The idea of healthcare workers embarking on an indefinite strike action at a period of national emergency is a ludicrous nightmare that only a few could envisage. Yet, until it was called off on Monday, doctors were on strike in Nigeria for one week, as the country entered a very critical stage in the ongoing battle against the new coronavirus disease, also known as COVID-19. Beyond the pandemic, the strike brought Nigeria’s grossly underfunded and generally fragile healthcare system to a new height of uncertainty, putting many lives at risk.
Citing grievances such as the lack of adequate personal protective equipment for doctors in the frontline of the COVID-19 battle, owed salaries, non-payment of their allowances, and sacking of some of their colleagues in the teaching hospital in Jos and generally trifling with their welfare, resident doctors said they were withdrawing their services. Not mincing words, the doctors, in a statement, told the government, “It is important that you make alternative arrangements for the care of the patients as the strike shall be total and indefinite.”
According to Lancet, an authoritative medical journal, a strike action is a right recognised by the UN, for without it employees have no choice but to accept the terms imposed by employers. However, strikes by doctors represent a conflict between their rights as employees and their ethical and professional frameworks. Although, this time, it only involved resident doctors, strike is a refrain that is becoming all too familiar in the Nigerian health sector. If the nurses are not on strike, then it will be the doctors or the medical laboratory scientists.
What are the consequences of these strike actions? More often than not, they come with untold hardship on patients. Many of them are left to die from ailments that should ordinarily not result in fatalities. It is an ugly trend that should stop; but it can only stop when all the parties to the dispute come together to create a harmonious working relationship.
This is imperative now, as cases of the COVID-19 infection have been mounting alarmingly, with a clear indication that government responses, both in human and material terms, have been short and under the threat of being overwhelmed. According to figures from the Nigeria Centre for Disease Control, as of Monday afternoon, no fewer than 20,244 cases of the killer infection had been confirmed from 111,760 samples tested. From the number of confirmed cases, 6,879 people have been treated and discharged, while 518 have died, leaving 12,847 active cases. In what has been described as a single-day highest, no fewer than 745 cases were announced on June 19, a significant rise from the initial trickles that were reported when the infection first broke out in the country in February.
Instead of stirring up dissent, this is the time to support healthcare workers fully to be able to deliver their best for the country. At a time when health workers across the globe are being appreciated for their acts of humaneness and sacrifice during the ongoing COVID-19 pandemic, it is extremely disheartening that their counterparts in Nigeria are making the headlines for all the wrong reasons.
Mahatma Gandhi said, “All compromise is based on give and take, but there can be no give and take on fundamentals.” Of all the grievances of the doctors, the most fundamental is the lack of PPEs for the health workers, which instantly exposes them to dangers of infection. Aliyu Sokomba, the President, National Association of Resident Doctors, described the supply of masks, gloves and other PPEs as “grossly inadequate.” This is simply akin to sending a soldier to the frontline without adequately equipping him with the necessary offensive and defensive weapons to prosecute the war. At least 10 doctors have died of COVID-19 and another estimated 200 have tested positive for the disease, the Voice of America says.
If anything, this high rate of infection is evidence of how vulnerable the health workers are as they risk their lives to keep members of the public safe. For this reason, the Ghanaian government insured every health worker in addition to giving each of them 50 per cent of their basic salaries as bonus in the three months to June 2020. The health workers were also promised tax relief on their enhanced emoluments for the same period.
In other countries, people have made out time to appreciate the efforts of the health workers. Aside from special packages from the government to incentivise them, millions of people also took to their balconies at designated times to applaud them and show how much they were appreciated. In the United Kingdom, the Prime Minister, Boris Johnson, and members of the Royal Family were not left out. Incidentally, Johnson and Prince Charles are among those that have survived the infection.
Although the government had announced in April that it was taking an insurance policy to cover 5,000 frontline workers, while working out some allowances for them, it is doubtful if the beneficiaries have received anything yet, which is why their grievances included some of the promises made by the government. The government is notorious for making promises that are never fulfilled, be it to university lecturers or doctors or athletes. This has to change; government should not enter into an agreement it cannot keep.
A strike action by doctors always precipitates intense ethical debates. The Indian Journal of Medical Ethics argues that in medicine, as reflected in the Hippocratic Oath, there is a general presumption against a strike action by doctors as the action may result in unnecessary (and preventable) human suffering. For instance, when junior doctors in the UK decided to withdraw their services in April 2016, they were doing so for the first time in 70 years, and it was over a dispute that had been raging for three years, according to a CNN report.
While the genuine concerns of clinicians for themselves and their patients should be addressed by their employers, it is important for doctors to be circumspect in going on strike. Medical unions should always ensure that the reason for a strike is a just cause and the intention is right. Apart from making a strike option the last resort, it should be proportional and there should be reasonable hope of success.