(37): Open letter to President Goodluck Jonathan

Mr President,

I hope this letter reaches you in the best position of health and wellbeing, and I do hope you will find the time to go through the content of this letter. I feel duty bound as an ordinary citizen of the Federal Republic of Nigeria to draw your attention to some of the critical decisions that your government has taken. These decisions are very critical and could determine the stability of our country. I am aware that you have advisors who have the responsibility to guide you in taking decisions, because as the leader of the country you will have to rely on the expertise of these advisors before you take a final position on issues. But I am also aware that a lot of government appointees are more interested in advancing their personal interest rather than guiding the president in the right direction.

Mr President, after the unfortunate church bombings in Jaji, the Chief of Defence Staff Admiral Ola Saad Ibrahim ordered the removal of two senior Army officers from their respective positions in Jaji. The senior officers are, Air Vice Marshal Abdullahi Kure and Major General Muhammad D Isa. As the president and Commander in Chief of the Nigerian Armed forces, I am sure you will agree that this critical decision cannot be taken without your consent. I also believe that you must have acted on the counsel of some of your advisors, but whether this is the right advice is an issue that you need to find time and think about. But the most important thing is the implication of this rushed decision which I would like to highlight.

First of all, the two senior officers were removed from their positions without proper investigation being completed. Professionally, there is need for caution in handling matters like this especially in a country like Nigeria where religion, ethnicity, and regionalism constitute an unwritten form of constitution, and whatever the circumstance, a leader has to take this into consideration if he is to maintain the unity and peace of the country.

Secondly, all the officers that were removed are Muslims, and immediately replaced by non Muslim officers. If you feel strongly, that these senior military officers have to be redeployed from their positions, you have the right to take action as the commander in chief; but looking at the security situation in Nigeria, and the division and lack of unity since the controversial 2011 general elections, you need to be cautious by replacing them with Muslim officers, that may douse the tension such action might generate; at least there should be enough Muslim Army Generals of the same calibre with an unquestionable loyalty to their country.

Thirdly, by replacing them with Christian officers under the current security climate, and if we are to believe newspaper reports that the entire control of Jaji is now in the hands of Christian officers after the redeployment of Air Vice Marshal Kure and Major General Isa, be rest assured that such a move will cause rancour and ill feeling especially from religious leaders, as it will definitely be seen as an attempt to use divide and rule tactics in favour of one religion over the other.

Mr President, beyond the points I have raised, my main concern in writing this letter is actually the wider implication this move could have on the stability of the Nigerian Army. The military institution in Nigeria is in my opinion the most professional, disciplined, and the fit for purpose institution in the country. As imperfect as the army may be, the brave Nigerian soldiers have stood for the country in the most difficult circumstances. They fought a bitter civil war to keep the country united; they have extended their professionalism in brining stability to foreign countries like Congo in the 1950s, Sierra Leone and Liberia in the 1990s, and are currently serving in the region of Darfur in Sudan aimed at bringing stability. But their most important contribution recently, is staying away from politics since the return of civilian rule in 1999, and even at the time when cynics thought they could truncate our democracy when president ‘Yaraduwa was sick, they worked hard to remain in the barracks, which enabled you to become Acting President and later President and Commander in Chief of the Armed Forces. The composition of the military command at the time, comprising of both Muslim and Christian officers working together must have contributed greatly in stabilising the polity; and I believe you can learn a lesson from that.

Finally, Mr President I advise you to avoid anything that will divide the Nigerian Army under whatever circumstance, because the implication of that will not be good for our country. I strongly recommend that you create time to read more about the political history of Nigeria especially between 1960 and 1970, and try to learn the lessons of what disunity in the Army could cause the country. I also advise that you consult widely with former Nigerian leaders and senior military officers who are still alive on issues related to the military, as they have the experience that current members of the armed forces may not have.

