Mr Chukwu (not his real name) is a Nigerian who travelled to the United Kingdom, accompanied by his wife, a few years ago on a business trip. While on this trip, Mr Chukwu , who suffered from hypertension and diabetes, developed a cerebrovascular accident that led to a left-sided hemiplagia with some degree of dysarthria. This means that he developed a stroke that led to the paralysis of the left side of his body with some difficulty in making speech. Following discharge from the hospital, Mr Chukwu  continued to receive medical care at a nursing home in London. When this misfortune sets in, he exhausted the money on him, including those remitted to him from Nigeria by family and friends. His wife resulted to doing early morning odd jobs, cleaning and the likes, to raise money so as to make ends meet. One day, at about six in the morning and while at work, Mrs Chukwu was arrested by the police and immigration officials for working illegally in the UK. It was discovered that Mr and Mrs Chukwu came to the UK on a six month visa that had expired. This visa did not permit either Mr or Mrs Chukwu to work in the UK. Mrs Chukwu was subsequently prosecuted and spent 5 months in jail. Not only this, she and her husband also faced deportation back to Nigeria.

Mr and Mrs Chukwu decided to contest the case – they were given rights of appeal. Their solicitor argued that deporting the couple to Nigeria amounted to passing a death sentence on Mr Chukwu. His reason was that Nigeria’s healthcare system is parlous, expensive and not easily accessible. He raised the difficulties Mr Chukwu would face in Nigeria in receiving adequate care of his complicated physical health. Mr Chukwu was duly assessed by a qualified and registered medical practitioner in the UK who listed his findings. These findings formed the thrust of the solicitor’s argument. However, a few weeks ago, the British immigration authorities responded. In their response, they said that they had conducted an investigation on the state of healthcare system in Nigeria, with special emphasis on the type of care Mr Chukwu was likely to receive. In the said investigation, they claimed to have spoken to two government medical practitioners in Nigeria. One was based in the Eastern part of Nigeria (where Mr Chukwu comes from) and the other in Lagos. They claimed that the two medical doctors concurred that Mr Chukwu would receive more than adequate care for his ailments in Nigeria. This is because the Nigerian healthcare system has been greatly revamped by the National Health Insurance Scheme (NHIS). They maintained that a very high medical ethics is now being practiced in Nigeria as, for example, only qualified nurses are allowed to administer Insulin in the treatment of diabetes, and the country can now boast of sophisticated medical equipment, courtesy of the NHIS. On the basis of the outcome of this “investigation”, the immigration authorities maintained that the deportation order on the couple stands. At this point, Mr and Mrs Chukwu’s solicitor decided to reach out to Nigerian physicians practicing in the UK, more so those with a recent experience of our healthcare system. He wanted to have the true picture of healthcare in Nigeria as he refused to be satisfied with an investigation that only involved speaking to two doctors in Nigeria.

Let me start by stating that I am a Nigerian and happen to practice medicine in the United Kingdom. I stopped practicing in Nigeria in early 2000 but also had a brief stint of a couple of months about three years ago. The above scenario was brought to my notice by a senior colleague who is well aware of my familiarity with the Nigerian medical system. The senior colleague sought to know my opinion on this issue. Many other Nigerian doctors were also contacted by the Chukwus’ solicitor. I remember that while in Nigeria, I was conversant with the noise about a proposed NHIS. Then it was more of a noise without anything concrete on the ground. When I went home about three years ago, I must admit to my blissful ignorance of the existence of a national health insurance scheme. If it was operational, I was not aware of this. No colleague brought its existence to my notice and there was nothing in my short private practice to indicate that Nigerians had a buffer programme to ameliorate the impact of the exorbitant and substandard nature of medical care in the country. Thus, I was perplexed by the outcome of the “investigation” by the British immigration authorities which painted a picture of Eldorado for healthcare delivery in Nigeria. Also, I need to mention that I have always been in contact with family and friends in Nigeria who partake of the available healthcare. No one remembered to inform me of the sudden transformation of our healthcare system. I felt I must have missed something big. I decided to conduct a little research.

