Chief Medical Director of the University of Uyo Teaching Hospital, Prof Emem Bassey, talks to Patrick Odey about the challenges in Nigeria’s health care system, and how brain drain has affected the institution, among other issues
What are some of the challenges that come with being the chief medical director of a university teaching hospital? 135 Kva Generator
It is a privilege to be the first among equals as the chief medical director of the University of Uyo Teaching Hospital. That reinforces in me the will to build responsibilities. Yes, there are challenges, challenges of running a health system in an underfunded economy. However, I always believe that the challenges are not insurmountable. What I have to do as a human being is to ensure that I progressively move forward, tackling the ones I can tackle, but overall, trying to add value to the system which I lead.
Which of the challenges are peculiar to the University of Uyo Teaching Hospital?
The challenges that we have, I will say are generic, peculiar to me but also peculiar to other hospitals. If I were to put them on a scale, I would say my number one challenge is power (electricity). For quite a long time and even before I came on board, the electricity supply has been very bad. I know that previous administrations had attempted to provide a dedicated power line to the hospital, that was in 2011, but later, all the agreements were stopped without getting a community line. So, power remains the number one challenge. When I was appointed the chief medical director, together with my team, we attempted to tackle that, first of all, by reconnecting the hospital back to the national grid. It was off for well over a year, but even when we reconnected, we discovered that the power was very poor in the two lines. So, we opted to generate electricity. We bought generators; over the last five years, we bought more than six generators. We also repaired our 1000 KVA (generator) but the cost of diesel has now moved from 180 to N1,200 (per litre), so you can see the increase. We are trying to tackle it again by trying to undertake another dedicated line which is advanced, but we still have the challenge of raising adequate money for completion because of the variation in the exchange rate.
What is the state of physical infrastructure in the hospital?
Another challenge which, to a large extent, we have solved is infrastructure. The hospital progressed from being a general hospital to state specialist hospital, to a federal specialist hospital to a federal medical centre and now, a teaching hospital without a commensurate improvement in infrastructures. So, I will say that this is one of the successes that my administration has recorded. We were able to complete most of the abandoned projects that we found on the ground. From the general outpatient department, the radiology block, the laboratory complex, and others, we have been able to complete all those projects and we have started some new projects that are there for people to see. The hospital is a huge construction site. We hope in the next few years, both staff members and patients will be able to derive maximum value from the projects.
The third challenge, which is generic but peculiar to every other hospital, is finance. For whatever reason, the government pays the salaries of staff members and also gives capital which may not be adequate. We are grateful but the cost of everything is high. We don’t produce, the cost of our consumables, supplies, and equipment are all denominated in dollars. In this hospital alone, if one is not careful, one could end up spending over N10m just for basic consumables. So, finance is still a major challenge.
Does the teaching hospital not generate revenue?
When we generate revenue, we end up spending almost 50 per cent of what we generate on diesel alone. We are a training institution; we need money for training, workshops, and seminars. Another challenge is that our human resource is still poor. I would like to thank the Federal Government again for allowing recruitment into the hospital but it is still not enough because while we are recruiting but not retaining. A lot of health professionals are leaving the country daily. This week alone, I have seen two professionals resign. So, health professionals, primarily resident doctors, and even consultants, are going to Saudi Arabia. Doctors and nurses are leaving, and we are now seeing a large number of physiotherapists, radiographers, and laboratory scientists leaving. Even though we’re recruiting, how do we replace experience? I can bring in young physiotherapists for now but how do I replace the 10 to 15 years of on-the-job experience?
Of course, the final one (challenge) is the attitude of some staff members. This may be peculiar to our hospital. We have a relatively poor organisational culture, and that’s because I don’t think there has been any targeted attempt to change the poor organisational culture but we are trying to see how we can have that conversation, and have regular training here to improve on the attitude of the staff members. I wish I could get my staff members to begin to see patients as clients in the corporate sector and relate with them as such.
What do you think is responsible for medical professionals leaving the country?
There are multiple reasons, but I think the most serious one is the economy. If, for instance, the highest-paid medical doctor right now in Nigeria’s public service earns about $1,000, a very junior medical entrant in the United Kingdom earns about $3,000 before tax. In the United States, some doctors earn up to $500,000 in a year. So, doctors earn that high even though they have to pay taxes. So, the primary reason is the economy; we don’t pay our health professionals enough. So, other countries see Nigeria as a breeding ground to poach and take Nigerian doctors. The other reason has to do with job satisfaction. If you are working in an environment where there is no power and equipment to work, with no opportunity for training and to develop yourself, you may not be happy. The third reason has to do with insecurity in some parts of the country. So, they opt to leave. These are some of the challenges that are responsible for doctors leaving the country.
What would you recommend to the government as a solution?
