Why our doctors, nurses are in high demand abroad, by Fabamwo

Prof. Adetokunbo Fabamwo is a consultant Obstetrician and Gynaecologist, and Chief Medical Director (CMD) of Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos.

Fabamwo in this interview with The Guardian gave reasons Nigeria-trained doctors and nurses are in high demand in Europe and America and what the hospital is doing to stem the tide.

You were recently quoted to have said that five nurses resign daily from the hospital for greener pastures. What is LASUTH doing to stem the tide?
The challenge we have is an exodus of health workers travelling abroad because governments of the developed world have decided to focus on Africa to source manpower- doctors and nurses to fill their own missing gaps, especially in Britain and Canada, among others.

This is because people are no longer studying medicine there, and the COVID-19 pandemic has affected a lot of manpower in those countries. So, they look for manpower to fill the gaps in their health system and they recognise the fact that Nigeria has highly-trained health workers and they are highly skilled. So, they focus especially on Nigeria; they have made it easy for doctors and nurses to apply for jobs in their countries. However, as health workers travel abroad for greener pastures and it affects us.

However, the Governor of Lagos State in his magnanimity has approved a training programme, where we train and employ health workers so that there will be no gaps. But when you lose highly skilled doctors, and you said you are training new doctors, actually they are not the same in terms of experience.

The management of LASUTH has responded actively, for three weeks, after the nurses’ resignation. The first thing we did was to look forward to assistants. We recognise the fact that nurses have different functions, which they learnt in school and other functions they perform are not necessarily professional in a way, that non-professional staff members can perform. For instance, dressing beds, bathing patients and disposing of the wastes of patients, including urine. So, anybody can really perform these functions.

We decided to take off the burden of these minor functions away from the remaining nurses, who are still with us and employ others who are not nurses by profession to perform these functions. So, right now we have a number of people who work in the wards, we call them ward assistants and they help nurses to do minor work.

The other thing we did was to look at the entry qualification for nurses into the hospital. Ideally, we should be recruiting fresh graduating nurses and those that have advanced qualifications in the profession, for instance, professional nurses, midwives or psychiatric nurses, among others. So, these are called double qualified nurses, which the government recommended for us to employ.

But we have problems in getting this set of nurses because they will go for an additional qualification programme after two years to enable them to stay in the system. We recognise the fact that there are two ways nurses retire in the profession; it is either they have attained the age of 60 or they have worked for 35 years. But there are nurses who finished school at the age of 20 years and started work immediately, by the age of 55. These nurses have worked for 35 years; they have to retire at the age of 55.

At 55 years, they are still active, so, we look at the possibility of engaging some of them on a contract basis, which will be renewed yearly until they get tired and will no longer be useful.

What have been your other challenges as CMD of LASUTH?
Our major challenge is the lack of space. I will like to say that LASUTH was just a cottage hospital in the 40s and it gradually became a general hospital in the 50s and 60s through the 70s and 80s.

In 2001, the government in its wisdom decided that Ikeja General Hospital should be transformed into the Lagos State University Teaching Hospital (LASUTH), to offer a platform for practical training for medical students that have already been admitted to Lagos State College of Medicine (LASCOM) as at that time.

The LASCOM started in the year 1997 and admitted the first set of students and LASUTH came into existence later in 2001, to offer a laboratory where these medical students will be trained. You can see that it moved from a cottage to a teaching hospital. It was supposed to be accompanied by huge infrastructural development.

As a matter of fact, in 2001, when the LASUTH was conceived, one of the options was to have a new purpose-built teaching hospital somewhere on the Mainland. But I believe that it was the cost of that kind of project that discouraged the government at that time, they decided to just upgrade the existing general hospital and started using it.

I will admit that substantial upgrading has occurred because we have more buildings now compared to the year 2000. New buildings have been erected to emphasise the need for expansion. But what I am saying is that it is still not enough to cater for the huge load of patients that we have to care for.

LASUTH offers advanced treatment compared to Lagos University Teaching Hospital (LUTH) in Idi-Araba and the Federal Medical Centre Ebute-Metta, Lagos. But the institutions are not adequate to carry the loads of patients that need tertiary hospital treatment.

