Gboyega Alaka writes on the increasing trend of Nigerians seeking medical care abroad, resulting in massive capital flight and a further impoverishment of the vital health sector at home.
IN time past, going abroad for medical treatment of any kind was the exclusive preserve of the elite, who had the money and would always seize every opportunity to underline the class distinction between them and the general populace. And of course government functionaries, who were largely out to revel in the abundance of government purse. Those were the years that literally reminded one of the Orwellian theory of “some animals (being) more equal than the others” as most of the illnesses they travelled abroad for, could well have been taken care of within Nigerian shores. Also the destination then were mostly the developed western countries, such as the United States of America, the United Kingdom, Germany, France, Canada et al, fuelling the term ‘medical tourism,’ as it seemed these patients also took the opportunity of such trips, to enjoy the beautiful scenery and hospitality system of those countries. Besides, those who had the opportunity of going on account of the government, also get to over-bill the government and pocket the unspent chunk. We all still remember the former NAFDAC boss, Dora Akunyili’s story of how she returned a huge unspent amount of her medical allowance. That singular virtuous action catapulted Akunyili to the pinnacle of her career, even as it seemingly exposed to Nigerians, one of the main reasons their officials always want to jump on the next available plane, even at the prompt of an ordinary headache.
With the re-establishment of democratic rule, which has translated to more VIPs in government, the number of people who travel abroad for medical treatment on account of the government, has also increased tremendously, such that it is now a case to celebrate, when a government official opts to get treated in Nigeria. At least, such was the case of Governor Idris Wada of Kogi State who over a year ago opted to treat his fractured femur in Nigeria against the norm of going abroad.
The story is however different today, as even the ‘poor’ and the common masses now seek treatment abroad. Of course, theirs have been borne largely out of a genuineness to get well from mostly life-threatening afflictions and stay alive. Most often than not, theirs are also cases for which the Nigerian medical system is incapable of treating- or is believed to be incapable of treating, due to lack of standard equipments or perceived lack of qualified and experienced personnel. Medical issues for this group of people therefore range from Cancer, hole in the heart and other related cardiac failings or afflictions, to brain and other highly technical neuro-surgical treatments and some kinds of skin graft operations requiring top-class equipment and expertise.
For this set of people, it is therefore not much of tourism, even though the term is becoming more generalised. This may also be the reason, Funmi Adewale who some years ago escorted her sister to treatment in one of the Indian hospitals quarrels with the term: “How many people suffering from life-threatening cancer or kidney problem would find time to go sight-seeing or even appreciate the beautiful scenery, food and luxury of the these countries in the sense that tourists do?” To her therefore, labeling medical treatment abroad ‘medical tourism’ is like trivialising what to some people is a matter of life and death. Adewale goes a bit further by likening it to stigmatization. As far as she is concerned, many of those who embark on this trip would rather save their precious earnings and get on with their modest life here at home, if all was well.
Popular music producer, Babatunde Okungbuwa aka OJB Jezreel, who only recently came back from a successful kidney transplant in India also quarrels with the expression, saying “How can a life-saving trip be compared in any way to tourism! Really, trips like this are motivated by lack of medical commitment to saving lives and poor facilities in our environment.” In a clear response to top government officials who regularly go abroad for treatment, OJB also said “even the policy makers in the health sector don’t trust the system.”
N250 billion spent annually on medical treatment broad
Be that as it may, the trend has recently reached an unprecedented height, prompting stakeholders and experts to put the annual figure Nigerians spend on medical trips abroad at approximately N250 billion. This much was revealed by Dr. Kingsley Esegbue, secretary, organizing committee of the Nigerian Centenary Charity Ball during the countdown to the celebration that took place earlier this year. He also used that occasion to disclose his committee’s plan to rake in N8 billion for medical facilities in the country, as part of the centenary celebration. According to him, “Sealing a hole in a child’s heart needs not cripple the parents financially or take place in India; replacing a damaged kidney should and can be done within our borders.”
He also said “Every breast, cervical or prostate cancer patient should have access to quality care within Nigeria. Our neuro-surgery units need to serve the Nigerian people: no woman should have her bladder torn giving birth and for victims of cruel acid attacks, re-constructive surgery should be done within our borders.”
The N250 billion – if the calculations are correct – also represents about 300% increase from the N78 billion ($500m) earlier put forward by the Nigerian Medical Association in 2012. Of the N78 billion, the NMA also said that India rake in well over N40 billion, which is about 50%. (Over 5000 Nigerians travel to India, with each of them spending between $20,000 and $40,000 on the average.) India was also projected to have raked in a whopping $2billion from a global medical tourism valued at $20billion that year. Investigations also revealed that over 40,000 Nigerians obtained visas from Indian embassy that year alone.
