How many Nigerian doctors practice abroad? Currently, 40,000 of the 75,000 registered Nigerian doctors practice abroad. In 2018 alone, we lost about 5000 trained medical personnel to brain drain. And honestly, this is no great puzzle or mystery. The reasons are evident. With a health allocation that is just 4% of the national health budget (as opposed to the suggested 15%), the Nigerian government is unable to keep its healthcare infrastructure up to standard, or adequately provide for the remuneration of its healthcare workers, due to lack of financing.
This under-funding evidently leads to poor infrastructure, poor pay, poor working conditions, poor whatever you might want to call it. The WHO recommendation for the doctor to patient ratio is 1:600.
According to the Federal Minister of Health, Nigeria currently has a doctor-patient ratio of 1:5000, leaving the average Nigerian doctor overworked (yet underpaid).
And it’s funny, in that weird way sad things are funny, that for a country with such a low doctor-patient ratio, the unemployment rate of doctors is estimated to be at about 40%.
That means for a country so desperately in need of doctors, almost half of these doctors are unemployed or underemployed. Fresh-eyed graduates leave medical school bursting with ideals; eager to change the system, eager to save the world. But reality first hits when they find out that getting a placement for their housemanship is well, easier on paper than it is in real life. The hustle is real, and time is running fast.
Not only is the process unregulated, it’s time-bound too- if they don’t get a placement within two years, they have to retake the professional exams. Say they get a placement. Say they make it through the harrowing 1-year experience and move on to undertake the youth service. After completing the service, part 2 of the struggle begins- getting a placement for residency training.
We’ve heard of doctors who spend 7 years searching for places to go through the residency training in their specialty of choice. If again, they are able to get a residency placement, well, they are welcome to the harsh reality of the Nigerian healthcare system.
Understaffed and underequipped, the average Nigerian hospitals are unable to meet the patient demand. They witness patients die from entirely treatable conditions either because they cannot afford treatment, or the facilities for treatment are simply unavailable.
They work unreasonable hours, under terrible conditions. We have reports of hospitals where doctors perform surgeries aided by candlelight.
Under conditions like this, leaving to countries where they will not only be better paid for their work, but will also have the wherewithal to actually save the lives they are sworn to save, becomes terribly appealing. Even though the problem of brain drain in the Nigerian health sector is universally recognized, there have been no stop-gap measures implemented to halt the vicious cycle because the more professionals we lose, the more the burden we place on the professionals who stay. The more burden on their shoulders, the more they leave.
With the Federal Minister of Health encouraging doctors to make career changes into the fields of agriculture and fashion design, there are evidently no plans to address this issue. So if all the pointers say go, why do the doctors who choose to stay, stay?
Maybe we are suckers for punishment. Maybe we like the pain. Maybe it’s madness. Or maybe we just believe that every life we stand in the gap for is worth the struggle. Because here’s the thing: a whopping 1billion USD is spent annually on medical tourism.
Even our president travels to London for medical care. This indicates that a certain percentage of the population, when unable to obtain quality healthcare in the country, can afford to travel to foreign countries for medical care.
But what about the remnant, the majority of the population who are poverty stricken and cannot afford to? If we all leave, what happens to them?
They will be caught in the middle, victims of the system same as us. In this messed up system, the difference between life and death for a lot of people is the doctor who decided to stay.
Somewhere, a mother is holding a child she thought she’d never hold again because of a doctor who stayed. Somewhere, a man who thought he’d never walk again is walking because of a doctor who stayed.
Even in this messed up system, there are doctors striving every day to make a difference, to impact the system in whatever way they are able.
While, in all clarity of conscience, we cannot request this from everyone, we just wish that more people would appreciate those who decide to stay for the sake of the remnant, for the sake of our brothers and sisters who have nowhere to go.
We wish that more people would appreciate these doctors who choose to make the sacrifice, choose to believe, choose to fight for a people worth saving. Because ultimately, the Nigerian Patients are worth it.
Or aren’t they?
Credit: John Afam
(Medical Doctor and Anaesthesia Resident)