Critical Conversations

Striking Resident Doctors: Between Professional Oath to Save Lives and Self-Preservation

Nigerian doctors embarked on an indefinite strike on 1 April 2021. The ongoing strike has paralyzed medical services at public hospitals, leaving hundreds of patients unattended. The National Association of Resident Doctors (NARD), an association of Nigerian resident medics, last week gave the Federal Government an ultimatum to improve the wages and allowances of doctors to avert the indefinite strike. Uyilawa Okhuaihesuyi, the head of the association, had said the medics would sustain the strike until their demands are met.

A meeting between NARD and the delegation of the Federal Government was held on 31 March 2021. Many were hopeful that the meeting would shelve the strike action, but according to Okhuaihesuyi, “The National Executive Council (NEC) has unanimously agreed that NARD should proceed on a total and indefinite strike on April 1, 2021.”

The doctors’ demands include settlement of salary arrears, review of hazard allowance to 50%, and payment of death-in-service insurance for all health workers who died from COVID-19 while on duty. According to Okhuaihesuyi, “we have members who have not been paid salary for four months. There are Resident doctors that have been in the system and were paid through the Government Integrated Financial Management Information System platform, but when the government stopped GIFMIS and moved to Integrated Personnel and Payroll Information System, they have not been paid for months.”

The NARD president confirmed that Abia State University Teaching Hospital, Imo State University Teaching Hospital, and University of Medical Sciences Teaching Hospital in Ondo State were exceptional cases of how bad things were. For ABSUTH, he revealed that doctors have not been paid for 20 months and how efforts were made to get the governor of the state to get things kicking in the dilapidated hospital but failed, same as IMSUTH. UNIMEDTH was an exception as some of the demands are currently being attended to.

COVID-19 hazard allowance was supposed to be paid for six months, but in the words of Okhuaihesuyi, “they paid for three months and stopped”. As regards death-in-service insurance, Okhuaihesuyi noted that 17 members were lost to COVID-19 during the course of duty, while other doctors have not been insured.

Meanwhile, Health Minister Olorunnimbe Mamora said the Federal Government had released about $53 million for death-in-service insurance to health workers. Scores of patients said the strike could aggravate their pains and health conditions as medics stopped working.

The question as to whether or not doctors should be protesting or embarking on strike is a heavily contested one. It is both a professional question as well as a moral one. Embarking on peaceful demonstrations and strikes to protest salary emoluments or drive home other agitations is a fundamental human right. Doctors are equally human beings.

However, the medical profession involves working to prevent the ultimate danger which tantamounts to patients’ lives being in the hands of doctors. Their contiguity with life and death and the Hippocratic Oath that binds both doctor and patient is what elicits this professional and moral dilemma. The Hippocratic Oath is one in which all doctors all over the world swear. Prospective medical practitioners before they are issued with a practice license are required to freely but solemnly swear to consecrate their lives to the service of humanity. That is, “to make the health of their patients their first consideration”. This places the patients before the doctors. So the question is when doctors go on strike, deserting the hospital and wards to register their agitations at the mercy of the ailing patient, where does it leave the Hippocratic Oath?

Several hospitals have tried to manage the situation by only tending to emergency cases in the middle of such crises, but the processes themselves have always been selective. For instance, one Mrs. Itoro Sunday who was at the University of Uyo Teaching Hospital (UUTH) where the strike was also visible noted that she brought her sick baby who had been vomiting and stooling all night but was rescinded:

“I came here (UUTH) this morning because my baby was running temperature and has been vomiting and stooling since last night. The lady at the counter did not sell a hospital card to me, she said that doctors are on strike that I should go. I am just stranded.”

Another Bello Adewale, a patient in Lagos, Nigeria’s commercial capital, also said that he was scheduled to see a doctor at the Lagos University Teaching Hospital (LUTH) after undergoing series of tests. In his words, “I am afraid my condition could worsen with the strike.” Patients at the University of Maiduguri Teaching Hospital (UMTH) and Federal Medical Center, Gombe in Nigeria’s Northeast, said they were not attended to by the striking doctors.

The demands of the doctors are constitutional and reasonable but the fact that it is at the expense of the patient is what makes the situation more discombobulating. It is indeed mindboggling that the trend of doctors embarking on strike has become a recurring decimal. It is noteworthy that if a doctor is underpaid, has no option of career growth, and forced to work excessively, the quality of medical care and the ability to act in the best interest of the patient will be compromised and adversely affected.

More so, there is the September 2017 Memorandum of Terms of Settlement between NARD and the government to bring lasting peace to the health sector and curb the ongoing ugly trend of brain drain from the health sector. Resident doctors make up about 70% of all the doctors in the workforce. Doctors are deserting the country at an alarming rate. The country has become one where other countries come to search for doctors and “price” them away. Those doctors would agree to leave because there is insurance, good welfare packages, and mortgages. A certain Nigerian scientist was a huge contributor to the engendering of the Pfizer vaccine.

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Meanwhile, there is Ngige’s rash statement that the US and UK do not pay resident doctors. NARD has said this could add to the brain drain in the sector. Nigeria Medical Association has equally knocked the Minister of Labour for his approach to the strike. According to a statement by its General Secretary, Dr. Phillips Ekpe, “inasmuch as we appreciate the efforts being made by the government to resolve the issues that have led to this avoidable and unnecessary industrial action by NARD, the NMA wishes to clarify the misinformation by the minister in the interview, which is seriously viewed to be a hate speech capable of bringing down the health system in Nigeria and thereby worsening the health care delivery and further escalating the rather unimaginable current brain drain.”

It is no news that Nigeria is definitely in her trying times. Her ever-increasing debt profile upshots the problem as this is mainly money-related. It is nonetheless a matter of exigency that all stakeholders come together to reach a common ground. It is only reasonable that resident doctors be open to compromise. This is in view of the fact that some of the demands may not be met in a short term. Hospital administrators and consultants should equally be prudent while the strike is ongoing by ensuring that emergency cases, especially life-threatening ones are not sacrificed on the altar of self-preservation.

Peters Abodunrin