The big question therefore is: how did Nigeria degenerate to such a level? Even the president, Goodluck Jonathan more or less agreed that the trend has reached an alarming level, when he declared at the official Commissioning of the Nigeria – Turkish Nizamiye Hospital Life Camp, Abuja in February this year that “private sector initiatives such as this hospital will help government’s effort to halt the enormous capital flight arising from increased medical tourism and avoidable stress experienced by Nigerians on such missions.
Earlier, at a meeting to forestall an impending medical doctors’ strike in January this year, the president had also promised officials of the Nigeria Medical Association, that his administration will reduce medical tourism to the barest minimum, except in special cases. He also directed that before any government official will be allowed to travel abroad for medical treatment, it must first be confirmed that medical competence for such ailment or disease is non-existent in the country.
Unfortunately, Nigeria has continued to wallow in unacceptable healthcare poverty, sitting pretty in position 187 of 191 countries in a recent United Nations health report. Needless to say, that also underline why 23% of the world’s malaria cases are endemic in Nigeria and four other African countries. Even the president’s half brother, Meni Innocent Jonathan reportedly died of acute malaria and typhoid late 2012, just before arrangements were concluded to take him abroad for better treatment.
According to Femi Ajayi, a Professor at Babcock University, Ilishan-Remo, Ogun State, this horrible statistics is enough to get the government kicking and vote overwhelmingly for a turn-around in the medical sector, instead of toying with a laughable and unrealistic plan of banning public officials from going abroad for treatment.
In an essay titled Government has no right to ban citizens from seeking better medical services abroad, he wrote: “On Friday, April 13, 2012 the Minister of Health, Prof. Onyebuchi Chukwu announced that the Federal Government of Nigeria is to ban public officials from travelling abroad for medical treatment. I read the piece with disdain. In less than a day, Saturday, April 14, 2012 of the announcement, Sen. David Mark, Senate President, travelled out to Israel for medical attention.
Not always the case
Back in the 1970s and 1980s, virtually every Nigerian hospital worth its salt, had at least one Indian doctor. The reason at the time was alluded to the stable economy and strong currency, which served as attractions. The hospitals were also fitted with basic amenities that helped these experts, with support from local doctors; giving Nigerians easy and affordable access to top quality treatment in their own domain. Even the Indian High Commissioner to Nigeria, Masesh Sachdev, corroborated this at a Medical Tourism and Wellness Destination Exhibition held in September last year in Abuja and Lagos, when he said “While a large number of Indian medical personnel served here during the 1970s and 1980s, most have returned.”
Indeed they have returned, to supporting and giving vent to what the whole world has come to acknowledge as a calculated Indian national policy directed at positioning the country as destination one in global medical/health care. The high commissioner stopped short of saying this expressly, when he again said on that occasion that “India has become Nigerian patients’ destination of choice because of the competitive cost, seamless facilitation through pre-diagnostics in Nigeria itself and smoother visa issuance procedure, wide choice of good hospitals and the better patient-doctor interface leading to higher mutual comfort and trust.”
Aside the first world countries, which India has successfully shoved aside, Nigerians also throng countries like Saudi Arabia, South Africa, Egypt and even Ghana for medical treatment. The Egyptian Embassy in Nigeria was reported to have declared that 12,000 visas were issued to Nigerians in 2011 alone, with 3,500 of them going on medical ground.
Medical experts speak
Is this penchant for going abroad for treatment a fad or something borne out of genuine necessity?
Dr Oluchi Kanma-Okafor, a consultant Public Health Physician of the College of Medicine, University of Lagos thinks it’s more of a fad. In her words, “you are right to have described it as medical tourism, because that is what it is.”
“Health treatment out of the country” in her opinion “has become very popular amongst Nigerians. It has also become very accessible; and if you know Nigerians very well, you would agree that we like to go along with what seems popular.” She also said the fact that it has become so popular does not necessarily translate to the fact that they get better treatment in the countries they travel to.
According to her, people have been known to fly abroad for mere appendisectomy, which every trained doctor in Nigeria can perform; or even anaemia. She argued that it is not all the time that these trips yield the desired result, but that the public hardly gets to know this.
In her words: “Given that we have some challenges when it comes to health care. But it’s not really as if the professionals here are not able to give the service that is required, nor is it that the facilities are not available. But people would rather go abroad and spend so much money, just because it is popular.”
