|
|
|
|
|
|
|
|
|
|
Saturday, 16 June 2018
Top ten news items in the Nigerian health ecosystem past week
Sunday, 27 May 2018
INTERVIEW: Why Nigerian doctors are leaving country to other climes – NMA President
Francis Adedayo Faduyile
Francis Adedayo Faduyile is the new president of the Nigerian Medical Association. He was elected in the recently concluded 58th Annual Delegates Meeting of the association to serve for two years. He is a consultant pathologist and an associate professor.
In this interview with PREMIUM TIMES‘ Ebuka Onyeji, Mr Faduyile speaks on why Nigerian doctors are leaving the country in droves and how they can be made to stay and work at home. He also addressed the issue of incessant strike in the health sector, why doctors are opposed to demands of other health workers and how the dispute between both parties can be resolved.
Excerpts…
PT: Why are Nigerian doctors leaving the country to other climes, what are the factor responsible for this?
Faduyile: The major factors here are poor remuneration, poor facilities and working condition, and job satisfaction. Many of our health professionals are over worked. A doctor is supposed to see a maximum of 20 patients a day but they are seeing about 150 in a day. Certainly by the time he gets to 50 he is already exhausted. Even a nurse that is supposed to see about four patients has to take care of 50 patients in a ward, certainly he/she will get tired. The truth is that in Nigeria the working environment for many doctors is very hostile. Many doctors see patients that they can treat or intervene on their issues die in front of them because the hospitals they are working in does not have the necessary equipment to take care of them. Many patients in dire need for help don’t have enough money for the kind of services they need at that particular time. I can tell you many doctors are spending fortunes on patients that they are not related to because it’s painful to see patients die.
So, if we have our NHIS fully functional and we can always treat any patient, I can tell you many doctors will have job satisfaction because at the end of the day you have saved so many number of lives. But by the time you don’t have that, you will be dissatisfied. The remuneration of doctors is very poor, if you go to other climes, what we are paid here is just 10 per cent of what they collect and they respect doctors, they put you in that right position where you feel very important. We don’t have good funding maintenance for hospitals in the country. The few doctors that we have are over worked and are not appreciated, these are some of the reasons why so many of them are leaving unfortunately.
PT: How then can we keep our doctors from leaving?
Faduyile: First is when you appreciate your doctors, it will make them to stay. Government needs to bring more equipment. We need to have more fund for health. The NHIS is one way to resolve this issue. If we have more enrolee and funds to it then there will be enough money to maintain the hospitals and to bring in equipment, to buy drugs and for doctors to be retained.
PT: There are issues of internal migration inside the country. Doctors seem to avoid the Primary Health centres in the villages (PHC) and opt for the tertiary institutions in the urban areas due to the terrible state of facilities and standard of living in the grassroots. An investigation by PREMIUM TIMES revealed how many PHCs in the country operate with no doctors. How can this issue also be addressed?
Faduyile: The major reason is that the government does not give additional compensation to doctors working in the rural areas. What is in the national health act is that doctors working in the PHCs should be compensated more. However, most PHCs are ran by the states and even the normal payment for doctors, many states are not even paying. Many states are owing doctors and other health workers an upward of nine months. Many are being paid half salary for an upward of 18 months. So every human being naturally will look at those places where they will be much more appreciated. Until the state government key into payment structure of the health system and bring a pay that will make doctors and other health workers comfortable wherever they are, that is only how this issue can be addressed. This is why NMA is asking for universal applicability of CONMESS to all states and everywhere. If that is done enough pay will come for even the workers in the PHC which is initially structured to take care of 70 percent of Nigerians. 70 percent of our ailments but unfortunately, that area (PHC) is almost dead and we don’t have any other option than to revive it if we want to achieve Universal Health Coverage. This one percent consolidated allocation on basic health fund will go into the NPHCDA and we believe that with that it will strengthen our primary health care.
![Primary Healthcare Centre [Photo credit: LinkedIn]](https://i2.wp.com/media.premiumtimesng.com/wp-content/files/2016/11/Primary-health-care-centre.jpg?zoom=3&w=600&h=392&crop&ssl=1 "primary-health-care-centre")
PT: Why Has NMA repeatedly and vehemently opposed to the demand of salary adjustments by other health workers?
Faduyile: There are so many demands they put forth, but the one on the front line is about their salaries and it’s unfortunate that we are leaving the main reason why we are on the health sector to talk about mundane things. There is a special salary scale for medical doctors as well as other health workers and in that doctors earn a particular leverage over and above other health workers. And we must understand that in this JOHESU we have the cleaners, the drivers, the typists, we have the administrative staffs, we have the hospital engineer, we have all other type of people who are supportive staff.
