YOUR EXCELLENCY THE VISITOR, MR CHANCELLOR, YOUR EXCELLENCIES, DISTINGUISHED GUESTS, LADIES AND GENTLEMEN, AND MEMBERS OF THE UNIVERSITY: I am very grateful to His Excellency our Visitor and to our Chancellor for graciously permitting me to address Congregation on this Red Letter Day in the history of this University.

Though I propose to base my address on a Biblical text, namely, "The Tradition of the Elders" (St. Matthew 15, 2 and St. Mark 7,3), I hasten to assure you that I do not intend to deliver a Sermon ! You would of course be aware of the fact that the "tradition" to which my text refers, and which our Lord rebuked in the Scribes and Pharisees, was that of strict and uncritical observance of the letter rather than the spirit of the tenets and practice of Judaic Law.

What is Tradition? and what is its relevance to the prob­lems of the academic community of the present generation? It is to that generation that, as one of the "elders", I wish largely to address my remarks.

Tradition may be defined as the corpus of usages, opinions, beliefs, conventions and practices which genera­tions of elders have handed on to a new generation for their guidance and edification, and for handing on by them in their own turn to future generations. It may perhaps be compared to the "precedents" so beloved of the civil servants, or to the "case law" of the lawyers, based on the final validity of previously decided judicial cases. I rather fancy however that the ordinary layman sometimes sum­marily dismisses it all with only just two words: "red tape" !

The observance of tradition is a very necessary ingredient in the evolution of the cultural history of any nation or society. But let me venture to say at once that the fact that it is the elders who, as its guardians, hand tradition down does not necessarily make tradition sacrosanct or infallible. The beard of the elders, it is said, is not the sole repository of wisdom, though one notices that the so-called young radicals of now-a-days do sport beards of varying degrees of luxuriance or scragginess! I daresay that some of these youngsters sometimes imagine that they are the original cats whiskers ! In fact, I understand that one of them claims to be the Nigerian "Chairman Mao" ! We now await his "Thoughts" !

Tradition must certainly be respected where it serves a useful purpose and where no better substitute can be devised to take its place. But the true spirit of tradition must be flexible. It must be dynamic. It must obey the wind of change provided, of course, that the change produces an improvement on the old. Tradition must recognize the need, where necessary, for reform and even for abolition, if progress is to be continued. To follow, or not to follw a practice simply because our forefathers did, or did not do so, or merely because that practice is, or is not, sanctified by antiquity and hoary usage, is not the true spirit of tradi­tion. That, I submit, would be the spirit of static, unpro­gressive and uncritical reaction ; and an academic community is the very last place where reactionaries should be allowed to find peaceful refuge.

It may well be true, as the legal maxim has it, that "via trita via tuta"-"the trodden path is the safe path". But, to follow that maxim literally in these days of modern vehicular traffic may land one's car squarely in the middle of the bush !

However, let me not be misunderstood. Having delivered myself of all the foregoing perhaps somewhat iconoclastic utterances, it must not by any means be supposed that I necessarily consider all tradition suspect. On the contrary, the truth is that the observance of those traditions of the elders which are compatible with the necessities and demands of this atomic and space age, and which will enable the youths of today and their successors of tomorrow to attain greater heights of achievement than their elders did, is imperative if contemporary youths for their part are to make their own maximum contribution to history and to posterity.

That, Ladies and Gentlemen, is the sort of tradition which this University had been endeavouring to create since its foundation. If, during the 21 years of its existence, our oldest University had failed to create such a tradition for its own community and for other academic communities to emulate and even to excel, then we of this university would have failed in our duty to this great nation. For, to be sure, we are the national University of Nigeria. We are cosmopo­litan in composition; and we are truly all-Nigerian in outlook and philosophy.

Briefly, then, what traditions have we been trying to create these past 21 years? I do not propose to give you a detailed catalogue. Let it suffice to mention a few.

First, the very establishment of this institution 21 years ago as the first university in this country is a fine example of Nigerian fortitude and determination to succeed in spite of all odds. Perhaps it is only those who knew the snake-infested jungle which this beautiful campus, now with its complex of magnificent buildings, was in those days before we were established as the University College of Ibadan can truly appreciate the perseverance, industry and faith of its founders. It is only they who can most fully esteem the results, which we now see, of the goodwill and munificence of the Nigerian and British Governments, and of the various overseas Foundations and philanthropic organizations which helped to make this unique phenomenon possible. We arc very grateful to them all and long may this noble tradition of national and international goodwill continue to flourish.

The pioneering difficulties through which this University passed to become what it is today have been well described in detail in two excellent books written by our first two expatriate Principals, "The Birth of Nigeria's University" by Dr Kenneth Mellanby and "University College Ibadan" by Dr J. T. Saunders. They are a notable contribution to the history of our nation's higher education. I do hope that the distinguished Nigerian successors of these two previous Heads of the university will continue this historical tradition.

