“Brain Drain: Why Some Nigerian doctors resist it ” Maiduguri Teaching Hospital CMD
Mohammed Kaka Misau
Chief Medical Director, Maiduguri University Teaching Hospital, Prof. Ahmed Ahidjo has offered reasons for his decision to turn down juicy employment opportunities outside the country in order to serve his father land.
Speaking in an interview with our Corresspondent yesterday, Professor Ahidjo stated the reason why he remained in Nigeria.
BDT: You have been to so many countries of the world and with all the opportunities you returned to Nigeria to work, why?
CMD: The sole reason is to enable me build our people and our systems. There is no doubt that being there will earn one salaries that could be ten times more than what you will get here. In 2011, I was in Geneva but I decided to return because I wanted to develop the Radiography program in the whole of Northern Nigeria where there wasn’t any. So, I came back from where I was earning tens of thousands of dollars in a month for two thousand dollars, to start the Radiography program. Today, I am proud to say that we do have Radiography in Maiduguri and we have produced massively over 3000 Radiographers and they have jobs all over. We have established Radiography and Radiographers in Kano, Jos, Sokoto, Zaria, Ilorin, and now the North East is full of Radiographers. So these are the kinds of things that make you happy when you do because you uplift the standard of living and the quality of skills acquired by our people.
BDT: How easy or difficult has it been, managing a teaching hospital during your four years as the CMD?
CMD: Well, managing a teaching hospital is not easy, health care is a delicate system, you must act promptly, it needs prompt action, medical services given to patients virtually all the times is an emergency service. If somebody is sick or somebody is having pains, you don’t just sit down and look at him. You must act promptly.
BDT: What have you done to improve the services of the hospital?
CMD: We have done planning on how to advance the hospital from where we took it, to where we really want it to be. When I took over the hospital, we had about 630 bed capacity but today I have raised the hospital to 1,200 bed capacity, as the largest hospital in the country. Ibadan used to be the largest but now we have overtaken them, they are within a thousand beds, Lagos university teaching hospital is about 850, Zaria is about 750. So, we have increased our bed capacity, we have increased infrastructural development and we have brought in changes in so many ways. Now we are working on centre system instead of department system. On the centre system, we have built a trauma centre that is 150 bedded, a centre for treatment of burns alone, a new General Outpatient Department (GOPD) and National Health Insurance Scheme (NHIS) complex, a new physical rehabilitation center for prostheses, and a conference centre constructed by the Borno state government to boost training of our school of Nursing and other schools in the hospital. From there we moved to extension of our kidney centre where we have state of the art facilities with four operating theatres- two for kidney transplant and two for other urology procedures, including laser lithotripsy to crush kidney stones, endoscopic surgery system that entails opening up patients without a wide incision or with a pin hole or minimally invasive surgery and so many other facilities in the kidney centre. We have about 20 dialysis machines and so many laboratory equipment, and we are happy that the centre is 85 bedded and is one of the largest.
The cancer centre that we just commissioned is the largest in the whole of the West African sub-region. It has four bunkers, two linear accelerators- An elekta infinity which is the first one to be established in Nigeria, and the HD versa elekta linear accelerator which is the first one in sub-saharan Africa, I think east Africa just got their own two months ago or so. We are also working on Fertility care centre, Stroke center, and Interventional Radiology centre. So the hospital is moving towards centre system. The child Institute is a full centre and 150 bedded. The beauty of the centre system is that it’s a one bus stop for a patient, you do not need to be moving from one part of the hospital to another and it gives a specialized care for the staff to be managing one type of disease so they will have expertise. Let’s say kidney centre, it means everybody there is targeting managing only kidney diseases with all their expertise, so it improves a lot. We have a lot of infrastructure and development other than the ones I have mentioned in the hospital. We have the new Hadi Ukashatu hall, solar power plant substation in the hospital, road infrastructure, solar street lights, and vinyl flooring. So many changes have taken place in the whole of the hospital that sometimes, I find it difficult to mention. There are over thirty projects that we have done in the last four years.
BDT: What of the area of staff development and well-being?
CMD: In the area of staff development, we are one of the best, we have earmarked a staff development plan in which we do a lot of training within the hospital, at national level and international level. We sent people in 2020/2021 outside the country to go for training, and attend national conferences. We also host our own conferences and invite people all over to come and learn because we are a tertiary centre. So, we have a robust staff training program. We have also improved the staff in terms of number in the last four years and it’s almost doubling since I took over. The staff strength at the time I took over was about or over 2000 but now we have about 4000 and we have created a conducive working environment for them to operate.
