Blessing Enenaite
The President of the Nigerian Medical Association, Dr. Uche Ojinmah, tells BLESSING ENENAITE about his career, the healthcare sector and other issues
What inspired you to be a doctor?
I come from a family of doctors, and I grew up seeing them around me. I have an aunt who is a nurse, and an uncle who is a pharmacist. I used to jokingly say that I was anointed to be a medical doctor by my nuclear family, considering that there are other doctors in my extended family too. At the early stage of my life, I was told that I was a smart student. So, I was going to be a doctor. Basically, I worked towards it.
What are your roles as the President of the Nigerian Medical Association?
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The buck of the work concerning doctors in Nigeria and in the Diaspora stops on my table. As the president of NMA, I oversee an association with eight affiliates, including the Medical and Dental Consultants Association, and the Nigerian Association of Resident Doctors. We also have an association of Nigerian doctors in the United Kingdom, Canada, Germany, South Africa; and many more. I protect the welfare of Nigerian doctors and also advise the government when necessary.
How would you describe your experience so far at the helm of the NMA?
There was nothing that prepared me for the level of stress I met when I came to the office. I am a former president of the National Association of Resident Doctors (2006-2007). I thought the stress was much there, but this one has a greater level of stress because everyone wants me to do whatever they desire immediately. At times, some of these tasks require me to send representatives. It is like a globetrotting affair. Some people may require my presence in one state in the morning, and in another state in the evening.
The government may require that I show up in Abuja. In that case, I would not have a choice but to show up, regardless of where I was in the country. As a matter of fact, those who are close to me have said I have aged rapidly, and I am aware of that. That is because I always have to be on my toes. There are many speeches to write; as well as negotiations and discussions.
What are your most notable achievements since you assumed office?
I became the president in May 2022. Between May and now, I can say that I have a more united and informed association. My goal is to make sure I carry members along. The struggle for the payment of the new hazard allowance started with the last administration. We have also started it in my administration, although the money may not be up to what we desire. However, it is better. We were earning N5,000 as hazard allowance for ages. It has now increased to something more reasonable. N10,000 is better than N5,000. But, we still want people to know that we are not happy with it.
We have also worked towards reviewing the medical ethics. A Nigerian has also taken over as the president of the World Medical Association. We feel we can utilise that office to project Nigeria in a better light.
Also, I am working towards helping to solve the brain drain issue, which is a problem in the country now. We are also discussing the fact that Nigerian doctors and all health workers need a review of their salaries. They have been on the same salary since 2009. There is a lot on the table.
What are some of the challenges you have encountered in the course of executing your duties?
Sometimes, I wonder why the government does not see the obvious. Something is clear and it is before them. They don’t need to call a meeting or discuss any issue. I pray the government will begin to act on issues. I believe my job will be easier if we have a more proactive civil service.
Second, there is a scarcity of resources for us to carry out our responsibilities.
We do not get subvention from the government as an association. We rely on what (dues/levies) our members pay. What we pay as annual dues in practicing license has been taken over by the inflation rate. One knows what good healthcare services cost now.
Also, sometimes, we find out that we need more assistance in the office, even to the extent of getting a speech writer. We write many speeches. There is a need for a personal assistant to arrange one’s roaster and movement patterns.
What is your career trajectory?
After I became a doctor, I went into residency training. I had wanted to be a specialist, and my older brother steered me in that line.
I became a Fellow of the National Postgraduate Medical College of Nigeria in Dermatovenereology in 2010. I have been a consultant dermatologist and a senior lecturer at the University of Nigeria, Enugu; and a consultant dermatologist at the University of Nigeria Teaching Hospital, Enugu. I teach and practice dermatology.
I am also the head of the department of dermatology at the University of Nigeria Teaching Hospital. I am a national progressive medical examiner in the faculty of internal medicine at UNN. That was where I was before I became the president of NMA.
In recent times, there has been an increase in the number of medical doctors relocating outside the country. What do you think is the solution to this issue?
The push factors are those things that are encouraging Nigerian doctors to leave the country for developed nations. Meanwhile, the pull factors are the things in the developed world that are pulling our doctors over there. Whenever people are asked for their reason for relocating, they usually say it is because they want to go to saner climes where there is security, and obedience to the rule of law and order. In those places, if laws are not obeyed, a person who breaks them will be punished. A good education for their children is another pull for those doctors.
