Stay or Japa to Saudi Arabia

by Hameedah Aruwa

Tell us about yourself.

My name is Aleeyu Jamiu Olamilekan, popularly known as Abu Zayd. I graduated from the University of Ilorin in 2016.

Glad to know that you’re an Alumnus. What was your major driving force in medical school?

I got into medical school in 2010. I just wanted to become a doctor, not because I had a profound love or passion for it, but because it was one of the few professions that offered a job or financial security. Along the way, I lost most of the initial passion due to the sheer amount of work. There were many days when I questioned my choices and abilities, but I pushed through. became a doctor. By the time I graduated, medical practice was no longer as attractive as it used to be, and opportunities were scarce. And by the time I finished House-Job, I told myself that I'd either practice medicine abroad or pivot to another discipline entirely.

Sorry about your experience. Some of us are praying for renewed strength to push through to the end.

Yes, I pray so too.

What would you have done if you stayed back in Nigeria?

I've always been more interested in art than science. In secondary school, I took to literature. In medical school, I was a two-time editor for At-Tabeeb magazine as well. So, if I didn't go ahead with medicine, I'd be somewhere writing or doing something artsy.

But then, having dedicated six years to medical practice, I wasn't just going to throw those years away. Other than my literary passion, I'd have gone into the non-clinical aspects of medicine.

Where did you train? How was life as an intern?

I was fortunate to be placed in a Federal Medical Center in Azare, Bauchi, in 2017. I say "fortunate" because before I graduated, I vowed to myself that I wasn't going to have my internship training in Unilorin. I'd had some unpleasant encounters with senior colleagues, so I was bent on leaving Ilorin. Moreover, I grew up in Ilorin and was ready to spread my wings to experience the core Northern culture, which was my dream.

The first few weeks were so hectic that I felt close to depression. I was now living and working in a new town where people predominantly spoke Hausa. Hardly will you meet anyone who speaks English, except maybe on the ward rounds. To complicate matters, there’s no onboarding process to ease you into the system; I tell you, I was already on call, on my second night. Imagine clerking a patient with little to no assistance; it was tough. Eventually, I picked up the language and caught up to speed

Any positives?

Apart from the language struggles, I think House Job in Azare is one of the best things medicine has afforded me. Although it didn't succeed in changing my perception of clinical practice in Nigeria, I enjoyed my time there.

The pay was comparatively good. My monthly take-home was about 265,000 naira at the time. Another thing I enjoyed was my cordial relationship with my senior colleagues. Consultants didn't talk down on anyone; they even joked with us, and never did they lose our respect.

Where did you go from Azare?

After my house job, I was posted to Damaturu for NYSC, where I worked at Sani Abacha Specialist Hospital. I was still getting accustomed to the environment when the Dapchi Abduction occurred. The following morning, I took a bus and traveled back to Azare and even started planning my relocation, but I paused and eventually returned to Damaturu. I was scared at first, but I stayed until the end of the service year. After my NYSC, I went to Azare, where I worked as a medical officer (M.O.) in the same facility. In total, I spent about four years in the North before I left the country.

Do you have any regrets about leaving Azare and Nigeria as whole?

I don't know about regrets, but the North gave me so much, and it was a lovable place, yet I relocated. This decision was made out of necessity due to growing security concerns.

Maybe I miss pepper soup and a few local dishes. Other than that, there really isn't much to miss. I may feel home-sick from time to time, but it doesn't go beyond that. Well, I pray Nigeria gets better, but at the moment, no regrets!

I give it to Nigeria. Our dishes are to die for.

You won't know how much they mean until you leave.

You're right about that. Let's just keep hoping Nigeria gets better.

As I've said, when I finished medical school, I was constantly thinking of ways to escape clinical medicine. The first was to get a Master's degree, so I started applying for scholarships. I was thinking of doing the Graduate Record Examination (GRE) since I'd gotten my IELTS in 2017. I was applying to schools both in the UK and the USA. It was during my application that I realized something important; if you want to apply for a Masters in the UK, for example, medical school is the right place to start building your portfolio. You should have records of volunteering, organizing projects, relevant research, and case reports. There I was with no published article, nothing outside the usual logbook lifestyle. Extracurricular was zero, and my published articles just weren't enough. I was highly disadvantaged in this, and It really affected me.

