My pathway at the Cameroon Medical Council and why I left the civil service for private practice – Dr. Peter Louis Ndifor, Vice President, Cameroon Medical Council and proprietor of Limbe’s untra-modern health facility, Bota Polyclinic
Dr. Peter Louis Ndifor is a household name within and out of the medical circles not only in Anglophone Cameroon but beyond and even among diasporans. Open, engaging, passionate and sociable, he is one who mixes with all age groups. His pathway at the Cameroon Medical Council, where is currently the vice president, is a description of one born to lead.
His jump from the civil service to an uncertain and challenging private practice in a country where few do dare, is even more fascinating. Today, the nascent Bota Polyclinic, an untra-mordern health facility, that compares happily to western standards, may afterall be a culmination of the dreams of this 57-year-old Sasse Old Boy of the 1978 Batch. This is a story of commitment, passion, dedication, pain and success. The SUN had an exclusive no-holds-barred interview with Dr. Peter Louis Ndifor.
The SUN: Dr. Peter Louis Ndifor, thank you for finding time to grant this interview to The SUN newspaper despite your very tight schedule. We want to first of all congratulate you for this new edifice Bota Polyclinic and also for your election as vice president of the CameroonMedical Council. Theseare two big feathers on your cap almost at the same period.
Dr. Peter Louis Ndifor: Thank you. It is a pleasure for me to receive The SUN newspaper today and receiving congratulations for double success if I may call it success but I think it is a step ahead because we know the sky is still bright and we have hopes for much more better days and I am appreciative of your presence here today.
Thank you very much, we will come to Bota Polyclinic later. Let’s begin with the CameroonMedical Council. You were a council member in the last executive. You have moved a notch up to become the vice president. What do you think shall change with the new bureau?
Let me start with my path through the Medical Council. It is not surprising to so many to see my progress in the NMC. The first thing is that the role of the Cameroon Medical Council is to promote, protect and uphold the health and safety of the Cameroonian population through the provision of high standard of care. In doing this the Medical Council first of all has several roles.Number one to be able to identify qualified medical doctors and register them in the roll of the Cameroon Medical Council giving them a legal status to practice in Cameroon. Without registration in Cameroon, just to insist about it any doctor practicing in Cameroon without registration is doing so as an illegal practice and can be sent to jail.
Apart from that the Cameroon Medical Council also tries to promote the best practices for doctors by trying to reinforce respect of medical ethics and also controlling and recommending training of doctors. You know for you to get best practices as doctors you have to undergo good training. You can remember a few years back I think in 2014 there were 21 medical schools in Cameroon and most of them didn’t have the technical platform for academic staff to be able to run the medical schools and the Medical Council together with other health professional institutions like the Pharmacy Board and the Dental Council actually created a platform and after a long battle only six of these 21 schools were actually validated.
So, one of the roles of the Medical Council is to actually ensure that these schools actually follow international norms. Apart from this the Medical Council is there to give advice to the government and also bring discipline within the doctors’ corps.
Do you think you have been able to clean the profession?There have been complaints of quacks opening clinics everywhere.
The profession presently has several challenges.The new president has a roadmap, well defined principles and goals to be able to bring back the dignity of the doctor because that was his mandate defined under bringing back the dignity of doctors.
Number one, the precarity of medical doctors.It is very regrettable that in Cameroon now we have about 800 medical doctors that graduate every year and only about 50 are actually employed by the state. All of us know that the state is the highest employer.For example, when I went to school, it was an automatic thing that by the time you graduate from school, you are being employed by the state.
As of now it is difficult for the state because of budget constraints, but ironically doctors to patient ratio is significantly below the recommended WHO standard where it is recommended that the doctor to patient ratio should be one doctor to 1,000 patients. In Cameroon the doctor-patient ration is 1 to 50,000.
So we have doctors that graduate and are not employed. This unemployment of doctors leads to two main things. One, unethical and illegal medical practice since they are not employed and the number of private clinics that are around are not as many as to be able to employ all of them and financially most of the private clinics are unable to meet their ends and so the employment of these doctors by the private and conventional hospitals is a problem.