What JOHESU is asking is not just increment in their salary, they are asking for parity with doctors. We have been disadvantaged for more than 12 years in the health sector until 2014 when the government realised this and readjusted our salary scale which is CONMESS. We had an agreement with government through collective bargaining and they begged us to reduce the relativity and we have reduced it from 3.3 to 1 ratio to 1.5 to 1 ratio. This means over 50 per cent reduction and in our lower level we have appropriated relativity. In 3 steps out of the 7 steps that doctors are paid in the service, there is parity of 1 is to 1. So what we are saying is that it is getting out of hand. Before like I said, the salary ratio of doctors and other health workers used to be 3.3 to 1.0 but today we have cut it down to 1.5 is to 1.0 so that peace will reign; but they just want it to be at par. But we are saying we have given so much to that level of 1.5 and we can’t go beyond that.
PT: But if government finally adjusts the salary of other health workers, will it affect the salary of doctors?
Faduyile: No, it will not affect our salary but it will be a bad morale to us. I am working as a doctor and I’m collecting N5; another person in service who did not go through the kind of training I went through and is not working as much as I do will still be collecting the same salary. Why am I going through all these stress then? In America even among doctors, there is relativity. An anaesthetic doctor can collect up to five times the salary of a pathologist.
When CONMESS was implemented, JOHESU went and made up their own salary scheme which is CONHESS. They transferred all the figures and salary steps in CONMESS into CONHESS and that means parity. Doctors have to go back to government and tell them we have been short-changed. And in 2014 when the government realised their mistake they readjusted our own salary and it is that same readjustment that the JOHESU is asking from the government.
If that is done, then it means we have gone back to that position where we were disadvantaged. They are asking that everything in CONMESS point for point, level for level must be the same thing with CONHESS. Nobody is against them from having increment in salary. What we are saying is that it will not be at the same level with doctors. Government should follow its own agreement. In every institution in the whole world and in all international best practises, relativity begins with salary of doctors and other health care professionals.
(Editor’s Note: CONMESS is the salary structure for medical and dental officers in the federal public service while Consolidated Health Salary Structure, CONHESS, is the salary structure for pharmacists, medical laboratory, nurses and other health workers in the health sector of the federal public service.}
PT: JOHESU have always argued that they are not asking for same pay with doctors and that relativity suffices at point of entry into service since doctors enter service at grade level 12 while others enter at 8 or 9. What can you say about this?
Faduyile: That they enter service at grade level 9 and we enter at 12 is not relativity, it does not appear here. Can a degree holder that enters service at grade level 8 and a PHD holder that enters at level 10 earn the same salary? No. A PHD holder should get more gratification and enter service at higher grade than his degree counterpart. The relativity we are talking about here is not on the point of entry, point of entry is just about the degrees and level of education. We are talking about the ratio in the salary scale.
PT: How much does a doctor earn at entry level?
Faduyile: Doctors collect about N150,000. I am a consultant, I’ve been a consultant for more than 10 years and my salary is just a little above N500,000. With all the taxes, the money is even lesser while my counterpart in other African countries collect well above that and even a higher salary than Supreme Court judges. The judges collect nothing less than N2 million and for your information a neuro-surgeon in America collects more money than their president and we are working here, a typist is saying I must collect same salary with doctors.
PT: What do you make of this other demand by JOHESU for a chance to vie for the position of Chief Medical Director (CMD) in health institutions in the country?
Faduyile: In NNPC for example, can a doctor working there say he wants to be the group managing director of NNPC? There are clinics in the ministry of justice which doctors and nurses run but can they say they want to be the attorney general because they and the lawyers work in the same ministry? So what question are we asking? The representatives of the cleaners and the administrators now want to be CMD that will not go well for the health industry.
NMA: What are your objectives and target over the next two years?
Faduyile: My first target is to see how we can resolve all these issues of strike and disharmony in the health sector. It is a lot of distractions creating unnecessary deaths all over the country. We want to see that we direct our efforts to how patients are well taken care of in Nigeria. We want to strengthen our hospitals working method because a lot of hospitals are not working appropriately. We want to make government responsible to the health of the populace. The national health act is the law that has certified what government should do for the citizenry in terms of health care provision. Thank God that the Senate for the first time in history included in the 2018 budget the one per cent of the consolidated revenue fund in the allocation to the health sector. That one per cent will go into revamping the Primary Health Care system and the National Health Insurance Scheme, NHIS. It will stop out of pocket spending for health delivery. It is one of the greatest things that can happen. We want to plead with the president to quickly give assent to this budget and ensure it is well spent.
PT: How Do you intend to use your office to curb incessant strike in the health sector and by extent settle this perceived disaffection between doctors and other health workers?
