 Thank you for staying with us. Well, it's still the breakfast on plus TV Africa. We're auditioning now It's different topics that are happening in Nigeria and around the globe right now. It's time for a hot topic And we're talking about the over 500 workers that have left Nigerian hospital national hospital in Two years and this was being said by the CMD Well, I guess today to you know, just give us more insight and this is dr. Shea Boulogne drew these an interventional cardiologist in over heart and vascular Institute, Virginia USA. Good morning, sir Thank you for joining us Very well, thank you. I hope I got your surname, right? I'm not your bar, but I hope I try Yes, I love that All right, so we're talking about the brain and drain in Nigeria right now, I mean you are on the other side your overseas and I'm sure you're leaving your best life there But Nigeria has this brain drain where almost everybody the goal the the Nigerian dream is to move abroad is to move away from this whole system and We're seeing this happening Time and time again Almost every day you go to the airport is filled with so many people and these are people who are doctors the medical Practitioners Tech bros, you know people that are supposed to be here to help, you know, push this nation forward and bring all of their ideas and You know just implement good good good things that could just help Nigeria really But we're seeing them move away and now there's a report that over 500 people have moved in two years So what is your take on all of this before we start to dive right in? Yeah Brain drain is a complex process It's a complex process and then you said I've been like you said you that I was in the US Well, I am in the US most of the time Okay, my welcome to you guys, but We do a Medical mission and education and program will be coming to Nigeria frequently. So I'm currently in Nigeria. Oh, nice. Nice. Nice You're touching base You're touching base every now and again. Yes. Yes. Yes, so The last time I was on this Interview on the breakfast show what we did was this was September We had a medical mission project that we do where we do interventional cardiology work of people's hearts in Nigeria. We do it in a number of locations they go to the University In a pool jar some other centers in in here where we come in and we just volunteer our time with equipment and everything to Walk on people's hearts. So I'm here actually For the same process this this week. So Brain drain is not always a drain. Sometimes it might be some gay to it But to a large extent it's brain drain not good, you know, yes We might try to make some benefits out of it by trying to bring about some You know improvement in the health system. We're left behind A few of us come back to your due process is trying to build our system to try to make the system more Better all together for our people Well, like you said, it's a very complex process And it's quite sad that, you know, I saw that news people article that was published talking about 500 workers leaving the National Hospital one hospital in two years. Yeah, I hear about Other hospitals facing the similar process and then I have friends, you know, friends, colleagues, mentees, you know Who reach out and then to the asking questions or just people generally who reach out on LinkedIn and other platforms trying to figure out what's to do with your lives and unfortunately Like it said the Jack Bar Syndrome. Yeah, it's a big deal. We're trying to get out of the country It's very complex, but I guess we'll do that Okay, so, okay I think let's start with the root cause of the matter because before we start to, you know Go up. Let's just start with the root cause. Let's start with what the issue the cocoa of the matter is What is the problem with Nigeria? We know there are quite a number of problems But what is the major problem that is causing this brain drain because we're talking about one hospital Just one hospital and over 500 people leaving in two years Imagine if we start to collate the numbers of different hospitals, you know in Nigeria and even in Abuja alone and then we go to Lagos, Potahakot and all of these, you know states We would find out that the numbers are in thousands and and hundreds of thousands and millions even So what is the root cause of the matter that is making people just, you know, move away? You asked a question. What is the problem with Nigeria? That's a problem Like I said, I know I know we have a lot Well, let's just talk about the fact that these medical practitioners are moving Yes, and so it's a very complex process Brain drain so I have a master's degree in public health and then one of the things that I did when I left Nigeria 15 what 2008 so that's 16 years ago Was initially on public health and the idea was to try to improve myself and both the health system improves the whole world's global health and One of and this is a concept that's discussed extensively in public health the push for phenomena There is what's pushing you out of your country and there's what's pulling you to other countries And so now it's a multifactorial process, you know Something pushes you out of Nigeria or whatever country you are Developing country to go for greener pastures, but there's also a pool on the other side What's pulling you the other countries them to us the other countries? Nigeria has a lot of push factors And some of those push factors like we know is our healthcare system, you know, not having adequate resources You know, you get trained You know, you want to be You want to be this you want to Be somebody who does procedures on the heart And as at the time I was finishing training, there was no place in the country That could give you that kind of resource to do procedures on the heart So you would hear that it's possible and you would read it in the books when you can't do it Now we've actually found processes So many of us who had that kind of mentioned in mind with leaving the country to do that That's part of what we're trying to change By coming in and do this programs in the hospitals to train the The physicians on ground that way they could also train the next generation So yes, there is that push of not having resources There's a push of not being paid salaries people are not, you know, people would like, you know Not being paid salaries, you know losing their income There's devaluation of the Naira. So they have purchasing power gets worse There are