Nigeria Declared Ebola-Free by WHO

Medic-ALL (20:10:2014) by Kayode Kuku

With no new cases of Ebola reported in Nigeria over the last 42 days, the World Health Organization (WHO) today declared the country "Ebola Free", a sign of how the deadly virus could have been easily contained had the other West African countries ravaged by the disease acted swiftly.

There haven’t been any cases of Ebola in 42 days, said WHO Country Representative Rui Gama Vaz in a news conference in Abuja, Nigeria’s capital.

“The last chain of transmission has been broken. The disease is gone,” said Dr. Vaz. “This is a spectacular story, that Ebola can be defeated.”

This is following an announcement that Senegal is also rid of the virus.

The entire world and health officials particularly were concerned of a possible worldwide outbreak  and wary of the spread throughout the world when a Liberian-American "transported" the virus into Nigeria when he flew into Lagos, the Country's most populous city with a population of about 21 million people late July.

A different story has been unfolding in Liberia, Sierra Leone, and Guinea, whose governments didn’t notice Ebola had arrived in their interiors until March, four months after the disease first erupted in rural Guinea late last year.

More than 4,500 people are known to have died from the disease in those countries, the WHO says. Thousands more are thought to have contracted it without ever being tallied in the United Nations health agency’s records.

Meanwhile the United States continue to put in place measures to ensure the diseses which has so far been confirmed in 3 persons in the U.S. 43 contacts of the country's first Ebola case, Thomas Eric Duncan have been cleared after not developing any symptoms following a 21-day period in quarantine, while 4 others are close to the end of the isolation period.

 Reports from Spain, reveal that the nurse's aide has also beaten Ebola after spending weeks hospitalized with the disease.

Ref : Wall Street Journal

Related posts: Yes!! Nigeria, Ebola Free

Ebola In America: Nigerian Flight raises Fears

Medic-ALL (17:10:2014)

A man died on a plane from Nigeria landing at Kennedy Airport in Queens early Thursday, sparking fears that the deadly Ebola virus had finally touched down in New York, sources said.

Unnamed man aboard an Arik Air flight from Lagos, Nigeria, died an hour before the plane landed at Kennedy Airport

.

Centers for Disease Control and Health Department members in protective gear swarmed the Arik Air flight landing at JFK’s Terminal 4 after the 63-year-old man, a U.S. citizen, died on the plane about an hour before landing at 5:45 a.m.

The Arik air plane had departed from Lagos, officials said.

The man, who was traveling alone, was vomiting profusely and complaining of chest pains before he died of an apparent heart attack, a Port Authority source said.

Passengers were held on the plane for about 45 minutes after arrival as CDC officials determined that the dead passenger didn’t have the disease that’s infected more than 7,500 people in the West African countries of Liberia, Sierra Leone, Guinea and has recently surfaced in Dallas.

The United States has recently been hit by the deadly Ebola virus that has ravaged parts of West Africa in the past months with three cases diagnosed on U.S soil and five others infected in the West Aftrican outbreak treated in the U.S.

About  3400 people have died from the outbreak as the world continues to fear a pandemic.

Ref: DailyNews, New York

Ebola: Containing The Spread...How Feasible?

Medic-ALL (13:10:2014) by Kayode Kuku

Nearly 3 months ago, the news of a Liberian-American infected with the Ebola virus entering into Africa's most populous nation, Nigeria filled the air and the spotlight was on the African continent, particularly the West African countries; Guinea, Sierra Leone and Liberia that had been ravaged by the outbreak of the  deadly disease many months before one of Africa's biggest economies was hit by the news of the "immigrant" index patient ; a remarkable 38 years after the first recorded outbreak in the Democratic Republic of Congo in 1976.

Fears were raised at the time as to the the likelihood of the virus to spread to other parts of the world as many believed the alarming spread in the lesser developed West African countries may have been due to sub-standard level of their healthcare systems. 

HOW MUCH ATTENTION AND ASSISTANCE DID THIS COUNTRIES REALLY GET FROM THE INTERNATIONAL COMMUNITY before the Nigeria incident was reported late July?

In a Medic-ALL blog post titled "Ebola; Will it Keep Spreading" at the outset of the now aborted outbreak in Nigeria, it was reported that Public health experts expect the virus to reach other parts of the world including the United States but unlikely to spread in regions with well-funded hospitals and standard infection-control procedures. Barely months later and the news of the first case diagnosed in the United States and then another case of an infected healthworker in Spain were reported, raising worldwide fears of a pandemic if more austere measures are not in place to contain the virus and its spread from continent to continent. ARE WE REALLY WINNING ?

