The suicide of Dr Allwell Orji on Sunday- the day of the Lord- was a shock to many. Although numerous Nigerians die every day, without arousing this shock. I think part of the reasons Nigerians were shocked was because they were wondering what would have led a man with a reputable profession, a Jeep, a driver and a two storey accommodation with presumable love and affection from his mother and siblings kill himself. Apart from proving that material possessions do not guarantee happiness and peace of mind, it also proves that the human mind is really unpredictable. Dr Orji’s driver will best appreciate this.
On different social mediums, Nigerians, as if participating in an ultimate search, have tried to find out the possible cause for the suicide. Many ruled out recession or financial burden bearing in mind the assets I earlier mentioned, many others think it may be mental disorder, depression, spiritual attack, selfishness. In the normal Nigerian style, a campaign has already begun for the need to take our mental health seriously.
Things changed after I had a discussion with a consultant. With “PowerHorse” in his hand and intermitted sipping, he spoke of insufficiency of doctors in Nigeria, enormous workload, bullying in the medical profession, tedious learning process, long work hours, anti-social life, all these when put together, are responsible for divorce and suicides among medical doctors. This was my first time hearing this. The consultant, who trained aboard, stated that there are studies and reports on the high rates of divorce and suicide among doctors in countries where statistics are taken seriously. When I asked several other doctors many agreed with the divorce aspect but many doubted the connection of their profession with suicide.
This was the first time the reality of the situation in the medical profession hit me, although while in University, I used to refer to medicine and surgery as medicine and suffering, I recently realised that although I was right, I didn’t deeply understand what I said. All this made me to investigate and read further.
The insufficiency of doctors in Nigeria is real when one visits the hospital, either public or private and queues up for hours to see the doctor or when one visits a village that lacks a doctor, this isn’t solely because the Nigerian universities aren’t training sufficient doctors, it’s because many doctors after their training prefer to practice outside Nigeria. According to the list of Registered Medical Practitioners (LRMP) there are over 4,500 Nigerian doctors currently in the UK. As of 2013, President Jonathan stated that President Obama affirmed that there were over 25,000 Nigerian Doctors in the US, the numbers should be higher now. This is not only in Nigeria. In Malawi, there are about 600 doctors working for a population of 18 million. It is even joked that the number of Malawian doctors in the UK are higher than in Malawi. This isn’t good at all because it means that the doctor patient ratio is extremely high thereby mounting serious pressure on the doctors.
The training process (six years in the university, one year housemanship, minimum of 4 years residency) of a doctor takes on their mental stability and physical health. Their lectures, course work and exams are entirely different and tedious from those of other students. As a student I have seen medical students get depressed and some lose their mental composure. Even when they begin practising as a consultant/specialist, their workload only increases, it is estimated that doctors work from 90 hours to 120 hours weekly.
Despite the volume and importance of their work, doctors’ salaries aren’t commensurate to their efforts, thereby necessitating several of them to engage in private practise (PP) or working in numerous places, making it difficult to give their best. Some, in order to make more money, try to take full advantage of the Consolidated Medical salary structure (CONMESS) getting call duty allowance, Clinical Duty Allowances, Teaching Allowance, Specialist Allowance and Rural posting allowance all at once.
Also, we expect too much from doctors. Sometime we don’t expect them to even get sick and when they fall sick, it’s expected that they should bear it or conceal it, the same way men are taught not to cry in public. These social pressures and demands aren’t easy to bear with, and for the doctors, nobody notices. Pranay Sinha best captures this in these words “There is a strange machismo that pervades medicine. Doctors, especially fledgling doctors like me, feel pressure to project intellectual, emotional and physical prowess beyond what we truly possess. In his famous essay “Aequanimitas,” Sir William Osler, who founded the first American residency program at Johns Hopkins Hospital in 1889, stressed the importance of equanimity in a physician. While steadiness in tense situations is an important quality for doctors to have, I believe that the imperturbability that Osler extolled has been misinterpreted to a dangerous degree. We masquerade as strong and untroubled professionals even in our darkest and most self-doubting moments. How, then, are we supposed to identify colleagues in trouble — or admit that we may need help ourselves?”
All these are factors which can increase a doctor’s risk to commit suicide. There are numerous researches which prove that doctors are more than twice likely to commit suicide than non- doctors (and female doctors three times more likely than their male counterparts). Showing rates of over 250% higher among women and about 70% higher among men versus the general population. Unfortunately, depression and other mood disorders may be under-recognized and inadequately treated in physicians because physicians might: be reluctant to seek treatment or attempt to diagnose and treat themselves
In Nigeria, even though we haven’t heard of numerous doctors committing suicide, we can’t dispute the veracity of this claim as it is already established in other countries. That of Dr Orji may just be an eye-opener. With this I think the Nigerian Medical Association (NMA) have to take drastic measures to check mental disorder and depression, for example, before admission to study medicine and before renewal of licences, doctors must disclose a mental health diagnosis or treatment history. The US has a physician’s health program (PHP) which evaluates, monitor, and treat doctors. Doctors too have to take care of doctors.
Work is really work and when done, it makes either man or woman ennobled. But we have to recognise that the human being is not a machine whose sole end is to work and work. Man is a social being and to live a full life he/she must be sociable. The government and policy influencers have to pass polices which are labour and family friendly so as to help workers live family work integration.
J.B Nwachukwu
