Professor Thomas Agan, the Chief Medical Director, University of Calabar Teaching Hospital, is also the Chairman, Committee of Chief Medical Directors/Medical Directors of Federal Tertiary Hospitals in Nigeria. In this interview with journalists in Calabar, he speaks on issues affecting the health sector. Bassey Inyang was there
The health sector has been faced with perennial strikes which have been described in some quarters as unreasonable demands. What is your take on this?
It is very unfortunate that we are faced with series of crisis in the health sector resulting in unnecessary and unwarranted deaths among the Nigerian populace. The sector is supposed to be a succour to the people.
Unfortunately, over the years, it has been riddled with crisis. For me, welfare issues are necessary in life, but incessant welfare requests from the healthcare providers tend to undermine the sector itself.
I feel really pained that this situation has not been taken care of both by staff, and the government. And each time any union declares industrial dispute, you cannot quantify the number of people that die, you cannot quantify the suffering people go through. It can be very enormous.
However, I want to thank the Ministry of Health and that of the Ministry of Labour and Employment for deeming it wise to have discussion on the issues of the resident doctors. The doctorâ€™s challenges did not start today. They have been having interface with the government over the years. Itâ€™s rather unfortunate that it degenerated to a point they had to go on strike. I donâ€™t know where the lacuna came from, but I feel there must have been a break in communication.
Having said so, I think that Nigerians are feeling that these demands cannot be met. If you read the memorandum of agreement that was signed between the doctors and the ministers as well as those of us that were part of the discussions, you will see that some of these things are solvable. You see on the average, everyone working in the health care sector is a better paid graduate than any graduate in this country. We are feeding from the same pot, and itâ€™s rather unfortunate that everyone wants to increase his pocket. There is economic recession today and Iâ€™m thinking that by the time we over demand, other workers in the country will also want to demand. So, my appeal is that we have to be very cautious in whatever we are looking for.
But going by the oath taken by these doctors to save lives, some people are arguing that those doctors are not supposed to go on strike?
Yes because our oath for instance says we should preserve life from conception to death. This means that life that is entrusted into your hand must be preserved. The implication of this is that if you go on strike and that life is lost, then you cannot reconcile that with the oath you took. So, for me I agree with you that the oath you took is something too extreme for doctors to go on strike. I have never believed in strike to solve problems, and I will never subscribe to strike in its entirety.
Other workers in the health sector are also agitating for improved welfare package, and restructuring of the administration of teaching hospitals, else there will be no end to industrial disputes. What would you say to that?
The tertiary hospitals are supervised from the Federal Ministry of Health. Secondary healthcare is the property of the states, while primary healthcare is the property of the local government areas. So, the health system in the country is already decentralised. There is no problem in that.
The administrative autonomy is what you see. That is why you have the CMD of this hospital (UCTH).
Unless there is something that needs the ministerâ€™s attention, and thatâ€™s when I take it to him, otherwise the hospitals are autonomous. Decree 10 of 1985 established teaching hospitals, and created two directorates. Apart from the office of the Chief Medical Director, we have Directorate of Administration and Clinical Services and Training. That means in an office like this, you can have directors, but they are not directing any directorate. So, we have some level of professional autonomy because we have the laboratory scientists. We have Medical Laboratory Council of Nigeria (MLCN), we have Nurses and Midwifery Council of Nigeria (NMCN), Physiotherapy Council of Nigeria (PCN), Radiography Council of Nigeria (RCN). So, what autonomy do they want again? That means that when you become autonomous, in a teaching hospital like this, the Chief Medical Director should not have authority over you again, the director of administration should not have authority over you again. The chairman medical advisory committee should not have authority over you again? This is ridiculous. Iâ€™m sorry to say so. Itâ€™s not done anywhere in this world. Itâ€™s only in Nigeria that you wake up and want to do anything you want to do.
So, can we say that their demands are unrealistic?
I wouldnâ€™t want to use that adjective. They are not feasible. Some of their demands only have to be looked into. Besides, some of their demands have to do with the National Health Act, which has been passed. So, why has it not been implemented? That Act should be implemented. If we implement the National Health Act, and there are issues there, those issues will be resolved in the course of its implementation.
