BUKOLA ADEBAYO reports that poor working conditions are forcing medical doctors in the employment of the Lagos State Government to seek greener pastures abroad
Doctors are leaving the employ of the Lagos State Government for what they consider better opportunities in Saudi Arabia, Israel and some Asian countries, according to investigations.
One of the new employees who spoke with our correspondent on condition of anonymity in Lagos on Monday said no fewer than 30 doctors working in state-owned hospitals would be taking up appointments in Saudi Arabia this month alone.
The doctor, at present, a medical officer in one of the general hospitals in the state, said the appointments were facilitated by an agency that recruits doctors for hospitals in Saudi Arabia.
He disclosed that not less than 60 doctors, including consultants, attended the interview that was conducted at a popular hotel in Victoria Island last December.
According to him, physicians in the lowest cadre would be receiving N450,000 per month, excluding other allowances which cover the tuition and upkeep of two children in any school in Saudi Arabia or abroad.
“We were about 60, including our consultants who attended the interview, but I know about 30 that have been shortlisted. It was a colleague of mine who was leaving for Israel that told me to register with the online job placement firm.
“It has a website. The recruitment drive has been going on in other states of the federation before now, but doctors in Lagos State have now indicated more interest more than ever before,” he stated.
It is not only Middle East countries that offer better pay packages to doctors, as countries whose economies are not better than Nigeria’s are also dangling irresistible offers before medical doctors.
This was confirmed by another doctor, a surgeon who also works in one of the state-owned hospitals. He said countries like, such as Gabon, Senegal and other East African countries were engaged in massive recruitment of Nigerian doctors with specialties in surgery, orthopaedics and anaesthesia, among others, and offering pay packages that were too tempting to resist.
He said, “I’m relocating to Gabon with my family next month; I’m at the last stage of my accreditation. Though I was posted to a rural area there, for every surgery I perform, I would be paid $1,500 daily. What I’m being paid here is peanut, compared to what I’m being cajoled to consider in Gabon. In my department, six surgeons have left for Senegal because of the offer.”
Forced to resign
The doctors who spoke with our correspondent said the move was to prevent a repeat of the labour crises which led to first, the sacking, and then the recall of over 788 consultants, specialists, resident doctors and house officers by the Lagos State Government last year.
They said doctors could not be blamed for leaving en masse. According to them, since last year’s labour crises, the state government has continued to reel out “unfriendly policies” which they said frustrated doctors employed by the state.
They argued that it was part of some measures that government was using to ensure that medical workers did not clamour for the implementation of the Consolidated Medical Salary Scale.
A medical officer in LASUTH who had also got an offer in Israel, said he was leaving because the salary package offered by the state government was poor, compared to the services doctors rendered.
According to him, it was not unusual for a doctor to attend to about 70 patients in a day, apart from emergencies.
The source said, “During a clinic (meaning each time he is on duty), I can attend to between 70 and 80 patients in a day. What four doctors should do is what a doctor does here. Worse still, I have not attended any tangible training in four years because there is no time. I’m always with patients all day. How do I learn new techniques or give my best under such circumstances? Yet, when we agitate for more pay, they sack us or intimidate us into silence.”
Earlier, the surgeon who is leaving for Gabon said victimisation and intimidation that doctors faced, in spite of shortage of hands, were reasons why he had decided to terminate his appointment with the government.
He said, “An operation that should be done by five doctors is handled by one or, at best, two doctors because there are not enough hands. That is why emergency cases are not attended to and patients are not getting surgeries as soon as they should.
“We are overworked. I have been on call everyday for the past five weeks. How can that be? In other countries, a patient can sue just because of that, because it could constitute a harm to their health if I don’t give00 them the best medical advice.”
Slavery or medical practice?
The doctors also alleged that instead of recruiting more doctors in order to address the shortage, the state government was recruiting locum (casual) and contract medical doctors and consultants, a decision that, they argued, could destabilise health care delivery in the state.
One of the locum doctors, a consultant who spoke with our correspondent, lamented that the terms and conditions of service they were subjected to were a disgrace to the profession.
According to her, the state government had lowered the payment terms and conditions they had offered before they took up the appointment.
She said, “They were paying us about N302,000 monthly before, but they have stopped. They said they could no longer afford it and changed our appointments to Contract Medical Officers. Now, we are paid N1,000 per hour and we do rotation like nurses.
