by Nnaemeka Ugwu

I met Ikenna Obieze last year when I had just started my houseman ship. 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 work environment has 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, coursing through his over-grown beards. But, he did not cry for long; he was just starting the second of three ninety days, twenty four hours 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, going to write primaries-a hectic West African exam that qualifies one for the residency program which 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 medicine and surgery. 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 of the candidates fail the exams, each time they are 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. My British trained consultant, he loves to speak like the white man. “You’ll never become a consultant, if you follow that path” he warned. “You’ll never be a CMD, or the head of any big hospital and you will watch your mates leap frog you in the practice, earn more than you in the hospital.”

I just sat there, nodding as he spoke on and on. 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 or more, 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, prompting her to go with his boyhood friend who was a banker. Not because he was often seen dozing 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 madman just gave me a needle prick”, he lamented.

“What?” I was shocked.  That was the first time I knew what risk I was to face 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 in 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. His hands were shaking.

“Who knows?” he reflected.  “Please 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.

I would later have my own encounter with that kind of hazard three times but, luckily for me, the patients were not infected. Each had happened owing to tiredness during my own surgery posting.  After staying almost awake for three weeks at a stretch, it was inevitable that I would injure myself in the process of caring for my patients. Lack of sleep makes people less careful and shaky and one getting one’s self injured while giving drugs or setting IV lines or performing almost every other procedure involving sharp instruments, becomes very easy. It stems from over work which stems from the fact that very few doctors are left in the country because, majority have run away from the stifling working conditions in the country.  And work has got heavier and heavier, as time went by. And again, more patients are coming in as economic hardship hit the populace harder and harder.

And just like Ikenna, over sixteen thousand resident doctors sweat and bleed daily, spending practically every second of every day in the hospital, and working to save patients’ lives. Often time, 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 and sadly on very insufficient pay. The Hazard allowance is just five thousand naira. “Greatly unfair,” was how my South African friend described the situation.  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 remuneration, 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 anti-doctor association of every other health worker, termed JOHESA, troubling the hospitals. And this is the one I’ve experience myself, just like Ikenna.

I wouldn’t have gotten really exposed to those 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,  and messenger etc., all in the bid to help the patient effectively, without delay.  The support 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. That’s why they lose their lives, and family lives, working to keep the hospitals going.

 And, anyone who has been to the hospitals will testify to this.  The average resident doctor and house officer, works five times more than the average pharmacist or laboratory scientist or nurse. 

The government now sees them as students who should pay school fees, because JOHESA allegedly, 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 residents who do every body’s work in the hospitals? Residents 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 and house officer, works five times more than the average pharmacist or laboratory scientist or nurse. They and the house officers 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 worker in the name of JOHESA, allegedly,  were busy moving from office to office,  from one media house to another, talking to people,  lobbying, 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 JOHESA 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 become 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; Doctors must never be paid more than us!” 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 overboard.  That morning, Ikenna had just called me to help him review a consult which my unit gave to 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. There was literarily no space for one to step in.

But, I had something important to do so, I summoned courage and went ahead to search for the patient’s folder. But, the folders were nowhere 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 ‘oppressive’ doctors.

I was given the scariest shock of my life when, after waiting with no success 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. O boy! 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 authorities 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 do 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 students 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 of department anymore because he was a pathologist; they wanted only their fellow scientists to be the head. The government had just ordained them-the scientists,  ‘doctors,’  even though they are not qualified to do the doctors work in the laboratories.  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 every curriculum there is, in laboratory practice and, merging this with his qualification as a doctor, becomes then, the most capable and best qualified personnel to run medical laboratories. Unlike the lab scientist who only went through the University, not medical school, to obtain just a BSc and perhaps masters and PhD, which are 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 laboratories. Yet, JOHESA 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. It’s like placing a lesser qualified personnel to direct a far more qualified personnel just because the lesser qualified personnel cried for equality.

That Tuesday morning continued to throw up drama, until things got to a head. The theater was suddenly shut down by the JOHESA 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 procedures done against all odds, and that’s when the fight began. The JOHESA mob descended on the consultants. Meehn!  The old men had to run for their lives. This was a 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 JOHESA, who had already swiftly gotten the other trade unions to sympathize with them, by telling the lies of ‘doctors’ pride and arrogance.’ So, the government people threw out the doctors’ demands, ordering them to get back to the hospitals, to honor the Hippocratic Oath which they swore.

