United Ijaw * Welcome to United Ijaw on the web. Our preference is national self determination, the independence of Ijawnation as a Sovereign State. A state that promotes sustainable economic and social development, democratic principles, liberty, free enterprise, equal rights and justice. This is our story, this is our struggle. **** On Kaiama Declaration We Stand **** United Nations Under Secretary-General, Dr. Antonio Maria Costa, in Abuja condemned the theft of Nigeria's assets by past corrupt leaders. He said that kleptomaniac leaders stole more than 400 billion dollars from the Nigerian treasury between 1960 and 1999. **** IJAWNATION THINK! THINK. **** Almost $170 billion of the country’s wealth disappeared and ended in the private accounts of individuals between 1999 and 2003 alone... Priye Torulagha ****Nigeria has failed Niger Delta – Nnamani **** Resource Control: Niger-Delta governors are traitors – Evah **** Only the fear of a volcanic social eruption from below can stop barbaric behaviour by holders of political power – Gani Fawehinmi ***** “ if the Confab and Nigerians are not willing to heed to Resource Control, they will take it by force” - Oronto Douglas We Dare To Be Different.
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ICHR, 2003
This material is anti-copyright. Please feel free to reproduce it but kindly acknowledge the source.

1. Introduction
2. The Historical Background
3. State of Medical Facilities
4. Cost of Health Care
5. HIV Screenings without Consent
6. Privatization of Power
7. Recommendations
8. Appendices

This report was written by Patterson Ogon, Founding Director, Ijaw Council for Human Rights (ICHR).


The Ijaw Council for Human Rights (ICHR) is a policy advocacy non-governmental organisation. Founded in 1998, ICHR strives for the promotion and advancement of human rights in the Ijaw region of the Niger Delta, Nigeria.

For over 200 years, the Ijaw have been victims of organised assaults perpetrated by unsympathetic corporations and governments. This remains true of the slave era and the period of palm oil trade as it is of the present when the global economy is driven by oil and gas.

There is now irrefutable evidence that oil which was first discovered in Nigeria at the Ijaw community of Oloibiri has endangered the Ijaw environment. On the political, cultural and economic fronts, the Ijaw are under threat. It would seem as if all that the Ijaw - the largest ethnic nationality group in the Niger Delta and the fourth in Nigeria - did all along was to accept these indignities, without resistance and struggle. That impression is false. It is not the evidence of our memory. The heroic resistance of the Ijaw led by Isaac Boro and before him King William Koko and King Jaja among others easily come to mind.

ICHR is founded to build upon this rich history of commitment to social change. By promoting human rights in the Ijaw country, we believe we are contributing to the advancement of democracy and human rights in Nigeria, Africa and beyond.

ICHR derives its inspiration from Ijaw history, culture and politics. Our work is rooted in local and international human rights charters, including the African Charter on Human and Peoples' Rights. Specifically, Article 22 of the Charter says that:

All peoples shall have the right to their economic, social and cultural development with due regard to their freedom and identity and in the equal enjoyment of the common heritage of mankind

ICHR exists to:
i) clearly and sharply articulate and promote the rights of the Ijaw to self-determination, resource and environmental control and sustainable development;
ii) encourage human rights education and training in the Ijaw country.

ICHR's work is conducted in the following ways:

i) education and training of members of the Ijaw society, especially its women and youths for progressive social change;
ii) action-oriented research emphasising the possibilities of alternative political, economic and social futures;
iii) human rights campaign and advocacy.

ICHR work is organised around three key programmes, namely: Peace and Social Justice; Environment; and Economic Justice.
The Peace and Social Justice Programme comprises activities to strengthen the advocacy capacity of the Ijaw civil society; design and implement strategies to resolve conflicts; monitor governance and promote gender sensitivity in public policies.
The Environment Justice Programme consists of a consolidated campaign on the negative impacts of the extractive industry in the Ijaw country.
The Economic Justice Programme is concerned about issues of trade and development, especially the consequences of globalisation on the Ijaw. The programme aims to work with other civil society groups in Nigeria, Africa and beyond to promote a people-driven alternative to the regime of the World Trade Organisation (WTO) and other trade liberalisation policies.