I started by trawling the worldwide web. There abound lots of sources of information on the Nigerian NHIS. The NHIS was an idea that surfaced in the first republic when Dr Majekodunmi was then the Health Minister. However, it failed to receive the required support and went into premature coma. It was resuscitated again in the nineties and was eventually launched on the 15^th October 1999. It was reported to have finally taken off sometimes in 2001. The concept as enumerated on the official website of the NHIS Corporate Office, Abuja, remains laudable. It was reported as a well thought-out and detailed programme that has the “most comprehensive benefit package” in the world. You can trust the Nigerian penchant for grandiosity! Somehow, I failed to glean the content of the so-called package from the information available on the net.

As at September 2008, the NHIS was said to have covered 2.7 million Nigerians (remember that there are over 150 million Nigerians). It was officially described as a social security system that guarantees the provision of needed health services to persons on the payment of token contributions at regular intervals. The government attempted to justify the necessity of individual contribution thus:

“The Government had initially provided 'free healthcare' for its citizens funded by its earnings from oil exports and general tax revenue. However, the global slump [ in oil prices in the 1980s greatly affected Nigeria's major source of income. Government could therefore no longer afford to provide free health, and subsequently introduced several cost recovery mechanism like user charges and Drug Revolving Funds. Furthermore the introduction of the Structural Adjustment Programme in 1986 adversely affected the health sector allocation.”

In addition to the economic hindrances listed above, it was stated that the aim of the programme was altruistic, albeit redressing the general poor state of the nation’s healthcare services, the excessive dependence and pressure on government-provided health facilities, the dwindling funding of healthcare in the face of rising costs and the poor integration of health facilities in the nation’s healthcare delivery system. Obviously, the programme has received international support and co-operation as the World Bank, in particular, promised funding and the Ghanaian government has been motivated to implement something similar.

After the internet search, I decided to speak to colleagues on the ground in Nigeria. Unlike the British Immigration authorities, I spoke to more than two doctors that covered a very wide part of the country. My findings were very revealing but I would try and list those that are pertinent to the Chukwu’s case. These are:

1. The NHIS as currently obtained in Nigeria, mainly applies to civil servants. This is because a certain percentage of their monthly income is deducted to cover costs.

2. A civil servant is only entitled to treatment with his spouse and 4 biological children.

3. Currently, most states in the federation are NOT practising the NHIS. The scheme currently applies mostly to Federal Civil Servants.

4. Lagos State, for example, does NOT practice it. The state practices Free Health for children less than 17 yrs and those over 65 yrs. However, this programme is limited in scope in terms of availability of drugs and other resources.

5. For those entitled to the NHIS, the programme is pegged. Pegged in terms of cover for costs of treatment. For example, cover for the treatment of Malaria is only 350 Naira. The Artesunate group of drugs are currently the drug of choice for Malaria. A complete package costs between 1500 to 1800 Naira. So, for anyone on NHIS, to achieve complete cure, the balance of payment has to be coughed out.

6. Generally, working class people are NOT covered by the NHIS. They pay for their services.

7. For operative procedures, written permission (paper or electronic) has to be sought from NHIS providers. This often times causes conflicts with emergencies, unless the affected patient can afford to pay.

Of course, the official NHIS website stated that the programme is targeted at various groups, such as rural community and the urban self-employed, but this is yet to materialise. With the present coverage of 2.7 million people and with the situational report from practising physicians, it is apparent that to date, the NHIS has not greatly influenced the state of healthcare in Nigeria. That particular state of healthcare does not merit repetition here; suffice it to say that it is an uncaring system that spells early end to the grievously sick. With this in mind, I wondered at the type of doctors that gave an aura of Eldorado to the British authorities. The answer was obtained from those on the ground.

