Brain drain began collapse of Nigeria’s world-class health sector — Prof Ladipo

At 85, retired professor of obstetrics and gynaecology, Prof Oladapo Ladipo, looks back on a remarkable medical career spanning decades, from his early years in Nigeria and medical training in the United Kingdom to his return home and service in a healthcare system he once considered among the best in the world. He speaks with BIODUN BUSARI about his journey, brain drain and the challenges facing the country’s health sector

What memories and experiences from your childhood have stayed with you?

I grew up in different places. I was born at the Baptist Hospital in Ogbomoso, Oyo State, on September 23, 1941. I was privileged during my childhood to visit different parts of the South-East because my father was a civil servant in the forestry department and was transferred to many places. So, I grew up in Enugu, Abakaliki, Calabar and Ikom.

I started my primary education in Anambra State. Later, I came back to the South-West, to Ibadan, where I spent a year or two at Idi-Ikan Baptist Primary School. When my father moved to Akure, Ondo State, I completed my primary education there.

Those were formative years in which I experienced love and care, not just from my parents but also from my grandparents, who looked after me. They not only made new clothes for me at Christmas; they also ensured that I was well cared for and fed. So, I always looked forward to seeing my grandparents.

How did your secondary school years shape you?

I attended Baptist Boys High School, Abeokuta, Ogun State, from 1954 to 1958, at a time when the missionaries still had much influence.

In 1954, we had the first Nigerian principal of the school, whose son was in my age group. We had a disciplined upbringing at Baptist Boys High School at that time. The school instilled in us values of excellence, transparency, accountability and respect for institutions and elders.

I was privileged to be the prefect of the dispensary. That was also the formative period of my interest in the medical profession, which eventually took me to the United Kingdom.

How did you begin your medical career in the UK?

When I graduated from Baptist Boys High School, I worked for nine months at the Civil Service Commission Secretariat in Ibadan. After that, I proceeded to the United Kingdom with my father in October 1959. My father was going to Oxford University for one year, so it was a privilege to accompany him and do my A-level studies at Norwood Technical College in London.

My transition from the Nigerian environment to British society was seamless because we had some workshops organised by the British Council. For the first few weeks in London, I stayed at the British Council Hostel in Knightsbridge.

I later stayed with an Irish landlady whose husband was Ghanaian. They had four foreign students in their house. They were from Ghana, Sierra Leone and Venezuela, and I was the fourth. That was the first time I interacted closely with people from other countries, and it was an opportunity to learn about their cultural and behavioural patterns.

The technical college provided opportunities to study and work late in the library, which I had not experienced in Nigeria. The institution was well equipped, and the teachers were respected by the students, two-thirds of whom were foreign students.

Most of us gained admission to universities at the end of the two years. I won the Governor’s Prize in Zoology, Chemistry and Physics before gaining admission to the Welsh National School of Medicine, now the University of Cardiff Medical School.

Was your experience in Cardiff different from London?

I was fortunate to earn additional income because my monthly stipend was barely £25. Even though I could cope with that, my landlady took £15, while I saved £5. I used the remaining money to go to the cinema or attend the weekend dances at the college.

I also participated in what we called the Christmas Rush at the post office. During the Christmas period in those days, the post office recruited students to cope with the huge volume of mail because many people sent Christmas cards and other items. The experience exposed me to people from different cultures. It was a good experience going forward to medical school, where I also interacted with people from different backgrounds.

I also worked during the summer vacations to raise extra money. I worked at the Selfridges restaurant, an El Dorado ice cream factory and even a waste-paper factory, where I lasted only a week because of the dust and the sinus problem I had.

By the time I went to medical school, I was already familiar with the hospital environment because I had done a holiday job at a hospital, where I worked in the mortuary and looked after dead bodies.

Initially, I was really frightened, but I got used to it. When I got to medical school, we had to dissect a human body from head to toe.

What was your university experience like?

The university experience was very useful. The Provost of the College of Medicine at that time was an external examiner in Nigeria, and 10 per cent of admissions were reserved for foreign students.

During his tenure, at least one Nigerian was admitted into my class. I was the only Nigerian admitted that year, although there had been about three other Nigerians before me. Another Nigerian was admitted after me during the tenure of that professor.

Many of us were assigned a professor at the university as a guardian, with whom we could discuss academic and non-academic issues. Once a year, the guardian would invite you to his home for dinner.

