For Osahon Enabulele, Consultant Family Physician at the University of Benin Teaching Hospital, UBTH, and President, World Medical Association, MWA, achieving feats and breaking jinxes has become a way of life. Before surmounting the odds to emerge Africa’s first WMA President, since inception of the global body in 1947, Dr. Enabulele rose to become the President of the Nigerian Medical Association, NMA after his tour of duty as Edo State Chairman of the NMA etched his name in the annals of the Commonwealth Medical Association, CMA as the first Nigerian physician to be elected president in 2019 since it was founded in 1962. In the same year 2019, Enabulele also became the first Nigerian physician to become a statutory Council Member of the World Medical Association, as well as the first Nigerian physician to preside over one of the only three standing committees (Socio-Medical Affairs Committee) of the World Medical Association, following his election as Chair of SMAC in Chile in 2019. The mandate was renewed early this year. Nigeria is still acclaimed as a big country in Africa, the giant of Africa; but unfortunately, in terms of its healthcare arrangement, I think we still have a long way to go. Click To Tweet
In this interview with Adekunbi Ero, executive editor, Enabulele shares his odyssey as the world’s number one physician, the burden of being the first African, and painfully, the lack of appreciation by his home country of the honour of having one of her own at the helm of affairs of the global organisation. Enabulele says while the WMA expects home countries to support their officers because “there are no salaries and allowances attached to the office”, he has only not received any support from the federal government, his request for a diplomatic passport to ease his mostly impromptu travels was denied. And in spite of his global visibility professionally and contributions to national development, he has not been found worthy of national honour. This, he attributed to “wrong priorities, a wrong selection of those who ordinarily cannot be said to be role models”. Dr. Enabulele also spoke on the poor state of healthcare delivery in Nigeria.
You were elected President of the World Medical Association, WMA, September 2021 but took office October 2022. Why did you have to wait a whole year as president-elect before assuming office? As President of WMA; and I must put this on record, I have no allowances attached to my office. I have no salary attached to my office. So, in fact, what I do extraordinarily is to use my resources. What they pay for is your accommodation,… Click To Tweet
Thank you very much. The structure of the organisation is quite known to a lot of people, especially those who have engaged internationally at that level. There is a process of succession in the organisation, and so, it’s expected that your one year as president-elect is to prepare you for your eventual inauguration as president – one year of studying, one year of further improving on your level of engagement, experience and preparation for the real deal – the real deal of now taking over as the number one officer of the organisation. After one year, you spend another one year as immediate past president after which you are now formally pulled out and decorated with a life membership of the organisation. So, past presidents are the only ones who have that distinct honour of having what you may call life membership of the organisation.
So, it’s a very structured transitional arrangement; but the most important phase is the phase of presidency which I am currently holding – the President of the World Medical Association.
One year as president seems rather short to make the desired impact. Don’t you think so?
Yes, it may be seen as very short, but it’s one in which you really need to run very fast because it involves a lot of engagements, a lot of travelling, trying to go to different places to sort out issues confronting your members in various parts of the world; and of course, engaging other global bodies like the World Health Organisation, and other partner organisations at the international level. So, it’s very engaging, and some think it’s just about the glory of the office. There is no glory there.
For me, it’s about work, work, work. And in my own peculiar case as the first Nigerian, and the first West African to ever be elected as the president of the World Medical Association since the body was founded in September 1947, it’s even more of trying to make the needed impact to create the openings for many more to be able to, of course, get recognised at that international level to be appointed much more easily than what I went through.
One cannot but wonder how you were able to achieve this feat and how has this challenged you to leave an enduring legacy within the one year that you have?
I spent close to over 15 years engaging at that level to make sure that people knew that there was a force from Nigeria, from West Africa, that should also be given the opportunity and the privilege to superintend over the global organisation. And I am happy that I was given that opportunity by virtue of my election in 2021.
Of course, when I was declared victorious through an electoral contest that spanned over six days of voting by physicians all over the world, it’s a unique privilege, an honour which I do not take for granted; and that is why you see me every now and then trying to engage at different levels by creating the needed impact. And I am happy that people are already appreciating the level of work we’ve been able to do in so short a time.
