By Ugoji Egbujo
Continued from last week.
Everyday people die from illnesses that have easy cures . They are denied healthcare because they cannot pay. They die because they are poor. And many are poor because they lack opportunity. But even those who are poor , the way libertarians would have us believe , should not die cheaply. Our common humanity must mean more. Every civilized society must aspire to attain free/affordable health care for all its citizens.

If all must be treated with human dignity then none should be denied health care and none should die from a curable disease by reason of poverty. It is true societies have limited resources and competing social demands , the ideal of health for all is a compelling moral objective and should be pursued with all vigour. Leaving the poor to suffer and die from easily curable diseases lies within the moral proximity of torture which we now all consider grossly inhuman.

It can’t be left to doctors to bear the burden of health care costs for all. Responsible governments all over the world know that it is one of their primary duties. In Nigeria serious matters are often attended to half-heartedly and sometimes with mere political gimmickry.

The national health insurance scheme (NHIS) was crafted to address many of the issues bedeviling the health sector. But what has the scheme achieved? The Guild of medical practitioners have nothing to recommend of the Health management organizations (HMOs ) through which the NHIS is supposed to further its aims of fair financing of health care costs through pooling, cost burden sharing and judicious utilization of risk protection . The HMOs are seen by many doctors as parasitic institutions lacking in moral convictions and intent on destroying private participation in medical service delivery in the country. Most private practitioners regard the HMOS as vampires for whom health business is solely about profit maximization and opportunism.

The HMOs themselves decry poor participation in the national health insurance scheme which has enrollment figures in the proximity of three percent of national population . Poor participation has led to an inevitable subsidy gap which has bred desperation. Hospitals are paid unhealthy capitation fees which leave no room for any thoughts of qualitative health care through the system. The system has failed , doctors feel exploited and insured patients receive very poor services. The participant triangle is defective.

How do the HMOs arrive at the figures , the slavish rates they pay doctors? And why is the NHIS council that should monitor fairness and quality derelict of its duties to protect the health care providers under the scheme ? Some companies have pulled out of the scheme because their staff get abysmally poor services from participating hospitals. The NHIS is in shambles.

The scheme had lofty objectives and would need a reworking. The scheme needs a critical mass of subscribers to function. The net of mandatory participation currently meant for only companies and institutions employing more than 10 people may have to be widened. We can learn a bit from the American Obamacare. Alternatively, the scheme should be funded directly from tax receipts like the British NHS. If the NHIS is not broadened, if the majority is supposed to participate voluntarily then any hopes of equitable health care for the majority who are poor, underemployed and unemployed will be unattainable.

Dedicating a good percentage of our crude oil receipts to the scheme would guarantee an improvement of health care delivery to the ordinary man. Oil wealth has made us indolent. It has because it has been wrongly applied and largely looted. If we dedicate half of our crude oil earnings exclusively to fund accessible health care and education, our nation will be a more equitable society and our economy will be forced to diversify. Our NHIS has failed woefully. Patients continue to die from curable diseases. And for many private practitioners survival is not a given. And under such adverse circumstances, cold economic considerations may have priority over moral considerations. I have seen hospitals struggle to pay rents and foot salary bills, and I have seen many become insolvent and crumble. And many of these hospitals died because they couldn’t recover debts owed by patients. So when scorn is poured on doctors who detain corpses so that bills are settled, I urge for understanding. Doctors should be compassionate but doctors have families they feed.

Many doctors were the very best students in their schools and the choice of medicine on getting into the university was partly to further general well being and societal recognition and status. It is sad enough that the route taken for most of them may earn them none of these aspirations but it would be tragic if doctors can’t send their children to the common private schools around. How do people pay millions for kindergartens and primary schools in Nigeria and pay nothing for health? If Lawyers and pastors pay those fees , doctors should. Public schools have been allowed to decay and businessmen have left Alaba market to establish schools with only profit in mind . And nothing but ego and vanity dictate fees charged by these schools.

Poor doctors , medicine cannot tolerate sharp practices. Poor souls. It’s unfortunate that excessive fees for health care come across as sharp practice while excessive legal fees and school fees don’t. And legal fees are in a sense never excessive. Medicine, they argue, is about life. And they do not think they should pay more for their lives?

