I was in the United States of Nigeria recently and I felt that I needed to go to the clinic. My sister in-law booked an appointment. When I arrived, I was warmly received by a receptionist who gave me a form to fill. He was neatly dressed and after collecting my data, ushered me into a room. Soon afterwards a lady walked into the room to take my vital signs- blood pressure, pulse rate and temperature. This healthcare professional who I got to know was a nurse was decently dressed in a white over coat. But at first he could have passed as a medical doctor. He asked me a few questions and got me ready to see the physician. A few minutes after, the medical doctor also walked in wearing a white overall. He took his time to examine me, asking questions. At some point, he asked me to undress for a thorough physical examination. Then he left. Thereafter someone I suspected must be a health technologist walked in with an ECG machine and strapped some wires on my chest. When he finished, he left and the medical doctor returned to discuss the ECG readings with me. Afterwards, the doctor requested some laboratory examination and I was escorted by a nurse to the lab. My blood and urine samples were taken by a medical laboratory scientist. He told me to come back and see the doctor in two days time.
On my return, I was again courteously ushered in to a waiting room. The doctor whom I had seen two days earlier reviewed all the test results and wrote out a prescription. Then he asked me “what is the name and code of your Pharmacy?” I asked why and he said, he was going to remit the prescription to the pharmacy, so I would go and fill the prescription at a Pharmacy. I then told him I was not resident in the USA and would rather fill the prescription when I returned to Nigeria. He insisted that I must begin to take some of the medication immediately while I begin the others when I got back. I agreed and suggested if he could let me have those medicines from the clinic. He said I could only get any prescription drug in the pharmacy in town or the pharmacy in a hospital not from the clinic or elsewhere .I was impressed as this contrasted with the situation in my country where you can get drugs (prescription or not) from anywhere- open markets, kiosks, moving trucks and all manner of clinics and health centres.
That was not just what pleased me most. I was thoroughly impressed by the harmony that existed within the healthcare team. Everybody knew his job, respected each other and kept in their lanes. They all looked happy, contented and proud of their professional duties. And all these worked in my favour- the patient. Again this seems to contrast with what happens in my country. I really do not know how it all started but there seems to be so much acrimony within the healthcare team in Nigeria. This acrimony came strongly to the fore during the recent health workers strike under the auspices of JOHESU. What was meant to be a protest by public sector health-workers against their employers – federal and state governments turned into a war between medical doctors and the other health workers- pharmacists, medical laboratory scientists, physiotherapists, nurses, midwives and health technologists. I could never understand why the gain of one group should turn to be the loss of another group. Is it not possible for the gain of one to be the gain of all? I am pleased that the leaders of the different professional groups are working hard to restore the relationship and I commend them. For me we must ensure that this does not happen again. Since healthcare is a team operation, it is not in the interest of the patient for some to be happy and others sad. A demoralized team member can ruin the good work of other team members. It is in pursuit of this objective of restoring inter-professional harmony that I offer the following suggestions
First, the current practice of having a particular professional group head hospitals must be reviewed. Leadership of institutions is a competency based activity. To make it a birthright of any particular professional group is not fair to all. Let the most competent or most senior professional head the hospital or the establishment. That is what happens in every progressive organization. The best leads! Peace is elusive where there is lack of justice and fairness. It is appalling and almost sounding like apartheid policy when a 5 year old medical doctor becomes the boss of 20 year old pharmacist for example in a hospital just because the hospital must be led by a medical officer. Everywhere in the world that a ceiling is placed on the growth or advancement of one group and another is allowed to advance, there will always be discontentment that eventually leads to rebellion. See what happened in America in the days of racial discrimination or in South Africa due to the apartheid system! Alternatively we should return to what used to operate in our days in the hospital. There was a director of administration who ran the administration while the professional groups had their heads and ran their clinical services without any problems. This made for more harmony among the healthcare professionals. The change in the nineties or so that dislocated the old system bequeathed to us by the British has effectively dislocated inter-professional harmony in our healthcare systems and must be revisited if the much desired harmony must be restored.
Similar to the above is the growing practice of always making medical doctors ministers of health and as is so often, the two ministerial positions including minister of state for health are assigned to medical doctors. Ditto for states where it is almost becoming an article of faith that health commissioners must be medical doctors. This is breeding professional arrogance on one hand and on the other hand professional jealousy. Way back, some of the best health ministers we have had were not medical doctors and some like Chief Ugwu in the first republic were not even healthcare professionals. In recent history, the likes of Professors I.C. Madubuike, ABC Nwosu and Eyitayo Lambo were not medical doctors and during their tenures, professional harmony soared among the healthcare professionals and many left great landmarks. In 1993 when Prince Julius Adelusi- Adeluyi, a pharmacist, was secretary of health for only a few months, he left enduring legacies. So if we must make health professionals ministers in the health ministry, we should rotate it between the different health professions and specifically, we must never make the two ministers come from the same professional group. It is a patently unfair practice.
Thirdly, welfare issues for healthcare professionals should be taken together. The existing dichotomy must be removed. In my days as a pupil pharmacist I was employed on salary grade 8, step one and my house officer colleagues were started on grade level 8, step three. And when we had any issues with the hospital administration, we presented our cases jointly and we rotated leadership amongst ourselves, looking for the most competent, blind to our professional groupings. But somewhere along the line, the medical doctors were removed and placed on a different salary grading while the rest of the healthcare professionals were left in another salary grading. This was how the seeds of suspicion and disharmony were sowed. There is nowhere else in the developed world that this dichotomy exists. To be true this is the major destabilizing factor in the healthcare team. Nobody is proposing that the salary or allowance of any group presently enjoying advantage should be reduced, rather the gulf created between one group and others should be reduced. I do not see how this causes any loss to any group but I see it helping to bridge the current subdued differences and resentment.
I must conclude that in making the above suggestions, I sincerely do not have any prejudice against any group. I am a very concerned Nigerian who wants our health care professionals to work in harmony for the good of the patient and the improvement of healthcare in Nigeria. The unrelenting poor rating of Nigeria’s healthcare may not be unconnected with this simmering animosity and disharmony among our healthcare professionals. Even the worsening medical tourism out of Nigeria may have its roots in the enthronement of a patently unjust system of compensation and rewards in the health care team.
I call on well meaning healthcare professionals to join me in this crusade to restore inter professional harmony in our healthcare team, keeping in mind the following wise sayings: Injury to one is injury to all;
Do unto others as you will like them to do unto you. What is good for the gander is good for the goose; where there is no justice and equity, there will be no peace. May God help us to heed this appeal.
Mazi Sam I. Ohuabuinwa OFR