More disturbing news emanated yesterday, with the United States confirming a second case involving a female nurse at the Texas Health Presbyterian Hospital infected as a result of an unknown breech in hospital Protocol and was confirmed positive for the virus on Sunday afternoon according to the CDC. She is said to have attended to Duncan (the first U.S patient) after his second visit to the emergency room on September 28 and followed all CDC precautions including wearing of masks ,gowns, gloves and protective face shield. The CDC's Thomas Frieden in a statement outlined several steps taken to care for the health worker and prevent the infection of others, he however said more cases of the deadly virus may be likely.

There is no doubt that we are dealing with a highly transmissible and truly lethal disease that deserves worldwide attention. The question of whether the virus will "Keep spreading" seems to be getting answered on a daily basis and the staggering figures of the lives that have been claimed so far, particularly in the West African region is enough to put the whole world on our toes.

Containing the spread of the virus in countries with reported cases is most paramount at this stage and it is obvious that this will require not just a "well-funded healthcare system" but a step up in our standard infection-control procedures worldwide, as Frieden highlighted that taking off protective equipment- gowns, gloves, face masks and goggles is one of the greatest areas of contamination and risk. Certainly there is need for a new note of urgency to this outbreak , this cannot be over-emphasized.

Medic-ALL.Inc 2014 

CONTAINING EBOLA: Learning From Nigeria

Medic-ALL (05:10:2014) 

Ref: Washingtonpost

After several months of the Ebola outbreak and devastating reports streaming out of West Africa where the deadly virus has overwhelmed already weak public health systems and left thousands of people dead, anxiety has begun to grip in the United States over the first case of Ebola diagnosed in the country, one West African nation serves as an example of hope: Nigeria, which appears to have successfully contained  the Ebola virus, with no new case reported in the country since the 31st of August 2014.

As concerns spread over the readiness of U.S. hospitals , there are some lessons to be learned from Nigeria, where officials managed to get ahead of the fast-moving virus after it was brought into Africa's most populous country by an Ebola-infected Liberian-American man who had flown into Lagos from Liberia for an ECOWAS meeting.

As in the U.S. case, Ebola arrived in Nigeria by passenger plane. But unlike Thomas Eric Duncan — who arrived in Dallas before he became symptomatic and was therefore not contagious during his flights from Liberia to Texas through Brussels and Dulles International Airport — Patrick Sawyer was already symptomatic when he landed in Lagos on July 20. At that point, Sawyer, Nigeria's Patient Zero, was contagious and dying.

It was a nightmare scenario with the potential to spiral out of control, given the bustling city of Lagos, Africa's largest, is a major transportation hub. As Sawyer was placed in isolation, public health officials had to track down every single person who'd come into contact with him, from the flights he'd boarded to the Lagos airport and the private hospital where he went after landing. And they had to do so quickly, making the process known as contact tracing a priority.

"In the whole system approach in beating the war on Ebola, contact tracing is the key public health activity that needs to be done," said Gavin MacGregor-Skinner, who helped with the Ebola response in Nigeria with the Elizabeth R. Griffin Research Foundation. "The key is to find all the people that patient had direct close contact with."

From that single patient came a list of 281 people, MacGregor-Skinner said. Every one of those individuals had to provide health authorities twice-a-day updates about their well-being, often through methods like text-messaging. Anyone who didn't feel well or failed to respond was checked on, either through a neighborhood network or health workers.

Nigeria is said to have taken a "whole community approach," with everyone from military officials to church elders in the same room, discussing how to handle the response to the virus.

Such an approach, and contact tracing in general, requires people be open and forthright about their movements and their health, he said. Stigmatization of patients, their families and contacts could only discourage that, so Nigerian officials sent a message to "really make them look like heroes," MacGregor-Skinner said.

"This is the best thing people can do for Nigeria: They are going to protect and save Nigeria by being honest, by doing what they need to do, by reporting to the health commission," he said. This made people feel like they were a part of something extremely important, he said, and also took into account real community needs. "You got real engagement and compliance from the contacts. They're not running and hiding."

In Nigeria, Sawyer had come into contact with someone who ended up in Port Harcourt, Rivers State That person, a regional official, went to a doctor who ended up dying from Ebola in August. Within a week, 70 people were being monitored. It ballooned to an additional 400 people in that one city.

Success stories of people coming through strict Ebola surveillance alive and healthyhelped encourage more people to come forward, as they recognized that ending up in a contact tracer's sights didn't mean a death sentence.

In the end, contact tracers — trained professionals and volunteers — conducted 18,500 face-to-face visits to assess potential symptoms, according to the CDC, and the list of contacts throughout the country grew to 894. Two months later, Nigeria ended up with a total of 20 confirmed or probable cases and eight deaths.

