Demystifying the CUL-DE-SACS IN THE HEALTH SECTOR

In 2014 the health sector in Nigeria was
crippled through incessant industrial actions
by the very professionals who have taken
professional oaths to preserve life. Their
strikes and counter-strikes were
synchronized in such a way that they never
went all at once. The Joint Health Sector
Unions (JOHESU) would test the waters and
then back off after some hollow promises.
The senior students who go by the
appellation of Association of Resident
Doctors (ARD) would take the cue and jump
into the ring unjustifiably, then scamper
back after being reminded that they are
students. Thereafter, their mother
association, the Nigerian Medical
Association who consider themselves as ‘no
shaking’ will garner all their kindred-
consultants, ARD, house officers, medical
officers-for the battle of Armageddon. After
some crumps and carrots from a dilly
dallying, possibly-confused and exasperated
government, everyone will then shelve their
swords for a while to give hapless and
option-less patients some breath of fresh
air.
Initially the struggle appeared patriotic as
the demands were geared towards better
working conditions for all. Everyone talked
about a certain ‘cure-all’ health bill. Later
they talked about a certain ‘Yayale Ahmed
professional committee report.’ Later on and
till date and after now, the music’s changed.
It is now a struggle of “ I no go gree
because” you-gave-JOHESU-this or you-
gave-NMA-that. The implication is that the
hype about health bill and ‘Yayale Ahmed
Committee Report’ were mere subterfuge,
the real motive being “money, ina we
pocket, food ina we stomach’ as Ras
Kimono sang in the ‘80s.
The NMA feels outwitted because of a few
unknotting of the privileges of JOHESU.
JOHESU on the other hand is embittered,
and justifiably so. What are those privileges
for JOHESU that NMA frowns at? Nothing
really beyond the fact that government
corrected decades of injustice by Chief
Medical Directors (CMDs) who are medical
doctors, in not allowing the JOHESU groups
to get to the zenith of their career, the
Directorship level. Nothing much beyond
agreeing in principle that any group of
professionals who meet the criteria for being
a consultant should enjoy the status.
Nothing serious beyond approving the
skipping of a redundant grade level 11 for
JOHESU who are on a salary scale that is
an apology compared to NMA whose super
scale still gave them a call duty allowance
that is 100% higher. That skipping of grade
level 11 does not confer any significant
advantage on JOHESU as their salary is still
far and below their counterpart who are also
agitating for skipping.
And by the way, what is the duration of
training between a doctor and the JOHESU
groups? A mere one academic session! But
that one academic session has been
exploited by the NMA in the days of
ignorance of JOHESU to guarantee for
themselves an entry point into civil service
of level 12 whereas the JOHESU group start
on level 10. They have used that one year
advantage to wangle for themselves a call
duty allowance that is 100% over and above
any received by any other health
professional.
It is to the credit of the Medical and Dental
Consultants Association of Nigeria (MDCAN)
that they are not strike-hungry. But in those
instances when they teamed up with NMA to
cripple the hospitals are they really justified?
The call duty allowance alone of a newly-
appointed consultant is the entire salary, if
not more, of a JOHESU member on Principal
post. The question should be asked if most
consultants in teaching hospitals actually do
calls? It should also be investigated by the
public and government which, between
private practice and government job is the
first love of some consultants.
And yet we have government being
hoodwinked into doling out more and more
privileges and salary for work not
commensurately done. People who are
privileged should not abuse it so arrogantly
but thank merciful gods for breaking their
palm kernels for them. The consultants have
no moral right to go on any strike but should
act as elders to calm ARD or JOHESU when
they become intemperate. The tragedy is
that the Resident Doctors who are the attack
dogs of NMA will someday become
consultants. Then new Resident Doctors are
born. And the cycle continues ad infinitum,
unless halted now.
It is unfortunate that the fight has moved
from that of improving health care to the
level of ‘do-me-I-do-you-gods-no-vex.’ Well,
since that is the frequency the health sector
is operating on right now, perhaps the
issues should be laid bare so that the new
government may be well-guided. While the
NMA are only fighting to maintain what
JOHESU considers as traditional, unlawful,
unjust and untenable privileges, the JOHESU
group are only asking that justice to one
group should be justice to all groups in
order to have harmony. There have been
great and grave injustices done to the
JOHESU group who constitute 2/3 majority
of the staff in the health sector. It has been
a tyranny of the minority for decades as a
result of medical doctors in the corridors of
power from 1970-2000.
There are decrees and legislation in Nigeria
handing over the hospitals surreptitiously to
medical doctors whereas JOHESU members
are subjugated to be mere appendages.
Victor Hugo it was who wrote that “no army
can stop an idea whose time has come.”
The time to ask why our fathers were in
shackles has come. It was also said by
Frederick Douglass that “the limits of tyrants
are prescribed by the endurance of those
whom they oppress.” I guess that the
JOHESU group cannot continue to keep
