How Nigerian Health Care was Destroyed
By Dr John Mabayoje
egarding the terrible state of the Medical Care in Nigeria, I will like to throw a little light on how we got to where we are today.
The Health Care policy of Nigeria is so simple to describe. “He got no money,
Let he die”. It’s seeds were sewn in 1973, and by 1986, the “ Golden age of Medicine “ when Nigeria had Health Care that was at the frontiers of World Medicine in Nigeria,was gone.
Col Dr. Ahmadu Ali, General Murtala Mohammed, Dr Jibril Aminu and Prof Essien Udom together bear the brunt of the responsibility of this.
It really started in 1973 when Col Dr. Ahmadu Ali (of Ali must go fame) replaced Brigadier Dr Henry Adefope as one of the two representatives of the Armed Forces Medical Services on the Nigerian Medical and Dental Council.
Col Dr Ahmadu Ali on assuming his role in the council met a successful program called Compulsory Rural Service for Doctors (CRSD) which was started during the civil war. The (CRSD) was attached to Post Graduate Training Program and a vibrant Health Care policy Nationally. Every newly qualified West African trained Doctor or Dentist or every Overseas trained Doctor or Dentist had to go for one year rural service, supervised by a Senior Experienced Specialist in the area he served.After the one year Rotating Internship through 4 specialties or 5 , if you chose to do 1 month of Psychiatry, in your 3 months of Medicine, you went for Rural Service and earned SHO 1 salary for that 1 year as well.However there were exceptions to encourage people to go into medical specialties that were under served manpower wise, like Opthalmology,Dermatology, Radiology, Psychiatry, Pathology, Ear Nose and Throat Surgery etc.
In those specialties with manpower shortages, if you chose to go into them, you would serve in a Big City Hospital or one of the Teaching Hospital, and after that second year of training , you would be awarded your full Medical License.
Consequently, a lot of matured Doctors, female Doctors and those with families went into those “needed specialties” . Doctors got Car loans and served their second year after qualifying on Senior House Officer Grade 1 salary a step above the House Officer salary to enabled them to continue to pay their Car Loans during their Rural Service year. This kept many of them in the Nigerian system providing Good Healthcare for about 5 years.Not bad so far.
In came Col Dr Ahmadu Ali. He plagiarized the CRSD service program for Doctors in 1973 and took personal credit using it for setting up the NYSC program in place of the Rural CRSD Compulsory Service for Doctors which he later headed.
The Medical and Dental Council met and Col Dr Ahmadu Ali was asked to use his position to do two things:
1: Ensure the Supervision of the Rural Doctors was continued by Senior Specialist Physicians and that the exemptions for those wishing to go into those needed specialties were continued to maintain an improvement in the ratio of Specialists Population in these needed areas.
2:That Doctors continued to receive their Senior House Officer Grade 1 salary scale so they would be able to meet their financial commitments like Car Loan etc and the mature Doctors with wives and Children would not suffer.
The arrogant pipe smoking Physician Soldier refused. There was a stalemate because the Medical and Dental Council refused to allow Doctors in Rural service to be controlled and supervised by Non Physicians during their SHO 1 year, because it was against WHO and internationally recognised guidelines for Postgraduate Medical training.
The Medical and Dental Council warned him of the immediate and long term consequences of his actions. He was told that the Car loan scheme would soon collapse and the young Doctors would seek more welcoming pastures overseas and not come back.
Col Dr Ahmadu Ali was adamant that all NYSC members must be treated equally despite the Senior Council members’ remainder that he plagiarised a system that was already in place and working without giving consideration to the CRSD Rural Service for Doctors Program. He simply used Military fiat and the decree establishing the NYSC was worded to cancel any similar program.
TO allign with the latest government decision, the Medical and Dental Council met and passed an edict granting all Doctors and Dentists full license across board to practice Medicine after their 1 year of rotational Housemanship training.
In a few years, the Car loan program “ fizzled out”.
