Prof Oye Gureje is the Director, World Health Organisation Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse at the Department of Psychiatry, University of Ibadan. He speaks to ALEXANDER OKERE about his background and career

Did you spend your childhood in Ilesa, Osun State, where you were born?

I attended primary school in Ilesa, at Methodist Primary School, but attended secondary school in Akure, (Ondo) at Aquinas College. I later attended the Federal School of Science in Lagos.

You were eight years old when Nigeria gained independence in 1960. Can you describe what life was like for you in the 60s?

I was growing up and enjoying life as a child. Life was generally okay for me. A lot of things were better. For instance, my home was in the centre of the town in Ilesa. My elder brothers used to come and park their cars in front of the house on the main street and there was no fear about someone removing their tyres or batteries before daybreak. When I started driving, driving was much more pleasant; there were no riotous okadas on the road and all that. Of course, as you might also expect, the population was less than what it is now. But some things have got better, like information technology; communications. Postal services were good at that time but relatively slow, compared to what we have now. Materialism was not a problem at that time but now, it is. So, it was a mixture of good and bad.

You studied Medicine at the University of Benin. Did you experience lecturers or other university workers going on strike then, as we have it today?

No. I think we might have had some riots by students that disrupted education for a while but there was no major strike by lecturers that lasted for a long time. It would be correct to say there were no prolonged industrial actions. There have always been agitations for better conditions of services; it is just that things did not get so protracted; in worst cases, they lasted for a few weeks.

We had an interesting life at the university. In the hostel, there were two or three students per room. The facilities were good. We had very good meals; we had Sunday afternoon meals with quartered chicken and ice cream that people cannot dream of now. Also, there were clubs for those interested. We had student unionism and it was interesting. In terms of the quality of education, the classes at that time were more manageable in size; they were not overcrowded, so we had more interaction with our teachers and among ourselves. The libraries were good places to go and read; they were not stocked with the latest journals, but relatively, we had good access to books and journals, which we needed. So, in that regard, the facility was relatively adequate for the students.

To many Nigerian youths, the picture of the country you have painted is a fairy tale. Do you count yourself lucky to have been born then than much later?

I was there when the standard started deteriorating and I am still here. I will count myself lucky to have been educated when the circumstances around education were much better. That luck is relative. Don’t forget that at the earlier part of my career, there were challenges. For instance, when I did not have access to literature, I had to ask someone overseas to photocopy materials and send them to me. But that is not the case now when I have easier access to literature and what others are doing elsewhere. But overall, I will say the younger generation has more challenging circumstances to cope with now. Many graduates can’t get job. When I graduated, I was able to buy a brand-new car within two years of graduation. This is something people cannot easily dream of now except their parents are rich.

Did you graduate with distinction in medicine?

I did very well in some courses. In medicine, it is not just the final examinations; there are exams in all stages.

You also attended the University of Manchester for a postgraduate degree. Did you experience racism?

Not really, certainly not in the course of my study. There might have been occasional interactions in a shop or market that might have not been particularly courteous but I will not say there was overt racism during my study. I was not the only foreigner or black person there. I had a good experience.

Were you eager to return to Nigeria after graduation?

Absolutely. They wanted me to stay back. The people at home told me not to return, saying that Nigeria was terrible. Many of my colleagues did not return but I wanted to. It depended on what one wanted to make of their career but, yes, there were reasons to be tempted not to return to Nigeria.

What was the attraction for you to return to Nigeria?

The attraction for me to return, not just then but sometime when I lived in Australia for about four years, was to make a career in Nigeria. I thought I would make more impact in Nigeria and, personally, the impact I could make on services and people that would interact with and learn from me. Actually, the temptation not to return to Nigeria was stronger when I lived in Australia because I was a senior consultant there earning a good salary and doing good research. However, I thought it would be easier for me to look back many years later and feel more satisfied working in Nigeria than outside.

Insecurity, corruption, unemployment, and poverty are some of the major problems facing Nigeria now. At what point do you think things began to take a negative turn in the country?

I think when Nigeria started earning a lot of money from oil, life started taking a drastic turn for the worse. People started looking for easy money. There was a time our Head of State then said that we had so much money that the problem was how to spend it. That created a wrong impression for people. There has always been corruption; there is corruption everywhere in the world but it is all about managing it so things don’t get out of control. (In Nigeria) people started feeling that the easier way to make money was through foul means and our ability to curtail that started going down because our law enforcement agencies started getting corrupt too; those who were supposed to apprehend criminals and those who were supposed to send them to jail were affected by corruption. What normally curtails corruption in other places, which is the fear that one might be caught and sent to jail, started going down. The younger ones saw all that; they grew up in a situation where they saw their neighbour making money from doing virtually nothing. The language of corruption crept into every part of our lives, even in churches.

Your surname, Gureje, is not common. Is it native to Ilesa?

My parents were from Ijesa. Two families bear the name, Gureje. My father’s name was Asogbe, from the Asogbe family, but he started being called Gureje when he was growing up. It was like an appellation (nickname) before it became a name for him, so all his children started bearing that name. He was a businessman. He was at a time a distributor for PZ. He started as a contractor and veered off into business. My mother was a trader all her life. She traded in food items.

You are a recipient of several grants and awards from international bodies, including the UK Medical Research Council and the US National Institute of Mental Health. Did these result from personal determination to excel academically or products of the type of parenting you had?

I don’t think those are mutually exclusive. People grow up to become what they are as a result of various interactions and various influences, including parental influence. So, certainly, the parental training I received was instrumental in what I eventually became. The determination to excel did not just come; it came from upbringing and training both at home and in school and from peers. I did not set out to win awards but to work and pursue my interests and it turned out that those interests were leading to success through completion and exploration. But I have always been interested in what I have been doing, and there have been hard work and a lot of luck. One should not attribute one’s success to hard work alone; there would be opportunities that came one’s way not because one worked for them. Of course, it is said that opportunities present themselves to the prepared mind, so maybe I was prepared to take advantage of those opportunities.

After your undergraduate degree in medicine, you not only chose to become a psychiatrist but also obtained a doctorate in neuropsychiatry. What was special about psychiatry that you could not ignore?

Oh, that’s a good question. When I wanted to make a choice about where to specialise, I went about it in a funny way. I identified the options and scored them but ultimately, I decided I wanted to study something about the brain and nervous system. There were three main areas here, neurosurgery, neurology and psychiatry. To me, among the three, psychiatry posed the most curiosity. It was the one I thought had a lot of more unknowns and challenging interests. That was why I ended up in psychiatry rather than the two other areas.

You are a former chairman of the World Psychiatric Association’s task force on brain drain. What is your reaction to the spate of migration of young Nigerian medical practitioners to Europe and America? Who should be blamed?

The chairmanship you talked about was born out of a long interest in that topic and that interest is mainly derived from, sometimes, the embarrassment I feel about the way we lose our highly-trained people. People don’t want to come back when they are gone and want to go away while they are still in their country. This was part of why I became interested in brain drain. Unfortunately, the brain drain has been getting worse as conditions in the country got worse. So, that is an interest I continually write about.

So, who should take the blame for the increasing desire for greener pastures by young professionals in Nigeria?

The quest for greener pastures is the outcome of a process. So what is the process driving that? There are pull and push factors. The pull factor is the fact that there are better opportunities outside, not just in terms of salary but also in terms of conditions of service, prospects for growth, and professional development. The push factors are the things that drive people out and they are also related to the conditions of service like poor remuneration, and then you begin to have other social problems such that even when people earn good salaries, they might feel the weight of insecurity and unhappy about the lack of social service in terms of having to be their own local government by proving their own water, electricity, education for their children and others. But the pull factors also include the aggressive recruitment of people by other countries looking for a workforce. They do that sometimes without consideration of the conditions of the country of origin of the recruits.

What are your fears about the implication of this trend, if it continues like this? Will Nigeria’s health sector be headed for a collapse?

Absolutely! Our health sector is not where it should be. If you talk about collapse, it depends on what you mean because some people think it has already collapsed. Unfortunately, we have some people at the helm of affairs who display amazing ignorance. We heard a minister saying it is good for our doctors to go away, make money and transfer money to Nigeria. That is absolute ignorance because we don’t train doctors to become money-makers outside. We train them to provide services in the country. For every doctor trained, the idea is that they will provide health services to Nigerians, not to go outside and become labourers. Sometimes, they (politicians) say we have enough doctors; they absolutely have no sense of what the statistics of what the doctor-patient ratio ought to be or they ignore it because they just want to justify what is clearly unjustifiable.

Don’t forget that one of our military leaders said our hospitals had become mere consulting clinics. I don’t think things have taken a turn for the better; they have actually taken a turn for the worse. So, collapse is a relative term, depending on what you are comparing it with. The issue is not just about personnel, it is also about planning, and what I mean by that is that if you have a few doctors that are well-motivated and you have good policies, non-doctors could be trained to perform some good services. Our primary care services are not manned by doctors but by non-physicians, community health extension workers. These are people that can be trained to deliver good services. We don’t need thousands of obstetricians to reduce infant or maternal mortality. You need them to supervise those people that will provide the services that will reduce the abnormal or terrible statistics we have in those areas. In the same vein, we don’t need thousands of psychiatrists but we still need them to be able to provide support and supervision for those working at the frontline, and to do that, we need planning. We need a government that is thinking about how to do this effectively by providing non-physicians occasional top-up training and refresher training and, of course, motivating them. All of these things are what we lack to make our health system as functional as it should be.

Does Nigeria have an effective mental health policy, especially with growing concern over rising cases of mental illness?

Well, you just put the right adjective, ‘effective’. The first mental health policy was adopted in 1991 by a former minister, (the late) Olikoye Ransome-Kuti. We had a second version; that was the one I was much involved in as the chairman of the mental health action committee and that was adopted by the National Council on Health in 2013 but has not been implemented; things that should be done were not done. So, the meeting I attended was a way of trying to revive that policy and take it forward in terms of complementing it with a plan of action about how specific things will be achieved. These are all expectations but many of our hopes and expectations have been dashed in the past, so we can only hope that there will be movement this time.

There have been several reports about cases of suicide and attempted suicide. Do you think it is spiking in Nigeria?

Certainly, there is a rise in the reporting of it; we don’t know whether there is a rise in the actual number of people doing it because there has always been suicide occurring in the country that people outside do not know, that those of us in hospitals know. But there is a lot of stigma around it so much that people often deny it. Recently, there was a story about a young man that was said to have killed himself but a few days later, some other people said he just slipped and hit his head. Whether it is true or not, again, I don’t know, but it just shows the stigma around it. Journalists and newspapers have taken interest in it and they are bringing it out more. Sometimes, it is reported in a way that is not professional enough. So, it may be that there is higher reporting or a rise in the rate of suicide. However, 90 per cent of the things that drive suicide are related to mental health problems. The most common ones are depression and substance abuse and if these are increasing, then we will not be surprised if suicide does increase. Depression and substance abuse can increase in situations of turmoil, social turmoil, or upheaval, the kind of thing we have in Nigeria in terms of rising insecurity, unemployment, terrible level of poverty, and all of that. So, even if we don’t have the figure because we are not doing enough epidemiological studies, one can surmise that it is possible that the rate of suicide might actually be increasing.

What were your most challenging moments?

Some of the most challenging moments were about taking decisions about whether to return to Nigeria when one is outside the country or not because, as I told you, there were push factors and pull factors. Career-wise, I have had challenges but they were motivations to do more and work harder, and they were part of whatever success I eventually achieved. I don’t look at them in a negative light; they were motivating factors to try more. My best moments were when I get encouraging comments from peers within and outside about what I have done