Death on duty: State negligence leads to exodus of Nigerian doctors

For years, Nigerian doctors fled overseas, seeking better pay. Now, they say they are doing so to avoid dying on duty.

A surgeon is seen at work on a patient with a bullet wound at the main hospital in Maiduguri, northeast Nigeria
A surgeon is seen at work on a patient with a bullet wound at the main hospital in Maiduguri, northeast Nigeria, January 25, 2022 [Audu Marte/AFP]

Lagos, Nigeria — At about 7pm on August 1, when Vwaere Daiso exited her room on the ninth floor of the 10-storey residence for doctors at the Lagos hospital where she worked to retrieve a parcel from the ground floor, she had no idea it was the last time she would do so.

Moments later, she crashed to the floor together with the lift which had become unhinged.

No help came until after 40 minutes of frantic calls for a rescue team by the facility manager and Daiso’s roommate, who sprinted several flights of stairs to call him. The machines in the emergency section were not working either when she was taken there, so she was pronounced dead just as resuscitation began at about 8:59pm.

The 26-year-old’s death and the state of the facilities in the state-run establishment have angered many of her peers, including Joy Aifuobhokhan, one of the first responders at the scene.

“With all due respect, I feel like that [the late treatment] was medicine after death,” Aifuobhokhan, who was stuck in the same lift last year for hours, told Al Jazeera. “Imagine all of that was in place when Vwaere was first brought in within the first five minutes.”

The struggles of Nigeria’s healthcare system are well-documented and have affected the quality and number of doctors available locally, for decades.

According to the World Health Organization (WHO), at least 2,000 Nigerian doctors emigrate yearly to hotspots like the United States, the United Kingdom, and Canada. Since 2019, Nigerian newspapers have been reporting about recruitment exercises conducted by Saudi officials in Lagos and Abuja.

The average salary for a Nigerian doctor in the employ of the federal government, is 240,000 naira ($312.92) monthly, a fraction of the 2,448 ($2,967.20) average remuneration for their peers in the UK. Those employed by the state governments earn even less.

And that has been a key factor in their migration.

But doctors say fleeing Nigeria is also a matter of life and death even for them due to deplorable working conditions and poor equipment as they work round the clock.

On September 17, a doctor at the Lagos State Teaching Hospital died after working nonstop for 72 hours.

‘A vicious cycle’

After Daiso’s death, the Lagos state government fired the hospital facility manager and suspended the head of the agency responsible for maintaining the lift. The police also arrested three people.

The incident highlights the state of the health system, according to Dr Fejiro Chinye-Nwoko, general manager at the Nigerian Solidarity Support Fund, a Lagos-based NGO fundraising for medical interventions.

“A strong health system needs to be able to forecast, plan, and respond adequately to health emergencies,” she said.

Only about 72,000 doctors are registered with the Nigerian Medical Association even though approximately 3,000 doctors graduate from Nigeria’s medical schools yearly.

Worse still, only about 35,000 practise in Nigeria, a country of 200 million people, a ratio of one doctor to 10,000 people. This is far below the WHO’s recommended doctor-to-patient ratio of one doctor to 500 people.

This is compounded by a steady decline in the number of nurses, 75,000 of whom have left the country in the last five years.

Routine strikes for better wages and working conditions by available medical personnel have also led to patients now waiting long hours in hospitals to see a doctor. Some have died waiting, especially in areas of conflict in the country’s north.

Doctors often have to innovate on the go, sometimes using cartons as makeshift incubators or conducting critical surgeries by candlelight.

According to Dr Orji Innocent, president of the National Association of Resident Doctors (NARD), doctors now die on a weekly basis due to increased stress and unfavourable working conditions. The association is compiling data on deaths to release soon as a report, NARD told Al Jazeera.

“We have entered a vicious cycle because the few doctors that are left are overworked. Many of them feel that they cannot cope and they will pack their bags and leave the system,” he said. “We believe that with what we are seeing, it will be a matter of weeks before there will be a total collapse of the healthcare system in this country.”

“When you check the surgery booking note, you see people are already booked till July next year. And these are cases that shouldn’t take more than a month for the patient to go under surgery,” Innocent added.

A general view of the main gate of an isolation centre in Gbagada General Hospital, Lagos
The main gate of an isolation centre in Gbagada General Hospital as activities resume following the suspension of strike by doctors in Lagos, on May 21, 2020 [Pius Utomi Ekpei/AFP]

Waning interest

Besides going to practise abroad, many medical personnel are now leaving their jobs in pursuit of less strenuous work elsewhere.

Ayomide Ogunrinde, a trained doctor, told Al Jazeera that she endured sexual harassment from superiors while working at a government hospital and then depression from seeing people die “avoidable deaths”.

“The way the hospitals work is that you have to buy the things you need down to the littlest things like cotton wool and that makes work very ineffective. No one would assume that in a public hospital, patients wouldn’t have to be buying plaster,” the 25-year-old said.

Ogunrinde said she sometimes worked 72-hour shifts, attending to patients despite being tired and running the risk of making costly mistakes. Last year, she quit her job and now works as an administrator at a Lagos-based hospitality firm.

Experts say doctors need to be in optimum physical, mental, and psychological state to be able to save lives, but an increased workload and lack of an enabling environment have made that difficult.

“Nigeria has never had an adequate number of doctors, and the recent challenge of brain drain has further worsened the situation,” said Professor Tanimola Akande, a consultant community health physician at the University of Ilorin Teaching Hospital. “This will certainly worsen our already bad health indices. Patients’ patronage of quacks and other unreliable places has increased.”

To discourage doctors from fleeing the country, a member of parliament recently proposed that newly inducted doctors practise for a mandatory period of five years in Nigeria to get a licence.

Critics of the government say this will be ineffectual. Instead, they want to see more political will from the government, to ameliorate the situation.

An upgrade of existing facilities and introduction of competitive benefits will boost job satisfaction for medical personnel, said Chinye-Nwoko.

“Prioritising safety by maintaining equipment, and implementing safety protocols is vital to prevent accidents and promote a safer work environment. By taking these steps, the government can help keep doctors in the country … and improve healthcare for all citizens, especially those who are most vulnerable,” she said.

In Lagos, Aifuobhokhan joined other doctors to observe a candle procession in honour of their colleague, days after her passing. She too is leaving her job, to avoid deja vu.

“Now I know for sure I do not want to practise,” she told Al Jazeera. “I don’t want to be in the four walls of any hospital saving lives and then dying where I am saving lives.”

Source: Al Jazeera