Eben Enasco Reporting.
The objective of setting up a healthcare institution is to provide care in an appropriate and highly competent fashion to the specified population, usually those who are poor and without access to other sources of care.
The public institutions created by a county, city, or state to deliver health services to a specific population have an unambiguous mission and foundational institutional ethic.
Their ethics is to carry out the function for which they were created and for which they continue to receive operating funds from the public sector.
Whereas, on paper, the goals and objectives of these institutions never change, but the public’s commitment wavers from year to year, with the obvious result that there is considerable variation in the level of financial support the public is willing to provide; serious underfunding for many public hospitals thus significantly compromises the quality of care in many places.
So there remains the paradox, despite an unambiguously consistent mission statement: Compromised public commitment to provide services for the poor translated to a serious loss of quality in some of these healthcare institutions.
The profit motive seldom creates untoward tension among workers at these institutions; the limits imposed by funding sources may, however, lead to the curtailing or closing of certain expensive services, perhaps to the detriment of the patients.
The CEOs of the larger of these hospitals, especially those at the more prominent academic and tertiary-care institutions, are treated and paid as though they were corporate executives.
This trend toward providing top-level management for these institutions came from the growing awareness beginning in the early 1970s that these institutions were administratively out of control or at the very least generally ill-prepared to fulfill their potential in a volatile marketplace.
Few would argue that the majority of these institutions have become heavily bottom-line-oriented.
Balancing cross-subsidization among the various payers with issues of access for the poor is a fine art.
Many of these hospitals, though losing money on every Medicaid and uninsured patient, manage to produce an overall surplus.
They do this by increasing the volume of high-paying expensive procedures on insured patients.
This goes far afield from a care mission of investing in prevention to foster healthier populations.
Positive bottom lines are often then used to implement programs aimed at increasing “market share” for the hospital, rather than increasing services for the most needy.
This part makes the health care system porous with those without relative professional backgrounds occupying sensitive operations.
Yes, the quacks are lined to replace the specialists
The word quackery in the medical profession sometimes refers to those murderers who have no idea about the implications of the drug they administer.
These professional charlatans take advantage of the porous checks and fast-selling drugs in the townlet and random society in the medical community to usurp unsuspecting millions of Nigerians.
These people are in our community, hinterlands, motor parks, and cruel streets in our places of residence.
It is no longer news that Nigeria lost 3,782 nurses to the UK alone in the year 2021, this is according to figures released by the Nursing and Midwifery Council of the UK and since then the figures have skyrocketed.
Similar figures apply to the other segments of the Nigeria Health sector; a gross loss of skilled manpower.
However, several efforts have been made towards reverting this dangerous progression with none seems to be working.
This progression is gradually creating a defect in the Nigeria healthcare delivery framework; which can best be described as a case of “National Diabetes”.
According to data from the World Bank and Nigeria Medical and Dental Council, Nigeria produces an average of 3,000 doctors yearly and currently has about 35,000 doctors practicing, and an estimated doctor-to-patient ratio of 4 per 10,000 population which makes the Job uneasy to continue.
According to data from the Nigeria Nursing and Midwifery Council of Nigeria, the school produces about 12,000 nurses yearly and has a total workforce of 250,000 registered Nursing and Midwifery professionals across the country.
Despite the above figures, it is estimated that Nigeria will require an additional 149,852 doctors and 471,353 Nurses to meet its rising healthcare professional need by 2030.
A report by the International Institute of Investigative Reporting estimated that within a-two year period,(2018-2020), Nigeria lost over 9,000 doctors to the UK and other countries.
Before the year 2015, healthcare professionals leaving the country were mainly junior-level professionals.
However, over the last 7 years, the dynamics have changed.
More and more high-level professionals are leaving the country.
Considering the existing shortage of high-level professionals, if this trend continues unchecked, two grave consequences await the nation.
First is the imminent collapse of medical training architecture in the country, and second is the loss of standard of healthcare practice.
Due to the aforementioned, the Auxiliary Nurse now treats, administers, and sometimes carries out minor operations on patients.
Although Auxiliary nurses can perform various tasks such as taking vital signs, assisting with personal hygiene, feeding, dressing, mobilizing, administering medications, monitoring health status, providing health education and counseling, and referring patients to higher levels of care when needed.
Auxiliary nurses can also help improve access to key maternal and newborn health interventions in low-resource settings by providing antenatal care, postnatal care, family planning, immunization, and management of common illnesses.