The CDC also pointed to the robust public health response by Nigerian officials, who have had experience with massive public health crises in the past — namely polio in 2012 and large-scale lead poisoning in 2010.

When someone is on a contact list, thatdoesn't mean that person has to stay at home for the entire incubation period of 21 days from the last contact with someone who had Ebola. People on contact lists are not under quarantine or in isolation. They can still go to work and go on with their their lives. But they should take their temperature twice a day for 21 days and check in with health workers.

Officials in Texas began with a list of about 100 names; they have whittled the list down to 50 people who had some contact with Duncan. Of those, 10 are considered high-risk.

The CDC recommends that people without symptoms but who have had direct contact with the bodily fluids of a person sick with Ebola be put under either conditional release, meaning that they self-monitor their health and temperature and check in daily, or controlled movement. People under controlled movement have to notify officials about any intended travel and shouldn't use commercial planes or trains. Local public transportation use is approved on a case-by-case basis.

When symptoms do develop, that's when the response kicks into high gear. People with Ebola are contagious only once they begin exhibiting symptoms, which include fever, severe headaches and vomiting.

While four people in Dallas are under government-ordered quarantine, that is not the norm. Those individuals "were non-compliant with the request to stay home. I don’t want to go too far beyond that," Dallas County Judge Clay Lewis Jenkins said Thursday.On Friday, the four people were moved to a private residence from the apartment where Duncan had been staying when he became symptomatic.

A law enforcement officer will remain with them to enforce the order, and none of the people are allowed to leave until Oct. 19.

Duncan is the only person with an Ebola diagnosis in Dallas, and no one else is showing symptoms at the moment. But, as Nigeria knows, the work in Dallas has just begun.

Washingtonpost article by Elahe Izadi

Journal: Nigerian Medical Students; Underappreciated and Underutilized Research Resource

By Rober. H. Glew (Highland Medical Research Journal) 
Having taught biochemistry to medical students in the U.S and Nigeria for three decades, I have been fascinated by the many contrasts that differentiate the education and training these students receive in the two countries. One of the most glaring and interesting distinctions between undergraduate medical education in the U.S. and Nigeria has to do with the extent or lack thereof to which Nigerian and American medical students become engaged in biomedical research while they are in medical school. The percentage of medical students in the U.S. who are involved to a significant degree in research certainly varies considerably across the 140 or so allopathic and osteopathic schools of medicine. 

Nevertheless, regardless of whether research is a required or voluntary activity, at most U.S. medical schools at least one-third and as many as one hundred percent of the student body participates significantly in research of one sort or another, be it epidemiology/population-based or laboratory-centered. At the University of New Mexico School of Medicine, for example, even before the requirement that students do a research project was put in place about 12 years ago, 30-40% of the medical students elected to engage in research under the tutelage of a faculty research mentor in one of the clinical or basic science departments. 

In contrast, however, based on what I have observed first-hand from having taught medical students and done research at a number of teaching hospitals in different regions of Nigeria over the past 30 years, I cannot recall a single instance in which a Nigerian medical student ever involved himself or herself in a collaborative research project with a faculty member in any serious manner during the six years they were in training.

Continue Journal Article HERE

Ebola: Sierra Leone Quarantines A Million People

The Guardian (25:09:2014)

Sierra Leone’s government has quarantined more than a million people in an attempt to bring an end to the spread of the deadlyEbola virus.

Areas in the east of the country on the border of Guinea have been under quarantine for months but travel is now restricted in three more areas where an estimated 1.5 million people live. Nearly a third of the country’s population across 14 districts is now under curfew.

The move comes as world leaders meet to discuss the crisis at the United Nations, and days after a three-day nationwide lockdown ended.

Healthworker being disinfectted after helping out with a suspected case of Ebola on Freetown, Sierra Leone

In an address to the nation, Sierra Leone’s president, Ernest Bai Koroma, said the weekend’s lockdown had “met its objectives” but had also exposed the challenges posed by the Ebola crisis.

In addition to announcing the new isolation districts, the government is establishing corridors for travel between non-quarantined districts, with a curfew on all travel outside the hours of 9am and 5pm. Koroma said the isolation would “definitely pose great difficulties for our people in these districts”.

The British charity Street Child said there had been no warning given of the latest lockdown and said it was concerned that this would lead to mass starvation. “We were not prepare for the quarantine overnight. The areas being quarantined are really poor communities, most people live on 50p a day,” its country director, Kelfa Kargbo, told the Guardian.

“We need more help from the World Food Programme, but more than that we need a distribution network to be built to make sure the food gets in and gets in regularly to the starving people. I am expecting starvation to show in three or four weeks unless this is addressed.”

The northern districts of Port Loko and Bombali have been closed off indefinitely along with the southern district of Moyamba, effectively sealing in around 1.2 million people.

The deadliest Ebola epidemic on record has infected more than 6,200 people in westAfrica and killed nearly half of them, according to the World Health Organisation’s latest figures.

The virus is spread through bodily fluids and once symptomatic can kill within four or five days. Symptoms include rampant fever, severe muscle pain, vomiting, diarrhoea and, in some cases, internal and external bleeding through the eyes and mouth.

World leaders are due to attend a meeting on Ebola convened by the UN secretary general, Ban Ki-moon, in New York later on Thursday, with Koroma and Liberia’s President Ellen Johnson Sirleaf connected by video link.

The meeting, part of the UN general assembly, will hear from Barack Obama, and world leaders are expected to pledge help for attempts to contain the spread of the virus.

Obama, who is sending 3,000 troops to west Africa to help health workers, urged other countries to get behind a broader international effort.

In a speech to the general assembly, Obama grouped Ebola with the crisis in Ukraine and the threat posed by Islamic State in Iraq and Syria as new dangers to global security.

“As we speak, America is deploying our doctors and scientists – supported by our military – to help contain the outbreak of Ebola and pursue new treatments,” Obama told the assembly. “But we need a broader effort to stop a disease that could kill hundreds of thousands, inflict horrific suffering, destabilise economies and move rapidly across borders.”

Door-to-door searches during the three-day curfew in Sierra Leone identified more than 350 suspected new cases of Ebola, according by the top US diplomat in the country. Charge d’affairs Kathleen Fitzgibbon said teams of volunteers had also discovered 265 corpses, of which 216 had since been buried.

In an email to emergency workers, she said one of the priorities was to ensure all bodies were buried correctly, as funerals have been identified as one of the ways the disease has spread, with relatives touching the bodies of the deceased.

The US Centres for Disease Control estimated that the number of cases in Liberia and Sierra Leone could rise to 1.4 million by January, in a worst-case scenario based on data obtained before the world ramped up its response.

Yes! Nigeria Free of Ebola

Medic-ALL (24:09:2014)

Exactly 2 months ago, after Nigeria was hit by the news of a "mystery" Ebola virus disease patient , a naturalized American and  Liberian Ministry of Finance official; Patrick Sawyer, who found his way into the country via the Murtala Mohammed International airport in Lagos to attend a meeting of the Economic Commission for West African States  (ECOWAS) in the city of Calabar. The Minister of Health, Dr. Onyebuchi Chukwu declared yesterday that there is presently no single case of the Ebola virus disease in the country. Stating that there are no cases of the disease under treatment nor any suspected cases. He added that there are no contacts under surveillance having being under observation for at least 21 days.

Prof. C. O. Onyebuchi Chukwu, Honourable Minister of Health, Federal Republic of Nigeria

About 400 contacts from the Southern part of the country in Rivers State, Port Harcourt had earlier being on medical surveillance, with 25 of them remaining as at Monday the 22nd of September and none showing symptoms, they were scheduled for discharge on the Tuesday. Indeed it appears the disease has being successfully contained in Lagos , a city of 21 million people and Prt Harcourt which has a population of 1.4 million people.

Nigeria, which is the most populous black nation in the world , with about 177 million people suffered a total of 21 Ebola cases and 8 deaths, this is in contrast to Liberia with a population of  4.3 million and had suffered 1,459 deaths out of 2,710 reported cases as at last Friday. This is truly a remarkable achievement for a country plagued by relative insecurity and pervasive and chronic corruption. A rare signal that things can indeed go right in some parts of Africa.

The Ebola survivors in Nigeria were not treated with any experimental drugs. Contact tracing and early identification of cases were managed by isolating patients and replacing fluids and electrolytes, while some were transfused.

The Nigerian Health Minister was full of praises for the World Health Organization (WHO) Director General, Margaret Chan MD, who assisted the country by sending experienced physicians to the country to help manage the cases. Other organizations which helped in the fight against the deadly virus in the West African country include, UNICEF, CDC and MSF.

IVF in Nigeria: Nordica's First Baby Turns 10

Medic-ALL(11:09:2014):

One of Nigeria's Leading Fertility Clinics, who specialize in assisted reproductive services, including In-vitro Fertilization (IVF) , Nordica Fertility Centre , yesterday the 10th of September 2014 celebrated the 10th Birthday of her first IVF baby, a boy, Julian.

Julian's parents were said to have walked into the Fertility Centre on the 11th of October 2003 and following a single treatment cycle, four months later were greeted with the news of the mother being pregnant with a male child.

