Chairman, Edo State branch of the Nigerian Medical Association (NMA), Dr Osahon Enabulele, has said that the kidnapping of doctors, which the state witnessed in recent time was instigated by comments from some government officials but the indiscriminate act has been curbed by a mass protest by the Edo NMA.

He spoke on this and other issues such as Governor Adams Oshiomhole’s one year in office plus the politics in the health sector. According to the former gubernatorial aspirant in Edo State who is at the forefront of calling for the position of the Surgeon General of Nigeria, “We need a technical expert close to the president, who will from time to time, guide the president on how the health care environment should be allowed to evolve, or develop and the needs and necessities that are required to ensure that we have a robust health care environment are met.”

Excerpt:
Sir, how would you access the current state of medical practice in Nigeria?
Well, the current state of medical practice in Nigeria is still low in terms of the environment. We have practitioners who are willing to give their best but the enabling environment is not there and so you find out that the practice is still struggling to arrive at where others in developed parts of the world are. A lot of challenges and constrains such as human resources, remuneration pattern and the workplace is extremely challenging. By and large, it is still a struggling practice. The manpower and excellent expertise is there but when you have no tools to work, it becomes a very terrible situation. We believe that there is still a lot to be done to improve the level of practice essentially if the government sees it as a priority.

Has the situation always been like this?
The situation has never really changed. It has been like that for quite some time. You find out that essentially, when a government does not have priority for the health sector, then little or nothing is done to improve it. Every now and then, you hear of government officials going abroad for the slightest of medical condition and that tells you that they do not have regard for even their own health care environment. And so, you find people who are supposed to care for the system, rather than do that, prefer to receive treatment even for upper respiration infections and gastroenteritis abroad.

Over the years, less and less emphasis on the health sector in Nigeria has led to intense degradation and of course, even the little that has been given to the sector, there is no guaranteed measure to sustain these facilities or the environment. As a result of these, there is total decay and it cuts across states of the federation; different facilities in the country. Even in the re-branding, we need to now internalise some kind of re-branding of our style of administration, our style of management right from the top to the lowest. The situation has tremendously been like that and we hope there would be an improvement.

What do you think is problem with the health sector ?
I have said it. The problem is that most leaders of the various states in the country, including the president, over the years, have not really seen health as a priority. They have failed to realise that health is important to drive the economy of any nation, to drive productivity in any economy. And if the health of the country is down, of course, the economy will be down, productivity will be down and so, you cannot drive wealth. If government is really interested in realising the so called vision 2020, health must be seen as number one priority. For instance, why should a state vote less than 3 per cent be for the health sector?

That is tremendously appalling. Even when the world is saying that look, at least 15 percent of the budget of any nation should be voted for health, in most states of the Federation and even at the national level, you still find increasingly that people don’t even vote up to 1/3 of the budget for health and that tells a lot how they regard health. Rather, for a country that is not at war, you find more of the resources of the country channelled towards defence, channelled towards situations that do not call for that kind of huge expenditure. Unless and until they begin to see health as number one, as a prima towards driving human capital development and of course, even productivity, economy and the wealth of the nation, we will continue to be like this. So, it is beyond politicising issues of health, singing political tunes as to how you want to achieve Millennium Development Goals (MDGs) and all that. There is nothing on ground to show that we will be able to match those political words with actions.

How will you differentiate medical practice between then and now?
I can only speak for the time I have been in practice because I am still growing in the practice even though I am a consultant family physician and I can only speak for close to about 19 – 20 years down the line. I can also say yes, even from stories we have heard from those who went before us, there was a time especially when we had the Chief Medical Adviser who was very close to the president as a statutory organ of a government, there was a time when medical practice in this country was at an appreciably, acceptable level where the needs of the health care environment were looked after.

