Health Matters: Medical Association Past Chair on PMB
Dr. Ofem Enang, former Chairman of Nigerian Medical Association (NMA) in Cross River State, is like the proverbial goldfish: He never hides. Rather, he always stands out, outstandingly. He is always at the forefront of leadership. His leadership positions started gaining uninterrupted ascendancy in Federal School of Arts and Science (now Federal Science College) Ogoja, Cross River State, where he served as Hall Head, Hall 8, before serving as Senior Prefect of that school during the 1985/1986 session.
Thereafter, he served as President, Calabar University Medical Students Association (CUMSA) in 1990, during his undergraduate years at University of Calabar. He was also National Vice President of Nigerian Medical Students Association in 1990. Dr. Enang has held several leadership positions in the course of his career as a Medical Doctor. He was President, Association of Resident Doctors, University of Calabar Teaching Hospital (UCTH) from 2003 to 2005 and National President, Association of Resident Doctors in 2006. He became Chairman, Nigerian Medical Association (Cross River State Chapter), from 2010 to 2012. Dr. Enang is currently, a Senior Lecturer and Chief Consultant/Physician, Endocrinologist, at UCTH.
He is always impeccably dressed. Surely, this complements his rich intellectual endowments. LinCornellah’s blog met him yesterday (Friday, August 25, 2017), at Transcorp Hotel Calabar, venue of the ongoing biennial Conference of Medical and Dental Consultants Association of Nigeria. Despite his busy schedule at the Conference, he found time to speak with this blog on the controversy that has been generated by President Buhari’s health status. He also spoke on the current state of health care in Cross River State.
Please read on:
Was the President’s decision to go for medical attention abroad an indication of distrust for medical personnel and health facilities in Nigeria?
Dr. Enang: I would start by saying I am one of those who wish the President very well and I am very happy about his return, but I do not think the President distrusts the medical facilities or the personnel here. I say that for obvious reasons. I think the President is a very deliberate person. I think he is conscious of the verdict of history and he is unlikely to have taken those decisions lightly. He has a medical team around him and I believe they took that decision to have him treated abroad. One, he is somebody who, at least from the time he came in, the medical body has had interactions with him and from the glimpses we got, the people who had gone to see him at the level of the NMA leadership seem to have very good sense of balance about him. They seem to appreciate his judgement relating to health facilities and all that. The only unfortunate thing is that basically, there has been rot in the system which has gone on for a long time. Most of the infrastructure and facilities are dilapidated and in want of repair.
Two, depending also on the real nature of what his real ailment was or is, his personal Doctors may have reached the conclusion to have him access the latest which in this instance, we may not have. So, I don’t think it is a decision that was taken lightly. We must also consider the fact that regardless of what we feel, at this point in time he is the President of the country and he is entitled to whatever is the best available. In that regard, we may become sentimental and say a lot of things. But we must agree that not a few people would have decided in the circumstance they were, not to accept to avail themselves of what possibly is the best medical option available. So, we shouldn’t make too much out of this. We should look at it as someone’s life and we should be happy that he is back.
So, the clear conclusion is that he doesn’t distrust our personnel and facilities. He has very high regards for our personnel. We should also know that Nigerian Doctors are some of the best anywhere in the world and the President had stated this in his private interactions with the leadership of NMA. He has high regards for them. So it must be the circumstance at the time and the decision of his medical team. He is not a Doctor so I am sure Doctors around him would have taken that decision.
Has the President led by example in the decision to travel for medical attention abroad, rather than in Nigeria?
Dr. Enang: The argument about the common man or leadership by example doesn’t hold water in this circumstance. Nobody would ask for illness to befall him. The President himself publicly admitted that this had been one of the worst times in his life and that he had never been this sick. It would mean that the sickness came upon him like any other human being. In that circumstance, I don’t think he was in a position to decide that ‘go and begin to build the best facility’. It was an immediate thing that required immediate attention. What do you want? Would you rather watch the man die? It is easy for us to say this should have been done, that should have been done. I am not trying to absolve the government of any blame. The point I am making is that it has happened. This should be a blessing in disguise. It may have taught people in positions to learn a lesson, if they do learn any, to make things better for everybody. Because you never know who is going to be the next patient. Nobody is immune to illness. Even a Doctor could fall sick, could even die from complications of whatever may come up.
