Brain drain 2.0: Nigeria’s best doctors are leaving

Less than 24 hours after BusinessDay reported the number of Nigerian trained medical doctors working in the UK, the number increased by one when BusinessDay checked again yesterday bringing Nigerian doctors practicing in the country to 5,340, according to data from the UK General Medical Council website.
An average of 12 doctors who had their primary medical education in Nigeria are said to register for practice in the UK every week, and when Nigerian trained medical personnel in other places such as the US, Canada, and some oil rich gulf countries are added, the total number of Nigerian doctors practicing abroad could be in excess of 20,000.
BusinessDay correspondents visited some public and private hospitals within Lagos, to interact with doctors and with the exception of only one doctor with a contrary view, all expressed willingness to go abroad at the first chance they get.
The only doctor (practising in LASUTH) who said he’s not eager to go abroad, said this is because he has some other personal businesses he is engaged in.
For the majority however, the perception is that “leaving the country to practice abroad gives you the opportunity of being exposed to recent technological advancements in the medical health sector, and an opportunity to for instance, conduct surgeries with more effectiveness (for patients) and ease (for the doctors).”
Others expressed more personal reasons like the need to get the best education for their children, since they cannot afford the huge cost of sending their children to private schools considering the poor state of the public schools’ system.
“Our best doctors are leaving Nigeria. Over 50 doctors left LUTH (Lagos University Teaching Hospital) this year,” a senior medical practitioner told BusinessDay.
Kelechi Otuneme, public relations officer at LUTH, however said while he could not confirm the number of doctors who have left, more importantly, it cannot be established that they left the country entirely.
The unfriendly work environment has implied health workers in Nigeria continually find every possible way to exit the country, leaving behind a health system which many in the mildest of descriptions, say is simply not working; not for the patients and not for the medical practitioners.
“We are having a second wave of brain drain of medical professionals in the country. Interestingly, those who participated in the first wave of brain drain of medical professionals in the early 90’s want to come back now that they are older. But the conditions back home are not encouraging them to come back with the skills and experience they have acquired from their years of staying abroad,” said another senior medical practitioner who operates a hospital where he says three of his doctors have already relocated abroad in the last one year.
In 1948 when the university college hospital Ibadan was set up, up till the 1970s, it ranked among the top four in the commonwealth, but now it is not even rated, BusinessDay findings show.
But as doctors, nurses, and other health workers leave the country in droves, even the medical schools that are supposed to train doctors to replace those leaving are also suffering.  Some of the country’s best hands in the medical schools are also finding their way out of the country, with the quality of medical education gradually eroding away.
Informed sources in the health sector told BusinessDay that the quality of medical education has depreciated, almost as much as medical facilities in the country. It was even stated that at some point some medical schools were threatened with decertification of some courses, and of note were the Surgery and Dentistry programmes at the College of Medicine, University of Lagos (CMUL).
“The quality of medical education in the country has dropped significantly,” said Ogbonnaya Igbowke, head, Health Thematic Group, human capital policy commission, Nigeria Economic Summit Group (NESG) “A lot of what is done today is more of theory and less of practical, and the reasons are not far-fetched. There is indeed lack of materials, equipment and research grants or funds to boost learning outcomes in medicine and medical health sciences.”
“We are in a deep problem to say the least. Most doctors have never seen physically, most of the machines that they are required to use in the course of their practice and they have been in practice for a long time,” said Igbokwe, who is also CEO of Heartwells Group.
The President, Association of Resident Doctors in one of the tertiary health facilities who did not want his name in print, told BusinessDay there are “universities that are losing accreditation because of basic things to train medical personnel. If these things are not available, why would I as a lecturer want to train students that I am sure cannot boast of being compared to others in other parts of the world?
“A lot of good brains, people who are distinction candidates, who should have stayed back to impact knowledge are no longer in the country but abroad because of the same set of reasons that we have. Even teaching aid to teach medical students are not available in a lot of our universities,” he said.
Besides poor equipment, most medical schools have been accused of taking in more students than they can cater for adequately.
“We have medical schools admitting 150 students when they have capacity to take in just 20-50 students. Some students have told us, they do not do much of practical but ‘theory of practical.’  They are asked to describe a practical procedure, instead of actually carrying out the procedure,” a senior medical practitioner told BusinessDay.
When BusinessDay contacted Oladejo Azeez, the College Secretary and Head of Administration, CMUL, to confirm if the school has been threatened with decertification, he declined to comment.
But BusinessDay also learnt from some practicing doctors that even internship positions have become scarce for trained doctors when they leave medical school.
Some of them have to wait between one to two years to get an opportunity to do internship, further putting the quality of their learning at risk. It is understood that poor funding means that most public hospitals do not want to take on new interns until they are sure they have the money to pay them. But in the process, they end up making this medical graduates stay idle waiting for internship positions.
But sources say that because of the risk of not getting internship positions, most medical graduates have started writing foreign medical examinations from their 500 level, hoping they can pass the exams and leave the country.
The result is that the falling standards of medical practice in Nigeria, has become the gain of other countries, and it is unlikely when the trend will come to a halt.
“If we continue like this, our health system, in a few years will not remain the same because there will be reduction in the quality of graduates that we have, (owing to) a reduction in the transfer of skills and knowledge among medical practitioners.”
Francis Faduyile, president, Nigerian Medical Association, explained in an interview, that medical schools are confronted with a lot of challenges, mostly due to inadequate funding, whereas even the little available is not properly spent.
Faduyile also confirmed that when many of the specialists conclude their training, it is easier for them to sit for one or two foreign qualifying exams, then leave the country for foreign destinations where he says “they do very well”.
Whereas, the same people could be “roaming around for up to five years looking for internship placement, if they choose to stay in the country.”
“These are challenges faced in terms of capacity to produce the right quality of medical personnel,” Faduyile explained.
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