Managing Menopause: An Individualized Approach

Yvette C. Terrie, BSPharm, RPh

Menopause affects every woman differently, so most clinicians recommend an individualized approach.

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Hot flashes, chills, night sweats, trouble sleeping, weight gain, oh my!

Menopause is a natural and inevitable part of life for every woman, and this transition may present challenges that affect a woman’s quality of life, sleep pattern, and daily routine. Because the onset of menopause affects every woman differently, most clinicians recommend taking an individualized approach to managing the bothersome symptoms of menopause.

The average age of onset of menopause is between 50 and 52 years; however, most women begin to experience menopause symptoms between 44 and 55 years of age.^1,2 Physiologic menopause is defined as the absence of menses for 1 year.^1,2 The onset of menopause symptoms, which is called perimenopause, occurs in most women between 45 and 47 years of age.^1-4 During this phase of life, a woman may start to experience changes in her menstrual cycle, such as a change in the amount or length of her menstrual flow as well as irregular or missed menstrual cycles.^3,4

Signs and Symptoms
During perimenopause and menopause, a woman may experience a host of symptoms that can vary in rate of occurrence and in severity. Some women may ease through this transition, while others may struggle with a variety of symptoms. Vasomotor symptoms such as hot flashes are considered to be the most prevalent, affecting 50% of women during perimenopause and menopause, according to estimates.^1-4 A hot flash episode may last from 30 seconds to 5 minutes, and sometimes women experience chills afterward.⁴ Common triggers of hot flashes include ingestion of caffeine, alcohol, or spicy foods; smoking; wearing tight clothing; and eating foods that contain nitrates or nitrites.^1-4 Other common symptoms include irregular menstrual cycles, other vasomotor symptoms (eg, night sweats), dizziness, mood swings, insomnia or other sleep disturbances, headaches, weight gain, and fatigue.^1-4

Products for Managing Menopause
Pharmacists are likely to encounter patients seeking counseling on the management of menopause symptoms and the available treatment options. Several nonprescription products are marketed to relieve menopause symptoms (Online Table 1). Many patients may elect to use these supplements because of concerns about hormone replacement therapy.⁵

Table 1: Examples of Nonprescription Products Marketed for Managing Menopause Symptoms

Emerita Menopause Plus Formula Dietary Supplement

Estroven Maximum Strength Natural Menopause Relief Estroven Weight Management Estroven Nighttime Estroven Mood & Memory Estroven Energy Estroven Femcare

Enzymatic AM/PM PeriMenopause Formula Enzymatic AM/PM Menopause Formula

GNC Women’s Menopause Formula

Healthy Woman Soy Menopause Supplement Tablets

i-cool Bone Builder + D for Menopause i-cool for Menopause i-cool Hot Flash Relief Cloths

Midnite for Menopause dietary supplement

NaturaNectar Easefemin Menopausal Support dietary supplement

Nature’s Bounty Complete Menopause Support Complex dietary supplement

Natrol Menopause Formula Natrol Complete Balance AM/PM for Menopause Natrol Black Cohosh Natrol Soy Isoflavone Natrol Hot Flashex

Nature’s Way Change-O-Life Herb Blend Nature’s Way EstroSoy Nature’s Way EstroSoy Plus Nature’s Way Soy Isoflavones Nature’s Way Black Cohosh Root

New Phase Complete Menopause Support

One A Day Women's Menopause Formula

Options Healthy Woman

Promensil Menopause

Remifemin Estrogen Free Good Night dietary supplement

Remifemin Menopause Relief herbal supplement

Soy Care for Menopause

WINDMILL Menoprim Nutritional Support for Menopausal Women

Zand Changes for Women, Day & Night Formula

Products for managing menopause symptoms include herbal and alternative remedies that may contain phytoestrogens (plant estrogens, isoflavones), black cohosh, vitamin E, evening primrose oil, and/or chaste tree berry. These products are available in single-entity or combination formulations, and many are formulated with vitamins, minerals, and alternative sleep aids. There are also multivitamin/multimineral dietary supplements such as One A Day Women’s Menopause Formula (Bayer Healthcare LLC), which is formulated with natural soy isoflavones and other nutrients to decrease the incidence of hot flashes and mild mood changes.⁶

i-Health, Inc—the manufacturer of Estroven menopause supplement products—has introduced the new weight-management formula Estroven Weight Management, and Estroven Femcare, which is marketed to decrease hot flashes, night sweats, and mood changes. The manufacturer has also released new and improved formulations of Estroven Maximum Strength, Estroven Nighttime, and Estroven Mood & Memory. In addition, i-Health, Inc, markets the new product i-Cool Hot Flash Relief Cloths.

Because many products for treating and managing menopausal symptoms are on the market, the selection of an appropriate product may be overwhelming and challenging for many women. By providing information on how to effectively manage menopause symptoms, pharmacists can be instrumental in helping women select appropriate products. Pharmacists can also provide patients with key information about the safety and efficacy of these products, as well as the potential adverse effects associated with their use.

Many products are formulated with phytoestrogens, including soy products and red clover products, which are derived from plants and have been used primarily for managing menopause symptoms.⁷ Isoflavones may cause adverse effects such as gastrointestinal (GI) problems, headaches, and allergic reactions.⁷ Because the long-term effects of phytoestrogens have not been fully established, especially among individuals with an increased risk of estrogen-dependent cancers and thromboembolic disorders, use of these products should be avoided in these patients.⁷ Patients should be encouraged to discuss these issues with their primary health care provider.

Black cohosh is found in many supplements for managing menopause symptoms and is derived from the dried rhizome and roots of Cimicifuga racemosa.⁷ Adverse effects associated with the use of black cohosh include GI effects, headache, rash, nausea, dizziness, weight gain, and acute hepatitis.⁷ Using black cohosh for more than 6 months is not recommended because there are insufficient data regarding the effects of long-term use.⁷

Clinical Trials
Results from clinical studies show that soy isoflavones may provide relief from vasomotor symptoms such as hot flashes, but results from various studies are still inconclusive.^7-10 However, a 2011 study reported a significant decrease in vasomotor symptoms when isoflavones were used.^7,8 While there is still great debate about the efficacy of soy isoflavones, the North American Menopause Society (NAMS) recommends 50 mg/day of soy isoflavones for treating vasomotor symptoms, when appropriate.^8,9 If symptoms do not resolve, NAMS recommends a trial using an alternate therapy.^8,9 Several clinical trials evaluating the safety and efficacy of black cohosh have had mixed results; there are currently insufficient clinical data regarding the use of black cohosh for menopausal symptoms.^7,8,11

Research regarding the use of these supplements is ongoing. For more in-depth information on these supplements, menopausal symptoms, and ongoing studies, visit the National Institutes of Health National Center for Complementary and Alternative Medicine website at http://nccam.nih.gov/health/menopause/menopausesymptoms.htm.

Closing Thoughts
Patients should always be advised to discuss the use of products to relieve menopause symptoms with their primary health care before they are used, especially if patients have preexisting medical conditions or are taking any other medications. This can help patients become aware of contraindications and avoid potential drug interactions, as well as confirm that a medication is appropriate. Patients electing to use the supplements discussed above should be counseled on the potential adverse effects associated with their use. Patients experiencing severe and unmanageable symptoms should be encouraged to talk to their primary health care provider about the best treatment options for managing their menopausal symptoms.

When a woman reaches menopause, the risk of developing cardiovascular disease and osteoporosis can increase; therefore, it is imperative that postmenopausal women discuss these issues as well as preventive and treatment measures with their primary health care provider. During patient counseling, pharmacists can discuss nonpharmacologic measures that may help provide symptomatic relief, remind patients of the potential triggers of vasomotor symptoms, and direct patients to the online educational resources (Table 2). To manage vasomotor symptoms, The American College of Obstetricians and Gynecologists recommends that patients wear layered clothing, lower the room temperature, and consume cool drinks.¹² It is also important to remind patients to maintain routine medical visits and incorporate lifestyle modifications such as practicing relaxation techniques (eg, yoga), getting sufficient rest, eating a well-balanced diet, and establishing some type of exercise routine.

Menopause may present challenges and require women to make adjustments. Pharmacists can encourage women to take charge of their overall health and learn how to manage menopause symptoms effectively and safely.

