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By Cosmas Omegoh
Nigeria’s healthcare professionals are still leaving the country in droves. And the number of those leaving keeps increasing every passing day without any let. The migrants are going for greener pastures.
Doctors spoken to said that nurses and some other health experts are leaving the country in their large numbers too, thereby throwing up enormous crisis in the Nigerian health care sector.
They feared that the crisis might lead to a much bigger one the country might find hard to handle. Patients will be attended to by rookies; others will be at the mercy of quacks.
Now, the doctors still remaining in the hospitals are overworked, Sunday Sun was told.
Many of them are working their ways out because they can’t continue with the challenges they face.
Our correspondent learnt that people who have not been to various government hospitals lately might not know what is going on.
The doctors accuse the government of knowledge of the crisis but chose to remain unfazed.
The doctors fear that in no time, quality manpower in the various hospitals will be a thing of the past, declaring that right now, it is getting seriously scarcer. Many will be falling ill without experts to care for them.
A patient, Livi Madu, told Sunday Sun how he visited a Federal Government health facility in Lagos recently, and was shocked to note that the doctors he knew and once received quality care from way back had all left.
His words: “When I got to the hospital, I saw some young female doctors attending to patients.
“I recognised one of the nurses I knew for a long time. When I asked her after my doctor friends, she had a good laugh. ‘They have all gone to UK,’ she toned. It was then that I realised that the said exodus of Nigerian doctors was real.”
Recently, the General Medical Council of the United Kingdom said that 6,058 Nigerian medical doctors moved to the UK between 2015 and lately, bringing the total number of doctors who had migrated to the country over the years to 10,096.
Nigeria is believed to have the third highest number of doctors working in the UK, after countries such as India, and Pakistan.
A sizeable number of Nigerian doctors over the years had left the country for the USA, Saudi Arabia, Jordan, South Africa, among others. This is in addition to those who trained in such countries and are working there.
The doctors Sunday Sun spoke to said that their colleagues who left were chased away by incessant industrial crisis, poor remuneration, insecurity, inadequate equipment and government insensitivity to the yearnings of the doctors, among other things.
Every now and then, overseas recruitment agencies jet into the country to net the health professionals. On arrival, they set up tents in hotels and other facilities where they interview interested doctors. Successful ones are ferried overseas and offered working permit, better pay, accommodation, exposure to quality training and improved status.
It was also learnt that the exit of the doctors had affected the number of doctors seeking specialist medical training in the country.
The National Postgraduate Medical College of Nigeria (NPMCN), for instance, had had to scale down the number of centre for its fellowship examinations this September from the usual nine to four.
The College cited “marked decline in the application for the Primary and Part 1 fellowship examinations.”
What doctors say about colleagues’ exit
Doctors who spoke recently gave startling accounts of the exodus of their colleagues in the industry, discussing the trend with trepidation.
“The number of doctors leaving is scary,” Dr Tajudeen Mobolaji, vice chairman, NMA, Lagos State chapter, revealed.
“I don’t think I have sat down to think about the figure, but I can tell you for sure that every month, at least one doctor leaves us. That is not staggering enough; what is, is that doctors who have just graduated or those that are about to graduate, now have their sight on leaving. They don’t want to practise here. About 70 to 80 per cent of them are planning this – they want to leave immediately after graduation. That is very worrisome.
“I want it to be understood that it is going to become more worrisome as long as we are not graduating fresh doctors that want to stay. It means that time might come when we might not be able to have fresh doctors. Yet the ones on ground, plan to leave. You can now do the mathematics yourself.”
From Jos, Dr Sunday Lengmang, an expert in Fistula at Bingham University Teaching Hospital, Jos, told our correspondent: “Honestly, every day, we hear of doctors leaving.
“I will think that an average of 30 per cent of the Nigerian doctors has left. And another 30 per cent is trying to work its way out.
“It is not only doctors that are leaving; nurses are even leaving faster, including general nurses, theater nurses, anesthetic nurses; they are all leaving in droves.”
Doctors’ feeling as colleagues exit
How do the doctors feel hearing that their colleagues have left or leaving? This is what Dr Mobolaji said: “I feel bad; I feel more responsible; I feel over worked.”
To Dr Jide Onyemelukwe, secretary-general, Nigerian Medical Association (NMA), “we feel quite sad. It is a sadness that fills us with deep sympathy for this country. We feel sad that our colleagues are leaving – colleagues we need to work with to sustain the healthcare delivery system of this country. They are leaving. That leaves greater burden on all of us.”
He is unhappy that even when Nigeria is unable to attain the WHO recommended doctor-patient ratio, his colleagues are still leaving.
“We feel sad too when we recall that for the WHO, the doctor-patients ratio stands at a doctor to 500 patients.
“But in the Nigerian situation, we have one doctor to 6,000 patients. In some areas the ratio is as high as 1-10,000. Now ask me, how can one doctor cope with that staggering figure? That is just not possible.
“So, we feel sad because what we are expected to do, we are not able to do because our number keeps depleting. Yet, the number of patients is increasing.
“We feel pain because we are over burdened. That keeps telling on our health. We are human beings too; we are not robots; we too get tired.
“When you see a patient you can help and you are not able to help because you are down, you are weak, you will not even sleep when you go to bed.
“But if we have the right numbers, we will be able to render the services to those that need them urgently.
