syndrome

Japa syndrome compounded by the shutting down of hospitals over a hike in electricity tariff is taking its toll on sick Nigerians requiring surgery as they wait for months in excruciating pain before having the life-saving procedure done.  SODIQ OJUROUNGBE reports

For 44-year-old Chioma Okoro, the pain in her lower abdomen had become a constant companion, making everyday tasks feel like climbing a mountain. Simple things like playing with her children or cooking dinner for her family became frustrating.

Okoro has always been the rock of her household but is now limited by excruciating pain.

Life became unbearable for the mother of three after she was diagnosed with a hernia—a painful condition where an organ or tissue bulges through an abnormal opening.

Accompanied by her husband, Okoro was at Lagos State University Teaching Hospital in Ikeja, to complain about her excruciating pain when our correspondent approached them on one Wednesday afternoon.

Initially hesitant to speak, the husband eventually spoke after several minutes of persuasion. He revealed their ongoing struggle to secure surgery for his wife, a battle that had persisted for over six months.

The husband lamented that despite being told by doctors that surgery was the only solution, his wife remained trapped on a never-ending waiting list, with her condition deteriorating with each passing day.

“When we came here in February this year, the doctors informed us that surgery was the only viable option. They explained that they would monitor her condition for possible complications using an approach called ‘watchful waiting.’

“They also said we would be added to the waiting list of people who want to do surgery. Despite my wife’s pleas about the severe pain she was experiencing, the only response we received was that we would be given a date for the operation.

“Our scheduled surgery was supposed to be in August, but as the date approached, we decided to come to the hospital today to express our concerns and to seek immediate attention. The pain had become increasingly unbearable, and we were desperate for any form of relief or intervention. But they insist we have to wait till next month,” he explained.

Speaking further on how the present condition of his wife has affected their home, the husband added, “The strain of waiting had taken a toll not just on Chioma’s health, but on our family’s emotional and financial well-being.”

“I have been forced to cut back on work to provide support, leading to mounting bills and increasing anxiety about our future. Our children, once lively and full of joy, now sensed the heaviness in our home and worried about their mother’s deteriorating condition.

“My financial resources were dwindling, and with each passing day, the hope of a timely resolution seemed to slip further away,” he expressed in sadness.

Okoro is not alone in this situation, findings by PUNCH Healthwise revealed that many patients face similar agonising waits before having their surgeries done.

For many, the wait becomes a daily battle against despair, as their health continues to deteriorate with each passing day.

Further findings by our correspondent revealed that the country is currently grappling with a severe shortage of surgeons, operating theatres, and medical equipment, leaving hundreds of patients like Okoro on long waiting lists.

During visits to different hospitals including the Lagos University Teaching Hospital, Idi-Araba; the National Orthopaedic Hospital, Igbogbi, and LASUTH, it was discovered that patients are stuck in limbo, their lives on hold as they wait for their turn on the surgery list.

Our correspondent gathered that a complex web of factors, including a severe brain drain that has seen hundreds of medical professionals leave for opportunities abroad and a chronic lack of investment in healthcare infrastructure, led to patients enduring months-long waits for surgical care.

Findings by PUNCH Healthwise revealed a critical shortage of surgeons relative to the high volume of patients requiring surgery. As a result, individuals are often left waiting for months, and in some cases, years, for life-saving operations.

It was observed that the few available surgeons are often overworked and underpaid, leading to burnout and decreased morale.

Our correspondent also observed that most hospitals in the country are struggling with a shortage of surgical theatres, which are often overwhelmed as surgeons from various specialities have to share these limited spaces.

Further findings show that this overuse of available theatres contributes to a significant backlog of cases, worsening the delays for patients requiring critical surgeries.

However, when PUNCH Healthwise shared its observation with the Chief Medical Director of LASUTH, Prof. Adetokunbo Fabamwo, he claimed many patients do not keep to their appointment schedule.

The CMD explained that the cause of waiting time in LASUTH is not necessarily a result of the Japa syndrome but that patients’ workloads are more than the capacity of health personnel on the ground because of the confidence patients have in hospital services.

PUNCH Healthwise investigation revealed that the exodus of doctors from Nigeria has increased the workload of those still in government services.

The devastating impact

Some of the patients’ relatives who spoke with PUNCH Healthwise shared how their family members were forced to wait for months for elective surgeries like hernia repairs, cataract surgeries, joint replacements, and gallbladder removals, among others.

They lamented that the waitlist for these surgeries stretches on for months, with some patients waiting up to a year or more for a chance to receive treatment.

Lekan Olawale claimed that the University College Hospital in Ibadan, Oyo State, contributed to the death of his mother, Esther Olawale.