God bless Nigeria. Long Live the Federal Republic of Nigeria

 

Sincerely,

Muhammad Jameel Yusha’u

 

11: 53

05/12/12

 

(36): Chinua Achebe: A Biafran in Nigerian clothes (I)

Professor Chinua Achebe is arguably the best literary writer in foreign or more precisely English language that post colonial Africa has produced. He is fearless, intelligent and able to speak truth to power in the most difficult circumstances. Those of us from the younger generation have in one way or the other been inspired by the intellectual prowess of Chinua Achebe. He has never failed to intervene in debates about the future of Nigeria. At a critical time in the history of Nigeria, particularly due to the key challenges that continue to raise the blood pressure of the country; namely the controversial result of the 2011 general elections, the so called Boko Haram insurgency, and the general state of hopelessness and insecurity, ethnic and regional divisions that pervade the country; when things are falling apart for the country, Chinua Achebe intervened with the recent release of his memoirs; There was a country: A personal history of Biafra.

The review of the book by the Telegraph newspaper created a huge reaction. After reading through the debates, I had no intention then of making further comments especially after the series of articles that appeared in both Nigerian and other newspapers around the world. But then came an invitation from the Foreign Policy Centre in London asking me to serve as a panellist in a debate about the book at the British Parliament, the House of Commons, Westminster, London. The centre organised the debate in collaboration with Africa Foundation for Development on Monday 10^th December, 2012. 

The composition of the panel is itself partly a reflection of the diversity of Nigeria. The other three panellists were Donu Kogbara from the Greater Port Harcourt City Development Authority, Dipo Salimonu, co-founder of Ateriba Limited, a financial consultancy firm in Lagos and London, and Onyekachi Wambu Director of Policy and Engagement at the Africa Foundation for Development. Without saying it, I believe the organisers wanted to ensure “federal character” in the composition of the panel, or may be call it “UK character” if such thing exists. The event was chaired by Chi Onwurah, the UK’s Shadow Minister for Innovation, Science & Digital Infrastructure. The story of Chi Onwurah is equally relevant to this debate as her parents relocated to the UK as a result of the Biafran war.

The debate is actually not a review of the book. It is a discussion especially from Nigerians in diaspora about the wider issues that the book has addressed, and their implication for the future and stability of the country. It is therefore difficult to avoid making a review even if mildly. There Was a Country is a 333 pages book published by Allen Lane, an imprint of Penguin Books. The hardcopy is sold at £20 (approximately five thousand Naira, depending on the exchange rate).

The book is very provocative especially in a country like Nigeria where religion, ethnicity, and regionalism can easily raise the blood pressure of the country. In summary here are some of the contentious issues that Professor Chinua Achebe has highlighted. That the premier of the defunct northern region Sir Ahmadu Bello has a “limited political vision” (p.46). Chinua Achebe made this assertion in reference to the reason why Malam Aminu Kano decided to break away from the so called northern establishment and join the Northern Elements Progressive Union (NEPU).

That Alhaji Abubakar Tafawa Balewa “who has been built into a great statesman by the Western world did nothing to save his country from impending chaos”. Achebe continued by stating that “the British made certain that on the eve of their departure that power went to that conservative element in the country that had played no real part in the struggle for independence” (p.51-52). Chinua Achebe suggested that the Igbos who drove the British out of Nigeria became scapegoats after the January 1966 coup.  The book suggested that there is a deliberate conspiracy to promote the hatred of Igbo people. He added that “a lot of this hot blooded anger was fanned by British intellectuals and some radical Northern elements in places like Ahmadu Bello University. They were aided by a few expatriate population from outside Nigeria, who easily influenced the most self-satisfied and docile Northern leadership to activate  a weapon that has been used repeatedly in Nigeria’s short history-a fringe element known as “area boys” or the “rent crowd types”- to attack Igbo’s in an orgy of blood” (p.69).

