Dr Paul John,firstname.lastname@example.org,08083658038
While in the university, the term ‘shortage of medical personnel’ was misconstrued as inadequate number of doctors in Nigeria as compared to the total Nigerian population, hence we were ‘deceived’ to study harder in order to fill up the vacant spaces that never existed anywhere. However,on graduation ,it dawns on the Nigerian doctor that there is always a Nigerian version of everything, be it time ,corruption,movies et cetera. After staying at home close to two years after graduation and without securing placements for the mandatory one-year internship programme,many young Nigerian medical doctors will come to the reality that ‘shortage of medical personnel’ ,in Nigerian context, means there are many unemployed medical graduates, tramping from one street to another in search of jobs, but our hospitals’ administrators have refused to employ them with no other reason than either the federal or state government has not released any funds to that effect.
It is now commonplace seeing 5000 medical and health job seekers applying for a job interview where only 8 people are needed. The managements of many health facilities have seen job applications as the surest and easiest source of huge revenue. If 5000 people pay N5000 each for an interview ,that will give a total of N25,000,000 but at the end only 8 will be employed. A closer look will show that at least 6 out of the 8 people employed, got the employment by their connections and not on merit. I agree that the number of registered medical doctors practising in Nigeria is not enough for the Nigerian Populace,according to the recent WHO statistics, but I still insist that we should employ those that are unemployed first before talking about how our medical schools will be producing more doctors per year .
The number of years you spend at home before securing internship or residency placement is inversely proportional to the connections you or your parents have .The more politically and/or financially connected you are the smaller the period of time you will spend at home before securing a placement in any hospital. Some will be travelling round the country in search of places for placements ,all to no avail. The unlucky ones will lose their lives on transits while others may be involved in ghastly Road Traffic Accidents with different degrees of injury. In view of this ,the Federal government of Nigeria, through the Federal ministry of Health, decided to embark on a central placement of house officers. That idea may have been jettisoned just like any other Nigerian Projects which are flagged off today and abandoned tomorrow, at least The Jos University Teaching Hospital(JUTH) that initially suspended her Internship interview few weeks ago ,has re-invited interns to appear for the same interview. The Abiriba-Nkporo-Oso-Edda federal road that passed through my Village, Nkporo, was tumultuously flagged off in 2013 but it is still as God created it till date.
In Nigeria ,a hospital will intentionally employ lesser number of medical personnel than it requires with the attendant effect of overwhelming the few workers employed with jobs. That was my personal experience,as a house officer, many years ago,during my rotation in the Internal Medicine unit ; there were some weeks I was the only House officer in a busy Internal medicine sub-unit, Neurology, with 44 patients on admission.I was expected to do early morning review for each of the 44 patients and was still expected to administer their Intravenous medications before 7:30am when I would present to my superiors ,who would then get prepared for the final presentation to the Consultants at 8am.
As a house officer ,I complained that such number of patients assigned to one House Officer negated the principles of medical practice but I was assured that Medical practice was a calling and humanitarian in nature hence we would be ready to sacrifice our lives for humanity . I was reminded of a senior registrar one time ago in the centre who fainted while on a weekend call. That is what Igbos call ,Eji ahuhu anya-isi?,which when translated means,can one boast of suffering? Seeing your colleagues who are still at home praying to God for them to get Internship placements, is enough in making you believe that accepting a job meant for 10 doctors is a privilege and not a suffering. What will you say when some of your colleagues have stayed at home while their provisional licences expired in their hands and they would prepare for MDCN examination before proceeding with their internship. Other smarter colleagues,in order to avoid allowing their provisional licences expiring , would simply take up House job placements as supernumeraries hence no pay for them. The management of the hospital is always there to remind any grousing worker that the employment in the first place ,was out of the management’s magnanimity as there are many unemployed workers out there willing to take up the job. In some centers it is not out of place,seeing registrars doing the work of house officers because the management has refused to employ new house officers. In the same vein,it is commonplace nowadays seeing senior registrars doing the work of registrars because the registrars have all passed their part one exams but the ‘almighty’ management has refused to employ new registrars. Some even prefer employing NYSC doctors and be using them as registrars at least they will be easier to be controlled,cowed and tamed unlike resident doctors who belong to a stronger ARD/NARD. I think time has come to place a ban on posting of NYSC doctors to tertiary hospitals,the same way NYSC members are barred from being posted to Oil companies and banks.
