The post graduate medical Colleges, National health indices and an SOS

The West Africa College of Physicians concluded the second diet of exams recently. The faculty of psychiatry declared a pass rate of 13.8% at its part one membership exams (8 of 58 candidates). The faculty of public and community health recorded a 32% pass rate (23 of 70 candidates) Twice every year, candidates from all over the country converge in Ibadan and Lagos for the West Africa college of physician and National post graduate medical college exams respectively, each diet of examinations consisting of written, objective structured clinical exams, picture tests and oral/long case exams as the case may be. It is usually a very grueling and trying time for any candidate with psychological, emotional, financial and sometimes physical consequences. A minimum of sixty thousand naira (#60,000) is paid for each exam attended without consideration of transportation, feeding, and other ancillary expenses incurred. It is funded by the candidate after an initial one time sponsorship by the training hospital. A candidate may repeat the exams as many as seven (7) times. There are records of up to ten (10) times and over at one stage. Usually, candidates do not scale the first stage, and even then, meeting hurdles in each subsequent stages of the OSCE, Picture test and long case stages. Each must be passed independently, usually under stifling time constraints. It is pertinent to shed some light on the long case examination, already phased out by certain faculties of the college owing to its largely subjective nature. A candidate is assigned a patient for the purposes of the exam, and is to conduct an interview, physical examination and prescribe a course of management under harrowing time conditions. The candidate is to make an oral submission of his findings to two or more examiners who are usually less than dispassionate in their assessments. Mark you, less than 10% of these examiners have any degree in education, evaluation, assessing or any pedagogic training for that matter. It is under this long case that a lot of examiners excise their “pound of Flesh” as a candidate may be faulted in practically any and everything! Thus, a candidate who manages to scale through the first, second and third stages, is truncated at the last stage by an examiner who chooses to sleep during proceedings! A lot of candidates have been maimed as a result of the activities of these colleges with the active connivance of some training hospitals. Failing to pass these exams, a doctor is unable to make any professional advancement; he is stuck and sooner or later shown the way out of the residency program with no life line. He is unemployable as a specialist, and cannot proceed as a general practitioner. Medicine is touted to be an apprenticeship; so, if a candidate has to repeat a particular exam so many times, has he been properly mentored? Small wonder the high morbidity and mortality rates; the capital flight in medical tourism and the total loss of faith in the healthcare system. Such candidates who are frustrated out of the system for their inability to scales these exams, where do they go? Where do they start from with families and other dependants? What about the psychological toll on him? Something to with he has committed a lifetime of effort and suffered untold deprivation? A number of questions beg for answers; 1. Does this “high” standard that candidates are held up to translate to favorable health indices for the country- reduced morbidity, mortality and medical tourism to India and other nations? Capital flight? Is the nation any better off from the efforts of the Postgraduate medical college? 2. What does a failure rate of 87% connote? The trainers are not doing their jobs? The trainers do not understand what is required of them? Their candidates are so dull? Or is it simply a case of unregulated and misguided leadership? 3. What role does national interest play in the determination of proceedings, procedures, modus operandi and outcomes of the college? The national postgraduate medical college of Nigeria prides itself in having produced 4,000 plus specialists in over 30 years of existence and in a country of about 160 million people. Whose interest do they really serve? 4. What is the role of international best practice in the regulation of the colleges? Any peer review mechanism? Any interoperability or exchangeability with any other such international bodies? 5. Any validity and reliability studies on the mechanisms of these colleges? 6. Should each region or state not regulate its own postgraduate education, require and needs? 7. Who oversees the activities of these colleges? It is high time the House committee on health, the federal ministry of health, policy makers and other interest groups gave some scrutiny into the workings of these colleges in the interest of all stake holders, and the nation as a whole bearing in mind the various ramifications, dimensions and implications of the activity of these colleges on all and sundry. It is no longer acceptable that things remain the way they’ve always been. Indeed, the mark of humanity is the ability to adapt; to evolve; to meet challenges and peculiarities of the day, a peculiarity that once again challenges our resourcefulness.