               Julian & Dr Abayomi Ajayi(MD/CEO Nordica Fertility Centre

The Centre first opened on the 14th of April, 2003 at Victoria Garden City, Lekki Lagos. But later moved to the Ikoyi area of Lagos in a bid to be closer to their clients and a desire to expand. They have since followed with a branch in the Mainland area of Lagos which was opened in 2003 as well as a Clinic in Asaba, Delta State, in the Southern part of the country five years ago. The Center in Sapporo, Abuja, the capital of Nigeria was commissioned in November 2012.

In a statement by the center while marking the landmark event, it stated that the story of Nordica Fertility Centre has been one with a number of “firsts”, some of which include:

1. The first IVF clinic to have a baby from Laser assisted hatching

2. The first and probably the only IVF centre to use/using IMSI to solve male related infertility issues.

3. The first IVF Clinic in Nigeria to start Oocyte cryopreservation, otherwise known as Egg freezing.

4. The first solely dedicated IVF centre in Abuja.

5. We are also one of the few clinics in Nigeria to do Pre-Implantation Genetic Diagnosis

6. The first to utilise acupuncture for IVF treatment

The statement also said that whilst they had achieved monumental growth in the number of babies conceived, The centre had equally not neglected it's corporate social responsibility. Working in conjunction with the Fertility Treatment Support Foundation (FTSF), free fertility treatments have been made available to over 30 couples with diverse infertility challenges. "We also work with the ESGN (Endometriosis Support Group Nigeria) the only Foundation supporting this cause in West Africa" it said .

The lack of information about fertility options coupled with the stigmatisation associated with childlessness has contributed to the reason why a lot of people do not explore the possibility of assisted conception. This should not be seen as a taboo but seen as a means to an end.

The center continues to strive to Keep Hopes alive by "Completing Families".

Ref: Nordica Fertility Center blog

Ebola: Nigerian Scholar suggests Ewedu Cure

Medic-ALL (05:09:2014):

Corchorus

A Professor of Ophthalmology at the Lagos State Teaching Hospital (LUTH), Lagos, Nigeria, Professor Adebukola Adefule Oshitelu, has laid claims that ‘Genus Corchorus’ popularly known as Ewedu in Nigeria is capable of curing the  deadly Ebola Virus Disease.

She made  this statement at the 2014 African Traditional Medicine organised by NAFDAC (National Agency  for Food and Drug Administration and Control) yesterday at Ikeja, Lagos state. The programme which was arranged for Traditional Medicine Practitioners and Conventional Medicine Practitioners was in response to the  urgent need for cooperation between the two health bodies in order to enhance better and reliable healthcare delivery system.

According to Oshitelu, Ewedu cures Ebola by improving an infected person’s immune system, likewise providing prevention against the deadly virus .for uninfected persons.

“The qualities inside Ewedu is so much that it will kill Ebola by preventing the virus from replicating and destroying more organs in the body. This would immediately stop the symptoms such as high fever, stooling and vomiting. Ultimately, leading to the cure,” Oshitelu said.

She further advised people to consume Ewedu on a regular basis but with strict adherence to its preparation and usage.

The way it will be prepared will be different from the normal way they cook it. It should be washed and rinsed with liquid vinegar, afterwards blend and cook with drinkable water. No salt, potash or seasoning should be added, take 25cl of the concoction a week and it would boost a person’s immunity so that they become impregnable to the virus.” Oshitelu said.

However, In a statement made by the Director General of NAFDAC, Paul Orhii who was represented by the Director of Laboratory Service, Stella Denloye, NAFDAC said it has banned illegal advertisement of herbal products and bogus claims of cure for diseases.

“Unpatriotic Nigerians who continue to engage in illegal advert of their products and those making false claims not evaluated by NAFDAC should desist from acts misleading the unsuspecting public. I want to warn and inform them that NAFDAC would deal decisively with anyone found to contravene,” Orhii said.

He noted that there was the need to institutionalise traditional medicine in the health systems worldwide including Nigeria.

He said the stigmatising of the traditional health care by modern/conventional medicine needed to stop. So much that in some countries, it is even illegal to practice it.

“Regulation is the key to ensuring that only good quality, safe and effective traditional/herbal medicines are available to consumers especially if traditional medicine and complementary medicine is to be integrated into the nation’s healthcare system,” Orhii said.

Ebola: CDC in talks with Nigeria over Human trial as suspected cases rise

Medic-ALL (01:09:2014)

There are strong indications that officials from the Centers for Disease Control and Prevention (CDC) in USA are in talks with health officials in Nigeria about the prospects for conducting a phase 1 safety study of the Ebola vaccine among healthy adults in the country amid mounting anxiety about the spread of the deadly virus in West Africa, according to the National Institutes of Health (NIH).

