Dr. Salmon Abeeb Oladapo, President, LASUTH-ARD shares his thought in an interview with Business Hallmark’s Tumininu Ojelabi Hassan concerning the negligence of the Nigerian government towards the welfare of doctors, as well as the multifaceted issues crippling the health sector.
He shed light on the issues relating to the recently suspended resident doctors’ strike, while explaining the plights of doctors, the demands of NARD and their expectations from the government. Based on his years of experience in the medical profession, he explained factors contributing to the brain drain in the health sector and suggested measures to reduce the brain drain.
The health sector is facing a lot of challenges, what are the issues?
We can’t capture the challenges totally but I will say the problem of the health sector is in three forms. The problem of manpower, the problem of where to work and the last is the problem of sophisticated equipments to work with. Another one we can add to it is the lack of administrative process to harness the aforementioned problems. These are the problems medical practitioners are currently battling with in Nigeria.
Let me start with the lack of manpower; to become a doctor, one has to spend nothing less than six years in medical school. The way medical school is structured is different from the way other courses are structured. Medical school is structured in modules, aside Part 1, where we do first and second semester, after this, once you get to part Two, there are certain number of months you must spend, which depends on the curriculum of the medical school.
In Part two, you spend exactly 12 or 14 months. No holiday, while doing courses upon courses and tests upon tests. For example, you can attempt more than 1000 questions in anatomy and at the end of the day the whole answer is just 10 marks….
Does that mean 100 questions is equivalent to 1 mark?
Percentage can be over 2000 marks. That’s why we don’t use marks in medical school, instead we use percentage. So, it takes time to produce a medical doctor. Now ASUU strike is really causing a lot of problems, also lack of funding in the university and NMA strike is delaying students in medical school. Medical school requires a lot of money to buy textbooks and the needed materials. The number of medical doctors we are producing are reducing.
The Medical and Dental Council of Nigeria (MCDN) has given a maximum number of doctors each medical school can produce, which cannot be exceeded. We are producing lesser number of doctors. Our area of buffering up is through our colleagues studying in Russia and Ukraine, but due to the war in Russia and Ukraine, all the medical schools have been closed down. The buffer in that aspect isn’t there anymore and other people that have trained overseas have to write professional exams when they come to Nigeria in which majority of them fail it.
Recently, we realized that some medical students write exams from Part four/five, once they graduate they relocate abroad. So the number of medical doctors attending to Nigerian citizens has now decreased greatly.
According to World Health Organization, WHO, one doctor is to 500/600 patients, that is the WHO standard. As at January 2022, it was one doctor to over 10,000 citizens. Since the beginning of this year, do you know how many doctors and nurses have left Nigeria?
Presently, maybe the percentage will be one doctor to over 15,000 patients. For instance, our colleague died recently, this means that over 15,000 patients won’t have access to healthcare. In terms of manpower, we are deficient. Schools and government need to do the needful by ensuring medical schools are well equipped, give people more allocation, increase their quota because there are a lot of people that are very brilliant and want to study medicine, dentistry, nursing and other medical related courses but because their JAMB score isn’t that high, they don’t gain admission.
It doesn’t mean only those at the top position in the classroom should qualify to be a doctor. Some people are brilliant but not smart and in medical school we need smart people. The second one is the problem of where to work. I have been to about 33 states out of 36 states including FCT in Nigeria, so I know what is trending in the country. Lagos state has a good healthcare system and if other states can emulate it, it will be good. Lagos has 30 general hospitals and LASUTH.
Most of their general hospitals do not have consultants, what they do is take their doctors to the teaching hospital for residency training, once they are done, they will go back to the general hospital. This is making healthcare accessible to people residing at rural areas. However, in most states of the federation, it is only the teaching hospital and general hospitals that are located in the urban areas that you will find consultants, in primary healthcare centers and some other general hospitals, doctors are not usually available.
When you visit the hospitals, you will notice that they are dilapidated and no house for doctors. We don’t have structure at all but some hospitals with good management have started building structure, but structure won’t treat patients. Manpower is needed, doctors need to work with sophisticated, latest and advanced equipments. Sometimes, we use our money to buy instruments to treat patients in a government hospital.
Whenever we go on strike, people will start blaming us but they don’t know what we are facing. The government gives us Hazard allowance, which is N5000. Our colleague died recently, yet the hazard allowance hasn’t been paid to house officers of which it was the hazard of the job that killed her. Our problem has always been lack of manpower, lack of structure and, of course, lack of infrastructure.