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Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

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References

1. Menopause. US Department of Health & Human Services Office on Women’s Health website. http://womenshealth.gov/menopause. Accessed May 1, 2014.
2. Menopausal symptoms and complementary health practices. National Institutes of Health National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/health/menopause/menopausesymptoms.htm. Accessed May 1, 2014.
3. Gold E. The timing of the age at which natural menopause occurs. Obstet Gynecol Clin North Am. 2011;38(3):425-440.
4. Menopause. Merck Manual for Health Care Professionals website. www.merck.com/mmpe/sec18/ch245/ch245a.html#sec18-ch245-ch245a-193b. Accessed May 1, 2014.
5. Bedell S, Nachtigall M, Naftolin F. The pros and cons of plant estrogens for menopause. J Steroid Biochem Mol Biol. 2014;139:225-236.
6. One A Day Menopause Formula [package insert]. Whippany, NJ: Bayer Healthcare LLC; 2013.
7. McQueen C, Orr K. Natural products. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.
8. Glassy C. “Alternative” cures for hot flashes: worthwhile, or a waste? Medscape website. www.medscape.com/viewarticle/822488_3. Accessed May 1, 2014.
9. North American Menopause Society. The role of soy isoflavones in menopausal health: report of the North American Menopause Society/Wulf H [abstract]. Menopause. 2011;18:732-753.
10. Menopausal symptoms and complementary health practices. National Institutes of Health National Center for Complementary and Alternative Medicine website. http://nccam.nih.gov/health/menopause/menopausesymptoms. Accessed May 1, 2014.
11. Leach MJ, Moore V. Black cohosh (Cimicifuga spp) for menopausal symptoms. Cochrane Database Syst Rev. 2012;9.
12. New guidelines issued on menopausal symptom management. Medscape website. www.medscape.org/viewarticle/818509. Accessed May 1, 2014.

- See more at: http://www.pharmacytimes.com/publications/issue/2014/June2014/Managing-Menopause-An-Individualized-Approach#sthash.605ekUFB.dpuf

OTC Product News

Ausanil Marketed by: VR1, Inc Ausanil, a homeopathic nasal spray, is now available for rapid relief of severe headaches and migraines. It contains Capsicum annuum as an analgesic and Zingiber officinale as an antinausea agent. Patients 18 years and older should prime the pump by depressing it several times before its first use or after prolonged non-use. The product should be sprayed once or twice into each nostril. Patients will experience a stinging sensation in the nose when administering Ausanil, as a result of its action on the sensory nerve in the nose. For More Information: www.ausanil.com 









Children’s Zyrtec Dissolve Tabs Marketed by: McNeil Consumer Healthcare Children’s Zyrtec Dissolve Tabs are formulated to relieve symptoms of hay fever or other upper respiratory allergies, including runny nose; sneezing; itchy, watery eyes; and itching of the nose or throat. Each tablet contains cetirizine HCl 10 mg as an antihistamine. Adults and children 6 years and older should take one 10-mg tablet once daily, and should not take more than 1 tablet in a 24-hour period. Tablets melt in the mouth and can be taken with or without water. For More Information: www.zyrtec.com 








AZO Bladder Control Marketed by: i-Health, Inc AZO Bladder Control is a drug-free dietary supplement that helps control the need to go to the bathroom. It contains a naturally sourced blend of pumpkin seed extract and soybean isoflavones to help optimize normal bladder activity and bladder strength. For the first 2 weeks, patients should take 1 capsule 3 times per day: once in the morning, once at noon, and once at night. After 2 weeks, patients should take 1 capsule twice daily, once in the morning, and once at night. For More Information: www.azobladder.com










 Estroven Weight Management Marketed by: i-Health Inc Formulated to address the physical changes associated with menopause, Estroven Weight Management contains soy isoflavones and black cohosh to reduce hot flashes and night sweats; Synetrim CQ, a proprietary ingredient to balance serotonin; and an herbal blend of naturally sourced ingredients to support healthy weight management and a healthy lifestyle. The recommended dose is 1 capsule in the morning and 1 capsule in the evening, taken with food. For More Information: www.estroven.com

culled fro pharmacytimes

PHARMACY CASE STUDIES

Case 1: Emergency Contraception
ML is a 15-year-old female who comes to the pharmacy looking frantic. She is near the contraceptives aisle looking for something specific. Upon questioning, she states she is looking for emergency contraception. She says she has been sexually active with her boyfriend of 2 years. They always use protection, but last night, she realized that the condom was not intact after they had intercourse. She is concerned about getting pregnant and wants to know if there is anything available over the counter. She says she does not want to use her insurance because she is concerned about her parents finding out. What recommendations would you give ML?

Answer
In June 2013, the FDA announced that Plan B One-Step (levonorgestrel) can be used as a nonprescription product by all women of childbearing potential. Before this, the product was marketed over the counter for patients 17 years and older. Currently, 2 options are available for emergency contraception: Plan B One-Step does not have an age restriction, but Next Choice is restricted to women 17 years and older. To purchase Next Choice, presentation of identification is required. Plan B One-Step and Next Choice contain levonorgestrel.

ML meets the criteria for emergency contraception because her unprotected intercourse occurred within the past 72 hours. Studies have shown that emergency contraception can be effective if given within 5 days (120 hours). However, it is most effective when used immediately.

The side effects associated with Next Choice and Plan B One-Step include nausea and vomiting. Patients not using a routine form of contraception should be educated on the various methods available. Because ML is 15 years of age, her only option is Plan B One-Step. ML should be informed that it will not protect her from sexually transmitted diseases such as HIV/AIDS.

Case 2: Osteoporosis
NM is a 58-year-old female who comes to the pharmacy looking for an OTC vitamin. She says her doctor recommended that she get a bone density test, and her T-score showed that she is close to having osteopenia. She does not want to take prescription medications to prevent bone loss because she heard they have terrible side effects. Because she does not have osteoporosis yet, her doctor recommended that she start taking a calcium supplement. NM does not exercise, and she smokes 1 pack of cigarettes per day. Many OTC options are available. What can you recommend to NM?

Answer
Osteoporosis is a disease in which bones become fragile and more likely to fracture. Osteoporosis can be prevented before fractures occur. Treatment using calcium can help prevent bone loss. The best way to receive an adequate amount of calcium is through the diet. NM should be encouraged to incorporate calcium-containing products into her diet. Women 51 years and older should take 1200 mg of calcium per day divided into at least 2 doses. NM should also be encouraged to take vitamin D 800 IU per day to help with calcium absorption.¹ Because she does not exercise, she should be encouraged to engage in weight-bearing and strengthening exercise to improve her strength and balance. Exercise will also decrease her risk of falls. NM should also be encouraged to quit smoking because smoking increases the risk of osteoporosis. Smoking cessation products can be recommended if NM is interested.

Two forms of OTC calcium are available: calcium carbonate and calcium citrate. Both are recommended, but individuals who have heartburn and take medications to decrease stomach acid can absorb calcium citrate more easily. Calcium carbonate requires more stomach acid and it is therefore recommended that it be taken after meals or with a glass of juice to aid in absorption. Because NM does not have heartburn, either supplement could help her.

Case 3: Douche
SN is a 28-year-old female who comes to the pharmacy looking for douching products. She says she notices an odor from her vagina and wants to clean it with a douching product. Upon questioning, she says she has been douching 6 to 8 times every month for the past 2 years. She claims she has multiple sexual partners and feels like cleaning her vagina regularly. She says she feels that the douche keeps her safe from syphilis and gonorrhea. She typically douches immediately after intercourse. She also heard that eating a lot of yogurt can help prevent infections, so she has been eating a cup of yogurt daily for 1 year. She has not had any symptoms related to infection. She denies smoking or drinking alcohol. She is currently taking a multivitamin daily. What recommendations do you have for SN regarding douching products?
 
Answer: SN should be educated that douching does not safeguard against sexually transmitted diseases. The best way for her to reduce her risk of syphilis and gonorrhea is to use contraception products such as condoms. Many women use douche products frequently. Women tend to mistakenly believe that douching regularly cleans the vagina, rinses away blood after menstruation, helps get rid of odor, and prevents infections. However, repeated douching has been associated with pelvic inflammatory disease, reduced fertility, vaginal infections, and cervical cancer. Regular douching should be discouraged for all women. The most common product contains water and vinegar (acetic acid) solution.
SN should be informed that douching is not recommended for cleaning her vagina and will not eliminate the odor. It increases her risks and does not provide much benefit. It is recommended that if she uses vaginal spermicide, she should wait at least 6 to 8 hours after sexual intercourse before douching. If she is concerned about keeping her vagina clean, she should be encouraged to gently wash it with lukewarm water and mild soap when she is in the shower.
 
Case 4: Menopause
MG is a 56-year-old female who is complaining of hot flashes. She says she is going through menopause and wants to know what she can take that is natural. She is concerned about taking estrogen replacement prescription products because there have been so many problems associated with them. She heard natural products such as soy and black cohosh work well. She wants to know if you have heard anything about these products and if there is one you prefer for treating menopause symptoms. Upon questioning, she states she is not taking any medications and smokes 1 pack of cigarettes per day. What recommendations do you have for MG?
 
