(REJOINDER) NMA STRIKE: THE NURSES’ POINT OF VIEW – WHO STEPPED ON MY TOES?

Oladayo Afolabi

Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity.

 – Martin Luther King, Jr.

Historically, the first documented envy-ridden feud between Nurses and Doctors was during the Crimean War (1853-1856), when Florence Nightingale was commissioned to go to Scutari barracks in order to join military doctors to combat the high mortality rate in the military hospitals. The doctors, feeling threatened, resisted the help of Nightingale and her Nurses until they became overwhelmed with casualties and succumbed to reality. This pattern of doctors being threatened by the educated and empowered Nurse has continued to plague the working relationship in the healthcare system till today.

I am therefore not surprised as the current situation is not peculiar to Nigeria. The war between Nurse Practitioners and Doctors is still on even in the country with the supposedly most advanced nursing practice in the world, USA. However, it is being done using tact, legislative lobbying and empirical evidence. In Nigeria, professional civility and self respect has been thrown to the winds as some Nigerian doctors handle this situation in an appalling manner, using a combination of verbal brawl, comical assertions and frustrated rants. This betrays their characteristic ego-servicing claims of being the most knowledgeable member of the healthcare team.

I have been silent about the ongoing row between Doctors and other health professionals since its beginning. While my colleagues and friends from other health professions have continued to spit fire and brimstone deriding the doctors, my social media walls have been squeaky clean, devoid of such tirades. This is not because of lack of professional patriotism or inability to lay the bricks of words to construct a towering harangue about the issue. But, due to many reasons – personal, interpersonal and professional, I have kept my cool and refused to give in to cheap ineffective social media rants. However, when someone like the author of this article publicly displays crass ignorance of the nursing profession through a charisma-laden, highly bombastic but grossly information-deficient and intellectually-flawed article like this; I feel forced to talk, better still, write.

The incessant strikes in the health sector have rendered the system moribund over the years. The ongoing feud has further grounded the ailing system. This article is not meant to expatiate and justify the (absolutely justifiable!) position of nurses and other health professionals (that is reserved for another day), but to answer Mr Fowosire’s beautifully-written article, an A-rated effort in sincere ignorance and conscientious stupidity. As much as I am highly disconcerted and extremely irritated reading Mr Fowosire’s article, I will try not to walk the dishonourable path of name calling. Therefore, in order to answer his pathetic rants, I do not intend to join issues with him or stoop low to trade banters, but this article will address the misrepresentation of facts presented by the previous writer.

On this background I can begin to address Mr Fowosire’s points. Firstly, the author’s effrontery to undermine the knowledge base of graduate nurses in basic medical science courses is a display of nescience. I still remembered that when I was in second year in the university, we attended the same lectures and wrote same exams for Reproductive and Digestive physiology and Neuroanatomy courses with third year physiology and Biochemistry students. Are doctors not being taught physiology and Biochemistry by graduate physiologists and Biochemists? Maybe a graduate nurse can now boast that s/he was taught in the same class with your teacher. Also in our third year, we were taught pathology with the same note used for part four Medical student. My transcript still says I scored 77% on the same Histo and chemical pathology MCQ given to part four Medical students. How did I know this? We used part four medical students’ past MCQ questions to prepare for exams.

I will not forget to let you know that as a part 4 undergrad, I led Nursing department team to victory over senior part 6 medical students’ team in an interdepartmental debate on bothering national and international health issues; not to talk of the fact that we attended the same lectures with medical student colleagues during first year in the university and some of us clearly surpassed most of them in first year academic performance. And this is not as a result of ‘la cram la pour’ as you said, because the consistency I, specifically and many of my colleagues have shown in academic and intellectual performance over the years could not have come by that. In addition, this ironing of facts should not be misconstrued for vain ego aggrandisement but to let Mr Fowosire, many other doctors like him and the general public know that many Nurses (especially degree holders) did not do nursing because they are academically-impaired but because of their love for the profession and some because of the socio-political environment of securing admissions into University in Nigeria.

The question of who should lead the healthcare team has also been a long-standing one. While many developed countries have undergone the health management structure-shift from vertically structured systems to a matrix structure, Mr Fowosire and many Nigerian doctors like him still live in the dark ages clamouring for ‘oga- omo ise’ relationship within the healthcare team. They want the Medical doctor to be even the director of Hospital security. This is inane absurdity. The National Health Service UK has been named as the best performing national health system in the world many times. The NHS and Hospitals in the UK are being managed by managers who are recruited through the NHS management trainee scheme. These trainees come from myriads of field, from geography to history, what matters in their recruitment is intelligence and ability to provide creative solutions to health system problems. These are recruited into the management cadre and grow through the ranks mastering the dynamics of the health system until reaching the highest managerial post of the hospitals and NHS trusts. Space will fail me to talk about the US, Canada, Sweden and so on. However, a six hours flight down south to Nigeria, we have the best medical professors and consultants wasting human resource by sitting down romanticising administration as CMDs, instead of taking care of the patients they claim to own. A predilection fuelled by the position-consciousness, power-hungry-proclivity, greed and corruption eating the fabrics of our society.

