Getting Off the High Horse

In the past week I have been slandered, insulted, even threatened. I have been called arrogant, egocentric, delusional and maniacal… In fact, they have said they may not allow me to pass my “part 6 (sic) MBBS exams”. Interestingly, majority of such statements came from a particular profession more than others; yes, the very ones I said must have been taught sauciness in school. Well, I am a doctor, to be, and I hereby, here and now, pledge allegiance to, and pitch my tent with, Doctors– the ones with powers to pass me, or not.


Perhaps I have been biased in my stance. Perhaps.


In this sequel to CONSULTANT, My FOOT, and The Eyes of JANUS, I shall therefore endeavour to set aside passion and emotion, affiliation and allegiance, set the issues raised on the table, and discuss them openly. For the truth is, everyone has been toying with the truth– as the Yoruba say, Kò s’ẹ́ni tí kìí kọ ebè s’ọ́dọ̀ ara ẹ̀; no one hoes the soil away from himself. But the Yoruba also say, ẹjọ́ò ní jẹ́ẹjọ́ẹni k’á má mọ̀ọ́ dá; one cannot have a matter and not know how to judge it.


When I said

When I said the politician like everyone else wants (his credentials) to be doctored, not nursed, I was referring to the modern trend of everyone being doctors, PhD holders, even when such certificates are bought or forged.


When I said other health workers did la cram, la pour in school, I didn’t mean there were no brilliant students in those courses. I meant most of them cram structures, equations, doctrines,… I meant in Medicine, more than anywhere else, cramming is a tricky art for one needs in-depth understanding and demonstrable applicability to survive– particularly the clinical exams, and ward rounds.


When I referred to my pharmacy wife, it is NOT because I do not respect her, as has been suggested; it is because I respect her enough for mention. In fact, if there is any bias I have been guilty of, it is that I have been very fair to pharmacists, more than anyone else; which is because I believe they are the “men of honour,” only they are joining hands with the wrong folk…


I am now aware that the Nursing and Midwifery Council of Nigeria (NMCN) has been registering male midwives since 2007, but how many of them were trained in Nigeria? and practise in Nigeria? Since when have midhusbands been registered elsewhere in the world? And I know that a lot of high-ranking nurses– in Nigeria as well as all over the world– are yet opposed to the idea; or why did it become a court case? I have never seen one… so for me they still do not exist– now I’m being like the Biblical Nathaniel; or is it Thomas?


When I said the admission requirements for Medicine are higher than for others in the health sector, I meant currently, not in the 50’s, 60’s or 70’s when some professor was in university. I meant a lot, not all, of these people were (repeatedly) denied Medicine for lack of admissible results before they moved on to study para-Medicine, and now they yet want to have their cake and eat it: consultancy, CMD-ship…


When I said Nightingale was put in charge of orderlies, it was to mean she oversaw their work, as nurses yet do, and even screened and employed them. That was how much she was respected, and is, even by me.


When I said Nightingale did not leave behind an oath; of course, she didn’t. The Nightingale Pledge was composed in 1893 by Lystra Gretter, and modified in 1935– hopefully story for another day…


They have said…

They have said they had higher JAMB scores than most Medical Students. How many of them did? There is no denying that each course of study has brilliant students within its fold, but in what proportion?


They have said their courses are just as strenuous. Again, how many of them? The eighteen-month course? Àbí the three-year own. As the Yoruba say, he who has not been to another’s farm will claim his father’s is the biggest… Why aren’t the paramedics turned medics not supporting these claims? At least they have been on both sides and are in the best position to compare… and some have come out to tell us how they wrote JAMB after JAMB, year after year, to finally get into Medicine.


They have said they took Reproductive and Digestive Physiology, as well as Neuroanatomy as borrowed courses. In the Medicine Curriculum there are six in-courses in each of Physiology and Anatomy. Can someone who studies three outta twelve claim to know quite as much as one who studies all?


They have said we use the same textbooks. As we all know, knowledge goes beyond textbooks. I can as well not go to Med School and just read textbooks; will that make me a Doctor? will you lemme treat you? They forget that we all have textbooks on the market. Will reading a nursing textbook make me a nurse, registrable with NMCN? or reading a PCG textbook, a pharmacist, registrable with PSN?