The needs of the professionals of practitioners of medicine were looked after but when the position of the Chief Medical Adviser to the president was eclipsed, we have had a situation whereby the health care environment became highly politicised and increasingly also, we have had a situation whereby top priority has not been given to the health care environment since the eclipse of the position of the Chief Medical Adviser. And that is why we are calling again for the position of the Surgeon General of Nigeria, that we need a technical expert close to the president, who will from time to time, guide the president on how the health care environment should be allowed to evolve, should be allowed to develop and the needs and necessities that are required to ensure that we have a robust health care environment are met. From the stories we heard from those who have been there and from the little we have witnessed, compared to now, one of the reasons like I said is because the health care environment has been so politicised and nobody believes again in professionalism, everybody wants to be like the doctor in the health care environment. Nobody believes that he has defined limits or defined responsibilities even within the health care system.

In developed societies of the world, you find out that everybody knows what merit is, even in the application to the health sector. Everybody knows what professionalism is all about. Again, government must begin to recognise merit and professionalism even in the allocation of resources to the various sectors in this country, especially the health sector so that people can have some level of job satisfaction and increase productivity in the sector.

Are you saying that politics brought about the woes in the health sector?
Absolutely, politics has infiltrated into the health care environment. People must now restore professionalism to the health sector and properly place individuals. There is no basis to say that because health care professionals are not anywhere in the corridors of power, their needs would not be catered for.
For instance, look at the remunerative injustice in Nigeria. Before 1995, a medical consultant in this country was earning just less than the Chief Justice of Nigeria.

He was even earning more than the permanent secretary because of the nature and dictates of his job. But these days, you find the same medical consultant in Nigeria, even with the recently improved medical salary structure for doctors, which I was instrumental to way back 2003, as the acting Secretary General of the Nigerian Medical Association, which will take effect from January hopefully, the medical consultant is still not anywhere close to a judge who he was earning almost twice his salary even as far back as 1995. Because the man is catering for his patients and does not have time to play politics with others, or finds himself in the corridors of power, the man has been neglected and that invariably has impacted on the quality of care within the health care environment and so, we are saying that politics has had a tremendous impact in destroying and decimating the vital essentials and structures within the health care environment.

A councillor today is earning far above a medical consultant. In a responsible society, why should that be?
Who is a councillor compared to a medical consultant who has gone through years of rigorous training? I mean, just because you are elected into a national assembly, you are now almost like a god in this country, earning far and above those who are really giving care. It is only when they fall ill that they remember that practitioners of medicine are there. That was not why the Hippocratic Oath was formulated by Hippocrates in the days of yore. The Oath was to be kept strictly with the assumption that the necessities of life, an acceptable environment, will be provided for the health care practitioners.

Societies cannot expect that much from health care professionals in the name of adhering to Hippocratic Oath without providing those essentials that Hippocrates asked to be provided for the practitioners. That was why Rudolf Virchow, as far back as 1920s, who indeed, was very instrumental towards redirecting the focus and position of doctors towards politics said, “Essentially, medicine and politics are no difference. If there is anything at all, politics is medicine on a grand scale. And that is why we are now encouraging practitioners of medicine to veer into politics so that we can begin to direct policies in this country and prioritise the various sectors so that those who deserve to get much should be given so that the society can move forward.

I have always said that if the president of Nigeria is sick, it is assumed that this country is sick. If a judge is sick, he cannot deliver sound judgement. If the president is sick, of course, he cannot rule. The same thing applies to state governors and other individuals. Health is number one but this country has failed to realise that and we hope and pray that we can have a critical mass of individuals who can now begin to re-prioritise the system and ensure that there is growth, sustainable growth at that in this country. That is the only way we can achieve Vision 2020 and the MDGs.

Edo State in retrospect: The Comrade Governor is one year in office. How would you access his administration vis-a-vis, the health sector?
Before I come down to the health sector, I want to see one year as a year of struggling to stabilise, a year of planning and organising. I am not one of those who want to quickly begin to access and score any government on the basis of having spent one year.

