THE THINGS THAT WE DO

Growing up in a 3-bedroom flat with four siblings and quite a number of uncles and cousins present at various times can be termed as eventful and a much needed dress rehearsal for facing head-on the harsh realities of life in the future. My banker father and Nurse Mother did their absolute best to ensure that every child in their home got a good enough basic education at primary level. They squeezed through thick and thin to ensure that they met the financial requirements to send ten children to perhaps one of the best private schools in Surulere at the time over a twelve years period. I was very much aware of their sacrifices and strived hard to excel, a task not made easier by having an older sister who seemed to glide through classes effortlessly all the way to secondary school. A visit to the accident and emergency room as a 5year old to the hospital where my mother gave over 30 years of service to have a close to 7cm laceration on my right foot sutured must have contributed to forging in my mind, a desire to help others medically. That scar now appears like the mirror image of the “NIKE” symbol, I should be modeling for the sportswear manufacturing giant now.

Medical school in Nigeria can best be described as an anticlimax for the many successful and not quite successful entrants. If one took a quick survey of the new medical intakes waiting to register at the University of Ibadan a few years ago, one would have realized that a good number of these individuals possessed quite excellent O’Level results and could easily have strolled into any department in any university across the land. Some were most likely local or state champions at their respective secondary schools, ignorant of the meaning of failure and already used to competition and academic excellence. The many lectures (mostly boring), numerous texts to read and memorize; ward rounds truncated by insults and fainting spells, theatre time to observe surgeries and practical sessions inclusive of non-palatable cadaver dissections, autopsies and field trips all combined to further deflate the psyche of the average medical student. A diet made up of biscuits, soft drinks and plenty chewing gum over many sleepless nights and restless days marked our normal routine. The reward was just a piece of paper that read: “The following students have satisfied the examiners…” followed by digits that represented the candidates. On rare occasions, a few students had their numbers asterisked indicative of distinctions while some others would have references in one or more courses. The mixed emotions of rejoicing, disappointment or outright failure despite significant hard work were sometimes very difficult to deal with plunging a few into depression and varying degrees of mental instability. These individuals would have perhaps excelled elsewhere but ended up being weighed down by the huge burden of letting self and family down. Our teachers insisted there was no room for error especially where human life was involved. We needed to be thorough, rapidly executing examination for instant and spontaneous diagnosis even before the results of requested investigations arrived.  The absence or relative absence of a robust reward system for outstanding students coupled with the rat race for placements following graduation contributes in no small measure to discouraging even the excellent ones amongst us.

The uncertainty that follows graduation only serves to throw the young doctor into overdrive, unto a quest for survival and fulfilment. It used to be the mainly the United Kingdom and North America; Australasia, Scandinavia and the Caribbean have now become new havens for the many doctors who have closed the chapters of their Nigerian origins. The doctors who are left in Nigeria are either happy enough to stay at home, too patriotic, older or hustling in preparedness for whatever exit door opens up to them. The distribution of doctors and specialists across the nation is skewed heavily towards the more developed regions and states where teaching hospitals exist. The population and greater awareness of health also allows for more and in a few cases, sophisticated private practices to thrive. The less developed states are left to make do with their few indigenous doctors and the few sojourners that come their way. Some states from time to time depend on volunteers on board Non-governmental organizations, unaccredited imports from North Africa and Asia with the few NYSC doctors that choose to stay. The remnants are either with the Armed forces or the paramilitary agencies.

My first year after medical school saw me launch up North to the capital city Abuja. I remember sleeping on a couch in a living room area for three months due to limited rooms available and preferential treatment given to well-connected individuals. We regularly had a sitting male senator at the time visiting a particular room in the house where we stayed. He came with the number plates of his vehicles covered always and by the time we were done with our internship, we noticed a brand new “Kia Cerato” left behind in the parking area. Abuja was plagued by all sorts of vices ranging from underage drivers, teenage junkies, reckless drivers and suicides. Saving lives and patching up the traumatized was guaranteed. I worked so hard that I weighed a mere 56kg with my trousers loose around my waist, a marked drop from the 64kg that I recorded in my second year at the university. It was due to a combination of unhealthy late eating and outright work overload. I still remember vividly most of the cases of trauma and assault I had to deal with many times late into the night; nights not even followed by rest. I was so engrossed in my work one night at about 2am when the current senate president David Mark alongside his long time army buddy, Tunde Ogbeha passed behind me to see a Caucasian expatriate who had been involved in the car accident which the patient I was attending to was also involved in. He was the driver of the ill-fated vehicle on the way to the airport, no one even bothered to come to his side to give him a word of support and encouragement. No case tore at my heart like that of a very young man in his early 20s who had a huge tumour growing from the right side of his head and which was in fact bigger than his head, he had to support his head with his hand. I was the first to see the lad who had no money on him. My consultant had not seen such a case in his many years of practice and was immediately compelled to count some money from his own pocket to enable the patient take an immediate CT scan. We eventually got a lady correspondent with the AIT to cover the story in order to raise funds for his management and after just a few minutes with him, she could not control her emotions and just began to shed tears. The monies eventually came in and when blood for the marathon surgery planned was required, my immediate boss who is normally steel eyed and devoid of emotions was the first to roll up his sleeve to eke out a pint, a gesture that was soon emulated by myself and a few other doctors involved. I do not want to recount the many other situations that eventually landed me on the physiotherapist’s table. I had been only able to sleep on hard ground and feared that I would live the rest of my life with a debilitating back pain.

