The Registrar of the Medical and Dental Council of Nigeria, Dr. Tajudeen Sanusi, in this interview with LARA ADEJORO speaks on the efforts of the council in ensuring that only qualified doctors practice in the country
There have been mixed reactions regarding the statement of the Minister of Health, Dr. Osagie Ehanire that there are enough doctors in the country but as the MDCN registrar, what is your take on it?
I want to believe that the Minister was misquoted. Misquoted in the sense that by our record, we have about 50,000 practitioners that have renewed their licence for this year, 2022. Maybe you can say exactly what the minister said for me to make comments.
That was exactly what he said. He said that there were enough doctors in the country.
I cannot say whether there are enough doctors or there are not enough doctors in the sense that, there are some of our medical practitioners practicing in the hinterland that have not even renewed (their licences). Officially, those who have renewed were about over 50,000.
As a body, do you have a record of those who have left the shores of the country?
If you say we have a record, one of the means of getting the record is through the request of good standing, and two, for those of them that are honest enough to write us to suspend their licensure when going abroad, that is the only way we can know those who are outside. Some have been outside that are not documented here, looking for jobs. It’s only when there are openings and the jobs are available that they now request letters of good standing.
Do you have an estimated figure for the people who have requested the letter?
I remember the last few months, it’s over 2,000 that we had for this year. As I mentioned, some of them are already outside, it’s not that they are just leaving. Then, some of them again are within the country, applying for jobs so you cannot exactly say that they are outside. As a registered practitioner, you are not only registered to practice locally, you are being registered to practice globally and that is why if you are moving from one jurisdiction to the other, you need a letter of good standing to ensure that your name is still maintained in the relevant register in your area, wherever you are.
Recently, the Nigerian Medical Association decried the move by the Federal Government in sponsoring a bill to establish a Traditional, Complementary, and Alternative Medicine board in the country. Do you think some components of the bill will conflict with the functions of the council?
It’s already conflicting because, by the 1992 amendment that vested the control and regulation of alternative and medical practice on the council, there is a conflict. Traditional medicine is different from alternative medicine and complementary medicine. I believe that the bill should be changed to a traditional medicine bill, not a complementary and alternative and traditional bill. Acupuncture is traditional in China but once it leaves China, it becomes an alternative. So some of these things are being misconstrued, even the ones we have registered here we are keeping our eyes closely on them because some of them want to assume responsibility for orthodox medical practice which is illegal. So going to that one, the National Assembly needs to look at it microscopically, they can dot the Is and cross the Ts so that conflict can be removed. We are not against that but there is an existing law that vested the control and regulation of alternative medicine practice on MDCN.
What are the processes involved in reporting cases of medical negligence?
For medical negligence, either reporting doctors engaged in private practice or in public service, when you notice anything, you will write to the MDCN. Within the MDCN, we have two bodies, that is the MDCN Investigative Panel and the Medical and Dental Practitioners Disciplinary Tribunal. The MDCN Investigative Panel is the panel saddled with the responsibility of carrying out a preliminary investigation into the professional allegations and the panel meets in camera. Before a complaint can be valid before that panel, that complaint must come in form of an affidavit sworn to before a notary public.
What are the processes of sanctions for any doctor who is found guilty?
If after the investigation and the doctor has no case to answer, then the matter ends there because the panel meets in camera. But if the doctor has a case to answer, the matter is transmitted to the Disciplinary Tribunal. In extreme cases where the doctor is found to constitute a danger to public health, that doctor is suspended there and then. Of course, by law, we are expected to facilitate the trial within three months but when you look at the context of Nigeria, that possibility is remote, and that’s why some of them end up being on suspension for over three months. Some of them come themselves going from one court to the other challenging the validity of that suspension, so in the process, some of them may be on suspension for two years before the trial. From our experience, it’s very clear that even when they go to court, the court will always order that they should be reinvestigated. If you’re reinvestigated, and they still find you to constitute a danger to public health, they still place you on suspension. Invariably, as a regulatory body, we are set up to safeguard the health of the public, not necessarily shield our colleagues. When you look at the health regulatory bodies, I can tell you that we are one of the foremost because we investigate our colleagues where necessary and if found guilty, they are sanctioned. After the trial by the tribunal that has the same status as the court luminary, it’s either you are discharged and acquitted or you are admonished, it’s still a form of punishment because you are warned not to sin again or you are suspended for not more than six months but there is a caveat to that depending on the severity of the offence; maybe five count charges and you are found guilty in three of them, the tribunal can give six months suspension, not running concurrently, one after the other depending on the severity of the offence or in an extreme case, the Registrar is advised to strike out the name from the relevant register. The importance of this is that if your name is struck off here and you think you can escape to another jurisdiction, you are wasting your time because they will request that you bring a letter of good standing and we are the ones to issue the letter of good standing, which is usually communication between two regulatory bodies. So, it means you cannot go and practice anywhere and even if you want to practice there, we have to lift the sanction here.
Is the assessment exams of foreign-trained doctors a doubt of their qualifications?
