However, a lecturer at the College of Medicine, LASU, who pleaded anonymity, said that the standard of medical training and practice had fallen in the country. He blamed the situation largely on the decline in the quality of students leaving secondary schools for universities.
The lecturer also identified the frequent industrial crises in universities and teaching hospitals as another factor responsible for the dwindling standard of medical training and practice in Nigeria. He said, “The quality of students that come to us has dropped. So, we cannot take medical schools in isolation without looking at the quality of education in the primary and secondary schools. Basic education is worse in Nigeria today than it was some years back. And since our students are products of the rot we see in primary and secondary schools, the problem tells on the quality of students that come to the universities.
“Other problems include the proliferation of training centres that have not been accredited and frequent industrial crises. At the moment, there is also lack of foreign exposure. Doctors are supposed to go on exchange programmes abroad to gain more exposure but that tradition is gradually dying because of lack of funds. “Also in a year, we could have 50 to 100 days of industrial shutdown, which means that teaching hospitals could be shut one-third of the time a student is undergoing training. “The truth is that a lot of patients die when hospitals are shut down. Strikes also affect capacity building; if a young doctor should have been trained with 100 patients and he ends up seeing just 30 because of strike actions, his level of exposure will not be what it should be. “Also, it will mean that the installed facilities in medical schools and teaching hospitals are left to rot because they are not utilised within the time that workers are on strike.”
The lecturer recalled that there were hardly strike actions in his time as a student at UI about 20 years ago.
However, a consultant at LASUTH, who did not want his name published because he was not authorised to speak to journalists about such matters, also faulted the quality of the country’s medical training and practice. The source commended some recent moves by the National Universities Commission to improve the standard, but added that more work needed to be done.
Some of the moves the consultant credited to NUC to stem the decline included introducing stricter admission policy and making PhD the minimum qualification for lecturers in medical schools.
He said, “But there are so many other rots in the teaching hospitals where students go for attachment. The standard there has fallen woefully; facilities are grossly inadequate or obsolete. There is constant power outage and industrial crises, all of which have impacted negatively on the standard. “Most hospitals that say they are open 24 hours a day don’t have doctors on ground all the time. The doctors are only available for 12 hours and then leave the nurses to man the facilities. “Inter-cadre rivalry also affects medical practice with different health care professionals spending so much time arguing over superiority in the sector when they should be caring for patients. There is no team work, which builds needless bureaucracies, so a patient could end up spending a week for a treatment he could have got in a day.”
Condemning some of his colleagues, the source said many consultants in teaching hospitals frequently abandon their jobs “because of private practice in town.” “Some of the consultants have their own hospitals where their primary obligations lie. The ones that don’t have hospitals consult for private hospitals or establishments,” he added.
Confirming the trend, a student at the college, Funmbi, identified the situation as one of the factors affecting the quality of medical practice in the country. She said, “I know about the case of a diabetic patient who died at the hospital last year. He was being treated here and had been given drugs but her case worsened and the inexperienced house officer couldn’t reach the consultant on time to assess the situation. The delay must have been responsible for his death since the house officer was inexperienced and didn’t know what else to do. “Cases like that often happen at the hospital; the house officer places a patient on a drug and goes, but the oga (consultant) will not come to assess the situation.”
Investigation also shows that the regulation of medical practice should also be taken seriously as no laboratory in any teaching hospital in the country has ISO 15-189 accreditation.
According to a pathologist in private practice, Dr. Idris Durojaiye, the implication of the laboratories not being well-accredited is that “the resident doctors being trained to practise pathology are not exposed to international best practices, which include standardised internal quality control and health and safety standards that measure up internationally.”
But apart from the problems of obsolete and inadequate facilities, power outages and frequent industrial crises already identified, some other problems affecting medical training and practice include funding and shortage of manpower.
Shortage of health care professionals
For instance, Enabulele said Nigeria would need about 250,000 medical and dental practitioners to meet up with the standard required to effectively take care of its population. Enabulele said the country “currently has less than 30,000 doctors looking after 170 million Nigerians,” a situation he described as “unacceptable.”
He said, “At the moment, we have a ratio of one doctor looking after about 6,000 patients which is suffocating. We need to invest more in medical training school. Ideally, we should have a ratio of one doctor to 600 patients. In the African economy and low income and middle income countries, we can accept a ratio of 1:1000, but it is expected that all countries should work towards a ratio of 1:600. We need an extra 253,000 graduates of medicine in Nigeria to cope.”
To achieve that standard, Enabulele said each medical school in the country would need to start graduating an average of 4,000 to 5,000 medical students as against an average of about 80 medical students currently graduating annually from each school.
According to Enabulele, the current shortage of medical doctors in the country could result in brain drain, drop in doctors’ output, loss of public confidence in hospitals, patronage of quacks, unorthodox medical practitioners and foreign hospitals.
He said, “Doctors are human beings, so the care they give to the first set of people they see in a day will not be the same with what they give to others they see later in the day. One person is doing the job of 10 persons, so he will not exert the same level of energy for all the patients that come to him. “For government, people will lose confidence in the system because of the long queues in the hospitals. There will be long waiting hours. People will resort to other less refined systems including quacks and unorthodox practitioners. And that has an effect on the quality of care and the morbidity and mortality indices in the country. Some patients who can afford to travel abroad will contribute to medical tourism. So it has reverberating effects.”
But Enabulele disagreed with the assertion by some people that the standard of medical training has dropped over the years “because even now there are graduates of medicine in Nigeria who are doing wonderfully well abroad.” He, however, said that the public confidence that had been lost could be rebuilt with “adequate infrastructure, work environment, health human resource, necessary investment and financing and proper attitude of the human resource.”
In addition, Okewale said it would be unfair to isolate medical practice by highlighting its failures.
He said, “If Nigeria as a country improves economically and generally, it automatically transfers to educational, teaching and health sectors. You can’t pick them in isolation and pump more money into the universities for instance, with other areas still lacking.
“So doctors are not killing people, it’s the Nigerian system that is killing people. The same doctor that we claim is killing people, put him in an environment that is working and he will function well. Doctors are just individuals who have the knowledge in their heads. There are other things that will make the work easy for them and make them more functional. If those things are not in place, you can’t blame the doctors for them.”
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