BY
Benjamin C. Ajufo
It is no more news that, for some time now there has been constant strike in the Nigerian Health Sector. The University College Hospital Ibadan, has just suspended a seven days strike and by next month, the Nigerian health sector might be paralyzed by Joint Health Sector Unions (JOHESU), if the Nigerian Government does not meet their demand. The health sector is supposed to be where medical humanism reigns supreme, but what do we see? A place, saddled with acrimony, strife and tension all written in the system.
According to WHO “The Hospital system is made up of Healthcare Professional Attendants”. These include the Physicians, Nurses, Pharmacists, Physiotherapist­s, Radiographers, Dental Technologist, Nutritionist, and Medical Laboratory Scientist etc.” They are all called attendants because they are to attend to the patient, in other to reduce their pain. After all the word Hospital which is derived from the mid-13TH century French word Ospital meaning "shelter for the needy," which is related to hospitality the embodiment of caring for the patient by reducing his pain. All these group of professionals are to work collectively for the good of the patients but what do we see? Lingering crisis that has become a hydra-headed monster that is about to cripple the healthcare system, if the menace is not urgently addressed.
What is the reason the Joint Health Sector Unions are about to down tools and why was UCH Ibadan closed? In this article as medical diagnosticians,­ we are going to collectively identify the problems and bring a lasting solution.
(1) Flagrant disregard of the laws of the land/Public Service Rule.
The Chief executives of the Nigerian Hospitals (MDS/­CMDS) are fond of disregarding the laws of the land, they create Post and Responsibilities which are not in their power to do so, nor backed by laws. E.g the recent creation of the office of the Deputy Chairman Medical Advisory Committee (DCMAC) to be headed by Medical Doctors in the Nigerian Hospitals ,as a means of derecognizing the directorate cadre of many other professional groups. In the case of UCH about five DCMAC were appointed. In line with the organic law setting up the University Teaching hospital (Reconstruction­ of Board) Cap U15 2004 LFN there is no provision for DCMAC. Section 4 “states there shall be for each Hospital, a chairman of the Medical Advisory Committee who shall be appointed by the Board and be responsible to the Chief Medical Director for all clinical and training activities of the Hospital”. Section five states “Subject to this Act, the Board shall have power to appoint (including power to appoint on promotion and transfer and of confirmation of appointments) advance, terminate or discipline employees (including consultants) holding or acting in any office in the hospital; and any such appointment shall be made having due regards to any personnel establishment approved for the Hospital.” This organic law never made provision for DCMAC. PSR 160201 states statutory boards shall set operational and administrative polices in accordance with government policy directives and supervise the implementation of such policies…………..T­he internal memo that generated this crisis which came from the office of the CMD, Stated that he was working under the instruction of the Nigerian Minster of Health. It should be noted that in line with the above quoted law governing the teaching hospital in sections 17. The Minister may give to the Board directions of a general character or relating generally to particular matters (but not to any individual person or case) with regards to the exercise by the board of its functions under this Act, and it shall be the duty of the Board to comply with the directions; but no direction shall be given which is inconsistent with the duties of the Board under this Act.”In this act or edict there is no place administrative power/­responsibility is conferred on the CMAC not to talk of being Deputy MDs/CMDs, which they have arrogated to the CMAC. Again there is no office of DCMAC . Yet the Nigerian Medical Association and Association of Pathologist are supporting this brazen illegality as published in the various Nigerian Print media by their Presidents Dr Francis Faduyile and Dr Kenneth Iregbu. The Nigerian State is Bigger than any individual and only under the rule of law can it thrive.
2 Professional Interference /Insincerity/­Encroachment.
Every profession in any sector has a job schedule, job specification, and job designation as provided in their various Scheme of Services. The Medical and Dental Council of Nigeria regulates the practice of Allopathic Medicine, like Medicine and Surgery, Dentistry and some forms of Alternative Medicine like Naturopathy, Homeopathy, Osteopathy and Acupuncture. Pharmacy Council of Nigeria regulates the Practice of Pharmacy in Nigeria. Nursing And Midwifery Council of Nigeria regulates Nursing and Midwifery practice in Nigeria. While Medical Laboratory Science Council of Nigeria (MLSCN) regulates the practice of Medical Laboratory Science in Nigeria, Surveyor Council of Nigeria regulates the practice of Surveying etc. In line with MLSCN Act 11 2003 in section 4a,b,c,e,h-The functions of the Board
(a)determine from time to time the standard of knowledge and skill to be attained by persons seeking to become Medical laboratory Scientists, Medical Laboratory Technicians and Medical Laboratory Assistants (in this Act referred to as ‘scientists’ ‘technicians’ and assistants respectively)
(b) regulate the practice of Medical Laboratory Science in Nigeria.
