In Defence of the Nigerian Medical Professional | Sayo Aluko

“…But then, according to the Medical and Dental Council of Nigeria, we have approximately 35,000 practicing doctors in the country. Which means, it’s 1 doctor to 5,200 people in Nigeria, which further means an average Nigerian Doctor works almost 10 times more than expected, 10 times more than his/her colleagues in saner climes… “…the body holding data on doctors in the UK, says that 5,250 Nigerian doctors were working in the UK as at April 25, 2018. Checking the same data today, May 13, 2018, that number has grown to 5,273 – that is an alarming increase of 23 emigrant doctors in 17 days….”

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Last year, my 7-month old son was sick. A good friend had introduced us to a kind pediatric Doctor who owned a private practice somewhere in town. He doubled as a Senior Registrar at the University College Hospital (UCH), Ibadan.

The day came to meet up with this Doctor, and he was by obligation at work in UCH – we had to go meet him there and not at his private practice as hoped.

Well, we saw hell.

The Doctor ordered a Malaria Parasite (MP) test and a Full Blood Count (FBC) for our son. Let me just say myself and his mother weren’t thinking aright right there that day – because, somehow, we made the unthinkable mistake of approaching the UCH Laboratory for these tests. Five freaking hours later, we were still waiting for the results. Yes, 5 hours, you read right.

I can’t remember the number of times I went back to that Lab that day asking and asking “what’s up, how far?”, only to be served an unproductive and lukewarm response. I also can’t remember the last time I was that vexed to stupor – waiting in pain, waiting in vain. 

We finally received sense, drove out of UCH to a private lab just across its second gate, and paid 100% more (₦3000) than what we paid to the UCH lab for the same procedure(s); in barely 25-30 minutes, we were done and headed back with results of the tests.

The Doctor provided consult, and as we headed out, I bumped on some activity at the Emergency Unit of the hospital that added more flux to my vexation.

Three accidents victims, all bathed in blood and apparent writhe, were brought (not rushed) to receive emergent treatment at that supposed Emergency unit. The first Nurse came out strutting and laughing tiresomely off a banter she was having with a male colleague, who on his part, was sifting through some rack of files inside.

I shouted twice, “E se kia now! E se kia! ” [Hurry!]

Whether I was heard or not, I still can’t say till today; because, it was as if I just bellowed into thin air, they did not flinch.

Picture the pace of a snail in reverse, that was the nonchalant pace these guys, three nurses and a Doctor, were using to render deemergent treatment at a supposed Emergency Unit. No urgency, no passion, no drive, and no Hippocratic appetite in sight.

At that point my vexation had morphed into indignation, and I chose to just walk away from that scene before I burst into a fit. It was a hell of a day.

All my indignation was clearly directed at the poor services I experienced and witnessed, and also directed at the people behind it (laboratory guys, the nurses, the doctors and the admin of the hospital). 

But, later that fateful day, after rechanneling my anger into deeper thought about the whole UCH experience and also a thought about the big picture, I reckoned that the anger I felt and expressed was misdirected.

I reckoned without doubt, that the average Nigerian Medical professional is also a victim; that, they too are victims of a crushed system, victims of the listless lull largely existent in Nigeria’s healthcare system. They are not the ones I should direct my indignation towards.

Dear reader, the average Nigerian medical professional encounters our national decay on a daily basis and at a very close personal and professional range. And, sadly, a lot of compromise in effort and output definitely stems from this.

Either partly or fully, that frustration that you see, that inhumane tendency, that poor service, that lack of drive, passion and urgency, that apathy you complain about, all have valid roots in the agelong crack in the system.

They are overworked, fatigued, underpaid, sometimes unpaid, discouraged, and most unfairly, de-skilled.

As an example, I know for fact, that apart from the overworking, the worst thing you will do to any Medical Doctor who is primed by oath to save lives, is to drown him/her in a swathe of theory, and thereby de-skill and “de-teach” them, albeit in a supposed “Teaching hospital”.

This above, is a modest way to describe the unbelievable and unbearable theoretic torture most Resident doctors face in UCH and in most, if not all of our teaching hospitals across the country.

Last week, I visited a couple of my Doctor friends who work inside UCH, and all those indignant feelings from my experience months ago came back to me while we talked. Two of them are junior residents, and the other one, a final year student who could have graduated by the end of this present month if they weren’t on strike.

They wailed endlessly about the substandard and anachronistic work environment they are forced to put up with as Doctors.

“Sayo, I sought residency here because I felt UCH was the best. But, bòbó, imagine that they don’t even have IVF equipment in their OB-GYN. All we do in a supposed residency program is theory, theory, and more theory”, one of them said.

“They have only one malfunctional MRI machine Sayo. A machine that’s supposed to give you a clearer image for better diagnosis, gives you the opposite”, another moaned.

“Sayo, in another 5 years, maybe only CHEWS* will remain to dispense Healthcare in Nigeria”, she echoed.

“See, me, I’m already saving money for my PLAB, I can’t wait to finish and leave here. It’s like we are being trained to kill lives, not save lives”, chanted the one in his final year.

Well, you should know, that almost every Nigerian Doctor or medical professional you meet has at least one personal tale of woe along their professional journeys, that brews from the substandard and neanderthal nature of medical practice in Nigeria; surgeries by candle light, a litany of preventable mortalities, NEPA ‘showing up’ at bad times, getting stuck to antique techniques, etc.

As at the time of writing this piece, the UCH, Nigeria’s premier teaching hospital, is dry and competes with the graveyard in decibels of silence. Almost every arm of activity therein is on industrial strike. The Provost of the college and the medical students too are at an impasse regarding a sudden hike in fees. 

