Doctor firings expose medical failings in Nigeria

LAGOS, Nigeria – The firing of nearly 800 doctors working at hospitals in Nigeria's most populous state has exposed the failings of the nation's medical system, as lawyers said Wednesday negotiations over the physicians' fate continued.

The sick and injured continue to line up at state hospitals in the nation's largest city of Lagos, but there aren't enough doctors to care for them. Many of the 17.5 million Lagos residents earn less than $2 a day, so the state hospitals represent a crucial safety net for the poor in a nation where the political and business elite routinely fly out of the country for care.

"In the 1960s here, even in the 1970s, the golden days of Nigeria, people came from Togo, the West Africa sub regions to receive treatment," said Dr. Olusola Adeyelu, a leader among the fired doctors. "That is when the ruling class had a clear philosophy. ... (Now), they have no clear idea about human beings."

From the villages of Nigeria's arid Muslim north to the steamy swamps of its oil-rich southern delta, proper medical care remains an out-of-reach luxury for many people in this nation of more than 160 million people. Clinics in rural regions often lack lifesaving anti-malaria medicines, while others cannot their afford rudimentary care.

While state hospitals also charge for care, they provide much cheaper service that others hospitals in the country, making them accessible to many. In 2010 alone, Lagos state hospitals and health centers treated more than 3 million outpatient cases and admitted more than 21,000 patients, according to an annual state report. That does not include those who sought help in federal and military hospitals in the state, nor those who went to private clinics.

Meanwhile, the wealthy fly to Europe, the Middle East and Asia for medical care. Late President Umaru Yar'Adua, who suffered chronic illnesses while in office, left the country for medical care in Saudi Arabia before his 2010 death. Senate President David Mark recently returned from seeking care in Israel.

Doctors in several of Nigeria's states have embarked on strikes in the past, as have other professional guilds about low government salaries in a country where inflation continues to rise and people run generator sets to have electricity in their homes.

In Lagos, however, the administration of Gov. Babatunde Raji Fashola took a harder line against striking doctors and fired 788 of them last week.

The decision saw Lagos state immediately lose between half or three-quarters of all physicians working in state hospitals and health centers. Some have been replaced with doctors from other states or young physicians doing a mandatory year of national service, though not enough to properly staff the hospitals.

On Wednesday, lawyers for the doctors and Lagos state attended a hearing at the National Industrial Court, which handles labor issues in Nigeria. Lagos state Attorney General Ade Ipaye told the court negotiations with the doctors continued and the state would not evict physicians from any state-provided housing they have.

However, it remained unclear how a compromise would be reached as both sides haven't backed down from their demands. Even in court, Ipaye said Lagos state had "not done anything wrong," while the doctors' lawyer Bamidele Aturu accused the state of committing "sabotage" against of the rule of law.

Judge Benedict Kanyib urged the two sides to reconcile outside of court.

"The moment you involve (judges) in the processes of this, we have to close our eyes to the reality and look just at the law," Kanyib said. He later added: "I am certain common grounds will be found."

Yet, as he spoke, shouts from protesters and counter-protesters of the doctors outside the court nearly drowned out his soft words.

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Jon Gambrell can be reached at www.twitter.com/jongambrellap.