 Thank you for staying with us. Brain drain, otherwise known as jakba, is a slang term that indicates a substantial emigration or migration of individuals. A brain drain can result from tumour within the nation, the existence of favourable professional opportunities in other countries, or a desire to seek a higher standard of living. The chairman of the Nigerian Medical Association, NME Uche Rulan gave a keynote presentation at a symposium to discuss recent brain drain in Nigeria's health sector and its implications on health service delivery. Where he said that the official statistics show that as of 2019, Nigeria's doctors to patients ratio is at 1 to 4,900. He said this number has increased as the country continues to lose medical practitioners to develop countries and that Nigeria is in their need of health workers. He further added that from 1963 to date Nigeria produced only 93,000 doctors, which is inadequate skater for the general population. Research among health workers show that the U.K. and United States of America are the top two destinations for Nigerian medical doctors to seek work opportunities with 93% and 83% respectively. The real question is, what is the root cause of the brain drain and why are doctors and health workers living in Nigeria? Please let's hear what you have to say. Remember you can join the conversation. Send us an SMS or WhatsApp to 0818384663. We could also tweet at us as we show Africa one with the hashtag ways show this topic normal. Anyway, Dr. Johnson Babajide Oryomizan award winning medical practitioner who bagged his medical degree from the prestigious Lagos State University College of Medicine in Kejha. Dr. Johnson is currently the director of clinical and occupational health services at Citron Health, a subsidiary of Ambulance Nigeria. An organization dedicated to quality, occupational health and emergency care across Africa. Also, we have Dr. Safina who is a Nigerian medical doctor in the U.K., living in a town called Chesterfield, Derbyshire. She had worked for seven years as a senior medical officer in family medicine and then oncology in Las Vegas, Nigeria. Before relocating to the U.K., she is currently wrapping up her general practice training in the U.K. to work as a GP. She is passionate about medicine, humanity and passionate about Nigeria as well. So, I'm glad that we have two doctors speaking to us today about this jackpot of doctors. I did mention on one day. I didn't even know that Wednesday. I said we need the doctors to come in to tell us how they're feeling because up until now we've been talking about oh, this is a major, major epidemic going on in Nigeria. What is going on and how are the people who are directly involved, how are they feeling about it? So, I'm really glad that I was here. We have this conversation. It's really painful, Chinelo. I took a story on Monday that said we have about 11,055 Nigerian trained doctors currently in the U.K. Imagine that number in U.K. alone. You're not talking about all the other countries, Canada, all of them. So, it's something that we need to discuss. Anyway, Dr. Johnson is glad to have you here. Dr. Johnson is drinking water. Are you saying that we have him here? Yeah, we have Dr. Safina. Who is going to check the dashboard and go through it? Until that's why this is actually happening. Hello, Dr. Safina, welcome to the show today. Hello, thanks for having me on as well. Thank you. It's a topic that's quite close to my heart. I'm quite passionate about it. So, yeah, looking forward to engaging on this, absolutely. Okay, so first things first. Let's start from here. Dr. Johnson was saying something before we came on. He said 95% of your classmates have now left the country. Let me start from there. Why is this? All right, so for me, I think the first course is the financial remuneration that comes with practicing medicine in Nigeria. All right, I think it's really, really bad. The economic power compared to the buying price in the market is not that bad. And like they say, you cannot buy your license, you cannot buy plantain in the market. Sure, you get it. You need to feed the family, you need to rent the house. Of course. And that's really for most people who are not working. But if you go abroad, you can make enough to meet your basic needs. Stuff that are just basic. And I think for most people is the fact that they don't have, so you have the skills you've learned, you're passionate about this medicine, but you get into where you need to work. There are no equipments to work with. So you want to save this life, but you don't have, exactly, your hands are literally tied because you can do what you know how to do. And that's for most people can be saddening and depressing. So most people just say, instead of me staying here where my skills, I cannot use it as much as I want to. Let me just go to where I have all the equipment that I need and I can save as much life as possible. And I think thirdly is going to be the issue of insecurity. And when I say security, it's not things happening at the nut. It's even within the setting. There are stories of patient relatives stabbing doctors, beating doctors up. I've seen doctors being beaten up by patient relatives before. The doctor now became the patient just because he was trying to save a life. So I think for those three things, at least for my experience, at the top three reasons why people, I believe, why doctors are leaving. Okay, so Dr. Sathina, let me hear from you. Why do you think doctors are, why do you think this exodus is happening in the country? Dr. Jones said, you know, the first thing is that financial manipulation, if it's not there, you know, there's a limit to how long any individual, no matter how nice or