I have been listening to the ongoing condemnation of Nigerian medical doctors with increasing worry. Because of the grief involved, there is usually finality, totality and fatality involved in the complaints. ALL Nigerian medical doctors are blamed, and no one remembers to speak up for the many who may be doing well and trying their best. Not many people have examined the challenges that our doctors may be facing and very little has been done to actually find workable and measurable solution to the problem that we all face – repositioning the doctors and indeed our health sector for better performance. Oftentimes, the narrative gets carried away with the illusion that elsewhere is better than here. Cognitive biases are at full throttle – you know; at least one of them is that which makes us feel the grass is greener on the other side of the wall. The ugly, sad narrative even feeds into the recent call for Nigerians to better seek Plan B by one popular Lagos pastor. The upshot of it all, is despair, and a further loss of hope in our country and ourselves.
So I felt strongly that I should speak up on the subject.
1. NOT ALL NIGERIAN DOCTORS ARE BAD – As a matter of fact MOST Nigerian doctors – just as elsewhere – are good. They are indeed great at what they do. I think we should always check ourselves as we condemn them all, or condemn the profession itself. I cannot even imagine being in a profession where they cut human beings open and sew them back together. Imagine the risk! We hear statements like “Nigerian doctors are useless and incompetent!”. You mean all of them?! See this gem I found on Nairaland:
“They are all useless and stupid beings who are only after their pockets. Many of them do not know what they are doing. They keep complaining about lack of equipment but how does one explain a situation where a so-called doctor administers a dangerous injection without asking for the patient’s medical history? Our doctors are killers, quick to pass all blame on government but failing to do their own part. If you are a medical doctor, what will it cost you to read up on the drugs you prescribe for your patients and the adverse effects as regards their medical history, do you need government to provide equipment for this too? If you have the money seek treatment abroad, our doctors are trial and error doctors, very careless with no sense, bunch of proud idiots.”
Now this statement raises a number of issues. Competence. Equipment. Experience. Arrogance. Health tourism. Disputes with government. And so on. However, the sheer bile laden in the statement cannot but discourage anyone in that field. Is this how to solve problems? If our doctors were so useless, careless, senseless, most of us will not be alive today. The modern-day Nigerian netizen is driven so much by unmeasured anger. Anonymity allows anyone to write anything they like on social media without caring how it damages someone else – emotionally and otherwise. Usually these statements have no consequence on the writer. Everybody has become a publisher and editor-in-chief. All the medical doctors I know, have kept quiet, as if in concurrence with all that is being said about them but I reckon they are not happy. Not even the Medical Association has said anything in response to recent allegations and accusations.
2. MEDICAL DOCTORS ABROAD – One of the fallouts of the narrative on bad Nigerian doctors is that medical doctors abroad are better. On one hand, this feeds into the same habits of our rulers, who get their medicals done abroad (starting notoriously from the president). Their lack of faith in the medical services that the nation provides – and by extension this country – has fully permeated to the younger ones who love to criticize them. In other words, even when the current youth generation begin to lead this country (in pieces or as a whole), not much is likely to change. On the other hand, it is important to unbundle some issues; not all medical doctors abroad are good. Look at covid-19 and how many died in the USA for example. It has been alleged that many people were left to die perhaps to bring up the numbers and justify a pandemic. It is hard not to see incompetence with that number of deaths. In other instances, they said the doctors were gunning for the money paid to them for admitting covid patients. But here, our medical doctors mostly exposed themselves to the elements even without government support. Yes, some of them positioned themselves to milk people and capitalize on the fear. I think those ones should be isolated because most of our doctors showed up at work everywhere in that season and treated people who could have been covid-infected without discrimination. One of our saving graces was the ease with which prescription drugs could be accessed in Nigeria – and indeed the speed with which our doctors here work. While I studied in the UK, on my only attempt to use the NHS service I was given an 8-weeks appointment. I reckoned I could be dead before 8 weeks, so I went ahead and self-medicated. Many doctors abroad also have no knowledge of tropical medicine, which ours have been handling for so long. In fact, many of theirs are also quite incompetent. In this life-and-death business, I don’t know how much perfection we should expect from people. However, they have to keep improving.
