As a young lad in secondary school, it was a thing of pride to be among those considered worthy of being part of the “science” arm of the class. With all the chemistry and physics…oh dear, what a waste now. Biology was my joy…I could draw the most beautiful of cockroaches; I knew the life cycle of the butterfly, cocoons, and all. Oh, how much I reveled in my elements then.
So as the time approached to write the secondary school certificate exams, and subsequently the almighty JAMB, it was only a matter of being counted among the elite who had decided to pen down the choice of “Medicine” as a career option.
It was also “Medicine” as a second choice…
I didn’t know jack about Medicine. I wanted to be called “Dr”; my parents were delighted at the thought of having a Dr in the family.
I was raised in average family background, with a father who was a Civil Servant and a Teacher for a mother. My lot could be described as being born with a silver-plated spoon. A good basic education was key to my subsequent academic success but on the back of parents who gave their all, sacrificed in excess of what I got to learn later to be from genuine selflessness.
Hmmmm, sometimes I wish…
I chose to do Medicine and gained admission to one of the best Universities in the country. We, “medical students” strolled around the campus with an air of arrogance. Well, some did.
However, some hated their choice right from the onset while only an insignificant number changed course after the first baptism of PHY 101, 102, and 103. The nightmare that was biochemistry.
The kreb cycle remained what it described ever in my memory…only a cycle. I read it with my eyes open only to forget once I blinked a couple of times. I could make no point of it. I avoided reading it and didn’t bother about it in the exams. I began to wonder if this was “Medicine”. And this toil continued throughout the length of the course.
It became more familiar to my imagination at the clinical end. The wardrounds, clinics, theatre sections, Community medicine postings, lectures etc. In the hospital, we interacted with the senior Drs, Professors. We looked up to them. Admired their carriage, knowledge but not their lifestyle.
Only a few of my teachers lived a life of opulence, a handful really. Then the strikes. The resident Drs strikes were frequent and sometimes long. The University staff also had their share of strikes.
A six-year course, on paper, stretched further and further. It was frustrating to see my friends in Economics, Sociology, or even Industrial Physics finish and graduate after four (4) years. It was frustrating, to put it mildly. Our friends in Engineering supposedly would graduate after 6 to 7 years. My set graduated after 8 and a half years of schooling, without exam repetition.
At last a Dr, Dr. A.A. was like a badge of honor. My efforts had been fruitful. The sleepless nights, the endless cramming, the deprivations- social and nutritional had now come to an end…or so I thought.
Then on graduation day, our lecturer told us “your MBBS is the certificate you need to start studying medicine”. What…? Hell no. And that statement is true, only if you choose to practice “Medicine” at a higher level. Most of us did, eventually.
Practicing with only the MBBS certificate can make one rich, no doubt, but it comes at a price to the clients and patients.
We learned about the USMLE, UK Plab, and the residency training in Nigeria. Residency here takes another 6 to 7 years to complete. Meanwhile, it’s very competitive to get into one. The training can be grueling, and humiliating if you have horrible supervising consultants.
The junior residency was a nightmare. One is overworked, sent about like a houseboy by senior residents and consultants alike, and looked down upon by the medical students. The professional exams are expensive and could be a potential banana skin. Many times examiner dependent. It was horrible.
The pay was at best enough for your daily needs. Not suffering, but not able to afford many luxuries.
The years passed, the salaries remained meager. We looked forward to it from month to month. We made fun that a resident Dr could not afford to do a CT brain scan if he had a need for it. It was laughable. Pay has improved over the years as resident Dr can afford a lot more now than before, but the Nigerian economy makes rubbish of these gains. It’s just a rat race.
By the end of the residency program, one has the option of going into private practice as a specialist or going into public service. At this point, I was well into my thirties, I knew only medicine. I got a job quite alright, but that was all. It was again one payday to another. Sometimes you are able to get a little extra from extending your expertise beyond your routine job. That extra can be very rewarding depending on your expertise and scope of activity. The rarer your practice the more one can charge for his services. I know a surgeon who charges up to N2m for a case, while I have also seen one who runs his practice like a business model…a huge partnership with retainerships of multinationals. One depends on his hands to make money; the other is capable of retiring while the business remains productive.
