Medical Negligence: Appointing MDs as County Health Officers and Abandoning the Hospitals

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As a healthcare professional, one of the biggest practice challenges I continue to face, and might be shared by my peers, is the significant shortage of medical doctors in hospitals. In addition, I have also witnessed a frustrating gap in the absence of formal management and leadership training provided to medical doctors, many of whom, immediately upon graduation from medical school, assume roles as County Health Officers (CHOs) or double as CHOs and hospital personnel. Note that the work of a CHO is highly administrative and does not generally involve clinical practice. This has a significant trickledown effect on the ordinary citizens thus further weakening the health care system.

What makes the matter worse is in the Liberian context about which I write this article, the doctor to patient ratio is a staggering 1 doctor to over 76,000 patients. In 2013, there were only 51 medical doctors in the country, and some died during the Ebola outbreak. Given such a gap, does it make lots of sense to remove the scarce number of doctors from the theater, meaning the operating room and bedside of patients, so that they can serve as practicing healthcare administrators?

And for those of us who have watched these doctors at work as County Health Officers, their inability to navigate the political bureaucracy or deal with personnel issues becomes natural consequences of being put in positions to do what they are not taught to do. Doctors, at least in Liberia, are trained to deliver clinical care, but when they are misplaced in administrative positions, the result can only be the kinds of mishaps we see happening in the society. Sadly, many medical doctors trained in Liberia never get to sharpen their skills in developing treatment plans and seeing patients and then transition quickly on to becoming County Health Officers. They end up not practicing the clinical art of diagnosis and treatment and over time become mere healthcare administrators.

Speaking as a nurse and public health specialist, I have witnessed doctors assigned at hospitals and also as CHO/CEO continually attend meetings outside their duty stations; meaning, patients who require emergency medical attention might have to pass away or travel to other facilities long distances away.

This situation is worse when considering the hours it takes to reach hospitals and even clinics/health centers, especially in rural Liberia.

The question that keeps looming in my head is the following: Is this the best use of our limited healthcare human resources, particularly our doctors? Could we not utilize the skills of the many graduates of graduate programs in public health in the County Health Officer role? Could we not train college graduates to become county health officers especially those with backgrounds in Nursing and related fields? Have you ever felt overwhelmed as a nurse working with a doctor whose clinical knowledge is so sparse because he or she has spent much of their professional life in administrative positions? Could this issue be the source of the many unexplained deaths that are occurring in hospitals? Could it also be that the scarcity of practicing medical doctors is overwhelming the few who are practicing to violate medical ethics by working longer hours than they should? Or could it be the reason why some regional hospitals depend on foreign doctors (contractors) for day-to-day patient care?

As a society, if these issues are not tackled in a substantive way, the investment of national resources in medical education will certainly not produce the needed dividend. We have contained the Ebola outbreak, but there could be other epidemic outbreaks on the horizon requiring more practicing/experienced healthcare professionals, including medical doctors. What public policy remedies are proactively being employed to ensure that when that time comes, the society will be prepared to fully optimize the already small number of trained doctors that we have? The key to leveraging our healthcare investments is making sure that the few doctors that have been trained at home and abroad return to the hospital and clinics full time, doing what they were prepared to do professionally.

Therefore, let medical doctors be left alone to do medical work and let those with the requisite qualifications be ushered in regardless of their professions (not being restricted to medical doctors or staff). Furthermore, medical doctors who so desire to be CHOs/CEOs can be given study opportunities to enable them advance themselves.

The Author: Eddie Miaway Farngalo is the Head of the Research Department at the Center for Liberia’s Future. A trained nurse who practiced at the Jackson F. Doe Memorial Regional Referral Hospital, he returned to graduate school and completed a Master of Public Health degree in Health Services Planning and Management (Ghana); served as a Health Training Specialist and Surveillance Assistant, Grand Gedeh County (IOM); triage nurse at the Sinje ETU; Community Support Officer for Ebola Community Care Center, Karnplay Nimba County (Project Concern International). He is currently leading the CFLF team conducting a national study on community perceptions about Ebola and the reintegration of Ebola survivors, orphans and caregivers. Contact: 0886484351;[email protected]

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