Let us remove that adjective of doubt. It’s a global practice that if you train in a particular jurisdiction and you want to go to another jurisdiction, you subject yourself to an assessment exam. Even if you are a professor of medicine here and you’ve never practiced in the United Kingdom or the United States, when you go in there, you subject yourself to their assessment exam. So, it’s a global practice.
For those who fail, what’s the way forward for them?
They should go back and read their books. The answers are in their books.
Recently, there were mixed reactions when you said you are not going to take doctors who were taught in Ukraine. Has this been resolved?
There is no controversy about that. There is no doubt that the war is raging in that jurisdiction between Russia and Ukraine. When the war broke out on February 24, 2022, if I’m not mistaken, and by March 7, we wrote a letter to the Federal Ministry of Health about the fate of Nigerian students that are being cut up in that situation, thinking of ways out, that they should come back, if they come back, we will see what we can do for them. We had three different meetings in the Ministry; the National Universities Commission was there, the Joint Admissions and Matriculation Board was there, and the Federal Ministry of Education was there. There is nowhere in the world you tell me that you learn medicine online, let us face the fact. Can you allow a doctor who trained online to treat you? The people clamouring for this don’t know they will be the first victim. Since the war broke out they have not graduated anybody so how will you bring one paper and say you have graduated, I won’t accept that paper; when the Ukrainian government took their students to the UK to complete their training. Why can’t those universities go to neighbouring counties, have agreements with medical schools and transfer their students there; instead they are taking money from Nigerian students and telling them they are teaching them online. It’s a fraud. We may be black but our minds are not black and our brains are not black. We know the system in that place, it’s just that Nigerians are always looking for the cheapest way out or the quickest means out. On this seat, we will not jeopardise the health of Nigerians and other people living in this country and we are not ready to take quantity for quality. The fact that we need doctors in Nigeria does not mean that we should inject into the system unqualified individuals. We just returned from Ghana, it’s the same problem in Ghana. The delegates from South Africa were there, the delegates from Kenya, it’s the same story. Why is it that it’s the third world that this is happening? They can’t go to the UK or France, or the Netherlands. The arrangements we have made for them are these; you come in here, we have met with JAMB and JAMB said they are ready to waive their side because every candidate must be registered by JAMB but the thing is you have to choose a medical institution of your choice, we will scrutinise the requirement, whether you meet up with the minimum requirement or not. If you meet up with the minimum requirement, then they will now access you and that will determine the level they will take you to. The fact that you are in the 600 level there does not mean you will qualify for the 600 level here because every country has got its standard. Nobody can ambush us because we are set up to protect the health of the public and this is one of the ways of doing that. We are not ready to inject into the system people in whose hands people will not be safe.
How many students from Ukraine have been absorbed into schools in Nigeria?
Unfortunately, they’ve not been reporting here. So, I wouldn’t know because the standing order to the medical colleges is that once they access them and they are ready to absorb them, they should forward the list to us for indexing and as of today, I’ve not received any letter from any institution. When we had the meeting at the Ministry of Health, the Ministry of Foreign Affairs was there, the Ministry of Education, and the NUC were there and they said about 8,000 Nigerian students were stranded and about 1,500 elected to come back home. Out of the 1,500 students, about 300 are medical students but the fact is this, we know that most of those people do not meet the minimum criteria for admission for medical training here before they went there. It’s even embarrassing to know that some of them don’t have a science background. How can somebody that did Government, Economics, Commerce, Agric Science be qualified to read medicine? I keep giving this example, a few years ago, we have about 20 Nigerian students who claimed to have graduated from Venezuela Medical College, these people wrote their school sat in 2012, and by October 2017, they had come back with MD degrees. Meanwhile, in Venezuela, the medium of expression is Spanish. How did they learn Spanish within that period talkless of being trained of becoming doctors? We found it difficult to verify their certificates, they were giving all sorts of excuses about the diplomatic relationship between Venezuela and the US but our own is if we are unable to verify your certificate, you will wait till we can, even if it takes us ten years. Surprisingly, when we went to the Association of Medical Councils Africa meeting in Ghana, we were told not to listen to them. There are so many mushroom schools in Venezuela churning out people they will call quacks. Of course, since then, we don’t see those people here. Then, there is another set of people that are nurses and other paramedical who practice for about 20 years, they will now move to some of these American colonies, and within three or four years, they claim to have graduated and earn their degree of MD. Meanwhile, in those colonies, they cannot practice there. Our own is to protect the health of people.
What are the challenges facing the council?
Our challenge is inadequate funding because we largely survive on our Internally Generated Revenue.
What are you doing to fight quackery in the health sector?
We have met with the Inspector General of Police on the issue of quackery and we are working closely with the Force Intelligence Bureau in this respect very soon you will hear us again
What advice do you have for doctors who are planning to leave the country?
There is no place like home. We go for programmes outside, we see our Nigerian doctors and some of them want to come back home. There is a certain level you reach there and you are unable to do anything for your people, you don’t feel fulfilled. Everything is not about the money because being called a doctor is a call to service and it is a service to humanity. What is the essence of acquiring many things and you cannot change the lives of common men? That is why we continue to tell the young graduands during inductions that if it is money they are looking for, the medical profession is not a place for them. As doctors, you won’t be rich and you won’t be poor either but you’ll be comfortable.
