Essay by Ayokunle Adeleye

“I solemnly pledge myself before God and in the presence of this assembly,

To pass my life in purity and to practice my profession faithfully.

I will abstain from whatever is deleterious and mischievous,

And will not take or knowingly administer any harmful drug.

I will do all in my power to maintain and elevate the standard of my profession,

And will hold in confidence all personal matters committed to my keeping,

And all family affairs coming to my knowledge in the practice of my calling.

*With loyalty will I endeavor to aid the physician in his work,*

And devote myself to the welfare of those committed to my care.”

– The Nightingale Pledge, 1893. (Asterisks added.)


Those are the words of the original version of the Nightingale Pledge. Back then, the health team was one, had a doctor as the captain and the nurse as his sidekick, and worked. Back then, daughters of Nightingale were not averse to swearing loyalty to Doctors, the men of honor were yet men of honor, and no one thought he had to displace the sons of Hippocrates to “reach the peak of their careers”. Back then… before the envy and strife and hypocrisy that we see now.


For now we have a health team wherein everyone wants to do everything that is a doctor’s job even when they can barely master theirs, where everyone wants to take everything that is a doctor’s pay even when theirs is relatively more, where everyone wants to be the doctor’s public foe yet private friend so that they may keep those free, secret, consultations aboard. Now they want to be doctors (and consultants), do not want to go through medical school to be such, and definitely do not want to endure the rigors of residency.


And what is worse? Rather unlike when they threatened strike actions, cut ICU power supply, and locked everything up, even bedpans, whenever they go on their political strikes; now they form a coalition against the disciples of Hippocrates so that they can challenge our rights to freedom of association and of decision, malign us, and sue us to court– and actually do.


So that now government hospitals are paralyzed, people are dying, and privatization is looming. And all these because of insincerity, for JOHESU wants to have its cake and eat it too, yet he who comes to equity must come with clean hands… They feed the common man with lies to turn him against his doctor, Boko-Haram style, and hope, foolishly enough, that their propaganda will survive. Of course they won’t; falsehood may endure for a night but truth comes in the morning…:

The peak of their careers: Consultancy.


JOHESU are quick to point out the particular dictionary meaning of a consultant being a specialist in his chosen field. Yet, as there is hardly a word worthy of placement in the dictionary and yet having a singular meaning, JOHESU are mischievously silent on such definitions (for example, as in Oxford Concise Medical Dictionary, Sixth Edition, page 155), that “A consultant is a fully trained specialist in a branch of medicine who accepts total responsibility for patient care.”


Alas, each field of human endeavor has its rules and regulations, and consultants– those that, as JOHESU conveniently put it, have reached “the peak of their careers”. Yet, there are requirements for reaching this peak, and there are jurisdictions. For example, however brilliant, versed, confident a paralegal is, he will not represent the client in court, not as a lawyer; he will never be a Judge without first going to Law School and being a lawyer; he will never be the Chief Justice or the Attorney General, arguably the peak of his career.


Coming back to medicine… In the other climes that JOHESU readily cite, non-doctor consultants are fellows of postgraduate colleges such that there are minimum requirements and qualifications, and so that the competence of each consultant can be vouched for having been assessed. The question therefore that the NMA asks is, Are JOHESU consultants-to-be going to be enrolled in residency programs? Are they going to be Fellows of (inter-)national medical colleges? Or are they just going to be sharing consultancy titles among themselves?


Sounds fair, doesn’t it? But the best answer JOHESU can proffer is that Doctors must not dictate the goings-on in other professions. Fair enough! In the spirit of the International Best Practices that JOHESU are purportedly agitating for, standards must be set, especially since human lives are irreplaceable – and to set standards, each discipline must know its duties and boundaries so it may (itself) be disciplined and be disciplined (of others). Yet JOHESU have refused to state what shall be the boundaries of their own consultants, one thing very much worth clamoring for since every arrangement must have a control.


