Professor Thomas Agan is the Chairman, Committee of Chief Medical Directors/Medical Directors of Federal Tertiary Hospitals in Nigeria. He is also the Chief Medical Director, CMD, of University of Calabar Teaching Hospital, UCTH. In this interview with Orient Daily’s JOSEPH KINGSTON in Calabar, Prof Agan barred his mind on incessant strike action in the health sector, and posited that 90 percent of deaths in Nigerian hospitals are due to attitude of both of healthcare givers and receivers. Excerpts:

How would you rate medical practices in Nigeria in terms of rendering services to patients?

All through the years, our attitude is the major problem we have in this country as far as rendering services to the patients. The attitude of the health care givers to the patients and the attitude of the patients to their health leave so much to be desired. Over 90 percent of deaths in our hospitals are due to our attitude. Until the healthcare givers in our hospitals begin to realize that the health of the patient he/she is handling could be his own, his wife or siblings and all that things, it will not go well. Until we realize that we would be held accountable to every challenge we create, things will not go down well. I have always told people that if you don’t know what to do, leave out or do no harm. That means, it is better you do nothing than to do something that creates harm.

Generally speaking, we are well trained. What is deficient is our attitude to patient care. I see no reason why a doctor for instance, whether he is on call or not, when he gets home, he switches off his/her phone.
You have no business switching off your phone because the call you may receive keeps someone alive or keeps you alive. It is rather unfortunate that we find ourselves in this situation. Yet, majority of us are either Christians or Muslims. In fact, so many of us are pastors, deacons, knights and all kinds of religious titles.

But how do we respond to the challenges of others. Put yourself in the shoes of the patients and ask yourself: if I were in the shoes of these patients or if she were my wife, or my child or my relation, how would I manage this patient? The answer you give to that question, use it in managing others. The book of James 2:26 say ‘just as the body without the soul is dead so is faith without works dead.’

After holding the federal government by the jocular over welfare issue, Residents Doctors, last week, called off their industrial action. What do you think should be done to permanently solve this problem of perennial strikes in the sector?

I’ve always told people that I choose to be a doctor and that’s why I’m a doctor. Some other person chooses to be a nurse and that’s why he/she is a nurse. You choose to be a laboratory scientist and that’s why you are a lab scientist. I think that the National Council on Establishment should review and streamline career of workers in the health sector.

You see, a doctor cannot go and perform the functions of a nurse and also a nurse cannot go and perform the functions of a doctor. In the health sector, not only in Nigeria but the world over, there is no doubt that the doctor is the head of the health sector. No patient comes to the hospital and says he’s coming to see the accountant or he’s coming to see any other staff but the doctor.

So I believe that people should mind and focus on what they are trained to do. Bickering and professional rivalry is the cause of all these troubles and I believe that it is not healthy. It is the Nigerian people that are suffering and dying. I often tell people it could be me, or you or any member of your family who is dying because of our strikes. You never can tell the number of people that have died as a result of this current strike. I told them in the course of negotiations with the federal government that the blood of all Nigerians who have died as a result of this strike is upon our heads. It’s not healthy.

Do you think some of their demands are reasonable?

Indeed, it is very unfortunate that we are faced with series of crisis in the health sector resulting in unnecessary and unwarranted deaths among the Nigerian populace. The health sector is supposed to be succour not only to the rich but the ordinary poor Nigerians.

Unfortunately, over the years it has been riddled with crisis. For me, welfare issues are necessary in life, but incessant welfare requests from the healthcare providers tend to undermine the sector itself.

I feel really pained that this situation has not been taken care of both by staff and the government. And each time any union declares industrial dispute, you cannot quantify the number of people that have died. You cannot quantify the suffering people go through. It can be very enormous.

The doctor’s challenges did not start today.
They have been having interface with the government over the years. It’s rather unfortunate that it degenerated to a point they had to go on strike. I don’t know where the lacuna came from, but I feel there must have been a break in communication. Having said so, I think that Nigerians are feeling that these demands cannot be met.

If you read the memorandum of agreement that was signed between the doctors and the ministers as well as those of us that were part of the discussions, you will see that some of these things are soluble.


