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in the US
By Dimeji Akinloye
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How Nigerian Doctor Tagbo Arene Became a Sought-After Psychiatrist in the US
Dr. Tagbo Arene is a revered Psychiatry specialist in the United States. But his journey started back in his home country, Nigeria, where he schooled and worked sacrificially in the health sector with little or no financial reward.
After finding his calling in whole-person medical treatment – physical and mental healthcare – he knew the abysmal Nigerian system would stifle his dream. So, like many Nigerian medical practitioners, he sought greener pastures in the United States. However, he had no idea of the challenges that awaited him in the US. Thankfully, he beat the odds.
Dr. Tagbo Arene is now the Medical Director of one of the biggest clinics, San Bernardino County, in California, and also the largest county in the United States by area. In this interview with Business Elites Africa, he shares his interesting story of strife, triumphs, and more.
How was your experience at the University of Port Harcourt Medical School leading up to when you left Nigeria?
I went to Government College, Umuahia, Abia State, and then to the University of Port Harcourt. I completed my Housemanship at the University of Port Harcourt Teaching Hospital (UPTH), then proceeded to do my National Youth Service Corps(NYSC) at Jigawa State. I was the medical officer covering the entire Maigatari local government primary healthcare center, which was very intense. But we did a lot of programs there, community-based programs that helped the community.
Then, my interest in mental health spiked while I was working with new mothers in Maigatari. So I looked at available programs and some foreign postgraduate programs, and luckily for me, I was able to relocate to the United States. My interest in the US was based on what we call “Diagnostic Statistical Manual (DSM) in Psychiatry. It was developed and published in the US. DSM was the first official manual of mental disorders to focus on clinical use.
Of course, I didn’t just go straight to do my postgraduate program. You have to write all the United States Licensing exams, and you also have to work to support your family. It wasn’t an easy task. But I think the background in Nigeria, where there are so many uncertainties, and you still have to evolve despite all the uncertainties, created this resilience you must keep pushing. So, despite all the challenges, I took all my exams and came out with flying colours.
What sparked your interest in mental healthcare?
In Jigawa State, I ran a program where I worked with new mothers that were traumatized by ethnic conflicts. I was at Maigatari, a border town between the Niger Republic and Nigeria. And there were these pregnant/ new mothers that were underage indigents and migrants. They had what we call uterovesical fistula and were urinating (incontinence) on themselves.
The issue was not even healing the condition but the psychological trauma itself. I had to visit them weekly, and I realised that talking about just physical health is not where it ends; you have to look at the whole person. It’s like you can put a bandage on a wound, but if you don’t get to know the person, understand where they’re coming from, understand the stresses they have experienced in life, the traumas they have experienced in life, the person is not going to heal.
I tell every patient, ‘I’m going to give you this medication, but it doesn’t end there; you have to be connected with a counselor, you have to be connected with a therapist.’
And also, as I’m prescribing medication, I infuse applicable psychotherapy into what I do. In Maigatari, I had a New mothers’ group. So, as I’m repairing fistulas, doing Caesarean Section and Appendectomy, treating malaria, etc., I would sit with these new mothers and talk about their trauma, which was eye-opening for me. You would see somebody that cannot speak, and they would think it’s a spiritual attack. No, it’s not a spiritual attack! It is trauma related presentation.
Coming back home, I have also had very close relatives with mental health issues. They take them to the church and all that. But when I got involved and started the person on the medication, I started seeing significant improvement. So, it’s not just what I see outside; I have friends and family members who have been through this. And I understood that mental health was something missing in Nigeria.
How did your career take shape after postgraduate?
Okay, so I did four years postgraduate and became a board certified Diplomate, American Board of Psychiatry & Neurology. I did it at
Loma Linda University Health California. To be competitive, I also did a Master’s in Public Health with an emphasis on community health. When I finished my postgraduate, I started working in a local government’s Department of Behavioral Health. I started as a staff psychiatrist, treating complex neuropsychiatric problems. Then I became the clinical medical director of the whole clinic/program. I’ll say it’s one of the biggest clinics in California for individuals with severe mental illness.
