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. Still, 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. It is 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 examinations, 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 traumatised 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 non-payment 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.

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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-roots thing, where the local governments play a significant role.

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