(c) regulate the training of Scientists, technicians, and assistants in any institution in Nigeria and give periodic accreditation to the Institutions.
(e) regulate the production, importation, sales, and stocking of diagnostic Laboratory reagents and chemicals;
(h) inspect, regulate, and accredit medical laboratories;.
In section 19 (1)The Board may make rules for –(d) the maintenance of good standard of medical laboratory practice and services with respect to regulation and control of private practice including statutory inspection, approval and monitoring of all medical laboratories including those adjoined to clinics, private and public health institutions. In pursuant to fulfilling the statutory role giving to MLSCN by law, she articulated an inspection team which was going all over Nigeria to make sure that ethical Standards are maintained in all Medical Laboratories in Nigeria. MLSCN closed a lot of Medical laboratories that were substandard. She even went further to expose these places that unethical practices were taking place. MLSCN not only closed Medical laboratories of her members, she went further to close private hospitals laboratories that were substandard. It was discovered that most of the unethical practices were going on in most private hospital laboratories that were owned by Medical Doctors, who use unqualified hands to man their Medical Laboratories. When MLSCN continued to do its job effectively in the interest of the Nigerian populace and the patient interest, the Nigerian Medical Association (NMA) and Association of Pathologists of Nigeria (ASSOPON) started having press conferences telling their members not to allow their Hospital Laboratories to be inspected by MLSCN. These two Medical Bodies, after series of meetings with their members influenced the Federal Ministry of Health to stop MLSCN from performing her statutory functions. In a letter titled RE-NATIONAL LABORATORY ACCREDITATION PLAN, the Ministry of Health in a circular dated 24th October,2011 with reference number C1359/S.1/C2/­vol.1/23 addressed to the Registrar, Medical Laboratory Science Council of Nigeria, stopped MLSCN from doing its statutory function. This letter was signed by the then Permanent Secretary, Fatima B .Bamidele (Mrs) and the letter was copied the Registrar, MDCN, President NMA, President AMLSN, President ASSOPON. What an irony that ASSOPON under the leadership of Dr Kenneth Iregbu is the one talking now about standard Medical laboratory practice ,when he is the one at the hem of unethical Medical Laboratory practice in Nigeria, what a hypocrisy!. In many fora he has been granting press conferences that Nigerian Hospital laboratories should operate without meeting the ethical standards put in place by the regulating body MLSCN. It is in these hospital Medical laboratories man by doctors that you have most of the quackery taking place because they use WAEC/SSCE holders and non qualified personnel.
(3)Professional­ Favouritism.
Before the appointment of the incumbent Minister of Health, Prof Onyebuchi Chukwu on the floor of the Nigerian National Assembly, he was asked how he would make sure that there is peace and harmony among health workers. He answered that he would do all his best to promote peace and harmony by making sure that all health workers are treated fairly. But what have we seen since his emergence as the health minister is more problem in the health sector. Before his emergence as the health minister, all professional consultants were paid consultancy allowances. When he came, he stopped paying consultancy allowances to other professional consultants outside Medical Doctors, that no other individual can be a consultant except a Medical Doctor. It should be noted that under the United Kingdom National Health System you have professional consultants outside Medical Doctors. You have Consultant Nurses, Consultant Pharmacists, Consultant Physiotherapist­s, Consultant Biomedical Scientists who are Medical Laboratory Scientists but in Nigeria we are told that this is the best international practice.
