Doctors go to America, Canada, UK in droves
Why Nigerian doctors are relocating abroad
By Job Osazuwa
The exodus of Nigerian health care professionals is apparently making the sector to progress in reverse order. The mass emigration of these skilled workers has continued unabated over the years, grinding the system in no small proportion.
Many analysts and public health experts have exerted that the lapse was due to decades of harsh economic policies, which had led to chronically under-funded health systems. There is no gainsaying that the effects of brain drain syndrome in Nigeria’s health sector are devastating. Today, Nigeria’s health system wobbles and the future bleaks even the more, no thanks to the huge challenges this single problem of human capital flight.
A former Minister of Health, who served 2003 to 2007, Prof. Eyitayo Lambo, once warned that African health development face a double-edged crisis, pointing out that its health systems were fragile and its human capacity grossly inadequate. More than 10 years after the postulation, Nigeria’s health industry is already left in a state of quagmire.
The health institutions/facilities have continued to beg for an overall cleansing; this is a necessary antidote without which health care delivering will remain in total disarray.
The flight of medical personnel from Nigeria is not unconnected with the prevailing severe economic recession and hyper-inflation, among many others, which has reduces the purchasing power. Many other glaring and remote factors are culpable for the brain-drain conundrum.
Despite the dearth of personnel in the wellbeing sector, it is laughable that only less than one-third of the registered Nigerian doctors practise in the country while over two-third of the professionals are migrating abroad, solely to earn better wages and career development. It is simply stating the obvious that the ugly trend has also reduced the number of dynamic and innovative people in the health care sector, which the stakeholders and keen observers believed to be responsible for the medical quackery in the length and breadth of Nigeria.
In most states, the situation is palpable. Only one doctor is incredibly available to treat 30, 000 patients, while states in the North are as worse as one doctor to 45, 000 patients. In some rural areas, patients have to travel more than 30 kilometres from their abodes to get medical attention. Many have described brain drain as a product of bad governance.
The ration is sharply against the World Health Organisation’s (WHO) standard of one doctor to 600 patients 1-600. In the USA, that ratio is one doctor to 300 patients, therefore raising the bar. As a result, public health experts have postulated that Nigeria needs at least over more 200, 000 doctors for its population to meet the global standard set by the WHO.
Having an overview of the situation, the former Registrar of the Medical and Dental Council of Nigeria (MDCN), Dr Abdulmumuni Ibrahim, observed that over 10, 000 doctors were practising illegally in Nigeria. With the alarm raised and in relation with the nation’s weak monitoring mechanisms and systems, one is left to imagine how many charlatans are posing as professionals.
Many people who chose the medical profession at tender age did so with a desire to save their fellow countrymen and women from communicable and non-contagious diseases. Little would they know that when they are finally awarded the golden degree and working briefly but would be frustrated to jet out of the country by several factors.
It is reported that approximately one third of graduates from Nigeria medical schools migrate to USA, Canada or the UK within 10 years of graduation.
However, some persons have repeatedly accused Nigerian health professionals who export their knowledge as being unpatriotic, but others have also countered and called on the accusers to recognise the rights of doctors to have the freedom of choice on where they would like to work. The latter are rather asking governments at all levels to address the factors that push the practitioners out of the country.
The then President of the Nigerian Medical Association (NMA), Dr. Osahon Enabulele, had once revealed that out of the 71, 740 doctors registered with the Medical and Dental Council of Nigeria (MDCN), only 27,000 were practising outside the nation’s shores.
Similarly, a September 2016 report authored by the British National Health Service states put Nigerian doctors plying their trade in the United Kingdom (UK) at about 4. 000. Several reports reveal that 20, 000 and 40, 000 Nigerian doctors are practising in the United State of America (USA). These figures, even to a layman, represent the ugly phenomenon of brain drain in the nation’s health sector.
Many developed countries, notably US, have been accused of deliberately creating the brain drain syndrome by issuing specially-tailored visas to woo Africans to strengthen their own health care sector.