My journey to Plateau state thereafter got me to spend almost a year at the General Hospital Langtang for the compulsory national service. I observed that the hospital like many others in the towns that made up the old Benue-Plateau state was commissioned by Joseph Gomwalk during the reign of General Yakubu Gowon in the early 1970s. They deemed it fit at the time to build accommodation for the workers in the staff quarters fully equipped with furniture, gas cookers and refrigerators, the one room that housed the dental clinic I was to run had what was left of a formerly functional chair, a compressor and a dental x-ray machine. This sight reminded me of the Jos railway terminus. The main building had intact wooden and glass structures installed at inception and the commemorative plaque had the name of the then commissioner of transport Tafawa Balewa as the individual who opened the terminus in 1954. The railway system has however waned since then. My clinic lacked sufficient instruments and there was only resource for cold sterilization of used instruments. We always had to improvise and the only few occasions we had electrical power was when the HIV clinic generator was operated to facilitate the management of the many affected patients who came from far and wide. I had to help a frail woman with Ludwig’s angina with the limited tools at my disposal. Not acting or waiting for an ideal situation would only have assured her of an early grave. It was difficult to do the things I did there, there just had to be done. There was a 3month shut out of all Plateau owned hospitals while I was there as a result of issues that could easily have been resolved. Sadly, the people had to bear the suffering. I had the opportunity to go on two volunteer missions to Bali, Taraba state and Benin City. The General hospital in Bali was constructed under the reign of General Babaginda but had by and large become a desolate land. At that period, there was not even a single doctor resident in that town even though the hospital was constructed to have a substantial kitchen and laundry service. The hospital had more or less degenerated to the status of a hostel for sick people. At Benin, we were stationed at the hospital built by and named after the late wife of the then president Obasanjo. We realized that there were two dental rooms that had never been utilized since the large hospital was commissioned. We requested for access but were denied so we had to make do with improvisation to render help to those in need. Two weeks of travelling by road and volunteering opened my eyes to the vast opportunities inherent in our land and people. Unfortunately, these lofty ideas do not register in the minds of our leaders and policy makers. It will only concern them if they have something to directly benefit financially or personally.

I have not had to be involved in so much surgery since returning to Lagos but I will not forget operating into the night  till about 4am with my team to retrieve a bullet from a young man’s broken jaw and patching him up. We were back at an academic seminar before 8am in the morning and this is just what the daily routine of some doctors is like and they do not grumble but get on with it. These doctors may hardly find time for a convenient relationship with their spouses and/ or children. They may never be available to pick up their children from school as they go about trying to help the children of other people who may never say a word of gratitude. We are ever weary of transporting infection to our spouses and children and all we get for all the risk taking is a miserly 5000 naira or some figure slightly higher. Those who call us when we are busy may assume that we are avoiding them; relationships could easily get strained during these periods. Marketers come to sell their products and packages to us assuming that we only need to snap our fingers to conjure up money. When we tell them we have not been paid or do not have enough, they find it hard to believe.

Sports people negotiate huge contracts and oil rig workers get paid all sorts of allowances because they take huge risks and their employers understand these facts. Should it now be difficult for those who are key players in providing befitting healthcare for Nigerians to make basic demands for better working conditions and reasonable remunerations? Is it too much to request for relevant training for certain specialties overseas so that our people would no longer need to storm India and other medical tourism sites for treatment? Is it too much to request for decorum in the administration of the health sector instead of some people promoting selfish agendas rather than demanding for measures that would guarantee quality leadership? Is it not necessary for Nigerians to arise and make concrete demands for their own welfare and for their children? 

The things that we do and must yet do; it goes beyond just watching medical themed series like Grey’s Anatomy and wishing what we see on those sets to miraculously appear. It will require revamping the training and retraining programs at all universities and teaching hospitals; it would require policies that would encourage Nigerian scholars, halt the brain drain and improve the distribution of practitioners and facilities across the nation. The biggest problems of doctors are doctors; we do not require an alliance of joint health workers to add to the menace of those that derive pleasure in sabotaging us. Nigeria worked before and can yet work if only we can retrace our steps and at least believe in the Nigerian state again.

God raise for us selfless leaders from amongst us. Amen.

Jide Akeju

10/07/2014