Ad Flammas

It is possible to be aware of a problem on a subliminal level, to know yet not know. One day, however, that problem will stand up and punch you in the face. That day arrived for me when I heard the news across social media — the best in community medicine had left the community. All of the sudden, it seemed the floodgates were open and I could see it everywhere. Doctors were migrating in droves to the United States, the United Kingdom, Canada, Australia, even to the Kingdom of Saudi Arabia. And these were not just house officers migrating. Medical officers, registrars, consultants, professors were joining the bandwagon at a stupefying rate. The tectonics of the Nigerian health sector were shifting, but the shifts were mostly unannounced, unrecorded, off camera, silent.

Oh for shame, you may say, why all the bother? We have so many doctors that this loss is just a spoonful out of the Niger. There is no room for concern. Or is there? It is estimated that Nigeria has somewhere about 40,000 practising doctors and somewhere about 200 million residents. This breaks down to somewhere about 2 doctors per 10,000 people. For context, the WHO guideline is 20 doctors per 10,000 and most of the countries we donate doctors to overachieve that even up to the 30s and 40s. The anemic is donating blood to the polycythemic. Each hand that is taken away from the collective burden of Nigerian health care makes the burden heavier for those left which makes even more give up on the burden which makes the burden even heavier which makes even more give up which...the vicious cycle continues ad infinitum until the only doctors we have left are Small Doctor and Dr Sid.

Or is it the caliber of people who are migrating? Some of these are regarded as the best in their respective subspecialties. They would have had placements in Teaching Hospitals across the country where they would spend their time imparting the wealth of knowledge gathered across years, if not decades of practice to every upcoming crop of doctors. But now they are gone, and the temperature of the hospitals is lower. A hospital that cold in working experience cannot but churn out half-baked doctors.

In a couple of years, as the trend accelerates, it will begin to pinch, and the pinch always starts with the common man. Maybe you're rushed in for a surgery at NAUTH, let's say for ruptured appendicitis, but the only anesthesiologist left for Saudi last week. You are referred to COOUTH where you are told they have an anesthesiology problem too as their specialist left three days ago amidst much acrimony. You rush to Borromeo and they inform you that the man who just left as you were entering was their anesthesiologist and that he isn't coming back. At this point, if you aren't dead yet, you have limited choices. One — undergo surgery without anesthesia and take your chances with the pain. If you die, you die, and if you live, you have a good story to tell. Two — find a roadside "hospital" where the "doctor" assures you he knows "appendetology" and all those doctors in big big hospitals come to him to learn. Three — take Dr Aladdin Seven Keys to Power for staphylococcus erus, maybe with a side dish of Goko Cleanser. Four — go traditional. After all, before the white man came, our fathers were living long. I hear they remove appendices spiritually in Arondizuogu. Five — locate Odumeje ASAP. Maybe if he dances on your right iliac fossa, the pain will disappear. Six — gather together your family, friends and well wishers, give them your final words, then close your eyes like a boss.

How did it get this bad? Well, it didn't happen all at once. Practising medicine in Nigeria has progressively gotten less attractive as the years go by. Let's talk about money first. A professor of surgery can make somewhere around N500,000 for every month that he actually gets paid. A bloody medical officer in the UK in that same month can make N6m, and he gets paid every month. Not only is our beloved professor earning just 500k, he has to spend that money in an environment where commodity prices are new every morning. At a whopping inflation rate of 20%, each new salary package feels like a demotion. In contrast, Bloody Medical Officer is earning his 6m in a nation where there was a loud public outcry recently as inflation rates breached 4%, and committees are frequently set up to adjust salary scales for inflation. How about job satisfaction? Our erudite professor is besieged by teeming masses of deplorable humanity. All he has on his side is clinical acumen honed to a razor edge, maybe throw in one or two outmoded appliances. He shouts his voice hoarse in committee after committee begging the Nigerian government to fulfill the promise they made in 2001 and allocate 15% of the budget to health. Bloody Medical Officer is living the life, dealing with an adequate number of patients, ordering expensive investigations without fear of non-compliance (thanks to insurance), using state-of-the-art medical equipment and generally feeling like a lifesaver in a health system that has spent about 17% of its massive budget on health year after year.

Or is it the security? Our distinguished professor across the course of his hallowed career has been in the frontlines of the Ebola, Lassa and COVID-19 pandemics with minimal personal protection. He put his life on the line time and time again and his hazard allowance is the grand sum of N5,000. In that same period of time, Prof Sir has lost two children, one to Boko Haram and the other to unknown gunmen. His car was taken from him by random street thugs during an IPOB sit at home. He has been beaten by patient relatives twice and brutalized by JOHESU belligerents once. But he is sure his reward is in heaven. Bloody Medical Officer (I'll call him BMO henceforth), on the other hand, seems to be collecting his reward right here. He lives in a society where politeness is second nature. He can't even remember the last time he argued with a patient. There are no terrorists, no herdsmen, no insurgents, no freedom fighters, no unknown gunmen, no cause to fear for his life. Loud sounds still startle him, but he recognizes this as PTSD from his Nigeria days and he's currently undergoing therapy.

Should we talk about standard of living? Our indefatigable Prof has never owned a brand new car. He settles for tokunbos, second hands, fairly used, unfairly used, London used. Meanwhile, BMO is in London using the cars that'll be shipped down to Nigeria. All it takes is one serious illness to bankrupt Prof, meanwhile BMO is fully covered under the NHIS. Prof's children went to schools were they learnt to draw and label grasshopper legs. BMO's children tackle international relations, genetics and coding from a young age. Prof's first daughter died of puerperal fever. BMO's consultant, one drunken night at Stamford Bridge, confided in him that he has never seen a maternal mortality case. Prof has a four bedroom flat in his hometown he spent ten years building. BMO recently completed a spectacle of a mansion in his village. He also dug a community borehole for his people and lit up his alma mater with solar energy. BMO can call 911, Prof can shout JEEESUUS! BMO has a dog, a pet lapdog that is so fluffy and rolls over for belly rubs. Prof has a dog too, a demon of an animal with a murderous, intelligent glint in his eyes, almost like he is calculating whether it would be more or less profitable to eat Prof in place of his evening meal. Prof keeps him out of necessity, as he makes the robbers avoid the house Prof rents in the city. BMO is happy he left and sponsors scholarships for fresh doctors looking to leave too. Prof wishes he left with his classmates, but he is an old man with a crown of white, and a man does not learn the usage of his left hand in old age.

Now we have arrived here, what can be done? One solution is privatization. I dislike this solution for two reasons — it can lead to the multiplication of quacks, and it, most likely, will make healthcare prohibitively expensive for the common man. I've been reading Ayn Rand of recent, and I've been thinking. What if the solution is to let the brain drain continue, to let it all go to hell? A lot of the health sector's problems could be solved if the people in charge were better stewards. But the people in charge do not care. As long as things remain in a mediocre state of efficiency, they are okay. So, let's ruin the system! Let the news be inundated with reports of hospitals across the nation shutting down due to manpower lack. Let the budgetary allocation to health fall from the already paltry 3% to a full out 0%. Let a death certificate be signed for the moribund health system. Maybe that would get our overlords to notice, maybe that'll shock them out of their unholy amalgamation of greed, incompetence and indifference. Maybe when we tear it all down, we can rebuild anew. Let's burn the structure down. Maybe a new reborn system can, like a phoenix, rise from the ashes.

Eziokwu Fab-Emerenini

07064366711

Nnewi, Nigeria