Why Nigerian doctors rush to S’Arabia, UK, others – NMA President – Ezenwoko’s Blogpapers

The National President of the Nigerian Medical Association, Uche Ojinmah, shares his thoughts with DAMILOLA AINA, about the union’s plans ahead of the January 31st ultimatum to the Federal Government to begin implementation of its salary demands, among other issues

With regard to the directive issued by the Medical Dental Council of Nigeria, what has changed? Have you met with the registrar on this issue?

Well, let me make one thing clear; the Nigerian Medical Association is not in conflict with the Medical and Dental Council of Nigeria. The MDCN is a regulatory body. The NMA is an association for medical practitioners and dental practitioners, while the MDCN regulates medical and dental practice.

The fact of the matter is that MDCN has every right to issue directives to guide actions within the medical practice, but what we do not like is the timing. It looks like an attempt to hamstring the association. And there are many issues on the table that we could have also got their input positively on. They could have written to the government advising them to pay doctors and not let them have any reason to go on strike. I still met with the MDCN registrar recently and we discussed. He has done what he could do from his office. And I have done what I can do from my office. He gave me his reasons. Some of them are plausible. But from where I stand, the shoe is pinching me and trying to hamstring me; I don’t think it was properly timed.

What were the reasons the registrar gave?

He said the directive was only trying to protect the profession from running afoul of the law. That’s his perspective, which could expose members to unnecessary interventions from outside bodies that do not have a right to do that. But the fact is that the NMA should have the latitude as a union to go on strike. As I said, we are not all about industrial action. We don’t want to go on strike. But if it is the only option left, we have no option but to survive because we are all Nigerians. We buy from the same market. We also use the same transport system; we fly the same airlines. And you could see the difference in rates and prices. Inflation is affecting our personnel too. So, that’s a fact. He is entitled to his opinion. And we have also expressed our opinion. And most of our members have applauded us for our stand. He also said the directive was not to specifically disrupt our activities but a standard directive.

But it was issued weeks before the deadline was given

Well, I cannot answer for him. I think you should see him to talk more about that. I have spoken of my part and what I know.

Medical associations went on strike last year and nothing of this sort came up. Why is this circumstance different?

It was the National Association of Resident Doctors that went on strike and not the Nigerian Medical Association. They regulate that association too but there is no evidence to prove he wrote to them or not. I may not know because I’m the president of NMA, which is the umbrella body for everybody. There may be specific issues, but I don’t think we should overflog this matter. It’s been taken care of.

Moreover, the letter was addressed to the administrative head and chief medical officers and not to the association. Why was it so?

They are the administrative heads that are supposed to run the hospitals. They are in charge of our hospitals, whether good or bad, functional or non-functional. So, the council is only giving them an advisory so that things are done from their perspective properly. The administrative officers are in charge of the hospital. So, their business is to, even if there is no work, see how they can sustain some health services. But as I said, I don’t want to overflog that matter. It’s been taken care of.

An industrial strike is not new in Nigeria. That’s been happening for years. But there’s always a particular thing about when it concerns doctors and even medical practice. People lose their lives because of your actions. How do you feel about that?

Let me, first of all, say that on behalf of whoever has lost someone in any of these processes, I want to apologise to all of them and pray that they understand. Even in the United Kingdom, doctors are on strike. In America, doctors go on strike. What the system should do is limit the options so that strikes will not be on the table. Doctors’ strike by NMA is not common. I am sure if you go back to history, you will notice that it’s difficult for NMA to go on strike, but when we are forced to, we will go on strike because it is somebody’s responsibility to implement agreements.

For instance, we signed an agreement with the government last year, but it hasn’t been implemented. Why do we need to beg for it? If you accepted and released a circular six months ago, you don’t need me to talk about it. You should follow through that the circular, effective from June. The government should be able to give a promise and implement it without hassles, which is a very important ingredient in good leadership. I keep telling our labour people that if the government remembers its promises to civil servants before the civil servants remember them, things will be better.

The government will give promises to increase salaries in five years, but when the time comes, they pretend not to remember anymore until we decide to go on strike. By the time members of these unions start agitating and the leadership is pushed into prompting the government, things can go crazy. But if it is the government that calls for dialogue, things will be different.