Faduyile: My predecessors already started that, he had series of meeting with other professionals in the health sector. And when this current dust settles, I will call them so we can work out a plan that will benefit us all. And once we can work in harmony, there will be unity and improvement of health delivery. On the part of NMA, we are being proactive to avoid issues that can cause or degenerate to industrial action. We are trying to nip issues at the bod and that is why you see NMA is coming in on this JOHESU issue to let the government know that there is an agreement.
PT: There has been lots of cases of medical negligence and bad attitude of health workers towards patients. How is NMA working towards curtailing this trend?
Faduyile: You also have to understand and consider the plight of health workers on this. Some of them can be over worked like I said earlier and some of these attitude can stem from exhaustion. But regardless, we need to up our game in terms of professionalism. We have all sort of people coming into the system today with lots of behaviour that are unbecoming. On our own we are going to educate our members more, we will continue to pressurise the government to always put in the appropriate number of personnel needed; both doctors and other health workers. I think when we have that, all these harassment will reduce.
PT: How do you plan to check quackery in the health sector?
Faduyile: The first thing to do is to educate the public. You must be able to make the public to understand that your health is the most important thing you can lose. A lot of people will go and meet quacks who they know are quacks but they do so because they will tell you they don’t have money to go to hospitals. But if they are wrongly treated and they lose their life, what is now more expensive than that? We need to do a lot of education in this. We need to put pressure on our government to see that the Medical and Dental Council of Nigeria (MDCN) is set up.
The MDCN has not been up for more than three years now; it means that medical profession is likely unregulated in Nigeria. Once the council is in place, then we can enact laws to strengthen our security operatives in beating these quacks. On our own, we are going to raise the awareness and work with security agents to be able to pick those quacks and ensure that they are taken to court for impersonation. A quack anywhere is a threat to everybody. I don’t know where my sister or brother is now, they may be somewhere and it is a quack that is treating them. He can kill them or cause a lot of damage them.
PT: What is your take on Public Private Partnership (PPP)? Don’t you think it will further impoverish Nigerians by increasing out-of-pocket spending?
Faduyile: If you go outside Nigeria, most hospitals are private and that is why they are having good services. For you to enforce professionalism and discipline, it will be difficult within the public. If you go to India, most hospitals are privately owned. Government only supports because government cannot enforce professionalism and a whole lot of things because it is public. PPP is good and NMA supports it. On whether it will impoverish Nigerians, that is if we are still talking of out-of-pocket spending, we are now working towards changing the spending system through the NHIS where people can spend less.
Saturday, 19 May 2018
Doctors at ISTH irrua respond to Mass casualty involving UBTH JOHESU along Benin-Auchi Road.
Sources gathered that 19 out of the 20 victims were members of the UBTH chapter of JOHESU, the arm of health workers who are currently on strike and have placed most government hospital facilities under lock-and-key. They were said to be on their way to a social function at Auchi.
Thankfully, this is not the story at ISTH, IRRUA EDO STATE, as the hospital management along with the doctors who have been at their duty post for the past one month duration of the strike, have kept the hospital running at optimal levels.
The Presidents of the association of resident doctors, the NMA Edo Central zone, medical and dental consultant association, ISTH chapter, alongside the hospital management have all called out their members to assist at the emergency room.
The Doctors as usual, have all swung into action to cater for the casualties while trying to access the locked theatre for those who would need surgery.
More than half of the casualties have varying degrees of fractures and dislocation. While a few of the dislocations have been reduced under conscious sedation methods, others may need the orthopaedic, plastic surgeons attention in the theatre under control by the anesthetic surgeons.
We thank all doctors for coming out, even those that are not on call-duty. Indeed, this underscores the statement that "BEING A DOCTOR IS NOT JUST A TITLE, IT IS A MENTALITY"
This story is an exclusive from the secretariat of the association of resident doctors, ISTH chapter.
Friday, 29 September 2017
Sell us your mother! #BizOfHealthNg
— By Dr. Biodun Ogungbo
Fact: Nigerian doctors cannot walk into Europe, America, Turkey, India or even South Africa and set up a hospital.
You cannot even just hop off a plane and start consulting clinics or treating patients.
Fact: Foreigners from Europe, America, Turkey, India or even South Africa can walk into Nigeria and set up a hospital.
You simply find a lackey whether a Nigerian doctor or a politician and start a consulting clinic or treating Nigerian patients.
You can also set up a billboard advertising your big hospital in Dubai or Saudi Arabia on any major street in Nigeria.
You simply do what you like so long as you have the money!
In Nigeria, you will find someone who will take the money, trample on the National flag, sell their inheritance or simply sell you their mother; if the price is right! It is called business regardless of whether it destroys the future for generations unborn! It’s me, myself and my family! What can I gain today? Stomach infrastructure Many organisations and groups have located enterprises to other countries because our representatives demanded remunerations and kickbacks for themselves! How long are we to continue to play into and suffer from this stomach infrastructure? This abject poverty of self-awareness, a complete lack of self-respect and totally devoid of nationalism.
