By Bala Ibrahim
Barely few days after the government had succeeded in reaching an agreement with the striking resident doctors, whose nine days strike almost completely crippled activities in public tertiary hospitals across the country, the momentum for another strike is fast building again in the hospitals. This time around, it’s coming from doctors on Houseman-ship or internship.
Contrary to the established tradition of permitting students to do their internship in the schools of their training, where they would be moulded further in the hospitals they underwent training, a new policy is in the pipeline, to post them elsewhere. By the planned arrangement, students from ABU for instance, could find themselves in Akwa Ibom, and the vice versa.
In theory, it sounds laudable, because it would support the principle of federal character, but in practice, it would achieve the reverse, as some sections of the country that are already disadvantaged, in terms of indigenous intakes and cultural familiarity, would be further short-changed.
By training and convention in Nigeria, Houseman-ship or internship program for the newly graduated doctors is a one-year compulsory period in the hospital, under the tutelage of the Consultants. After the internship program under the supervision of these senior licensed doctors, each house officer is expected to complete a one-year program in the National Youth Service Corp, NYSC.
During this period, they would have a provisional license from the Nigeria Medical & Dental Council MDCN, to practice temporarily, still under supervision. Thereafter, they can go into the residency program, which is available to any one that wants to continue in his or her medical career.
The duration of residency training in Nigeria is about six years or more. The training program affords graduates of medical colleges the opportunity to advance their knowledge in any medical or surgical specialty.
For the doctor in Nigeria, the journey from internship to residency only begins after his or her 6 year degree programme studies in medicine and surgery, where the doctors are heavily tasked on various courses that are relevant to the medical field.
This means, by simple estimate, it takes a minimum of ten years, for one to emerge as a consultant in Nigeria, after leaving the four walls of the university.
If we look at medicine as the science or practice of diagnosis, treatment, and prevention of disease, we should also look at the convenience of the doctor to discharge this responsibility in the context of his or her culture, particularly at the first line of practice, which is the internship.
Culture plays a huge role in medical interactions, because it influences how an individual might view an illness or treatment. Depending on culture, a physician’s approach to patients, particularly the elderly patients, may differ. And the vice versa. Some patients are more comfortable being treated by doctors of their own culture.
Since disease is a two worded word that stands for, DIS-ease, or the opposite of EASE, it means the objective of every doctor is to help the patient to arrive at a state of ease. As such, the propensity of the patient getting better or feeling at ease, would be higher if he feels more comfortable with the doctor he shares the same culture.
It is on the basis of the bias for this cultural comfort and cultural humility, under the supervision of their trainers, that it becomes imperative for doctors on internship, who are at the first line of practice, to be permitted to serve in the areas of their training, as that could affect the decision-making process of diagnosis, as well as the ease of transforming the patient from the DIS-eased, to the EASED.
Whereas the resident doctors’ strike was based on issues relating to underfunding, with attendant poor payment and the owing of arrears, the planned strike of the doctors on internship is to do with more. Apart from the underpayment by the MDCN, there is the issue of postings outside their catchment areas, or areas outside their cultural orientations and training, with the north poised to suffer most.
Similarly, the new policy of postings of these doctors for internship by the MDCN, may sound attractive, but could be subject to abuse by the staff of the MDCN, which has not taken the stakeholders, who are mostly the chief Medical directors into consideration before the commencement of the central program. A policy which may even give room to indiscipline by the doctors on houseman ship, because they know, they will be paid by the MDCN at the end of the month, whether they work or not.
It may interest us to know that, of the less than 50,000 registered doctors in Nigeria, 16,000 are resident doctors, while the remaining are doctors on internship and consultants. And the north is the most disadvantaged in terms of the intake, distribution and spread of such doctors on internship.
If the few that are trained and used to service their areas of familiarity and common culture are taken away, the distress of the diseased, may compound the pain of the patients.
Statistics have shown that Nigeria has less than 4 doctors per 10,000 people, with the bulk being doctors on internship. This is in sharp contrast to the UN recommendation of 2015, which suggests that countries should aim for a minimum of 1 doctor per 1,000 people. In other words, Nigeria would need at least 200,000 doctors to sufficiently cater for its 200 million people.
Should the little doctors on houseman-ship in the north, for instance, be continuously posted outside their areas of culture, or stay without a placement at all, the region stands to suffer additional jeopardy, because people in remote and rural areas, who already have limited access to any health care services, will be additionally, and adversely affected.
There are examples abound, during the corona virus pandemic, of how millions of northerners were deprived of potential lifesaving health services, because of the shortage of doctors. The MDCN should have a careful look at this policy and urgently call a stake holders meeting with the chief medical directors, in order to reappraise this new central posting programme of house officers.
As a country, apart from being the most populous nation, Nigeria is recorded with the highest poverty rate in the world. If the country is really interested in ending poverty and improving the health sector, it must desist from surreptitiously introducing such programme, which may end up worsening the health indices further.
Additional attention should be paid to the plight of those on internship, as well as the socio-economic dangers and the ripple effects that could push the doctors to strikes, and by extension, push more people into poverty.