He insisted that if his mother, who was battling breast cancer, had not been placed on the lengthy waiting list—one that extended for several months, she might still be alive today.

“If my mother had not been forced to wait on that interminable list, she could have received timely treatment that might have prevented her condition from deteriorating.

“She was in urgent need of care, and the delays she faced were not only frustrating but potentially fatal. The waiting period denied her the opportunity to receive necessary treatments that could have extended her life and improved her quality of care”, Olawale expressed.

 “She was a fighter, and she deserved better. The system’s failure to prioritise urgent cases like hers is devastating. I can’t help but feel that her death could have been avoided if the hospital had acted sooner,” he insisted.

A relative of another patient identified as Emmanuel said his younger brother, Solomon has been waiting for hip replacement surgery for over a year, unable to walk or work due to a debilitating hip condition.

Emmanuel added, “My brother Solomon has been waiting for a hip replacement surgery for over five months now. He is unable to walk or work because of his debilitating hip condition. Every day is a struggle for him; the pain has become a regular thing, and it’s affecting his ability to support his family and live a normal life.

“He was once very active and worked tirelessly to provide for his family, but now he is bedridden. Despite numerous visits to the hospital, he is still on the waiting list with no end in sight. It is heartbreaking to watch him suffer, knowing that a simple surgery could change his life, but the system can’t keep up with the demand.

“The wait for surgery has not only impacted Solomon’s physical health but also his mental and emotional well-being. He is becoming increasingly frustrated and disheartened.

“The waiting has taken a toll on his spirit. We’re desperate for any form of assistance or intervention that could expedite his treatment.”

“I’ve been on the waiting list for one month now, and I am still waiting for my turn to come,” 29-year-old Michael Agbo, who needs surgery to repair a damaged meniscus in his knee told our correspondent during a visit to the Orthopaedic hospital at Igbobi.

“I’ve come to the hospital countless times, and each time, they tell me to come back next week. It’s like they’re playing with my life.

Michael, a father of two, said he has been living with the pain for over a year now, declaring, “It’s affecting my work, my family, my entire life. I  want to get the surgery done so I can go back to normal.”

Michael lamented that his knee problem has made it difficult for him to walk or stand for long periods, adding that he had to rely on painkillers to manage the pain.

He explained that he tried to get help from private hospitals, but the costs were too high.

“I’ve been quoted millions of naira for the surgery, which I simply can’t afford. I am stuck, waiting for a chance to get treated.

“I am tired of living like this. I want to get the surgery done so I can play with my kids again, so I can go back to work without feeling like I am going to collapse,” he concluded..

Leading experts in Nigeria’s health sector say it will be impossible to have sufficient personnel to effectively meet the country’s increasing healthcare needs with the current burden of brain drain.

One doctor to 8,000 patients

Speaking with our correspondent, a past President of the Nigerian Medical Association, Professor Mike Ogirima, said the massive migration of Nigerian health workers to foreign countries, mostly in search of greener pastures, had taken its toll on the few doctors left in the system.

He said Nigeria has a worrisome ratio of one doctor to 8,000 patients, which is against the World Health Organisation recommendation of one doctor to 600 patients.

He described the doctor-to-patient ratio in Nigeria as horrible.

Ogirima, who is also the Provost, College of Health Sciences, Federal University Lokoja, Kogi State, said for now, the country only produces an average of 3000 doctors annually, lamenting that Nigeria was faced with a huge doctors deficit.

He said, “If we are producing 3000 annually, the gap for doctors is about 280,000. So we need about 10 years to catch up at the rate with which we are producing doctors.  If we now add other health workers, we need to double that rate.

“The gap of doctors we need in this country with our population is up to 300,000 now. We need about 10 years to catch up and we can’t wait for 10 years to catch up.

“Currently, Nigeria has a doctor-to-population ratio of one doctor to 8,000 population, instead of one doctor to 600 people as recommended by the WHO. That is why when you go to the hospital, the doctors you meet there are tired.”

Patients seeking dangerous alternatives

Findings by PUNCH Healthwise show that the long waiting list for surgeries in Nigerian hospitals has led to a surge in people seeking alternative solutions.

Desperate patients are now turning to quacks and traditional healers, who promise quick fixes and cheap solutions.

It was further learned that these quacks often have little medical training, and they prey on vulnerable patients who are desperate for relief. They use unproven methods and untested remedies and worsen the patient’s condition.

In some cases, patients have suffered severe complications, including infections, organ damage, and even death.

A paediatric surgeon, Prof. Aminu Muhammad said he had seen several poorly performed surgery cases by unlicensed practitioners or quacks.

