Unpaid salaries: The appalling plight of trainee doctors

Abimbola Abatta, Osogbo

The gross mistreatment and outright insensitivity to the plight of health workers in Nigeria is no longer news. Over the years, health workers have resorted to protests and strike to drive home the depth of the injustice they experience.

Despite their grievances and selfless services offered to the rich and poor, issues such as non-payment of salaries and hazard allowances, reduction in payment, inadequate welfare packages and lots more still confront the health workers.

Trainee doctors are not left out in this predicament. For about three months, house officers across Nigeria were owed salaries yet they are compelled to continue with their obligations to the hospitals where they work.

Earlier this month, it was gathered that house officers in about 19 federal hospitals have received payment. However, those at Obafemi Awolowo University Teaching Hospital (OAUTHC) are among the trainee doctors who have not received a dime in the past three months.

House officers are medical school graduates who are employed for a one-year period before their National Youth Service Corps (NYSC) programme to receive further training.

During this period called housemanship, house officers receive salaries while acquiring practical knowledge in hospitals.

With a heavy heart, Salami Bankole (pseudonym) a reliable source at Obafemi Awolowo Teaching Hospital, OAUTHC, who pleaded for anonymity lamented his ordeal as well as that of other house officers who have not received remunerations for the past three months.

“We can’t rest until we die. This is what we signed up for. Despite being overworked as house officers, we have not received salaries since December 2020.

“We cannot leave work because our country needs us, especially during this COVID-19 period. How do they expect us to survive? We don’t have the time to rest, yet they refuse to pay us our entitlements. This is why many of us are running out of the country. We jump at offers to practise outside the shores of Nigeria,” Bankole said.

To worsen the plight of these trainee doctors, they are constantly overworked and underpaid. Salami who is entitled to only 12 calls per month is compelled to work extra hours. He has no choice but to take twenty calls per month.

Speaking through a telephone interview, Bankole revealed that “A house officer is to have a maximum of 12 calls per month or less. And call allowance is 60k per month at 5k per call. But at times, I do over 20 calls in a month. This is due to the lack of many hands. And rather than pay for all the twenty calls, they reduced the salary.

“For the past three months, it has been God.

I decide to skip breakfast, take lunch, and take snacks as dinner.

“Financial obligations are mainly towards parents and siblings. Each time they call and demand money, I made it clear to them over and over that we haven’t been paid.”

He noted that many health workers are prepared to endure the pains of working in Nigeria for a short period before seeking greener pastures in countries where their services would be valued.

In his words, “All we want to do is finish and get out of the country as soon as possible.”

“Motivation? Most of us quickly want to finish our housemansship which is a criterion for us to get a permanent licence. We can’t go on strike alone as internship is a one-year uninterrupted program. Unless NARD declares strike on our behalf, we can’t go on strike. If we do, we will come back to do what we should have done which translates to extension,” he added.

Nigerian NewsDirect gathered that the situation is the same across the country. However, as of March 12th, 2021, out of over one hundred federal government hospitals spread across the 36 states, only about 19 have received payment.

The National Association of Resident Doctors (NARD) through a statement on Thursday, March 18th, 2021 issued an ultimatum to the National Executive Council (NEC), threatening that the concerned doctors would commence a nationwide strike starting on March 31st, 2021.

The statement which was jointly signed by the NARD President, Dr Uyilawa Okhuaihesuyi and Secretary-General, Dr Jerry Isogun reads thus, “in January, NEC gave an ultimatum that will elapse on the 31st of March 2021 for all pending issues to be addressed. In the light of the above, we ask that all members should be sensitized and encouraged to prepare mentally, socially, and financially for a strike action that will commence on March 31st indefinitely.”

When contacted, the Public Relations Officer, Association of Resident Doctors, OAUTHC, Dr Godwin Eze registered his dissatisfaction with the situation, noting that the house officers experience is unfair.

It should be noted that the Association of Resident Doctors (ARD) is a body of medical practitioners that cater to the welfare and other needs of the interns in Nigeria.

Dr Eze said, “I should not be discussing doctors being owed for three months. In short, no one should hear of this because it is unfair.”

He corroborated Bankole’s story that house officers are overworked, saying, “As I speak to you, I know of some house officers who are always on call every day for a month. They don’t go home.