One of the most provocative statements by Chinua Achebe which has been quoted by almost every review of the book is his impression about the Hausa/Fulani and the Yoruba. On page 74 he stated that “unlike the Hausa/Fulani he was unhindered by a wary religion, and unlike the Yoruba he was unhampered by traditional hierarchies”.  Achebe even made an attempt to exonerate Chukuma Kaduna Nzegwu and the rest of the plotters that killed Sir Ahmad Bello in carefully crafted approach, because to him, Nzegwu speaks Hausa fluently and dresses like people of the North (p.79).  While Professor Achebe was more cautious in his choice of language in reference to the predominantly Igbo plotters of the January 15^th 1966 coup, he described the mainly northern officers who staged the counter coup in July 1966 as “murderers” (p.95). 

To be continued...

19:51

09/12/12

(35): Palestine's UN observer status: What next?

After the ceasefire agreement between Hamas and Israel through Egypt, now it is the turn of Mahmud Abbas, President of the Palestinian Authority, to join the public relations war by making sure he remains relevant in the power struggle for the support of the Palestinian people. A trip to the United Nations to receive recognition as an observer nation provides that opportunity to reassert himself.

 

Media organisations around the world have been celebrating the upgrade in status for the Palestinian people. Pundits have praised it as if Palestine had already become truly independent. Certainly the gesture shown by the 138 countries who voted in favour of the Palestinian observer status was a good gesture. At least it has shown that countries are getting tired of the lawlessness of Israel. Even western countries like France and Spain have voted in favour of the Palestinians, while the likes of Germany have abstained rather than thumbing their rejection on the vote. Only the United States and Canada among the economically powerful countries rejected the bid.

 

But the question we need to continue asking is: what next? How do Palestinians achieve statehood? Here are some important points, though not exhaustive. The first and foremost, in my opinion, is the economic independence of Egypt. If there is one country that is part and parcel of the Palestinian struggle, and in a position to influence the outcome of the conflict, then the mother of civilisations should be at the forefront. Egypt has the advantage of population, it is considered the leader of the Arab world, especially since the ascendance of Jamal Abdel Nasir. Although the rise of Saudi Arabia’s oil economy has snatched part of that role from Egypt, but it continues to provide both moral and intellectual leadership. Egypt is now under the leadership of the Muslim Brotherhood government, a movement that basically gave birth to Hamas, which at the moment holds the ace for any meaningful peace negotiation on Palestine. And above all, the success of the Arab awakening in Egypt solidified the effort of other countries in the Arab world.

 

At the moment, the United States provides aid worth $1.5 billion to Egypt annually. Out of this £250 million is economic aid while the remaining $1.3 billion is a military assistance. Other European countries also provide some aid. Now this economic package could explain why the Muhammad Mursi government could not take a tough stand on Israel’s attack on Gaza, rather they cautiously play the mediator role as the case was during Husni Mubarak, but with a dose of diplomatic support to the Palestinian people in Gaza. A visit by the Egyptian prime minister and a strong rhetoric from president Mursi in order to appease the street of both Egypt and the Arab world. At the moment it has worked, but how long will Egyptians accept a mediator role by Egypt in this conflict? This is where the question of economic independence once again becomes relevant.

 

Establishing economic independence is not an easy task, let alone the kind of mess that President Mursi has inherited. So what is the solution? Here are two proposals on how to address this question. The first is for a combination of Saudi Arabia, Qatar, Kuwait and Turkey to establish an economic quartet that can provide the same aid that the United States government provides to Egypt. Saudi Arabia, Qatar and Kuwait have enough resources to provide this assistance, while Turkey can provide more of the military support. But here comes the big challenge: with the exception of Turkey, the rest of the countries are wary of the Muslim Brotherhood government because it is a government that came to power on the shoulders of protesters. This has implication for their countries.

 

The second route is for the Organisation of Islamic Cooperation to work towards supporting this cause and encourage member countries to provide this aid. But as long as Egypt remains economically dependent, any recognition of Palestine on the floor of the United Nations will remain a glorified public relations tango.