In Radiology, we have completed the Radiology extension with fully furnished staff offices, conference and seminar rooms. Similar things were done in the hematology department and other departments. We were together with you at the COVID-19 centre, and you saw how we have expanded it, the ICU there and so many things that I can’t really remember by heart.
BDT: Mr. President yesterday commissioned new Doctors’ Quarters, tell us more about it.
CMD: Thank you very much. The new Doctors’ quarters is a 24 three bedroom flats that have been furnished. The whole of the idea of the quarters came as a result of the pronouncement by His Excellency, the Executive Governor of Borno state Prof. Babagana Umara Zulum. He built a 1000 seat capacity auditorium and conference center for us in 2020, and during the commissioning ceremony, he made mention, after thanking him by Mr President for the job, that he was going to build additional housing for the hospital. However, not long after, we entered into the COVID era, and things were really difficult. Before ours, he built Doctors’ quarters for the state government, about 81 staff quarters. So to fulfill his own promise he came and built 24 three bedroom flats for us. It is worth noting that not only did he onstruct auditorium and conference centre in the hospital, the governor donated a hundred million Naira that we used to build the solar power plant that will supply the vital areas in the hospital. Also, during COVID-19, he gave us 20 million Naira to start treating the patients before anybody could assist the hospital. So, the executive governor is the friend to this hospital and we will ever remain grateful to him. He does not separate the teaching hospital from the state government hospital, he sees them as the same, he treats them the same, he comes in any time to check for things to ensure they are working and ask what are the challenges, what do you really need, what can I do for you? So, he keeps on saying that the teaching hospital treats the people of his state. And I believe he really meant well. He is a governor that is different from others, he has the passion and the desire to change his own society, and it is evident, going by his actions.
BDT: What about the relationship between the hospital and the host communities?
CMD: The university of Maiduguri Teaching Hospital is one of the luckiest Institution in which the host communities are really supportive to the hospital, you can see it yourself when we went round the Institution, I keep on mentioning, the North East Development Commission (NEDC) and many prominent sons of the state have done a lot to help the hospital. Senator Ndume has done that, Hon. Betara has assisted the hospital massively, Dr. Kyari Mohammed Dikwa has helped the hospital so much, the governor has helped the hospital so much, there are so many other stakeholders that are really coming in and helping the hospital. We work in collaboration with the host communities and they are really supportive. I have to thank our own father, the Shehu of Borno who sees this hospital as part of his house because of the love and care and the way he cherishes this hospital. Anything that we want, we go to them, and they really push the button to see that it is solved. We commend the communities for all the support.
BDT: What are some of the challenges of this hospital?
CMD: We have so many challenges all the time. The first challenge that really hit us was electricity challenge, but we thank God now that it’s almost over. For over two years, university of Maiduguri Teaching Hospital had no light, virtually every month we have to spend almost forty, fifty, sixty million Naira in diesel, in fact we were just living on debts because the hospital generates less than that, and the overhead that is sent by the federal government is less than ten million, if you remove the outsource, precisely about 8.1 or 8.2 million and diesel alone is 50 million monthly, averagely for two good years. So, this is the most challenging aspect of running this hospital, I won’t hide it from you. I had few grey hairs before I took over as CMD, but, if I remove my cap you will see my head now it’s almost white, it’s one of the major challenges. The second challenge has to do with price increase. We are running a revolving fund in the hospital settings. Today you will buy commodity and you find that the price has changed when you go back tomorrow. so, once you have revolving fund, it’s a fixed amount of money that you go and purchase the items, you come back to sell them and then purchase them again. Once the prices are increasing, it means the quantity that you can be able to buy in the market will reduce and the people may not understand. Caring for patients under the National Health Insurance Scheme is one of the most challenging things we have in the hospital. The government pays 750 Naira per person, that is a dollar, imagine treating a person for the whole of the month for one dollar, the whole of the year for twelve dollars, so it’s a loss to Institutions like ours. You spent may be, thirty, forty, fifty million in a month on NHIS, the fund or the reimbursement may not be more than twenty something million, so we are operating at a loss. I think for proper service provision and sustainability, the government needs to increase the capitation fee for the NHIS.
BDT: What are other challenges?
CMD: Equipment maintenance is another thing. It’s very very expensive, if you acquire any machine coming from abroad, to maintain it is difficult because of its sophistication. The staff development too is one of the challenges. Dedication to service and taking ownership of what we have are important. It’s our own people, it’s our relations that we treat, so let’s take care of them, let’s be kind to them, let’s be prompt and proactive in all our management systems. Staff must be prompt. When you see a doctor abroad he will be nice, courteous, respectful but here somebody will feel he is big, our staff attitude must be changed in terms of their relationship with patients, and the patients too should consider our own limitations, if you are given appointment come on the actual time.
