Part 2
What is your opinion as regards the ongoing argument of who should head hospitals?
It is a very interesting area and it tells you a lot about human nature and psychology. One thing I have noticed here is people always say, we have a lot of labour unrest, discontent, unnecessary and unreasonable professional rivalry - and it is true. As a result, we are terrible at team work. People want to stay in their own silos, fight their way up their own particular ladder. Look across at any other profession as a competitor, depending on where you are in the pecking order in your profession and find ways to bring down the other profession. I see it all the time. I say I like to look at things positively but that is one aspect that depresses me. One thing that I criticize about that whole process and that I see as an important component is that we are very good at being humble at the beginning when everybody is struggling for the next step up the ladder. At the beginning you are desperate for an education because you are desperate to become employable and people are happy to accept their level. The so-called academic ones may either get into engineering, law or medicine and the less academic may have tried for that and have to go for something else and accept that these guys are cleverer than me o. Everybody finds their level and goes into their course. Now you finish your course and get employed. Then you now start your professional battle to get back on level terms with those who got ahead of you when they did the exams and that is what is going on. People who accepted when they were doing their course, let’s say for example you did Medical laboratory science and you accept at that time that ‘Awon to mowe lo lo se medicine’ and the other person who goes for medicine and gets a broad education that goes on for many years and covers not in as great depth as any of those individual professions. But the point about the education of doctors is that they try and give you education across the board. So when it now comes to professional roles in the healthcare team, it is natural to say that the person who has the broadest view should naturally be the team leader. But what has happened is that the professions have turned this into a human rights issue. Why am I being discriminated? Why are you looking down on my profession? Why this, why that. You know my answer would be, well if you wanted to be in a position to head the team, why is he a doctor and you are not? Now I have to be very careful to put what I just said into context. Because I am not saying and especially in Nigeria where all our systems have been turned upside down and are not functioning as they should, I am not saying that there are not many (of any other profession) who are far more competent than many of the doctors we have. In fact it is obvious and that is part of the problem because the system is not bringing up people who are demonstrably more suited for that leadership position. The others would say this guy is incompetent. In fact get doctors out. The system is so jumbled. If you are in a pecking order not in terms of superiority but in terms of positions that people can occupy; if people are demonstrably better prepared or more competent because of the preparation they have or the experience on their job people won’t complain - because you are fighting to get into that position to go and fail. But in the system we have, we are pushing up so many incompetent people into position of leadership. That I fully support. You see I am turning things around. If things worked properly, there should be none of these competitions. But when you are sitting there as a competent medical laboratory scientist and you can see an incompetent human being, with poor people skills, hopeless at management, who does not really even know his stuff and he has been automatically made a team leader and you know you are dedicated and smarter than this guy and you have to sit there and swallow him being imposed on you and know that you can never aspire to that position, it will demoralize you. If truly people lived up to how they are supposed to perform and live up to their duties, the professional rivalry will be reduced. There is always going to be jostling for people trying to raise the level of their profession. That is how life should be. And if your profession is strong enough you will get up and you will fight yourself into getting privileges and opportunities. That is normal. What I complain about is when it turns into constant industrial unrest and constant bickering between team members who therefore fail to work as a team, and it is so important in medicine because nothing happens in medicine without full collaborations of a team. Doctors cannot function if they don’t have the support of all the other people who help them make a diagnosis, manage treatment, and look after the patient and so on. So it is a complex area and I think there is reason on both sides. But the bottom line is that our educational system and our professional advancement systems are operating so sub optimally that it is basically free for all. Once you get to your professional level, you start fighting to regain the position you feel that you lost and the lost opportunity when you were to choose focus in the university.
What are your plans when you leave office?
I am actually not planning ahead. I am enjoying the fact that for once I don’t think I have to worry too much, because I will have options. In general I am currently feeling that there will be a lot of work left undone. No public official or politician wants to leave where they are if they are truly dedicated to achieving some results because they never quite think they have got there. Part of me says I wish I could in some way or another be involved in pushing healthcare forward in Ogun State. At the same time, things are going to change. Most of the time, commissioners don’t usually spend a long time- although a few do. Usually a good opportunity for a change is when the administration changes. You bring in fresh blood. I would do that as a Governor. I will change things round. My assumption is that after four years I will try and find another opportunity. Part of me is tempted to go back to the development world, where i would love to work with the WHO at some time or a similar organization. But that is about specific as I am going to be. One thing I am very sure I don’t want to do is to get into hard core politics. I don’t want to become a career politician. If I remain a politician, it would have to be in healthcare. To me public health is my passion and one way or another I will remain involved in public health.
What are your plans for the coverage of Ogun State workers under health insurance?
Once you believe in health insurance that means you buy into the idea that if you have your citizens able to pay for healthcare then it’s going to increase the money that is available for the health economy. You are paying customers like any business, if you are paying customers the business grows. So once you say Community Health Insurance is good, that is good for access to healthcare for people in rural areas who are outside the formal systems of employment. So naturally other forms of insurance will also do the same thing. They will enable people to pay for services without feeling it and money will circulate; private and public hospitals will thrive. We are going to try to ensure that one form of insurance or other is available for every single stratum of Ogun State citizens NHIS is not being implemented, not because governments don’t want to, but because implementing it is highly expensive. One of the biggest problems government has is their wage bill. NHIS automatically bumps that up by 5 to 7% and it is a significant amount for any government. There are other forms of insurance that can be done where government does not have to contribute and where the individual does not have to contribute more than they are prepared to. Once you have tailored plans and you start making sure as many citizens as possible are insured in one way or the other, then you will have a massive improvement in healthcare. Not just improvement in health for the individual but that money that is circulating in the health economy will boost all healthcare service providers ability to plan, invest and provide good healthcare. One way or another we want as many of the Ogun State citizens to be covered by some form of insurance.
What advice would you like to give to the young and upcoming doctors?
A mischievous part of me wants to say something like examine yourself and if you really should be a business man or something else - if that is your passion, abandon healthcare now. Nobody has to sacrifice till the point where they suffer. Medicine is not appropriate as a business. But of course there are private medical concerns that must work as business. What I am saying is that if you are commercially minded and where you are prepared to put your commercial interest above the patient then you are in the wrong profession. You are in a humanitarian calling and you must be prepared to be humane, compassionate, respect others and elevate the value of human life. Not only above everything else but understand that all human lives are equal. You can’t just dismiss something because the people involved are not in your circle. Ultimately my advice to anybody coming up is remember you are getting into a profession which is going to require a lot of hard work. There will be people who work far less than you and earn more. Be ready for that. If you can’t live with that, you are in the wrong profession. But once you are able to be compassionate humble and care for others, you are in the right profession. So learn as much as you can. Gain as much experience as you can. My final word, when you have graduated you are not fully cooked, you are green and in -experienced You are just beginning a life long professional learning experience in which the lives of others depend on how much experience you gain or how competent you become as of that point. You are not competent at many things when you are qualified from medical school. Be humble and realize you have just started learning when you graduate. Do that and you will be an excellent professional.