all those factors that basically make it such that In this day and time you see what you don't have in Nigeria But you also realize that in You know, once you just get online, you could be on Instagram, you could be on LinkedIn You see people succeeding elsewhere So there is that pull from other countries where Okay, look, I could just do this exam and get out And so that's those are factors that are happening and obviously we need to From a policy perspective Look at what we're doing on ground. Look at how we could improve the health system in Nigeria How we could improve resources for the doctors for the nurses for the Pharmacist for other people in the system such that they could do their work happily They could have, you know, I mean we as As trainees in Nigeria many times have to give our own blood We would pay for patients some healthcare who would give our own blood You know, because there is no patients can afford it people would die in your presence You get frustrated because you know everything you can do that you have in your mind that you don't have in the pharmacy To give the person or in the blood bank, but they can afford it and indeed die Those prostrations lead to the overwhelming sense of look, I can't do this anymore. I need to do something different So it's a lot of things that we need to do We may not be able to do as much for the poor factors Where that's based on the international of the other countries that are pulling Nigerian Human capital away But for the push factors we have to try to do less to push our people away And that I would say the first thing we could do is try to get Health insurance get health care available to everybody so that when you want to help somebody You're not frustrated because the resources you have even though they are right there beside you I can't give it to the child who is one year old that is dying in front of me because I can't afford it and I can't afford to pay because I spent all my money on the last patient So those are some of the factors that are coming Yeah, okay So I want to talk about the economic effect on you know Nigeria for instance You say we have a lot of push factors We're sending people away and Obviously that's going to have an impact on our economy because if we're sending people away So the money that we're supposed to be making the revenue We don't have that anymore instead another country like You know the u.s. Or the uk or or canada or any other country They are benefiting from these people that were pushing away and they are pulling them in so what is the What's the effect economically to us nigeria? Or rather to our own nigerian economy in this state? Yeah, so definitely very important health care spending in nigeria is hechillian We have the largest green population in the world And so our health care spending is never going to reduce It's going to keep you know in terms of our growth of our population over by 2050 We're going to be so Such a large population that we need to think about how health care expenses are going to multiply in that period And what are we doing for those people and how we develop in our capital infrastructure? Because when you think about it like you have to I am I am I strictly pointed out you have people who all Human capital a lot about human capital is leaving the country. Yeah, human capital is a sense huge part of Any form of capital is not just financial capital So you're losing all those finances to those countries and then we're losing people who travel Oh, I need to get a procedure done. Well, I can't get it in nigeria. So where do they go? They go to india So you have nigerian patients who would otherwise have gotten good care delivery in nigeria Moving over to and they were spending billions of dollars every year as a country on On on the under you know sending people out of the country people going out using Things that could easily have been done locally. I mean things are getting better in some perspective We don't want to always focus on the negative. I mean things are getting better in some perspective There are some procedures that we're beginning to have because like I said, you know, there are some physicians who Are trying to come back to the country and help develop the infrastructure we have here So yes, they are coming with some skill sets that we historically could not do here And we're beginning to do those things But altogether there's a net loss of human Human capital of financial capital all forms of resources that we have to take seriously You know before nigeria could say oh, we've always had this problem It's multiplying because you got to remember the focus of the internet Before there was we didn't know what we did not know So I had medical students in university You know, I didn't know what my colleagues were doing With the same skill set that I had because I couldn't see it every day But as time evolved I came to Lagos. I was talking to some people. I knew some things now You don't have to talk to anybody. You just need to just look at your phone And you see what people with the same skill set that you have are doing all over the world And you ask yourself I can do better And I do better. Yes. Does somebody want me? Yes So this change is not going to get any better unless you know The country the policy makers everybody comes together to create a something that is going to work Bring the people that the national medical association bring people to the table unless we walk on something that could improve retention Um, because we're going to lose a lot It's okay. So that was okay. Yeah, so I mean you just talked about some policies So what do you think are some policies that that could help um to mitigate this whole? You know jack batten from our system Yeah, I mean there's a lot that that can be done. I mean and you know, you have to address them in phases You know, they have to be policies that are addressed at Infrastructure in the country. So talking about teaching hospitals talking about our hospitals You know to try to improve those from those structures because that has to be addressed improving infrastructure There has to be health insurance policies that will be made that will make our people get good care You know And then there has to be human capital policies that have that involve salaries that involve You know giving pathways to growth People will feel like okay. Yes. I could have my man And then there's you know, there's a lot