It is in those areas that the government can come in. We need a proper salary structure. The remuneration is very poor. The consolidated medical salary structure, which is what doctors earn today, was created in 2009. The only adjustment to it is the amendment to the minimum wage.
The rate of the naira to the dollar in 2009 is different from what it is in 2022. You know what a flight ticket cost in 2009, and what it costs now. Yet, people are still receiving the same salaries. An average doctor (in Nigeria) gets paid less than $1,000 in a month. Meanwhile, in other countries, some doctors earn up to $4,000 per month. Some people have left the country because there are better facilities in the Diaspora, and they are paid well. When one is drained as a specialist, it means that one needs some tools to work with.
I am not even talking about state-of-the-art facilities. At least, let us have something to work with first. The environment is key. Some government hospitals have been overgrown by weeds. Some of them don’t even have windows or comfortable chairs to sit on. There are also no fans or air conditioners in rooms with large numbers of medical students.
We need a comfortable working environment. It is a matter of priority. As of today, the primary concern of the government is security. If insecurity is pushing doctors away from the country, by the time they become a target for kidnap, people will not be safe. Those are some of the issues on the ground.
Some doctors who have relocated outside the country have complained about not getting fair treatment like their counterparts in other nations. What could be the cause of this?
I have read that our doctors are being overworked outside the country. That is the problem when one is not in one’s home. Taxation also comes with it. What we will not like is when they put our doctors on duty until they collapse. We are not slaves. They only went abroad for greener pastures. NMA totally condemns any attempt to overwork any Nigerian doctor anywhere they might be. It is totally wrong.
They should use them (doctors) properly and give them time to rest. No matter what one does in life, certain people do not know how to treat others. It is common in the western world.
Medical practitioners have often been involved in strike actions over the years. What are the doctors seeking and has the government met their needs?
Strike actions, as far as we are concerned, are the last option. We have a government that pretends not to see through issues. If we don’t react fiercely, we will not be given what is due to us. Our salaries were last reviewed in 2009. The understanding was that it would be reviewed again after five years, which would have been in 2014. But, since 2014, we have been writing reminders and begging the government to sit down with us to talk.
Since I became the NMA president, I have also written letters, but the feedback we get is that they are still working on it.
When the government sees a problem but they decide to play the ostrich, thinking the problem will go away; it engenders a strike. If the association decides that they have come to a point where they need to take such action; I will lead it.
There have been several complaints about how some doctors discharge their duties, which has led to the loss of lives. Have you got any such complaints and how does the association discipline erring doctors?
Medicine is one of those professions that is self-regulatory. Doctors punish their colleagues when they do wrong. The society trusts us enough to do that. What people don’t know is that if a death arises from one’s practice, it is not classified as a homicide. It is not manslaughter. It is malpractice that may lead to death or harm.
Such an issue is not really a police case, according to the law. The investigative panel of the Medical and Dental Council of Nigeria will be the one to investigate and take up the case. When they see that there are merits in the complaint, the association would then deal with the issue appropriately.
If one believes that there is malpractice, that person should not waste time complaining on the pages of a newspaper or take it to blogs like some people do. The right thing to do is to lodge the complaint at the Medical and Dental Council of Nigeria because it is not under the purview of the NMA. We usually direct them properly to do the right thing.
As a dermatologist, you once warned that piercing the body with certain inks can cause cancer and keloids. However, some people are not aware of this. What do you have to say to them?
The NMA is not the Nigerian Association of Dermatologists. That is another aspect of medical practice. NAD had been teleguiding people, especially during the era of the late former Director General of the National Agency for Food and Drug Administration and Control, Dora Akunyili. We saw signposts on the highway discouraging bleaching because it negatively affects some internal organs. However, people are free to do whatever they desire. Wound swelling on the skin can lead to keloid. People should be careful what they put on their skin because tattooing the skin with certain inks can trigger skin cancer.
Depression and mental illness seem to be rising, especially among the youth. What is the medical explanation for this?
I am not a psychiatrist, so I won’t give you an immediate analytical explanation. As the world has now become a global village, everybody needs to know what happens to everybody else. Things were not like that before. It is believed that it (mental illness) was under-reported in the past.
