By: Dr. Prosper Ikechukwu Igboeli, President, Nigerian Medical Association.

Every year, the Nigerian Medical Association set aside one week in the year to reflect on the role and place of doctors in our society. We also use this period to rededicate ourselves to the service of humanity. The week usually features rededication and prayers in our mosques and churches. Every state branch and FCT plan activities and programs to benefit their immediate communities. These activities usually include Scientific workshops, Sensitization Campaigns, free Medical services, visit to orphanages and charity homes among others.

By any measure and if we are honest to ourselves, Nigerians must acknowledge that our health System needs restructuring and our current health -indices maternal and infant mortalities -do not speak well of our vision of the right of all Nigerians to access good health. Restructuring will require the participation of government, private sector, good infrastructure and human resources to enable us attain the MDGs and Vision 2020.

I pose this question to all of us, my Compatriots : What should be the role of physicians in our decaying Health Sector? We could sit on the sidelines and wait for the legislative branch to arrive at a solution to our health sector problems. We could be reactive, offering commentary and critique as various plans are introduced. We could just defend our economic interests to the detriment of our patients and communities. Or we could be proactive, vigorously engaging in the process, proposing innovative solutions and passionately advocating on the issues with our colleagues, our patients, in the media, with our government and the international community.

Patients must be able to trust doctors with their lives and well-being. To justify that trust, we as a profession have a duty to maintain a good standard of practice and care and to show respect for human life.

In particular as doctors we must:

make the care of our patient our first concern;

treat every patient politely and considerately;

respect patients' dignity and privacy;

listen to patients and respect their views;

give patients information in a way they can understand;

respect the rights of patients to be fully involved in decisions about their care;

keep our professional knowledge and skills up to date;

recognize the limits of our individual professional competence;

be honest and trustworthy;

respect and protect confidential information;

make sure that our personal beliefs do not prejudice our patients' care;

avoid abusing our positions as doctors; and work with other health professionals (pharmacists, nurses, lab scientists) etc in the ways that best serve patients' interests.

Healthcare is increasingly provided by multi-disciplinary teams. Such collaboration brings benefits to patient care, but problems can arise when communication is poor or responsibilities are unclear.

Doctors who lead teams should promote good communication, ensuring that:

Each member of the team knows where responsibility lies for clinical and managerial issues and who is leading the team.

Systems are in place to facilitate collaboration and communication between team members.

Systems are in place to monitor, review and, if appropriate, improve the quality of the team's work.

Teams are appropriately supported and developed, and are clear about their objectives.

History will judge us not by our status as doctors, not by our specialized fields in medicine, but by how we treat the weakest and most vulnerable amongst us. By any critical measure of analysis, our performance has been less than optimal due to the gross inadequacies of our health system.

As a result of these, we have been unable to deliver to our communities a fair and equitable distribution of healthcare. Every day in our country, patients needlessly suffer poor outcomes.

We fail, because we provide healthcare unevenly, offering extraordinary benefits to the most economically privileged and inadequate access to healthcare for the weakest and poorest amongst us.

Throughout Nigeria, there are thousands of communities where basic healthcare even at the Primary Health Care level are non-existent and such communities succumb to quacks and traditional medicine practitioners.

Nigeria is battling with increase in Polio cases because of low routine immunization coverage. This should be a grave concern to every doctor in this country.

What strategies can we proffer to government and ourselves to bring affordable good medical practice to our very poor at the grass root levels? How do we show true leadership in a country that desperately need our services. Have we demonstrated equity, fairness and justice to other members of the health force who toil with us ?

The most powerful thing we can do to change our health system is to change our own beliefs about the nature of life, people and begin to act accordingly. We must learn to understand and respect the ideas of other people. We must hear the voices of the young and the old. Our success or failure will depend on our ability to appreciate the need and the value of mutual respect and understanding, tolerance and inter-dependence.

If and when we find ourselves in any coveted positions of authority or leadership, we must learn to be humble, considerate and show integrity. Man's achievements in life are measured not by how much wealth he amassed or knowledge he acquired, but rather by his contributions to the happiness of his fellow citizens and mankind in general.

Always remember that

When WEALTH IS LOST, NOTHING IS LOST

When HEALTH IS LOST, SOMETHING IS LOST

But when CHARACTER IS LOST, ALL IS LOST.

The political, technological and economic changes that have occurred in our health sector over the past decade are increasingly difficult to manage within the traditional framework of health-care. The organization of health-care is seen to need radical reform to sweep away many of the internal barriers. Doctors must equip themselves with skills in advocacy and political action to influence the direction the system will take.

Protecting Health from Climate change

This is the theme for this year's Physicians Week and is in tandem with the theme of World health Day -2008

Many elements of human society and the environment are sensitive to climate variability and change. Human health, agriculture, natural ecosystems, coastal areas, and heating and cooling requirements are examples of climate-sensitive systems.

Overwhelming evidence shows that many human activities are affecting our climate with serious implications for public health.

Rising average temperatures are already affecting the environment. Some observed changes include shrinking of glaciers, thawing of permafrost, later freezing and earlier break-up of ice on rivers and lakes, lengthening of growing seasons, shifts in plant and animal ranges and earlier flowering of trees.

Global temperatures are expected to continue to rise as human activities continue to add carbon dioxide, methane, nitrous oxide, and other greenhouse (or heat-trapping) gases to our atmosphere. The extent of climate change effects, and whether these effects prove harmful or beneficial, will vary by region, over time, and with the ability of different societal and environmental systems to adapt to or cope with the change.

Climate variability and change cause death and disease through natural disasters, such as heatwaves, floods and droughts. In addition, many important diseases are highly sensitive to changing temperatures and precipitation. These include common vector- borne diseases such as malaria; as well as other major killers such as malnutrition and diarrhoea. Catastrophic weather events will affect the food we eat and the water we drink.

There will be hunger, poverty, human migration and pestilence.

Climate change already contributes to the global burden of disease, and this contribution is expected to grow in the future with emergence of new infections . Developing and poor countries with weak health infrastructure will be hardest hit by global change because they will lack the necessary funding and resources to cope with disastrous conditions brought upon us by climate change.

Nigerian Medical Association is using this period to appeal to the conscience of the world especially the industrialized countries to develop strategies and regional co-operations aimed at reducing the effects of climate change on the health of earths inhabitants. Bailing out initiatives like the current exercise to salvage the near collapse of the worlds financial markets is good but protecting the health of our progenitors against the consequences of our changing climate is even better. Prevention is better than cure and a stitch in time saves nine.

We commend the various arms and agencies of government as well as the private sector that have initiated projects such as tree planting campaigns that will help in protecting health from climate change.

I thank the media for the positive role they are playing to educate our masses on attitudinal changes for improved health and life-styles.

Thank you all.