Professor E. E. Ekanem, a professor of Epidemiology, also of the College of Medicine, University of Lagos however disagrees with her slightly, especially on the last statement. Having schooled abroad, he can tell you categorically that Nigerians are very intelligent people, who can compete anywhere, be it with Americans and what have you. Based on that, he agrees that Nigeria indeed have the expertise. He however says that “Most of the time, the equipments are not there. Even when the equipments are there, you know that we are very short of power. Sometimes, you may want to carry out an operation, but you can never be sure of power. Sometimes you can never be sure of gas. Common gas.”
In Prof. Ekanem’s opinion, Nigerians go for treatment abroad for various reasons, chief amongst which are the lack of equipment and infrastructure; but “definitely not for lack of expertise.”
On the kind of treatment people may want to go for abroad, Prof. Ekanem said these would range from some special kinds of skin graft; specific kind of surgical operations, and chemotherapy and radiotherapy, in cases of neo-plastic conditions and cancers. For people battling cancers especially, Ekanem says time is of the essence and somehow aligns with them in their quest for quick treatment abroad: “You know if you come here to LUTH, you may have to be put on a long waiting list just to be on chemotherapy or radiotherapy. And sometimes, even before it gets to your turn, you may have died, because the facilities are over-stretched.”
Dr. Kanma-Okafor and the professor however seem to share the same opinion in the area of care level and speedy attention, when she said the excuse of poor hospitality may not be unfounded. “The waiting time at government facilities is longer than in the private facilities, and this is not unusual, given that government facilities are cheaper and given the size of our population.”
On the issue of wrong diagnoses- another major reason Nigerians cite for going abroad for treatment, the professor and the young doctor agree that it does occur, even as they both say that it is not peculiar to Nigeria. The professor also says the lack of any specific research in that regard would not enable him give a proper appraisal of the rate at which this occurs. He nevertheless concedes that “If you have the money, it is always better to go to a place where you are sure to get the right diagnosis than to go to a place where you’re not too sure.”
Dr Kanma-Okafor on her part says “Sometimes, if you require a very sophisticated equipment to make a pin-point diagnosis and you don’t have it, then you are deficient. In the US for instance, they have far-reaching equipments and it just seems like they are better. So we just need to get to that level where we can access everything we need.”
She also says it is not as if the doctors on ground cannot handle most of the so-called complex illnesses. “The main issue, I’ll say is that people don’t present early. We have all sorts of hindrances such as finances, religion, culture, denial; and when they finally decide to come to the hospital, they are usually at their wits’ end. They’re here when there’s little or nothing the doctors can do to help them. So in terms of training and expertise, we are top notch. But like I said, in public hospitals like this, we have the challenges of funding; we have the challenges of overstretched facilities.
She said that most of the hospital in the US and co where Nigerians throng to are manned by Nigerian doctors, who are never found wanting.
One other area Professor Ekanem believes people would rather go abroad for treatment is in the area of the attitude of our medical personnel. In his word, “there are some health care facilities you walk into, and the way they receive and attend to you will immediately raise your spirit and make you feel like you are getting better. But here, the attention that people get is zero.”
He adduced this mainly to transferred aggression, which he says is a direct consequence of being overworked. “If you go abroad, doctors on the average may see about ten patients per day; but here in Nigeria, I can bet you that doctors see between 30 to 40 patients per day; especially those who work in the out-patient department.”
On how the number of top-class hospitals N78 billion (the amount Nigerians allegedly spend abroad for health services) could help put in place, Professor Ekanem said that may be difficult to say, going by the fact that “The amount quoted for a project is sometimes, five or more times more than the actual price because it have to pass through the middle man, third man and so on. So a project that will cost like N10 million, could get to as much as N20 million or more, when Nigerians are quoting it.”
The fact that the secretary of the organizing committee of the Nigerian Centenary Charity Ball was however shopping for just a N8 billion to put up a standard medical facility says a lot.
Lack of commitment
Responding to pointed questions on his experience, when he went for medical treatment abroad, OJB Jezreel said though kidney transplant could be done in Nigeria, the experience of the Indian doctors, by virtue of more frequent encounter with such operations, gives them an upper hand, and therefore made them a preferred choice for him. Second to that is their level of commitment, which he says is higher. He emphasizes commitment as one of the major selling points of the medical personnel and hospital he encountered abroad, adding that they are not necessarily better than our doctors in terms of expertise.
“Funny enough, I believe our doctors are amongst the best in the world, it’s just that our policy makers need to encourage them and provide the incentive needed to move the nation’s medical sector forward.”
On the cost of his treatment, the music producer said it is difficult to put a cost to it because it had “more dimensions than the average.” He however advised the government to in the meantime subsidize such treatments for Nigerian citizens, especially those who are not financially capable on their own.
