Professor Ememabasi Bassey, a former Commissioner for Health, Akwa Ibom State and Chief Medical Director of the University of Uyo Teaching Hospital in this interview FLYINGEZE BLOG’s Lovina Emole highlights the causes and effects of brain drain, among other issues. Excerpts!
The Federal government recently opened up recruitment of medical practitioners, will that curb the effects of brain drain?
First of all, I would like to thank the federal government for allowing recruitment into hospitals. But that is still not enough because while we are recruiting, we are not retaining. A lot of health professionals are leaving the country on a daily basis. This week alone, I have seen two professionals just resign; so health professionals, primarily residents doctors, even consultants are going to Saudi Arabia. We are seeing a large number of physiotherapists, radiographers, laboratory scientists leaving. Even though we’re recruiting, how do we replace experience? I can bring in fresh physiotherapists for now but how do I replace the 10-15 years on the Job experience?
So what are the reasons for them leaving the country?
There are multiple reasons, but I think the most serious one is ‘economy.’ The highest earning medical doctor right now in Nigeria’s public service is about $1000, but a very junior medical entrant in the UK earns about $3,000 before tax. In the United States, some doctors earn up to $500,000 in a year. Doctors earn that high even though they have to pay tax. So, the primary reason is the economy; our health professionals are not paid enough. Other countries see Nigeria as a breeding ground to poach and take their doctors.
The other reason is lack of job satisfaction. If you are working in an environment where there is no power and equipment to work with, no opportunity for training and developing yourself, you may not be happy.
The third reason has to do with insecurity in some parts of the country. So, they opt to leave. These are some of the challenges that are responsible for doctors leaving the country.
How does this issue of brain drain affect your hospital?
It has affected us, may be not as much as it has affected some teaching hospitals because I think sometime in 2021, in my capacity as Secretary Committee of CMDs, I had a database and I could see the many hospitals that were affected but for me, it affected me in the form that many of my residents doctors and nurses had left and a number of my consultants had also left. And like I said, how do you replace knowledge and experience? At one point, some units were totally empty, all the specialists in those areas had left, so it really affected us.
What are the challenges you encounter as the CMD of UUTH?
The challenges that we have I will say are generic, peculiar to me but also peculiar to other hospitals. If I were to put them on a scale, I would say my number one challenge is power. For quite a long time and even before I came on board, electricity supply was very bad, and I know that previous administrations had attempted to do a dedicated power line to the hospital, that was about 2011, but the job wasn’t completed and by the time NEPA became Power Holding Company, all the agreements were stopped without getting a community line.
When I was appointed the Chief Medical Director, together with my team, we attempted to tackle that, first of all, by reconnecting the hospital back to the national grid. We later discovered that the power was very poor in the two lines. So, we opted to generate electricity. We bought generators, over the last five years, we bought more than six generators- 750kVA, 500KVA we also repaired our 1000 KVA but what has happened is that the cost of diesel has now moved from 180 that it was to N1,200, so you can see the increase. But we are trying to tackle it again by trying to undertake another dedicated line which is advanced, but we still have the challenge of raising adequate money for completion because of the variation in the exchange rate.
Another challenge, which to a large extent, we have solved is infrastructure. The hospital progressed from being a general hospital to State Specialist hospital, to a federal specialist hospital to a federal medical centre and now a teaching hospital without a commensurate improvement in infrastructures.
So, I will say that this is one of the successes that my administration has recorded. We were able to complete most of the abandoned projects, which we found on ground, from the general outpatient department, the radiology block, the laboratory complex and others, we have been able to complete all those projects and we have started some new projects which are there for people to see; the hospital is a huge construction site. We hope in the next few years, both staff and patients will be able to derive maximum value from the projects.
The third challenge which is generic, but peculiar to every other hospital, is finance. Government pays salaries of staff and also gives capital which may not be adequate. We are grateful but when you realise that the cost of everything is high, we don’t produce everything in Nigeria, the cost of our consumables and supplies and equipment are all denominated in dollars. This hospital alone, the cost of buying such things as antiseptics, methylated spirit, bleach, if you are not careful, you will end up spending over N10 million just for basic consumables.