Medical profession all over the world is modeled on Military command where the junior officers must obey the command of the superior officers unconditionally. Any attempt to question or object to some rules will be seen as disrespect and must be sanctioned .Any house officer who questions the instructions from a senior colleague will of course be extended;for the registrars your consultant may refuse to sign your logbooks and that will, of course, delay your participation in the postgraduate medical examinations. This idea is not only in Nigeria,when Dr Ben Carson( as he was not then a professor) performed the heroic surgery of separation of the Craniopagus (siamese) twins in 1987,he kept on dodging granting any press interview;when the pressure was much, he pleaded with a colleague to go and do that on his half. What was Carson’s reason of not granting the Press interview?He later explained the reason in one of his books; at the time of the surgery ,he was preparing to appear before a board of examiners. He was afraid that granting such interview would jeopardize his chances of passing the interview by the board of examiners, as the examiners might become bias and envious of his fame ,hence they would be out to fail him.
In the same vein,there is nobody who passed through the University of Nigeria in our days that would not respect the mental prowess of late Dr Ifewulu Gabby. He was simply the brain-personified. I always tell people that I thought I was the most intelligent chap in the world until I got admission to study medicine in the University of Nigeria,Enugu Campus where I met guys that were more perceptive and brilliant than I was. Students there set the standard ,that even if you scored 49.9 in an exam ,examiners would not pass you because the majority of the class scored close to 80 marks hence no moral justification for special consideration of people closer to the pass mark. However,one lecturer who must have heard and felt threatened by Gabby’s exploits in the medical college waited for him until Gabby came for Paediatrics clinical examination,he failed Gabby on the ground that Gabby was ‘unteachable’. The little Gabby argued with him over a fact Gabby was very sure of.Just like Military command,the seniors transmit others and the lesser mortals can never questions such orders.
Others that had resits in the examination never bothered themselves after all ‘almighty’ Gabby equally failed one of the courses in the examination. Gabby wrote the examination after 6 months and passed ; few months after that ,he wrote his final medical examination with his class and passed all his papers . Gabby’s case rejigged the medical school, examiners sat to review the then rule that prohibited students that failed a clinical course like Paediatrics et cetera from becoming the Overall Best Graduating Medical student no matter their previous and later performances. The board of examiners saw Gabby’s failure in Paediatrics as ‘man-made and hand of Esau but voice of Jacob’ hence he was the best graduating medical student of his class(known as 06). Anybody that doubts my facts about UNN should look at the NARD leadership. The NARD secretariat will be manned by three UNN graduates in three consecutive years. The immediate past,the current and the next NARD General Secretaries are UNN products ,the same with the immediate past and the current NARD presidents. That is just to mention but a few.
The Nigerian doctors are trained to believe that the life of the patient takes preeminence over their own lives ,even when the bible says Thou shall love thy neighbour as thyself ,meaning you should love yourself and take care of your health first before loving and taking care of the health of your neighbour( patient). There is no holy book that tells us that we should love ourselves as our neighbours. I thank God for the New Hippocratic oath that recognizes the health of the medical doctors as the first step in the care of our patients . I am aware that the World Medical Association( WMA) must have been influenced by the happenings in third world countries like ours before inserting that new lines to the Physician oath. The new lines read:
I will attend to my own health,well-being
and abilities in order to provide care of the
Before these new lines ,complaint of sickness by a doctor is malingering until proven otherwise .
Rule 68 of the Codes of Medical Ethics in Nigeria outlines the procedure for determining the fitness to practice ,however rule 69 of the same code fails to differentiate the punishment to be meted out to those not fit to practise as a result of their indulgence in narcotic drugs/alcohol and those not fit to practice due to non-self-induced ailments. With the ambiguity surrounding rule 69,many doctors may prefer to die in silence than divulging their health secrets. It is only in Nigeria where a health worker is seen as being above sicknesses and when a health worker complains ,he/she will be told that the patient is somebody else’s husband,wife,fiance,fiancees,father,mother et cetera as if late and forgotten Dr Stella Adadevoh was not someone else’s mother,daughter,daughter-in-law ,breadwinner et cetera.
Late Dr Esther Iniobong
Just recently,another young and promising female doctor has joined her departed colleagues while on service. Announcing her untimely departure on Monday,16th October 2017 ,Dr Isa Ohyoma of POTARD FMC Keffi, Nasarawa state, stated as thus:
‘It’s with a heavy heart that I write to announce the passing on to glory of yet another colleague. She was Dr Esther Iniobong; a House Officer with FMC Keffi who died this morning after she reported to the A&E( Accident & Emergency) Department with complaints of headache following a Call last night.
While acknowledging the inevitability of death, I enjoin us all to take
May the Almighty rest her soul.’
The next question is how could a young female doctor who might be quartered within the premises of the hospice not detect the indicators of such sudden death 24 hours before her demise? Now she is gone,what will happen to the early morning reviews and jobs assigned to her as a house officer. At least now ,she is dead no more threat of extension of her stay in any unit and the previous call before her untimely death would be adjudged successful ? Time has come for us to realize that we are not super-humans;the earlier we make regular medical checkups compulsory for all cadres of medical personnel the better for us.