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Brain drain: How shortage of doctors, nurses puts your life in danger

Betty (not real name) was diagnosed with tachycardia, an unusual rate in heartbeat, and was referred to see a cardiologist at the Lagos State University…

Betty (not real name) was diagnosed with tachycardia, an unusual rate in heartbeat, and was referred to see a cardiologist at the Lagos State University Teaching Hospital (LASUTH). But when her sister took her referral letter to the Cardio unit to schedule an appointment, she was asked to return after two months to see a specialist.

“My sister had tachycardia in December last year. The doctors at the medical emergency of LASUTH referred her to cardio and when I went to drop the letter, they gave her appointment for February this year. So what do they want to happen to her before that period? We had to take her to a private facility where she was attended to,” Betty’s sister, Amina, explained.

While the siblings could afford the bills at a private hospital, many Nigerians, who could not afford the relatively high cost of treatment, will have to keep waiting for their appointed dates and time in public hospitals mainly because of acute shortage of doctors and specialists.

A similar health problem as Betty’s reportedly led to the untimely death of 11-year-old Ibrahim. His mother, simply identified as Mrs Umar, alleged that he was not given proper treatment at a Lagos public hospital where he was admitted.

She said, “My son died on the hospital bed. He had difficulty breathing and was placed on oxygen for weeks and that was how he died. After his death, his corpse wasn’t released to us immediately until we sourced for the bills which they said had accumulated.

“What special treatment was he given apart from placing him on oxygen? I don’t even want to talk about the hospital environment and the doctor’s and nurses’ attitude.”

When asked the name of the hospital, she retorted “My son is no more. Will I get him back if I tell you? All I know is government hospitals are just there to take your money.”

At the R-Jolad Hospital, a private health facility in Lagos, an elderly man in his late 60’s, who came to see a specialist, told one of our correspondents that he prefers paying N20,000 for consultation to going to a public hospital.

“Young lady, I value my health and time a lot. I would rather come to where I will be asked to pay to get value to go to a teaching hospital where I will waste my valuable time and might still not get to see a specialist that same day. Doctors in government hospitals are overstretched,” the man said.

A recent brain drain report in the Nigeria’s medical profession which puts doctor-patient ratio at 1 to 5000 as reported is a source of serious concern.

The migration of Nigerian health workers in search of better prospects, and friendly environment to work has increased over the years, contributing to the outrageous decline in the number of doctors and nurses especially in the public hospitals. This is a crisis that comes with serious implications for poor service delivery to members of the public.

The Chief Medical Director of the Federal Medical Centre (FMC) Abuja, Professor Saad Ahmed, said the rate at which doctors are leaving the country is alarming.

“At the moment, there is a committee on health reform by the federal government that has been inaugurated to look into the issue. Currently, there is even a memorandum to assist them in carrying out the work,” Prof Ahmed added.

Ahmed also said that the issues of remuneration as well as the heightening insecurity in the country are some of the major factors pushing the doctors out of the country.

Increased workload

One of the major effects caused by shortage of doctors in the country is the increased pressure on the few available ones, especially in public hospitals. This means that there is high number of patients a doctor is expected to see within a limited period of time.

Dr Ahmad Tanko, a medical practitioner with the Federal Medical Center (FMC) Abuja, told Daily Trust that the shortage of doctors in public hospitals leave the available doctors with heavy workload and high number of patients to attend to daily.

He said, “This shortage of doctors is a vicious circle, because more doctors are leaving and then the ones that remain, with either the plan to leave or not, will be subjected to too much work.  One person will do the work that is meant to be carried out by 10 doctors.

“So, that will further push the doctor that decides to stay back into also leaving the country to work where things are working better.”

High chances of mistakes, misdiagnosis

Due to overstretched work hours and stress the few available health workers face, there are high chances of misdiagnosis – a situation where a patient is wrongly examined by the physician.

Dr Tanko stated that this challenge usually affects the outpatients who come to the hospital during the day and queue for consultation.

He said, “To take a detailed history of a patient and arrive at a diagnosis and put up a proper treatment plan for that patient should be at least 30 minutes. But with one doctor having to see 30 patients in the outpatient department within seven hours for example, you don’t have the luxury of time to examine that patient to the fullest and give him the appropriate diagnosis.

