FERTILITY SERVICES IN NIGERIA: WHERE IS THE REGULATION?

At an informal chat in our Consultants' Lounge at my place of work, a senior colleague warned me to beware of special interests entrenched in the fertility services in Nigeria when the issue of ethical practice, policies and regulations came up for some critical discuss. These clinics are springing up in major cities in Nigeria, and the whole thing is becoming a multi-billion naira black market business scooping the desperation of couples and other persons who want to have children at any cost, literally. However, there appears not to be any existing legislature regulating this practice in Nigeria, and I am not aware of any existing policy by any medical specialties or government board in the country stipulating procedures in fertility services. Please anyone who knows of any existing regulation could bring it to attention.

The resultant effect is all manner of media advertisements and claims for fertility "guarantee" by all shades of centres parading as fertility clinics and now young men are sought to sell sperms in circumstances that present grave danger to public interest and may bring about a whole new unintended genetic consequences and ethical dilemma. The report in Punch newspapers on how selling sperm has become a street business in the city calls for urgent intervention.

Since these sperms are stored in a bank and since sperms are tissues and sperm banks are tissues banks, which is the regulatory body at the national or state levels? Who assesses the quality of laboratory procedures carried out at the sperm banks in Nigeria? Who evaluates, for public interest, the ethical policies used in accessing sperms from the donors? Who monitors and ensures the rights of both the clients of fertility clinics and the sperm donors are protected? Apart from testing for infections such as hepatitis and HIV, do these banks also test for genetic diseases and which ones? Who ensures that the screening is thorough and in line with standard of practice? Has anyone reviewed the policies and procedures of sperm banks to ensure they align with best practice, safety and ethical imperatives? What are the measures put in place to track, monitor and evaluate each semen donor and their specimens to avert abuse of process and assure safety for individuals and the larger society? 
Feeding off on the desperation of childless couples and largely uniformed donors, who are only concerned about the economic benefit in a harsh socioeconomic reality, sounds like exploitation and corruption.

Strikes in Health and other Sectors: We've Lost our Way

An average Nigerian is pretty tired and sick of unions declaring strikes at every opportunity to “press home their demands” on a range of issues usually thrown into the basket as a veil for the issue-more money and position. I’m somewhat in a position to have an opinion on the validity of so many strike actions that take place in Nigeria and I dare submit without any apologies that it is largely self seeking, greed induced and lust for power, influence, affluence and unmerited remuneration.

I work in the public sector and I witness some distasteful attitude of government employees on daily basis. Mind you, there a few hard working and highly committed public sector workers out there but these ones are in a diminishing minority.  A significant number of workers in the public sector are earning far more than they put into service to the people. Government has largely abdicated leadership and necessary regulations to the various unions in the public place; some of which operate with impunity. Of course it is very convenient to blame “government” for all our woes but please who is “government”? I’ve asked this question many times and intuitively people point to the state secretariat or to the federal secretariat in Abuja. No, I disagree. We are the government; all of us in this nation state. We are part of the rot that has bedeviled our country and virtually every sector of our lives. If I may ask, what efforts have we committed in our various departments and offices to make things work even with the limited resources available to us? ASUU, for example, has been on strike for several weeks for the “good of education” in Nigeria but I’m not buying that argument. Throwing money at the education sector without a solid foundation for accountability, attitudinal change to work, responsibility, monitoring and evaluation, will be akin to fetching water in a basket. Has anyone bothered to conduct a research on how students perceive the input of their lecturers in their academic pursuit? How often do time tables change because some lecturer is not just available only for lectures to be crammed within a few days to exams? What about the timeliness of students’ assessment, exam results, and project supervision? These and similar issues are areas we should not ignore. How much effective hours are lecturers supposed to put in as part of their routine work and how is this input objectively assessed and by whom? How long should a thesis sit on the shelf of the assessor and who monitors that time limit is adhered to in the name of standard of practice and quality assurance? These checklists should also apply to health and other sectors. We must be able to account for the public trust and expectation of our position before we ask for more trust and responsibility.

