‘Japa’ syndrome: Doctors who abandoned Nigeria for UK lament slave labour, exploitation

Some of the doctors who left Nigeria for green pasture are currently lamenting tough condition in their current place of employment, a BBC investigation has shown.

Some of the doctors who left Nigeria for green pasture are currently lamenting tough condition in their current place of employment, a BBC investigation has shown.

Brain drain is a big challenge in the country as Nigerian-trained doctors are recruited overseas from time to time.

• Brain drain: Lagos employed 920 health workers in 9 months – Official
• Brain drain: Nigeria’s doctor-patient ratio now 1 to 5,000

Two months ago, the Nigerian Medical Association (NMA) said out of the about 80,000 registered with the Medical and Dental Council of Nigeria (MDCN) from 1960, 30,000 medical doctors were currently practising in Nigeria.

The NMA also revealed that Nigeria currently has a doctor-to-patient ratio of one doctor to 4000-5000 patients instead of the one doctor to 600 patient ratio recommended by the World Health Organisation (WHO).

In a Twitter Spaces, Daily Trust had in August, several doctors attributed the brain drain in the health sector to welfare.

With real life experiences, they spoke on issues ranging from shortage of manpower with attendant burnout, lack of adequate hazard allowance, outstanding Medical Residency Training Fund, etc.

In its report, BBC said it found evidence that doctors from Nigeria are being recruited by a British healthcare company and expected to work in private hospitals under conditions not allowed in the National Health Service.

Augustine Enekwechi, a young medic who worked at the private Nuffield Health Leeds Hospital was quoted to have said he felt like being in “a prison”.

Enekwechi said his hours were extreme – on-call 24 hours a day for a week at a time – and that he was unable to leave the hospital grounds.

The British Medical Association (BMA) has described the situation as “shocking” and says the sector needs to be brought in line with NHS working practices.

Enekwechi said the tiredness was so intense that there were times he worried he couldn’t properly function.

“I knew that working tired puts the patients at risk and puts myself also at risk, as well for litigation,” he says. “I felt powerless… helpless, you know, constant stress and thinking something could go wrong.”

Nuffield Health disputes those working hours, saying its doctors are offered regular breaks, time off between shifts, and the ability to swap shifts if needed. The company adds that “the health and wellbeing of patients and hospital team members” is its priority.

Enekwechi was hired out to the Nuffield Health Leeds Hospital from a private company – NES Healthcare. It specialises in employing doctors from overseas, many from Nigeria, and using them as Resident Medical Officers, or RMOs – live-in doctors found mainly in the private sector.

The young doctor said he was so excited to be offered a job that he barely looked at the NES contract.

The BBC said it found that 92% of doctors had been recruited from Africa and most – 81% – were from Nigeria.

The majority complained about excessive working hours and unfair salary deductions.

Enekwechi said he was preparing for the stage 2 of Professional and Linguistic Assessments Board test (PLAB) when he was approached by NES Healthcare and later offered visa sponsorship and a potential job.

Another doctor, Femi Johnson, also shared his own experience in his place of work where he is expected to work between 14 and 16 hours a day and be on call overnight.

“I was burnt out,” he says. “I was tired, I needed sleep. It’s not humanly possible to do that every day for seven days.”

But when he needed a break because he was too exhausted to continue, NES were entitled to deduct money from his salary. The company says that is to cover the cost of finding a replacement doctor, but Femi says it leaves NES doctors in a terrible dilemma.

“In situations like that, I always make that internal discussion with my inner self – ‘Femi are you doing right by yourself and are you doing right by the patient?'” he tells us. “Unfortunately, I haven’t always been able to answer that question.”

Dr Jenny Vaughan, the Doctors’ Association

Some NES doctors have received help from Dr Jenny Vaughan from the Doctors’ Association. She receives many complaints from Resident Medical Officers and says the UK healthcare system has developed into two tiers – one for NHS doctors, the other for international recruits working in the private sector.

NHS doctors can only be scheduled to work up to 48 hours, and if they request, up to 72 hours a week.

“No doctor in the NHS does more than four nights consecutively because we know that it’s frankly not safe,” says Dr Vaughan.

“This is a slave-type work with… excess hours, the like of which we thought had been gone 30 years ago.

“It is not acceptable for patients for patient-safety reasons. It is not acceptable for doctors. ”