In 1975, General Murtala Mohammed decided to enact a retirement exercise that cut across board. I was the President of the Students Union of the University of Ife then and I told the new VC at Unife Professor Ojetunji Aboyade that we in Ife had no body to retire and that he should watch how the Northerners would replace the Southerners retired with Inexperienced Northerners. He said that was not possible. 6 months later he apologized to me in the presence of the Registrar Chief Akinyele. It had devastated the Civil Service and Government controlled Parastatals with no respect whatsoever for people of Southern origin who formed the core of the pioneering professionals, technocrats and administrators that kept Nigeria functioning efficiently.Thousands and Thousands of Senior experienced Professionals Technocrats and Administrators were retired for “ Old Age “ at the age of 55 years.Drs and Nurses were not left out.
Dr Sir Samuel Manuwa, the Architect of Modern Medicine in West Africa who was Deputy Chairman of the Federal Civil Service Commission,the powerful body that oversaw the recruitment,of Graduates etc into the Federal Civil Service among other duties, was retired “ with immediate effect “ and asked to leave his Ikoyi residence at Alexander Avenue. He was Africa’s 1st Board Certified Surgeon as well as the Chairman of the Governing Council of the University of Ibadan. He was present at every Final Examination of the Premier Medical School at the University of Ibadan, staying in the background meeting with external examiners and making sure that standards were improved.
An unknown fact was that he used this final UI examination period to ensure that the other Medical schools in Nigeria lacked nothing and that University of Ibadan, already a recognized place in World Medicine, did not grow at the expense of the other Medical Schools.The selfless people who ran the Medical and Dental Council of Nigeria were all represented among the external examiners and all the Medical Schools’ top Academicians looked forward to that time of the year to exchange brilliant ideas and rub minds.
All that ended in 1975 summer thanks to Gen Murtala Mohammed.
Dr Sir Samuel Manuwa was suddenly “driven “out of his official Residence of 20 + years and forced to live in a rented place in Surulere provided by Mr Phillips. He died a few weeks later.His death, as a singular factor put fear and created mass insecurity, financial and otherwise in the Medical community that has remained unchanged and unaddressed to this day.
Murtala Mohammed then replaced a lot of the retired positions with inexperienced Northern Civil Servants.
A young UCH trained Brilliant Lecturer Dr Jibril Aminu was appointed to become the Secretary of The all powerful National Universities Commission with Professor Essien Udom a Political Science Professor being appointed the NUC Chairman.
Col Dr Ahmadu Ali left as the Head of The NYSC to become the Federal Commissioner for Education. Essien Udom was Murtala Mohammed’s “ smoking and partying buddy “ .
The trio of Essien Udom, Ahmadu Ali and Jibril Aminu, set forth on a destruction path and destroyed the Medical and Tertiary Educational system we had enjoyed in Nigeria for many years.
It was a downhill process from then onwards.
The top Academicians in Nigerian Universities including his former Medical School Teacher Prof Ogunlesi sought audience with Dr Jibril Aminu to advice him and bring the deterioration to his attention and to ask him to bring back some professionalism and decorum into the system. What did Jibril Aminu do? He became extremely rude and arrogant to his former teacher Prof. Ogunlesi and the other top Academic Dons who came to see him.He told the delegation that came to see him to “ pack out of University housing and go”. This reaction was a huge shock to Prof Ogunlesi and some of the others who left there and went to LUTH to see one other Senior Medical Professor , originally one of the delegation,who advised other means including a Mass Resignation of the top Academicians in UI, UNILAG axis rather than going to see Jibril Aminu the outcome of which he had predicted and refused to go with them to see Dr Jibril Aminu (A Lecturer Consultant under Prof Ogunlesi in UCH until his appointment).
The rot and destruction of Tertiary Education especially in medical profession continued under that trio even after Ahmadu Ali was removed following the bloody Students riot that spread from Ibadan University to the campuses of every University down South as well as the main Northern Universities.
By the time of the “ Ali must go Riot” the damage had already been done.