And what is worse? Since our government is only amenable to violence and strike actions, the latter a rather frequent tool of JOHESU in recent times and one they are now begging the courts to approve their copyright patent to, and to grant them a monopoly of; the government went ahead anyway and appointed non-doctor consultants despite NMA insistence that the appointees only be those, if any, who have successfully passed through residency training and/or are fellows of reputable postgraduate colleges.


At the Nnamdi Azikwe University Teaching Hospital, a “consultant pharmacist” invaded the wards with his team, cancelling patients’ prescriptions and also demanded that a consultant cardiologist remove a key drug in an inpatient prescription, on grounds that the drug has some known adverse effects.


In the Abuja University Teaching Hospital, the Antenatal Clinic was invaded by Nurses who decided to consult patients and make prescriptions; the doctors left the clinic and the patients were confused. Patients who sought to see their doctors were told that there was a “consultant nurse” who does whatever a consultant does.


In the University College Hospital, Ibadan, a consultant plastic surgeon was barred from reviewing the surgical wound he created postoperatively because a “consultant nurse” had reviewed the wound earlier and was satisfied with her findings.


Suffice it to say that these are unbelievably new results as they are scenarios that were not created anywhere else in the world and could only have occurred in Nigeria being uniquely Nigerian; read: JOHESU.


Now the questions the NMA asks are, If a pilot study showed chaos, would you, sane as you are, go ahead and implement the full-scale design? If some insane elements insisted that a chaotic model be implemented nonetheless, wouldn’t you oppose such brainless act to the extent of your strength and resilience, especially if you took an oath to only act in the best interests of your patients?


And the best JOHESU can see fit to do, rather than apologize for the apologetic actions of its members, is sue the NMA to court since “only trade unions can go on strike.” Ignoring the sensibility, or otherwise, of the suit, one still finds himself proceeding to wonder if Nigerians were a trade union when we protested the non-installation of GEJ as President following the obscure demise of Yar’Adua, if we are a trade union in protesting the abduction of our girls, if we need to be a trade union to stand for commonsense, which regrettably, but not unexpectedly, is not so common– and, particularly so, in some quarters…


The peak of their careers: Directorship.


Another lie JOHESU have peddled is that only doctors hold important positions in the Ministries of Health! Yes, such positions as directors; Chief Medical Directors (CMDs); chairmen, Medical Advisory Committee (CMACs); Ministers of Health; positions they have eyes on; but not permanent secretaries, a position they very much have noses upon. And the real Oliver Twist that they are, they forever want more.


To set the records straight, the Federal Ministry of Health (FMOH) of Nigeria has eight directorates, and they are not all headed by Doctors. Going by the Presidential Committee on a Harmonious Work Relationship amongst Health Workers and amongst Professional Groups in the Health Sector, chaired by Hon. Justice Bello A. Gusau,

“By its approved structure, the Federal Ministry of Health has eight Departments, namely:


Department of Human Resources;

Department of Finance & Accounts;

Department of Planning, Research & Statistics;

Department of Procurement;

Department of Hospital Services;

Department of Public Health;

Department of Family Health; and the

Department of Food & Drugs Services.


Of the four Professional Departments, three are headed by medical practitioners while one is headed by a health professional who is not a medical practitioner.”


Do you propose JOHESU to head Hospital Services, Public Health or Family Health?


Yes, the CMD and the CMAC are doctors, but the latter is a director of clinical services representing all the clinical departments with a single vote just like the director of administration, the director of nursing services, and the director of pharmaceutical services, all of whom are JOHESU members.


And as the CMD is a Doctor because the law said so, JOHESU can always go to court if JOHESU are not happy about that; after all, they very well know the way to Equity and have mastered the art of presenting gloved hands, they very well have people in the House of Representatives that they have fed their doctors-only-examine hogwash, they very well know how to get the government to sign silly deals and ruin the status quo…


The peak of their careers: Remuneration.


JOHESU have, like the thieving child spanked by his no-nonsense father, come out to say the doctors’ pay is unfairly higher than theirs. Yet, this is not considering that doctors spend far longer in school and to acquire specialist skills, that doctors do not run shifts and get nights off, that doctors do call duties but do not get call-duty offs, and that Doctors should therefore be paid more.


