When the Chief Medical Director of the Lagos University Teaching Hospital (LUTH), Professor Wasiu Lanre Adeyemo, took to the stage on the 31st of July, 2023, he did as a Guest Lecturer at the 38th Professional Initiation and Admission Ceremony of Medical Graduands, at the University of Ilorin (Unilorin). In his guest lecture, which was supposed to be about twenty minutes long, almost half of it was spent reading his citation—a show of immaculate reverence indicative of his ongoing illustrious career.
In the dizzying assembly of the stage that shared the professor’s podium were other dignitaries, formal commencement officials, and whatnot; but none was as immaculate and physically discernible as the professor. The backdrop of the stage was dominated by a trident of projectors that maximized the screen of the professor's laptop, whose blinding white background was centered with the topic of his lecture "Brain Drain: The Grass is Greener Here Too!"
The Brain Drain Bill from three months earlier, coupled with the vitae of the luminary, made the choice of topic unsurprising but nevertheless anticipatory, turning several of the audience’s preemptive scorn to acquiescence—they'll listen, just for the sake of it, and see what gives.
In the beginning, the lecture succeeded in its bid to inform. It explained the etymology of the word Brain Drain as coined and used in the 1960s by the "Royal Society to describe the emigration of 'scientists and technologists' from post-war Europe to North America" (Today, Brain Drain generally describes the emigration of skilled and educated people from poorer countries to richer ones); and its inverse, Brain Gain, which describes the immigration of global talents into a country where there are far greater opportunities.
The result of the successful liftoff of the lecture was a partially solemn crowd who might have been mildly awed, where to some, those moments were of no great epiphany. Very soon afterward came the moments of communal gloom and transient sympathy, summoned by the professor’s revelation of the worrying drop in the number of applications for residency at LUTH. In five years, it plunged from about 1600 (in 2017) to 250 (in 2022), a decrease principally attributed to the Japa (migration) epidemic.
Informative and poignant, the lecture coasted along with unorthodox points and perspectives to its original proposition. And then it nosedived. There was the typical nitpicking of foreign unrest and sterile anecdotes of the unsuccessful migrations of several known medical professionals. It failed to appreciate that those commonplace scenarios only represent the cracks that lead to argumentative and ideological fissures. From there on, the lecture imploded and could be best described as frothy. It continued to ground its points on the possibilities that there's something for the graduates here: “You can earn in USD here too" and “You can have better opportunities here too.”
The lecture wasn't much of an appeal to the 144 new medical graduates as much as it was a stark reminder to them—and the invitees—that there's something fundamentally wrong with the Nigerian health sector that's ominously inseparable from the doom and gloom of the country itself. Far from the reach of the lecture was its address on the foundations of the japa epidemic. It forgets or ignores the most basic fact of all, that the inductees are, first and foremost, humans, Nigerians, who, regardless of their profession, would—most likely—still have sought a way out of their perceived predicament—being a doctor is only a means to an end.
But you have to give the professor his due (never mind that he and several other dignitaries arrived considerably late to an induction ceremony where they were supposed to put on a convincing show for their incoming junior colleagues). His choice of topic was bold and ambitious, an attempt to persuade the inductees of the needlessness of leaving Nigeria to practice abroad. But the lecture, however well-intentioned, fell short of itself. More often than not, many a tale of its kind ends up as logical fallacies: surprisingly superficial, pitifully incomplete, and inadvertently evasive.
To the point, the lecture wasn't much about what Nigeria had to offer the newly minted doctors (should they choose to stay) than it was about the shortcomings abroad (should they decide to leave). Saliently, it was about the chlorotic and deficiencies of the system overseas than it was about the greener pastures here. While it acknowledged some of the inadequacies of the current reality (for example, low remuneration), advocated for and advised on subjects like patriotism and compassion, and talked about what the inductees can—and should—give back to their country, it ultimately failed to acknowledge the mindlessness with which Nigeria can take it all away from them or, simply put, how Nigeria can happen to them.
For many other university graduates in Nigeria, the next step after valediction is the one-year mandatory National Youth Service Corp (NYSC), a program established by the Nigerian government in 1973 to foster national unity and integration among the youths. For medical graduates, however, an internship (technically, housemanship or house job) precedes NYSC and intermediates their years as undergrads and their path onward.
Housemanship, for its timing and modus operandi, is one of the distinctive initiatives in the medical field that makes studying medicine stand out from several other fields of study. In contrast to other internship programs like the Students Industrial Work Experience Scheme (SIWES), during housemanship, medical doctors are titular: they become House Officers and are remunerated.
But with roses come thorns. Being a house officer isn't all it is cut out to be. Behind the gold chains of stethoscopes and divine garbs of lab coats is the strife of doctors, contingent on the basal nature of the beast (the medical field itself), pushing them towards acceptance and resilience or away onto despondence, burnout, and resignation. The yearlong internship is often their first real-world experience where they begin to learn the cardinal truth about grasses and their greenery.
Like infantrymen in the military who are the first line of defense, house officers are trained, supervised, and expected to be the first responders, providing medical care to patients whenever needed, however, outstretched the working hours.
Be that as it may, being a house officer is a patriotic call of duty, a doctor’s first foray into the unknown and unwelcoming void of reality. It is a year-long period of self-affirmation and a clinical rite of passage into saving lives. At this crossroad, where parents marvel at their children’s coming of age, lovers sizzle at their lover’s earnestness, siblings blush admirably for their kin, and friends rejoice for their playmates, Dr. Diaso Oghenevwaere met her tragic and unavoidable demise, the seed of which was planted in 2018, unbeknownst to her, when she was in her 4th year of medical school.