Answer: Many women like MG are concerned about the safety of hormone replacement therapy during menopause, and some are turning to natural products to help alleviate some of their symptoms. It is important to remind patients that many herbal products work similarly to estrogen replacement, so their safety profile may be similar as well.
Soy has the most data to support its use in treating menopause symptoms. A few studies have shown that 20 to 60 g of soy protein per day can decrease the frequency and severity of hot flashes in menopausal women. However, the use of soy is controversial because some data have shown no benefit. If a patient enjoys including soy in her regular diet, it may be beneficial. Black cohosh is very popular for treating menopause symptoms and has some estrogen-like effects. However, MG should be informed that black cohosh has been associated with liver damage. Because soy currently has the most evidence to support its use, MG should consider trying it to see if it is beneficial for her.

Other lifestyle modifications may also help control her menopause symptoms. Women who are overweight are more likely to experience hot flashes; therefore, a good exercise and weight-loss regimen may help. Another beneficial lifestyle modification for MG would be decreasing the number of cigarettes she smokes per day or, preferably, quitting completely.

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Dr. Mansukhani is clinical assistant professor at Ernest Mario School of Pharmacy, Rutgers University, and transitions of care clinical pharmacist at Morristown Medical Center in Morristown, New Jersey. Dr. Bridgeman is clinical assistant professor at Ernest Mario School of Pharmacy, Rutgers University, and internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.

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Reference

1. Clinician’s guide to prevention and treatment of osteoporosis. National Osteoporosis Foundation website. http://nof.org/files/nof/public/content/file/2791/upload/919.pdf. Accessed May 13, 2014.

- See more at: http://www.pharmacytimes.com/publications/issue/2014/June2014/Self-Care-for-Womens-Health#sthash.RfKdDKfI.dpuf

Culled fro Pharmacytimes.

Summary Of The Yayale Ahmeds Presidential Committee On Inter-Professional Relationship In The Public Sector: Interactive Session With Stakeholders

SUMMARY OF THE YAYALE AHMED'S PRESIDENTIAL COMMITTEE ON INTER-PROFESSIONAL RELATIONSHIP IN THE PUBLIC SECTOR: INTERACTIVE SESSION WITH STAKEHOLDERS.

Meeting started with silent prayer by all the attendees at exactly 11am.

Introduction of all participants and the associations they represent was done.

ASSOCIATIONS IN ATTENDANCE:
1. Association of Medical Laboratory Scientist of Nigeria (AMLSN).
2. Association of Pathologist of Nigeria (APN).
3. Association of Private Radio diagnostic and Imaging Directors.
4. Association of Radiographers of Nigeria (ARN).
5. Committee of Heads of Pharmacy in Nigeria Health Institutions.
6. Environmental Health Officers Association of Nigeria (EHOAN).
7. Guild of Medical Laboratory Directors.
8. Health Information Managers Association of Nigeria (HIMAN).
9. Joint Health Sector Union (JOHESU).
10. Medical and Dental Consultants' Association of Nigeria (MDCAN).
11. Medical and Health Workers Union of Nigeria (MHWUN)
12. National Association of Community Health Practitioners of Nigeria.
13. National Association of Government General Medical and Dental Practitioners (NAGGMDP).
14. National Association of Nigerian Nurses and Midwives (NANNM).
15. Nigerian Dental Association (NDA).
16. Nigerian Dental Therapists Association (NDTA).
17. Nigerian Medical Association (NMA).
18. Nigerian Optometrists Association (NOA)
19. Nigerian Society of Physiotherapy (NSP)
20. Nigerian Union of Allied of Health Professionals (NUAHP)
21. Pharmaceutical Society of Nigeria (PSN).
22. Senior Staff Association of University Teaching Hospitals (SSAUTH)

REGULATORY BODIES IN ATTENDANCE;
1. Dental Technologists Registration Board of Nigeria (DTRBN).
2. Dental Therapist Registration Board of Nigeria.
3. Environmental Health Officers Registration Council of Nigeria.
4. Health Records Officers Registration Board (HRORB).
5. Institute of health Services Administration of Nigeria (IHSAN).
6. Medical and Dental Council of Nigeria (MDCN).
7.Medical Laboratory Science Council of Nigeria (MLSCN).
8. Medical Rehabilitation Therapist Board (MRTB).
9. Nigerian Institute of Science Laboratory Technology (NISLT).
10. Nursing and Midwifery Council of Nigeria (NMCN).
11. Optometrist and Dispensing Optician Registration Board of Nigeria.
12. Pharmacist Council of Nigeria (PCN).
13. Radiographers Registration Board of Nigeria (RRBN).
14. West Africa Health Examination Board (WAHEB).
15. Community Health Practitioners Registration Board of Nigeria.
16. Institute of Public Analysts of Nigeria.

The Chairman, Alh. Yayale Ahmed welcomed everybody and stated that, he hoped the committee would find a lasting solution to the disharmony among the stakeholders in the health sector. He promised the committee would do a thorough and perfect job and be an unbiased umpire. Not the headship of the organisation that matters but raising a team to deliver the best for our patients in line with the best practices across the globe. He prayed, this would be the last face off and disharmony in the health sector.
He further stated that all memoranda submitted by each association and regulatory bodies were carefully gone through so all we needed to do was for each association to present what should be solutions and the way forward.

Each association was given 7mins to make her presentation and 2mins to conclude.

AMLSN;
Accused ASSOPON of not changing from the old practice, which gives room for anachy in our laboratories.

APN;
Demanded for an Organogram which should have a Pathologist as the undisputed head of the team in accordance with MDCN Act.

Assoc. of Radiographers of Nigeria(ARN);
Accused the Radiologists of not issuing reports on time, which they claimed is largely due to maladministration of the head of the department of radiology.
Their prayers are;
1. Radiographers to be allowed to scan the patients as this is now done in the advanced countries.
2. Radiographers should be allowed to report their films.

Committee of Heads of Pharmacy in Nigeria Health Institutions;
They alleged;
1. Repression from Doctors.
2. Their fellowship not backed by any circular, so they want the fellowship to be recognised in the scheme of service and remunerated accordingly.
3. There's stagnation in their carrier progression which should be corrected.

Environmental Health Officers Association;
1. Functions are streamlined in the ministry
2. They want a directorate of environmental officers in the ministry.
3. Recruitment of more environmentalists.
4. From the Ministry of Health, ministry of preventive health should be carved out so as to resolve role conflict that is in existence presently.
5. Adequate and sustainable budgetary allocation.
6. Department of environment should be captured in the 3 tiers of Govt.

Guild of Med. Laboratory Directors;
1. Their colleagues in the public sector are repressed.
2. The infighting among stakeholders should stop.
3. Employment of Auxiliary technologists should be discouraged.
4. Allow independent observers to inspect laboratories both within and outside the hospitals.
5. Respect the rule of law.

Health Information Managers Association of Nigeria:
1. They alleged complete neglect.
2. Not allowed to rise to the peak of their profession.
3. Exclusion from decision making in our hospitals.
4. Hippocracy of the managers of our hospitals.
Prayers;
1. Record officers to be drafted to all departments in the hospital eg NHIS, A&E etc.
2. Records dept to be operated electronically
3. A curriculum should be developed for them within the university system in Nigeria.

JOHESU:
1. NMA is not a registered labour union, it's a professional association operating as a labour union.
2. The extant Labour laws in Nigeria as well as International Labour Organisation laws should be adhered strictly to by the Govt.
3. JOHESU under it has 5 registered unions hence can negotiate with the Govt.
4. Clinical services in our hospitals can be headed by doctors but the head of health care services should be left open for any qualified health managers.
5. They desire equity, fairness and justice in the health sector.

MDCAN;
1. Medicine should be practiced according to international best practices.
2. All areas in the health sector has a doctor consultant in that field so creating a non doctor consultants will bring chaos and anarchy in such department and who will take the ultimate responsibility of patient care?
3. The laws regulating medical practice in Nigeria need to be amended.
4. Surgeon General of the federation or Chief Medical of health office should be resuscitated.

MHWUN:
1. The headship of our institutions should not be the exclusive right of doctors, every other professional in the health sector should be able to apply for the post or in the alternative a professional administrator to manage our health system.
2. Doctors dominate all the directorates in the ministry of health.
3. Salary relativity should be equitable, they want a single salary structure in the health sector.
4. Entry points for all graduates in the health sector to be level 9.
5. Advocated a health summit.

NAGGMDP;
1. Medicine is an act with a team work hence we need a leader in that team who is a doctor.
2. Appropriate regulations from all regulatory bodies should be sought after.
3. Indiscipline and insubordination should be tackled frontally.
4. Each professional should know his/her limits
5. Respect team work and leader.
6. Office of the Chief Medical of Health or Surgeon-general should be resuscitated.
7. Relativity as it is practised world over should be maintained in our health sector.
8. Conflicting laws governing health care delivery in Nigeria should be abrogated.