One of the earliest traditions which we have laid down is that of high class academic performance. By first basing our curriculum on that of London University and taking its degrees (which are some of the highest esteemed in the world), we proved that our graduates and postgraduates are second to none in the world academic community. This fact largely accounts later on for our high international reputation when, after 15 years of Special Relationship with London, we became a fully fledged and autonomous University in 1963, with power to award our own degrees based on our own locally oriented curriculum. This is particularly true of our Medical School, about which I shall say a few words later.

Let me say here at once that we are very proud of our long and very fruitful association with London University, and we are very glad to have with us here today a very senior member of that university- to express our gratitude in a fitting academic manner.

We would, I think, be right in ascribing our high academic performance to two factors, firstly, the high standard of the selection of our students, and secondly the loyalty, devotion and international character of our senior staff, and particu­larly the excellence of their capacity for teaching and research. The tradition and standards which we have laid down in these two areas must never be allowed to deteriorate.

We are now very actively pioneering the tradition of lay­ing down a strong foundation in the field of Applied Tech­nology of university standard. Most appropriately, I am sure you will agree, as the petroleum industry will be a major mainstay of our economy in the years to come, we have started first with postgraduate petroleum technology and petro-chemical engineering, and I believe we are the first university in West Africa to do so. University training in technology and applied research is a very necessary deve­lopment in a developing country such as ours and it is to be hoped that it will not be long now before Nigeria establishes her own autonomous University of Applied Technology and Science.

Let me mention another tradition. I well remember the frequently repeated injunction of our first Principal Dr Mellanby to his dons to "publish or perish". The observance of that injunction has now ensured for this university an international reputation for producing the authors of the largest and most impressive series of scientific books and literature in all West Africa embodying, as they do, the results of first class and dedicated research carried out by our academic staff. It is a tradition which future generations must follow and surpass, because we of this university are very conscious of the cardinal fact that a teaching institution which does not enrich and advance scientific knowledge by carrying out meaningful research does not deserve to be called a university.

Many colleges and great universities place much emphasis, perhaps sometimes too much emphasis, on the develop­ment and pursuit of sports. In this, too, we have set a fine tradition by being the first to suggest and establish the biennial West African Inter-Universities Games, in which the universities of all English-and French-speaking West African countries participate. In this field, we have main­tained our pre-eminence by consistently winning most of the major trophies since the inauguration of the Games in 1965.

The Vice-Chancellor will no doubt be telling you in due course and in greater detail of our other achievements-and failures-and of the many other traditions which we had been trying to create in this university. But I must not fail to mention our tradition of excellent staff student-workers relationship, which I suggest is the result of the importance which we place, among other factors, on respect for human dignity and regard for collective participation.

Now, a last word on our tradition in the field of medical education, to which I referred earlier. I crave your indul­gence for speaking at some length today on this particular subject because it is one of most urgent importance, and one with which I had been connected for many years.

Before I do so, however, let me on behalf of the Univer­sity Council congratulate all of you new graduates who are taking your degrees in the various Faculties today.

I congratulate most particularly the new medical graduates. As a senior colleague, I welcome you into the ranks of a noble and, in this country especially, a much needed profes­sion. Let me remind you, our new medicos, that your graduation is not merely the end of a beginning. It is the beginning of a much larger end. By taking your degree today it is true that you do end your career as "medical students"; but you must at all times remember that you are also only just beginning your career as life-long "students of medicine".

In this university, we have created one of the finest medical schools of its size in the world. In 1948, we opened our medical school with twenty students. Between then and 1957, we sent our students overseas to complete their clinical studies. With the opening, however, of the Univer­sity College Hospital in 19S7, we started giving a complete medical course locally, and the Ibadan Medical School has now produced altogether a total of 456 doctors. Our largest output ever was in 1964, when we graduated fifty.

Today, we are graduating forty-one. But that number, added to the number who will be graduating for the first time in Lagos University in a few months time, is a very minute fraction of the minimum number required to sustain an adequate delivery of medical care to the teeming popula­tion of this vast country, particularly in the rural areas.

One may therefore well ask: in this matter of the main­tenance of our medical services and the much needed acce­leration in the production of medical manpower to operate them efficiently, are we right in maintaining our traditional insistence that we must produce only the fully qualified basic doctor? To do so would of course be the ideal and the best, if we can afford the time and the expense. But in our particular circumstances, are we not, by doing so, allowing the best to be the enemy of the good?

Let us examine the problem and the facts. What are the realities of our health situation today? Less than 2,000 doctors, about Boo of whom are expa­triates, and many of them in the Teaching Hospitals and concentrated in the large cities, at present provide medical and health care for a population of some sixty million. Our doctor-population ratio is i to 30,000, one of the worst in the world, and only little better than the average of I to 40,000 for the whole of Tropical Africa. This compares most unfavourably with twenty-seven countries in the world which have a ratio of 1 to 1,000 or less. For example Israel, one of the younger nations, has a ratio of i doctor to every 420 of population. In India, where they had a similar problem to ours, the ratio now is 1 to 5,000 i.e., six times better than ours. The U.S.S.R. had a similar problem before the First World War, but their ratio now is i to Soo, despite a greatly increased population in the interval.

