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The fourteen weeks old strike by doctors in Lagos State may have ended. But it left in its wake sorrows, tears and blood. Among the affected communities are people living with HIV and AIDS in the state. According to Ibrahim Umoru, Coordinator of the Network of People living with HIV/AIDS(NEPWHAN)in Lagos, the strike was a nightmare especially as it affected  access to life saving antiretroviral and other quality  monitoring and follow ups.

As the world marks World AIDS Day(WAD), many are celebrating  achievements recorded in the global AIDS response  especially the 2010 Global AIDS Report published by UNAIDS which indicates a reduction in the rate of new infection and as well as access to treatment. But for Lagos state, the death of PLWH during the strike by doctors should be a cause for all to be worried as their death were indeed avoidable.

To mark this year’s WAD,NIGERIAN HEALTH JOURNAL reflects on this seemingly glossed over tragedy in this interview with NEPWHAN’s Ibrahim Umoru.

As someone representing a community that was at the receiving end ,what would you consider the cost of the suspended strike by doctors in Lagos?

Umoru

The cost is enormous to the citizenry generally and particularly heavy to People Living with HIV (PLWH). You will agree with me that in the management of HIV, one gets to see a doctor quarterly. That is for patients who have been on treatment for long and are stable; while those who just started treatment would have to see their doctor say, monthly. It’s so worrisome for our secondary hospitals where our nurses have not been strongly grounded in triaging*. Many people who could not afford private hospitals resorted to taking traditional herbal medicines and those who had no choice actually died.

That means the strike led to treatment interruption for many PLWH…what is the implication of this on AIDS control in the state especially with the likely issues of drug adherence and resistance?

There can’t be anything closer to the truth than this. You know there are various categories of PLWH. Some have vast treatment literacy experience while some were just  initiated into treatment and others were  just about to start treatment . The implication is that those who have been on treatment for a long and time and are experienced and  have become very stable but within the period of the strike there can’t be  any quality evaluation of tests done .Also, there were no consultations for opportunistic Infections(OIs)  just in case any was present. Patients were just coming to pick their drug refills without doctors’ examinations that are routinely done quarterly for this class of patients. However, some are not that experienced and worst of it is OIs could just come up within that period and the only alternative is private hospitals. How well informed are doctors in private hospitals with regards to the management of HIV and AIDS? So, that becomes an issue. I lost a close client to complications resulting from opportunistic infections. I have  another PLWHA who committed suicide that period too. These are some of the numerous painful losses to us in the PLWHA community resulting from the strike.

Is it true that knowing the consequences of a strike on PLWH some doctors in a particular treatment centre tried to ensure that there were no treatment interruption despite the strike?

Yes! Very well yes. I am aware of a particular doctor that took all the risk to be available for some days to PLWH during the strike. This is very commendable as the risk was enormous if his colleagues  had found out. That to me is the height of humanitarianism.

So, what becomes the fate of PLWH who died during this strike? Are you making your case known to Lagos State has that become one of the many casualties of being HIV positive in Nigeria?

Definitely, I am going to make a case to Lagos state as am trying to collate data from the various treatment sites around. At least, we have it on record. But come to think of it, can they bring back those lives again?

What could have been done other wise to prevent these needless deaths even in the face of the strike?

There is great need to improve the skills of nurses in triaging and palliative care. However, our leaders have to be more sensitive and proactive in the welfare of workers generally and health workers particularly. What the doctors were asking for were not out of the moon. They were things they had all negotiated and agreed upon long before now.

Someone has argued that doctors should get a bit more creative when considering a strike action given the implication of a doctors strike. Do you think so?

Our leaders and policy makers should be more creative and compassionate too. The problem is when most of them get there; they care no more about the populace. This should not be so!

So what can be your advice regarding the best way for doctors to strike without downing tools especially when you consider the fact that when their needs are finally met, they cannot bring back the lives that  have been lost?

The underlying fact is we should not allow issues to get to the point of strike at all. A strike that lasted for months is a reflection of the gross insensitivity of the people at the top. They don’t attend these hospitals as they and their families get health care outside the shores of our land. The people need to ask questions. We need to engage our various representatives in the legislative arm of government. The government too need to engage with the populace as they are too far away from the people they govern. These lives as you rightly attest to cannot be brought back. We should be more proactive in leadership and be on ground with the people.

For PLWH on treatment and for AIDS support groups, what lessons have been learnt from this ugly experience bearing in mind that  workers strike in Nigeria is now a way of life and healthcare workers are not left out?

We need to address our positive living lessons more creatively and increase the treatment literacy efforts in the support groups. Most importantly, we need to engage the government particularly in Lagos state to make sure we are heard at the right quarters. To this we have started restrategising to engage with government. You would recall  that the Lagos state government has a law in place protecting PLWH and a section of that law provides for a board and PLWH are supposed to  be part of that board that focuses on fund for drug buffer for people living with HIV. Furthermore, we wish to engage with Lagos State AIDS Control Agency( LSACA) to find out the composition of their board as the law that sets up such agency up to NACA provides for our representation there. That way we can be heard.

 

*prioritization of patients for medical treatment: the process of prioritizing sick or injured people for treatment according to the seriousness of the condition or injury: Microsoft® Encarta® 2009.

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