The 2 Post Graduate Medical Colleges of West Africa and Nigeria were deliberately created by the same person, they went to see at LUTH after leaving Jibril Aminu, to ensure that the politicisation of Medical Specialty training by Nigeria’s Northernisation Policy Agenda was put in check by having 2 Postgraduate Medical Colleges of equal parity in West Africa and Nigeria. It has remained so to this day.
Sadly the products of the Nigerian Medical Schools no longer enjoy Car Loans, they no longer enjoy 1 year training abroad during their West African or Nigerian Post Graduate Medical College training,that produced the likes of VOR Member Harvard trained Neurologist Dr Seyi Roberts and 100’s of others.
Dr Bayo Fajemisin the brilliant Ear Nose and Throat Surgeon whom the Royal Saudi Family followed from a London Hospital to UCH in the late 1960’s and early 1970’s was the 1st to spend his sabbatical year in 1978 in a Saudi Teaching Hospital. He returned to pack his “ property” and go back to Saudi Arabia.
The “Volkswagen Car “ Loan started by Mrs Victoria Gowon a UCH trained Nurse, that led to the rapid expansion of the Nursing Profession, was abolished in the 80’s and Nigerian Nurses with RN qualification flocked to the US, Canada and the UK along with their Physician Colleagues who trained at LUTH,UCH, IFE and other Hospitals. There is hardly a Hospital of Note in Urban USA where you will not find Nigerian Physician Specialists as well as Nigerian Nurses working to maintain the System and its strict standards.
Post Graduate training funding went down after Sehu Shagari became President and misgovernance that created Serious Economic Challenges became the order of the day.
Medical Care continued to go downhill and by the late 1980’s the seeds sewed by those 4 people had spread it’s “ bloody fruits to the mess we have today…. “ He got no money let he die….” .
By late 1989 when the Brain Drain Commission headed by VOR Member Professor Oye Ibidapo-Obe was inaugurated,to stop the “Andrew l am checking out slogan”, the damage had gone completely out of control. Our best brains after 1 year of Housemanship training were taking their full licenses and seeking greener pastures abroad immediately.
Today there are no less that 15,000 Nigerian Specialists in North America and the UK a larger Number are in the UK, at least 5,000 are in Southern Africa.
The greatest tragedy is that we the “ Andrew don’t go “ generation of Physicians who “ checked out “in the 1980’s and 1990’s , our Children are now Specialists …… I am ashamed to say that I have no less than 30 younger professional colleagues who are my Children, Cousins, Nephews and Nieces on the list of 10’s of 1,000’s of Nigerian Doctors who are Specialists in the Diaspora. Included among them are also relations of Prof Oye Ibidapo-Obe the Chairman of their Brain Drain Commission.
In our greater family alone there are enough medical practitioners at home and abroad to staff a new teaching Hospital when you add in laws married to Doctors in the Family. I know many of us have the same experience of Children and Relatives specialising and practicing Medicine in the Diaspora, lost to the population of Nigerians no longer living in the country called Nigeria, yet they remain Nigerian’s.
Meanwhile, the ratio of Ear Nose and Throat Surgeons in Nigeria has risen to a disgraceful 1:> 1,000,000. The other day, one of my Male Staff snuck off to get a “ tonsillectomy “ done by a Hausa/ Fulani Quack. When I got the call that he was dying after an operation of “ belu belu “ removal in a crude surgery of his inflamed Tonsils, a simple operation that should not cost life. But for the Clindamycin and Ceftriaxone injections I had my staff buy and take to a kind Physician Colleague who administered it to the poor staff member in a simple inpatient facility in rural Nigeria,that staff member would have died a victim of the 1:>1,000,000 ratio of ENT Surgeons to Nigeria’s population.
Thank you all for allowing me to share my little knowledge of what I know firsthand, my experience, and my account of the journey about how we got to where we are.
John Mabayoje MD
Franklin Medical Mall
Mobile Alabama
USA.