Joint Health Sectors' Unions (JOHESU) were on strike for about one week last month (August 2013) shutting down public hospitals across Nigeria except for skeletal services rendered by you. But what worried me most is the stand of colleagues during the strike and the current threat that you too would use the same device that you largely condemned other health workers for using if the government agrees to the demands of JOHESU. (There were some words of reason and call to understanding from MD of FMC Gombe and CMD of Gwagwalada Specialist in the media).
But words coming out from the majority of leadership of the Nigerian Medical Association (NMA) and from colleagues in the medical profession were very coarse to say the least. In engaging with the discussion about other health workers you find people saying/writing things like “anti-doctors”, “our enemies” “eliminate”, “fight-to-finish” and so on. That there were some skeletal services provided by colleagues during the time of the strike was more to frustrate the strike of the other health workers than it was about genuine interest of patients or the general public’s health. A friend quoted the following on his blog said by a lady which seem to capture the position of most people on social media except of course the striking health workers:
‘I am asking you if you would take your pregnant wife to a hospital to be attended to by a nurse. I know you won’t. A nurse is a nurse. If you are admitted in a hospital she will nurse you, but not treat you. Everyone that goes to hospital wants to see a doctor. A doctor checks you and tells you what is wrong and prescribes what you will take. If there is an injection, the nurse will do it. But if you need an operation, a doctor does it. If you need drugs, you go to a pharmacy and get it. A pharmacist is dealing with drugs, not patients. When you have a drug unit, give it to a pharmacist to head, not a doctor. When you have a laboratory, give it to a laboratory technician to investigate samples on doctor’s orders. Don’t give it to a doctor. When you have a ward with patients, a nurse is who you need to administer drugs on doctor’s orders and to nurse the patients. But when you have a hospital, you have to give to a doctor, not a pharmacist or nurse or what have you. I know everyone is important in a hospital, but a doctor is the doctor. I am sure you don’t want a nurse operating on your wife.’
This understanding of leadership is rather curious. It seem to suggest that we agree that leadership should be about control and therefore power over the resources of particular spaces based professional knowledge. Should it follow then that since Mine and Quarry Engineers know more about cement production they should not allow Dangote (who is not an engineer) as their CEO? Leadership is much more than knowledge and control of resources. Leadership especially in delivering public services is first and foremost about responsibility and accountability.
The question is what are our health institutions for?
For example, looking at Teaching Hospitals and Federal Medical Centres because they form the battlegrounds for most of the inter-professional disputes. Could the CMDs/MDs as the CEOs of the scores of tertiary hospitals bring forward any verifiable data about the core purposes of their hospitals?
Are these centres supposed to reduce preventable deaths? How much of that has each achieved in 2012? How much more could they have achieve? How much did it cost the society?
Are they supposed to reduce suffering? How much of that did our hospitals achieve in 2012? How much more could they achieve and at what cost the society?
Are these centres supposed to produce future health workers? How many do we need and how are they filling in the gap and at what cost to the society?
Are they supposed to produce knowledge through research? What do we know about the many things that are killing and maiming us and what solutions have they managed to produced and at what cost?
All indicators are suggesting that our health is deteriorating as the health budget sour in Nigeria. Here, one might argue that increasing spending on the health sector is damaging our health and reducing our survival?
What exactly is the purpose of our health institutions?
My position is not that the JOHESU strike is justified or in the interest of Nigerians and not because they will genuinely offer better results. But that the current framing of what leadership is within the health sector is rather cynical. And that need to be thoroughly worked out before embarking on another endless and meaningless cycles of strikes and counter strikes.
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