Mankind and medicine are inseparable in a neat way. The holy alliance is of considerable antiquity understandably because the human body is prone among other things, to a myriad of infections and/or injuries as an individual tries to explore and exploit the material and to a limited extent, spiritual world in which he lives. These infections, injuries and ailments are not fixed once and for all, as man faces new problems, aspirations and challenges through time and space. Medical attention prevents or combats these health challenges. However, new diseases or health problems are bound to occur because of the ever-changing phenotypic and genotypic conditions. These conditions arise from modern ways of life and living. But for this to become a reality, all the main stakeholders must begin to proactively work together in order to free medical education in Nigeria from the fetters of complacency and rigidity. Up till now, proactive measures in this sector of our national life are a far cry.
Therefore, re-inventing medical training in the context of today’s challenges, aspirations and expectations is a task that must be accomplished at all costs. It is a necessity – a matter of utmost importance as opposed to an option. Health and development are inter-connected. For the sustenance of healthy life and living within the context of social and material development, high-profile medical training and practice have to occupy a central position in our vocabularies of popular discourse.
It is against this backdrop that medical training including practice on a sustainable scale gains its relevance or pivotal status. The Western form of medicine which has continued to dominate the health landscape of Nigeria since the dawn of Nigeria’s entanglements with Europe more than four hundred years ago is the focus of this article. In other words, the indigenous knowledge system on medicine vis-à-vis its barbarisation and imprisonment by the Western medical practice through the lens of powerful European and to some limited degree, North American intellectual oligarchy is a topic for another time.
All the 33 universities offering medicine in the country have at least a total of 2,700 students as enrollees on a yearly basis. This is a huge number although not too much for Nigeria – a country with a population of 200 million or thereabouts. Apart from this huge human population which is second to none in the black world, Nigeria has extraordinary natural resources and an enviable human capital needed for sustainable development in all its ramifications. But sadly enough, these abundant resources are yet to be translated into meaningful projects for the betterment of the human condition particularly in the area of robust health care delivery as well as health management.
I will try to illustrate this sorry state of affairs generally in Nigeria within the framework of housemanship for fresh medical graduates. After 5 or 6 years of medical training, every graduate has to do a mandatory housemanship job in a public hospital before going to participate in the one-year National Youth Service Corps Scheme. No fresh medical doctor or dentist can skip this stage of practical exposure (housemanship). The bottomline is to further develop the skills of these young doctors beyond their school environment. It is a legitimate attempt to strike a balance between knowledge and wisdom otherwise called knowledge applications.
They cannot afford to be mediocres understandably because they are going to be dealing with humans in our rural, semi-urban and urban settlements and even beyond the shores of Nigeria. They are Nigeria’s ambassadors at different levels of social and professional engagement. This scenario shows that thoroughgoing education must necessarily take centre stage in the scheme of things. Nobody can contest this reality. However, the main stakeholders such as the Medical and Dental Council of Nigeria (MDCN), Nigerian Medical Association and the management of each university have to begin to do a rethink of aspects of the current medical knowledge productions. Indeed, good policy decisions and targetted interventions of the above stakeholders among other categories of people have to derive from adequate appraisal, re-appraisal, appreciation, understanding and appropriation of the fast shrinking space for housemanship in our public hospitals (state and federal). The available public hospitals have no sufficient space to absorb the huge numbers of medical doctors and dentists being produced yearly from the Nigerian medical schools.
It follows from the above that if the space for housemanship in the state and federal hospitals across the country is becoming too small, then all stakeholders particularly the key players must not shrink from proactivity in several senses. Even the available public hospitals in most cases, are not ready to engage the services of these young men and ladies for the one-year housemanship usually due to the popular but unwarranted rhetoric of tight budgetary positions. This is in addition to the fact that good quality health care delivery is yet to be a top priority of the political class. All the above excuses are a reflection of a very low standard of patriotism in the face of rampant greed or materialism of modern Nigerian society.
This shrinking space will lead to cut-throat competitions among the newly trained doctors as they jostle for positions in the few public hospitals that are ready to take them. One concomitant effect of this situation, is an increase in sharp practices at different quarters or levels of social, professional engagement. Thus, for example, those in charge of recruiting or employing fresh medical doctors and dentists become ‘super-humans’ or arrogant managers of human capital as numerous candidates and sometimes, their wards or parents beg for space for housemanship.