For physicians who dedicate their lives to the pursuits of wellness of others, it is a career nothing short of demanding, an occupation requiring intense schooling, constant training and a chaotic schedule. Whether a practitioner works in the private or public sector, one would naturally assume the rewards of this lifelong journey to be plentiful. However, in Nigeria, the reverse is the case. In this report, Akewushola Afeez detailed the experience of working as a medical doctor in Nigeria.
Like every young child, Abdul Abubakar as a young boy dreamt of becoming a medical doctor. A majority of children do like a profession when they see someone excelling in it. They developed a passion for it through what they could see and could imitate at a very tender age. This they put in mind as they journey towards adulthood.
Some of them who are really determined will be curious to know what it takes to do better in their studies and pursue their desired careers. For Abubakar, he was motivated by the nature of the job medical practitioners do. The joy of seeing someone who was terribly sick, treated and recovered in due time motivated him to be a medical doctor.
Abubakar’s parents were not medical doctors. They neither work in the medical field. They are civil servants who work in government organizations.
“Just like many other doctors, before even gaining admission into the university, many people have passion of becoming a doctor, and the passion is just like “everybody wants to save lives” probably right from the younger age, and then you have this passion that you want to work as a doctor, so that you can save lives and help people and also some people, can be influenced, probably by their parents or an elder person who works as a doctor, so I think these are the two major things, but personally I think it’s the passion to save lives,” Abubakar said.
Life in medical school
The journey through medical school can be excruciating, and could come with a lot of daunting tasks, narrating his sojourn in medical school, Abubakar said, “What one goes through in the medical school, is such a long story to talk about and of course very rigorous, right from the 100 level to 600 level. Any trained doctor must have passed through a series of rigorous activities, and you have to learn a lot of things so that you can become one, and in medical school you have to go through stages, two major stages; (the pre-clinical and clinical stages).
“The preclinical stage is where we learn some basic about the field, and those learning continue, because in medical school, there’s nothing like you learn and forget, whatever you learn at the basic level, you are expected to have it at heart and continue with it at the clinical stage so that you can harmonize the two. At the clinical stage, we also go through a lot of programs that we do in school which involves the one we do in the clinic and outside the clinic, the lectures, practical.
“We are also to go several facilities, that’s part of our clinical training, going to hospitals to learn what you are likely to face after school, even at the preclinical stage we are exposed to those things that we go through like a community experience, where we go to some core villages in the states within Kwara state for example, and the training, when you talk of the clinical training, in medical school, I don’t know if it is something we can talk about in details because just like anybody that goes to the university, each level we go for a course/program and pass, because without passing we can’t proceed to the next stage.
“What is obtainable in medical school is not a program of who is the best. Of course we have best student but everybody is just like a champion, and in each stage you have a pass mark, which determines whether you proceed or you take a re-sit, but if a student were to fail twice then, he/she will be kicked out of the school, or he/she will have to withdraw from medical school. This case happens a lot, and this happens to even the best student.
In the medical training, all programs in the clinical stage (starting from 400level) are outlined from the beginning stage till you graduate, these programs are in batch by batch, and each batch commences immediately after the other and there are no holidays, and they are also a continuation each other. In medical school, most of the courses are taught in full nothing like the borrowed course. When you talk about rigorous activities one goes through in school, it’s more than what one can actually talk about.
“Of course, everyone will say they are going through a lot, but when you look at what we do in medical school, sincerely all those big textbooks are not only displayed, we read all. I can say categorically that I read majority of all my textbooks, we don’t just read to pass, but to understand, because there is a lot of chemical assessment, and exams that you do. Sometimes, you have to face some lecturers, and there are exams you do that you have to face a patient, and you show them what you know, and if you make a mistake, it is unpardonable, even if you score 100% in your theory, the clinical exam is also a must to pass.
“I finished from the University of Ilorin of Teaching Hospital just like many other students, I give thanks to almighty Allah that made everything easy, because it is not by one’s doing, and also to the parent that sacrifices a lot to make that their children achieve great things.
“Medical training in Nigeria is very cheap when compared to the people that study abroad, but despite that our parents that paid our school fee, what they also get as salary is so small compared to what they are paying as school fees. When I was a medical student, I pay school fees, buy textbooks, pay for hostel accommodation and other stuff, and we spend more time in school compared to other students. I can remember when we were in school, people usually asked “you people don’t go on holiday?” and yes we don’t go on holiday, and some say “you are the one that knows what you are looking for”.
“And you know the parent sacrifice and on the government part, we also give credit to them. Just like they are saying that medical school is subsidized, during our time we know that we paid for everything. At least all the books I read in school, I bought all of them. The school fees, I paid for it. Also hostel and accommodation I also paid for it. All the exam was also paid for, even for outside program, we also paid for it with our contribution.”