The point I want you to understand is that we always get very emotive when we discuss other people’s issues. But if you look at it clearly, if you were the President and you woke up one morning and you were gravely ill, the facilities at that point in time may not be optimal for your care, we are talking about optimal care, your advisers now decided that where we can get this sorted out is abroad, would you rather say ‘because I want to be seen as the best leader, as leading by example, let me just die.’ I mean, that would be foolish death. So I think we should spare the man. That is my opinion.
Is it ethically right for the President’s media team to withhold information on the nature of his ailment?
Dr. Enang: There are instances where the basic rights of a patient are sacrosanct. A Doctor does not have a right to disclose a patient’s illness outside of the medical realm. It is a patient’s right. Unless a patient gives a Doctor that permission…. It is solely his responsibility. That is one. Two, a patient has a right to tell the Doctor ‘I do not want this’. That is ethical. Again, according to our oaths, you would not disclose a patient’s ailment unduly. Here we have the whole world listening out. Yes, the argument can be made about public citizen/private citizen, but there is an extent to which you want a man to be exposed. I think it falls squarely within the President’s purview to decide that this is what I want. That is not taking away the fact that in a broad sense, the president has X or Y. But it would lead to several conjectures.
I know that in all these things, there is no way that you can remove politics from it. But there is nothing medically unethical about not disclosing information on his illness. The Doctors have done the proper thing. If not, a Doctor would be walking around and everybody’s medical record would be on his forehead. That is not proper. It is the patient’s right to decide whether to disclose or not.
What are we going to do with the information that he has this disease or that disease? Is it going to change anything? For me it won’t change anything. People want to take on the role of saying that they are all-knowing. They want to know everything. You want to know so that what happens? That is my question. For me, let us pray that the man should be okay to carry out the responsibilities of state. If he wants to disclose his health status, fair enough. If he doesn’t want to disclose it, fair enough. If we want to take him up by saying he has broken any laws concerning governance, we can take him on.
There are other things concerning governance which we can fault him for, such as proper issues of governance like slow pace of things. But it is not to worry about a man’s non disclosure of his illness. How is that going to help the economy, the insecurity and things like that? And why do we need the physical presence of a man for things to move? The laws are there, the institutions. When we strengthen our institutions, things can happen. Besides, the man duly took a vacation and it was approved. In his absence, the Vice President became Acting President and carried on. What is the fixation with the physical presence of a man? So, even we are wrong as followers. While we insist that we should strengthen our institutions so that they can run seamlessly, we are still insisting that unless a man is physically present, things cannot go on. So that is a contradiction. And that is the contradiction that we have as a people.
What should President Buhari do for the health sector in Nigeria, to ensure that leaders of this country would not have reasons to travel abroad for medical attention?
Dr. Enang: I think that the President is a conscionable man. Depending on what may have happened, because every other thing is in the realm of conjecture now because I wasn’t with him abroad, I think that he would do right. Do right in the sense that he would try to improve things given that he has had a personal experience. Although I am not saying that you need a personal experience to be able to do things right, but that is just in answer to your question. I think he would try to turn things around. The truth is that we need to be patient. We need to be patient, not because we have not been patient. But it does appear that we are not willing to give him any ample room to be able to unfold the things he has. I think generally, he would try to improve on the health facilities and indices as the case may be.
What is your perception of the current state of health care facilities and personnel in Cross River State?