 

So, for some weeks now, it’s been ‘no treating, no teaching’ at the “iconic” teaching hospital. 

A dirge of emptiness, empty beds, empty drug shelves, empty hands, empty labs, empty, empty, empty, rings into your consciousness as you walk round the hospital, and sadly, this is not sensationalizing it. I wish I were.

The way it is today, if Queen Elizabeth visits UCH now, instead of being unable to recognize the edifice she commissioned years ago due to graded levels of improvement over the years, she’ll have perfect nostalgia [SELAH].

The way it is today, a sick Nigerian stands a better chance to be correctly and promptly diagnosed and treated by watching some episodes of Grey’s Anatomy drama series, than inside a government hospital in Nigeria.

The way it is today, the best Nigerian Doctor is the one whose guess-work game is exponential. Guess work.

In all, most Nigerian Medical professionals are just tired to the marrow. They are just tired. And yes, they are fleeing in droves to better and befitting pastures.

According to AfricaCheck.org, Nigeria loses an average of 12 Medical Doctors to the UK alone every WEEK! 

The UK General Medical Council, the body holding data on doctors in the UK, says that 5,250 Nigerian doctors were working in the UK as at April 25, 2018. Checking the same data today, May 13, 2018, that number has grown to 5,273 – that is an alarming increase of 23 emigrant doctors in 17 days. 

This efflux of hands to the UK alone. That means more figures when other countries are considered.

Actually, a survey conducted in August 2017 by a Nigerian Polling organization, NOIPolls, in partnership with Nigeria Health Watch, revealed that about 9 out of every 10 (88 percent) medical doctors in Nigeria, from final year students to Consultants, are actively and currently seeking work opportunities abroad. This figure includes my three Doctor friends I mentioned above.

In fact, at the time when this poll was conducted, many Nigerian doctors were (and many more are) registered to write foreign medical exams such as PLAB for the UK (30 percent), USMLE for the United States (30 percent), MCCE for Canada (15 percent), AMC for Australia (15 percent) and DHA for Dubai (10 percent) amongst others.

In addition, the World Health Organization (WHO) recommendation puts the ideal doctor-patient ratio at 1 to 600. National Population Commission (NPC) projects our current population to be about 182 million at a 3.5% growth rate from the 2006 census. This means we need about 303,333 medical doctors now, and at least 10,605 new doctors annually to join the workforce in order to fit that WHO recommendation, like some other countries who don’t have a quarter of Nigeria’s potential. I mean, if a country like Libya can meet up….

But then, according to the Medical and Dental Council of Nigeria, we have approximately 35,000 practicing doctors in the country. Which means, it’s 1 doctor to 5,200 people in Nigeria, which further means an average Nigerian Doctor works almost 10 times more than expected, 10 times more than his/her colleagues in saner climes.

It’s all sickening maths,…these figures.

While we were talking, my Doctor friends told me one of the stories that keeps fueling their acquired lack of faith in Nigeria and their resolve to leave soon.

Over a year ago, they said the Minister of Health, Professor Issac Adewole, who is a product of UCH himself and who is also the immediate-past Vice Chancellor of the University of Ibadan, was around on a working visit. My friends said they were “moved” by the way the Minister spoke, especially after promising that his office will “promptly” facilitate the procurement of modern facilities into the hospital and even an IVF equipment to their department. But, while they (new residents at the time) were clapping for the Minister, to their surprise, their senior colleagues seemed totally uninterested in the Minister’s talk and promises. They later asked why, and were told that their uninterest stems from the fact that they’ve heard many of such promises from government officials without any fulfillment.

Almost a year and half later, the senior colleagues remain right, my friends clapped for nothing, because nothing has happened indeed. And that point, I even asked, “must promises be made before a government realizes a need to perform an obligation in the first place?”

This is the saddening situation of things in Nigeria’s health sector at the moment, also how it has always been. 

And now, if you raise convictions against the present government that they haven’t “CHANGEd” anything in true effect as promised, and that they should allow Sai Baba to retire in order to pave way for something new and braver, Buharideens will call me names and say hogwash like, “errr, people like you don’t understand how government works, errr, 16 years of….”

16 years kee you dia!

In this era, the Minister of Health oversaw the “rehabilitation” of the President’s son in Germany after suffering a head injury from a biking spree; the President himself just came back from his umpteenth foreign medical checkups against the gradient of his words; he’s back to be ushered into a party congress that will cement his reelection bid, a party congress reported to gulp a six(6) Billion Naira contribution from APC Governors.

It is obvious that the political elite in our country just seems deliberately blinded to the consequences of our failed health sector, as no sane person should be able to understand why a UCH for example, just like any other Nigerian tertiary or general health institution, can be not only substandard in setup and output, but also rendered totally useless for weeks!!

Among many endless things that 6 billion Naira will do to change the fortunes of medicare and medicarers in Nigeria, it will setup complete IVF equipment in 20 of our 22 teaching hospitals as an example, or buy 10 MRI machines spread across them. But, then, according to vuvuzelas of CHANGE, the underpaid and frustrated Nigerian Medical professional can’t “understand how government works”. 

Yes, they can’t, and today, I rise in their defence, choosing to totally understand their desire to fly away in order to learn better and earn better, as against staying here to moan whenever and yearn forever.

PS: Oh! I forgot to tell you that we eventually got my son’s test results from the UCH Laboratory that day, some 7 hours later; the FBC was inconclusive. No kidding.

*CHEWS – Community Health Extension Workers