Life after medical school
Many do say and believe that medical doctors are likely to get jobs immediately after graduation following the rigorous drilling process they went through to become a professional. Also, medical professionals are usually held in high esteem and well respected due to the selfless services they render to society.
The narrative is seemly changing as medical school graduates are finding it difficult to secure a job either in government or private hospitals. After graduating from medical school, it is a must that every doctor goes through internship training (Housemanship).
According to Abubakar, “it is a must for everybody even if you school abroad you must do internship, the internship is not as easy as we think, a lot of people struggle to get placement for internship, even some people get their certificate expired before getting placement, you know people believe that doctor work is easy, and they get work immediately they are done with school, but it’s no longer so in this era.
“I personally had to travel to a farther state to get started. In fact, I started as a local officer before I could be fully employed. So a lot of people are like that- they struggle to get placement for their internship and it is a must training. It is also one of the most important because the majority of what we learnt in school are theories. A lot of practice are needed, and when you start, a lot of responsibilities are entrusted to you. You have to see a patient and know what is going on. You are still under training because you have to be under a consultant or a medical officer. And the internship training is when the doctor has to learn the work, manage a patient and attend to them.”
‘I know a lot of people and doctors who are still looking for job’
Doctor Abdul Abubakar Oluwashina, a medical officer, working with the Kwara State Government hospital, expressed his disappointment at the rate of unemployment that is affecting medical personnel in the country, saying such could lead to “brain drain”.
“I work in Ilorin, in one of the hospitals that belongs to the Kwara State Government. The issue of unemployment is a major issue and also a general issue in the country now. I know a lot of people and doctors that are still looking for jobs. Even though there is brain drain in the country, there are still people looking for jobs, because the government are not taking care of them enough,” he expressed.
A news report published by Thisdaylive.com on July 25, 2019 stated that “40% of Doctors in Nigeria are unemployed”.
According to the report, the President, Nigerian Medical Association (NMA), Federal Capital Territory (FCT) Chapter and the Medical Director, Nyanya General Hospital, Dr. Ekpe Philips Uche, had revealed that up to 40 per cent of doctors in Nigeria are unemployed.
Ngige claims Nigeria has ‘surplus’ doctors
Despite official data showing that Nigeria obviously lacks an adequate number of doctors, minister of Labour and Employment, Senator Chris Ngige has claimed the country has ‘surplus’ doctors working in different hospitals.
The World Health Organisation (WHO) statistics, as of 2013, showed there were about four doctors for every 10,000 Nigerians (one for 2,500), far below the organisation’s recommendation of one doctor to 600 patients.
Also, according to official data from the Medical and Dental Council of Nigeria (MDCN), as of December 2017, Nigeria had over 39,000 registered medical doctors. This implies that with an estimated population of 193 million as of 2016, Nigeria had one medical doctor to about 4,845 citizens, less than 20 per cent of the WHO recommendation.
Reacting to the Minister’s claim, Abubakar said, “There are lots of hospitals that are in need of medical personnel, not only doctors but also nurses and pharmacists because when you go to some facilities you will realize that a doctor might be doing the work of ten people when there’s supposed to be ten doctors for different jobs. It is one of the problems we are facing in the country, not only Kwara State. You see one doctor doing the work of ten doctors. So, getting the job is one of the problems people are facing despite the brain drain and the number of people leaving the country.”
“It is known that the number of people outside the country is more than that which is working inside the country, we all know that recently the Sudan government came to the country to recruit doctors in the country, unfortunately, they are even recruiting the consultant and specialist, so it’s a big issue for the country.
“I know it is just this year that people started talking about it and it is an issue that has been happening over the year even though there are some doctors that have been living outside the country for 20 to 30 years. The number of doctors outside is more than that inside the country, and we haven’t found a solution to it-and what’s going to happen in years to come is going to be very dangerous because medical students are already planning to leave the country once they are done with school.
“The government has to do something about it, and I know why this is happening, the reasons are poor working conditions, poor wages and salary, security and hazard allowance, those are the conditions the country is facing.”
Industrial strike actions and brain drain in Nigeria health sector
Unfortunately, there has been a massive brain drain in the Nigerian health sector in recent years. The incessant strike actions have caused grave damage to the country’s health sector. Medical practitioners are tired of demanding the same things repeatedly without government intervention.
And sometimes when people hear about the strike they would not want to know why the medical practitioners were on strike, they will only be concerned about their relatives lying on the sick bed. When the patients are left unattended to, that’s what usually led to people attacking, beating and injuring doctors and other medical professionals who are demanding their rights from the government.
Doctors working in Nigeria often expose themselves to various hazards, especially when an epidemic or pandemic erupts. There is usually little or no equipment to contain such deadly diseases. A telling example is the global COVID-19 pandemic. It revealed the poor states of many hospitals in Nigeria and claimed the lives of some front-line medical personnel.