You have preempted the members and the leadership will go with a calmer attitude to discuss and then revert to the members. But when the members are already angry, any small mistake you make, they would say you’ve compromised, and the leader is caged and things can go wrong. So, the government should learn to be proactive. When you say something or sign something, remember it. That is why they have desk officers in those ministries. Why would they forget?

Going to those demands the President promised to implement, can you talk about them?

There are many demands. We demanded an upward review of the Consolidated Medical Salary Structure. And this is coming 14 years after it should have been done. The current salary structure was released in 2009. It was agreed that it would be reviewed after four years in 2013, but 10 years later, several leaders of the NMA have gone through office and they have written to remind the government with no response.

When I became president, I immediately wrote to the government with facts on what they promised. As fate would have it, a discussion ensued and in the process, even though it was a bitter pill to swallow, we demanded a 200 per cent increase in salary. Why did we demand for that amount? We did a calculation of the purchasing power of the naira in 2009 and 2023, you look at the fuel pump price and the exchange rate; we noticed that our salary depreciated by over 80 per cent between the time it was given and now. So, it’s like we are earning minus 80 per cent of what we were earning in 2009. Therefore, we said that the first 100 per cent was to bring it up to what it was in 2009. Then the next 100 per cent is a salary increment.

So, we presented a 200 per cent demand. And after much negotiation, the government appealed us for our understanding and our members were quite nice to say, ‘Give 25 per cent for CONMESS 1 to 6, and 35 per cent for CONMESS 7 because you want to make sure you retain the top cadres that are draining.

They also approved a new allowance for our clinical coats and scrubs, which we used to buy ourselves. Our members urged us to accept and we did. By July, the circular came out saying it would take effect from June and no longer January 2023 which we agreed with them. But from that time till now, it has not been paid, and nobody has told us any reason why it has not been paid. Even negotiations on the upward review of CONMESS allowances, nobody has called the meetings for that till today. So, when you put it all together, it’s obvious that somebody is taking us for a ride and that’s not right. Hence, at our national council meeting, we gave them till the end of January to pay, or we will activate the process within our constitution for an industrial action.

In a scenario where the government decides to start payment from January 2024, forgetting all that happened last year, what will the association do?

As long as there is a laid down process of clearing the arrears, they can’t disregard it because the signed circular stated the commencement date. There is no argument for that. Sometimes, the government can say, ‘Please, give us till the end of two months to pay the arrears’, but let’s start fresh payment this January. We are all human beings. You just keep your promise. That’s the most important thing in this system. Doctors are people of promise and they should keep their word.

Has the FG reached out to the association concerning the ultimatum?

No, it’s the ministry that reached out to you. You know that the presidency cannot jump over the ministry. It is the ministry that can escalate to the President and say, ‘You need to come in here, and I don’t think they need him yet.

If nothing is done before the ultimatum given elapses, what will you do?

The NMA has its own system and mechanisms of action, and if understanding is also sought and the members decide to agree, I cannot, as an individual, tell you what will happen because whatever will happen will be decided at a meeting. So, if things don’t happen, we will go back to a meeting and take a decision. It depends on when issues crystalise. But one thing everybody knows is that the NMA knows its powers and does not throw them around anyhow. And that means if it must be thrown around, there must be concrete reasons and the government must be quite culpable for that.

If you go on strike, will you adhere to what the MDCN has said?

I don’t know why they (MDCN) needed to re-emphasise that, because a whole lot of times when there is a lower-level strike, the consultants always come around to do those skeletal services. Anybody could have his relative or his family member on admission. We are humans too. There was a time when there was a strike and I had to take a patient to be administered treatment free in a private setting. It was a patient that used to take anti-cancer drugs. And I knew we could not break it. So, we arranged a place for treatment, and we’ll go away without paying anything for that. But we’ll maintain it until we return to work.

So, a lot of doctors in Nigeria do many free things. I want you to know that the fact that I’m practising here is sacrificial by nature. This is the fundamental truth. If as NMA president, I decide to leave Nigeria today within the next three months, you won’t see me here. So, every doctor who remains in Nigeria today is aware of their potential and has chosen to stay. So, people should not think we are fools. We know what we are doing. But when there is no option; if you beat a dog or kick a dog, it will bite.