They have said they scored higher than (some) Medical Students in their borrowed courses. Yet, if I score better than (some) nursing students in a core nursing course, does that make me better than nurses? a better nurse? or a nurse at all?


They have said they attended the same classes as the biochemists, physiologists, anatomists and pharmacologists that teach us at some point in our programme. Yet, if a student I taught to pass JAMB ends up being a nurse, does that make me a nurse, or better than a nurse? If she ends up teaching in School of Nursing, does that make me a nurse, or better?


One has said nursing students won final-year medical students “in an interdepartmental DEBATE on bothering national and international health issues” (capitals mine). How does a debate help me to manage patients? Na by force to write article? If una no get point why belabour the issue na? Ó ga o. Bí’yà nlá bá gbé’ni ṣán’lẹ̀, kékeréá máa gun ni; when the big issues fell one, the small ones walk over him…


They have said we bar them from attaining the peak of their careers: consultancy. Why do auxiliary nurses not become Chief Matrons? Why do orderlies with as much length of service as CNOs not have a title of honorary nurse conferred on them? Why can’t pharmacy technicians become Director of Pharmaceutical Services? Why can’t a gateman become a Minister of Defence?


They have said that a nurse-led hospital in the UK having an MRI machine as against many hospitals in Nigeria not having one is proof that nurses make better Directors. Yet the questions I ask are, Did the nurse buy the machine out of her own purse? Do Nigerian CMDs control government’s budget or priorities?


They have said Doctors are no big deal. One wonders why they urge us back to work when their wealth of experience can very well replace us. They must not have understood what it means to (want to) be consultants: to be your own boss, to stand alone, to take responsibility…


They have said C. we-sef-waka-come is here to stay. Well, I agree. But on what basis shall these consultants be appointed? In the health sector of all places, consultancy should be about competency and not length of service, about residency and not experience. After all, we deal in lives; and lives are irreplaceable. Are members of JOHESU going to enrol in residency programmes to become consultants, or are they just going to share titles of honorary consultancy? Because in the latter case, they will start off with experience/length of service, and, like everything else in Nigeria, end up with Oga at the Top, and godfatherism, and na-who-get-money-pass.


They have said they study 18 000 drugs in one year, that they learn about 25 000 drugs– like we don’t! Please ask them why they can’t cure cancer or sickle cell disease, or defeat malaria… Since, apparently, Medical Doctors do not know about that many drugs– at least that is how they make it seem– how come we know just the drug(s) to prescribe? how come they come around to lobby for their drugs to be prescribed? how come the ones posing as Doctors to patients and criticising us in their presence play Nicodemus and bring their relatives to us in secret? Yes, I said it! Na lie? No be so una dey do?


They have said we can’t make diagnoses without them. Do they even know what clinical diagnosis is? or differentials? or provisional diagnosis?


They have said Doctors are egocentric. What about the nurses that ridicule Doctors in the presence of patients? Or that will not join ward rounds until summoned? Or paramedics that will consult as Doctors in their bedrooms and shops, and perform abortions on their beds and tables?


They have said we care about money. Who doesn’t? They have said the only thing we care about is money! Then who saves the lives? They? Then why not manage patients when the Doctors are on strike? When they go on strike they lock everything up, even ordinary bed pans! But they won’t tell you that. They do shifts and take night-off’s… We don’t. We are at work Mondays to Fridays, 8 till 4; plus weekend calls every now and then. Still all we care about is money. Really?!


They have said Medicine is charity. Well, so is para-medicine– unless they do the Devil’s work on that side of the divide. But to put things in perspective, Medicine is a humanitarian service. And that is why we donate money for patients, even blood! What more can one ask of us?: That we kúkú do not make a living? Abaa! There is God o…


They have said Consultants don’t do anything. Please ask them why they so want to be consultants. So they too won’t do anything? Well, while it is true that Consultants run their clinics once a week, the surgeons have a theatre day another once a week, and they all have a ward-round day another once or twice a week. So, coupled with their teaching under- and postgraduate medics, how can they possibly not do anything?


They have said House Officers don’t teach! Well, they teach us Medical Students. And they are the reason we pass: they come down to our level, teach us all the tricks in the books, and the answers to all the choicest questions our Ògá’s love to ask. And nurses too learn from them– If their egomania will allow them admit. But then, why do these people say stuff they know nothing about?