3. COST OF MEDICALS – It could cost as high as $30,000 (N15,000,000) for a woman to have a normal, unassisted delivery of a baby in an average American hospital. Caesarians could cost as high as $60,000 (N30,000,000). The American health system, in my opinion, is very exploitative. This is because of the influence of capitalism. The health service providers lean hard on the insurers, who in turn lean hard on government policies to extract as much as possible from workers. They then make uninsured people pay through their noses… or die. Before the OBAMACARE Act, millions of poor blacks who couldn’t get insurance because they had bad/no jobs, were simply dumped by their families at the entrances of hospitals where they will either be picked up or left to die. In the UK, the biggest employer of labour is the National Health Service. The idea is that there should be health for all, free. But critics of the NHS believe it is a cesspool and an over-bloated one at that. So, every health system has its flaws.
4. DISCOURAGEMENT TO REMAIN IN NIGERIA – This may be a hard argument to make in a season when many people are angling for a break-up of the country. For some, whatever works for them to see this break-up become a reality should be done – including discouraging a nation’s doctors. Otherwise, what is going on today can only encourage more of our medical doctors to head out abroad en masse. The narrative seems to be that our young medical doctors can only do better if they end up abroad. Most of them are presently looking for opportunities abroad. It is bad enough that the salaries are not very fantastic, the equipment and support are not there, and so on. This other heartbreak is the last straw that break the camel’s back. I have seen a number of our medical doctors who speak to us from abroad, happily. But give them a bit of time, they will start to tell us how they miss home. Thankfully, the medical profession is still a tad conservative, so we don’t see many medical doctors cursing out Nigeria on social media, but they are most discouraged. Ironically, most of the doctors only find joy and happiness in coming back to Nigeria for outreaches. Why? This is where there is yet so much to do, not out there. And that profession is all about saving lives. Given the low ratio of doctors to patients in Nigeria, it could have been wise to hold on to what we have and not cast them away so cheaply
We must make our country conducive to those great achievements that we admire elsewhere. We have seen how doctors of Nigerian origin, partly trained in Nigeria, have worked wonders abroad. One of them operated on a foetus the other day. Another was very embedded with Pfizer’s vaccines. There are way too many out there. My issue is with the absolutism and fatalism in our comments. Our people say we need to see fairly well even when we weep. We must not shoot ourselves in the foot and end up in a race to the bottom where we have less and less doctors and fewer and fewer of them are competent, or even care. For a lot of the achievements of medical doctors abroad is as a result of the best equipment that they have. No one wants to die or lose a loved one, but we will not do ourselves any favours if we lose the few doctors we have and everyone searches for visas to go to Ghana.
In my own experience, the nurses also need some waking up. There is an everlasting conflict between nurses and doctors as to who is more hardworking and relevant. Sometimes this conflict bubbles over. But between the two professions they have seen so many deaths and horrible things that they may have become inured to people’s suffering. The nurses sometimes bare this out more often. In some Nigerian public hospitals they are notorious for calling people by their ailments. You hear “oga diabetes come o! aunty HIV where you dey go? Baba hepatitis wetin you think say you dey do?” The doctors may not show open disdain but sometimes abandon duty, some show laziness, carelessness and what have you. However, for anyone who does this, there are 4 who starve themselves, who work for free, who go all out of their way to help, to save lives and to assist. All the medical doctors I have had around me are like this. Dr Michael Alabi in Akure as our family doctor was/is an angel. My current doctor, Olumide Alao, is a true friend and brother. My ‘best pal’ in Canada, Olumide Oyefeso, will do anything to save humanity. I cannot have all these people around me and curse out medical doctors. Some nurses are angels too. We know them. They calm patients down and make you realize that life is worth fighting for. However, given their experiences with tragedies and deaths, perhaps more frequent forums should be organized for them to speak out and unburden their hearts, and reconnect with their own vulnerability and humanity. I’m sure too few of such takes place here in Nigeria. In fact, no one cares how doctors take care of their own health. They make the worst patients and often die young. Scary.
