THE quagmire we call health care system! If you have ever had cause to visit a state-owned hospital, you will be appalled at the deplorable state of health care system we have in this country. You might think what we've got is fair enough, then you travel overseas for treatment and you would wish you would not have to come back home. A personal experience will suffice. In 2005, three medical doctors diagnosed three different ailments from the same test results. On every appointment date, I was always unfortunate to see a different doctor from the one I saw previously. How can there be effective follow-up on my medical condition when I see a new doctor every time I am at the clinic' So, a patient can have as many doctors attending to him as the number of his appointment dates. My discourse of the state of our health care delivery takes a new dimension when the doctors fatally err. A doctor prescribes a medication that is out of use or does so with wrong specifications. We may blame the doctors and call them 'incompetent' but, hey, take the chill pill. Even if we must blame the doctor, we must remember that he or she practises within a health care system.Strikes or industrial actions generally take the discourse about our ailing health care delivery system to a whole new level. Here are examples: On 18 April 2012, nurses at the Federal Medical Centre, Idi-Aba, embarked on a strike over a tussle that occurred between a certain doctor and a nurse. According to media reports, the doctor in question had physically assaulted the nurse. These reports turned out to be grossly inaccurate. The hospital management could not resolve this scuffle amicably and the nurses went on strike. It is worthy of note that this strike occurred a fortnight after the doctors in the same hospital resumed from a three-day strike. April 25 2012, doctors at Lagos University Teaching Hospital went on an indefinite strike. On the 7th of May 2012, 788 medical doctors in LASUTH were sacked by the Lagos State government. According to the Nigerian Medical Association, Lagos state chapter, 'by sacking 788 doctors, the state has succeeded in increasing the patient-doctor ratio to 50,000 to one.' Doctors in Federal Government ' owned hospitals joined in a solidarity strike with their counterparts in Lagos State sacked 10 days earlier. On Friday, 25 May 2012, the Nigerian Medical Association, Oyo State chapter, joined also in solidarity with their colleagues. We are not unfamiliar with strikes by medical doctors but this is about the murkiest I have witnessed. It makes me ask: 'Is this a health care delivery system''The work of the personnel in the health care system is often underrated until one becomes privy to the profession and its members. Living with a doctor has changed my perspective. First, their working conditions in Nigeria. These are not particularly healthy. Globally, the recommended patient ' doctor ratio is 1: 1,000. However, it will interest you to note that in Nigeria, the ratio of patient-doctor is one doctor to 33,000 patients! This is more than burdensome for a doctor; this is suicidal! In a report published in 2005, there were about 26,000 registered doctors in Nigeria serving a population of 160 million. Seventy percent of Nigerians live in rural areas and are typically out of reach of a primary health care. So, for the 30 per cent that has access to medical care, a doctor is apportioned to 33,000 patients. The regular working hours of a doctor are 8am to 4pm. However, if he is on call, he stays on in the hospital from 4pm till day break. As the day breaks, he rushes to get cleaned up and off he goes to meet the usual 8:00am briefing. In developed countries where calls are as biting as this, the patient to doctor ratio is far better than it is in Nigeria. For instance, in the U.S., the patient to doctor ratio is 350:1. For the Nigerian doctor, things get as bad as being on call two straight days. By implication, he works for 48hours with barely any sleep! They go that extra length just to save lives.I make bold to say that Nigeria has a crop of good and well-trained medical doctors in Africa but the Nigerian hospitals and laboratories are yet to be abreast of the 21st century medical technologies. It is alarming to discover that our leading hospitals cannot boast of having a sphygmomanometer per consulting room! How many government-owned hospitals have MRI scanners' Which laboratory in the country can run an accurate and complete test on deoxyribonucleic acid (DNA) samples' And for those that seem to have some equipment, they hardly last for long. It could be maintenance culture but I bet you, it is because they were not standard equipment.Until lately when some hospitals were given some facelift, hospital structures were decrepit and almost falling apart. Consulting rooms were without cross-ventilation or fans to flush out stale air. So let's get the picture straight: a doctor who has the burden of 33,000 patients is put in a consulting room without a fan or air-conditioner and a sphygmomanometer. In the burning tropical heat, he is in a dilemma of what tests to run, knowing full well that laboratories do not have the necessary equipment or reagents.As he works so hard to keep his kind alive, he hears of the corrupt and fraudulent practices of people in the corridors of power who do not lose sleep nor their comfort in order to save lives. It embitters the heart that no one is made to answer for these scams and yet you expect the man who loses his sleep not to call for a raise in his income' If the doctor was incompetent, the system has aided him to be more incompetent.Many have died because strikes have deprived them of medical attention. People in their numbers have died because health care has become unaffordable. Our NHIS is dysfunctional and hardly caters for such ailments that are dire. I really wonder how to rate the effectiveness of an NHIS that caters for head-ache but not an appendicitis surgery. Many are deformed today due to medical negligence. I can continue to reel out the woes but I'll save the exercise in the hope that things will get better, someday. As for me, with three doctors diagnosing three unconnected ailments from the same test results, I live with my fears!Someday, in the end, everything will be alright. If it is not, then it will not be the end.Owoyemi Olorunfemi is a Lawyer. He wrote from Abeokuta
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