Greatest Gba Gba of HCW toxicity
A HO account of the ongoing ARD-NANNM issues at OAUTHC
Since I started my second posting in house job, I have wanted to write articles on some issues and I am glad to be able to put some of this together now.
I was on casualty call on the cool evening of June 16th, when some of my Chiefs were discussing the problems between nurses and doctors in OAUTHC. A lot of things were said regarding the causes of the never-ending rift between the two parties especially here in Nigeria. A few hours later, I got a notification on my phone which read:
Notice is hereby given of a virtual emergency general meeting of our association.
Date: Friday, 17th June, 2022.
Time: 8pm
Agenda: Forceful confinement of a medical house officer at IHU.
To be honest, I was dumbfounded. I could not believe what I had just read. The group chat was ablaze with doctors expressing their unhappiness and discomfort over the issue. Different stories of “disrespect and bullying surfaced”. I was really interested in how the matter would be handled, and I really looked forward to the meeting.
The following day, the meeting held at the scheduled time with over 90 doctors in attendance (some listened from the devices of their colleagues so the real number cannot be ascertained). The incident that happened the day before was brought up with the moderator describing the details of the incident.
A HO in CTSU (Cardiothoracic Surgery Unit) was detained by a Nurse on the Orthopedics ward after the team had completed a procedure (central line placement) for not cleaning up the waste generated. The team was said to have properly discarded the sharps and separated other medical waste for whoever would dispose of it because an appropriate waste bin was not provided.
The nurse on the ward was not involved in the procedure at all.
The other members of the CTSU team were present and urged the nurse (from the other side of the locked gate) to open the door so that they could settle the issue amicably to no avail. The Chief Registrar was called to the scene and tried to resolve the conflict which yielded no fruitful result.
The hospital management called the ARD (Association of Resident Doctors) and NANNM (National Association of Nigeria Nurses and Midwives) to a meeting in the early hours of the following day and asked that the nurse apologize to the HO and that the ARD should allow them follow due process. (It is important to note that little faith was had on the “due process”).
A lot of things were said after the floor was open for comments and a few stood out to me:
1. The Consultants own patients, not Hos, Registrars or Senior Registrars. I mean we write “Open case note under Dr. Consultant’s Name” or “Admit patient to so so so and so ward under Dr. Consultant’s Name”. Even when we write consults and referrals, it is never the name of the HO that is written as the sender of the letter, but the Consultant’s.
We see patients on behalf of consultants and as such a harassment meted out to a member of the team is one meted out to the consultant.
2. Why wait till the “bosses” left before addressing the issue of waste disposal? Why didn’t the nurse bring it up while the SR and Reg were still on the ward? Why wait till it was just the HO? Did she perform the procedure herself? Why does the responsibility of waste disposal go to her (If she is not considered as the bottom of the food chain and easily bullied)?
3. Why did the nurse not partake in the procedure, as it was done on a surgical ward? I stand to be corrected, but is she not supposed to?
It was said that when the issue reached the higher authorities, she claimed that she was attending to another patient on the ward while the patient the procedure was performed on was reported to be the only patient on the ward.
4. It seemed like she had higher backing as a phone call was made/received where she was reporting the issue to the person on the other end of the call and they could be heard supporting her “line of management”.
5. A few people spoke of the bullying that is rife within the medical practice, even amongst doctors, where our senior colleagues say demeaning things to their colleagues as a way of education in front of nurses, patients and their relations.
Most times, HOs are made to do the work of other HCWs. Many times, we have heard nurses on the ward tell patients that it is the doctor’s job to collect results from the laboratory. Even the lab technicians refuse to give patients/ patients’ relatives their result, telling them that it is the doctors (HOs) who should retrieve the results of investigations. (This is something that should be served to the patient’s case notes by health assistants or health porters).