The pace of human safety testing for experimental Ebola vaccines has been expedited in response to the ongoing virus outbreak in West Africa which has impacted negatively on businesses in the three affected countries of Liberia, Sierra Leone and Guinea, with neighbouring countries closing their borders and banning flights from affected countries to other parts of Africa.

NIH explained that “the early-stage trial will begin initial human testing of a vaccine co-developed by NIAID [National Institute of Allergy and Infectious Diseases] and GlaxoSmithKline (GSK) and will evaluate the experimental vaccine’s safety and ability to generate an immune system response in healthy adults. Testing will take place at the NIH Clinical Center in Bethesda, Maryland, USA.”

The experimental vaccine is expected to first be given to three healthy human volunteers to see if they suffer any adverse effects. If deemed safe, it will then be given to another small group of volunteers, aged 18 to 50, to see if it produces a strong immune response to the virus. All will be monitored closely for side effects.

It is understood that the vaccine will be administered to volunteers by an injection in the deltoid muscle of their arm, first in a lower dose, then later in a higher dose after the safety of the vaccine has been determined.

Anthony Fauci, NIAID director, explained that there is an urgent need for a protective Ebola vaccine, as it is important to establish that a vaccine is safe and spurs the immune system to react in a way necessary to protect against infection.

“We know the best way to prevent the spread of Ebola infection is through public health measures, including good infection control practices, isolation, contact tracing, quarantine, and provision of personal protective equipment. However, a vaccine will ultimately be an important tool in the prevention effort. The launch of phase 1 Ebola vaccine studies is the first step in a long process.”

Preclinical studies that are usually carried out on such drugs were waived by the FDA (Food and Drug Administration) during the expedited review and care is being taken to go slowly, particularly as it pertains to the dosing .

Meanwhile, the number of suspected cases in Nigeria has continued to rise after one of the initial contacts of the Liberian-American-Sawyerr, a Nigerian Diplomat working with ECOWAS, Olu-Ibukun Koye who was said to have escaped from quarantine and traveled to Rivers State in the Southern Part of the country. Where he was attended to by a now late medical doctor, Dr Enemuo, who died a few days afterwards and whose corpse tested positive to the deadly virus. The late doctor's wife and other possible contacts in the Southern State have now being placed under quarantine.

Ref: BusinessDay

Medic-ALL.Inc 2014

THE NIGERIAN HEALTH SECTOR: "SOME TRUTHS AND SHAPESHIFTERS" PART 3!

Final Part
By Dr. Jide Akeju

The introduction of an expanded program that involves greater specialization was introduced in the USA, this is generally not a worldwide practice and only one institution in the United Kingdom offers something similar to the Doctor of Physical therapy program popular in the USA. JOHESU affiliates readily point to other climes to justify their demands. It can be deduced that the agitation for a residency program by the NSP has been copied from the USA, it is not what anyone can term as best global practice and regarded as excessive in some climes where masters or PhD programs are viewed as sufficient postgraduate training. Do the NSP have the requisite facilitators and experienced trainers to oversee a qualitative residency program or are they just copying and pasting what is practiced in another place without adequately evaluating the pros and cons?

If residency program is part of the agitations of JOHESU, which of the professional bodies are going to benefit? It is clear the NSP are going to reap significantly. The terminology “Consultant” refers in our system to specialist senior doctors who are appointed to ultimately take responsibility for patient admission and management. They are also involved in clinical training and supervision of medical students and resident doctors. Some of these individuals do have dual appointments in institutions with affiliated colleges of medicine where they also teach students outside of the clinical environment; undertake research and participate in general University duties and activities. It becomes laughable when JOHESU release a statement contesting double salaries given to honorary consultants and allegations that some doctors are so highly paid even more than university professors when in fact a few of them are university professors. The term is consistent with the British system as well as some commonwealth nations.

 It should be easy to understand why some allied healthcare workers are called consultants in the USA where the equivalent of hospital medical consultants and specialists are called “Attending Physicians”. Although Prof. Alonge appeared to support the appointment of consultants from other health workers, he did point to the fact that a discrepancy exist in the interpretation of the term as it affects both groups hence a need to clarify issues. I do not think that is exactly what the deserving members of JOHESU want. They constantly point at what doctors are enjoying and I guess it is those benefits they assume doctors are enjoying that has led to the demand. 

What is the yardstick to determine who and who is deserving of consultancy positions?

 Would it not lead to further rift within the ranks of JOHESU if certain affiliates do not benefit from the consultancy largess?

What would make the non-professional groups inherent in JOHESU undeserving of being appointed as consultants? 

Are the agitators of consultancy willing and competent to shoulder the responsibilities of patient care and the demands of such appointment? 