20:43

Newcastle upon Tyne

2/12/12

(34): Gaza war coverage and media propaganda

A ceasefire agreement has been reached between Hamas and Israel. But one thing that was clear from the conflict was the propaganda angle. The western media in particular provided an Israeli angle that shows Palestine as the aggressor and Israel as the victim. But this approach is not new. The veteran journalists and war correspondent John Pilger has given us some food for thought on BBC’s coverage of the war. The article entitled “As Gaza is savaged again, understanding the BBC’s historical role is vital” was culled from John Pilger’s website. Enjoy! Jameel

 

In Peter Watkins’ remarkable BBC film, The War Game, which foresaw the aftermath of an attack on London with a one-megaton nuclear bomb, the narrator says: “On almost the entire subject of thermo-clear weapons, there is now practically total silence in the press, official publications and on TV. Is there hope to be found in this silence?”

 

The truth of this statement was equal to its irony. On 24 November, 1965, the BBC banned The War Game as “too horrifying for the medium of broadcasting”. This was false. The real reason was spelt out by the chairman of the BBC Board of Governors, Lord Normanbrook, in a secret letter to the Secretary to the Cabinet, Sir Burke Trend.

 

“[The War Game] is not designed as propaganda,” he wrote, “it is intended as a purely factual statement and is based on careful research into official material… But the showing of the film on television might have a significant effect on public attitudes towards the policy of the nuclear deterrent.” Following a screening attended by senior Whitehall officials, the film was banned because it told an intolerable truth. Sixteen years later, the then BBC director-general, Sir Ian Trethowan, renewed the ban, saying that he feared for the film’s effect on people of “limited mental intelligence”. Watkins’ brilliant work was eventually shown in 1985 to a late-night minority audience. It was introduced by Ludovic Kennedy who repeated the official lie.

 

What happened to The War Game is the function of the state broadcaster as a cornerstone of Britain’s ruling elite. With its outstanding production values, often fine popular drama, natural history and sporting coverage, the BBC enjoys wide appeal and, according to its managers and beneficiaries, “trust”. This “trust” may well apply to Springwatch and Sir David Attenborough, but there is no demonstrable basis for it in much of the news and so-called current affairs that claim to make sense of the world, especially the machinations of rampant power. There are honourable individual exceptions, but watch how these are tamed the longer they remain in the institution: a “defenestration”, as one senior BBC journalist describes it.

 

This is notably true in the Middle East where the Israeli state has successfully intimidated the BBC into presenting the theft of Palestinian land and the caging, torturing and killing of its people as an intractable “conflict” between equals. Standing in the rubble from an Israeli attack, one BBC journalist went further and referred to “Gaza’s strong culture of martyrdom”. So great is this distortion that young viewers of BBC News have told Glasgow University researchers they are left with the impression that Palestinians are the illegal colonisers of their own country. The current BBC “coverage” of Gaza’s genocidal misery reinforces this.

 

The BBC’s “Reithian values” of impartiality and independence are almost scriptural in their mythology. Soon after the corporation was founded in the 1920s by Lord John Reith, Britain was consumed by the General Strike. “Reith emerged as a kind of hero,” wrote the historian Patrick Renshaw, “who had acted responsibly and yet preserved the precious independence of the BBC. But though this myth persisted it has little basis in reality… the price of that independence was in fact doing what the government wanted done. [Prime Minister Stanley] Baldwin… saw that if they preserved the BBC’s independence, it would be much easier for them to get their way on important questions and use it to broadcast Government propaganda.”

