Re: Addressing The Crisis In Nigeria's Health Sector; US As A Guide

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There are some information I would like to comment on, in response to Safeeyah Musa’s article: Addressing The Crisis In Nigeria’s Health Sector…Part 1

I have noticed that people tend to mention what obtains in US to misinform others. There are a few points I will like to clarify.

1. Patient care is a team work, and everyone is important, but not as important as the patient. The patient should always be the focus.

2. While in the team, no one is superior to the other, someone must direct the patient care and the doctor has the training, ability and responsibility to do this.

3. Patients are admitted under the care of the doctor not any other health worker. The bulk stops at the doctor’s table in patient care but everybody’s opinion is important.

4. Since doctor’s are more expensive to hire, nurses have found some quasi- independent role as nurse practitioner. But importantly they work under the covering of a doctor, and with extreme limitation on what they can handle.

5. Remuneration is based on training and job performance. So while a nurse practitioner earn much more than other nurses, they earn much below the doctors. However some anaesthetist nurse may earn some how close to Some doctors. Doctors’ salary varies, so a neurosurgeon who works average hours will earn more than a paediatrician who works average hours. Not as in Nigeria were all doctors earn same salary in government hospital.

6. As per the head of hospital, the CEO is the administrative head, usually someone with background in administration, and may or may not be a doctor.

Because medicine in US is business in the real sense the trend was non-doctor CEO. However of late the trend is changing toward making a doctor CEO. There are many doctors with MBA and many medical school offers MD/MBA options. In addition there is a chief medical officer position which is always a doctor.

7. Surgeon General (SG) in US army is different from Surgeon General (SG) of US. Appointment to SG US army is for someone in medical field with the highest military rank, so it could be a doctor, RN etc. on the other hand US SG is always a doctor.

8. There is a rehabilitation medicine specialty in the US and a doctor in this specialty coordinate the physical therapy for patients. The physical therapist (physiotherapist in Nigeria) here work with the doctor who evaluate patient and determine the appropriate treatment and give a prescription to the physical therapist. Physiotherapist from Nigeria eventually work in the US as physical therapist and nothing more.

I work in Michigan and I am aware of the collaboration between the physiotherapy body in Nigeria and university of Michigan Flint. That training is good for our system but even at the end they still will only be able to work as physical therapist in US. Because Nigeria do not have rehabilitation medicine, physiotherapist have usually been taking this role. So the system in US is different in this respect.

We have a good system in Nigeria. The problem is the people and changing the system without people changing their ways will not make things better. If all CMD do what the law enable them to do and use the resource given to them well, we won’t be in this mess. Ultimately we need to find what works for us using other nations as a guide.

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