However, it is inevitable that trade disputes may arise between employers and employees and that should have some rules of engagement by the unions so as to minimize damage to public interest and achieve the highest good for the people. There is also need to lead by example by subjecting any withdrawal of service to true democratic process. It is not just enough for the union executives to take a decision to proceed on strike or call a congress where members in attendance are usually those who are pro-strike. The grave implication of a total withdrawal of service warrants extending to all members of the union an opportunity to decide their willingness to be involved or not in such drastic measures. In some decent clime, ballot papers are sent to all members and time given for them to return their verdict on whether a strike action is supported or not.  A critical percentage of members must endorse a strike action before it is undertaken. This is not what happens in our own situation where a handful of “hot” heads gather and take “aluta” action in the name of “congress” and it is not unusual for a good number of members of these unions to be totally ignorant of the reason(s) for their strike action. What is the morality of this process of withdrawal of service by union members or “congress”, especially considering that members of the public suffer most in the situation? Has anyone quantified the needless loss of lives and worsening of diseases of patients in many needles s strikes in the health sector? Just recently some amalgam of striking unions in the health sector, named JOHESU, called their members for a total strike for reasons that are difficult to situate in the context of any improved health care delivery to the people. Is it not a shame that for selfish and pecuniary reasons, we betray public trust and the responsibility we owe to professionalism and humanity? Visit a typical public health institution and you will see many “health workers” that have no business in the hospital order than union activities and fomenting trouble. These redundant workers sit back and think of ways to advance themselves to unmerited positions on the back of reckless unionism and frank lawlessness. Unfortunately, government instead of showing leadership and applying the principle of rule of law will rather engage these unions in endless negotiations on issues that basically do not address any real growth and development in the sector. Walk into any public institution, and I can speak of health, and you’ll find staff watching video or playing games on their computers, being on endless breaks, or chatting away while some eyes are fixed on the clock for the magical time of 4pm when they leave without delay for a day of “work done”. We can accuse “government” of inefficiency and all manners of incompetence, but there is no word to describe the level of irresponsibility, deficient work ethics and lack of productivity by a good number of government workers who are quick to down tools to press home for “better condition” of service. In any well supervised system or in the private sector, these workers won’t last a day on their job except of course they prove they deserve to be paid at the end of the month. Worse still, when they embark on the incessant strike, they still collect their monthly salaries and entitlements while members of the public suffer untold hardship, misery and death due to these actions that are contrived to deceive the public as fighting for a general good. A real fight for the general good will include rejection of salaries if government fails to address issues that will optimize work and improve the wellbeing of the public. People go on hunger strike to press home their firm beliefs or convictions on the subject of their protest. No, our “strikers” continue to “earn” their salaries for doing no work and in fact it is usually factored in as a part of resolution of the dispute that all remunerations for the period of strike are paid in full before calling off the strike. What is the morality in accepting salaries from government when your claim for a strike action is government lack of attention to the sector? Won’t it be a stronger statement to refuse salaries as a mark of principle and to clearly demonstrate to the public that their interest is the primary concern? No, a good number of our lecturers in public institutions have their children in elite private universities or outside of the country. How many health care workers will be happy to be treated in their own institutions when ill, and how many of them who can afford to “travel out” for medical consultation, will readily submit themselves to the local facilities and personnel when they or their close relations are ill? Are we not deceiving ourselves and going in a vicious cycles that is  spinning out of control by  a total lack of national rebirth ethos, and  by not taking our future into our hands through giving in our best, even in the midst of obvious limitations? Everywhere one turns, it is the scream of “Gimme! Gimme!!” and there is a deafening silence when it calls for sacrifice and to give back to the system. We are running down our institutions, countries and African continent by the recklessness that is prevalent in our unions and lack of individual accountability and we are failing to address personal responsibility by laying blame on some imaginary “government” when in actual fact we are the government and we must take a collective responsibility and start the process of rebuilding our institutions, sometimes in pains and discomfort. We cannot eat our cake and have it. The call now is for sacrifice and for all categories of workers to have some introspection and operate within their bound of competence, professional calling and local and international best practice. A country cannot choose to isolate itself from the comity of nations and apply strange modalities of doing things. We must examine what is obtainable in similar environments and learn what makes their system to work and ours not working. There is no need to reinvent the wheel. Unions and organizations should place a ban on strikes, step away from military mentality and start to retool strategies in engaging organs of government in effecting any desire change in the context of general improvement of quality of service rendered to the public. The interest of the people should be of paramount importance to such extent that members of the public will be the ones to champion our position in any event of dispute with the government. If we bother to gauge public perception of the current incessant strikes, we will be shocked to know how much they loathe our actions and how much they are seeking for alternative ways to bypass our inefficient, unreliable and poor services. 

Hopefully, one day government will come to realize that our service public institutions cannot be sustained this way and will consider handing over to Organized Private Sector to manage while government provides the enabling environment/infrastructure for operation. Until the process of recruitment of staff, work supervision and output evaluation are streamlined, we’ll continue to have over bloated workforce that is essentially jobless and willing tools for destabilization and reckless strikes action that are basically self seeking and immoral in approach and execution. We have placed our interests above the general interest of our society.