You see on the average, everyone working in the health care sector is a better paid graduate than any graduate in this country. We are feeding from the same pot and it’s rather unfortunate that everyone wants to increase his pocket.
There is economic recession today and I’m thinking that by the time we over-demand, other workers in the country will also want to make demand. My appeal is that we have to be very cautious in whatever we are looking for.

Going by oath taken by these doctors to save lives, some people are arguing that they are not supposed to go on strike. What is your take?

Our oath, for instance, says we should preserve life from conception to death. This means that life that is entrusted into your hand must be preserved. The implication of this is that if you go on strike and that life is lost, then you cannot reconcile that with the oath you took. So, for me I agree with you that the oath you took is something too extreme for doctors to go on strike.
I have never believed in strike to solve problems and I will never subscribe to strike in its entirety. However, I want to thank the minister of health and the minister of state for heath as well of the minister of labour and employment likewise the minister of state for labour and employment for doing everything possible to ensure resident doctors return to work.

JOHESU/NUAHP have issued an ultimatum threatening to proceed on strike if their demands, including restructuring of the administration of teaching hospitals and revamping infrastructure, are not met. What do you have to say on this?

The tertiary hospitals are supervised from the federal ministry of health. Secondary healthcare is the property of the states while primary healthcare is the property of the local government areas. So, the health system in the country is already decentralized.

There is no problem in that. The administrative autonomy is what you see that’s why you have the CMD of this hospital.
Unless there is something that needs the minister attention, and that’s when I take it to him, otherwise the hospitals are autonomous.

Decree 10 of 1985 established the teaching hospitals and created two directorates. Apart from the office of the Chief Medical Director, we have directorate of administration and clinical services and training. That means in an office like this, you can have directors but they are not directing any directorate.

So, we have some level of professional autonomy.

In UCTH, we have medical laboratory council of Nigeria; we have nurses and midwifery council of Nigeria, physiotherapy council of Nigeria, radiography council of Nigeria. So what autonomy do they want again? That means that when you become autonomous, in a teaching hospital like this, the Chief Medical Director should not have authority over you again.

The director of administration should not have authority over you again. The chairman medical advisory committee should not have authority over you again. This is ridiculous. I’m sorry to say so. It’s not done anywhere in this world. It’s only in Nigeria that you wake up and want to do anything you want to do.

So, can we say that their demands are unrealistic?

I wouldn’t want to use that adjective. They are not feasible. Some of their demands only have to be looked into. Besides, some of their demands have to do with the National Health Act, which has been passed. So why has it not been implemented? That act should be implemented. If we implement the National Health Act and there are issues there, those issues will be resolved in the course of its implementation. It was a serious brainstorming to get that act passed.
I agree with JOHESU/NUAHP that there is need to revamp the facilities in the teaching hospitals but that should not be a demand to threaten a strike. As you are aware, the World Health Association recommends that the allocation to the health sector in National budgets should be 14%. You know that because of our low economy we have not been able to do that. The highest that we have attained is about 7-8%.

And even at that, what may eventually be released will be between 3 – 4%. So how do we go about this? It’s good that they are going about this revamping of infrastructure but can you squeeze water out of a rock?

Again, their demand for residency training is amusing. This is the only country in the world where you want to do residency training in administration and everything. Residency training is done for post graduate doctors. Doctors who have qualified as medical doctors and have done their mandatory one-year housemanship,

they have done their one year youth service. After that, you pass the fellowship examination which we call the primary fellowship. After that, you are admitted into a teaching hospital which is recognized by the post graduate medical college and you spend between 6 to 10 years depending on the faculty you find yourself.

If you are in neurosurgery for instance, you spend 10 years to become a specialist doctor. So it amuses me when everybody wakes up one morning and says he wants residency training. It’s sad. It then gives me the impression that a lot of us have not read the history of the medical practice not only in Nigeria but the world.

OrientDailyNews:


https://orientdailynews.com/interviews/90-percent-deaths/

falcon01:
hell yeah

ogbonti:
Who conducted the survey to peg that figure of 90% ? This is why the country is going to hell. A man who is supposed to be an academic chief, skilled in research and data analysis, wakes up, grants an interview and begin to concoct figure's and statistics from thin air. None.sense!