The emigration of young doctors abroad for greener pastures is provoking a new concern, especially among training institutions in Nigeria, which fear that the already poor environment for medical practitioners appears to be worsening. The National Post-Graduate Medical College, the apex body mandated to train specialists in clinical medicine, has taken up the gauntlet, calling on the authorities to save Nigeria from losing some of its young, but best brains. ADEGUNLE OLUGBAMILA reports.

 

Brain drain across various sectors of the economy is not alien to Nigeria. In medical practice, it is common among specialists, who often escape once the opportunity presents itself. This is because the environment at the home front is suffocating. However, a new trend of brain drain is fast evolving among in-training doctors, a development that worries the National Post-Graduate Medical College (NPMC), the apex body mandated to train specilaists in clinical medicine.

 

At its 36th convocation last month, the leadership of the college expressed fear that the problem would not abate until the government attends to emergencies such as lack of jobs/job security, poor pay, poor remuneration poor facilities for training and practice, general insecurity and low sense of patriotism, among others.

 

Nigeria’s Minister of Health Prof Isaac Adewole last month  stirred the hornet’s nest when he admonished young medical doctors, who are unlucky to become specialists to ply other trades.  Adewole further said his tailor, a doctor, made the best gowns.

 

Adewole was responding to a question from reporters on why Nigerian doctors have to wait for a long time to get residency training.

 

He said: “It might sound selfish, but we can’t all be specialists. We can’t. Some will be farmers, some will be politicians. The man who sews my gown is a doctor. He makes the best gown.”

 

Going down memory lane, NPMC  President Prof Opubo. Da Lilly-Tariah recalled that the college was able to withstand the brain drain in the 80s and 90s, which was occasioned by the economic downturn at that time, as specialists trained by the college replaced them. Nonetheless, he said the country faces another brain drain as doctors-in-training have also joined the bandwagon.

 

According to him, the college’s greatest headache is funding, which is threefold – relating to teaching hospitals, the residency programme, and the college.

 

He said: “The teaching hospitals are the training arenas of the resident doctors and the workstation of the trainers. Poor funding of the teaching hospitals result in paucity of facilities and poor motivation for trainees.  Consequent to this is the dwindling number of places available for training of resident doctors. Some other hospitals have lost their training status because of a drop in patient load as many patients are unable to afford the fees of the revolving funding in various teaching hospitals. Learning resources are poorly developed. Funding of college activities is less than satisfactory. The college is also in need of a befitting library.

 

“The combined effect is that our most experienced hands and our brightest minds are being drained away. We are thus losing both our present and future.”

 

Lilly-Tariah said the college survives on two sources of income – subvention, which is used to pay salaries, and revenue realised from examinations and course fees run by the college – both of which, he said, are inadequate.

 

“These sources of income are truly not enough to run the activities of the school. This has resulted in periodic increases in examination fee and the dwindling buying power. The college has only attempted to relate fees paid to ‘appropriate costing’ of the examinations. This has become more imperative since the advent of the Treasury Single Account (TSA),” he added.

 

Basil Chukwuemeka Ezeanolue, a professor of Otorhinolaryngology (ear, nose and throat) could not agree more.  He even said while delivering a lecture titled: “Do not be afraid and do not fail to rescue – A discourse on the challenges  confronting Nigeria’s health sector”, to 434 new fellows, that though unhealthy for Nigeria, he did not blame doctors plying their trade abroad because the conditions at home were suffocating.

 

He said the fellows deserved to be applauded for not abandoning their Residency training to immigrate to foreign lands.

 

Ezeanolue lamented that infrastructure in training institutions have been on steady decline. Aside unrepaired facilities, obsolete tools have not been replaced.

 

He said: “Take the example of radiography machines in Nigeria, information at my disposal is that we have eight government-owned centres all over the country. How many of them are functional and giving services at all times?

 

“I have a patient that I spent over five hours in a major head and neck surgical resection of tumour mass procedure. At the end, I was satisfied with my efforts, not minding the challenges of resecting his cancerous tumour; yet I was so downcast and apprehensive because the required radiography may not be available. My fears were confirmed! This patient has travelled to four of these centres across Nigeria and the story is the same: “Our machine broke down and we are awaiting repairs. Come today, come tomorrow, come next week…”

 

Ezeanolue further identified factors that make medical practice rigid to include: patients going outside health facility to do emergency plain radiographs, governments facilities being shut down owing to trade disputes, delay in seeking definitive treatment and unavailability of relevant facilities in nearby centres.