It is on ‘debatable‘ record that the best ever Minister for Health in Nigeria in performance was an economist not a Medical Doctor, Prof Eyitayo Lambo. The reason for that is not surprising, it is just common sense. A simple google-oracle consultation will show all his achievements as the longest serving Minister for Health in Nigeria. I will like to highlight that majority of my colleagues in graduating class 2012, Master in Health Planning and Management, University of Maiduguri, were seasoned consultants in different medical and surgical speciality from all over Northern Nigeria.  However, I finished in top three out of the over forty six members of the class. Therefore, if the CMD position is filled based on performance and best management knowledge, skill and expertise, why should I not be lined up for consideration for such alongside my classmate medical consultants? Nevertheless, going by the meaning of CMD (Chief Medical Director), the inherent nominalistic connotation in this position is the reason why the doctors have made the position their exclusive preserve; a domain they plan to extend to commissioner for health and Minister for health positions too. As a responsible professional, in my personal opinion (which many of my colleagues may differ with) it will be clearly unreasonable to make a nurse the chief medical director. Notwithstanding, my proposition has always been, ‘why do we need a CMD if we have a CMAC?’ Therefore, I think the name CMD should be ditched and changed to favour international best practices. I think something like Chief Executive Officer or Chief Operating Officer as used in developed world should be adopted. This de-clutters the name and removes any exclusive preserve that medical doctors may lay hold on.

In trying to disparage and clarify Mr Fowosire’s embellished bombastic views of the superiority of the doctor over other health professionals, I mentioned my previous consultant classmates who I respect for their professional achievements in their field. I do not in any way use this to mean that I know what the consultants know about medicine, but I bet the consultants do not know what I know about nursing too. You do not compare grapes to mango. There is no basis for such. They are two different fruits. However, in your five-a-day dietary plan, you need to have both; one cannot replace another. On this premise, if the dictionary meaning of the term consultant, which has been selfishly usurped by doctors, is ‘a specialist’; then, why should a nurse, pharmacist or Laboratory Scientist not be called a consultant in their field if they have gathered enough knowledge, skill and competency to attain such specialised level. An expert who gives advice on business even if he has never managed one single start-up is called a business consultant. This is the case in many other professions and vocations. Why will doctors refuse to face their own effectiveness in their profession? Why are they trying so hard to bar other professions from progressing?

The ludicrous height of Mr Fowosire’s display of crassitude was the un-informed assertion that there are no male midwives in Nigeria. There is nothing like tradition in an Evidence-driven age and there is nothing like Midwifery being the exclusive domains of female nurses. I am a male midwife registered and licensed to practice by the Nursing and Midwifery Council of Nigeria. Male midwives have been produced and registered in Nigeria since 2007 and I was one of the early set of male midwives to be registered in the country in 2009. I am proud to be who I am and I am striving to be the best at what I do. I only wonder where Mr Fowosire is undergoing his medical education if he is boldly casting such un-informed aspersion about Nigerian Nursing in 2014. Your stereotyped labelling of all male nurses as wanting to become a doctor can be forgiven as another symptom of your ‘hypo-exposure-induced myopia’.

Furthermore, Mr Fowosire tried to lark about, tinkering with words. He used a comparison of ‘doctored’ and ‘nursed’ as a contextual basis to make an assertion that we live in a society clouded by vanity. What a comedy? What a good understanding of English language? Nevertheless, I will ask, ‘why do we nurse children and not doctor them?’ ‘Why do we nurse ambitions…?’ ‘Why do we nurse wounds and pain…?’ I guess ‘nurse’ is not a bad verb after all; but why does the verb- ‘doctor’ sound like someone falsified claims, adulterated the original and committed fraud. This is exactly what the doctors in Nigeria are currently doing raising unfounded propaganda and spreading intentional half-truths and falsified claims about the essence of the ambitions of the other health professionals, an archetype of fraud.

Mr Fowosire, your fear and concern for the society and posterity in this issue is highly unnecessary and totally misplaced. Empirical evidence has it that Nurse-Led Units are making the difference in patient’s life in the developed world. In the UK, a Nurse led unit, Barking Community Hospital (Yes a nurse-led hospital) close by my apartment has MRI machine. How many Professor of Medicine-Led teaching hospitals in Nigeria have that? That is what you should be concerned about, the fact that our hospitals are ill-equipped for 21st century medical practice. What you should be getting concerned about is the fact that Community Health Extension Workers (CHEWs) are consulting at Paediatric Out-patient departments in State Owned supposed Specialist Hospitals in Nigeria. The fact that after government spend lots of money to train a doctor (common in Northern Nigeria) till he becomes a consultant in a rare speciality then he goes to sit in the office as a CMD while all the money spent and specialist knowledge gained wastes. What you should be concerned about is the jungle medicine still being practiced in Nigerian teaching hospitals and many other cases of malpractice and negligence (documented by Olatunji Ololade in the Nation of 5th April, 2008), where doctors spent one month diagnosing a brain tumour as a sinusitis problem. And, most of all you should be very concerned about the fact that, after spending nine years for a six years course, you still have your part six MBBS exams to write. Until you become a fully certified medical doctor, your contributions in this debate are rather unwelcomed.

– Oladayo Afolabi is a trained Nurse-Midwife Researcher, Health Management Consultant and Idea Driver for MACHE initiative Nigeria. He is currently studying M.Sc. at London Metropolitan University on Dr. Muritala Muhammed Postgraduate Scholarship. Twitter handle @deeone6603