“So, sometimes mistakes do happen when a doctor overworks himself to the point where he doesn’t comprehend what he’s doing anymore. And we see that often.

“Let’s say you work for 48 hours straight and you’re expected to make rational decisions, and some of these decisions are life-changing decisions for both the patients and the relatives, so a doctor that is already overworked and stressed out will not be in a good position to take that decision and mistakes are bound to happen.”

Patients bear the brunt

The low-income patients are the ultimate victims of the effects of inadequate doctors at public hospitals, because they heavily depend on public health facilities to access healthcare services.

Tanko observed that this usually affects “the low socioeconomic patients who cannot afford to go to private hospitals where they have fewer patients with enough doctors working for them.”

“The poor patients are those who ultimately suffer from this challenge because they depend on the government-owned hospitals that are usually ill-equipped and understaffed.

“So, most of the time, by the time they come to the clinics, the place is usually filled to the brim by patients and then doctors are overworked so they are referred from one centre to another due to inadequate manpower.”

Inadequate home-trained specialists

Due to the mass exodus of many qualified doctors from the country, there are many gaps left in the medical field without corresponding production of specialists to fill them.

The Medical and Dental Consultants Association of Nigeria (MDCAN) recently revealed that about 500 consultants in various medical fields had relocated abroad in the last two years.

Speaking at MDCAN’s Annual General Meeting in Benin, Edo State capital, last Sunday, the association’s President, Dr Victor Makanjuola, blamed the problems in the nation’s health sector  on unresolved issues by the government.

Dr Ali Waziri, a consultant hematologist at Ahmadu Bello University Teaching Hospital (ABUTH), told Daily Trust that medical brain drain causes inadequate or even lack of home-trained specialists in various fields of medicine in the country.

He said, “The effect (of brain drain) could be short term or long-term. In the short-term, migration or rather brain drain of doctors in a setting of an already grossly-understaffed health sector increases the pressure on the little work force available, which can lead to poor quality of services delivered.

“Long-term effects include lack of home trained specialists in various fields of medicine as shown by a recent news publication stating poor and diminishing rate of registration for the National Postgraduate Medical College examinations.

“Sometimes, people start the training with the sole intent of getting funding for their foreign examinations and the moment they are successful, they abandon the residency training and leave the country.”

A consultant rheumatologist at Lagos State University Teaching Hospital, Dr Hakeem Olaosebikan, said the situation is worse as more nurses are leaving the country than doctors. He however noted that brain drain is not peculiar to the medical field.

He said, “It is very worrisome and should be of concern to all stakeholders; the government, citizens, patients should all be concerned. Leaving because of danger is a characteristic of every human, including animals. This is the reason why a lot of people migrate apart from the opportunities.

“One can migrate for different reasons as some reasons are very valid due to specialisation in a certain field which might not be possible in one’s home country and would require travelling to achieve it in other to get the requisite training. This used to happen in the 70’s, 80’s when Nigerians travelled abroad to get their masters and PhDs.

“Doctors used to travel abroad for professional trainings and return home but what we are having now is brain drain because of a number of reasons. There is a lot of infrastructural deficit in the health sector; doctors’ take home is another issue. When you see your colleagues who are not as bright as you are abroad earning higher than you are, you’ll begin to ask yourself questions. Generally, people migrate for greener pastures, better life and to secure the life of one’s family.”

Olaosebikan urged the people and the government to show commitment towards solving the problem, adding the purpose of life is to solve problems and make impact in the society.

He said, “A lot of people identify this problem, however, nobody is ready to contribute their own quota to solving that problem and part of solving any problem is sacrifice. Most Nigerians are not ready to sacrifice. We want things to occur seamlessly. The leaders and the led are not ready to sacrifice in this country. If the leaders would steal money, send their children abroad, the led would also do whatever it takes to leave the country either legally or illegally.

“When we leave, we are running away from the battle and the problem still remains. Unfortunately, those that will solve the problem are the ones that are leaving because the old men in politics will not solve any problem. Even the training of doctors would collapse because when there are no teachers to train medical students, the medical schools would collapse and at the end of the day, we won’t be able to produce doctors and those that have reached the age of retirements will eventually. There is gross inadequacy of health workers now and everybody is feeling it.”