A hospital consultant position is not a reward for longevity nor is it like the appointment of delegates to a conference. It is not the peak of a doctor’s career, a doctor does not necessarily need to be in a residency program and become a consultant before he/ she can be regarded as successful or accomplished. We should not just simply adopt terminologies that are used in other climes and take them out of context to adopt them in our own system. Nurses have also recently pointed to the appointment of a female nurse as the US Army Surgeon General as validation of their demands.

It is really easy to be awed by such information but what many fail to do is read just a little about the woman concerned Patricia Horoho. It is clear that she did not attain such lofty heights just because of being a member of a gender or profession minority; she is a first class Lieutenant General highly trained and equipped to manage such a responsibility that entails human, material and enormous financial resources. Our people in Nigeria always clamor for equation balancing at the complete expense of competence. Should the JOHESU not demand for better funding and standardized education and training instead of striving for potentially unsustainable projects that could be deflated by politics and underfunding? A fellow named Nwaneri commented on a link to a JOHESU draft on the 20th of January 2014. The man commended the JOHESU executive for their resilience but asked when and if they would also ensure residency training for medical laboratory scientists and BSc nurses. Someone should lodge a requisition for NASU residency quickly.

I searched for a JOHESU website but could not locate any so I turned my attention for a facebook page at least. I did find three (3) affiliated to institutions in Yobe, Gombe and the Federal Medical Center Abeokuta (FMCA). The one for the FMCA had 148 members and one administrator called Otunba Tiamiyu who is also the public relations officer of the Abeokuta chapter of JOHESU. The” admin” seems to be a young man hell bent on misinforming him many members and launching constant abuse at the management and consultants of his institution. The fellow’s command of the English language and utterances is rather appalling and one can only imagine how such a man is responsible for representing the interest of any credible association that includes pharmacists and physiotherapists. He described the resident doctors as toddlers and their protest as senseless; he was reported in the Leadership newspapers (a paper that I think is sympathetic to the mission of JOHESU) on the 26th of July 2014 to say that doctors only jump at strikes to divert patients to their private hospitals in order to charge exorbitant fees. He rejoiced that the public had arisen to curb the excesses of doctors who he accused of behaving as gods. These are the kind of people who peddle all sorts of falsehood and inconsistencies about doctors and the NMA. They regularly accuse the NMA of incessant strike actions and easily forget the many occasions the JOHESU have threatened or outrightly embarked on strike actions that effectively grounded the health sector.

A quick search through Google will produce results that clearly show that the “development” of the health sector has been greatly slowed down by frequent strike actions detonated by the camp of the JOHESU. May 7, 2012; August 21, 2013; January 15, 2014: these are all dates of outright nationwide strikes embarked upon by JOHESU. They have been calling for the sack of the current Minister of health since 2011. They made this demand on the 21st of February 2011 accusing the minister of sabotaging their interests in favor of doctors. They continued with this demand in December 2012 and January 2013. This same minister is currently being hailed for enforcing the sack of resident doctors who are not contesting CMD or director positions with the JOHESU top brass. In a letter dated January 17, 2014 and addressed to the Minister of Health, JOHESU had stated that its good faith, patience and restraint to go on strike had been taken for weakness by the government. I wonder what JOHESU needs to do for the health ministry to sack all medical laboratory scientists in order to restructure the health sector.

JOHESU has claimed that the NMA have no right to negotiate labour disputes for any reason and to embark on strikes which has been supported vehemently by a few supposedly experienced public commentators as well as some journalists who through their reportage express clear partisanship and a clearly lackadaisical approach to their work devoid of intelligent research and fairness. One reporter with the leadership newspaper put up 2 headlines online in the space of less than 30minutes that referred to the same story that aimed to vilify the NMA and doctors. The same JOHESU that claims the NMA has no bargaining right with the FG constantly make reference to a 2009 bargaining agreement that was implemented for doctors but yet to be done for them. The public commentators usually mention that doctors are part of what is regarded as “essential services” that should never go on strike. In a blog post on the 25th of October 2012 titled “The Right to Strike in Nigeria and ILO Principles on the Right to Strike”; Femi Aborishade of the Polytechnic, Ibadan and center for labour studies reviews and appraises the laws guiding strike actions in Nigeria, the principles recommended by the International Labour Organization (ILO) on strike actions and how such affects Nigeria especially the drawbacks. The Committee of Experts and the Committee on Freedom of Association of the ILO appeared to justify the scope of restriction of strike action in “essential services” which was defined in 1983 as those services “the interruption of which would endanger the life, personal safety or health of the whole or part of the population”. The Committee on Freedom of Association described that essential services in the strict sense of the term depended to a large extent on the particular circumstances prevailing in a country and that a non-essential service may however become essential if a strike lasts beyond a certain time or extends beyond a certain scope, thus endangering the life, personal safety or health of the whole or part of the population. The committee considered essential services in the strict sense may be subject to major restrictions or even prohibitions; this is inclusive of the hospital sector; electricity services; water supply services; the telephone service and air traffic control. It is instructive that the ILO’s committee mentioned “hospital sector” and not medical doctors because striking doctors renders all other health care workers redundant likewise doctors left in a health sector paralyzed by absent health workers is also a waste of time and resources. Essentially services in the UK are listed as Emergency services, Armed forces, Health and social workers, Food industry; Agriculture, veterinary and animal welfare; Essential workers at nuclear sites; Water, sewerage and drainage; Fuel and energy suppliers; Public transport,  Licensed taxis; Coastguards and lifeboat crews;  Airport and airline workers; Postal, media, telecommunications; Central and local government workers; Essential financial services staff including those involved in the delivery of cash and cheques; Prison staff; Refuse collection and industrial waste;  Funeral services; Special schools and colleges for the disabled and Essential foreign diplomatic workers. 