Anyway, this is not even the story. It is estimated that Nigerians spent $2.5b (that is about N1.25t) on foreign medical trips yearly, most of the cases are frivolous and could be handled in Nigeria.
Many countries, companies and even individuals are therefore longing after the luscious Nigerian healthcare cake.
It is not enough for them capturing the many patients (including Mr. President) who troop out daily for medical tourism.
Many of the organisations are now looking to establishing a strong hold right inside Nigeria in manners similar to the market dominance currently enjoyed by the likes of Spar and Shoprite.
Study after study are being conducted to analyze the financial returns in doing business in Nigeria.
Opportunity areas of interest include health infrastructure; medical equipment, devices and technologies; financing; consulting services and other areas where Nigerians are backward in realizing the huge potential resources they are sitting on
Or aren’t we?
Let me give you some examples.
1: We cannot seem to be able to work together harmoniously with other Nigerians.
There are Nigerian doctors well capable of performing open heart surgeries but the National Hospital is happiest collaborating with foreigners.
2: We advertise our stupidity and colonial mentality openly. A hospital in Abuja advertises that it will be conducting clinics and operations on patients in collaboration with Chinese doctors.
They said that the Chinese team can treat patients cheaper than Nigerian doctors from the Diaspora.
3: We promote results from other countries as our own.
Another hospital is collaborating with Indian doctors to perform kidney transplants even though there are Nigerian doctors well capable of doing the procedures locally.
The operation has been successfully performed many times over at Garki Hospital, Abuja.
Yet, the hospital in Abuja touts the Indian results as its own!
4: We frustrate local talents and pay them less than foreigners.
The Akwa Ibom specialist hospital started operations boasting it had foreign doctors and specialists.
Why? Why rubbish local doctors in this way and play into the colonial mentality of yester years? And then, when they cannot afford to pay the foreigners, they look around and start employing local doctors at much cheaper rates but still expecting the same quality of care!
5: We welcome foreign doctors with red carpet reception and many appear first in Aso Rock! Indian, Chinese and other foreign doctors can simply walk into Nigeria and start operating on patients without respect for our local health establishments and in utter disregard and disdain for both local practitioners and the Nigerian people.
When things go wrong, they simply pack their bags, leaving death and destruction behind.
Sell us your mother. It seems that there are people who can be bribed, paid, convinced or simply bullied into selling their birthright, their children’s inheritance, our natural resources, entitlement and future, even perhaps their own mothers to foreigners.
It is a big shame that politicians, doctors and other healthcare practitioners do not appreciate the massive business opportunities and remunerations possible if we develop our healthcare infrastructure, by our own eff orts, for ourselves.
Big business is coming into the Nigerian healthcare space to conquer and carry our inheritance away at a canter.
They can only achieve this if we fail to appreciate what we have and the huge potential that exists for all.
When big business calls, and asks for your mother’s hand, will you sell? Will you sell out your motherland for base immediate gratification? Or will you realise that we have the world at our feet and can dictate the dance?
Disclaimer: This post was shared as received. Views are of the writer and not necessarily the views of the association of resident doctors. We found it worth sharing as we pray for a better future of healthcare in Nigeria.
Who else is attending the future of health conference?
The best place to be on November 3 2017 is at the Future of Health Conference, #BizOfHealthNG. Register to attend ->
https://docs.google.com/forms/d/e/1FAIpQLSfa_I-Q56RDkcYhSM-C9cVeafjAWr0CF_UVDliTsCQ7rxxIuQ/viewform
Fact: Nigerian doctors cannot walk into Europe, America, Turkey, India or even South Africa and set up a hospital.
You cannot even just hop off a plane and start consulting clinics or treating patients.
Fact: Foreigners from Europe, America, Turkey, India or even South Africa can walk into Nigeria and set up a hospital.
You simply find a lackey whether a Nigerian doctor or a politician and start a consulting clinic or treating Nigerian patients.
You can also set up a billboard advertising your big hospital in Dubai or Saudi Arabia on any major street in Nigeria.
You simply do what you like so long as you have the money!
In Nigeria, you will find someone who will take the money, trample on the National flag, sell their inheritance or simply sell you their mother; if the price is right! It is called business regardless of whether it destroys the future for generations unborn! It’s me, myself and my family! What can I gain today? Stomach infrastructure Many organisations and groups have located enterprises to other countries because our representatives demanded remunerations and kickbacks for themselves! How long are we to continue to play into and suffer from this stomach infrastructure? This abject poverty of self-awareness, a complete lack of self-respect and totally devoid of nationalism.
Anyway, this is not even the story. It is estimated that Nigerians spent $2.5b (that is about N1.25t) on foreign medical trips yearly, most of the cases are frivolous and could be handled in Nigeria.
