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The President of the Nigerian Medical Association (NMA), Dr Uche Ojinmah has said a good healthcare system relies on the political will and seriousness of the major player.
Ojinmah in an exclusive interview with Nigerian Tribune said it takes money to cook good soup.
Speaking further, Ojinmah said “If you don’t give me enough money and you ask me to cook good soup, you are about to eat rubbish. And that is what is going on in Nigeria, like they say in Computer, it is garbage in, garbage out.
“You ask me to run a hospital, and I tell you I need one million to run it, and you say I will use N200,000 based on a properly evaluated budget, automatically, I will only give you a service worth N200,000 and that is why you get to a hospital, there is no trolley, your people have to carry you in.
“You get to a hospital and there is no defibrillator or cardioversion equipment, so, someone that suffers a heart attack cannot be revived.
Ojinmah pointed out that “In Nigeria, 80 per cent of you have a heart attack, you are dead. But outside this country, it is not a death sentence.
“You could be salvaged, there is cardiovascular equipment that can help to take over the system until you return to normal. That is why you come to our hospitals, instead of being comfortable, you want to go home fast.”
Ojinmah said there are hospitals where staff come in the morning, even if they are through with their duty, they have a library, they have a good office, they have where they can relax, watch television.
“But in our system, it looks abnormal that you have a TV with cable network in a hospital call room, for people to relax or you have a hotspot for internet activities in a call room, it looks abnormal.
“That is why I’m beginning to get this idea that we need people who are in tune with current realities to lead every nation because, for somebody like me, the internet is a must. So, when you don’t fund each system, it’s like having a wife and you don’t give her anything to take care of the house every month, then you will eat rock.
“That is the same situation in the health sector. They know what to do, they know how to do it. They’ve had a meeting where they agreed on a standard, that this is what it should be. For any healthcare system in Africa to grow, you need 15 per cent of the annual budget of that nation.
“It was in this Abuja they agreed. I wasn’t there in 2001. They call it the Abuja declaration. This year, the 2023 budget is 5.75 per cent, and for people that know is 15 per cent. So, what do we expect? Health is capital intensive, in the sense that, equipment changes almost every six months, newer versions come up with better health outcomes.
“You have to maintain a building because a lot of filth happens around it. So, we have gotten used to going to hospitals that don’t look good and that is not nice.
“When our leaders are sick, they go to hospitals that are clean. I’m sure you saw where the vice president had his surgery. Every time I pass that place, I laugh. I say how many Nigerians can ever afford to enter here? Why didn’t he go to Obalende General Hospital? Because they know they cannot stand what they will get. So, in a nutshell, it takes money to give you a good health system, and we need it. I think we deserve it.”
Ojinmah stated that the fundamental problem in Nigeria is that there are no clear demarcation lines. Firstly, lack of political will. And secondly, the National Health Act came decades after the health sector came to Nigeria.
“From 1960 till 2014, we didn’t have an NHA. People were just acting based on different pieces of laws in different places. Meanwhile, the standard should have been an NHA, which will delineate job sections and rules for everybody ‘so that you don’t do my job, I don’t do your job, and you will bear your name and I will bear my name’. This is the simple problem in the health sector.”
“Another issue which people may not like me to talk about is the fact that so many other health workers are not satisfied with being what they are. They rather want to be something else. And then, thirdly, some doctors are poor in leadership, we cannot argue that.
“That is why one of the programmes we have for December is a two-day leadership retreat for all the leaders of the health sector that are doctors. We want to go and talk to ourselves and acquire the capability to lead better because if you want to be a leader, you should prepare to be a leader, it doesn’t fall from heaven.
“Now, it is imperative that the person who is a pharmacist knows that his business is to dispense drugs and to check the quality of the drugs. Classically, dispensing is not even the job of a pharmacist, it is the technicians that do dispense in classical places.
“A pharmacist’s major business should be producing, compounding, getting molecules and making them useful to us. But in a hospital setting, they understand the quality controls and storage; not to prescribe drugs, but that is what is going on everywhere.
“An average pharmacy shop in this country today, go there in the evening, you will see people coming to take injections, people coming to be given drugs, and you wonder why things are going wrong.
“Some people even say they are community pharmacists, and so they must prescribe, but the policy of prescription is with the doctor. If you are a nurse, please restrict yourself to nursing. I’m sure you’ve not seen a doctor practising as a nurse. I don’t still encourage doctors practising as pharmacists”.
“The difference between medicine and other professions is that everything they do, we do in training. I did pharmacology, which is an aspect of pharmacy that deals with drugs, the prescription and the impact on the body and the possible side effects.