In this regard, former President Goodluck Jonathan was commended for signing the National Health Act into law in October 2014. Section 11 of the Act mandates that 10 per cent of the basic health care provision fund to be spent on developing human resources for primary health care. But implementing the law has remained a hard nut to crack till date.
A pharmacist based in Benin, Mr. Idiagbonya Moses, in a telephone conversation with the reporter, said abandoning the country for developed and more serious-minded countries could be too tempting to resist when the opportunity arise.
According to him, “it is not only the US and UK that Nigerian medical professionals migrate to. I have a close friend, who is one of the finest surgeons in South Africa. We finished the University of Benin same year. He only practised in Nigeria for three years before he moved out of the country.
“I still can’t believe why the Nigerian government feels it is not a major issue. In fact, it is something that needs to be tackled because everybody in the sector wants to leave the country for one reason or the other. Whoever believes that the reason we want to leave is mainly about money should have a rethink. There are number of contributing factors. They range from dilapidate equipment in hospitals and the mismanagement of the little resources, especially in government hospitals.
“We do not have the basic framework to allow me to do my job properly. There are rare or no opportunity for professional career development and training. Every health worker, order than a doctor, wants medical research and up-to-date clinical knowledge, which are not accessible in Nigeria. Most of my colleagues have already left and those remaining are making plans to leave.”
A doctor, who practises at a private hospital in Lagos, Akinwunmi Adebayo, described the losses, which include loss of public educational investment and intellectual capital flight, as a national embarrassment.
He said the scenario would lead to reduced range of available services, chronic understaffing of health facilities, and poor healthcare services. Other areas of concern to him are the continuous widening of the population health gap that is capable of consequently reducing productivity, loss of national economic investment, and overall potential damage to economic development.
He said: “There is need for greater incentives from the government to keep the doctors that remain, and attract those trained overseas to come back to Nigeria to help make a positive difference in the sector. Nigerians deserve a better health care system. The rich men run abroad for treatment mainly for the well-equipped hospitals and highly-motivated doctors over there. But the people on the street cannot afford the cost; they cannot secure a visa let alone the money for flight.”
A nurse, Roseline Agwu, told Daily Sun that no one should expect that the salary of doctors in Nigeria will match that of their US or UK counterparts, stressing that it was unrealistic in three decades. She said many of her colleagues that left Nigeria about seven years ago never returned after professional courses abroad. She said many of them had confessed to her that they were not happy leaving their family members and loved ones behind but took the decision in order to develop their careers in an environment that provides the needed supports.
Said she: “We are in the same profession, but there are some facilities they might be using, which will take another four or more years to get to Nigeria. You will agree with me that the health care system of last 10 years in Nigeria still remains the same. When I sometimes think of what they earn, minus taxes, l don’t know where I still get the strength to continue practicing here.
“There is poor funding, yet, those at the helms of affairs still embezzle from the limited resources. It is the patients that suffer at last. We also suffer as well because there have been preventable deaths we couldn’t help stave off.”
Some practitioners have also raised the alarm of government tax collectors turning doctors in private hospitals to become endangered species and prime targets for both legal and illegal taxes.
“Different agencies, such as state Board of Internal Revenue, Ministries of Health, Commerce and Industry, Environment, Environmental and Waste Management Board and Local Government agencies demand levies for similar items. This has made the environment not conducive for optimal medical practice,” an affected stakeholder lamented.
Causes and consequences of brain drain
Emigration is traceable and tied to a combination of push factors in source countries, and pull factors in the recipient countries.
The reasons most Nigerian health workers don’t return to their home country after training abroad include: Lack of research funding; poor research facilities; poor intellectual stimulation; lack of good education for children in home country and lack of the evidence-based decision-making culture among decision makers.
The key push factors driving out health workers from Nigeria are: weak health systems; poor living conditions; low remunerations; lack of professional development opportunities – continuing education or training; lack of clear career development paths; nepotism in recruitment and promotion; widespread poverty; poor governance; and case overload (leading to burnt out syndrome in health workers).