The university experience was very good. We had good lecturers, the university was well equipped, and the learning environment was excellent. One was able to perform admirably.

The one thing that shocked them was that I got a distinction in physiology. I remember how I was quizzed during the viva. I thought I had failed, not knowing that it was a distinction viva. That was the beginning of my success in life because it was not usual for a foreign student to be awarded a distinction in any of the subjects.

Aside from your distinction in physiology, what other experiences influenced your medical career?

I had the opportunity to work as a house officer, that is, as a doctor, even before I qualified. In my medical school, whenever a house officer went on holiday, the consultant would identify a medical student to do the house officer’s job. For that, you were allowed to wear a long white coat instead of a short one. You also had accommodation and free food.

I was privileged to do that three times. So, before I even qualified, I had already been doing a house officer’s job. I knew the dos and don’ts of the job and all the laboratories in the hospital.

When I qualified, I was to apply for a position as a consultant in obstetrics and gynaecology. Others did their house jobs outside the teaching hospital. The first job I did was with my guardian, who was a cardiologist. I went to the medical department.

That winter, many older people died of flu, so I was not happy with that type of discipline. Then I went to do my surgical posting. I still was not happy because I had to pick up the knife and operate on patients. I was looking for something that was more fulfilling.

After the one-year house job, my consultant got me an appointment with the obstetricians and gynaecologists. Again, in the teaching hospital, I was posted to obstetrics and gynaecology. I decided I would become an obstetrician and gynaecologist because it provided me with an opportunity to use both my medical and surgical skills and, in addition, to support women to bring forth new life. That excited me greatly.

That was the beginning of my career in obstetrics and gynaecology. I specialised in obstetrics and gynaecology within two and a half years. In addition to that, by sheer coincidence, my mother was a midwife.

What do you attribute your success in the medical profession to?

Firstly, the secret is hard work. I was committed and diligent in my work. During my time as a resident, we had to work 108 hours per week. We had to be efficient and respect time. There was no room for laziness at all.

Every life must be saved. Every human being must be given an opportunity to have access to quality healthcare. I had that in mind as I performed my duties.

As I advanced in my career, I acquired the necessary skills. Secondly, I had opportunities for research. At the teaching hospital, every Saturday afternoon, for example, I sat down with a professor to review at least three obstetrics and gynaecology journals and articles.

We dissected and critiqued them. That became part of me and encouraged me to do research.

My first research was published in the British Medical Journal and the British Times, and that opened other opportunities for me because I was invited to lecture on the topic many times.

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What is most important to me is mentoring younger people. In terms of success as well, I had the support of my wife and family members, who accommodated my being away from home many times.

What has helped you stay healthy and active at 85?

My humble submission is that it is the grace of God. Also, I do a little exercise every day and avoid foods that have limited value to me. I also have regular physical check-ups. But, in general, I think it is the grace of God.

How would you compare the healthcare sector in your time with what obtains today?

Doing my three-month elective posting at the University College Hospital, Ibadan, was one of the best experiences for me. At the time, UCH was one of the best hospitals in the world in terms of the quality of education, research output and funding.

Patients did not bring food from home or buy drugs outside the hospital as they do today. They received the best care available, and people even came to UCH from Saudi Arabia for treatment.

We were well staffed, and the grand rounds were comparable to those of university teaching hospitals in Europe and North America. I was very proud of what UCH represented at the time. That was what encouraged me to return home after I specialised in the UK.

The University of Ibadan and its teaching hospital produced some of the brightest medical brains in the world. Today, I do not think we can boast of the description I have just given you.

There is a shortage of staff because of the Japa syndrome, and its effects have been overlooked by the government. The most experienced and internationally recognised professionals, including professors and academics, started leaving the country in the early 1980s.

Even my mentor, who served the nation with distinction, could not afford to buy a Volkswagen, and that motivated him to go to Saudi Arabia. After that, many others followed suit. These great intellectuals were economically rescued by Saudi Arabia. This marked the beginning of the decline of the country’s healthcare sector.

Are you saying the decline in the healthcare system began as far back as 40 years ago?

Absolutely. When such people leave the system, the government is happy that their positions are filled by younger, inexperienced colleagues. They are intelligent but have limited experience and international connections, which the system needs. The medical field lacks that now.

