Nurses and midwives, under the auspices of National Association of Nigeria Nurses and Midwives, Plateau State chapter, recently threatened to go on strike. Their threat, notwithstanding the continued spread of coronavirus in Nigeria, is over alleged non-provision of Personal Protective Equipment for the health workers. Chairperson of the council in the state, Briskila Dabit, tells JAMES ABRAHAM about the planned strike and other issues affecting the healthcare sector in the state
Nurses are among the front-line workers in the care for coronavirus patients. How prepared are your people at this time of crisis?
We are really concerned, I must say, because the nurse is the first person of contact a patient will always meet in the hospital. The nurse is also the last person a patient will meet before leaving the hospital. Even as the patient recovers, the nurse is the person who will finally discharge them. And in case of death, they are also there with the patient. Therefore, the nurse is the beginning and the end when it comes to the management of patients because they are there with them all through.
Naturally, nurses are the most hit during this era of coronavirus because they are in the forefront. When you also talk about the population in a hospital set-up, they are in the majority. Sometimes, you can see between 10 and 20 nurses to just two or three doctors. That is the situation in most health facilities in Plateau State and elsewhere in Nigeria. But even in the face of the danger, we cannot abandon our patients.
Your group recently threatened to go on strike over lack of protective gear for members, how bad is the situation?
It is true that I addressed a press conference over the matter but I did not say that we were going on strike. I only instructed nurses not to attend to any patient if personal protective equipment is not given – that is if they don’t have it or if the government does not make it available for them in order not risk their lives by attending to patients with suspected cases of coronavirus.
I told nurses that for them to attend to a COVID-19 patient, they must have a complete PPE. When those things are in place, there is no need to go on strike. We are here to save lives. After all, those who are sick are our brothers, sisters, relations, husbands, wives and so on. As nurses, we are out to help but we want the government to also cooperate with us and ensure that the necessary things we need to fight this coronavirus safely are made available
How long has that been going on as people are wondering why you are just speaking out now?
We have to complain now because we don’t understand what is happening with the plans and other arrangements being put in place by the state government regarding the fight against the coronavirus. There were some committees set up by the government, including central planning and sub-committees and nurses, who are in the forefront of taking care of the patients, are not being carried along. As I said initially, we are in the majority when you talk about health care. Go to Jos University Teaching Hospital and you will discover that the majority of the health professionals there are nurses. If you go to Plateau State specialist hospitals, you will find the same thing. You will also find the same thing in other health facilities across the state. And all the nurses in those places have been calling and complaining to me that they don’t have this and that. There is no PPE for them.
How do you want me to handle this in case they have suspected cases? And I told them that nobody contacted me and that I am not included in any of the committees set up by the state government. And so, I don’t know if there is any arrangement in place to address their concerns and I don’t know who to contact about the issues raised by them. And because these are genuine issues that should be looked into, we decided to bring our concerns to the public domain by addressing a press conference.
What if there is no coronavirus outbreak, does that mean you wouldn’t have come out to demand better conditions for the nurses?
I would have complained. In fact, the complaint as to the shortage of nurses in the state was already on the ground. We really do not have enough nurses in the state and that issue had been there. We have tabled that problem as a union before the government. And we have been negotiating with the government over that. There is the issue of the implementation of the new minimum wage and in the course of negotiation, we also included the issue of lack of manpower and the government said it would employ after the implementation of the new minimum wage. And we have been expecting the government to honour its promise.
And with the outbreak of the COVID-19, government went back again to say that it would not implement the new minimum wage or embark on new employment. And one of the points I made during our press conference is that government should exempt nurses from the ban on employment because this is the right time we need them so that we can work collectively to fight this deadly virus. The few people that are working are overworked and tired. And that is why we are begging the government to exempt nurses from the embargo on employment in order to get things done and save the lives of our people in this trying times.
After the press conference, what kind of response has the union got from the government?
I have got some responses from the government. I have seen an invitation letter suggesting that there is a meeting at Government House with the Border Management Committee, which they indicated that we are now part of. They did that probably because of the concern we raised earlier and decided to include us in that committee. Again, I have seen another invitation letter from the Commissioner for Health. But I have yet to honour the invitation. I hope that when I honour the invitation, we will understand one another and sort things out. These are the responses I have got so far.