 

Unknown to the public, Reith had been the prime minister’s speech writer. Ambitious to become Viceroy of India, he ensured the BBC became an evangelist of imperial power, with “impartiality” duly suspended whenever that power was threatened. This “principle” has applied to the BBC’s coverage of every colonial war of the modern era: from the covered-up genocide in Indonesia and suppression of eyewitness film of the American bombing of North Vietnam to support for the illegal Blair/Bush invasion of Iraq in 2003 and the now familiar echo of Israeli propaganda whenever that lawless state abuses its captive, Palestine. This reached a nadir in 2009 when, terrified of Israeli reaction, the BBC refused to broadcast a combined charities appeal for the people of Gaza, half of whom are children, most of them malnourished and traumatised by Israeli attacks. The United Nations Rapporteur, Richard Falk, has likened Israel’s blockade of Gaza to the Warsaw Ghetto under siege by the Nazis. Yet, to the BBC, Gaza – like the 2010 humanitarian relief flotilla murderously attacked by Israeli commandos – largely presents a public relations problem for Israel and its US sponsor.

 

Mark Regev, Israel’s chief propagandist, seemingly has a place reserved for him near the top of BBC news bulletins. In 2010, when I pointed this out to Fran Unsworth, now elevated to director of news, she strongly objected to the description of Regev as a propagandist, adding, “It’s not our job to go out and appoint the Palestinean spokesperson”.

 

With similar logic, Unsworth’s predecessor, Helen Boaden, described the BBC’s reporting of the criminal carnage in Iraq as based on the “fact that Bush has tried to export democracy and human rights to Iraq”. To prove her point, Boaden supplied six A4 pages of verifiable lies from Bush and Tony Blair. That ventriloquism is not journalism seemed not to occur to either woman.

 

What has changed at the BBC is the arrival of the cult of the corporate manager. George Entwistle, the briefly-appointed director general who said he knew nothing about Newsnight’s false accusations of child abuse against a Tory grandee, is to receive £450,000 of public money for agreeing to resign before he was sacked: the corporate way. This and the preceding Jimmy Savile scandal might have been scripted for the Daily Mail and the Murdoch press whose self-serving hatred of the BBC has long provided the corporation with its “embattled” façade as the guardian of “public service broadcasting”. Understanding the BBC as a pre-eminent state propagandist and censor by omission – more often than not in tune with its right-wing enemies – is on no public agenda and it ought to be.

 

09:48

Newcastle upon Tyne

26/11/12

(33): Five reasons behind Israel's terror on Gaza

So the blood of Palestinians has become a political capital in the hands of Israel. By the time you finish reading this piece probably more people have died in the State of Palestine as a result of Israel’s bombardment. The terror unleashed on Gaza, which already is under siege by Israel has taken away attention from another terror taking place in Syria from television screens.

 

The question to be asked is why did Israel attack now, what will the Netanyahu government benefit by killing innocent civilians under the pretext that Hamas is firing rockets into Israel, ignoring the fact that the emergence of Hamas itself is a reaction to the occupation of Palestine by Israel? There are at least five possible reasons for the attack on Gaza.

 

The first is a political strategy to get Netanyahu re-elected in the January elections in Israel. Politicians in the so called advanced democracies for a long time have been using war as a way to get voters attention. They use conflict to shift public opinion to issues of national security rather than economic well being. Two examples here will be useful. Before the 2004 presidential election, the American economy was showing signs of decline, which is not good for an incumbent, more especially one like George Bush who inherited a healthy economy from Bill Clinton. The war on Iraq, though already in the agenda of some neoconservatives like Paul Wolfowitz and Donald Rumsfeld, was brought forward, linked to the war on terror, and Bush was re-elected. But it does not always work. Former French president, Nicholas Sarkozy used the attack on Libya and the ousting of Laurent Gbagbo in Ivory Coast in order to improve his approval rating, we know the rest of the story.