So, yes, one year; short to many people. I think if you recognize the several engagements you have to do at the international level, you will find that even in one year, you’ve done so much; and of course you create opportunities for other players from other parts of the world to also engage. Don’t forget that we have over 115 national medical associations representing millions of physicians; all trying of course to also make their contributions at this official level. Perhaps that explains why we have that kind of short tenure.
Of course there are other organs of the organisation. You have the Council, also having its own leadership. There they have up to about two years to govern the Council. But the president is the face of the organisation or what you may call the ambassador of the World Medical Association. And so, he does a lot of ambassadorial work for the organisation, trying to of course brand the organisation, intervene in some conflict areas. And recently, I just came back from Turkey where I had to support our colleagues in the Turkish Medical Association who are unfortunately being persecuted by the government because they always speak out on issues of public health which of course is very important to the health and wellbeing of the people, and the government doesn’t think anybody should speak in a way that does not advance their own political interest, and health is not about political interest; it is about the wellbeing, and of course, the safety of the people.
So, I am happy I was able to go to Turkey, and I am happy I was able to make the needed intervention and of course to encourage them, to motivate them, to inspire them and also used the opportunity to see the devastated areas that were submerged by the recent earthquake that took place there. It was a real emotional moment for me. What is very sad is the fact that several thousands of lives were lost; and of course properties were lost. It was like a double tragedy for communities that were just recovering from the COVID-19 pandemic. For me, it was a good opportunity to show presence, show commitment to global health, and of course also giving inspiration to those who are looking up to you for leadership.
Of course your office has taken you round the world. How would you draw comparisons between what you’ve seen elsewhere to what the situation is at home in terms of medical care and doctors’ welfare?
Well, it varies, really; but substantially, when you look at the disparity between the low income countries and the high income countries, the difference is very wide apart in terms of where we ought to be. Nigeria is still acclaimed as a big country in Africa, the giant of Africa; but unfortunately, in terms of its healthcare arrangement, I think we still have a long way to go. Even just coming from Turkey, it was clear that we are not just there at all; we’re still struggling and that is very unfortunate especially when you consider the humongous resources that this country is endowed with, but unfortunately being frittered away through some level of irresponsible pecuniary acquisitions by officers of government most times.
I’ve rejected over 40, 45 awards because I just thought I want to have an award for instance, that I can have a sense of meaning, a sense of attachment to; not the one on the basis of because they saw your name on the internet as this or… Click To Tweet
We see all the cases, of course, at the level of the EFCC, the courts, and all of that. And if you spend half of that, even one-eighth, for the purpose of governance; for the purpose of advancing the prosperity of the people, you don’t have any need for people to be travelling abroad in the name of medical tourism. By now, we should have centres of excellence; places that people can go to, visit, and look for experts because we have the experts in Nigeria. And those who have travelled abroad can be pulled back to Nigeria if they know that the conditions are now very enabling.
So, clearly, in response to your question, we still have a long way to go to get to where we can say okay, we have comparatively, satisfactory healthcare arrangements in our country compared to what we see outside the country, and I hope we can get leadership that can really generate that because this is not rocket science. These things are possible; they are doable, and we’ve see some centres of excellence in some private health facilities that have been built in this country. That shows that these things are not too distant from us. We can do it if we have the right focus, the right leadership, and the right commitment. And of course, draw back from any rapacious tendencies and see government as an opportunity to serve the people and make the lives of the people better.
In what ways have your home country encouraged you in your present engagement?
I can’t say I have received any level of support. I can only commend my state government (Edo State) which, at least at the very beginning, offered support to me; of course, pledging to support my tenure, material and other ways. The government was represented at my inauguration. Of course, as for the federal government, I really cannot say much about them because it’s been tough trying to get them to be part of this whole endeavour. But I find it very unfortunate because they failed to leverage on the opportunities that the position offers.
I have tried to reach out several times. At a point in time, I even tried to pay a visit to them. It’s been very difficult, and I do not want to waste my time on that because when you go to other countries, you see how they embrace the opportunity; I mean presidents of countries. The other time, I was received very satisfactorily by the president of Taiwan, for instance, and we are already partnering in some fundamental ways. But what I see is that Africa seems to have a challenge in that regard. But again, I do not know whether it’s because I come from Africa that this is happening. They say a prophet is not recognised in his home. Again, I am not bothered about that. I still try to reach out and ensure that I keep close contact with the local association, for instance, the Nigerian Medical Association at the national level; even the state branch of the NMA, I try to make myself available to the physicians, to other health workers, just the way I have tried to make myself available to the Nigerian government but I think incredibly, it’s been difficult.