ICHR is a democratic organisation with membership built around the programme areas. It is governed by a Board composed of eminent academics, professionals, NGO and social movement activists.


Ijaw Council for Human Rights (ICHR)
#10, Ibaa Street; Off Okomoko Street;
D-Line; Port Harcourt
Rivers State, Nigeria
Tel: 0803 705 5301
E-mail: izonchr@yahoo.com

…acquiescence in or even silence before the violation of sacred professional ethics, the service by medical men of any goal but truth for the service of humanity, can lead to dishonour and crime in which the entire medical profession of a country must in the last analysis be considered an accomplice.
- Andrew C. Ivy, American Physician testifying at the Nuremberg Trials in 1949

The health sector is one important aspect of our daily life. It does not only sustain society by providing cure to our ailments and succour to our pains. It also stands at the centre of all human development. The age long held cliché of a "healthy society being a wealthy society" drives home the point.
The importance of health in reproducing humanity for higher responsibilities has created the need for those who fall sick to find cure in hospitals. Similarly, the medical profession has achieved a huge public appeal, honoured with the phrase "a noble profession". This is evidently so because it is a trade driven more by an abiding call to save lives than anything else. While profit does not attract prime placing, service delivery and the will to ensure sustenance of our lives are pre-eminent.

If we take these to be true with the Federal Medical Centre (FMC) Yenagoa, capital of Bayelsa State, Nigeria, we shall be doing grave injustice to society. There is a deepening rot at the Medical Centre, so far the only visible federal establishment in Bayelsa State. This 60-bed hospital which was upgraded to a 100-bed hospital recently has some of the poorest and unimaginable facilities in the heart of the Niger Delta and is indeed a sad advertisement of the level of decay of social and essential services in Nigeria.

This report, "Health for Sale: Deepening Rot at the Federal Medical Centre, Yenagoa, Bayelsa State, Nigeria" is an exposition on the issues which have made a health institution of referral status a glorified dispensary. The report takes a detailed look at the establishment of the Federal Medical Centre, the frightening state of health care delivery, the near absence of facilities as well as the brazen sacrifice of moral and professional ethics by its management on the altar of greed and exploitation of the sick. In 2002, our findings revealed, the management of the hospital increased some charges by a scandalous one thousand per cent. Medical staff, piqued at the development, have pointed out that this is the most expensive government health institution in Nigeria.

ICHR findings also indicate that beyond all these, are cases of professional misconduct of screening patients and staff for HIV without consent. Our curiosity led us to piles of yellow laboratory request forms ordering retroviral screening between June and October 2002 with irreconcilable handwritings. This is indicative of the fact that the examining physician in all cases never approved the requests.

The management has also demonstrated a dictatorial grip with a penchant for flouting statutory rules both in its disciplinary approach, even of very senior officers.

Our investigations revealed that retroviral screening carried out by the laboratory department was surreptitious and indiscriminate and at the instance of the medical director, Dr. K.K. Imananagha. He has also at different fora gleefully announced the growing number of HIV cases in the hospital, much to the consternation of the National Association of Resident Doctors (NARD), who for the basis of direct contact with patients needed to be primarily aware.
The Ijaw Council for Human Rights (ICHR) is publishing this report for the following reasons:

· To draw the attention of the federal government to the pitiable state of health facilities at the Federal Medical Centre, Yenagoa. This should be the only place where the poor can seek excellent health care at minimal or no cost.

· To bring to the notice of both the Medical and Dental Council of Nigeria and the Nigerian Medical Association unethical professional acts by some of its members in clear violation of the principles and codes of medical practice as declared in Geneva in 1948. It is clear to us that he pursuit and practice of medical excellence is dependent upon sound ethical principles.

· To campaign for a drastic review of the medical charges, which has turned the hospital, undoubtedly into the most expensive government medical facility in Nigeria. A large segment of our population is poor and can ill afford the expensive medical treatment offered at the hospital.
Adequate checks should be initiated to monitor untoward and sharp practice by management of the hospital as healthcare delivery appears anchored on profit.
The ICHR hopes by this report to add to the corpus of viewpoints on the state of our health institutions and help to redirect the social thinking and behavior of our public officers.