NANNM;
1. Training, skill acquisition, and service delivery have moved up.
2. Nurses are not seen and recognised as a professionals
3. They want intenship program for graduate nurses.
4. Fellows of postgraduate nursing college should be recognised as consultants.
5. Incursions of doctors into their profession eg. midwives are no longer allowed to take deliveries in teaching hospitals, Nurses no longer do wound dressing on the ward.
6. Doctors as the head of the team that they claim to be must carry everybody along.
7. Other professionals in the health sector must be allowed to head the hospitals.
8. Doctors should see others as colleagues and not look down on them.
9. All laws should be harmonised

Nigeria Dental Therapist Association;
1. Nigerian university should be allowed to train them in other words, they want to start getting BSc degree.
2. It's a branch of Dentistry but they are not allowed to do their job because of hierarchy in the system.
3. Disparity in the call duty allowances between them and the Dentists is too wide. 1.2 to 7.5%.
4. There's no provision for their freshers to do internship which they want government to make provisions for.

NMA:
1. Medical practice is about patient care therefore, adherence to core professionalism, job description and definition in accordance with international best practices should be our focus.
2. Adherence to principles of relativity in line with training, levels of responsibilities etc, should be strictly observed.
3. Appropriate no-skewed job evaluation facing the reality, as against 2008 evaluation report that NMA refused to sign because of the fraud detected in it.
4. Total avoidance of nomenclature and designations alien to medical practice.

Nigerian Optometrists Association;
1. This profession is supposed to be responsible for primary eye care in our society, but they are not allowed to do so by the ophthalmologists.
2. There's rivalry between them and the ophthalmologists
3. Optometrists are relegated to doing refraction alone, they are not allowed to consult at the OPD.
Prayers;
1. Full recognition and participatory roles in the care of the eye.
2. They should be given full opportunity to consult at the OPD.
3. Department of optometry to be created and stand alone in our hospitals.
4. Scheme of service to be created for them.

Nigeria Society of Physiotherapists;
1. There are certified consultants and specialists among them who should be allowed to practice to their full potentials.
2. Support JOHESU's submissions.
Prayers;
1. In full support of relativity but should be paid according to training and skills.
2. Directorate of physiotherapy should be created.
3. Clinical residency program should be started in physiotherapy.
4. There should be carrier progression without repression or suppression

Nigerian Union of Allied Health Professionals;
1. Appointing doctors both as Hon. Minister of Health and Minister of State for health is no longer acceptable to them, henceforth, for peace to reign doctor should occupy 1 while any other health professional occupy the 2nd.
2. Entry point for all degree interns should be level 8 step 1, pharmacist, 8 step 2, and doctors, 9 step 2, thereafter, all allowances should be fixed for all, abolishing salary dichotomy we are experiencing in the health sector.
3. Directorate for all health departments.
4. In the composition of the management team, instead of about 8 doctors representing themselves and other health professionals, the distribution should be spread out.
5. There shouldn't be a perpetual leader in the health management team although in the clinical setting this can be. In each department, other professionals there must be allowed to head, eg. Radiology, pathology etc.
6. Headship of the hospitals should be left open to all.
7. Registered trade unions should be recognised in the hospitals and be represented in committees and especially, in the National Council on Health.
8. We don't need a Surgeon General.
9. No particular section should lay claims to be the head of all.

PSN;
1. A Pharmacist is an indispensable link in the care of patients.
2. The role of pharmacist should be well defined in Nigeria.
3. No single health profession can provide the health needs of a patient.
4. A pharmacist is a 7man professional viz; a pharmacist, decision maker, leader, teacher, community leader etc.

SSAUTH;
1. There's shortage of staffs in our hospitals.
2.NMA and NARD are not registered trade unions so, they are not qualified to call for strike.
3. Direct employee of the hospital should be the CEO and not doctors as it is obtainable now.
4. Support creation of more directorates for other professionals.
5. The pronouncement made by NMA that some units should be concessioned or outsourced was unethical.
6. They want only one salary structure in the health sector.
7. Justice Gussau committee report of 2008 should be implemented to the letter.

Dental Technologists Registration Board;
1. Discrimination between HND and BSc holders should be looked into.

Dental Therapists Registration Board;
1. They want degree for Dental Therapists so as to earn respect from other professionals.
They repeated virtually all what the association presented.

Environmental Health Officers Registration Council of Nigeria;
1. Pure preventive health should be looked into instead of concentrating on curative medicine.
2. BSc degree for her members so as to enter into the management cadre.

Health Records Officers Registration Board;
1. To abolish the dichotomy between the HND and BSc holders.
2. To make it as a law that, all hospitals in Nigeria be it public or private should employ a record officer.
3. Record keeping in Nigeria must change from analog to computer.

Institute of Health Services Administration of Nigeria;
1. The leadership tussle should be looked into.
2. Proper structure for team work.
3. Reorganise Ministry of Health.

MDCN;
1. Improvement in funding the health sector.
2. The conflict between the MDCN Act and MSN Act must be corrected.
3. Team work and harmony in the health sector should not be disrupted.

MLSCN;
1. Claimed there's no conflicts in the MDCN and MLSCN Acts.
2. Hospitals to be headed by administrators.
3. Signing what you did not perform is tantamount to fraud so asking pathologists to append their signatures on the results of tests performed by medical laboratory scientists is no longer acceptable to them and this should stop.

Medical Rehabilitation Therapists Board;
1. Internship for their fresh graduates should be approved.
2. More higher institutions of learning should be compelled to offer the course.
3. Postgraduate training for them to be embraced.
4. Discrimination against them should be looked into.

Nigerian Institute of Science laboratory Technology;
1. We are all guilty of the mess we put ourselves in the health sector.
2. There's no reason for the infighting.
3. Discrimination cuts across and not limited to one group an claimed by all.
4. Call duty allowance should be extended to them.

NMCN;
1. The nurses constitute the largest workforce in the health sector.
2. It is the only profession having 24 hrs contact with the patients.
3. The shift allowance for nurses should be improved upon.
4. Government should look into method of salary negotiations.
5. The issue of skipping for nurses must stay.
6. Midwives should be allowed to palpate pregnant women and take deliveries in our tertiary institutions.
7. Internship for their graduates should be allowed.
8. More Nurses should be appointed into the boards of our health institutions just as we have Doctors in all the boards.

Optometrist and Dispensing Opticians Registration Board;
1. Creation of the department of optometry in the public service.
2.members should undergo internship compulsorily with adequate provision made for that purpose.
3. Review scheme of service to cater for their consultants.

PCN;
1. Government should compel all hospitals in Nigeria both public and private to employ the services of a pharmacist.
2. The activities of pharmacy technicians and patent medicine vendors should be looked into and properly regulated.
3. Government should improve on the funding of the council.
4. The council is opposed to the office of Surgeon-general as been requested for by NMA unless if the office is left open for other health professionals eg. Pharmacists, Nurses etc to aspire to occupy the office.

Radiographers Registration Board of Nigeria;
1. Increase in funding and proper monitoring.

Institute of Public Analysts of Nigeria
1. Proper integration into preventive health.

After all the presentations, the Chairman, appreciated all the stakeholders present, he asked, 'do you all believe that if there are no patients there can't be hospitals?' which we all answered in the affirmative, he further asked that in total honesty ' who do we think patients come to see in the hospitals?' There was murmuring. He reassured us that the committee would be unbias and that arrangements have been concluded for members of the committee to visit advanced countries to look and study their health systems and come out with recommendations in line with international best practices and put an end to recurrent altercations, indiscipline, insubordination and industrial disharmony in health sector.

Meeting was brought to a close at 5.10pm with silent closing prayer from everybody.

Representatives of NMA are,
1. Dr. Titus IBEKWE
2. Dr. Adewunmi ALAYAKI
3. Dr. Abdulrahman ABUBAKAR
4. Dr. Nosa ORHUE
5. Dr. Nurudeen AKINDELE
6. Dr. Henry EWUNONU
7. Prof. Amos GAZAMA
8. Prof. ADETUNJI
9. Prof. E. J. C. NWANA

Signed.
Dr. Adewunmi ALAYAKI
Secretary General. 

Open Letter To The Secretary To The Government Of The Federation On Facing The Challenges In The Health Sector

Open Letter To The Secretary To The Government Of The Federation On Facing The Challenges In The Health Sector

OPEN LETTER TO THE SECRETARY TO THE GOVERNMENT OF THE FEDERATION

Senator Anyim Pius Anyim
Secretary to the Government of the Federation
Shehu Shagari Complex
Three Arms Zone
Abuja.

Your Excellency,

FACING THE CHALLENGES IN THE HEALTH SECTOR.

