I met Ikenna Obieze last year when I just started my horsemanship. A tall, brilliant chap with a tired smile. He always wore that smile, he told me, to ward off the spirit of aggression that seemed to threaten his relationship with people especially, his patients. "Excessive work in a suffocating working environment have a way of making people angry so, I have to smile away the anger," he smiled. I had just started my obstetrics and gynecology posting when he was about to Start his neurosurgery posting. And that same day, in the common room, he received a text from his girlfriend saying goodbye to him, breaking up with him.
He showed me that text with hot tears running down his cheeks. But, he did not cry for long; he was just starting the second of three ninety days, 24hours calls. And soon as he showed me the text, his phone started ringing; some new accident victims had just been brought into the hospital. There was no room for petty emotions or his work would be compromised. He would have to toss his life away, immediately, in order to save the sick. Yet, he too, was sick, only that he could not notice. But I saw it in his eyes.
That was the day I swore never to become a surgeon. Or even to do residency in any clinical field at all. That singular encounter with Dr Ikenna completely discouraged me. I couldn't just imagine myself, after the hell of medical school, writing primaries - a hectic West African exam that qualifies one for the residency program, that then leads into years of more hell, like Ikenna was experiencing.
The program is designed to train would-be specialist in the different areas of specialization in medical and surgical practices. It takes on the average of six years to complete the program. But, in reality, it takes a lot longer because, it is designed in such a way that ninety percent fails the exams, each time it is conducted. "It's relatively, deliberate" an examiner once told me. "It is to ensure that any would be consultant is properly trained, taken through the furnace, so that he would be able to handle a patient's life and the teaching hospital. It is a holistic training," he concluded.
That same day, I made up my mind to go for master in pharmacology instead of residency. And when I discussed it with my consultant, he gave me a stern warning. "You'll never become a consultant," he warned. "You'll never be a CMD, and you will watch your mates leap frog you in the practice." I just sat there, nodding as he babbled. In the end I just said "no problem". My, mind was made up. I wasn't going to be a slave in the hospital, a prisoner for up to a decade like Ikenna had chosen. And I was right.
Ikenna's life became more distorted as time went by. Not because his fiancé had left him because, as she lamented, he wasn't giving her enough attention. Not because he was often seen dosing off at almost every corner of the hospital because he never had time to sleep at night. Not because some people started doubting his sanity; lack of sleep actually affects our mental health and Ikenna had not slept adequately for two years now owing to excessive, overwhelming work load. It was rather because of what happened in the middle of his neurosurgery posting. It was on a cold December monday.
We were watching a premier League match between Chelsea and liverpool when his phone rang for the millionth time. It was a patient calling. A patient that had been previously in coma and had just recovered. Ikenna, as usual, ran off for the millionth time.
"It's that patient I told you about, let me go and empty his urine bag. The nurses won't go close to him, you know. He is violent and HIV Positive; they are afraid of getting smeared by his ever bleeding hand", he said to me in one breath, as he ran off.
"But, you can't be doing your work and do the nurses work, too," I countered.
"Is that what you are considering; of what use is it to wait for the nurses? In this practice you, the doctor, is responsible for the patient's life and if you keep waiting for the non committed support staff, you'll lose a lot of patients." He replied in one breath, as usual, and ran off.
The match was nearing the end, when he came back, so sad and sullen. He had a slight dressing on his forehead. I noticed it as he quietly came and sat beside me, dropping his head to cry.
"That bastered just gave me a needle prick", he lamented.
I was shocked. That was the first time I knew what risk faces me daily, in medical practice.
"How did it happen," I asked, a bit angry that he didn't take precautions.
He shook his head at me. " Of course I took precautions, Emeka, but as I bent to fix his catheter, he pulled out his Butterfly cannula and stuck it on my forehead."
" You should go for Post exposure prophylaxis, you know," I proffered.
" I got it covered already" he feebly replied. But, he was shaken and really scared.
"Who knows.... Just pray for me so I wouldn't just become infected doing this job." He resumed watching the match.
"We have to pray for one another," I said.
And just like Ikenna, over sixteen thousand resident doctors sweat and bleed daily, spending every second of every day in the hospital, working to save patients' lives. Often times you could see it in their faces, the excessive suffering they go through. Tattered and hungry, these brave doctors keep the hospitals ticking and without them, there would be no teaching hospitals. They are bleeding to become capable consultants in the future, to create a better healthy future for the nation. The Hazzard allowance is five thousand naira. Greatly unfair. Even for hazards like the ones both Ikenna and I suffered. Even ones bigger than ours. But, that's not the major difficulty these days.