The Federal Medical Centre (FMC), Yenagoa was established in 1999. It had served at various times as General Hospital and later Specialist Hospital.
At the creation of Bayelsa on October1, 1996 the Specialist Hospital was the only existing health facility of reckoning, at least, in name. In July 1999, the Federal Government moved to convert it to a Federal Medical Centre. The decision not to establish its own functional institution to cater for health needs attracted mixed reactions from the generality of the people. Questions arose bothering on the appropriateness of the take-over of the only existing institution. The agenda people thought should have been to increase people's access to more health facilities, not to deprive the already weary population the options of comparative medical facility of choice.

Proponents of the take-over had reasoned that it would be a quicker way of drawing federal attention to the miserable state of health care delivery, which had been worsened by a polluted and denuded environment arising from "the crude business of crude oil".

The Hospital's Management Board, Ministry of Health and the Bayelsa State Government all stood opposed to the conversion. They voted for the establishment of a new medical institution as against the take-over. In light of the stiff opposition from both the State government and the medical institutions in the State, the Federal government made efforts to access the General Hospital Okolobiri. Other options that were considered included the General Hospitals at Ogbia and Odi. These efforts drew blank as the structures never met the expectations of the federal team. Under these circumstances, the then Specialist Hospital was conceded to the federal government.

There was however a twist. The Governor, Chief D.S.P. Alamieyeseigha almost immediately reverted the new FMC to its former status. Not resolute in this decision, probably for good measure, the governor succumbed to intense pressure and gave in. The State government reasoned that allowing the FMC take off will substantially reduce its monthly wage bill as more indigenes of the State will for the purpose of the conversion, become employees of the federal government.

Besides, the presence of the Federal Government shall be felt by way of a tertiary health institution.
On or about September 1999, there was an exodus of medical officers at the medical centre. This development left behind only four highly placed medical officers and fewer junior ones. The nursing section was not anything better.

The reasons, ICHR findings revealed, was the fear of lack of promotion among nursing staff, a perception ascribed to federal institutions.
The exodus was also propelled by the appointment of Dr. Kobina Imananagha as Medical Director. Dr. Imananagha had earlier served as Commissioner for Health during the military dispensation. Close sources say he exhibited unsavory imperial tendencies to his professional colleagues. As the mass movement never appeared to abate, appeals came from all corners, including the Federal Ministry of Health that staff of Bayelsa extraction should remain. Federal officials argued that even though it will be easy to employ people from far and near to fill vacant positions at the hospital, it certainly will defeat one of the very essences of creating the Federal Medical Centre, which is the employment of its indigenes.

Undeterred, more staff moved on. Among these were a Physician and Nephrologist who left to head the Okolobiri General Hospital, a position he held until sometime last year. The Chairman, Medical Advisory Committee, a Surgeon and second only to the Medical Director also transferred his services to the State Ministry of Health. This surgeon took over the headship of Okolobiri General Hospital from the nephrologist. The exodus became so alarming that it prompted the State Government to put a stop to it. Sources revealed that His Excellency gave the directive following a petition from
Imananagha to the State Governor accusing the then Honourable Commissioner for Health, Dr. Tarilah Tebepah, of being responsible for the mass exodus.

Beyond all these, expectations were high and this was a source of joy to generality of Bayelsans. Fees were moderate and affordable. Medical staff exhibited diligence and great enthusiasm in the discharge of their duties. There were hunches though; facilities and equipment were near absent.

The circumstances of the take-over notwithstanding, there were a considerable comfort that the dearth of equipment and facilities were teething problems associated with new institutions and that it would disappear with time. How wrong people were.

Curiously, the internally generated revenue of the hospital rose dramatically from an all time low of about N30, 000.00 to One Million Naira monthly at the initial take over time. It is said that the facility generates over Three Million Naira at present.


Public concerns about the state of health care delivery in Nigeria are alarming. Besides limited medical facilities, there are sharp and unethical practices by a section of medical practitioners. For a people who have sworn to uphold ethics of the job, this is a particularly dangerous dimension to health care principles.

The worry and apprehension is heightening. These concerns are not misplaced. Neither are they figments of anybody's imagination. They are simply fall-outs of the perilous circumstances that health administrators have forced on those in search of medical attention on a daily basis.