I think we are not probably funded but that is the case for every hospital. So, finance is still a major challenge. When we generate money we end up spending almost 50% of what we generate for diesel alone. We are a training institution, we need money for training, workshops and seminars.
Also I have the challenge of the attitude of staff to patients. This may not be peculiar to other hospitals but to me. One of the challenges I have is that we have a relatively poor organisational culture, and that’s because I don’t think there has been any targeted attempt to change the poor organisational culture but we are trying to see how we can have that conversation, have regular trainings here to improve on the attitude of staff. I wish I could get my staff to begin to see patients as clients in the corporate sector and relate with them as such.
What do you think the government can do to tackle some of these issues, especially brain drain?
Actually, this involves a lot of articulation of policies. I think at the highest level we have to begin to have a discussion on how to reverse brain drain and see people come back to Nigeria. First, there has to be a conducive environment for them to work. Imagine, a situation where even when there is 10-15% of Nigerian experts in the United States come back to Nigeria and there was funding for them to set up high brow medical facilities or even be integrated into the current government facilities with the right equipment, what you are going to see is migration of people from other countries coming to Nigeria to seek medical care, so, it’s one of the things which we have to do.
But beyond that, we have to address the gaps in pay. I wish I could say health professionals should be paid in dollars but that is not possible but whatever it is, salaries of health professionals should be looked into. For instance, I would rather earn the equivalent of three or four thousand dollars in naira and stay in Nigeria, than to go to the UK or US and earn N10, 000 dollars. Why? Because with that N10, 000 dollars I am going to pass through a lot of taxes and work in a very restricted environment.
There is a bill seeking to compel medical professionals to serve for more than four years before leaving the country, what is your take on this?
I am very careful because I’m an employee of the government, but I would say that the bill has positive and negative sides. From the negative side, I would say it is against somebody’s fundamental human rights. If the person is not owing, for instance, if you are on scholarship or student loan and all that, then the bill can apply to you. But when you have to pay for your education then it shouldn’t be.
But on the positive side, I want to say that university education, to a large extent, is highly subsidised because I have a son in a medical school and I also have another son in a private university. My son in the private school is not studying medicine but his school fee is 15 times more than my son who is studying medicine in a government university. So, what does that tell us? To a large extent medical education in government universities is highly subsidised. So, patriotism should set in, people should not be in a hurry to leave.
What inspired you to become a medical doctor?
My mother was a nurse and you know that the dream of every nurse at that time was to have a doctor son. Apart from that, we had family friends who were medical doctors and for whatever reason very early in life, I just took the liking, there was never any other choice. I never considered doing any other thing than becoming a medical doctor. Let me shock you that I was the best art student in my class. I had a very funny combination which I have not seen anybody do before; I did physics, chemistry, biology, literature, Bible knowledge and history. I was the best in the Arts and above average in the sciences. If I had applied, it would have been easy to read history and enjoy them. I think I would have made a good lawyer but like I said, I never had any choice.
There is this bad work ethics that is going on, especially among health professionals in public hospitals where most of them run their private hospitals at the detriment of government facilities. What is your take on this?
I would say every civil servant does private practice because your pay is usually not enough. For instance, a person who is running a farm, a shop. For doctors and health professionals, it is not a good thing to engage in private practice. So, I really will not support medical doctors leaving their work and going to government-owned facilities and in the process shifting patients from government facilities to private facilities; it’s totally against work ethics.
Recently, there have been incessant strikes by resident doctors. Are you worried about this?
I would say there has been incessant strikes not only by medical doctors, a lot of other health professionals also go on strike, but if you look at the labour today, there have been strikes upon strikes. So, strike is a Nigerian problem. I was a resident doctor before I became a consultant and beyond that I was also a national officer of both the local branch of the National Association of Resident Doctors and we did have strikes. As an administrator, strike is something you go as a last resort when every other attempt at settlement has failed but what I see is that strike has become a first line charge; it shouldn’t be so.
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