The information obtained from my colleagues in Nigeria did not just flow without hesitation and reluctance. It was professional fraternity that thawed the ice. Ostensibly, doctors in some states had received government directives warning them of instant dismissal if found criticising or making disparaging comments about the programme. The instruction was always to portray the programme in good light. However, my medical colleagues agreed that for Mr Chukwu to be returned home in his present state without access to adequate funding, instant death seems to be the prognosis. Even with a full pocket, the care needed by Mr Chukwu is still better sourced outside the country. So much so for our much orchestrated NHIS.

Before we go any further, may I firmly affirm that it is the duty of a responsible and responsive government to provide qualitative, adequate and affordable healthcare for its citizens. The case of the Chukwus serves as the pivotal for a reflection on the continued sad state of our healthcare system. It is amazing that for a programme that was launched in 1999 and took off in 2001, the coverage is still a mere 2.7 million Nigerians and specifically those who can make monthly contributions from their salaries (hence civil servants). This brings the sincerity of this much touted programme into question. The argument that it is still at the infantile stage may not hold, not after nine years of launching.

The concept of some form of insurance to support widespread delivery of healthcare is not novel to Nigeria. However, the model we seemed to have copied, modified and implemented, is not populist in concept and almost elitist in implementation, hence the problem with widespread coverage. It is imprecise and pejorative in concept and almost narcissistic in implementation. The obvious constraints that would forever limit the success of this programme stare at us in the face daily. These include:

• Absence of an acceptable population census. An acceptable census holds the potentials of providing essential demographic information that would have been vital at the planning and implementation stage of this programme.
• Pervading lack of industrialization with associated economic poverty.
• Lack of an efficient and corruption-free taxation system in the country. Take away some Islamic countries where it is a taboo to tax citizens, Nigerians are probably one of the most under-taxed people in the world. A good taxation system would provide needed fund to ensure the generalisation of the health insurance scheme and also introduce needed quality.
• The multiplicity of insurance providers. This is of concern as it could lead to massive exploitation and lack of structural control and uniformity. A more structured and streamlined corps of providers might probably be the best.

Nigeria as a nation has to learn to divorce the delivery of healthcare from its perennial political problems. Saving Nigerians from preventable deaths through the provision of an effective and comprehensive healthcare is as important as moving the nation forward via an equitable, just and practical political formula. The health of a nation is intricately tied to its wealth. A healthy people make a healthy nation. Sadly, in this wise, Nigerians can be said to be sick.

Back to citizen Chukwu, the London-based solicitor is trying to marshal his argument on the situational facts on the ground as compared to the outcome of the British authority who spoke to two frightened medical practitioners out of about twenty-five thousand practicing doctors in Nigeria. I am a Nigerian and sincerely love my country. I did not set out to epitomise the British healthcare system as the panacea to all. Unfortunately, as things still stand, Mr Chukwu is most likely to meet a certain death if he is returned to Nigeria.

Let me conclude by saying that this is not a deliberate attempt to undermine the British authorities on the way and manner of conducting their immigration policy. Rather, it is a lamentation of the chaotic system that obtains in Nigeria, especially one that has contributed immensely to the legion of economic and health migrants in the British society.

Dr Olusegun Fakoya

Robot  # 1 | 25.12.2008 09:35

With the present coverage of 2.7 million people and with the situational report from practising physicians, it is apparent that to date, the NHIS has not greatly influenced the state of healthcare in Nigeria. That particular state of healthcare does not merit repetition here; suffice it to say that it is an uncaring system that spells early end to the grievously sick....Read the full article.