4. Lack of Interprofession­al Respect/`Jack of all trade’ mentality.
The Leadership of Nigerian Medical Association and Association of Pathologists instigate her members not to allow other health care professionals to get to the zenith of their career through the various MDS and CMDS. The system hardly employs Optometrists. These Medical Bodies instigate their members that they must be the head of all Departments in the Hospital even when they are not in that professional cadre. Nurses must be headed by a Medical Doctor. A Pharmacist cannot be a director in the hospital despite his years of qualification. They hold on that no other Health professional can rise to become a Director even though it is not stated so in Cap U15 2004 LFN which is the organic law used to administer Tertiary Hospitals in Nigeria. Few days ago Dr Kenneth Iregbu was in the mass media calling everybody and all other health professional ignorant because they are saying that the action of the CMD of UCH is unlawful. All over the world professional hospital administrators are the ones who govern the Hospitals. Dr Iregbu wants everybody to accept the lies that one who never had professional training in administration will be better than a professionally trained administrator. Who is then the person that is ignorant? These two bodies (NMA and ASSOPON) are saddled with so much selfishness that their action is against the Nigerian State. They are the vanguard that all other profession should not grow. Dr Iregbu goes about misinforming Nigerians, that the practice of Medical laboratory Science was conceptualized in America in the 1930s by pathologists. But he forgets that as at 1800 B.C.E, the ancient Medical Diagnosticians of Egypt were doing medical investigations,­ like Urinalysis, they had perfected pregnancy test using barley and wheat. They could determine the sex of the child and if the child would be born a still birth or born alive, through the urine pregnancy test. No wonder the ancients assert that Afa is foremost in Health practice which is currently called Medical Laboratory Diagnosis. The practice of Allopathic Medicine is a 19th century medical trend/­innovation. Why is NMA and ASSOPON against the bill for Postgraduate training in Medical Laboratory Science in Nigeria? Yet there are two postgraduate colleges for Doctors approved by the government and sponsored by the Ministry of Health. They want to regulate every council in Nigeria. The ‘Jack of all trade’ mentality is cardinal to these problems. NMA, ASSOPON, NARD, etc are all Medical Associations and they are not registered trade unions, but they are always on strike. If a patient has a quarrel with a Doctor the next minute it is strike, if a doctor is kidnapped, the next minute all the hospital is closed. They never follow the stipulated government rule for strike. No MD or CMD ever remembers that these bodies are not trade unions. But when other health professionals follow the due process of going on strike, then comes the blackmail, ‘your strike is against patient interest’. Why the hypocrisy? The Chairman of NMA Oyo State in NMA’s usual bid to misinform the public has shown crass ignorance by one who calls himself a professor that they are ready to throw ethical reasoning to the wind. It is so unfortunate that Prof. Adefolarin Malomo can be so petty on the pages of Nigerian new paper in Vanguard 30th April, 2013. Since when has NMA become the regulating Council for Medical Laboratory Practice in Nigeria? About 95 percent of Nigerian Medical doctors that are Professors do not have M.Sc/Ph.D as a minimum standard to be a lecturer as stipulated by the National University Commission , so they are not qualified to talk on issues of University Education for Medical Laboratory Science in Nigeria. Again it is not NMA nor Medical and Dental Council of Nigeria (MDCN) that determines the type of qualification or minimum standard for Medical Laboratory Science in Nigeria. In line with the laws of the land, Medical Laboratory Science is a full-fledged profession with its statutory mandate to improving the total well being of Nigerians. Nigerian Medical Association is always acting contrary to the laws of the land, they act on impunity without having respect to due process and rule of law. Just for personal and selfish interest, you can see how the National Health bill is championed, even though there are areas that have been shown to be against the Nigerian State and the Nigerian People. Every Nigerian everywhere must say no to this megalomania. The Health Sector must embrace rule of law, the hospitals must be governed by standard norms and decorum.
5. The Ministry of Health as not being pro- pluralistic medical system.
The Ministry of health has not been pro- pluralistic medical system. Only allopathic medical system that is being promoted. The ministry only promotes the study of western system of medicine and the welfare of medical doctors. The ministry has to be restructured to meet modern healthcare needs by making the Nigerian Healthcare system pluralistic to accommodate, ethno- medicine, natural medicine, functional medicine and all other forms of Holistic Medical System.
6. The Presidential Report.
The only way there will be peace is when justice and equity reigns supreme. Setting another Committee to look into the Presidential Report on Harmony in the health Sector, is postponing the evil day because the problem has already been identified, globe throttling for best international practice is another waste of time, because the government already knows what is obtainable and what is the problem? The problem is happening here in Nigeria, created by the Nigerian factor and must be given a Nigerian solution.
Solutions
1. The Health Sector should be restructured for carrier development, where every professional group advances as provided for in their various schemes of Service.
2. The Health sector should be demilitarized by ensuring that the system is guiding by the relevant provisions of the Constitution, the Public Service Rules, and Circulars.
3. The government should create a good environment devoid of professional favouritism.
4. Medical Doctors should eschew the jack of all trade mentality and see other healthcare professional as partners in progress.
5. The Health Sector should be restructured that all healthcare professional can be appointed consultants in their chosen career.
6. The Hospital should be given to professional health managers or administrators to manage. This will bring back our lost glory. It will give room for better harmony in the healthcare industry. It will also enhance professionalism­ and better patient care.

Clinical Pathology Overview
What is clinical pathology?
Clinical pathology covers a wide range
of laboratory functions and is
concerned with the diagnosis,
treatment, and prevention of disease.
Clinical pathologists look at the body's
biochemical processes, such as
hormone and enzyme production.
Clinical pathologists are doctors with
special training who often direct all of
the special divisions of the laboratory,
which may include the blood bank,
clinical chemistry, hematology,
immunology and serology, and
microbiology.
What does a clinical pathologist do?
A clinical pathologist looks at blood,
urine, and other body fluid specimens
under a microscope, or with other
diagnostic tools, to observe levels of
certain chemicals and/or other
substances in the body. A diagnosis or
determination to conduct further
study is then made based on the test
results.
m.hopkinsmedicine.org/healthlibrary/conditions/pathology/clinical_pathology_overview_85,P00955/