DR ABUBAKAR IMAM 13TH MEMORIAL LECTURE

In the name of Allah, the Magnificent the Merciful
It is a great pleasure and privilege to be invited by the Board and Management to Aminu Kano Teaching Hospital to deliver the 13th Dr Abubakar Imam Memorial Lecture. It all started when I received a text message from the CMD of AKTH Dr Abdulhamid Isa Dutse requesting me to give the 2009 Lecture. I did not hesitate to accept the invitation for many reasons .
First of all I can’t refuse any request coming from the CMD who was the Foundation CMAC and the person to whom I handed over when my tenure as Foundation CMD ended in June 2003 .The administration of Dr. Abdulhamid Dutse has in the past six years not only built on what we started together but improved and even introduced new innovations. Whenever I come to AKTH I cannot but be impressed by new structures that are springing up all over the hospital grounds as well as new ultra modern equipment installed.
Secondly the Lecture is in memory of a person I have known for over 50 years, who came from the same Genawa clan as I do, whose family house in Soron Dinki is within stone throw from mine in Kurawa Kano City. Even more important than these is that as far back as 1957 when I was confused as to which profession should I choose between medicine and engineering Dr Imam returned to Nigeria from Aberdeen, UK. I was so fascinated by him. Then the “CHOISE WAS CLEAR”. I dropped Additional Maths for biology in my WASC and went ahead to Keffi Government College for pre med HSC. Course. Dr Imam not satisfied as being just a medical officer returned to the UK to specialize in Obstetrics and Gynaecology and soon returned to Nigeria as the fist Obstetrician and Gynaecologist in Northern Nigeria. After the creation of Kano State in 1967 Dr Imam was deployed to the new State where he held positions of Director Medical Services and Permanent Secretary Kano State Ministry of Health. His contributions were immense.
It is no exaggeration to say that Dr Imam laid the foundation of Health care delivery system in the infant State. His contributions in areas of Maternal and Child Health Care, establishment of School of Midwifery, Danbatta and training of Clinical Assistants are but a few. At national level he contributed immensely to ensure that specialists were trained in our sub region resulting in the establishment of National Post Graduate Medical College of Nigeria and West African Colleges of Physicians and Surgeons. When he retired from public office, the State Government allocated a big expanse of land in a new modern layout with central sewage system to him in appreciation for his services to Kano State. Having dedicated his life to humanity Dr Imam could not do anything with the land but to establish together with friends a very modern private hospital from which he continued to serve his community especially women. With such verse experience patriotism and dedication to service it was not surprising that when Bayero University Teaching Hospital was established in 1988 the logical person to head its Board of Management was no other person than Dr Abubakar Imam.


We enjoyed working with him immensely. All the teasing problems of a new Hospital were tacked easily as we tapped from his verse experience, but as usual with Government the Board was suddenly dissolved leaving us stranded. His death which followed soon after his return from the UK where he had a routine check was very devastating. I remember seeing him on his hospital bed; weak as he was, he continued to ask me about the BUTH/AKTH.

Choice of topic of lecture
It was difficult for me to decide on the topic of my Lecture .The topic had to be one that Dr Imam would be interested in. He would like to know the state of health care system in Nigeria.


He was aware that the goal of “WATER FOR ALL BY THE YEAR 1990” was not achieved .
He will however, be pleased to know if the goal of “HEALTH FOR ALL BY THE YEAR 2000” was achieved..
How about maternal and infant mortality rates?
How about life expectancy of Nigerians which was in the 50s when he left us?


He was aware that the goal of “WATER FOR ALL BY THE YEAR 1990” was not achieved .
He will however, be pleased to know if the goal of “HEALTH FOR ALL BY THE YEAR 2000” was achieved..
How about maternal and infant mortality rates?
How about life expectancy of Nigerians which was in the 50s when he left us?

How about overseas treatment?. It should have been minimized with the improvements taking up in our tertiary hospitals like AKTH
What about NEPA and Water Board?
What about health staff situation-manpower, misdistribution, strikes, brain drain. Have our doctors, nurses, physiotherapists,etc, who fled to Saudi, Australia, and even South Africa and Papua New Guinea started to return home?

These and many other questions made me choose the topic of my lecture

“FROM BRAIN DRAIN AND BRAIN WASTE TO BRAIN GAIN”
BRAIN DRAIN.
Brain drain otherwise called human capital flight is defined as “a large emigration of individuals with technical skills or knowledge normally due to conflict, lack of opportunity, political instability, or health risks,”
The term was coined originally by the Royal Society of UK after the Second World War to describe the emigration of “scientists and technologists” from Europe to North America.
Brain drain is a worldwide problem. Examples include:
By 1961 over 3.5 million Eastern Germans young and well educated including their intelligentsia left for the West costing East Germany $7-9billion.This eventually led the construction of the Berlin Wall
Over 50000 Russian scientist and computer programmers left the country since the collapse of the Soviet Union’
In Philippines approximately 8 million Philippinos are working abroad. Over 100000 nurses emigrated between 1994 to2008. And 15000 are expected to leave in 2008.the outflow of health professionals has lead to the closure of medical schools and hospitals.
In Latin America a study in 2000 showed that 11% of every year’s university graduates from Ecuador and Columbia and 14% from Mexico live overseas.