Most of these doctors stay on the streets and involve themselves in illegal things. You can’t imagine that a doctor graduates and still stays with the parents and is unable to eat, cloth himself, pay his taxi. It is very unfortunate that in 2023, two doctors died on a moto bike trying to go to work to catch up calls from different clinics and hospitals. It is very pathetic and those are things that touch on the dignity of a medical doctor. We expect doctors to actually respect medical ethics, respect best practices but when a doctor is not satisfied, he is even worse than somebody who is having a gun because when a doctor is not satisfied he can commit errors, can do unethical things, can practice unprofessionally and stuffs like that. So, the level of practice we are seeing here is because of the precarity of doctors not working, which was not like that before. When we were in secondary school we admired doctors – they all stayed in Govt residential areas, GRAs, had cars and facilities that made most of us eager to become medical doctors.
What is the Council recommending to government to improve the situation?
The first recommendation from the new bureau is to create medical institutions in “medical deserts” or places where you don’t have hospitals or clinics especially in the rural areas were we don’t have doctors.You see the vast land around Misellele I am not sure Misellele area has a medical doctor. This is true also for enclaved areas. If we could create some health centers under the supervision of a senior doctor who is not unemployed because you know for you to be practice privately you must have at least practiced for five years, this could help greatly. Those who just come out from school do not have a legal authorisation to practice privately. What we are trying to do is to identify because it is not only for the graduates this has been going on for years. You have probably other medical doctors who must have practiced maybe for five years and don’t have a stable employment.
We are also trying to look for ways to have credits from banks to be able to sponsor these doctors and the Council will be like a guarantor to get these loans to give to doctors to actually set up practices. The other point that the current bureau is looking at is very unfortunate because the medical profession is now open to everybody. For instance, a business man with no medical profession can own a clinic.It is not seen or done. I have never heard that a business man opened a law firm. I have never heard about a business man going to open a pharmacy. I have never heard about a business man opening an engineering firm.
There is the 1990 Law which was actually signed by a decree of the Prime Minister to open up private practice to the civil society for non-professionals and the number of doctors who were supposed to enjoy this practice were actually taken by other persons. The conditions of employment for these doctors are horrible. The business people are out to make their money. They can’t really understand the sacrifice doctors put in to practice.The president is planning to get an appointment with the prime minister to try to see how they can be able to rebuild that decree so that doctors should enjoy their professions like any other liberal profession rather than allowing people to get in there.
The next problem is over-the-counter selling of medications.In Cameroon, when you go to the pharmacy you can buy antibiotics without prescription. It was discovered in Douala that you have about 3000 over the counter sales of drugs there was sales of drugs without prescriptions. We are trying to work with the Pharmacy Board to make sure that some particular medications cannot be served over the counter without a medical prescription. This means patients must consult doctors to get certain prescriptions from doctors. If that decision is taken all of these consultations will come back to the doctors.
Why are these decisions difficult to implement in Cameroon?
The problem is not only with the Medical Council or the medical profession, it is almost everywhere. We need to have the principle of respecting the law. In Cameroon, there are lots of conflicts of interest and integrity of the authorities that be. People go around laws and decisions to be able to favour one person. Our problem in Cameroon is that we lack integrity. It is fondly said Cameroon has good laws but its implementation is a problem. We need to have a change in mentality and try as possible to make our country reflect a responsible country for the good of everybody.
How many doctors have we gotten in Cameroon.
For now, those who have registered in the Cameroon Medical Council is about 13,000. For the past ten years the Cameroon Medical Council has registered 7,000. 15 or 20 years ago wehad just like 3,000 to 4,000 doctors. But the number of graduating doctors has increased progressivelywith about 800 graduating from medical schools, so we have like 13,000 on the roll but the number is less than that, we are still trying to update the roll of active doctors.
Do we have the problem of doctors fleeing the country as we hear in other African countries?
That is an understatement as doctors are actually going out in their numbers. Is like mass exodus of doctors. Imagine intelligent, young dynamic doctors who are willing to serve their population. For example, how do you expect a doctor earning less than FCFA 150,000. How can he survive?His rents, feeding, transportation and families to look after. When doctors look at all of these and they don’t see their future, comparedto doctors in the US where a doctor will earn like 120 dollars per hour. It means a doctor in the USA working just for two hours will earn the salary of a doctor in Cameroon.
The context may be different because maybe their rents, transportation, and taxes etcbut you can’t compare them. As young people, when you see the differences in the compensation of doctors it is just but normal that they leave the country for greener pastures and you can’t blame them. I will bet you that Cameroonian doctors in the UK and US are one of the finest professionals you can be able to get there. So instead of us using our fine products in Cameroon, we don’t compensate them and they travel abroad.