The apprehension simply recalls the grim and vivid picture of Nigerian hospitals described by General Sani Abacha, Nigeria's late maximum ruler, in a coup broadcast on December 31, 1983 in the now famous cliché "mere consulting clinics". Tragic as the situation was, indications were, it could worsen. And indeed it worsened
By official records, there were 105 health centres in Bayelsa as at 1995. These we are made to believe constituted of the following:

i. 9 general hospitals
ii. 34 rural health clinics
iii. 6 Leprosarium
iv. 56 health clinics

Current records lay claims to the existence of 180 comprehensive health centres. These claims are spurious and do not truly reflect the realities in the various communities in the state. It can not be said to be the picture desired by an already weary population in need of succor. Communities located in isolated creeks and rivulets are even farther from health care delivery.

At the FMC, the state of facilities is alarming. Medical administrators have failed to improve the services and facilities in the hospital. The situation, inside sources revealed to the ICHR, worsens every passing year. These are few of the highlights.

(a) Water
The FMC does not have an independent source of water supply. Whenever the public water supply is interrupted, which are not infrequent, services at the hospital are crippled. The situation is worsened by the lack of water storage facilities.
ICHR findings revealed that this situation has led to cancellation of several surgical operations. Sadly, women in labour are sometimes told to bring along with them several litres of water in cans. In other cases, patients are moved to buy sachets of water for medical personnel for washing purposes after attending to them. Water vending is a common sight in Yenagoa, the state capital. Our fear is anchored on the sources of this water, as they may not be pure for human use. The use of contaminated water for surgical purposes can possibly complicate health matters and our medical practitioners should have known better.

b. Equipment
Inside sources are of the view that the Federal Medical Centre generates at present over Three Million Naira monthly. It also receives an overhead of between Two Hundred and Fifty Thousand Naira (N250, 000.00) and Five Hundred Thousand Naira (N500, 000.00) monthly from the Federal Ministry Health.

Internally generated funds are meant for the upkeep of the hospital. There is no remittance of such funds to the Federal Ministry of Health. One would generally believe that in view of the state of facilities, attempt would be made by the management of the hospital to equip it with quality and up-to- date facilities in medical science. Much as the state of facilities is shocking, it is our belief that this is the result of a demonstrable lack of commitment by managers of the hospital. Some of the specifics are as follows:

i. Use of unsterilized Instruments in Casualty Ward
In the casualty ward, medical staff confirmed the use of unsterilized instruments in suturing and dressing of wounds. They attribute this situation to the availability of only one set of such instruments. This development is worsened by the absence of sterilizing units and the unwillingness of the hospital management to procure them. We fear that this is an open license in the spread of deadly diseases including HIV to unsuspecting patients.

ii. Labour Ward
Findings by the ICHR revealed that only one set of delivery equipment exists in the hospital. If there are 2 or more women in labour at a time, the instruments are simply used in turn without sterilization. This again puts our women and babies at greater risk of contracting deadly diseases including HIV.
There are also no functional suction machines in the casualty, labour and theatre. Worst still, there is no oxygen in the hospital. Any sick person needing oxygen to survive simply dies. Several complaints by medical personnel in the hospital have been futile.

iii. Special Care Baby Unit
The Paediatrics Department of the Federal Medical Centre runs a Special Care Baby Unit. ICHR findings revealed that this programme is being run without a Consultant paediatrician. Headed by the wife of the Medical Director, a Russian and medical doctor, hospital staff maintain that in certain cases, four babies are put in the same incubator. This act raises the risk of spreading infections. Medical practitioners are alarmed that it is scandalous for a hospital to have a special baby care unit run by a non-paediatrician. By medical norms, such a unit should be headed by a neonatologist or at worst a paediatrician.

Complaints about the state of working environment at the FMC have attracted little attention. As voices grew, especially from various quarters including patients with whom they have direct contact, the Association of Resident Doctors (ARD) at the hospital set up a committee.
In a memo to the Medical Director dated October 24, 2001, they wrote:

We, the primary stakeholders in the health care delivery system in Yenagoa and Federal Medical Centre, Yenagoa, in particular believe that the primary aim of the hospital is to adequately cater for the health care needs of our patients, while maintaining and upholding the dignity of our noble profession, as our training demands.