I’m focused on individuals with severe mental illnesses that require a particular medication they call ‘Clozapine.’ I’m among the few Psychiatrist that prescribes this medication in the United States. It’s a medication that helps when everything else has failed. They refer these very bad cases to me, which is what I do in this clinic, and managing other physicians. I’m also an assistant professor at Loma Linda University, Health, Western University of Health Sciences in California, and the California University of Science and Medicine. I nurture new doctors in neuropsychiatry.
Sadly, listening to you reminds me of Nigeria’s brain drain problem. Imagine if we didn’t lose you and many other brilliant medical doctors to the west. Is the problem with our healthcare system irredeemable?
Just to let me give you a background. You won’t believe that all through the time I was working in Maigatari, taking all the risks, part of my team was threatened with an attack on two occasions. The irony is that they don’t pay you a living wage when they pay.
This is why I call it economic migration instead of brain drain. You work for like six months, no salaries. I supported some of the projects we were doing in Maigatari through what we call moonlighting or private practice. You work in a private hospital in addition to your regular assignment, just to feed yourself. So it’s not like doctors don’t like Nigeria; it is very shameful.
If you look at the strikes that are going on, it’s due to nonpayment of salaries; it doesn’t make sense. I listened to the news during the COVID epidemic; the hazard allowance wasn’t paid. Do you know how many doctors died in Nigeria from COVID? Imagine a doctor who doesn’t have a house and can’t pay his rent. He can’t even put fuel in your car. What are you giving to your patients? So, you come into the office hungry, thinking about rent payment and buying fuel for your vehicle. Just imagine that kind of picture.
Sometimes last year, the Minister of Labour and Employment, Dr. Chris Ngige, described Nigeria’s medical treatment as “fairly okay.” Do you agree?
No, I don’t see it this way. Just to let you know that I’ve been involved in many consultations in-person and via zoom, where I educate Nigerian doctors on treatment recommendations. It’s not like the doctor doesn’t know, but there is something we call continuous medical education. That means you have to be updating your knowledge. If I don’t do it here, I will lose my license. There is an exam I have to take once in a while, even at my level as a consultant.
I’m a diplomate of the American Board of Psychiatry and Neurology and a Life Fellow of the American Psychiatry Association. I still have to maintain that certification. It’s not like the doctors don’t know you have to update, but when you think about feeding and paying your bills, how will you have time or money to do all these? I’m not saying that the doctors are not good, but we are lacking in all those areas. We lack the facilities to make this happen. What many Nigerian doctors are doing is managing what they have. Why are they setting drips for everybody? You come into the hospital, and they put a drip on you because that’s all they have.
What is the standard practice?
They call it Evidence-Based practice. It means that guidelines are developed based on tested and proven treatments that have yielded results. The testing is what we call randomized controlled trials, where you say, ‘I gave this person this medication, what was the outcome? I have done this procedure for the last 20 years, and a new procedure has been introduced as a modified version of the older one. Let’s compare the outcome.’ So, you have to test everything; that is the essence of science.
Science is not absolute, and medicine is an art and a science. I’m not saying there is no indication for drip, don’t get me wrong. I’m trying to say that a lot of the things that are being done, the “software” (knowledge/skills/attitude), need to be updated. The government has a significant role since most consultants are in government hospitals.
We know that the problems are there. In your opinion, what needs to be done to get things right?
I’m still an advocate of what we call Private-Public partnerships. Government has to partner with the private sector. I believe there should be an investment in training to monitor/evaluate medical education. I think there should be international collaborations with many doctors in the diaspora.
I participate in a lot of medical education in Nigeria from here. I do many activities through my foundation, TAF, and other non-governmental organizations owned by people like me - doctors in the diaspora – are doing a lot in Nigeria. If you go to rural places during holidays like Christmas, you’ll see many free health care programs. Most of these free health programs are organized by doctors in the diaspora.
I think there must be more coordinated activities between every local primary health care and private sector—local and international private sectors. The key, to me, is equipping our primary health care centers, not even buying too much equipment but grassroots innovation, where you are training the health care at grassroots on evidence-based methods of treating people that are readily accessible and sustainable. This is not something that should start from the top, and it should be a grass root thing, where the local governments play a significant role.
What are the life lessons you have learned on your journey?