The second reason behind the attack is the reconstruction effort in Gaza. Since the 2008 assault on Gaza by Israel, there has been more sympathy for the people of Palestine, of recent there has been series of visits by foreign governments in order to reconstruct Gaza, the most recent being the visit by the Emir of Qatar who promised more investment and reconstruction. Much earlier than that, King Abdullah of Saudi Arabia has pledged on behalf of the Arab governments the sum of £1 billion dollars towards reconstruction in Gaza. Although the world will prefer to see more concrete steps towards ending the occupation from the Arab governments, at least the reconstruction can bring some relief to the people.

The Turkish president was also on his way to provide additional support. But in whatever form support will come, Israel sees it as detrimental to its interest. As King Abdullah of Jordan stated in his recent autobiography, the ultimate aim of Israel is to expel all Palestinians and occupy the remaining areas in West Bank and Gaza, and suggest Jordan as the new country of Palestinians; this even by the standard of King Abdullah, one of the Arab leaders who believe in the myth of two states solution, is unacceptable and could result in war.

The third reason why Israel hastened to launch this attack is the re-election of Barack Obama. Binyamin Netanyahu had openly supported the candidature of the Republican Party nominee Mitt Romney, because of the doubts he has about Obama’s approach to the Palestinian issue, even though supporting Israel by American presidents is like an article of faith. But Israel still doesn’t like the approach of presidents like Obama and Jimmy Carter, who although they are pro-Israel, they believe also that unquestionable support for Israel hurts American interest in the Middle East.

As such immediately after the re-election, Israel tied the hands of the  American president by starting an aggression, so instead of peace talks between the Palestinian Authority led by Mahmud Abbas and Israel, effort will now be made towards stopping the aggression, and by the time Obama spend two years in office without conducive atmosphere for peace talks, then he will become weak, because the US will enter an election mood, first, the midterm congressional election and then the presidential election, a time that politicians normally withhold their plan on foreign policy due its implication on their campaign.

The fourth reason is that Israel wants to test the military capability of Hamas, and the real foreign policy position of the Muslim brotherhood government in Egypt. The position of the Egyptian government is becoming clear now, the hands of Muhammad Mursi’s government are tied, refusing to support the people of Gaza will cause outrage among Egyptians. Open confrontation with Israel will attract economic problems from western governments, particularly the aid from the US which has been used to blackmail Egypt, and Mursi has not been in power long enough to put Egypt in the path of economic independence. 

The fifth reason is to link the response of Hamas with Iran, something the international media is already promoting. As reported by NewStatesman newspaper, on 16^th November, BBC’s Today radio programme interviewed chief Rabbi Jonathan Sacks, at the end of the interview, unaware that he was still live on air, he was asked about the attack on Gaza, and he responded, “I think it's got to do with Iran, actually”.

22:22

18/11/12

Newcastle upon Tyne

(32): Re: Misdiagnosing patients in the Nigerian healthcare system

The article last week on the above subject attracts a lot of attention, and I would like to share one of the reactions that provided another perspective, sent  by Dr Suleiman BM (mbskt@yahoo.co.uk ). Jameel

 

I decided to take some time out of my busy schedule to contribute on this important topic. First of all, I am a medical doctor. Wholly trained in Nigeria by the Nigerian educational and health system. I am a Pediatrician. Secondly, I have been a hospital administrator as a CMAC from February 2009 to Sept 2012. Thirdly I have been involved in the training of medical students during my fellowship years between 2003 and 2007. I hold two fellowships of the National Postgraduate Medical College of Nigeria and the West African Postgraduate Medical College.

The problem of misdiagnosis happens all over the world, no doubt. We are however more aware of our own immediate surroundings. If one is in the field of public health, he will recognise that virtually all African countries and most Asian countries have weak health systems and are therefore battling these problems.

One issue I have observed during my time as a resident doctor is the “quality” of students being admitted to study medicine. When the student is admitted because of who he knows, not merit, the result will surely be what we are now experiencing. But as a hospital administrator, I will tell you we see the quality of the products being churned out as house officers from our universities. Yes, I agree that the standards have fallen. But many are still good.