They are attracted to developed countries as a result of: sophisticated working equipment; availability of information, easy access to communication and technology; availability of employment opportunities; better remunerations and working conditions; secure and conducive living conditions and opportunities for intellectual growth.
Nigeria appears clueless and hapless in the face of this syndrome, as the authorities can neither control the outflow of these specialiased skill labourers nor ignore its consequences on the entire society.
Brain drain not entirely bad, but…
There are immense comparative advantages imbedded in international collaboration, with doctors moving around the globe to gain further training and different clinical experiences. But the fear for Nigeria remains the fact that the western world gains more in the seemingly romantic delusion, while developing countries, including Nigeria, lose out by losing their doctors permanently.
Nigeria has refused to develop sustainable strategies and incentives to persuade doctors and other health workers to return to their countries of origin after training and seminar abroad. Even with that, the practitioners believe that as long as the rich countries have plenty of vacancies, the flow of health care professionals from Nigeria and the rest of developing countries will continue.
The need for an enhanced salaries, better pensions, cars, and housing allowances for health care professionals and consolidated working environment has remained at the front burner.
Groundnut: Rich source of protein
By Doris Obinna
Groundnut (Arachis hypogaea), which also goes by several other names, such as, peanuts, earthnuts, monkey nuts, pinders, etc, is actually a legume that grows in the ground.
According to experts, groundnuts, along with peas and beans, are among the best sources of protein in the plant kingdom and they are also super high in polyphenols; the chief of the antioxidant group.
Groundnuts play a vital nutritional role in many parts of Africa, since they are high in protein and healthy fats. In some parts of Africa, groundnuts represent a substantial percentage of the protein available for consumption.
It has a high nutritional value. It is a rich source of energy, high in protein content, vitamins such as A, E, B complex and vitamin C are found abundantly in groundnut. It is a rich source of minerals calcium, copper, manganese, phosphorus, potassium, zinc etc. Groundnut is rich in protein content; it contains more protein than meat, eggs and any other.
Health benefits of groundnut
Heart healthy fats: Groundnuts contain monounsaturated and polyunsaturated fats that keep the heart healthy. A good level, of both; monounsaturated and polyunsaturated fats result in lowering blood cholesterol levels, and thereby; reducing the risk of coronary heart diseases.
Proteins: Protein is essential to the health of our cells. The cells in our body are constantly being replaced and repaired. To ensure that the new cells are healthy, and the damaged ones are repaired well, we need protein. Peanuts are an extremely high source of plant protein. It should be regularly incorporated in diet for children, vegetarians and protein deficient people.
Antioxidants: Groundnuts contain high concentrations of the antioxidant polyphenols, primarily a compound called p-coumaric acid and oleic acid that not only protect the heart but also inhibit the growth of free radicals keeping infection at bay. They also lessen the risk of stomach cancer by preventing the formation of carcinogenic nitrosamines in the stomach
Minerals: A rich source of minerals like magnesium, phosphorus, potassium, zinc, calcium, sodium, etc, so needed by our body to function well, is ensured by a regular consumption of peanuts. Adequate supply of these minerals ensures a healthy heart, and ensures minimized risk of mineral deficient diseases.
Vitamins: Vitamins are important for overall growth and development. Vitamins ensure vital health for cells and tissues, and for fighting infections, etc, that in return ensure smooth functioning of our organs. Groundnuts provide our body with essential vitamins that also help in regulating metabolism, converting fat and carbohydrates into energy, and facilitating bone and tissue formation.
A good source of folate, groundnuts reduce the incidence of birth defects, and anemia related conditions.
The number of groundnuts health benefits match the number of ways it can be consumed; shelled nuts can be eaten fresh, roasted, or boiled, salted peanuts are often sold in packets or cans, the peanut oil extracted from this legume is used as a cooking medium, and broken peanut is used to make candy bars, and yes, let’s not forget the creamy, crunchy groundnut butter!
However, excessive groundnuts intake might lead to gas, heartburn, and a suddenly developed food allergy to peanuts.