RESOLUTIONS OF THE NIGERIAN MEDICAL ASSOCIATION (NMA) NATIONAL OFFICERS’ COMMITTEE (NOC) MEETING HELD ON THE 10TH OF JUNE, 2014 AT THE NATIONAL SECRETARIAT AND SUBMITTED TO THE OFFICE OF THE SECRETARY OF THE GOVERNMENT OF THE FEDERATION WEDNESDAY 11TH JUNE 2014.

1. The post of Deputy Chairman Medical Advisory Committee (DCMAC) has been circularized and operational. Rather than abolish it, the NMA hereby demands that four (4) DCMACs for teaching hospitals and three (3) for the Federal Medical Centres be appointed forthwith to assist the CMACs whose statutory responsibilities are too heavy for any single individual to handle. Directors in other government agencies are supported by several Deputy Directors, why not the CMAC who is also a Director? Such a DCMAC must have same qualifications as the CMAC.

2. The NMA is opposed to the appointment of Directors in the Hospitals. This Position distorts the chain of command in the hospital, induces anarchy and exposes the patient to conflicting treatment and management directives with attendant negative consequences.

3. The NMA demands that grade level 12 (CONMESS 2) in the health sector MUST be SKIPPED for medical doctors. Consequently no medical/dental practitioners should be on that grade level anymore.

4. The title “CONSULTANT” in a hospital setting describes the relationship between the Specialist Medical Doctor and his patient. It will be a source of confusion if the title is applied to any other health worker who statutorily does not own patient. NMA therefore declares with unmitigated emphasis that if “non-doctor consultants” are appointed, it will lead to chaos and anarchy in the health sector. This should not happen.

5. Relativity in health sector is sacrosanct. The NMA hereby demands for immediate implementation of the January 3rd, 2014 circular. The NMA also demands the immediate payment of the arrears of the corrected relativity for 22 years during which her members were short changed.

Much as we are not against salary increase for any category of workers, either in health or elsewhere, the NMA demands for immediate adjustment of the doctors’ salary to maintain the relativity as agreed and documented once CONHESS is adjusted.

6. That Government should expedite the passage of the National Health Bill (NHB), and extend Universal Health Coverage to cover 100% of Nigerians and not 30% as currently prescribed by National Health Insurance Scheme (NHIS).

7. Surgeon General of the Federation MUST be appointed with immediate effect.

8. The entry point of the House Officer should be corrected to CONMESS 1 step 4 as originally contained in MSS/MSSS while the Registrar/Medical Officer is moved to CONMESS 3 step 3.

9. Clinical duty allowance for Honorary Consultants should be increased by 90% of CONMESS

10. Adjust the specialist allowance as contained in the 2009 collective bargaining agreement. Additionally, ALL doctors on CONMESS 3 and above MUST be paid specialist allowance or its equivalent that is not less than 50% higher than what is paid to other health workers.

11. Hazard allowance MUST be at least N100, 000 per month for Medical Doctors.

12. Immediate release of the circular on rural posting, teaching and other allowances which MUST include house officers.

13. Immediate withdrawal of the CBN circular authorizing the Medical Laboratory Science Council of Nigeria (MLSCN) to approve licenses for the importation of In-Vitro Diagnostics (IVDs).

14. Immediate Release of Circular on retirement age for Medical Doctors as agreed with the Federal Government (FG)
15. The Federal Government through the Federal Ministry of Health should formalise and implement the report of the interagency committee on residency training as well as release the uniform template on appointment of Resident Doctors in line with earlier agreements. Moreover, a concrete Funding framework for residency training must be established. The Overseas clinical attachment must be fully restored and properly funded in the interest of the nation.
16. That in the interest of harmony in Federal Medical Centre, Owerri the government should pay the salaries of our members in the centre as agreed on 21st October, 2013.
17. Immediate concrete steps must be put in place for the reintegration of our members back into the IPPIS platform.
18. All attempts to coerce house officers not to join NARD must stop.
19. The orchestrated intimidation, harassment and physical assault of our members in departments of Pathology (Laboratory Medicine) by Laboratory Scientists which is being tolerated by the Federal Ministry of Health (FMOH) must stop.
20. The Endless circle of incomplete salary payment to our members in many hospitals in the name of shortfalls in personnel cost must stop.
21. Universal applicability of all establishment circulars on the remuneration and conditions of service for doctors at all levels of Government must be guaranteed.
22. Government should as a matter of urgency set up a health trust fund that will enhance the upgrading of all hospitals in Nigeria.
23. The position of Chief Medical Director/Medical Director must continue to be occupied by a Medical Doctor as contained in the Act establishing the tertiary Hospitals. This position remains sacrosanct and untouchable.
WHY DID THEY NOT ASK THAT THE POST OF VICE CHANCELLOR BE OPEN TO EVERYONE IN THE UNIVERSITY SINCE ASUU AND SANU ARE MADE UP OF GRADUATES

CAN YOU BE A JUDGE OF THE HIGH COURT OR COURT OF APPEAL IF YOU ARE NOT A LAWYER?

WHY DO THEY THINK THE HOSPITALS WHERE LIVES ARE SAVED EVERYDAY SHOULD SACRIFICE THE ESTABLISHED LEADERSHIP I.E. CHIEF MEDICAL DIRECTOR?

24. The NMA henceforth shall not accept the continued violation of any of the terms of the 2009 Collective Bargaining Agreement. This is exemplified by the payment of Medical Physicists and Optometrists with OD (who are on CONHESS) call duty allowance using the CONMESS Circular. Similarly, the phrase “Ministries, Departments and Agencies” (MDA) in the said agreement should replace “Federal Ministry of Health and other Federal Health Institutions” as contained in the 2009 CONMESS Circular.
In the light of the fore-going therefore, the NMA hereby gives government 14 days to meet all her demands as stated above or have her members called out for a resumption of the TOTAL and INDEFINITE withdrawal of service suspended on 5th January 2014.
The NMA is taking this painful route because our silence and gentle approach to these contending issues have been taken for granted.
We have to take this action in order to save the health care delivery system from anarchy that is palpably imminent.

We hereby appeal to all Nigerians for their understanding and to press on Government to meet with our demands to avoid the STRIKE which is scheduled to start on the 1st of July 2014 from 00.10 hours GMT.

…………………………….. ..…………………………………..
DR. Kayode OBEMBE DR. Adewunmi ALAYAKI
President Secretary General

Cc:
President of the Senate, FRN
Speaker, House of Representatives, FRN
Hon. Minister of Health
Hon. Minister of State for Health
Hon. Minister of Labour and Productivity
Hon. Minister of Finance
The Head of Service of the Federation
Chairman, Senate Committee on Health
Chairman, House Committee on Health
DG Budgets
Chairman National Salaries, Wages and Income Commission
Inspector General of Police
Chairman, MDCN
Director of State Security Service
Chairman, Committee of CMDs
All CMDs/MDs
All Heads of NMA Affiliate bodies
Media

87th Annual National PSN Conference

ADELUSI-ADELUYI ELECTED PRESIDENT OF NIGERIA ACADEMY OF PHARMACY

(By Yusuff Moshood)

Prince Julius  Adelusi-Adeluyi has emerged president of the Nigeria Academy of Pharmacy.

Adelusi-Adeluyi was elected at the inaugural meeting of the Academy, held at Sheraton Hotel and Towers, Ikeja, Lagos, on 20 March and attended by foundation fellows of the Academy.

Other officers elected at the meeting are: Prof. Abdulahi Mustapha, vice president (North); Pharm. (Sir) Ifeanyi Atueyi, vice president (South); Prof. Fola Tayo, general secretary; Pharm. (Sir) Anthony Akhimien, assistant general secretary; Pharm. (Sir) Ike Onyechi, treasurer; and Pharm. Sam Nda-Isaiah, publicity secretary.

Adeluyi-Adelusi is the executive chairman of Juli Plc., the first indigenously owned/promoted company on the Nigerian Stock Exchange. He is a former Minister of Health and Human Resources, and also former president of the Alumni Association of the National Institute for Policy and Strategic Studies (NIPSS), Kuru.

REPS OKAY AMENDED NATIONAL HEALTH BILL, WORKERS HAIL MOVE

• Defaulters risk 10-year jail term, others

• Reps okay amended National Health Bill, workers hail move

• Lawmakers plan constituency devt fund

PRESIDENT Goodluck Jonathan Tuesday signed into law the 2014 Pension Reform Bill, effectively repealing the 2004 Pension Reform Act.

Meanwhile, after exhaustive deliberations, the House of Representatives yesterday passed the amended version of the National Health Bill (NHB) 2014 or rather the ‘People’s Version’.