Lets face it , there are many unscrupulous doctors. And many careless and inept doctors. But the picture of rot in the health care is a picture of an abandoned garden suffering more from rampaging thorny weeds than the dishevelment of flowers in need of pruning . Because the public space is very poorly regulated, more quacks than doctors offer health services in Nigeria. From pharmacists who have turned their pharmacies to consulting clinics to nurses who have become doctors without medical license and training , it’s now an all comers affair and it is so free. As a child I was once had my finger stitched by a nurse and I thought nothing of it. He was my father’s friend, he did small surgeries by the side. Amongst Patent medicine dealers that dot all our streets are hardened providers of black market abortions. Some of them have become family physicians for even people who can easily afford doctors.

Hospitals run by fraudsters who know nothing about medicine but who carry out complex surgeries are all over Lagos. Homeopathy, naturalopathy , all sorts of practitioners and babalawos have learnt to encroach on the orthodox medical field with impunity. No one cares about regulation. Haven’t those seemingly benevolent people who preach , crack jokes , and then sell fake medicines on buses remained in business forever. But lives are cheap here. You can open newspapers and see adverts of magic drugs that cure everything. Media houses , purveyors of morals , owe nothing too to the public?

So patients contend with poor facilities and a diminishing quality of doctors training programmes. They contend with genuine mistakes and unacceptable errors from some doctors. They contend with doctors that have gone rogue. They contend with other health workers who usurp roles of doctors, who impersonate doctors, as many nurses and pharmacists and lab scientists routinely do now. Then they contend with fraudsters who rather than pose as plumbers prefer to pose as doctors to drain and to mangle victims.

While the society may have decayed , we must be concerned about the grave consequences of allowing a totally degenerate health sector. Doctors must be re attuned to their duties towards patents and must update their knowledge regularly. Our medical schools unfortunately do not teach much of medical ethics and law. Patients must understand their rights and the boundaries of their relationship with doctors and what the parties owe themselves. Many doctors aren’t conversant with the consent and confidentiality requirements of the codes and law. Patients have the right to know what they suffer from and to have the course of management discussed with them before they are instituted. Consent that is not informed is no consent.

And many doctors are ill equipped intellectually to handle the many ethical dilemmas medical practice throws at them. And importantly, lawyers must come to grips with medical law and medical ethics and must be capable of advising and protecting victims. It is however sad that many lawyers in Nigeria have poor knowledge of medical law and are therefore incapable of instituting effective redress for victims.

People who feel aggrieved and have suffered damages arising from medical malpractice and negligence must make demands on the doctors so that the level of care is improved. Often heartfelt apologies from doctors to patients for mistakes may suffice. Where patients feel apologies aren’t morally sufficient they can report such matters to the medical and dental council of Nigeria which is empowered by law to discipline erring doctors. Such patients can in extreme cases and if they feel sufficiently disposed , find a good attorney and seek redress in court. Conducts that constitute crime must be reported to the police. Majority of our doctors care about the reputation of the profession and would welcome the excommunication of bad eggs.

Doctors globally are uncomfortable with litigations. And feel always victimized. In a sense that sentiment is justified. But to arrest decay in medical care , to protect patients from easily avoidable harm , to preserve the reputation of the profession , responsible litigations are important. But I must stress that when litigations are taken to an extreme they will become counter productive. Unrestrained irresponsible litigations will end in raising the cost of medical care astronomically . Because doctors will need to pay higher practice premiums and may engage in the defensive medicine of overly elaborate investigations and procedures. In Nigeria where doctors often juggle things to match patients’ means, poor patients may be adversely affected.

Let us be our brothers’ keepers.

MEDICAL LAW AND ETHICS

A conference on medical law and medical ethics organized by the Outreach health innovation centre and co sponsored by the vanguard newspapers will hold on the 22nd of July 2015 at the Civic Centre victoria Island Lagos. Medical and Legal luminaries will speak at the event and the key note address will be delivered by Professor Onyebuchi, the immediate past minister of health. The Medical and Dental Council of Nigeria , the NMA and the NBA will be represented at this event aimed at nation building. Interested persons can reach Health Editor, Vanguard Newspapers