The memo went further thus:
Following complaints from various quarters especially from patients with whom we always have direct contact, about the declining state of things in the hospital, a committee was set up by the ARD to verify such claims and where possible proffer basic workable solutions.
The Association of Resident Doctors (ARD) in their observation drew the attention of the hospital management to the fact that "it is important for the medical doctor to take all necessary precautions in safe guarding the life of patients while discharging his duty and not making the cure of the disease more grievous than the disease itself". They regretted that "in the absence of functional suction machine, doctors and nurses had helplessly and painfully watched children die of what they call meconium or liquor aspiration. This for them had become a burden especially because these patients labored to carry these pregnancies for nine months.

Parts of the observation of the committee in their report were the unavailability of installed emergency lights in the casualty wards. They fear that power failure may impair continuity of any procedure in the absence of emergency lights. In view of these and many others, the ARD urged the management to critically examine the issue they had raised with firmness and decisiveness. ICHR feels saddened to state that the situation has worsened tremendously.

Social control in the area of medical charges is not novel. Given social understanding of human differences attempts at organized social conducts has become the norm. In many parts of the world, there is a focused attempt at improving quality of health care delivery at reduced cost without limiting access and equity.

About 4000 years ago, the Code of Hammurabi was set out as one such aspect of social control in charges by medical professionals. The principles, which arose from the codes, specified eight articles upon which those in medical practice could levy charges.

In view of our peculiarity, we wish to draw on items 5, 6, 7 and 8 respectively of the codes on factors that should be considered in medical charges. These include:
i. Equipment and establishment running cost
ii. Time involved
iii. Locality where the practice is carried out
iv. Cost of living

On April 18, 2002 the management of the hospital in a memo, released a new set of medical fees for patients. These charges, which internal sources say shot up by an incredulous 1000 per cent never took into consideration, the pitiable state of equipment and facilities and the debilitated state of healthcare delivery.

Nor was the peculiar environment of impoverishment and dispossession of Bayelsans factored into the exorbitant medical rates. In Bayelsa State, there is penury and starvation occasioned by the lack of an industrial base, the civil service status of the state and most fundamentally by the devastation of our rich agricultural base by transnational corporations involved in the "crude business of crude oil" These have compounded health problems and created room for the sick to look at the direction of quacks and unorthodox medical practitioners.

Concrete examples of the criminally high cost of health care at the FMC include the following:

In the obstetrics and Gynecology department, patients are charged N12, 500.00 for caesarian operations. However, an additional charge of N2000 meant for normal delivery is still slammed on such patients. Patients are made to pay for services not rendered.
Patients are made to pay a casualty admission deposit of Two Thousand Naira (N 2,000.00). Out of this, Six Hundred Naira (N600) is charged on drugs. Various sources revealed that money charged for drugs are never used as patients are made to buy their own drugs after prescription. In cases of surgery, patients are made to buy their consumables even after the hospital has charged them for the items.

Other sources say that when a patient sees a medical doctor, the person is made to pay another N600.00, half of this money represents an "Emergency Nursing Service" and the other half "Emergency Medical Service". Medical practitioners insist that no such term exist in any other government owned or even private clinic in the country. What is known as consultation fees are charged through the purchase of a hospital card. At the Federal Medical Centre, consultation fees are charged along side a nebulous term of "Emergency Nursing Service" and "Emergency Medical Service".

Hospital sources reveal that most patients are only willing to take their prescription away as drugs at the hospital pharmacy are most times more expensive than in other pharmacies within and around Yenagoa. On this realization, the management of the hospital instructed the attending physician in casualty ward to hand over all prescription notes to the nurse on duty who demands for receipt of payment of Six Hundred Naira before such prescription are given to patients.

The reviewed charges also show that admissions into the casualty department rose from Two Hundred Naira (N200.00) to Two Thousand Naira (N2, 000.00) for adults and One Thousand, Two Hundred Naira (N1, 200.00) as deposit for children. This did not qualify the patient for any sort of medical care, except the bed space. This also excludes the card fee of Three Hundred Naira (N300.00).