The cause of this issue is not far-fetched as many times our senior colleagues will hustle us to hustle the labs to run these tests and provide results as though it is our job to do so. These labs have Chiefs, so why can’t a consultant speak to the Chiefs about the lag in the work rate of their technician/ scientists. Why does the HO have to bear the brunt?
In my first posting, there was a registrar who always fought us whenever he saw us carry case files from the nurses’ table to distribute to the patient’s table. He would always tell us that it is not our duty to do so and that we should inform the nurses to distribute it or that they should inform the appropriate authorities to do so. Many a times we told them this and we were met with stares that could pierce the soul, or responses that could breed conflict, and so we learnt to do it ourselves. (In retrospect now, we should have left them to do it. The problem is that some consultants/ SRs will not be interested in whose job it is, but that the case note should be on the tables when due).
6. When similar incidents were brought before the hospital management in the past and nothing concrete was done about the issues. One incident stood out and was reiterated over and over again at the meeting. It is something I call “What is good for the goose is good for the gander”.
This incident occurred at Wesley Guild Hospital, Ilesha a subsidiary of OAUTHC.
This is a first hand account of the affected HO.
HOW A NURSE SHOWED ME LOVE
I had worked up a patient for emergency surgery. Then the theatre said, no oxygen, so we had to transfer the patient to Ile-Ife.
At this point, all the relatives were already angryyyy and wanted to know what was delaying the patient from entering the theatre. But the time we were ready to transfer, it was already past 6 pm.
The nurse came to meet me and asked why we were transferring the patient so late and that he wants to go home immediately after his shift ends and said he is not going to Ife.
He said that “maybe the patient’s relatives would wait till the next morning and that if the new nurse resuming by 7pm can’t take him, he would have to wait till the next day”
Mind you, this was a patient we are scheduled for emergency surgery, not elective.
I finished all the necessary documentations and was about to leave the place.
The relatives were getting agitated because the patient wasn’t too stable and we told them that we were done with the transfer documentations and all that was left was for the nurse to sort them out, so that they could be on their way as is the usual practice. The ambulance was already parked outside; the patient’s relative knew the ambulance guy, so he came on time.
A while after the relatives noticed that they were not been attended to, they went to harass the nurse. In an attempt to share the violence, the nurse lied that it was the doctor delaying them and told them that if a doctor does not sit in the ambulance, it won’t move even if a nurse was there. (Which is not how it is done).
And so, they started looking for the doctor.
This same nurse called me and told me he needed to see me urgently. I asked why? (Because the A&E nurses never call us, attendants do). So, I was taken aback. He never said the reason but insisted that it was very urgent and urged me to come down to A/E immediately. He later called and told me that he was on his way to meet me.
A few moments later, he called and told me that he’s already on his way to meet me and suggested that we met halfway because it was important. He kept calling, I thought it was urgent, so I was rushing down. Luckily, I was with the other unit HO that volunteered to escort me. We got to the corridor and met the patient’s relatives with him, who were asking loudly “Are you the doctor we are waiting for?”
Confused, I say yes. Then, they said I must go to the ambulance because I have been delaying them. I told him to hold on while I called my Chief and he asked me to get out of there. By the time I looked back at the relatives, everyone had a cane with them, with different harmful objects.
I was like, ahhhhh, I was already hovering in fear. The other HO wanted to call the SR again, but his phone was collected by the relative and we were pushed saying “if you don’t want this cane to land on your body, move to the ambulance now”. I was pushed till I almost fell down and at that point, I was begging, “please don’t hit me, I will do whatever you want”.
At that point, the relatives became the boss and I, the house girl the nurse wanted me to be.
We even said only one doctor was needed but they said, “No, both must go if you value your lives”.
And the rest is history.
The next day, the head nurse said to our faces, we were called because what’s good for the goose is good for the gander. So, if relatives are violent to nurses, then the doctor must also have a share of the violence. So, if the relative had in a fit of anger severed my carotid artery, all the nurse’s concern was that I had to take part of the violence.
