Chief Medical Director, DASH, Dr. Ikrama Hassan
Dr. Ikrama Hassan is the Chief Medical Director, (CMD) Dalhatu Araf Specialist Hospital, Lafia, Nasarawa State. In this interview with, he speaks extensively on alleged abolition of training of residents’ doctors at the health facility among others. Excerpts:
By Umar Egbunu Muhammed, Lafia
Residents doctors at Dalhatu Araf Specialist Hospital have alleged that you have abolished training of residents’ doctors. Can you clear the air?
When I came here, only one department in this place had full accreditation for residency training, so anybody that we wanted to train, we had to send him out for training and when I came, the people that were outside for training were just 10 doctors that was what the former Chief Medical Director of the hospital sent within 8 years he spent as CMD. And on assumption of office within two years I sent about six doctors on training. Now if you are sending people out for training, you are spending a lot of money, you will be paying their salaries, allowances, exams fees and every other thing and they will not be working here and it will be for 8 years and when they come back, they will come back as consultants and you will still need younger doctors to work with them. So instead of to keep doing that, it’s better to be doing the residency here. So, we increased the number of consultants here and improved the number of structures and equipment so that we will be able to do the training and we were able to do the accreditation from one department to full accreditations.
They also alleged that the hospital doesn’t have accreditations, what is your take?
We have five departments with full accreditation and we are doing the training. Full accreditation means that we do the training until they become consultants. So why do I need to send people out when I have full accreditation and if am able to get full accreditation in the hospital who has done better for the training from 1999 that the
hospital was established to 2018 that was one full accreditation. In two years, I have four additional accreditations. So, how can one say I have not tried for residency. So that is it on residency training.
It was said that scores of doctors were affected with COVID-19 and is the rationale behind their strike, how true is that?
Now, what happened is that resident doctors during the second wave of COVID-19 at the time that only two doctors were infected here, they said we should shut down the hospital, close down clinics, stop ward rounds, stop surgeries and attend to only emergencies and we said we won’t do that. No hospital has done that, no hospital has done that not even in the world. What we need to do is to provide adequate equipment and a conducive environment for you to work. If, for example, somebody gets infected in a particular department and you have twenty doctors and one is infected, is there any justification to close down the hospital? But if five or ten people get infected, the Head of Department for example, will bring it up and say, five of my people are down, they can’t come to work, so he will reduce the services to carter for the people in the place and not even to close it down completely. There are hospitals where in one department they have twenty-nine doctors and twenty-three got infected with COVID-19 in this Nigeria and they didn’t close down the hospital. The twenty-three went and managed themselves and the others maintained the department, ours at that time was only two doctors and they said we should close down the hospital and we did not agree.
All the other unions in the hospital had their meetings here and they said there was no need to close down the hospital. The resident doctors went and had their meeting and immediately directed their members and we are talking about trainees here in the hospital, went and directed their members to boycott activities except emergencies and even academic activities. Now clinics in the hospital belong to the consultants, the wards, the theater because they are the trainers and the resident doctors who are unilaterally trainees said they should close down the hospital and that is to tell you the kind of regards we have for our teachers and the consultants did not take it lightly with them. The consultants said they were going to maintain services in the hospital and every other union, nurses, pharmacists and everybody said they were going to maintain services. But the academic activities that the resident doctors suspended the consultants agreed that we won’t train them. So, we as management had to come in because we know that there have been a lot of problems with regards to our training and relationship with residents and consultants and residency and management that we just need to address, especially now that we just gotten accreditation and it’s just like a learning process and we are having slot of hitches. So that was why we said we should suspend this residency especially in the midst of COVID-19. We set up a committee to examine what was wrong with our system where every now and then you hear strike by resident doctors.
This committee had a representation from Ministry of Justice, the head of the committee is permanent secretary, Civil service Commission, Head of finance ministry of health and then we got senior trainers
others and Nigeria Medical Association to come and be part of the committee so that we will know the problem. So, it is temporary suspension so that we will look at the problem so that we will move forward. That is why they are saying that we have stopped residency training.
There are issues of a lot of duties on some of these policies that has made a lot of doctors to resign, what is your reaction that?
Resignation and engagement of residency training is a continuous thing. People come, people leave. One of the most stable centres in Nigeria is University College hospital, Ibadan. That was the place I trained. Through-out my stay there was not any local crisis in that hospital, but I think they have the highest number of doctors leaving Nigeria for abroad. Every doctor is as if he or she is preparing to leave for abroad even UK is having brain drain. Doctors from UK are moving to Canada and Australia. So naturally if the doctors in Lafia, if they have opportunity to move to Keffi which is a Federal Medical Centre, they will move. If they have the opportunity in Jos they will also go because Jos has a university that you can become a professor or Lafia is too hot for you, you prefer Jos or Abuja, they may move. You cannot stop that but is not because of our condition of service even federal institutions do not have good condition of service than ours in DASH. Now to the number, when I came here the number of doctors I met was seventy-five, and from the time I assumed office till date the number of doctors has increased 75, now, 109 as at January 2021 and I have a lot of applications. Time-to-time, we have people that are moving. When Keffi did their examination, people moved from here to Keffi but we quickly replaced them. If Jos will take, a lot of people will move. We have a lot of people that will replace them so we have gained from 75 to 109.
There is this other issue that they raised that they give queries even when you go out to eat especially those in the emergency and there is no restaurant where one can eat.