That said, it is quite interesting how that among the healthcare workers in other climes, particularly the United States, the United Kingdom, Canada, India, Australia, and South Africa, nurses, on the average, seem to earn the least even though the difference in salary is not particularly marked in comparison with the laboratory scientists, and physiotherapists; while the highest earning professionals in the health sector are Clinical Pharmacists and Doctors.


The highest average salary for Nurses, Pharmacists and Doctors is distributed in a ratio of 1:1.4:3.1 in the US, 1:2.6:3.0 in the UK, 1:1.9:2.8 in Canada, 1:1.1:2.3 in Australia and 1:-:2.5 in South Africa. In Nigeria, within the health care system alone are two salary structures:


CONHESS (Consolidated Health Salary Structure, for Pharmacists, medical laboratory scientists, nurses and other health workers in the health sector of the Federal Public Service), and

CONMESS (Consolidated Medical Salary Structure, for Medical and Dental officers in the Federal Public Service).


It will appear that while NMA is asking for relativity ranging from 1:1.1 (at CONMESS 3) to 1:1.5 (at CONMESS 7), JOHESU are at variance with this proposition. But judging by the relativity highlighted above as per the other countries, can the demand by the NMA be considered unreasonable? And for all the International Best Practices and how-it-is-done-in-other-climes claims that JOHESU conveniently pop out of their tall, pointed, hats, shouldn’t they rather agitate that Doctors be paid more? But no, we doctors are charitable slaves deserving no much money; no, not while we even like money too much!


Apart from alleging that consultants only work once a week, JOHESU proclaim that they get paid twice for the same job, or no job at all. One expects that even a junior staff knows that everyone’s salary is divided into basic salary and allowances. As consultants are lecturers in the universities as well as specialist Doctors in the hospitals, the Ministries of Education pay them basic salary as lecturers, while the Ministries of Health pay them call and specialist allowances. Does that constitute double salary?


You see, JOHESU should never dabble into something they have no knowledge of. If they don’t understand something, it is better asked than assumed. Ojú àfọ́-ìfọ́tán, Ìjà níí dááálẹ; the partially blinded eye causes disagreements…


Ayokunle Ayk Fowosire.


BBM: 7A99EC96

Whatsapp ONLY: +2348068619636


And contrary to JOHESU-made popular opinion, doctors do not lord over paramedics, doctors do not fight to be put in charge, doctors do not agitate to be noticed or respected. One wishes one could say the same for our waka-comes. Uneasy lies the head that bears the crown. Being a doctor, being the captain, being the boss, are not a pastime, they are a responsibility; for with great power comes great responsibility.


And the doctor’s leadership role is not without limits.


The doctor will not head a maternity center; being neither a midwife nor -husband. Yet, they must refer complications to him, and he must head the labor room, the department of obstetrics, the hospital.


The doctor will not head a pharmacy department or a patent medicine shop that is not his. But he may choose what drug, what brand, and (therefore) what shop. Besides, why, in their sales adverts, do pharmaceutical companies ask patients to consult their doctors after certain periods, commonly three days, of insignificant improvement in condition? after their drugs must have (apparently) failed?


The doctor must not head the medical lab scientist; but a doctor must head the clinical laboratory. If you decide to open your private lab, no Doctor will lord over you, but then he may not accept or make use of your results.


In light of these, one can only hope that this composition is reason enough to set the Eyes of Medusa upon the hydra-headed monster that JOHESU has (inadvertently, eventually) become; that the legendary Eyes of Medusa, the hydra-haired mortal Gorgon, yet turn into stone; that the Eyes of Medusa stop JOHESU dead in their hydra-footed tracks towards plunging the Nigerian Health Sector into abysmal chaos, one from which it may never recover.


That everyone now sees that as the peak of the paralegal’s career is not the peak of the lawyer’s career, the peak of the paramedic’s career is not the peak of the doctor’s career: the peak of JOHESU’s career is invariably not invariably the peak of JOHESU’s career.







The Eyes of JANUS


Getting Off the High Horse