silent in the face of tyranny and in these
times of great moral crisis, else the man
would have died in them.
The JOHESU group are made up of
articulate Pharmacists, dogged Medical
Laboratory Scientists, resilient
Physiotherapists, ingenious Radiographers,
formidable Nurses, calculating Dental
Therapists, and a host of other brilliant and
hardworking professionals. JOHESU group
are not strike-hungry as propaganda has
made it seem. They care about their
patients who are their neighbours,
compatriots and brethren in faith by the
way.
So, embarking on strike is not in their
professional character but as a tool of last
resort, to bring their grievances to the court
of public opinion. That they didn’t ask
questions in the past was probably due to
the military era where having someone in
the corridors of power was more effective
than agitation. Today, the train of
democracy is on course and every citizen
and groups are exploring their rights and
privileges without fear.
JOHESU is not asking for new and
unjustifiable privileges like the other group
but are merely demanding that the shackles
of ‘slavery’ be broken. There is no man of
goodwill, alive or in the throes of death who
catches a glimpse of the JOHESU tragic
story that will not cringe in empathy. Now
JOHESU is asking that courageous leaders
translate empathy to justice. JOHESU is
praying that men of goodwill will arise and
condemn the dangerous caste system being
watered in the health sector. An end to
industrial disharmony in the health sector
and concomitantly, stability in our body
polity may well start by the government in
power acting without fear or favour to do
justice to all. To avoid boring the reader
with too lengthy an essay the cul-de-sacs
which have resulted in the agitations by
JOHESU are summarized below.
The National Postgraduate Medical College
which is to train all health professionals has
turned out to be specifically for medical
doctors. Their students called Resident
Doctors are paid heavily for going to school
while JOHESU members go back to
conventional universities with no pay to
pursue further academic quests. After the
Resident Doctors graduate from their 5-year
program they are automatically made
Assistant Directors (consultants) whereas
the M.Sc and PhDs of JOHESU members
add no single kobo or career advancement
to them. Then, when the Resident Doctors
become consultants, they automatically
become HODs of JOHESU members, HODs
of some brilliant folks, some of whom
started civil service 20 years before the
consultants qualified!
And because of a parlous impression that
some animals are more equal than others,
there are two salary structures in the
hospital, CONMESS for medical doctors and
CONHESS for JOHESU. The disparity
between both? Eye-popping! It is this same
CONMESS salary structure which has given
undue advantage to medical doctors that the
ARD are doing ‘try-your-luck’ strike to see if
they could skip a grade level. When that is
achieved the disparity may well be in the
region of 99.9%. Will JOHESU keep quiet?
Will the much sort-after harmony be
guaranteed after all? Whatever government
does should be ‘all-or-none.’ Do it for all or
do it for none.
If there are 10 members of the Board of a
teaching hospital, five are automatically
allotted to medical doctors while the rest of
JOHESU have just one. Now, with such a
composition it is clear that the voice of the
minority may or may not be heard but the
will of the majority, whether fair or not, will
often prevail. To continue that hegemony, all
JOHESU members are subjugated under the
Chairman, Medical Advisory Committee
(CMAC) who is imposed as the overall
Director for JOHESU professionals. That
means there is a single Director for JOHESU
and that fellow is a medical doctor! Can’t
JOHESU members rise to Directorship
cadre? The government of President
Goodluck Jonathan said they should but
many CMDs who are medical doctors are
not complying faithfully, atleast under the
former government. Thank God we have a
man who has the courage of his convictions
as President today. There is hope that
justice and fairness will prevail.
The mother of all cul-de-sacs is that the
position of CMD is foreclosed to JOHESU. It
is legislated for medical doctors alone.
Why? What is the fear? Only a person who
has sometime to hide will manipulate the
law to protect illegality. It is like saying the
Air Force or Naval officer can never rise to
become Chief of Defense Staff because they
are not as popular as the army or because
the army had been in the corridors of power
much more than them. The CMDship
position should be open to all or Health
Administrators who are neither NMA or
JOHESU should be appointed.
May God guide our leaders right to divorce
our noble causes from ignoble ones. May
He grant them them the courage to change
what they can, bear what they can’t and to
know one from the other.

Trash.
why being biased.
Give analysis from no side of the divide, then we can talk.
Imagine comparing Army, Navy and Airforce with NMA and Johesu. Don't you think you need a doctor?
The comparison should be between Medical Doctors and Dentists. We have the medicals and paramedicals as we have the military and paramilitary, please find your place.
Till you stop feeling inferior and face your work,I won't join issues with you.

BTW, Jamb forms are still on sales for Medicine and Surgery or Dental surgery.
Many of your colleagues have done the needful and are in medical school now.
Meanwhile, hope you didn't fail to meet the admission score for Jamb when you decided to go for the paramedics. Try harder.