on each of those components that we could actually do So I don't want to be short-sighted and say oh, yeah, pay everybody better or do all that It doesn't just walk in isolation. You just don't take it in silence You need to look at everything all together and say okay, what would I do from health systems perspective? And then what would I do? And then the major thing that we have is um health insurance As a problem, I mean many countries Have this problem and then they have had this problem right and then they walked towards improving it um, you know, um The you know It was improving how to deliver the services And so if we can do a system where anybody in Nigeria Who is sick can get significant amount of care can't get most of their care delivery Most of the people who walk with these people will want to stay because I feel like I could do what I was trying to do I can help people that's why we got into this field most people didn't get into this field because oh, I want to be um an influencer on the instagram But they got there because That cracks me up a little bit But go on That's everyone's goal now, right? But seriously, um, like you said, um, you know We have to figure out those systems and then I think you know, um from a public possible health policy perspective There are multiple tools that have been recommended. There are things that we publish we work I work closely with the group by john s Hopkins where I did my I'm public health and then we still talk quite regularly about stuff like this I still wasn't meeting with them on Friday And so we have, you know, policy things that we'll talk about what What we can do differently But of course those are focusing on the pool of what they can We all just we have to do our push and see how we can keep pushing people keep Keep from pushing people away because our system right now Just keeps pushing everyone away Okay, so you talked about, um health health insurance The truth is a lot of people cannot afford health insurance. You know, there might be a sex that can Um, because I think the average one you probably hear about would be about let's say 17 000 narrow um Probably annually anyway, so I think that should be like one of the cheapest ones you can find But people who cannot even afford three square meals People who are living in shanties How can they, you know afford this health insurance? So does it mean that their lives don't matter because I mean you would expect that the government should be able to You know give this to people there should be free health care That's like if you don't have if you don't have if you don't have people in your country You don't have a country because there's no country. There's no country to rule So what can we even do to ensure that people can start to afford this health care? Is there going to be like, you know some form of respite? Maybe like a palliative or something or you know subsidy? Um, I mean not the fuel subsidy, but you know just try to subsidize the amount That people have to pay for health care because health is wealth and your health matters a lot But what can we do um for people who cannot even afford health care right now? And even how can they go about it? Exactly what you're saying and that's exactly what we're talking about the push factors So the government policy makers Um in the federal government on the state level, you know need to understand that yes We are when you walk with the formal health center And then we try to which is great There's a great way to start when you walk to the formal health center to try to establish a health insurance program That will cover most people That's a good way to start, but it's not the end like you said 17 000 era A year is a lot of money for people who can't eat Some people spend their whole money just on transportation to get to work And they have no they haven't paid their they haven't paid their kids. They haven't paid school fees They haven't done anything else. So we need to understand that Health is a fundamental human right And so in our system in Nigeria, we need to have a national health insurance system that not just covers the formal health sector But for the formal income strength sector, but then the informal sector which means everybody So everyone should be able to get basic health care basic primary health care services Secondary health care services to a certain extent and then you know and we start that in phases and then we could build up With our resources at least get the basics in place get the secondary in place And then we start working on tertiary health care. Now, I know this is expensive Expensive to the country. It's important to understand that yes, there will be some adjustment in priorities in our In our budget in the way we manage our things both statewide um Local government wise and even in the federal government definitely But it has to be done because if it's not done The push will continue. So yes, I definitely agree with you um, it's important. It's really not practical to expect people to pay all of this out of pocket It has to be integrated in our system such that we have a national identification number. We have people who and then being Nigerian comes with this level of um perks And then afterwards, you know, maybe you might need a little extra as a copy You know some a little extra out of pocket Which is a little less when you can get care and you would not die Because you don't have Any healthcare. Yeah, I mean I agree with you But I wanted to just ask one more question which goes off tangentially to be they're still in regards to this but Last year the House of Representatives passed a bill Saying that you know, all of the medical practitioners have to They're mandated to stay in Nigeria and practice for five years before they can move abroad Now you talked about some push factors where you said No adequate resources No payments of salary devaluation of the Naira But do you think that's also another push factor because you're you're telling me that Even when I'm done studying, you're not going to give me the resources that I need. You're not going to pay me my salary leaving in Nigeria is You know, I don't I don't even know the word to use But all of these factors and then you're still telling me that I'm mandated to stay here And I can't leave Isn't that even another push factor that would make people to say You know what I don't even want to be here at all and I'm just going to leave