Some of the life lessons I’ve learnt include not giving up. Keep pushing, don’t settle, and keep questioning the system. When I have meetings here, and everybody tells me everything is okay, I’d say, ‘No, that means things are not working well. We have to test the system.’ In Nigeria, we have leaders who don’t want to be questioned. We have people in positions that are hesitant to attract new graduates with new ideas.
You can’t be comfortable with how things are working. Even if it’s working well, you keep challenging the system, and that’s how you bring about constant development.
When I was in Nigeria, this chief executive didn’t want to allow experts to get involved because he had the ‘this is the way we do things’ mindset. But when I got to the US, I was surprised by how everything was questioned. You will hear something like, why did we make this error? Are we likely to make this error? Or what can we do to prevent errors we are not even sure would happen? It’s like a constant stress test.
What do you tell a young Nigerian still struggling to achieve career success and probably looking to travel abroad for greener pastures?
I would say, don’t ever give up. Bad times will happen. If I tell you that it was smooth sailing for me, that would be a lie. I met some house officers when I visited Nnamdi Azikwe University Teaching Hospital around 2021. I told them that if there are no problems, what are we living for? If there are no challenges, what are we living for? You are going to fall flat, you’re going to fail, and it’s okay to cry. But you have to wipe your tears and keep moving. That is life.
I have colleagues who have done well in Nigeria. They are investing heavily in healthcare. Is it affordable for the average man? That’s another question for discussion. But they were committed that ‘I’m going to make the situation work for me, I’m not traveling,’ and they made it happen. Then there will be many disappointments for those who want to travel. Many of us came here and took all the exams, some didn’t pass, and some even passed, but the program couldn’t recruit them. So, the bottom line is this; life is all about challenges; just keep pushing.
You mentioned some of your friends are investing in healthcare in Nigeria; are you considering doing the same?
Yes, I’m already investing. I do a lot of nonprofit activities in Nigeria. I collaborate with doctors at the medical centers, and many of my colleagues are consultants. We collaborate to do a lot of grassroots programs. I have a small office in my village in Nigeria that focuses on grassroots health. So, I’m not giving up on Nigeria. I hope to do more. We discuss innovative ways to bring about grassroots health, and that’s my main focus.
By Dimeji Akinloye
How I Became the World’s First & Only Fully Trained Heart and Kidney Specialist - Olurotimi Badero
If adversity were a person, that would be Dr. Olurotimi John Badero, the world’s first and only fully trained Cardionephrologist. From his childhood in Nigeria to when he relocated to the United States, he barely experienced success in his first or second attempts at anything, not because he was not qualified, but simply from obstacles in his path at nearly every turn of his life, but interestingly, his father had prepared him for it all
Eventually, when Dr. Badero began to break barriers in the US and his name became familiar in Europe, Asia, and Australia, the trials and tribulations he faced finally made sense to him. As he says, he was on a journey to destiny. Dr. Badero shares his compelling story with Business Elites Africa in this interview. He talks about the accidents that almost took his life, the day he became a beggar at a Philadephia train station and more.
Was it your choice to study medicine or your parents’?
I’ve learned that you can’t possess inheritance by ignorance, but you can possess ignorance by inheritance and what I possessed by inheritance from my parents was education and especially my dad, whom I was very close to. Being a physician or a doctor was never my choice. I never wanted to be a doctor. I actually wanted to be an engineer.
My dad was very persistent; he told me it was part of my destiny. I refused a couple of times. I remember one night he invited me to his room. He had a conversation with me and told me that ‘if you study medicine, you’re going to follow the path of your destiny and you’re going to do something very special in the world, and you’re going to have a significant impact on the world.’
And lastly, he mentioned that his blessings follow me. Actually, that was why I decided to study medicine - when I heard that his blessing was going to follow me, and I guess he was just trying to make sure that I did what he wanted me to do. That’s how I ended up in medicine.
In hindsight, would you say that you’ve achieved your dream?
The work is never done, and I’m never satisfied. People always ask me, what is your motto? And for me, my motto is ‘11, never 12. This means that the clock never strikes 12 in my book. When the clock is about to strike 12, I bring it back to 11 and then start again.
Basically, I never stay satisfied. I never stay complacent. There is always more to do. If you think you’ve done it all, that means you just don’t have a clear understanding of life. You have to understand that you can always get better. Only God is perfect. Nobody is perfect. If you think you’re perfect, then you’re mistaken. As long as you are in this world, you have the opportunity to keep doing things and keep getting better.