Deposits in open adult male/female ward are Three Thousand Five Hundred Naira (N3, 500,00), while the children ward is Two Thousand Naira (N2, 000.00). Children are charged Five Hundred Naira (N500.00) daily, while adults pay Eight Hundred Naira (N800.00) in the wards. This does not also include another Three Hundred Naira (N300.00) once paid for consumables.

Suturing of the smallest laceration in the Casualty Ward attracts a fee of Two Thousand Naira (N2, 000.00). The amount here excludes cost of purchase of drugs, gloves and injectables. It is not uncommon therefore to find patients who having struggled to pay deposits especially in the casualty, end up signing against medical advice due to financial constraints.

The FMC Yenagoa, once a beehive of clinical activities has become a ghost of its former self. The casualty ward that used to be filled to capacity resulting in rejection of patients for lack of bed space now boasts of empty beds in a great number of days in the week. Only seriously ill children on blood transfusion and terminally ill patients are seen. ICHR sources reveal that the Medical Director has at different times ordered staff to pray against the devil at the FMC gate preventing patients from coming to the hospital.

Findings also revealed that while patients pay N300.00 for in-patients folder, receipts reflect N150.00 for emergency card. Most people are never admitted and therefore do not need an in-patient folder. In spite of this, the extra charge of N150.00 for un-admitted emergency patients is never refunded.

The ICHR is aware that our lives still run on 24 hours daily. However, at the accident and emergency unit of the hospital, we were pained to find out that charges are in most instances not based on the first 24 hours of admission. Against the norm, if a patient is admitted in the hospital at 10.00 pm for instance, his bill should cover him till 10.00 pm the following day. Quite on the contrary, patients are charged for two (2) days instead of the initial deposit. Our understanding of this kind of charge is anchored on the reasoning that because a new dawn breaks from 12 midnight, the patient is presumed admitted for two days anytime beyond 12 midnight

The Federal Medical Centre, Yenagoa charges N800 daily per bed space. From our investigations, the following charges are obtainable in other Teaching Hospitals.
a. University of Benin Teaching Hospital N420/night
b. UPTH - N3000.00, first 14 days
c. UCH - N300.00/night
d. UMTH - N150.00./night

We wish to stress that the charges are criminal, inhuman and only reflect the hospital as a commercial enterprise. The FMC Yenagoa, appears undoubtedly the most expensive government medical institution in Nigeria.

We regret that this hospital at the heart of an impoverished population is an institution of plunder and rape on sick and poor people.

"The rights to information, informed consent and respect for a patient's anatomy are well accepted". Recent epidemiological surveys show that the south- south has reached an explosive level in the prevalence of HIV/AIDS. Part of the dilemma associated with this dreaded disease, first discovered in 1986 in Nigeria, is the level of stigmatization that goes with it.

Modern medical practice is founded upon the Hippocratic Oath known in current terms as the Geneva Declaration adopted at the 2nd World Medical General Assembly in September 1948.

The Hippocratic oath (Geneva Declaration) states inter alia that "I WILL NOT PERMIT considerations of age, disease, or disability, creed, ethnic origin, gender, nationality, political, race, sexual orientation or social standing to intervene between my duty and my patient". Elsewhere it further states "I WILL respect the secrets which are confided in me, even after the patient has died".

A great part of the medical community here and else where has handled the HIV/AIDS pandemic with levity. It only reveals how un-informed some medical professionals are about the AIDS scourge vis-à-vis the ethics of their profession. There have been reports of HIV patients being refused medical attention, even in government hospitals. Surgeons even deny them surgical intervention in life-threatening situations. This situation has encouraged Voluntary Confidential Counseling and Testing (VCCT) even in ante-natal clinics. The availability of anti retroviral drugs in cases of pregnancy has helped reduction in Mother-To-Child-Transmission (MTCT).

It is the view of experts that VCCT will greatly reduce the prevalence of HIV/AIDS as proper counseling is the key to realistic living, even in the most hopeless of situations. A properly counseled person will therefore not help in propagating the disease. He /She may rather help in propagating the message.