how human you think you are, you know, you can continue to remain in an environment where you feel that, you know, you don't feel well when you're merited for your skills. So the truth is, a lot of us went into medicine, we're passionate about medicine, we're passionate about helping people. In quotes, you're a nice person because you want to help, you know, sick people. But somehow when you're placed in an environment where you're seeing a lot of people die, you're seeing a lot of people, you know, not get access to medical care because they can't afford it. You know, again, 95% of people in Nigeria pay out of pockets for healthcare, which is very, very unsustainable no matter how developed the country is. So you're watching people die, you're watching people die because they can't afford drugs, you're watching people die because they can't afford to pay for hospital bills, admission costs, operation costs. And, you know, so there's a limit to how much you can take and after a while, yeah, it does get, it gets to you as an individual, it gets depressing and you just start to say, okay, where else can I work, where I'll be well supported, I'll be well paid and I get to see medicine being practiced, you know, in a standard manner as it should be, okay. So, yes, it's a lot of factors but definitely the finances, both on the side of the healthcare professionals and even seeing our fellow loved ones, you know, the people in the population we're serving, you know, seeing them die, seeing them not be able to get the right, I mean, to think that people are still dying because they can't afford hospital bills of 50K, 100K and it's ridiculous. And then now comparing it to a system, of course healthcare systems are different but comparing it to a healthcare system where, you know, someone complains of headache and they've literally done a CT scan and MRI and without paying a penny from your pocket, it's, you know, like I said, it's only a matter of time before you start to say, no, this is in a way absolutely ridiculous and in medicine should not be like this. Okay, it's interesting that Dr. Safina brought this up because I had a conversation with a friend, with family this evening, she said she was having some headache and stuff and I said, oh, have you been to the hospital? And she said, yes, she was in the hospital and she was asked to do a CT scan and she was like, the money. Because the out-of-pocket experience is no joke at all. When you see how people have to pay, that's why maybe people think that people don't consider their lives here in Nigeria because when you think about just me alone having to spend all of this for healthcare, no, we have more than needs to take care of and that's what they concentrate on and then you see people get to the point where it's so bad that, oh, we can't help this situation and we don't have to live like that and it still goes back to governance. Being able to put in the right kind of structure and I'll always come back there because like I was saying on Monday, I said, why is the government, they put up a bill saying, oh, doctors must spend, practice five years and it took me back to when I was at the university I had a lot of doctor friends. Currently most of them are in Canada or in UK or in the US and I have one in particular that says Noma, nothing is going to bring me back to Nigeria for no reason. He has lots of family members who did not have any business dying the way they did and he said, Noma, I'm not coming back to Nigeria because Nigeria has nothing to offer to me and I'm asking myself, why hasn't the government had this conversation with the people who are coming up with a bill? How does it affect the doctor? Do you think of that? Is that the best incentive to keep our doctors in Nigeria? So my question to you, Dr. Safina and also to Dr. Johnson is what can the government, what's the government not paying attention to when it comes to our medical space? What are they not paying attention to? I can start with Dr. Safina then we'll come back to you. Okay, thank you Noma. Like you rightly said it's like using a sledgehammer to kill an aunt or sometimes I don't like it to an abusive relationship where instead of the person to do what is right and leave a partner stay you decide to lock the doors and you say the partner should not escape. That's, you know, in no way does it make sense. So now to answer your question about what the government can do first of if you want to keep people at the end of the day because what this has just shown is that everyone has autonomy I can decide after I've stayed in my own country I can decide that I want to go somewhere else if I'm not being served if I don't feel fulfilled as an individual as a career person so what can you the government do I don't think it's right to now say you want to make me or let me say my colleagues back home sign a contract or some kind of bond absolutely that's I don't think that still obtains so what can you do instead of course we call it softer skills or softer ways of handling professionals or handling institutions first of like everyone has said salary is a major thing salary is a major thing and of course it also cuts across both other professions teachers, nurses other healthcare professionals so yeah we need a major overhaul when it comes to the salary structure in Nigeria and of course not just salaries what are the conditions under which these people are working how can you say you're working in an A and E when I was I did a posting in A and E I never saw a defibrillator hmm wow please I never saw a defibrillator and now having done it here I'm like he will just go down saving my license and saving the people, the patients that came in honestly you're talking about