Nigerian doctors are on strike amid an exodus of talent, but abandoned patients fight for their lives

By Nimi Princewill, CNN

Emmanuel Agbenro sits helplessly inside his sparsely-decorated ward at a hospital in Nigeria. He is supposed to be having treatment for colon cancer but doctors in Nigeria have downed tools in a nationwide strike over better pay and conditions.

“I’m only surviving by faith,” said Agbenro, who is supposed to be starting a second round of chemotherapy at the state-run National Hospital in the capital Abuja. He says he has received no treatment since August 2.

“Since the strike started, no doctor has come to check on me. I’m only surviving by faith,” Agbenro told CNN.

“We are not accepting patients with serious medical needs,” a member of staff at the National Hospital told CNN. “There are no doctors on the ground, so patients in bad conditions are referred to private hospitals,” added the employee, who asked not to be named as he doesn’t have authorization to speak with the media.

However, treatment at private hospitals cost significantly more than those run by the government and those who cannot afford private healthcare will suffer most.

Resident doctors in the country’s state-run hospitals are striking over “poor welfare” amid a resurgence of coronavirus infections and a move by authorities to scupper the industrial action.

As the strike by doctors over pay and conditions enters its third week, patients requiring urgent medical care such as Agbenro have been left in the lurch at the public hospitals.

At the National Hospital, CNN also met Emmanuel Ejim who had surgery to repair a ruptured abdomen shortly before the strikes started, has gone untreated since the doctors boycotted work.

“Doctors are no more attending to me. The nurses only check on me whenever they please because there is no one to supervise them,” Ejim told CNN.

Both men said they cannot afford the cost of seeking healthcare in a private medical facility.

CNN has contacted the National Hospital spokesperson for a comment.

Healthcare ignored by the ruling class

Many wealthy Nigerians rely on medical services abroad due to the country’s crumbling health infrastructure.

Nigeria loses an estimated $2 billion annually on medical tourism, and the country’s President Muhammadu Buhari is one of the ruling classes who frequently seek treatment overseas.

Buhari recently returned from the United Kingdom where he attended a summit and underwent a “scheduled medical check-up,” a presidential spokesman said.

The 78-year-old Nigerian leader has made multiple visits to the UK for medical treatment for an undisclosed ailment.

His aides say his medical record is best handled by UK specialists, who have looked after his health for four decades.

“Buhari has been with his doctors and medical teams for about 40 years and it’s advisable that he continues with those who know his medical history… That is why he comes to London to see them,” Buhari’s spokesman, Femi Adesina, was quoted in local media as saying.

The National Association of Resident Doctors (NARD), an umbrella body for doctors in Nigeria’s teaching hospitals, said the country’s heath sector is ignored because little attention is paid to it by the ruling class.

“We are not pointing our fingers to the right direction. Anybody who has malaria in the upper strata can travel abroad to get a checkup because they can afford it. But most Nigerians can’t afford treatment overseas,” NARD President, Uyilawa Okhuaihesuyi, told CNN.

“Our health sector is ignored because they’ve paid no attention to it,” said Okhuaihesuyi, adding that Nigeria’s budgeting for health has been poor.

‘Nigerians dying needlessly’

The doctors’ strikes come as Nigeria is battling a spike in Covid-19 infections, just weeks after the contagious Delta variant was first detected in the country. Okhuaihesuyi says this spurred strike action after some of doctors died while handling Covid cases.

He added that medics are also protesting unpaid salaries of around three to six months for some of NARD’s members, and a lack of insurance benefits to relatives of doctors who died from Covid.

The doctors’ union wants a substantial increase of health workers’ hazard allowances — an additional payment made to frontline medical staff.

“As of today, the hazard allowance is 5000 Naira ($12) for all health workers, and this was last reviewed in 1991,” Okhuaihesuyi said.

In early June, the Nigerian government announced plans to increase the hazard pay by 600% (30,000 naira, or $72) for senior health workers and 350% (17,500 naira, or $42) for junior staff.

Okhuaihesuyi has rejected the proposed increase as “not good enough.”

“Since the start of the year, we have lost 19 members (of NARD) to Covid-19. There’s supposed to be insurance covering all health workers but as it stands, we do not have any death in service insurance given to the next of kin of our members,” the NARD president added.

The Labour and Empowerment Ministry did not respond to CNN’s request for comment. CNN also reached out to the Nigerian Health Ministry but received no response.

The Labor Minister has responded to the strikes by invoking labor laws against the striking doctors, and a “No Work, No Pay” rule implemented, he said in a recent interview.

“I invoked laws of the federation on withdrawal of wages during period of strike, which in common parlance is called the principle of No-Work-No-Pay,” Minister Chris Ngige told journalists Friday.

Ngige faulted the doctors for “failing to give mandatory notice” to the government before commencing the industrial action.

Citing labor laws, the minister stated: “If you are on essential service, you must give the mandatory notice before you down tools,” adding that attempts at conciliation failed.

The doctors’ union, however, argued that the strike became a last resort after its ultimatums to the government were ignored.

Columnist Israel Ojoko wrote recently that “many Nigerians, who are supposed to be alive today, have died untimely due to the niggling battle between NARD and the federal government of Nigeria.”

While criticized the country’s Labour Minister for “preferring” to spend government resources on litigation against the doctors’ union than meeting their demands for better welfare.

“Ngige will rather spend money to take NARD to court than meet the demands of the resident doctors and save the lives of innocent citizens who have been dying since August 2 when the strike resumed. He has even threatened them with a no-work, no-pay rule,” Ojoko said.

Brain drain intensifies

Many Nigerian doctors have long given up on the country’s health sector as the brain drain intensifies.

Okhuaihesuyi said poor working conditions had contributed to the mass exit of Nigerian healthcare workers, who seek better-paying jobs overseas.

An estimated 20,000 Nigerian doctors have fled the country for greener pastures abroad, one study found and there is an ongoing recruitment of Nigerian doctors by an Abuja-based consulting firm to work in Saudi Arabia.

“It’s going to get worse,” Kingsley Douglas, a Nigerian physician and public health consultant, said about the exodus of Nigerian doctors.

“Many doctors do three to four jobs to just be able to earn a basic living in Nigeria,” he said.

The physician remarked that Nigeria’s pandemic response will be greatly affected by NARD’s indefinite strike.

“To a large extent, the strike will affect the Covid management situation but doctors need to be alive to save lives,” said Douglas, who suggested that the timing of the strike could be strategic.

“One could argue that the timing is wrong, but the doctors are also strategists. The timing of the strike comes at a point it will have the most effect.”

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