Exodus of doctors as NARD strike lingers

As the ongoing industrial action by the Nigerian Association of Resident Doctors (NARD) continue to deny many Nigerians access to healthcare, Daily Trust investigations reveal that there is a mass exodus of medical personnel out of the country, in search of greener pastures.

Medical experts warn that this is further worsening the country’s health system.

Findings also reveal that many doctors are presently trooping to Abuja for an interview with the Saudi Ministry of Health holding tomorrow (Tuesday).

A flier for the interview seen by our reporter called on doctors who specialise in anesthesia, ICU, pediatric surgery, family medicine, obstetrics and gynecology, Ear Nose and Throat (ENT) and emergency medicine to attend the interview.

The recruiters also invite all sub specialties of surgery, all sub specialties of internal medicine, orthopedic surgery, radiology and haematology.

‘Rate of doctors’ migration from Nigeria worrisome’

The Chief Medical Director (CMD) of the Federal Medical Centre (FMC), Makurdi, Benue State, Dr Peter Inunduh, said the situation is worrisome.

He said that government must act fast to change the trend or else the health sector of the country would be in jeopardy.

“We experienced this (migration) in the late 80s and 90s. And now it is happening. You’re aware that the Kingdom of Saudi Arabia is even conducting interview next week. What is the impact?

“For example, you have one anesthetist in the hospital and it is the anesthetist that manages the Intensive Care Unit (ICU) in an hospital, if he leaves, what do you think will happen to the ICU?

“If you have only one nephrologist who is managing the dialysis unit and if the person leaves, what do you think will happen? Something is just wrong and we do not know. The rate at which doctors are leaving this country; I’m just not comfortable.

“Mind you, these doctors leaving have experience. You can replace them but you can’t replace that experience and it is scary.”

He said this is happening at a time the country was thinking about post-COVID-19 recovery and still not out of the third wave of the pandemic.

“There is going to be a lot of challenges when you find your technocrats exiting the country. It means something is fundamentally wrong in the system that government needs to fix,” Inunduh said.

Inunduh told our correspondent that he also authored the statement, which went viral on social media last week lamenting the exit of his best hands from his facility to Saudi Arabia.

He said it summarised everything presently happening in his facility in respect to the high rate of migration of doctors to Saudi Arabia and other countries.

The statement read, “In the last two years, I have lost three orthopedic surgeons, one maxillo-facial surgeon to Saudi Arabia. Within the same period, I lost my only nephrologist, SR Anesthesia, a urologist, an orthopedic surgeon to the UK.

“There is information from the grapevine that many more consultants will leave in the coming months. Just last month, I lost an SR (Surgery) to Saudi Arabia.

“Just this morning, my only anesthetist who is the most senior in Benue State walked into my office to inform me he is leaving for Saudi.

“The situation is so serious that many just drop a letter of resignation and walk away while others just abscond.

“Except something is done urgently, many critical areas will be shut!” he warned in the statement.

‘Less than 40,000 doctors practising in the country’

President of the Nigeria Medical Association (NMA), Prof Innocent Ujah said it is difficult to say the exact number of doctors currently practising in the country as they continue to leave in droves daily.

However, he said the estimated 40,000 doctors before now “has been thoroughly depleted because they are leaving by the day.”

He said by the WHO standard, one doctor should treat 600 people, but in Nigeria one doctor treats about 4,000 people and that still depends on one’s location.

In some states such as Kano, the state government spends millions of naira to train medical doctors and most of them, it was gathered, only work in the state for the number of years indicated by the bonds they sign with the state government after which they seek greener pastures.

For instance, Dr. Fatima Damagun, a family physician in Aminu Kano Teaching Hospital (AKTH), said more than 20 doctors, most of them senior ones have left her hospital (for hospitals outside the country) in the last three years, with as many more planning to exit the country as soon as possible.

Of the many senior doctors that have left recently, she said it was more painful to see one of the two professors of neurology in the hospital depart the country for greener pastures.