Sadly, they too, are not immune to the difficulty facing every serious minded intellectual in the country. The same leadership problems pushing intellectuals, daily, out of this country to greener pastures, real greener pastures. Problems like poor renumeration, not in any way commiserate with the amount of effort invested in working for the government.
Problems, like anarchy in work place, instigated by the hydra-headed anti-doctor association of every other health workers, termed JOHESU, troubling the hospitals. And this is the one I've experience myself, just like Ikenna.
I wouldn't have gotten really exposed to these hazards had I had time to rest, and I would've rested relatively adequately, had I just done only my work and not that of other health workers in addition. And I'm not lying, where I work, I do the work of a doctor, a nurse, a cleaner, an orderly, etc. All in the bid to help the patient effectively. These supporting staff wouldn't do their work, because the government is encouraging their demand to dethrone doctors as the leaders of the health team. They now feel they are not answerable to anyone but, themselves.
So, most times, the doctor is run ragged, covering every inch of ground in the hospital because, literally, the patient is his and he answers for the patient's life or death. The Paramedics wouldn't do their work these days because they are fighting doctors. They want to be earning what the doctors earn, they want to be identified as doctors. And doctors like Ikenna have borne the brunt of the fighting. That's why they are literally slaves in the hospital. Thats why they lose their lives, and family lives, working to keep the hospitals going.
The government now see them as students who should pay school fees, because JOHESU told the government so. "This is what makes it a grave injustice," the Association Of Resident Doctors president recently said during the meeting that precipitated the strike. "How could they-the government, be so against the resgistras who do every body's work in the hospitals? Registrars who practically live in the hospitals, caring for the patients, twenty four hours. How can the government be fighting the most hardworking people in the country?" he raged.
And, anyone who has been to the hospitals will testify to this. The average resident doctor works five times more than the average pharmacist or lab scientist or nurse. They are the first people to meet the new patients. Clerk them, examine them, make diagnosis and commence treatment. And if there's an epidemic as we have seen with Ebola, they'd be the first to get it. While going through such work- related difficulty, they are still reading for their exams. And so, for the whole duration of their training, they are literally in a furnace.
* * *
While the doctors were in this hell, in recent years, trying to save lives, the other health workers in the name of JOHESU, were busy moving from office to office, from one media house to another, bribing people, cutting corners, spreading lies against doctors, trying to win the public opinion to their side. And of course, such an approach is bound to be successful in a dark, unenlightened country like ours and now, everyone sees the doctors as proud and greedy thanks to JOHESU lies. No one bothers to think, how did all these begin?
No one remembers young men like Ikenna anymore, nor their brave selflessness. And that's so grievously unfair.
The mayhem started from envy raging in the hearts of the other health workers against doctors. They all started wanting to be doctors, to 'share' in all the doctors have except of course in the suffering. So they stated going on incessant strikes to press home their agitation. "We want to be doctors," they all chanted. "We are tired of feeling inferior to the doctors". And each day they went on strike, they'd lock up every property of the hospital, in order to frustrate the doctors; they knew that the doctors would easily take up their jobs in their absence. Of course this is because they do the low tech jobs and any doctor could easily do it in their absence. I remember the day they switched off the power in the ICU and a lot of patients died. Of course the doctors were blamed by the patients' relatives.
On one funny day, this whole agitation of the other health workers to become doctors went over board. That morning, Ikenna had just called me to help him review a consult which my unit gave his unit. So I went to the male medical ward to wait for him. But, I nearly ran away from what I saw in the ward. There were just too many people. Anarchy. A lot of stern looking men and women in suit and a lot of younger ones who looked a lot like pharmacy students.
But, I had something important to do, so I summorned courage and went ahead to search for the patient's folder. But, the folders were no where to be found. The pharmacists had taken all the folders. And for hours on end, I couldn't review the patient nor do my ward round because the newly ordained 'pharmacist doctors' by our able federal government, had occupied all the patients and their folders, rewriting doctors prescriptions and telling the patients to stop doing what the doctors had instructed because, 'they-the pharmacists, knew better than the doctors.' And many patients died as a result of this. For goodness sake, a pharmacist does NOT know anything about a patient. He is only trained to make drugs and dispense drugs NOT prescribe them.
