In a Press Release by the Nigerian Medical Association dated Wednesday 9th March, 2016 captioned “IMPENDING DISASTER AND COLLAPSE OF GOVERNMENT HOSPITALS AND THE PUBLIC HEALTH SECTOR IN NIGERIA: A CALL FOR IMMEDIATE ACTION AGAINST EXISTING AND EMERGING ABSURDITIES ” signed by Dr. Kayode Obembe and Dr. Adewunmi Alayakin on behalf of NMA as President and Secretary.NMA had raised a lot of pertinent issues in the Nigerian Health Sector. In said Press Release NMA was fighting tooth and nail to get the public on her side. She was hiding under the guise of altruism that her action is based on the need to protect the interest of the public and the patient. But in digging deeper you will see that NMA is encapsulated with the fabric of illegality to usurp the statutory functions of the other Health Care Professionals.She epitomizes this by turning herself into a fifth columnist that is not amenable to obeying the laws of the land. She sits as “Eze Onye-agwanam” -“The King Above The Law” , to undermine the rule of law, Government established extant circulars, criteria of appointment as stipulated in the Public Service Rule, Government approved Scheme Of Service, different Court pronouncement/rulings and judgments, and above all the code of conduct as exemplified in the Nigerian 1999 Constitution (as amended). Why the entire hullabaloo by NMA? Why all the misinformation?In the writings here-under we shall try our best possible to unfold the issues at stake in the Nigeria Health Sector for the public to be the judge as she has taken the problems in the Health Sector to the Court of Public Opinion.
NMA AND FLAGRANT DISREGARD OF CONSTITUTIONAL PROVISIONS AND RULE OF LAW.The Civil Service of the Federation is a creation of the Nigerian Constitution as Stated in section 169 of 1999 Constitution (as amended). Section 318 of the same Constitution defines the Civil Service of the Federation as thus-“means service of the Federation in a civil capacity as staff of the office of the President, Vice-President, a Ministry or department of the Government of the Federation assigned with the responsibility for any business of the Government of the Federation. Underline the words CIVIL CAPACITY and ASSIGNED with the responsibility for any business of the Government of the Federation for us to really appreciate the role of the Civil Service of the Federation. It is the Government through her Ministry, Department or Agencies that assigns responsibilities. While the creation of Posts and Responsibilities is also the statutory function of the Office of the Head of Service of the federation.The Head of Service is also the Chairman National Council on establishment. Section 171 (1) B saddles some responsibilities on the Head of the Civil Service of the federation. Government approved Scheme of Service is a policy document from the Office of the Head of Service/National Council on Establishment to be used as one of the criteria for appointment into the Public Service of the federation.The Government approved Scheme of Service for Medical laboratory Scientist in sections, 2.9,2.9.1, 2.9.2, saddles the responsibilities of taking charge of general administration of the Medical laboratory Services Department, budgeting and ordering laboratory equipment and reagent, advising on the formulation, execution and review of Medical Laboratory Policies on the Director of Medical Laboratory Services who is a Medical Laboratory Scientist. But in many hospitals today the Scheme of Service is not implemented.NMA’s prescription is that illegal posts and responsibilities are created where a Director of Medical Laboratory Services is made to be under another Head of Department who is a Doctor this is alien to the Scheme of Service, a blatant absurdity.The Public Service Rule (PSR) 020506 states “POSTING OF OFFICERS WITHIN THE MINISTRY TO POST OUTSIDE THEIR PROFESSIONAL CADRE SHOULD BE PROHIBITED” The Medical Laboratory Science Council Act 11 2003 states in section 18(2) “SUBJECT TO THE PROVISION IN THIS ACT, NO PERSON NOT BEING A FULLY REGISTERED MEDICAL LABORATORY SCIENTIST UNDER THIS ACT SHALL BE ENTITLED TO HOLD ANY APPOINTMENT IN THE PUBLIC SERVICE OF THE FEDERATION OR STATE OR ANY PUBLIC OR PRIVATE ESTABLISHMENT BODY OR INSTITUTION, IF THE HOLDING OF SUCH APPOINTMENT INVOLVES THE PERFORMANCE BY HER IN NIGERIA OR ANY ACT PERTAINING TO THE PROFESSION OF MEDICAL LABORATORY SCIENCE FOR GAIN”. The law is lucid that Allopathic Doctors cannot put themselves forward as Medical Laboratory Scientists, just as Medical Laboratory Scientists cannot put themselves forward as Allopathic Doctors.Section 22(2) of MLSCN Act 11 2003 states “A person who is not a member of the profession shall not practice the profession or, in expectation of reward, take or use any name, title, addition or description implying that he is in practice as a member of the profession”……….a situation where Allopaths wants to put themselves as Medical Laboratory Scientists is against the law.