Many countries, companies and even individuals are therefore longing after the luscious Nigerian healthcare cake.
It is not enough for them capturing the many patients (including Mr. President) who troop out daily for medical tourism.
Many of the organisations are now looking to establishing a strong hold right inside Nigeria in manners similar to the market dominance currently enjoyed by the likes of Spar and Shoprite.
Study after study are being conducted to analyze the financial returns in doing business in Nigeria.
Opportunity areas of interest include health infrastructure; medical equipment, devices and technologies; financing; consulting services and other areas where Nigerians are backward in realizing the huge potential resources they are sitting on
Or aren’t we?
Let me give you some examples.
1: We cannot seem to be able to work together harmoniously with other Nigerians.
There are Nigerian doctors well capable of performing open heart surgeries but the National Hospital is happiest collaborating with foreigners.
2: We advertise our stupidity and colonial mentality openly. A hospital in Abuja advertises that it will be conducting clinics and operations on patients in collaboration with Chinese doctors.
They said that the Chinese team can treat patients cheaper than Nigerian doctors from the Diaspora.
3: We promote results from other countries as our own.
Another hospital is collaborating with Indian doctors to perform kidney transplants even though there are Nigerian doctors well capable of doing the procedures locally.
The operation has been successfully performed many times over at Garki Hospital, Abuja.
Yet, the hospital in Abuja touts the Indian results as its own!
4: We frustrate local talents and pay them less than foreigners.
The Akwa Ibom specialist hospital started operations boasting it had foreign doctors and specialists.
Why? Why rubbish local doctors in this way and play into the colonial mentality of yester years? And then, when they cannot afford to pay the foreigners, they look around and start employing local doctors at much cheaper rates but still expecting the same quality of care!
5: We welcome foreign doctors with red carpet reception and many appear first in Aso Rock! Indian, Chinese and other foreign doctors can simply walk into Nigeria and start operating on patients without respect for our local health establishments and in utter disregard and disdain for both local practitioners and the Nigerian people.
When things go wrong, they simply pack their bags, leaving death and destruction behind.
Sell us your mother. It seems that there are people who can be bribed, paid, convinced or simply bullied into selling their birthright, their children’s inheritance, our natural resources, entitlement and future, even perhaps their own mothers to foreigners.
It is a big shame that politicians, doctors and other healthcare practitioners do not appreciate the massive business opportunities and remunerations possible if we develop our healthcare infrastructure, by our own eff orts, for ourselves.
Big business is coming into the Nigerian healthcare space to conquer and carry our inheritance away at a canter.
They can only achieve this if we fail to appreciate what we have and the huge potential that exists for all.
When big business calls, and asks for your mother’s hand, will you sell? Will you sell out your motherland for base immediate gratification? Or will you realise that we have the world at our feet and can dictate the dance?
Disclaimer: This post was shared as received. Views are of the writer and not necessarily the views of the association of resident doctors. We found it worth sharing as we pray for a better future of healthcare in Nigeria.
Who else is attending the future of health conference?
The best place to be on November 3 2017 is at the Future of Health Conference, #BizOfHealthNG. Register to attend ->
https://docs.google.com/forms/d/e/1FAIpQLSfa_I-Q56RDkcYhSM-C9cVeafjAWr0CF_UVDliTsCQ7rxxIuQ/viewform
Sunday, 28 May 2017
ARD ISTH receives the best of house officers
So past week, precisely Monday 22nd of May, 2017 between 4-6pm, the ARD ISTH executive team officially welcomed the new house officers to the #ArdIsthfamily With an ORIENTATION WORKSHOP at the hospital conference hall.
It was indeed a successful event with the house officers themselves attesting to the graciousness of the #ArdIsthfamily.
The president gave his welcome address with his usual warm smile and charged the houseofficers to be of good conduct, reminding them of their primary purpose, which is to learn and build their characters for the future. He encouraged them to always turn to the ARD for help whenever they have issues.
Election of the House officers' representative into the position of Ex-officio 3 of the executive team would be conducted in the coming days.
Dr Ehidiamen Thomas, Chief resident of the department of Obstetrics and gynecology, also reiterated the need to have individual learning plans, that would drive them to partake and acquire specific skill sets that they would need as medical officers.
He reassured them of the continuous mentorship available to them from chief residents and senior colleagues in their everyday work activities.
Dr Chuks abejegah, now fellow of the faculty of community medicine, admonished them further and introduced them to the presence of CMDA in our community.
The CMAC, an invitee to the occasion, also joined in welcoming them and re-echoed management's good disposition in catering for their welfare.
The vice president leading the welfare committee, distributed #ArdIsth Branded wardcoats to all house officers in attendance to give a sense of belonging and stimulating the spirit of unionism in the young doctors.
