In Defence of Medical Internship and Professional Qualifications

On the 12th of April, 2020, a circular was released from the Head of Service of the Federation regarding internship programmes in the civil service. In the widely read, yet highly misconstrued circular, the National Council on Establishments (NCE) at its 42nd meeting approved the removal of the internship programme (also called housemanship in Medicine) from the scheme of service. The decision, they argued, was due to the fact that internship is part of training in the respective medical fields and so should not be considered as ‘work’ according to civil service regulation. Not only is this line of thinking wrong, it is also putting the health professional at a distinct disadvantage.

Let me explain.

MBBS, the medical degree obtained in Nigeria is made up of two degrees: A bachelor’s degree in medicine and another bachelor’s degree in surgery. Hence, the mandatory six years spent in university. Because this is Nigeria, the usual duration is “6+x”; that is when you factor the number of times ASUU goes on strike, resit examinations and the chaos that is our university system. Also, when you factor in students that did not gain admission immediately after secondary school or those that had to go through the remedial programme, the number of years in medical school increases drastically. This means that, the average medical student graduates at the age of 25 to 30. On graduating as a doctor, one has to do the mandatory internship/housemanship, which is a year’s training in an accredited health institution in Nigeria. Securing a place to do the internship is itself another herculean task as it has been overtaken, like all things in Nigeria, by politics and nepotism. That is a story for another day.

The training is vigorous, physically and mentally and has caused many a doctor to collapse. The house officer is at the bottom of the medical food chain and is the first on call. This means he or she is in charge of clerking the patients, examination, taking blood samples, resuscitation and treating the patients. Senior doctors are only there to guide the house officer on what to do. In many centres, the house officer participates in surgeries, conducts deliveries and carries out many medical procedures. They are often overworked and at the receiving end of all the senior doctors’ insults. Years ago, a friend of mine was involved in a car accident while returning home from work after a particularly stressful call. She had dozed off at the wheel on the Shehu Yar’adua Expressway in Abuja and so hit the car in front of her. Fortunately, there was light traffic and so the impact of the crash was not much. One can only imagine if she was speeding on that highway.

The point I am trying to make here is that: Firstly, by the time an individual has graduated from medical school, his mates are already far ahead of him. Those who read four-year courses in the university must have since done the mandatory NYSC and started working and earning an income. Therefore, the doctor, who has only just graduated years later is already at a disadvantage. He or she then has to do the housemanship. How do you discount the year a person puts in working, in a government agency as mere ‘training’? Even if it is training, has this not been the modus operandi since time immemorial? What then changed? When an apprentice works for you at the market and you intend to settle him, do you not count the years he worked under you as years of service? How can a Nigerian start work at the age of 28 years and the government refuses to count it as a year of service? By this interpretation, we might as well add internship to medical school, so that medical school becomes seven years, Kawai!

Secondly, like I said earlier, housemanship is not a cup of tea. It is marred by blood, sweat and tears. Personally, I have cried a number of times in the solace of my car and the bathroom over the stress of internship. Discounting this year of suffering, and I know most doctors would agree with me on this one, is tantamount to cruelty.

You may wonder- so what if the internship year is scrapped? Why does it matter? It matters because, the NCE is implying that when a doctor is done with the mandatory housemanship and service, he or she will be employed as a fresh graduate. And herein lies the injustice of it all. The NCE argued that the decision was based on the numerous internship programmes being incorporated into the system. In the last few years, Physiotherapists, Nurses, Pharmacists and Medical Lab scientists have also introduced a mandatory internship year after the 5-year degree programme. However, instead of the civil service to think of how to accommodate them, this insensitive decision was reached instead.

This decision is far from altruistic. Arguments that Nigeria cannot afford to pay salaries and other hogwash have been brewing over time. However, what prompted the release of this infamous circular is not unrelated to the recent protests by house officers over non-payment of salaries for the past 5 months. These young doctors, fed up with being owed salaries orchestrated a local protest in the south western part of the country. And how did Nigeria respond? Iyeh! These young doctors even have mouth to talk? we will deal with them!

In the same vein, the circular also talks about recognising university degrees over professional degrees and their equivalent in the civil service. Again, this is another purposeful jab at the medical profession. They know that in Nigeria, when doctors wish to specialise in a specific field, they join professional bodies like the West African College or the National Postgraduate College of Nigeria. These professional bodies award fellowship degrees after another training period of not less than 5 years. This is called Residency and by all indications, will be the next to be attacked after internship. At this rate, doctors will only qualify for entry level positions by the age of 40!

Nigeria as a country, is like the proverbial beast that continues to eat its young. On the day that circular was released, many twitter threads, websites and Facebook groups trended. And all for the same reason. People were taking it upon themselves to teach young medical graduates, the various paths in which to leave the country without the stress of writing exams. I learnt more that day about medical emigration than I had previously known in my lifetime. The way Nigeria is haemorrhaging doctors and exporting them to other countries is alarming and should be a matter of national concern.

The time for Nigerian Medical Association to act is now. Policies that are thoughtless, vague and vindictive should be not be allowed to see the light of day. I consider it an insult that the NMA was not consulted before such a circular was released. But there you have it. We are in Nigeria. And here, anything goes.