I remember when I first even applied to be granted some level of support in terms of my travels by way of applying for diplomatic passport because my itinerary is so involving that at impromptu moments, you can be asked to travel anywhere in the world, but the request was turned down very strangely and surprisingly. I was told that I was not a government officer, and I just marvel at that. So, every now and then, I have to apply for visas; go through the rigours of visiting embassies to apply for visas. These have been very constraining. This is just a tip of the ice berg in terms of the kind of challenge I am even having from those who are supposed to benefit from the opportunity.
So, in terms of support from the federal government of Nigeria, I can say I have received no support. Yes, on the basis of my invitation, the former minister of state for health, and of course the then director of family health who is now special adviser to President Tinubu on health, Dr. Salma Annas, were both in Berlin when I was inaugurated in Germany. But after that, there has been no engagement, really. Like I said, I wrote officially for a courtesy visit to the federal ministry of health which is the superintending ministry for health in Nigeria, and it took them almost 24 hours to the date to invite me and I told them I do not visit people alone; I have to visit with a team. You do not just wake up one night and say okay, they should tell me that you can come the next day. I mean it was an insult, and I felt it was the height of unpreparedness and unseriousness at that level. So, clearly, I had to look beyond that; I had to face the serious issues of my responsibilities and my mandate.
Like I said, other countries have been very warm; they’ve received me in a way that it encourages you, inspires you; whether in Japan, whether in Sweden, in Austria, Germany, several countries. But back home, it’s a different story. I’ve received no support from the federal government, whether logistics, financial or otherwise. And that of course tells the story.
Many people will find this so shocking and surprising because the immediate past health minister, Dr. Osagie Ehanire, is your kinsman and one would have expected some synergy between you two.
Maybe it would have been better if I did not have my kinsman as minister. Perhaps that is what people are saying. It looks like when you are too familiar with people, it’s also a problem. So, I do not think that I received any level of support from him at that level. If he did, I am not aware. Whatever happened in terms of even my courtesy visit through the Nigerian Medical Association to the former president, President Muhammadu Buhari, to invite him to personally grace my inauguration in Germany, was not through the effort of the minister, or the ministry of health. It was through the effort of the NMA; and of course, my own efforts, that enabled that to happen.
And like I said, I had written officially to invite them – both the minister, and the minister of state – to come for my inauguration. But thank God the minister of state for health who is from Ebonyi State was there at my inauguration, in addition to Dr. Anas. I mean, it’s not something I really want to talk about. I don’t like such distractions because I have a focus. It’s not something that happens so easily. There are a lot of countries that are struggling for this position.
I remember those from Germany telling me the last time that in the last forty something years, they have not had the opportunity of producing a president, and that they envy me a lot; and I was marveled because Germany is a powerhouse in the World Medical Association. It’s a very strong body. That is to tell you how it is. And yet we have a Nigerian, an African, and I don’t get to see that level of support.
Like I said, I am not discouraged because in the first place, when I was engaging at this level, I did not also receive any level of support from government; from other bodies. I had to deal with personal struggles. I spent my personal finances, my lean resources, attending meetings to keep our country, and of course yours sincerely, relevant at that level for over 14, 15 years of global engagement, just to keep the Nigerian flag relevant at that level. That is why anywhere I go, in spite of these contradictions, this very unfortunate attitude that I have seen displayed back home, I still showcase the Nigerian flag everywhere I go.
The last time I was in Germany, I put the flag in front of me, and it was well showcased because everywhere I go, the first thing I tell them is I come from Nigeria. Have you been to Nigeria before? And they say no; I say please I’m inviting you to come to Nigeria. In different forms, I have showcased the Nigerian State as an ambassador and yet I’m told that I am not entitled to a diplomatic passport.
There is this worrisome Japa syndrome that is taking away our doctors out of the country for greener pastures such that it is giving the federal government a lot of concern. Recently, a member of the House of Representatives sponsored a bill that would compel young doctors to serve for five years before being given licence to practice in order to discourage them from leaving. What is your take on this?
