Brain drain in mental health: Robbing Peter to pay Paul: Part I

Tunde is the first of seven children and his parents are retired civil servants who struggled to put him through medical school. Upon graduation, he opted to go back for postgraduate residency training in the field of psychiatry.

His parents were not very comfortable with his choice. ‘I have heard that after a while, the psychiatric doctors begin to behave like their patients’; ‘and that if you are not careful, some of the spiritual attack responsible for their illness, may also affect you’, his father warned. ‘Besides, they cannot even make money, unlike surgeons or gynaecologists’. ‘Why don’t you have a rethink?’ His father queried.

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But Tunde was determined and his mind was made up. He had seen too many cases of untold suffering and emotional pain, that could very easily have been helped if only they had sought expert’s psychiatric care. He was motivated to understand the rudiments and contribute his quota to promoting the emotional well-being of Nigerians.

Finally, after four years of hard work and several postgraduate examinations which he passed in flying colours, he was awarded the Fellowship of the Postgraduate College and qualified to take up employment as a consultant in any hospital where he could offer his expertise.

The first rude shock was a letter from his hospital management that his postgraduate employment would lapse in six months’ time, having passed the final stage of his exams – and thus concluded his postgraduate training. Not to worry, he reassured himself.

Six months is a long time to apply to different hospitals and secure a new appointment as a highly competent Consultant Psychiatrist. His initial enthusiasm gradually waned and he became dispirited as he travelled far and near to submit his applications and in some places, he was told clearly to his face that his services were not needed. How can that be? He wondered.

Surely there are patients with cancers and other chronic conditions such as HIV/AIDS or terminal end of life cases who may become depressed! How about women or couples with infertility? How about children and adolescents with autism, substance use disorders? Elderly patients with dementia?

How can his services not be needed when the hospital does not have any psychiatrist in its employ? So many unanswered questions ran through his mind.

The six months soon elapsed and he was disengaged from the hospital where he had worked throughout his postgraduate training. His wife was still in school, studying for a Master’s degree and their two children aged four and two years old were also in a private school.

Four of his younger ones were still in the university, and considering that his parents were retired and struggling to access their pensions, he had become the breadwinner and sponsor of their education. But now, he suddenly had no salary and was fast depleting his savings from travelling around the country to submit applications or attend job interviews.

After working hard over the past 15 years continuously since he entered medical school (seven years in medical school; one-year internship, NYSC year, and then straight back into postgraduate training for another six years), he was now suddenly idle and woke up in the morning with nowhere to go. He started volunteering part-time at a friend’s private hospital.

But the financial and emotional strain started wearing him down. He could no longer meet his financial obligations to his immediate family, not to talk of his younger ones and aged parents. What to do?

 

Travelling abroad as an attractive option

He started paying attention to discussions on his class group Whatsapp page about options for travelling abroad. Saudi was recruiting consultants.  The United Kingdom was in dire need of psychiatrists and he could apply and agents would process the entire documentation required and he could be on his way within six months.

Australia was another possibility. Alternatively, he could consider highly skilled migration application to Canada and switch his professional interest to family medicine (which is in high demand). His previous qualification as a psychiatrist will also be an advantage.

Indeed, another viable option would be to prepare to write the United States Medical Licensing Exams (USMLE) and relocate to the USA. All of these options will guarantee him a job, better remuneration, better quality of life and working environment as well as a better future for his children and family too.

Apart from the occasional shootings and terrorist attacks, it would also be a much safer environment. What did he stand to lose? Why should he stay back when his country obviously does not even need his services?

To be continued next week.

In commemoration of the theme of this year’s Annual General Meeting of the Association of Psychiatrists in Nigeria titled ‘Brain Drain in Mental Health: Impact and Solutions’.