“I’m not saying I don’t need a pharmacist. I need him to work, I may not know all the side effects, and I may need to consult for instance, but he should be astute in his field and be proud to help when I need his help, not to try to be me.
“Everybody in the hospital wants to be the doctor and there can only be one doctor. In classical places, today the rave is that every course related to medicine is trying to produce a degree that would make them bear doctor. You now talk of PharmD, they say they are doctors of Pharmacy.
“Very soon, nurses will also have NurseD and everybody keeps allowing it. The National University Council does not regulate and say no, this will cause confusion to the people”.
“In places like America and Britain, where things are well drawn out, even if you have a PhD in Pharmacy or PhD in Nursing, and you put Dr. in your name in a hospital, you must write PhD behind it so that patients will know that you are not a medical doctor.
“While those of us who are doctors can write just Dr If it’s in America, they write MD. So, there is general confusion, due to the lack of proper regulation and punishment. Because in practice, regulation is vital.
“That is why when they were recently talking about a bill to bring what they call Physician Assistants, we said no, we are still battling with the ones that overstep their bounds and nobody will control them.
“Nigerian has regulation issues. That is why I tell them, this country cannot be okay until the police and judiciary understand their responsibilities. Police and Judiciary need to understand that the future of this country rests on them”.
“We have a problem of regulation, and therefore, you now want to bring another thing that looks like a doctor, and you say you will regulate him to work within a certain limit and boundaries, it is not going to happen. This is the core of the problem. And let me also point out, the court of appeal has made it clear that there is nothing like equal pay for working in the same place.
“He who hires decides what he pays, and my job description determines what you pay me, different from yours. It does not rest in continuing to elongate your syllabus, because medicine is doing six years, everybody is doing five years, six years, the same content, nothing new.
“When the medical syllabus is due for review, which we are pushing for, we are going to put imperative courses and recent advances in molecular biology, to upgrade it to where it should be.
“An average medical course, I’m not boasting, a one-year course we do in medicine, if we are really serious, can give us a degree. You can get a degree in something like pharmacology or pathology, you can get a degree in all of them.
“So, until we decide to strictly implement regulations in the health sector, and make everybody understand from the day you are hired that you are coming to be a gateman, not a doctor, you are coming to be a security man, not a doctor, you are coming to be a nurse, not a doctor, you are coming to be a pharmacist, not a doctor.
“Recently, you can see that people even put RN for being a nurse; these are not standard titles, and so I don’t know why it looks like everybody wants to be a doctor. To me, I’ve said it, left to me, I will drop the doctor and become a Mr doesn’t change me. I will still be a dermatologist; I will still take care of people with skin problems.
Ojinmah explained that in America, medical doctors are taken aside, they are not kept with the crowd, unless they committed an offence, then they will be treated like everybody, but their worth is taken seriously.
He said: “There used to be an office known as the Chief Medical Officer of the Nation, Americans call it Surgeon General. Nigeria adopted from the United Kingdom. Britain has a Chief Medical Officer of the Nation who is different from the Minister of Health. The Minister of Health is a political appointee that should be in the implementation of policies.
“But the Chief Medical Officer of the Nation is supposed to be the man who has risen to that post based on his pedigree, he’s appointed as a high-ranking and well-known doctor. He is the major adviser to the president on health matters and he is the one charged with protecting the public health interest of the nation.
“That’s why you will see that in cigarettes, they say Surgeon General warns that tobacco smoking is dangerous for your health, that’s different from the health secretary of America. We used to have it, during the time that the British were in power. When the governor General who is in charge of Nigeria travels, he hands over to the Chief Medical of the Nation to run the country till he comes back.
“That’s where we are coming from. Today, a cleaner will spit at me, because I’m a doctor and nobody protects to me. I’m expected to be quiet and gentle, I shouldn’t have emotions, we have taken a lot in the health sector. Before you see us reacting, we have realised that the patient’s dog dies in Nigeria and that civility is taken for weakness. That’s why we started responding.
“We had a salary that was after the president, was ours, before the judges of the court. But today, what do we earn? What do the judges earn? Nobody cares about the fact that we need cars, even if it is a car loan, I don’t have any form of scholarship for my children, I have to pay. My society expects me to be a helping hand. I don’t want to tell you how many school fees I’ve paid.
“When relations come to you, you can’t tell them no, you will still manage to see how you can carry them along. But people who don’t stand where we are standing in society are earning N13 million a month.
“The judges don’t even need to talk, because they handle election cases, they are given whatever they like, they change cars every four years or two years, and something of some sort.
“And then you say I am the intelligent person who gives the care to keep your health, safeguard the health of the nation, and I must go on strike before I get anything. So, you judge for yourself, there is no premium.”
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