Once upon a time, a dreaded electronic apocalypse was predicted to trigger the end the world.
It was the dawn of the internet, and while we didn’t fully understand it yet, my generation of health workers were faced with the cataclysmic fear of the Y2K bug, meaning no new millennium, and never practicing medicine. It never happened, we graduated, and we lived happily ever after.
Doctors and dentists, spread all over the world. In our final class photo, there are about 250 of us. At any time, there are about five sets in Medical School.
About 3,000 doctors and dentists graduate every year from 48 medical universities across Nigeria.
Over 80,000 doctors are registered, but about 64 per cent are not in service; brain drain is the biggest factor, but others may have changed to other professions, including politics.
The World Health Organisation recommends one doctor to 600 patients but since 2020, Nigeria has dropped from four to one doctor, per 10,000 patients.
Brain drain has always been integral to the colonial nature of African education.
We may talk of resource extraction in terms of Congo cobalt, Ghana gold and Nigerian crude oil, but the colonization of the educated middle class is the biggest disease.
Now renamed jápá, the mass exodus of highly skilled, middle class Africans, including experienced doctors, was exacerbated by sudden rising global demand created by the COVID-19 pandemic on global health systems, and a rapidly deteriorating economy locally.
For me, why highly educated, upper middle class Africans are steadily lost to the colonial core via mass migration is an unresolved question.
Easy answer, the economy. More complex answer is a nuanced mix of workplace conditions, including toxic workplace hierarchies that cripple the mental health of health workers generation after generation, brewing inter-cadre crises that increase workplace friction, plus the sad reality of watching patients slip through weak health systems in spite of our skills, and other non-health determinants that go beyond medicine into the political.
There is a deteriorating social crisis including pervasive insecurity caused by malignant poverty, coupled with the inbred coloniality of our education that wires our educated egos to be incompatible with the insufferable backwardness of our political development, and therefore selfishly opt to leave rather than have the moral courage or political sagacity to collectively fix our societies.
And, yes, the allure of earning in foreign currency, in a harsh reality where Nigeria, despite being Africa’s richest economy by GDP, suffers the world’s third fastest deteriorating currency by value. Our Hippocratic Oath was not designed to survive this complex social and economic metacrisis. For context, Africa has 25 per cent of the global burden of disease, but three per cent of the world’s skilled human resources for health.
Bridging this gap is a global challenge, possibly the biggest step in our collective journey to reach universal health coverage, before the end of this decade. Obviously, the answers lie beyond medicine in particular, to governance, and a surgical approach to increased quality of life that rekindles not only hope for the future, but also patriotism for the present and a collective effort by both citizens and the political class, to hold ourselves accountable to one another until we reach our collective goal.
Dr Adene is a medical doctor with 20 years multi-stakeholder experience from over 20 countries in Health Financing & Governance. He can be reached via: ayoadene@gmail.com, or +2348161856363.
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