NMA AND MEGALOMANIANMA has always used derogatory terms to address other Health Care Professionals and she has always tried to put on the misleading posture that the terms Medicine, Medical and being medically qualified is an exclusive preserve of Practitioners of Allopathic Medicine.The word “MEDICINE” was in used before the advent of the Medical Certification MBBS or MBCH. In fact the word “MEDICINE” was in use before the birth of Hippocrates who is wrongly said to be the father of “ORTHODOX MEDICINE”. Hippocrates never practiced ORTHODOX MEDICINE even though he was a Physician. The word “MEDICINE” is defined as the Act, Art and the Science of Healing. It is worthy to note that Allopathic Medicine is one of the newest comers in the “Terrain of Medicine”. There is Traditional Medicine and the Comparative study of Traditional Medicine is known as Ethnomedicine. You have Diagnostic Medicine, Alternative Medicine, Botanical Medicine/Herbal Medicine/Phytomedicine. There is Functional Medicine, Holistic Medicine, Integrative Medicine, and Quantum Medicine and finally Allopathic Medicine .All these are established Therapeutic Medical Systems. The “Curative Regimen” produced by the Pharmacist is also called “Medicine”, yet Allopaths only see themselves as “Purveyors of Medicine” the word “Medical” is an adjective which means related to the Act, Art And Science Of Healing, yet NMA says that Pharmacy, Nursing, Optometry, Radiography, Dental Technology, Dietetics and Nutrition, Medical Rehabilitation/Physiotherapy and Medical Laboratory Science etc. are not part of the Act, Art and Science of Healing (Medically Oriented Disciplines). It is of value to state that the Medical and Dental Practitioner Act CAP M8 2004 that regulates the practice of Allopathic Medicine in Nigerian is not in agreement with NMA’s postulates. The Act is in agreement that there are other Therapeutic and established Medical systems outside Allopathic Medicine. In section 17 subsection 6 of Medical and Dental Practitioner Act CAP M8 2004 we are told “where any person is acknowledge by the members generally of the community to which he belongs as having been trained in the System of Therapeutic Medicine Traditionally used in that community, nothing in paragraph (a) of subsection 1 or paragraph (a) of subsection 2 shall be construed as making it an offence for that person to practice or to hold himself out to practice that system”.Allopaths should stop misinforming the general public that they are the only people who practice “Medicine and are Medically Qualified”. The law provides that trained, licensed and registered Traditional Medicine Practitioners are also “medically qualified” to practices their “Medical System”. In line with Delta State Traditional Medicine Board Edict 1997 in section 2 it goes thus: “TRADITIONAL MEDICINE INCLUDES PRESCRIPTION, TREATMENT, CONCOCTION OR, AND DRUGS INDIGENOUS TO NIGERIA TRADITIONAL SOCIETY INTENDED FOR CURING OR PREVENTING DISEASE OR ANY OTHER FORMS OF ILL HEALTH”It went further to state on Traditional Medicine Practitioner (this) “means a provider or purveyor of Traditional Medicine and this includes Herbalist, Bonesetters, Traditional Birth Attendant, Traditional Midwifes, Healers of Psychological and Allied illness, Traditional Surgeons, herbal dealers and every other persons whose beneficial practice falls within traditional practice.” It is crystal clear from the above that even Traditional Medicine Practitioners are Medical Practitioners, medically qualified to practice the medical system they have been trained, licensed and registered by the laws of Nigeria to practice.A Medical Practice is any practice related to the act, art and science of healing provided that the practitioner is trained, registered and licensed by the laws establishing that practice for him/her to practice that profession. That is the fulcrum of being medically qualified, being fit to practice as stated by law. It is in that vein that Nursing, Pharmacy, Radiography, Physiotherapy, Optometry, Medical Laboratory Science etc. are all Medical Practices in the Medical Field regulated by Autonomous And Independent Regulatory Bodies established by acts of Parliament (Law) and the practitioners are full-fledged Medically Qualified Professionals.
