They spend eight long years in institutions of higher learning in Nigeria for their MBBS degrees more than any other class of professionals. With the worsening insecurity and downturn in the economy, it is no surprise some doctors are now leaving Nigeria to take up appointments in Europe – the UK especially. But as some of them have now found out, the exploitative work condition is far from what they expect. THEWILL considers some recent cases of the griping medics against their employers. Michael Jimoh reports…
Before Dr. Augustine Enekwechi, a Nigerian medic, arrived the UK some time ago to take up appointment at Nuffield Hospital Leeds, he hoped all would be well. Though with a medical degree from his home country, Enekwechi still had to sit for Professional and Linguistic Assessment Board to be recruited. He did. Overseen by the General Medical Council in London, PLAB is the first of a series of recruitment tests for foreign doctors to secure a license in the UK as required by the British medical authorities.
Enekwechi had done his PLAB 1 successfully. He was in the second phase when NES Healthcare got in touch with him, with “visa sponsorship and a potential job.” He accepted. Then things began to go the way he never expected. Like a plough horse, he worked round the clock for his employer, all through the day, week to week and so on. The result was only too predictable. He was exhausted. He broke down.
Quoting the Nigerian medic in a recent BBC publication, Enekwechi said “his hours were extreme; on-call 24 hours a day for a week at a time,” adding that “he’s unable to leave the hospital premises which feels like being in a prison.”
Possibly abiding by the Hippocratic oath, doctors do their best to not cause any harm to patients under their care. Even so, there is a limit to how long the human body can function. Like other professionals in the line of duty, doctors need time for rest, to relax their mind and body for optimal performance. It was clearly not so in Enekwechi’s case. Since he was constantly on his feet, moving from hospital bed to another, performing this or that surgery and generally attending to patients 24/7, the good doctor himself felt he couldn’t function properly. “I knew that working tired puts the patients at risk and puts myself also at risk…I felt powerless… helpless, you know, constant stress and thinking something could go wrong.”
Another Nigerian medic Dr. Femi Johnson may also have been recruited the same way his compatriot was. He had a similar fate with Enekwechi though not in the same hospital. By his own admission, he said he was “expected to work 14 to 16-hour days and then be on call overnight. I was burnt out. I was tired, I needed sleep. It’s not humanly possible to do that every day for seven days.”
Unable to follow the punishing schedule and to retain his sanity, Johnson took some time off. His employers, NES, promptly deducted from his salary, insisting it will “cover the cost of finding a replacement doctor,” prompting Johnson to conclude that doctors like him hired by NES are “in a terrible dilemma.” Continuing, the Nigerian doctor said such frustrating situations made him reevaluate his current job status. “In situations like that, I always make that internal discussion with my inner self, ‘Femi are you doing right by yourself and are you doing right by the patient?’ Unfortunately, I haven’t always been able to answer that question.”
No one seems to find an answer yet to the complaint by the Nigerian doctors even though the British Medical Association has called the action of the private hospitals “shocking.” To stop the practice of overworking medics, especially those from Third World countries, BMA is insisting that the private sector “needs to be brought in line with the NHS working practices.”
But Nuffield Health has defended its actions, saying “its doctors are offered regular breaks, time off between shifts, and the ability to swap shifts if needed,” adding that “the health and wellbeing of patients and hospital team members is its priority.”
If so, why are doctors Enekwechi, Johnson and many others from Nigeria complaining? NES Healthcare, according to BBC investigations, “specializes in employing doctors from overseas, many of them from Nigeria, and using them as Resident Medical Officers, or RMOs – live-in doctors found mainly in the private sector.”
Enekwechi himself has said that when NES Healthcare got in touch and apprised him of a possible job offer with a private hospital, he was so excited “that he barely looked at the NES contract. In fact it opted him out of legislation that protects UK workers from excessive working hours, the Working Time Directive, and left him vulnerable to a range of punishing salary deductions.”
Faced with such humiliating working conditions in private hospitals in the UK, especially for those in a privileged profession (doctors are the first to see an individual at birth and the last to see him when he dies) why are they still flocking to work outside Nigeria?
Follow the money
The attraction is nothing but money and better working conditions, as some of those the Beeb spoke with admitted. “The Nigerian doctors who spoke to the news agency, said they were attracted by the potential of higher salaries and better working conditions.”
Though the World Health Organisation long ago warned against poaching medical personnel from Third World countries where their services are needed most in red-list countries like Bangladesh, Ghana, Pakistan and Sudan, private health institutions in the UK have continued to make overtures to doctors from these nations.
In a Punch report of June 2021, for instance, 200 fresh Nigerian doctors swelled the number in the UK to 8, 384. The numbers are still rising. In an interview with Dr. Seun Yusuf, president of the Nigerian Doctors in the UK, she noted that “the number of Nigerian doctors migrating would continue to increase as long as doctors were not well paid and hospitals lacked equipment,” insisting that “in the last three years, more than 6,000 doctors would have left Nigeria to different places but because the UK is the easiest place, the pathway becomes very easy so the UK gets a higher percentage of Nigerian doctors migrating. Some people are still in the UK writing their exams and they are not included in these statistics.”
According to her, poor pay and incentives were possible causes of the exodus. Hear her: “The doctors who finish school struggle to get house job placement and they don’t get paid. Imagine attending school for eight years and you don’t get a job on time and when you get it, they don’t pay you.
“You finish from school and go to NYSC and after eight years of medical school, one year of houseman-ship during NYSC, someone pays you N80, 000 when you know you can earn better with that certificate in another country. If Nigeria had enough incentive, work/ life balance, people would not leave.”
One major consequence of the mass exodus of Nigerian doctors to foreign countries is depriving their own countrymen and women much needed services. The WHO warning against poaching doctors from developing countries is not for nothing. In a report published by International Centre for Investigative Reporting, last March, Marcus Fatunmole wrote that there are four Nigerian doctors to 10, 000 Nigerian citizens. “Only four doctors could attend to 10,000 people living in Nigeria, and the trend has been so in the past two decades.”
With the recent outflow of medics from Nigeria, the ratio is bound to get higher. It also means that many of them are likely to end up like the Enekwechis and Johnsons in foreign hospitals. Even so, a medical doctor in Edo state told THEWILL in a phone interview late last Friday that cases of exploitation are not peculiar to doctors working in the UK. Overworking doctors also happens here, he said.
In his view, private hospitals in Nigeria, unlike government-owned hospitals, are profit-oriented businesses. The proprietors of such health facilities, he contends, make bricks of cash at the expense of those they employ, including doctors. They also put them to work, he went on, like galley slaves. The difference between doctors working in private hospitals in foreign countries and their equivalent here is that such exploitative tendencies are barely talked about, let alone make the headlines as Enekwechi and Johnson’s case.
About the Author
Michael Jimoh is a Nigerian journalist with many years experience in print media. He is currently a Special Correspondent with THEWILL.
