NIGERIA: Medical schools in crisis

Medical academics in Nigeria have expressed concern about falling standards in doctor training. They have complained about ineffective admission policies, inadequate facilities, low remuneration and the brain drain, among other ills - and recommended actions to tackle problems at the country's 33 medical schools and produce quality medical graduates.

One of the major problems is lack of a coherent admissions policy. Uncoordinated admission has damaging domino effects up the entire medical training system.

The Medical and Dental Council of Nigeria (MDCN) fixes the number of students each college of medicine should admit. This quota is determined by a number of variables: staff strength, especially in pre-medical faculties; the carrying capacity of teaching and research facilities; and funds for renovation and expansion of facilities.

Unfortunately, these parameters have not been adhered to - especially during periods of military rule, when arbitrariness and dictatorship were imposed on tertiary institutions.

Ben Ukwuoma, science correspondent of the Nigerian tabloid The Guardian, conducted a detailed investigation into medical school admission policies.

The results were alarming. For example, the annual intake of students into the College of Medicine at the University of Ibadan rose to about 600 at one stage, while the intake into the College of Medicine at the University of Lagos was said to have hit 700. Ukwuoma found the same trend at medical schools in Ilorin, Ife, Benin, Enugu, Port Harcourt, Shagamu and Zaria.

One consequence of poorly implemented admissions policy is over-crowding in student hostels, which degenerate into high-density slums.

A new dimension to selection, particularly in private and state-owned universities, has been the ability of some medical students to secure a place thanks to substantial financial contributions made by wealthy parents.

To address admission problems, the MDCN has created a student indexing system to improve transparency. Medical schools are now expected to stick to their admission quotas and send lists of students to the MDCN, said Registrar Abdulmumuni Ibrahim. "We open files for the students, and follow and monitor them to their final stage."

Two graphic illustrations of decay in medical training are inadequate numbers of cadavers and lack of patients in teaching hospitals.

Professor Oladapo Ashiru, a former head of anatomy at the University of Lagos College of Medicine, pointed out that in one medical school in southern Nigeria, 40 students are assigned to one cadaver. "In our days as medical students, there were eight students to a cadaver; four students on each side. The student population was 80 to 100 students," he said.

Patients in teaching hospitals used not to be charged fees, so as to attract adequate numbers of patients. This is no longer the case. As government subsidies to teaching hospitals have dwindled, patients have been made to pay and their number has dropped. This has affected the quality of teaching because only wealthy people with uncomplicated diseases show up.

Further, graduating students are finding it increasingly difficult to find suitable places for compulsory internship.

Professor Akin Oshibogun, Chief Medical Director at the Lagos University teaching hospital, has suggested that one solution to this problem would be for each state government to improve facilities in at least two general hospitals and employ some specialist consultants so that the facilities could be accredited for internship.

A major problem at medical schools is lack of adequate infrastructure and the inability to replace obsolete equipment.

Some doctors believe this problem is political in nature. They have argued that if the ruling classes had been patronising teaching hospitals - the apex of medicine in Nigeria - they would have revamped their infrastructure. But most go abroad for medical treatment.

Examples are former head of state General Ibrahim Babangida and current president Shehu Musa Ya'Adua, who visit Germany and Saudi Arabia for medical check-ups. Senior officials and top private sector managers have also gone abroad for medical treatment.

According to recent statistics released by the Federal Ministry of Health, Nigerians annually spend about US$207 million on medical treatment abroad. If this huge amount of foreign exchange was ploughed into medical infrastructure, deficiencies in medical schools could be corrected, critics have argued.

To tackle the problem, 14 teaching hospitals are being renovated and rehabilitated with state-of-the-art equipment by the Australian company VAMED. This project will be completed in November and, said Federal Minister of Health Professor Babatunde Osotimehin, should instil confidence among Nigerians in the country's health facilities "and thus reduce the number of wealthy Nigerians seeking medical attention abroad".