They have said Doctors travel out to become orderlies and nurses. Please ask them to get their facts straight…


We say…

Currently, hazard allowance is 5 000 naira for all health staff (those who receive it) in Teaching Hospitals irrespective of status– both doctors and non-clinical staff. Do they face the same hazard? Don’t you think the Cleaner who cleans up blood and vomit of patients should get more hazard allowance than the administrative staff who sits in an air-conditioned office till the close of work? Yet that of university lecturers is said to be 30 000; and if we talk, we too like money…


The developed countries they keep referring to have maintained the hierarchy and status-relativity in their health system. If JOHESU wins this lobby, one day in Nigeria:

Court clerks will ask to be Judges– after all, they are graduates;

Police will ask to be Chief of Defence Staff, or are they not part of the sector?;

the Chemist can answer Pharmacist, don’t they both deal in chemicals?;

the auxiliary nurse can ask to be Chief Matron– after all, she has 30-year experience;

a recruit soldier can ask to be General after fighting several battles…


Nobody is looking down on any profession. They all have their relevance and limits.


And it is perhaps on that last note that I should remind you that I am yet a bloody Medical Student after “spending nine years for a six-year course”. But, that “until [I] become a fully certified medical doctor, [my] contributions in this debate are rather unwelcomed”– as they have said– in a country where there is freedom of opinion, and of speech, and in an academic environment, is to become arrogant, egocentric, delusional, and maniacal– as they have also said, even one who graduated in 2012, seven years after I entered for a six-year course.


Ayokunle Ayk Fowosire.


One of the defining moments of this struggle for me was an article by a JOHESU member analysing the 24-point agenda of the NMA strike, and concluding– erroneously, of course, as I have shown in the foregoing– that only one holds water: “the endless circles of incomplete salary payment to our members in many hospitals in the name of short falls in personal cost must stop”. It was for me the height of mischief and hypocrisy, and I will explain…


The writer felt having a Surgeon-General as is done in other climes will lead to anarchy since it will be a position accessible only to Doctors, and since, according to him, other professionals will want to have Generals too– as is not done in other climes. Yet he fails to see how having multiple consultants will likewise lead to anarchy– and for the same reason…


Concerning skipping of levels on the Civil Service Scheme, he wrote that one’s entry point is “based on the number of years one spends in school.

Those who spend four years have their entry point as level 8,

Those that spend five years on level 9,

Those that spend five years with one year of internship on level 10,

[permit me to include this at this point: Those that spend six years on level 11– If there was one]

while those that spend six years with one year internship on level 12.”


The untold part of the story is that there is no level 11 in the Nigerian Civil Service Scheme and as such paramedics move from levels 10 to 12 at some point in their careers. But since Doctors enter at level 12, they are denied that privilege. In the name of fairness and equity and justice that JOHESU has been singing, why then shouldn’t Doctors enter at level 13 to make up for the promotion everyone else gets? But no, to JOHESU the House Officer is a “neophyte, a green horn,” deserving of nothing– not even the acclaimed fairness and equity and justice!


And when you consider that unlike other courses that manage to throw out their students (nearly) on schedule, Medicine holds onto you until she deems you safe enough to save lives and salvage destinies, so that one ends upon spending an unknown number of years overtime, isn’t the purpose of entering ahead of others defeated when one still enters at level 12– or 13? Yet, when we say these, we ask for too much from our high horses…


And for me, the whole purpose of JOHESU is summarised in this rather pathetic reasoning: “…within the next ten years of a doctor starting work, he can get to the zenith of his career[;] which work will he be doing? And when most of our consultants are part time doctors because they work and have Clinics days only once a week.”


Now you know why they want to be consultants and CMDs; why PS of Ministries of Health is not enough; why they beef us so much. Yet we are the ones on the high horse?


I only hope everyone realises that this too shall pass eventually, however it ends. That we will yet work in the same hospitals, the oppressor and the oppressed alike. That one must be mindful of the way he shuts the door, lest he shivers when he finds he needs the same door on his way out. And that anger brings out the pride in one; so that one is not as humble as he writes, nor as proud.


Truth is, we have all been toying with the truth.

Ayokunle Adeleye

Ayokunle is a doctor, a writer at heart, his opinions are strong and he wants a better society. Follow him on twitter @adelayok