Lapalapa  # 2 | 25.12.2008 10:20

Dr Fakoya, Thank you very much for bringing the plight of the Chukwus to our attention. It is quite a sad story that exemplifies what many Nigerians go through outside and inside our country. Any attempt to call our leaders to order in Nigeria is branded as a lack of patriotism. Again, an attempt to call attention to the selective illiteracy of Western embassies in Nigeria or home offices outside Nigeria is branded as a form of reverse racism. Well, I am trying to avoid sounding political here, it is very laughable that a government official in the UK would call 2 random (?) physicians out of 25000 in Nigeria to arrive at a life and death decision! This is even when there are documents, well researched documents, out there on the state of healthcare in Nigeria. If anyone is interested, go to the following worldbank website and see an example of what we are talking about here, in spite of the so-called National Healthcare Insurance scheme: http://econ.worldbank.org/WBSITE/EXTERNAL/EXTDEC/EXTRESEARCH/0,,contentMDK:20681362~pagePK:64214825~piPK:64214943~theSitePK:469382,00.html I tried to attach a pdf copy of some of the findings but I am not sure of how to do it on NVS. If anyone is interested, all the dataset from the study and the seventy-something paged document are there. And there are several other studies published in reputable journals on the present state of healthcare in Nigeria. Let it be known that the British Home office is intentionally committing murder if the Chukwus are returned to Nigeria in their present condition.

igalaman55  # 3 | 25.12.2008 10:32

This is a no brainer.Mr Chukwu's solicitor should agree to the deportation as long as it is made conditional on the provision of the healthcare support.As they say,the truth shall set you free.

Dewdrops  # 4 | 25.12.2008 10:39

=Robot;304478> Back to citizen Chukwu, the London-based solicitor is trying to marshal his argument on the situational facts on the ground as compared to the outcome of the British authority who spoke to two frightened medical practitioners out of about twenty-five thousand practicing doctors in Nigeria. I am a Nigerian and sincerely love my country. I did not set out to epitomise the British healthcare system as the panacea to all. Unfortunately, as things still stand, Mr Chukwu is most likely to meet a certain death if he is returned to Nigeria. In as much as I sympathize with the Chukwu family....the law is the law. If you are found illegal in a country.....you can be deported. Just the way it is. Mr. Chukwu should take heart and go back to Nigeria instead of allowing these hungry immigration attorneys to deceive him into thinking he has a case that favors his status as an illlegal immigrant. It does not work that way. I wish the Chukwu family all the best.:shake: How anyone lives illegally in a foreign country in the year 2009 is beyond me. Not worth it at all. Dear Nigerians...if you cannot get a legal means of residence in the diaspora...please do not attempt to become a willing fugitive in any foreign country......you are setting yourself up for untimely death. Just stay in Nigeria and take your chances please. Thundering Typhoons!

Bunch17  # 5 | 25.12.2008 11:37

=Dewdrops;304482>..... instead of allowing these hungry immigration attorneys to deceive him into thinking he has a case ........... Gbam! It would be very difficult to comment on this case without knowing the full details of his medical history. However, one has to bear in mind that there has of late been a crack down on people without legal status receiving NHS care.

Lapalapa  # 6 | 25.12.2008 11:57

=Dewdrops;304482>In as much as I sympathize with the Chukwu family....the law is the law. Dewdrops, That was my initial reaction to this story. Yes, the law is the law. However, we have to realize the difference between law and justice. The purpose of the law is to ensure justice. We know that many of our countrymen and women are often involved in this illegal act of overstaying the validity of their visas and falling into the trap of "smart" attorneys. Illegal immigration is indeed one of the most stupid things to do in the year 2009. In fact, my personal belief is that immigration, whether legal or illegal, is one of the most retrogressive steps any human being could ever take. It is only when we have the good fortune of success in the diaspora one could consider it really worthwhile. Research has shown that success can only be claimed if, at the minimum, the second generation becomes successful in the adopted country. Well, let's leave that for another day. In the meantime, we also have to remember that the application of the law requires that those who enforce it apply due diligence. If the health of Mr Chukwu is an issue the home office is willing to consider in this case, then the officers involved have a duty to ensure that they obtain credible information upon which they will base their evaluation of the situation, not by calling 2 physicians at Alaba market or PortHarcourt.

