THE RISE AND FALL OF NIGERIA HEALTH SYSTEM

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I will share this article with you my brothers and sisters just to further highlight the reasons why our past is to important to influencing our present and reliably predicting our future. The descent of our health system from one of the best in the world in 1970’s to one of the worst in the world according to the latest ranking by WHO started many years ago. The specifics and the trends are well highlighted in this lengthy but insightful article, enjoy as you read and reflect ;
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“ HE GOT NO MONEY ? LET HIM DIE”

Ladies and Gentlemen, regarding 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.

The Health Care policy of Nigeria is so simple to describe. “He got no money? l
Let him 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, it 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 Adefowope as one of the two representatives of the Armed Forces Medical Services on the Nigerian Medical and Dental Council.

Col Dr. 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 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 after the one year Rotating Internship through 4 specialties of 5 , if you chose to do 1 month of Psychiatry, in your 3 months of Medicine.

However there were exceptions to encourage people to go into medical specialties that were under manpower shortages like Opthalmology,Dermatology, Radiology, Psychiatry, Pathology, Ear Nose and Throat Surgeries, etc.
In those specialties with manpower shortages, if you chose to go into them, you would ha e served in a Big City Hospital or Teaching Hospital, and after that second year of training , you would be awarded your full Medical Practise 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 salaried a step above the House Officer salary to enabled them to continue to pay their Car Loans during their Rural Service year. Not bad so far.

In came Col Dr Ahmadu Ali. He plagiarized the Rural CRSD service program for Doctors in 1973 and took credit by 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 and vice versa would not suffer family disruption.

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 drcision 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 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 SW origin who formed the core of the pioneering professionals that kept Nigeria functioning efficiently . Thousands and Thousands of Senior experienced professionals were retired for “ Old Age “ at the age of >55years.

Sir Dr 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, etc of Graduates and Teachers 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 Medical School at University of Ibadan in the background meetings with external examiners and making sure that standards were improved.

An unknown fact was that he used this final examination period to ensure that the other medical schools in Nigeria lacked nothing and that University of Ibadan, already a base for super knowledge in World Medicine, did not grow alone 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 yo exchange brilliant ideas and rub minds.

All that ended in 1975 summer thanks to Gen Murtala Mohammed.

Sir Dr. Samuel Manuwa was suddenly“ driven “ out of his house of 30 years and forced to live in a rented place in Surulere provided by Mr Phillips. He died almost immediately, completely broken as he cannot bear the rate at whixh things were falling apart. His death, as a singular factor put fear and created mass insecurity, financial and otherwise in the medical community and it 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 named 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 “ .

Those, 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 downhill process from then onwards.

The top Academicians in Nigerian Universities including his former Medical SchoolTeacher 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 told and the delegate that came with him to “ pack out of University housing and go”. This unexpected reaction was a huge shock to Prof Ogunlesi and some of the others left there and went to LUTH to see one other senior Medical Practitioner, originally one of them, but changes his mind and refused to go with them to see Jibril Aminu (who had been a Lecturer under Prof Ogunlesi in UCH just months before his sudden appointment).

The rot and destruction of Tertiary Education especially in medical profession continued under that trio even after Ahmadu Ali was removed after a 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 Nigeria. It has remained so to this day.

Sadly the products of the West African and Nigerian Postgraduate Medical Colleges no longer enjoy Car Loans, they no longer enjoy 1 year training abroad 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 under Murtala Mohammed.

Post Graduate training funding went down after Sehu Shagari became President and we had misgovernance that created Serious Economic Challenges.

It continued to go downhill and by the middle to late 1980’s the seeds sewed by those 4 people have spread its “ bloody fruits to the mess we have today…. “ He got no money let him die….” .

By late 1989 when the Brain Drain Commission headed by VOR Member Professor Oye Ibidapo-Obe was inaugurated, that led to “Andrew 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. 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 in the Diaspora…… 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 my nuclwar famy alone there are enough medical practitioners abroad that to staff a teaching Hospital when you add in laws married to Doctors in the Family. I know all 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 on the country.

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 dying of his seriously inflamed Tonsils, a simple opwration that should not cost life. But for the Clindamycin and Ceftriaxone injections I had my staff buy and take to a kind Physician Colleagues 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.

BY

John Mabayoje
Franklin Medical Mall
Mobile Alabama
USA.

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