Some doctors say the craze by some Nigerians to seek medical care abroad may be inimical to their well-being and the Nigerian economy. The doctors, who expressed the opinions in a News Agency of Nigeria (NAN) nationwide survey, said Nigeria had the personnel to provide good healthcare for the citizens.

Dr Adefemi Afolabi, Chairman, Medical Advisory Committee, University College Hospital, Ibadan, said reasons for Nigerians seeking medical treatment abroad included a lack of confidence in the healthcare system and ego. Afolabi, however, said one of the consequences of medical tourism was follow-up which had become an expensive venture for the patients.

He said it would be a bit difficult for a doctor to complete a treatment started by another doctor overseas. Afolabi said that some patients returned from treatment trips with more complications than those that existed from the initial diseases.

"There are practical examples of medical errors and stress of the patients. "These consultants are given advanced ailments which they have never seen before.

"It is only in Nigeria that patients wait for ailments to reach advance stages before seeking professional medical help. "Treatments now become difficult and tricky for those experts as they have never seen such worse cases before and diagnoses now become trial and error because they had never seen peculiar cases before," he said.

Afolabi said government could reduce or stop the rate at which people sought medical treatments abroad since adequate expertise was now available. "For the restraint to be effective, government needs to build on expertise through training and retraining and make available conducive atmosphere for newly trained doctors to practice.

"Government should equip our hospitals with state-of the art medical equipment to the extent that these experts would be able to practise and discourage importation of obsolete equipment," he said.

Prof. Juwon Arotiba, a Consultant Dental Surgeon and Dean, College of Medicine, University of Ibadan, said medical tourism was understandable in the past because of the under-developed state of the health sector.

"There were inadequate and modern equipment, no well trained medical personnel and drugs and dressings were sad stories. "But those stories are now in the past and anyone seeking medical tourism will be putting a lot of problems on himself.

"There are so many disadvantages wrought by this idea and I believe that a responsible government would not allow this to happen to its health sector. "I can say that Nigeria's health sector has improved considerably in many areas despite challenges faced by it," he said.

Arotiba said going abroad for medical treatment had become a drain on the nation's foreign exchange reserve and the economy. He said the cost of treatment, transportation, maintenance of the patient and accompanying persons, depleted foreign exchange.

"Nigerians now see travelling for medical treatment as a class issue to the extent that any little medical discomfort is treated abroad. "If consultants refuse to give referrals based on the fact that hospitals in Nigeria can handle such cases, the patients become insistent.

"But the medical consultant has the right to state in the referral note that the patient insisted on seeking help overseas despite the fact that such cases could be treated here in Nigeria.

"After patients return, there is the challenge of follow-up and feedback. "It is not easy for a doctor to effectively review a patient whose case-history was not adequately monitored by home doctors," he said.

Dr Buki Adewole, Oyo State Chairman, Medical and Dental Consultant Association of Nigeria, said the decay and dysfunction in the larger society had also affected the health sector.

Adewole said many patients were being exploited abroad, with many returning misdiagnosed after paying exorbitant bills. She urged the government and Nigerians to take full responsibility for bringing the health sector to the desired enviable level.

Mr Samuel Adeyemi, the immediate past Chairman, National Association of Nigerian Nurses and Midwives, urged government to re-orientate Nigerians on medical tourism.

"I believe that the health sector in Nigeria is ripe enough to take charge of the delivery of healthcare and government should do the needful by allocating more money to healthcare delivery," he said.

Mr Olalekan Fashesin, Chairman, Oyo State branch of Pharmaceutical Society of Nigeria, said Nigeria had enough manufacturing companies to complement tertiary health facilities. He said World Health Organisation had certified over 50 companies to produce drugs locally in accordance with best practices.

Mr Muideen Olatunji, Oyo State chairman of the Nigerian Medical Association (NMA), said the health sector in Nigeria could compete with its counterparts overseas. He said the Federal Government should take measures to reduce medical tourism to conserve foreign exchange and ensure the safety of Nigerians.

Dr Benedictus Ajayi, the Group Managing Director of Eleta Eye Institute, said Nigeria was losing huge sums to medical tourism because of ignorance and inadequate healthcare facilities. Ajayi advised government to give tax incentives and loans, as in the agricultural sector, to further stimulate investment in the health sector.

"If the government encourages the private sector through tax incentives and loans like it is being done in the agriculture sector, then we would save the amount of money Nigerians pay outside," he said.

The Secretary General of NMA in Ogun, Dr Adewunmi Alayaki, described medical tourism as a means to make illegitimate money by some Nigerian doctors without conscience.

Alayaki said the association was not happy with some doctors who referred patients abroad without consulting senior professionals in the field. He said some doctors referred patients abroad because of the commissions they received from such referrals.

"Medical tourism is not something we are happy about because most of the ailments we take outside the shores of the country can actually be handled in this country. "At times, it is because we don't know where to go to. We see some of these hospitals over there approaching Nigerian doctors to send them cases which could naturally be treated here.

"The primary aim of a medical doctor is to give the patient the best. "If I know the ailment can be treated in UCH or LUTH, I won't say because if I refer to hospital in India they are going to give me a rebate back, so I want to refer them. "I have been approached by some of these hospitals. Personally, I am against it," he said.

