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Sunday, November 24, 2013

As Federal Road Safety Corps (FRSC) Investigates Prof Festus Iyayi's Death




So much has been written in the media about possible causes of recent fatal road traffic crash that involved the convoy of Kogi state governor. Prof Iyayi of the University of Benin was a known figure among the casualties. The state of Nigerian roads and human factors, which play major role in the incessant road crashes that have claimed more lives than natural diseases, was a subject of this blog under Traffic Medicine (http://uwomeze.blogspot.com/2013/04/traffic-medicine-1-managing-carnage-on.html and http://uwomeze.blogspot.com/2013/04/traffic-medicine-2-behavioural-factors.html). Since the death of Prof Iyayi and others in the crash, more Nigerians continue to die daily from needless and preventable crashes that hardly attract the attention of the media but those who work in hospitals can attest to the number of the dead and dying brought into the Accident and Emergency Departments on their way to the mortuary. It is a sorry sight to see the human waste on Nigerian roads especially involving the young and we appear helpless about stemming the tide.

The Federal Road Safety Corps (FRSC) saddled with the responsibility of ensuring safe driving and accident prevention has openly declared their plan to investigate this latest crash involving the convoy of a state governor and a high profile university lecturer. Many have questioned the ability and credibility of the FRSC in recent times as the agency appears to be distracted from its main mandate of ensuring safe road for Nigerians and have embarked on many other ventures a lot of people feel are indicative of some loss of focus.
However, it may be important to point out a few things as FRSC undertakes this investigation:

  1. Deaths in road traffic crashes are apparently unnatural and violent deaths, and fall within the cases investigated by the Coroner who presides over the jurisdiction of such incidents. It is therefore hoped the FRSC is working with the Coroner in the affected jurisdiction as road traffic crashes are medico-legal (forensic) cases. 
  2. Environmental and human factors are valid considerations in such investigation. While much has been written about death traps called roads on our major highways, the public may not have paid enough attention to the human factors involved in causation of road traffic crashes in Nigeria. 
  3. A good scene reconstruction will be critical to understanding this crash. It is expected that positions of the vehicles involved and the casualties would have been marked by the relevant authorities. It is therefore important that issues are based on evidence. There is a tendency to be carried away by sentiments and sensationalism usually expressed in some segment of the media. Such is not helpful in coming to some premise supported by evidence. Media "trial" and conclusions must be deemphasised if we are interested in 
  4. seeking evidence based facts. 
  5. Forensic autopsy should be conducted on all the dead victims. This is particularly vital to the investigation. It is important to exclude natural conditions or diseases that may have influenced the situation. Toxicology must be an essential ancillary to the autopsy to unravel any role some drugs or alcohol may have played in the crash. That a good number of drivers do abuse drugs or alcohol in Nigeria and drive under the influence is a known fact to the FRSC. It is therefore imperative that toxicological analysis be carried out on relevant biological specimens. A question one is yet to get an answer to is the legal alcohol limit in Nigeria. What blood alcohol concentration (BAC) is considered the upper limit, by law, in Nigeria? The FRSC may want to address this question since it has touted the use of breath-analysers on drivers in Nigeria. The principle of use of breath-analysers connotes a need for confirmatory blood test at some reading. What BAC will officials of FRSC be keeping an eye on Nigerian roads? 
  6. Coroner's Inquest: A proper Coroner's Inquest should be conveyed by the appropriate authority, and all the pieces of information from the various investigations and witnesses are examined by the Coroner in a public forum. FRSC will be one of the government agencies to present their findings and at the end of the proceedings, a Coroner's determination will be made and verdict entered.

Like relations of deceased often wonder what value investigating the death of their loved ones will bring to them since the dead cannot possibly be called back to life. I usually respond that it does justice to the dead to be able to understand how death came about and to speak to their unique circumstance; it also enables loved ones, families and affected communities to come to closure and move forward; and it protects individual and public health as lessons from a particular death could potentially save others from a similar situation. Furthermore, it is a strong statement to the society that we place high premium on the life of every individual and there must be accountability and justice in the event of any loss of lives.

Monday, November 4, 2013

Lights Out for another Rape Victim in Nigeria



A silent epidemic rages at the background as our institutions and communities only make occasional sporadic motionless spurts in response to senseless dehumanisation and degradation of our most important human essence, women and children.
A colleague just shared with me a distressing episode he witnessed of how a judge threw out a case of rape in court in response to some submission by the defence that "she enjoyed it and even had orgasm". This is the level of (lack of) knowledge and backwardness in most of Africa as the rest of the world makes conscious efforts and progress at stemming this predatory warfare on human dignity by aligning with contemporary evidence based modalities and discarding damaging myths that have retarded any meaningful progress in this area, mainly in Africa. From the police who take a report of sexual assault, to state prosecutors and judges, a common mindset thread runs through the chain that blinds African societies to the realities of this horrendous assault on human dignity. The prevalent patrilineal slant in the African society has entrenched this culture of impunity. It is almost hopeless reporting a case of rape, as the victim is immediately re-victimised first by relations, community and the police who often  judge her appearance and demeanour; her clothing; life style and "what were you doing in a man's room (or alone with a man) if you didn't want sex?" arrogant and senseless posture. And the attendant stigmatization is suffocating.
The situation is so appalling and depressing that it is driving victims to take their own lives. The recent report widely reported in national dailies, 18-year-old gang-rape victimcommits suicide highlights the insensitivity of our community, and institutions to this malady and it is a call for urgent and concrete action by relevant institutions and agencies. This is just a tip of the iceberg; the scale of the problem appears to be beyond what our society is ready to accept and act upon. Husbands are sexually assaulting their wives; boyfriends their girlfriends; fathers their daughters; close family and authority figures their own relations and those who are deceived by their “sheep appearance”, when in actual fact these are ravaging and unconscionable wolves who abuse their position and betray trust.
We can't afford to keep writing this way. There is urgent need for action. First, relevant government agencies should set up Rape Crisis Centres as clearing houses for immediate and long term management of sexual violence. These centres will be One Stop Centres for both medical and forensic management of survivors by specially trained medical staff, social workers, police officers and others working as a team. We need to put a FULL STOP to having victims of sexual assault go to our regular police stations (as presently constituted and operated) to report such cases. Time after time, with one scandal after another, it is evident that continuing this manner of attending to victims of sexual assault by regular police officers and untrained medical personnel (in the area of forensic medical management of sexual violence) is essentially traumatic and a further victimisation of hapless victims. There is also need to tinker with the existing laws that are based on primordial understanding about sexual violence in most of Africa, and bring them up to speed with contemporary understanding and practice in this area. Our lawyers and judges will need to be educated on the facts of the matter based on evidence with regards to sexual violence. It is therefore time we invested in safeguarding our humanity from aberrant humans, mainly males, who inflict indelible scars on the honour, dignity and sanctity of life.

Sunday, October 20, 2013

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.

Thursday, August 29, 2013

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.

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