In Jamaica over 80% of persons with higher education live abroad.
Africa: South Africa has been experiencing brain drain in the past 20 years resulting in “white communities” overseas.
Nigeria:
The earliest brain can be traced back to the civil war disturbances in 1966 culmination in the Civil War 1967 to 1970. A large number of health professionals from Eastern Nigeria fled to North America and Europe and virtually never returned.
From Mid-seventies brain drain started to pick up gradually involving professionals from other parts of Nigeria. The Nigerian Government realized the seriousness of the situation such that the Babangida Administration set up the Presidential Committee on Brain Drain in 1988.
According to the Committee

“between 1986 and 1990 Nigeria lost 10,684 professionals from tertiary institutions alone but the total estimates including those who left public, industrial and private organizations totaled over 30 000.”
About ten years later the then Nigeria’s Minister of Health Dr I Madubuike lamented that
“In 1995 over 30000 Nigerian doctors were working outside Nigeria, twenty one thousand [21000] of whom were practicing in USA alone”
According to WHO Bulletin 2004
“Nigeria is a major health staff exporting countries in Africa. Between April 2001 and March 2002, 432 nurses legally emigrated to work in Britain. In the previous year the number was 347. There are about 2000 legally emigrated African nurses.

Economic Impact Global remittances have been increasing. In 1970 it was less
than $2bilion but in 1995 it was $70billion. In 2006 the figure was $264 billion
shared as follows:
Asia: $115billion
Africa: $40billion
Latin America:40 billion
Note that the remittance money sent home is more than of international assistance
UNCTAD has estimated that one highly trained African migrant aged between 25 to 35 years represents a cash value of $184000 at 1997 prices
It is quite clear that despite the remittances countries of origin suffer net loss. The recipient countries are receiving qualified workers without having to bear the cost of training them. Our education budgets are nothing but a supplement to the education budgets of the West. THE RICH NATIONS ARE MADE RICHER AND THE POOR NATIONS POORER.

BRAIN WASTE.
Another problem in some African Nations is that many qualified professionals are not practicing what they are trained to do. Examples in Nigeria include
Several highly qualified persons have their professions to politics,business,administration traditional chieftaincy NGOS etc
Another serious problem is lack of vacancies for internship, so many doctors,pharmacists,physiotherapists and lab scientists are roaming our streets as they await for placing.
BRAIN TRANSPLANT.
This is a situation in some countries where as they lose their highly qualified professional to the West they gain others from the Third World. Examples are Canada and South Africa.
BRAIN GAIN.
This is the reverse of Brain Drain. The major beneficiaries are USA. Canada, Britain and Australia (table 1 shows International Medical Graduates (IMGs in the physician workforce of USA ) there are 2302 Nigerian Physicians (0.3% of the workforce while 40838 95(4.90%) are Indians) In the case of UK there are 1529 (!.1%) Nigerians and 15093 (10.9%) Indians in the work force(table 2)
In the USA IMGs constitute 25% of their physician work force, 60.2% of whom are from Lesser income countries. While that of the UK the figure is 75.2 %( table 3 )

Table 1


NIGERIAS HEALTH SITUATION OVER THE LAST FIFTY YEARS
Preindepence period
The colonial authority’s heath system was aimed at serving and protecting the colonial authorities. They consisted of
Nursing Homes where expatriates were attended to e.g.Nassarawa Hospital in Kano.
Later they established hospitals in Provincial Headquarters e.g. City Hospital(now Murtala Mohammed Specialist Hospital established in 1926)
They are primarily to serve African civil servants
Preventive medical services were established to combat diseases like guinea worm, tryponosomiasis, malara.etc. Duba Garis were very effective enforcing public health regulations. Vaccinations were offered regularly.
Schools of Nursing,Hygiene,Medical Schools in Yaba and Kano and UCH at Ibadan
A flying doctor service in Northern Nigeria and Kenya.