One of the other problems facing the medical profession is that of illegal practicing. There are three different kinds of illegal practices. First isdoctors who are not registered with the CMC. But that is even better because we are sure of the quality of their services. But some of them don’t have authorisation to practice privately.
For you to actually practice privately you have to follow the law that stipulates that you must obtain an authorisation from the Council. That is the only law that exists.
There is another form of practice by nurses who open clinics and are doing things that are not supposed to be done by nurses. Most of them do not have authoriaation and it is also very unfortunate because some of them go at the level of the ministry and obtain authorisation to create a health facility or a clinic. How can a nurse own a clinic? They can own health centers but not a clinic nor a hospital.
It actually goes with the previous statement I talked about authorization for creation by non-medical professionals which you can give to any person. So, you have nurses and other health professionals, you have lab technicians, midwives who open health centers and stuffs like that which is illegal. Some of them don’t have authorisation. Most of them have deplorable conditions under which these medical practices are done.
One of the goals of the Medical Council is to actively fight illegal medical practices.
That’s why a few weeks back the president, together with some members of the Council visited the Littoral governor, Wouri SDO, Legion commanders and commissioners of Douala to explain the legal backing of fighting illegal medical practices and requesting for their support which they promised. This action will proceed to Yaounde and all the other regions.We are trying to create local committees to identify illegal clinics and report to the national executive and then we will have to use the authorities.
Dr I am a bit worried if not skeptical. More than 30 years ago I remember how pharmacists tried to fight street drugs and medicine stores. This resulted to virtually nothing. Are you people going to be more successful than the pharmacists?.
The fight of illegal medical practice is also a very delicate thing. For example, if I am in Limbe and we identify a structure and whether they see me there or not everybody will say he is the vice president of the CMC. He is probably the one fighting the competition. You know what I am talking about. But then, as I said from the onset we have to try to respect the integrity of the law. We have to take a purposeful decision that our society has to be looked up to with respect. Because how will people view us if we don’t respect our laws and I don’t know how it will look like but I am hopeful that it starts somewhere and the authorities actually accompany us in implementing the fight.
When you resigned from government to go into private practice a lot of people were surprised. What was your motivation?
I want to change the word I didn’t resign at that time. Just for a short history, when I left school, I first worked at Johong district hospital at that time it a was medicalised health center in Adamawa region, 90 kilometers from Meiganga. From there I came to the Regional Hospital Limbe where I worked for four years and Bota District Hospital where I worked for four years. After then I was appointed chief medical officer for the Fontem District Hospital. My motivation to go into private practice came when I was working inLimbe. Being a young medical practitioner, I had alot of experienced doctors who were there for the younger doctors, who tried to pull me up, tried to perfect my surgical skills, my clinical skills, tried to perfect my ethical practices and stuffs like that. So truly speaking when I was working in Bota hospital, when I had 35 patients to consult in a day that was a low-key day. There were days when I will find 60 consultation books and I will beg them to go consult different doctors but they will prefer to come the next day.
I used to be really afraid of myself because I was like asking myself what are these people seeing behind me? A young doctor and you have specialists around but they are insisting to come consult me. I was like good in surgery, pediatrics, gynecology, etc Infact, I used to do four to six surgeries a day.
So when I was transferred to Fontem District Hospital I got frustrated because when I went there I tried to upgrade the hospital, tried to do surgery, painted and equipped the hospital, went round the villagetrying to counsel the patients on what to do to no effect. The unfortunate thing about the Fontem district hospital is that it is located out of the centre of Fontem. It is actually in a village where the Paramount Fon of the village lives. A district hospital is supposed to be centrally located and easily accessible to all the population. I tried to talk about it because all the services in Fontem were in Menji but the district hospital was somewhere were access is difficult. So the district hospital was actually playing the role of a health center and I will tell you it is frustrating after doing health education going around, doing vaccination, doing publicity for the hospital and you will see old men and women still coming and bypassing you in front of the hospital walking for more than 35 to 40 minutes to go down to the Mary Health of Africa for simple things that could be handled. Later on, I found out that it was down in their heads that their treatment care was at Mary head I can’t blame them because maybe in the past the doctors who were there didn’t try to convince them enough and you know like a young person we think about a few things before talking about it.
