In October 2021, Bashirat Adeyemo, who had just moved from Lagos to Ibadan, 130 kilometers away, began experiencing fever and constant stomach pain. He contacted his GP, who resides in Lagos, and she advised him to go to a medical laboratory for analysis. As Adeyemo was walking out the door of the house, he ran into a neighbor who had just finished her training as a nursing assistant. Popularly known in the neighborhood as ‘the nurse aunt’, she offered to help him by giving him some painkillers.
The discomfort subsided and Adeyemo called her when she needed medical attention. But things went wrong in December of the same year, when she woke up in even more pain than usual and vomited in bed. This time, her children insisted that she go to the hospital, where she was diagnosed with appendicitis. “Since I had surgery, I warn people not to allow themselves to be diagnosed only by assistants,” admits Adeyemo.
Although the law requires that nurses meet certain requirements, such as attending schools or colleges accredited by the Nursing and Midwifery Council of Nigeria (NMCN), passing the licensure examination and registering with the body before practicing, some private centers They turn to the figure of assistants – who normally provide basic care and support to people under the supervision of a registered nurse or midwife – to fill the gaps in medical personnel. This is reported by the Nigerian Medical Association and the country’s National Association of Nurses and Midwives.
The lack of training of health personnel and the exodus of doctors and nurses in Nigeria is a fish eating its own tail. The African country has one nurse for every 1,160 patients, compared to 9.2 nurses per 1,000 patients in the countries of the OECD. The World Health Organization (WHO) warned in March last year that by 2030 there will be a shortage of 10 million health and care workers worldwide, a shortage that will mainly affect low-income countries such as Nigeria, where many workers in the sector go abroad in search of better jobs. opportunities.
The WHO made public in 2021, and renewed in 2023, a recommendation so that rich countries do not steal health workers from 55 vulnerable countries (including Nigeria) where there are staff shortages. Responding to questions from this newspaper, Nigeria’s Minister of Health, Muhammad Ali Pate, estimated that 16,000 doctors have left the country in the last five years. According to the Nigerian Association of Resident Doctors, six out of every 10 doctors in Nigeria plan to emigrate abroad, and the National Association of Nurses and Midwives estimates that 75,000 of these professionals left the country in the last five years.
Nigeria has one nurse for every 1,160 patients, compared to 9.2 nurses per 1,000 patients in OECD countries
‘The nurse did not manage to enter a higher education center to study Nursing, a five-year university degree, because her parents could not pay the tuition, she explains over the phone. So she enrolled in a private clinic. “We were about 10 students and we always followed the doctor to the operating room to assist during operations, witness births and perform other services such as cleaning and sweeping the hospital facilities. After completing the six-week program, I was awarded a certificate,” she says. When she is asked about the dangers of treating patients without having sufficient knowledge to practice, the woman states: “God will always help me. And I usually call my boss whenever problems arise that are difficult for me to deal with.”
Adeniji Abdul-Rafiu, a member of the National Association of Nurses and Midwives of Nigeria, believes that people like the ‘nurse aunty’ have caused more harm than good to the Nigerian health sector. “They emerged as a result of a failed system that refused to retain its professionals. They do not have any document that shows that they were trained by an authorized body or institution,” he explains.
“When I was working in rural areas, I met a nursing assistant, without any approved qualification, who performed a circumcision on a child and caused serious bleeding. The woman sutured the wound with a needle and thread used by tailors. She intervened to save the child’s life. The situation is atrocious in Nigeria, so the government and professional associations have a lot to do to ensure that our country is free from danger by regularly monitoring private hospitals,” she explained.
Another alleged medical imprudence especially shook the country last year: the young singer Ilerioluwa Oladimeji Aloba, popularly known as Mohbad, died under unclear circumstances in a Nigerian hospital. Police investigated as a suspect to a nursing assistant, the British network BBC reported. Apparently, the woman had administered three injections to Mohbad at her house. “She was not qualified to provide these medications (…) in a non-clinical environment and in a negligent manner,” reads one of the statements collected by the authorities investigating the case.
Borrowed diplomas, illicit practices
In a bid to ensure that the country can address the shortage of health personnel, the Nursing and Midwifery Council of Nigeria recently issued a directive prohibiting nurses from obtaining authorization to travel abroad within two years of obtaining of your diploma and requires you to wait six months between the date of application and authorization. The Association of Nurses and Midwives has spoken out against the measure, claiming that the regulatory body wants to put barriers to its activity.
After completing the six-week program, I was awarded a certificate. God will always help me.
‘The nurse aunt’
But at the same time, this organization and the Nigerian Medical Association admit that no one can practice without the necessary prior training and without a diploma. Toba Odumosu, Secretary of Registered Nurses and Midwives, believes that “it is unfortunate that the Nigerian healthcare system is facing such regulatory problems, which has led to the presence of unqualified people performing medical functions for which they are not prepared.”
Ajayi Pelumi, a gynecologist and obstetrician, points out that assistants are not authorized to perform certain tasks, such as prescribing medications or giving injections and infusions, but they help registered nurses with patients’ vital signs. “They must be under supervision,” she stresses.
Despite the provisions of Nigerian law on the need for diplomas to practice medicine or nursing, these unions report that some assistants manage health care centers in rural areas without supervision. This is the case of ‘the nurse aunt’. “I have a project to start running my private practice. The colleagues I trained with will help me and, if we have complications, I will call the doctor who taught me,” she says. How will you get approval from the ministry to open the center and practice without the necessary degree? “I will borrow the RN diplomas to get approval for my clinic and return them later.”
In February, the Nigerian Oyo State Government closed no fewer than six health centers for “quackery.” According to the state government, the affected centers were sealed for various crimes, including the hiring of unqualified personnel to provide medical services and carry out illicit practices. The hospital where ‘the aunt nurse’ received training for six weeks was one of the closed health centers.
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