Now I see stories about how I willingly went to Ife that day because my to do list is to ride in the ambulance before my internship year runs out, I regretted not making an attempt to make a recording of that situation no matter how little.
No one was held accountable and the nurse still works in the A&E.
After the meeting, the following conclusions were made:
1. The ARD should hold a press conference on Monday 20th June, telling the world what happened/is happening in the hospital.
2. The ARD on Monday 20th June should issue a statement to hospital about our intending 48hr strike starting at 8am on Tuesday 21st till 8am on Thursday 23rd demanding for the following:
· That an investigatory panel to be set up to within 48hrs
· Job description of both HOs and Nurses clearly stated
· Punishment for the perpetrator of the violent act
· Clear black and white rules about waste and other related issues stated and pasted everywhere, in all the wards and clinics.
On Monday, the press conference held with a press release (See below) and patients were handed over to their “original owners”, the Consultants, who adequately managed the patients for the two days of the strike.
This was NANNM’s response.
Today, 27th June, 2022, the NANNM alongside JOHESU (Joint Health Sector Unions) OAUTHC chapter embarked on a ?3 days strike (at the time of this publication, I have not seen a communique from the joint association on the strike).
I resumed at work today to find the nurses stations empty and learned that the laboratories have not been giving out sample bottles since yesterday. The health attendant and porters were also not on duty. A congress was held at about 9am at the hospital’s car pack in Ilesha, where a statement like “HOs are medical students” are reported to have been heard.
The labor ward is locked, the record offices are locked, such that outpatient cases were seen with 2A notebooks in clinics. In Ife, it is reported that even drip stands are missing in some wards. The hospital is on a mini-lock down.
So, why are the NANNM striking? I learnt that it was because the nurse involved was given a query (of which was also given to the HO).
Why is JOHESU a part of the strike? ARD’s quarrel is not with a JOHESU member, so I don’t get it. My guess is that they want to cripple us for the next ?3 days and they need JOHESU to do so because technically work would still go on if it was just NANNM that went on strike.
Frankly, I am not surprised that JOHESU went with them, as some of them are complicit in a HO’s problem. An example: a HO would send samples to the laboratory for investigations at night and would go back to check for the result after some time. We would be told that the scientist is asleep or not around. Often times, we would have to beg them to come to work. Even some of the nurses, especially at the A&E.
My Experience
I was in a situation where a patient needed urgent transfusion as she was in shock, I had gone to secure blood at the blood bank and informed the nurse that the patient would need to be transfused with 2 pints of blood that night. He told me that he would not be doing the transfusion as it was too late at night and he was tired (this was someone who resumed work at 7pm in the evening). He went on to tell me that he had been in the practice for about 20 years and I cannot tell him what to do. The health attendants present agreed, calling me a child.
There are lots of issues between health care workers in OAUTHC, much more than this article would give me room to express. Most of the times, we (HOs) do more than is our work for the sake of our patients especially when others are failing to see the need for urgency, but we are not regarded as real doctors. However, we become doctors when they want us to fill their NHIS prescriptions. When their relatives are ill, even when it is not emergency, they would want us to prioritize their care, but we are medical students.
I personally have no issues with anyone, I would just appreciate that everyone does their work well. Healthcare should be a well-oiled machine, because it is all about patient care. Anything outside that is not important.
Also, let’s not drag culture into professionalism (but we are in Nigeria, aren’t we?), because the mindset usually stems from a younger doctor giving an older nurse instruction which is usually viewed as disrespect.
I think it is really important that a job description is done as per ARD’s request and appropriate punishment is meted out to parties that are found wanting.
I really hope things end well and justice is served.
Shoutout to the HO involved, I hope you are holding on strong.
N.B: This is not to say that all nurses or JOHESU members are the bad guys, some of them are angels.
Here is a link to the POTARD-OAUTHC interview with Punch on the matter.