There are a lot of things that will make life easier. Anywhere in the world, machine is used to run tests after the doctor must have given provisional differential diagnosis. I attended Obafemi Awolowo University, OAU, we were 54 in my set, presently we are just three left in Nigeria. Everyone in the set that graduated after me have all travelled abroad. Government needs to make soft loan available for all the healthcare workers.
As a doctor, I don’t have to build a house. The government needs to build a house that is close to our work place, and the money will be deducted from our salary. Mortgage is done in the U.S, Canada, and in other countries. There are car companies in Nigeria, where as a doctor I should be able to go to, present my pay slip, pick a car of my choice then the money will be deducted from my salary.
Aside house loan and car loan, there are other things you may want to do. For example, if a doctor is servicing a loan, which would take six years, of course, the doctor knows he isn’t going anywhere until he’s done servicing the loan, is it not a way to retain doctors? Meet the leaders of the association and ask them what they need. Like house loan, car loan and other soft loans they can assist them with. If the government can do everything I just said, not only will doctors stay in Nigeria, we will have peace of mind.
The distance from my house to the hospital is about two and a half hours, sometimes three hours depending on the heaviness of the traffic. Resident doctors should live in the hospital, our colleagues in LUTH and UCH live inside the hospital. If I’m called at 2am for an emergency, as far as my house is within the hospital premises, I will be able to attend to patients if I’m the one on call or assist my colleagues who are on call. I should be able to read in my house in the middle of the night without the fear of power outage.
These are the things government should do to make people stay more. Government has totally neglected the healthcare because they don’t receive healthcare services here. If they are receiving healthcare services here, our health sector will be improved. I don’t believe in people in the helms of affair going to receive healthcare overseas and sending their children overseas. How can you be teaching in a public school and your children will be attending a private school? It means what you are offering is substandard.
So the issues in health sector is multifaceted. We have given the Lagos state government 21 days ultimatum to meet our demands. Our demands are firstly, the money meant for our exams that hasn’t been paid this year. Imagine obtaining loans to write exams. Secondly, our house officers are yet to receive hazard allowance. They are at the first line of this job. The third demand is that, people have left Nigeria, can the government kindly employ house officers and resident doctors, so we won’t be overworked.
Another problem is the issue of owing doctors salaries, especially the newly employed ones. Sometimes, 2 to 4 months salaries. Imagine going to work everyday with no salary when you have a family to feed. We also asked about the house they are building for us, can we be given a timeline? With that we will know who is lagging behind, whether it’s the contractor or government. When we complain of power outage, they expect us to treat patients with our torch lights. Sometimes during a minor procedure I will be sweating.
Based on everything you said, there are unresolved issues. What prompted NARD to call off the strike?
The strike was called off by our National body. They were able to meet the government and they promised that the money for exams will be paid, which I can confirm to you that they have started paying our colleagues at Federal hospitals since Monday. But for those of us working in state hospitals, we are yet to receive payment, they are yet to process it and we write the same exam depending on your centre either in UCH, Abuja or Ghana.
Is this the only issue that has been resolved?
What we do is that, whenever we send demands to them, we give them minimum requirements. If they are able to meet up with them, we will suspend our strike. The minimum requirements include: the immediate payment of Medical Residency Training Fund (MRTF) which the federal government has paid. We are also expecting a circular for one-on-one exit replacement. If a doctor leaves the country and you need to employ another doctor, the minimum duration is 8-9 months before you can process it.
Actually, this doesn’t happen in LASUTH because the hospital has the permission of the governor to replace every exited doctor, it now depends on the management of LASUTH on when to do that. They promised that the memo to that effect will be out next week. Also, we are begging the government to return our salary to what it was in 2014. The salary should be reviewed every five years, the last time it was reviewed was 2009, which wasn’t implemented until 2014.
After implementing it in 2014, it was due for another revenue. In 2019, it wasn’t reviewed probably due to COVID-19. The 100% of 2014 and 100% in 2019 made us demand for 200% gross increment in our salary. Our demand was before fuel subsidy removal but now subsidy removal has made the price of everything triple, we are now demanding for 550% increase in our salary. If the government can do these, even our colleagues overseas will come home.
What they are earning aboard isn’t so much but when it is converted to naira, the money is a lot. Plus they have a working system. Here, doctors work for 100 hours in a week. There are some departments with one doctor meaning the doctor will be on call everyday for 24 hours until there is another doctor to relieve him. The problem of doctors is better understood by doctors. Government should ensure that doctors, nurses and other healthcare workers are taken care of. We can’t even see our family everyday.
