How the military takes advantage of young medical interns

by Daniel Essien

Charles O. qualified as a medical doctor in July 2013 and was inducted to the medical profession 2 months later, much to the pride and delight of his family. His struggle was just beginning though as he toured round the country searching for a centre to undergo the one year compulsory medical training. After attending numerous interviews and sitting for various exams, he was finally offered appointment by the ministry of defence and deployed to the 445, Nigerian Airforce Hospital Ikeja.

His appointment letter made available to us and signed by the director, Human Resource Management, on behalf of the minister of defence, dated 17th January 2014 states that his appointment, for a period of 1 year is for an internship position at the level of CONMESS SGL. 01 Step 1.

O resumed work in February and normal Nigerian civil service rules allow for a maximum period of 3 months following employment to process all relevant documents prior to getting paid. However, 3 months turned to 4, then 5, then 6 and O and his colleagues are yet to receive a dime from the ministry of defence. After frustrating periods of writing to the relevant authorities and getting no favourable response, the doctors and interns across the services took the final option available to them. With effect from Monday, 6, September they embarked on a strike action.

House slaves

Ibeh is just one of the about 300 interns currently employed by the defence ministry for housemanship training. Other interns are employed in the disciplines of medical laboratory science, pharmacy, physiotherapy, dental services and optometry. The same story is obtainable in all the hospitals, across the various services under the ministry. The hospitals involved apart from the airforce’s are; The Nigerian Navy Reference hospital Ojo, 68 Nigerian Army Reference Hospital Yaba, Military Hospital Ikoyi Lagos and 44 Nigerian Army Reference Hospital Kaduna.

Just one of the about 300 interns, is currently employed by the defence ministry for housemanship training
Just one of the about 300 interns, is currently employed by the defence ministry for housemanship training

These interns who are resident in their various hospital premises, work day and night under difficult conditions, sometime taking calls for as much as 7 days a week but while their counterparts in the ministry of health are adequately taken care off, those in the defence are left to their own devices. Civilian staff of the defence ministry- temporary or permanent- are severely discouraged from partaking in union activities and as such whenever industrial actions are embarked on by health workers- like the recent Nigerian Medical Association strike action, or that of the Joint Health Sector Union, (JOHESU)- they are unable to participate.

A rotten history

This system of owing health workers salaries by the ministry runs deep and goes back as far as 25 years. Interviews conducted with various doctors and interns across the 3 services, as well as senior doctors who have worked at different times within the ministry reveal a common frustration with the defence system and with the administrators who manage the hospitals. Year in, year out, the story is always the same. Fresh graduates are employed for a 1 year internship and salaries are not paid voluntarily until the health workers resort to actions such as this. Even permanent staff are not left out as some of them are still being owed salary arrears dating back as far as January 2013.

Whenever the interns route their complaints to the officials in their various hospitals, the directors and commanders express their helplessness at the situation and point them towards ministry officials in Abuja.

“The hospital did not employ you, neither did the army or navy or airforce medical corps. It is the ministry that pays you so when you take these strike decisions, it is the wrong persons that suffer.” One of the hospital directors said to his staff as he cajoled, then begged, then threatened his interns not to embark on their proposed strike action.

But Dr Tope Ojo, the Lagos state chairman of the Nigerian Medical Association who incidentally was a house officer at the 68 Nigerian Army Reference Hospital in Yaba 22 years ago says the situation has always been the same. In 1992 while he was undergoing training, his colleagues had to down tools for a while before the authorities deemed it timely to pay them. He recalls, “We embarrassed them to no end and they eventually brought out cash and were paying us physically at Bonnycamp. What kind of country do we claim to be running if the evils of 20 years ago are still repeated today?” He says the national body is aware of the situation and is preparing an appropriate response.

The 2012 set of interns only got paid after 9 months of work when they downed tools and commenced on a peaceful protest at the Channels television premises in Isheri, Ogun state. Last year’s interns were paid 5 months into their appointment on the day they were to commence their own strike action. Till date, majority of last year’s interns are owed at least 2 months salary even after they have disengaged services with their various hospitals. Dr Daniel Okoye who is currently partaking in the national youth service scheme in Abuja says he is still expecting 2months salary from the ministry. He left the Nigerian Naval hospital after completing his housemanship in February this year. Because the ministry does not disburse payslips to the interns and due to their ignoble style of paying in bulk, he says the figures paid sometimes vary across the board.

Every year ministry officials give the health workers a similar version of the same script. It is always something along the lines of the interns’ salaries not being captured in the annual budget, leaving much put upon ministry officials to go out of their way to secure funds from other sources to pay up. Or a delay with the ministry of finance whose officials are notoriously tardy in approving claims of the interns salaries.