If Nigeria is to reach the goal of a doctor-population ratio of 1 to 10,ooo, which is the minimum standard which the World Health Organisation prescribes should be reached by all developing countries within the next decade, we in Nigeria will need to produce no less than 6,ooo additional doctors by the end of that period, when our population will be of the order of 80-9o million. This means that we must produce 6oo doctors every year.

Our two medical schools, Lagos and Ibadan, at present are able to produce between them only some eighty doctors annually. With the third Medical School at Zaria and the proposed school at Ife, we expect this number to rise to 150 in three years and 200 a year in five years. We hope that sonic of the approximately ioo medical students train­ing abroad at present will return home after qualifying, though so far, they have not been very enthusiastic to do so. Even so, the sum-total of these figures will still be far below the annual figure of 6oo which I have indicated will be required in order to attain the standard minimum doctor-population ratio of i to 10,000.

Expansion of the existing medical schools, and the esta­blishment of new medical schools by making more use of the present excellent facilities in Government hospitals which are not yet being employed for teaching purposes, have both been suggested as possible solutions. But these are expensive and long term solutions. Even when imple­mented, they are unlikely to yield an annual output of more than 300 to 400 doctors, as against our minimum requirement of 60o doctors a year.

Is it not quite clear, therefore, that all these additional activities, even when prosecuted to their maximum limit, cannot be the whole answer to the pressing problem of providing total coverage of the country by medical per­sonnel? And yet, it is vitally necessary for the growing economy of this nation that the entire country must be covered, at as an early date as possible, with a complete network of basic health services which should be within the reach of all citizens wherever they may live. It is therefore obvious from the foregoing that if we have to wait till a sufficient number of fully traditionally qualified doctors can be produced, total medical coverage for the generality of our population will most certainly not be achieved for very many years to come, and perhaps not even in this generation.

 

What, then, is to be done?

I suggest that we must immediately devise, as an interim, a purely interim stop-gap measure, a national emergency crash programme for the training of a sub-professional class of clinical health workers, a class of assistant or auxi­liary doctors, who will fill the gap during the several years which must of necessity elapse before sufficient numbers of fully qualified doctors are produced. Surely, is it not better to have the services of such clinical workers who, though not so highly trained can, as doctors' assistants, nevertheless provide basic health care particularly in the rural areas, and who can in fact be subsequently fully trained if they show the aptitude, than to wait helplessly without any services at all (as is at present the case in many places) until such time as fully trained-doctors are available? The answer, I suggest, is an emphatic "yes". It is better to do so. The ultimate aim would of course be that the emergency scheme would gradually disappear as more and more of these auxiliary doctors arc absorbed for higher training, or are replaced by fully qualified doctors.

I am aware that this suggested scheme which, as former head of our medical services, I had been advocating for some years past, is admittedly controversial. It has met with serious but understandable opposition in certain influential quarters. Its opponents claim that what is really being pro-posed is nothing but a veiled attempt to create a cheap class of what they term "how-for-do doctors". It is nothing of the sort. With some justification, the objectors vividly and painfully recall the failure of our previous short-lived scheme of the 1930s to create a class of what we then called medical assistants and assistant medical officers or "Yaba doctors".

I suggest, however, that this objection is misconceived because the present proposal is not quite the same. Our failure with the old medical assistants scheme was due, not to conceptual, but to methodological and tactical errors. First, we over-selected the candidates. They were the elite of the secondary schools and they possessed quite superior school qualifications which would have entitled them to university entrance. Then, for the limited objective in view, we over-trained them. Thereafter, we proceeded to underpay and to underclass them ! Under such circums­tances, was it surprising that frustration and failure were the inevitable result?

The emergency programme which I have suggested is less expensive. It has been proved to be practicable and successful in various developing countries such as Vene­zuela, Burma, Algeria and the Sudan. It has been particu­larly so in Eastern Europe, notably in Poland and in Soviet Russia, with their "feldsher" training scheme. Like us, these Eastern European countries had the same initial prob­lems with medical manpower several years ago, and they have now solved them by the means now proposed. We, in fact, are now sending expensive recruitment teams peram­bulating overseas to these very same countries to import doctors, at great cost to our economy and, if one may add, with some damage to our national prestige and self-respect as well.

It might well be that in our present critical situation a good step would be the immediate establishment of a high-powered national Commission to examine, as a most urgent exercise, the whole problem of shortage of medical and para-medical manpower in this country. India did so when faced with the same situation some twenty years ago, and did so with great and lasting success. If the proposed Commission consists, like the Indian one, of local experts as well as eminent experts from countries abroad which formerly had or now have a similar problem, then the Commission's recommendations, if accepted by Govern­ment, would carry immense weight.

Naturally, those recommendations would have as their object the enhancement of the public health and the public good; and you will doubtless recall Cicero's dictum sall.as populi est suprema lex-the welfare of the people, or, in other words, the public good, is the supreme law. Accor­dingly, should any attempt be made by any vested inte­rests to oppose, ignore, side-step or otherwise impede such approved recommendations, then perhaps the best prescrip­tion for their effective implementation would be the pro­mulgation of an appropriate Decree, and the serving on the obstructionists of a Detention Order! Download