Wednesday, 30 August 2017

CRISES IN NIGERIA MEDICAL PROFESSION - THE WAY FORWARD



The Medical profession is a noble profession that ought to be treated with great dignity and respect. Unfortunately, a malignant mutation has emerged giving rise to a myriad of crises and disorders.
It is quite incredible that the medical graduates after passing through the rigorous training in the medical schools are denied of the opportunity to undergo their internship within the time of graduation.
In accordance with the code of medical ethics in Nigeria, section 9.1a, every registered new medical graduate is entitled to internship during which he/she is meant to practice under a close supervision of the senior colleagues (consultant/specialist) before heading to the society as an independent practitioner or in pursuit of specialization.
The current administration in the various teaching hospitals in Nigeria, especially in the south-east geopolitical zone has made things extremely difficult for the new medical graduates.
Some teaching hospitals in Nigeria have graduated a lot of medical doctors who were thrown into the society to wallow in joblessness. Many doctors have overstayed the period of validity of their licences in idleness without any hope of placement for house job.
The medical profession among other professions takes the longest period of training. In spite of this, the medical graduates are compelled to spend extra: one, two, three or even four years looking for placement for house job. It takes a minimum of six (6) years to become a medical doctor and some due to one setback or the other spend up to eight (8) to ten (10) years in the medical school. If this is added to three/ four years of awaiting internship, this would amount to ten (10) to fourteen (14) years of undergraduate training. Almost half a generation; what a tremendous squander of time?
It is quite disheartening that parents who with fortitude had sponsored their children through the medical school in the hope of experiencing relief after their graduation still behold their children languishing in joblessness after all the suffering. Some parents have begun to doubt the authenticity of their children having passed through the medical school owing to the untoward delayed house job placement.
Some medical graduates who cannot withstand the stigma of being tied to their parents apron string after one, two or more years of graduation resort to private practices in the remote parts of the country. They become private practitioners without having undergone internship contrary to the code of the medical ethics, section 9.1.
Some teaching hospitals in Nigeria like the University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, for no justifiable reason have been graduating doctors without placing them for house job. They graduate a good number of doctors and take only a small proportion of them. Many doctors from UNTH have been wandering about like sheep without shepherd searching for house job. In every house job interview conducted across the country, the UNTH medical graduates constitute the greatest proportion of the house job seekers. Considering the number of the UNTH medical graduates that always attend house job interview, one would think it is another round of UNN Doctors Alumni Home Coming. This is a damning indictment of the health administration therein.
Some teaching hospitals in Nigeria like UNTH conduct substandard internship interviews just for formality sake after which they manipulate the scores of the candidates in accordance with those they  had wanted to take. They deceitfully keep the spurious result sheet as a concrete evidence in pretext of having conducted a genuine interview in case they are investigated. This is one of the reasons why the results of the UNTH interviews usually take a long period of time (months) before they are released.
Some teaching hospitals in Nigeria now derive pleasure in exploiting the poor medical graduates in the name of fees for house job interview.  This has been the practice of the University of Benin Teaching Hospital (2014), University of Ilorin Teaching Hospital (UITH) and University of Port-Harcourt Teaching Hospital (UPTH) who charge the sum of five thousand naira (#5000) yearly as a prerequisite for house job interview.
The system of allowing the new medical graduates to search for house job has constituted a great stress to them. Apart from the risk of travelling from one hospital to another, many have exhausted their resources without success.
This system has also given room for a lot of egregious practices by some Chief Medical Directors. They now take house job positions as personal possession and can decide whom to give it or not. The house job positions meant for the medical graduates has become an article of trade for some CMD's who sell them for a huge amount of money. However, they don't collect the money by themselves rather they set up some agents who covertly and diplomatically reach out to the medical graduates in need of house job. Payment of money for house job is an open secret in UNTH. In fact, it has become a sacred cow.
Again, this system tends to subject the fate of the new medical graduates under the whims and caprices of the Chief Medical Directors even when they have a streak of sadism in their personality.
The present administration in some teaching hospitals in Nigerian like UNTH has succeeded in creating two unhealthy criteria for house job placement namely:
(i)                  Personal knowledge of the CMD or any person who can influence him.
(ii)                Payment of astronomical fee as a quid pro quo.
Any new medical graduate who fails to meet up with the above criteria has no hope of securing house job in UNTH. Some medical graduates who for some moral reasons had resolved not to yield to these unwarranted demands had begun to compromise their faith after waiting for two to three years beyond the limit of their endurance. The University of Nigeria Teaching Hospital has been turned into a microcosm of a politically corrupt society unleashing professional torture and inhumanity to the young medical graduates. What a great tragedy!
The collection of exorbitant fees for house job placement has further worsened the situation for the new medical graduates. Some of the house officers who paid a huge sum of money to secure house job are provoked to do a second and even a third internship (second or third missionary journey) in order to make up for the paid money; causing a further increase in the number of house job seekers and leading to a vicious cycle of apparent house job scarcity
The health administration could easily detect this insalubrious practice if they had wished but they have deliberately feigned ignorance of that since it does not militate against their monetary gain but rather enhances it .