“But, sir” the doctors’ representative began, “The hospital is not like every other institution. Things must be of the highest standards and order; you don’t just go about granting consultancy to everyone because, that term describes patient-doctor relationships and granting it to everyone will bring about mediocrity and lowering of standard and will destroy the quality of our health care. Besides, how can we grant consultancy to clerks, cleaners, ward orderlies, cooks, nutritionists etc.?  That will lead to anarchy.” Our representative was as cool as ice, while he spoke.

Everybody in the hospital must be equal. That’s what JOHESA demands and it must be done,” the government spokesman thundered.

Somehow, the post exposure prophylaxis he took after the HIV patient had stuck a needle in 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.

“How can you say that everyone must be equal?” our representative asked. “Of course, there is a natural disparity determined by qualification and training. That is the practice worldwide in order to maintain order and the highest standards. This is not about doctors being proud people but, about the need to keep the hospital in order.”

“You doctors are so oppressive; you must let others come to your level” the government guy retorted.

“We are not oppressive, it’s just that in our practice, human life is what is at stake and we must keep things in order. Everyone is free to become a doctor so far the person goes through the right path Ok? We are not preventing anybody. We are trying to protect the quality of health care, that’s why doctors who have not done residency cannot become consultants no matter where they schooled or how many PhDs they have, no matter how many years of experience they have in their bags.” Our guy, continued to keep it cool.

The government guy smiled. Then, said: “I told you that you doctors are proud. Who told you that they are going to become consultants in your own field?” He asked.

Our man looked irritated. But, he went on to explain: “if you start making other health workers who never had residency as the original and accepted, normal pathway of their careers consultants because, they are agitating for it now, through JOHESA of course, what are you going to do with those other doctors who have not done residency but, have even more years of experience and qualification than the other health workers? Are you going to make them consultants too?

The government guy was silent. Our man smiled for the first time.

Then, he, looking straight into the eyes of the government guy said: “That’s what we are talking about. The other health workers should not be agitating for residency and consultancy because it’s not the right thing; their primary qualification does not lead to residency. They should go through the right pathway which is masters and the rest. If you grant them residency, that means that practically everyone with a BSc will start agitating for residency in the future. And this will be the end of health care in this country. I don’t understand why nonresident doctors who are also working in the hospitals understand this yet, JOHESA refuses to understand. That’s why we are advising that the term ‘consultant’ be kept for those who have completed the right pathway which unequivocally is MBBS and residency. That’s how it’s done the world over.” Our man paused for breath. He thought he had won it. He was startled when the government guy thundered

“Our decision is final! Case closed!” He stood up. Our guy swung into pleading mood, immediately.

“OK, whatever,” he began. 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 as they please.”

“That’s not the concern of the government for now,” the government spokesman, with a heavy Igbo accent thundered, still standing.

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 JOHESA be stopped from chasing and pushing pathologist away from the lab,  as you know, the pathologist is by 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 who are the ones that make the decisions on the patients.” 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, JOHESA has demanded that none 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, JOHESA’s alliance with the unsuspecting media had paid dividends.  The politicians always follow the public opinion and through lies to the media, JOHESA 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! It is now or never!”  We chorused.

We were all elated and ready to fight. Because, the fight was not about our ego and pride, as they had told the media, but, about the wellbeing of the health sector and the patients, whom we were sworn in to protect, 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 patients died in their numbers because, the ‘doctor pharmacists’ had started tampering with doctors’ prescriptions, and the lab scientists had started prescribing drugs and taken over the role of the pathologists. Of course, the doctors were blamed, as usual.

This hastened the decision of the doctors to go on strike and continue with the strike. And even the sack of most of the doctors did not break their resolve to continue the fight until order and sanity was restored. Only one thing hurt me, personally, though-my friend, Ikenna.

Somehow, the post exposure prophylaxis he took after the HIV patient had stuck a needle in 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.

————–

Nnaemeka Ugwu is a graduate of university of Nigeria, Enugu Campus.He studied medicine and surgery but, it is literature, history and journalism that he loves. And, his biggest desire is to become a movie maker in the mold of Zhang Yimou.