Dewdrops  # 7 | 25.12.2008 12:18

=Bunch17;304490>Gbam! It would be very difficult to comment on this case without knowing the full details of his medical history. However, one has to bear in mind that there has of late been a crack down on people without legal status receiving NHS care. Even if........you cannot circumvent the law....the best that could happen is that the UK would stabilize him and send him back to deal with the Nigerian health crises over there. If the let this go in Mr.Chukwu's precedent....others will follow suit and play this for a game. Why is he delaying by the way? He should leave now before he quenches on one BA or VA flight and start another wahala between the UK and Nigeria. Immigration lawyers are lousy at deportation cases.....most of the fights are usually won only after the deportee has left the country. Most Nigerians fall prey to these immigration attorneys even where they know the cases are shut...over and out cases. This topic is all about going to Nigeria to die.....it is the wish of many....who love Nigeria......what is Dr. Chukwu afraid of? Mr Chukwu (not his real name) is a Nigerian who travelled to the United Kingdom, accompanied by his wife, a few years ago on a business trip. While on this trip, Mr Chukwu , who suffered from hypertension and diabetes, developed a cerebrovascular accident that led to a left-sided hemiplagia with some degree of dysarthria. This means that he developed a stroke that led to the paralysis of the left side of his body with some difficulty in making speech. Following discharge from the hospital, Mr Chukwu continued to receive medical care at a nursing home in London. Do you just wake up one morning and suffer from hypertension and diabetes over night?...We all know that those are very chronic situations. Or could he just have been eating a lot of junk foods and ice cream...or spending too much time at "The Buka and Wazobia" combined on a daily basis eating Ugba and Nkwobi for breakfast, lunch, dinner and inbetween snacks? :lol: How many Nigerian men allow their wives to follow them on real "business trips" huh?:p Hmm! How many Nigerians actually take care of their health issues even where possible in Nigeria?...I bet you my last nickel...this dude was already half dead and a walking corpse before he hit the shores of the UK. The UK has done marvelously stabilizing him.....can he get that in Nigeria?...Having stabilized him......he needs to face the full extent of the law and go back to Nigeria where he could take his chances......no sentiments attached please! NO SACRED COWS PLEASE!!!! No one else to blame but ourselves for having the kind of country we say we have....one that cannot afford to give the basics of health care....but would gladly declare "left over funds" year after year.....to distribute as Xmas bonuses amongst heartless ministers and the people who put them in power. Lessons to be learned for the future I guess. We did the same to Ghananians years back right? They are better off today....so with the swift deportation of many illegal Nigerians....maybe things would take a turn for the better like we see in Ghana.