So, to answer your question, I don’t think I’m completely fulfilled. You can only be completely fulfilled in God. In terms of my professional career, I’m happy and grateful to God for what he has done. And I’m hoping that he gives me more grace and strength to impact more lives and leave a better legacy.
Let’s talk more about your growing up in Nigeria. What was your background like?
I grew up in a middle-class family. It was a large family of eight children. My dad is an erudite figure. He didn’t know his dad - his dad died when he was eight months old, and his last name was actually Onasoga, not Badero. His father’s first name was Badero, and everywhere he went, people would say he looked like Badero. So, to immortalise a man he never knew, he adopted Badero.
I grew up in a household where education was very big for my parents. My mom was a banker. I was the closest child to my dad, which really helped me because I stayed in his room. We actually slept on the same bed until I was ten years old when I attended secondary school.
He taught me a lot. He talked to me in parables and showered me with so much love. I was the the first one with a bicycle in my house. I was the first to attend a private school; all my siblings attended public schools and did well. But he was adamant that I would attend a private school. He showed me so much love, and he didn’t hide it. He didn’t spoil us because he didn’t have much money but placed emphasis on education.
I faced a lot of challenges as a child. When my mom was around five months pregnant with me, she went to Lagos Island maternity hospital, and in those days, the doctors were mostly Caucasians. An ultrasound was performed and there was no baby inside her womb. They told her she was not pregnant, and she said to them, ‘this is my seventh pregnancy; I know when I’m pregnant.’ Three months later, I was born.
Also, when it was time for elementary school, my dad wanted to enroll me in a private school which was quite difficult and competitive at the time. In a miraculous circumstance, I got in. I took the national common entrance and was accepted at King’s College. When it was time to resume, my name was taken off the list and replaced with a Northern student and the battles went on. As a compensation, I was given admission into Federal Government College, Odogbolu, where I was one of the last admitted students. As God would have it, in my fifth year, I won an award for the best student in the country in a science quiz competition.
Every stage was quite tough. My dad always told me, ‘ born to win means born to fight. If you’re going to be special, you will be faced with many adversities.’ Anyway, I had a great childhood. I can’t complain. I grew up with what I would call the A and the B sides. I grew up with privileged kids and, at the same time, with kids that didn’t have anything. I think the ability to transcend that barrier and relate with different types of people shaped my adulthood.
Did you relocate to the US after University?
After graduating from Obafemi Awolowo University (OAU), Ile Ife, I completed my internship there as well and my Youth Service Corps (NYSC) in Lagos. I eventually relocated to the United States, which was quite challenging. I spent eight years in medical school at OAU Ife instead of six due to multiple student unrest and school closures. The day the final results were released, I hitched a ride to Lagos to inform my parents and I had a motor vehicle accident. The car flipped over multiple times, and were unhurt. It was only by the mercies of God that we survived
When I eventually got home, I never got a chance to celebrate being a doctor because I was told my younger brother had just had passed away. He was my closest sibling. He was very intelligent with a quiet and calm disposition. Wonderful human being. His name was Olanrewaju Badero
That was a tough time for me. When I eventually decided to relocate, my visa applications got rejected everywhere I applied. I then applied for a visa at the American embassy, and on getting there for my interview, the process had to be stopped for some reason. Eventually my interview was successful and was told to return later to pick up my visa. When I returned to pick up my passport with the included visa, I kept waiting until everyone had obtained their passports with visas. I was the only one left, and the official asked me, ‘what are you still doing here? I said I was waiting for my passport, and he told me there was no more passport left. It turned out that one of the cleaners found my passport in the trash can. How the passport got in the trash can is still a mystery to me.
That just tells you the journey you have to embark on to get to your place of destiny or Rehoboth. I believe destiny has to go on a journey. In the Bible, David had a destiny but had to go on a journey. He was anointed king when he was young but didn’t become king immediately. He got to Saul’s palace, and Saul tried to kill him. He had to flee. The same thing with Joseph. He was sold into slavery and had to be in the pit before fulfilling his destiny. So, when you have a destiny, you must go on a journey. It’s not very straightforward and nice, but it’s something that you have to pass through. This is because you’ll discover God, your passion and destiny during that journey.
