Why I hated practising Medicine in Nigeria
I signed up to study Medicine and Surgery because it seemed like the most logical thing to do. I was a science student in secondary school and all my mates were either going to study Medicine or Engineering in university. The girls were more inclined to Medicine, so I joined the bandwagon.
After trudging through an unexciting clinical journey in medical school, one that got me contemplating dropping out severally, I got my M.B.B.S. I survived housemanship in a teaching hospital, lazed away National Youth Service year in a primary care centre and became a job seeker for many months before landing in the private sector.
I hated practising Medicine in Nigeria for the following reasons. I always didn't feel competent. I hated not knowing exactly what to do and not having reference points. As long as you are called doctor, patients expected their ailments to end with you, not willing to be referred to specialized institutions. This is mainly because Nigeria's health system is mainly funded by out-of-pocket payments. Many do not have adequate insurance and so they can easily go bankrupt because of a disease.
I didn't like the great expectation, the lack of support as a medical officer, often working alone, the fact that apart from the clinical pressure of functioning as a general practitioner without appropriate training, I had to deal with financial pressure as well. I had to decide/communicate the cost of treatments and factor that along with the size of the patient's pocket in making a clinical decision.
In the places I practised, we had no universal guidelines. Lab results were unreliable. They often arrived late. Poverty of the people would not allow us perform necessary but expensive investigations. I spent my housemanship year running ward errands like chasing up investigation results much more than I did managing the sick. Children suffered pain unnecessarily when we could have given numbing agents before bleeding them. Patients would endure multiple needle pricks to get several blood samples when only one prick most times would suffice with the appropriate equipment. Our medicine was crude; too crude to be human. I couldn't bear practising like that for the rest of my life. It depressed me. I would rather spend my life making music, writing stories, bringing happiness, than watching the sick deteriorate and not offering much help, but sometimes worsening their debility.
Now on the other hand, I've seen civilization in medicine here in the UK and this excites me. There is strong support. No one is left alone to tackle a case they are not trained for or fully confident about. As you work, you get trained on the job, while making a satisfactory living. Working hours are regulated also. You get enough breaks to recuperate from on-call hours. Theatre lists are not cancelled due to delay in laundry department providing scrubs. Skills are well maximized. Nurses administer IV drugs, so the junior doctors are freed to attend to higher skilled jobs. Hospitals are not shut down due to inter-professional feud or strikes. There are standard guidelines for every condition, for example the NICE guidelines or local hospital guidelines. You are not expected to memorise the doses of all medicines. You are encouraged to check the BNF before prescribing. There are regular audits and quality improvement projects to keep us on track.
I could go on and on to compare the health system I witnessed in Nigeria to that of UK, but it is obvious Nigeria is centuries behind. Of course, it is not all rosy in the UK but this post focuses on Nigeria. Nigeria needs those that have seen the light, those that have tasted and imbibed best practice in a system that works to lead the way. So why should doctors in Nigeria not leave in search of light? The bone of contention should be why the ones that have obtained this light are not coming back to guide the rest. This is not different from other sectors. Sectors that have made progress have people there that have been trained in developed countries. Check the CVs of top performers in Finance or Business in Nigeria you will see that most of them have had foreign exposure. So doctors should not be criticised for going out to get proper training, rather we should be talking about how those that have been trained in these developed countries can give back to their country of origin.
Dear Lord, send labourers into Nigeria's health sector. We need to make advancements.
NB: This post by no means intends to belittle the work of faithful sound medical practitioners currently in Nigeria, making the best out of the harsh working environment and system. This is me telling my experience of how I turned from hating Medicine to loving it and a call for Nigerians in diaspora to think on how we can improve the Nigerian health system.
NICE - National Institute for Health and Care Excellence
BNF - British National Formulary
Radiant ~ December 2019