Saudi Arabia, for instance, is massively recruiting and they are the easiest path for doctors, especially for those from the Northern part of the country while those from the Southern part favour the United States, she said.

Going to the United States is, however, more expensive, she said, putting into consideration that each of the exams to be taken cost about $1,500 to $1,700.

From her interaction with most of her colleagues that have left, two issues stand out among their reasons for leaving: poor job satisfaction and financial constraints.

She said the professor of neurology that left her hospital and the country left his family in a rented apartment because of all his years of working in Nigeria, he was not able to build a house of his own due to poor remuneration.

“It was when he left for Saudi a few years ago that he was able to buy a house and refurbished it to his taste”, she said.

She said it is embarrassing for them to always have to refer patients to other hospitals because major equipment needed to deliver optimal healthcare are either not functioning or not available.

An official in the Kano health ministry said the state does not have a problem with the doctors as none of them have ever defaulted on the bonds.

Reasons for mass migration of doctors – NMA

Prof Innocent Ujah said unemployment, poor working conditions and hostile working environment such as poor remuneration, overworking of doctors, poor health facilities and equipment and insecurity are the issues pushing doctors out of the country.

The NMA president said doctor’s migration is not a new phenomenon and is also a fundamental human right.

He said, “Wherever you find that the work environment or condition of service is not good or not satisfying, you look for a better place and that is called ‘mobility of labour’; that is a fundamental human right. Everybody has a right.

“Many Nigerians (aside from doctors) move to America on a daily basis because the environment in the country is not conducive. Apart from the federal government, many of the state governments are not paying salaries, not to talk about pensions.

“If you go to hospitals, the facilities are less than optimal and therefore you have to struggle so much to do so little.

“Many doctors are not employed. For those employed, the hospital environment is very hostile. Facilities are not there and we believe that the government should intervene to arrest this issue.

“Apart from the remuneration, what about insecurity? There is no part of the country where you can stay and sleep with your two eyes closed. So insecurity is also a factor. Everybody wants safety and security. So if you have an option, you move.”

‘NMA cannot do anything about the situation’

He said NMA cannot do anything about the mass migration because this is guaranteed in the constitution. “You can move to anywhere you want. The only thing we are advocating to the government is to see how they can improve the condition of service of health workers, not just doctors, so that they can have good retention.

Younger doctors more problematic

He said, “The younger ones are even worse. They would leave and they don’t care about it at all. Many of them are single. Maybe when they go there, they will get married.

“I decided to come back to Nigeria in 1987 on my own. People said I shouldn’t come back and I have no regrets. But the younger ones don’t have the patience that I had, because things are really difficult,” he added.

Origin of high doctor’s brain drain

Tracing the doctor’s brain drain in the country, Prof Ujah said there was a private practice decree by the federal military government in the 70’s that made many doctors to leave government service and established their own clinics. He said some left the country because the law was restrictive.

The NMA president said the second one was from about 1990/91 to 1995 when working conditions were so bad that many consultants could not send their children to good schools, or take care of their families.

He said this made them to move to Saudi Arabia, adding that the situation is worse now than (1990/91) because it was only consultants that were leaving then but now any doctor that qualifies and has his way, would leave the country because of the poor condition of service.

He added that the high rate of consultants migration to Saudi Arabia in 1991 was later tackled by the Babangida administration, through a different salary scale for doctors called ‘Medical Salary Scale’ (MSS) and ‘Medical Salary Super Scale’ (MSSS). “And that brought some level of stability in the employment and retention of doctors in Nigeria,” he said.

Training Nigerian medical doctors

Prof Ujah said many countries are clamouring for Nigerian doctors because they are well trained.

While saying that many Nigerians are migrating and not just doctors, he said that of doctors’ is monumental because they are taken in every country they go.

“If they go to the UK and 500 Nigerians write the examination, 450 will pass, because they are properly trained here. Nigerian doctors are very well trained. In Saudi Arabia, you don’t even need to write any exam before you are taken if you are from Nigeria,” he said.

