know very well, who renders home call services, is more dear to the hearts of her clients than the doctor who would never write a prescription while coming out of the banking hall but would insist on seeing the client at the clinic.

I intend to challenge stereotypes with this article.

For too long the Nigerian Doctor has done everything to reinforce stereotypes. The Nigerian Doctor is the only one who doesn't know that Community Medicine is the new Medicine and Private Practise is the next best thing. To make it all grim for the doctor in the midst of his support staff, the Nurse unites with the pharmacist, the Laboratory Scientists, technicians and technologists, the physiotherapists, record clerks and administrators, and as long as that continues to happen so long will they get whatever they want. That's the bitter truth. They will increasingly make the consulting rooms a prison for the Nigerian Doctor from which he must break out. I write this out of frustration. For today all the doctor has is the moral strength that comes from saving lives but the support staff have the numerical strength. The doctor has the position of power but the allied health workers have the voting power. And soon the position of power will be up for contest. On any issue, the other health professionals are certain to have their way. They have understood the game of politics, that it is all about numbers and a unity of purpose.

The lack of unity among doctors is as legendary as it is a shame. The rift is sharp and the gulf is wide between Senior doctors and younger ones. The divide is marked between Consultants, Resident doctors and Medical Officers. The doctors pride and prejudice over and against his fellow doctors in training is alarming and that is the cause of their travail. It brings tears to my eyes that the Chief Medical Directors stand in strong opposition to their colleagues and I don't blame them. The CMDs are always caught in the cross fire between House Officers and Medical officers, between Medical officers and residents, between residents and consultants... So even if a CMDs or CMAC was a former NMA or NARD leader, the realities of sharp division in the doctors ranks neutralizes his power and ties his hands. I speak from the vantage point of being a family friend to a couple of CMDs. Have you ever heard some CMACs lament? Listen to what they say in the community. After consulting hours go out into social circles. Save your profession by Saving yourself from a reclusive existence. Your power starts and ends in the teaching Hospitals O Nigerian Doctor. You are bereft of the efforts that go into legislations, legislations that will turn around and bite you. O Nigerian Doctor you have no clue what goes on in the hallowed chambers of the National Assembly. You have no clue what goes on in the meetings of the nurses and pharmacists and Laboratory Scientists. But they know all that goes on in your NEC meetings as we speak. We have them as wives and husbands and we tell them our hearts. Because they are more united and more committed to the advancement of their profession by fair or foul means, they tell their leaders all you discuss at your NEC! They even have spies in your midst, regular attendees of your meetings. So their leaders preempt your every move and launch preemptive strikes.

The Nigerian Doctor has been alone cooking for the entire health sector and they have enjoyed the feast. Now the entire Health Sector has decided to cook for the doctor and what we find is a situation in which the last JOHESU strike was actually preemptive strike.

Iroko Obasi ND

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