In our time, doctors in teaching hospitals did not have private practices. Today, almost every doctor, or at least 99.99 per cent of them, even in teaching hospitals, has a private practice.

The hospitals are also not well equipped because the equipment is outdated. In those days, the government understood the need for teaching hospitals to have modern equipment. There is now a huge funding gap. Older institutions require more funding than third-generation institutions, but they are not getting it.

It is only now that the Minister of Health and Social Welfare is trying to acquire modern equipment for some hospitals, but it is not enough. Funding for teaching hospitals and universities is totally insufficient.

The same applies to the education sector because education and health are the twin engines of development, economic growth and stability.

Is there a link between these challenges and the high cost of healthcare for ordinary Nigerians?

Yes. Dysfunctional healthcare is partly a result of poor governance. For instance, there is the National Health Insurance Scheme, but the government has been slow to implement it. There is no reason why less than 15 per cent of Nigerians should be insured under the NHIS.

All the government has to do is make a rule that everybody who has a bank account must pay N15,000 for the NHIS, which would enable them to access healthcare anywhere. Without this, healthcare will remain expensive for ordinary people.

In the UK, everybody who works pays a National Insurance contribution every month, and they have access to government healthcare facilities, often at little or no cost. I do not pay anything when I am treated because I paid into the National Insurance fund when I was working there.

I think the government needs to be intentional about addressing the crisis in the health sector. It must recognise that the health sector is a priority area. A healthy population will be productive and innovative.

There are too many people who are chronically sick, and the rate is very high. The average life expectancy for a male in Nigeria is 54.5 years. Even poorer countries have better life expectancy than Nigeria. If we produce good-quality drugs locally, it will reduce the cost.

What are the key areas of concern that the government should address?

There should be improved health literacy. People will be better able to prevent diseases if they are health literate, and their health-seeking behaviour will also improve.

For example, we do not have 100 per cent immunisation coverage for children, and we do not even have 100 per cent of births registered. We have vaccines to prevent cervical cancer, but not many parents are taking their children, aged 10 to 14, to receive the vaccine provided by the government.

One of the things that concerns me is the high maternal mortality rate in Nigeria, which is unacceptable. I always say it is the greatest social injustice of our time. Women are dying in large numbers, and Nigeria has one of the highest maternal mortality rates in the world.

We know what to do, but implementation is the problem. If only two out of five pregnant women are currently being delivered by skilled birth attendants, the government should know that it needs to increase that rate to at least four out of five. At least 80 per cent of pregnant women should be delivered by skilled birth attendants to reduce maternal mortality.

When the former governor of Ondo State, Olusegun Mimiko, was in office, he had these programmes. That model can be replicated anywhere, and within a short time, we can reduce the maternal mortality ratio from three digits to two digits.

Personally, one of the things the government can do is make antenatal care, delivery and postnatal care free of charge. We have free immunisation, so the government should also make family planning free of charge.

There is a group of women classified as having high-risk pregnancies. Contraception can help prevent some high-risk pregnancies, including those involving women below the age of 18 and those above 35. The use of contraceptives and other modern family planning methods can drastically reduce maternal deaths by one-third within a short time.

We have policies, but implementation is the problem.

What is your advice to young and aspiring healthcare professionals?

My advice to those who are intellectually inclined to pursue medical training is that they should know that the medical profession is a noble one. They should not be discouraged by the current dysfunctional state of our system. It will get better.

The current administration is doing what is possible to improve the healthcare system by upgrading the infrastructure needed to provide quality healthcare and proposing to manufacture some medical products locally, among other measures.

Going forward, young people should not think only about travelling abroad. There are still opportunities here to learn, improve their skills and contribute to the improvement of healthcare services.

When you go abroad, you can acquire new skills and return home. For example, good models can be adapted in our hospitals in areas such as surgical and clinical management of cases. Even robotic surgery is now being performed in Nigeria.

When you look at areas such as infertility, which is my area of specialisation, we have more than 200 in-vitro fertilisation centres now performing admirably. Women who previously could not conceive are having babies. It is a sign that things will get better.

It may be expensive because of the depressed economy. Many people are unemployed and may therefore not be able to afford treatment in the private sector. This is where the NHIS comes in.

I would encourage young people to plan to return home after obtaining specialist training abroad and complement those who are available here. Currently, those working in government facilities are overstretched and overworked. We need to retain our doctors, nurses and laboratory personnel as well.