For the vast majority the monthly pay is their gain. Some private hospitals do make a whole lot of money, but the business model is the problem. Revolving around the proprietor. The quest for self-improvement and greater financial reward can be overbearing too. Those who have the means, relatives living abroad, or with an early burning desire for a better life as a Dr. get to leave the country as soon as they obtain the MBBS degree. Those who leave much later, do so after they have had some experience here in Nigeria. About 65% of my graduating class is outside the country practicing. With each passing year, the proportion gets closer to 75%.
And if one chooses to practice in Nigeria, the challenges are enormous; The out of pocket payment system largely practiced here is inhumane. Nobody puts money aside for hospital expenses, No. From their savings they pay for everything. Only a few have health insurance. And most cannot afford basic care. Tests cannot be done, are too expensive, or come too late for the purpose for which it is meant. The produced result could also be outright wrong.
Patients may also be unable to afford basic medicines or surgeries. I believe medical care should be subsidized in this country. Many people die not because of their illness and cannot be treated, but because they lack the necessary means to obtain the right treatment.
I have seen patients die from tetanus or meningitis because they could not afford the drugs. I have tasked my Drs and sometimes students to raise money to get drugs for some patients. But to what end I ask myself most times when raised monies can only afford a day’s worth of drugs. A small contribution all the same.
Medical practice in a government-run hospital is very gloomy. The environment is dense with the stench of suffering among the people. Sometimes visiting relatives look more wretched than the patients themselves. They have had to deprive themselves to provide the little for the sick family member. Yet this is the last point of call for the vast populace.
The private sector deals mainly with those who can pay more for the same service, albeit, provided at a much-expedited rate. But it also provides an avenue for quackery and unprofessional practice. Ethical malpractice is also rife in government hospitals.
However, what I still find difficult to fathom is the ease with which Drs can readily abandon their patients already on admission to embark on strike action. It is understandable why they have to go on strike, but what role has the farmer on the bed post-op or, the child with a broken tibia got to do with it?
Compounding these is the lack of commitment from political officeholders. I once interacted with one who had weird ideas about how a hospital should be run. It is pathetic. Nothing touches them; even the coronavirus infection has ignited their desire to exploit the already abhorrent state of medical care in Nigeria, than a desire to fix it. For health workers to go on strike in the middle of a pandemic is not only condemnable but also pitiable.
Health is wealth means nothing in this country. I as a Dr want to work, work hard, and be adequately rewarded. Also to provide a level of service that is obtainable anywhere in the world. Most people talk about medical tourism India is providing. Yes. Both private and public hospitals in India aim to make more money by providing state of the art facilities with the attendant manpower. We read about procedures and treatment modalities in texts and medical journals…and it is as it is practiced in Europe and America. They put to pen what they do. Nigeria still does things not even recommended anymore. Most times not found in the texts.
So what other joy can a Dr have…to practice using the best available evidence, producing tangible and reproducible results while getting remunerated appropriately? To be fully committed to one job, and yet enjoy the little luxuries life has to offer.
I do encourage any Dr to go out and experience the world. Broaden one’s horizon and choose to practice at the highest level. It can be achieved here in Nigeria, but for others, they shall find their calling in other climes.
However, medical practice also has its non-material rewards. The smile and laughter of a recovering patient despite the numerous challenges can be exhilarating. That sense of fulfillment of getting a diagnosis spot on when others have failed. For some, it is the elixir that enables one to continue in what one does. Only, I wish that the number of people who leave our care better off should dwarf into insignificance the number of those who succumb eventually. I just wish sick Nigerians come earlier for their necessary care.
The only regret I have in this practice…most of us, through the long period of training, have been shown only the narrow tunnel that is medical practice.
I now wish I know a lot more about the world, about business and making money. Not being daily surrounded by sick, sad, and incapacitated patients in an environment considered to be a cesspool of antibiotic-resistant organisms.
There are bound to be disappointments too. As a Dr, I realize now I can do anything, any course and excel in it; finish with a first class. I wonder sometimes how life would have turned out for me as an accountant, or computer scientist. But probably not in this life anymore or just maybe…we never say never in medicine. I still love what I do, as working on the human body instills into most people a certain degree of reverence. My only wish now is to make the best of what is left of the years ahead of me.
Written by A Medical Consultant.