When all the ongoing strikes are eventually “suspended” (to be resumed at a later time as service oil for our “famous” unionists) I hope we can muster the sincerity to count the losses:

• Worsened diseases that have resulted in preventable complications and permanent disability in some cases; 
•  Deceased patients who can’t be brought back to life;
• An unreliable health care system that cannot be trusted with the health of the people;
• A workforce that generally lacks ethos of service with a distorted sense of entitlement;
• Students who will never return to school because their circumstance has changed irreversibly;
• A battered education system that remains perpetually in coma;
• Lack of faith in government and in public institutions by the people and resort to self help with resultant jungle mentality and low premium on lives and property

We can’t possibly build a healthy nation and in turn, a progressive continent, with the above indices. We can’t afford to continue on this destructive path any longer. It’s time we cared more deeply for our people and in turn create a fertile bed for us to thrive as individuals and as a community.

Child Marriage: We are not Overreacting.

"Also condemning any attempt to legalise child marriage, Tofa, in a statement yesterday from Mecca, Saudi Arabia, said it was wrong to marry off young girls.

He said: “Some ignorant people, or shall I say mischievous people, will always use religion for their personal and political ends. They hardly even care that they are dragging the image of ‘their’ religion into the mud. As long as they can satisfy their desires, for them any statement is justified. It is very sad when people of meagre knowledge about a matter do disseminate nonsense to an ignorant public, and most people who should know better keep mute about it.
 “What perplexes me even more is from which section of the Shari'ah they are quoting when they say a matter is Islamic? Marrying off innocent young girls has nothing to do with religion. It is a bad and cruel social and cultural practice that in these days and times must be rid of by whatever feasible means. It is a practice by people who are backward, and who do not care about the progress of their communities or the society at large.”
He urged the National Assembly to be brave enough to enact a law that would prohibit the marrying off of girls that are below the age of 18 just as he urged the federal and state governments to give free education to all indigent boys and girls to discourage child marriage".

Above statement was credited to Alahji Bashir Othman Tofa, a Muslim from Kano State, Nigeria. He called up enough courage to speak the truth and challenge men and women who hide under the cloak of religion to destroy the fabrics of humanity for reasons that defy commonsense; for purposes that are self serving; for living of unending hedonistic pursuit; and for extremism that starts and ends with  pursuit of control over the lives of others, especially the vulnerable. Religion is only a cowardly facade to hide mischief, oppression, sense of insecurity, complex and other vices not compatible with humanity.
Child marriage is despicable, an act of gross child abuse and the "ultimate" child rape.
We must rise up in one accord across the continent of Africa and condemn in the strongest terms available any practice that destroys the future of Africa at the very foundation. Children will never grow up if we do not allow them grow through their childhood, and such unfortunate situation will be the sad tale of a community that will never grow.
We must also press for the establishment of functional institutions that will properly manage victims of child abuse.
Appropriate paediatric forensic medical services should be in place with requisite expertise and infrastructure and must work closely with the police, justice system and child protection agencies in providing holistic care to victims of child abuse and prosecuting alleged offenders.

Meanwhile, many thanks to Tofa for siding with commonsense and for speaking up. We hope other people of our shared humanity will "unmute" and tell the Yerimas of this world that one word aptly defines their actions and inactions against humanity: Shame!