I wished this was not brought up but I can tell you that there was a time a doctor in a casualty ward, one of our staff left work in the evening around 4:00, on his way home and had an accident and had a severe head injury. He was brought into the casualty ward bleeding, for 45 minutes there was no doctor and casualty is a place that there must be doctors because emergency can help at any time and these doctors run three shifts there one of the shifts starts around 2 or 3 0’ clock and ends around 8 or 9 0’clock in the night. How can you come to work 2 or 3 o’clock and go to eat by 4 o’clock? This patient was brought around 4 pm and for 45 minutes the doctor was not there. They came to my office to call me because it was our staff and nobody was there. So, I rushed there and our surgeon then came. It was around the time that the surgeon came that was the time that the doctor strolled in by then I was new so he didn’t even know me, so he moved to their call room, spent one or two minutes there, this man was laying down and bleeding. He came out and by the time he wanted to attend to the patient, we lost him and the father of that patient is somebody very important. So, if it is you what are you going to do with that doctor? So, we punished him. We suspended him and that is what they are referring to. So, there is no gravity of offence the doctors do that they feel is wrong. When you tell them to do the right thing then you are an enemy. Just imagine, if the father of that child had taken us to court, how would it looked like? So a lot of these things have happened and it is not acceptable. That is what I have been fighting and how do you fight it? A lot of time when I go round, I ask who is the doctor that is supposed to be here? Ordinarily, if you have a good structure, you will first of all go to the consultant before to go to the medical doctors but that structure was disrupted. The HODs, consultants and residency structures have been distorted so the resident doctors come when they want and leave when they want. When the consultants come, they cannot talk to the resident doctors. If they do anything, the punishment is a query or they will add call duty for you or you will not go for weekend. They go to this their union and start abusing consultants that they are being persecuted, they are being treated like children so we are constantly under pressure because of these kinds of things and the management cannot control them and if you go to control them, they will go on strike and we don’t want them to go on strike so we have to just overlook them and let it go. So, I think that the best thing to do is to bring back that structure. You should be accountable to your superior if you are a House Officer, you are accountable to registrar, registrar to senior registrar and consultant so that everybody will now be looking at what the other person is doing whether it’s right or not and we will now hold the consultants accountable. So, the problem is that they do not want to be accountable to the consultant and the relationship is trainer and trainee so there should be that respect that this person can say do this and don’t do this and if there are violations there should be sanctions and they are not use to it and that is why instead of discussing issues, it is personal attacks. The things we have seen in this hospital are scandalous. If you are not going to adhere to our rules and order and if these things are done, they should be punished that is what will serve as deterrent.
Are they taking your rules and regulations for granted? Are doctors still operating their private hospital outside?
There are rules and regulations formed by the unions and the hospital management. A lot of these things that they are doing are things that can earn you outright ban, dismissal from their work place or the union. It can cause them their license but because it is a system. We need a lot of tactics to gradually implement it. Despite all these that we are doing what they want is that nobody should reprehend them. We have reached a stage where a doctor who is supposed to be on call, traveled and refused to come back for another three days, the HOD talked to him and he replied rudely and the HOD gave him query and he told him that he will not answer it. The HOD forwarded the matter to the management and we sent it to disciplinary committee. The committee wrote him query and he refused to answer it and we said we are going to punish him and they went on holding meetings that they want to go on strike. One of their colleagues told her consultant that she has mismanaged because the patient was his relation and he was hissing at his teacher in clinical presentation. All the consultant said what the doctor was doing was too much and he must be punished that he should be transferred from the department to another department while the investigation goes on so they went and gathered themselves and declared strike. So, we won’t continue like that if we do how are we going to manage the place? So, it is all the effort to bring back sanity in this hospital and we can do that only by having that structure and people must obey that structure. That is what all this thing is all about and that is why they will wake in the morning and decide that they will not go to clinic and the consultants said that no this is not ideal.
The residency is temporarily suspended because the committee is working and we gave them four weeks. There are other doctors that who are undergoing training somewhere. We recalled them because the overwhelming situation of COVID-19 and after that, they will go back. These ones are saying we should close down services and we have a lot of patients coming in and we have a lot of people outside, where they are training, they have surplus manpower while we don’t have so they came to help us with the work. Secondly with this review of residency training, they should also help us with it. We have a group of resident doctors that have become a kind of Students Union Government that are more interested in the unionism than their academic pursuit. What they are doing is that they have become landlords and training is supposed to be six years but some of them have stayed for 10 to 12 years so they have become ogas so they determine who becomes NMA president and who goes to represent them at national level and so on.
There must always be a reason to create problem so that they will say management is the oppressor or HOD is oppressing these people or consultants are oppressing these people and then they will create crisis and everybody will now come behind them and then they will declare strike so that is what is happening in this place. Every now and then, something that should not be a problem at all will just become a problem. Just imagine this COVID-19 issue, all these things that we have done, I don’t know of any hospital that has done as much as we have done to prepare for COVID-19 and after doing it, I called for a meeting of all unions to prepare for the second wave and we discussed it and everybody was happy and we said let’s go and implement it. So, what is the management supposed to do to bring about peace and to carry people along. You that you are not the teacher, you are not expert in public health, you are just out of the university and you went and hold a meeting and said we should close down hospital. So, it is just people that are fighting for the unions. The national body got across to us and I told them all these things and they said they are wrong and that they will do someone about it and the next thing I received a warning strike. Now, the consultant and every other person in the hospital are working so let them continue with the strike, there would be no work, no pay and services in the hospital will not stop.