I eventually got a WHO-TDR scholarship placement in Bangladesh, and because I applied late, I couldn't raise enough money for accommodation, which was around $10,000. I weighed the pros and cons, so I just decided to let it go. From then on, I had to build from the ground up.

I'm really sorry about that. What was your next move?

I took PLAB 1 and passed. At the time, I was still working as an M.O. Then, I began working towards PLAB 2, but it's quite capital-intensive, and I didn't have enough money at the time. Luckily, the Saudi route was opening, so I followed it.

Now I'm curious. How was that possible? Is Saudi cheaper than PLAB-2?

Lots of Nigerian doctors were flocking to Saudi Arabia, partly because their Ministry of Health permitted the employment of doctors without interviews as a result of the pandemic. Prior to COVID, one had to undergo interviews to get a job. Even though the Nigerian agents hiked the price, I still opted for Saudi. I had a business decision to make.

How so?

PLAB 2 seats were opening up, and then I had this pathway to Saudi. It was either I paid for the PLAB 2 seat and channeled all my resources into it or I moved to Saudi, worked for a while before writing PLAB 2 from there. For the UK pathway, I could either pass or fail. And if I did pass, I'd still come back and start applying for jobs. Upon getting a job, I'd need to raise enough capital for the visa and relocation process. On the other hand, I could delay PLAB 2 for a year and practice in Saudi while raising money for the exam. This way, I won't need to borrow so much (if at all) or get worked up preparing for that. Of course, I chose Saudi.

Has your decision been worth it?

Financially speaking, there's no question. Saudi Arabia has been far more rewarding than Nigeria.

I spent 3.5 million relocating with my family, and I have recouped and made much more money. Anyone moving without an interview will definitely spend more than I did.

Let's talk about salaries…

So, the basic salary is about 4600 Riyals.

For each year of experience, you receive 230 Riyals. There's also an Exceptional Allowance, which is given every year, depending on your performance and assessment score. Lastly, there's a transport allowance of about 400 Riyals. Everything adds up to about 7500 Riyals.

When I came in 2021, the exchange rate was 125 naira to a Riyal. Now, as we speak, it's above 200. So with 7 years of experience, this person is earning close to 2 million without taxes because income is not taxed in Saudi. I forgot to add that if you're not given accommodation, you're entitled to accommodation and furniture allowance.

The accommodation allowance is the basic salary multiplied by 3 (7,500×3). You'll be given the lump sum once a year. Most people do not even spend up to half of the sum on actual accommodation, so they just save it up. Then the furniture allowance is half of the basic salary, which you get once during your stay.

You also get to and fro plane tickets, for 2 children and a wife or husband, and they're covered by health insurance. Lastly, as a Muslim in Saudi, Umrah is free. Your employment contract typically lasts a year and is renewable, and that's all about the monetary aspect of the contract.

Wow! The pay is quite attractive. How about the aspect of work?

It has its pros and cons, but I'll talk about the former first. I work in a General Hospital (GH), which is a secondary-tier facility. Needless to say, their secondary hospitals are better equipped than our tertiary centres. Working in the PHCs might not allow you to enjoy Saudi life because you'll most likely be stationed in the remote cities, but you're going to save a lot on accommodation, so most Nigerians opt to work in such places.

I work in the ICU as an ICU Resident, the equivalent of a Medical Officer. It was like a dream when I first stepped into the ICU. Things that I never imagined I'd see. I've been to several ICUs back in Nigeria, and I know what I'm saying.

The first time I witnessed thrombolysis in a stroke patient. The patient had a stroke at home and was brought to the ER within 5 minutes by an emergency service. The procedure was performed, and there was resolution of function within 2 hours. And this is only one of numerous instances. Honestly, the differences between Saudi and Nigeria are astronomical. I just wish everybody could experience these things at least once so they could change their perspective about clinical medicine.