Dr. Enang: I talk as a professional about health care in the state. One, as a former Chairman of NMA in Cross River State, I have a very good knowledge of the state of health care in this state. It is abysmal. I believe that there are two very bright and hardworking medical doctors that the Governor has placed at the helm of affairs. I think those ladies can deliver. The only thing is for him to listen to them. They are professionals. There are several things to be done. You need to start from a point. I recently contributed to Cross River at 50. I wrote an article regarding what should be done. It is a treatise on what we can do as a people. We need to be proactive. I think recently they launched a health policy for the state. That is the way to go. Bring in stakeholders, other stakeholders, contribute ideas and try to implement them.
Government should start seeing health care as a social service. I think we make the mistake of thinking that unless you construct roads, these physical things, you haven’t done anything. Health belongs to one of the things that you can spend so much money, but you probably won’t see it. It reflects only in the quality of life. I am going to still maintain that the Governor should translate the ideas of the people around him into reality. That is the major reason he appointed them. He should be able to listen to them. They are the people who should advise him on health. I think the people at the helm of affairs are very capable of giving him the best advice to move the state forward in the health sector.
How satisfied are you with the manpower in medical centers and hospitals in Cross River State?
Dr. Enang: It is very sad that we don’t have the complement of Doctors in our hospitals. When I had access to one or two people at the time I was Chairman of NMA in Cross River State, I told them that you need personnel. A hospital can function when people come to the hospital to see the health care providers. There is no need to put so much money in building health centres and hospitals where there are no people to deliver health care. What you need is the people on ground. It is the knowledge that they have. You could treat somebody anywhere. Although it is better to treat in a facility, what I mean in reductionist terms is, why don’t you devote resources in training manpower and enhancing their skills?
Our brothers in Obudu travel for five, maybe six hours, to come to Calabar in very bad roads. Why don’t you make sure you employ Doctors, nurses and all other health care professionals in a small cottage hospital in Obudu so that at least they can attend to those people there first, rather than building a one billion naira health care facility with no Doctor, no nurse? Do you get the difference? So change that paradigm. Don’t build these things. Use very modest facilities. You could renovate some small hospitals. Make the incentives attractive for doctors to be retained.
The real reason you see that there are no Doctors in most public hospitals in Cross River State is because of the differential in pay between state Doctors and those at the Federal level. People are willing, even nurses are willing to go to the Teaching Hospital and take the demotion because of the pay difference. So why are we pretending? The thing to do is that the Governor should implement the current salary structure for Federal Doctors, at the state level. There is no big deal. Do it and Doctors would be willing to work. I am from Yakurr. There is no reason if I want to, I cannot go and work at the General Hospital in Ugep. You know the reason? I am being paid the same salary as my colleague with the same skills set. I am a Specialist. You should not expect me to now go to Ugep to work for the state government and I am paid one tenth or thereabout. What do you expect me to do with that? It is my skill set and I would take it to the person who can pay what is the best. So, that is the problem.
I fought with my Exco at the time, under the good leadership of Governor Imoke, he was the one who increased the basic pay of Doctors in the state to the level it is. But it is not full yet. How many years have passed? No administration has done it. Until they can make it commensurate, they won’t find Doctors. The Doctors would only go and mark time and when they see greener pastures, they would leave. And I am only using Doctors as an example. It is the same for all other health care professionals across board. So let’s change it. Don’t keep building structures. Rather, provide equipment, provide manpower and the people would use it. The people come to see Doctors. If you are ill, that is what you go there for. Also, the primary health care facilities should be manned by trained personnel.
Let us strengthen the College of Health Technology to train Community Health Officers who can do great jobs in the communities. Post them to those places. Make incentives attractive. If you give car loans to people who do so many things, why won’t you give car loans to Doctors? You can give car loans to Doctors and say, “Look, I give you this car loan to pay for ten years, serve us in this place”. Doctors would go to rural areas and stay. We have more people living in rural areas. Doctors would save lives in such areas. If they won’t do anything else, they would be able to identify complicated cases and refer to appropriate hospitals. What I am saying is not rocket science. It is simple nuances that we all should know. It is either people are not listening to advice or they are not willing to do it. So it is one or the other.
- Cornelius Ellah