Maybe I would not even study here. So that even still affects our revenue when it comes to The money that was supposed to make from education because people would want to move over to other countries to study And so that way they can move abroad. So is that a push factor for you as well? No, I mean, I think those are definitely push factors. Um, you know, because the And then when policy makers make decisions, I think it's always great to bring all stakeholders to the table Yeah before those discussions Yeah, I concluded because you know, the national medical association You know, obviously has an interest in keeping things Keeping doctors in place So we have interest in keeping things in improving our health system locally. So being able to walk with um The policy makers towards something that is sustainable not just bring some arbitrary numbers saying you have to stay five years Because then it seems like oh, yeah, you're going to be trapped for five years We're not going to give you any resources. We're going to frustrate it and you're going to be trapped for five years As opposed to okay. Well, when you're going into school, we're going to create this process where you're going to get funding So when you go to school, you're going to you're not going to be Begging for money to feed your food to eat or to pay your trophies or to do all of this We're going to have that incorporated in your training such that you won't have to Get um, you know, you won't have to take so many Um You don't have to deal with so much to deal to to gain for your education And then, you know, maybe that comes to the commitment for two years Maybe that comes with something else where you would have if you choose to you could sign that But then you know that you get some funding in advance in advance for that purpose But you know, if you don't give that anything or you say, well, you know The assumption is you're in Nigeria. You have this and so you now have to stay for five years. It becomes a trap So, you know, working together with our key stakeholders And then saying, okay, look, this is something that we can together create a plan for I think would be ideal um But and then, you know, and then with multiple ideas that have been proposed and together we can come up with something that Works, but I think we just have to just take it one step at a time Oh fantastic, but so final words. I'm just going to ask how You know, what are ways you think we can start to attract and retain our skilled workers? So we're not just in this same position whereby people study They practice for maybe a year or two And then they move abroad and all of these other countries are benefiting and meanwhile we are at the receiving end So what are some, um, you know, some things you just want to highlight before we wrap it up Okay, so first now highlight is We need and I'm not Because I know that policy makers are listening to this and that's why I focus on this. We need to have a health insurance system for management of our population The next thing I would say is That for the people that we have on ground right now Let's improve our retention packages Let's improve retention packages that will make people want to stay so well Look, if you stay in the country for five years and you walk in the in this kind of a hospital I mean, if you start from the government perspective you walk in a government hospital for five years This is what you get every year for retaining for staying but make it viable So it's something that I look at you guys It's valuable I want to stay because I want to get this every More 4 to 500 company every large institution that actually has great work cultures Have retention program and structure So they have to be aware of creating that so whether it's money Whether it's like we said we stay with the health insurance first because that is what makes people Have joy from doing what they do. If you go to work every day and then people die And you know you could have helped them but you didn't do anything, you know Then you know you would um Not be able to do your best. You would not be able to bring what's in your head Yes, you would not be motivated and then obviously We want to also create a system where people can come back and want to do stuff to create those facilities You know we could there's a lot of people there's the decision of Nigerian physicians in america and park And then I'm sure they have a lot of other medicines also across the world Of people who want to come back and help and then most of the time coming back to help There's like, you know, we want we feel like we've We're we're Nigerians. We love Nigeria. We want to give you back to that country So creating that avenue also where you could get a lot from Um, that's for our physicians and all the other other other other Practitioners coming back into help and then once they do that, you know, the system gets strengthened and some people might be more inclined to stay All right. Thank you so much. I think that's a good note to leave it We want to say thank you um for joining us and just you know, shedding more light on this. Thank you so much Thank you very much. Have a nice day. You too. Enjoy the rest of your day All right, we've been sticking to dr. Shea Bollinger. He's an interventional cardiologist in over heart and vascular institute from virginia USA and we're talking about the brain draining our system and how over 500 Medical practitioners how over 500 workers have left the national hospital in two years The optimist expects it to change and the realists adjust the sales and that is by william author word He is or rather he was an american motivational writer And so what we're just telling you today is that you should stop complaining Stop being a person is that's complaining about the wind make sure that you are an optimist Who knows that it would change and you're also a realist that adjusts the sales So whatever life throws at you do not complain about it You can feel some type of way But do not just stay there complaining and not doing anything about it Instead you should start to adjust the sale the sales of it. Um, you have to start to develop yourself Anything that can take you into that place That you aspire to be into that person that you aspire to be And so that's all wrap it up on the program today. You've been watching the breakfast on plus tv africa My name is bremer paul sin and i will see you tomorrow. Have a good day