Asked if doctors pay tuition fees in the university, he said while there is no tuition fee, the charges for medical students are enormous.

He said medical students pay the highest charges because of the demand for their training and these charges are often shouldered by their parents.

He said training of doctors is very expensive, even where the government subsidises fees. He, however, added that the situation is worse in private universities, where some charges are over three to four million.

Prof Ujah added that the average cost of training a doctor, (excluding accommodation and feeding) on a yearly basis in public universities is between N400,000 and N500,000 and varies from one university to the other.

“On a yearly basis, in most places, it’s between N400,000 to N500,000 while in other disciplines while  it may be between N150,000 to N200,000.

“So it is the most expensive and the parents are the ones paying, not the government because the issue of tuition fee is for everybody. The doctor is not given any preferential treatment. What happens is that the parents pay more to train medical students,” he said.

The Dean, Faculty of Environmental Sciences, Nasarawa State University, Keffi, Prof Nasiru Idris said while tuition might be free or just a small token in Nigerian tertiary institutions, it is just one aspect of the training.

“What about accommodation, feeding, levies, acceptance fees and other services that might come in the course of the study?

“However, the truth of the matter is when compared with private universities in Nigeria and abroad, public medical schools in Nigeria are almost free,” he said.

He said in the United Kingdom, students pay school fees between £10,000 to £20,000 per session but it depends on the university.

“So also in Europe. In Asian countries, for example, Malaysia, UAE, Singapore and Japan, medical students pay between $5000 to $10,000 per session. All these fees do not include living expenses and other hidden costs in the course of the study. While in Nigerian private universities, medical tuition fees vary, the rate is between N500,000 to N3,000,000 per session,” he added.

Why we are migrating – Gombe medical doctors

A Resident Doctor at the Federal Teaching Hospital (FTH), Gombe who simply gave his name as Dr Mohammed, said difficulties in getting a job after training is one of the reasons some doctors are leaving the country.

“In my view, this problem started with doctors finding it difficult to get employed as House Officers especially in the southern part of the country, because of bureaucracies in the health sector.

“Some will spend one to two years after graduation before getting employment as House Officers,” he said.

Dr Sani added that he is still practising in Nigeria because he has gone far in his residency training, saying he may leave whenever an opportunity knocks after his training.

A Consultant Pathologist, Dr Mohammed Abdullahi, said “In the developed countries like the United Kingdom and the United States, they have a good working environment where one can have all the required equipment and tools to work with.

“These make the work much easier and also the number of doctors to patient ratio in the developed countries has made the number of patients a doctor attend to be very minimal, unlike here where a doctor attend to a large number of patients daily.”

However, despite the prospect and the good picture painted for working abroad, he is personally unlikely to leave the country for greener pastures abroad.

“Therefore, going by experiences shared by those that have left the country, the racism and the loneliness is not worth cutting ties with one’s family and friends and the country of birth,” he added.

In Kano and Katsina, doctors sign bonds

In Katsina State, the Chairman of the NMA, Dr. Abubakar Dahiru, confirmed that a number of doctors have travelled out of the country in search of greener pastures, estimating at least 40 in the last three years.

On the bond between the state government and medical doctors trained by the government, Dr. Dahiru said it only takes two years for the bond to expire for someone “Who did his NYSC and four years for the one who just became a doctor, after which they can go”.

An official of the Katsina State Hospital Services Management Board, who craved for anonymity, said in Katsina, there are no cases of doctors who leave while their bond is active, as such there was no issue of enforcement.

Many reasons are making us leave Nigeria, Lagos, other practitioners

Dr. Chinedum Eluogu, a Consultant Cardiologist, Specialist Physician and Chairman, Committee on Doctors Mobilisation of Nigerian Medical Association, Lagos, said  it is frustrating for any doctor to work in a poor environment with poor facilities including electricity, which is key where emergency cases are concerned.

He lamented that doctors in Nigeria are not adequately protected, particularly in the face of the COVID-19 pandemic.