HOW TO GET BETTER – This should be the focus. And it will have to be a combination of many things being done at the same time. Certainly, training must improve, and that means more pressure on government to increase allocations for education. Also, cost of tertiary education may have to increase especially for courses like medicine which is incredibly expensive to deliver. I reviewed some videos about LUTH and in it, some of the students claimed that the Medical and Dental Council of Nigeria had since limited the number of doctors that can be graduated yearly – since about 20 years despite the growth of Nigeria’s population. The state of the facilities in LUTH (where I used to read for my ICAN exams around 1995) is presently quite appalling and too unbefitting for a medical school; a big shame, just like everything else in Nigeria. Imagine a dental lab with 40 chairs, none of which works! The walls of the dental laboratory was overgrown with fungi! Some things about Nigeria are just unbelievable. With this kind of crisis, we still recruit students into medicine based on quota! We have one of the lowest doctor-patient ratios in the world and we still limited the production of doctors… yet most of the ones we produce promptly empty abroad! Amazing.
Apart from more investment in education, governments across the board must be forced to make the needed investment in public good for the wellbeing of the people of this country. One of those public goods, is healthcare. Most of our public health centres are unmanned, and thousands of them have been shut down across the country. Our people die cheap deaths. Primary health centres have been abandoned such that everyone with a headache clogs up our referral institutions – like teaching hospitals. Lastly, so as to keep this short, we have to think about periodic psychological therapy for our doctors and nurses and charge their associations to wake up and keep that delicate and difficult profession in check. It does not help to remember how their last elections in Enugu went bloody, almost as bad as, if not worse that the APC primaries in Ekiti State some time back. Still, this is the profession where our smartest young people – the PhyChemBio crowd who scored all the As in secondary school end up. They need our help to save that profession. They certainly don’t need just lampooning, and curses and total lack of appreciation from us. There is also a need to institute proper professional liability management in that sector, just as is done abroad. They need insurance, in case of mistakes while performing their duties. The insurance will pay those who get hurt, but also keep these professionals in check by the investigations they perform. Like every profession, we have rogue doctors too. We have drunk ones. We have those who are on drugs. We even had a medical doctor who was an armed robber in Abuja once. Then we have a rash of quack doctors, who are practicing by the thousands in our ghettos where no one asks any questions. Some are operating on Nigerians based on what they watched on TV. Some are nurses who believe they should be earning more, after all they have studied what the doctors did and believe they are better at patient care! All sorts happen in this field. Also, beyond so much controversies on social media, there is the need to make real examples of real people who are negligent, greedy, careless, or callous in this field. Usually what happens is that people make noise, the case gets referred to the Medical council, from where everything dies down.
THRESHING FLOOR – Just like in the political space, it is also good that Nigerians are complaining loudly about this matter. Indeed, Nigeria is going through a threshing floor from where a new, better nation may emerge. But we must understand how and when to bank our gains and not to go on and on about complaining without identifying and implementing solutions. This matter is a long-haul issue. Improvements will be gradual. People will still lose their lives once in a while in our hospitals. And many will allege neglect and greed, whether or not that is the case. Losing a loved one is a tough thing to pass through. Let us however not see a situation where things will get even worse because our medical doctors – especially the ones in public service further disconnect emotionally. I worry more because I am training one under my roof. My son is studying to be one. He has always been a compassionate one (like me, lol). Each time I hear the way angry people describe medical doctors, I fear maybe he is in the right profession. Should everyone who wants their peace abandon that profession? Then how do we survive? Do we then rely on foreigners to be our doctors in Nigeria? Or do we encourage all the medical doctors to run abroad immediately Nigeria finishes training them? After all, abroad they will earn 50 times what they will earn here… or even more? Thankfully, my pal, Joseph Edgar, the Duke of Shomolu, who has been up in arms against the negligence of the medical profession in Nigeria, has taken things a step further in seeking for solutions – he is launching a N10 billion fund to help public health institutions in the area of training, equipment and welfare. Way to go! He needs our support.
It’s a real dilemma. But I believe with deep and honest thinking, we can find a solution.