This gift was received with love and thankfulness for the association.
The house officers residing in the HOQ were asked to make a list of the challenges in their apartments and channel via her office for onward transmission to the appropriate quarters for action.
Dr Imadiyi, Chief resident of the department of anaesthesia, led the cardiopulmonary resuscitation session, where all HOs had hands-on on BLS. It was just awesome.
Refreshments was made available to oil the lips of all in attendance.
We are grateful to the entire members of the ARD ISTH for allowing the executives give expression to this nouveau welcoming idea.
Special mention to all executive members.
Special thanks to all chief residents that were in attendance and we acknowledge those that took excuse for the kind gestures
Finally, Greetings to all new house officers. Thanks for making the event a success.
We look forward to more promising events together.
Long live ARD ISTH.
Long live the medical profession.
It was indeed a successful event with the house officers themselves attesting to the graciousness of the #ArdIsthfamily.
The president gave his welcome address with his usual warm smile and charged the houseofficers to be of good conduct, reminding them of their primary purpose, which is to learn and build their characters for the future. He encouraged them to always turn to the ARD for help whenever they have issues.
Election of the House officers' representative into the position of Ex-officio 3 of the executive team would be conducted in the coming days.
Dr Ehidiamen Thomas, Chief resident of the department of Obstetrics and gynecology, also reiterated the need to have individual learning plans, that would drive them to partake and acquire specific skill sets that they would need as medical officers.
He reassured them of the continuous mentorship available to them from chief residents and senior colleagues in their everyday work activities.
Dr Chuks abejegah, now fellow of the faculty of community medicine, admonished them further and introduced them to the presence of CMDA in our community.
The CMAC, an invitee to the occasion, also joined in welcoming them and re-echoed management's good disposition in catering for their welfare.
He hinted that management is working on measures to reducing the burden of errands being run by HOs, that once completed, an official circular would be released and solicited for ARD's backing to making it see the light of day.
This gift was received with love and thankfulness for the association.
The house officers residing in the HOQ were asked to make a list of the challenges in their apartments and channel via her office for onward transmission to the appropriate quarters for action.
Dr Imadiyi, Chief resident of the department of anaesthesia, led the cardiopulmonary resuscitation session, where all HOs had hands-on on BLS. It was just awesome.
Refreshments was made available to oil the lips of all in attendance.
We are grateful to the entire members of the ARD ISTH for allowing the executives give expression to this nouveau welcoming idea.
Special mention to all executive members.
Special thanks to all chief residents that were in attendance and we acknowledge those that took excuse for the kind gestures
Finally, Greetings to all new house officers. Thanks for making the event a success.
We look forward to more promising events together.
Long live ARD ISTH.
Long live the medical profession.
Thursday, 6 April 2017
DEPRESSION AMONGST DOCTORS. THE NIGERIAN RESIDENT DOCTORS IN FOCUS. ARD ISTH IS CONCERNED. Dr OKOGBENIN SHARES HER INSIGHTS.
Here is the highlight from the Questions and Answers session.
Q1. Good afternoon ma, could you please give us a brief overview of depression?
A1. Depression is an illness, characterized by persistent sadness, reduced or loss of interest in previously enjoyable activities and the inability to cope with daily activities for at least two weeks. It’s important to note that it is not just a simple transient emotional response but a clinical condition that can be treated. It is important again to recognize depression because it is very common in our environment and more worrisome to note that the prevalence is higher amongst doctors than non-doctors because of so many reasons which I think we are going to TALK ABOUT AS WE GO ON.
Q2. When do we say a person is depressed?
A2. Talking about clinical depression, there are specific criteria. Usually, we talk about the major symptoms (loss of energy, reduced interest and persistent sadness), and other minor symptoms (poor appetite, moody feeling, poor concentration, forgetfulness, poor sleep, low self-esteem, feeling of hopelessness). So, for you to say a person has depression, at least two (2) core symptoms plus two (2) minor symptoms must be present. Some persons may somatize their depression, having physical symptoms like headache, internal heat, palpitations, pains, peppery sensations instead of having the classical symptoms. In the words of Prof. Binitie of blessed memory, “Africans tend to externalize their depression”. For such persons, you may need to explore further to make this diagnosis where you look into any change in personality trait depending on the age group, like anger with adults, excessive sleep with children, and cognitive decline with the elderly.
Q3. How common is it in our environment?
A3. I was lucky to be a part of the team that did a recent study on the prevalence of depression amongst medical students in the six (6) geo-political zones across Nigeria. We looked at stress, drug use and anxiety and we found out that, the prevalence of depression across Nigerian medical students was 21.3 percent. So, you see that it even starts from medical school because of the stress of the training. Other studies in the general population put lifetime prevalence between 20 percent (women) and 15 percent (men). It is noted that one-in-six women have depression following child birth. So the figures are increasing by the day both for doctors and the general population. An American Study reported depressive symptoms as a universal experience in the first year of residency training. We are yet to have our Nigeria statistics on this, but so much work is going on.