The other thing that gives us issues in LASUTH is that the residents have not yet imbibed the culture of using primary and secondary health facilities as the first option. A lot of the citizens still see us as a second option. There was a time a particular governor tried to legislate that all patients that come to LASUTH, should come with referral letters but it was never put down as law. So, we still receive a number of patients that just come in without any referral letter, even without the need for tertiary healthcare. So, we have a huge load and limited space.

Another challenge is the no-bed syndrome that keeps embarrassing us. I always tell people that we are in this business to manage and treat patients and we are not in the business to turn patients away. It does not even pay financially and economically to turn patients away. The more patients we were able to treat and manage, the more revenue we generate. Even though our cost of medical treatment is highly subsided by the government, at least something will come in as income if we admit and treat more patients.

The whole of our landscape in LASUTH has been choked up, so, there are only two options as a solution. One is for government to put up high-rise iconic buildings on these premises, which will be like a landmark expansion. As we speak, all the buildings here are bungalows and they are occupying space. You can make more use of that land economically by having high-rise iconic buildings. It is one of the things already in the plan of the current management board of this hospital.

Another option is to add more floors, especially in our emergency unit. Our emergency unit is a bungalow, which is also limited. So, if we are able to add more floors to double the number of beds we already have now, we will admit more patients to our emergency than we have currently. I will admit that these are the things we have already put in our project plans for 2023, that if the iconic building does not come up next year, the expansion of the emergency floors will come up.

The positive role Governor Babajide Sanwo-Olu has played in assisting us is that we have never been short of funds to manage the hospital. I must thank him, including Commissioner for Health, Prof. Akin Abayomi, the Permanent Secretary of the Ministry of Health, Olusegun Ogboye and Commissioner for Budget, Samuel Avwerosuo Egube, for their efforts.

As Obstetrician and Gynaecologist, how has your expertise affected maternal and child mortality in LASUTH?
I am one of the pioneers of ultra-modern Ayinke House, as far back as 1990. I am one of the first three consultants that were posted to start Ayinke House in 1990 and since then Ayinke House has moved from just a Department of Obstetrics and Gynaecology to becoming an Institute for Maternal and Child Health with 150 ultra-modern centres, five operating theatres, 12 intensive care units and 12 wards among others.

When we started Ayinke House in 1990, we recognised the fact that we needed to expand, even though the General Hospital, we were situated in then, was not yet a teaching hospital. We took a deliberate decision to start postgraduate training for young doctors so that we can train them to become specialists. When specialists are offering services, the more likely maternal mortality is reduced because, at various points in service, you recognise experience and skills in various institutions.

We thank God, that in 1997, we were able to start a resident training programme in Obstetrics and Gynaecology in Ayinke House. We were one of the state-owned secondary facilities to start postgraduate training programmes. The Obstetrics and Gynaecology department was a crucial department to start the postgraduate training programme in Ikeja. It was later in the year 2001 when I became the director of clinical services and training that we now started looking for accreditation for other clinical departments. Now, we produce more than 50 consultants for the state and a lot of them are now in general hospitals, and maternal and child centres. Some of them are now medical directors in general hospitals and we continue to train doctors.

As we speak, Ayinke House’s Department of Obstetrics and Gynaecology has 22 consultants. We have operating procedures every day of the week and we have consultant coverage for emergencies every day of the week. We ensure that we are offering the safest maternity care systems for our patients. It is difficult for a pregnant woman to die due to a lack of medical facilities or manpower; our mortality rate is almost zero.

In addition, we have another ultra-modern care unit in Ayinke House where we take care of sick babies that were born in the hospital, with seven consultants and two professors, to ensure that none of these sick babies will die. We have about 15 functional incubators where these babies are being looked at. We have another unit where babies that are born outside the hospital are taken care of. We separate them to ensure that there is no cross infection among the sick babies.

In addition, we offer a continuous training programme for health workers both insiders and outsiders. We mount training workshops for doctors and nurses from private hospitals in different aspects of obstetrics and gynaecology. Even as we speak, there is a training workshop going on. We train the health workers on how to take care of sick, newborn babies so that the babies will not die needlessly even in private hospital setting.
Can you account for the trained consultants and other health workers? Where are they working presently?

They have gone out to other hospitals because it is tenured. When you come to LASUTH for training and you complete it, you have to go either to private or state general hospitals. Most of the health workers we trained have been employed by the Lagos State Government to work in their obstetrics and gynaecology unit in different general hospitals all over the state.