[Source: The ANPA Blog]

Nigerian doctors and nurses work under conditions that few of us in the Diaspora can fathom. Despite lack of equipment, broken facilities, and poor remuneration, the vast majority of these health workers do a fabulous job. We have noted on this blog the atmosphere of insecurity under which Nigerian doctors perform their work, having become targets of a thriving kidnapping industry, particularly in the South Eastern part of the country. The incessant strike actions, such as those recently called by Lagos State and Edo State doctors, reflect deep overall dissatisfaction by these doctors. So, it is not surprising that such poor working conditions might take a toll on their professionalism.

While we feel common cause with our colleagues at home, and support their fight for better working conditions, we are troubled by the myriad complaints that ANPA members receive from family members and friends alleging unprofessional and unethical treatment at some of Nigeria's flagship hospitals. The following from a Nigerian parent is, unfortunately, an all too common tale (the identity of the patient, doctors, and hospitals have been removed):

"My daughter's condition exposed me to the level of corruption in the public healthcare system in Nigeria. The doctors are a Lord unto themselves, operate private hospitals and divert patients to their hospitals with impunity. The only language that drives them is money. At the first private hospital we went to, we met a doctor who turned out to be a [Teaching Hospital] staff. He initially said the condition could be treated with antibiotics. Each time we went, we were arm-twisted to buy antibiotics at four times the normal price. Even when the X-ray showed that surgery was necessary, he continued to prescribe the same drugs for us which must be purchased in the clinic. On another visit, we met a second doctor who was so lackadaisical in his manners and utterances that we decided not to go back to the hospital.

"Next, we went to the [Teaching Hospital], where we began the process again. We went for X-ray and other examinations and waited for weeks before they finally settled for surgery. At the [Teaching Hospital], you can spend the whole day waiting to pay a fee of N200 as the whole payment and accounting system is so cumbersome. Even after payment, you can spend more hours waiting for samples to be collected. There are always crowds everywhere. Sometimes I took turns with my wife to spend hours at the hospital.

"By the time my daughter was being booked for the surgery, we started getting overtures from many of the doctors and other staff. "If you really want the surgery to be performed without problem, you have to go to the private hospital of this and that doctor." The consultant was also on top of the game. Eventually, we ran into a distant relative who is a doctor in the hospital. She sincerely advised us to go to the private clinic of the consultant. And so we went. There, we started the examinations again including X-ray, eventually the surgery was performed.

"My wife was quite disappointed and bitter at the run-down condition of the consultant's hospital. Everywhere was so dirty and the nurses were rude and nonchalant. After the surgery, my wife complained of the consultant's arrogance and inaccessibility. He did not say anything to my wife, did not explain anything to her or hint or prepare her on my daughter's subsequent reaction and behaviour. And if my wife she dared to ask any question, he would respond so condescendingly, offering little information.

"This morning (several days after we were discharged), the two or three bottles of drug we were given had almost finished. The hospital did not tell us what to do next except to return for follow-up in two weeks. We did not know whether to discontinue the drugs after finishing the ones from the hospital or to buy new ones. We called the doctor and he retorted ''but you should know you should buy the same drugs again". My wife got very upset because we had not been told how long the drugs should be taken. Now, the doctor said the duration was one week. My wife then asked why that information was not provided from beginning and what the doctor thought could have happened if the parents of the child were illiterates. The doctor had nothing to add.

"This is what we go through in Nigeria even in the hands of foreign trained doctors. God save all of us!"

We cannot verify these allegations, but few would deny that such sentiments are rife among Nigerians. Overcoming such cynicism will require renewed effort by health workers to ensure ethical practice and professionalism at all levels. This should be a priority concern for the Nigerian Medical Association (NMA), the National Association of Resident Doctors (NARD), the National Association of Nigeria Nurses and Midwives (NANNM) and other professional groups of doctors, nurses, and allied health workers.

Source: The ANPA Blog  from the Association of Nigerian Physicians in the Americas (ANPA)

Nigeria, home to 150 million people, is the most populous country in Africa. Endowed with huge amounts of natural resources, it hardly sits well among the category of "low income countries". Even the relatively large population is a poor excuse for Nigeria's tragic underdevelopment. Its 2008 estimated GDP was $206 billion, the second largest in Africa, behind only South Africa ($276 billion). While the 2008 GDP per capita ($1,401) ranked 18th in the continent, it was still nearly twice that of Ghana, and more than ten times larger than Burundi.

The contrast with Ghana could not be more stark. Facing tough times three decades ago, 1 million Ghanaian citizens fled to Nigeria, whose newly found oil wealth powered the regional economy. However, as Nigeria's leaders began to loot the nation's wealth on an unprecedented massive scale, economic anxiety across the land produced a xenophobic rage that led to the expulsion of Ghanaian refugees in the infamous "Ghana must go" affair of 1983. Ghana licked its wounds and picked itself from up from its bootstraps, while Nigeria continued searching for scapegoats for its many missed opportunities and self-inflicted wounds. In the current UNICEF rankings, Nigeria lags behind Ghana in Infant Mortality Rate (96 vs. 51 per 1000 live births) and Maternal Mortality Ratio (1160 vs. 550 per 100,000 live births, adjusted).

High infant and maternal mortality is, of course, only a symptom of the myriad problems facing Nigeria's health system. Fortunately, the resources for an enduring solution can be found in Nigeria's abundant natural and human resources, including the 5,000 to 6,000 physicians and tens of thousands of allied health professionals in the diaspora.

ANPA is geared up for the fight to improve Nigeria's health system, working with Nigeria's government and citizens, international agencies, and the many friends of Nigeria across the globe. Please, join us. It is a goal worth fighting for.

We congratulate "Doctor in the House" for volunteering his time and expertise to provide this excellent service.

keep up the good work!