I tried traveling out of the country for studies at that time and had significant financial difficulties and a few people, my friends, relatives, especially Dr. Ndifon of Solidarity Clinic in buea and Dr. Tassang of Polyclinic Mutengene etc they put me down and talked to me. With my volume of patients while at Bota and portfolio of companies,they told me I was wasting my time in Fontem. I made two years in Fontem, I realised that my profession was not moving,but was instead going down, I took a bold step to go private in 1999.I had worked for the civil service just for seven years at that time. We started like an NGO. I had a project to do something like a community health education and clinical foundation to help the under privileged patients. So, I wrote to the ministry of public health that I was requesting to go on secondment to my project that I had written and they never replied me.Three months went by and the law in Cameroon states that if you don’t have a reply silence means acceptance. So my motivation was based on the confidence of my practice. The solid practice I had from when I left school, it is different today. We didn’t have many specialists around. We had senior doctors that pulled me up and showed methings so I was confident that I was going to do it and so apart from that the other thing was the frustration I had in Fontem not being able to practice what I actually was used to practicing.
1999 to 2004 makes you 25 years in practice. You had challenges but I know today many people looking at Bota Polyclinic would say Ndifor has arrived. Have you arrived?
I have not arrived. I am just moving from one step to another. Before I come to Bota Polyclinic because you have been talking of it. Let me just take a step back to the Cameroon Medical Council. My path towards being the vice president of the Cameron Medical Council is traceable and visible because of dedicated, constant, persistent and ability to serve doctors in the Southwest. I started up in the Southwest being the secretary of our social meeting in Limbe and Fako-based doctors. Trying to bring doctors together. I later became the secretary of our Southwest clinical forum. We moved from Buea, Limbe, Tiko, Muyuka, Kumba and EkondoTiti to hold clinical meetings with doctors trying to improve on our clinical case presentatations. It was a meeting that brought a lot of doctors. I will look for sponsors. Doctors were together. By doing that doctors started having a sense of belonging towards me. I started behaving like somebody with positive influence over people. The hallmark of this came whenwe had funerals of doctors. We decided to create and organise what we call the medical funeral honour. This started with the late Doctor Mafani Njie. I was surprised one day when late Dr. Daniel Muna who was the president of the Cameroon Medical Council called me from Douala. Many things ran through my head at the time. Had I done something unprofessional or unethical. I went there and I was shivering. My nerves calmed that when he started saying he just called me to know me because he has heard about all the good things I am doing in the South West Region.
He enumerated everything trying to bring doctors together, trying to promote continuous medical learning, to bring solidarity actions to medical doctors for being friends with almost everybody and so he actually wanted me to be the regional representative of the medical council I was not even 40 at that time.
We had senior doctors in Buea, Limbe, Tiko, Kumba and I asked himMr. president how can I be able to do? He said I have monitored you. Not knowing that our icon in the South West Dr. Edmond Agbor is the one who actually recommended that I am the person that can do this thing. So that is how I became regional representative and I was regional representative for ten years. After ten years, there were national elections and the then former president encouraged me in 2017 that I should stand like a council member. I was voted a council member. After one term, the next term I was voted in again as a council member and within the council I was voted as the assistant secretary general of the CMC and in December 2023, I was voted in the council and in the council I was now voted again as the vice president of the Cameroon Medical Council.
So back to Bota Polyclinic, have you arrived?
I will still repeat that I have not arrived. I have not even gone half or 25 percent of what I want to have. For the small story when we started private practice I went into a rented property which was a two-apartment buildingand we tried to transform it to a clinic.