NMA AND USURPATION OF STATUTORY FUNCTIONS OF OTHER PROFESSIONAL GROUPIn the said Press release, NMA had stated that Pathology and Medical Laboratory Science Profession are related but the description, training and responsibilities differ. Even with the above statement, she had stated that doctors and dentists are hereby cautioned against using pathology service result not reviewed, interpreted and reported by Pathologist thus guaranteeing, reliability, and safety and assuring responsibility for outcome of use. Arising from the foregoing, one is forced to ask is there any Scheme of Service in Nigeria that give the Allopathic Doctors such a job schedule? A situation where an Allopathic Doctor, signs out results he did not do is a scientific/professional fraud, a scientific plagiarism. It is already settled in the UK that you cannot sign out a result you did not do. In line with the Scheme of Service for Medical Laboratory Scientist, it is the duty of the Assistant Chief Medical Laboratory Scientist to supervise the subordinate staff. It is the duty of the Assistant Director and the Director, to make sure that Medical Laboratory results meet agreeable standards in line with the Standard Operating Procedure. They are to promote accuracy, reliability of results through the use of quality control and review of Laboratory policy. This job description is no where given to the Allopathic Doctor who majors in Pathology. NMA and her members should be amendable to discipline by working according to their job description. She should put off the toga of “Jack of all Trade”. Allopaths who major in pathology are by job description to be the doctors’ doctor, a consultant to his fellow doctors and not to sit, to usurp the job function of another distinct professional group, the Medical Laboratory Scientist.
NMA AND IMPOSITION OF MASTER-SLAVE RELATIONSHIP IN THE NIGERIA HEALTH SECTORAllopathic Medicine like every other Profession has its humble beginning. The training of Allopaths started as “MEDICAL APPRENTICESHIP” which gave rise to Medical Assistants. Through evolutionary trends it has metamorphosed to what it is today, where from being a “Medical Apprentice” to a “Doctor of Medicine (MD)”. Today Surgeons, who were one time called “Barbers” were medical assistants to the Priest and they did all the menial jobs the Priest as Priest could not do. The separation of medical practice from Priesthood gave rise for surgeons to have autonomy which came with enrichment of their scope and corpus of knowledge acquired.The former Barber-Surgeon, a Middle Manpower and Medical Assistant became a distinct full-fledged practitioner of the Act, Art, and Science of healing. Initially Allopathic Medical Practice and Surgical Practice where distinct. The amalgamation of Allopathic Medical Practice and Surgical Practice gave rise to the certification “MBBS or MBCH”.Allopathic Medicine commonly called Orthodox Medicine did not start just as “MBBS or MBCH” it had a humble beginning. A situation where NMA makes prescription that other Medical Practices like Nursing, Pharmacy, Optometry, Radiography/Medical Imaging Science and Medical Laboratory Science etc should not advance in scope and in corpus of knowledge is gross absurdity. The recommendation of NMA takes us back to the days of “Antediluvian Patriarchs” in the practice of Medicine in Nigeria.Allopathic Medicine is not indigenous to Nigeria and that is not how it is practiced in other clime like in the UK, USA, FRANCE, HOLLAND, DENMARK etc. In such places where International Best Practice is maintained is Medicine practiced as a Master-Slave Relationship as prescribe by NMA? The answer is no.Under the Nigeria Civil Service, the law provides that such appointments have statutory flavor. This being at the back of our mind, NMA cannot dictate how people should be employed, their job description, how they are to rise and where they are to terminate in the employment. NMA should stop carrying herself as if she is the Government that assigns responsibilities. Just like every other person in the Health Sector, the members of NMA are also just employees of the Government. Government through her policy directives have provided how things should be done.NMA AND PREJUDICEIn line with section 172 of the Nigerian 1999 constitution (as amended) “A Person in the Public Service of the Federation Shall Observe and Conform to the Code of Conduct”. The code of conduct as exemplified in the Constitution fifth schedule part 1, articles 1, 9 and 10 provides:Article 1: “A Public Officer shall not put himself in a Position where his personal interest conflicts with his duties and responsibilities”.Article 9: “A PUBLIC OFFICER shall not do or direct to be done in abuse of his office, any arbitrary acts prejudicial to the rights of any other person knowing that such acts is unlawful and contrary to”Article 10: A public officer shall not be a member of, belong to or take part in any society the membership of which is incompatible with the function or dignity of his office. A situation where NMA calls her members to take laws into their hands in other to undermine the laws of the land by promoting their own personal interest is against the fundamental principle of the practice of “TRUE MEDICINE” “THAT A PHYSICIAN MUST CAUSE NO HARM”.The action of NMA undermines the code of conduct for public officers, her actions is prejudicial to rights and responsibilities of other Healthcare Professionals. Above all her public outcry has nothing to do with patient interest, rather they are self serving.NMA AND MISAPPLICATION OF THE DICTUM INTERNATIONAL BEST PRACTICE:
