Abia doctors facing hardship over 23-month unpaid salaries –NMA chair

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Chairman, Nigerian Medical Association, Abia State chapter, Dr Isaiah Abali, shares his views with CHUKWUDI AKASIKE about the unpaid salaries of medical doctors in the state and other issues

Doctors in Abia State have not been paid for some months. What is the current situation with your members who have been working without earning salaries?

If you are talking about doctors who work in the ABSUTH (Abia State University Teaching Hospital), the doctors that work in ABSUTH are actually owed about 23 months’ salaries if you add the September salary. So, it is 23 months salary arrears and not 26 months. The resident doctors in the ABSUTH are owed 25 months. But yesterday (Monday), the Commissioner for Health called me and said the resident doctors alone would be paid seven months today (Tuesday). So, at the end of today, we will know whether that one will materialise or not, while the other staff members will be paid one month. That will reduce the salary arrears owed resident doctors to 18 months, and that of the other workers to 22 months.

It is surprising that medical doctors, who are held in high esteem in every society, have not been paid their salaries for more than 20 months. It appears the Abia State chapter of the NMA is silent about this. Why is it so?

There have been protests on this matter. We have met with the government and other stakeholders on this issue. I joined several groups in the past, including the Nigerian Medical Association and that of critical stakeholders in the ABSUTH, and each time, we get promises that never get fulfilled. Mind you, the Health Management Board, the general hospitals, the doctors there are also old, they are owed about 13 months, and this September will make it 14 months.

Do you have any fear that the doctors in your state may embark on a protracted strike if their salary arrears are not paid?

The resident doctors of the ABSUTH have been on strike since April last year. Currently, from what I have heard, the National Association of Resident Doctors, which is the national body, said they would ask their South-East members to join the strike, so that it will not just be this hospital. Of course, that will make more impact. But I don’t know if they (resident doctors) will be pacified if they receive the seven months’ salaries today (Tuesday). I am not a member of NARD; so, I wouldn’t know.

How far has the doctor’s stamp implemented in your branch of the NMA helped to end quackery in the state?

Many people who go to hospital don’t really need the stamp; they just go to hospital to get their treatment and then go away. The issue of stamp comes when you need a medical report. The stamp helps to stamp out quackery at that level so that people use the stamp to identify who is a doctor, but most people in Aba, where I stay, don’t mind; they go to where they think they will get the services probably cheaper. That is why quackery thrives. Don’t forget too that some of those places we classified as quack centres may be registered hospitals. Let me give you an instance; a doctor may register a hospital with his name, and then for whatever reason, decides to lease it out. It is like all these people travelling to Saudi Arabia, the United Kingdom, the US and other places. When the doctor does this, he may lease that hospital to be managed by somebody he probably calls an experienced nurse. Of course, you know that a nurse practising as a doctor is a quack.

Also, some nurses may get a hospital and get some doctors to register it for them. The hospitals may actually be registered hospitals, but it is just that the person managing the hospital may not be qualified. Again, some people don’t even bother registering. They just open it with any name – hospital, clinic. Some people also register as other establishments that are not really hospitals. An instance is a pharmacy. Even pharmacists sit down in their offices and somebody comes to ask for medicine for high blood pressure, they will prescribe drugs for you. That is another form of quackery because for now, the law establishing pharmacy does not allow them to prescribe drugs. So, if they prescribe drugs, it is another form of quackery. Even lab people too, when they carry out lab tests for people and they list out the medications and give prescriptions, it is a wrong practice. The issue of quackery is multifaceted.

Is there anything the NMA is doing to ensure that quackery is eliminated or reduced?

In the past, we have done a few things. There was a time when we caught a man who was working in a mission hospital as a doctor, but he was not a doctor. When we got the news, we got him arrested by the police and on interrogation, we found out that he had a certificate from the University of Port Harcourt, but he confessed that he just took his friend’s certificate to an artist, who duplicated the document with his name on the certificate. Then I was the state NMA secretary and not the chairman. So, we eventually got the police to take him to court. To be frank, I don’t know how the case ended because the case was ongoing when we handed over to a new regime.

What is the level of campaign against monkeypox in Abia State? Is the state making the kind of progress it made during the COVID-19 era?

Many people are not so much aware of monkeypox. Really, jingles are there, but I don’t think the impact is like that of COVID-19. You can’t compare the impact of COVID-19 campaign to that of monkeypox. In fact, some people don’t even know what monkeypox is. The campaign is going on, but the impact is nothing compared to even the Ebola virus campaign; everybody was aware of Ebola virus compared to the knowledge about monkeypox.

What is the current state of public hospitals in Abia State?

The public hospitals in Abia State are working. Members of staff are not on strike except members of the Association of Resident Doctors, which I talked about earlier. Apart from that, other people are supposed to be working. But the level of activities there is minimal; it is nothing to write home about compared to what it should look like.

Is it because of the non-payment of salaries?

Yes, the issue of non-payment of salary is causing incessant strikes. Today, we are back; tomorrow, we are on strike. So, a lot of people have lost confidence in the system. I remember, as a surgeon, I wanted to operate on one man last year, the man told me that his fear was that I would leave him and embark on a strike, and that he preferred going to a private hospital. I told him that I would not abandon him or take him to any private hospital. If I meet a patient in the private hospital, I will take care of the person. So, I don’t know what he finally did. He rejected the surgery on the grounds that we may proceed on a strike after the surgery.

What about the current state of facilities in Abia State public hospitals?

