BY SIMON REEF MUSA
Penultimate week, Governor Nasir el-Rufai of Kaduna State returned to what he is best known for: creating ripples in silent waters. The fiery fervour with which doctors in public hospitals ripped off helpless patients financially has portrayed them as Mammon worshipers, rather than professionals committed to saving lives. Many healthcare seekers have plunged into their early graves due to inability of victims/relations to cough out whopping sums for quick treatment.
Even at the federal level, the deteriorating state of health has been attributed to poor disposition by health practitioners, especially doctors, to abide by their terms of engagement. Disturbed by the worrying trend where doctors in public service are more committed to private practice than treating patients in public hospitals, the Federal Government in 2017 had announced a plan to bar doctors in public service from private practice with the hope of ensuring that doctors’ increase commitment is attained to revive the public health sector.
The move by Governor el-Rufai to prevent government doctors from private practice resonates with the earlier threat by the former Minister of Health, Professor Isaac Adewole, who could not walk his talk. Sounding upbeat on his government’s determination to emancipate the state’s health sector from ruination, the Kaduna helmsman disclosed a plan to pass a law that will constitute an offence for doctors working in public hospitals to engage in private practice. However, like the threat by Prof Adewole, the Kaduna state governor may just be in engaged in a mere act of braggadocio for public attention.
On a simple level, without recourse to serious analysis, el-Rufai’s plan could serve as a prologue in realising the common good of rejuvenating the collapsing public health system in Kaduna state, made worst by traders masquerading as doctors. On a closer observation, the plan by the Kaduna state governor to stop government doctors from private practice runs contrary to Section 4(1) of the Constitution of the Federal Republic of Nigeria (CFRN), as amended, which regulates private practice by medical doctors in public service.
The plan by el-Rufai is in clear violation of relevant laws enacted by the National Assembly. While it is an incontrovertible fact that the role of most doctors in these public hospitals is in clear breach of what they were employed for, some of them have deployed official hours for private practice. The dearth of health facilities for citizens makes it imperatives for the existence of private hospitals to meet the yawning gaps created by these inadequate healthcare facilities. On the basis of present realities, it is normal to welcome and encourage the establishment of these private hospitals to complement decaying public health infrastructure heightened by the absence of regulatory measures to rein in the greed of doctors in public service.
Relevant laws in Nigeria, including Code of Medical Ethics, recognise the right of doctors in government hospitals to engage in private practice. Rule 49 of the code states: “(1): Medical and Dental practitioners who are in full time employment in the public service in Nigeria are free to employ their spare time and unofficial hours to engage in medical or dental practice for remuneration as follows: a) A registered practitioner in full time employment in the public service shall not engage himself in extra-mural private practice during official duty time under any circumstances. b) A registered practitioner who holds the appointment of Consultant status or a medical or dental officer of more than ten years post-registration experience may run one private consulting clinic which will open for business only during periods when he is not on official duty.”
From the above, it is crystal clear that neither the state governor nor the Kaduna State House of Assembly possesses the powers to bar government doctors from private practice. Against the backdrop of the above stipulated rules, it is far beyond the powers of the governor and the state lawmakers to determine what doctors should do with their spare time. Any attempt at barring them from engaging in private practice could be viewed as tampering with their indisputable rights to their dignity and personal liberties as guaranteed in sections 34, 35, 38 and 41 of the Nigerian constitution.
It is a tragedy of monumental proportion that medical doctors who should be in the business of saving lives have become businessmen and women in search of filthy lucre. More worrisome, they now deploy these public hospitals as platforms to market their private hospitals. The urge to become wealthy by all means has beclouded their sense of professionalism. As it is in other sectors, the nation’s health sector has been invaded by people who worship money and will do anything to compromise their professional calling just to earn a few naira notes. Governor el-Rufai may be right in his motive, but his roadmap towards enhancing the state decaying healthcare service cannot be implemented.
The dialectics behind decaying healthcare services in Kaduna state, including other states of the Federation, is far beyond the issue of stopping doctors from private practice as in resolving the crisis plaguing the health sector. The dearth of health facilities, poor remunerations for doctors and the enthronement of the corruption as an idol of worship, among others, are some of the issues confronting the country’s collapsed health sector. Anyone who has visited and Nigerian public hospital for treatment knows that our public health facilities are really sick than the patients they are established to treat. It is not just about the quality of facilities and personnel, public hospitals have been turned into oil blocs of a sort by medical practitioners to create a ceaseless source of wealth for themselves and their immediate family members.
Permit me a personal illustration to buttress the sad tale that we all are victims of the amoral disposition of these doctors who have turned our public hospitals into ATM to serve their bottomless pit of greed. One of my kids in 2009 had a minor problem. We were advised to meet an experienced orthopedic doctor at the Asokoro Hospital in Abuja. After examining my child, the doctor recommended a cast on my child’s leg to correct the position of the right heel. When later we returned for a review after two weeks as ordered, the doctor was nowhere to be found as he had zoomed off to only-God-knows where. The other doctors on duty and those in charge of the casting insisted we wait until he returned. Alarmed by the discomfort suffered by the child, I approached a private orthopedic doctor in Abuja who immediately removed the cast that was now creating a bigger problem. Thereafter, an operation was carried out to solve the problem created by the recalcitrance of the Asokoro doctor famed for his expertise.
Again, in 2012, there was another need for a medical attention for yet another of my kids. Without a waste of time, and taking into cognisance the bitter experience from Asokoro Hospital, I returned to the private clinic that saved my daughter’s leg in 2009. The child was just nine months then and, without any form of in-depth examination, the doctor recommended another surgery. Another doctor from another private sector warned me against the surgery, as the child was too tender for such. The surgery was carried out, but this time around, I was not as lucky as something had gone awry as would be shown in later years.
After several years of hoping that my child’s leg would eventually sort itself out, I decided to try my luck on yet another private hospital located in Wuse II. After paying the sum of N10, 000 as consultation fee, I was allowed to see the doctor. I was transfixed as I came face-to-face with the man who had abandoned my child in 2009 in Asokoro Hospital. Bitterness almost overwhelmed me as I reminded him of my experience in the past. He profusely apologised and said: “Very sorry, I had to travel out for a course to update my knowledge. You know, even as government doctors we pay in dollars to go for courses in order to upgrade our knowledge. As for this your kid’s leg, it was poorly handled initially. I can fix it for N500, 000 without any form of surgery.”
I left with an initial intention to return, but I never did. Just few months ago, I approached a consultant orthopedic in another Abuja public hospital. He recommended an urgent action in a specialist public hospital as the fees charged by his hospital were too exorbitant for people without tails. Only the coldblooded wickedness in man could frown at el-Rufai’s plan to rein in the excesses of these doctors in public service who now see healthcare seekers as commercial commodities for their comfort. Some of us are no longer strangers to the recklessness of these doctors who vision is now restricted to the attainment of the good things of life.
What is needed now is not barring doctors from private practice, but evolving effective regulatory measures to ensure they perform their jobs during their official hours. Some of these doctors who turn public hospitals into marketing platforms and deploy public healthcare facilities to treat patients admitted in their private hospitals should be shown the way out. Barring doctors from private practice will breach existing laws and lead to further complications for a system that is on its death throes.
