Ngige’s surplus doctors

Dr. Chris Ngige, minister of labour and employment, may indeed be a  typical old school civil servant whose noble qualities include being a stickler for law and order, processes and procedure and, above all, unalloyed loyalty and obedience to almighty GO – the late but lamentable General Order with its litany of dos and don’ts.

As a team player, the said GO forbids you to disagree publicly with any position duly canvassed, discussed, debated and arrived at either with a vote or by consensus at official meetings.  Doctrine of collective responsibility ensures that you must toe the official line at all times even if you have genuine reasons to dissent. Loyalty is absolute. And it forbids you to criticise or draw attention openly and publicly to the seamy side of government or some clear inadequacies of government. For the avoidance of doubt, don’t wash government’s dirty linens in public.

Minister Chris Ngige must have borne all these in mind the other day when he appeared on public television to defend government position on the unending debate about the adequacy or inadequacy of doctors in the country and why the government cannot and should not lose sleep over the apparent brain drain as it affects the medical profession. Appearing as guest on Channel TV’s sunrise programme, he was taken up on the exodus of doctors from the country in search of greener pastures. He flatly denied there was any brain drain. And if there was any brain drain at all, he said, it was a welcome development because the country had surplus doctors.

And he was ready to bet. “Who says we don’t have enough doctors? We have more than enough. You can quote me. There is nothing wrong in them traveling out” said the minister who reminded his listeners that in the good old days he had teachers who came all the way from India to teach him Chemistry and Biology because that country could let go their surplus teachers.

“I am not worried, if we have surplus doctors, we export” says the honourable minister who exalted with pride because of the money they remit home to their people. But as an unelected umpire watching the encounter on the side line, I could see clearly that the minister was in a tight corner. The problem with Dr Ngige’s argument is that he appeared to be unable to draw the line between patriotism – protecting the country’s image and telling the truth as he was wont to do or facing the reality that was common knowledge to even the uninitiated.

I am quite convinced that the minister was not unaware of the true situation in the medical profession and the health service in general.  He may not have touched his stethoscope in a while or, for that matter forgotten, his Hippocratic oath but he couldn’t have been totally out of touch with reality to say it in such a lavish manner that the country was adequately supplied with doctors and only the surplus is what constitutes the brain drain that is apparent.

Even if Dr Ngige was mistaking all the medical attendants, including recent graduates of schools of health technology for doctors as it is common practice with the rural folks, Nigeria has not achieved the ratio of doctor-to-patient as recommended by the World Health Organisation, WHO.

Let’s turn to those who know, and who have no business white-washing the situation to make the country look good. One of them is the President of Nigerian Medical Association, NMA, Dr Francis Adedayo Faduyile. He says Ngige was economical with the truth. If you want to know whether Nigeria has adequate number of doctors, he says, all you need do is to compare the doctor- to-patient ratio in the country to the ratio recommended by the WHO and that ratio is one doctor to 600 patients. For Nigeria, however, the ratio is one doctor to about 6000 patients. A far cry from what Ngige says is adequate.

All you need do to come to the conclusion of this appalling inadequacy is to take a trip to any of the rural areas of this vast country.  In  some of the rural areas, the people’s “doctors” are invariably the patent medicine dealers whose  “hospitals” are no bigger than one little store containing a cupboard and a shelf  for storing  some analgesic drug which is a cure-all medication for all manner of ailments ranging from common cold to  malaria  and  even high blood pressure.

A sick fellow in the village who has been calling his relations in the cities requesting for money for drugs, would cheerfully tell them, if they asked why he had not been to the hospital, that he had in fact gone to all the hospitals around without any improvement. You would be shocked to learn that the doctor who had been treating the fellow in question was no other person than the patent medicine seller next door whose omnipotent drug is either paracetamol or panadol or some expired antibiotics.

But Minister Ngige says, all the same, that the country has enough doctors to go round. But even if he adds these quack doctors to make up the number, the country may still be far short of the recommendation of the WHO.  Even if by some miracle Dr Ngige picks these health workers and dispensary attendants and lump all of them together to make the number, the arithmetic may still prove stubborn – the number would simply not add up.

Truth is there is no pulling them back, those migrating to better opportunities abroad. Yes, they may be attracted by the good money to be made there but majority of them, I beg to wager, want good environment with adequate facilities to practise their profession.

Until recently, some of our teaching hospitals had been in dire need of facilities. The hospitals, like their patients, were also in urgent need of cure, cure from neglect, from abject lack of essential facilities that would make them truly hospitals for training students and for treating the sick.

Ngige may be right after all. He may be right not about the number of doctors at home, but about the money they make abroad and remit home. A friend recently sent me an unverified graph or table showing remittance from Nigerians in diaspora. The figure for 2018 was put at $25.1bn compared to gross oil revenue for the same year which was put at $18.2bn. These figures, if true, show that Nigerians in various professions abroad including hair dressers and those women who ply their trade in the dark alleys of Italian cities, are in good business and they are patriotic enough not to forget home. The money they send home tickles our economy and help greatly to tweak the figures of national earnings.

Ngige may have surplus doctors for export but he will make a more sensible contribution if he can persuade his colleagues in the Federal Cabinet to look more closely at the inadequate medical facilities at home and set them right for doctors, not urgently minded to emigrate, to stay back and give their best.  By his own admission, he is aware that there are many government hospitals in the country today which cannot maintain some vital facilities like CAT scan and MRI scan which are available only in some private hospitals.

Another area of concern is the training of doctors. The carrying capacities of universities offering courses in medicine should be expanded and equipped with the best facilities and the best teachers to create a more conducive training and learning environments to produce more qualified doctors.

Finally, if the Buhari administration curbs corruption sufficiently enough, hopefully, it would save enough funds with which to improve our health delivery services if it believes truly that health is wealth.