doing ECGs for patients coming with maybe cardiac chest pain that's basically heart attack and these are my colleague and I were laughing the other day you do one ECG and that ECG can probably last a month so that's the rhythm of the heart stream a month or a week and then the next time the patients is coming to clinic and they're oh okay you've looked at it okay it's fine meanwhile I'm now in a system where literally you're doing ECGs before we send the patients out of A you have to do it and that's in the space of four hours alone so it's just amazing that's why I said God really loves you know Nigeria in fact we're just surviving on God's business this country perhaps we can't take the spiritual out of it because it's amazing so yeah make the conditions right put to the basic you say you have a hospital you say you have A and E you say you have ambulances let them be well equipped look at standard there are standard operating protocols everywhere not just in other professions even in medicine there's a standard that should be in an ambulance there's a standard even if you don't have it in Nigeria they say we follow WHO WHO is our standard what is the appropriate thing that's supposed to be in an ambulance what is supposed to be in an A you understand don't just bamboozle everybody and say you've opened a hospital or you've got a government hospital like the one in Nigeria exactly so that's just the tip of the iceberg but yeah of course I'm quite curious what my colleague has to say as well oh yes so I think I'll start from what the government should have done so when it comes to policy making in healthcare there are two strategies push and pull the best thing to do is to use the push not the push like they've done so push means we're going to work in Nigeria for the next five years you cannot go anywhere the point is get the incentives in place increase enumeration push strategies in place that we want to make people stay so that's what they should have done when we say incentive the research has shown that most workers employees as a worry it's not really about the salary it's about the benefits that come imagine asad asad PR before was five thousand they've increased it to two thousand if you get picked by a new do or someone asked about that it's been in Nigeria about one twenty thousand compared to the thirty thousand so what is asad and I've seen doctors so far this kind of when I was in my house at the government hospital he happened to a colleague of mine the guy would have been he was going up and down with infectious diseases and all and then the tip of it for me is getting the right equipment in place in those hospitals like she said what they do is they buy the one AED for the hospital they don't keep it they don't have it they don't have it they don't have it but here it's supposed to be everywhere, train station and asad these are the issues they are not trained in most government hospitals are not trained in basic life support advanced cadillac life support which is standard you have to know how to do this things and when you do you need to go and make sure you get the right equipment and then remuneration and incentive is just the right way to go pull and don't push it away and interestingly their policy is just a joke because the UN says there's a rule in the UN that says that everyone who has the right to seek medical well-failed in the better country if you're in the capacity to do that and when we come back, we will continue from the conversation. If you are just tuned in, we are discussing the topic brain drain, a.k.a. jack for why doctors are living in Nigeria and we are discussing with Dr. Johnson Babadidi Umiyomi and Dr. Safina Aldi. Please let's hear what you have to say. Remember you can join the conversation, send us an SMS or WhatsApp to 08-180-384-663 or Twitter to us as we show Africa one with the hashtag we show, we are talking about NHS. I can't believe what my ears have heard today. No, but actually understand, because I have a friend who is a medical doctor and he's not practicing. He wanted to say was. Oh, actually was because he's no longer practicing. He's doing consultancy now with, I don't know what they are called, some NGO thing like that in Abuja, that's what he does now. I need to ask him, is actually please, I would rather do this than practice medicine in this country and I'm like, it's really is that bad. Because think about it, you go to school for that long. You're in university for what, five years or six years. I was going to touch on that. You do housemanship. You go to that whole rigorous process, you come out and then at the end of the day you are not written in the writing. And now they're telling you five years. If I'm the one, boy, I'm going to leave. So I mean, I can completely understand where you're going, but then I want to touch on what you just said. Okay, so I was discussing at the back about the NHS scheme and how it's not really functional as it were because the amount that the eventual hospital, because real insurance works is you put money together and then when you get sick, you go to an hospital and then they get paid. But the amount that these hospitals get paid to offer you care is not really what it is. And how much is that amount? So some of us, there are 700, 800 there, that some of these hospitals get paid. So imagine you're going to assess care at the private hospital and it's not going to happen. What kind of care do you expect? But the good thing is that I must mention this because this initiative is doing well. The one that the state government is doing is really really amazing. And I think that's the way to go. Instead of depending on the national health insurance to let the states pick up the