The nurses were in their own fighting mood, too. They, too had just been ordained 'doctors' on that rainy Tuesday morning. So, they had swiftly elevated themselves above the very work they were trained, appointed and sworn in to do. Works like wound dressing, sterilization of instruments, making of the beds, assisting the doctors, etc. And that morning they were all ready to resist the 'oppresive' doctors.
I was given the scariest shock of my life when, after waiting with no success for for the aggressive 'Pharmacist doctors' to release the folders and patients, I wanted to start dressing wounds because I had a lot of them to dress that morning. So, I went over to the nurses and asked for instruments. Oboy! See fighting. A lot of whiny female voices started raging. All at the same time.
"Don't insult us! We are not your servants! You doctors think you are better than us! We too, are doctors! Very soon, we'll become consultants! Let's see how you can come and tell us to give you instruments!" They were all pointing fingers at me.
"But, that's the nurses' work now," I calmly put, because, I hadn't eaten and I knew they'd defeat me, if I fought them.
"Which nurses work?" they all countered. "See, the time of nurses assisting doctors is over. You people should find other assistance" They were still pointing fingers at me.
"Hia, O!" I was too hungry to argue so, I just left them to go and report to the nursing head because, I was really angry. For goodness sake they were NOT on strike that morning. They were just reveling in their new found bragging power, given to them by the federal government who had just signed their demand to be equal to doctors. So they all wanted to start seeing patients and doing the work of doctors. Even though, the ONLY people qualified to be doctors are the ones who have MBBS.
Another ugly incident met my face, as I was moving away from the ward, leaving it for the 'all-knowing pharmacists' and their sstudents who had abandoned their own duty posts and invaded the doctors'. You know, the building housing the wards lies just adjacent to the laboratory complex. So as I just stepped out of the ward, I met the ugly scene. The lab scientists were physically assaulting the head of hematology department, in a jungle justice-like fashion. And story had it that their demand was that he shouldn't be their head anymore because he was a pathologist. The government had just ordained them-the scientists, 'doctors,' even though they are not qualified to do doctors work. So, they were hell bent on taking over the doctors work in the lab. And any sensible human would understand that this would be disastrous for the patients and the quality of health care delivery.
Just for the lay man, a pathologist is a doctor who, after graduating from medical school, goes ahead to cover evey single knowledge there is, in laboratory practice and, merging this with his qualification as a doctor, is then the most capable and best qualified to run a medical laboratory. Unlike the lab scientists who only went through the University, not medical school, to obtain just a BSc, which is so insufficient in medical practice. So, since the best practices are what we want in our hospitals, the pathologist is the best qualified to run the laboratory. Yet, JOHESU won't have this. They hate the fact that the doctors are more qualified. They do not want to be directed by the doctors. So, they are fighting so hard to remove the doctors from the laboratories. That's why they are fighting to have their own people put as directors of the different aspects of the hospital. And this will spell death for the patients because it's pure
quackery.
That Tuesday morning continued to throw up drama, until things got to a head. The theater was suddenly shut down by the JOHESU people. They all wanted their own consultants to join up with the consultant surgeons for the surgery before anything could be done in the theater. Even the cleaners, the clerks, the technicians, all wanted their consultants to dress up and join the surgeons. After all, the government had just approved their demands, one of which and most importantly was to appoint them consultants. "You are not better than us" they chanted. "We have switched off the power and water; the theater is not swept; the instruments are not washed; and we have locked up the theater. Nothing will happen here until, we have our own consultants; The federal government has signed it!"
The surgeons, adamant, wanted to break the doors and have the procedure done against all odds, and that's when the fight began. The JOHESU mob, descended on the consultants. Meehn! The old men had to run for their lives. This was real hate-driven fight, nothing like surgical procedures which they were used to. But, this was the last straw that broke the camel's back.
* * *
There were emergency meetings of all doctors' associations all over the federation because similar ugly anarchy had occurred national wide. That was when the doctors came up with the twenty four point demand for the federal government to look into and implement, in order to sanitize the health sector and bring it back to order. But, they were wrong.
They were wrong because, some politicians, desperate to win elections next year, had already sided with the far more populous JOHESU who had swiftly gotten the other trade unions to sympathize with them, by telling the lies of "doctors pride and arrogance." So, the government threw out the doctors' demands, ordering them to get back to the hospitals.