Fuel subsidy debate and other outcomes

Subsidy removal has engendered certain discourses which hitherto were an open secret, but were somehow forbidden, never received due attention, or conveniently swept under the carpet because people never had the platform, opportunity or cohesiveness to push them.
The debate over Fuel subsidy removal and the attendant wide spread protest however has provided a platform and opportunity to speak.
For me, these are issues that have been nagging, and fuel subsidy removal pales into insignificance. If the Nigerian Labor congress would bring these to the table as a bargaining chip, and demand change, it would have achieved much.
What are the issues?
1. Operation of a constitution bequeathed to us by the military. Until now, the people of Nigeria have not sat at a table, freely of themselves, in a democratic dispensation to discuss the basis of their existence, cohabitation, and nationhood. An article of faith, stating that “we the people of Nigeria declare….” freely debated, freely entered into, and freely enforced has not been made. Fundamental and significant changes need to be made which the 1999 constitution does not adequately address. Parliamentary or presidential government? Regional governments or states? 50% derivation formula? Confederacy or federalism? Community policing? Immunity from prosecution for governors? Remuneration structure for public officers etc.

2. An over bloated, predatory Presidential form of government consisting of a bi cameral house of 109 senators, 360 plus representatives; the judiciary and the executive. It also consists at the state level, a replication of the executive, legislature and judiciary. Each of these include a huge retinue of ministers, ministers of state, executive aids, special assistants, advisers, commissioners, secretaries, legislators, chairmen, vice chairmen, counselors etc.

Constituency allowance- Besides the huge retinue of aids each legislator is entitled to, they all receive large constituency allowances totaling in the hundreds of billions of naira annually. To what end? Isn’t this a duplication of function already provided for, being the duty of states, and local governments? Where else in the world do we legislators execute “projects”? Does it not amount to a distraction for legislator to be the executors of capital projects? Do their primary duties of legislation not suffer?
Security votes- Similarly, governors receive a yearly allocation of funds to with no account of its disbursement or utilization is provided to anyone. It is labeled security vote, and totals billions. We got a glance into the figure recently when Mr Rochas Okorocha, governor of Imo state re-appropriated 4 billion of the 6 billion naira provided for him under this subheading to education. This is the amount of money that would have disappeared into one governor’s hands in one year. How unfair!
Town hall meetings- Besides being unwieldy, over bloated, and expensive, it does not provide the much needed representation of the people or adequately cater to their needs. Government officials are impossible to see. They are domiciled in Abuja, state capitols and overseas. There are no fora for meeting the public, no town hall meetings where everyone and anyone is welcomed and free to air their view -lay men and women, market women, tomato sellers, unemployed youths, masons, cobblers, professionals, civil servants etc. Why? These remind them of their failures in providing social amenities and growth opportunities for the people, and the antithesis to what they represent-opulence, ostentation, affluence, and ill got wealth. The reality is that this form of government is wicked and unsustainable. It is predatory and feudalistic.
Examples- I know that President Obama of the United States pay for his meals, cooks, clothes and other personal effects. What, after all is the purpose of a salary? British Members of parliament board regular transportation as commoners and retire their expenditures later on for reimbursement. The British monarch or Prime minister has no private planes. What about that?

Corruption & redundancy- The unwieldy nature of government also fosters corruption. With a large bureaucratic civil service, multiple government agencies often with overlapping functions, it becomes impossible to hold individuals responsible for acts of omission or commission. Similarly it is next to impossible to track continuous training and development of personnel, as well as continuous improvement of the system etc. For instance, Enterprise resource programs, ERPs, Just-in-time, JIT procedures, project management procedures and E-government initiatives etc are not yet standard in the ministries, department and agencies.
The redundancy in government provides various avenues to milk the system of valuable resource, naira and kobo. The 2012 budget makes these provisions for the presidency; maintenance of vehicles-382 million, purchase of scanners-150million naira, purchase of computers-265million,, photocopying machines-23million, residential furnitures-295 million, medical equipment-93 million, provision of infrastructure-324million, hospital/health centres-265 million, drug and medical supplies-314 million, provision of electricity-203 million, provision of residential buildings-300 million, provision of office buildings-3 billion, rehabilitation of office buildings-419 million, rehabilitation of hospital/health centre-122million, all in Naira.
What in the world….? Say, must computers, scanners, photocopiers and furniture be changed every year? Must health centers, hospitals, office and residential complexes be built yearly in the precinct of the state house? At this rate, I probably should take heart because Aso rock will soon extend to my village in kogi state. What a shame! What paradox! Small wonder the angst in the land!

