A STAR FADING WHILE WE WATCH
Written by:
Dr. Olaniyi Olushola.M (Olaniyi is a registrar in the department of Anatomic Pathology, IRRUA specialist Teaching Hospital)

I shall begin with a quote from Leigh Hunt; "The groundwork of all happiness is health". In as much as we aspire to develop in all horizons, development in healthcare is critical. In the last decade, the health system in Nigeria has been characterised by unending chaos. Recent manifestations of poor health indices have assumed an unprecedented magnitude; also, it is changing form and character, with negative implications for socio-economic stability and consolidation.
World Health Organization's ranking of the World Health Systems ranked Nigeria a lowly 187 out of 191 sampled countries in 2015. You would expect this to cause a declaration of "State of Emergency" in the health sector rather our absurd system continued business as usual.

Health as it were, is a State of complete physical, mental  and social well-being and not merely the absence of disease or infirmity. Of course,  it is obvious that the institution that is suppose to initiate,  propagate and impose health is sick and the populace are watching with their arms folded.
Considering the pronunciations of some persons within the Ministry of Health, the heinous health indices been experienced is probably benign and maybe the malignant form is coming soon. The continued decline in our health indices supports my assertion. The remote causes are numerous including lack of political will, poor health policies, corruption, alienation, political power abuse, and so on. Expectedly, the morphological recipients are the poor masses. The reasons are obvious; Top government functionaries and the rich seek healthcare outside the shores of the country and do so for even trivial ailments such as ear infections. The implications are devastating to a developing country like ours.

Before I proceed, let me state that resident Doctors work full time while being trained. They are indispensable in delivery of healthcare in secondary and tertiary institutions, in training of medical students, grooming of House officers and so much more. However, I think the general public don't appreciate their efforts. This may not be deliberate as they have been wrongly educated about core issues affecting the health sector and of course an average Nigerian is likely to settle for a comfortable conjecture that buttresses his/her opinion rather than researching facts and asking the right questions. The Press is the greatest sower of falsehood; to slander a revolutionary movement, to misrepresent all that is said and if that be impossible, to invent for them what was not said; to put in circulation whatever baseless calumnies against the movement that are necessary to defeat them - these are habits so common as to have ceased to excite notice or comment, much less surprise or disgust; Media fascism is however a discourse for another day.
In the practice of medicine, the prime directive has been the interests of the patient. The secondary directive has been the physician interest to sustain the practice, himself or herself, and his or her family. The tertiary directive is that of the society. The society expects the doctor to give it all, to uphold the norms and values of the profession without regards to the conditions the doctor has to painstakingly endure so as to deliver.

A doctor whose welfare isn't well catered for cannot be in a state of complete mental and social well-being and output of course will be suboptimal. The interest of the patient is undoubtedly paramount, nevertheless the persons required to protect this ought to be treated with dignity. My only quibble would be that while the poor masses themselves may not have developed or held a well-defined ideology, all actions bear an implicit and objective content in terms of their attitude to the lingering health crises, and what I expect from the public is, in fact, a tactical decision and almost certainly a correct tactical decision to demand from the government their right to health. This is at the very least, part of our demands considering the dilapidated system we are enduring. We need to refocus on fundamental questions and invite technocrats into the on-going imbroglio. The masses need to speak and protect the welfare of her doctors and by so doing protect her health. Until we recover our understanding of this truth, and our outrage at it, and recognize that that the mayhem in the health sector is entirely as a result of incompetence on the part of the government, we will be unable to organize effectively against these autocrats and their instruments.

This attitude documents a dangerous trend, one that is undermining the ability of tertiary centres to carry out their apical sapiential mission. It also demonstrates, though, that the problem is not only a tertiary one, as the primary and secondary institutions are more or less similar to a "patent medicine store". Who would have guessed 30 years ago that a specialist Surgeon will be carrying out procedures as simple as appendectomy, a Paediatrician will be treating uncomplicated Malaria or a Pathologist will not have access to basic immunohistochemistry stains for breast malignancies. Medical field is an area of continuing research and growth which requires astute political will for the practice to climax.

This article was inspired by an apparent declaration of hostilities towards doctors especially in recent times. The weapon of choice has been selective implementation of circulars, intimidation, incomplete remunerations and so on.

In hospitals, we have seen a deprofessionalization of medical doctors which has manifest itself in a number of ways. In many areas, groups have broken up and atomized across the health sector, in response to poor legislature. In others, productive interdisciplinary groups have been disrupted by reorganizations which have obstructed innovation.
In any ministry, to talk of ‘under-performing officers’ as a generic description, would be recognized as pure incongruity; since the polity decide the ever-ascending criteria for promotion to this level, they might be trusted to not betray their own judgment. There seem to be some degree of ‘moral panic’ among senior management teams in many tertiary centres and the ambition to progress to the next level supersedes taking a stand for what is right. My humble submission: "Life is built up by the sacrifice of the individual to the whole. Each cell in the living body must sacrifice itself to the perfection of the whole; when it is otherwise, disease and death enforce the lesson"
- Helena Petrovna Blavatsky.

This is the society in which, just as one hurdle is surmounted, another, higher one presents itself, with the end point always at the far horizon. If we fail to pass and enact laws and policies that will build and consolidate positive reforms in the health sector, so as to improve our health indices, peril will continue to loom and unfortunately strike...politics as usual can no longer turn a blind eye and deaf ear.
"When there is teamwork and collaboration, wonderful things can be achieved." - Mattie Stepanek. Patients...stand with your Doctors and say no to medieval healthcare.


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