"But, your excellency, the hospital is not like every other institution. Things must be of the highest standards; you don't just go about granting consultancy to everyone because, that term describes patient-doctor relationships and granting it to everyone will disrupt the chain of command which is critical to the success and efficiency of the hospital. Besides, how can we grant consultancy to clerks, cleaners, ward orderlies, cooks, nutritionists etc. This will lead to anarchy." Our representative was as calm as ice, while he spoke.
"Everybody in the hospital, must be equal. That's what JOHESU demands and it must be done," the government spokesman thundered.
"OK, whatever, but, we thought we could help in organizing the health sector since the doctors are the protectors of health care in the country. We thought it was our duty to point out this disaster about to happen", our representative offered. He continued. "What you are about doing is like coming to the army and ordering that everyone must be equal. You know, this will cause a lot of anarchy and disruption and then collapse because, everyone would start doing do as they please."
"That's not the concern of the government for now," the government spokesman, with a heavy Igbo accent, thundered.
Our representative was visibly disappointed. But, somehow, he, managed to go on.
"Fine. We don't have much choice here, but to find a way to cope with the anarchy. But, what about the other demands we made, like the government equipping the hospitals, granting 100% insurance to the citizens, improving our hazard allowance, and payments of all the allowances government have never paid us even though it has been promising to pay us for the last twenty years. We also want to be reassured that JOHESU be stopped from chasing and pushing pathologist away from the lab, as you know the pathologist is far far the best qualified to head the Labs. And we also demand that the post of CMD be reserved for doctors because it is a post defined by doctor-patient relationship and as such, belongs naturally to the doctors." He went on to enumerate all the twenty four point demands. And all along, the government spokesman looked impatiently irritated.
" Have you finished?" he asked our representative.
"Yes, sir"
"Well, JOHESU has demanded that non of these your demands must be met. They do not want doctors to earn higher than them or be placed higher than them in any case. So, Your demands are null and void".
"But, you met their demands, why not ours?"
" I'm done with you people. Just go away."
We were so downcast when we left the meeting hall. Surely, JOHESU's alliance with the bbiased media has paid dividends. The government always follow the public opinion and through bribery and lies to the media, JOHESU had won the public opinion.
It was really not difficult to explain. And one question was in our minds. How were we going to run the hospitals, now? The anarchy would surely worsen. The doctors would start going abroad and establishing their own teaching hospitals; the government hospitals would surely collapse. Everyone will now become a doctor and patients will surely die as a result. But, in the midst of the sorrow, our ever strong president spoke up.
"We'll down our tools; this is the time to save the health sector or let it fall apart, if we fail. We'll go on our own strike, to press home our points, our demands." He beamed with resolve.
"Yes, supported! Solidarity! Now or never!" Came our coruse.
We were all elated and ready to fight. Because, the fight is not about our ego and pride, as they have told the media, but, for the well being of the health sector and the patients, we were reinvigorated and ready and resolved to fight till the end. We knew that letting up would spell the end to excellence and quality in health care in this country. So we went home encouraged.
* * *
Meanwhile back in the hospitals, the anarchy worsened. the newly appointed 'consultants' would not listen to anyone, tampered with patients management, would not do their work. And as patients died in their numbers because the 'doctor pharmacists' have started tampering with doctors' prescriptions, and because the lab scientists were now prescribing drugs, the doctors were blamed.
This hastened the decision of the doctors to go on strike and continue with the strike. And even the recent sack of most of the doctors have not broken their resolve to continue the fight until order and sanity is restored. Only one thing hurts me, personally, though. My friend, Ikenna.
Somehow, the post exposure prophylaxis he took after the hiv patient had stuck a needle on his forehead, did not work or perhaps, failed at a point. And now, he has become infected. He recently went to test himself for his international passport and there, he tested positive. Ah! He was only trying to save lives. And he is still a virgin. He could not have gotten it through sex.
Yesterday, he cried again, while we perused through the papers and saw the headlines and words used to describe doctors. Words like 'wicked', 'Barbaric', 'greedy', 'insensitive' etc. I too, shed a tear or two.
By
Nnaemeka Ugwu.
thanks
ReplyDeleteHow about this, 7yrs of absolute nothing, no wonder you people come out to kill innocent patients in the hospital. B
ReplyDeleteThank you for sharing
ReplyDelete