In the same vein, if a legislation being considered by the House of Representatives sails through, a constituency development fund would be established in no distant time from now.

The new pension law prescribes among others, upward review of penalties and sanctions to pension defaulters and employers which fail to remit deducted monies of their employees.

The new law was passed between May and June, this year by the National Assembly and subsequently forwarded to the President for assent. The House of Representatives passed the bill on May 27, while the Senate passed it on June 3.

According to the signed document, “The Pension Reform Act 2014 also makes provisions that will enable the creation of additional permissible investment instruments to accommodate initiatives for national development, such as investment in the real sector, including infrastructure and real estate development. This is provided without compromising the paramount principle of ensuring the safety of pension fund assets.”

Highlight of the new pension law indicate that, the sanctions provided under the Pension Reform Act 2004 were no longer sufficient deterrents against infractions of the law.

“Furthermore, there are currently more sophisticated mode of diversion of pension assets, such as diversion and/or non-disclosure of interests and commissions accruable to pension fund assets, which were not addressed by the PRA 2004. Consequently, the Pension Reform Act 2014 has created new offences and provided for stiffer penalties that will serve as deterrent against mismanagement or diversion of pension funds assets under any guise”.

The law provides that, “Persons who mismanage pension fund will be liable on conviction to not less than 10 years imprisonment or fine of an amount equal to three-times the amount so misappropriated or diverted or both imprisonment and fine”.

The 2014 Act also empowers PenCom, subject to the fiat of the Attorney General of the Federation, to institute criminal proceedings against employers who persistently fail to deduct and/or remit pension contributions of their employees within the stipulated time. This was not provided for by the 2004 Act.

The Pension Reform Act 2004 only allowed PenCom to revoke the licence of erring pension operators but does not provide for other interim remedial measures that may be taken by PenCom to resolve identified challenges in licensed operators.

The Senate had earlier in the year passed a version of the NHB, which was however, rejected by other health workers under the aegis of the Joint Health Sector Union (JOHESU) and Allied Health Professionals Association (APHA).

Members of JOHESU and AHPA which include pharmacists, nurses, medical laboratory scientists, physiotherapists, radiographers and other health workers besides medical doctors had “strongly enjoined the House of Representatives to conduct a proper public hearing to redress outstanding contentious issue in the NHB 2014 rather than adopting a concurrence of the flawed version passed by the Senate in the ultimate professional and public interest.”

President of the Pharmaceutical Society of Nigeria (PSN), Olumide Akintayo, told The Guardian yesterday: “We are happy that the National Assembly that is the House of Representatives has at last passed the people’s version of the NHB. We were not happy with some sections of the Bill passed earlier in the year by the Senate. We complained and asked for our input, which the House of Representatives obliged us. We are happy with the Bill as passed. It reflects the expectations of 90 per cent of the workforce in the health sector. It is a way forward towards better, more accessible, affordable and universal health care.”

JOHESU and AHPA had consistently called on the National Assembly (NASS) to amend Section 1(1) of the NHB 2014, which was still reflected as in the original draft passed by the Senate recently.

The controversial Section 1 (1) of the version passed by the Senate posits that a “National Health System will provide regulatory framework for the regulation of health services in Nigeria.”

Yesterday, a bill to that effect aimed at ensuring even development of all constituencies in the federation passed the second reading on the floor of the House of Representatives.

Sponsor of the Bill, Mr. Ben Nwankwo, who led debate on the general principles of the legislation, maintained that there was the need to dedicate a specific percentage of the budget to the development of the rural areas in the country.

Lamenting the lukewarm attitude by the authorities to rural development, he argued that the problem would be redressed with the establishment of the fund to be administered by the rural development agency established by the government.

Nwankwo who represents Orumba North, South Federal constituency of Anambra State while canvassing the support of the lawmakers, further believed that the fund would alleviate poverty in the polity since 70 per cent of Nigerians live in the rural areas.

Stressing that the main thrust of the legislation was “to legitimise the contentious constituency support project,” he maintained that the bill was intended to correct the top-bottom approach of governance whereby the welfare of those at the grass root were often neglected.

Meanwhile, Speaker of the House of Representatives, Aminu Waziri Tambuwal has reiterated his resolve to ensure openness and transparency in the affairs of the lower legislative chamber.

Speaking at the inauguration of the leadership of the House of Representatives Press Corps, yesterday at the National Assembly complex, he explained that as lawmakers, they were not operating in a secret cult in the House.

Stating that members of the public could access any information, he expressed readiness to avail the public with relevant information on the affairs of the House of Representatives.

“I urged the public to appreciate our constraints. Some believe that we’re just an appendage of the Executive, but that is not the case. Without the legislature, you can’t have a democratic government,” he said.

WHAT, ANOTHER DOCTORS’ STRIKE?

With due respect to my teachers, senior colleagues and colleagues, the call for downing of tool by the doctors is needless having read the ratio in which the strike was called upon.

Over the years, having worked within and outside Nigeria both in clinical and public health domains, I am strongly obliged to state that the nation’s health drawbacks are essentially caused by doctors who ordinary are meant to be the leaders of the health team. It suffices to state that, while it is true that the leadership of the health team is like a birth right, their roles and responsibility are equally a birth right, only when these are aligned that we can claim the leadership of the heath team. Come to think of the request placed before the federal government, It is sad to note that the issues are quite petty and trivial to culminate to such a decision that will result to irreversible consequences and loss of lives.

As a medical doctor with over fourteen years experience, I have never had a course to question if I am the head of any health team where I found myself as the most senior doctor or the only doctor in a collection of health practitioners in a health mission, for the simple reason that, I know my bound and appreciated that even the weakest link in my team count. I will also not pursue vanity to a disreputable feat. The posture and activities of my colleagues both at the public and private sectors is appalling, such that it has left some of us who have seen our shortfalls and have made or shown some resentment to it are seen as deviance. We must note that what we think and promote is what can endear us or otherwise to the good books of the government, other health workers and the general public.

For me, I am not surprised at the backlash we receive from other supposedly team mates in the hospital. Looking critically at their opposition to us, you will naturally find out that something is wrong with us as doctors, if not, how could we have lose the confidence of all our team mates including non medic such as the ward attendance, administration staff etc? The truth of the matter is that, if we change our corrupt and indiscipline posture, we will naturally occupy our rightful place. Take for instance, the Heads of Hospitals and many health agencies are being led by the doctors, most of which their hall mark is characterized by kickbacks, high contract inflation even to outright thieving of public funds. Our colleagues will promise heaven and earth to be appointed as heads of organizations, but as soon as they get there, their best friends and new found colleagues are the finance and admin managers and the procurement practitioners.

I have survived several heartbreaks from my colleagues (very senior) in the past and have vowed never to listen to their germane-less advocacy for headship of the health team. From national assignments to international and so many other clinical/public health engagement I have found myself, one of the most recent once was in a supposed tertiary institution headed by a doctor anyway, where doctors no matter your rank should go to the record office and queue up for prescription paper being issued by an officer below the rank of a record officer. I have also been to an organization where patients are dying in troops for simple reason of lack of machine to run tests for a certain class of patients visiting a specialty clinic. Another one was a jamboree organization where names are submitted arbitrarily for ad-hoc jobs that needs some level of expertise, yet competency was dropped into the bin and meritocracy upheld.

The peak of my heartbreak was when I worked in one of a supposed tertiary institution where in a bid to save patient life, a doctor rushed to the theatre to get an oxygen as a last point where such equipment are unarguably handy, could not find one, and we watch the man die. Here, I am not saying the man couldn’t have died, but could have died gracefully, and with some human effort. One can count on and on the rots in organizations headed by doctors. Now my question is, of what value is the appointment of a DCMAC adds to the already CMD and CMAC that has been exclusively for doctors? How does the work of a doctor be affected by the appointment of the most senior health practitioner to direct the activities of his other colleagues as a director or how does your work being affected if a health practitioner has reached a level of expertise in his field and he is refer to as a consultant”. It is quite worrisome to hear that my colleagues have down tool for the simple reason that the post of a Surgeon General is yet to be filled, even when the two ministerial slots are occupied by them. I believe that the hazards’ allowance be review, but doctors especially our Consultants most justify the little that has been paid by actively and routinely availing themselves in the daily routines of the hospital instead of turning attainment of Consultant in the hospital as a gateway to truancy ; my colleagues certainly know what I mean.
We are already fast losing our respect from the government and the general public, and in recent time even from our colleagues whose disposition is for the good of man.

Let me also use this opportunity to congratulate our President who has just assumed office and to urge him to be steadfast in his decision where reasoning should take over precedent than mere emotions and sentiment. Accept my unalloyed loyalty.