health care system and put it by themselves, that's honestly the way to go. But then why do we even have to wait for the states to pick it up? I mean, yes, I can understand that, right? But then there's a reason there's also a national board across to be able to cover all of the countries. So that doesn't even, that doesn't, well, that's not great excuses for them and say, okay, because legal status, no, no, no, no. The federal government should do something right about our health care system. And I like what Unoma has been saying for everything she has said, it has always still come back to governance. And that's why we always talk about governance on the show because those are the people who don't know what to do. Maybe we should let them know. So in that light from Chinlal I wanted to ask what needs to change in the health care system in Nigeria? Alright, so it's policy first, and the allocation of the budget. The amount being allocated to healthcare in Nigeria is about 1.2 trillion, just about 5%. And the target should be at least 50%. So imagine, it can't really do much. And these things are driven by money, like it or not. 7% was very horrible numbers. But now at least it's improving, but it's not there yet. So we need to allocate more money to the health care system, health care education, these basic stuff compared to putting all the money in some people's salary, people in government's salary, and they take the bulk of the budget. Let this percentage come to health care. Second is policy like we mentioned and governance and all those things. Put the right policy in place where health care is concerned. Health care policy in Nigeria is nothing to write them about. So we need to sit down how policy makers have conversations around these things and then build the right policy that can help us move forward. Okay, alright. We've heard from Dr. Johnson who is in Nigeria, right? So now I want to ask you. You've seen how the health care system runs in the UK, right? How do you think we can implement that in Nigeria? Okay. So one of my recommendations having like I said, works both home and now abroad. I'm a clinician. So meaning that I'm not in that I'm very patient facing. I deal with patients. So besides all the things we mentioned health policies, renumeration I think also the culture of what I would like to call the senior colleagues those you met in the game so to speak. It also has a way on impacting those that are coming into the profession. I'll give you an example. When I was doing my internship in Nigeria I trained in Nigeria and I did house job in Nigeria so that's your internship period. I remember literally starting on my first day at work and they were expecting me to do everything I was expected to know how to do this how to take blood samples how to see patients with chronic illnesses how to see someone that has been macheted and all of that and now that I've seen another health care system I'm seeing that you can't role was not built in a day. There's a reason why you're an intern there's a reason why you're a junior doctor working under a consultant so you have more experienced colleagues who are supposed to show you the way show you the ropes allow you gradually develop or build yourself but it's like you start from zero to 100 in Nigeria here you have something called a shadowing period literally any job you start in the UK there is something called a shadowing period so where you get to observe sometimes you might not even be seeing patients but it's just that gradual introduction see how we do it before you come in before you're allowed to start to do things and not in a not in a demeaning way but more like you're new here so we're not expecting you to know everything so that's part of what I mean by the culture yeah and then of course even things like I'm a big believer in the fact that you can be better than the environment you're in unfortunately okay so in as much as you're trying your best you're a hardworking doctor you love people you want to save the world what is the structure that you found on ground so I believe our senior colleagues have a lot a role to play in this area I don't think it's by doing policies and saying people should stay in the country when we were when it was our turn when junior doctors we were not even driving cars you hear senior colleagues saying things like that and I'm like what's the meaning of that we were not even driving cars these young doctors all they want to do is drive cars and look nice you're like is that what we're talking about you know my supervisor like I said I'm a clinician so I see patients and they will tell me if he sees that the way I'm looking I'm looking stressed I usually don't want to take a day off I said hey they're asking me if I want to take a day off you know because he will tell you he will say that if you're not well you can't see patients if your mental and physical health is not alright you can't now be giving what you don't have you know so that's why I said the seniors are not in large role to play so I don't think it's by oh expecting people should stay automatically no you that has been in the game for a while what are you doing for the younger colleagues you understand you see a younger colleague struggling what are you doing are you just there expecting I don't know how you want to do it but when I come in the morning 36 patients should have been clapped 36 patients should have taken out blood samples for so you just have so I just feel that yes government has a role to play policies have to be in place but even those senior colleagues in the profession I think they have they have a big role to play as well interesting let me add something here that some people the reason why