I think it was a very crazy bill by that legislator. Of course I spoke very well on the issue both through the electronic media, and the print media. I made it very clear that he was offering a cure that was going to be worse than the ailment, and that it clearly shows lack of clarity, lack of understanding and ignorance about what was happening in the health sector, and the contending factors that were driving the whole issue of what is now known as the Japa syndrome, not only amongst Nigerian doctors, but amongst all Nigerians really.
If you go to embassies now, there are a lot of Nigerians seeking to move; vote with their feet out of the country because the whole issue of the Nigerian State has not been well managed. There’s been a pervasive experiment, or what you call a pervasively dysfunctional experiment in managing our Nigerian State and it is very unfortunate. And I say that not as the president of the World Medical Association, but as a Nigerian who has also been involved, and made my contributions towards rescuing the Nigerian State. I was a participant in the national conference of 2014, and I know how many of those issues we looked at, and of course proposed very purposive and progressive resolutions which were never implemented in the first place.
Again, it was an exposition of the fact that we elect people into such hallowed chambers who really do not understand what it is to legislate, and who are not even ready to seek support. Here was a man who was quoting very wrong statistics at that level of legislation; that we have only 10,000 doctors in Nigeria, and I am marveled that where did he get his figures. And that was said on a national TV. If only he had even Googled, he would have been told the actual figures. And yet, you are paid money for your legislative aides. What researches do you do? Nothing! So, at the end of the day, you get your allowances and you are passing all sorts of stupendous, anomalous, very unproductive bills; and that is why I say I hope the Nigerian people wake up to understand that those they throw up to those chambers should actually be there to serve our interest and not their skewed, narrow, tenuous interests.
You expressed frustrations about the past administration. What are your expectations from this new government regarding the welfare of your members and healthcare delivery in the country?
Well, I am not really ready to talk about that because I am operating at the level of the World Medical Association, so for such matters, we leave it to the national medical association to talk about because we try as much as possible not to be seen as being political. We are all about health and so whatever is done to promote health is what we support. But when it comes to government, we leave it to the national association to engage, and that is why you find us hardly reeling out congratulatory messages for any government because we do not want to be seen as though we are attached. We like to be neutral, very independent; and that was why when I went to Turkey, you saw the way I spoke fearlessly on the issue of Turkey. It’s not about who is there, it’s about the system, about issues; it’s about objective appreciation of the realities. So, all I can wish the Nigerian State is the very best.
I’m told also that the cases are still in court so it’s also somehow premature to be talking about that until when all the cases have been rested. But for whatever it is, the system has to continue. There ought not to be any vacuum and so in that light, I can only wish the present occupants well and hope that they can attune themselves to the whole tenets of democracy, good governance, and of course, putting the people first; and in this case, the health of the people first.
What deliberate efforts are you making to create openings or opportunities for more Nigerians, indeed Africans, to occupy this position?
Well, I have been doing that for a long time, even at the level of the Commonwealth Medical Association where I was the first Nigerian to ever be president by virtue of my election and inauguration in 2019. I just handed over last year as president having served three years, and I tried to encourage a lot of our people. I can gladly tell you that I left behind a vice president for that organisation from Nigeria who is doing very well now as one of the vice presidents. I was also once a vice president, so it’s a good point for the person to stand; and hopefully, in the next couple of years, I see that individual and many more holding serious responsibilities at that level.
At the level of the World Medical Association, I am also trying as much as possible to encourage a lot of people. You see, not many people are able to make that level of sacrifice and commitment. It’s not a tea party; when it comes to making commitments, you must be ready to make sacrifice. Like I told you, I was spending my lean resources to engage at those levels. Even as President of WMA; and I must put this on record, I have no allowances attached to my office. I have no salary attached to my office. So, in fact, what I do extraordinarily is to use my resources. What they pay for is your accommodation, flight ticket; apart from that, you have no other allowances attached to you because at that level, they expect you to come and contribute to the organisation and the society.
So, a lot of what you see happening sometimes comes from my personal resource and that is why they expect the country to also support officers from their countries. But most times, you don’t see that from Africa; you don’t see that from Nigeria. But in the West, in Europe, a lot of them who come to such offices are heavily supported by their governments. In fact, they create offices for them. As I am talking to you, I have no office in Abuja for instance, so I operate from anywhere and I am happy I have been able to do that very sufficiently. But it’s not ideal. However, I am not used to lamentations. I just make sure I move forward and organise properly, and make sure that the mandate is executed as much as I can.