According to Public Health Nigeria, the main responsibility of an auxiliary nurse is to ensure patients are kept as comfortable as possible.
They wash and dress incapacitated patients, feed patients at meal times, and help those who have difficulty walking, to get around.
They also help the elderly and disabled with going to the toilet.
They also assess patient’s health by taking temperatures, measuring weights, and assessing respiration levels.
An auxiliary nurse also performs minor medical procedures and assesses blood pressure levels. She or he will also make the patient’s beds and assist with the general upkeep of the ward.
They also work alongside healthcare scientists, assisting them in the identification and treatment of a range of diseases.
They also help healthcare scientists with the analysis of blood and urine samples and patient histories. All under the supervision of health care professionals.”
Speaking on the training of auxiliary nurses, consultant orthopedics at the Federal Medical Centre, Jabi, Abuja, Dr. Ganiyu Aremu, told a source that auxiliary nurses are trained by doctors in private hospitals for some time and when they are employed by other hospitals, they are also retrained to adjust to the culture and practices of the hospital.
According to him, auxiliary nurses are trained by doctors in private hospitals and the systems that are peculiar to that particular doctor, the way he does his things, and the way he expects people, who work with him, to also do things.
So, if a doctor employs an auxiliary nurse who has worked in another hospital, he will have to retrain the auxiliary nurse to the level of how he does his things. The same goes for nurses and doctors.
Agreeing with Dr Aremu it is clear that there is no training to be an auxiliary nurse which is synonymous with being an apprentice. There is no school of auxiliary nursing. It is private hospitals that train them. Some of them spend two to three years in training. After their training, they get their certificate. It is like an apprentice. They may have the technical skills but they lack the theory to back it up.
Despite their lack of qualifications, they seem to take on some important roles in the healthcare setting. Consequently,
Auxiliary nurses have become very important in filling the gap created by the Japa syndrome where registered nurses are in short supply in the country.
According to him, “The Japa syndrome is complicating things. It has a damaging effect. The nurses who are fresh graduates don’t even apply to work anymore, they write exams and start planning to relocate.
In most private hospital practices, it is not possible to get the number of qualified nurses that we need. There is a shortage because the salary is not commensurate, it is poor compared to government hospitals.
Most of them graduate and do not come to private practices and this is what informed the auxiliary nursing.
Auxiliary nurses are most times preferred and employed by private hospitals because of their cheaper wages because they have become a temporary solution to the gap created by the Japa syndrome.
So, to train more nurses would probably assure the masses of a veritable healthcare system and not engage quacks like auxiliary nurses.
If they want additional qualifications, they can go for midwifery training and become staff nurses/midwives.
Remember the auxiliary nurse Feyisayo Ogedengbe who is one key element of the current investigations, who reportedly treated Mohbad a Nigerian musician before his demise.
The suspicion looming over her is that the injection administered by her may have contributed to the singer’s tragic end.
Imagine if the investigation is concluded and found to be true, you will imagine tens of thousands of Nigeria who would have been murdered through similar traits.
In the medical profession, there are so few people monitoring the practitioners including the auxiliary nurses.
The auxiliary nurses have no regulatory bodies that monitor their actions when they administer drugs to patients.
Auxiliary nurses have no place within Nigeria’s healthcare system and laws, legal experts, nursing and medical professionals have insisted.
They said that a nurse or midwife is either registered by the Nursing and Midwifery Council of Nigeria, or the person is a quack.
The Nigerian Medical Association NMA is the umbrella body of all medical and dental practitioners in the nation.
With over 40,000 members from 36 state branches and the branch from the federal capital territory, the NMA is the largest medical professional body in the West African region and about 19,000 in the Diaspora.
The Association holds training courses for doctors and participates in radio programs and TV talk shows.
It has several ongoing projects including those on AIDS, family planning, and primary health care.
But is it on record that the same training courses are prepared for auxiliary nurses to close the gap?
In Nigeria, the malaria parasite and typhoid fever are common illnesses that have been staggering in every home. The curative in the time past was very effective. Those directed to administer drugs to patients likely failed to do their parts which may have led to several lives lost to medical treatments.
Quackery is a crime in the country’s healthcare system and the constitution, and without a license, nobody is permitted to provide any medical or healthcare services to a patient without the prerequisite training certification.
The government at all levels must find a way to educate these hospital assistants to have a fundamental and relative medical background to make the work easier for them as their intervention would make society safer from quackery.