By CHARLES IKE-OKOH
THUR, AUGUST 3 2017-theG&BJournal-Audrey had a very serious stomach ache. She was scheduled for surgery the next week after medical examination. The surgery was recommended by a medical doctor who runs a private hospital despite being employed by a public hospital. Audrey was luckily saved from the knives at the nick of time when her severe pains suddenly vanished.
In July this year, a 29-year-old graduate, Kolawole Idowu was sent to early graves by a careless, wrong diagnosis in a Lagos hospital. Staff in the hospital didn’t do the right test as it where. Kolawole had malaria but tests conducted showed he had a different sort of ailment. He died needlessly from wrong diagnosis.
Both cases underscore the poor state of Nigeria’s medical education and reflect a health system in crisis. The ramification is felt even beyond the country’s borders. The system of training doctors is broken, plagued by hush-rush delivery system that sees trainees under-go clinical in six months.
And so the argument remains the same. Irreversibly too. Most Nigerian medical doctors and nurses, particularly those trained in the last ten years, are incompetent. A faded certificate of graduation and a lifetime of experience no longer suffice as evidence of competence even for some of the older professionals. The consensus is that doctors and nurses are comfortable watching people die needlessly.
The hospitals-private and public- are unsurprisingly now more of super markets-if you don’t pay you don’t get treated-even if you are in a dire condition. This also underscores the degenerated level of the profession.
One senior general practitioner added some vital rationale. ‘Medical doctors have lost their humanness, they are lazy and they have allowed commercial consideration over-take their primary duties.’’ He told me it is common these days to see a doctor, two years fresh from school establish a one-bedroom clinic where he conducts all manner of practices.
Besides, you will find to your surprise that dentists provide services a gynaecologist should take care of and optometrists run a clinic as if they have qualifications in dental surgery. Of course, you know the outcome of these shenanigans-foreign objects forgotten in a patient after surgery and wrong diagnosis. Heavy consultancy fees are common place and the consequence is that more Nigerians are now frequently resorting to churches, prophets and juju men. The wealthy ones simply fly out to London, Dubai or where-ever for reassuring treatment. Serious medical emergencies are treated with scorn and abandon. It is common to see families pleading to surgeons and nurses for medical attention in a severe situation. While doctors in public hospitals grudgingly accede to attend to emergency cases, their counterparts in private hospitals turn themselves into specialists for all ailments.
Diagnostic practice is minima-less than the value at all points. In fact while a patient is still explaining his/her predicament, the private ‘general practitioner’ is already scribbling his/her prescriptions-the most expensive, irrelevant drugs in his shelves.
The most vulnerable are patients in the rural areas of the country. Medical doctors who set up around the rural communities have had little or no experience practicing and for the required number of period before setting up. It is debateable if they went through the set rules of practice by their regulator, the Medical and Dental Council of Nigeria (MDCN), in the Code of Medical Ethics in Nigeria. This is not to say that there are very visible loopholes in the process of establishing a private practice, but it is the cut-corner mentality that is driving the trend.
Ironically, quack nurses are graduating in droves from the illegally established clinics/hospitals. Initially recruited as trainee nurses, some lucky ones climb quickly through the ladder to the rank of midwives. They learn over night how to administer injections and drugs even in the absence of their employer. They are responsible for the rising cases of needless deaths in Nigerian hospitals today.
Indeed, confidence in the Nigerian medical profession is at its lowest since the establishment of the first medical school, the University of London College at Ibadan, with a Faculty of Medicine as one of the initial faculties in 1948. This is driven largely by professional negligence or outright malpractice.
Medical education on its own is still basking in the early, ancient curriculums. Most of the topics are just as boring and there is no concerted effort to flow with trends that is today largely driven by technology. Easy medical issues such as peptic ulcer are still being treated with antimuscurinics which has long gone out of fashion and use.
Medical teaching is almost ad-hoc these days, relying on faded hand-outs because, as one expert put it, the teachers themselves need a lot of teaching. There is no moratorium on the establishment of more medical schools. Universities just put it there as a prestige thing and so there are no efforts to work on improving and increasing the number of medical teachers in the existing universities.
Teaching aids such as clinical teaching centers in the universities for students have all but disappeared. And wisely most universities in the country have lost accreditation for their medical school. Even the top teaching hospitals in the country have nothing near the capability to take on effective Medicare.
The attitude of the law towards medical practice for the protection of the patient is lackadaisical and doesn’t help in securing punishment for medical practitioners who have sent their patients to early untimely graves in the course of their professional duties. And I doubt those who should, care to treat medical decisions as object of legal scrutiny and control.
Those who know will tell you that what obtains everywhere, except perhaps Nigeria, is that it is mandatory for all intending practitioner to undergo schooling in the knowledge of the subject of medical ethics. Maybe I am over reacting, but the knowledge of medical ethics is not reflecting in the attitude of Nigerian doctors. At least 65 percent of medical professionals have not undergone any subjective or implicit check since they began practicing. Take me up on this if you care!
Worst still, medical doctors take the ignorance of most Nigerians on what to do when wrong diagnosis lead to fatality. For instance, not many Nigerians know that, where death comes within 24 hours of surgery, the police ought to be called in and a post mortem examination is compulsorily undertaken. There have been numerous cases of fatalities shortly after surgery, the police is hardly notified, investigation is ignored or discouraged and families are prevailed upon to ‘’leave everything to God.’’
Globally, there has been considerable interest from the public, governments and within the profession to ensure doctors are fit for practice. Accountability is an important contemporary issue. With doubts emerging on the effectiveness of professionally led regulation, a variety of mechanisms are employed to ensure that patients, including those who are ignorant of their medical rights, are effectively protected. But there is nothing to suggest here that the practice of medicine is ethical and that competence rules.
The regulators of the profession, the federal government and legislators must respond fast to these issues by firstly, identifying the gray areas; and it must move to seal all illegal set-ups, crack down on quacks and place severe sanctions on any medical facility where an unnecessary death occurs.
And these organs must begin to show that they have the capacity and are willing to support a more robust medical practice in the country. They know what to do.