What you are saying in effect is that there are no special privileges?
There are no special privileges. And I think people need to know that. A lot of people think that at that level, you are earning dollars, earning pounds, earning Euros; there is nothing like that; completely zero. So, if at all they expect your country to come with resources to support you at that level. And that is why again, I need to thank the state government (Edo) for the level of commitment they made at the very beginning, but I hope to see them very soon. I also need to use the opportunity to thank the Oba of Benin, Oba Ewuare 11 who showed strong presence at my inauguration in Berlin through the presence of three very important chefs and other supporters who came and I am hoping to see him very soon to appreciate him amongst others who also supported my inauguration, including the Esama of Benin Kingdom, Chief Gabriel Osawaru Igbinedion, CON. I look forward to more support from them than what I saw at the inauguration.
By the way, talking about national honours now that you mentioned that of Chief Igbinedion, I can’t remember you being conferred with one in spite of your visible contributions to national development and medical profession. You’ve paid your dues to deserve national recognition. Does it bother you that your impact has not been so acknowledged?
No, no, no; and I think a lot of people are also surprised about this. In fact there was one person who was very alarmed recently when he looked at the list of honorees and was asking me what happened. I said well, I don’t look at such things; but in ideal countries who understand what merit is, I would search out for people who merit such things. Awards in Nigeria these days are largely cash-and-carry, depending on whether you are a politician, public office holder, or whether you can buy your way through. Unfortunately that is what it is.
And in my own career, I’ve rejected over 40, 45 awards because I just thought I want to have an award for instance, that I can have a sense of meaning, a sense of attachment to; not the one on the basis of because they saw your name on the internet as this or that. But for the Nigerian State, I expect that going forward, they should look for role models really; because there are a lot of role models around, but they are discouraged sometimes because of the wrong priorities, a wrong selection of those who ordinarily cannot be said to be role models. If at any point in time they are able to get those things right, I am sure Nigerians, a lot of young ones, will be inspired.
And that is what I do now. I have a lot of mentorship platforms where I encourage a lot of young ones develop their leadership skills and capacities for them to of course even do much better than what we are doing right now because this is the whole essence of continuous systemic transformations. If you do not have those coming behind better positioned, better prepared, the system someday will collapse.
By October, you would have completed your tour of duty as WMA President. After that, what is next for you?
What else would be guided by a lot of factors; I look forward really eagerly to come and immerse myself in local efforts of raising the whole level of engagements with the governance. I want to make more contributions towards ensuring that, like I’ve always done, people appreciate that leadership is one that can be well-driven in a way that it empowers the people; it empowers the system and gets them to reap certain dividends. And I think that is what I’ve tried to do in my whole leadership career, my profession, whether at the state level, at the national level, at the global level. I always want to let people know that leadership is really not complex. It is the people who make it complex.
Before I became chairman of the Edo State branch of NMA, I don’t think people were talking about the state branch. If anything, the Nigerian Bar Association, NBA, was the toast of all. But when I came, I could see the people were even writing petitions against their leadership asking what had happened to NBA because a new spirit was in charge of the NMA. I remember my engagement with the then governor, Adams Aliyu Oshiomhole; we were respected by government. We turned around the whole image of the organisation. I started the Doctors’ House and got it to a level of appreciation, to the extent that we started having meetings in that place, and now it’s an edifice everybody appreciates.
We were very vocal in terms of the people’s issues, and we had serious engagements with the people in terms of our corporate social responsibilities. At the national level, I did the same thing. NMA became a brand. So, everywhere I go, I let people know that this thing is possible; it’s not rocket science. And that is why I think I need to come back after my tenure to see what more we can do to support either those currently in leadership, or take another leadership responsibilities; not necessarily because we want to occupy office, but whatever office is thrown at us, to see how we can use that as an opportunity to transform the lives of people, and let them see that look, it is their government, and not the government of a few elements. And so, whatever I do, I like to place myself as a servant-leader, and not a boss and ensure that the needs, the interests, the legitimate aspirations and expectations of the people at any point in time, are attended to. And of course, I look forward to God guiding me in whatever I am going to do, post-October 2023.