“In Europe, fresh doctor graduates get 60 pounds per hour but the remuneration in Nigeria is ridiculous and as such, doctors in the country don’t live the quality of life, they should be living,” he said.

He further lamented that in Nigeria, doctors are owed salaries despite being paid N5,000 as hazard allowance.

Dr. Chinedum said in Lagos State, there are about 8,000 doctors servicing a population of 20 million people.

This, he said is overwhelming and adversely affecting the quality of care rendered and the health sector generally.

Dr. Otito Frances Iwuchukwu, who graduated with distinction in the year 2000 from the Faculty of Pharmacy in the University of Ibadan, who is presently a consultant in the state, said the lack of basic training resources, poor pay for mid-career doctors and irregular payment of salary are factors contributing to the relocation.

The Chairman of the Oyo State chapter of the Nigerian Medical Association, NMA, Dr. Ayotunde Fasunla said “Almost on a weekly basis, doctors are leaving the country. I don’t have the statistics but I know they are leaving in large numbers.

“One of our senior colleagues told us recently that a medical professor earns N450,000 in Nigeria but abroad, those who are not professors are earning between N6 million and million (after conversion to Nigeria currency). So, if you compare the money and value for the job you are doing, it is normal for an individual to migrate. In addition, you will like to go to where your services will be appreciated and you will get equipment to save the lives of your parents unlike what we are having presently in the country,” he said.

Effect of doctor’s migration on Nigeria’s health sector, tertiary institutions – Experts

The NMA President, Prof Innocent Ujah  said  the country’s health system is worse now than ever before because of the strike and the doctor’s migration.

“So it is a pity and requires a round table conference. Let’s brainstorm with the government because if we leave it this way people will go. Europe and America are looking for the best and the best is in Nigeria,” he said.

The Dean, Faculty of Environmental Sciences, Nasarawa State University, Keffi, Prof Nasiru Idris said the migration of Nigerian trained medical doctors to other countries will further widen the ratio (gap) between a doctor to patients in Nigeria’s health sector.

He said this will also let to a drop in the number of academic medical doctors in Nigerian tertiary institutions to seek for a better staff welfare system in those countries.

He said the earned academic allowance that ASUU is fighting for also covers the medical doctors for their overtime and their miscellaneous services in the course of rendering services.

Prof Idris Mohammed, a former Chief Medical Director at the University of Maiduguri Teaching hospital and a Life Fellow of the Royal Society of Medicine (UK), said the brain drain is also causing a dearth of medical teachers in training institutions.

“The teachers are not there; brain drain has taken our best brains out of the country to greener pastures. They said they send millions of dollars back home, but dollars do not treat malaria; dollars cannot go into the laboratory and do a test for you. The people are required to teach the medical students and render service to patients and also get the laboratories working to produce diagnostic results for proper management of those patients,” he said.

How to curb brain drain – Experts

For Prof Ben Ugheoke of the University of Abuja, brain drain persists because “Government has failed to work out and put in place an internationally competitive worker’s compensation plan and as long as the government turns a blind eye on rejuvenating the work environment and deploying a competitive compensation plan for the Nigerian worker, brain drain will continue unabated.”

He said it is, therefore, expedient and high time the Nigerian government commissions a study on work environment and suitable\competitive compensation plan for its workers in general, in order to stem the tide of brain drain.

Dr Aminu Garba Magashi, a medical doctor, said the exodus of doctors is not peculiar to Nigeria, as it affects most developing countries.

He said the problems are multifaceted and include poor funding of the health sector.

Dr Magashi said: “For instance, the average budgetary allocation to health in the last 10 years in Nigeria has been less than 5% and it reflects in the salary and wages of medical doctor and other health workers.

According to him, implementation of appropriate remuneration and working conditions for medical doctors and dentists will minimise industrial agitations, disputes and crises in the health sector and the exodus of doctors abroad.

He added that emphasis should be given to the urgent issue of brain drain challenge through public and private interventions, including the provision of competitive wages and better welfare packages and working conditions.

  (Text, excluding headline from Daily Trust)