Dewdrops  # 8 | 25.12.2008 13:14

=Lapalapa;304495>Dewdrops, That was my initial reaction to this story. Yes, the law is the law. However, we have to realize the difference between law and justice. The purpose of the law is to ensure justice. We know that many of our countrymen and women are often involved in this illegal act of overstaying the validity of their visas and falling into the trap of "smart" attorneys. Illegal immigration is indeed one of the most stupid things to do in the year 2009. Your initial reaction to this story? The difference between law and justice?...you break the law to get justice? You stay illegally in a foreign country and you expect some form of rights to justify your ability to break the law and show the world how silly your actions are......while paying a crook of a lawyer for additional punishment? :confused1 In fact, my personal belief is that immigration, whether legal or illegal, is one of the most retrogressive steps any human being could ever take. It is only when we have the good fortune of success in the diaspora one could consider it really worthwhile. Research has shown that success can only be claimed if, at the minimum, the second generation becomes successful in the adopted country. Well, let's leave that for another day. Yeah...thank you!:lol: In the meantime, we also have to remember that the application of the law requires that those who enforce it apply due diligence. If the health of Mr Chukwu is an issue the home office is willing to consider in this case, then the officers involved have a duty to ensure that they obtain credible information upon which they will base their evaluation of the situation, not by calling 2 physicians at Alaba market or PortHarcourt. What does this mean please? the law requires that those who enforce it apply due diligence? the officers have a duty? NOT WHEN YOU ARE ILLEGAL AND YOU ARE BREAKING THE LAW. This reminds me of the other thread....where one Mr. Okorie was attempting to get some form of pardon from George Bush before he lives office.......being faced with deportation. Look...some of us are in the diaspora ok? When you decide to leave the confines of your home country, it behooves you to do a proper feasiblity study with plans and back-up plans to navigate the legal terraines of your host country. How does a man pack his bags and those of his family to move to the UK on a mere visitor's visa...which he allowed to let expire after six months...in present day 2008? What kind of a person is that? This man avoided any kind of plans to regularize his stay WITHOUT the proper planning. I have stated many times.....living in the diaspora is not for dummies....you will be weeded out for sure. Why do some of us like to rationalize actions based on lack of principles? Why do we love to twist and turn things to suit us......at all cost? I just don't understand this kind of mentality at all. Ghana is proof that there is absolutely nothing with the black man's brain.....it is all a matter of choice. It is not "juju" either! Mr. and Mrs. Chukwu...please pack your bags and move back to Nigeria where you really belong.....the diaspora is not for people who are illegal. God will definitely take care of Mr. Chukwu's medical conditions in Nigeria.

Lapalapa  # 9 | 25.12.2008 14:20

Dewdrops, It is not my aim to justify any form of illegality or try to explain it away. This is the summary of what we know: -a businessman travelled to the UK, fell ill and was treated in an acute healthcare facility followed by a long-term care facility. -he could no more pay his bills and, therefore, had his next-of-kin resort to illegal work to sustain him. -they are being deported because they have broken the law. In a normal world, the acute care facility would stabilize him and transfer him to a comparable/appropriate healthcare facility in his country of origin, often paid by a medical insurance company to which the patient subscribes. This was not done in this case. Rather he was moved to a long-term facility; we were not told whether this was a result of the patient's opinion or medical opinion. All we can say is that he needed continued medical care. Now, through his attorneys, the patient states his belief that he would not receive appropriate medical treatment if he returns to Nigeria and, therefore, declares his intention to remain in the UK for health reasons. The immigration authorities consider this a plausible argument for him to avoid immediate deportation. They then called 2 physicians in Nigeria to determine whether the patient's fear is justified. My gripe is with the method of the immigration authorities, not the legality or illegality of the patient's action. The decision to immigrate, whether legally or illegally, is based on a patent belief by the immigrant that his country of origin can no longer provide what he needs for survival and prosperity. If the receiving country also believes he has something to contribute to their social and economic survival, the two beliefs allow for what we call a "legal" migration. In the same way, if the host country believes that Mr Chukwu will not receive appropriate healthcare in Nigeria and that it is their duty not to deny good healthcare to a human being, they will grant him a stay of deportation if their law supports it. That is the law. But the question at issue here is, "how does a UK immigration officer determine the appropriateness of the Nigerian healthcare system?"

Bunch17  # 10 | 25.12.2008 14:37

=Lapalapa;304512> But the question at issue here is, "how does a UK immigration officer determine the appropriateness of the Nigerian healthcare system?" By surfing the web, reading publications coming out of Nigeria etc. The other side of the coin which one has to consider is " do all those who have a stroke in Nigeria or similar illnesses die as a result?" There is a case for an appeal on compassionate grounds but having to denigrate a country's health care professionals for this purpose is kind of taking the piss. The fact of the matter that is being overlooked here is that there have been very drastic attempts to reduce health care and social spendings in the UK because the country is broke. In fact in some places, they are starting to enforce the stipulation that if you have not been in the country for 3months (UK Citizens) you are not entitled to NHS care.

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