How about the cons?

The cons are quite numerous. First, if you come to Saudi Arabia as a resident, you're likely going to leave as a resident, even after working for 15 years. You come in as a specialist, and unless you become a consultant after 5 years, you'll leave the same way. The only extra qualifications you can acquire are through part-time programs online. The specialist training programs are strictly reserved for citizens, so foreigners hardly get in. Which is why many Nigerians come here purely for the sake of making money.

The second is the language barrier, which is a major issue. You might think you understand some Arabic because of Islamiyyah, but I can assure you the language is robust and you'd have to adapt a lot. The language is another reason why people don't stay long in Saudi Arabia and why it's difficult to get training jobs—because the teaching language is 99% Arabic.

Oh really?

Yes. Another problem is that of citizenship. For example, after working for 5 years in the UK, you get an ILR (Indefinite Leave to Remain), and after a year, you can apply for your passport. But here in Saudi, you can work all your life and not get citizenship. Even your Saudi-born kids of immigrants are hardly considered for citizenship, and it's particularly difficult for Nigerians. It's not easy for your partner to get a job or for your kids to go to school. Although the elementary schools are free, they teach in Arabic. Then the international schools are too expensive for the average resident.

That's insane. Does citizenship affect doctors' salaries in any way?

Yes, absolutely! There are four levels for grading people coming into Saudi. If you're from any African country (apart from South Africa), you're in the third level; the second level is for those from South Africa or other European countries, and the first level is for the UK, US, and New Zealand.

These differences reflect in the salaries as well, because they're calculated differently. Even if a Nigerian trained in the UK, they're still at level three. As long as you only own a Nigerian passport, training in the UK changes nothing. The salary breakdown I shared with you is that of a third-level doctor. Immigrants from first- and second-level countries are paid more, and Saudi citizens outearn all other categories of immigrants. As a Nigerian citizen, if your goal is just to gather enough money and move, then that's fine. However, if you're planning to stay long term in Saudi, these issues will affect you.

Another downside is that you can lose your job at any time. In the past, doctors could renew contracts up to the 10th year, after which it can be abruptly terminated. These days, things aren't the same. Contracts are now terminated at will. For me, my contract is in its second year. The specialists and consultants are still quite safe, but the low cadre staff can be let go at any given time.

Are there any concerns about the issue of racism?

Yes, that's another disadvantage. It is no news that the Middle East is one of the most discriminatory places on earth. And it gets worse when you're unable to speak or understand the language. It could be because most of their domestic staff are Blacks, so they just think lowly of black people generally. But it is what it is—racism.

It's safe to say that the cons are even more than the pros.

Probably

How would you rate your stay in Saudi so far?

Well, personally speaking, I think I achieved all my objectives for coming to Saudi. So it may not be fair to judge based on my own experience. It’s like they’re phasing out Nigerian doctors; the intake has dropped drastically to like 10% of what it used to be before the visa saga. The only place opening up now is Oman, and doctors from Saudi are flocking there. It’s only a matter of time before that place gets saturated.

I see. So what advice do you have for doctors who are looking to thread the Saudi Pathway?

Like I said in my previous response, it depends on what you want to get from coming. It could be that you want to seize the opportunity to make enough money in a year to sit for exams and then leave for your dream country, or you just want to get a feel for the working experience. The latter is more likely for specialists and consultants, as they earn a lot more than residents. A specialist makes double the amount a resident makes, while a Nigerian consultant makes up to 23,000 Riyals per month. They can afford to stay as long as they desire because they have reached the peak of their careers, and they will still land jobs easily if they move back to Nigeria.

Is it possible to be laid off within your first year of work?

It happens, but it's rare to be able to get laid off before the end of your contract. Usually the layoffs start at the end of the first contract (after a year). If your contract is terminated before it ends, they'll pay you out. They give you what you're expected to get for the remainder of the contract.

Can you get another job after the payout?

Yes, you can get another job from the Ministry of Health or from a private hospital. It's easier to get to a private hospital if you have a fair command of the language.

Thank you so much for the clarification. That being said, has the environment affected your lifestyle in any way at all?

I'd say I came here with certain expectations, so I didn't experience many cultural shocks. Not to boast, but I'd like to say I've always been the religious type, so with my wife and my kid, I felt right at home immediately.

Having worked here for a while, I've learnt and adapted to the work experience in developed countries. From applications to interviews to the actual work, I believe I'll fit in well when I arrive in the UK.

The third thing is the money; I really don't need to think about most things that I pay for. I have traveled to places I wouldn't be able to afford if I were still in Nigeria. It feels good to not have to worry about bills piling up and all of that. Most importantly, I'm glad to say that I'll be moving out of Saudi before the first quarter of the year runs out to resume my new job.

That's superb, Congratulations!

Thank you.

What other migration routes are available from the Saudi Pathway?

There's the US, but as you know, it's quite capital intensive. Unless you are a Trust-fund child or you have a high-paying job and you're single, the US pathway may not be the best fit for you. Also, when it comes to Visa applications to the UK, it's easier from here. I can't say the same for the US.

With your schedule, are you still able to do some of the things you enjoy, like writing?

It hasn't been easy, but I try. The last piece I wrote is now a year old. I work in the ICU, and the workload and environment aren't really conducive to extracurriculars. I have to be there for my family, and there are exams to write. I've started writing exams to become a Fellow of the Royal College of Anaesthetists (FRCA)—I'm really passionate about the ICU now. I want to do my postgraduate studies in the UK in Intensive Medicine. I'm also tutoring some PLAB 2 groups. So I've got quite a lot on my plate, and it's really not healthy to add to the mix. But from time to time, I try to shove everything aside and write a poem. I'm also trying to do something with Podcasts, but it's still in the formative stage. You must have figured by now that I love to try new things and to think outside the box.

Yeah! I'm here wondering how you're able to combine all these things. How would you describe a typical working day?

Let's make that a typical 36 hours because my shift lasts for 12 hours and there isn't much to talk about.

After waking, I do some house chores because I enjoy cooking. When everything is done, I spend some time with my family. Besides family time and tweeting on my phone, I spend the rest of my day in the hospital. At the hospital, if I’m not working, I’m either reading or tutoring some PLAB sessions. I enjoy my hours in the ICU. Working in the ICU comes with an adrenaline rush because it keeps you on your toes all the time. One minute everything is fine, and the next, a patient is desaturating or having a cardiac arrest. I love that, in such emergencies, I can actually help them, not just stand and watch them slip away.

Concerning your job in the UK, will you be in the ICU of a Trust hospital or in a private hospital?

My job is with the National Health Service (NHS), so it's a Trust ICU position. It's a non-training position in the ICU, but I hope that if everything goes well, after a year, I can apply for a training position.

Now that you have tested medical practice in a developed country, do you have any plans of coming back to Nigeria?

Before I passed my PLAB 2, one of my biggest fears was not getting licensed to practice in another country and having to return to Nigeria. It's a dreadful thought, and frankly speaking, for me, there's nothing to look forward to in the Nigerian medical system as it is. Of course, I don't plan to live all of my years outside; at some point, I'll have to return home, but not for the foreseeable future. I need to become a specialist, make a ton of money, and gain another passport first—these are my priorities.

It's been a pleasure talking to you. Lastly, how would you advise medical students who want practice outside of our clime?

Thank you. I'm glad ILUMSA is ensuring that medical students get the right orientation early on. I'll start by saying your transcript from Nigerian Universities puts you behind most of your counterparts already. You have to put in a lot of work to surmount these challenges and level up. Your training equips you to perform well within the Nigerian system, but it's a bit inadequate outside the system. You'll still have to learn about quality improvement projects and audits.

Apart from your transcript, what else are you bringing to the table? What contributions are you making to enhance your CV? These are the real issues. Endeavour to host workshops, volunteer for projects, publish papers, and build your portfolio. If you're passionate about leaving the country, you have to start working towards it now. Give it your best shot, and you'll excel.

On a scale of 1-10, rate your quality of life in Saudi.

It was great while it lasted. I'll rate it 6.