Q4. Ma, concerning the rise in incidence of depression among doctors. What in your opinion could be accountable for this?
We may need to look at the risk factors that predispose the medical student and the resident doctors to depression. The residency training itself is a major psycho-stressor and so is medical school because of the excessive workload involved, not to forget the constant pre-occupation with failing exams. When this is combined with genetic predisposition, it becomes very easy for one to tilt into depression. Of course, a lot of other factors such as conflicts at work (with senior colleagues, patients, other health workers), derogatory/disparaging remarks ( trainers/senior colleagues) tends to take away self-esteem from the resident and it has been found that those with certain traits of self-criticism/perfectionism tend to be worst hit. Working round the clock, sleep deprivation, making medical errors and coming across a lot of poverty and social deprivation on the part of his/her patients and then frequent mortalities, all has its emotional toll on the doctor. Residency has job demand that outweighs job resources amidst authoritarian training methods, poor job satisfaction, remuneration squabbles especially in recent times. Again, family demands as the society expects so much from the doctor. People tend to tell you on one hand that, medicine is a humanitarian job for each time you complain about low wages but on the other hand, remind you that you earn some good income at the instance of asking money from you. Truth is, the doctor pays his bills too and the market woman may even jack up her fee when she realizes you are a doctor.
Q5. What preventive measure can a resident doctor take in the light of these psychosocial risk factors?
Yes, work load is excessive so there may be need for more hands to do the job. The doctor on his/her own part needs to play a role. A doctor is supposed to be able to balance work with leisure. Relaxation and enough time to sleep refreshes the brain. The doctor needs to create time and conserve energy by monetizing his/her stress and learning how to delegate and leverage some domestic task (driver, school-runs, house-help, laundry etc.) Also, Conflict reduction as much as you can, Healthy eating, exercises and reduction in alcohol and illicit substances which themselves are CNS depressants. These would give you more time to apply to the training itself and boost your confidence level thus, reducing the pre-occupation with failing exams. In short, the resident doctor would need to organize himself by planning time and energy.
Q6. In your opinion ma, are there specific inputs to be made into the training of doctors, from medical school through residency to reduce this problem?
Funding for the training programs cannot be overemphasized. Getting more hands to work by way of employment would help. Very pertinent to me is that our trainers need to be talked to,so as to reduce the disparaging/derogatory manner to addressing performance of the resident. The #TrainTheTrainers program should emphasize this. In fact, this calls for a paradigm shift. Residents should be treated with respect within a tension-free environment. One area to be looked into, is the possibility of creating a residency-mentorship program within every department where every resident is assigned to a mentor/educational supervisor whom he can direct his challenges, fears and concerns to. This could take the place of a counselling unit. I find it particularly shocking each time I hear that residents are not allowed to go on annual leave. This is wrong and condemnable no matter the structure of the departmental program bearing in mind that a doctor that comes down with depressive disorder ultimately, cannot be an effective doctor, Truth be said!
Let me say that one of the major barriers in managing depression in doctors is failure to present. Coupled with the fact that doctors are generally not so good at recognizing depression even in their patients, let alone themselves. For those that see the obvious symptoms in themselves, because of both social stigma and self-stigma, they refuse to present. A few may present to general practitioners outside their hospital environment for privacy sake but because they are not specialist, the treatment given is almost always never appropriate. Quite a number resort to self-medication which in itself poses more danger to the doctor. It is worthy of note that the issue of stigmatization is worse within the health workers’ community and this heightens the self-stigma amongst those with symptoms. The risk of being misunderstood as having other mental illnesses if seen approaching a mental health clinic, the fear of being appraised as ineffective by senior colleagues, the worry of being looked upon as an ineffective doctor by both patients and other health workers, are deep issues for him/her really.
Q8. Studies have shown that most depressed physicians do not seek any form of treatment. What could be done to encourage doctors seek help?
Thank you. We are raising awareness. If there is anyone to fight stigma better, it should be the doctors. But we as colleagues, need be the ones to help with this fight and not going behind him/her and be like “are you sure he is okay? Is he seeing his patients well? Is he still able to practice?” we should be our brothers’ keeper. If we find someone exhibiting depressive tendencies, the least we could do is approach them in love, speak to them and encourage them to seek help. Here at Irrua specialist teaching hospital, the department of mental health is ever willing to offer help. Our HELPLINE IS 08113953146. Help us share. Thank you.
Q9. How effective are the current treatment methods?