When you got to the US, did things just start working out for you?
No, things were not easy. Nothing is ever easy. I did all types of jobs. I worked as a security guard, and I did menial jobs. There were times I had to eat leftover food from a Chinese restaurant and could not afford McDonald burger when I was studying for my exams. I had no money.
I had to take 3 exams before starting post graduate medical training in the US. The first two were paid for by a sibling which I was grateful for. But I had to sort out the third one on my own and I didn’t have money to pay for the exam. God brought a total stranger to rescue me, an Ethipioan lady whom we studied together. Her name is Seble Wongel Bulcha. She gave me $1,000. The exam cost $1,200 at the time which was a big relief. I had to work multiple security jobs to raise the remaining $200.
This was an eight hour exam offered in Philadelphia which was the only site in the US, so everyone has to come to Philly to take the test. I didn’t even have transportation
money from New York. So, this same person had to give me some money for transportation.
When I arrived in Philadelphia, I didn’t have money for hotel or a place to sleep so I slept at the train station overnight, and the police had to wake me up in the morning to get up and then I went for the test. I had no food to eat throughout the whole exam. After the test was over, I didn’t have money to return to New York where I was staying at the time. I was stuck in the train station on market street where I had to beg passengers for money to get back to New York.
I wanted to be a Cardiologist but my dream was met with a lot of resistance related to personal politics which I didn’t want to get into. Despite being one of the best in my set and scoring high at the interview, my application was rejected. I eventually got into Nephrology training program at Emory University, which was very difficult to get into as an African-American, especially as a foreigner from Nigeria.
On getting to Emory, I wanted to be the best, so I was admitted to three concurrent programs simultaneously; Nephrology, Interventional nephrology and MSCR programs. The cardiology offer eventually came mid way through my Nephrology training which was pivotal point during my career and training. Thanks to Prof Moro Salifu who advised me to do both. I started my Cardiology training and the resistance started again when I wanted to apply for Interventional Cardiology training. I had to apply for a scholarship by the ABC (Association of black cardiologists) given to the best cardiology trainee in the country. I won that award in 2008 and lost it because I was not in my final year at the time, so I was not even eligible to apply for the grant. My academic path was blcoked everywhere I went. And that’s how I ended up in Cardio-Nephrology, Combined Heart and Kidney.
I never wanted to do it. I just wanted to be a cardiologist but God had other plans for me.
Thankfully, you were recognized as the only fully-trained Kidney and Heart specialist in the world. Do you still hold that title?
I don’t pay attention to those things. As I said, I wanted to be a Cardiologist, and people stood in my way. Eventually, I got into Nephrology, and the same people that refused me later gave me the opportunity and at this time I was just halfway through my Nephrology training, and I was the only black trainee in my department at Emory. So, I was caught in between a rock and a hard place.
I spoke to some people; who told me Emory was a very good school and I should just finish my Nephrology training there. while others advised me to leave my program uncompleted and pursue my
Cardiology training in New York. I spoke with my friend and mentor, Moro Salifu, who happens to is a Ghanaian and a wonderful person.
The first thing he told me was, ‘why don’t you do both? It’s never been done before. I said, how are we going to do it? So, he said we had to devise a strategy, and we did. I deferred my admission to Cardiology, finished in Nephrology, and then went back to study Cardiology. That’s how I became a cardio-nephrologist.
When the media people came to me for interviews, saying I was the first to do it, I said I was not interested because I’m a very private person. I don’t really like publicity, and they told me, ‘well, this is not about you. This is bigger than you. This has to be documented.
There is a doctor, Latunde Odeku who was actually the first black neurosurgeon in the US and nothing was written about him because of things like this. He died in Nigeria. So I was told we don’t want you to be another Latunde Odeku
To answer your question, I don’t pay attention to the narrative. I’m thankful to the God that I was the first to do it, complete a full training and be certified in Cardiology and Nephrology. I hope there will be others in the future because it’s an important and emerging field.
I’m appreciative of the opportunity to do something special and represent Nigeria and indeed the African continent. It’s a blessing and could not have been achieved without God’s grace. It’s not because I’m the smartest person around, but just destiny, which was what my dad spoke about when I was 16 years old.