“We are just in the system. Even as a consultant, I’m not entitled to any training, I cannot sign for anything and I have no office. I cannot attend clinical meetings and we are forbidden to unionise, so we cannot protest this ill-treatment. We cannot use any of the facilities in the hospital.”
Also, in the appointment letter obtained by our correspondent, a contract medical officer on Grade 12 Step 2 would be paid N242,000 (N1,100 hourly) for a period of one year in the first instance, and the contract would be renewed, based on performance on the attached terms and conditions.
The consultant said many of the terms under which they had to work were not only unfavourable but also creating friction between the locum doctors and those on permanent employment in the hospital.
She said, “We cannot run to the Medical Guild to fight for us to be converted to permanent employees because they are also angry that it was our appointment that frustrated their agitation for CONMESS.
“The state government does not even reckon with us; they keep changing our agreements every day, and they don’t care if we leave because they keep recruiting doctors on contract terms every day. They have stopped employing doctors on permanent basis since the labour crises last year. Contract doctors are even more in number than permanent doctors in LASUTH.”
Asked why she took the employment in spite of the warning by the Nigerian Medical Association, which threatened to disaccredit doctors who were employed by the state government during the strike by Medical Guild last year, the consultant said that was the only offer she had received in the last two years.
She said, “The politics involved in recruiting doctors into state and government hospitals in Nigeria is very dirty. After my programme in LUTH, I was not retained. I applied to several parastatals, including the Ministry of Defence, University College Ibadan, and Federal Medical Centre to no avail. You must be connected to get a job, rather than on merit. Many of the employers were asking for bribe, which I could not give. Let us not be deceived, there is no job for doctors anymore. That was why we jumped at Fashola’s offer.
“I took it because I had to feed my family, we had to survive. After two years without a job, I had no choice but to accept the offer. I wake up every day defeated since I took this job because it offers no opportunities for me as a doctor or consultant. We call on the NMA to fight for us. I’m also looking for better opportunity locally because I don’t want to leave the country.”
In his reaction, the President, Dr. Osahon Enabulele, described the act of recruiting doctors as casual workers by the state government as an assault on physicians. He said it demeaned the credence of the profession and warned that the trend could affect the quality of medical services offered in public hospitals in the state.
Enabulele said, “LASUTH is a teaching hospital, they are to train doctors; but a situation whereby the state government is now employing more locum doctors than resident doctors or consultants in its tertiary hospitals is wrong and could affect their credence and re-accreditation as a tertiary institution. It also shows the direction they are driving the institution and health care service in the state. We are begging them to have a quick rethink of this policy.”
He also warned that the policy would be counter-productive by increasing the already gory doctor-to-patient population ratio in the state; saying, if not urgently checked, it would worsen all the health indices in the state.
He said further, “There is no sane individual that will stay in that kind of system. Doctors may be accepting the offers now to survive, even though we had asked them to reject such appointments. Right now, the doctor-to-patient ratio in Lagos is 1-14,000, which is far from the global standard of 1 doctor to 600 patients. This is going to impact negatively on maternal and infant mortality, which is always a direct result of a distorted medical manpower system. It will also affect access to health services.
“They should stop employing locum doctors. Rather, they should employ qualified doctors on pensionable basis because they are shortchanging the workers. We are ready to engage the state government to convert their appointment to a permanent basis to encourage them to stay.”
Enabulele urged the state government to implement CONMESS in order to check the exit of doctors from its hospitals.
According to him, information gathered by the association showed that doctors were emigrating from the services of the state government on a daily basis due to the poor conditions of service and skewed salary structure.
He said, “Everyday doctors are getting dissatisfied and leaving the system.We hope that the managers of health in the state have the correct information to arrest this exit because when you have this type of brain drain, it would affect medical services, especially response to emergency cases.They should address the root cause which is the renumeration they give doctors.Lagos is supposed to be the centre of excellence; that means other states should not beat them in welfare packages for doctors.”
In order to confirm the veracity or otherwise of the doctors’ claims, on Monday, our correspondent placed some calls to the mobile phones of the Commissioner for Health, Dr. Jide Idris, but he did not pick his calls.
Again, he did not acknowledge the text messages sent to his mobile phones and e-mail addresses on Tuesday. In the message, our correspondent had requested his response to the physicians’ allegations.
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