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

Doctors performing surgery on a patient
Doctors performing surgery on a patient

Hospitals are short-staffed and doctors overworked.

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.

LASUTH shortage

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.

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“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.

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