3. Antiquated Judiciary-An antiquated, outmoded, slow, and corrupt judicial system which fosters more injustice than it curbs. The evidence Act remains that of the 1950’s, legal technicalities exonerate murderers and justice is delayed in perpetuity. Justice is expensive to procure. It is also inaccessible. A court is no more powerful than its enforcement of judgments. Where are the bites? It bites only the weak, poor felon; felon no doubt! The igbenidions, ibrus and Baloguns are given soft landing-plea bargain! While the Kalu’s, turaki’s, and sarakis walk the streets in their majesties. What a world!
4. Social security/welfare- I have always asked the question, “what, do i have to show for being Nigerians?” What benefits or privileges accrue to me over and above foreigners who dwell here? Any social benefits? Any for education? Unemployment benefits? Social housing? Welfare benefits? What if I get in trouble on foreign soil? The grim answer is none. No wonder the anger of people at the suggestion of subsidy removal from PMS, being their only benefit from government. What country has no safety nets for its vulnerable population? How do you inspire a sense of citizenship, patriotism and nationalism without these? Isn’t this why it seems there’s so much money flowing around redundant, availing kleptomaniacs to help themselves to some when it could otherwise be used for social security? An average Nigerian lives….and dies alone.

Isn’t about time?

Boko Haram, Passion and Nigerians

Nigerians are a complex and curious lot. So vocal, so vociferous and passionate about issues they sometimes little understand, if only to be seen saying something! The punching bag of any and every baby that can blab is the government.
The recent menace of Boko Haram brings this to the fore.
Most associates of mine severely castigate the president, Goodluck Jonathan as being weak, lame and unprepared for leadership of this country. Their assumption is that he is doing less than required since we still hear of bomb explosions every now and then. He inept they surmise. They posit that former President Obasanjo would have crushed the menace of Boko haram by now!
I never knew Nigerians could be this nostalgic for Baba Iyabo!
What they fail to see however, is that Nigeria is is not alone in this experience and that the government is doing her very best in these situations.
The IRA held North Ireland hostage for generations, detonating bombs at will, even killing the much revered Lord Mountbatten, the patriarch of British monarchs on British soil. Not even MI5 and MI6 were able to foresee this.
Equally, the Spaniards were held hostage by ETA for decades with indiscriminate killings of citizens.
There is a catalogue of terror related incidences globally, including September 9/11 2011 of new York, 1996 Timothy Mcveigh bombing in Arkansas, the 32 Virginia tech massacre, 17 columbine high, fort brag soldier/psychiatrist shootings, the Norwegian 92, the July 7 london train bombings in which a Nigerian died, Madrid train bombing and the catalogue goes on.
Clearly, none of these were preempted because, how do you get into the mind of anyone intent on destruction, particularly the suicidal type?
American soldiers were severely decimated in Iraq from IEDs (Improvised explosive device), with very little they could do about it for a long time.
The success of these terrorists lies in their guerilla tactic. They are not uniformed, they wear no badges, there is no face to them, and they operate surreptitiously and in covert. How do you intercept this?
Over the years, because of corruption, nepotism and lack of professionalism, our security infrastructure have gone decrepit, bust and bankrupt, ill-prepared to meet the challenges of the day. Unfortunately, the ills and decay of the yesteryears cannot be repaired fast enough and Boko Haram thus appears to be having a field day.
Understandably, the cries of Nigerians are borne of the novelty of bombing to our soil, the fear, the grief and devastation left on their trails.
We nevertheless must endeavor not to give in to panic and fear which is the principal objective of Boko Haram. It wages a psychological warfare and aims to portray the government of the day as weak and lame; incapable of protecting her citizens.
“What we need to fear, is fear itself….” Winston Churchill in admonishing his people during the World War 2 bombing of London said.
Unfortunately, the media seem to be at the forefront of misinformation, weeping up popular sentiments and fear.
What Nigerians must do is to brace up in unison, not against the government, but against the enemy, Boko haram. We must determine to work hand in hand with security agencies by remaining alert, possibly constituting vigilante and watch groups.
We must also be willing to understand the issues and provide valuable information of suspicious activities wherever they are noticed.