“When you hear that a doctor is on call it means he will come to work by 8:00 am and leave the next day by 4:00 pm. That is more than 24 hours. And when they are on weekend call, they work throughout the whole weekend and return home on Monday by 4:00 pm. Such a person works for three days at a stretch.

“That’s why you hear that some of our members are collapsing while working. This is not fair. They have been waiting for three months.”

The PRO further said, “These house officers are members of the Association of Resident Doctors (ARD). They are currently undergoing the mandatory one-year house job which comes after medical school.

“The truth is that we have been trying to find out the reason behind it and we think that the reason is because of the central placement of House officers. For OAUTHC, the quota allocated is about 166 including doctors and dentists. We have medical and dental house officers. There was a delay, and we are planning to make every effort to sort it out before the stipulated day which is March 31st. We hope that before then, all the money would have been paid to them.”

Speaking further, he said, “These house officers are always in the hospital. They do a lot of work. They have endured a lot because three months is not three days UCH has gone on a warning strike based on the same complaint. After all, it is not a local affair.

“Although the case is a national affair, as the Association of Resident Doctors, different hospitals have tried to do little things for the affected ones. The National Medical Association (NMA) has helped to contribute money to these members. Our hospital here has helped by giving them access to loan without interest. This has not been easy because we know the type of work these people do.

“Whenever we go on strike, Nigerians do not understand what we are facing. They are not the ones paying us but the government. Many are leaving the country because of this salary issue. You know you can’t be struggling with the little amount you are given and still struggle to get the little money too.

“If the small money is getting across to you, at least you will know your budget for every month, but when you are working without being paid, so many doctors try to find their way out of the country.

“This will definitely affect us because while one doctor is covering one emergency the same doctor will be called to attend to another emergency. Now, we are asking the government to pay our members for the three months salaries. I don’t think anybody should blame us if we go on strike,” he added.

It was gathered that there is a clash between the Medical and Dental Council of Nigeria (MDCN) and Chief Medical Directors (CMD) which, according to the news making the rounds, is largely responsible for the unpaid salaries of house officers.

According to an investigation carried out by the International Center for Investigative Reporting (ICIR), it was revealed that “the house officers had been engaged and paid by the hospitals until recently when the federal government took over the posting and payment of the doctors to avert alleged abuse.

“Government’s decision did not go down well with the CMDs who then refused to forward the list of the interns to MDCN for vetting and onward salary payment.”

Several futile attempts were made to reach the President, Association of Resident Doctors, OAUTHC, Dr. Kusoro Simeon to validate the claim that CMDs are to blame for the delay in payment of salaries.

Meanwhile, in a report by the ICIR on March 14th, 2021, the president of the National Association of Resident Doctors (NARD), Uyilawa Okhuaihesuyi, said the feud “is more like a rift between the chief medical directors and the MDCN. Because of that, they have not paid the house officers for over three months. We have written to federal ministries of health and labour, speaker of the House of Representatives and the Senate president.

Okhuaihesuyi alleged that the CMDs were “more like sabotaging the Federal Ministry of Health and the MDCN so that they can reverse the payment to them.”

“The CMDs know that if they do not submit the list, the house officers would not be paid. If they are not paid, the CMDs know that the house officers will react and will probably call for a strike,” he said, adding that “that is their aim. They know that with that, they will reverse the payment to the CMDs,” he added.

Reacting to the NARD’s allegations, the chairman of CMDs and chief medical director, National Hospital, Abuja, Jaf Momoh, said that nobody would accuse the CMDs of training medical doctors to enable them to get their licences.

In an interview with the ICIR, Momoh said: “Nobody can accuse us of trying to train a medical doctor for his licence and that you are over-recruiting. What happened to those who have finished training? So, they should go and roam the streets? A doctor who spent seven years of training, his training should not be completed? It’s only one year. That is why the federal government decided that the training should be centralised, that everybody will be absorbed. The responsibility of MDCN is to get placement for all of them.

“MDCN has been given three months by the National Assembly to get placement for all of them. There can be no issue of over-placement. It is like NYSC, it is one year. Are you going to say NYSC corps members are being over-placed? Everybody who is due is supposed to get a placement. People are misunderstanding it, thinking that it is employment – it is not employment.”