You know when you are trying to transform something to a clinic which was not meant for clinical purposes, you will not actually get the guidelines. We were there for 20 years. I bet you it was not easy.At one stage the land that we are actually occupying now we started paying for that land. It was very discouraging because we couldn’t imagine the amount of money we were going to spend on the land. And you were supposed to pay 20 percent progressively. We finished paying for the plot and had our land permit and the building permit and we started building. If you look at the quality of what we are providing since I a US resident I try to copy what I have been observing in the US. All of us know the quality of care and standard of hospital and clinics in the US – the structure, organisation, plan of services etc. As much as possible we are copying western standards. Large sitting spaces, many toilets etc We have a small template of an emergency room that you find with cubicles and privacy and stuffs like that. Because most Cameroonians don’t even know what an emergency unit should look like. But if you go into our place here, you look at the emergency room there is a guideline of the reception of patients. It is rather unfortunate because there is a video that went viral last weekend and maybe the doctors actually did their best but there are guidelines in an emergency room. The emergency room we have here whether you have money or not they will sterilize you without asking you money and then you will try to see how you can pay later. Our set up for now we have occupied just the down floor which is significantly bigger than the previous location where we were. We have not arrived because we still have equipment to buy. The operation room we are still looking for equipment to upgrade. We are trying to get specialists, consultants in every field so that by the time patients come into Bota Polyclinic, they should meet equipment that they are comfortable with. We need a health facility that will reflect the personality of the people working there.
So that the doctor who is coming with good reputation here will say waow!! atleast I am entering here patients will be able to respect mebecause I am working in a decent, well organized institution so that is what we are trying to do. To make sure that the institution can be able to respond to the needs of our consultants that are here and to be able to respect the patient. Our set up is motivated by experience and exposure to the UK and US. I will say I have arrived when we must have completed this structure.
We intend to actually put up a specialist center which will be meant for visiting doctors abroad, so that patients will not be traveling to India, China, South Africa to take treatment. We are also are trying to work in partnership with other institutions to make sure that patients receive the best care. For now, we have just started arriving.
What is the capacity?
For now we have six emergency beds, four critical beds, we have two delivery beds, with experienced midwives. Most of us watch films abroad and we see the husband actually being there when the wife is delivering. We have a couch in the delivery room with AC and a tv and we want that woman to be as comfortable and relaxed and cared for as much as possible. One of our showcases in this Bota Polyclinic is our maternity. It is a VIP maternity and all the beds in here are from the US.Progressively we will be buying them and bringing them and so we have two delivery beds and we have seventeen beds for hospitalisation in private wards.
Semi private wards and general ward and there is no room that has more than three beds and each room has its own toilet. The facility within each room depends on the type of room. Private room, semi private and we try to do general room so that they should not be too expensive for other patients. Ironically there is no clinic in Douala that consults a patient for less than FCFA 10,000.
It is an official legal rate for consultation. I know we in Limbe tend to shy away from institutions because most often people pass here and think it is a hotel and it is like that place will be too expensive. We know where our money from Bota Polyclinic comes from. We have offshore patients and company patientswho pay the normal Douala rate, but you will be surprised that at Bota Polyclinic consultation is just FCFA 3000 to FCFA 3500. Which as I said my colleagues in the private health syndicates know about it they will not take it lightly.
But you know I have my explanation because you cannot refuse treatment for under privileged people because one of our objectives is to attend to under privileged persons but then our main payments that may come from companies and insured companies will not pay that cost.
Globally we talk about seventeen beds, six emergency beds and that gives you about 30. Which gives you the definition of a Polyclinic. Bota Polyclinic is a legal clinic.We dooccupational health and we have the transformation document issued by the Medical Council moving from Family Health Care to Bota Polyclinic.
We want to thank you so much for your time.
Thank you very much for coming here and one of the things we do is to respond to the challenges that those abroad have to take care of their patients because more and more we have our children, brothers and sisters who go out and all their loved ones are here. They want to actually send them to decent hospitals. What we try to do as much as possible is to communicate with those abroad, try to inform and update them about their patients. And have participatory approach in the treatment of their patients. There are some of our brothers and sisters home here who want money from the people claiming that it is for treatment meanwhile it is for something different.
We want to actually offer that solution to communicate with those who are abroad to update them on daily basis about the progress of their patientsso that they can directly pay to us. I just thought I should talk about that. I want to thank you guys for coming and it is a pleasure.
I just pray the questionyou asked us about whether we have arrived comes to see the light of the day. I will end by thanking God because we have had alot of challenges through our passage from the civil services till now and it is not giving to any person to actually do thisbut I think even If we have not arrived, I am a happy man because I am prepared to serve the population.
We should be happy and glad to have such an infrastructure in Limbe that can be able to compete with other infrastructures in Cameroon and the response we are having from our brothers abroad shows that they really appreciate us.
I am proud and want to be thankful to all those within all our years of practice that have actually promoted us and depend on us and think we can save their lives. Thank you very much.