•As robotic surgery debuts in Lagos, Abuja
By Sola Ogundipe
Fresh concerns have been raised over the worsening internal and external brain drain of medical doctors and other health workers from Nigeria even as experts warn that tertiary hospitals are losing top specialists to private facilities at an alarming rate.
While external Japa drains talent out of the country, internal Japa is also draining expertise from one part of Nigeria to another, leaving entire regions medically stranded and deepening health inequality.
Nigeria’s healthcare system is caught in the double drain that leaves the poorest and most vulnerable communities with no specialists, few general doctors, and collapsing service quality.
The warning emerged at the annual conference of the Association of Urological Surgeons, Nigeria (NAUS), where senior clinicians, policymakers, and medical educators gathered to discuss advances in minimally invasive surgery—and found themselves confronting the personnel crisis threatening these advances.
A Senior Consultant Urologist at the Lagos State University Teaching Hospital (LASUTH) who is the LoC Chairman for the AGM, Prof Folarin Omisanjo said internal brain drain is fast becoming as damaging as international migration.
“Training centres invest millions in producing specialists, only to lose them before they can serve as consultants, mentors, and researchers. Many Nigerian-trained specialists complete residency only to leave for better-paying positions in private hospitals or abroad. The rate at which our NAUS members leave after training is alarmingly high. We need them to stay with us even after training. Let’s try to keep them as much as we can.”
Also speaking, a Consultant Urologist at the Lagos University Teaching Hospital (LUTH) and Senior Lecturer at LASUCOM, Dr. Abimbola Abolarinwa, painted a disturbing picture. Abolarinwa, who is Nigeria’s first female urologist in a field with just seven qualified women out of more than 200 specialists nationwide, observed that Nigerian surgeons shift internally because the system cannot support their expertise.
“We are training the world, but losing Nigeria, so why don’t we retain these people? Retain our surgeons going abroad, let the skill remain here, let the patients remain here. Nigeria has the talent; what it lacks is the ecosystem to keep them.
“If you must go, please return. We can’t stop movement, people have personal goals., but if you go, come back. Your families are here, your colleagues are here. Come back and establish something.
“Those that go make big sacrifices — new cultures, new systems. But if we had what they wanted here, they wouldn’t need to go.”
Describing internal brain drain as the crisis within the crisis, the President of the Association of Urological Surgeons of Nigeria, Professor Nuhu Dakum, said doctors are fleeing within Nigeria from insecure, underfunded, rural regions to safer, better-equipped states.
Dakum said the pattern of movement has reached an alarming level and threatens to further destabilise an already fragile health system.
“We are seeing doctors move within the country from one area to another in search of better pay, better working conditions, and above all, safety. Security is now a major factor. Where they know they’ll get better pay, they move, where they know they’ll get better conditions, they move, and now, security is a major factor.
“Doctors have been kidnapped, hospitals have been attacked, rural postings are seen as punishments, the result is that large swathes of the country are left with little to no specialist care.
“The few doctors left behind are overwhelmed, burnt out, and unable to deliver optimal treatment. We call on the government at all levels to fix security, welfare, and working conditions,” Dakum urged, noting that it is the only way to stop internal Japa.
On his part, the Chairman, Medical Advisory Committee, and Director Clinical Services and Training, Lagos State University Teaching Hospital (LASUTH), Prof Adebowale Adekoya, said Nigerian urologists are demonstrating skills in areas of their specialty, noting that some of the surgeries that people travel abroad for can now be carried out in the country.
“Some of these we call endo-urological surgeries and very rare urological surgeries, now also, with the assistance of robots. As we speak, we have been able to drive the system up to the point that the country can now boast of three robots spread across the country, two within Lagos and one in Abuja.
Gradually we’re beginning to see that surgeries that people go to the Western world to get done can now be safely done at home, and Lagos state will continue to be in the driving seat for that.
Adekoya said the Lagos State Government is adopting a proactive strategy to mitigate the effects of the ongoing japa phenomenon by dramatically increasing the production of specialized medical personnel and various cadres of health workers.
The conference focused on emerging trends in urology including minimal access (keyhole) surgery and the rising prevalence of urological cancers. It was highlighted that prostate cancer remains the most common cancer among Nigerian men and the second most common worldwide, with 1 in 6 to 8 men having prostate cancer in their lifetime, the forum stressed the need for specialists to be evenly distributed across the country.
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