- Each time NMA goes contrary to the laws of the land, she shouts “International Best Practice”, forgetting that the world is a global village. The “International Best Practice” is that expert Administrators administers hospitals. All over the world most hospitals have non-Allopathic Doctors as Chief Executive Officers. These Chief Executive Officers are individuals, who have bias in Hospital Administration and Management, not necessarily having a degree in Medicine or in Medical Sciences. And these Hospitals are doing well. As a result of the misinterpretation of the decree 10 of 1985 and the emergence of Hospital Chief Executive as Allopathic Doctors, “Things Have Fallen Apart and the Centre Cannot Hold, Mere Anarchy is loosed Upon the World”. The Hospitals have become hoodwinked territories by NMA and her likes that run the place according to their whims and caprices. All over the world it is not only Allopathic Doctors that are appointed as “Consultants” in their chosen field of expertise. There are Consultant Pharmacist, Consultant Optometrist, Consultant Physiotherapist, Consultant Radiographer, Consultant Biomedical Scientist etc., but the prescription of NMA is that all these autonomous Professions should remain as “Middle Man Power” even when the laws of Nigeria lucidly proclaims that they are “High Level Man Powers”. Is this also International Best Practice?
NMA AND HER ATTACK ON THE NATIONAL ASSEMBLY AND TEMPLE OF JUSTICE.It is a Constitutional creation that judicial Power is vested in all the Courts of competent jurisdiction in Nigeria. Without prejudice to section 6 (1) of the 1999 Constitution (as amended) “The Judicial Power of the Federation Shall Be Invested In the Courts to Which These Section Relates, Being Courts Established for the Federation”. Again, section 11 (1) empowers “The National Assembly to Make Laws for the Federation or any Part Thereof With Respect to the Maintenance and Securing of Public Safety and Public Order and Providing, Maintaining And Securing of Such Supplies and Services as May be Designated by the National Assembly as Essential Supplies and Services”.A situation where NMA attacks the National Assembly for doing their jobs which is law making in order to maintain peace and harmony in the Nigerian State is unfortunate. A situation where NMA also attacks the Temple of Justices for rendering land mark judgments that will strengthen democracy and Healthcare Practice in Nigeria is highly worrisome. NMA and her cohorts should know that a situation where they are attacking the different arms of Government is following the “Path of Autolysis”. It is time for NMA to curb her excesses, bearing in mind that she is just a mere “Association” and not an arm of Government
NMA AND ABSURDITIES IN THE HEALTH SECTOR.NMA has stated that she is a law abiding Association but it is crystal clear that all her actions are anti-Professional autonomy and the Rule of law. A situation where she gives directives to her members to undermine the Constitution of the Federal Republic of Nigeria, Government Established Scheme of Service, Extant Laws, Courts Rulings, and Judgments has a lot to say. Where NMA makes prescription for the creation of posts and responsibilities that are not backed by any Scheme of Services is ultra verse.The Public Service Rule (PSR) 020205 “To be eligible for appointment into the Federal Public Service every applicant must 020205 (e) posses requisite qualification as provides from the “Scheme of Service”. No Nigeria Scheme of Service gave Allopathic Doctors the job description they have ascribed to themselves such as being the Director of Pharmaceutical Services, Director of Nursing Services, Director of Physiotherapeutic Services, Director of Radiographical Services, Director of Medical Laboratory Services etc.NMA having told her members not to use Medical Laboratory results generated by qualified, registered and licensed Medical Laboratory Scientist except, they are signed by the Allopathic Doctors is an absurdity. The International Best Practice is when the Medical Laboratory Scientist have finished conducting test, the results generated is released to the Requesting Physician that is the doctor who made the original request for attention.This upholds confidentiality of the test results. If the Requesting Physician feels that he needs an extra opinion to enable him manage the patient, it is his duty to invite his colleague the Pathologist for advice on other forms of patient care and management if need be. NMA should stop trying to meddle into the job function of Medical Laboratory Scientist which is not their area of licensure.