This piece is a wakeup call to my colleagues to look up within us and appreciate the rots and imbroglio our actions and in-actions has brought to this noble profession and the health sector in general; as the only way to solve the problem of a leopard wanting to be called a lion can only be addressed by a change of behaviour of the supposed “LION”.

Dr Abdul is former UN medical personnel in Trinidad and Tobago < >'; document.write(')

Pharmacists, nurses, others should stop competing with doctors –NMA president

The President, Nigerian Medical Association, Dr. Osahon Enabulele, in this interview with GBENRO ADEOYE, insists that physicians are best suited to head teaching hospitals

Is it not biased to say only doctors should head hospitals when health care delivery is encompassing?

In any human system, even in heaven and hell, there is order. The phenomenon playing out in the public health care sector amounts to an unnecessary equality beauty contest and unholy quest for the doctor’s leadership authority. This is quite unfortunate and uncalled for.

Every profession and system has a ‘soul’ and a custodian of the core values. That should be someone that has a broad-based general knowledge of the intricate workings of that system or sector. In the health care sector, this professional is unquestionably the medical doctor.

People have been referring to some settings outside Nigeria where the so-called professional managers are heading hospitals. May I point out here that recent evidence has proved that physician-led hospitals perform better in terms of positive patient outcomes which are the primary concern of the health care sector. The argument as to who is best suited to head the hospitals/health establishments has essentially been put to rest by results of scientific studies, the latest being that by a world renowned researcher Amanda Goodall in the USA, who established that hospitals run by doctors were doing far better than those run by the administrators and any other groups of persons. She went further to posit that the main reason for this is that patient care is at the centre of doctors’ training and practice and are therefore in a better position to take certain decisions which are critical for patient’s survival.

Are you saying we can’t find a trained nurse, pharmacist etc who can manage a hospital better than a doctor or be a better administrator?

This is beyond emotional reasoning. In the management of public hospitals, physicians are better suited to manage hospitals as it is not purely a profit-oriented venture, but one in which a delicate balance has to be made between quality patient care/patient needs and profit making. It is expected that the manager of a hospital would be one with a broad and deep understanding of patient needs in addition to his/her cognate managerial experiences which could be garnered as head of several units and departments within the hospital.

Medical and Dental practitioners are not only good clinicians, but also good and excellent managers of human, material and financial resources through administrative acumen, generally garnered on the job through experience and other formal and informal training.

Health care or hospital management is not about democratic selection or election. If it was, then one day, the catechist would start celebrating masses in the Catholic Church since he now possesses PhD. Or the Nurse anaesthetist would start performing surgery on the basis of the votes garnered from members of the surgical team. For those who want to turn best practices upside down, I encourage them to establish a hospital and appoint a paramedic or allied health care worker as the head.

The health minister, Onyebuchi Chukwu, once said that a hospital is totally a doctor’s territory, do you agree with this assertion?

Many a time, public officers are misquoted or interpreted out of context. This is what I suspect could have happened here. I am sure the Hon. Minister was trying to explain what I just told you now. No medical doctor would want to become the managing director of a pharmaceutical industry if he has no specific training in Clinical Pharmacology or Therapeutics which are also clinical specialties. No medical doctor has attempted becoming Head of the Nigerian Institute of Pharmaceutical Research and Development whose management has been colonised by pharmacists or the Army, Navy or Air force. Doctors know their limits. Doctors are simply support staff in these sectors.

Many paramedics, including pharmacists,nurses, laboratory technologists/’scientists,’ physiotherapists, etc. have changed their professions by going back to school to study medicine and become what they feel should guarantee their happiness. Have you heard of a doctor who left the medical profession to read physiotherapy or medical laboratory science or nursing? People should be contented with their professional status, defined roles and positions instead of over-heating the health care environment with frivolous allegations and agitations.

Issues of performance can sometimes be subjective but we will find quite a number of people who will say that Prof. Eyitayo Lambo did well as a health minister. Yet, he was not a doctor but a health economist? Why can’t other health care professionals become health ministers?

Prof Eyitayo Lambo is a man well respected in NMA circles. It is on record that Prof. Eyitayo Lambo received tremendous tutelage from late Prof. Olikoye Ransome-Kuti (a medical doctor). I am sure that his performance could have been better if he had some medical training. Indeed, I am convinced that if you ask him today what else could have made his administration achieve more, he would tell you that it is medical training. This is so because the head of the health care sector should truly have a general knowledge of most, if not all the component areas of health and the health care delivery system. It is also for this reason that a lawyer heads the judicial sector. The lawyer is in addition the Permanent secretary in the ministry of justice despite the fact that there are other paralegal professionals in the judiciary.

As a doctor who signed the Hippocratic Oath, don’t you think that you’ve broken the oath with unhealthy relationship between doctors and other health care professionals which does not help the health system?

I am quite sure that Hippocrates would be very uncomfortable in his grave or wherever he is, seeing what is happening in Nigeria today. Imagine a situation where one of his assistants would tell him to step aside for them to take over headship of the health team. That would be outright sacrilege. This is the more reason we are complaining loudly against the emerging phenomenon of unhealthy rivalry and unholy equality beauty contest in the health sector. Doctors are leaders who are always ready to accommodate the allied health professionals as members of the health team which he/she leads. After all, the doctor essentially created them in the first place when he/she transited from his solo hospital practice (where he rendered all the clinical and ancillary healthcare services to his/her patient) to hospital practice after he developed most of the support services and allied health professions and middle-level health workforce.

What about the incessant strike actions by doctors, which are mostly about allowances and money, how do you explain or relate this with the oath you signed?

The father of modern medicine did state that he made the declarations in good faith with the condition that the society would give him his due and the good things of life. The father of modern medicine never anticipated that a day would come when a physician would be owed salaries or other earned allowances for several months or made to work in despicable and rodent infested work places that constantly distract him/her or be victim of kidnappers. Today, the society and governments at all levels are flouting their own part of the covenant.

Other health professionals rarely go on strike; why is it that they are more committed to health care delivery than doctors who are always seen to be fighting for their pockets?

You must be joking about this. You talk as if you are not in this our country where the other health care workers have made strikes a past time and an instrument of blackmail. I am sure you followed up the last strike action embarked upon by allied health professionals in the month of August. I mean when they metamorphosed into an amalgam of strange bed fellows under JOHESU and other contraptions and embarked on strike action. I am sure you heard that some of them, especially at the Nnamdi Azikiwe Teaching Hospital (NAUTH), Nnewi, switched off power and water supply, as well as life support machines that were supporting patients being treated by doctors in the intensive care unit. Were you happy with these vicious attacks launched on innocent patients? What will you call this kind of method? I expect you as a journalist to hinge your position on facts.

Some people say that most doctors working in government hospitals have their own private clinics, is this ethical?

Let me state here that it is the inalienable fundamental right of any free citizen of Nigeria to utilise his time and space outside official government working hours (8am to 4pm) the way he/she so chooses. I am very conscious of the fact that many public servants on account of years of pauperisation through systematic economic deprivation now have private ventures which they superintend once they close from official government work at 4pm. Now, what we despise and abhor as a body of doctors is the use of government time for private business or practice.

Some people even say that such doctors in government hospitals go on strike to give attention to their own private hospitals? Do you think it’s fair?

If it is true that the sole motive of embarking on strike action is for selfish reasons, that can never be fair. But do you really think that the reason for incurring extra burden of work is for paltry profit? How profitable really do you think medical practice is? I can tell you that private medical practice in Nigeria is generally one of strenuous community service. Cases abound where the medical/dental practitioner treats a patient and also pays the hospital bills of the patient, as most patients who are treated in private hospitals are usually too indigent to pay their bills.

Why do some doctors aid fake drug dealers?

How? I respectfully beg to differ. Doctors are not the professionals involved in drug importation. Pharmacists are the professionals that are usually involved in drug importation. So, you may want to ask pharmacists this question. I am yet to see a medical doctor who wilfully patronises manufacturers or importers of fake drugs. No doctor would want to cause harm to his/her patient no matter how strong the desire for profit could be.

Does the Pharmacists Council of Nigeria inspect pharmacy units of hospitals, including private ones?

The Pharmacists Council of Nigeria (PCN) is only empowered to regulate licensed and registered pharmacists as these are the only group of professionals under their jurisdiction and regulatory ambit. They are not empowered to regulate the practices of medical doctors and dentists or hospitals owned by them.

Doctors seem to be complaining less about their salaries but on relativity, which describes your salary in comparison with those of other health professionals, why are you competing with them?

It is very demeaning for you to say that we are competing with any group. For very obvious reasons, medical doctors are in a distinct class and income group in virtually all countries of the world, including the United States of America and the United Kingdom. It is pertinent to state that there are international best practices guiding the remuneration of professionals and health workers all over the world. On account of the difference in the value and worth of the different categories of health workers, there is a globally acknowledged principle of relativity in the determination of the wages/salaries of health workers with the salary and allowances of medical doctors/dentists distinctly higher than that of allied health professionals or paramedics. It is only in Nigeria that this globally acknowledged practice is not observed. All the efforts of the NMA over the years to ensure institutionalisation of this globally held principle in Nigeria has not yielded much dividends.