“Patients who cannot wait any longer for their scheduled surgeries might seek out anyone who offers a solution. This includes individuals who operate outside the formal medical system and may not adhere to established standards of care.

“We’ve seen cases where patients, in their desperation, have undergone procedures that were poorly performed or entirely inappropriate. These situations often result in severe complications that could have been avoided with proper medical care.”

The professor stressed that the growing demand for surgeries, coupled with the insufficient number of qualified surgeons, creates a fertile ground for these dangerous practices.

High cost of surgery

Our correspondent also discovered that the long waiting list for surgeries has led to a surge in costs, making it even more difficult for people with little income to access healthcare.

PUNCH Healthwise investigation also observed that as patients wait for months to have the procedure done, they are forced to pay for repeated consultations, tests, and medications. These costs add up, making surgery increasingly unaffordable for many patients.

Adding to persistent japa syndrome is the closure of private hospitals owing to a hike in electricity tariffs.

The National President of the Association of Nigerian Private Medical Practitioners, Dr Kay Adesola, recently revealed that no fewer than 500 private hospitals have shut down in the last 12 months due to their inability to meet operational costs.

A registered nurse, Olamide Thomas, told our correspondent that private hospitals, which offer quicker access to surgery, are pricing their services out of reach for the poor.

Thomas, who is also an activist, revealed that a single surgery can cost millions of naira, a sum that is unimaginable for most Nigerians.

According to her, the cost of surgery is becoming a barrier to healthcare, with the poor being disproportionately affected. Those who cannot afford to pay are forced to wait even longer, which worsens their condition.

She added, “The Nigerian government’s failure to invest in the healthcare system has led to a shortage of surgeons, anesthesiologists, and other medical professionals. This shortage has driven up costs, making surgery even more expensive.

“The lack of health insurance coverage for most Nigerians means that patients must pay out-of-pocket for surgery. This is a significant burden, especially for those living on meagre incomes.

“As surgery becomes more expensive and unavailable, it is becoming a luxury only the wealthy can afford. The poor are being left behind, forced to rely on quacks or traditional healers who offer cheaper but often dangerous solutions.

“The situation is a clear example of health inequity, where access to healthcare is determined by wealth rather than need. It is a violation of the fundamental human right to health.

“The Nigerian government must take action to address the root causes of this crisis. Investing in the healthcare system, increasing access to health insurance, and regulating costs are essential to making surgery affordable.

“Until then, the poor will continue to suffer, forced to wait for surgery that is increasingly out of reach. It is a ticking time bomb, waiting to explode into a full-blown healthcare crisis.”

Exodus of surgeons worsens shortage

Also, findings by PUNCH Healthwise showed that the migration of surgeons has significantly worsened the shortage of medical professionals in many countries, particularly Nigeria.

This growing trend, often referred to as brain drain, is driven by a variety of factors, including poor working conditions, inadequate remuneration, and a lack of professional development opportunities

Some of the surgeons who spoke with our correspondent lamented that their colleagues left the country for better prospects abroad, explaining that the strain on the remaining healthcare system intensifies, leading to longer waiting times, reduced access to care, and increased pressure on the few remaining professionals.

They said this exodus of skilled practitioners created a significant gap in the availability of specialised medical services, leaving a skeletal workforce to handle an ever-increasing patient load.

Surgeons react

Continuing, Ogirima revealed that he had been forced to take on surgeries meant for junior consultants due to a shortage of skilled doctors.

The surgeon expressed concern about the current state of the healthcare system, lamenting that he now finds himself doing procedures he last did 20 years ago.

He said, “There are grades of surgeons, the chief surgeons; those who have paid off the price in the system, people who have been practising surgery for the past 20 years or more, and I put myself in that category.

“I work as an honorary consultant in the Department of Orthopaedic Surgery, Federal Teaching Hospital of Lokoja. There are surgeries that the junior consultants should be doing, but here we are. The surgeries I have done maybe 20 years ago as a younger consultant, you find me as a chief consultant now being called to come and do the surgery. And we can’t refuse it, because if we don’t do it, nobody will do it. And the patient will suffer.

“I met five surgeons on the ground when I joined the department as an honorary consultant two years ago. When I arrived in Lokoja, one of the surgeons got a job in Saudi Arabia, and we were left with four. Three months later, the second one left. So, we are still four with two surgeons in two teams.”

Ogirima further said, “As a professor of orthopaedic surgery, I am supposed to have at least two other consultants working with me. Each of us should have nothing less than one registrar and at least two junior resident doctors. In my team, we are two, and there is only one senior registrar with no registrar. So, the picture is similar as long as we practise in Nigeria.