Well, I have not gone round the general hospitals, but the teaching hospital, where I work, has very good facilities. Of course, you can’t describe it as being the best, but it has some facilities that if well utilised, they will go a long way to provide good services for the people. But the problem is poor utilisation; that is just the problem. Again, poor maintenance is another issue. When some facilities develop technical problems, they are kept in one corner and abandoned, and when accreditation is approaching, you see them looking for equipment that is not working and somebody to come and fix it. After accreditation, of course, the equipment will work for the first time, and once they develop issues, everybody abandons them again. So, poor maintenance culture has always been an issue.

There is this claim that doctors love going on strike because they have private hospitals where they will always go to practise. How will you react to this?

Some of us, our private hospitals are far busier than government hospitals. Like a surgeon, you will discover that the doctor may carry out 100 surgeries in his private hospital in a year or 50 in a year, but in the government hospital, he may just do 20 surgeries. It is not because you as a doctor shied people away from doing surgeries, but because more people come to the private hospital. So, it is completely not true that doctors go on strike because they want to have the freedom to work in their private hospitals. The government should do their own beat and pay the people their salaries. Our Chief Medical Director has been saying that if you pay doctors and they are not coming to work, they will be sanctioned. So, you cannot owe somebody salary and you keep giving excuses.

Is it true that you members are currently going through hard times because of unpaid salaries?

Yes, there was a day I was in a keke (commercial motorcycle) in Aba, from Bata to Ogbor Hill. As I was moving, I saw one of our staff members around the post office area and she was just trekking. Initially I wanted to stop and pick her since I was using a drop. On second thought, I said she might be doing something there. So, I went to where I was going, finished what I was doing there, which took me over 20 minutes. When I was going back, I saw the same person still trekking. When I stopped to ask her why she was trekking such a long distance, she said she didn’t have money for transport. If the person faces such stress today, the following day, she will definitely be tired and not want to go to work. So, when people cannot take care of their basic needs because they are not paid, it becomes an issue.

I was also with a doctor one time; he was around for accreditation. The wife called him, saying their only daughter had been sent away from school because her school fee had not been paid. The young man broke down and started crying. I just consoled him. When people are pushed to the wall and they are going on strike, instead of looking at the issues, somebody is trying to divert attention. The best thing is to pay them; they should pay them and if the person is not doing his or her work, then you sack the person or sanction the person through other means. Our members are really going through tough times because they have not been paid their salaries for months. I know sometimes, people start making calls to say they have not paid their house rent and their landlord is on their neck and they ask for a loan to complete the house rent. So, people are going through hard times.

What became of the fate of one of your colleagues, Dr Uwadinachi Iweha, a 74-year-old man, who was kidnapped in Umuahia?

Honestly, he has not been found. So, he has officially been declared missing.

For how long has he been held captive by the kidnappers?

He was kidnapped in June; we are talking about four months ago.

What efforts have been made so far to ensure his release?

I am not part of the people at the forefront of ensuring his release, but the little I know then was that at a point, I learnt that about three or four various security agencies; one directly from the state Commissioner of Police, another one from the DSS, then a special squad that reports directly to the Inspector-General of Police were involved. There were about three or four groups working independently to rescue him. At a point, the village, through the traditional ruler, sent out youths to comb the bush with the hunters. The mandate was to search for anywhere the doctor must have been kept. After searching, they couldn’t find him. So, probably they might have moved out of that place at that time if they were actually in the bush. There was a call for ransom after he was kidnapped on a Sunday; I think it was N60m, then later, the family negotiated it to about N5m, which they paid by Monday evening. The kidnappers told the family to come and pick him somewhere. The family went there at night and waited till morning, they couldn’t see him. That was when they raised the alarm.

How many of your members have been sanctioned for going against their Hippocratic Oath and other ethical malpractices?

For now, I don’t think we have any that has gone against the rules since I came on board as the state NMA chairman.

Will you link the proliferation of traditional healers and traditional drugs to self-medication?

It is not actually self-medication because there are practitioners who give them the drugs. They (patients) consult before they get the drugs. The highest level of self-medication is where you prescribe, procure and give yourself. The other mild one is when a patient is told to take a particular drug twice a day and the person thinks taking it three times a day will make it work more effectively. The patient is not strictly abiding by the doctor’s treatment protocol. The patient is doing it his own way. If you look at the issue of African medicine practitioners or so, I cannot say it is self-medication because the patients go somewhere where they are given the medications. The only problem there is the issue of safety and dosage. Sometimes, they don’t have (accurate) dosage. Again, most of their drugs do not undergo all the clinical trials that standard drugs go through, especially for safety. That is one of the reasons people think it is the reason for the increase in kidney failure.

So, what is your advice to those patronising traditional medicine practitioners?

If I meet them, I will tell them that somebody who uses the same method to treat dislocation, fracture of the femur, fracture of the tibia, while in orthodox medicine, we have different methods of treating each of these conditions and you will get the total result. So, if you are sick, you should consult where you will get standard treatment, undergo tests first if need be before treatment, and go to get a particular medicine that will cure typhoid, ulcer and other diseases at the same time.

There is a claim that doctors in public hospitals have made the cost of healthcare expensive because they often refer the sick to their private hospitals. What is your take on this?

The truth is that some people do refer, but they are in the minority because most are not involved in such acts. People go to functional public hospitals for some reasons because they are sure that for example, in a teaching hospital, all the specialists are there. The other reason is that it is generally cheaper there (public hospitals) than private hospitals. But people also have their reservations. If somebody comes to a private hospital, they will tell him to deposit N100,000. From that amount, they will start work until the money is exhausted. But in public hospitals, most of them don’t do that. If they need a drug of N2,000, they will tell the person to go and pay at the pharmacy where they will give you the drugs. But because people queue up, it may take you 30 minutes of standing before you get the drug. So, some people don’t want that, and that is why they go straight to private hospitals.


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