Dr. Rukayat Salami left Nigeria after her housemanship at the Lagos University Teaching Hospital to pursue a Masters in Public Health (MPH) at Johns Hopkins University School of Public Health. “I decided to leave Nigeria whilst I was doing my house job right after medical school,” she said. “I was trying to find an escape route from being a clinician into the field of public health, mainly because I felt like the system and the clinical environment was a little overwhelming and felt a bit challenged by the poor infrastructure and the work environment in the clinical setting, and I felt like in the long term I probably won’t be happy, and so I wanted to dabble into the field of public health.”
For Dr. Salami, the thought of becoming a clinician in Nigeria was harrowing. “The work environment was depressing and seemed challenging for me, following the clinical experience in medical school, facing the reality of being a physician in Nigeria, seeing people die for very frivolous reasons that pretty much were attributable to poor infrastructure, poor organisation, and a very low support system for the physicians,” she said. “I primarily did it to find an alternative route, I didn’t want to get stuck in clinical medicine because I thought it would break me at some point.”
After earning her MPH, Salami did a residency training in Pediatrics at the John H. Stroger Jr. Hospital of Cook County. She is currently a Pediatric Hospitalist with the Ann and Robert H. Lurie Children’s Hospital in Chicago.
Dr. Otito Frances Iwuchukwu, who graduated with distinction in 2000 from the Faculty of Pharmacy in the University of Ibadan, said the lack of basic training resources were instrumental in her decision to leave. “I recall as an undergraduate trying to get my final dissertation done and having to travel almost every other week or so to the University of Lagos (thank you Professor Ifudu) to get my analysis done because the one machine we had in UI had broken down. It was quite stressful being on the road all the time with all the attendant dangers, but we did it because that’s just what you had to do to graduate on time,” she said. She decided not to pursue a post-graduate degree in Nigeria, and left in 2005. She is currently an Assistant Professor of Pharmaceutical Sciences at Fairleigh Dickinson University School of Pharmacy in Florham Park New Jersey and practices clinically at St Barnabas Medical Center in New Jersey.
Salami & Iwuchukwu are just two of a continuously growing retinue of Nigerian doctors who have gone beyond the shores of the country to seek better opportunities or different experiences that those afforded them in Nigeria. This brain-drain in the health sector, which has always existed on some level, has in recent years taken on an alarming turn with the changes in the state of the Nigerian economy.
The increasing trend in the emigration of health workers, especially Nigerian doctors, for other more favorable climes spurred Nigerian Polling Organisation NOI-Polls to conduct a survey in May that sought to explore the reasons doctors were choosing to leave Nigeria. In partnership with Nigeria Health Watch, the survey has been developed into a report which draws out the prevailing issues that are challenging doctors in the health sector and driving them away from Nigeria’s shores. The survey was targeted at Nigerian medical doctors of various cadres, and it employed both quantitative and qualitative methods.
The report, titled, “Emigration of Nigerian Doctors Survey Report,” was launched on Thursday, August 3, 2017, at a press conference held at the NOI-Polls office in Abuja. A total of 705 doctors completed the online survey, the majority of whom were in Nigeria. Respondents to the survey cut across house officers, National Youth Service Corps members, medical officers, senior registrars, consultants, and medical directors. In addition, 26 in-depth interviews (IDIs) were conducted with medical doctors in Nigeria as part of the qualitative approach to gather insightful information on the challenges and underlying factors causing doctors to seek work opportunities abroad.
For Dr. Hilda Ekochin, who studied Medicine at the University of Nigeria Nsukka (UNN), and Surgery at the University of Nigeria Enugu Campus (UNEC), leaving Nigeria was not originally on the cards. “My class was the 2002 class. Thanks to strikes, we finished in August 2004. I started housemanship right away and finished that in September 2005,” she said. “I actually never wanted to leave Nigeria. I was rather brought up with a desire to stay and make the most of it. In fact, any suitors I had from America at the time were immediately disqualified for that reason!”
Still, in 2005, she found herself leaving Nigeria for the US. “I married a school mate. He was done and I had a couple years to go. He is the one that decided that we would leave. I tried to convince him otherwise, but he was bent on it. He wanted us to leave because he was convinced we would have a better life in America, job opportunities and job compensation. He had family here (in the US) who convinced him as such.” Dr. Ekochin is now an Internist and works as a Hospitalist.
The Emigration Survey Report noted from the responses to the interviews, “Some doctors complained about how house officers and junior doctors are maltreated and verbally abused in the presence of patients, making the patients lose confidence in the house officer’s abilities as a physician. House officers and junior doctors were said to supervise the most number of beds on the floor, yet instead of being encouraged they get bullied and openly chided for every wrong decision made when their attending resident was not available.”
