After the juju man comes the con man

That giant sucking noise you hear is African doctors and nurses entering US and UK hospitals.
Chinwuba Iyizoba | Mar 4 2009 | comment  



Photo: Eric Miller/ World BankDoctors and nurses are leaving Africa in droves, in search of higher wages and a better lifestyle. This delights Americans, the British and the Saudis, but what about us in Nigeria?

The good news is that we still have some competent juju-men.

Here’s a story I heard about their skill. Back in my father’s day in eastern Nigeria, a palm wine tapper fractured his leg. He was carried to a juju-man miles away. His relatives gave the old man gifts -- tubers of yam, kola nut, a keg of palm wine and a cock.

After incantations and libations, the juju-man abruptly struck the fracture. The pain was so intense that the patient passed out. When he recovered his senses, he saw the juju-man breaking the leg of the cock. “The day you see this cock walk, you will walk”. And so it was. The villagers tended both the man and the cock. One day the cock stood up. The wooden splints were removed and the tapper walked too.

The treatment was primitive but effective. So effective, in fact, that in 1976 the World Health Organization began to employ "village healers” in African rural health services.

The bad news is even the juju-men are scarce nowadays.

About one in five doctors born in Sub-Saharan Africa are now working abroad. About 20 qualified doctors leave Kenya each month. According to Randall Tobias, the US global AIDS coordinator, there are more Ethiopian-trained doctors practicing in Chicago than in Ethiopia. In Zambia, the public sector only retained 50 out of all the doctors trained in the country’s medical schools from 1978-1999.

Nurses, pharmacists and social services personnel are also leaving, thanks to massive international recruitment drives. Overseas, African nurses can earn as much as 20 times as much as they earn at home. There is a huge shortage in the developed world. The US has 126,000 fewer registered nurses than it needs and this could rise to 800,000 by 2020.

Tens of thousands of doctors from my own country are working in the US, Saudi Arabia and the Gulf States, Europe, Australia and other African countries. The remaining ones are competing for the few available spaces in government-owned teaching hospitals; since only a few private ones are successful.

The problem is worse in rural areas. Villages are overlooked by government health planners. Few qualified doctors are willing to live there and good juju men are a dying breed. So the vacuum is filled by con men who are not qualified in either Western medicine or traditional medicine. They exploit the ignorance of the locals.

A friend of mine works in a teaching hospital and laments the high number of villagers who come from rural clinics to die. He recalled the pathetic story of a child with a minor infection of the chest wall. The local con-man told his parents that she had stepped on a fetish. After two months of absurd concoctions, the infection spread to her chest and her abdomen distended to an unbelievable size. Her parents took her to the hospital and she died there.

Another young girl was dying. A lab test from a village clinic showed that her blood haemoglobin level was normal. But alarm bells went off when the mother produced a list of prescriptions from the technician who had done the test. A technician prescribing drugs! My friend knew that technician pretending to be a doctor might be pretending to be a technician, too. The doctor asked for a second test urgently. In fact, the poor girl was severely anaemic. Fortunately he was able to send her home hale and hearty.

This is an incredible scandal. The Nigerian poor are being murdered by charlatans with no medical background who open clinics to make money. They only refer patients when they feel that they are on death’s door. By then, it is normally too late. And such deaths are seldom reported to the Nigerian Medical Council so that these criminals can be prosecuted.

But the US and other nations who benefit from poaching doctors and nurses from sub-Saharan Africa must share the blame for these tragedies. The World Health Association has suggested more scholarships for African medical students, to reverse the present trend of poor medical schools subsidising American healthcare. Another solution is a compulsory repatriation scheme for immigrant doctors and nurses.

One Nigerian entrepreneur has suggested that the United States should impose a “brain gain tax” to be paid to supplier countries. The funds would be kept in a trust fund and disbursed as salaries of doctors working in village clinics to keep them out of the hands of kleptocrats in the government bureaucracy. Whatever the solution may be, the people of the developed world should realise their health is being subsidised by African sickness.

Chinwuba Iyizoba is an electrical engineer in Enugu, Nigeria.

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