I think perhaps, by the time he has spent two years in office, we will come to substantial point when we will be able to access him. If you look at how he came in and what he has been trying to do, trying to address the fundamental challenges that were thrust upon the state by years of lugubrious and doleful performances by past governments, you may not be able to critically access him but if you ask me based on what he has presented to the people, based on the budgetary performance and the manifesto, one may want to say perhaps, he is still trying to get on board.

Yes, there are one or two areas where interestingly one can easily score him well in terms of changing the face of Edo state by way of the beautification exercise even though that has come with a lot of demolition and a lot of harm on the poor citizens which again, has the tendency to increase the level of criminality in Edo state, but in terms of core policy direction, one thinks he has been doing a lot of planning and by the second year, we may be able to see a lot of these physical developments.

In the first year budget, he spoke about synergising or integrating road construction with beautification, flood and erosion control but we know that up till now, our roads really have not received tremendous attention in terms of physical construction and he has tried to explain it out that he has been doing a lot of planning and design and at the town hall meeting, he told us that the designs are now ready and hopefully, at the end of November or December, we shall see road construction coming on stream.

In the area of education, they have faced a lot of challenges and up till now, we are yet to see any real development in the education sector.

In the health sector, the same thing is there. Right now, the Nigerian Medical Association (NMA), which I superintend, toured all the health facilities in the 18 Local governments and we have since declared through a press conference that the public health facilities are still as bad as the government met them. We have been told that a lot of contracts have been awarded.

In one year, it has been that of planning, designing and award of contracts and hopefully, we are saying that in the second year, we can begin to see the much we are expecting.

Kidnapping of doctors in Edo State
The level of insecurity in the state has been bad and we as an association felt that we could no longer endure it since it looked as if everybody was left to address his own problem security wise, even with the provision in the constitution which guarantees that certain arm of government, especially the executive, will have to guarantee the lives and properties of the citizens.

Admittedly, some efforts were made by the government but were not substantial enough to address the situation and so, on a daily basis, the citizens of Edo State were being kidnapped especially doctors. And the kidnap of doctors got to an ascendancy after certain individuals in government were making pronouncements to suggest some very wrong assumptions concerning the earnings and income of the doctors in the state and increasingly, doctors became the focus of these kidnappers, criminals and hoodlums. It came to a point when we relied in the words of Chief Obafemi Awolowo who said, “If those who are vested with the responsibility of guaranteeing the security of lives and properties cannot do that, then, the citizens must rise up to take that responsibility.” We also felt that our cup of endurance had run over and we could no longer wait to see our doctors frustrated out of practice.

Again, people were no longer practising because of fear. That engendered the historic cum monumental first ever street protest by doctors in this country which we did on Wednesday, August 5, 2009. The mass protest has given us respite for a long time because since that protest, we have not witnessed any case of kidnapping of our members and that tells you that even the kidnappers got the impact of that mass action. We also believed that in doing that, we will be raising the consciousness of our people because government may do everything but if there is no neighbourhood watch, and the people not conquered fear and wake up to their responsibility, to care for themselves and guarantee security, then will just be missing the point.
Our protest was not only aimed at gingering government to rise up and do the needful but to also raise public consciousness to the fact that we all have a responsibility to even guarantee our collective and individual security and that essentially has resulted to a situation where since August 5, I can tell you happily that no doctor has been kidnapped in Edo state.

Proper measures must be put in place to guarantee the lives and properties of this state. Edo state used to pride itself as the most peaceful state in Nigeria but right now, by 6pm, everybody is indoor not because you want to be indoor, but because the fear of the criminals have forced you indoor. The fear of kidnappers and criminals is now the beginning of wisdom in Edo state and this should not be.

We believe that certain factors have made Edo state become very unattractive for the citizens and investors but we also believe that with our action, coupled with the renewed action of the governor by way of the joint police and army task force, we can look forward to better days ahead.

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