INEVSTIGATION (1): Nigeria’s Health Sector Faces Critical Doctor Shortages

Nigeria appears headed for a grave
health crisis as the nation’s hospitals
face a severe shortage of qualified
medical staff in key areas of
specialisation, forcing thousands of
patients abroad yearly. Those who are
unable to afford travelling abroad are left
to die or placed on queues that in some
hospital last years.
PREMIUM TIMES investigations reveal
that with the country taking the negative
lead in several global health indicators,
health personnel who should help reverse
the tide are in short supply across the
country with training and recruitment
increasingly ebbing.
Currently, the country has only 600
paediatricians to care for its over 40
million children, compared to the United
Kingdom’s over 5,000 for 20 million
children. The figures are more depressing
in other areas of medical specialisation.
With the rising cases of cancer across the
country, there are only a little above 15
oncologists; 10 neurosurgeons to attend
to issues related to the nervous system;
and 120 urologists to manage conditions
related to the male urinary tract and
reproductive organs such as prostate,
kidney, bladder cancers, prostate cancer,
testicular cancers, infertility in men,
sexual dysfunction etc.
There are currently no podiatrists in the
country- a doctor that treats conditions of
the foot, ankle and related structures of
the leg; a key specialisation considering
the nation’s teeming diabetics.
While all hospitals in the country are
affected, the pressure caused by the
shortage is by far clearer in some
hospitals than others. At the Lagos State
University Teaching Hospital, LASUTH,
Ikeja, for instance, the shortage of doctors
has led to many resident doctors
remaining on call for a month,
overworked. Patients in need of special
care are forced to remain on queues for
weeks, months and, in some cases, years.
Endless wait
Nine-year-old Abdul Ibrahim was five
when his parents took him to the
paediatric unit of LASUTH in 2009. He
needed surgery to treat hernia. Such
services are promptly delivered in private
clinics, and even with usual delays in
government hospitals, a patient should
get attended to in three months, some
experts and patients have said. But
Abdul’s first appointment for an operation
was one year after-2010. However, when
they called at the hospital 12 months
later, the operation was rescheduled
repeatedly until 2013 while he continued
with routine checkups. The reasons for
the delay, according to the hospital, were
the already waiting line of people
scheduled for the same procedure and the
few doctors available to provide it.
“We came to LASUTH in 2009 and after
thorough examination, he was diagnosed
with hernia. One of his testes was swollen
and it was causing him a lot of discomfort
and he could not play or move with it,”
Abdul’s mother, Silifat Ibrahim, narrated
to PREMIUM TIMES recently, sobbing.
“We felt the surgery would be done as
soon as possible but to our surprise, we
were asked to come back in March 2010
for the operation. When I complained, I
was told that there were hundreds of
patients waiting for the same surgery at
the unit.”
When Abdul showed up with his mother
on their assigned date in 2010, they were
turned back again and given another date
for 2011. The hospital said there was
spillover of patients from 2010. A year
later, in 2011, the story turned worse:
Abdul’s file was missing.
“They had reassured me that my son’s
operation would be done that day and we
got there as early as 6 a.m. but the nurse
told us again that the surgery would not
take place because his file was missing.
The nurse just said I should better go and
start the tests all over again, because
without it there would be no surgery,” his
mother recalled.
While the delay continued, the young
Abdul remained in excruciating pains with
abdominal ache that gave him sleepless
nights. His parents were subsequently
told to return in November 2012.
But the family received the shock of their
lives. When they took Abdul who was still
in pains to the hospital in November, they
were told to come back in 2013, four
years after he was initially billed for the
surgery.
“When Ibrahim first visited the hospital, he
was five years old and now he is nine. We
see other patients lamenting that they
have been coming even before 2009. My
fear is that they may also postpone the
surgery from 2013 to 2014,” the little
boy’s mother lamented amidst sobs.
According to duty registers shown to
PREMIUM TIMES, some of the
departments with a severe shortage of
doctors, where the few available ones
remain on duty for over a month, include
but are not limited to surgery,
neurosurgery and the cardiothoracic unit.
“The unfortunate thing is that when
patients come to the hospital, they think
we are just resuming, they don’t know
and don’t even want to know that many of
us are overworked doctors who have not
rested in a long while,” one doctor said,
asking that his identity be protected to
avoid sanctions.
“All they want is excellent treatment.
Patients are assuming that the right
things would have been done and the
right things are on ground but that’s not
exactly what’s going on here.”
In the last three years, no resident doctor
has been employed by the Lagos state
Government; only a few medical officers
have been absorbed into the system.
