Nigeria’s brain drain; foreign countries brain gain

It is no longer news that Nigeria is set to re-open its airports for international flights from the 29th of August, 2020. The Aviation Minister announced on twitter that flights will resume in Lagos and Abuja after protocols are put in place to minimise the risk of coronavirus infection. The news was met with a mixture of excitement and trepidation. While some are happy that resumption of these international flights around the world is an indication that things will be back to normal, others are skeptical as to whether Nigeria has the capacity to control the spread of infection when the borders are opened. The reality, however, is this- while Nigeria has been largely lucky in terms of the burden and mortality associated with COVID-19, much work still needs to be done to reduce community spread of infection to the barest minimum as well to boost the capacities of health care facilities in the management of cases.

Among those excited about the resumption of international flights are those in the Nigerian medical circle. Suddenly, various websites and recruiting agencies are aggressively marketing the advantages of moving to Canada, the UK, the US, Saudi Arabia, Australia, and the United Arab Emirates for work. Those in the healthcare sector can attest to the various adverts seen swarming our timelines, emails, and WhatsApp groups. For a modest fee, an interview is conducted and sometimes an offer letter can be generated on the spot. The visa process can be fasttracked and in under a month, one is ready to begin a new life in an entirely new country.

This migration of health care workers to other countries is not a new phenomenon. Indeed, Nigeria has been exporting doctors and nurses to the UK, the US and, Saudi Arabia for a very long time. Nevertheless, in the wake of this pandemic, the deficiencies in human resources in these countries, Nigeria included, are glaring for all to see. A lot of them have therefore relaxed their rigid visa process and increased the remuneration of health care workers in hopes that it will lure people from other countries into theirs. And because we are true Nigerians, a nation made of up people who, despite all the warnings of NAPTIP, will engage in any process available to leave the shores of this country, willingly rise to the bait. Professors in all medical specialties, consultants, and younger doctors are seen scrambling for seats at the venues of these interviews. Two years ago, an interview by a Saudi Arabian recruitment firm, in a hotel conference room in Lagos, had to be cancelled due to the sheer number of applicants and the stampede that threatened to ensue. The agency had neither anticipated the desperation of Nigerian health workers nor our collective inability to follow simple instructions like forming a queue. How a gathering of intellectual minds managed to turn into a bumbling travesty similar to the 2014 Nigerian Immigration recruitment tragedy, baffles me. Anyway, I digress.

The question that begs to be asked is this: Why are health workers in Nigeria leaving in droves? The most simplistic answer of course would be, for the money. But is it real?

The common misconception that the Nigerian government has is that Nigerian doctors are greedy. That we are being paid well but our ‘longer-throat’ will not allow us to be content. That we are ‘eyeing’ our contemporaries in developed nations. I laugh in Fulfulde! This would be funny if it were not ridiculous. The truth is, a vast majority of us would rather not leave the country. Why would we want to leave the comfort of our families and communities where we are seen as ‘mini gods’ to slave away in a faraway land? Why would a consultant or Head of Department leave his place of work to practice as a medical officer in a cold country like Canada? Why would I suffer all through medical school to start writing exorbitantly expensive medical licencing examinations of other countries all over again? Why would I want to be subject to the institutionalised racism that is rife in the Arab world? Why?

The truth is most people would rather not leave, but when your country does not value your work and turns a blind eye to your demands, health workers are forced to take drastic measures. Nobody wants to live in a country where a doctor has to work three or four jobs in order to live comfortably. Why do we have to ‘hustle’ in medicine too? Why can’t one job be enough? All the average health worker demands are that his sacrifices be recognised so that he can be paid sufficiently enough to live a comfortable life. Is that too much to ask?

Another reason health workers give when asked why they leave is job satisfaction. As a doctor, this scenario is all too familiar: You are on call in the emergency department of a rural hospital and a patient is crushed in critical condition. He was involved in a road traffic accident and is bleeding internally. You want to go to theatre immediately to arrest the bleeding immediately but Nigerian factors like a) No bed space b) The patient has no insurance and relatives cannot afford the surgery c) the anaesthetist has gone home because he is the only one employed by the government and therefore cannot work 24 hours a day and 7 days a week and d) there is no water or electricity in the theatre. As crazy as some of these reasons sound, they are all sadly very true. And so, workers are left dissatisfied. The lure of working in a hospital where the system works is amazing! A hospital that has more than 10 operating theatres where surgeries are carried out back to back to accommodate their large population. A clinic where you can comfortably ask a patient with chronic headaches to get a brain CT (which the insurance company pays for), just to rule out the possibility of an aneurysm without having to wonder whether the patient can afford it or not. A system where early diagnosis and treatment is emphasised instead of waiting until the patient has gathered enough funds and has deteriorated significantly in the interval to institute management. Losing patients to conditions that can be easily treated gradually takes a toll on the conscience of every health worker.

The big joke is however on the government who instead of wooing health workers with incentives, mocks them instead with statements like: “All doctors cannot become specialists, they should try their hands at other things like farming, tailoring, and politics”. How can a minister make such an insensitive comment? How many cardiothoracic surgeons do we have in the country? How many hospitals carry out open-heart surgeries? How many retinal surgeons do we have that we can allow them to leave? When an organisation that has only one professor in a particular medical specialty who decides to leave the country- will you then allow him or her? Can we not sit down and negotiate the terms of his employment? Do we not find out what he or she will be paid there and double it here? What will it cost us? If the argument is that others will demand the same payment, then they should also aspire to be as knowledgeable as he or she is. When we have a significant number of specialists in all the fields of medicine, then we can afford to let people go. And please do not preach to me about the cost, what the average doctor makes is not up to a fraction of what the lowliest politician in Nigeria makes.

There is a Hausa proverb that says that when you see your brother’s beard on fire, then you should wet yours. This is not the time for the government to bury its head in the sand. At a time like this when other countries have realised the monumental importance of human resources in health care management, Nigeria cannot afford to be the leaking pipe that willingly allows its best brains to be flushed out of the country.

A word is enough for the wise.