The problem with Nigeria Doctors

Once a doctor has been trained, he is proficient in many fields in medical practice, at the basic level. He has been through the pre-clinicals where he learns about anatomy, physiology, biochemistry, pathology, etc. Then, he passes through the clinical years when he shadows senior doctors and becomes trained in medicine, surgery and community health. He is, on qualification, a mini-surgeon, mini-gynaecologist and mini-physician all rolled into one. For example, you effectively become a General Practitioner (GP) with basic knowledge in many fields. You have basic surgical, obstetrics and medical skills to make you poly-efficient and self-sustaining. You are able to provide fairly satisfactory health services to the community, especially in a rural area. You should be able to recognise ill health, diagnose appendicitis and deliver a baby. So, what is wrong with Nigerian doctors? Lack of guidance What medical school does is give you a general dose of common sense. What you do with it next is up to you and the community. ‘Baby’ doctors need to be “properly trained” in the actual practice of medicine: in the real business of decision-making, action taking and attitude/ethics of the profession in the big, bad world. This new doctor should have a mentor — a senior doctor with the prerequisites and the sensibilities of a ‘trainer,’ and the responsibilities that follow. Ideally, each doctor should be channelled into a training programme suitable for them and be properly guided to be the best they can be. Lack of information We do not know how many doctors are working in Nigeria, where they are, what they do, the population they serve and how many doctors are required in each speciality. For instance, how many orthopaedic surgeons does it take to change a light bulb? How many gynaecologists are required for the population in Ado-Ekiti? How many are there right now? How many are being trained for Makoko or Bwari Local Government Area in the Federal Capital? How many ophthalmologists do we need in five years’ time? How many are being trained now and when will they be ready for the work place? How many neurosurgeons are in the Diaspora who could be invited to cover while we grow our own local produce? What is the quality of our local products in comparison to others? How have we equipped them for the market place? Postgraduate training The residency programme is basic and incomplete. The training is not that structured, not enforced and substandard; while our so-called specialists are ill-prepared for their calling. The costs and choice of training is borne by trainees and so highly subjective. The more enterprising doctors get the better training, but you have to spend money to get educated. What about those who do not spend money on further training? The postgraduate trainers The old boys’ network of examiners in the postgraduate schools does not help in the production of quality doctors in Nigeria. Doctors are intimidated and severely traumatised, such that only few doctors pass the exams and many become demoralised. The programme, as it is today, ends up producing ‘aged,’ timid doctors. The teaching hospitals and training units Our teaching hospitals are often glorified general hospitals and the centres of excellence exist in name only and cannot boast of ‘paracetamol’ among them. Many of the teaching hospitals are invisible and you cannot hear them, as they are not ‘speaking.’ They have not promoted protocols or designed treatment paradigms for anyone to follow. No publication of repute has come out of many of these units. If they have no idea of what they are doing right or wrong, how can they be training the giants of tomorrow? The organisation, basic essentials, state-of-the-art equipment and futuristic ideas are often lacking. For example, the National Orthopaedic Hospitals continue to use archaic instruments and perform operations long abandoned by others. Cutting-edge research and technology are non-existent in many of these hospitals; and you could not get worthwhile statistics on outcome in any of them. So, what is wrong with Nigerian doctors? Some solutions Only a mad man does the same thing over and over again while expecting different results. It is time for change. If we truly desire good health care in Nigeria and wish to turn medical tourism round, the government must look seriously into the training of specialists. We need to know who, what we lack and where. The national and West African postgraduate colleges are trying but more needs to be done. More courses and improvements in the quality of education are required. Better pay for trainees and subsidies should be arranged to help with the costs of training courses. The medical schools and the specialist training centresmustbe overhauled and supported with serious finances and a complete overhaul. State-of-the-art equipment must be provided and a culture of ground breaking, ‘not plagiarised’ research, created. Doctors in the Diaspora should be encouraged to return and a conducive atmosphere created for their integration. We simply must wake up and be more competitive.