 

The bad ones are still few and with adequate supervision, you can polish most of them. Medicine is an apprenticeship programme. After you get the knowledge, you need to work with an experienced senior doctor to get the needed skills to practice adequately. That is where most of our governments have gotten it wrong when young graduates are allowed to function and practice alone without supervision. We do need to get back to the drawing board on the issue of adequate experience and on the job training.

We should not forget that all medical equipment are now essentially computers. One thing that is common with all computers is that they are shut down, not switched off. One big issue we face as administrators in provision of equipments in the hospital is constant breakdown because they are switched off many times a day by PHCN.

 

The health service sector cannot work in isolation. If power is not improved upon, we should forget about getting state of the art hospitals that are affordable. Go to Redington and Lagoon hospitals in Lagos. They are state of the art, but not affordable to generality of Nigerians. Have you ever wondered why hotel fare is more expensive in Abuja than in London? The government needs to generate power for us to progress; otherwise, progress will remain a dream.

However, more than 70% of cases presented to hospitals can be diagnosed by the bedside with minimal investigations. To me, the most important issue we need to address is with all of us Nigerians… attitude. We talk of empathy in healthcare sector as against sympathy. I was at the Nigerian High Commission in London on Monday. I saw a small Nigeria within London. Even the community surrounding the commission has not changed our ‘ways’.

We all need to work on our attitudes and love our brothers more than ourselves. I believe there is a hadith (saying of prophet Muhammad, upon whom be peace) related to that; “None of you is a believer until he loves for his brother what he loves for himself”, otherwise “your iman [belief] is not complete”. All health workers in particular need to change our attitude for our system to move forward.

I don’t know how many of us have been to a typical general hospital set up in Nigeria. I have worked in general hospital Katsina outpatient department as a young inexperienced doctor. I was presented with one hundred and fifty patients to see in one day. Even today, go and do a study in any general hospital. The story has not changed. I left general hospital because I could not cope with the work without cheating the system. I was feared for my iman. It is impossible for any doctor, no matter how good, to treat even hundred patients properly within one working day.

Like I said earlier, this is just a contribution, introducing the tip of the iceberg of the problems bedevilling the Nigerian health care delivery system. My advice, however, to all of us that feel we can contribute to the system is to go back home and see what we can do. I am in the UK for a master’s study. I will go back insha Allah when I finish. Some of us have decided we will remain in Nigeria and see what little difference we can make. And we can really do a lot.

(31): Misdiagnosing patients in the Nigerian healthcare system

After writing a piece in this column entitled “new hospitals, new corruption, new challenges”, the article elicited one of the highest responses, and many of the readers shared their experiences with me via email. One of the key issues that they drew my attention to was the issue of misdiagnosing the illnesses of patients, but once they travel to either Egypt, India or UK, they are told that, they have been wrongly diagnosed, and within a week or so after treatment they become normal. To address the reasons behind this problem, I have invited Dr Jaliya Braimah (jaliyaadda@hotmail.co.uk), a highly experienced medical doctor in Manchester with a comparative understanding of Nigerian and UK healthcare systems as a guest columnist. The original title of his article was “Reasons behind Misdiagnosis of Patients’ illnesses in the Healthcare systems of Nigeria”. Enjoy. Jameel

It is universally accepted that no healthcare (HC) sector in the world is spared the unfortunate issue of making a wrong diagnosis of diseases afflicting patients under its care. Although this article is on Nigeria, it should not be seen as purely an issue peculiar to the Nigerian HC system alone. However in developed countries at least, such events are the exceptions and whenever they occur, they are thoroughly investigated, lessons learnt from the mistakes and recompense given to victims where appropriate. There is no evidence at the moment that such investigations are a normal practice in Nigeria.

The main reason for writing this article is to highlight a few of the important reasons behind our doctors’ inability to make the correct diagnosis of diseases in Nigeria. For ease of discussion, I’ll like to separate this under three sections i.e. the ‘Doctors factors’, the ‘facilities factors’ and the ‘Patients factors’ although these three do overlap extensively.