Constitutional Approval of Child Marriage in Nigeria: Rolling Back Common-sense

Just last month we celebrated the Day of the African Child, and it was with a heavy heart that I delivered a talk titled "Forensic Perspectives on Harmful Social & Cultural Practices affecting Children in Africa" in an event organized at the University College Hospital, Ibadan to mark the day. Why the heavy heart? I referenced the infamy of a serving Senator of the Federal Republic of Nigeria who literally bought a child for a "wife" against an existing federal law, the Child Rights Act 2003. And to underscore the impunity, this "marriage' ceremony held at the Federal Capital territory, Abuja. Nothing happened to Mr Ahmed Yerima despite a great hue and cry raised by the civil society and human rights advocates. He was never arrested nor charged to court for contravening the law of the country which stipulated 18 years as age of marriage for a female. Yerima's travesty is just a tip of the iceberg. Many female children, in their early teens or once they start menstruating, especially in the Northern part of the country are usually given out in marriage to men old enough to be their grand fathers, all in the name of religion or culture. These girls are soon abandoned for another child "bride" when they develop complications of child birth especially vesico-vaginal fistuala (VVF) in a child giving birth to a child, and resultant mental health issues due to the loss of their childhood to the crave of primitive men who seek to "revitalize" themselves by violating "young virgins" under the cloak of "religion" and "culture" . Many local and international medical missions have been undertaken to give some life to these abandoned children who become destitutes as their perverted husbands have soon found them too "smelly" and an embarrassment to live with. They also face rejection from their families and are often ostracize by the community.
This same "Senator" Yerima has now become the arrowhead of  "Senators" in the National Assembly seeking to legalize marriage to girl child.
“The senator is in the habit of marrying minors and has gained notoriety in enticing girls to marry him, having contracted one in 2006 with a 15-year-old (Hauwa’u) whom Mr. Yerima allegedly caused to drop out of school at JSS 3, as his fourth wife,” the petition read.
Hauwa’u, who has one child with Mr. Yerima, will turn 17 today (from the date the news was first published). However, the senator recently severed the marriage to make room for the 13-year-old Egyptian girl.
According to the women groups, Mr. Yerima’s request to marry the minor was turned down in Egypt because marriage to children is prohibited there. They accused the senator of luring the girl’s family with money, paying them a bride price of N15 million and sponsoring about 30 members of the child-bride’s family to attend the wedding ceremony."

Nigeria is about to roll back every gain and impact made by the Child Rights Act and the conventions the country entered into on the rights of the child and other human rights issues. The "democracy" this country is practicing appears to be a reign of impunity by a minority of "elected" persons who subvert popular will of the people. The show of shame at the Nigerian senate is a clear signal that common sense is desperately needed at the legislative arm of government. This is the height of gender based violence perpetrated by a group of inordinate men who take females for objects of possession and sex toys. With their new found "status" and over-bloated sense of entitlement, and largely unaccountable access to the national treasury, these perverts can now take on many girls as "wives" and concubines without any restrictions whatsoever imposed by any law. This is the sorry state of "democracy" practiced in Nigeria and a good number of African countries which some hapless citizens have described as "government of the politicians, by the politicians for the politicians and their cronies".

On this particular ignoble role by these reckless "law makers", Nigerians will have to take their destiny into their own hands and protect our children, the future of the nation, by immediately mobilizing to occupy every city and pass a clear message to the law breakers that Child Marriage is the Rape of a Child! The action of a few men should not define the ethos of a nation like Nigeria. And check out these characters, none of them will ever give out their girl child in "marriage" as most of their children are schooling in the best private schools in Nigeria or in elite schools abroad. They quite well know the value of education, and the opportunity therein, when it concerns their own families. It is simply preying on the weak and an exercise of power and control over the vulnerable. Nigerians and the international community should come out strongly and condemn this perversion by the National Assembly. The right of the girl child, and women in general, to liberty, dignity and self actualization has been compromised in Nigeria, and in many African countries. We cannot allow this situation to subsist if there is ever any chance for a sustainable society on this continent.

ASUU Strike: an Endless War with no Exit Strategy

WHO defines Health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. (Emphasis mine)

Has anyone, therefore, bothered to find out the mental health challenges and social disruption that ASUU strikes impose on the youth of this nation? Do students have any rights to uninterrupted academic calendar?

We grew up with the name “ASUU” evoking imagery of militancy, disruption of academic calendar, forced holidays on students and parents, and general uncertainty on career and future of university students in Nigeria. That was decades ago. Unfortunately, nothing has changed about ASUU and their mode of engagement with government till date.

What do we usually get from ASUU strike? University lecturers rightfully lament about the poor state of our universities and the educational sector generally. And following one failed negotiation after another, with successive governments, strikes are called.

What is this strike? Services/teachings are withdrawn and our universities become a ghost town.

Parents and guardians toss from one side of the bed to another thinking how to manage the emergency of their "jobless" children.

The future of the students is put on hold indefinitely.

The government in place appears to move on to the next item on the menu as the effect is apparently not directly felt.

Their children are either in private universities or studying outside of the country.

ASUU members, hitherto moonlighting in private universities or in some other endeavours, could now devote the entire time for their private pursuit. After the strike or even within it, ASUU still expects all salaries be paid in full!

What is the morality in all this? How can we possibly run a nation in this way? The waste and missed opportunities that both government and labour unions appear to condone is alarming and unsustainable.

The future of the nation and a leadership generation is short-changed, and a dicey and uncertain future awaits the rest of us.