The health administration in UNTH does not have in mind the welfare of her medical graduates. It is only hell-bent on making money even if it means stepping on someone's toes. How can a health institution fail to consider her own medical graduates whose licences were about to expire and some of whose licences had expired only to take newer medical graduates from other institutions who are willing to respond to their cash demand?
University of Nigeria Teaching Hospital, (UNTH) is in quagmire. The present administration has nothing to write home about. The cost of medical service has been hiked ranging from the consultation fee and the cost of surgery. Patients are now mandated to pay for oxygen whether it would be used on them or not. Yet, the quality of service rendered therein amidst this high cost is continually depreciating due to  mismanagement. For goodness sake, the incumbent administrators should be called to order. UNTH is not a private hospital where a single individual should dominate over its affairs almost to the level of a tyrant. Over the years, the affairs of the hospital has been kept under the selfish interest of the so called administrators. It is time for radical positive changes.
Moreover, the apparent house job inflation in the country is not due to the aforementioned second and third missionary journeys because only very few rapacious ones indulge in it. It is mainly due to the periodic increase in the number of "ghost interns". A considerable proportion of the house job positions due for the new medical graduates have been unfairly allocated to “ghost house officers” to the egocentric aggrandizement of the CMD. Many medical graduates are languishing in stagnation and joblessness while some CMD's are busy amassing wealth to the detriment of the new medical graduates. This is an apogee of callousness and sadism. The truth about ghost interns is evident in the scarcity of house job considering the number/capacity of all the accredited hospitals and the number of doctors produced yearly in the country. It is high time the Federal Government re-evaluated this. 
Some teaching hospitals in Nigeria deliberately delay the yearly intake of new interns for some months even when the preceding house officers had completed their internship and vacated the hospital. This they do in order to divert the salaries paid within this period to their personal pockets thereby creating artificial house job scarcity for the new medical graduates. This has been happening in UNTH. For instance, in the 2016 house job intake, the preceding house officers at UNTH completed their internship on July, 2016. House job interview was delayed till 5th of September, 2016. The result of the interview was further delayed till the month of November. Now, one would logically ask; who received the housemanship salaries paid for the months of August, September and October? Worse still, it has become a norm in the hospital not to release at once the list of the admitted interns. Instead, they are released bit by bit so as create another delay tactics for further embezzlement.
Nevertheless, not all CMD's are involved in the perpetration of these anomalies. A handful of them are above board regarding the housemanship affair. For instance, it is apt to recognise and commend the uprightness of the incumbent CMD of the Federal Medical Centre (FMC), Owerri, Mrs. Agnes Uwakwem who for the past few years had sanitized and has continued to sanitize the hospital. FMC, Owerri is one of the hospitals in Nigeria where housemanship interview is conducted without any whiff of jiggery-pokery. She has left much examples for other CMD's to emulate.
The compulsory nature of internship in the midst of these corrupt practices has worsened the whole condition for the law-abiding new medical graduates. Being unable to proceed with their youth service and legally unqualified to commence a private practice they become entangled in a state of stagnation like a rat entrapped in a cage. 
Some teaching hospitals like the UNTH for no justifiable reason have been withholding the salaries of their house officers for the first three months of recruitment. They claim to use this period to ascertain the loyalty of the employees; but how do they expect them to survive within those period of “nil per oral”? Even the scripture says that a labourer deserves his wage when due.  
It is quite appalling that those at the helm of affairs who aid and abet these crises were once new medical graduates who enjoyed an un-delayed and hitch-free house job placement during their time but have failed to maintain a similar status quo for the present generation. Haplessly, some of the senior colleagues in the profession have remained apparently nonchalant to these obnoxious developments. Probably, they are not directly affected. However, it is pertinent to note that darkness can only dominate in the absence of light. Evil can only perpetuate in the society when the righteous ones fail to challenge it. And the righteous has a share in the recompense of the wicked for any evil he fails to reprimand either in this world or in the world to come.
The medical profession by the virtue of its humanitarian service, remains the prime of professions where unalloyed order and discipline should thrive but unfortunately, the reverse has become the case in our country today.The prestige that accrues to the medical profession has begun to wane as many young medical graduates who ought to be looked up to are seen as frustrated jobless young men and women. Many medical graduates for lack of house jobs are untimely and illegally resorting to private practices just to keep body and soul together. This is a seed of potential disaster which if allowed to grow will eventually cause an unmitigated devastation in the fabric of our national health.
A glimse into the prospect of medical profession in the country reveals a colossal migration of Nigerian doctors to other countries in search of greener pastures (brain drain) unless these anomalies are nipped in the bud.
Since the health of a nation is the wealth of the nation, it is time we all faught tooth and nail to restore the dignity of medical profession which is at the verge of decadence
Therefore, this is a solemn appeal to the incumbent patriotic Nigerian leaders, the office of the President, the House of Senate, the House of Representatives, the Ministry of Health and all at the helm of affairs to look into this matter with justice and fairness and come to the rescue of the beleaguered medical graduates.
THE WAY FORWARD
In search of remedy to the above problems, the following suggestions have been made:
1.       Since internship is mandatory for all the new medical graduates and no new medical graduate is legally qualified to indulge in any private practice or proceed with youth service without the completion of internship, then internship should be integrated as a part and parcel of undergraduate training.