The First Republic.(1960 to 1966)
The Southern Regions had their self government in 1957 and The North in 1959 while Nigeria attained its independence in 1960,these governments were very patriotic, building on the colonial foundations expanding them and creating new ones. Budgets were planned and implemented according to law.
The Military Regimes
Nigeria was ruled by the military from 1966 to1999 less 4years of Shagari Regime Massive expansions were undertaken; basic health clinics were constructed to form the foundation of primary car. Several Teaching and Specialist Hospitals were established. Several Universities were created. Many initiatives and innovations came into existence However
The civil Service which was disciplined and efficient was shaken to its roots by mass dismissals and retirements.
Conflicts reared their ugly heads between Governments and academicians professionals and lab our unions. They were dealt with iron hands.
Devaluation of the naira (SAP) drastically reduced the take home salaries of public officers leading to agitations for more pay
.Inter and intra professional conflicts became day to day events
The civil servants who were disciplined and honest turned to corruption not only to make ends meet but to en-mass massive wealth. The sacking of their colleagues without following due process and the sad fate of pensioners including military were enough lessons.
Public infra structure and public owned companies deteriorated, NEPA,RAILWAYS, AIRWAYS,INLAND WATERWAYS,NATIONA SHIPPING LINE NITEL etc.
A free and fair election in 1992 was annulled, civil disturbances followed culminating in the death of a military Head of State and the person widely acclaimed to have won the election.

TEN YEARS OF CIVIL RULE (1999 TO DATE)
Nigerians celebrated the return to Civil Rule with enthusiasm and hope. This however, did not last long:
Nearly all public owned enterprises were sold to what Nigerians believed were friends and associates o the ruling elites
Corruption escalated at all arms of Government: Executive, Legislative and Judiciary.
Infra structure further deteriorated: water supply, electricity, telephones, railways, etc.
Security deteriorated: Niger Delta, Sectarian Crisis, Assassinations, Kidnappings etc
Elections deteriorated progressively from 1999 to 2003 and 2007
Our educational system suffered from prolonged strikes NUT,ASU NASU etc.
In spite of our oil wealth shortages of petroleum, diesel and gas are common day occurrences.
However, there are some positive developments:
National Health Insurance after several decades of planning eventually took off but it is serving only some persons in the formal sector leaving vast majority of Nigerians uncovered
Reform of Pensions
GSM has revolutionized telecommunication in Nigeria with less than 500,000 lines before to 21million now. although at the expense of national telephone service (NITEL)
ATM and online banking for those who can afford it, 419 is infiltrating the system
Nigeria has paid up its debts, but new loans are being secured

CURRENT HEALTH SITUATION
With all the problems highlighted above there was massive deterioration in the performance of Nigeria’s health delivery system. In Year 2000 Nigeria was ranked 187th out of 191 countries ranked by WHO.
Our life expectancy which was in the 50s is currently 47 years.
Maternal mortality is 1000 per 100, 000 (300 per 100,000 in Southwest Nigeria, but 1,020 in Northeastern zone (NDHS 2008) )
Deliveries at home 67%, in health institutions 33%
Neonatal mortality 53 per 1000 live births`
Infant mortality 113per.1000 live births
Under- 5 mortality is 201 per1000.live births
Routine immunization which in the early 1990s was in the 80s % has dropped to 27%
Primary Health Care % facilities have been abandoned serving only 5-10% of the population.
Only 43% of Nigerians have access to potable water in 2003
In the Northwest zone only 11.2% have access to pipe borne treated water, 15% have access to bore hole, while 23% have protected wells.

OPTIONS
Nigeria with its vast human and natural resources, 3rd largest economy in Africa is trailing behind several of the countries we assisted during their civil conflicts. Seventy percent of its people are earning less than one dollar a day has several options including:
1.Maintain the status quo, in which case the conditions will further deteriorate:

Fall in life expectancy
Increase in poverty level
More civil disturbances
Little or no turnout during elections” It is no use voting at all”
Kidnapping extends to the North
Self imposed curfew by the elite for fear of kidnapping and mob attack.
More brain drain
Resurgence of old diseases
Epidemics wiping out a significant portions of the population
Nigeria breaks up into several countries
Nigerian refugees in Liberia ,Ghana,Sierraleone,South Africa Botswana EU and USA
Nigerians collectively decide any say “ENOUGH IS ENOUGH”
Free and fair elections are held, popular leaders in control
EFCC is revived..Reports of panels past and present acted upon
Judges deliver just judgments. “no fear no fever”
Politicians fulfill their promises
There is uninterrupted light supply 24 hrs a day 7 days a week

IS THIS A DREAM? NO IT IS NOT. WITH DETERMINATION AND PATRIOTISM, TO BORROW OBAMAS WORDS “YES, WE CAN”. WE MUST AND WE HAVE TO.
MAY AKTH BE ONE OF CENTRES ATTRACTING WORLD CLASS PROFESSIONALS A FAVOURITE DESTINATION FOR PATIENTS FROM ALLOVER THE WORLD
MAY ALLAH GRANT DR ABUBAKAR IMAM JANNAT FILDUSI. AMIN

THANK YOU

Posted On2009-08-09