If this nation realizes the importance of these diverse industries to the welfare of their people, why do our leaders assume they as politicians are more important that everyone else? 

They utilize divisive tactics to set sectors that ought to be in perfect harmony and operate in unison at each other’s femoral arteries while they simply embark on state funded trips to nations where doctors and health workers are well catered for to even think of strikes for checkup and definitive treatment. Workers who ought to know their services are equally as essential as what doctors provide sit perched on their moral high grounds to condemn doctors for demanding better conditions for the collective health sector while they move around without condemnation when they go on their own frequent strikes that shuts down record offices, morgues, theatres, pharmacies, stores, oxygen supply and wards amongst others. These frequent strikes are generally assumed to be doctors’ strike by the average visitor to the hospital. The mischievous members of JOHESU leverage on this misconception to divert the responsibility from themselves towards doctors instead.

Nigerians have to arise and make concrete demands from their government to improve their welfare. They should not just wallow in the mud and take just whatever crumbs the FG throws at them. The funds meant for developing the health sector to international standards are constantly being squandered and those who ought to know better have chosen not to be enlightened enough to ask the relevant questions and have offered themselves with the associations they represent willingly or otherwise to be tools in the hands of politicians to perpetually impoverish Nigerians. 

The story in the book of 1kings chapter 3 tells the story of 2 characters; prostitutes who had babies. One woman canvassed for the living baby to be split down the middle while the other only wanted the integrity of the baby. The king in his wisdom judged rightly and awarded the baby to the true mother. The NMA is asking for the status quo to be maintained while JOHESU wants what they deem are their rights and privileges. This is not to say doctors are immune to blame in all that has transpired but the truth is that the things demanded for by the JOHESU if granted would largely plunge the health sector into further crises that may not even involve the NMA. The Nurses, pharmacists and physiotherapists would become consultants; directors would emerge and then a number of the “patch patch” members would be left stranded or with crumbs. The pharmacists and physiotherapists know that they cannot embark on any effective strike to get their desired consultancy status and residency programs without the foot soldiers that would lock the doors and grind federal institutions to a halt. These unfortunate ones will realize albeit too late that they were only used and deceived with promises of better welfare packages and wage grade level increases. Some of them may never get to those grade levels by virtue of their limited educational qualifications and poverty of additional training irrespective of the years of service they offer.

The FG approved huge benefits and amnesty for reportedly surrendered militants from the Niger-Delta region. Some of these individuals have been widely reported in the local media to be on training or academic programs overseas. This is not entirely true as many Nigerians from a certain geopolitical region of Nigeria favored by the incumbent have flooded choice institutions across the world for undergraduate degrees in the stead of these militants and to the detriment of the nation’s tertiary educational sector. It is shocking that Nigerians are unmoved by the nonchalance of the FG to ensuring equity and providing even good facilities within the country. It is not surprising that government runs like normal despite the onslaught of misguided insurgents in the northeast and the over 130days of secondary school girls stranded in captivity. It is baffling that some Nigerians find it convenient to tolerate the idea of the President Jonathan's reluctance or refusal to visit his troops in the north east of Nigeria despite having the resources to do so in a flash. 

Why do some Nigerians who are supposedly educated find it very appropriate to berate doctors who insist on certain minimum standards before the strike is called off or before moving all out against the Ebola scourge? For them and some health workers, it is all about a Hippocratic Oath they seem to know nothing about. Nurses also have their oath but conveniently forget it when it comes to vilifying doctors. Is it only doctors that take oaths before embarking on their assignments? Did President Jonathan recite a poem at his inauguration?

Dr. Jide Akeju 

Senior Resident

Jideakej@gmail.com

Medic-ALL.Inc 2014