In the past, people also used to commit suicide. Some people would go out in the morning and in the evening, they would hang themselves from a tree. It must have been depression, even though back then, some people thought it was as a result of witchcraft.
If a lack of fulfillment causes one to be depressed, it depends on the picture one paints for oneself. People who have creative personalities often compare themselves to other people. People must try to be satisfied with their little achievements.
However, some medical and social conditions could push one into depression.
Also, people who visit psychiatrists shouldn’t be seen as being mad. It is just like a person saying they don’t want to see a doctor, even though they have a fever, because of fear of being told one had more health issues. Many people battled mental illness, overcame them, and achieved great things in their lives.
The media should raise awareness so that people do not continue to die in silence. When someone does not interact socially unlike before or feels sad all the time, then something is wrong. That person must see a doctor.
Some doctors and hospitals demand for money before treating patients. What’s your take on that?
A private hospital is a business concern. Some people actually open those hospitals with loans. Have you ever seen someone go into a betting shop and request a ticket without paying? It is the same thing with hospitals, especially private ones.
However, if it is an emergency that could lead to the person’s death if something is not done, it is better to be owed money and save a life, than refuse and lose a life.
I got into trouble for signing to get blood for a patient that was bleeding. We had to save her and I signed for pints of blood for her. She later ran away. It is what some patients do that makes people see some doctors as wicked. They (doctors) have suffered a lot, especially private practitioners.
A doctor could treat a patient without charging them, and once they get better, they would run to a non-governmental organisation to sue the doctor for demanding to be paid for his services. The way people come begging for money is not the same way they would talk to you when it is time to pay.
That makes doctors reject patients too. The government should keep aside funds for healthcare and emergencies. The government can decide to pay for the first eight hours a patient spends in an emergency ward. After eight hours, the patient should have recovered from the emergency ward.
Medicine is a noble profession that has been infiltrated by quacks who are out for quick money. What is the association doing to curb this menace?
We are sensitising our people through the state branches and at the national level. We have a committee that is tackling the issue, which is the most we can do for now. I am sure that every state has a director of health services. By law, it is their duty to check those things. Unfortunately, the government has not been funding health services. The office of the director of health services is not funded, and there is too much bureaucracy in their functions.
At times we give out information on these quacks, and some of them move from one state to another. NMA cannot arrest these quacks. We need the Medical and Dental Council’s enforcement, and also permission to arrest them. It is a business that the government must be interested in to protect citizens. The government must wake up to the menace of quackery. We have heard about these people (quacks) shifting to mission hospitals.
The NMA is to enlighten people and also help the government to fight quackery. If they leave the job directly to the NMA, then we shall take it up.
Is it the duty of the association to ensure that hospitals are up to standard before they can be issued a license to operate?
Not really; that is the duty of the ministry of health. For private hospitals, it is the duty of the respective states’ ministries of health. It should be channeled through the director of medical hospital services to ensure that those things are properly done.
There is a lot of bureaucracy in the system that makes anything acceptable. In this country, one would tell people that a doctor is a quack, but they would tell one to mind one’s business. Many of them are still operating because the high and mighty aid them.
In what ways has the association aligned with the ministry of health to achieve its objectives?
We are always ready. However, what are the objectives of the ministry? The National Health Act that was passed in 2014 created a committee that would supervise the teaching hospitals that are supposed to show their certificates of standard. The standard includes having a clean environment and meeting other requirements. If the ministry of health calls us to help, we will always be available for them.
You are a surgeon, dermatologist, physician, and venereologist. How do you juggle them all?
By law, I have the right to represent my people as the NMA president. It is a matter of managing my schedule and being disciplined. That is why I said that stress has been my greatest setback since I assumed this office.
Bleaching (skin whitening) has become a trend among some people. In what ways can it be discouraged considering the damage it does to the skin?
Some people just want to be who they are not. The grass always seems greener on the neighbour’s lawn. Bleaching causes cancer. There is a way one can take proper care of one’s (dark) skin, and it would still glow. Fair/light skin is not a sign of healthy skin. People need to calm down and appreciate who they are. The Bible makes us understand that we are fearfully and wonderfully made by God. That is also my belief. If anyone wants a better version of their skin, they should see a dermatologist.
