Doctor Drain: An Exodus From Nigeria Threatens Its Health Care System
WHY YOU SHOULD CARE
Nigeria is losing $1B a year due to medical tourism as its doctors head to Saudi Arabia, the US and UK.
This story has been updated. It was originally published in June 2018.
The hospital waiting room overflows with people. It’s an unusually hot day in Lagos, Nigeria, the temperature over 90 degrees Fahrenheit. Sweaty patients silently clasp their hands in prayer, hoping to see a doctor. In a nearby room, physicians wrestle with cords and switches on brand-new anesthetic and radiology machines from the U.K. that short-circuited during recurring power outages. With no money to repair them, these well-intended donations to a resource-strapped hospital are useless junk. It’s one more reason for doctors to look for opportunities outside Nigeria, and yet another nail in the coffin for the country’s health care system.
Africa’s largest economy is rapidly bleeding doctors it has trained and educated, unable — or unwilling — to stanch the flow that medical professionals blame on low salaries and poor working conditions. Approximately 20,000 Nigerian medical doctors are currently working outside the country. A survey by NOIPolls found that about eight out of 10 doctors who remained in Nigeria were looking for jobs overseas, with the U.S. and U.K. as leading destinations. In 2017, Shehu Liberty, a Nigerian political analyst, wrote an open letter to the country’s President Muhammadu Buhari, pleading with him to stop the “mass exodus” of doctors. He had just stumbled upon a group of 200 trained Nigerian doctors interviewing for jobs in Saudi Arabia.
A crumbling medical infrastructure is pushing better-off Nigerians to seek treatment abroad. In 2017, the Healthcare Federation of Nigeria reported an annual loss of $1 billion to the nation due to medical tourism. For those who can’t afford foreign treatment, it’s worse. The country currently has a doctor to patient ratio of 1 to 4,000, far higher than the World Health Organization’s recommendation of 1 to 600.
It isn’t opportunism that’s driving the “brain drain,” doctors insist. In fact, many of them who settle abroad return frequently to offer medical expertise, training and help in the land of their birth. Several others study abroad and return to Nigeria to practice medicine, only to face frustration.
Doctors [in Nigeria] are not well taken care of.
Nnamdi Elenwoke, Nigerian doctor based in Spain
For Dr. Nnamdi Elenwoke, who left Nigeria 18 years ago to go to medical school in Cuba, returning home was a stipulation of his scholarship, offered to 100 students under an agreement between Fidel Castro and then president of Nigeria Olusegun Obasanjo. But Elenwoke struggled to adjust to Nigeria’s medical system and left again to train in family medicine and neurosurgery in Spain, where he now practices. He returns to Nigeria nearly every year, and each time hopes he might find a way to stay — only to leave disappointed. The faulty electricity in the country’s hospitals is emblematic of the neglect Nigeria’s health care system suffers from, and offers a stark contrast to what the nation’s doctors see in other countries, where they can also earn much more. When you look at it like that, Elenwoke says, the choice to leave becomes obvious.
“Doctors [in Nigeria] are not well taken care of,” Elenwoke says. “We’re not a priority of the politicians.”
Well-educated and armed with English skills, Nigerian physicians often succeed as students and professionals, in countries as far apart as the U.S., the U.K. and Saudi Arabia. Dr. Akinloye Julius Makanjuola, a pulmonary and critical care physician in Atlanta, Georgia, practiced medicine in Nigeria for several years in the early ’90s. Then, frustrated with the lack of proper medical equipment, he left for the U.S. Makanjuola had to do his residency and internships all over again to get his U.S. medical license, but it was worth it. “I was finally able to do things practically, like put a line in someone’s heart,” Makanjuola says — a procedure he didn’t have the resources to perform in Nigeria. Like Elenwoke, Makanjuola has dreams for his country. He hopes to one day open a small medical school in Lagos and instruct doctors to practice medicine like they do in the U.S. and U.K. But it’s unlikely to happen. “Nigeria doesn’t want me back,” Makanjuola says. “There’s not enough pay, the security isn’t as good [as in the U.S.] and there are no policies in place to help.” Makanjuola believes the Nigerian government could afford to put more funds toward the medical sector if it wanted to, but it doesn’t seem to value human life enough.
There are those who buck this trend, doctors who intended to leave Nigeria years ago but felt compelled to work toward change at home. Dr. Ifeoma Okoye works in the radiology department of a Lagos teaching hospital, where she witnesses her students’ severe lack of resources firsthand. Nigeria’s unstable economy is partly to blame, she says, but she agrees with Makanjuola that the government neglects the health sector. Okoye’s students have to go abroad to train with proper medical equipment. And those who don’t travel outside the country for medical school struggle with a lack of confidence. “They don’t see themselves at the same level as doctors who were trained abroad,” Okoye says. But Okoye doesn’t think the responsibility can be shouldered by the government alone. “There should be more private sector investments and hospitals run by public-private partnerships,” Okoye says.
A part of that help is — ironically — coming from doctors like Elenwoke who left the country. Along with family physician Dr. Okechukwu Ekemezie, Elenwoke helped launch Docotal Health two years ago. A global network of Nigerian doctors who perform online medical consultations free of charge, Docotal Health is a way for Nigerian doctors to help at home from afar. Elenwoke stresses that while donating money and resources toward Nigeria’s health care system is helpful, the country’s medical problems will be settled only by long-term planning. “Donations are like giving us fish instead of teaching us how to fish,” he says, referencing the old adage about the benefits of self-sufficiency.
That Nigeria’s health system needs to build in self-sufficiency and long-term planning is particularly so because it can’t rely on a notoriously fluid polity. The turnover within Nigeria’s national assembly is so drastic that every four years, a majority of lawmakers lose their seats. The result is a continually young and inexperienced government, ill-equipped to create accurate budgets with properly funded spending.
What Nigeria does have is highly qualified doctors, both in the country and outside, who remain committed to helping the nation, wherever they might live. For now, that personal commitment of the doctors appears the country’s best bet if it can’t clot the exodus of medical professionals.