“That is why we feel sympathy for this country. We often wonder: how can a country spend money to train a professional that is so good whom the whole world is seeking, yet the same country cannot retain him? Then another country poaches that resource person. Then the country that trained him starts all over again to train another set of professionals. And the circle continues. It is very sad. It looks like a country that does not know what it is doing. How can such country allow such circle of shame to befall it? It is very sad. It is sympathetic. Words cannot describe what is going on in our minds as doctors,” he said.
Why doctors are leaving
But why are Nigerian doctors leaving the country the way they are doing? Here the doctors gave their reasons, leaving hints that they too might be on their way out.
Dr Lengmang said: “It is a lot of investment to study Medicine – your time, your money, and psychological stress. So, it will be unfair for such a highly trained and endowed people to watch the situation in the country disintegrate before their own very eyes without making an attempt to get a better livelihood where they will be valued much more than they are valued in their own country.”
With his voice dripped with regret, Lengmang said: “Last year, my retirement family house was burnt to ashes in Jos. I lost money in millions, which I had laboured for. I cannot understand it.
“Here, human lives have no sanctity. People are being killed and kidnapped daily. Robbery is going on at every turn. The political space is so intolerant. And we don’t know what the future holds. Definitely, survival comes first. That is why people are leaving and I don’t blame them. That is the honest truth.”
According to Dr Onyemelukwe, “the doctors are exiting because the things that will retain them are not here. The push factors are too many.
“First, the doctors are not well remunerated; there is insecurity everywhere; what they need to work with are not there. There is no enabling environment.
“The doctors are also human beings that have families to take care off. That is why they are leaving.”
Impact of their exit
For Dr Mobolaji, when their colleagues leave, that “increases the pressure on us; it is making us more responsible. It is adding more duty to us. It is making us more sensitive to the plight of our people; and it is worrying us, and forcing us to keep asking what is to be done?”
For Dr Lengmang, “it leaves a severe burden on us.
“We see great hands, great professionals leaving. You place ad vacancies for consultant physicians, for long months, no one applies. You then realise how much things have gone South. That is the feeler we are getting in various health facilities of note.”
He said that the situation was growing more worrisome when you realise “on the other hand that it is the younger doctors that are leaving faster than the older ones. That means that we are creating a very serious gap that cannot be filled once the few crop of the older specialists leave.
“And what does this mean for us? It means over work for the available doctors. It means less quality of care. It means overall poor quality of life.”
Explaining, he said: “A doctor colleague just gave me this analysis. He said some years ago, he was a house officer. The value of his salary then was like $1,200. Right now, he is a senior medical officer. His salary in naira has gone much higher. But its value is about $400. So, you can imagine that.
“It is sad when you see your colleagues out there getting $10,000 per month. So, why won’t you make effort to move?”
To Dr Onyemelukwe, what is going on has impacted badly on the healthcare sector. The number of doctors we have now is very small, yet more and more doctors are leaving; our numbers are reducing by the day. What that means is that the remaining doctors can’t cope; they cannot deliver – not because they don’t know what to do, but because our numbers are small compared to the numbers of people needing our services.
“That means the quality of healthcare delivery is dropping. That also means that charlatans will take over; the environment will be good for them to take over because the patients that need healthcare will have no alternatives. If a patient is sick and the doctor is not there, he will seek assistance from the charlatans on the streets. Before you know it, the patient is mortally injured and might lose their lives in the process.”
What to do to keep doctors
For Dr Mobolaji, “I will be looking at what is forcing our doctors outside. What is the push factor? It could be remuneration. It could be condition of service; it could probably be the social-economic status here compared to where they are going to. It could be the ability to learn more.
“More of our colleagues could have loved to be here and learn, but they will rather make sacrifice and stay away from where their loved ones are just to give them a better quality of life.”
But are the government and the Nigerian society listening to the voice of the doctors? Dr Onyemelukwe lamented that “Nigerian doctors are shouting themselves hoax. But the one to bring the required change, which is the government, is not listening.
“Our emphasis is that the government needs to appreciate what it has. First, government needs to review doctors’ remuneration. The doctors are poorly paid. In the whole world, Nigerian doctors are the lowliest paid. That I know,” he said, preferring to say that doctors’ pay is a policy matter.
However, he said: “Let the doctor be paid in a way that he can be a little more comfortable. They need to build their own houses when their mates are doing so, train their children when others are doing the same, and live in a manner that is also befitting of a doctor.”
Quality of Nigerian doctors
Dr Onyemelukwe rated his colleagues very highly in terms of competence, saying: “If I should put it on a scale, the Nigerian doctor is 100 per cent trained. They are about the best trained doctors in the whole world, that I can assure you. That is why they are coming to get them. If they are not good, people will not be coming for them from the UK, USA, Saudi Arabia, name it. It is because they are well trained.”
The clarion call
To Dr Legmang, it is the duty of the Nigerian people to change the mess now being experienced by all and sundry by being politically conscious.
He declared: “This is a clarion call on the leadership and the electorate. We have gone beyond sentiments.
“We have now gone beyond tribalism, religion and other things that had divided us. It is now time for us to think critically without any biases to vote for persons that had in the past, demonstrated capacity. If we miss it this time, we might not get it again. But if we replace the present crop of leadership with those who can deliver, that is when we will have hope; because everything rises and falls on leadership. The next election is very critical. Its outcome will decide whether the rest of us will leave or to stay.”