NMA AND STRIKE ACTIONNMA in many cases have called her members out on strike action to agitate for issues that are not backed by law. Currently in some hospitals there have been strike actions by NMA members. The reason is that Government should allow them to skip some grade levels that are not provided for in their scheme of Service, even when there are no enabling circulars backing such demands.It should be highly stressed that NMA is not a Trade Union. And it is settled in the Nigerian Law, that if you are not a Trade Union, you cannot proceed on strike action. NMA have always misinformed the public that her strike actions are as a result of Public Interest, while in actual sense, it is an act born out of an illegal selfish desire to enrich her, outside the provision of the law. This is detrimental to the Nigerian Populace. NMA is not a recognized Trade Union, so she cannot under the guise of illegality benefit from the rights and privileges of a Trade Union.NMA AND NIC JUDGMENTIt must be stated in clear terms that the “Press Release” by NMA Executives and her members are the averments they have canvassed in different Courts of competent jurisdiction in Nigeria and have lost in the matter. In three (3) rulings and three (3) distinct judgments from the National Industrial Court of Nigeria, the courts have ruled against those averments canvassed by NMA and her members. The Courts have past judgments that the law setting up Medical Laboratory Science Practice and Medicine are not in conflict, the job description, training and responsibilities are not the same. It is settle in law that you cannot reprobate and approbate at the same time. Moreover you cannot resort to self help on a matter already decided by a Court of competent jurisdiction. The action of NMA is subjudice for her to be calling Government to implement Alhaji Ahmed Yayale report which is before a Court of competent jurisdiction. It is worrisome that the NMA can have the temerity and audacity to cast aspersion on the judgments of National Industrial Court, on pages of newspaper in favour of Medical Laboratory Scientist in Nigeria. It will be a sense of exaggerated well being for NMA to think that she can intimidate and ambush the Court of Law by her contemptuous actions. In the words of the great Lord Denning the Master of the Rolls “YOU CANNOT BUILD SOMETHING ON NOTING AND EXPECT IT TO STAND” “NMA CANNOT BUILD HER HOUSE ON ILLEGALITY AND EXPECT IT TO STAND”. The rule of law provides that if you are not satisfied you take an appeal. NMA rather than putting on the “Antithesis of Civility” should make amends, for when “MERE MORTALS” try to desecrate the Temple of Justice and Truth, they are just digging their Waterloo, for the Temple of Justice and Truth are the abodes of “HIGHER MORTALS”.RECOMMENDATIONS/SOLUTIONS TO THE PROBLEMS IN THE NIGERIAN HEALTH SECTORGovernment should be bold to restructure the Health Sector where rule of law is not subverted by the whims and caprices of a collective few.Government in line with Public Service Rule 160201 which states “statutory Board/Council shall set operational and administrative polices in accordance with government policy directive and supervises the implementation of such polices.” Government should be firm to make all her employees specially NMA members to obey the rule of law, Public Service Rule, extant circulars and approved Scheme of Service.NMA should be called to order because of her conspiracy against Government policy directives and Court judgments in favour of Medical Laboratory Scientists of Nigeria.Government should entrench Medical Humanism and Medical Pluralism in the System.In order to meet Universal Health Coverage, Government should promote and advance other established Therapeutic Medical Systems, where no one Therapeutic Medical System has monopoly. Government can achieve this by creating an enabling environment for the practice of evidence based Traditional Medicine, Ethnomedicine, Functional Medicine, Holistic Medicine, Alternative Medicine, Quantum Medicine, and integrative Medicine etc.Let Medical Variety spice up the System and let the Patient be the King to Choose the System he wants like what you have in Countries with well established integrative system like in the USA, UK, FRANCE,CHINA,SRI LANKA,INDIA ETC.Government should revert to the System where our Hospital Chief Executives are experts in Hospital Administration and Management, for this will bring harmony in the Health sector. Medical Personnel should face their area of Medial expertise.CONCLUSIONTo all Patients, this is the time to be strong for you are the king; very other Healthcare Professional, is a Health care Assistant to you, including the Allopathic Doctors. You must be firm, for the agitation of NMA is not in your best interest rather; they are agitations, founded on selfish undertone and ego trip. You must give your voice for the restructuring of the Health Sector based on the Rule of law.Thanks:DR. BENJAMIN CHUKWUNONSO AJUFOAMLSCN (CHEM PATH) MPC (INDIA) MD (HOL MED) RMP (INDIA).