Alayaki, however, said the Nigerian government had not done enough to boost healthcare delivery. "Nigerian doctors are everywhere in the world, they go there because those people have equipment to work with while we don't have here in the country.

"If the government wants to do well, there is nothing stopping them from establishing well equipped hospitals in the six geopolitical zones of the country "Orthopaedic hospitals should be well equipped, if it is one in a zone, people will know and they will go there instead of going abroad.

"It is not about personnel, it is about having the equipment to work with, the government should equip our expertise with the best facilities you can get anywhere in the world.

"We have to start the campaign for our members to refer to team of experts in higher centres. "If your case cannot be handled in Nigeria, let it come from them. By the time we start campaigning about it, medical tourism will stop," he said.

Prof. Emmanuel Otolorin, the Chairman, Management Board of the Olabisi Onabanjo University Teaching Hospital, said the process of treatment and not personnel were the challenges of Nigeria's health system. Otolorin ?accused successive governments in the country of establishing health facilities based on political considerations.

"Nigeria is blessed. When you look at Africa, we have some of the best practitioners in Africa and even elsewhere in the world. "Many of our doctors and nurses who have migrated are doing very well in a different environment where the input are; the processes are in place and the outcome is therefore appreciable.

"I worked in the UK for a while and I used to laugh when people will come from Nigeria to UK for a service and a Nigerian doctor is the one taking care of them. "So we have good healthcare workers but we need to put in place processes and systems that everybody will follow.

"The problem with us is that people take shortcuts and when you take shortcuts; the quality of services you provide will be not be optimal. "So we need to stop taking shortcuts," he said.

Dr Tajudeen Ajiboye, Head of Accident and Emergency Department at the University of Ilorin Teaching Hospital, Ilorin, said most patients travelled abroad for treatment because of lack of trust in the country'' health system. He urged the government to encourage and empower private hospitals to promote the development of the health sector.

Ajiboye also said that government should allow the importation of health equipment duty free. " Government should set up policy that will create enabling environments for the health personnel in Nigeria," he said.

The Dean of the Faculty of Clinical Sciences of the University of Ilorin, Prof. Abdulwahab Johnson, called on the government to lay emphasis on curative healthcare. "Those people who embark on health tourism to India and China come back most times dissatisfied.

"Quite a number of people get marooned with quack doctors and Indians who are quick at taking advantage of them," he said. Dr Dayo Adeyanju, Ondo State Commissioner for Health, however, said there was a need for better specialist and teaching hospitals to provide specialised care for Nigerians.

"If the Federal Government can provide standard health facilities it will help to take care of critical ailments, such as heart surgeries, brain surgeries, cancer and others which our people are trooping out of the country to treat. "I believe that people don't go abroad to treat common ailments, so the Federal Government needs to strengthen its health institutions and staff to be able to tackle special cases," Adeyanju said.

Dr Kayode Olabanji, the Chairman Medical Advisory Committee, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun, urged government to strengthen healthcare services at all levels. Olabanji said "If government provides adequate equipment with competent experts in hospitals, at all levels, people would not bother to seek medical treatment out of the country."

Mr Leke Ogunsola, the Chairman, Osun House of Assembly Committee on Health, said it was sad that Nigerians who travelled abroad were being used for experiments by incompetent doctors. Ogunsola, said government must monitor hospitals Nigerians were being referred to for treatment abroad.

He, however, said the dehumanisation of Nigerians abroad could be stopped if there was proper funding of the nation's health sector.

The lawmaker also called for sanctions against doctors who referred patients to low grade hospitals abroad for monetary gain. Dr Temitope Oladele, the Permanent Secretary, Osun Ministry of Health, said there was a need for government to set up a medical referral mechanism in the country.

Oladele said this would enable government and individuals to assess the quality of healthcare some Nigerians sought abroad.

He said the initiative would be a "two way referral system in which referred patients will be examined at the point of departure and also given feedback after the completion of the treatment. "In order to access and ensure quality healthcare delivery for Nigerians abroad, there is an urgent need for medical immigration which will serve as referral mechanism.

"The control body will be saddled with the responsibility of monitoring the quality of health service available to Nigerians in referral hospitals," he said. Dr Suraj Ogunyemi, the Chairman of NMA in Osun, said doctors found sending patients abroad for monetary gain or interest should be reported to the association.

The Chief Medical Director of Federal Medical Centre, Ido-Ekiti, Dr Ayodele Majekodunmi, said while medical tourism was not wrong, it must be done with some level of patriotism and decorum. He said given the current state of healthcare services in the country, it would be wrong for anyone to embark on medical tourism now.

Similarly, the Chief Medical Director of Ekiti State University Teaching Hospital, Dr Kolawole Ogundipe, said those travelling abroad for medical treatment never got better care than they would have got in Nigeria. He said the Ekiti facility had some of the best equipment and staff in the country.

"We appreciate the fact that in Ekiti State, we don't have so much resources but in terms of healthcare delivery, we are far better than many of the so called places that have resources. "In some places, they have the equipment but no manpower while in others, they have the manpower but no equipment, " he said.