The good thing about depression is that treatment is very readily available, cheap and effective. They include PSYCHOTHERAPY, PHARMACOTHERAPY, AND ELECTRO-CONVULSIVE THERAPY. atimes, combined treatment options are offered. Whichever methods made available to someone based on the physician’s assessment, they are very effective. It is important to note that the prognosis is very good with doctors than non-doctors. Mental health accessibility is very easy. One can stroll into our consulting room without a referral. Again, however that we may offer VIP TREATMENT, its usually not the best as the patient is usually encouraged to come out with it without worry of what anyone might think. VIP TREATMENT also makes it difficult for your physician to talk about it freely, about suicidal tendencies and care plan. This surely wouldn’t help with overcoming self-stigma. It is the same type and quality of treatment offered to a non-doctor that would be offered to a doctor. We treat for as much as 6-9 months after which we place on maintenance therapy. Very important in treatment is, removal of the stressors. It is highly effective.
Q10. What are our fellow colleagues-Nigerian psychiatrists currently doing to stem this ugly trend within the doctors’ community?
Oh well, one of the things the Association of psychiatrist Nigeria is currently doing is raising awareness both within and outside the doctors’ community. I am sure most psychiatrist talk about it a lot on their online doctors communities like the MDCAN, ARD online chat rooms. I guess it is being taken as a serious matter as it would give the doctors hope that there is help just nearby. There are also dedicated news columns on our various national print media. We are gradually entering the online social media community. We are currently pushing for the NATIONAL MENTAL HEALTH BILL to be passed as it has a lot of provisions that would take care of the current challenges we face in managing this conditions as a nation. The last one passed is over 50 years old. Note, this is different from the NATIONAL HEALTH BILL.
Thank you very much for your time and With this, we come to the end of our questions. it has been exciting with you. We are sure doctors out there would benefit from this interview. We appreciate your patience and quality discussion.
Dr Mrs. Okogbenin is a medical Consultant and currently the head of department of psychiatry at the Irrua specialist teaching hospital, Edo State. She is widely read and publishes in various local and international journals. Her view are personal to her and there are no financial involvements in this exclusive interview. This was held on the 4th day of April, 2017.
Wednesday, 8 March 2017
Subsidized Mammography screening for Breast cancer available at the Irrua specialist teaching hospital, Irrua, Edo State.
One very pertinent health issue is Breast Cancer and as a sequel to our earlier post there-is-can-in-cancer, we can talk a bit about mammography as a useful tool for its early detection and #EndTheConfusion most of our women have about it.
Mammography is the main test used to find breast cancer in women who do not have symptoms and is the only screening test that has shown to reduce the number of women who die from breast cancer by about 30%. 👉You may enjoy this clip
Before mammography became a screening tool, about half of women with breast cancer died of the disease.
Mammography uses low-dose X-rays to take pictures (shadows) of the breast. Cancers, in lay terms, are usually seen as either bright dots or as masses that are denser or whiter than the normal breast tissue.
One doesn't need to experience a painful breast or feel a lump before considering a mammogram.It's recommended that Every woman above 40 years of age have a Screening mammogram done at least, every year.
This however, does not replace the fact that every woman should continue the habit of breast self awareness (Daily breast check). That in itself, is a life-saver and to add, it's at no cost.
One of the major drawbacks with having a screening mammogram is the high cost, especially for women in the middle and low income class. Present day Radiodiagnostic departments in Nigeria charge a fee up to the amount of NGN 15,000-20,000 for this, and even higher in bigger cities.
Speaking with the head of department of Radiology here at the Irrua specialist teaching hospital,Dr Elohor Ejakpovi confirms that the hospital has very affordable mammography service subsidized by the MTN FOUNDATION in a synergy to reducing the financial and social burden on women in our subserving communities.
According to her, Mammography can be carried out for as cheap as NGN 3,000 at ISTH. Wow! Over 80% subsidized.This is massive. A rare gift.
While thanking the hospital management for sustaining this collaboration over the past years, she enjoins everyone of us (readers of this post) to help share the GOOD NEWS and encourage our mothers and sisters to avail themselves of the opportunity.
From the desk of the association of resident doctors here in ISTH, as we join the world in celebrating the #InternationalWomensDay, we urge every woman above 40 years of age to talk to her doctors about breast cancer screening before leaving the consulting room irrespective of whatever ailments brought her to the hospital.
To get this good news far and wide, we would appreciate you,reading this post to #RaiseYourHand and #StandUpForWomen by sharing this on your various social media platforms.
our voice is our action.
#ArdIsth cares about our mothers and sisters. Let's help them stay healthy.
For more information, contact the ISTH secretariat of the association of resident doctors via our website http://www.ardisth.org/contact-us/ or send us a message on the comment section below. We are always willing to help you make informed decisions about your health.
Subscribe to:
Posts (Atom)