By Ray Ekpu

The National Association of Resident Doctors (NARD) had gone into a long conversation better known as negotiation with the Federal Government of Nigeria on Wednesday last week. The meeting ended at about 12 midnight and an agreement was hammered out and signed by both parties signifying their decision to end hostilities. Then a few hours later the agreement collapsed in universal ridicule before it had a chance, any chance, even a slim chance, of being implemented.

The doctors reneged on the agreement by starting an indefinite strike action the day following the agreement signing ceremony. I was not there at the agreement signing ceremony and the media have not told me whether the atmosphere was that of euphoria or conviviality or champagne popping or backslapping. In the absence of such a report, we are only left to do some second-guessing because most people had thought that the agreement signing represented a new horizon of hope for a stable health delivery environment. Now, that has not happened. What has happened gives us a new vista of hopelessness as many patients are left stranded in many government hospitals around the country.

By this strike the doctors have denied the Minister of Labour and Employment, Dr Chris Ngige, himself a medical doctor, the full cup of congratulations that he deserved to have. Dr. Ngige is appropriately angry that the doctors have made a fool of him by giving the impression that everything was cotton candy, an impression he must have given to President Muhammadu Buhari who is on a short medical trip to London. The timing of the strike is awful even though no time is ever good enough for a strike in the health industry. Why it is awful is that we are still battling with the problem of the COVID-19 pandemic and any health crisis now can compound the situation miserably. Besides, the President is away from his duty post, trying to nurse his own health challenges in London and needs no distraction from his own wahala.

Or was the timing of the strike meant to draw the attention of Nigerians to the fact that the President ought to have been around to solve the health problems of the country instead of going abroad to deal with his own? The President is a privileged citizen and if the health facilities of the country cannot take care of his own ailment I am not going to insist that he stays here with his ailment insufficiently attended to. At the same time I am also willing to suggest that there ought to be in this huge country with huge resources a couple of well funded public health facilities that can take care of any tertiary ailment. That has been the problem of poor governance over the years. Nothing has changed even today.

Ngige says the doctors acted in bad faith by keeping close to their chests, their desire to go on strike even as they were signing along the dotted line. Ngige says that the agreement is called “Memorandum of Action” and that “we agreed on everything. There is no point we did not agree on.” That is probably what baffles Dr Ngige, the fact that both sides agreed on everything and the next day one side pulled the trigger. The NARD President, Dr Uyilawa Okhuaihesuyi’s response is that the government’s proposals are not new. Apparently what is new is the fact that this is actually a memorandum for action, not for jaw-jaw. And the NARD President apparently wants the action to be implemented today, now, yesterday.

The doctors’ demands seem genuine. They want a review of the current hazard allowance; payment of outstanding COVID-19 allowance especially in state owned tertiary institutions; immediate payment of salary arrears for their members in all federal and state tertiary health institutions nationwide; death in service insurance for all health workers who died because of COVID-19 infection or other infectious diseases in the country. The truth is that doctors as a whole are doing a very difficult job that involves life and death. At this period of the COVID-19 pandemic the job has become extra difficult and extra risky for doctors and other medical personnel. So their work environments need to be improved as well as their welfare packages. I have no idea whether what they got is the kind of sweetheart welfare package that they wanted. The logic is that if they signed the agreement it means they were satisfied with the package. The problem appears to be that of implementation.

The Federal Government of Nigeria is not the most faithful implementer of agreements. It seems to want to sign agreements when the heat is on only to be overwhelmed by the stark reality of implementation. That is apparently why the doctors do not seem to trust the government. The university union called ASUU has had a running battle with various governments including this one on agreement implementation over the years. That is a serious problem. If governments sign and don’t keep to the letter and spirit of the agreement it leads to distrust and scepticism. That is the point at which the Federal Government is today. The unions with which it does business have gradually come to the conclusion that the government signs these agreements simply to fulfil all righteousness. This may not be so. The government may simply find itself constrained by lack of funds or some bureaucratic bottlenecks. If there is goodwill on all sides, these creases can be straightened and people can be saved from the consequences of these stings and clashes of battle. Signing an agreement is not the equivalent of easy street.

Anyone who signs an agreement must think of the full ramifications of the agreement so that people do not continue to suffer from no fault of theirs. Agreements must only be signed with the view of keeping them not simply to temporarily avoid a crisis. Not keeping to the terms of the agreement may lead to an even bigger crisis. The pictures shown of patients stranded in many hospitals as a result of the strike is heart-rending. Patients on admission are not attended to but are left to vegetate. Patients who have the necessary financial ability are able to discharge themselves and seek solace in expensive private hospitals. Others can stay in the hospitals and die before help comes if luck is not on their side. Others that have deep wallets can go to Dubai or London or India or South Africa and get the best of attention because their money can speak for them. The rest of the populace are not in such a situation of audacious pampering.

The problem with strikes is that they hardly affect those who need to take decisions for their resolution because their lives are cushioned by the taxpayer. Those who actually suffer from such strikes are the general populace. The thinking behind strikes is that when they occur the government may feel a twinge of conscience and do something urgently to remedy the situation. But what if the government is conscienceless? The other reason is that when strikes occur and people begin to suffer the people will put pressure on the government to resolve the issues. But in a partisan political setting such as we have people who urge the government to do something to resolve the matter may be called “traitors”, “wailers” and “haters” of their country. They turn a genuine concern expressed by the citizens into partisan political rhetoric.

We keep complaining about brain drain to countries in Europe, North America, Middle East and even Africa. If the working environment in Nigeria was as good as what you find abroad, Nigerian experts would not bother to leave home in search of greener pastures abroad. We also complain about medical tourism and the large amount of money that Nigerians spend abroad for medical treatment. No one can halt this medical pilgrimage except the medical situation in Nigeria is drastically improved. Right now even the tertiary medical centres owned by the Federal Government are some of the worst in the world in terms of infrastructure and funding. If you doubt it, just go to any one of them and come back and weep. If the medical centre at the Aso Villa as described by Ms Aisha Buhari, the First Lady, is as horrible as she said it is, what other evidence do you need to know that we are in dire straits healthwise and that we need to face our health problem full square. And if the President doesn’t get his treatment there that confirms that it is just as horrible as Aisha told us.

Let us return to the agreement recently signed by NARD and the Federal Government. I don’t expect that agreement to be the type that Frederick the Great of Prussia (1712-1786) signed with his people. He said: “My people and I have come to an agreement which satisfies us both. They are to say what they please, and I am to do what I please.” That one was four one nine.

In this article: