When I graduated from Nursing School in 2007 and started working in a private hospital in Nigeria in 2000, I did not think about healthcare migration or even travelling outside Nigeria to improve my skills and knowledge of healthcare provision.  After working at two private hospitals, my quest for knowledge motivated me to return to school for a 12-month course in perioperative nursing, which propelled me to work with one of the biggest hospitals in Lagos, Nigeria for nine years with outstanding nursing achievements, which earned me a secondment in one of the most reputable hospitals in India. 

During my secondment in India, I realised the limitations of the health care system in Nigeria. I remember vividly a case of active gastrointestinal bleeding in India and how a series of investigations were carried out on the patient to identify the bleeding point immediately after the patient presented to the hospital, without the need for payment before treatment for such a life-threatening emergency. The first few investigations I knew about from my experience in Nigeria did not reveal the cause of the bleeding, but further investigations revealed the bleeding point. As such, the right intervention was applied, the bleeding stopped, and the patient survived. 

What has travelling to India got to do with a blessing in disguise, you ask?

Well, that one clinical experience inspired me to seek international nursing opportunities that would enable me to acquire additional best-practice clinical skills, knowledge and exposure. However, nothing prepared me for the health system that the UK has to offer.

Following the end of my secondment in India, I began to reflect on what it would be like to live and learn in a country where I could acquire the skills that would contribute to better healthcare provision in Nigeria. I continued to compare the prompt and in-depth investigations that resulted in the best outcome of surviving and staying alive for that first patient and other patients who presented with similar and different emergency cases. These outcomes of being alive cannot be compared to a similar case in Nigeria, where patients presented with active gastrointestinal bleeding and had several endoscopic diagnostic investigations without locating the bleeding point, resulting in a high mortality rate. Don’t get me wrong, Nigeria’s healthcare system is great in a lot of aspects, including but not limited to highly skilled and knowledgeable healthcare workers with limited access to medical resources to perform their duties and deliver best practices that will save lives, accessible chemists run by qualified individuals who acquired skills through apprenticeships with pharmacists, and on a global platform, our proven infection control pathways with reduced mortality rates during global pandemics, such as Ebola and Covid.

The Global Strategy on Human Resources for Health: Workforce 2030 and the International Migration of Health Workers (World Health Organisation, 2016) aimed to establish and advance health worker mobility as a global platform for the globalisation of health systems. While this is not always to the advantage of some countries when viewed as an entity, it has become a source of knowledge acquisition for healthcare workers who seek to improve themselves through the continuous development of skills, knowledge, and career progression. 

I can confidently say that I am one of those healthcare workers who have benefited from health worker migration to the UK. In 2021, I decided to relocate to the UK to acquire additional clinical skills, but nothing prepared me for the differences in healthcare delivery between Nigeria and the UK. For example, while the UK offers free healthcare for consultations, investigations like CT scans, MRI, endoscopy and all treatments, including therapeutic procedures and surgeries, except for those who choose to go private, Nigeria operates a pay-as-you-go healthcare system where patients pay before they receive any form of treatment. Also in the UK, we are provided with up-to-date and compulsory training, courses and support to improve our nursing skills and competencies. The UK NHS also provides numerous career progression pathways for nurses, but this is not readily available in Nigeria, and even if available, awareness and access are usually limited to a few nurses. There is also the availability and accessibility of medical equipment and resources in the UK, compared to Nigeria, where we sometimes experience a scarcity of basic consumables to treat patients, such as gloves, and are left with old, worn-out, or even non-functioning medical equipment, especially in government hospitals.

Don’t get me wrong, I applaud every health worker in Nigeria and the hospital management for the delivery that they provide for patients amid limited resources. Mind you, the limited resources have nothing to do with funds because, as some may know, Nigeria is not a poor country, but the poor management of resources is the main issue. 

Therefore, patients in Nigeria must pay for healthcare on delivery or there will be no delivery of healthcare. For some, the pay-as-you-go pathway to accessing healthcare represents a death sentence, long-term illness and suffering, and anxiety about how to access treatment for oneself, family, and loved ones. 

For those who do not know, I want you to imagine having to pay before you can access any treatment from the UK National Health Service. Yes, imagine having to pay to see a consultant, x-rays, and MRI scans, return to see the consultant again, and pay for blood tests and all other diagnostic tests. Okay, now imagine having to pay for an emergency operation before you, your family members and your loved ones can be treated. I hope you can understand my gratitude for the opportunity to learn from a system where patients are treated first and with the most up-to-date and best medical practice that provides more opportunities for sustaining life and reduced mortality rates.

Words of wisdom for nurses

For nurses who migrate to the UK, I hope that we all count our blessings, naming them one by one. For the international policy on migration, we hope that someday, interprofessional learning between nurses, universities, and hospitals will be introduced as one of the strategies for healthcare migration to advance health worker mobility as a global platform for the globalisation of health systems and delivery. 

Ndidiemelie Theresa Okeke (RN, RPON, BNSc) is a clinical lead in general theatres at Royal Bournemouth Hospital with 15 years of experience in open, laparoscopic, and robotic minor, major, and complex multispecialty surgical procedures. Ndidi has six years of experience in operating theatre administration and management and is currently the laser safety link person for her team.

Dr Josephine NwaAmaka Bardi (RN) is the associate dean for education and student experience at the School of Nursing and Midwifery, London South Bank University. Additionally, she founded the campaign to Raise Awareness of Mental Health in Higher Education (RAMHHE).