It involves a lot of articulation of policies and I think at the highest level, we have to begin to discuss how to reverse the brain drain and see people come back to Nigeria. First, there has to be a conducive environment for them to work. Imagine, a situation where even when 10 to 15 per cent of Nigerian experts in the United States return to Nigeria and there is funding for them to set up high-brow medical facilities or even be integrated into the current government facilities with the right equipment; what you are going to see is the migration of people from other countries to Nigeria to seek medical care. So, it’s one of the things which we have to do. But beyond that, we have to address the pay gaps. I wish I could say health professionals should be paid in dollars but that is not possible. However, the salaries of health professionals should be looked into.
A member of the National recently proposed a bill seeking to compel medical and dental professionals to practise in Nigeria for a minimum of five years to be granted a full licence before the bill was rejected by the Federal Government in May. What is your thought on that?
I am very careful because I’m an employee of the government, but I would say that the bill had positive and negative sides. From the negative side, I would say it is against an individual’s fundamental human rights. If the person is indebted, on a scholarship or student loan, for instance, then the bill can apply to that person. But if you had to pay for your education, then it shouldn’t be.
But on the positive side, I want to say that university education, to a large extent, is highly subsidised because I have a son in a government medical school and I also have another son in a private university. My son in the private school is not studying medicine but his school fee is 15 times more than my son who is studying medicine at a government university. So, what does that tell us? To a large extent, medical education in government universities is highly subsidised so, patriotism should set in, and people should not be in a hurry to leave. Related News Governorship Election Live Updates Varsity plans mass burial of corpses abandoned for over 10 years UUTH plans mass burial for 100 abandoned corpses A'Ibom plans teaching hospital to complement UUTH
In specific terms, how has brain drain affected the UUTH?
It has affected us, maybe not as much as it has affected some teaching hospitals because I think sometime in 2021, in my capacity as the secretary of the Committee of CMDs of federal tertiary hospitals, I had a database and I could see the number of hospitals that were affected. However, it affected me in the sense that many of my resident doctors and nurses have left and a number of my consultants also left. As I said, how do you replace knowledge and experience? At one point, some units were empty because all the specialists in those areas left.
Why do some consultants in public health institutions run private hospitals to the detriment of government-owned facilities?
I will say every civil servant does private practice because your pay is usually not enough. For instance, a person who is running a farm, or a shop. For doctors and other health professionals, it is not a good thing to engage in private practice. So, I really will not support medical doctors moving patients from government facilities to private facilities; it’s totally against work ethics.
Are usually worried when doctors embark down tools in a bid to demand better pay?
I will say there have been incessant strikes not only by medical doctors. A lot of other health professionals also go on strike, but if you look at labour today, there have been strikes upon strikes. So, a strike is a Nigerian problem. I was a resident doctor before I became a consultant and beyond that I was also a national officer at the branch and national levels and we did have strikes. As an administrator, a strike is something you see as a last resort when every other attempt at settlement has failed but what I see is that a strike has become the first option. It shouldn’t be so.
Government-owned hospitals have in the past decried the rate at which corpses are abandoned in their mortuaries. What is the situation at the UUTH?
If you go to the mortuary, there are corpses some of which have spent more than 15 years in the mortuary. At one point, we may have to do a mass burial of abandoned corpses because I think it’s very wrong for people to abandon corpses and not bury them. The families of the deceased may not be aware because the police just just bring corpses. So, the issue of abandoned corpses is a major problem. I think we will need to do something.
Has the teaching hospital carried out any mass burial in recent times?
What reason do people give for abandoning the corpses of their damaged relatives for as long as 15 years?
Many of them may not even know when the police brought some (of the corpses) in. A person may not have seen their son or brother, and think he is in Lagos, not knowing that he is actually in a mortuary somewhere in Lagos. It is because of a lack of identification and communication. If every corpse is identified and there is adequate communication, it would have been easier. The second reason has to do with the cost of burials in our society, especially in Akwa Ibom and Cross River states. What I see sometimes, because I have poor relatives, is that money was not spent when they (the deceased) was alive but when they died, their children had to sell their land to bury them. Why not sell the land when the man was alive and let him enjoy the proceeds of his labour?
Can you give us an estimate of the number of abandoned corpse in the mortuary?
I can’t do that off hand but I know that we have possibly 100 abandoned corpses. We may have to do a mass burial.
You are, perhaps, one of the youngest CMDs in Nigeria. What motivated you to become a medical doctor?
My mother was a nurse and the dream of every nurse at that time was to have their son become a doctor. Apart from that, we had family friends who were medical doctors and for whatever reason very early in life, I just took the liking, there was no other choice. I never considered doing any other thing than becoming a medical doctor. Let me tell you that I was the best art student in my class. I had a very funny subject combination which I had not seen anybody do before. I took Physics, Chemistry, Biology, Literature, Bible Knowledge, and History. I was the best in the arts and above average in the sciences. If I had applied myself, it would have been easy to study History and enjoy it. I think I would have made a good lawyer but as I said, I never had any other choice.
18kva Generator I was privileged. I had parents who were educated. My father was a civil servant; he was an engineer. He was also an educationist and well-cultured. My mother was a nurse. They were not too rich but they were able to afford our basic needs. They were disciplinarians, so a lot of discipline was inculcated in me.