For Public Health Dentist Bunmi Adekugbe, who studied at the University of Ibadan, and worked in several organisations after school, the decision to leave was made four years before he actually carried out his plan. “I made up my mind in 2002, and I left in 2006,” he said. “I looked at the medical system in Nigeria and I just felt it was not going to bring out the best in me. Residency in Nigeria was completely out of the question. I wasn’t impressed with the level of service that the medical system was offering to the patients, and I felt that I should avail myself of other opportunities, and leaving the country was perhaps the only way I felt I could take advantage of those training opportunities, and possibly just to see medicine from a different set of lenses.”
NOI-Polls CEO Dr. Bell Ihua, said, “Imagine what would happen to the country if 88 percent of our qualified and experienced medical doctors leave the shores of the country in search of greener pastures abroad. Doctors’ emigration is a ticking time bomb which needs to be nipped at the bud by engaging in critical reforms of our health systems, structure and policy.”
When asked what advice they would give to other doctors who are thinking about leaving, Dr. Salami, Dr. Ekochin and Dr. Adekugbe were frank with their thoughts.
Dr. Salami said, “Honestly the advice I would give people considering leaving would be that it’s not a bad idea, unfortunately. I am a very patriotic Nigerian, for many years and still going onwards I do feel very homesick, I come home often, I want to give back, but I would say to those who want to leave that first you have to define the reasons why you are leaving and you have to be true to self.”
For Dr. Ekochin, it’s important for those thinking of leaving to plan. “We all don’t have to leave. Be sure what your destiny path is. Have a plan! If you just decide to show up and then figure it out, there’s a high chance you would settle into a life that may not be as good as what you have in Nigeria. A lot of Nigerians misrepresent things to people back home. It’s in our boastful nature to make people think ‘life is good’ when in actuality it’s not. The grass is not always greener on the other side. Americans wouldn’t hire a foreigner for a job if there is another American able and willing to do the same job.”
Dr. Adekugbe feels that some exposure outside Nigeria is important, whether permanent or temporary. “I would strongly encourage them to (leave), but everybody leaves for different reasons, some leave to return, some leave for good, and some just find a way to make it work, but I think that to just sit in the Nigerian system and expect to understand medicine in its entirely may not be a very good career choice. I think every doctor should try to see how things are practiced in other places. So even if you are not going to leave permanently, to consider leaving for a bit to kind of see how medicine can be practiced elsewhere.”
Dr. Salami pointed out that there are challenges for those who are leaving to consider. “The truth is that the overseas environment is getting saturated so you have to come with extra, extra in terms of whatever qualifications you are coming with. As a physician, you have to do really well in your board exams, you have to have certain extra credentials to give you a leeway because the foreign environment seems to be getting more and more saturated. But I would be a hypocrite to dissuade anyone from leaving because I left, but quite frankly when I left I honestly, sincerely had plans to return way earlier than I ended up being here,” she said.
Dr. Ifeanyi Nsofor of Nigeria Health Watch pointed out that emigration affects the very heart of access to healthcare in Nigeria. “Emigration of Nigeria medical doctors is a great impediment to achieving Universal Health Coverage for all Nigerians,” he said.
Dr. Salami said any change in the system needs to come from the top. “I believe that the one thing that would make a serious change in the system is to have checks and balances and consequences, and it will start from value, it’s going to have to start from the very top,” she said. “Once health is viewed as an extremely valuable commodity as it is in the countries where the brain drain is leaning towards, things will change.”
Dr. Iwuchukwu said, “What could be in place in the Nigerian healthcare and education system is collaboration, and I do not say that lightly. No man is an island unto himself. We all need each other; doctors, pharmacists, nurses, physical therapists, you name it. The days of people being a God unto themselves should effectively be over, whether you are a Professor or a Consultant Fellow of the Academies, we need to come together to effectively train the next generation of healthcare practitioners. The world is changing and is not waiting for Africa again.”
And despite having left Nigeria, Salami said that many doctors who have emigrated are still looking for ways to make impact on the Nigerian health system, and implores government to make that process easier for them. “I think they (government) should try to get those who have been part of the brain drain to come back,” she said, adding, “Many physicians want to help. Many physicians in the foreign environment, they want to be part of the brainstorming process, they want to help fix the system. They want to be part of the system. But then the system isn’t welcoming, it’s not embracing… I’m hoping that maybe someday that would come to pass.”
Read the full Emigration of Nigerian Doctors Survey Report
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