 Is it not embarrassing that most doctors prefer to practise abroad?

Who is to blame? Certainly, not doctors. From my earlier analysis, is it really surprising to you that several Nigerian trained medical professionals are practising outside the shores of Nigeria?

In life, man has always adopted self-preservation and survivalist tendencies as the ground norm. The doctor is not an exception. However, what embarrasses us is why people like you journalists are not trying to find out why doctors born, bred and trained in Nigeria are migrating in droves to foreign lands despite the huge burden of disease back home. In those foreign lands, they find job satisfaction, greater reward for work done, greater prospects of actualising their life ambitions; they are not encumbered in the work place by suffocating and very irritating equality beauty contest for position, status and relevance with the doctor. They are protected from kidnappers; the society they serve accords them appropriate recognition and respect which Hippocrates promised his followers. Have you now seen why things are the way they are?

Why do so many doctors engage in carrying out abortion?

I don’t know what you mean by many? I also don’t know where you got your facts from? Is it from your experience or what? What proportion of Nigerian doctors do you consider as many? Abortion is still illegal in Nigeria. I concede that some doctors may be involved in this act of abortion procurement but I must hasten to inform you that some do it as a therapeutic measure to save the life of the pregnant mother. This is allowed. What I think should worry you more is the fact that there are several unscrupulous individuals, both health and non-health professionals who are involved in this illegal practice with the patients who patronise them left to suffer unmitigated disaster and sometimes death.

I encourage members of the public to report such cases and also report themselves that approached the unscrupulous individuals for such illegal abortion services. It takes two to tangle.

These days, there are many cases where patients have been misdiagnosed by Nigerian doctors. For example, former president, Umaru Yar’Adua and late Gani Fawehinmi. Is it that doctors are not well-trained?

Medical diagnosis is a process that is influenced by several factors. There are some occasions where the doctor/clinician has to rely on other support services or technologies, including ultrasound scans, ECG, laboratory test, CT-scan, MRI and x-rays to assist him/her in making a diagnosis. This, the doctor does in about 20% – 30% of the patients that consult him. Unfortunately in our country, the state of our health facilities, particularly the medical laboratories and the individuals who operate these laboratories are unsatisfactory. This is not helped by the unhealthy and unnecessary conflict between the laboratory technologists and the clinical pathologists who are supposed to review the results produced by the laboratory technologists/scientists. This accounts for most cases of mis-diagnosis in Nigeria. Again, most clients expect a one stop miracle each time they visit a doctor. Even in developed countries, it could take certain time consuming processes to finally arrive at a diagnosis. This is the reason why we have such terminologies as preliminary diagnosis, working diagnosis and final diagnosis. Sometimes, the final diagnosis may even be made after autopsy. Yes, this is medicine.

Unfortunately, in Nigeria, doctors are judged unfairly in the court of public opinion aided with the on-going propaganda engineered by certain groups of health workers against the doctor, all in an attempt to pull the doctor down at all cost. I wish to responsibly and respectfully state here that the two distinguished Nigerian leaders you mentioned were not misdiagnosed in Nigeria but the processes at arriving at the proper diagnosis were not exhausted for several reasons.

Another factor worth considering is the evident lack of equipment in our health facilities, particularly at the primary and secondary levels of care, such that the Nigerian doctor doesn’t have most of what he requires to deliver quality services.

Majority of Nigerians believe that doctors are half-baked and killing Nigerians, is it that you doctors should be paid to kill?

It would amount to over flogging the matter to start answering that question. If our doctors are really bad, would you still find people going to hospitals? Go and check the scores of Nigerian doctors who write foreign qualifying exams, then you would be convinced that the Nigerian doctor is a genius. However, one must concede that a lot can still be done to restructure both the undergraduate and post graduate medical training curriculum, fund the medical training institutions in order to attract and retain quality medical trainers and guarantee global best standards.

People say that consultants earn millions of naira for doing nothing.

That is preposterous, scurrilous and sacrilegious. Ordinarily, I would not have bothered to respond to this question because I am quite conscious of the fact that it was the president of the Pharmaceutical Society of Nigeria (PSN), Pharm. Olumide Akintayo, who arrogantly and mischievously told this lie. However, I am compelled to respond because I think he took his obsessive bitterness, hatred and inferiority complex too far, and certainly without the mandate of his members who are traditionally respected allies of doctors. I must say that Pharmacist Olumide Akintayo instantly lost my respect when he arrogantly told this and other blatant lies against the medical profession. We know he has a penchant to blindly deride and oppose the medical profession. I will urge his elders to pull him back from his self-destructive mission. Leaders don’t behave this way.

Fortunately, I was one of the key players that negotiated, on behalf of the NMA, the current Consolidated Medical Salary Structure for medical and dental practitioners in Nigeria (CONMESS) between 2003 and 2009, and I can authoritatively declare to you that there is no hospital consultant in Nigeria that earns that amount of money that he claimed. Not even the highest paid hospital consultant at the terminal of the public service scale takes home anything near that, especially after the heavy tax imposed on him by his/her employers.

I must posit that there is also no truth in his false and incredulous statement that the medical consultant does nothing in the hospital. By that unfortunate statement, he clearly exposed his crass ignorance of the nature, position, role and responsibilities of the medical consultant.  The medical or dental consultant is the seen and unseen guardian angel of the health team. He/she is the hand that directs; the faculty that thinks; the seal that binds the clinical decision making process and implementation of those clinical decisions taken in the hospital.  Surely, the medical consultant is the officer that takes the ultimate clinical decisions on patient care. These are weighty responsibilities which the peddlers of this falsehood have failed to appreciate. I urge them to quickly come to terms with the philosophy behind the position of the medical consultant as the ultimate clinical decision maker as it concerns patient management; and one who takes ultimate responsibility for the actions and inactions of the health team and its members.

I strongly advise the PSN President to stop misleading his members and the general public. He should stop pettifogging over very serious matters of national and international importance.

I urge the PSN President and all those who are ignorant of the role of the Medical Consultant to please study and discover for themselves the practice world over.

Consultants have abandoned their work to resident doctors, who are more or less trainees, is this not very dangerous?

Resident doctors are not medical students. They are not trainee doctors. Rather, they are trainee consultants/specialists. Please, let this sink into the faculties of those who deride house officers and resident doctors in Nigeria. Moreover, they are acting on behalf of their medical consultants who have found them worthy of discharging any responsibility assigned to them. This is the world-wide practice and training requirements for would-be medical consultants.

Nigeria currently has a huge gap in the number of medical consultants available in the country and one sure way for the needed specialists to be produced is this kind of exposure and training. So, there is nothing abnormal about this.

The clamour for the reduction of the period of medical training had recently grown, are you in support of it?

It has been proved that the  Minister of Health, Prof. Onyebuchi Chukwu, to whom this statement was credited, was actually misrepresented in that news report. He was actually condemning the practices by some professional groups who are unscrupulously elongating their years of undergraduate training as a means to equate themselves with the doctors.

We realise the gross deficiency in health manpower needs of the country but reduction of standard in any manner would be inimical to patient care. It would certainly not help to mitigate the challenge of health human resource. As an association, we are convinced the way to go is to expand the available facilities in the existing medical schools with recruitment of the appropriate and adequate number of medical trainers; We also advise that greater efforts should be made to encourage the establishment of medical schools but without compromising standards in any way.

Again, the government and the training institutions should introduce schemes to guarantee the recruitment and retention of quality medical trainers and medical consultants/specialists to deliver the right knowledge and quality training.

Assess the state of Nigeria’s teaching hospitals

Though Nigeria’s teaching hospitals may not be operating at their optimal levels as a result of evident systemic challenges and poor funding, one must appreciate the ingenuity of most of the managers of the teaching hospitals which has ensured their survival unlike the frequent collapse of other government parastatals and private companies, including banks which are managed by supposed business managers and CEOs.

Undoubtedly, the needs and challenges of the teaching hospitals are legion, but the resources to satisfy those needs are getting increasingly tenuous.

Doctors are not allowed to treat gunshot wounds, I don’t know if this has changed. But if it has not, what are you doing to change it?

There is no law banning doctors from treating patients with gunshot wounds. What happened was that the Nigerian Police started insisting that doctors should only treat those who have security clearance and police report. Many innocent doctors who treated gunshot wound patients were frequently harassed and traumatised by the law enforcement agents. Similarly many innocent citizens suffered on account of this and lives were lost.



Source Punch Newspaper