I totally condemn applying bleaching creams on children. Allow them to grow up and make their choices.
What is the prevalence of skin cancer in Nigeria, and how can it be better managed?
I cannot tell you upfront the prevalent rate of skin cancer in the country, but it is not high. Those who have a high possibility of having skin cancer are those who do not have a high volume of melanin protecting their skin. People should use sunscreen and umbrellas to protect themselves from the rays of the sun.
Kidney disease is on the increase among the young and old. What is the way out?
The world is now a global village, so we all know what is going on everywhere. In the past, people used to assume that those who had kidney disease must have done something bad and they would be cast into the evil forest.
We are now ‘westernised’ as a people. Our foods and other aspects of our lives are just like theirs. We see people living a comfortable lifestyle with air conditioning wherever they go. We also have remote controls and we don’t have to move to change TV channels. This makes people unfit, and conditions such as high blood pressure become a common occurrence.
Such conditions, if not properly handled, can lead to kidney failure. Another thing is the consumption of ‘bitters’; which is an excuse to drink alcohol. Sometimes, the alcohol content is too high. These days, some people just hawk herbs along the road. These herbs contain different things, and people do not ask questions.
People must be told what they are drinking; in terms of the dosage and side effects. People also need to exercise a lot more. Obesity can affect blood circulation. We need to be more enlightened. When someone is not feeling well, that person should stop being careless with his health. That person could be contemplating either paying a doctor’s consultation fee or whether to just visit a pharmacy to purchase drugs.
These days, some people think they can learn how to be medical doctors via the Internet. What’s your response to that?
It is just like asking if someone can learn to fly a plane virtually (laughs). A pilot must have flown several times before they can be allowed to fly commercial planes. And, we are talking about doctors who learnt virtually to handle human lives?
I don’t think we have got to that level. I believe such a day would come, but it is not now. Medicine is a science that is being delivered as an art.
Do you still lecture at the University of Nigeria, Enugu?
Definitely. Thank God for Zoom (video calls), one can lecture from anywhere. My experience has been good so far. When one is young, one would be angry with the system and the students. But the older one goes, one starts seeing oneself in the system. Lecturing is fun for me, especially when I am lecturing dermatology. I will still keep doing my best. If I can do it physically or virtually, it is fine. It is a great experience. However, I will not like to teach for long. I will likely retire early.
What are your most memorable moments as a doctor and the president of NMA?
My most memorable moment as a medical doctor was when a patient waited to see me for almost a day because I was in a lecture hall conducting exams. I asked the patient to go, but she insisted that she would wait for me, even if I didn’t come back until the evening. It is one of the things I tell my students– learn to deliver on your job. Nothing is more exciting for a doctor than for a patient to insist they prefer one to be their consultant. My greatest joy is when my patients say they would see no one but me.
On the other hand, my most memorable moment as the NMA president was when I won the election. I look forward to the day I will be able to deliver an upgraded salary structure for my people. That would be a great day for me, and I look forward to it.
How do you balance work with family?
This is where I want you to help me thank my wife (laughs). I do my best and make sure that I am humble and responsible. It is not easy being in my shoes. We have three sons and they are all under my wife’s good care. I do my best to go home whenever I have the opportunity. I have the belief that children are better raised by a couple. There are things men and women bring to the table, and they are not the same.
I rely heavily on my wife, and I also thank God for the children He gave me. They are very responsible children, and they don’t stress me too much.
How did you meet your wife?
I was preparing for a pediatric assessment in medicine at the University of Port Harcourt, Rivers State, where I was training then. I went to the library with my friend to read and I saw my wife coming out of the library. At one point, I focused on my book but I still noticed her. When I went outside, I introduced myself to her. That was how we started and she is my wife today. Since we met at the library, our children should be bookworms (laughs).
What are your other areas of interests?
I am a social crusader, and I am interested in nation-building. I want a country that works. I am a master of ceremonies too. I am multi-talented.
How do you unwind?
One thing God has blessed me with is the ability to make close friends. I hang out with my friends, gist, and share experiences. I like playing online football and I also have the app on my phone. I also pray and worship God.
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