ASUU needs to rethink strategy. If strike becomes "inevitable", ASUU should well mobilize their members, civil society, ordinary citizens and even students to join in public protest, nationwide, to bring to the attention of the world the precarious state of our education, and the reasons they will not continue to “aid or abet” such dangerous decline by pretending all is well. But this is not what ASUU does. Indefinite strikes are declared and there is no obvious plan for public activities to continue mounting pressure and drawing local and international attention through public protests/demonstrations. How many ASUU members truly believe in these strikes enough to participate in public protests and risk their convenience or lives for the passion of sound education in this country? That's why ASUU's strike could last up to six months or more and the nation simply "moves on". The thriving private universities are a testament of some bypass mechanism.

The ultimate victim is the ordinary students and their parents, and a public university education on auto-pilot that may give way to some disastrous landing any time. The implication is far reaching with the turnout of poor quality graduates in medicine, engineering, law and other professions. The people and the nation as a whole suffer damages as a result of a decline in standard of care from the very foundation.

Meanwhile, with the decline in purchasing power of Europe due to economic crisis, the increase in oil production quota from the Middle East, the discovery of oil in other countries (especially in Africa), and the Americans weaning to some clean energy, oil money will soon dwindle down drastically and the states and federal government of Nigeria may soon be unable to maintain the present over-bloated recurrent expenditure which mostly goes into paying salaries (real and ghost) with little productivity to show for it.

It may not be too long before workers in the public sector will have to make a choice between a pay cut and downsizing. Already, some indirect pay cut has been introduced by some state governments in the name of higher taxes.

We should carefully consider that time has changed. Our population continues to grow and there is little and inadequate infrastructure to support such growth. Every sector of the nation, be it health, education etc, must take a holistic view of the situation to be able to know how best to engage in our collective struggle to achieve a nation state we can all be proud of.

Making demands for a desired state of affairs is not out of place. However, without due consideration of the inter-relatedness of the problems and needs in the larger society, it may amount to chasing shadows to insist on narrow demands. Yes, "agreements" may eventuality be reached and signed but we'll still get back to this vicious cycle again at the point of implementation which usually reveals the weakness of such agreements which might have been reached at the exigencies of the moment without some deeper thoughts and strategic planning taking into consideration national developments goals, in all honesty and selflessness, by all parties involved.

I wish ASUU good luck in this present venture but I sincerely believe that if anyone wants to know why this country, Nigeria, is such a sick giant, the answer will be found if as individuals we take the courage to look at a mirror.

We should strike against ourselves and honestly ask if we are truly working enough for the money we earn, and for the small privileges we enjoy (of course we still have so many complaints, no doubt). More importantly, we should ask ourselves how much we've utilized available facilities/resources in the best interest of common good. These posers are both for the labour unions and the government-both are driven by people; WE!

This is simply my opinion and this opinion does not in any way pretend to know all the ramifications or have all the answers. It is an opinion borne out of my personal conviction that we can do things differently, and that we can also modify our attitude towards one another and towards public cause. ASUU should urgently device an exit strategy from incessant strike actions. We must think out of the box, re-examine our tactics and rethink our strategy. Let’s give students and the public some respite!

ASUU is acronym for Academic Staff Union of Universities

 

Strikes in Healthsector: When Patient Care takes the Backseat

There is an alarming situation in our hospitals in Nigeria and some African countries. The ready use of strike actions by healthcare workers to settle industrial dispute has caused a big dent in public confidence. Strikes have become incessant these days; possibly reflecting a culture of militancy that has bedeviled our society. A closer look at the list of "demands" often reveals some self-centered pursuit. The big picture is often ignored and the patient, the very reason for our hospitals, is betrayed. Lives are lost. This is an ultimate failure by both the healthcare workers concerned and the hospital  management/government. The brazen manner patients are abandoned and the "contract of care" breached is unconscionable and shameful.  
I know a few things about dying and about the dead, and I know it is not simply a cessation of vital signs.

It is much more complex. It is an irreversible phenomenon that changes the lives of many people for ever.

It is a loss to an individual, a family, a community and the nation.It is not merely some statistics. The loss is not addressed by some "tests for statistical significance" because it is already 100% loss to all concerned. The loss of any patient's life is unacceptable and unjustifiable. Unfortunately, here no one is held to account.

It appears the public has been taken for granted and there is some misplaced sense of indispensability often exhibited by healthcare workers. I reckon this is our big loss.

And I think our loss is the gain of "alternative medicine".

Our loss is the gain of medical tourism.

Our loss is the growing loss of public confidence in healthcare workers and in our hospitals.

There is, therefore, urgent need to balance the right of a healthcare worker to agitate for some good working condition with the right of a patient for undeniable healthcare available.