Dr. Diaso was two weeks away from completing her housemanship before her unceremonious passage in the line of duty at the General Hospital, Odan, Lagos Island. As reported, she passed on from the sustained injuries in an elevator crash from the 10th floor—an experience that according to Einsten's general theory of relativity, would mean that she would have been weightless with no point of reference to know how fast she is- or how far she has fallen, only realizing her weight and the deathly crash at the moment of impact. Soberly, the physics of the crash would have been simply macabre—a finality that, in hindsight, was avoidable.
In 2018, many other Nigerians and certainly several of Dr. Diaso's colleagues noticed a mechanical failure with the elevator in the hospital and called for a fix. Their initial whispers of worry and concern quickly boiled into clamors, all of which, as reported, the management was acutely aware of but ignorantly—ad nauseam—applied makeshift solutions like reducing the number of people and weight the elevator carried.
Also reported was the continuous malfunctioning of the elevator over the cause of its eventual breakdown, like hanging in a balance when it suddenly halts between shuttles. The reports and awareness of an impending catastrophe went on for 5 years (2018 to 2023), but the acknowledgment of the dire consequences was simply non-existent. For every single day until the 1st of August, 2023, nothing good happened, and then something terribly bad happened.
A psychic might think back to the beginning of Dr. Diaso's housemanship and surmise that it was filled with optimism and contractable glee. She had, after all—as many medical undergrads do—spent at least six rigorous and grueling years as an undergraduate, amidst the deteriorating situation of her homeland. In a field whose specialists are, by default, disproportionately affected, people like Dr. Diaso persisted regardless.
Occupational hazards are an innate part of the job for health workers—it is the risk they're constantly taking. Nevertheless, it isn't enough reason to ignore the general guidelines of avoidance. Take for example, in the Netflix medical documentary series "Pandemic: How to Prevent an Outbreak," when an employee of the New York City Health and Hospitals, who had just undergone a major flu outbreak Simulation Exercise (SimEx), in the debrief session said "If I have to take the time out to switch my gown and someone needs to be intubated, I'm gonna pick their life over switching out my garment," the American epidemiologist Dr. Syra Madad responded “If you're not protected, if you can't protect yourself, then how are you gonna help others?”
Unfortunately for the Nigerian physician Dr. Ameyo Adadevoh, who diagnosed and isolated Patrick Sawyer, the first Ebola patient, in 2014, protecting others meant putting herself in the line of fire. A heroic tale to many, but one that reinforces the need for a mutual effort to protect health workers—they need us as much as we need them.
The WHO, in its continuous bid to protect the health and safety of health workers, notes that the 136 million global healthcare workers (approximately 70% of whom are women) all “have the right to decent work, including protection of health and safety risk at work.” But Dr. Diaso didn't have to be a health worker to commute in a working elevator, she didn't even have to be a Nigerian, she simply had to be human, the first and last thing anyone should ever have to be. And clearly, that also didn't matter.
As a trained specialist who’s expected to save lives, and whose service many feel entitled to, the recklessness with which we failed and lost Dr. Diaso is emblematic of the exact problem with Nigeria. It’s an all too enduring familiar tale of simplistic recklessness, fortified maladministration, and casual ignorance, from functionaries who have simply become desensitized and disconnected from the grievances and plight of the people, the consequences of which is the psychic numbing of the public. But even in the sheer amount of catastrophes that deprive us of the potential joys of life, there are the conspicuous ones that force us to take a pause and pay attention—however brief. It offers the consciousness of a rude awakening that can not be refused: it could have been you, however the circumstances.
For the countless trips the elevator of death made, the countless lives that had traveled with it, the sheer amount of weight it had endured, and how long and how much it had held on, there must be those closer to ground zero that won't be getting off the trauma anytime soon.
In situations analogous to Dr. Diaso's, it is not uncommon to ask the what-if question. What if she hadn't gone into the elevator? What if she had been rescued immediately instead of after forty minutes? Thirty-nine? Thirty-eight? Thirty-seven? What if when life reversed roles and she became a patient, there was blood available for resuscitation? What if she wasn't a doctor? What if she hadn't come to work that day because she was processing her japa documents? We'll never know. But what we do know with surgical certainty is that situations like Dr. Diaso’s are what refute claims of greener grasses and render well-intentioned propositions futile. Slowly but steadily, there's an innate rot irrigated by the system itself that pulls us, ever so slightly, to the fact that, on the topic of Brain Drain, we are fighting a losing battle or that we've simply lost the battle—like many of Professor Adeyemo colleagues believes. It is a system trenched by a level-wide incompetency by a society that can't take care of itself, talk less of its own—one that it does not recognize for what it is or what it can become. Sad.
At the induction ceremony at Unilorin last month, the inductees were advised to be compassionate and sympathetic to the plight of their patients. They were instructed to either help a hundred percent or not attempt to help at all. And they were warned of the retribution of torching the medical profession in a bad light: license revocation. And if they thought they'd simply leave their locality to practice elsewhere, a letter of good standing would be their brick wall.
The lecture from Professor Wasiu Lanre Adeyemo was a well-intentioned proposition and counsel from a reputable scholar. But it was also a speck in time, a timestamped admonition—for the inductees—in the race for a better life in the harsh realities of Nigeria. Some will remember—if at all—until that latest catastrophe hits them like a hurricane, or they will take solace in the unknown: that the professor didn't have enough time to complete his lecture, remember, they had to read his citation for almost half the time he was allotted.◼︎