On the other hand, accidental information on a person's HIV status could be damaging to the individual. It could also portend great danger to society generally. In extreme cases, such a person may either commit suicide or go on a "distribution mission". It was therefore a shock when staff of the hospital discovered that for over a year, staff and patients were being secretly screened for retro-viral status without their consent. There were no pre-test and post test counseling. Well over a year, a patient lay ill at the hospital. He needed a pint of blood, which was never forth coming. Eventually he approached a staff for donation. As expected, the staff was scared because he was not sure of his/her HIV status. When he expressed his fears, the laboratory scientist assured him that he was negative. It turned out that the said staff had gone to the laboratory department a day earlier for malaria parasite test and had been tested for HIV as well!

The above example is only one of the several cases of involuntary screening and a clear demonstration of professional misconduct. We wish to state that it amounted to unethical professional conduct on the part of the medical director to order for mandatory HIV screening as part of pre-employment medical examination of staff, even for those who had been in the employ of the hospital for between 6 months to 3 years. ICHR findings revealed that an order was given to the coordinator of the laboratory services of the hospital by the Medical Director to have blood samples of staff collected for pre- employment medical test to be screened for HIV without their consent and without the examining physician's directive. The Medical Director was to be informed of the result and a copy kept in the file of the member of staff in the administrative department. Also, the results submitted to the attending Physician who also expressed shock at results he did not order for. For some strange reasons, ICHR was told these results are not in the medical files of staff, which is meant to contain all such records. ICHR could not confirm if the Chief Medical Officer in charge of staff medical care made any formal protest relating to this matter, as is expected of him.

In Bayelsa State, recent epidemiological surveys keep the prevalence rate of HIV/AIDS at 7.2 per cent. This means that for every 14 persons, at least 1 person has the virus. It is therefore not a surprise that 11 persons have tested positive in the hospital. As the rumour of infected staff took over the premises of the hospital, others hurriedly stopped their medical examination. Besides, they were being made to pay for it with their monies ranging from N2, 500.00 - N4, 000.00 deducted at source. We wish to add that this is in clear violation of the Federal Civil Service Rules, Chapter 9 Section 1, Paragraph 3 which states inter alia: "every person selected for appointment either temporary or in a permanent capacity shall be required to present himself for examination by a Government Medical Practitioner (or one so approved by Government) with a view to it being ascertained whether he is physically fit for service. Unless otherwise provided in the offer of appointment, the fee for such an examination shall be paid by the Federal Government".
Following the non response of staff to do the medical test, internal memos addressed to individual staff were issued by the administration department, requesting such staff to go for their medical and that such staff were to compulsorily do a HIV screening amongst other things. (see attached document).

It is on record that the Medical and Health Workers Union of Nigeria (MHWUN) as well as the Association of Resident Doctors (ARD) acted promptly by asking the management to desist form such malpractice. They went further to boycott the 3rd anniversary of the Federal Medical Centre.

ICHR feels concerned that on the basis of this, some staff were unofficially threatened to leave the employ of the hospital because they were HIV positive. Besides, the level of ethical decadence and professional misconduct is alarming, especially in the laboratory unit of the hospital. Officials of the Administrative Department know the medical history of any staff that uses the medical outpatient department.

From the position of the International Labour Organization (ILO) Code of Practice on HIV/AIDS and the world of work, there should not be discrimination against workers on the basis of real or perceived HIV status. This is in order to create room for decent work spirit and respect for human rights, and also for the dignity of persons infected or affected by HIV/AIDS. Essentially this is because discrimination and stigmatization of People Living with HIV/AIDS (PLWHA) are the bane to promoting its prevention.

According to the ILO, HIV screening for purposes of exclusion from employment or work processes should not be required of job applicants or persons in employment. This is not the case at the Federal Medical Centre, Yenagoa.

The Federal Medical Centre, Yenagoa is a public enterprise. It should be run in accordance with the rules and procedure of the public service. However, power at the health institution has been privatised to the advantage of the medical director.

6.1 Internet facility/Mobile phones
Sources reveal that on or about July 2003 the director acquired an Internet facility for the medical centre but sited it in his official residence. As at the time of going to press with this report, no office in the hospital has been connected to the facility. Only recently, he spent over One Million Naira (N1, 000,000.00) in the purchase of mobile phones for some heads of departments and selected nurses. This is a clear case of misplaced priority for a hospital that can ill afford a water storage tank.