This has made a lot of consultants, specialists prefer to work offshore than work in Nigerian hospitals. Nigerian doctors migrate periodically to the U.S, Canada, Saudi Arabia, the UK and other nations. It is estimated that at least 12 Nigerian doctors leave the shores of this country to practice overseas, weekly.
Similarly, the chairman of the Nigerian Medical Association (NMA), Abuja Branch, Ekpe Phillips, in his lecture at the 2018 event advised the government to emulate India by bringing back its medical professionals who migrated to other countries.
“This exodus is continuously increasing. We produce 1,600 doctors every year, and 1,200 are leaving the country. With the number of doctors getting old and retiring, you see there is no replacement, which is a big problem that might lead to the collapse of the Nigerian health system if not tackled,” he said.
Strike actions
Research shows that between 2017 and 2019, medical doctors in Nigeria embarked on industrial actions on numerous occasions.
Most of the issues always centre on salaries, upgrades of health facilities, and general welfare.
In 2018, research by Africa Check showed that at least 12 doctors leave Nigeria for the UK every week. According to the UK General Medical Council, which has records of doctors in the UK, 5,250 Nigerian doctors were working in the UK as of April 25, 2018.
The Joint Health Sector Union (JOHESU) embarked on a six-week strike in 2018 to press home its demands bordering on improved healthcare facilities, welfare and other demands.
As JOHESU called off its strike, the Nigeria Association of Resident Doctors (NARD) threatened to embark on another strike.
According to Dr. Abubakar, “Strike is one issue that is not only present in the medical practitioner’s but also in all areas. And when people hear of strike what comes to their mind is they are asking of more money. For instance, a strike that happened recently, it’s not because they want increment but asking for their normal right. When the federal government approved a certain wages for health workers but wasn’t implemented- that’s one of the problem we have in Nigeria”.
“We find out that the only language the government understand is strike, and when they are given an ultimatum they won’t do anything until the last minute. The allowance for health practitioners is N5,000, but something was approved for health worker recently but what’s happening now is that it hasn’t been implemented.
“The rigorous work we do doesn’t measure up to what we are being paid, and the government needs to find a lasting solution to this. People think this profession is giving a lot of money, but in reality it doesn’t and even people with private businesses are far better than doctors sometimes.”
‘People attack, beat and injure doctors’
“If you check, you will see that the wages being paid to health workers dates back to 2014, now on any strike action you will see that there’s a list of demands that the health practitioners need, like good working environment, even security.
“For instance, in Kwara State here, doctor and health practitioners generally complain of people attacking, beating and injuring them and it’s so unfortunate because all those things should not be happening,” he stated.
‘Some people are leaving the country not because of the money but the poor service’
Speaking further, Abubakar said, “Sincerely I must confess that the working condition and standard of work in Nigeria is not the best. Why do you think our leaders and politicians are leaving the country to get health care? When you get there, you will find out that it’s the people they left behind are that treating them there.”
“Imagine in Nigeria, you can just visit any hospital as a patient, you will find out that the doctors are incapacitated. Also, imagine going to the hospital and you find the patient that needs to be attended to but there is no equipment available for the treatment- even in some major hospitals.
“If five patients are in need of equipment, you will find out that there is not enough equipment. The availability is low, and the working condition is also bad. The working environment is bad for the workers and the equipment for them to work is not available. Even people that are leaving the country are not because of the money but the poor service. It’s just like learning and not having equipment to work with, it’s very annoying, so people like our leaders that leave the country for health care know what they are doing. And the government knows what to do if they want to do it.”
Ratio of doctor to patient
The World Health Organization (WHO) puts the doctor: patient ratio at 1:600 standard. However, Nigeria’s doctors to patient ratio of 4:10, 000 falls below the global recommendation.
“A doctor should have a certain number of patients assigned to them so as to be able to treat them appropriately-in fact, this is one of the problems we are facing in this country. When you go to the hospital, especially in the children’s section, you will find one doctor attending to 100 patients. It’s only the first five patients that will be well taken care of because the doctors would have been tired and it is not so in other foreign countries because they have a certain number of doctors assigned to each patient.
“There is actually an approved number not followed, currently the number of patients assigned to doctor is 1 to 4,000, and patients need at least 40 minutes to be attended to properly, and because of doctors not having much time to attend to their patients, some patients seek help from other professions which are not too qualified.
“And the news going around that the ratio of the doctor assigned to the patient is higher now is just a fallacy- there are records to support it.
“In Kwara State, we are getting our allowance on time and that’s kudos to the government.
“The advent of Covid-19 has shown us that the state of the health system in the country is bad and how it needs to be improved because it poses threat not only to patients but also to the doctors. And not only covid-19, Lassa fever and all other pandemic diseases. The major reasons why people go to other countries for job opportunities is because of poor security, low wages and many more. For instance, up to three doctors have been kidnapped in Kwara State here. I also have plans to leave the country for better job opportunities and safety,” Abubakar submitted.