It was a serious brainstorming to get that Act passed. I agree with JOHESU/NUAHP that there is need to revamp the facilities in the teaching hospitals, but that should not be a demand to threaten a strike. As you are aware, the World Health Organisation (WHO) recommends that the allocation to the health sector in National budgets should be 14 per cent.
You know that because of our low economy we have not been able to do that. The highest that we have attained is about 7-8 per cent. And even at that, what may eventually be released will be between 3-4 per cent. So, how do we go about this? Itâ€™s good that they are going about this revamping of infrastructure, but can you squeeze water out of a rock?
Again, their demand for residency training is amusing. This is the only country in the world where you want to do residency training in administration, and everything. Residency training is done for post graduate doctors. Doctors who have qualified as medical doctors, and have done their mandatory one year housemanship, they have done their one year youth service. After that, you pass the fellowship examination; what we call the primary fellowship. After that, you are admitted into a teaching hospital which is recognised by the post graduate medical college, and you spend between six to 10 years depending on the faculty you find yourself. If you are in neurosurgery for instance, you spend 10 years to become a specialist doctor. So, it amuses me when everybody wakes up one morning and says they want residency training. Itâ€™s sad. It then gives me the impression that a lot of us have not read the history of the medical practice not only in Nigeria, but the world.
What do you think should to be done to permanently solve the problem of perennial strikes in the health sector?
Iâ€™ve always told people that I choose to be a doctor and thatâ€™s why Iâ€™m a doctor. Some other person chooses to be a nurse, and thatâ€™s why he or she is a nurse. You choose to be a laboratory scientist, and thatâ€™s why you are a lab scientist. I think that the National Council on Establishment (NCE) should review, and streamline career of workers in the health sector because a doctor cannot go and perform the functions of a nurse, and also a nurse cannot go and perform the functions of a doctor. In the health sector not only in Nigeria, but the world over, there is no doubt that the doctor is the head of the health sector.
No patient comes to the hospital to say heâ€™s coming to see the accountant or heâ€™s coming to see any other staff but the doctor. So, I believe that people should mind what they are trained to do. This bickering and professional rivalry is the cause of all these trouble, and I believe that it is not healthy.
It is the Nigerian people that are suffering and dying. I often tell people it could be me, or you or any member of your family who is dying because of our strikes. You never can tell the number of people that have died as a result of this current strike. I told them in the course of those negotiations, the blood of all Nigerians who have died as a result of this strike is upon our heads. Itâ€™s not healthy.
How can you rate medical practice in Nigeria in terms of rendering services to patients in public health institutions?
You have touched my heart. You see, all through the years, the major problem we have in this country as far as rendering services to the patients is concerned is our attitude. The attitude of the healthcare givers to the patients, and the attitude of the patients to their health leave so much to be desired. Over 90 per cent of deaths in our hospitals are due to our attitude. Until we realise that we would be held accountable for every challenge we create, things will not go down well. I have always told people that if you donâ€™t know what to do, leave out, or do no harm. That means it is better you do nothing than to do something that creates harm.
Generally speaking, we are well trained. What is deficient is our attitude to patients care. I see no reason why a doctor for instance, whether he is on call or not, when he gets home, he switches off his or her phone. You have no business switching off your phone because the call you may receive can keep someone alive or keep you alive. Put yourself in the shoes of the patients. The book of James 2:26 says â€œJust as the body without the soul is dead, so is faith without works dead.â€
Going forward, what do you think ought to be the medium and long term development plan for hospitals?
For us here at UCTH, our strategic development plan for the next five years is being developed. We want to see a hospital where facilities are working almost 100 percent. We want to see a hospital where infrastructural decay is properly devalued. We want to see a hospital where all post-graduate departments are fully accredited so that we can reduce the cost of training our post graduate doctors in other sectors. We want to see a hospital where patients will come here, go out, and say â€˜yes, we have entered a teaching hospitalâ€™. So, my advice to the country and staff in the hospital, is that it is high time we sheathe our swords and ensure that the country experiences peace in the health sector.
As I speak to you now, a lot of people in radiology department have opened X-ray departments, scan departments, radiology departments, CT scanning outside. If you go to the hospital clinics you hardly find them including consultants. Is that not a bad attitude?