6.2 Paediatrics Department
Indications are to the effect that he has made his Russian wife the Head of Paediatrics Department even though she is not specialist in the field. The wife is also overseer in all of the Casualty Department, store and kitchen. She is also chairman of the entire hospital revolving fund.
It is the view of the ICHR that no person is so endowed as to perform all the above-specified tasks in a federal institution in an era where qualified manpower parades the street in search of employment.

It was also revealed to the ICHR that during his tenure as Commissioner for Health, he prevented the Head of the Health Systems Fund from travelling oversees. This was a trip sponsored by the World Health Organization. He was accused of sitting on the file until he left with the exit of the military because his agenda of sending his secretary along failed.

6.3 Discipline of Staff
We wish to note that under public service rules, a disciplinary committee should handle matters relating to staff misconduct. However, the situation is such that the power to discipline and even interdict has been privatized. For reporting late to work, a medical doctor was punished with half salary for two consecutive months. This punishment was meted out without following the due process. Consequently the whims and caprices of the Medical Director have thus become the service rule in the hospital.

We hasten to add that under the Federal Government Public Service Rule 04103 (as revised on January 1, 2000), the Federal Civil Service Commission has delegated full disciplinary powers to Permanent Secretaries and Heads of Extra-Ministerial Departments in respect of officers on salary Grade Levels 01 - 13 with the exception of the power of dismissal which falls between Grade Levels 01 - 06.

Sometime in 2002 the Medical Director ordered for an internal audit of staff, unauthorized by the Federal Ministry of Health, in which he demoted a great number of staff, especially those who were in his bad books. This exercise led to many a staff losing one grade level or several steps in the same grade level. At the time this resulted in wide protest amongst staff.

Close sources say the Medical Director told affected officers not to protest. However, they could appeal. Should they protest, he said their case would be like the resource control suit, which the Supreme Court ruled in favour of the Federal Government. Undoubtedly, Management was likened to the Federal Government and the staff the State.

We wish to stress that a "government hospital should render social and essential services meant to assist the people". To turn a government hospital into a profit making institution without the benefit of quality services is morally and ethically wrong.

The Federal Medical Centre, Yenagoa, is a boiling pot with a sealed lid. We hope we can pull it steps away from the precipice.


In view of the above, the Ijaw Council for Human Rights (ICHR) demands as follows:
1. Government should make it a matter of urgent attention to equip the hospital both in terms of personnel and facilities, considering the harsh terrain and attendant deplorable health care services in Bayelsa State.

2. The Federal Ministry of Health and the Medical and Dental Council of Nigeria (MDCN) should properly investigate and prosecute the Medical Director of all allegations of professional misconduct leveled against him with the overall motive of safeguarding our health institutions from further abuse. ICHR is aware the Association of Resident Doctors petitioned the MDCN on account of this gross professional misconduct, which was later withdrawn because of mediations and pressures from certain quarters. We believe this withdrawal was ill motivated and improper. We therefore restate that the MDCN should as a matter of honour and urgency reopen this matter.

3. The Board of the hospital should be dissolved having shown gross incompetence in serving as a check on management.

4. The immediate removals of the Medical Director on grounds of gross incompetence, professional misconduct and abuse of public office.

5. The hospital should ensure relief for those who have suffered hardship with in respect of the surreptitious HIV screening every effort to commence anti-retroviral treatment if necessary at the expense of the hospital.

6. Employment of people with professional management experience in the management of the hospital. The present administrative machinery has shown incompetence in guarding the excesses of the Medical Director, particularly on matters of staff discipline in accordance with public service rules.


1. Medical certificate of fitness. Internal memo to staff of the FMC.

2. Sample copies of HIV test illegally obtained without consent of patients.

3. So called "Approved" charges for 2002 IN-PATIENTS".

4. Letter from the Medical and Health Workers Union of Nigeria to the Medical Director, Federal Medical Centre, Yenagoa.

5. Letter from Association of Resident Doctors to the Medical Director, Federal Medical Centre, Yenagoa

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"We, the primary stakeholders in the health care delivery system in Yenagoa and Federal Medical Centre, Yenagoa, in particular believe that the primary aim of the hospital is to adequately cater for the health care needs of our patients, while maintaining and upholding the dignity of our noble profession, as our training demands."

-Association of Resident Doctors (ARD)
Federal Medical Centre, Yenagoa