The standoff between doctors who studied medicine abroad and the Medical and Dental Council of Nigeria, which regulates medical practice in Nigeria, continues unabated. Foreign-trained doctors are required to under a 16-week re-orientation in tropical medicine and an assessment exam before they are licensed to practice in Nigeria.
MDCN said 437 out of more than 600 who sat for the exam at University of Ilorin Teaching Hospital failed the test in November.
A separate set of foreign-trained doctors was inducted to practise in Nigeria in July. Only 160 doctors and four dentists passed before induction, a 40% pass rate, out of a total 334 doctors and seven dentists.
Health minister Isaac Adewole called the pass rate “worrisome” then.
But the present standoff has pitched parents of students who studied medicine outside Nigeria against the acting registrar of MDCN, Tajudeen Sanusi.
“We have nothing against MDCN,” said Bala Jubrin. He is a former commissioner for education in Bauchi state, piloted airplanes of the defunct Nigerian Airways, and his son studied medicine in Egypt.
“Our grouse is with the acting registrar, who has turned himself into a tyrant.”
Parents of the medical graduates have petitioned health committees in the Senate and House of Representatives, prompting Sanusi’s appearance before the lawmakers.
They accused Sanusi of personal bias against foreign-trained doctors, pointing to media statements in which he questioned the adequacy of medical schools abroad and opined they were only interested in foreign exchange and churning out doctors for export.
Previous batches of foreign-trained doctors have undergone reorientation and passed tests to practise in Nigeria, parents said, citing programmes in Enugu, Lagos, Ife and Zaria under previous leaderships of MDCN.
But they accused Sanusi of having “a mindset” even before he met the foreign-trained doctors undergoing a 16-week reorientation and studying to pass assessment tests at University of Ilorin Teaching Hospital.
“He started by cursing them, even before exams,” said Jubrin.
“He came from Abuja and was castigating them. ‘You don’t know anything, you are incompetent, your parents wasted money training you overseas, you think you know something, you don’t know anything.’ At the end, only 243 passed, so he kept his word.”
In addition, parents said their sons and daughters were put through conditions unfavourable to learning. More than 600 of them lumped in a programme with carrying capacity for only 150; four weeks of strikes-by resident doctors and nurses combined-disrupted training; and on ward rounds, nearly 50 doctors in training followed a single consultant.
Another parent, Sadiq Kassim, said Sanusi had foretold only around 200 would pass the tests and suggesting most of the graduates were not qualified to sit for the assessment tests.
“Was there space that has been allocated, and how was the exam scored? Is there a quota for 200 only to practice after training abroad?” asked Kassim. “He said these are children who could not qualify for Nigerian universities, so their parents sent them abroad.”
The Nigerian Medical Association says MDCN assessment tests are the function of the regulatory council. Graduates must take similar exams to practise in the US or UK.
But it said measures in “quality management” were introduced in previous testing in Lagos, and later in Ilorin, with a pass rate of 35%.
Ghana, Lesotho and Kenya have seen pass rates of 15% maximum in recent years. Ghana now has a yearlong remedial programme for foreign-trained doctors before they can sit the licensing exam.
NMA faulted moves that have taken license examination before the legislature, noting that taking licensing away from the regulatory council would erode the powers of the MDCN, if licenses could be gotten through court judgments.
In a statement, Kingsley Ekweremadu, a vice president of NMA, spoke of “dismay with the quality of some foreign-trained” and questioned the “quality of service they render-if they do not contribute to high mortality in the health system.”
Parents have fought back. “If there are issues of malpractice by professionals, the regulator is to sanction whoever is at fault,” said Kassim, whose daughter studied medicine and surgery in Sudan.
“We have said, in the last ten years, let MDCN bring out the statistics of malpractice complaints and redress mechanism and punishment. Disclose how many of those doctors are foreign trained. Otherwise, it is something you are claiming to justify a mindset.”
Parents insist sending their children to medical schools abroad is the result of necessity, not elitism.
Medical colleges accredited by MDCN in Nigeria cannot accommodate all wannabe doctors and dentists. Three medical schools in the northeast have a combined capacity for 265 students but 9,980 want admission to study medicine, said Jubrin.
In the south west, 12 medical colleges have slots for 910 students but applicants number above 35,000, he added. “If we don’t complement with those overseas, how do we do this?” he wondered.
“Nigerian medical colleges can only admit certain numbers because of inadequacies,” said Kassim. “Our children, because there is space limitation, we decided to send them to schools elsewhere.”
Some of the students studied on scholarships, were sponsored by state governments or philanthropic organisations. State governments also have signed agreements to train students abroad in hopes of improving the number of healthworkers in their employ, with express understanding of past MDCN administrations.
Bauchi state, in particular, sponsored a two-week trip by previous leadership of MDCN to meet with Egypt’s ministry of higher education and assess select medical colleges where Nigerian students could study medicine, said Jubrin.
Bauchi also hired some 30 Egyptian doctors to work in the state, he said.
The result of the evaluation was positive, said Jubrin.
“But this man [Sanusi] said they are all useless. We drew MOU between Nigeria and Egypt, approved by [then president Hosni] Mubarakh, and this man is saying we took them to useless schools.”
Parents accuse Sanusi of assuming “sole administratorship” of MDCN, which doesn’t currently have a governing council. They said he “unilaterally” doubled fees for foreign-trained doctors from around N70,000 to N130,000, citing the council’s need for funding.
By their estimation, the council raked in more than N91 million but Sanusi provided only N5 million for the re-orientation programme at Ilorin.
Sanusi could not be reached to react to the complaints against him before publication of this story, and is yet to respond to messages sent to his mobile number.
Practising doctors with NMA have resolved to stand with MDCN decision, and criticized the Senate’s move to wade into the territory of a regulatory council.
Parents of foreign-trained doctors cite exceptional students passed in their countries of study before failing assessment exams in Nigeria. Among them, a nurse who worked at National Hospital before going to study medicine in the US in hopes of returning to Nigeria; a doctor who’d practised in the US for 15 years before deciding to return to Nigeria; and a prize-winning woman doctor who graduated best overall at her medical school in Dubai.
They don’t want a re-marking of the previous test papers done, but a “different set of people to run the show in giving them a new exam,” said Jubrin. “Let Sanusi be out of the show. Let all of those who had anything to do with Ilorin be out of it. We just don’t want anybody in Ilorin or Sanusi to superintend.”