 

Reactions

A Radiologist and Chief Medical Director of Zion Hospitals Ikotun, Dr John Abanike, said with the way the government runs the medical sector, no young and serious medical practitioner would wish to stake his future in Nigeria.

 

He said: “Our training institutes all over the country are an eyesore. In fact, it has gotten to a point that unlike before, you cannot train in any training institutes in this country and go out to beat your chest.”

 

He continued: “There are certain (medical) facilities that are very important across every specialty, but unfortunately you hardly find them in our teaching hospitals. What they do is that when two old instruments are faulty, they calibrate by replacing the part of one that is already damaged with the other that is still fairly manageable. So, a young man who sees these things and want a better future for himself will not wait.

 

“Facilities in our teaching hospitals, both at undergraduate and post-graduate levels are moribund. Some of the facilities have been in use since the 70s. Interestingly, medicine is dynamic. More technology evolves every day; so a technology that comes out today might become moribund in the next 12 years; so how do you expect, say a doctor in our teaching hospital, who has been using a 1970 tools to now operate CT Scan or MRI instrument? ”

 

According to Dr Abanike, the annual budgetary allocation to the health sector is still manageable if the government can stamp out corruption and ensure frugality in budget spending.

 

“Are you telling me that over the last 10 years, there have not been budgets for all our teaching hospitals nationwide? It then simply means some people sat down somewhere and have been helping themselves with the treasury.

 

“For instance, except the private sector, there is no single centre for cancer in Nigeria. We also have cancer in developed countries, but because they have instruments that detect it on time, that’s why the effect is minimal. But here, its often detected when the disease is at terminal stage. Don’t also forget that cancer is not treated by drugs, but through technology.”

 

A medical doctor, who works in Lagos State General Hospital Badagry, described the Minister of Health’s comment as a disservice to the nation.

 

The doctor, who pleaded not to be named, said: “Our Minister of Health is supposed to apologise not only to young medical doctors, but the entire Nigerians because what he said is a disservice to the nation.

 

“Let me take myself as an example, if after becoming a specialist, I decide to venture into a vocation, so be it because its my choice; but for the minister to be asking young doctors to take up a vocation is very disappointing. That means he does not believe in the Nigeria project.

 

“Aside those young doctors, what of their parents, who invested massively on their children while they were in the universities. Would they be happy to see their wards take up other vocation rather than their first love?

 

An Oncologist and Chief Medical Director, Maciland Medical Centre, Ikotun, Lagos,  Dr Durojaye Lasisi, recalled how he left Moscow and returned home  25 years ago  on ground of patriotism, saying that he regretted his action.

 

“I returned to Nigeria in 1993. It was during Gen. Sanni Abacha’s period; and things were tough. Many wondered why people like us returned home at the time, but for me, it was simply patriotism.

 

“But I regret my action!  Once I have the opportunity to leave again, say to US or Canada, I’m not coming back. I have also told my children that once they are out of here, they should forget returning home because there is no future here.”

 

He said his experience in Nigeria and Moscow were poles apart.

 

“I was doing well over there.  The remuneration was good. Power was constant and generally the condition of service was quite encouraging. It’s not like here where you have to do a lot of things with your bare hand because the machine does that for you,” he said.

 

On the way out, Durojaye noted that the government must take a holistic appraisal of the health sector.

 

“Everything in Nigeria, including the health sector, is bad. There is chaos everywhere.” he lamented.

 

“The government needs to improve the lots of doctors. Unfortunately, many people think doctors enjoy preferential treatment over others. So, once the government improves doctors’ welfare, JOHESU (Joint Health Sector Union) will start their own. Things need to be put aright. A lot of this rests on good policy.”

 

Recommendation

For now, brain drain seems unstoppable; yet there appears a new phenomenon called ‘brain circulation’, which may supplant brain drain if only the government could rise to the occasion.

 

Concluding his lecture, Ezeanolue said brain circulation means government’s ability to manage skilled workers by coming up with flexible work policy that will make the country more attractive to employ and retain best brains.

 

“Government should proactively manage the migration of skilled workers such that we shall have the return-street for them to change from ‘brain drain’ to ‘brain circulation,” said Ezeanolue.

 

“Restructuring the terms of employment in government services could offer enough flexibility such that those, who choose (to stay back) can be employed on terms that would still enable them work overseas. The nation would reap the dividends of training them and the benefits of the experience they had working abroad,” he concluded.