they decide to leave the country why they just absolutely say I'm leaving is because of some of your experiences with senior colleagues you know you know because in some places they won't bother like bullying you know and it's really bad some people say no I cannot face this I need to get out of here because so I absolutely agree with that you know senior colleagues need to do better when it comes to my in fact the conversation just brought out two things for me and these are things that I just continue to hammer on if madam consideration its empathy and consideration again because we don't put ourselves in the shoes or it's easy for you to post the bill it's easy for you to put our policies because they don't affect you directly when it affects you then you know if you have the heart of the people in mind in the first place then you will put down policies and governors that will guide them in the direction of productivity if it was me what I would have the policy I would like to put in place the policy that advance medical tourism for politicians and then the policy that outdoes the Putin which is improve the healthcare system in your country alright so I will say don't go out of the country for the next five years and then let's now let's move the healthcare system and let's say don't say doctors don't go don't go for medical tourism that was what I thought when I saw that I was discussing with my parents and I'm like that's what I think if you're saying that doctors shouldn't leave then you shouldn't leave for five years then you shouldn't go to get treated stay here when the doctors were here they didn't want to leave to go get treated somewhere else so now what is it really anyway now we've come we've seen what this has done or what this is doing to our healthcare system thank god for these doctors that we have with us they've also given us or whether they've preferred some solutions and you see this one that they talked about I think that's a very big deal because it's supposed to be mentorship like Dr. Sifina mentioned which happens in every profession anyway if you're new you start from some sort of internship right and then you gradually become whatever it is but there are people that should be able to guide you people that have been there before who should have your interests at heart trying to leave a better legacy for you right but as it is I think the reverse is the case in our their country if I was Dr. Sifina was talking I was going to ask the question of what your experience was but you had already talked a bit about it but the bully part and seeing mentorship I'm sure that was somewhat of a cultural shock for you because here everything is hard and complicated and then somebody say oh take a break oh are you okay you're like huh I'm sure you were wondering what I think you're like no I can walk I'm not lazy and they're like no there's a reason why you have personal time of there's a reason why you have sick leave use it because if you're not well you cannot come and see patients but you know the Nigerian in me was very was very keen to show that I could do it absolutely for me I worked with multinational and I had worked with guys from my brother exactly and what happened was immediately after my house job that I started this role and just at the end of my house jobs a doctor gave me an extension just because I was friends with somebody that she did not like and she wrote it in the extension let's just like that and said you're going to do one extra month in this place non paid because you're allowing this boy influence you because you guys are friends and she submitted to the government and nothing happened so it's that bad there are people that will tell you I'm not feeling fine I'm not feeling fine I'm not feeling fine so it's that bad so imagine you get into a multinational that has a doctor from the UK and he's telling you why I'm not taking the break what I used to do here by 5 o'clock what I used to do here the shock is crazy and across all the multinationals that you've had to that has been the standard we've heard from the Husseism and now we know that indeed we need to do better in this country first of all this bill of saying medical practitioners have to stay 5 years no it should be abolished we can't I don't think we can go through this at all it's not going to work let me just put it that way like Dr Johnson rightly said instead of using the push method I think we should start approaching it using the pull method start to create incentives start to make the healthcare sector better make the renumeration better and see if these doctors wouldn't stay they're happy being away from home anyway it's just because it seems like it's a better opportunity for them but if you create this better opportunity in our dear country here I'm very sure that they would stay anyway thank you so much Dr Johnson for joining us in the studio today Dr Safina thank you as well I'm sure that very soon we would come back to this and I hope that it would be for a better purpose and not because we're still talking about this she's passionate so she's going to bring back the passion we can't wait to hear her say guess what guys I'm coming back today okay before we go do ensure you follow us on instagram at wayshowafrica you can interact with us follow drop a comment and most importantly follow all our social media engagements remember to like share comment and invite your friends and family to watch us and follow us if you miss today's code here it is again it's time to end the brain drain it's time for a great mind of Nigeria to return home you are the mind we need doctor and this is by Deji Olukotun see you tomorrow at 8pm as we bring another great conversation see you later