This year has been no different as 2 intern representatives from each of the services’ hospitals were summoned to a meeting at the ministry of defence headquarters, with the permanent secretary and head of medical services on the 25th of August. A copy of the memo instructing the corps commanders to sponsor 2 interns to the “crucial meeting” in Abuja was made available to YNaija and a doctor who was in attendance but preferred to speak anonymously for fear of repercussions says the outcome was that they would be paid in 2 weeks. These 2 weeks have elapsed, yet no payments have been made, not surprisingly.

The permanent secretary, MOD could not be reached on phone and emails sent to both his official and personal addresses have not been responded to. Ohimai Amaize, a special assistant (media and strategy) to the minister of state for defence, Musiliu Obanikoro was reached on phone and claimed the minister was not aware of any of these developments but proposed to investigate. In a follow up phone call, he said the minister had been briefed and while the interns claims are true, efforts have been made by his ministry to compel the ministry of finance to release the funds as soon as possible.

Whenever the interns route their complaints to the officials in their various hospitals, the directors and commanders express their helplessness at the situation and point them towards ministry officials in Abuja
Whenever the interns route their complaints to the officials in their various hospitals, the directors and commanders express their helplessness at the situation and point them towards ministry officials in Abuja

The head of medical services at the ministry of defence, Dr Ikoku responded to a text message sent to her phone thus, “We are more concerned than every Nigerian because we appreciate the service and patriotic zeal they (the interns) have been putting in. We regret our inability to get the ministry of finance to release the funds despite our repeated appeals and letters written. However, efforts have been geared towards the release of funds.”

In a later telephone conversation, Dr Ikoku came across as condescending as she repeatedly referred to the striking interns as “these children” while stressing that they were wrong in taking their protests public as the military does not condone strike actions. She hinted that because of the IPPIS scheme, introduced by the federal government to check the menace of ghost workers, all payments come from the finance ministry and because the interns are temporary workers, on the payroll for only a year, theres been some difficulty getting their funds out. “I cannot do my job and then do someone else’s own” she stressed, before promising “They will be paid at the end of this month (September) by God’s grace.”

“It’s the civilians”

Because this is Nigeria and most issues of this nature are always traced back to a cabal, it is not unusual that there is talk of a small group of people at the highest levels of the ministry that hijacks these funds even when they have already gotten budgetary approval.

But the conspiracy does not end with corrupt civil servants with unfettered access to the ministry’s funds. They may be the origins of the ministry’s chronic problems but these big guns are aided, perhaps unconsciously by the various hospital managements who choose to feign ignorance at the status quo due so as not to ruffle feathers from up above. The military’s culture of secrecy, loyalty and “following the last order” does nothing to help these interns who have been posted there.

This creates a growing sense of disillusionment with the medical elders and with the country at large as the interns learn early on in only their first year of work that the country owes them nothing and they have to fight even for monies that they have earned already.

Bimbo Adelakun (not real names), a pharmacist in one of the army hospitals in Lagos, tells of one of the senior officer’s response to their plight. “A consultant dental surgeon and Lieutenant Colonel in the Nigerian Army told us to our faces that she has lost sympathy for our cause. She not only threatened us with extensions for every single day we are away on strike, she suggested that even if the MOD never pays us a dime, we should just accept that our country is owing us and move on with our lives.” Another uniformed consultant made it clear to his younger colleagues that it is the civilians that are holding on to their salaries and not the soldiers.

Once the interns went public with their plight, the army hospital in Yaba ordered the eviction of all interns from the hospital’s accommodation quarters. At the naval hospital in Ojo, a similar story occured as the commander publicly threatened not to sign them off upon completion of their programme and volunteered to evict them from the premises. He also threatened to read the military’s riot act and punish them accordingly.

Another female doctor from the 44, NARHY Kaduna who spoke with YNaija.com via telephone on conditions of anonymity for fear of repercussions is worried about the direction the profession is taking and fears that by the time her children qualify as doctors, there will be nothing in this country left for them. She says, “They told us about the brain drain in the 70s but it is coming back again. Any doctor graduating now already has a backup plan for leaving the country. Can you blame them? See what we are going through just to get our salaries

Dr O. who has vacated the interns quarters at the Airforce hospital voluntarily on account of the strike says, “We owe it to those coming after us to speak out on this tyranny now and we urge the NMA and the various professional councils to tackle this issue headlong once and for all, even if it means withdrawing the licences from these institutions to train health care workers. They are obviously not prepared for the task.”

As for the continuation of the strike action and it’s expected outcome, Adelakun is optimistic. “We are going to get our money” she says, “We have to. We have come too far to back down.”

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