Doctors’ factors

Nigerian universities have historically produced and still continue to produce some of the best medical graduates in the world. However, the recent economic/political climate has meant that the standard of training has become progressively worse. Overcrowding in our medical schools leading to very low teacher student ratio has resulted in sub-optimal training in most places. This has a direct impact on the quality of the graduates with increasing numbers becoming less able to attain the minimum standard required to cope with life as doctors. This phenomenon is true for both the undergraduate and post-graduate trainings. As a consequence the patients suffer. For example every case of fever is then treated as typhoid/malaria despite evidence to the contrary.

The 2^nd most important reason for misdiagnosis is what I call the ‘I know it all syndrome’ where doctors find it impossible to simply say to a patient “I’m sorry I just do not know what is wrong with you”. Hence there is a failure to suggest referral to a colleague who may be better able to help. The old medical dictum of ‘First do no harm’ will remain relevant till the end of times! In fact, patients are better left alone with their illnesses than putting them through an intervention which may cause them more harm. In this regard the behaviour of this group of doctors is not any different from that of our traditional native ones (the Babalawos).

In addition, the art of making a correct diagnosis in Nigerian Hospitals depends largely only on physical examination of the patients at bed side because of limited lab/imaging support. No matter how well trained a doctor may be, if they find themselves in a hospital with little/no access to experienced colleagues, they will struggle to make correct diagnosis. This is the experience of many NYSC doctors who work (especially) in rural areas where cases often come in late and are therefore more complex to manage.

‘Facilities factors’

There is no doubting the fact that modern technological development has made a big impact on the tools available for investigating diseases more accurately. Except for a few centres, most of these tools are lacking in Nigerian hospitals. This is the reason why experience of using them is lacking which means doctors do not get trained to use them, hence the patient suffers as a consequence. It is also true that even in the few hospitals with these facilities, when patients undergo such investigations, the results are sometimes not interpreted correctly, thus emphasising the need to ask for help from more experienced colleagues.

‘Patients factors’

The fundamental reason why issues of poor diagnosis will persist for a long time is due to the largely uneducated nature of our population. This means that patients are not able to challenge any decisions made on their behalf because they perceive seeing a doctor as a privilege/favour rather than as a matter of constitutional rights! Doctors are seen as demi-gods who are to be worshipped as they can do no wrong.

Another factor to consider is the fact that the Nigerian society is one of the most unbalanced in the world in terms of the haves and the have-nots. This means that while our leaders are suffering from diseases of gluttony (like in Europe/US), the masses are still dying of essentially old fashioned largely preventable diseases of poverty. This is an area that needs to be remembered when treating patients from differing social classes.

Even among the elites, there is another problem which we need to be aware of. For example, how many of them will be happy (content) to be sent home only on paracetamol and the advice to drink lots of fluids and take some rest following a trivial (often viral) chest infection (such as flu) which by its very nature is self limiting? ‘Haba man no antibiotics and no injection(s) for oga?  chineke god’. The expectation to ‘do something’ sometimes adds to the pressure on doctors leading them to make diagnosis which will not stake up to scrutiny. Sometimes doing nothing is best medicine but a number of the “shakers and movers” of our society prefer to be given a medical label. The fear of some doctors losing their customers can be overwhelming. The overall effect of it all is that the Nigerian healthcare system is defined by the over medicalisation of the rich and powerful, and a lack of even the most basic care for the many more!

Finally in this short article, I’ve tried to highlight areas that I think many who work and use the health sector in Nigeria will recognise, but this is by no means an exhaustive discussion. What is also clear is that I’ve done the easy bit i.e. identifying some of the reasons for this phenomenon without delving into the more difficult area of proffering possible solutions. Perhaps this is best left for another day? Let me know what you think.

21:08

Newcastle upon Tyne

04/11/12