Workplace Violence Against Health Workers in Nigeria: A Critical Analysis and Legal Implications

Workplace violence is a common phenomenon which cuts across all work settings. Its prevalence is particularly high in the health sector and adversely affect service delivery. However, in Nigeria, it's becoming an epidemic and a rising societal problem that needs urgent attention.
The health workers are people who have taken a vow to save lives so one will wonder why they have become victims of their patient's rage.
Some people may argue that health workers are the cause of violence. In this write up we would see a short analysis of the situation and decide for ourselves on who the true victims are.

An incident occurred on January 9 in Maitama District Hospital, Abuja, where a female doctor was beaten and stripped by relatives of a patient she was treating, was a trend on the social media this year.
Also at the Nnamdi Azikiwe University Teaching Hospital in Nnewi, Anambra State two male doctors on call at the special Care Baby Unit were beaten by a patient's relatives in the wee hours of January 14 this year. This was after the perpetrators lost a newborn baby to neonatal Asphyxia despite adequate resuscitation.

In the course of this discussion, I would like to give a working definition of some terms which includes

• violence: An action intended to cause destruction, pain or suffering to a thing or person.
• Workplace: Any health care facility, whatever the size, location( urban or rural) and the type of service provided.
• Victim: Any person who is the object of acts of violence or violent behaviours.
• Neonatal Asphyxia: The medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm especially to the brain.
• Cannula: A medical tube inserted in the body to drain or inject fluid.

CAUSES OF WORKPLACE VIOLENCE AGAINST HEALTH WORKERS IN NIGERIA
Now the question is what are the causes of workplace violence in Nigeria? Here we would look at it from the health workers side and the patient side.
Possible causes for violence from the health workers side may include

• The System: In Nigeria, dangers arise from exposure to violent individuals combined with the absence of strong violence prevention programs and protective regulations within the hospital. Here we would see a doctor alone in a room with a patient and there is no CCTV camera available or no 'call for danger' alarm just in case help is needed. These factors work to increase violence
• Administration: It's more like doctors now bear the brunt of the failure of Nigeria's health care system. Many times the doctors have to improvise while doing their job because the government have not provided most of the equipment in the hospital. Funny enough the doctors too are victims here! Sometime this month of January a doctor died because there was no cannula(a medical friend told me this tube is just 200naira!!!) in the hospital. So a lot of doctors too die daily due to the failed health care system. Imagine that moment a patient is in the hospital and seriously needs attention but there is no equipment for the doctors to use.
• Shortage of Doctors as against Increase patients. The Nigeria doctors are overwhelmed, we have a ratio of one doctor to about 5000 patients. So If a doctor is seeing more than 1000 patients in a day, how effective do you want them to perform? Most doctors in Nigeria work for 48hours none stop and it's wrong. This can be compared to the U.S. where the ratio is a doctor to 338 people or Qatar ( a north African country) where it's a doctor to 129 patients. What we see here is that even before a patient enters the hospital the doctors are exhausted already. Truth be told is a doctor in this situation will not be as enthusiastic as you would love them too.
• Now from the patient side, the major cause of violence is basically due to the tension of the moment which triggers a lot of psychological and emotional rage. Hence rage and a need to vent the anger of ones lost to another person also contributes to the causes. Here patient's relatives tend to find the doctors guilty for the loss of their loved ones which gives them a justification to inflict violent act on the health workers. Other reasons too may include a mental disorder suffered by the patient or relatives.

  POSSIBLE SOLUTIONS 
What then is the way forward. From the causes mentioned one will notice that most of the causes of violence are factors outside the will of the doctors or health workers. However possible solutions may include.

• Nigeria government needs to increase its budget in the health sector. The health sector deals with lives and what better way to improve on their performance than through the construction of more hospitals.
• Also, more health workers need to be employed in the system, it's just sad to see a hospital with just 5 doctors.
• Hospitals need to have a security-friendly environment and the health workers should be educated on how to make use of it so that they will be protected while doing their job of saving lives.
• Patients too need to be aware that inflicting violence on a health worker won't save the situation.

Whichever way you look at it, no person works well in an environment where his/her safety is not checked. The psychological trauma of violence alone is capable of reducing the performance of health workers.
They save lives and don't deserve to be put in danger while doing so.

THE LEGAL POSITION OF WORKPLACE VIOLENCE 
You might want to think twice before inflicting an act of violence against a health worker.
 Article 1 of the Universal Declaration of Human Rights provides that “all human beings are born equal in dignity and rights. ... This right prohibits any form of degrading treatment or inhuman treatment of another irrespective of tribe, sex, colour, religion or nationality. 
This article is now entrenched in Section 34(1) of the Nigeria Constitution 1999 which provides that “every Nigerian citizen is entitled to respect for the dignity of his person and accordingly (a) No person shall be subjected to torture or to inhuman or degrading treatment. Therefore no person in Nigeria can be subjected to any form of degrading treatment no matter the situation especially when the person is on the verge of saving lives like in the case of health workers 

Also, violence against a health worker can lead to a charge of assault which as provided in the Criminal Code in Section 252 provides 
“A person who strikes, touches, or moves, or otherwise applies force of any kind to the person of another, either directly or indirectly, without his consent, or with his consent, if the consent is obtained by fraud, or who by any bodily act or gesture attempts or threatens to apply force of any kind to the person of another without his consent, in such circumstances that the person making the attempt or threat has actually or apparently, a present ability to effect his purpose, is said to assault that other person, and the act is called an assault.”

 Section 351 of the Criminal Code Act punishes “assault.”It provides thus: “Any person who unlawfully assaults another is guilty of a misdemeanour, and is liable to, if no greater punishment is provided, to imprisonment for one year.

In conclusion, no form of violence can be justified and therefore we should all desist from it.