Concerning the exodus of medical doctors, how are doctors in Nigeria coping with this?
The problem is that the hospital management expect us to run things nonetheless. If we tell them about our colleagues leaving, they tell us to continue working. A doctor will continue working until he/she collapses. Majority of our members are fainting, battling diseases and one deformity or the other. Since Dr. Diaso died, we have lost at least three other doctors. The workload is becoming unbearable. We are telling government to allow us scale down on the service, if we continue to work and every doctor dies, who will attend to patients? Majority of us are experiencing burnouts, depression, suicidal thoughts. The pressure is too much, especially after failing an exam. Doctors are human beings.
What do you think can be done to reduce brain drain in the country?
These problems are like a cycle, which starts from the medical school to the point of onboarding; that is, when they are joining the workforce as house officers (NYSC), after this they can either work in the private sector, residency, hospitals, NGOs among others. They are expected to work for 35 years. What can be done? Firstly, they need more medical schools to produce more medical doctors, medical students should have access to social amenities.
Also, at the point of onboarding to become a house officer, there shouldn’t be delayed for several months before getting house jobs. I waited for one year and three months before getting my house job in sokoto. Once people are done, induct them immediately and give them practicing license, let them start this house job immediately, afterwards mobilize them for youth service, let them continue their career. Entice those already working with soft loans, car loan, house loan, social amenities, improve the security and, of course, a fantastic renumeration package so they will stop leaving the country.
For consultants that have spent 35 years, increase their age of retirement from 60 years to 70 years just like professors, so they can teach and mentor young doctors.
In an interview the president of NARD, Dr. Emeka Orji talked about the death of doctors as a result of work overload. According to him, the association loses one or two doctors every two weeks. What is NARD doing concerning this critical situation?
We are insisting on one-on-one exit replacement. If a doctor leaves the country, employ another one quickly so other doctors don’t die of overworking. Secondly, give us normal renumeration so that doctors can take care of themselves. The third one is give us packages like loan, overseas training, people won’t be in a hurry to go overseas anymore because they are already exposed to the system over there.
There are speculations that teaching hospitals have stopped admitting patients for over two weeks, what is the reason for this?
Whenever we are on strike, patients stop coming to the hospital because they know that resident doctors constitute a higher percentage of doctors working in teaching hospitals. As soon as the strike is called off, there is an influx of patients, which means that our bed spaces will be fully occupied by patients. We can’t admit beyond the capacity of the ward. That’s why we do referrals.
Lagos state has a population of 22 million people and we have just six centers in Lagos. LASUTH, HLT, LUTH, FMC Ebute Metta, Neuropsychiatric hospital, Yaba, and Igbobi Orthopeadic hospital. Do we have up to 10,000 resident doctors in the country? Are we even up to 3000? The probability that wards will always be full is high. Aside the government, other well meaning Nigerians can collaborate with us to assist us. Also, government should renovate all the call room for doctors.
In the next two weeks, if the demands of NARD aren’t met by the government, will the association commence another strike?
We suspended the strike at the federal level and in the next two weeks, another general meeting will hold with the government. For we in Lagos, we have given our employers 21 days ultimatum, if after 21 days they refuse to meet our demands, we can’t guarantee industrial harmony anymore.
What are your thoughts concerning the death of Dr. Diaso Vwaere, who died in an elevator at General Hospital Odan and what’s NMA and NARD doing to ensure justice is served?
Are we thinking what happened was a deliberate attempt or because people failed to do what they needed to do, or it was pure accident or an element of negligence? All these questions need answers. I have been to the venue of the incident, I saw the wreckage and I was at one of the meetings, where the government officials were doing a comprehensive audit and investigation. However, certain people failed to do what they were supposed to do.
For the people that failed to do their jobs that resulted in that fatal accident, they should be sanctioned heavily. I’m aware that some people are already in prison. We have a lot of committees in respect to this issue but the most functional one is the one set up by the Lagos state government that includes people from the government side and also the leadership of the hospital. The solution that has been proffered will be executed. Dr. Diaso is our hero, hero in the sense that because of what happened every other facility under Lagos state are now properly maintained.
I don’t want people to see it as a case of doctors killing a doctor or government killing a doctor. We doctors insisted that everyone involved in procurement, installation and servicing are supposed to be brought to book and to the best of my knowledge, they are in police custody. Whoever is culpable will be punished by law. It is very painful that our dear sister and colleague is gone, what is left is to look after the immediate family.