Medical experts deem that “strange”.
“Both the undergraduate medical students
and patients will suffer as there will be no
proper training for the students while you
can imagine what will become the fate of
patients when subsequently treated by
uncooked doctors,” Temiye Edamisan, a
Paediatric Oncologist with the Lagos
University Teaching Hospital, LUTH, Idi-
Araba, said.
Mr. Edamisan’s comments evoke outrage
especially considering that LASUTH is a
teaching hospital where undergraduate
and post-graduate medical training
should go together, experts said. Thus,
medical students cannot be trained
without post-graduate doctors (resident
doctors) who, as their name suggests are
supposed to be resident in the hospital
and involved in training and treating
patients 24 hours a day.
In standard practice, when the consultant
is not on ground, the next doctor who
sees a patient is the senior registrar. But
investigations revealed that LASUTH at
present does not have junior registrars.
This is comparable to a secondary school
where there are JSS1 classes and then
SS1 to 3.
As a result of the shortage of resident
doctors as well as consultants in
LASUTH, units that should have five to 10
resident doctors have only one; leaving
the available resident to stay for a
minimum of 17 hours on call in the
hospital. At the gynaecology ward,
doctors run a minimum of 10 caesarian
operations, besides normal births, within
24 hours.
Consultants at the hospital who spoke
with PREMIUM TIMES say resident
doctors were used as “machines”.
Doctors refused to be named, fearing
sanctions.
Under normal practice, experts said, a
doctor needs to spend a minimum of 15
minutes to clerk, examine and run tests
on a single patient and then see four
patients within an hour. Therefore, since
the doctors at LASUTH work from 8am to
4pm, they should consult with a
maximum of 32 patients a day, if they do
not go on break. If the supposed
mandatory one hour break is observed,
the doctors should, therefore, see a
maximum of 28 patients.
However, currently, resident doctors
attend to more than 70 patients in a day.
This situation could therefore be blamed
for the errors that are often associated
with their diagnosis and treatment.
The endless queues at the hospital have
resulted in a nickname- “wait forever
hospital”.
Government’s nonchalance
The situation in Lagos became worse
after the 2012 strike in Lagos state when
doctors, under the auspices of the Medical
Guild of the Association of Resident
Doctors, demanded for earlier agreed
wages from the state government, leading
to the sack of over 700 of the doctors. The
government finally reinstated the doctors
after some months, but the relationship
remains generally frosty.
The state commissioner of health, Jide
Idris, did not respond to our enquiries.
But an official of the ministry who spoke
under anonymity said one of the reasons
resident doctors were no longer employed
was “their truancy, laziness and last
year’s industrial action”.
“So, we feel that employing any other one
is simply going to be a waste of
resources, that’s why we simply employ
medical officers at times. The problems of
these specialists can be so enormous, so,
we decided to let them be,” the official
said.
Olarewaju Sodipo, Senior Registrar in the
Department of Family Medicine, who is
the president, Association of Resident
Doctors, LASUTH chapter, however
rejected that claim.
“One of the ways you can access if the
resident doctors are worse than resident
doctors in other parts of the country is
actually through the postgraduate,
medical exams,” he said.
In the last Obstetrics and Gynaecology
examination he cited, LASUTH presented
five candidates for the national
postgraduate medical exams and all of
them passed.
“No other centre had that type of pass
rate in the country. Obviously, if they were
truants and unserious people they would
not be getting those kind of results,” he
said. “For anyone to suggest that resident
doctors are truants, he or she must be
speaking from the position of ignorance.”
He said the few doctors around are busy
as the hospital is also for teaching.
“People expect to see doctors seated in
the clinic for 24 hours when in actual fact
there is a lot for us to do. For example,
some doctors have to be in the clinic,
have to conduct ward round, have to be in
the theater and have to carry out
researches. So, when someone comes
one day and doesn’t see one in the clinic,
they assume the person has gone on a
truancy mission meanwhile that person is
in the library carrying out the research
that will help the hospital.”
Francis Faduyile, Chairman, Lagos State
Chapter of the Nigerian Medical
Association, NMA also denied that
doctors are lazy.
“For someone to say that resident doctors
are lazy, it means he doesn’t know the
rigours the resident doctors are passing
through,” he said, insisting that the
problem was rather that they were
“overworked, ill-motivated, have been
beaten back.”
He said Lagos state has enormous
number of patients to cater for, so must
look for ways to train, retrain, retain and
have specialists.
“And if the government is shying away
from that responsibility, I think the public
needs to know that it is their right to insist
that we must have specialists,” he added.