The last discussion with the President led to the current unimplemented promises. Why do you think about this vicious circle of assurances and zero enactment almost every time?

As they say in administration, resources are limited and demands are unlimited. Therefore, sometimes you may have to be strong for your demand to be met. As a father, my children may all ask for something, but one may decide not to leave you and follow you around till he or she gets it because you may not have all it takes to solve everybody’s problems. But I also believe in prioritisation. In my family, if your demand is education-based, you are bound to get it faster than if your request is for fashion.

So, the government must learn to say there are areas of utmost importance. If they say we can japa and they will train new ones, I now wonder who will train the new ones. Are we going to convert nurses into doctors or servants to nurses? How do we do it? If I leave this country today as a consultant with many years of experience, who will replace me in the world of dermatology in Nigeria?

The government must change its concept. Exporting your skilled workers is not something to be praised. It’s not a positive assessment and they must match word with action on this issue of brain drain; medical brain drain and health brain drain. But nobody is doing anything. The four indices that push brain drain are well-known in this country. They are poor remunerations, lack of job satisfaction, insecurity, and an unstable economy. When the economy is unstable, even what you are paid depreciates in your hands. Do you know that the money we make every week goes down and the dollar keeps going higher? The money in your bank is getting useless.

In Nigeria, the government taxes core duty allowances, and basic salaries, and when I skip over to Saudi Arabia, I have a non-tax income. I am earning N4m to N6m a month relative to the N400,000 that you are taxing. Then they will give me a free holiday; paid for. I can bring my family. Wouldn’t it be unfair for me to say no? So, if you need doctors, you set up the system to get them. That’s what they do outside there in America, in the UK, in Saudi, Qatar, and Oman. They set up salaries, tax, and holiday incentives and they even make visas easy to get. Let me inform you that Sierra Leone, Liberia, and Gambia are still taking doctors from Nigeria.

Are you saying that trend has continued even with the outcry last year?

Yes, what were they supposed to do to stop the departures? They have not done anything. Is it not the same salary increase we were talking about that they haven’t paid? The system is still the way it was. It’s like we are looking at an armed robber stealing but nobody is shooting or chasing. It’s even worse now. That’s the truth because the pull factors are getting stronger; the naira is getting weaker, and the dollar is getting stronger. So, the economy is in bad shape. The salary is the same and continuously depreciating. Kidnapping has gone haywire and the hospital work environments are not looking better. I know they don’t want me to say it but I’m sure an average Nigerian knows this situation.

Recently, the Bauchi State governor applauded the export of doctors, saying it can increase our forex revenue. Is that not a good opportunity?

Oh yes, it’s a wonderful one. But why don’t we export our governors for forex or our senators to America for foreign exchange? If the aim is to bring in forex, and you have to use the same forex to go outside to see Nigerian doctors who have left, what have you done? We cannot because we like to eat rats, convert our home into a rat playground.

Likewise, we cannot train our medical personnel for export because we are looking for forex. Who will certify them fit? Will the customs stamp them for export? So, when you get the forex, what happens to our grandmothers in the village when they are sick? What happens to our children? Who will take care of the birth of the next generation? Who will train the next set of medical doctors and the nurses? It is obviously not well thought through.

They don’t understand why we are complaining about this particular brain drain that is peculiar. The brain drain that used to happen before now was that old doctors tending towards retirement leave the country to make money for retirement. They usually come back. Now we are losing the young and old too. So, it is like you’re losing your machine and your raw material together and the company will fold.

On the welfare of doctors, what is the association saying about increased cases of doctors collapsing during work?

We have our welfare committee that has been enlightening doctors about regular checkups. It’s very important. One thing about doctors is that they work continuously and they always neglect their health trying to resolve their patients’ cases till they collapse. Many doctors believe that they know the body system. So, when things are going wrong, they will have an idea. But there is a reason why we say every doctor should have a doctor. Don’t be your own doctor. And we have been sending out a message. During the physician’s week in October, we had a webinar on doctors taking care of themselves psychologically and physically because there are a lot of psychological components to our work.

So, we are encouraging Nigerian doctors to check themselves up, even if it is two or three times a year. Routinely look at your system; we have also made that part of our medical pledge to take care of our health and we hope there will be fewer cases of doctors collapsing during duty this year.