Is there an ultimatum after which if nothing is done, you will down tools?
There is no ultimatum. But we do hope that they will understand the urgency of our demands and act on them.
At the moment, how have your members been working despite the challenge?
They have been doing their best. They have been using the few hand sanitisers given to them. When I spoke with one of my members, he told me that they gave only one hand sanitiser to his clinic, which is grossly inadequate. And I think that is part of what I intend to discuss with the commissioner. They should try and make some of these things available because they are necessary at this period.
How much do nurses and midwives get as hazard allowance?
This is one thing we have been complaining about because the situation there has to change. Do you know that hazard allowance for each of our nurses in the state is just N1,000 monthly? Can you imagine that with all the hazards they go through in the course of doing their job? That is how bad the situation is. With all the Lassa fever, Ebola and now coronavirus, you are paying the nurses who are at the front line just N1,000. Isn’t that too small? That is why we are begging the government to do something about it and increase the amount to something reasonable.
How much increase do you want as hazard allowance?
We know that you cannot give what you don’t have but government can start somewhere by increasing it to at least N5,000 monthly. They can improve on that subsequently as things improve.
What are the other challenges you face on the job?
Most of the challenges we are facing today in the hospitals revolve round poor equipment. We need working tools. Government should do something about it because if you go to most of our hospitals, you will find most of them lacking in equipment or with broken down equipment. I work in the theatre and I know how bad it is to have a bad instrument in the theatre while you are trying to operate on somebody. Please, we are pleading with the government to do more for us. Another major problem is the issue of employment. They should employ more hands and equip the hospitals.
Has any of your members been exposed to coronavirus patients without the necessary kits?
For now, I have not received any report concerning anybody being infected.
What is the experience of your members in JUTH, which is one of the isolation centres for coronavirus?
As you are aware, Plateau State has yet to record any confirmed case of the virus. I can’t give you much about the situation in JUTH because I am not working there. I work with the State Hospital Management Board. But then, I know that there is an isolation centre in JUTH. As to what they told me, they have six nurses there, some doctors and other attendants. Our position is that they should take special care of the people working in those isolation centres. You won’t have any difficulty in doing this when you take into consideration that those who have been selected to work in the isolation centres are at risk to their family members and others around them.
There is the need for them to be given accommodation so that they self-isolate themselves as they work in those facilities and they should remain there until the issue of coronavirus is finally tackled before they can be free to go back to their families.
The truth is that it is dangerous to allow those directly involved in the management of coronavirus patients to be going back to their houses because they could infect their own people. And even as they are there, they are not supposed to mingle with people freely because they could infect other people as well. There should be proper training for them, permanent accommodation and feeding within the period of their coronavirus assignment. And that is one of the issues I raised during the conference.
How many members does NANNM have in Plateau and what implications will a strike have for the health system?
We have quite a number of nurses in Plateau State but the facilities differ. In JUTH, for instance, we are over 400. In Plateau Specialist Hospital, you will find over 300 nurses and in Hospital Management Board, there are about 300 nurses or thereabouts. But the worst hit in terms of shortage of manpower is in the local government areas of the state. If you put all the nurses together from across the 17 local government areas of the state, I am not sure if they are up to 200. The situation in the councils is like that because a lot of nurses there have retired and there have been no replacements for them.
There have been coronavirus cases in Kwara and Edo states where the patients didn’t fully disclose their travel histories. You said your members should not attend to coronavirus patients without proper kits, but how will they know that if the patient doesn’t fully disclose some things?
That issue is there. But you know that before somebody will go to hospital, they must have shown some signs and symptoms. And we usually ask questions to get information about a patient. And speaking of coronavirus, when you take the temperature of a patient, it is usually very high. The PPE, face masks and so on are just the preliminary measures. Before you attend to any person, you must wear those things and also maintain some distance as well. They are very important and that is why we are advocating training of nurses on how to manage this pandemic so that everyone would know what to do and remain safe.