2.       The country should adopt a new system of house job placement similar to the system of posting of youth corpers in the country. Biannually, the teaching hospitals should submit the list of her medical graduates who would then be posted by the Federal Government to any competent hospital across the federation regardless of where they had been trained. This will help to create orderliness in house job placement, prevent the problem of “second and third missionary journeys” and avert the corrupt practices of the Chief Medical Directors.

3.       The Federal government should ascertain the number  of interns each competent hospital in the country can absorb and post the same number of medical graduates therein. This would help to prevent the daily multiplication of ghost interns and save the country from wasteful spending on the aforementioned ghost workers. A clear knowledge of the number/capacity of all the accredited hospitals for housemanship in the country will also help the federal government to strike a balance between the number of doctors produced yearly and the number of spaces available for housemanship.

4.       The obtainment of medical degree (MBBS) and the acquisition of the provisional licence as issued by the MDCN should automatically qualify the new medical graduates for house job placement in any teaching hospitals across the country.
Sequel to this, no licenced new medical graduate who has passed his/her final MBBS should be subjected to any further examination in the name of house job interview. This will help to eliminate the chance of exploiting the poor medical graduates in the name of house job fees and unnecessary delay in house job placement as some hospitals spend several months before calling for interview and thereafter spend another several months before releasing the result of the interview.

If these measures are adopted, the problems of delayed internship training, selling of house job positions for a huge sum, second missionary journey, artificial house job scarcity, embezzlement of public fund, private medical practice without internship and multiplication of ghost workers will surely become things of the past. Hence, this article is a clarion call for all to join hand in restoring the dignity of the medical profession



 SON OF THE KINGDOM...