Dr Moshood (not real name) works at the General Outpatient Department of the Asokoro General Hospital in Abuja. His day at the hospital starts at 8 am to end at 4 pm. But this is just the schedule on paper. He lives a different reality.
He actually works for 20 hours every day instead of 8 hours due to the number of patients he has to see daily. The hospital has a daily patient visit of not less than 1,000, but the number of consultants and resident doctors is below 70.
He sees between 34 to 70 patients daily and has little time to spend with patients due to their population. While he’s supposed to spend a minimum of 30 minutes attending to a patient, he finds it more convenient to spend a maximum of 5 minutes with each of his patients, except in special cases.
On a Monday when THE WHISTLER visited the hospital, he was the only doctor left in the department- the other three had left. The time was about 4:12 pm and he had already seen 36 patients with an almost equal number still waiting to see him.
“The Dr- patient ratio in this environment is extremely, extremely high. I don’t know how to quantify it, but take a look at my screen here. Today, I’ve seen 36 patients.
“Imagine, on Monday alone I saw 61 patients. Tuesday, I saw 40. Yesterday was about 34 and today is 36. This is just 4:12 pm, I’m yet to close.
“Do you also know that whenever you come to the hospital you’re entitled to a full explanation of what’s wrong with you as a patient? You’re entitled to what’s wrong with you, your choices of treatment and the type of drugs you take and the different forms of treatment.
“That’s why you need to have time to talk properly. But when you need to see about 30, 40, 50 patients, definitely we will not kill ourselves, we cannot do that. By virtue of time, the quality of care is affected because the amount of time allocated to a patient may not be enough,” he lamented, showing the reporter the schedule on his computer screen.
At the Wuse General Hospital, Dr Muktar Aliyu recounted similar frustration. The hospital is meant to be a district hospital for people living within the Wuse District, but patients flock in from inside and outside of the Federal Capital Territory.
But despite the number of people flocking into the hospital – more than one thousand daily – they have to be attended to by less than 100 consultants and resident doctors.
“We see a lot of patients because people come from Plateau, Nasarawa, Sokoto, Niger States simply because we have a lot of specialists. So, the workload is quite a lot. This affects our work because the patient load is high and the number of health workers to attend to them is low, and this affects the timely provision of services,” he said.
Unlike nurses or other medical personnel, doctors do not run shifts. What it means is that a nurse resumes duty at the hospital by 7 or 8 am and closes by 4 pm when other nurses are expected to take over from them.
But this is not the case for doctors who would still be on call after official closing hours. This is how Dr Moshood explained it:
“The idea of calls is when you come in the morning, you come by 8 am and work till 4 o’clock, then by 4 o’clock, that’s when your call starts till am the following day, then close at 4 again. That doesn’t mean you’re going home; you’ll continue your work till the following day when it is probably a weekend or public holiday before you go home. So, imagine that some people are doing this.
“As a matter of fact, when I was just a House Officer back then, I’ve spent like 4-5 days in the hospital straight without having to go home. That’s how bad some places can be for doctors.”
The frustration of the doctors is aggravated by what they describe as a lack of government attention to their welfare and professional improvement.
Medical Residency Training Fund, which is a statutory fund, is not paid regularly while a meagre N5,000 is still paid as hazard allowance. These are at the core of doctors’ demands when they went on strike in 2021.
While hazard allowance was increased for the doctors with some categories to get up to N40,000, the raise is yet to be implemented.
To make matters worse for doctors, their take-home pay does not compensate for the time and effort put into service. There are two categories of doctors in government hospitals- permanent doctors and contract doctors.
According to vouchers seen by THE WHISTLER, the entry-level for a doctor employed by the government is between N275,000 and N280,000 per month, while contract doctors are paid N100,000 per month.
In July 2022, the National Association of Resident Doctors had given the Federal Government a two-week ultimatum to commence payment of the newly-reviewed Medical Residency Training Fund and hazard allowance, and a review of the Consolidated Medical Salary Structure (CONMESS).
The association threatened an indefinite strike if their demands were not met at the end of the two weeks. However, the ultimatum was extended by another two weeks on Aug. 21, which elapsed on Sept. 5.
It was a build-up from 2021, when they embarked on a strike over the unavailability of medical equipment in public tertiary hospitals and staff welfare for two months, ignoring orders from the Industrial Court to call it off. But the problems have persisted.
Dr Arafat Adamu of the Neurological Unit of Asokoro General Hospital was too busy to speak to THE WHISTLER about the challenges facing her and her colleagues. “I’m hungry and haven’t eaten since morning just because I’ve been busy attending to patients. Look at me, I look so exhausted. I’m about to attend to an emergency patient right now. We can have this interview later,” she said, before running off to attend to patients.
Overworked and underpaid, doctors and nurses are leaving the country for greener pastures abroad. Dr Aliyu said more doctors and nurses are going out now than five years ago.
“Five years ago, the statistics were an average of 700 doctors leaving the country annually. But now we’re producing an average of 2500 doctors annually, including foreign graduates but about 2,000 are leaving annually. The rate at which younger doctors are leaving is alarming,” he said, adding he was also planning on leaving the country.
But those who have resolved to stay back in the country are finding ways to manage the stress. The investigation by this website revealed that doctors in many hospitals do not resume at the normal time to enable them to do other private business to supplement their incomes, including consulting in private hospitals.
Some doctors leave the hospital once it’s official closing time even if there are patients waiting to see them. Doctors also push some of the work to nurses to give them some breathing space.
A senior nurse who spoke to this website at Nyanya General Hospital confirmed that the doctors are devising their own strategies to survive the situation, which includes pushing more work to nurses.
The nurse, who did not want to be quoted, said doctors in the hospital see only patients that deliver through Caesarean Section or have other health issues, while the others are attended to by nurses.
“So, we do both the works of nurses and doctors at the same time. Sometimes the number of doctors that see patients are between 3 or 4 and sometimes 5, all depending on their rosters.
“Doctors come anytime they like, even when we complain nobody hears us. Before I came into the office after trying the vital signs of patients, there were no doctors on the ground to begin to attend to patients. This is past 11 am.”
Professor Sa’ad Ahmed, the Medical Director, Federal Medical Centre, Abuja, said the World Health Organization’s ideal doctor-to-patient ratio is 1 to 600 but revealed that the ratio is 1 to 1000 in Nigeria.
“The situation is quite bad in Nigeria. We have 1 to 1000. About one doctor to hundreds of thousands of patients, and that is not good enough. It will not afford doctors to give patients the quality service they’d require.
“A doctor should see maybe 5 to 10 patients in a day. But you have situations whereby patients are lining up and you cannot send them away. You end up seeing maybe 50 or more in a day. That’s quite common in most of our hospitals in Nigeria,” said Prof Ahmed, adding that the FMC Jabi sees an average of 1,300 patients daily.”
For many doctors, the way to motivate them is for the government to improve the condition of service, equip the hospitals and employ more qualified doctors.
– This report was produced in partnership with the Civic Media Lab