“There is a serious shortage, and something drastic has to happen. Drastic in the sense that some specialists are looking for placement as consultants in federal hospitals. The spaces are there but the bureaucracy to get them appointed is too long.”

Only three paediatric surgeons for six states

Also speaking further on his experience at the Aminu Kano Teaching Hospital, Muhammad said the centre cares for patients from about five to six states seeking children’s surgery.

The don added that the waiting list for elective surgeries extends over a year with only three paediatric surgeons and two operating tables per week.

He noted, “Last Monday alone, we saw 106 patients, two-thirds of patients waiting for surgery.

“As a children’s surgeon working in the northwest in Kano, almost the neighbouring states except Kaduna, do not have paediatric surgeons.

“If you look at the population of children, which is about, let’s say in Nigeria, almost close to 50 per cent are children below the age of 16. Children surgeons in Nigeria are not up to 150 now. And this is what will serve this total population for children’s surgical needs.

“This is one of the reasons why it will take you a longer time to cover. And then, the patients keep coming weekly and you are adding anyone who comes on the next available operation list booking. So, that is what builds on to lead to this waiting period.”

The Professor of Paediatric Surgery at Bayero University maintained that surgeons were a scarce commodity, and several factors influenced the timing of surgeries.

He further said the shortage of surgeons had led to a severe backlog in elective surgeries.

“We have patients booked for surgeries as far as 2026 due to the overwhelming demand and an insufficient number of surgeons.

“This backlog is partly a result of the migration of specialists, which has left many hospitals struggling to keep up with the growing list of patients needing care,” he explained.

An orthopaedic surgeon and former National President of the Nigerian Association of Resident Doctors, Dr Emeka Orji, stressed that the migration crisis in the health sector was a result of ongoing systemic issues, including poor remuneration and working conditions.

“The government has not taken appropriate steps to address the root causes of brain drain,” he asserted.

One registrar, five orthopaedic consultants in FMC, Umuhai

Narrating his personal experience, Orji who works at the Federal Medical Centre in Umuahia, Abia State, said the centre has only one registrar for five orthopaedic consultants.

He noted that this shortage not only affects the quality of care but also extends waiting times for surgeries.

The former NARD leader lamented that the surgical field was faced with a crisis, characterised by severe shortages of qualified professionals and increasing patient wait times.

The crisis, according to the physician, stems from a persistent mass exodus of healthcare professionals to other countries.

He explained, “It is expected that when you have this form of acute and ongoing depletion of doctor strength, with the consequent worsening of the doctor to patient ratio, that is going to lead to a lot of things, including waiting lists, increase in waiting hours in the clinic.

“If you come to a standard clinic where you are supposed to have five doctors seeing a certain number of patients and you now have one doctor there, it will mean that the patients will have to wait longer before it gets to their turn to see their doctor.

“And sometimes they wait for the whole day without getting to their turn and they return home. The other sad aspect of it is in emergency sessions, which is also affected when you’re supposed to have a certain number of accident and emergency doctors and you have just one, the person will not be able to grapple with the influx of critically injured or critically ill patients to take care of them.

“This is also leading to death and permanent disability. So, it’s a serious problem and we are not seeing any end in sight because no appropriate step has been taken to address the root cause.

“I don’t need to be a former president to know what is happening. I am also a practising surgeon, so, I am also facing it.”

“In my department, for example, we currently have only one registrar. We currently do not have any senior registrar. And we have five consultants.

“And the way a teaching hospital centre clinical organogram is arranged is that you are supposed to have two senior registrars attached to one consultant, and a minimum of three registrars attached to one consultant.

“So, in a department where you have five orthopaedic surgeons who are consultants, you need at least ten senior registrars attached to one consultant and 15 registrars. But it is unfortunate we only have one registrar who is not even senior”, he said.

Way forward

On how to address the problem, the surgeons suggested that increasing the number of operating theatres and improving infrastructure could help alleviate the backlog.

They advocated for better support and incentives for surgeons, adding that, “Improving the working conditions and remuneration for medical professionals could help retain talent and ensure that more surgeries are performed.”

The physicians stressed that the combination of increased infrastructure, improved working conditions, and innovative scheduling solutions could provide much-needed relief for Nigeria’s overwhelmed surgical system.

“Introducing additional services during off-peak hours, such as weekends or nights, could help reduce waiting times.

“Patients who can afford to pay a little more could receive expedited care, which would, in turn, reduce the burden on the standard waiting list,” they suggested.

The surgeons also appealed to the authorities to address the shortage by employing more doctors and lifting the employment embargo.

While emphasising the need for training and retraining to keep up with global standards, the surgeons encouraged the government to sponsor training opportunities and conferences.